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HomeMy WebLinkAbout0110 BETH LANE - Health 110,Beth Lane, I-lyannis A= y i i C2 4 I SCv Commonwealth of Massachusetts Title 5 Official Inspection Form ie Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 110 Beth Ln Property Address p,t AIJ Realty �* Owner Owner's Name -ca information is Hyannis Ma 0261 4/22/19 required for every p.> page. City/Town State Zip Code Date of Inspection „. Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information 6I4t. ' on the computer; Michael DiBuono use only the tab key to move your Name of Inspector _ cursor-do not DiBuono Sewer And Drain use the return key. Company Name C 35 Content Lane ompany Address Cotult -Ma 02635 City/Town State Zip Code - B�, 508-364-9587 S113522 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address • listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 4/30/19 In pector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board, . of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector andythe system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form j Subsurface Sewage Disposal System Form-Not for Voluntary Assessments u 110 Beth Ln Property Address AIJ Realty Owner Owner's Name information is required for every Hyannis Ma 0261 4/22/19 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3,, or 5 and all of 4 and 6. 1) 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: System contains a 1000 Gallon septic tank as well as a concrete distribution box and three chambers in stone. No plan on file. Camera inspection of vent pipe to field. 2 System Conditional) Passes: Y Y ❑ 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): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 110 Beth Ln Property Address AIJ Realty Owner Owner's Name information is Hyannis Ma 0261 4/22/19 ' required for every H y ' page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational: System will pass with Board of Health approval if pumps/alarms are.repaired. ❑ 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): F 3) 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. a. 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 ' d Commonwealth of Massachusetts Title 5 Official Inspection Form J. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 110 Beth Ln Property Address AIJ Realty Owner Owner's Name information is required for every Hyannis Ma 0261 4/22/19 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. 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. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Io Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4� 110 Beth Ln 'u Property Address AIJ Realty Owner Owners Name information is Hyannis Ma 0261 4/22/19 required for every � - page. City/Town State Zip Code Date of Inspection C. Inspection Summary (conf.) 4 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow ' - ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the 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. El ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® 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. 5) 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 CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply -❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 cum Commonwealth of Massachusetts l ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 110 Beth Ln Property Address AIJ Realty Owner Owner's Name information is required for every Hyannis Ma 0261 4/22/19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for all inspections: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 cam, Commonwealth of Massachusetts Title. 5 Official Inspection Form , j Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Ya 110 Beth Ln Property Address AIJ Realty Owner Owner's Name information is required for every Hyannis Ma 0261 4/22/19 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330. Description: i Number of current residents: Vacant Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑. Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection El Yes '® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 168 GPD 9 ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes ❑ No Last date of occupancy: Date t5insp.doc-rev.4/26/2018 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form _ e _ Subsurface Sewage Dis posal sposal System Form Not for Voluntary Assessments u 110 Beth Ln Property Address AIJ Realty Owner Owner's Name information is required for every Hyannis Ma 0261 4/22/19 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 2. 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 Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Not provided Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 110 Beth Ln Property Address ` 8 t AIJ Realty Owner Owner's Name information is required for every Hyannis Ma 0261 4/22/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy El 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): Approximate age of all components, date installed (if known)and source of,information: Original tank. New leaching in 2008 Were sewage%odors detected when arriving at the site? ❑ Yes ® No . 5. Building Sewer(locate on site plan): Depth below grade: 2feet Material of construction: ® cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 110 Beth Ln Property Address AIJ Realty Owner Owner's Name information is required for every Hyannis Ma 0261 4/22/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.;l 6. Septic Tank(locate on site plan): Depth below grade: 1.5 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1000 If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 Gallon Sludge depth: 3 Distance from top of sludge to bottom of outlet tee or baffle 24" Scum thickness 3" Distance from top of scum to top o-outlet tee or baffle 4" Distance from bottom of scum to bottom of outlet tee or baffle 30" How were dimensions determined Tape Measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet inver, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments f 110 Beth Ln Property Address AU Realty Owner Owner's Name information is required for every Hyannis Ma 0261 4/22/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. 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 Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels.as related to outlet invert, evidence of leakage, etc.): . 8. Tig ht 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 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts e Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 110 Beth Ln Property Address AIJ Realty Owner Owner's Name information is required for every Hyannis Ma 0261 4/22/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cont.) 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 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Level and at normal level 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.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 c Commonwealth of Massachusetts 1 Title 5 Official Inspection Form I; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 110 Beth Ln Property Address AIJ Realty Owner Owner's Name information is required for every Hyannis Ma 0261 4/22/19 . page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. 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 orders stem is a conditional pass. p P 9 Y P ss 11. Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Dry Type: ❑ leaching pits number: ❑ leaching chambers number: ® leaching galleries number: 3 ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 110 Beth Ln Property Address AIJ Realty Owner Owner's Name information is required for every Hyannis Ma 0261 4/22/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.):No sign of failure 12. 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 Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts - Title 5 Official Inspection Form �a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 110 Beth Ln L Property Address AIJ Realty ' Owner Owner's Name information is required for every Hyannis Ma 0261 4/22/19 page. City town State Zip Code Date of Inspection D. System Information (cont.) Y 13. 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.): - r t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form la Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 110 Beth Ln u Property Address AIJ Realty Owner Owner's Name information is required for every Hyannis Ma 0261 4/22/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form- I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 110 Beth Ln Property Address AIJ Realty Owner Owner's Name information is required for every Hyannis Ma 0261 4/22/19 page. Citylrown State Zip Code Date of Inspection D. System Information' (cont.), 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar r ❑ Shallow wells Estimated depth to high ground water`: 1 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: 2008 Date ❑ Observed 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: Test hole data on Permit r Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 Commonwealth of Massachusetts ,IF Title 5 Official Inspection Form M � Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 110 Beth Ln Property Address AIJ Realty Owner Owners Name information is required for every Hyannis Ma 0261 4/22/19 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ❑ A. Inspector Information: Complete all fields in this section. ❑ B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ❑ C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ❑ D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 r� arEn x {„ �X a 3 pg'"£ QM s E & w € G R +: S \ / E�:, E ,E Fh� ��`� -•;� (�Et{€E S.:Y � EyC r � p�_ s _ _i i r € €n �.� �• ��°� ,, a:���a j£ w e'i� � t � � N /���`'E'{E £ �,y ,E f { „ 1 � 3 " Ww TOWN OF BARNSTABLE LOC'AT,'.JN � T SEWAGE VILI A6E ASSESSOR'S MAP&PARCEL M INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY /000 LEACHING FACILITY.(type) ?3--®S (size) 1 C'J 6— NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility.(If any wells exist i on site or within 200 feet of leaching-facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist.,- within 300 feet of leaching facility) Feet FURNISHED BY ���� �� � - � . � � �,� � w � -.� w � - i i � -..� �w � -� �� 0,�j oV� - l W 0 I(� No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIPpYicattou for 30tgool *p5tem Cou0tructton 30ermtt Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components ()Location Address or Lot Ntg o. / �-�T Owner's Name,Address,and Tel.No.�C /'yj0 � r Assessor's Marcel —�S� ��� f�Ss v4,E-1V150444 7 ��/� Installer's Name,Address,and Tel.No. i1/�'t'Y1 IDIN 497 Designer's true,Address and Tel.No�"�'eoe � U?6 moo/!//'/•�G sT .�/ �l 0 6a9 o )T457_,5RvuPM1'1C-1* M Type of Building: Dwelling No.of Bedrooms Lot Size oo sq.ft. Garbage Grinder ( ) Other Type of Building a 1 �j No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) � y gpd Design flow provided /e� gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank /��3U Type of S.A.S. LiT Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: - . The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date c 6p Application Approved by Date Application Disapproved by: V Date for the following reasons Permit No. 00 1. Date Issued U —} q— �-.-.. .� r_"�.-,..-nw-,..'y. +a.. .....r's-'�.1�.,- ..,....r"�.t'+�J""."""A �r't-te!r^'"••'A'�,r .1, .♦ r r � .. - . Fee THE COMMONWEALT�`'OFoMASSACHUSETTS Entered in computer: �. PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE, MASSACHUSETTS Yes apphratton for afgpool 6pttem (tonslructton Vermit Application for a Permit to Construct O Repair O Upgrade O Abandon O ❑'Complete System ❑Individual Components Location Address or Lot No. o � T/7` .LtfN E Owner's Name,Address,and Tel.No.�7G �JO 11` 14ol! ` /J�cc- CORD 8'� 5�ff7� Jfie Assessor's Map/Parcel / j7 14s'c d( IV1501� TV' �al�7 Installer's Name,Address,and Tel.No. /� /�1'Y! / /, 647 Des' ner's Name,Address and Tel. �/, '96 �U�Tf c s� %�% ;i � .tea O lea f 9b�r ` Type of Building: . Dwelling No.of Bedrooms Lot Size ����a sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �U gpd Design flow provided �, , /J gpd Plan Date Number of sheets Revision Date Titl Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) i .Date last inspected: i i 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 if.,f/�Iirl /. Date 7 f of f�/ C�Q Application Approved by �---1 ' -- Date p Application Disapproved by: Date - for the following reasons Permit No. DO� L Date Issued Lf —j q— --------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certiftcate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (`/') Upgraded ( ) Abandoned( )by 1�/� 1C..O1'-'r` V Df✓1)ram.k_ at /�0 f3T� has been constructed in accordance `Or/ with the provisions of Tit e 5 and the for DisposeSystem Construction Permit No. 900LI— 4 0Lf dated e O Installer Designer #bedrooms Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the systemm ilv�l functi a esi ned. Date " f s Lo R7 Inspector_ ————————-——— —————————— —————— No. aDO ` 6q Fee 1696) THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS 1=i.5po!5a1,6p!5tem Comaructton Verna Permission is hereby granted to Construct ( ) Repair ( �/)� Upgrade ( ) Abandon ( ) System located at a and as described°'in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction musCt/be completed within three years of the date of this pe Date 4f— ,y— o b Approved by Town of Barnstable � E Regulatory Services un&MAet.E. Thomas F. Geiler, Director F .6� Public Health Division Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: -503-362-4644, Fax: 503-790-6304 Installer & Desianer Certification Form Date: �. Sewage Permit# Assessor's Map\Parcel esia • 1 (N' , n b �Io Installer: D ner Address: 1 ° Address: PcWRI+C 0 zs � On % iliC/� / f�/j��% as issued a permit to install a ( ate ) (installer) septic system at �l �-e_ Lk AA based on a design drawn by (address) dated (designer) l 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 an6'or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS.or anv vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or ce ified as-built by designer to follow. OF ,y o D f3E r/,!G EYER f (Ins alleys Signature) No. 1140 R r f SAN I TAR�p� (Designer's Signature) (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-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q: Health/Septic/Designer Certification Form 3-26-04:'doe _ o c.. r . Jo - -o_ _ - _ - 57 -71 z LA 0 1 Al :r A • I v �4 - o r I C - _ o �•r� r " i Town.of B A rnstable Pit Department of Regulatory Services Public Health Division Date bM tee$ 200 Main Street,Hyannis M[A 02601 �ffD MA1 i • Q Date Scheduled Time' Fee Pd.— Date oil Suitability Assessment for Sewage D s osal Performed By: ` ` /"r /t ' w Witnessed By: t i LOCATION& GENERAL'IN]F ORMATION Location Address owner's Name L Moiz P&P IS 't'"1 Address SOLD 57it9'd�- �J"l/Gv�VI•�i�� 12.E A9PIC rS tl-� viSO - -tx 7S667 Assessor's Map/P4rcel: 2--7 2 l�s6 I Engineer's Name MGM NEW CONSIRU!nON REPAIR Telephone# 509 c3fo Z-... 2 Zl Land Use SIDEX172A'Z1 Slopes(96). O �_ •.SurfaceStones Distances from: (3penWater Body, y Zso ft Possible Wee Area' 72O°—.ft Drinking WaterWell /So ft ' Drainage Way •Prope•rty L'ine '!0• .ft . Other SKETCH:($treet name,dimensions of lot,exact locations of test holes&Pere tests,locate wetlands in proximity to holes) SEE 0`S`'/ St'- I Pig Dki-f- 6 y�z�ag •� t. -o .0� 1 �I I t I Parent material(geologic) L ,L Depth to Bedrock : :L ------ Depth to Groundwa.Or. Standing Water in Hole' i Weeping from Pit Face Estimated Seasonal i jigh Groundwater N A-- DtTERMINATION FOR SEAS O."L kIICII WAT t TA L Mett:nd Used; ln. Depth C bserved standing in obs.hole: in. Depth 10 sail mottles; Depth toiweeping from side of obs.hole: in, Groundwater AdJuetment Index Well# Reading Date: Index Well revel __- AEI.factoC•,,_.�- AtU.drt7ttndWaterLeVel.,,,e PERCOLATION T'UST'. Date..41Mlu,e Observation Time at 9" Hole# Depth of Pere 7� J Time at 6" ..... -- e Start Pre-soak Time.@ / _ I Time(9'--6--) �- -- --------- i End Pre-soak i - M�•N Rate Min./Inch L 2 �- --= Site Suitability Assessment:, Site Passed ' X Site Failed; Additional Testing Needed(Y/N) — original:.Public Health Division Observatiot Hole Data To Be Completed on Back------ ***If percola'ibn test is to be conducted within 100' of wetland,,you must first notify the Barnstable C #servation Division at least one(1)week priorto beginning. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consis enc %Gravel) it- DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil : -. Other Surface(in.), (USDA) (Munsell) Mottling (Structure,Stones,Boulders. fisitnc :%Gravel) j ao IoYR Z5y b�Y DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, o Gravel DEEP OBSERVATIONO HOLE LOG Hole# A114 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, I Flood Insurance Rate May: Above 500 year flood boundary No_ Yes Within 500 year boundary No Yes Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist.in all areas observed throughout the area proposed for the soil absorption system? �� S " 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. kmrn ,expertise and experienc,described in 3.10 CMR 15.017. Signature WA Date Q:\.SEPTIC\PERCFORM.DOC G l✓ , ! SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Address of property ((C'� } Owner's name Date of Inspection PART A CHECKLIST Check if the following have been done: Pumping information was requested of the owner, occupant, and 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. c/As built plans have been obtained and examined. Note if they are not available with N/A. yThe facility or dwelling was inspected for signs of sewage back-up. L-'*'- The site was inspected for signs of breakout. All system components, excluding the SAS , have been located on the site. yThe 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 SAS on the site has been determined based on existing information or approximated by non-intrusive methods. The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of SSDS. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION FLOW CONDITIONS If residential 3 number of bedrooms o number of current residents garbage grinder, yes or no laundry connected to system, yes or no seasonal use, yes or no If nonresidential , calculated flow: Water meter readings, if available: Last date of occupancy GENERAL INFORMATION Pumping records and source of information: System pumped as part of inspection, yes or no if yes, volume pumped 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) Other (explain) Approximate age of all components. Date installed, if known. Source of information: 4D Sewage odors detected when .arriving at the site, yes or no S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SEPTIC TANK: IWCI (locate on site plan) depth below grade: material of construction: �oncrete metal FRP other(explain) dimensions:_ _ sludge depth &: "distance from top of sludge to bottom of outlet tee or baffle "'scum thickness thickness " distance from top of scum to top of outlet tee or baffle 6 ' distance from bottom of scum to bottom of outl« tee or baffle Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evide ce of -leakage, recommenda ' ons for re airs, etc. ) f ' J DISTRIBUTION BOX: ✓� (locate on site plan) depth of liquid level above outlet invert Comments: (note if -level and distribution is 'equal, evidence of solids carryover, evidence of lea ge into or out of box, ecommendatio fop repairs c. ) PUMP CHAMBER: (locate on site plan) pumps in workin>ceor o �- Comments: (note condition of pumpon of pumps and appurtenances, recommendations for mai ,etc.. ) r ti l� i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ) - PART B SYSTEM INFORMATION continued SOIL ABSORPTION SYSTEM (SAS) : L' (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 and number — /OCyO leaching chambers and number leaching galleries and number leaching trenches, number, length leaching fields, number, dimensions overflow cesspool , number Comments: (note condition of soil , signs of hydraulic failure, level of ponding, condition of vegeta ion,, recommendations for ,mainte ance o repairs,etc. ) CESSPOOLS (locate on site ) lan : P number and configu ion depth-top of liqui to inlet invert depth of solids laye depth of scum layer dimensions of cesspool materials of construction indication of groundwater inflow (cesspool must a pumped as part of inspect ' Comments: (note condition of soil , signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs,etc. ) PRIVY: (locate on site plan) materials of construction dimensions depth of solids Comments: (note conditio of soil , signs of hydraulic ailure, level of ponding, condition of vegetation, recommendations for intenance or repairs,etc. ) 7 } SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE SPOSAL SYSTEM: . include ties to at least two permanent references landmarks or benchmarks locate all wells within 100 ' A' l DEPTH'TO GROUNDWATER /-S depth to groundwater method of determination or approximation: SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C FAILURE CRITERIA Indicate yes , no, or not determined (Y, N, or ND) . Describe basis of determination in all instances. If "not determined" , explain why not) N Backup of sewage into facility? IV Discharge or ponding of eff went to the surface of the ground or surface waters? Static liquid level in the distribution box above outlet invert? Liquid depth in cesspool <6" below invert or available volume< 1/2 da flow? Required pumping 4 times or more in the last year? number of times pumped Septic tank is metal? cracked? structurally unsound? substantial . infiltration-, substantial exfiltration? tank failure imminent? / Is any portion of the SAS , cesspool or privy: N below the high groundwater elevation? -�' within 50 feet of a surface water? � within 100 feet of a surface water supply or tributary to a surface water supply? ,4,/- within a Zone I of a public well? �ithin 50 feet of a bordering vegetated wetland or salt marsh (cesspools and privies only, not the SAS) ? _/—tl /within 50 feet of a private water supply well? '� 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 ane - , for coliform bacteria, volatile organic compounds, ammonia nitrog and nitrate nitrogen. TOWN OF BOARD OF HEALTH SUBSURFACE SEWAGE' DISPOSAL SYSTEM INSPECTION FORM - PART D - CERTIFICATION 5 ' -TYPE OR PRINT CI.EARLY- PROPERTY INSPECTED STREET ADDRESS -e bK1,Q�hsffl ASSESSORS MAP, BLOCK; AND PARCEL # OWNER' s NAMEte^ PART D - CERTIFICATION NAME OF INSPECTOR J2 a2/,#r.) COMPANY NAME y 2 t'y r ctS COMPANY ADDRESS 7-5 Sf) 1 o�- (2 r(1 Ala C>3U Street Town or City State LIP COMPANY" TELEPHONE IU`L 1 � �jc� la FAX CERTIFICATION. STATEMENT I certify that : I . have personally inspected the sewage disposal systemva' this address and that the information reported is true , accurate , and complete as of the time of inspection . The inspection was performed and any recommendations regarding upgrade ,,, maintenance , and repair are consistent _ with my tea`ining .and experience in the proper function and maintenance of on site sewage disposal systems . Check one: -1L System PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public Health or the environment as defined in 310 CMR 15 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. System FAILED* The inspect-ion which I have conducted has found that the system fails tc protect the public health and the environment in accordance with Title `5 , 310 CMR 15 . 303 , and as specifically noted on PART C - FAILURE - CRITERIA of thi's spection forma Inspector :Signature Date JZ One copy of this certification must be provided to the OWNER, the BUYER . . (where applicable ) and the BOARD OF HEALTH. * If the inspection FAILED, the owner or operator shall upgrade the system within one year of the date of the inspection, unless allowed or required otherwise as provided in 310 CMR 15 . 305 . partd.doc IS- LOX ATION SEWAGE PERMIT NO. !fp B.& zuh� VILLAGE f /I/yall All s INSTA LLER'S NAME & ADDRESS JOHN A. AALTO BACKHOE SERVI!'E 150 Walnut Street West Barnstable, Mass. 02668 BUILDER OR OWNER DATE PERMIT ISSUED ,7f DATE COMPLIANCE ISSUED r.,_, � � � �.� � ' � �r` � � � \ / � � `� . tee / / / �" j , i ✓; ., . , No.. .................... Fps............................_ THE COMMONWEALTH OF MASSACHUSETTS BOAR®. F` HEALTH t .............OF...... ��..........._.............................................. Appliration for Uhipugal Works Tomaratrtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at.' ........_. ----- --------- ---- ......................................................- .............. CCA --.- Location-Add re s or Lo `� 5 �..�-�..!�- �......._..s__._. t No 8 `�4.. 9..... ._. s.._...�y..�t..�............ Owner Address s .. ................................ .-•--........•----_... ........ .. .------•------•-•-------------- Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms......-.....................................Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building ............................ No, of persons............................ Showers ( ) — Cafeteria ( ) 04 Other fixtures ............................... .. W Design Flow...........��.......................gallons per person per day. Total daily flow............3.3.-j..................gallons. WSeptic Tank—Liquid capacity-`6"gallons Length---.�...... Width---It/........ Diameter... .......... Depth..../........ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.........r.......... Diameter.... Depth below inlet......6........ Total leaching area._Z.�'_ q..ems ft. Z Other Distribution box ( ) Dosing tank ( ) '_' Percolation Test Results Performed b C' '--.-_.__....�.-._...#-------.-.__•--.--.---- Date..�'�`� /0 9�--- y---- ------•--••- -•- •-----... -- aTest Pit No. 1----'�...minutes per inch Depth of Test Pit...L? ......... Depth to ground water._A__ ' Test Pit No. 2......1.......minutes per inch Depth of Test Pit-----f............. Depth to ground water...........Z2......... Chi •- ................................................................. Description of Soil-.....� --------- - - ----i----- --------------------------------------•------- x 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 ilTl.,% 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be issued by tj e b ar health. Sig ..................... .. 4. ••----••-•------ ................................ Date Application Approved By..;..--- . . ............................. ---- --�--- --7 .......... Date Application Disapproved.for the following reasons:--- -------- - ------•--•-----.....------•-•-----•------•---•-•--------••--•-•---••---................•- .....................................-................................................................................................................................................................... S�� ��, Date Permit No......................................................... Issued_.....t _.. ------------ ................... Date -Vf. No. . ................ FIca............._............... THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH r044 :.............OF....... � . ............................................................ Appliration for Disposal Works Tonstrnrtion ramit Application is hereby made"for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at , 7 i s1 Ih ............aFr f G� . ✓w.s ...,........ ... y I Location Add r s y or.Lot No ......................ah' e l I.ya n ti l a... ..ww .... .. ... �........... .........: �.�.t �................ . ... .-...Y..Y..i.........-......_......._... _.-..... ._ g Owner` Address t Installer Address Type of Building Size Lot...........................Sq. feet Dwelling—No. of Bedrooms...... ..................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building ............................ No. of persons............................ Showers — Cafeteria dOther fixtures ---------------------------------•-•---•----------••------------------------------------------------...........---...---................----......-- W Design Flow............ .......................gallons per person per day. Total daily flow_............,x_................._.......gallons. W .Septic Tank—Liquid capacity.� '`�...gallons Length.............. Width...!'LX........ Diameter-_.I.......... Depth--- ---------- x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.........i_.......... Diameter..../'/ �.�__ Depth below inlet.._...°-�.�....... Total leaching area.. '.S sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by......__°._.:u._..........,..........._> .............................. Date... __`....._....L . Test Pit No. 1....=.^.p.:_._minutes per inch Depth of Test Pit... _ ..._._.. Depth to ground water... .... ...... Test Pit No. 2.................minutes per inch Depth of Test Pit.................... Depth to ground water------------.'.....____ ........................... ....... ------------------•-•---------.-_•.-.-.-.-.-.-.-.•.--- ODescription of Soil �. V_ 1 . l ii� ---....- .-.-.- .0 ----------------------::...-----------...------------------------------•---•----------.....------•------------------------------------•------------------.---------•................................. .."" 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 TIT?:;:;. 1 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board"of health. Sigd ..._.. ----------------------------------------•-------------•-------- --- •-•------•-------------- Date Application Approved B Date Application Disapproved for the following reasons: ----------- . ... .................•------•---•----------------------------------------•----------..........--•-------'---------------------------------------....................................................... Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH O F...... .. Z*t. Tntifirate of Totit�lianrr TH I IT Off FY That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by -"" -.r: i� � .......................•----•---••----------------...-•--------------•----------•-----•-•-•-------•- �� Installer at- ...... ..° " tr.....,-. tr ------ r ------- -----------------------•---------•-•-----•---------------•--...--------,--........----------•-. has been installed in accordance with the prov' ions of 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No. .........!��.................... dated..... _-�'i� :.�_ __ THE, ISSUANCE,,OF,4THIS CERTIFICATE SHALL NOT BE,CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY.. . / DATE.......... .....l.. ........ ,�..Li�. �_��u �-� T '�- .•?. - ...... ........... Inspector::---.._....---.. _.. •f=--•-••-•--- THE COMMONWEALTH OF MASSACHUSETTS A. BOARD UEAT � . ` ..............O F......... �'k ..... ,,,... FEE........................ l4�Permission is hereby granted--- ------- . -d--`.----------------------•-------...--•---•-•----•----••--•-......---............._:to Construc (.., or Rep 'r Individ al Sewage"Disposal $ st street as shown on the application for Disposal Works Construction Per 't No ----- ----- Dated--_,/'I-'-.7;..•................. ` .jarti`l . ..... . .........••---••---......_ - /��� Board of e th DATE......... --------------------------------•------ .............. FORM 1255 HOBBS & WARREN, INC., PUB LISHERS.•' - Y' � LEGEND ��3 0 0 0 �q? S �� PROPOSED CONTOUR 3 w S m co Cell@ G � PROPOSED SPOT GRADE 9� S m a Mail 6s -- 98 -- EXISTING CONTOUR OR oCC z u, CORPO/ r — 1 + 96.52 EXISTING SPOT GRADE o l 65� \ m 120.00 ft EXISTING WATER SERVICE i \ ��___ — — — TEST PIT o0 \ Nco \ U1 I � 9 \ SHED I ! 0 STONE GO o "' I �yRl\iE�.NA`r o ven ., I JT 400 12 ft j LOCUS MAP N.T.S. GENERAL NOTES: oj 0 / Lnn ! T ~ n 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL j i I t I 'BOARD OF HEALTH AND THE DESIGN ENGINEER. j \ 0 I\ Ty� - j 2. ALL WORK AND MATERIALS SHALL CONFORM-TO THE REQUIREMENTS. Li / \ OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE WATER 1 / 7 LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: Q GATE / I \ I — 310 CMR 15.405 (1) >(8): f 0- j oPPro,. woje� SewTce I \ ! _ 1) UP TO A 1.0 FT. VARIANCE FROM 310 CMR 15.211 TO ALLOW Li ( L- I \ ! LEACHING TO BE UP TO 4.0 FT BELOW GRADE VS REQ'0 3 Fr. - (VENT PROVIDED) W O / I \ I ! ° 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR W W I •� r—O CC� % \ I ! 0W 1 p C — I DESIGN ENGINEER. O U) \ I 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING � �l O / I— I FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN z ! / Ol j— — _ j ENGINEER BEFORE CONSTRUCTION CONTINUES. U1?1 — Z EXI ting leach Pit 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF z THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF E HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. Li. j. j 1 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. > I I EX1St1 9 1,00q gal 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED Q ! I I 20 Tr S tic Ti5hk TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. 9. IT SHALL BE THE.RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE \ / \ / THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO .BEGINNING j \0 5 i I CONSTRUCTION. M T 2 9 !I 10. EXISTING LEACH PIT TO BE PUMPED, CRUSHED AND FILLED 1-1. 48 HOUR NOTICE-FOR ENGINEER CERTIFICATION 1 A,P.E A = 1 5 O 0 0 s f +.— ��\\ OF �9ss 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY o D R E G �- 13. NO PRIVATE WELLS WITHIN 150' OF PROPOSED LEACHING. L R -----— _ I o. 1140 14 NO WETLANDS WITHIN 150' OF PROPOSED LEACHING 20.00 ft H 15. ALL PIPING TO BE 4" SCH 40 0 1/8-/FT (UNLESS SPECIFIED) /sl M E f\J C H M A R I'< SANITAR\a` z2o� PAINT SPOT ON DECK x P L A NI ' ELEVATION = 66. 33 E PROPOSED SEPTIC SYSTEM UPGRADE PLAN BARNSTABLE GIS DATUM SCALE: 1 in = 20 f? 110 BETH LANE, HYANNIS, MA 20 O 20 40 • Prepared for: Mike Dedecko DR O f MAP. 56 AWN JOB. NO. SURVEY REFERENCE: 1 0 20 DARRENM.MEYER,R.S. Surveying by: SCALE PLAN OF LAND BY CHARLES N. SAVERY INC. LOT. 1PO Bco—Tech Ifavymameatel 1"=20� DMM 21191 BOX98f DATE CHECKED SHEET NO. DEED BOOK.- EAST SANDWICH,MA 02537 (508) 364-0894 DATED: JANUARY 2, 1973 DEED PAGE.•136 508-362-2922 04/22/08 DMM 1 Of 2 ELEV. TOP vent required FOUNDATION (Existing) = FINISH GRADE=65.0 65.54 F.G .EL: 64.75 F.G,EL: 64.77 F.G. EL: 65.0 MAINTAIN 2% MIN SLOPE OVER.LEACHING AREA MAX. COVER OVER LEACHING 3.0,FT. a COVERS TO WITHIN 6 OF GRADE 6" INSPECTION PORT W/IN 6" OF FINISH GRADE7 .• 6„ 4„ SCH 40 PVC 4" SCH 40 PVC 0 0 0 0 0 C 0 0 0 0 0 0 ' (MIN.) 10„I „ 14 @ S= 1% (MIN.) © S= 1% (MIN.) TEES ARE TO BE 4' SCH 40 PVC INV.60776: 0 0 0 0 . o 0 0 0 :.... .:: INV.61 .35 INV.60.75 GAS P - 0 O O 0 0 HO 0 O EXIST. OUTLET BAFFLE PROPOSED DB 3 4 ...• .,, , ...... .... H-10 DISTRIBUTION BOXAIM i 25' - INV. 61 .60 EXISTING 1 ,000 GALLON SEPTIC TANK INV. ELEV.= 60.68 • _ FXTM FAQ 9 MIN. GAS BAFFLE TO BE INSTALLED ON NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING ORE QED SIDHE PER T1 TLE 5 OUTLET TEE AS MANUFACTURED BY PIPE INVERTS PRIOR TO;CONSTRUCTION TUF-TITE, ZABEL, OR EQUAL 2) D-BOX SHALL BE SET LEVEL AND TRUE TO BREAKOUT EL. m st.25 GRADE ON A MECHANICALL COMPACTED SIX INCH CRUSHED STONE BASE, AS SPECIFIED IN INV. ELEV.= 60.68 310 CMR 15.221(2) J�''- '-'O" 24" 30 5" O.1.WASHED STONE 3) REPLACE EXISTING 1,0001 GALLON SEPTIC IN I/ER T TANK WITH 1500 GALLON SEPTIC TANK BOTTOM EL.= 58.68 IF FAILED, DAMAGED, OR UNDERSIZED. 5O" 8' 4) INSTALL INLET & OUTLET iTEES AS REQUIRED . SEPARATION 5.00 FT. SOIL LOGS SEPTIC SYSTEM PROFILE BOTTOM ,OF TH-1 EL: 53.68` SOIL ABsORPT6 SYSTEM (SECTION) N.T.S. DESIGN CRITERIA DATE:., APRIL 22, 2008 rs SOIL EVALUATOR: DARREN MEYER, R.S., CSE NUMBER OF BEDROOMS: 3 BEDROOOM DESIGN � WITNESS: -RAVE. STANTON SOIL TEXTURAL CLASS: CLASS I (0.74 GPD/SF) HEALTH AGENT DESIGN PERCOLATION RATE: <2 MIN/IN Elev. TH-1 Depth , Elev. DAILY FLOW: 110 G.P.D. _� TH-2 Depth DESIGN FLOW: 330 G.P.D. 64.68 0" 64.73 0" f7/N KI..T LBtjh BR GARBAGE GRINDER: NO (not designed for garbage grinder) A L OAMY SA 11OYR 3/1JD FILL Btl7 SEPTIC TANK: 330 gpd x 2 = 660 gpd USE EXISTING 1,000 GALLON SEPTIC TANK 64.01 8" 64.23 A 6" B LOAMY SAND LOAMY SAND LIV; RM BRLEACHING AREA yREQUIRED: (330) ,= 445.94 S.F. �^t 10YR 6/6 10YR 3/1 .74 P 63.81 11" BR USE THREE .(3) INFILTRATOR 3050 UNITS WITH 4 FT. STONE 61.35 c1 40" a LOAMY SAND ON THE SIDES & 1.3 FT. STONE ON ENDS: 25' L x 12.16' W x 2'D a„r 61.40 C1 1OYR 6/6 40" FIRST FLOOR BOTTOM AREA: 25 x 12.16 = 304 SF PERC 060.01 SIDE AREA: (25 + 12.16) X 2 X 2 = 148.64 SF S TOTAL SQUARE FEET PROVIDED = 452.6 vs. 445.94 REQ'D MED - COARSE DESIGN FLOW PROVIDED: 0.74(452.6 S.F.) = 334.95 G.P.D. vs. 330 G.P.D. req'd SAND SAND MED - COARSE �F 2.5Y6/4 2.5Y6/4 2��� Mgss9G PROPOSED SEPTIC SYSTEM UPGRADE PLAN' 1 11.0 BETH LANE, HYANNIS, MA 53.68 132" 54.48 123" V 1140 Prepared for: Mike Dedecko PERC RATE <2 MIN/IN. ("C" HORIZON) PERC RATE <2 MIN/IN. ("C" HORIZON) O Engineering by: Surveying by: SCALE DRAWN JOB. NO. NO GROUNDWATER OBSERVED NO GROUNDWATER OBSERVED AFGISTE� DARRENM.MEYER,R.S. DMM S01TA0 Po BOX981 Eco-Tech hwlroameatel N.T.S. 0 EAST SANDWICH,MA02537 (508) 364-0894 DATE CHECKED SHEET NO. t 0� ZZl O 508-362-2922 04/22/08 DMM 2 of 2 F 53 oa • 1 TYPICAL PROFILE AREA PLAN FINISH GRADE, NOT. TO SCALE FDN TOP i _ - O _ SCALE. i 52 FINISH GRADE OVER `T FINISH 41 ANK= 15= GRADE OVER PIT= , 'OQ I. , LO - T 29 � . ' - ETH S LANE - • _ � I VC OR w•o :. :•o•..:a .. o48.61 �.PC. I, TEES00S. F: g.8"BSMT : a.:. r +• °•.•;:,.e•" • • i•"`• •••. _/,• ee•' ` 1000 :. FLR 5,00 GAL. 41 5' #. _I / • ` • •._• • "� e + ` REINFORCED DUST. BOX CONCRETE 87777777 TO BE I N S T A e 1 • • • • • .o o .o. .. ,... . . :...._ .�< .., A LEVEL STABLE BASE ', a ., o ;e . , / • e • + .... SEPTIC TANK - • e e. • • • • • e ' e • • - ` J TO BE INSTALLED ON A + • • + • •' 1 • + e LEVEL STABLE 'BASE x. „. 2 I/8 1/2, WASHED PEASTONE ALL, • •, 0� BRICK .a .MORTAR COURSES AS AROUND 'FREE OF IRONS, F • • '• • • •- • e .� o' e FINE I REQUIRED TO BRING COVER TO GRADE I AND DUST IN PLACE LEACHING PIT ' 24 "C.I. MANHOLE COVER a . 3/4 "TO I-112 "WASHED CRUSHED FRAME —'SEE DETAIL STONE ALL AROUND FREE OF BASE TO BE LEVEL IRONS, FINES AND' DUST IN D ` PLACE < I Q J FOR FIN. GRADE SEE SYSTEM PROFILE I� SOIL AND PERCOLATION - 4„ DATA BE�fiH S LANE - �_ IN 2 5:0 0 PERC RATE : { � MIN:/IN. i - ,� • _ 4 '• o�` • •. '. �•o �o '. _ FOR INV. ELEV SEE , .o -moo • '. _ C. D., SPOHR INLET . . ' , o ; , . SYSTEM .PROFILE • " � . ,, TAKEN BY LINE 61 MR. PAUL Ma112.A4' # HOt i l Q ` Q ° o / WITNESSED BY. BAR►JSTAlp t 97 Bb. aF H£�l{1{ LOT 30 W 4 '. �rI LOT 2 y� - o — ° p OPENINGS /4 I8 „p ' . _ e: , . ; p OUTER DIA. a I -3/4, ,. o' .• a �,` ; , DATE: 5 DEG. i97F3 CFlzoe�1'} 79Wt�i 1r+1A7 ' o TEST PIT-GND ELEV. 5 1 ,7 INSIDE DIA . p 13 59, 6 a p TOTAL o 0 0 _ o0 N — - , i o . o0 0 Ao (st 1 IE { o o AREA 3 ° NO RUST LEDq fE 0 4 LOT . 'Q , � , ; , 000u 2 s.� o p ` 2 d M , 85 p - O R 1rVAT . 2 F 15 000 S , - 0 0 0 0 1..AY`��� � � � o 0 o p ` PRECAST Cyf R�T� >htv C + a o o o a o 0 0. o _ CQARSE SAIQID IOOU cif'► . O . - o o a o 0 ; ,n , . r PREGAS't CDt�t ,R '�"C DISIRt5u-n ,� 2' 6 6 u DIA. t p,OX^# SFF.�P'RGwil- o R,P,1 . plZcc^sT_Cc��, cPf—TF. t.EACFi 1t,.1. N `.T�� ' ��v�: z I p� �c,e1 EFFECTIVE DIA. BOT. PERC. HOLE ,aplT•-�SE.�,.'Dt~'TAt1.5 �,, .�i�t,�l. _ DOWN 3(c iI LEACHING PIT - SECTION 12 r _ 2 ao NO SCALE DESIGN ' DATA . S 1 30 25 ' 8" w NOTE: DO NOT RUN HEAVY EQUIPMENT OVER SYSTEM NO. OF BEDROOMS I _O DISPOSAL I LEACHING PIT NOTES; EST. TOTAL DAILY EFFLUENT 33 GALS. CONC.-TO BE-4000 :P_S.I q _28 DAYS .: . - SEPTIC TANK I C7 to Q GAL. OWNERS l BUILDER 2. REINF. W 6 � x 6 ' �6 GA- W. W. M. I 3. 2 'AND 4 ' SECTIONS ARE AVAILABLE FOR GREATER DEPTH REQUIREMENTS GENERAL. NOTES E30 I NOTE: 1 . ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN AL Q A e EXCAVATE TO ELEV. gC7.0O ACCORDANCE WITH TITLE5 0 THE STATE SANITARY CODE OR LOWER AS` DATED 'JULY 111977 aANY LOCAL RULES APPLICABLE. REQUIRED TO REMOVE ALL LOAM AND CLAY CONTAINING MATERIAL BENEATH PIT: REPLACE EXCAVATED MATERIAL 2. ANY CHANGE TO THIS PLAN MUST BE APPRD. BY THE r BD. OF HEALTH; AND CHARLES D. SPOHR. WITH CLEAN,CLAY FREE GRAVEL, MECHANICALLY COMPACTED IN PLACE. 3. WHEN CONSTRUCTION IS COMPLETED, PRIOR TO BACKFILLING, J M �} F SIDE AREA = •199 S.F. S.F./GAL GALS NOTIFY THE ENGINEER FOR INSPECTION. M . NOTE ' 4. FOUNDATION ELEV. MUST BE CHECKED WHEN COMPLETED. BOTTOM AREA= � S. F.��S. F./GAL— —GALS i _28 GJ 5. THESE ELEVS. MUST NOT BE CHANGED WITHOUT WRITTEN TOTAL AREA S. F. TOTAL $2 GALS ALL-. EL�I�'.: 1��+�,'r�' � 0�` �AV' •�t.4 UT� '�6'G�c ' APPROVAL BY CHARLES D. SPOHR: L_QT C ASSUMED ��� V, + 5Ca, CSC]' LEGEND 6. FOUNDATIO-N INSPECTION READ. WHEN EXCAVATED. AREA PLAN + 50.01 EXIST. GROUND ELEV. 50.0� FINISH GROUND ELEV.2UNDERLINED�� �I�EPARF-D F_RC>W ' ]�R�Y 'PL.AN r4=750� PIP i REV. DATE DESCRIPTION S �� E NVERT. ELEV. Dec. -�, D OY L �; , L .5, O ° TEST PIT LOCATION SEWAGE DISPOSAL SYSTEM o -o SEPTIC TANK FOR C LARK 4- FLYNN BU I LDER [] DISTRIBUTION BOX — - UF MA3s \ „ LOT 29 BE T WS LANE 4 C. I . PIPE - o '�/ SP OHR PI. C C T E Y T. FIBER V V l-tttt-f-ttt-I— BE PIP TIGHT J� E a f'1 _ G JOINT N N s IS No. 7468 w o 4 �10 0/sTERc, DESIGNED: C•D.SPOHR DATEDEC, ! DRAWING NO. — -- — PROPERTY LINE q����0 5 DE fSSIONA4 DRAWN: C•S, SCALE:AS SHOWN I Q D •�E• MIN. CODE DISTANCE 52 o MAP SEC PCL LOT CHECKED: C. D. S . • I