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HomeMy WebLinkAbout0246 BISHOPS TERRACE - Health 246 Bishop's Terrace Hyannis �M ° r e . a e ° TOWN OF BARNSTABLE I_.00ATION 'Z'41, oDS ►ccca.cc SEWAGE# Zol'I - y51 VILLAGE ►.(yQ,n�;5 ASSESSOR'S MAP&PARCEL Z51 - /G9 INSTALLER'S NAME&PHONE NO. $,rB EXCO.,jo A..'a n 471-OGS3 SEPTIC TANK CAPACITY 1000 I� LEACHING FACILITY. (type) Sb0 ocLI (size) 13 x 33 x 2- NO.OF BEDROOMS y OWNER KP► n . PERMIT DATE: I Z•19- I`? COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet. Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) ` Feet FURNISHED BY Ai- ZG'3'� 81- Z5 ' AZ Z$'`l'' ' 62. Z`7''s A3- L R EA R 63- y2'2 '' A Aq- S 9' 1 0 O TOWN OF BARNSTABLE LOCATION 6t4 2,m Ze , SEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL v2 57 /6 1 INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY 6,0-n g.,r,a LEACHING FACILITY:(type) > P p $�A� (size) 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 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 �- `'1 ��� � No. Fee v[J THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes Application for his .veer 6pstem Construction Permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System ndividual Components Location Address or Lot No. :N Psi 6,-r Ow er'st Name,Address,and Tel.No. All Assess�Sr's Map/Parbel f-5 f I n So(JWej r� 9 f7 Z( —93 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. -�62vq-7-74166 aheP,7-y Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures `,- Design Flow(min.required) gpd Design flow provided q,3a gpd Plan Date ►zlr-r i t`I Number of sheets 9=_. Revision Date Title Size of Septic Tank DQ i Type of S.A.S. S7b 6 r, w c Description of Soil Nature of Repairs or Alterations(Answer when applicable) - 2(�d�Q Z D aD ccal ckla W5 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 Boar �ealtli tt S' ed Date ��a g 1 7 Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued / --------------------------------------------------------------------------------------------------------------------------------------- st i w •iii�f 'Y (, 4 1 No. !i Gt fT / SI' Fee L�U THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 21ppliCation for Misposalk6pBtem ConetCUCtion Permit Application for a Permit to Constntct( ) Repair( Upgr de( ) Abandon( ) El Complete System ndividual Components 1316 I Location Address or Lot No. ��j hU/ � Owner's Name,Address,and Tel.No. Assessor's Map/Parcel _ S f I rj cj p jJ(�P( Q 17 Ll -�� -5 7 S Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Sn�_y7-7 -)a•he�,- y env 90Ll �9 4 ir � �. Type of Building: f Dwelling No.of Bedrooms 4 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided y t� gpd Plan Date (�! (� Number of sheets Z Revision Date Title i i Size of Septic Tank 1000 e.k,j Type of S.A.S. � � r W (%) r, ,, c Description of Soil Nature of Repairs or Alterations(Answer when applicable) 412-o(A ho X (3 2 U 5�0 Gal ra:lrt.mb,-1S Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of` ealth�. Sbmed A r� (7 Date jZ f Application Approved by YA, Date , Application Disapproved by Date for the following reasons Permit No. J _. ! Date Issued 11- / THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIF that P On-site Sewage Disposal system Constructed( ) Repaired(� Upgraded( ) Abandoned( �),by �� ri cA A..,U n at 2�� i s hv n 1e(ra_Lk_ t r_ 0 1 /has been constructed in accordance with the-pro'ai�si m of Title 5 and the for Disposal System, Instruction Permit No.,�d �- ��r�dated % (il //-7 Installer T Designer r #bedrooms Approved�des ignflow � U gpd The issuance of this permit sh 1 not be construed as a guarantee that the sy/s of m will funcfio`n as si ed. Date le-)/l Inspector ---------------------------------- ------------- j - No. �1 t j �I Fee U� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposaf *pstem Construction 3pPrmit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) System located at 4J i ; and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construc ion m st be completed within three years of the date of this permit. i J Date ri ( Approved by "l Town of Barnstable Regulatory Services Richard V. Scali,Interim Director • MIUMA13M . Public Health Division 1639.�° Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: 12-9- 18 Sewage Permit# Zoin - 451 Assessor's Map\Parcel 251- IG9 Designer: F10.1,crAw. E;r yjromcrNAm-1 Installer: Z4J3 jExe,7,v0_Aivr\ Address: �tt.,,0. gox 151 Address: ly'rr-,bcrr" LiJ [OrCSA-�-IG On 12- 19-1,9 $ R E xCa,ya A;o N was issued a permit to install a (date) (installer) septic system at -Z4L ►, .r,r ro.c based on a design drawn by (address) [)auG M0,:VNc.rAu Z dated 1 - 1`1 - tsl (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. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed E.o , liance with the terms of the M approval letters(if applicable) OFlyq�s� DAVIDD. c�a " FI-AHER7Y,JR, y (In Iler s Sign a No. 1211 �FG/STEREO s"NI TAR1 PN '(Designer's Signature) (Affix Desi is Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUMT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc Town of Barnstable P# Department of Regulatory Services ri 1 RUW ABM n Public Health Division Date 659. �� 200 Main Street,Hyannis MA 02601 �6 Date ScheduledXp"/// Time ID Fee Pd. Soil Suitability Assessment for Sew ge Dis osal Performed By: Witnessed By: t LO(j AT ON&G L INFORMA- ION Location Address / //� ersN v'1 /(,(�,-oAAAAV'✓' l� f�/�� Address Assessor's Map/Parcel: 2�� �9 Engineer's Name (/ f 4-41- NEW CONSTRUCTION REPAIR Telephone r Land Use I/�� Slopes 1%) 12 '� Surface Stones Distances from: Open Water Body >lyV R Possible Wet Area R ///' ft Drinking Water Well� Drainage Way�__ft Property Line.;L __,.__fl Other__ _______.__.__._____fI SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) Parent material(geolog Depth to Bedrock Depth to Groundwater: Standing Water in Hole: !"/ ( 1 Weeping from Pit Face Estimated Seasonal I ligh Groundwater DETERMINATION FOR SEASONAL-,HIGH WATER TABLE, .Method Used: Depth Observed standing in obs.bole: in. Depth to soil mottle& in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment R. Index Well 9 Reading Date: Index Well level Adj.factor Adj.Groundwater Level_ PERCOLAT-ION TEST " Hoete Tie ? Observation. .. , , Hole# Time at 9" Ito Depth of Pero Time at 6" All _ - Start Pre-soak Time @ `G Time(9"-6") 11 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 t J t^k DEEP-OBSERVATION HOLE LOG,« Hole#'•' 5 rv', , Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consist nc %Gravel) LE --C) DEEP OBSERVATIQN"HOI;ELOG Ho le#; .w t Depth from Soil Horizon Soil Texture Soil Color Soil they Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel , / pp V i DEEP"OBSERVATI(JNHOLE LOG Hole# "3 » Depth from Soil Horizon Soil Texture Soil Color Soil Cher Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) DEEP:.OBSER_VATION 1IfILE LOG: Rote Depth from Soil Ilorizon 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 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? If not,what is the depth of naturally occurring pe ,"o s aterial? Certificationfpertise 1 certify that on (date)I have passed the soil evaluator examination approved by the Department of Eotection and that the above analysis was performed by me consistent with the required trainnd e e ce de ibed in 310 CMR 15.017. Signature Date r ! QASEPTIC\PERCFOR M.DOC Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments U1 j rQd 7e,, �ce Property Address Owner Owner's Name information is r d� y T' 7 required for every 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. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your cursor-do not Name of Inspector use the return key• � r�� Company Name SA Company Address City/Town State Zip Code Telephone Number License Number i r-s 5 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 m�intenanc-e of on site sewage disposal systems. I am a DEP approved system inspector pursuant to I ection 135.340.;of Title 5 (310 CMR 15.000).The system: Z71 M asses ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority lnspectoC—sSign6ture Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•08M Tile 5 Official Inspection Forth:Subsurface Sevage Disposal System•Page 1 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address ,ry Owner Owner's Name information is / required for �t 'h-c.n /y � G Z lzG Z 7 every page. Citytrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: 911 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. Answer yes, no or not determined (Y, N, ND) in the ❑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 exfiftration 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. ND Explain: ❑ 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 ❑ obstruction is removed t5insp.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner Owner's Name information is required for �ii! �s>✓�vc G'�2lr, c./ ��a oZ_c`7 every page. City/Town State Zip Code Date of Inspection B. Certification t on (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ 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 ❑ obstruction is removed ND Explain: 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 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. t5insp.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface/Sewage Disposal System Form -Not for Voluntary Assessments 4 ^ F T ! Property Address ' Owner Owner's Name p information is r required for j 4�� every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): } ❑ 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 coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other. D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ �— Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ Er,-' Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Ido ❑ Static liquid level in the distribution box above outlet invert due to an overloaded 80)-(� or clogged SAS or cesspool ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ L 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. t5insp.doc-08/06. Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner Owner's Name information is , required for [!�� /J'ht /J G/ —iz —0—7 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cunt): Yes No ❑ E] - Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ / Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ 2' Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ �- The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems,you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ [r the system is within 400 feet of a surface drinking water supply ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑/ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. t5insp.doc-08106 Tile 5 Official Inspection Form:Subsurface Senage Disposal System-Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner Owners Name information is required for every page. Cityfrown State Zip Code Date of Inspection C. Checklist Check if the following have been done.You must indicate"yes" or"no"as to each of the following: Yes No ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ®-' Were any of the system components pumped out in the previous two weeks? ❑ Has the system received normal flows in the previous two week period? ❑ p,,-- 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 NIA) r— ❑ Was the facility or dwelling inspected for signs of sewage back up? ❑ Was the site inspected for signs of break out? L� ❑ 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: ❑ Ll 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-08/06 Title 5 Official Inspection Form:Subsurface Selvage Disposal System•Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 17 Property Address ` 1 Owner Owner's Name information is required for I % � f°� G'/ -.2 -C-7 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): Number of bedrooms (actual): C ,r'21 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Number of current residents: Does residence have a garbage grinder? ❑ Yes CU No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes [g No Laundry system inspected? ❑ Yes [H No Seasonal use? ❑ Yes M No Water meter readings, if available last 2 ears usage -7�5 c 9 ( Y 9 (gPd))� t/-A&-d& — V-/0-l.`7 Sump pump? jc,Ov CIC - "7 V-15-0 ❑ Yes No Last date of occupancy: Mee Date Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMVen allons per day(gpd) Basis of design flow(seats/pers Grease trap present? ❑ Yes ❑ No Industrial waste holding tank pr ❑ Yes ❑ No Non-sanitary waste discharged ❑ Yes ❑ No Water meter readings, if av 'a Last date of occupancy/u Date Other(describe): t5insp.doc•=06 Titie 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner Owner's Name information is J required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: 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 System: NO D 9-;/ 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) ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components,date installed (if known) and source of information: Were sewage odors detected when arriving at the site? ❑ Yes W No t5insp.doc•08/06 Title 5 Official Inspection Form:Subsurface Sevage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address T Owner Owner's Name information is � C �'—Z�_c 7 required for ' "'° every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: feet Material of construction: st iron ❑40 PVC ❑ other(explain): Distance from rivate water supply well or suction line: P PP Y feet o us._ Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Ze /r Depth below grade: feet Material of construction: 19concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle Scum thicknessy� Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle tIOrtt e� How were dimensions determined? S';;-i c r- T � t5insp.doc-08/06 Title 5 Official Inspection Form:Subsurface Savage Disposal System•Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form . Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �,2 V4, Property Address Owner Owner's Name information is required for 2— 7 c every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): vim' 'A 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 toXendation ee or baffle Distance from bottom of scum tdutlet tee or baffle Date of last pumping: Date Comments(on pumping recom , 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 ❑ berglass ❑ polyethylene ❑ other(explain): t5insp.doc•0=6 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner Owner's Name information is yytu required for every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) 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? El Yes ❑ No Distribution Box (f present must be opened) (locate on site plan): Depth of liquid level above outlet invert M) 1b 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): i Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No t5insp.doc•08/06 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner Owner's Name information is required for l � = � ��l %� '0 -7 every,page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number,dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 811�-. t5insp.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments M c2LN Property Address _ Owner Owner's Name `s information is required for p j �- Zl . every page. CityTrown State Zip Code Date of Inspection D. System Information (cont.) 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.): 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.): t5insp.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner Owner's Name o information is required for �� ykC (}�PeC i 0 02_;2 —G`7 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch 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. yj �r-Clc ri � �d5�. p,c c- f t5insp.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,�2 Property Address it Owner Owners Name information is required for 1'� �`45L Q�!e.O/ d-2Z—ram 7 every page. City[Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells 3if � Estimated depth to 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 ❑ 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: ��- Q -73 t5insp.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 .............. ................ ................... .. .. .... . .. .. .. .......... ..... ........................ .................................. .............................. ...... ..... ... . . .... . . ... ............ ......................................................... ..................... GENERAL NOTES DESIGN CAL CULA TIONS SYSTEM DETAIL Flaherty Environmental Services 1 ALL PRECAST COMPONENTS TO BE P. 0. Box 81 Yarmouth Port, MA 02675 MINIMUM H-10 RATED. ALL COMPONENTS NUMBER OFACTUAL BEDROOMS 4 774.994. 1166 WITH ANY ANTICIPATED VEHICULAR TRAFFIC TO BE H-20 RATED. GARBAGE DISPOSAL UNIT NO 2. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OFA GARBAGE TOTAL ESTIMATED FLOW GRINDER. (110 GAUBRIDAYX4 BR) 440 GAL./DAY 3. MUNICIPAL WATER IS AVAILABLE. REQUIRED SEPTIC TANK CAPACITY 880 GAL.- 4. ALL CONSTRUCTION TO CONFORM WITH - 310 CMR 15.000 AND ALL OTHER SIZE OF SEPTIC TANK 1000 GAL. (EXISTING) APPLICABLE LOCAL, STATE AND FEDERAL CODES AND REGULATIONS. SOIL CLASSIFICATION I 5. INSTALLER/CONTRACTOR TO REVIEW& VERIFY ALL ELEVATIONS AND DETAILS DESIGN PERCOLATION RATE <2 MIN./INCH AND REPORT ANY DISCREPANCIES TO EFFLUENT RATE 0.74 GALADAYIFT2 DESIGNER PRIOR TO CONSTRUCTION OR 12-83' 0 ASSUME ALL RESPONSIBILITY. LEACHING AREA 6. INSTALLER/CONTRACTOR IS MX(33.5'+ 12.83)(2) = 185SF RESPONSIBLE FOR MAINTAINING SAFE 33.5'x 12.83' =429 SF WORK AREA, VERIFYING ALL UTILITIES 614 SFx 0.74 454 GPD AND NOTIFYING "DIG SAFE" (1-888-344-7233) 72 HOURS PRIOR TO USE(3)500 GALLON H-20 CHAMBERS WITH 4'STONE 33.5' CONSTRUCTION. AS DIAGRAMMED INA 33.5'X 12.83'X2'CONFIGUR4TION 7. ANY CHANGES TO OR DEVIATIONS FROM (LINEAR FEET) THIS PLAN MUST BE APPROVED IN WRITING BY FLA HER TY ENVIRONMENTAL RESERVE LEACHING CAPACITY NIA SERVICES AND LOCAL BOARD OF HEALTH. 8. FINISH COVER OVER COMPONENTS IS NOT TO EXCEED XPER 310 CMR 15.000 UNLESS SHOWN PER PLAN (NTS) 9. ALL ABANDONED SEPTIC SYSTEM COMPONENTS TO BE PUMPED DRY AND FILLED WITH CLEAN SAND OR REMOVED SOIL EVAL UA TION AND REPLACED WITH CLEAN SAND. TEST HOLE#1 P#15553 I TEST HOLE#2 P#15553 10.ALL COMPONENTS TO BE PROVIDED Evaluator- David D.Flaherty Jr.,RS,REHS Evaluator. David D.Flaherty Jr.,RS,REHS WITH WATERTIGHT ACCESS PORTS SE#2755 OF Date: December 13,2017 Date: I December 13,2017 SE#2755 BOH Witness. Don Desmarais,RS WITHIN 6"OF FINISH GRADE. BOH Witness: Don Desmarais,RS A 11.ALL SEPTIC TANKS, DISTRIBUTION BOXES AND PIPING TO BE INSTALLED TH-I ELEV.58.0' FL "R -R. TH-I ELEV'58.0' WATERTIGHT. 12.NO KNOWN WETLANDS OR WELLS 8� A LS IOYR312 0'-8- A LS IOYR312 0. WITHIN 100 FEET OF PROPOSED Ao R% LEACHING. 8--28' B LS I0YR516 8--26' B LS I0YR516 13,THIS IS NOT A CERTIFIED PLOT PLAN AND UNDER NO CIRCUMSTANCES IS THIS PLAN TO BE USED FOR ZONING OR BUILDING PURPOSES. 28"-126" C MS 2.5Y614 28"-120" C MS 25Y614 14.LOT IS SHOWN AS ASSESSOR'S MAP 251 certify that on November 12,2002,l have passed SITE AND SEWAGE PLAN PARCEL 169. the examination approved by the Department of Environmental Protection and that the above analysis FOR 15.LOCUS PROPERTY IS LOCATED WITHIN has been performed by me consistant with the 8 & 8 EXCAVATION, INC./ required twining,expertise,and experience described AN AQUIFER PROTECTION- DISTRICT G.W.ELEV.NIA G.W.EL EV' WA in 310 CMR 15.018(2). KRISTIN SOUWEINE (ZONE 11). 246 BZSHOP'S TERRACE BOTTOM TH-1ELEV. 47.5' BOTTOM TH- 1 ELEV. 48 0' HYANNIS, MA PAGE20F2 ................................................................................................... ...................................................................................... .... ...... ... .... ................................................................................................ ........... ........ .............................................................................. .......................................................................................... ........... .............................................. ................................................................. ......................................... c . _ TOP OF FOUNDATION COVERS TO BE WATERTIGHT AND -- SEPTIC SYSTEM PROFILE EL. 60.0' EL. 58,0' BROUGHT TO WITHIN 6 OF FINAL GRADE • (n°t t0 S�,e Flaherty Environmental Services INSP. PORT TO GRADE CLEAN SAND ', p 2" of 3 to b" DOUBLE WASHED O. BOX 81 4" CAST IRON or EQUIVALENT PEASTON�OR GEOTEXTILE EL, sB.°' Yarmouth Port, MA 02675 MIN. PITCH 174" PER FOOT -¢ FILTER FABRIC �` �� 4"SCHEDULE 40 PVC PIPE 774.994.1166 4" SCHEDULE 40 PVC PIPE — FLOW LINE VENT IF REQUIRED —� �-- o' a,s�ra (Arst2'robalevel '.. • . •':.L.EXISTING :•••• •.°. ,,, ' 14" °:'• : a L.55.8't EL.EXISTING/®Q a ° •p p�p ' 000°000°c EL.55.6' --►- I o000°000000 0 , 0 0 0 0 0 �� 0��® p�® o°o°o°o°c El.54.T EL.54.53' °0°0°0 0 0°0°0°0° �LJ p p p ® C7 0°0°°°ooc a GAS BAFFLE EL.54.5' oo°o°o°o°o°o°o°oo° �p®p C� '�®u71 o°o°o°o°e 2.0' a �00000�00�00�0 ODODOD .d. (� p 0�C00000c 0 0 0 000 0 0 c 0°0Oo000osc .•g' •` �'+••�•°•• � 0,5'CRU SHED STONE OR (H2OD-BOX) 1000 GALLON SEPTIC TANK nIECHANICAL coMPACTION SOIL ABSORPTION SYSTEM (DATUM XISTING: ASSUMED) E ; (3) 500 GALLON H-20 CHAMBERS " to 1�" DOUBLE WASHED S ONE WITH 4'STONE AROUND IN A 5'0' 12.83'W X 33.5'L X 2V CONFIGURATION (SEE PAGE 2 FOR CONFIGURATION) EL. 47.5' ` BOTTOM OF TEST HOLE Cl 47,5' LOCATIONMAP USGS ADJUSTMENT' N/A 56 GROUNDWATER ELEV' N/A N TH LOCUS o 24' ' DRIVEWAY cq Ott y^ '• 1 O TH-1 1.'.O' 37' Br/an Ln. DECK 44 TH-2f;� O ;,`/ LP O EXISTING ? V RL28 4 BR �+ NTS O DWELLING 1" A\�ySF1 OF 414,9 co = .lY 40' BENCHMARK: FQ ,N JR.l 21 TOP OF FNDN I O EL. 60.0' S T ERA e� S'qNI FARE LET 21 0,31) ACRES± 140,79, DATE.•1211712017 REVISED: 56 SITE AND SEWAGE PLAN sa 1 FOR B & B EXCAVATION, INC./ KRISTEN SOUWEINE SCALE : 111 = 301 246 B/YANNIS, MA TERRACE REF.•LCP25306-B SH2 PAGE 1 OF2 1 rt# •