Loading...
HomeMy WebLinkAbout0323 BISHOPS TERRACE - Health 'f323 Bishops,.Terrace __.- ..... _ t Hyannis f' - 4A = 251 179 e � 0 I� a TOWN OF BARNSTABLE. LOCATION -5 2e� i��rs0 �grfC c SEWAGE# ;ZC)1`2.- 2-`1 0 VILLAGE ASSESSOR'S MAP&PARCEL 95 I 1'7 q INSTALLER'S NAME&PHONE NO. Ott, —tIgnu 9n; Tkc �� 'i SEPTIC TANK CAPACITY CX i Skl-t t 000 i3 odkos LEACHING FACILITY:(type) ik fc R,r, JA c h4-R Q (size) CgOe T(��� NO.OF BEDROOMS OWNER PERMIT DATE: -7 6 z COMPLIANCE DATE'. :13 1- Separation Distance Between the: AW NC v r%r Q Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility .. PC f C— 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 ]c ey�x5 EJ 4 I ! � Gs P n r N w 1 .a:" k, NOAV 2^ Z'f O � !6 �O Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ftplicatiou for Disposal *pstem Construction permit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 3 T515tvp l�frc�c r Owner's Name,Address,and Tel.No. C"vlo 3aNIC t5F Cli p4: Assessor's Map/Parcel 2 Sl — Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. >Povg ¢ j-vwN Type of Building: Dwelling No.of Bedrooms 3 Lot Size /.f sq.ft. Garbage Grinder( ) Other Type of Building /j cv; No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) >,30 gpd Design flow provided g+�, q gpd Plan Date 7,/G//�! Number of sheets I— Revision Date Title e Size of Septic Tank Type of S.A.S. , fie. `/G LjpivC Description of Soil Nature of Repairs or Alterations(Answer when applicable) S-A - S 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. ed CC lam— Date 7 Application Approved by Date 30 7u i Application Disapproved by Date for the following reasons Permit No. 2 0 l-— 7,1�0 Date Issued ` /30j?_0 i-Z_ No. Fee THE COMMONWEALT,H,,Q4F MAASSACHUSETTS Entered in computer: PUBLIC°HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS es Application for MispoSal *pstrm Construction 3permit Application for a Permit to Construct( ) Repair(✓Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components I . Location Address or Lot No. 3?3 1314 p leoltor P Owner's Name,Address,and Tel.\No. Coato &%-j( OF e-C,PC Cc Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. r 4,4-s /� 3/vL✓nI rrc C NSiN rri NS War/c S Type of Building: , ' Dwelling No.of Bedrooms 3 Lot Size j f 0 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) 1 Other Fixtures Design Flow(min.required) �3!3O gpd Design flow provided y�, ej gpd t Plan Date 7�/c.�i�z Number of sheets 'L Revision Date i Title ; Size of Septic Tank "69-,ySf Type of S.A.S. of&- ge, k4e_ Lt e,,vc r Description of Soil r Nature of Repairs or Alterations(Answer when applicable) I Date last inspected: I l 'j Agreement: jThe 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 i Compliance has been issued by this Board of Health. i ed Date -7 3 O / Application Approved by Date 30 201 Application Disapproved by Date for the following reasons I Permit No.?D 1- — Z 1ty Date Issued 7/30�Zo tZ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( lw� Upgraded( ) i Abandoned( )'by 1 -,od4 i; .q :l plc at r r! has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.Z01Z- 4 O dated -4(3o' zv t Z Installer'D�,4e� A Scn�} ^,jc Designer kA-^b r #bedrooms Approved design flow 3 S, gpd i The issuance of this permit shall not be construed as a guarantee that the system will nctib as de ' , ed. Date ,i t&r!1 © Inspector .— ----------------------------------------------------------------- No. ZO 1"2.-. Zy o Fee `off o0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS MispoSal *pstem Construction �ermit Permission is hereby granted to Construct( ) Repair( t.�/ Upgrade( ) Abandon( ) System located at 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. I Provided:Construction must be completed within three years of the date of this permit. } Date -1 13o 1 2.a2__ Approved by i i 07/30/2012 13:22 5084775313 ENGINEERING WORKS PAGE 01 Town of Barnstable RegWatory'Services Thomas F. Geiler,Director i WAS& Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-9624644 Fax: 508-790-6304 Dater c Sewage Permit# -a Assessor's Map/Parcel installer&Iksiner Certificate Farm Designer: ., WarF, In.L , installer: A• c w L Address: 2 W. . Address: 1�-f? D�C 1 Lt..Y- _ 4 A- puk d Z IL On 1�.F�• sus 2rw r. jyyt was issued a permit to install a (date) (insta er septic system at 1 s s � �`i % based on a design drawn by (addrcssT .k-C/' Pj� H-t- dated 6b ( 2. . (designer) 0C I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State& Local Regulations. Plan revision or certified as-built by designer to follow. Stripout(if required) wa cted and the soils were found satisfactory. OF PETER T. NlCENTEE staller's tgnature) CIV]L 9 M0.$51U9 Q �DtST (DPsignenes Ssgnature) (Affix Design ) LEASE RETURN TO BARN-STABLE PUBLIC UELLTH D ION. CATE OF COMPLLAN E WILL _NUT-- BE ISSUED UNTIL B FO AS- U_T T CARD ARE RECEIVED B' THE BARN 'FABLE PUBLIC HEALTH DIVISION• THANKX_QU• q,Wfics formawnignerucrOceiion form.doc Town of Barnstable ' De artiment of R 'p Re Services : .. 2-7 - . .Public Health..Divison Hate fo � 1 ZZ tsA 200 Main Street,Hyannis MA 02601 Mid ' Date Scheduled 1,7 h Time Fee Pd. l O O C1 Soil Suitability Assessment for S w ge Disposal Performed By: '��.C— Y' Witnessed By: P.2 LOCATION& GENERAL INFORMATION Location Address .;�r �o�5 -- Owner's Name Address 16, LC / Assessor's Map/Parcel: 2 t' —1 "7 Engineer's Name NEW CONSTRUCTION REPAIR Telephone# -50Ff'-73-7 --tt-7 6.� Land Use. Slopes(%) Z- Surface Stones / Distances from: Open Water Body wL�ft Possible Wet Area-LUA=ft Drinking Water Well-;?�ft Drainage Way A.11AV ft Property Line r-r 2;u ft .Other` ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands fn proximity to holes) Parent material(geologic) O� /'J�C `"` Depth to Bedrock Depth to Groundwater. Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: ^epth-O.s�rved'sf;rd:s.b js�abs:hole: Depth to weeping from side of obs.hole: in, Groundwater Adjustment ft. Index.Well# Reading Date: Index Well level-.p,,,,�„ AdJ,factor— Adj.C roundwater Level,, PERCOLATION TEST butte, Time Observation Hole# ( f_ Time at 9" Depth of Perc Q 7i M Time at 6' Start Pre-soak Time® 114 .4 CCI 1,Y1 Time(9"-6") End Pre-soak Rate MinJ1nch. Z, v 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:\SEPTICVERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Soil Color Soil. Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders, Consistency. Gravel) �ay(Z'91Z 32- 1Zs? C_ i;S JM5 2-5- DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) (�-►z � 5� t� (L`� z Z�-�) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other. Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, Gravel)- . DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,.Stones,Boulders. Consistency, &Ayel) Flood Insurance Rate Man: 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? r If not,what is the depth of naturally occurring perviot5s material? .._,.. Certification I certifyn (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 trai ' ,expertise and experience described in 310 CMR 15.017. Signature Date Q.\sEP nMERCPORM.DOC �. Z� 2 � COMMONWEALTH OF MASSACHUSETTS ' EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION Rv r FEB 0 ,) 2005 TITLE 5 '`' T, r'��� OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A °Z5 CERTIFICATION ^, Property Address 323 Bishops Terr Y l Hyannis Mass _ �0 Owner's Name: Amy Rained Owner's Address: 323 Bishops Terr. ; Hyannis Mass Date of inspection: 2/1105 ` '1 Name of Inspector:(please print)Timothy E. Cash Company Name: Cash's Trucking Inc _„ ' Mailing Address: PO Box 7 ! _ Yarmouthport, Mass 02675 ;- Telephone Number: (508)362-3221 csi CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15-W of Title 5(310 CMR 15.000). The system: XX Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: �-�-1� 4f Date: 2/1/05 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. Notes and Comments System should be pumped,solids are heavy ****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. Title 5 Inspection Form 6/15/2000 page i Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address. 323 Bishops Terr Hyannis Mass Owner: Amy Rained Date of Inspection:2/1105 Inspection Summary: Check AAC,D or E/ALWAYS complete all of Section D A. System Passes: XX 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: I Have found nothing that would indicate that this system fails under the regulations set by the DEP or the town 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 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. 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 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: Title 5 Inspection Form 6/15/2000 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address•• 323 Bishops Terr Hyannis Mass Owner: Amy Rained Date of Inspection:211105 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 wager 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: Title 5 Inspection Form 6/15/2000 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:323 Bishops Terr Hyannis Mass Owner: Amy Rained Date of Inspection: 2/1/05 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for ail inspections: Yes No _ xx Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool xx Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution lox above outlet invert due to an overloaded or clogged SAS or cesspool xx Liquid depth in cesspool is less than 6"below invert or available volume is less than'h day flow _ xx Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped xx Any portion of the SAS,cesspool or privy is below high ground water elevation. xx Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. xx Any portion of a cesspool or privy is within a Zone l of a public well. — xx Any portion of a cesspool or privy is within 50 feet of a private water supply well. xx 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] _N 0 (YeslNo)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. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no xx the system is within 400 feet of a surface drinking water supply — got the system is within 200 feet of a tributary to a surface drinking water supply _ roc the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 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 f "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. Title 5 Inspection Form 6/I5/2000 4 Page 5 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 323 Bishops Terr Hyannis Mass Owner:Amy Rained Date of Inspection: 2/1/05 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No roc _ Pumping information was provided by the owner,occupant,or Board of Health xx Were any of the system components pumped out in the previous two weeks? mot _ Has the system received normal flows in the previous two week period? xx Have large volumes of water been introduced to the system recently or as part of this inspection? xx _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) roc _ Was the facility or dwelling inspected for signs of sewage back up? XX Was the site inspected for signs of break out? mac _ Were all system components,excluding the SAS,located on site? xx Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the bathes or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? xx _ 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: Yes no xx _ Existing information.For example,a plan at the Board of Health. xx _ 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(3)(b)] Title 5 Inspection Form 6/15/2000 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 323 Bishops Terr Hyannis Mass Owner:Amy Rained Date of Inspection: 211/05 FLOW CONDITIONS RESIDENTIAL 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 Number of current residents:3 Does residence have a garbage grinder(yes or no): wo Is laundry on a separate sewage system(yes or no):e&_ [if yes separate inspection required] Laundry system inspected(yes or no): two Seasonal use:(yes or no):W Water meter readings,if available(last 2 years usage(gpd)): 2003-78NO 2004-$0000 Sump pump(yes or no):_ Last date of occupancy: 2/05 COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): w Industrial waste holding tank present(yes or no):tub Non-sanitary waste discharged to the Title 5 system(yes or no):t o Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Owner supled info Was system pumped as part of the inspection(yes or no): If yes,volume pumped:_gallons—How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM xx 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: Installed Bortolotti Const 1012/90 Were sewage odors detected when arriving at die site(yes or no): do Title 5 Inspection Form 6/15/2000 6 Page 7 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 323 Bishops Terr Hyannis Mass Owner:Amy Rained Date of Inspection: 211/05 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction:_cast iron 40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:_(locate on site plan) Depth below grade: 12" Material of construction concrete_metal fiberglass_polyethylene other(explain) If tank:is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: 1000 gallon septic tank Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle:2•6 Scum thickness: 4" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 15" How were dimensions determined: measured Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Tank is in good shave. no leaks,fs all in place 3.5"drop from inlet to outlet,but tank does need to t GREASE TRAP:_(locate on site plan) Depth below grade:_ 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: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Title 5 Inspection Form 6/15/2000 7 Page 8 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:323 Bishops Terr Hyannis Mass Owner: Amy Rained Date of Inspection: 2/1/05 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction:_concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Title 5 Inspection Form 6/15/2000 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 323 Bishops Terr Hyannis Mass Owner:Amy Rained Date of Inspection: 2/1/05 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type xx leaching pits,number.:2 leaching chambers,number: leaching galleries,number: _leaching trenches,number,length: leaching fields,number,dimensions: _overflow cesspool,number:_ innovative/altemative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): 2-leaching pits.pit 1 4`water pit#2 dry, no sign of any breakout,or ponding vegatation normal 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 or 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.): I Title 5 Inspection Form 6/15/2000 9 Page I O of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) ' Property Address: 323 Bishops Terr Hyannis Mass Owner:Amy Rained Date Of Inspection:211/05 SKETCR OF SEWAGE DISPOSAL SYSTEM Provide a.sketch of the sewage disposal system including ties to at(east two pera-ulnent reference landmarks or benclimarks.Locate all wells within 100 feet.Locate where public water supply enters the building. AC 1r9 An a� o M 42:' 5. ki t 5 V 0i Jw Title 5 Inspection Form 6A5!2000 10 Page It of I1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 323 Bishops Terr Hyannis Mass Owner:Amy Rained Date of Inspection: 2/1/05 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: _Obtained from system design plans on record-if checked,date of design plan reviewed: 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) xx Accessed USGS database-explain: Cape Cod Commision You must describe how you established the high ground water elevation: Augered 4 feet bellow pit#2,no water note next page Title 5 Inspection Form 6/15/2000 I l 4 Y Permit Number: Date: 211/05 Completed by: Timothy Cash HIGH GROUND-WATER LEVEL COMPUTATION I Site Location: 323 Bihops Tern Hyannis Lot No. Map 251, Lot 179 Owner:AMY Raineri Address: Same Contractor: Cash's Trucking Inc Address: PO Box 7 Yarmouthport, Mass 02675 Notes: No water encountered STEP 1 Measure depth to water table 2/01/05 16.0 tonearest 1/1 Oft. .............................................................._.............. Date month/day/Year STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: OAppropriate index wetL.............................................. aiw247 ©Water-level range zone ..................................................... C F STEP 3 Using monthly report"Current. Water Resources Conditions" determine current depth to 01/05 24.6 water level for index well ........................... month/year STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A),current depth to water level for index well(STEP 3), and water-level zone (STEP 28) 5.2 determine water-level adjustment .......................................................................................... STEP 5 Estimate depth to high water by subtracting the water- level adjustment (STEP 4) from measured depth to water 10 levelat site (STEP 1) ........................................................................................................ . 4 COMMONWEALTH OF MASSACHUSE 'TS Gx ExE,CUTIVL OFFICE OF ENVIRONMENTAL AFFAIRS 0. 0 a Y DEPAR,rMENT OF ENVIRONMENTAL PRO'ff CTION o,M _ s e vie 350 MAIN STREI'T WEST YARMOUTH,Mtn 508-775-2800 cc TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENT'S SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 323 BISHOPS TERRACE fr � 1 HYANNIS,MA 02601 / !`ii*�6�sE O\aiier's Name: JOSEPH KITCI LENS j Owncr's Address: 323 BISHOPS TERRACE t D EC 2 6 2Q00 _ HYANNIS,Mil 02601 Dale of Inspection DIiCI?MBEIt 20,2000 t Tf`litir F8;8R tSih�3� s H:rV.ri!i1�i; Name oflnspeclgr:(please print) .LAMES D.SEARS � Company Name: A&B Canco Mailing Address: 350 Main Street West Yannouth,MA 02673 Telephone Number: 508-775-2800 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). Tire system: X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: 12-20-00 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 bas a design Clow 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 tot he buyer, if applicable,and the approving authority. Notes and Continents ****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. Title 5 Inspection Form 6/15/2000 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 323 BISHOPS TERRACE HYANNIS,MA 02601 Owner: KITCHENS,JOSEPH Date of Inspection: DECEMBER 20,2 000 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X I have not found any information which indicates that any of the failure criteria described in 310 CUR 15.303 or in 310 CNM 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: N/A 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 exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with 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 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 Healthy' broken pipe(s)are replaced obstruction is removed j ND explain: Title 5 Inspection Form 6/15/2000 2 Page 3 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 323 BISHOPS TERRACE HYANNIS,MA 02601 Owner: KITCHENS,JOSEPH Date of Inspection: DECEMBER 20,2000 C. Further Evaluation is Required by the Board of Health: N/A _ 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 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 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Title 5 Inspection Form 6/15/2000 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 323 BISHOPS TERRACE HYANNIS,MA 02601 Owner: KITCHENS,JOSEPH Date of Inspection: DECEMBER 20,2000 D. System Failure Criteria applicable to all systems: N/A You must indicate"yes"or"no"to each of the following for all inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool N/A Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in pit is less than 6"below invert or available volume is less than%day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped X Any portion of the SAS,cesspool or privy is below high ground water elevation N/A Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply N/A Any portion of a cesspool or privy is within a Zone 1 of a public well N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well N/A 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.) NO (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CUR 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: N/A To be considered a large system the system must service a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes" or"no to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well. If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system is 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. Title 5 Inspection Form 6/15/2000 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 323 BISHOPS TERRACE HYANNIS,MA 02601 Owner: KITCHENS,JOSEPH Date of Inspection: DECEMBER 20,2000 Check if the following have been done. You must indicate"yes"or"no"as to each of the following Yes No X Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks? X Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection? X Were as built plans of the system obtained and examined?(If they were not available note as N/A) X Was the facility or dwelling inspected for signs of sewage back up? X Was the site inspected for signs of break out? X Were all system components,excluding the SAS,located on site? X 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 X 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)has been determined based on: Yes No X Existing information. For example,a plan at the Board of Health. X 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(3xb)] Title 5 Inspection Form 6/15/2000 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 323 BISHOPS TERRACE HYANNIS,MA 02601 Owner: KITCHENS,JOSEPH Date of Inspection: DECEMBER 20,2000 FLOW CONDITIONS RESIDENTIAL Number of Bedrooms(design): 2 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms: 220 Number of current residents: 2 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): YES Seasonal use(yes or no): NO Water meter readings,if available(last 2 years usage(gpd)): 1999 586 CU.FT./2000 727 CU.FT. Sump pump(yes or no) NO Last date of occupancy: N/A COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: N/A Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: gallons—How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM X Septic tank,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 copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: MAIN SYSTEM 1972.NEW PIT 1990 PERMIT 90-445 Were sewage odors detected when arriving at the site(yes or no): NO Title 5 Inspection Form 6/15/2000 6 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 323 BISHOPS TERRACE HYANNIS,MA 02601 Owner: KITCHENS,JOSEPH Date of Inspection: DECEMBER 20,2000 BUILDING SEWER(locate on site plan): N/A Depth below grade: Materials of construction: Cast iron _ 40 PVC _ other(explain) Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK(locate onsite plan): X Depth below grade: 16" Material of construction: X concrete metal fiberglass polyethylene _ other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1,000 GALLON PRE CAST Sludge depth: 4" Distance from top of sludge to the bottom of outlet tee or baffle: 26" Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle: 12" Distance from bottom of scum to bottom of outlet tee or baffle: 16" How were dimensions determined: ASBUILT AND TAPE Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): MAIN TANK AT WORKING LEVEL,TANK AND COVERS 16"BELOW GRADE.OUTLET BAFFLE. GREASE TRAP(located on site plan) N/A Depth below grade: 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: Continents(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Title 5 Inspection Form 6/15/2000 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 323 BISHOPS TERRACE HYANNIS,MA 02601 Owner: KITCHENS,JOSEPH Date of Inspection: DECEMBER 20,2000 TIGHT or HOLDING TANK: N/A (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/day Alarm present(yes or no) Alarm level: Alarm in working order(yes or no): Date of last pumping Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: N/A (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.,): PUMP CHAMBER: N/A (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Title 5 Inspection Form 6/15/2000 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 323 BISHOPS TERRACE HYANNIS,MA 02601 Owner: KITCHENS,JOSEPH Date of Inspection: DECEMBER 20,2000 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: Type X leaching pits,number: 2 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.) TWO 1,000 GALLON PRE CAST PITS.PIT(1)PTT AND COVER 2'BELOW GRADE.OUTLET TEE,WATER LEVEL AT OUTLET.PIT(2)3'BELOW GRADE.COVER 20"DEEP. 18"WATER,NO HIGH STAIN LINE. CESSPOOLS: N/A (cesspool must be pumped as part of inspectionX 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 or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation etc.): PRIVY: N/A (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.) Title 5 Inspection Form 6/15/2000 9 n Page 9 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 323 BISI-IOPS"LEIZIZACE I-IYANNIS,MA 02601 Owner: KIfCItENS,JOSEN-I Date of Inspection: DECEMBEIZ 20,2000 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two pennanent reference landmarks or benclunarks. Locate all wells within 100 feet. Locate where public water supply enters the building. 30 9/ , -CO) Title 5 Inspection Form 6/15/2000 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 323 BISHOPS TERRACE HYANNIS,MA 02601 Owner: KfrCHENS,JOSEPH Date of Inspection: DECEMBER 20,2000 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to groundwater 33 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observation site(abutting property/observation hole within 150 feet of SAS) X Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation X Accessed USGS database-explain: You must describe how you established the high ground water elevation: USGS AT BARNSTABLE HEALTH DEPARTMENT. Title 5 Inspection Form 6/15/2000 11 : TOWN OF BARNSTABLE LOCATION c �-s+ ��S %�,�',�.�G� SEWAGE # VILLAGE ASSESSOR'S MAP & INSTALLER'S NAME 6z PHONE NO.y��OGo-eW C4na;p- SEPTIC TANK CAPACITY —/ ZO fry r LEACHING FACILITY:(type) (size) � O NO, OF BEDROOMS PRIVATE WELL PUBLIC�WATE� BUILDER OR OWNER —fZL4 / DATE PERMIT ISSUED: DATE COLIPLIANCE ISSUED: VARIANCE GRANTED: Yes LNo/ o a Q i � ,a .� TOWN OF BARNSTABLE LOCATION SEWAGE# VILLAGE ?/ ASSESSOR'S MAP Cz LOT / P£-7- s ,, 'S NAME & PHONE NO. A & B CANCO 775-6264 SEPTIC TANK CAPACITYl��c� LEACHING FACILITY:(type) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: .Yes No fin,, O O 'No M CJs 3a a V M n O \ C� TOWN OF BA.RNSTABLE .LOCATION JOU -,3/;56QDS err. SEWAGE # VILLAGE H[/A/1!'1lS ASSESSOR'S MAP &LOTPL� INSTALLER'S NAME&PHONE NO._( Ck k ro,V5 SEPTIC TANK CAPACITY 00 gAI004, LEACHING FACILITY: (type) 4� i ft!Al'a Ms (size) 6 , Y/O � NO.OF BEDROOMS BUILDER OR OWNER lus_nmkel 2cm /� C'i?sl, PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 CASh'S In -Lis W3> Od O np o� cad 1 '� 'k ! i No.... ...7.�f' Fmc.�0.......�.._ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliration for Dispatial Works Tonstrnr#iun ramit Application is hereby made for a Permit to Construct ( ) or Repair PO an Individual Sewage Disposal System at: �.. _ • . __ - - a '�'- _..•----------------------•---•--................. Locati ddr s _ or Lot No. W Own ...... 710� 5 ... Installer Address Type of Building Size Lob_111,e.4090 .-._Sq. feet Dwelling—No. of Bedrooms..._. ..................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building .....Z90.......... No. of persons...............•............ Showers ( ) — Cafeteria ( ) P4 Other fixtures --------------- --------------- - Design Flow................5�........•.....gallons per person per day. Total daily flow........_ _..._ gal W .............. Ions. WSeptic Tank—Liquid-capacity.C10Q.gallons Length................ Width................ Diameter---------------- Depth................ xDisposal Trench—No. ..................... Width.................... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No--------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 1-.4 Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water---------------------- .. f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-----__-.__--__---_-___. P4 ----••--•--------------------•---•-•----....-----...-----•••-••--------•---.............-••-------•............;........................................... O Description of Soil.....................4V.-c ..----Z _$w--- 5l311�--c. .-�• a-----, --4P.4ZOW---_-- .............. .....Z �------•----------------------•-•---------•---------------_------------------------------------------------•------••---------------------••--------------- W UNature ofIRe ) 'rs orAlterations-Answer when applicable..__,��Q___:__ . _ 0.lzzw _.._. -a. e...ZL1�...... (�t! a -=-----ill-!!!s�-------------------------------------------------------------------------------------------.......................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance h be issued b t oard of health. Signed ........ .... ... . ........ --------- -- ...... -- . .............. to ApplicationApproved By ---- Ge -- --- -- ------ ----------------------------------................................................ ...`a Application Disapproved for the following reasons- ...............................................--------------..........................---------------.............................. ................ -- ---------------...-----.......------...........--------------..........----...----- ----- ----- -- .......................................................... ............................ ------ }at Permit No. ------------------ -- Issued --------.� e ....Z No.._ � - FEs.. ...- THE COMMONWEALTH OF MASSACHUSETTS r Et BOARD-. OF HEALTH TOWN OF BARNSTABLE Appliration for Disposal Works Tonotrurtion 1hrutit Application is hereby made for a Permit to Construct ( ) or Repair (�% an Individual Sewage Disposal System at: t "V✓✓ Locatio/ der s �j — or Lot No. _ ...�t�._�.. ... ..... ...::i.......RixiC:l:.:J._.._.1.. 1 ........... . W 1 Gam __ OW� � d_.. _.... S Installer Address U Type of Building' l Size Lot- jt`�/1.1: _-_Sq. feet 1­4.4 Dwelling ' No. of Bedrooms... ____- __-_-._____________________Expansion Attic ( ) Garbage Grinder ( ) a`14 Other—T e of Building �:_..._.. No. of persons............................ Showers YP g --------------•---- P ( ) — Cafeteria ( ) dOther fixtures -------•----------------------------•---------------------••-•••••-------------------------••---...•••••----•-••-------------........._........-----• W Design Flow..............:..5.5 .............gallons per person per day. Total daily flow........... ..................gallons. W Septic Tank—Liquidc' apacity.�_Q_0L1_gallons Length................ Width................ Diameter..............._ Depth___________..... x Disposal Trench—No..................... Width.................., Total Length.................... Total leaching area-------------------_sq. ft. Seepage Pit No-------- >___. Diameter____________________ Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing.tank ( ) aPercolation Test Results Performed by--------------•---•----•-••--•......----------•-...-•-••-......••-;-.--- Date........................................ a Test Pit No. I................minutes per inch,;Depth of Test Pit...t_..:_+ s_......l�Depth to ground water.._....____t............ /I ; t, Zia g _. Ps Test Pit No. 2........... minutes per,mch Depth of Test Pit.___. _-__ Depth to ground water._., -r .. x Description of Soil .- ....._.l./ ` 5 r�� �.�w��' ��. .... ! U ................ ......�_.l�F w........................................................................ j 4K ¢ r U Nature of Repairs or Alterations—Answer when applicable____:- 4_-4.40-------� �-2 ... .t1 ./-7 .3,1...... ---------------- -------- . .------------..--.--------........------------------------.....V - Agreement: N The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned•further agrees not to place the system in operation until a Certificate of Compliance ha be issued by the oard of health. p� — Signed .: ... / - . ..------ .... ----- ..?.. ...... .. te Application Approved By Q �! �- Application Disapproved for the following, fon':L 1_ a---=---------------------------------------------------------- .................................................... ........................................................... �-.( W .r --'- t LTa[e Permit No. -- !. I tts'" ---r .....---.-.. Issued .--------- --zeta------------------------ THE COMMONWEALTH OF MASSACHUSE17S BOARD OF HEALTH TOWN OF BARNSTABLE Gelrttftrate of (gomplianre THIS IS TO CPTIF.YT at he Individual Sewage,Disposal System constructed ( ) or Repaired (x ) by................................... 4 .,--.. ;-- '--------.-..--...--....... at .. ...................... ..--...--- A ... --..-.--.. --. .. has been installed in accordance with the provisions of TITLE S of The State`nvironmental Code as 4escribed inI application for-Disposal Works Construction Permit No. - -' ------------- ---- dated -:-!fib-�2 -.---- G�-..---...---. THE ISSUANCE*OF'THIS CERTIFICATE SHALL NOT BE CONSTRUI�D ki A GU R'AfaelE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE /0/.�-�- '.�-- ---------------------------------------------.................... Inspector -----f ...: - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No..��..:����� � FEE�6..:'.... Disposal Works Tonotrudion Hermit Permission is hereby granted................ ._J :._----..__......._...._._..........._...... to Construct ( ) or Repair an Individual Sewage Disposal System r at No.................. ..........�,. ics 1`1 .....7- L/2_p :��---------/� _1.Z...... Z............................................ Street as shown on the application for Disposal Works Construction Permit No._ � Dated..___4 .�................ ......................................� .•••• r �. .._. .-------•--•-- DATE-- �D ------------------------••.....•-••------- 7 y I FORM 36508 HOBBS 6 WARREN,INC..PUBLISHERS _ LEGEND N N 12.53 40 E LOCUS � 53p6_e ——102—— EXISTING CONTOUR 2 o 5 1/24.26' LCP x 100.98 EXISTING SPOT GRADE e H.W OVERHEAD WIRES o = a G EXISTING GAS SERVICE m x TP-2 o r z N W _--_-- ---- 0'lO1,lOTP-1 38' W EXISTING WATER SERVICE N 3 PpIOP SE A , TEST PIT v o 26'�--- L--L—. nL — — 1-1--L—?EI — Brian Ln (n ' 101.17 101.28 ; BENCHMARK Z EXISTING LEACH PIT (PER RECORD AS-BUILT) Rd_Route o T BE PUMPED, FILLED SO ND AND ABANDONED WI TH Falmouth 2 x - ��i x 101,49 EXISTING LEACH PIT Pond ti 101.77 101,88 _ (PER RECORD AS-BUILT) ---- ��� TOP OF TANK, EL.=101.23 "0 INV.=99.90f(FIELD VERIFY) NOTTLOCUS SCALE MAP 102.38 102.15 � GENERAL NOTES: x 0 �•9-2- BENCHMARK SET 1. 101,52 / DECK OUTSIDE CORNER/BULKHEAD ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL x / r--- EL.=102.24 (ASSUMED DATUM) BOARD OF HEALTH AND THE DESIGN ENGINEER. 102.53 x 01.89 x 10.1.55 2• ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS x OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE i LOCAL RULES AND REGULATIONS. I i 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR EXISTING N TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE 0 102.02� GARAGE HOUSE.C14J DESIGN ENGINEER. 102.74f= v, v 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING p � b T.0.F. 90 o FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN N N ENGINEER BEFORE CONSTRUCTION CONTINUES. x v o 5. ALL ELEVATIONS BASED ON AN ASSUMED DATUM. Z 102.47 403,E2 101.70 frl 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF x•10154_ THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF I� WALK + 102,27 HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. / � b Z 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. Z 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS -� AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE 101,64 x `� .:_ _: o DIRECTED BY THE APPROVING AUTHORITIES. IC x 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY v \ THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING QD x 101,27 b CONSTRUCTION. ? ' 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS c \ IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND n\ � LAM �\ , REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). i -�- -A 0 MqS 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE rt (LOT 68) ��P�� sq�y INSPECTED BY A CERTIFIED SOIL EVALUATOR PRIOR TO BACKFILL.. G ^� `�✓, o PETER T. 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND MBLU. 251.-179 �, NTEE TO B CONSIDERED A PROPERTY LINE SURVEY. i 19,520±SF i`' o McE N IS NOT E CO E i � Z � CIVIL 101,15 % No. 35109 101_ x� .100.17 100' 6 L=75.08' x 101 6I ����� 49 98 _ --R=1396__C�i� _�01 P0` s q" EN PROPOSED SEPTIC SYSTEM UPGRADE PLAN S 15°27'00" W . ---= 90t-------- 323 BISHOPS TERRACE, HYANNIS, MA 99,81 99.98 100,03 edge of pavement 100.28 1) 100,49 t�S 1 -�,_ 1 Prepared for: D.A. Brown, Inc. P.O. Box 145, Centerville, MA 02632 OWNER OF RECORD Engineering by: SCALE DRAWN JOB. NO. BI.SDI�OP S TERRA CE ' RAINERI, JASON A & KAREN Y Engineering Works, Inc. . 1"=20' P.T.M. 203-12 95 CAMELBACK ROAD 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. MARSTONS MILLS, MA 02648 (508) 477-5313 7/16/12 P.T.M. 1 of 2 NOTE: TO PREVENT BREAKOUT, THE PROPOSED 60' FINISH GRADE SHALL NOT BE < EL.98.3 r-------------------------------i FOR A DISTANCE OF 15' AROUND THE PROPOSED S.A.S.— _--_-_-- ------ ------- PERIMETER OF THE S.A.S. SEPTIC TANK INSTALL RISERS & COVERS OVER INLET & PROPOSED D-BOX PROPOSED S.A.S. OUTLET AND SET TO 6" OF FINISH GRADE INSTALL RISER & WATERTIGHT INSTALL 2 INSPECTION PORTS OVER END UNIT T.O.F. COVER SET TO 6" OF GRADE EXISTING F.G. EL.=102.3t F.G. EL: 100.3t F.G. EL: 100.3(MAX.) LO o /MAINTAIN 2% GRADE (MIN.) OVER S.A.S. 4 vj� / L = 26' L = 2'(MAX) INSPECTION P RT® S=1% (MIN.) ® S=1% (MIN.) 2 MINIMUM) PO 4°SCH40 PVC 4"SCH40 PVC 6" DECK 10"I 8' 14"IH 10.75:RTTOV�M EXISTING 48" LIQUIDINVELEVEL INV.=97.90 —GAS BAFFLE INV.=98.17 PROPOSED INV.=98.00 1 TRENCH W/12 ADS Arc 36HC UNITS ® 5'/UNIT = 60' 7,EXISTIN , INV.=99.90t D-BOX USE(#323) EXISTING SOIL ABSORPTION SYSTEM (PROFILE) EXISITNG SEPTIC TANK UNITS MUST BE STAMPED H-20 ESTABLISH VEGETATIVE COVER S.A.0 LAYOUT LA�o I 'T S.A.S. V BACKFILL WITH CLEAN NATIVE OR PERC SAND TO TOP OF CHAMBERS —15.5'=-1 .5'=�{ F2., NOTES: :.. .....;.,... 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE �= ," •:`' INVERTS, PRIOR TO INSTALLATION. TOP ELEV.=98.33 2) D—BOX SHALL BE SET LEVEL AND TRUE TO INV. ELEV.=97.90 ,,µ : �� 12" GRADE ON A MECHANICALLY COMPACTED SIX 15.5° 2; 8.. BOTTOM ELEV.=97.00 6" INCH CRUSHED STONE BASE, AS SPECIFIED IN ' 2.83' p '� 310 CMR 15.221(2). 5' MIN. ABOVE BOTTOM OF 3) INSTALL INLET & OUTLET TEES AS REQUIRED. T.P. EXCAVATION OR G.W. 3 OUTLETS - H-0 LOADING' 2" 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE EXISTING SUITABLE �( AS MANUFACTURED BY TUF—TITE, ZABEL OR EQUAL. NO G.W., EL=91.1 - MATERIAL D-BOX SEPTIC SYSTEM PROFILE ADS TRENCH CONFIGURATION WTHAm 36HC UNITS TO 13ENSTALLED NO STONEN 63.25" N.T.S. TYPICAL SECTION 1s" DESIGN CRITERIA SOIL LOG 34.5" NUMBER OF BEDROOMS: 3 BEDROOMS (PERMIT NO. 90-445) SOIL EVALUATOR:1 P�ETER1 MCENTEE3 E9 (SE#1542) SOIL TEXTURAL CLASS: CLASS I WITNESS: DONALD DESMARAIS R.S. HEALTH AGENT TOP VIEW. DESIGN PERCOLATION RATE: <2 MIN/IN ELEV. TP— 1 DEPTH ELEv. TP-2 DEPTH 60" DAILY FLOW: 330 G.P.D. 101,1 A 0 101.1 011 END CAP END CAP DESIGN FLOW: 330 G.P.D. SANDY LOAM FILL FRONT VIEW SIDE VIEW END CAP GARBAGE GRINDER: NO AND SHALL NOT BE USED WITH THIS DESIGN. 99.6 B 10YR 4/2 6' 99•6 A 6" REAR/TOP VIEW SANDY LOAM 10YR 4/2 NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT SIDE VIEW LEACHING AREA REQUIRED: (330) = 445.9 S.F. SANDY LOAM 99.1 12" TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY 10YR 5/8 B DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. 4 EXISITNG SEPTIC TANK: 1000 GALLON CAPACITY 98.4 C 32" SANDY LOAM 4640 TRUEMAN BLVD 10YR 5/8 HILLIARD, OHIO 43026 Arc 36HC DETAIL PROPOSED D-BOX: 1 INLET, 3 OUTLETS, H--10 RATED 98.4 32" ADVANCED DRAINAGE SYSTEMS, INC.® UNITS MUST BE STAMPED H-20 PERC C PROPOSED SEPTIC SYSTEM UPGRADE PLAN 40'/52" SOIL ABSORPTION SYSTEM /5 LOAMY SAND/ LOAMY SAND/ 323 BISHOPS TERRACE HYANNIS MA USE ADS Arc 36HC UNITS IN STONELESS TRENCH CONFIGURATION MED. SAND MED. SAND � � (GENERAL USE APPROVAL FOR 7.79 SF/LF IN TRENCH CONFIGURATION) P 2.5Y 6/4 2.5Y 6/4 Prepared for: D.A. Brown, Inc. P.O. Box 145, Centerville, MA 02632 4 12 UNITS = 60.0 FT Engineering by: SCALE DRAWN JOB. NO. 60' x 7.79 SF/LF = .467:4 .SF 91.1 120" -91.1 120" Engineering Works Inc. NTS P.T.M. 203-12 PERC RATE <2 MIN/IN. ("C" HORIZON) 12 West Crossfield Road, ForeAdale, MA 02644 DATE CHECKED SHEET NO. DESIGN FLOW PROVIDED: 0.74(467.4 S.F.) = 345.9 G.P.D. NO GROUNDWATER ENCOUNTERED (508) 477-5313 7/16/12 P.T.M. 2 of 2