Loading...
HomeMy WebLinkAbout0077 BUCKWOOD DRIVE - Health r(77 Buckwood Drives ! 'Hyannis P . p f , No. 6® Uc� t Fee /00 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01ppYication for �Bigoal *pztem Cow6trUctiun Vermit Application for a Permit to Construct( ) Repair(t-fo"Upgrade( ) Abandon( ) ❑Complete System LKhtdividual Components JLocation Address or Lot No. '7 7 6v Av�6«le Owner's Name,Address,and Tel.No. // Assessor's Map/Parcel A PA) 2 C`bl it^ �Q9 Installer's Name,Address,and Tel.No.. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms ;3 Lot Size 10,pp!j sq.ft. Garbage Grinder ( ) Other Type of Building -e No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 210 gpd Design flow provided .33 2 . 5 gpd Plan Date 7/010 Number of sheets Revision Date Title Size of Septic Tank J(j jE�_XiSfmNe Type of S.A.S. 4fr :5 C. 14C Description of Soil Nature of Repairs or Alterations(Answer when applicable) i-N6 f Q.I) m e i„s A. 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 and of Health. Signe /y/� Date '10 Application Approved by k. et, Date 77�d/!a Application Disapproved Date for the following reasons Permit No. Z01 U — U Date Issued G v No. a0(0 - �uc� � t : lU0 Fee —• THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 0(pplication for �Digogor �&pgtem Cow9truction Permit t Application for a Permit to Construct( ) Repair(41"'Upgrade( ) Abandon( ) ❑ Complete System Up Individual Components Location Address or Lot No. 7 9 Owner's Name,Address,and Tel.No. Assessor's Map/Parcel AP,) 2 7 2 o G �'✓1.�1 i P� �j �G Installer's Name,Address,and Tel.No. Y Designer's Name,Address and Tel.No. p a5� s A {qiU a C Sold-LICb-7)0 INr.1d of ww/ Type of Building: Dwelling No.of Bedrooms Lot Size 10,OOq sq. ft. Garbage Grinder ( ) Other Type of Building k ov-3 �e No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided 3.5 7, , .57 gpd Plan Date 7/ J Number of sheets 2 Revision Date Title Size of Septic Tank Type of S.A.S. Aft- Description of Soil ,Nature of Repairs or Alterations(Answer when applicable) I NS 1 tr. A 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 B and of Health. Signe Date 7 ?O Application Approved by y 4, Date < <, Application Disapproved y Date for the following reasons i Permit No. 2 U/0 �2 Vol Date Issued L.Zo /u THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance q THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (✓) Upgraded ( ) Abandoned( )by�G s �5in,,v�✓ Z NC at -7 "7 3 Oct rWOo0 i� I !< has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. d l U ?a g dated o Installer -Doo"V 5 A \ t C,W r1 1- N C Designer #bedrooms Approved design flow '3 7 • gpd The issuance of this pe a' d it shall not be construed as a guarantee that the sys em will ub esigned. l �(J Date 11 U Inspectors ._._...-- No. 1 Q!d _1 ! Fee !.p U THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Bigogal 6paem Congtruction Permit Permission is hereby granted to Construct ( >) Repair ( k<Upgrade (�_- ) Abandon ( ) System located at -7d��w©vV and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of tl�i�pz Date p Approved by _,. 5 07/23/2010 07:21 5084775313 ENGINEERING WORKS PAGE 01 Town of Barnstable Regulatory Services Thomas F.Geller,Director Public Health Division Thomas McKean,Director 200 Main Street, Hyena*MA OM1 Office: 508-8624644 Fax: 508-790-6304 Date: 2- l(3 Sewage Permit#��� Assessor's Map/Pareel 2,7Z --014 CMI&Idga Form Designer: ,�,g;,n�es rS t�dv�i ,�n C • Installer: Address: n W• Cre 4 St`k 1 cX 9-rk Address: a. �• x l'`!S- ��e � uyy c4. �� MA a 2�3z On �p �. A . l�cb,,,s was issued a permit to install a ( ) (installer) septic system at 7.2 Dc_ MN -3 based on a design drawn by (addresiF '�e -e•�T`�M c.�.r-cam f dated "7( 5-J (a tgner) I certify that the septic system referenced above was installed substantially according to the desip, 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 ma or changes (i.e. greater than 10, lateral relocation of the SAS or any vertical relocation any component of the septic system) but in accordance with State&Local Regulations. Plan revision� or certified as-built by designer to follow. Stripour(if required)was inspected soils were found satisfactory. 1.0 OF Mqs� A PETER T. er's SignatZ7— MCENTEE CIVIL .0 9 No.35109 9 . 9 FO WC ignature A ix D p O TL N q;Wf1ko*rao mtkmfamdm TRANS. NO.: CITY/TOWN: APPLICANT: ADDRESS:; DESIGN.FLOW; 3 30 t REVIEWED BY: DATE: N/A OK NO : Legal boundaries denoted [310 CMR 15.220(4)(a)] Street, Lot, tax parcel number and lot number noted on plan [310 CMR 15.220 4 'u Locus Provided 310 CMR 15.2204 t Plan proper scale? (1"=40'for plot plans, 1"=20' or fewer for ✓ components) 310 CMR 15.220(4)] Easements shown 3.10 CMR 15.220 4 b System located totally on lot served [310 CMR 15.405(1)(a) for upgrades]- _! not, a variance is required 310 CMR 15.412 4 Location of impervious surfaces (driveways, parking areas etc.) 310 CMR 15.220(4)(d)] Location all buildings existing and proposed 310 CMR. ✓+ 15.220(4)(c Location and dimensions of system components and reserve areas. 310 CMR 15.220(4)(e)] System Calculations 310 CMR 15,220(4)(f)] '� daily flow - septic tank ca aci (required andprovided) soil absorption system (required and rovided whether s stem designed for garbage grinder ✓ North arrow 310 CMR 15.220 4 Existing and ro osed contours 310 CMR 15.220 4 ✓ Location and log of deep observation holes(existing grade el. on each test) [310 CMR 15.220(4)(h)] Names of soil evaluator and BOH representative [310 CMR 15.220 4 h and i Location and da(e of percolation tests (performed at proper elevation?) [310 CMR 15.220(4)(i)] Percolation test results match loading rate? [310 CMR 15.242] Certification statement by Soil Evaluator 310 CMR 15,220(4)(j)] Observed and Adjusted groundwater (method for adjustment / given or indicated) [310 CMR 15,103(3) and 310 CMR V 15.220(4)(n)] Address Sheet J of 9 N/A OK NO_ . Location of every water supply, public and private, [310 CMR 15.220(4)(k)] within 400 feet of the proposed system"location"in the case of surface water.supplies.and gwo packed public water:supply . within 250 feet of the proposed,system location in the case within 150 feet of the proposed system location in the case of private water wells Location of all surface waters and wetlands located up to 100 ft. `f a . beyond setbacks"listed in 310"CMR 15.21.1 and any catch basins. located vintlun-50-ft 3=10 CMR 15.220(4)(1)] ' Water lines and other subsurface utilities located (310,C1VIR f . 15.220 4 m)- ' water line cross see 3 10 CM R 15.211 1 1 Profile of system showing invert elevations-of all system_ com onents and,tlie bottoms of the SAS. 31:0"CMR15.22" 4. o; Stamp of desi _`er ,310 CMR 15.220 1 an&310CMR 15.220 Stamp of Registered Land Surveyor(required if construction activities within ft" of lot line; 31-0::CMR 15,220 3 Test Holes adegtate(two in each,of the primary' and reserve unless trenches as permitted"in 310 CNIR 1-5.102(2)of"as approved for an upgade under LUA at 310'CMR`15 405 l Test-hole,adequate to demonstrate four feet of suitable.material? 310 CMR 15.1 3 4 Test Holes4deg4ate;to confirm adequate groundwater separation? 310 CMR 15.103 3 Benchmark-within-50-75'"of s ystem.. 31 O.-CMR..15.220 ,4 Materials'-specifications,noted?.[various sections of 310 CMR 15.000]" .. S` Ystem-comPon is not> 3 b"deep (unless Local Upgrade A royal"or.:LUA're uested) [3.10 CMR 15..405 i;" a H.4 Ace. Address Sheet 2 of 9 N/A OK NO IN MUN Size OK? 310 CMR 15.223 1 Inlet tee located'ten inches below flow line 310 CMR 15.227(6)] Outlet tee 14" or 14" + 5" per foot for increase ft depth [310 7 CMR 15.227 6 Outlet tee with gas baffle or approved filter 310 CUR 15.227(4)] Note regarding installation on stable compacted base [310 CMR 15,228(l)] Separation between inlet and outlet tees(no less than liquid depth) 310 CMR 15.227 2 Inlet/Outlet elevations at least 12" above high groundwater / (except as descriind 310 CMR 15.227(5)) or permitted for h upgrades under LUA 310 CMR 15.405 1 k - Minimum cover 9" (Tanks.buried more.than 9" must have risers on all openings and on the d-box) [310 CMR 15.2228(1) and 310 ✓ CMR 15.232(3)(0] Three access coyers (inlet and outlet must be 20" or greater) - middle access at least 8" 7/07 310 CMR 15.228 2 Access to within'6 " of grade -one port for systems<1 000gpd, two for stems>1000 gpd, 310 CMR 15.228(2)] All`at-grade covers secured to unauthorized access? [310 CMR 15.228(2)] > I G ft from build n foundation 310 CMR 15.211 1 Buoyancy calculation Re uired/Done 310 CMR y15.221 8 H-20 Where a ro� riate? 310 CMR 15.22b 3 Setbacks from resources 1310 CMR 15.211 o Required when other than single-family dwelling or flow>1000 d 310 CMR 15.223 1 b First compartment 200% daily flow; Second compartment 100% daily flow 310 CMR 15..224 2 .and 3 "U" pipe through or over baffle, outlet of each compartment with as baffle or approved filter 310 CMR 15.224(4)] Address Sheet 3;of 9 N/A OK NO Located-at least ten feat from any water line? [310 CMR 15.222 2 Disposal piping at least 18"below water line(when water and sewer cross, see 310 CMR 15.211 .1. .1 Clod outs '. aired/ rovided ? 310 CMR 15.222 8 Thrust blocks s ed in forte mains? 310 CMR 1$.221 6 c Slope of sewer line not less than 0.01 (1/8"/ft) 0.02 preferable 340 CMR 15.222.6 Proper piteh`on all runs? (.005 within gravitytdistributed trenches and beds) [310 CMR 15.251 9 and 310 CMR 15.252(2)(c)] Siphon roblem/ eachfield below pump chamber Endca s or vent manifoldspecified? Size and orientation of discharge holes specified?.(not smaller than . 3/8" not larger than 5/8") [310 CMR 15.251(8) and 310 CMR 15.252 2 ` Materials specified (310 CMR 15.251(5) specifies various pipe types allowed Stable compacted base [310 CMR 15.221(2) and 310 CMR 15.232(2)(a ' Splash plate or bate tee required on inlet/provided? (when pressure sewer to d-box or steep pitch of gravity sewer) [310 CMR 15.323 3 a Riser'if,deeper than 9 3:10 CMR 15.232 3 Inside muumum dimension 12" 3.10 CMR 15.232 2 b Minimum 310 CMR 15.232 3 e Watertight cover if<2000gpd),' waterproof manhole if>2000gpd J 310 CMR 15.23 2 3 d Capacity(emergency storage above working=design flow)? [310 Proper setbacks 310 CMR 15.211 same ass tic tanks)] 77 1 Watertight.20-in minium access manhole at least 20"MUST BE TO GRADE 310 CMR 15.231 5 Service components accessible(not too deep with piping, / disconnects accessible Alarm floats -alarm on circuit separate from pumpsspecified? Exceeds two units must have two pumps operating in lead-lag mode. 310 CMR 15.23 1 6 and 8 Stable Com ed.Base [310 CMR 15.221(2)] Address Sheet 4 of 9. Buo * calc,_ns needed'?Provided? 310 CMR 15.221(8)] ldl Address Sbeo 5:0f 9 4 N/A OK NO Calculations correct? 4 feet of naturally occurring material demonstrated? [310 CMR 15.240 1 1 Required separation togroundwater? 310 CMR 15.212 Aggregate specified as double washed 310 CMR 15.247 2 System Venting required/provided? (system under driveway or >36" d 310 CMR 15.241 Inspection ports specified and within 3"final grade? [310 CMR 15.240 13 Breakout requirements met? (No violation of breakout elevation within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and_ Guidance Document Chambers and Gal. in trench configuration supplied with inlet every 20 ft. 310 CMR 15.253(6)] 747 Each structure with one inspection manhole(if>2000 gpd must be tograde) 310 CMR 15.253 2 Aggregate I minimum-4' maximum: 310 CMR 15.253 1 2' sidewall credit maximum 310 CMR 15.253 1 a 4 In bed configuration, inlet every 40 ft. 310 CMR 15.253 6 MIMMM Lim Width 2'minimum 3'maximum 310 CMR 15.251 1 b 100 feet-maximum length 310 CMR 15.251 1 a] Minimum separation 2x effective depth or width whichever greater 3x if reserve between trenches 310 CMR 251 1 d Situated along cpntours 310 CMR 15.251 2 Breakout OK? [310 CMR 15.211 1,1[4.1 and Guidance Document minimum 2-distribution lines 310 CMR 15.252(2)(a)] Maximum se aration between lines 6' 310 CM R15.252 2 d Maximum separation between lines and outside of bed 4' [310 CMR 15.152(2)(101 Aggregate depth below discharge pipes 6" minimum, 12" [� maximum.: 31 C 0 MIR 15.252 2 Separation between beds 10'ninimum. 310 CMR 15.252 2 Bottom area used in calculations only 310 CMR 15.252 2 i Address . Sheet 6,of 9 7 X- Pressure Dosed System ? Provided pump and piping calculations / as required 310 CMR 15.220(4)(r)] l/ Pressure dosing required on all systems>200Ogpd or alternative systems under remedial approval [310 CMR 15.254(2) and UA Remedial Use ovals If used in gravelless system-make sure jet is directed as not to scour soil interface Guidance Document Inspections once per year(systems<2000 gpd)or quarterly >2000 dgood to note on plan 310 CMR 15.254(2)(d)] Construction in fill -Did the plan specify that the fill shall meet the s ecification of 310 CMR 15.255 3 ? Impervious barrier and/or retaining wall ? Guidance Document Impervious barrier installation must be supervised by designer 310 CMR 15.25 5 2 b Retaining wall must be designed by Registered Professional Engineer 310 CMR 15.255(2)(a)] Side slope not exceed 3:1 ? 310 CMR 15.25 5 2 Breakout retluirements met? [310 CMR 15.252(2)and Guidance Document At least 5 ft. from impervious barrier to edge of SAS (10 ft. recommended 10 CMR 15.255 2&21 Check DEP Approval letters for credits and design conditions If used with pressure dosing do not allow pressure discharge f to scour soil interface Was DEP Approval Letter provided and/or have you reviewed the letter for conditions? . Is the technology being properly applied and does it meet all DEP Approval Conditions? Is there a�ote on the plan regarding the requirement for perpetual maintenanceagreement? Any alarms involved on separate circuits Did the applicant submit an operation and maintenance manual? Has a . ,licant submitted a co of a maintenance a eement? Are the variances listed on the plan? [310 CMR 15.220 4 RLS Stamp;-necessary on plan if a component is within five feet of property line 310 CMR 15.412 4 Address ;:Sheet,.?of 9 y New on.or,increased flow proposed -.[Refer.to 310 z i r , Address Sheen S.of 9 J N/A ._ OK__ No Is the system in a Designated Nitrogen Sensitive Area(Zone II for a public supply Nell)? [310 CMR 15.214, 310 CMR 15.215 and 310 CMR 15.21¢ - also refer to Policy regarding upgrades of such existing systems] Is the system proposed on the same lot as served by private well ? 3.10 CMR 15.214 2 Aree the nitrogen loads proposed in compliance? [310 CMR 15.21 1 Pumping to septic tank ? 310 CMR 15.229 Z/ Shared System 5 i-CMR 15.290 r I Address Sheet 9.6f 9 , Town of Barnstable 7 Department of Regulatory Services Public Health Division DateKAM 5� ► `� 1 639- �� 200 Main Street,Hyannis MA.02601 DN1��A JDate Scheduled U Time L�___ Fee Pd. : G 0. U o Soil Suitability Assessment for Sewage isposal Performed By: t f M C E"� Witnessed By: � LOCATION& GENERAL INFORMATION Location Address 7_7 13 -z Lt,,j Oc1\ Owner's Name s4�,P V'e-\ N�kA A ss US'�a t Address S.C�V,v-Assessor's Map/Parcel: Z�77-—0 Engineer's Name PR� e\,-�c� NEW CONSTRUCTION REPAIR 0� Telephone# .5 0�—73'7—/ T 74 Land Use '45 LJ 4_% C&i Slopes(%) 2+/— Surface Stones �! Distances from: Open Water Body 7f 2 ft Possible Wet Area 2L_)__Jft Drinking Water Well ft k Drainage Way 'T I ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands In proximity to holes) p' - +�•1- ' � .' 'h,Y+ _ M Parent material(geologic) Depth to Bedrock Depth to Groundwater. Standing Water in Hole: _AJJ A. Weeping from Pit Face �a Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: in. Depth to Soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level ._., Adj.f'actor— Adj.Groundwater Level, PERCOLATION TEST date , Thnn.� Observation Hole# ' CS`J Time at V Depth of Perc �7/4: y� Time at 6" O M '^ Start Pre-soak Time @ - Time(9"-611) End Pre-soak Rate MinJlnch L 4 Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Back---------- i ***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 Holie# Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones;Boulders. Consistency,%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) o/z LOy�s� 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) (Munseli) . Mottling (Structure,Stones;Boulders. Consi ten Flood Insurance Rate Map: . Above 500 year flood boundary No_ Yes ._- Within 500 year boundary No Yeses Within 100 year flood boundary NoX. 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? • q�5 If not,what is the depth of naturally occurring pervious material? Certification , l�t , p _(date)I have passed the soil evaluator examination approved by the I certify that on Department of Environmental Protection and that the above analysis was performed by me consistent with;, the required trai ing,expertise and experience described in 310 CMR 15.017. Signature Date- 6 Q:\SBPTlC\PERCFORM.DOC No. �U (� Fee (U� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,, MASSACHUSETTS rtcatiott for pogal *paem Congtrurtion Permit Application for a Permit to Construct(,' epair( )Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No.—7� n G /1�,� Owner' Name,Address and Tel.No. 66 Assessor's Map/Parcel 3 72_ O j q N I is Name,Addressaand Tel.No. 4340 Designer's Name,Address and Tel.No. Type of Building: 7 � Dwelling No.of Bedrooms _ Lot Size sq.ft. Garbage Grinder( ) Other TI pe of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date % Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of R airs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees toe the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisio f T' le 5 f he Environ ntal Cod of to place the system in operation until a Certifi- cate of Compliance has bee I d b thi ar Signe Date Application Approved by - Date o? or' Application Disapproved for tWe following reasons Permit No. rt OO S--,201(r Date Issued 0! 1; t. t. �v s 2�i�' f i. No. o � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: I - _ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS �p�pYicatior� for ��po�ar �pmem �(Cow6truction Permit Application for a Permit to Construct( ' epair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location'Address or Lot No. �,`? �o Owner's N Address and Tel.No. � .�c.��,�,�fin' wner Name, Assessors Map/Parcel O L/ y% 7,4,41yJ)� Ins r s Name,Address and Tel.No. d 7 6 Designer's Name,Address and Tel.No. 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 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of R pairs or Alterations(Answer when applicable) Aw S' Date last inspected: Agreement: The undersigned agrees to a the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisio of T le 5 of he Environ ntal Cod of to place the system in operation until a Certifil cate of Compliance has been/i udd b this/ .oar ° Signed y Date i• _ 7 ,P Xi phcatibn Approved by - �rw � ' t.. _ Dateg.. � v??fr,f . Application Disapproved for the following reasons Permit No. 9 GO S"-- Date Issued G S t _. THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance Zpgraded `hP,7 THIS IS TO CE TIFY,t at the On-site Sewage Disposal System Constructed( )Repaiired( ( ) Abandoned( )by c,� r sl t at '7 c_�� = e se �r/i r` has been construct d in accordance with the provisions s 1 itle 5 and the for Dispo System Construction Permit No. 2 UU S` ,9 9f dated r ,Installer Designer The issuance of this pe t shall o e construed as a guarantee that the s wi on s designed. Date �nn [ S4-7 1 Inspector --------------------------------------- No.T�� 2�� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Migogal *pgtem QCongtruction Permit Permission is hereby granted to Construct( )Repair()C- )Upgrade( )Abandon( ) System located at -7 2 �R✓r K wa and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of erm•4. Date: L , _7 I a f Approved b `� COMMONWEALTH OF MASSACHUSETTS z w EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS d DEPARTMENT OF ENVIRONMENTAL PROTECTION e c e� ', 350 MAIN STREET P A WEST YARMOUTH,MA' ,,RCEL 508 775-2800 LOT . TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A L o Z'1 CERTIFICATION MAP 272 PAR 094 Property Address: 77 BUCKWOOD DRIVE RECEIVED HYANNIS,MA 02601 Owner's Name: DENISI,RON Owner's Address: 476 GREENWOOD LANE JAN 1 7 2003 KISSIMMEE,FL 34746 Date of Inspection DECEMBER 20,2002 TOWN OF BARNSTABLE HEALTH DEPT. Name of Inspector:(please print) JAMES D.SEARS Company Name: A&B Canco Mailing Address: 350 Main Street West Yarmouth,MA 02673 Telephone Number: 508-775-2800 CERTIFICATION STATEMENT 1 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 perfonned based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: J Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: � v/�� Date: �� ;7--Y 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 tot he buyer,if applicable,and the approving authority. Notes and Comments TANK SHOULD BE PUMPED. WASHER HOOK UP IN BASEMENT INTO TITLE V SYSTEM. OTHER LINE IN BASEMENT 2"PVC LINE ABOVE GROUND IN REAR, UNKNOWN WHAT IT IS USED FOR. ****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: 77 BUCKWOOD DRIVE HYANNIS,MA 02601 Owner: DENISI,RON Date of Inspection: DECEMBER 20,2002 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any infonnation 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: 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 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: 77 BUCKWOOD DRIVE HYANNIS,MA 02601 Owner: DENISI,RON Date of Inspection: DECEMBER 20,2002 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: 77 BUCKWOOD DRIVE HYANNIS,MA 02601 Owner: DENISI,RON Date of Inspection: DECEMBER 20,2002 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 ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool N/A Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in pits is less than 6"below invert or available volume is less than %2 day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation 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. 1 have detennined 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: 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 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 77 BUCKWOOD DRIVE HYANNIS,MA 02601 Owner: DENISI,RON Date of Inspection: DECEMBER 20,2002 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 nonnal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection? ✓ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ Was the site inspected for signs of break out? ✓ Were all system components,excluding the SAS,located on site? ✓ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum ✓ Was the facility owner(and occupants if different from owner)provided with infonmation 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 ✓ 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(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: 77 BUCKWOOD DRIVE HYANNIS,MA 02601 Owner: DENISI,RON Date of Inspection: DECEMBER 20,2002 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: 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)): N/A Sump pump(yes or no) NO Last date of occupancy: PRESENT COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): Basis of design flow(seats/persons/sqft,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 ./ 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: UNKNOWN.NEW PIT 1993—PERMIT#93-38 Were sewage odors detected when arriving at the site(yes or no): NO Title 5 Inspection Form 6/15/2000 6 f OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 77 BUCKWOOD DRIVE HYANNIS,MA 02601 Owner: DENISI,RON Date,of Inspection: DECEMBER 20,2002 BUILDING SEWER(locate on site plan): ✓ Depth below grade: 9" 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): ✓ Depth below grade: 4" 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: 1,000 GALLON PRE CAST Sludge depth: 16" Distance from top of sludge to the bottom of outlet tee or baffle: 14" Scum thickness: 4" 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: 14" How were dimensions detennined: 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 NEEDS TO BE PUMPED.INLET BAFFLE,OUTLET TEE.TANK AND COVERS 4"BELOW GRADE.NO SIGN OF OVERLOADING. 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: 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 r Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 77 BUCKWOOD DRIVE HYANNIS,MA 02601 Owner: DENISI,RON Date of Inspection: DECEMBER 20,2002 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: Alarn in working order(yes or no): Date of last pumping Comments(condition of alann 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) ( P ) 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 f w Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 77 BUCKWOOD DRIVE HYANNIS,MA 02601 Owner: DENISI,RON Date of Inspection: DECEMBER 20,2002 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ 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.) LEACHING IS TWO 1,000 GALLON PRE CST PITS.PIT(1)PIT AND COVER 27"BELOW GRADE. STAIN LINE AT OUTLET. LINE 8"WATER IN PIT. PIT(2)IS 4'BELOW GRADE WITH COVER AT 27".PIT IS DRY.STAIN LINE AT 12".WALLS CLEAN,NO SIGN OF OVERLOADING OR SOLID CARRY OVER. CESSPOOLS: N/A (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: 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 Nee 9 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 77 BUCKWOOD DRIVE HYANNIS,MA 02601 Owner: DENISI, RON Date of Inspection: DECEMBER 20,2002 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. ✓r i 57 Title 5 Inspection Form 6/15/2000 10 .Y Page 1 1 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 77 BUCKWOOD DRIVE HYANNIS,MA 02601 Owner: DENIS]. RON Date of Inspection: DECEMBER 20,2002 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to no groundwater 14 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) 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: HAND DUG TEST HOLE, 14'NO WATER. TEST HOLE 4' BELOW BOTTOM OF PIT(2). i f � �o - /y 1 °'7'� Title 5 Inspection Form 6/15/2000 11 r Fps...... . ......... THE COMMONWEALTH OF MASSACHUSETTS � 01- BOARD OF HEALTH par ` Y TOWN OF BARNSTABLE la tt er Ali►ipag al Works Tomitrur#inn Vamit Application is hereby made for a Permit to Construct ( ) or Repair (VI-oan Individual Sewage Disposal System at: ....7 ..._ _ c( .c � Q...... ----------------------------- .--------------- ar'C",-Addn•ss or Lot No. ...._. ...� s. I�------------------ ------ ------------------......Y�.....-----------....-----..........-•----.....--- y� n Owner a ... t r�1� -=----------------------------- Q-�-'� ��In1=---- ,� n 55 --- Installer Address UType of Building Size Lot............................Sq. feet �. Dwelling— No. of Bedrooms..................................._....__Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures ------------------------------- -- W Design Flow..........................:.................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid capacity............gallons Length................ Width---------------- Diameter---------------- Depth................ 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........................................ Test Pit No. 1................minutes per inch Depth of Test Pit-------------------. Depth to ground water........................ f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ..................-.......................................................................................................................................... 0 Description of Soil................................................................................ ------ •---......._----.......... x V ------------------------ •------------------ ....... ... .-•----------------------------------•-•--------------------------------------------•---------------------------------•-------- --•--•--------.... W ..................................................... ....................................................... ----------------- ------------- ... .. U Nature of Repairs or Alteration Answer hen applicable._...- �`E# ..... -...... ._ Q�...... 5.A!,-7-7--------- ---------------------- 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 Complia c a en is ue by the board of health. Signed . ------- -- -��----- .....J........^....... ......................... .-1.�...... ......... Da ApplicationApproved By ............. ----- -----------------:................................................ Application Disapproved for the following reasons: ............ ........ ..... . ...................................................................................... . ..................................................................................... ................... . .................................................... .--................... ---- ........... .......--............... ppDace Permit No. .. ..../...... ... ... ��--- -------------- Issued ----------- ...... Dace 1 1. No 73- 2 0 F!.... �c) t THE COMMONWEALTH OF MASSACHUSETTS . 01 BOARD OF HEALTH P TOWN OF BARNSTABLE � ltrattolt or fiiripw3al Work,i Towitrurtinn thrntit Application is hereby made for a Permit to COIlst uct ( ) or Repair ( n Individual Sewage Disposal System at: I ......7.2....23. L. �2.&..----fir=-•-----•.................... •-•-•-----------•---------•--•-----•----------•-•---•.._....-=----••------------......----.....--- LrocaPon-:\ddrcss or Lot No. �� ----- .... .v`= -------------------------------------------------- rss O%cncr A 4 ) �� -- • -- -----------•----_....__....._ ._.... Installer Address Type of Building Size Lot............................Sq. feet ... Dwelling— No. of Bedrooms------------- -----------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________-___._. No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures -----------------------------------•-------•---- W Design Flow............................................gallons per person per day. Total daily flow.............................................gallons. WSeptic Tank—Liquid capacity_____,-....gallons Length________________ Width---------------- Diameter.--------------- Depth................ 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 ( ) 1.4 Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 ----------------------------------- •.... _-_----- •------------------------------- -.......... _....... _............... •................. •........... _...... _-_-- 0 Description of Soil................................................................................................-------_..----•--------------------------------•---._..._-----------•-- U Nature of Repair$ or Alteration Answer-when hen applicable..__Zn4_1f'-----/.......A_ __w00•••--•Gt/ _�-- �d/�-2 o_F ...---,p x�. f 1 � -:-- �; s e z2:!-- -------- -------- -------- ------- -._._.... ------... ._....---- 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 Complia'c as en is ue by the board of health. Signed - ------- -- ---- -- -----�... .... I..... --------------------------------------- Da...... ..... 1. ./.....��.3.. Application Approved By ------------- --.'f ...-'5�...si��. �. te - ................................................................. ..�.-.gig..-...�.. . . �.... Application Disapproved for the following reasons: ................ ................ ................................................. ..............................:......... ............................................... ............................................ ...... .............................-- -.. . -- . ....................... .. ........................................ p Dace Permit No. ..........1.....��......... 1�...Y�................ Issued .................. . .. -G..' ............ Dare .-...asr.s-scas.rcaw.a.s�•+a--�.�su,r.;vs rr mw ------------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (gErttfi ate of CIImplianre THIS 1 CER IFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( �/) by .-...-------/�7 t-T .._...��9/1 �...........................................- . .......-_... ... _....................................... - .............................................. ..........,�/�' .tXA4;���a,JI�.Q.. ....... � ,...__...h,,a"d, 11�/i9/I/I1�5.... ---- ................................ - .............. has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. .___/.-j--....3.f.... ' dated ..... _.............._ -..__..__..._- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE-----_-7 ..�.j h-..: � ........_........ ........_.............................. Inspector .....t--.- ..................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH q TOWN OF BARNSTABLE No../: C FEE.... ... .. Dispnsa1 rk un #rr#iunrrutit Permission, is hereby granted......s - ---7L. ._-------- --WP_1.�------------------------------•----------------•----------....---...-----............. to Construct ( ) pr Rep it ( an)ndivic al Sewage Dispo1sf System at No..... J�o ------ - _-�•a•-------------.---_.(r treet Q �/ as shown on the application for Disposal Works Construction Permit N .1.3.�3�!1__ Dated........ .. --••------•••-••............ ... ...� -- ----------------•--------- -------•-----_ C Board of Health DATE---------- _ . " — _-----•-------•------------- FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS TOWN'OF BARNSTABL rLOCATION iwom) CtrCt f SEWAGE# 9010 �( j VILLAGE MiS ASSESSOR'S MAP&PARCEL a79--07q INSTALLER'S NAME&PHONE NO..� SEPTIC TANK CAPACITY JCM r' ",,-k' 'n _ LEACHING FACILITY:(type) re- gC. O G l� (size) 0,$ 1(?j(,2, NO.OF BEDROOMS OWNER .: e � PERMIT DATE: COMPLIANCE1DATE::.) " Separation Distance Between the: &4"-A Leach+ Ci i,20 Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility G,0 Wr 8(y,_Feet Private Water Supply Well and Leaching Facility(If any wells exist on 0 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 ( g �fChR�1V M S s( v% T �J H-. �aG TOWN OF BARNSTABLE LOCA.UON / UC 4.100,E SEWAGE # VII,AGES r ASSESSOR'S MAP &LOT !7�—Off ,w4STALLE'S N INSTALLER S NAME&PHONE N0. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS -:--BLtILDER Olt OWNER Rt off° S c l ox PERMITDATE: 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 :r, . 0 i M O I 1 ' V p 9 TOM of 'YAI4ICMI LOT NO. _ADDRESS: 79:�& ikAV0D 9. OWNERS NAME: �GA.)i S 1 SEWAGE PERMIT NO. : NEW: REPAIR:- DATE ISSUED: DATE INSTALLED: -a6- ,? INSTALLERS NAME: A & B CANCO Phone: 775-6264 INSTALLATION OF: i¢vaa (941 ®e*ew 'i`f WATER TABLE : FINAL INSPECTION BY: DRAWING OF INSTALLATION ON REVERSE SIDE: �� � � �_ � � �V �— r �� e �,. � �� _ �, . y �� ��-� Z .•, �, „ � 1�, LEGEND N m ® c •• ; —— gg —— EXISTING CONTOUR < ;,• X 100.98 EXISTING SPOT GRADE m 102 PROPOSED CONTOUR LOCUS —W EXISTING WATER SERVICE a' —G EXISTING GAS SERVICE S o 3 —0.H:W.— OVERHEAD WIRES S1�et 3) TEST PIT r a 0 0 4-A EXISTING SEPTIC•TANK _ P 3540 BENCHMARK o m 1,C Lot 36 (TO REMAIN) , . .TOP OF. TANK, EL.=95.19 wg EXISTING LEACH PITS INV.(OUT)=93.86t Q TO BE PUMPED & FILLED W/( � AND NDN ED Ben chm ark Set e ABANDONED oe1 LOCUS MAP ` TOP CONC./BULKHEAD COR. NOT TO SCALE EL.=96.65 (Assumed datum) 96,58 ( GENERAL NOTES: S 10'O6'30" W fence li (approx.) 94,58� r -95---->r - --�---------- — — — 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL, 111.00' \\ �93 BOARD OF HEALTH AND THE DESIGN ENGINEER. �'�, 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS 95.40 --�F� i OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE I N LOCAL RULES AND REGULATIONS EXCEPT AS REQUESTED BELOW: + 967 ` I 0 -310 CMR 15.405(1)(b): yl�� 1) A 2' variance to the 3' maximum cover requirement, for 5' of ' 0 ��'q)j '; Max. cover. S.A.S. shall be H-20 and vented. I �' � • 96,11 \l9_6�05 BM �''96,58�I ��� 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR I TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE I I I I x '--� 96.65 x' ` I N DESIGN ENGINEER. cn I JQLJ6 x 95,87 iINl deck shed �� 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING' ' 00 I 17 I f 96 FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN u, 19 ,1 z 1 ENGINEER BEFORE CONSTRUCTION CONTINUES. oI O T�-2 /EXISTING I v 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. sl M L J�L J HOUSE(#77) o' M11 1 1 I ICI I (slab) T.O.F.=97,65E ooI } 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF lal I 00 Cri I THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 96,75 ��_�� fence (full cellar) ( o HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. V,gNT I I I IINSP. 96,55 7. WATER SUPPLY PROVIDED BY TOWN WATER .SERVICE. 10,-1F8.5-iPORT I 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. 97.26 x i 96.97 96.66 96.65 9 deck 96.81 x 96,87 &58 GS 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED' AS AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE 4. 96,68 wa — DIRECTED BY THE APPROVING AUTHORITIES. I ' Off. c, 6,77 (LOT 36) 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY 96,83 / o APN(LOT 36) .4 THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING . v t CONSTRUCTION. -. Paved o 10,009 S.F.f - k; 1 1. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS' i OF Mq IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND DrivewayICE �P� SSgC9 REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR. 255(3).• g• i 11 .00' o PETER T. 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE 96,33 N 10' 8'10" E HYD U McENTEE N INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. 96,87 c� CIVIL 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY: AND % P LEr o. 35109 IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. 97,24 PK SET— 96.88 edge 96.25 °f C pavemen 96,66 ��' oFf�fclslE�`�°��� PROPOSED SEPTIC SYSTEM UPGRADE PLAN 97,04 96,07 JAL BUCKWOOD DRIVE � �,(� �� 77 BUCKWOOD CIRCLE, HYANNIS, MA Prepared for: D.A. Brown Inc., P.O. Box 145, Centerville, MA .02632 y OWNER OF RECORD Engineering by: SCALE DRAWN JOB. NO.• HODGDON, STEPHEN F Engineering Works, Inc. 1"=20' P.T.M. 153-10 " PETTIGLIO, JOAN g 9 .42 JUDKINS STREET 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. ' NEWTONVILLE, MA 02460 (508) 477-5313 7/5/10 P.T.M.• 1° Of 2 1 I NOTE: TO PREVENT BREAKOUT, THE PROPOSED (3) 5" DIA.OUTLETS FINISH GRADE SHALL-NOT BE < EL.92.5 15.5" I"' 16--�2% FOR A DISTANCE OF 15' AROUND THE F` '"I PERIMETER OF THE S.A.S. .• SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. CHARCOAL OR 12 INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & WATERTIGHT INSTALL INSPECTION PORT OVER END UNIT CONVENTIONAL VENT 15'S" 6„ `- !. 8„ T.O.F. OUTLET AND SET TO 6" OF FINISH GRADE :COVER SET TO 6" OF GRADE EXISTING F.G. EL.=95.5t F.G. EL: 96.2t F.G. 97.5(MAX.) ff MAINTAIN 2% GRADE (MIN.) OVER S.A.S. H-10 LOADING D-BOX 2" A PLACE INSPECTION COUPLER L = 43' L = 12'(MAX) -• PORT ' ® S=1% (MIN.) ® S=1% (MIN.) INV.=92.78 AT END 4"SCH40 PVC 4"SCH40 PVC TO s" (TOP LOADED) MANIFOLD 101 14" ) s 19" TO VENT EXISTING 48" LIQUID INVERT LEVEL ADD INV.=93.17 PROPOSED INV.=93.00 L GAS BAFFLE (3 ROWS OF 6 UNITS AT 5.0'/UNIT) + 1.2' (1 COUPLER) = 31.2' 17.04 INV.=93.86 D-130� Ir SOIL ABSORPTION SYSTEM (PROFILE) ��STALLED EXISTING SEPTIC TANK 945" ESTABLISH VEGETATIVE COVER 16 ]Mtl37" BACKFILL WITH CLEAN NATIVE OR . PERC SAND TO TOP OF CHAMBERS i 1�% INV. ELEV.=92.78 10.38 DOME END BREAKOUT=TOP INVERT TOP ELEV.=92.53 r' HEIGHT NOTES: POST END 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE BOTTOM ELEV=9120 33.75" . . INVERTS, PRIOR TO 'INSTALLATION. - NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT 2) D-BOX SHALL BE SET LEVEL AND TRUE TO 5' MIN. ABOVE BOTTOM OF 2`83' TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. GRADE ON A MECHANICALLY COMPACTED SIX T.P. EXCAVATION OR G.W. EFFECTIVE WIDTH=8.5' MUST BE STAMPED H-20 INCH CRUSHED STONE BASE, AS SPECIFIED IN gmqm 4640 TRUEMAN BLVD 310 CMR 15.221(2). EXISTING SUITABLE HILLIARD, OHIO 43026 3) INSTALL INLET & OUTLET TEES AS REQUIRED. NO G.W., EL=86.2 = MATERIAL ADVANCED DRAINAGE SYSTEMS,INC.s Arc 36HC SIDE PORT COUPLER 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE SEPTIC SYSTEM PROFILE ROW WITH NOUSE 3 ROWS S EPARATONrc 36HC BETWEENUEACH ROW & NOER PER STONE AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. 63.25" N.T.S. TYPICAL SECTION 16" DESIGN CRITERIA SOIL LOG 34.5" IJ NUMBER OF BEDROOMS: 3 BEDROOMS r DATE: JUNE 1, 2010 (REF#12,957 SOIL TEXTURAL CLASS: CLASS 1 i vi r--17 2' SOIL EVALUATOR: PETER McENTEE (SE 1542) I Q I WITNESS: DAVID STANTON R.S. TOP VIEW DESIGN PERCOLATION RATE: <2 MIN/IN vi i deck 11 HEALTH AGENT -60" DAILY FLOW: 330 G.P.D. N o / ELEV. TP- 1 DEPTH ELEV. TP-2 DEPTH i w I END CAP END CAP ' DESIGN FLOW: 330 G.P.D. i � L �` 96:8 . q 0 96.2 q 0 FRONT VIEW SIDE VIEW HSE. 77 SANDY LOAM SANDY LOAM END CAP GARBAGE GRINDER: NO ' o_ .3 �# �/ REAR TOP VIEW i O 1 10YR 4/2 10YR 4/2 / LEACHING AREA REQUIRED: (330) = 445.9 S.F. � 96 3 6„ ' 95 7 6„ I � B B NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT SIDE VIEW. SANDY LOAM SANDY LOAM TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY .74 L 10YR 5/8 10YR 5/8 DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. EXISTING SEPTIC TANK: 1000 GALLON CAPACITY (-8.5- 17. 94.8 24" 93.7 30" 4640 TRUEMAN BLVD PROPOSED D-BOX:: 1 INLET_ 3 OUTLET (MINIMUM), H-10 RATED deck C 36„ c 909m. HILLIARD, OHIO 43026 Arc 36HC DETAIL PERC ADVANCED DRaNAGE SYSTEMS,INC. - MUST BE STAMPED H-20 USE 3 ROWS OF 6-ADS Arc 36HC UNITS + 1 COUPLER PER C 48" PROPOSED SEPTIC SYSTEM UPGRADE PLAN ROW WITH NO SEPARATION BETWEEN EACH ROW & NO STONE S.A.S.LAYOUT M-C SAND M-c SAND BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.80 SF/LF OF UNIT) 2.5Y 6/4 2.5Y 6/4 77 BUCKWOOD CIRCLE, HYANNIS, MA (Arc 36HC Units) 18 UNITS x 5.0 LF x 4.80 SF/LF = 432.0 SF Prepared for: D.A. Brown Inc., P.O. Box 145, Centerville, MA 02632 Engineering by: SCALE DRAWN JOB. NO. (COUPLERS) 3 COUPLES x 1.2' x 4.80 SF/LF = 17.3 SF 86.8 120" 86.2 120" NTS P.T.M. 153-10 TOTAL AREA = 449.3 SF Engineering Works, Inc. PERC RATE <2 MIN/IN. ("C" HORIZON) 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET N0. NO GROUNDWATER ENCOUNTERED DESIGN FLOW PROVIDED: 0.74(449.3 S.F.) 332.5 G.P.D. (508) 477-5313 7/5/10 P.T.M. 2. Of 2 I