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Home My WebLink About0116 BUCKWOOD DRIVE - Health 116 Buckwood Drive Hyannis P A 272 081 0 _ n a M d i N I HY4N �� o aVe 0,01 L SYa��rs S' o PZA/)A)G 8C W N { c�, a • O � o t P CA 0 `1 O � 1 Commonwealth of Massachusetts aka d8� . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 116 Buckwood Drive Property Address Wildo Monzoya Owner Owner's Name information is c required for every Hyannis Ma 02601 12-22-15 M. page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not Brett Hickey use key.the return Name of Inspector B&B Excavation IC=V Company Name 14 Teaberry Lane Company Address Sandwich Ma. 02644 City/Town State Zip Code (508)477-0653 S113747 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 12-22-15 Inspector's Wature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer;if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. D �S t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Pe of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 116 Buckwood Drive Property Address Wildo Monzoya Owner Owner's Name information is required for every Hyannis Ma 02601 12-22-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 1 , Commonwealth of Massachusetts - Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 116 Buckwood Drive Property Address Wildo Monzoya Owner Owner's Name information is required for every Hyannis Ma 02601 12-22-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: El Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 f Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 116 Buckwood Drive Property Address Wildo Monzoya Owner Owner's Name information is required for every Hyannis Ma 02601 12-22-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system.has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes 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 ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 116 Buckwood Drive Property Address Wildo Monzoya Owner Owner's Name information is required for every Hyannis Ma 02601 12-22-15 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. . For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 116 Buckwood Drive Property Address Wildo Monzoya Owner Owner's Name information is required for every Hyannis Ma 02601 12-22-15 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? El ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (if they were not available note as N/A) ❑ ® Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 346 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts w . Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 116 Buckwood Drive Property Address Wildo Monzoya Owner Owner's Name information is required for every Hyannis Ma 02601 12-22-15 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 years usage d see below Detail: 2014- 78,540gallons 2015-65,076gallons Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M y 116 Buckwood Drive Property Address Wildo Monzoya Owner Owner's Name information is required for every Hyannis Ma 02601 12-22-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts _ . Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 116 Buckwood Drive Property Address Wildo Monzoya Owner Owner's Name information is required for every Hyannis Ma 02601 12-22-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components,date installed (if known)and source of information: 2010 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 2' Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): At time of inspection building sewer appeared to be in good working order with no sign of leakage. Septic Tank(locate on site plan): 1' Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallon 611 Sludge depth: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts - Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 116 Buckwood Drive Property Address Wildo Monzoya Owner Owner's Name information is required for every Hyannis Ma 02601 12-22-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 30" Y Scum thickness 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.): At time of inspection septic tank appeared to be in working order, tees present with no sign of back- up.Liquid level equal with outlet invert. Tank is in need of pumping at this time and should be pumped every 2 years for maintenance. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts 4 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 116 Buckwood Drive Property Address Wildo Monzoya Owner Owner's Name information is required for every Hyannis Ma 02601 12-22-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 116 Buckwood Drive Property Address Wildo Monzoya Owner Owner's Name information is required for every Hyannis Ma 02601 12-22-15 page. City(rown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 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.): At time of inspection d-box appears to be in working order but with some of carryover present. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 116 Buckwood Drive Property Address Wildo Monzoya Owner Owner's Name information is required for every Hyannis Ma 02601 12-22-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: (2) rows of 6 arc36 infiltrators ❑ 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.): At time of inspection leaching appears to be in working order with no sign of hydraulic failure. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 116 Buckwood Drive Property Address Wildo Monzoya Owner Owner's Name information is required for every Hyannis Ma 02601 12-22-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 116 Buckwood Drive Property Address Wildo Monzoya Owner Owner's Name information is required for every Hyannis Ma 02601 12-22-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately �Wo,(- O O 3 Ai - is' Zor t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 116 Buckwood Drive Property Address Wildo Monzoya Owner Owner's Name information is required for every Hyannis Ma 02601 12-22-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: No Gw 128" feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 4-27-10 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Plan on file at BOH. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1M , 116 Buckwood Drive Property Address Wildo Monzoya Owner Owner's Name information is required for every Hyannis Ma 02601 12-22-15 page. CityTTown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Town of Barnstable P# 2 r? Department of Regulatory Services . 11AMU„BM : Public Health Division Date 03 200 Main Street,Hyannis MA 02601 Date Scheduled �° ° Time Fee Pd. /Uu Soil Suitability Assessment for Sewage isposal Performed By:__HiC�e1 `iiMP-A T f G5 Witnessed By: ' 1\ J LOCATION& GENERAL INFORMATION Location Address t I b Owner's Name� �Nck. � �t VI Address ( [to vv j L CiU Q,o Assessor's Map/Parcel: 2 /(j / Engineer's Name sc &q5V1Qeff()5 5l?ti l73 b 3�7 NEW CONSTRUC 1ON `REPAIR ✓ Telephone# L1 t� `l o Z Land Use Sftt�Q \UtlY1c�Y dt �tYt� Slopes(%) I"Z Surface Stones Distances from: Open Water Body ft Possible Wet Area _ ft Drinking Water Well - ft Drainage Way ft Property Line 710 R Other - ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) See..a A��eel Pia i LlCtcial au{wzs1� "7128`�b-5 Parent material(geologic) Depth to Bedrock Depth to Groundwater. Standing Water in Hole: '7 12b"b55 Weeping from Pit Face 7(2$ bg Estimated Seasonal High Groundwater 12 b4�-S5 DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: VTCe 6bQWdcHdVl Depth Observed standing in obs.hole: 'i2 8 - — __in. Depth to soil mottles: 7128 in. Depth to weeping from side of obs.hole: 712_ in. Groundwater Adjustment ft. Index Well# - Reading Date: Index Well level Adl.factor Adj.flroundwater level,n a PERCOLATION TEST Dgte 'V-2010 Time /v Arfrf Observation Hole# Time at 9" a Depth of Perc 3� y Time at 6" Start Pre-soak Time @ 9 56 R - Time(911•6") End Pre-soak l 0;0 9 A 1-2— Rate MinJlnch Site Suitability Assessment: Site Passed yes Site Failed: Additional Testing Needed(Y/N) ti 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# 1 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency.%Gravel) Fill L�^Ib A LS 10 3/i %OYr5�6 ^ - $yo%gavel DEEP OBSERVATION HOLE LOG Hole# 2- Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.% b -(o L-/0 A LS loft 3/l — 16.3(o i 0 Yt V4 - 36-128 C- rS Z. Y`% DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consi ten 01) Flood Insurance Rate Man: Above 500 year flood boundary No_ Yes _ Within 500 year boundary No`� Yes,:�„r 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? _ Yes _ If not,what is the depth of naturally occurring pervious material?____...._..� Certification I certify that on 1b F (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,ex erti and ex ence described in 310 CMR 15.017. Signature Date Q:\.SEPTICIPERCFORM.DOC Town of Barnstable Regulatory Services 4 Thunins F. Geller, Director sAitivirAme. • Public Health Division MA88. t°�0 n`°� '1'tiornas McKean,Director 200 Main Street, HyHnnis,MA 02601 Ofticc: 508-W-4644 Fax: �l! .J;r .!.;;!:► Date: 13kLOtb Sewage Permit# OO10—1Zly Assessor's Map/Parcel 1 72/6I Installer & Desianer Certification Form DcsiKncr: 'J �. ��1� (1 d'L'.'(f��+-j f1 C - ItlStaller: CG1 wti de L`-r��t r�c I:S c_.:.t �.C- Addres+: ,'s _C.canes c __l-ki��Wr-_ Address: Ensi wnte nwt H c2;3 On 5-5 - 201'a �',� rl�rs was issued a permit to install a (date) intitafcr �— septic .systern at (I)U.- LUC''j6 Oovu ... based on a design drawn by (address) _ �L G`d� t4)e�<ovr �v,G dNted A ctl a7 z010 / (designer) _`✓-_ I certify that the septic systerin 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 %%crc found satisfactory. I certify that the septic system rei'm med above was installed with major changes (i.e. grouter than 10' lateral relocation of the SAS or any vertical relocation of any coinponew of the septic system) but in accol-danco with State & Local Regulations. Plan revision ol. certified as-built by designer to follow. Stripout (ifreq ' ' nspected and the sails %vCre found satisfcctory. %-A OF1W (In. :: er . .'ign' ur No •b58J7 kAL ' esigner's Signtatur° (Affix esi e s mp 1-.11ere) l?LEASE RETURN '[O BARNSTABLE PUBLIC HEALTI3, HVISION. CFR'rIFIg:ATE OF C Mt'IfIANCE WILL NUT BE 1 '5U NTMOTH THIS lit)1�jV>s, AND ,�S- BUILT CARD ARE RECEIVED IVED BY THE BARNSTABLE PUBLIC: I•iEALT.H DIVISION, •CHANi< YOrI_ y uiLU'!Gill'\'t1Gli�il�(gy.`Iil'I'Jllall i'. 111 IU, TM •A j 99A 9J 7 RPIQ nNrNAANiONBOr Wd 6V: TO OTOZ-21-AOW e ,per. �\ COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENERGY & ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON, MA 02108 617-292-5500 DEVAL L.PATRICK IAN A.BOWLES Governor Secretary TIMOTHY P.MURRAY LAURIE BURT Lieutenant Governor Commissioner MODIFIED APPROVAL FOR GENERAL USE Pursuant to Title 5, 310 CMR 1.5.000 Name and Address of Applicant: Advanced Drainage Systems, Inc, 4640 Trueman Boulevard Hilliard, OH 43026 Trade name of technology and model: BioDiffuser; 14 inch and 16 inch High Capacity, 11 inch Standard and Bio 2 and Bio 3 BioDiffusers, ARC 36, ARC 36HC, and ARC 50 (hereinafter the "System"). Schematic drawings of each model are attached. Transmittal Number: W000052 Date of Issuance: October 3, 2003, Revised December 17, 2003, Revised June 14, 2006 Revised July 19, 2007, Modified February 14, 2008, Modified July 23, 2008, Modified June 30, 2009, Modified February 18, 2010 Authority for Issuance Pursuant to Title 5 of the State Environmental Code, 310 CMR 15.000, the Department of Environmental Protection hereby issues this Certification to: Advanced Drainage Systems, Inc., 4640 Trueman Boulevard, Hilliard, OH 43026 (hereinafter "the Company"), for General Use of the System described herein. Sale and use of the System are conditioned on and subject to compliance by the Company and the System owner with the terms and conditions set forth below. Any noncompliance with the terms or conditions of this Certification constitutes a violation of 310 CMR 15.000. February 18, 2010 Glenn Haas, Acting Assistant Commissioner Date Department of Environmental Protection This information is available in alternate format.Call Donald M.Gomes ADA Coordinator at 617-556-1057.TDD#1-866-539-7622 or 1-617-574-6868. MassDEP on the World Wide Web: http://www.mass.gov/dep ��a Printed on Recycled Paper BioDiffuser-Advanced Drainage Systems Modified Approval for General Use Page 2 of 7 I. Purpose 1. The purpose of this Certification is to allow use of the System in Massachusetts, on a General Use basis. 2. With the necessary permits and approvals required by 310 CMR 15.000, this Certification authorizes the use of the System in Massachusetts. 3. The System may be installed on all facilities where a system in compliance with 310 CMR 15.000 exists on site or could be built and for which a site evaluation in compliance with 310 CMR 15.000 has been approved by the local approving authority, or by DEP if DEP approval is required by 310 CMR 15.000. 11. Design Standards 1. The models listed in Table 1 are covered under this Certification. Table 1. Chamber Dimensions Dimensions Invert Model W x L x H Height Inches Inches I I" Standard BioDiffuser 34 x 76 x 11 6.5 ARC36 34.5x60x13 7.13 14"High Capacity BioDiffuser 34 x 76 x 14 9 16"High Capacity BioDiffuser 34 x 75 x 16 11.3 ARC 36HC 34.5 x 60 x 16 10.75 ARC 50 51.5 x 42.75 x 30 22.25 Bio 2 BioDiffuser 15 x 87 x 12 6.87 Bio 3 BioDiffuser 22 x 87 x 12 6.87 1. Only Systems installed with this invert height shall be allowed to use the effective Leaching area associated with this model Table 2 2. The System is an open-bottom leaching unit molded from high density, high molecular weight polyethylene (HDPE) Type III, Class A or B, Category 1 or 3-or Polypropylene Group 03, Class 3, Grade 0. It can be installed without aggregate or distribution pipe as an absorption trench in accordance with the requirements in 310 CMR 15.251 or as a bed or field in accordance with the requirements in 310 CMR 15.252. 3. The use of aggregate as specified in 310 CMR 15.247 is not necessary with the System when installed as a trench, bed or field. When designed with aggregate in accordance with 310 CMR 15.253, the System shall be designed in accordance with Section II item 10. BioDiffuser-Advanced Drainage Systems Modified Approval for General Use Page 3 of 7 4. The minimum separation between any two trenches shall be as specified in 310 CMR 15.251. 5. The requirement that the Chamber installed in trench configuration as specified in 310 CMR 15.253(6) be provided with inlets at intervals not to exceed 20 feet is not applicable to the System. In accordance with 310 CMR 15.240 (13) a minimum of one inspection inlet shall be installed per system. The inlet shall be capped with a screw type cap and accessible to within three inches of finish grade.. 6. The total effective leaching area for any Chamber Model shall be calculated by multiplying the Effective Leaching Area per square foot of chamber times the total length of chamber from Side Port Coupler to Side Port Coupler including Side Port Coupler. 7. For new construction, the applicant can size the System in a trench configuration without aggregate, using the effective leaching areas presented in Table 2. No System shall be designed and constructed with a soil absorption system area of less than 400 square feet of effective area. Table 2. Effective Leaching Area for New Construction And Remedial Sites Effective Effective Model Leaching2 Leaching Area Area SF/LF SF/LF 11" Standard BioDiffuser 6.5 NA ARC 36 6.8 NA 14"High Capacity BioDiffuser 7.2 NA 16"High Capacity BioDiffuser 7.9 NA ARC 36HC - 7.8 NA ARC 50 NA 6.71 Bio 2 BioDiffuser 4.0 NA Bio 3 BioDiffuser 5.0 NA 2. Effective leaching area is equal to 1.67 (bottom width+(2x invert height)) 3. Effective leaching area is equal to 1.0 (bottom width+(2x invert height)) 4. The maximum trench width allowed for calculation of effective leaching area is 3 feet. 8. Systems installed on remedial sites shall be allowed to utilize the effective leaching areas presented in Table 2. above or additional reductions in soil absorption leaching area approved by the approving authority in accordance with 310 CMR 15.284. In no instance shall the reduction in the soil absorption system required in 310 CMR 15.242 f BioDiffuser-Advanced Drainage Systems Modified Approval for General Use Page 4 of 7 exceed the maximum reduction allowed for alternative systems approved in accordance with 310 CMR 15.284. 9. In accordance with 310 CMR 15.240 (6) absorption trenches should be used whenever possible. When the System is installed for new construction without aggregate in a bed or field configuration, as defined in 310 CMR 15.252, the System shall be designed using the effective leaching area for the bottom width presented in Table 3. No system shall be designed and constructed with a leaching area of less than 400 square feet of effective area. i Table 3 Effective Leaching Area for Bed or Field Configuration Effective Model Leaching Area SF/LF 11" Standard Biodiffuser 4.7 ARC 36 4.8 14"High Capacity BioDiffuser 4.7 16"High Capacity BioDiffuser 4.7 ARC 36HC 4.8 ARC 50 7.2 Bio 2 BioDiffuser 2.1 Bio 3 BioDiffuser 3.1 5. Effective Leaching area is equal to 1.67 times bottom width only. 10. The System, when installed in a bed or field configuration without aggregate on remedial sites, shall utilize the effective leaching areas presented in Table 3 above or additional reductions in soil absorption system area approved by the approving authority in accordance with 310 CMR 15.284. In no instance shall the reduction in the soil absorption system area required in 310 CMR 15.242 exceed the maximum reduction allowed for alternative systems approved in accordance with 310 CMR 15.284. 11. The System, when installed as specified in 310 CMR 15.253: Pits, Galleries, or Chambers, shall have an aggregate base and/or be surrounded by aggregate and shall be sized as specified in 310 CMR 15.253 (1) (a) and (b), effective leaching area is equal to 1.0 times a conventional aggregate system. Effective depth can be increased to two feet with the corresponding addition of up to 17.5 inches of base aggregate for the 11 inch Standard BioDiffuser to up to 12.7 inches for the 16 inch High Capacity BioDiffuser. Bottom width can be increased by two to eight SF/LF with the corresponding addition of one to four feet of aggregate per side. BioDiffuser-Advanced Drainage Systems Modified Approval for General Use Page 5 of 7 12. When the System is installed as specified in 310 CMR 15.255: Construction in Fill, the finished 15 foot horizontal separation distance, item (2), shall be measured from the from the top of the chamber. III. General Conditions 1. The provisions of 310 CMR 15.000 are applicable to the use of the System, except those that specifically have been varied by the terms of this Certification. 2. The facility served by the System, and the System itself, shall be open to inspection and sampling by the Department and the local approving authority at all reasonable times. 3. In accordance with applicable law, the Department and the local approving authority may require the System owner to cease use of the System and/or to take any other action as it deems necessary to protect public health, safety, welfare or the environment. 4. The Department has not determined that the performance of the System will provide a level of protection to the environment that is at least equivalent to that of a sewer. Accordingly, no new System shall be constructed, and no System shall be upgraded or expanded, if it is feasible to connect the facility to a sanitary sewer, unless allowed pursuant to 310 CMR 15.004. 5. Design, installation and use of the System shall be in strict conformance with the Company's DEP approved plans and specifications and 310 CMR 15.000, subject to this Certification. IV. ndi i n Co t o s Applicable to the.System Owner 1. The System is approved for the treatment and disposal of sanitary sewage only. Any wastes that are non-sanitary sewage generated or used at the facility served by the System shall not be introduced into the on-site sewage disposal system and shall be lawfully disposed of. 2. For new construction, the owner initially shall size a soil absorption system in accordance with 310 CMR 15.242 to demonstrate that a conventional Title 5 soil adsorption system using aggregate, including a reserve area, can be installed on the site. The owner may than size the soil absorption system for the System. The total area required for the aggregate system, which may include the area designated for the System, and a reserve area shall be preserved and the owner shall ensure that no permanent structures or other structures are constructed on that area and that the area'is not disturbed in any manner that will render it unusable for future installation of a conventional Title 5 soil absorption system. 3. The System owner shall at all times properly operate ,and maintain the on-site sewage disposal system. BioDiffuser-Advanced Drainage Systems Modified Approval for General Use Page 6 of 7 4. The System owner shall furnish the Department any information that the Department requests regarding the operation and performance of the System, within 21 days of the date of receipt of that request. 5. No System owner shall authorize or allow the installation of the System other than by a person trained by the Company to install the System. V. Conditions Applicable to the Company 1. By January 31 st of each year, the Company shall submit to the Department a report, signed by a corporate officer, general partner, or Company owner that contains information on the System for the previous calendar year. The report shall state known failures, malfunctions, and corrective actions taken for the System as well as the date and address of each event. 2. The Company shall notify the Department's Director of Watershed Permitting at least 30 days in advance of any proposed transfer of ownership of the technology for which this Certification is issued. Said notification shall include the name and address of the proposed new owner and a written agreement between the existing and proposed new owner containing a specific date for transfer of ownership, responsibility, coverage and liability between them. All provisions of this Certification applicable to the Company shall be applicable to successors and assigns of the Company, unless the Department determines otherwise. 3. The Company shall furnish the Department any information that the Department requests regarding the System, within 21 days of the date of receipt of that request. 4. Prior to any sale of the System, the Company shall provide the purchaser with a copy of this Certification. In any contract for distribution or sale of the System, the Company shall require the distributor or seller to provide the purchaser of the System, prior to any sale of the System, with a copy of this Certification. 5. The Company shall prepare and provide the Department an installation manual specifically detailing procedures for installation of its System. The Company shall institute and maintain a training program in the proper installation of its System in accordance with the manual and provide a training course at least annually for prospective installers. The Company shall certify that installers have passed the Company's training qualifications, maintain a list of certified installers, submit a copy`to the Department, and update the list annually. Updated lists shall be forwarded to the Department. 6. The Company shall not sell the System to installers unless they are trained to install these Systems by the Company. VI. Conditions Applicable to Installers of the System BioDiffuser-Advanced Drainage Systems Modified Approval for General Use Page 7 of 7 1. Each Installer shall install the System in accordance with Company training on the installation of the System and the conditions of this Certification. 2. No Installer shall install the System unless the Installer has been trained by the Company on installation of the System. VII. Reporting 1. All submittals of notices and documents to the Department required by this Certification shall be submitted to: Director Wastewater Management Program Department of Environmental Protection One Winter Street - 5th floor Boston, Massachusetts 02108 VIII. Rights of the Department 1. The Department may suspend, modify or revoke this Certification for cause, including, but not limited to, non-compliance with the terms of this Certification, non-payment of an annual compliance assurance fee, for obtaining the Certification by misrepresentation or failure to disclose fully all relevant facts or any change in or discovery of conditions that would constitute grounds for discontinuance of the Certification, or as necessary for the protection of public health, safety, welfare or the environment, and as authorized by applicable law. The Department reserves its rights to take any enforcement action authorized by law with respect to this Certification, the System, the owner, or operator of the System and the Company. ' TOWN OF BARNSTABLE LOCATION 1( Booe-Lo ab Dp, SEWAGE# VILLAGE 14y,4muf- ASSESSOR'S MAPP&PARCEL p r J � INSTALLER'S NAME&PHONE NO. (fAR�W'6 E��KcZ LLB SEPTIC TANK CAPACITY t,®O'er C'A.e.. a2.'TRBsx.Ff$ LEACHING FACILITY:(type) a) ARC. 3, Me- (size) 301 x 11,5d NO.OF BEDROOMS � hc[n� 3 p&-A -rare A � OWNER 1�t 642r-OVA _ PERMIT DATE: : y3' COMPLIANCE DATE: e 17—I D Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility A Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) N A Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) NIAFeet FURNISHED BY VI C o .� CARP®RT (�a y 0E . o� c C� Jf q )9 ii )9 Z e ov �p ' ' W N .'- ii y ri OQ -j � w 00 Er I TOWN OF BARNSTABLE .LOCATION A16 i uC.oulwd PIZ SEWAGE# VILLAGE .ASSESSOR'S MAP&PARCEL a,�+�) INSTALLER'S NAME&PHONE NO. �a e ce- [ems �� Ie f �?-k Cie)ZF SEPTIC TANK CAPACITY 000 -t 15�ry LEACHING FACILITY:(type) I Z h.-r-c. 3 41` (size) 60 3 x NO.OF BEDROOMS 3 OWNER' tits: lkl I e. �yl PERMIT DATE: ��S Z0 1a COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility A1040,11 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) 11 Feet FURNISHEDBY L.lappv�;(Qy Gh1�P�r�ef L-L%. ®C-1 C. O UJ i. TOWN OF BARNSTABLE LOCATION tI! to ��IG Lv�/6� �f'"• SEWAGE # 'VILLAGE, , , iAIIAI ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 40 LEACHING FACILITY:r(type) i Gx 6' (size) l NO.OF BEDROOMS dinn f BUILDER OR OWNER Y�� f 4WMArl PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted.Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching acility) 1 Feet a Furnished by n �0/c O l`V � � n Q00 i No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes rication for to oar�� *pgtem Congtructton Permit Application for a Permit to Construct( ) Repair V.� Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. 114, a Ke�`tltt0 r"�"\ Owner's Name,Address,and Tel.No. Assessor's Map/Parcel ?_7a --S I �� (�✓.tlLcvuOc� AYv� ',L \A1Q„r\ j Sad yZ�4fvz� !OrrA�1 03?� Installer's Name,Addre and Tel'N0. DesFigner's Name,Addresstand Tel.No. ..�C �r1 J t h�✓� 02-511 Type of Building: Dwelling No.of Bedrooms 3 Lot Size //, J ( to sq. ft. Garbage Grinder ( ) Other Type of Building V-� S No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 0 gpd Design flow provided 3 q 10, : gpd Plan Date y Z9 ty Number of sheets Revision Date Title Size of Septic Tank A000 V',czs Type of S.A.S. \ >` Ph-d`C Le 3.u ),Crse ir, Description of Soil 5'c-"— Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Sign 12p ate S 2-0 l v Application Approved by to Application Disapproved by: Date for the following reasons Permit No. Date Issued No.. R Fee THE COMMONWEALTH OF MASSACHUSETTS Entered is oompateI Yes . , tzPPUBLIC HEALTH DIVISION '- TOWN OF BARNSTABLE, MASSACHUSETTS` ,plication for Migpogal *pgtem Con5tructf ou j3ermit Application for a Permit to Construct( )` Repair ) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. 114, —&, `k jc;,j v -T)v``^1 Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Z 7a —St , gq-Z �'c/UZ81 s0�a73 - 03�7 Installer's Name,Addre and Tel.No. Designer's Name,Address.and Tel.No. 2 Type of Building: Dwelling No.of Bedrooms 3 Lot Size 0 t U sq. ft. Garbage Grinder ( ) Other Type of Building q-f S No.of Persons Showers( ) Cafeteria( ) �- Oth r,Fixtures ' Design Flow(min.required) 33 0 gpd Design flow provided to, 3 gpd Plan Date y L 9` Number of sheets Revision Date ° i —.,, Title Size of Septic Tank /U00, I?,/I ,. Type of S.A.S. J`C �� ► to ��,C�..sp r Description of Soil 5'crL �G Nature of Repairs or Alterations(Answer when applicable) , Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Sign Date 5 — f (v Application Approved by to Application Disapproved by: Date for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERT Y,that the On-site Sewage Disposal System Constructed ( ) Repaired ( yf. ) Upgraded ( ) Abandoned( )by cl2 un CL Pti�0. 0-P, f--2 at M.0 -\?ti.c(c "ivv0) '-�)Y-w I-1'1 '3,7 has e cola tru e in ccordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer C!2-�plu\OL Zv.�t,n�l� SR j Designer 3C. #bedrooms 3 Approved des • �flo 0 gpd The issuance of this it sh 1 not be construed as a guarantee that the system wi I functi as design,d. lid d Inspector K• RS 1 No. 2�0 Ll � Fee � `�- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS ligogal *papm Congtruction Vermit Permission is hereby granted to Construct ( ) Repair ( )(-) Upgrade ( ) Abandon ( ) System located at \\�, v.c w n��r) t wl ;2 h-w•.f► and as described in the above Application for Disposal System Construction Permit.The-a licant recognizes his/her duty -- pp • P Y PP g Y to comply with Title S and the following local provisions or special conditions. Provided: Construction m 9t be cdmpleted within three years of the date of thise Date , Approved by r , 4 COMMONWEALTH OF MASSACHUSETTS U9 EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION RE7EE SE TOWN OF BARNSTABLE TITLE 5 HEALTH DEPT. OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A <;4- CERTIFICATION Property Address: 116 Buckwood Drive Hyannis, MA 02601 Owner's Name: Bob Lowman Owner's Address: P.O. Box 703 Forestdale, MA 02644 Date of Inspection: September 3, 2002 Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford Mailing Address: P.O. Box 49 Map:272 Osterville,MA 02655-0049 Parcel: 081 Telephone Number: (508) 862-9400 Lot:44-46 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). The system: ✓ Passes Conditionally Passes Need urther Evaluation by the Local Approving Authority Fails Inspector's c or's Signature: Date: Se tember 8 2002 g p The system inspector shall subm 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 ****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 I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 116 Buckwood Drive Hyannis, MA Owner: Bob Lowman Date of Inspection: September 3, 2002 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. 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: 2 Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 116 Buckwood Drive Hyannis, MA Owner: Bob Lowman Date of Inspection: September 3. 2002 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ 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: I 3 Page 4 of 11 OFFICIAL INSPECTION FORM -,NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 116 Buckwood Drive Hyannis, AM Owner: Bob Lowman Date of Inspection: September 3, 2002 D. System Failure Criteria applicable to all systems:. You must indicate either"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 ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2 day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone I of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for 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.] No (Yes/No)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 System: 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 the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply _ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well If you have answered`yes"to any question in Section E the system is considered a significant threat,or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 116 Buckwood Drive Hyannis, MA Owner: Bob Lowman Date of Inspection: September 3, 2002 Check if the following have been done: You must indicate or"no"as to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection ? n/a Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ Was the site inspected for signs of break out? ✓ _ Were all system components,excluding the SAS, located on site? ✓ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum ? ✓ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: 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)]. 5 Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 116 Buckwood Drive Hyannis, MA Owner: Bob Lowman Date of Inspection: September 3, 2002 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: 0 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): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Unknown C OMMERCIALA NDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): pd 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: Pumped approximately 1 %2 years ago-per owner 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,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: Unknown Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 116 Buckwood Drive Hyannis, MA Owner: Bob Lowman Date of Inspection: September 3, 2002 BUILDING SEWER(locate on site plan) Depth below grade: Approx. 24" Materials of construction: _cast iron 40 PVC ✓ other(explain): Orangeburg 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: Approx. 10" 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 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 0" Distance from top of scum to top of outlet tee or baffle: 10" Distance from bottom of scum to bottom of outlet tee or baffle: 12" How were dimensions determined: Measurint,stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): Tees were present. The liquid level was even with the outlet invert. There were no signs of leakage. GREASE TRAP: None (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.): 7 Page 8 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 116 Buckwood Drive Hyannis, AM Owner: Bob Lowman Date of Inspection: September 3, 2002 TIGHT or HOLDING TANK: None (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: None (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.): l PUMP CHAMBER: None (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.): 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: 116 Buckwood Drive Hyannis, AM Owner: Bob Lowman Date of Inspection: September 3, 2002 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 6'x 6'-1000 gal. 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.): The pit has approximately T of water on the bottom. The scum line was approximately 4'up from the bottom. There were no signs of failure. The bottom to grade was approximately 86". The cover was approximately 20"below grade. CESSPOOLS: None (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: None (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.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 116 Buckwood Drive Hyannis, W Owner: Bob Lowman Date of Inspection: September 3, 2002 Map:272 Parcel: 081 SKETCH OF SEWAGE DISPOSAL SYSTEM Lot:44-46 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. as- 9,3 3 A3� a3 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: 116 Buckwood Drive Hyannis, MA Owner: Bob Lowman Date of Inspection: September 3, 2002 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 30' +1- 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: topographic and water contours maps Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: The bottom of the leach pit to grade was approximately 86". Using the Barnstable topographic map and the Cape Cod Commission water contours map the maps were showing approximately 30'+/-to ground water at this site. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees,either expressed, written or implied, relating to the system, the inspection and/or this report. 11 T.O.F. EL.= 62.5'± WISH GRADE OVER D-BOX= 61.5'± GENERAL NOTES 4" RADE OVER BIODIFFUSERS=SCHEDULE 4C PVC FINISHED G PROVIDE EXTENSION RISER ° 61 .2' - 61.5' WITH COVER OVER INLET& REMOVABLE WATER-TIGHT COVER OVER @ MIN. SLOPE 1% SLOPE @ 2/o MIN. 1. UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION OUTLET TO WITHIN 6"OF F.G. RISER TO WITHIN 6"OF FINISHED GRADE INSPECTION PORT WITH ACCESS METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL FINISH GRADE BOX TO WITHIN 3"OF F.G. @ FND. EL.= 61 .5 ± F.G. OVER TANK EL. = 61 .4 ± 5"DIA. OUTLET(S) CODE AND ANY APPLICABLE LOCAL RULES. _ NE PER TRENCH _ O - 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE DESIGN W ENGEER. EXISTING 4" PROPOSED 4" 9�MIN. 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL SEWER PIPE PVC SEWER PIPE 36 MAX. 9"MIN. 36"MAX. TOP OF SAS/B.O. _ 58.50' SYSTEM UNLESS OTHERWISE NOTED. 6" 3" 3"DROP MAX 3" 9" L = 40'± PROVIDE WATERTIGHT 4. TO PREVENT BREAKOUT,THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN 2 DROP MIN MIN.SLOPE @ 196 JOINTS (TYP.) ELEVATION =58.50' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A 10" L� 4" PVC IN FROML CLEAN SAND 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF 14" *rj9,2'-i SEPTIC TANK O 4" PVC OUT TO 1.33' t 16"TYP THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. LEACHING FACILITY (TYP.) t 0.90' [EKH 10.75"TYP 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. CONTRACTOR CONTRACTOR SHALL \ 7 12" 6" W14 + 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. " VERIFY CONDITION OF OUTLET TEE 58.50 MIN. 5$•33 , , " ( , SHALL VERIFY SIZE 48 5$.07 57.17 (LAID FLAT) 2.875 (34.5 )--I� 5.75� 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK AND CONDITION OF EXISTING TEES GAS BAFFLE 6"CRUSHED STONE 5 0' (TYP.) FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS EXISTING SEPTIC AND REPLACE AS OVER MECHANICALLY (TYP.) NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH TANK NECESSARY COMPACTED BASE 5'MIN. 1 •5 � AND DESIGN ENGINEER. 5 OUTLET DISTRIBUTION BOX 30.0'(TYP FOR BOTH TRENCHES) 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM OF 63.00' ESTABLISHED - - TO BE INSTALLED ON A LEVEL STABLE ON A NAIL SET IN A TREE AS SHOWN ON PLAN. BASE. FIRST TWO FEET OF OUTLET GROUND WATER ELEV.= < 50.73' 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION EXISTING 1,000 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT CROSS SECTION VIEW BIODIFFUSER (PROFILE) BIODIFFUSER (END VIEW) 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES TO THE DESIGN ENGINEER. SEPTIC TANK PROFILE 12 - ARC 36HC 3616 B D BIODIFFUSERS CONTRACTOR TO VERIFY EXISTING ELEVATION PRIOR DISTRIBUTION B UTI O N BOX DETAIL TO ^ "JORK& NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE NOT TO SCALE NOT TO SCALE 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT. -�-- - --- - �- - _ -- -- 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING SWING-TIES ' TEST PIT DATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM CP BH • • j j PERC NO. 12899 APPROPRIATE AUTHORITY. DESCRIPTION INSPECTOR: David W. Stanton, R.S. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS BIODIFFUSER CORNER(1) 34.3' 37.6' • OCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE �• * • a ',/r EVALUATOR: Michael Pimentel, E.I.T.ET THEY SHALL WITHSTAND H-20 LOADING. BIODIFFUSER CORNER(2) 45.0' 48.9' �" C.S.E.APPROVAL DATE: Oct. 1999 • 0 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT DUST AND FINES. BIODIFFUSER CORNER(3) 45.8' 61.2' • a ' ; • DATE: April 20, 2010 ' \ f • • ' TEST PIT#- 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE I \ BIODIFFUSER CORNER(4) 35.3' 52.6' • » • • . MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. ELEV TOP= 61.40' REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, • . o �r ELEV WATER= <50.73' FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). m \ • _ 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN PERC RATE <2 min./inch \ xX X X FENCELINE - SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. ZONE 2 " S89036'02"E X X-X-X-X-X- - - MAP 272 DEPTH OF PERC- 36 - 16. PROPOSED PROJECT IS LOCATED WITHIN: o • g75.00 \ \ LOT 82 I • • : I TEXTURAL CLASS: 1 ASSESSOR'S MAP 272 PARCEL 81 \ , • : • - - ___ - OWNER OF RECORD: WILDO S. MONTOYA o LOCUS J /y��✓ `� ` • • 0" 61.40' ADDRESS: 116 BUCKWOOD DRIVE \ \ 1 ; • , " Fill HYANNIS, MA 02601 O� \ • A Loamy Sand 28 I •\ y/� \ . • . • 10" 10Yr 3/1 60.57' FEMA FLOOD ZONE C EXISTING 1,000 GALLON SEPTIC . ♦ COMMUNITY PANEL# 250001 0005 C TANK TO BE UTILIZED AS PART • # B Loamy Sand W -u.w...__ _� OF THIS DESIGN _ _W � .� *• • „ . 10Yr 5/6 17- DEED REFERENCE: L.C.C. 169206 W-- \ �w+ • ` s 36" 58.40' \ r Perc 18. PLAN REFERENCE: L.C. PLAN No. 35404-B \ EXISTING LEACHING PIT TO BE 54' 56.90' 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. / \ PUMPED AND FILLED WITH CLEAN, COARSE SAND &ABANDONED • • '� 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY � Medium Sand kr° • , +. FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. ( #1 1 6 / �o 'z� ; � . . C 2.5Y 6/6 LLjI / EXISTING � �` 0 (5-10%gravel) LOT M 8P 72 2-BEDROOM a O LP ir I DWELLING Q O� I 11,016S.F.± TOF = 62.5' ± LOCUS PLAN O Q I It C SCALE: 1"= 1000' 128" 50.73' s I AS H No Mottling, Standing or Weeping Observed C) Gq 61 x7 S PATIO PROP. "D-BOX" � GAS B.H. DESIGN DATA TEST PIT DATA LEGEND coS Benchmark PERC NO. 12899 GAS Nail Set in Tree INSPECTOR: David W. Stanton, R.S. 50xO EXISTING SPOT GRADE GAS x5 Elev. =63.00' NUMBER OF BEDROOMS (DESIGN) 3 (MIN. PER TITLE 5) EVALUATOR: Michael Pimentel, E.I.T. - - - 50 - - - EXISTING CONTOUR f 360� Approx. M.S.L. DESIGN FLOW 110 GAUDAY/BEDROOM 50 PROPOSED CONTOUR 61 x5 C.S.E.APPROVAL DATE: Oct. 1999 CAR PORT (1 TOTAL DESIGN FLOW 330 GAUDAY DATE: April 20, 2010 -� MAP 272 DESIGN FLOW X 200 /o GAUDAY TEST PIT#: 2 0 660 - ❑/H/W EXISTING OVERHEAD UTILITIES 61x2 \ STONE DRIVE �� / LOT 163 USE EXISTING 1,000 GALLON SEPTIC TANK ELEV TOP- 61.40' GAS - EXISTING GAS LINE _ 0' 61x2 TP 2 / ELEV WATER= <50.73' W_____W_______ EXISTING WATER LINE P 6 4' / ! PERC RATE _ / INSTALL 12 - ARC 36HC (#3616BD) BIODIFFUSERS DEPTH OF PERC= TEST PIT LOCATION 61x2 TP 1 PROPOSED TOTAL 12 ARC 36HC BIODIFFUSERS SYSTEM CAPACITY TEXTURAL CLASS: 1 EXISTING 1,000 GALLON SEPTIC TANK A� o I (6 BIODIFFUSERS EACH TRENCH) _ _ 61.4' C PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE / \ 61 x3 (TOTAL L.F.OF BIODIFFUSERS)(7.8 SF/LF)(0.74 GPD/SQ.FT.)= GPD " (60.0')(7.8 SF/LF)(0.74 GAUSQ.FT.)= 346.3 GAL. LEACHING/DAY 0 61.40' ' 61 x5 Fill p PROPOSED DISTRIBUTION BOX 1 x3 o MAP 272 6" so.9o' \ 61 x2 TOTALS: A Loamy 10Yr 3/1 d 0 PROPOSED ARC 36HC (#3616BD)BIODIFFUSER (4 LOT 162 10" 60.57' i- C I Z w .75, l TOTAL NUMBER OF BIODIFFUSERS: 12 B Loamy Sand j S76° 11.5. TOTAL NUMBER OF COUPLINGS: 0 10Yr 5/6 a 12 40"E 3) BOXTO GRADE (TYP PORT WITH ACCESS 36" 58.40' TOTAL LEACHING AREA: 468.0 SQ.FT. 2.67, / ( TOTAL LEACHING CAPACITY: 346.3 GAL./DAY REV. DATE BY APP'D. DESCRIPTION PROPOSED SEPTIC SYSTEM UPGRADE a' PREPARED FOR: W MAP 272 / LOT 80 NOTE: C Medium diu 6/6 Sand CAPEWIDE ENTERPRISES EFFECTIVE LEACHING AREA OF 7.80 SF/LF OBTAINED FROM THE o � (5-10/o gravel) DEPARTMENT OF ENVIRONMENTAL PROTECTION APPROVAL LETTER LOCATED AT "MODIFIED CERTIFICATION FOR GENERAL USE" ISSUED TO NOTES: 61x3 ADVANCED DRAINAGE SYSTEMS, INC. ON OCTOBER 3, 2003(LAST 116 BUCKWOOD DRIVE MODIFIED FEBRUARY 18, 2010). TRANSMITTAL NUMBER=W000052. HYANNIS, MA 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF EACH SEPTIC SYSTEM COMPONENT. 128" 50.73' SCALE: '0 20 1 INCH = 10 FT. DATE: APRIL 27, 010 FEET No Mottling, Standing or Weeping Observed 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE g' g p g �, `" "` �. LOCATION OF THE PROPOSED LEACHING FACILITY TO ENSURE -- - -- -^-- - °2 jor,N �r PREPARED BY: CONSISTENCY WITH TEST PIT DATA SHOWN ON THIS PLAN. RESERVED FOR BOARD OF HEALTH USE R. JC ENGINEERING, INC. J t�. REPORT TO ENGINEER AND LOCAL BOARD OF HEALTH IF SOILS V� 2854 CRANBERRY HIGHWAY ARE NOT CONSISTENT WITH TEST PIT DATA. EAST WAREHAM, MA 02538 3. PROPERTY IS LOCATED WITHIN A DEP APPROVED ZONE 2. SITE PLAN __ _ 508.273.0377 SCALE: 1"= 10' Drawn By: MCP Designed By:MCP Checked By:JLC JOB No.1799