Loading...
HomeMy WebLinkAbout0175 BUCKWOOD DRIVE - Health 175 Buckwood Drive ... `Hyannis A = .271 034 I . e v fl 0 I' o a Commonwealth of Massachusetts c2l:v �f lP Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w r 175 Buckwood Drive i �'• Property Address Kingston Investment LLC �. Owner Owner's Name information is required for every Hyannis ✓ MA 02601 3/8/2019 page. Cityrrown State Zip Code Date of Inspedion }h 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. Inspector Information r filling out forms �'143�3 on the computer, use only the tab Patrick Rutledge key to move your Name of Inspector cursor-do not Title Five Specialists use the return Company Name key. 22 Taft Co Company Address Dorchester MA 02125 1� City/Town State Zip Code 5082374628 S114198 Telephone Number License Number B. Certification I certify that: 1 am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 175 Buckwood Drive Property Address Kingston Investment LLC Owner Owner's Name information is required for every Hyannis MA 02601 3/8/2019 page. Citylrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: 19 1 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: 2) 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): t5insp.doc-rev.726/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 k Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 175 Buckwood Drive Property Address Kingston Investment LLC Owner Owner's Name information is Hyannis MA 02601 3/8/2019 required for every y page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes(cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y 175 Buckwood Drive Property Address Kingston Investment LLC Owner Owners Name information is required for every Hyannis MA 02601 3/8/2019 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any)' determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank,and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: *"This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal` to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: ° Yes No :t Backup of sewage into facility or system component due to overloaded or ElCAI - clogged SAS or cesspool r Discharge or ponding of effluent to the surface of the ground or surface waters ` due to an overloaded or clogged SAS or cesspool t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 175 Buckwood Drive Property Address Kingston Investment LLC Owner Owner's Name information is required for every Hyannis MA 02601 3/8/2019 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ C9 Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ f�f Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ 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. ❑ 1� Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ g] The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 16,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section C.4. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply El ❑ the system is within 200 feet of a tributary to a surface drinking water supply El El Area system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Pape 5 of 18 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 175 Buckwood Drive Property Address Kingston Investment LLC Owner Owner's Name information is required for every Hyannis MA 02601 3/8/2019 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for a//inspections: Yes No M ❑ 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? ❑ 91 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? E ❑ Were all system components, excluding the SAS, located on site? EA ❑ 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? V- ❑ 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)] 15insp.doc•rev.7/262018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 175 Buckwood Drive Property Address Kingston Investment LLC Owner Owner's Name information is required for every Hyannis MA 02601 3/8/2019 page. CityrFown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 33 Description: Number of current residents: Does residence have a garbage grinder? ❑ Yes P� No Does residence have a water treatment unit? ❑ Yes n No If yes, discharges to: Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ffi No information in this report.) Laundry system inspected? Yes ❑ No Seasonaluse? ❑ Yes No Water meter readings, if available(last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes No Last date of occupancy: Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts Ip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 175 Buckwood Drive Property Address Kingston Investment LLC Owner Owner's Name information is required for every Hyannis MA 02601 3/8/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ❑ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/262018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 175 Buckwood Drive Property Address Kingston Investment LLC Owner Owner's Name information is required for every Hyannis MA 02601 3/8/2019 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 501, ASy(,Pfkbn S of�iPLvi in S�-a//�8b n 2a®S Were sewage odors detected when arriving at the site? ❑ Yes No 5. Building Sewer(locate on site plan): / Depth below grade: ,2 feet Material of construction: t]cast iron ❑40 PVC ❑other(explain): Distance from private water supply well or suction line: �r00 feet Comments(on condition of joints, venting, evidence of leakage, etc.): t5insp.doc-rev.7/262018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 175 Buckwood Drive Property Address Kingston Investment LLC Owner Owner's Name information is Hyannis MA 02601 3/8/2019 required for every H y - page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 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) `� El Yes ❑ No Dimensions: 1 7 Y 6 d --\1 6 Sludge depth: • 3 ' Distance from top of sludge to bottom of outlet tee or baffle f� Scum thickness 3 S f, Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 • a, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 175 Buckwood Drive Property Address Kingston Investment LLC Owner Owner's Name information is Hyannis MA 02601 3/8/2019 required for every y page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. 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 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �.J 175 Buckwood Drive Property Address Kingston Investment LLC Owner Owner's Name information is required for every Hyannis MA 02601 3/8/2019 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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 Ve/ r t5insp.doe•rev.7l M018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 175 Buckwood Drive Property Address Kingston Investment LLC Owner Owner's Name information is Hyannis MA 02601 3/8/2019 required for every y page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: P"f'AS qc,�/e G Z4X 12.S 1l 2-K'� Type: ❑ leaching pits number: ❑ leaching chambers number: LJ leaching galleries number: ❑ leaching trenches number, length: M ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Fond:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts r- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 175 Buckwood Drive Property Address Kingston Investment LLC Owner Owner's Name information is Hyannis MA 02601 3/8/2019 required for every y page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System(SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 12. Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of'solids layer Depth of scum layer Dimensions of cesspool Materials of construction i Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 175 Buckwood Drive Property Address Kingston Investment LLC Owner Owner's Name information is required for every Hyannis MA 02601 3/8/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection form:Subsurface Sewage Disposal System-Page 15 of 18 Commonwealth of Massachusetts ip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 175 Buckwood Drive Property Address Kingston Investment LLC Owner Owner's Name information is Hyannis MA 02601 3/8/2019 required for every H y ' page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: . hand-sketch in the area below ❑ drawing attached separately p p box t A, Iq I J blot /"�04- 6 . 51 ' c.fc.woo � t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 175 Buckwood Drive Property Address Kingston Investment LLC Owner Owner's Name information is required for every Hyannis MA 02601 3/8/2019 page. City town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: tK Check Slope Surface water (gj Check cellar [ , Shallow wells E 2t Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: Obtained from system design plans on record If checked, date of design plan reviewed: 2 0,05 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: A4 Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 175 Buckwood Drive Property Address Kingston Investment LLC Owner Owner's Name information is required for every Hyannis MA 02601 3/8/2019 page. Citylrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: A. Inspector Information: Complete all fields in this section. B. Certification: Signed & Dated and 1, 2, 3, or checked [ ] C. Inspection Summary: 1,2, 3, or 5 completed as appropriate 4(Failure Criteria)and 6(Checklist)completed ® D. System Information: For 8:Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Ins on Form:Subsurface Sewag e ge Disposal System•Page 18 of 18 TOWN OF BARNSTABLE L6CATION S 13ac i<wood .6r. SEWAGE # i. �;p7.LAGE / vGav n ASSESSOR'S MAP & LOTv17i .3V 7 7-6 INSTALLER'S NAME&PHONE NO. w°'^`c ����soR 3��/c►t Se�mice . ��775�� SEPTIC TANK CAPACITY /000 : LEACHING FACILITY: (type) aX Sl© ®rywd/ (size) �7/ /��'�►`�'/ NO. OF BEDROOMS CR uJ BUILDER OR OWNER HOU if PERMIT DATE: �21 i to 1c COMPLIANCE DATE: -;V1 oS` 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 709 0_5 W C v� G G R it u w'iPa f r 41 0 0..00 THE f+OMMONWEALTH OF MASSACHUSETTS Entered in computer: a Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pprication for Miopotal *p5tem (Construction Permit Application for a Permit to Construct( . )Repair(X)Upgrade( )Abandon( ) El Complete System El Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 7 7 8—7 8 6 5 ���,��Fkwood Dr Hyannis Scott Houle Assessor' y c�-7 a3 y 175 Buckwood Dr, Hyannis Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. 3 6 4—0 8 9 4 Wm E Robinson Sr Septic Eco-Tech PO Box 1089, Centerville 43 Triangle Cir, Sandwich Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage GrinderXio ) 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 Repairs or Alterations(Answer when applicable) Install a new Title 5 leach system to plans of Eco-Tech. 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 Certifi- cate of Compliance has been issued by this B d o Health. Signe �"���J' Date j—//,-o Application Approved by Date .U Application Disapproved for the following reasons Permit No.';4_c>�S ® �' Date Issued a- 16 FJ1 0Of 00 V I THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: .. . ^. ' :' Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS i 01ppYication for Zi5pozal *p5tem Contruction Permit Application for a Permit to Construct( )Repair(X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 778-7865 175 Bu�Ckwood Dr, Hyannis Acott Houle Assessor's ap/Parce a71 O3y 175 Buckwood Dr, Hyannis Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designee's Name,Address and Tel.No. 3 6 4-.0 8 9 4 Wm E Robinson Sr Septic Eco-Tech PO Box 1089, Centerville 43 Triangle Cir, ' Sandwich Type of Building: Dwelling No.of Bedrooms_ Lot Size sq.ft. Garbage GrinderT10 ) r 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 Repairs or Alterations(Answer when applicable) Install a new Title 5 leach system to plans ot Eco—Tech. 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 Certifi- cate of Compliance has been issued by this.M o ealth., ✓/�� Signed `",•� Date _ Application Approved by ��--' �d. Date 0 U 5 Application Disapproved for the following reasons N Permit No.� C 5 Date Issued a- G S A . TH6COMMONWEALTH OF MASSACHUSETTS Houle BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS J ,TO CER FY, that the On-site Sewage Disposal System Constructed( )Repaired(X )Upgraded( ) Abandon d((' �__Iuck_wood 6W�-�obKon Sr Septic Service at 175 Drive, Hyannis has been constructed i accordance with the provisions o`f Title 5 and the for Disposal System Construction Permit No.?-60`1 669�t dated Installer Designer—, The issuance of this pepuit shall not be construed as a guarantee that the syNm i unction as designed. Date a �b!(� Inspector Houle THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS lwi5po$ar *p!tem Con!5trUction Permit Permission is hereby gr to Construct( )Repair(X )Upgrade( )Abandon( ) System located at T_r 5 Buctwood Drive, Hyannis 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 conditio. Provided: Construction m st be completed within three years of the date of thi p� Date: +b �0 S Approved b _. PP Y ® �1 c g V N _g fit g iL Ii9 ® 4 `PY ® C w N O 1e1 le/ a ag r�"a — O ,. E �� � ,�� � ' � � � � , ^ �. � �� � Y p' t�• r� �4. 357 No... .... F�s...J..............._ THE COMMONWEALTH OF MASSACHUSETTS OAR® OF HEALTH OF... ..... . ...............................................-................_....------ Allp irFation for Bispos al Works Tom "rt' " rani# Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal Syst a • ,sue 4 S�rB lion-Address or Lot No. .... .- Owne � Installer Address Type of Buil Size Lot....................... q. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................. No. of persons............................ Showers ( ) — Cafeteria ( ) Pa Other fixtures ------------------------- ----------•-......-- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons Length................ Width................ Diameter................ Depth................. x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area.........._.........sq. ft. Seepage Pit No---_---------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_____-__---__------_-__. Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ......•--•--. ---------------------•--------------------------.......--••--••-••-•-••--•.--_........................................................... 0 Description of Soil......--•..... ........ ........... •-•-•-•••----•------...••-•••••-•--.......................................................................................... x •. -------------- --- x •--•-•••••••------------------------------- --------------- ............................................... .............. ----••--- - U Nature of Repairs or Alterations er when appl ble. ___ '________�/_ _�__g - ' ------ ----- --y. . •--•• ......... -- •• •••... ••---- --------- ---- A ment: The undersigned grees to install the aforedescribed Individual Sewage D' posal System in accordance with the provisions of iITiU 5 of the State Sanitary Code-The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i d by the board of health. Signe - ``` ..._... f Date Application Approved By.... = ----•-• :- —.- . Date Application Disapproved for the following reasons----------------•-----=-•---...------•--------=------------------------------•--•------------------............ ----------------------------------- ----------------------••--•---------•--------------------------------------------------------------------------------------------------------------------•-------- Date Permit No. _--•-- _ Issued--....... --� ,. ...... Date-•----•------------------•--•-. No.... ............ Fmic ........................ THE COMMONWEALTH OF MASSACHUSETTS ---BOARD O HEALTH ...................... ....................OF....�......._.:.......�'�, 'r.." ApplirFatiun fur.UiupuuFal Works Tonstrurtion ramit '''Application is hereby made for a Permit to Construct ( ) or Repair (V) an Individual Sewage Disposal Sys�j�'lr .►r1 /e...i __ � tion-Address or Lot No. ........ — +.... ..................................................... ............-----_.__. � -- Owner /� r"y� .� xlddress �� ...!.��[! A '��' '+ `a � .... ............................................... g ti.l d. E -e!.. Installer C. Address Type of Build , Size Lot........................fSq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) PL4 Other—Type of Building --------_----------------- No. of persons-------.-------.-_-------. Showers ( ) — Cafeteria ( ) WOther fixtures ------------------...................................................................... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter-..--.---------. Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area----.--..__.--------sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by........................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit..............----.. Depth to ground water-----------.----..----_ f� Test Pit No. 2................minutes per inch• -Depth of Test Pit.................... Depth to ground water..----.................. ................rt-=a-------..................................................................................................................................... O Description of Soil.............. x `'n/ x --...........................••--•--------------•-•---••-•-•-----•--••----•----••--•-----•----•--•--•-•--------.....-•-•-•--- ................................-----..... -----------.---- U Nature of Repairs or Alterations AnsWer when appli ble..f � """-''� y ?� .;t. ---• '............................................ _`" The undersigned 4rees to install the aforedescribed Individual Sewage D' posal System in accordance with the provisions of TITLL 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been isst. d by the board of health. Signed[.»:^22 G-}-r .C-__ rw.. ............. Application Approved B 1_'%�'.�`?---.. . � Date Application Disapproved for the following reasons:................................................................................................................ --••-•-------------------------------•.....•---•----------••-----•---------------..._...•--••---•---...--•-------------•-----•--•--------•-•----••-.....----•----•------••-------------•------•--.--•-•- Date Permit No......Z-j--.:....F'_.25l_.- .................... Issued....---.-- �a..� Date 0. THE COMMONWEALTH OF MASSACHUSETTSt BOARD OF HEALTH . O F....L...,. -.?' r��~''.'°'�'............................................ +F ................................. C9rrtifirate of Tuntlrlianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System c `�tructed ( ) orp fired byCr e' at 2 ........Vz_ has been mstalle ccord=4 with the provisions of TITLi j of State Sanitary Code as d soribed in the application for Disposal Works Construction Permit No-------------�------.A L............ dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. D ` �..DATE.. . (. .°Y.-......... Inspector_... _ ._f ...................................................... THE COMMONWEALTH OF MASSACHUSETTS 351 BOARD OF HEALTH. ..gO F... `<! ............."."`" ................................ No.... FEE...-•-•................ Diupupal urku C�unutrttrtiun rrnttt Permission is hereby granted... �. �-- __� --. ti; -- £"f_��y to Construct _ ) or Repair ( an Individ Sewage Dis; osal System .•- at No '' = 0-/" _sues. r/ � u Spree �y O' ?i el as shown on the application for Disposal Works Construction Permit No..................... Dated...77 /.. ... ._+ Board of r 6G�+ Health DATE. �' ........................................... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS �� r � � � � � _ - , r, _ _ � .� ��.. ; � _ �. • S - '� - . � � . .. ... � . . .� O � - � .. � •_ '. .. - � • � - '. e r c" A w C . - MOW OW d 7, , Aow t _ W II t; o. I' hit - - r •l c V. 'p 0 �� or / �� j GARAGE FRAMING RIDGE VENT j2*6 COLLAR TIES;4811 OC 30 YR ARCHITECT STYLE ASPHALT SINGLES 1 2" SHEATHING t6F /2*6 SINGLE PLATE 3/4" FLOOR SHEATHING PRIMED FASCIA TRIMfir/ 14"TJI: 16" OC VENTED.SOFFIT �-�'► 1 PRIMED FREIZE__ ___. `DOUBLE TOP PLATE 1/2 WALL SHEATHING -_.2*6 WALL STUD; 16"OC NATURAL WHITE CEDAR SI NGLE SIDING �-SINGLE BOTTOM PLATE 1*4 AND 1*5 PRIMED CORNER BOARDS i� l,, 2*8 PT SILL PLATE 1Z � -GRADE�� SILL SEAL 48" FROST WALL: MIN. 8" ABOVE GRADE '\,4" CONCRETE FLOOR WF 8" BY 16" FOOTING- '��- ,.. .t F R � � rr 1 t t '`, .} ,4 i �C�, 1 t^,��`� 'h,.r r . '. . i r �� 3 } 9 ` j 1 � F A 1 f i "s. t 5j i I 8 �. -aw" TOWN OF BARNSTABLE LOCATION /7 S Sa <wood br, SEWAGE # 0;�)0-5 VILLAGE_ l�'IwT�s�.� s9 ASSESSOR'S MAP & LOT27/" +V INSTALLER'S NAME&PHONE NO. ��""°c°!/d��so� 5eA/4t e,,yjze . Shy 77,5'F7% SEPTIC TANK CAPACITY /000 /• LEACHING FACILITY: (type) {2X S'bo brywdl (size) Jf a71/ NO.OF BEDROOMS BUILDER OR OWNERD��� PERMITDATE: ���a S" COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 709 �tS 13Acv- 000's C q f - � r `'rAN eG �•QDtt q , A-3 . (�r Town of Barnstable;. . INERegulatory Services � Thomas F. Geiler,Director + BARNMBLE, MASS. Public Health Division 'DrFn ''°i Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: Designer: Eco-Tech Installer:Wm E Robinson Sr Sceptic Service Address: 43 Triangle Circle Address: PO Box 1089 Sandwich Centerville On Wm E Robinson Sr Sept` as issued a permit to install a (date) (installer) Service septic system at 1 75 Buckwood Dr,Hyann; s based on a design drawn by (address) Eco-Tech dated o-5- (designer) substantial) according to I certify that the septic system referenced above was installed y g the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. �,IHAOFMgss9 i DAVID oy (Installer's Signature) CouGH',":: j 9 # 105; 0 / a'gN`rA��P� (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE.PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form PLAN REFERENCE a r LAND COURT PLAN 35404-A LOCUS 24 ft-x (t x 2" ft ASSESSOR'S MAP: 271 `� ��' N a o LEACHING GALLERY 144.09 ft ► — — LOT: 34 i m I' ROUTE 28 a� (^ 63 Ns P 0 O V O + 1 O NYANNIS. MA V� 16 z z_ �o V LOCUS MAP 6 1 � � I— I1 , _J �� O m Z NOT TO SCALE N O 16.2fr (nwLij O c O 3 X CZo� CONTOURS LliN C EdWATEfi, LINE � O EXISTING - - - - - - - 60 v63 CONIC f' 63 MINIMAL GRADING PROPOSED PAT,O LEGEND —�--- , \ STING 10010 GALLON o 0 UNPAVED DRIVEWAt SEPTIC TANK LOT 24 '� D-BOX 0 Sao � ,�. � AREA - 10776 S f +- -- — TES T. PIT s 143.30 ft 63 , EXIS TING O BE LEACH PIT PLAN PK NAIL IN D m ELEVATION TREE SCALE: I in - 2O ft USGS DATUM NIVINER R��s To DtnrrETER IN OUCHES. LETTER DENOTES TYPE -p i 0,OAK M-MAPLE P-POI E ENT FLOW PROFILE vPIPE TOP OF FOUNDATION RAISE COVERS TO WITHIN F[j 6 in OF FINAL GRADE 1 EL - 64.10 {— ONE INSPECTION RISER FOR LEACHING GALLERY 2' LAYER of I/8- D-BOX I/2'oSTONE SEWAGE DISPOSAL SYSTEM PLAN 3- DROP I FLOW LINE -TO SERVE EXISTING DWELLING 1 - 4- SHARON B. HOULE .. PRECAST ai4•-1IY4• OFMgs� 48' GASH DRYWELL r BAFFLE 6 in STON%E BOTTOM OF �� DAVID cyN 175 BUCKWOOD DRIVE HYANNIS. MA SOIL ABSORPTION D. ENVIRONMENTAL EISTNO STONE ECO-TECH ENVIR E TNO BASE S938 LEACHING` SYSTEM EXISTN° GALLERY �t ,o93 EXISTING 59.55 9F `` 43 TRIANGLE CIRCLE SANDWICH MA 0256 59.25 5.00 f► S G15_ EASTM IOOO GALLON (END VIEW) 57.25 ITA?' 508 364-0894 EXI9Tux� SEPTIC TANK 3s ft C> 5 {t 12.5 tt � �� 1�•-S ETE-1915 FEB 15. 2005 I/2 b> 14 it ,,''.ADJUSTED 36.5 -,Q� /� THIS PLAN IS TO BE CONSIDERED A DRAFT PLAN UNLESS IT' SEASONAL HIGH- �- s, // BEARS THE STAMP AND SIGNATURE OF THE DESIGN ENGINEER GROUNDWATER ORIGINAL PLANS INTENDED FOR SUBMITTAL TO TIE" BOARD { OF HEALTH WILL BE SIGNED N BLUE AND STAMPED N RED. SOIL TEST. L. O G SOILEEOVALUATQR; P AVIb DR COUGHANOWR. IRS WITNESS REQUIREMENT WAI�ED - NO VARIANCES SOUGHT DESIGN CAL _ J L A T I O N S NO GROUNDWATER TEST PIT I PARENT MATERIAL: E ROG ACIALDOUTWASH ELEVATION - 62.8 +- PERC AT 55 in 2 MIN/INCH IN C SOILS DESIGN FLOW: 2 BEDROOMS X 110 GPD - 220 GPD (USE 330 GPD- MINIMUM DESIGN FLOW) SEPTIC TANK: 330 GPD X 2 DAYS - 660 GALLONS DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING USE EXISTING 1000 GALLON SEPTIC TANK IF IN SOUND STRUCTURAL 0-4 FILLCONDITION. IF NOT. INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED) DISTRIBUTION BOX: USE 3 OUTLET D-BOX, 4-6 O LOAM 10 YR 2A NONE FRIABLE 6-7 E LOAMY SAND 10 YR 4/2 NONE FRIABLE SOIL ABSORBTION SYSTEM: A 24 ft x 12.5 ft x 2 ft LEACHING GALLERY CAN LEACH ) 7-12 A LOAMY SAND 7.5 YR 3/4 NONE FRIABLE Abot - ( 24 x 12.5 - 300 sfA s d w - ( 24 + 24 + 12.5 + 12.5 ) x 2 - 146 s f 12-34 B LOAMY SAND - 10 YR 4/4 NONE LOOSE A t o t - 446 s f Vt 0.74 x 446 - 330.04 GPD 34-144 C MEDIUM SAND 10 YR 6/3 NONE LOOSE USE A 24 ft . x 12.5 ft x 2 ft GALLERY. Vt - 330.04 GPD > 330 GPD REQUIRED GROUNDWATER ADJUSTMENT EXISTING GROUNDWATER LEVEL LEACHING GALLERY BASED ON TOWN OF BARBSTABLE GIS DEPARTMENT RECORDS. INDICATED GW 31.00 CONSTRUCTION DETAIL INDEX WELL AIW-230 DRYWELL UNIT ZONE D $•-6-x 4•-10•x 2'-9' STONE READING DATE DEC. 2004 2 ti EFF. DEPTH READING 24.5 24.0 f t ADJUSTMENT 5.5 ADJUSTED GW 36.5 NOTES- Ln LA` N_ Ln N 1) GARBAGE GRINDER NOT ALLOWED WITH THIS DESIGN 2) ALL LINES TO BE SCH 40 PVC AND PITCH AT 1/8 INCH PER FOOT MINIMUM. 3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REQUIREMENTS 3.5' 8.5, 8.5' 3.5' OF. MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15) 24.0 ft NOT To 4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES SCALE BEFORE EXCAVATING FOR SYSTEM, 5) EXISTING LEACH PITS TO BE PUMPED. COLLAPSED. AND FILLED. OR REMOVED 6) ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON. FINES AND DUST IN PLACE 7) LINES EXITING D-BOX TO RUN LEVEL FOR 2'-' 0' BEFORE PITCHING DOWN 8) ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION OF LOW FLOW FIXTURES AN P SEWAGE DISPOSAL SYSTEM AND APPLIANCES. AND BIANNUAL PUMPING OF THE SEPTIC TANK E I 9) SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. DO NOT -TO SERVE EXISTING DWELLING PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM. 10) INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE STARTING WORK. SHARON B. HOULE 11) SEPTIC TANKS SHALL BE INSTALLED LEVEL AND TRUE TO GRADE ON A LEVEL 175 BUCKWOOD DRIVE HYANNIS. MA STABLE BASE THAT HAS BEEN MECHANICALLY COMPACTED AND ON TO WHICH SIX INCHES OF CRUSHED STONE HAS BEEN. PLACED TO MINIMIZE UNEVEN SETTLING 12) SEPTIC TANK TO BE PUMPED DRY AT TIME OF SYSTEM REPAIR AND CHECKED ECO-TECH ENVIRONMENTAL FOR STRUCTURAL INTEGRITY. INSTALL" PVC OUTLET TEE FITTED WITH GAS BAFFLE. 43 TRIANGLE CIRCLE SANDWICH MA 02563 ETE-1915 FEB 15. 2005 2/2