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HomeMy WebLinkAbout0067 CANTERBURY CIRCLE - Health ., ?6TCanterbury circle 249- 121 Hyannis ° o � e x o o , o TOWN OF BARNSTABLE LC'CATION G 7 e_f_&- -YG�.ly C—le SEWAGE # 2 DG y -G046 I LLAGE ASSESSOR'S MAP & LOT 2` f -/f/ INSTALLER'S NAME&PHONE NO. .5 OF-q2G ME JOSe O, Z)c Z9,*^,o,5 SEPTIC TANK CAPACITY /SOD LEACHING FACILITY; (type) 2-5 DO 01N t,0511 (size) NO.OF BEDROOMS 3 BUILDER OR OWNER rt /" Sim ah PERMTTDATE: COMPLIANCE DATE:J L 17-a�/ Separation Distance Between the: ' Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist . on site or within 200 feet of leaching facility) _: Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) t Feet Furnished by j, s �y � ��� �, �''J� � Z a � � 1� YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates(cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L. -it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: 6'8— « Fill in please: yam, APPLICANT'S YOUR NAME/S: C'QY . BUSINESS YOUR HOME ADDRESS C eb�ru C Y c A rat Nl S Z 6 0 o TELEPHONE # Home telephone Number EMAIL: 3 { �-� _ c7�(l �r dSl NAME OF CORPORATION: C,oy\: 11 NAME OF NEW BUSINESS 1-1�mr� '2r O`er C�oylS TYPE OF BUSINESS IS THIS A HOME OCCUPATION? '✓ YES NO ADDRESS OF BUSINESS. j� CEXSIt1 O YC MAP/PARCEL NUMBER ' (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONE S OFFICE This individual has bee i rmed o ny ermit requirements that pertain to this type of business. Authorized Signature** COMMENTS: \ v I�'s r' —1,►..l,t�w.1. .� �R�►-L(�-'7d ('-..0 S1'R= ��7 t�-Q a �L-�?��i ti1.(� �� ��Eft i� T(L9./�� 2. BOARD OF HEALTH This individual has been informed of th mit r' ments that pertain to this type of business. MUST''COMPLY WITH ALL HAZARDOUS MATERIALS REGULATIONS Authorized Signa. re** COMMENTS: 3. _1 .'LICENSING AUTHORITY,. This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: Town of Barnstable P# 1 d Department of Regulatory Services g „,PNWABM : Public Health Division Date 0.79. ,6�' 200 Main Street,Hyannis MA 02601 Date Scheduled 3 / Time /Q.4y,7 Fee P Goo 0q) Soil Suitability Assessment for Sewage Disposal Performed By: Witnessed By: ���•� sy�'�Y/"' i�1 - LOCATION &GENERAL INFORMATION4' Location Address Owner's Name M M/'(f �r(1 U 5 r / 3� �p � Gin 2d'�U/'1� L��/�c./Q '�►'Ec�' Address Assessor's Map/Parcel: _ 1.a f Engineer's Name NEW CONSTRUCTION I�-� /REPAIR Telephone# 7 7�� Land Use A-Si Cl eA k&L/ ,`Ap Slopes(%} Z Surface Stapes -r'3— � ft Drinking Water Well __�ft Open Water Body ft Possible Wet Area�_ g Distances from: O y P Other r 'f ft ft Drainage Way ft Property Line o_�_ SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) I CA �r� V e 4 Parent material(geologic) Depth to Bedrock Depth to Groundwater. Standing Water in Hole: A-11A- Weeping from Pit Face A1IA Estimated Seasonal High Groundwater > 4 DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: in. Depth to Soil M01tift tu. Depth to weeping from side of obs.hole: _ m in, Oroundwater Adjustment ft. Index Well# Reading Date: Index Well level- Adj.f letor— Adj.Clroundwater Uvel,a9 PERCOLATION TEST Date Time Observation Time at 9" Hole# c� Y Time at G" Depth of Perc /� Z4 5 kho n S 'Time(9"-6") Start Pre-soak Time @ - - . tu•-1--1.; .t End Pre-soak l S wt�a�kc Pt�e�c3ca.C,C, Rate MinJinch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back---------- ***If percolation test is to be conducted within 100' of wetland,you nust'first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:\.SEPTif1PERCFORM.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. Consistenc %Gravel 0 -(09 A 5L (Z 6 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 tenc %Gravel I DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsisten el Flood Insurance Rate Man: Above 500 year flood boundary No_ Yes x _ Within 500 year boundary No Yes- Within 100 year flood boundary No Yes Death of Naturally Occurring Pervious Material_ 1 Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? _— If not,what is the depth of naturally occurring pervious material? Certification I certify that on (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 ing,expertise and experience described in 310 CMR 15.017. Signature Date 3� Q:\SEPTIWERCFORM.DOC No. � FEE COMMONWEALT14 OF MASSACHU SETTS Board of Health, m '� MA. APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( Repair( Upgrade(/ Abandon( - Complete System ❑Individual Components Location 6 7 G n �S Owner's Name j e. SZM VVs Map/Parcel# � C� /Z Address C�w��!�v `L Wti IS Lot# Telephone# -7'7.5=l $70 1 Q 2G v 1 Installer's Name ` }J` f✓� Designer's Name i Q,�;` Y`jiSPe1z, Address. ' -C. Address Z sJja_e_.6( Telephone# e_C)z6ojf3Telephone# 5-ag 7-7- L Zfa Type of Building �S�C , "" &--A ��1`T Lot Size 16c 4T�4?d sq.ft. Dwelling-No.of Bedrooms Garbage grinder ( Other-Type of Building LV/A No.of persons Showers ( ),Cafeteria O Other Fixtures A?f�Design Flow(min.required) w46 gpd Calculated design flow :Z 36 Design flow provided 3 2 d 11 gpd Plan: Date C5 d Number of sheets -- Revision Date Title r1Cl /�(R Description of Soil(s) 0-6 ",4e 5 L to if- 3d°,&i 'L-S; `�0 t`- ! " C ° /� e�Q 6 Soil Evaluator Form No. "- Name of Soil Evaluator / ld�/�7 �' !— Date of Evaluation Zia 04— DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to not o plac es tem.in operation until a Certificate of Compliance has been issued by the Board of Health. Signed -GG Date Inspections No. �C/(J ^1p FEE MM T� Of MA �t1t�1J�� ETT l� Board of Health, /-61,SAg-6 L` , MA. CERTIFICATE OF COMPLIANCE Description of Work: 0 Individual Component(s) ;JcComplete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ),Repaired ( ),Upgraded ( ),Abandoned ( ) by: at _ .3-7 C 01 r C�i� Qom_ �,+i•'r has been installed in accordance with the pvisi ns of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No.;2(!yt{��0A , dated (jr, t> Approved De Flow 3�0 (gpd) Installer Designer: Inspector: Date: �! 1 The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No. p G'1 ^fv � � � FEE r- t. �,-f#MMONWEALJR OF MASSAC-11KSETTS Cc �n S .,� Board of Health, , MA. APPLICATION FOP DISPOSAL. SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair( Upgrade Abandon( - .1d Complete System ❑Individual Components LG �^+ r Location 67 n )e,-6Lr If,,,c4 �},^� Owner's Name Map/Parcel# M-G r qv'Ce Z Address (0 7 ,t}�t�ov�y r c�e ✓L�/C'Vo>,� s Lot# Co 1 (P Telephone# .7 j` S'p 1 Li it I Installer's Name S ' Designer's Name�yt ,' Qr; VA ��Cs•e J � -§u� ,�f SSA� n �v/ S �.-•- Address�S �GwcvKQ 1"t '' Address Zf .S�1 t 1t5� M6Y� 4 Q A� �'1 Telephone# m A C�Z(o C Teleph-o-ne# S"UFS /f-'7'7_ z4 44 Type of BuildingS`�CvlA /1 �C l- gv"to`�Y Lot Size f Q/ ���� sq.ft. y Dwelling-No.of Bedrooms 3 Garbage grinder O Other-Type of Building AJI/4 No.of persons Showers ( ),Cafeteria ( ) �•- a "'Other Fixtures •^� Design Flow (min.required) d gpd Calculated design flow 'S_5c3 Design flow provided / gpd Plan: Date ?J/d�C1 Number of sheets � - �^ Revision Date A Title/`"tbdoor3�0 4'7"t Q 5-y-si-cm q c,,f-a de s 67 C_Ae'tk,,- 6Lr1-4 e`—Le x. V lr4ot t") fF 17 s � . Description of Soil(s) �-6 "1 L e 6 "n 3d v%, x L,S. '7J0 �zf f u r, C�A Al YA 5Cts� Soil Evaluator Form No.; Name of Soil Evaluator pf W MCI Date of Evaluation ?✓ �'4' DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further a ees to not o plllacV the tem in operation until a Certificate of Compliance has been issued by the Board of,Health. Signed L� Date Inspections F No.a w (CIS FEE COMMONWEALTH Of MASSACHUSETTS Board of Health, ✓%!S� MA- CERTIFICATE OF COMPLIANCE Description of Work: ❑Individual Component(s) Okomplete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ),Repaired ( ),Upgraded ( ),Abandoned ( ) by: has been installed in�accordance with the p ovisi ns of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No.2yV 7 -�ab , dated l! /) �� Approved Desidh Flow ���.;'' (gpd) Installer Designer: Inspector: �x,;. Date: � The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No. UV y r 6 Ob FEE /v V t_/ COMMONW[A , Of �'ASSAC14USETTS Board of Health, fn S/ k 'I tl DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is herebygranted to; Construct( f) Repair(C) Upgrade( ) Abandon( ) an individual sewage disposal system at 6 ( C �A 4�b- C I r't•(P , .9, < as described in the application for Disposal System Construction Permit No. 2W Lf- 46 ,dated l f S u r Provided: Construction shall be completed within three years of the date o t>, per it. All local onditionrs must be met. /( Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date l l o-A L/ Board of Health T t 1 12/01/2005 15:50 5084775313 ENGINEERING WORKS PAGE 02 Town of Barnstable SRegulatory Services Thomas F.Geller,Director Public Health Division Thomas McKean,Director 200 Mate Street,llyaants,MA 02601 Office: WI-962 $64 Fez: Sa-79a6304 INSdie_r&Des eer,Cardficadon Farm [ 21 �10)- 2��-~12► Date: Sewage Permit# Assessor's Map\Parcel C L DetrlgBer: �!�S� "a C V3 installer: Address: 1 Z V\1. GRi.SJ 4k-v,�d ICA Address: C,.-\A- a zG ti On "eY S G`J rwas issued a permit to install a (date) (installer) septic system at -7 4=.,- C``rt_ based on a design drawn by nn (address dated (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with ma or charges (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 do Local Regulations. Plan revision or certified wbuilt by designer to follow. N OF �tl1t T. ( nstaller's Signature) CIVIL 6 (Designer's Signature) (Affix Designer's Stamp Here) [LtaAS1>i 1tE?L]B1V �o BARNSTABLE PUBLW DIVIS10111 CERTIFICATE OF SQ_M[LIAacs WILL roT,��,ISSU1dD Il1�1TI1� 1>OTfI TNLTOBM A�'D Afl-BUD.Z,CA�Q ABF ttt[r .rV�ID BY TItL d�oNSTAwLK PUB -IC MEAL-TH D7V191ON. Tlj&3&YoL p.HcW*Asdtic/D*WVw Coni9oa lm Form 3-264e.dw 12/01/2005 15:50 5084775313 ENGINEERING WORKS PAGE 01 Engineering Works CWN Engineers 12 West Crossfield Road, Forestdale,MA 02644 TelMex (5M)477-6313 FAX COVER PAGE To: vo,n Ao� �/1''�(/1 �Qp� 1"h Dole - No.of al�se�s: F, —t0 From: �,,�-�-e.,Q °eft Re: 67 Rick0l" 15 CA Say -fi�� ee��--�•�:�fi�o►-� ��-,,.� �t— '� ��� �45 'ot- ) S y�-�•tvh W� 1 nS �Urr✓� N► hv�� ��� c�v� }-�c/hs 40kw� v e f Commonwealth of Massachusetts M. Executive Office of Environmental Affairs Department of Environmental Protection �t William F.Weld V Governor o �� Trudy Coxe Secretary,EOEA David B. Struhs f Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ti PART A CERTIFICATION Property Address: 0/q �(,c,1���sLw� C Care C� �'l u c-`•=S Address of Owner: Tr(157` Date of Inspection: � (If different) 4 Name of Inspector: ` „ Company Name, Add ess and ielleph In Number: 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's S nature: Date: '����`y� The System Inspector shall sub a copy of this inspection report to the Approving Authority within thirty (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 Department of Environmental Protection. The original should be sent tc,.:ne system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: A] SYST PASSES: 7I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not) The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 8/15/95) One Winter Street a Boston,Massachusetts 02108 a FAX(617)556-1049 a Telephone(617)292-5..500 A iJ Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: `g 7 C� (,,, v.Ix., j C f Owner: 60 A'svD/`y Date of Inspection: '—V BJ SYSTEM CONDITIONALLY PASSES (continued) _ Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed i r to a broken settled or uneven distribution box. The system will ass inspection if(with approval of the pipe(s) o due Y P Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four 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 CJ 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 the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND 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 APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ The wStPm has a septic tanK ano soil absorption system and is wlthui 100 ieci to c sulincc 'Wate supp!) or tributary' to a surface water supply. _ The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. _ The systen, has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis 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. Dj SYST,EM FAILS: 4 I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an 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. (revised 8/15/95) 2 I _ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1,e-7 64� cyk Owner:a e,oZp GX Date of Inspection., �/��� D] SYSTEM FAILS(continued): Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Al' Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation. �j Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. �-I 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. T 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The design flow of system is 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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' The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 8/15/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Owner: C p l""`(� Date of Inspection: (/ -C) Check if the'following have been done: _Pumping information was requested of the owner, occupant, and Board of Health. f done of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates ding that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _As built plans have been obtained and examined. Note if they are not available with N/A. he facility or dwelling was inspected for signs of sewage back-up. the system does not receive non-sanitary or industrial waste flow site was inspected for signs of breakout. II system components, excluding the Soil Absorption System, have been located on the site. septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum., he size and location of the Soil Absorption System on the site has been determined based on existing information or appr imated by non-intrusive methods. he fac iht-)) ov.r„ ;a~,c' occupants, if d1i4e.—I from owner';, were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 8/15/95) 4 t q SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: (o ,� � Owner: lc:: � Date of Inspection: FLOW CONDITIONS RESIDENTIAL: /7 Design flow: v Pal s Number of bedrooms: Number of current residents: Garbage grinder(yes or no): Laundry connected to system es or no):'> Seasonal use (yes or no):_ Water meter readings, if available: Last date of occupancy: (T _ COMMERCIAUINDUSTRIAL: Type of establishment: Design flow: gallons/day 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: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: 9b System pumped as part of inspection: (y or no)_ If yes, volume primped: gallons Reason for pumping: TYPE O YSTEM 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). Other(explain) APPROXIMATE AGE of all components, date installed-(if known) and source of information: �3 Sewage odors detected when arriving at the site: (yes or n6 (revised 8/15/95) S 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 64 �,� �/ Owner: 60 eii.-ti de Date of Inspection: g"�-?( SEPTIC TANK• (locate on site plan) PP G� Depth below grade: l� Material of construction:/--concrete _metal _FRP—other(explain) Dimensions: Sludge depth:_ �3c/ Distance from top of Vudge to bottom of outlet tee or baffle: Scum thickness: 01 ��• Distance from to of scum to to of outlet tee or baffle: P P � u Distance from bottom of scum to bottom of outlet tee or baffle: z P Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of li A level in relation to outlet invert, structural integrity, evidence of leakage, etc.) g�Oy2 GREASE TRAP: (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP —other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Dktance from hotto^ ni c tt to hotiorr. of owlet tee o•battle' S Comments: (recommendation for pumping, condition of inlet and outlet tees or oaffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (revised 8/:5/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION.FORM PART C SYSTEM INFORMATION (continued) Property Address: &7 6li c,7ra—k_o;'f 9, Owner: �,Nt,p`G� Date of Inspection: TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: Material of construction: _concrete_metal _FRP--other(explain) Dimensions: Capacity: gallons Design flow: eallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION .BOX._ (Locate on site plan) Depth of liquid level above outlet invert: Comments: (note ii ievei and distributioi, > eq{ cii, e,;dence of solid_ carr�o�er, evidence of leakage into or out of box, etc.) PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) r (revised 8/15/95) 7 ,l SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C �r- SYSTEM INFORMATION (continued) Property Address: 7����" `� cell v Z � Owner: CO PILL-w` y Date of Inspection: SOIL ABSORPTION SYSTEM (SAS):_ (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number:_ leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dime ions: overflow cesspool, number: / Comments: (note condition of soil, signs of hydraulic failure level of pondin condition of vegetation,etc.) 'i �2C 1" de CESSPOOLS: (locate on site pla ) 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 grounds%ater. inflow (cesspool must be pumped as part of inspection) 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.) (revised 8/15/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM(INFORMATION (continued) Property Address: &7 Ca ctTe /�l� Owner: CC�A ,01 �' j Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' r7 �y DEPTH TO GROUNDWATER-�� ��r e��.. Depth to groundwater: ,� feet �-. s method of determination or approximation:. (revised 8/15/95) 9 No..,.. 1 F$ .°. ........ THE COMMONWEALTH OF MASSACHUSETTS :BOARD OF HEALTH ....OF......................................................................................... --H .'llpfir-atiou for Bttivosal Workii Tonstrurtion Vamit Application is hereby made for a Permit to Construct { ) or Repair ( ) an Individual Sewage Disposal Sys at ..... !- . .......... ;- .. ......�1... ........... ...................... ocati Addre or Lot No. ....... ...= .. - �.............. ��.. .� ' :�L���..-:................. ..- wner 7 Address a ......... .......... ...................... ....................... . .tea ......� �s ]er Address d Type of Building Size Lot....... ...Sq. feet U Dwelling—No. of Bedrod ns.................. ......................Expansion ttic ( ) Garbage Grinder ( ) Other—T e of Building g ............................ No. of persons.......... . --I;;- ( .... Showers dry) - Cafeteria ( ) dOther fixt es .............................................................. ........................................ -- -- - W Design Flow................j...0.................gallons per person per day. Total daily flow---------_' gallo--n-s- . Septic Tank=Liquid capacity.b. 0 W V-gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—_No..................... Widt _.....--•. Total Length.................... Total leaching area....................sq. ft. _.Y_jt Diameter----- .. ." th below inlet.................... Total leaching area_...._..._.._.. s ft. Seepage Pit No... p g q. z Other Distribution ox ( Dosing tank ( ) Percolation Test Results I Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-__.-______-___-__-..,__ G14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_-_____-_-----_-__----_. -------------------- -------- ---------- O Description of Soil............ .. ... x W x ------------------------------ ......................................................................................................................................................................... U Nature of,Repairs or Alterations—Answer when applicable...._................................:.......................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions'of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance ha be "�issued by the board of hea t Signed---- -•• �.�,..� ...... --- •--- --•- - - ----- -- . _�...�`:,--�---.. .. Date Application Approved By-••-•------•----•--------------- --- - Date Application Disapproved-for the following reasons-................................................. ..... .............- ---------•-- .................•---..._.. ...--•---••-----------------•-•--••----------------.------------------------------......--•-••-•-• -- / Permit.No......................................................... Issued----•-. .v , ....:.. Date r Ia. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF.............. ....:.......:..................:............................................ Appliration for %posal HlorkS To tstrurthin Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .... Location,'Address .. ' �............... .l.......r: or'Lot ATo ................. vv.vve vee.v asv ww w.v.evv wwe ow .. Address ............ 4- .... xi' f.,q •.,_„••,_v_....._. r ner l,ri + r f l r b .�*[ I ...... :,. ...:::I; F........x. .,r..... .............. .......w .-i ... ,.. ,;,.A•Y,p'�.v f-'+"^h ............................. 6 jn�toler dress d Type of Budding Size Lot----- ,__ j4...Sq. feet �Ur Dwelling—No. of BedroAs................ ...Expansion Attic ( ) Garbage Grinder ( ) r04 4 Other—T e of Building .... No. of persons............LiAr!.... Showers '" r Cafeteria dOther fixtures --------------------------- -------------------•---------- - ------------•.......... W Design Flow..................:T:.._�f. .gallons per person per day. Total daily flow........__.:... A',j .........gallons. _-----....•. . WSeptic Tank—Liquid capacity.: `'ja.gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No .................... Width ... .it..,oTotal Length.................... Total leaching area....................sq. ft. Seepage Pit No... P ' rj,(,:. Diameter_. f� .. septh below inlet.................... Total leaching area....................sq. ft. Z Other Distribution" ox ( Dosing tank J,' Percolation Test P.esults . Performed by Date -----•------- ,.� Test Pit No. 1................lniuutes per inch Depth of Test Pit.................... Depth to ground water__..___________--...__. (� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ... _ C) , r Description of Soil...--••--. d '. ....... ........ • -•---------------------------•------•----------------------------------- V ........................ •--•---•---•............................................•-•-•-----•----......._..........-•--........-•-•-••-•----------------•-•---•--•---...--•---•--•---------••----•------- W ---•-----------------------------•...-----•-----------------.....------------....--•--•----•-••----.....--------------------------------------------.....-- ........................................... V Nature of Repairs or Alterations—Answer when applicable............._______.....__......._..._._............._____...._._,___..._._......•..........._. ------------------------•---- ••-------......................•--••....._._..._....................-••-••......--...------.-••-••-----•....•----••-•....._..---------•••----------------......._......•• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been,issued by the board of health, t', Signed. ................. � ,-�:_---...._._ ..... ,�.:;.__ �R,u�+• 't�:-' �- - s°--•- ApplicationApproved By..................... ....................................... ............... ..................... Date Application Disapproved for the following reasons:................................................................................................................ ..............•--------•-•----.......----•--•-•----•--•-----•--•-•-•--_._......•-----------•--............-•-•••••••---------•-••------------ .................•---•-••-- ---------- -----._...._.. � Date ..... Issued.... . -� ,.,_ Permit No................................................... > .:. _ �............ . .°"�atatlr' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .. It>,.......... OF........ f�rr#tfu�#r �f f�unt�tttt�trp T4f IS TO ERTIFR'.; That the Individual Sewage Disposal System constructed ( or Repaired ( ) 'Y, a aby . )a - .... ...... ..............................••-•-- t� t Installer � .z '--' at....... FS e...... dafy��a.+l� '.i. r. ..,Yv tiiifV, T Y'4 has been installed in-accornce wifh !he pros lsxlns Article I of The State Sanitary Code as described in the application for Disposal Works Construction Permit . o.__..._ e PP P - dated THE ISSUANCE OF THIS CERTIFICATE SMALL NOY'k C STRUED AS A G RAN�'I''i"IAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...........�� - - - ..................................... Inspector..........OPC60_-_9.................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Al ................................. .......OF........ ...........,.:� i.., ..... . :....:.................. ......... FEE..- . 19topum.1 lVildw 10.1anstrurthilt prrutit Permission is hereby granted......::' _ y .:...._ ft to Construct(°X ) or Repair ( ) an individual Sewage Disposal System atNo.......i....... 1'r tl a 1 { <<v ' A ............... ........ ...%... r... ................. Street y as shown on the application for Disposal tiVorks Construction Perintt No & ' r .Dateo_._.. . ................' ---- :!` .. ,,,........ i a' board of Health DATE--- .. ............................. FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS - { f i!1 LEGEND LOCUS PROPOSED CONTOUR 2�5 Nrr NW Vol 99 PROPOSED SPOT GRADE P�' BK �' ✓NS 1fpp� E 1 its 110-- EXISTING CONTOUR Route 28 N G0' _10. 03 II j, +9&3 EXISTING SPOT GRADE a F rG, 1t toak en 1 2 I TEST PIT fi Tl1l Rd 1 S adL' ' / i t _- A W--- EXISTING WATER SERVICE z �L U �U O 19' II FxISTING PIT A `° u h 1 ��P• M i,.: 1 I (approx, too cc Q SOoth a HIGH _ TO BE PUMPED & FILLED W/SAND Mo;� SCHOOL y OR REMOVED, IF NECESSARY S re (See also, Note 11) et 1�� — '1 F_XISTING SEPTIC TANK (approx, too cc tlon-record) 1 It ✓�N o _ TO BE REMOVED & REPLACED 1 — WITH 1500 GALLON TANK 2 /24' LOCUS MAP N.T.S. � Benchmark set FUTURE NO Right cor, conc, pool A DITION El,=104,25 (Assumed) G CELLAR GENERAL NOTES: _ 1• ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL I ` BOARD OF HEALTH AND THE DESIGN ENGINEER. EXISTING v + 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS 3 BEDRL70M % OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE 1 ro II GARAGE � OfM,S LOCAL RULES AND REGULATIONS. 1 ; c� HOUSE 7) ���`"� SgcyG 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR It a TOF=105,68 TERR TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE 10'`'' ANN DESIGN ENGINEER. (Assumed) WARNER v, 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING 1 1p' ✓o `o I No.38721 FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 11 ✓o �� A �p ENGINEER BEFORE CONSTRUCTION CONTINUES. It b __9 .- ��/qy �p� 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 1 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF APN 24 9-121 � THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF q 0 \\ti 1.6 'D O J� HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. Lot \1 �e lO,8S8 1.6 + QQ, fb 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 0,25 AC,+ a . { 8. THERE ARE NO PRIVATE WELLS LOCATED WITHIN 100' OF THE S.A.S. \ ` ✓ e�> p� , A=63. 32' ( ©� 9. SEPTIC SYSTEM COMPONENTS SHALL BE INSTALLED AS DESCRIBED \ IN 310 CMR 15.000 SUBPART C. 4 �' R=90,03' N 10. ALL AREAS DISTURBED DURING CONSTRUCTION ARE TO BE RESTORED 3157 m `�� -_-- AS AGREED UPON BY OWNER AND CONTRACTOR. \ 00 Ip _� I 11. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE t1 S 1104.✓' THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING \Ip0d9e .°� 12. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS 'OEo o IN THE AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF THE S.A.S. ✓© �o AND REPLACE WITH CLEAN FILL AS SPECIFIED IN 310 CMR 255(3). 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY oo Go•o + �� OF MAJf AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. N� o PETER T, C�4NT�'RBURY CIRCLE' McENTEE F67 ROPOSED SEPTIC SYSTEM UPGRADE CIVIL No, 35109 CANTERBURY CIRCLE, HYANNIS, MA Sj`CFO �� pred for: Terry Simmons, 67 Canterbury Circle, Hyannis, MA Engineering by: Surveying by: SCALE DRAWN JOB. NO. Engineering moor s^ Terry-4 #arnerP.L.S. 1"=20' P.T.M. 87-04 �A I✓��� �� 12 West Crossfield Road 22 Long Road "t Forestdole, MA 02644 Harwich, MA 02645 DATE CHECKED SHEET N0. (50$) 477-5313 (508) 432-8309 9/30/04 P.T.M. 1 of 2 t� '. t � - NOTE: TO PREVENT BREAKOUT, THE PROPOSED tt �� F.G. EL: 103t �= FINISH GRADE SHALL NOT BE < EL:100.0 f� TOF=105.68 FOR A DISTANCE OF 15' AROUND THE EXISTING F.G. EL: 103t(EXISTING) - F.G. EL: 103t PERIMETER OF THE S.A.S. MAINTAIN 2% MIN SLOPE OVER S.A.S. INSTALL RISERS OVER INLET & OUTLET INSTALL RISER OVER D-BOX TO 2-500 GALLON LEACHING CHAMBERS INSTALL RISER OVER CHAMBER/S SHOWN ON PLAN AND SET C❑VER/S TO WITHIN 6" OF FINISH GRADE WITHIN 6' OF FINISH GRADE IN SERIES WITH_STONE_ ALL SIDES WITHIN 6' OF FINISH GRADE <: L =26' L =16' L 13'(MAX) 4" SCH 40 PVC 4" SCH 40 PVC 4" SCH 40 PVC 2' LAYER OF 1/8' TO 1/2' 6' e @ S= 2% CMIN.) ta' I- ®a a® DOUBLE WASHED STONE @ S= 1% (MIN.) 6' @ S= 1% (MIN.) a®® aaa Q PROPOSED 2' EFF, DEPTH ®e®®aaa 1500 GALLON INV. ELEV.=99.80 INV. ELEV.=99.63 3/4'-1 1/2' ..r.:r.a..'.' SEPTIC TANK iI 4' 5.2' 4' DOUBLE WASHED INV.EL: 101.00 STONE FFECTIVE WIDTH INV.EL: 102.8t TIE IN TO SEWER INV. ELEV.=99.50 OUTSIDE FOUNDATION INV.EL: 100.75 INSTALL INLET & OUTLET TEES TOP CONC. ELEV.=100.3 —BREAKOUT ELEV.=100.0 GAS BAFFLE TO BE INSTALLED ON INV. ELEV.=99.50 a®®®® OUTLET TEE AS MANUFACTURED BY a®®®®eases® ease®®eases TUF-TITE, ZABEL, OR EQUAL ! BOTTOM ELEV.=97.50 3' 2 x 8.5' = 17.0' 3' SEPTIC TANK & D-BOX SHALL BE SET LEVEL AND TRUE TO 5' MIN, ABOVE BOTTOM OF EFFECTIVE LENGTH = 23,0' T,P, EXCAVATION OR G.W. GRADE ON A MECHANICALLY COMPACTED SIX INCH CRUSHED nF Nlq STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). LEACHING SYSTEM SECTION � Jf9��G NO G.W. ENCOUNTERED SEPTIC SYSTEM PROFILE " BOTTOM OF TP EL. 92,5 o PETER T. � McENTEE o i CIVIL (3) 5" DIA.OUTLETS f No. 35109 155� •—� 16' N.T.S. �------."I �' j DESIGN CRITERIA F� s1���q��`� 15.5' ; SOIL LOG ,�� NUMBER OF BEDROOMS: 3 BEDROOMS r i�� 6' h 8' nr.e 1 SOIL TYPE: CLASS I T 2' DATE: SEPTEMBER 23, 2004 p DESIGN PERCOLATION RATE: 2 MIN./IN. H-10 LOADING SOIL EVALUATOR: PETER McENTEE M11 P�0 D—BOX INSPECTOR: DAVID STANTON-AGENT ,, t DAILY FLOW: 330 G.P.D. (REF# P-10820) 1 DESIGN FLOW: 330 G.P.D , MM p GARBAGE GRINDER: NO (THERE SHALL BE NO GARAGE DISPOSAL) Elev. TP Depth LEACHING AREA REQUIRED: (330) = 445.9 S.F. 103.0 A SANDY LOAM 0 T- 74 _ 1OYR 3/3 102.5 6" 3' PROPOSED SEPTIC TANK: 1500 GALLON CAPACITY _ ®®®® ® ®®®® 8 LOAMY SAND ®®®®®®®®®®® 33" 10YR 5/8 N ®®®®®®®®®®® , ZZZ ®�®®®®®®®® too.5 C1 30" USE 2-500 GALLON LEACHING CHAMBERS IN SERIES 102", PERC SIDEWALL AREA: 2(13.2' + 23.0') X 2 = 144.8 S.F. BOTTOM AREA: 13.2' x 23.0' = 303.6 S.F. 60" EXISTING TOTAL AREA: 448.4 S.F. 4" KNOCKOUT 20' DMA. COVER 3 BEDROOM MED. SAND• DESIGN FLOW PROVIDED: 0.74(448.4) = 331.8 G.P.D. 4" KNOCKOUT O/4" KNOCKOUT 62" 2.5Y 6/6 HOUSE (#6 7) raF=105,68 PROPOSED SEPTIC SYSTEM UPGRADE 4" KNOCKOUT 92.5 126" (Assumed) 67 CANTERBURY CIRCLE, HYANNIS, MA PERC RATE: <2 MIN/IN ("C" HORIZON) I NO GROUNDWATER ENCOUNTERED � Prepared for: Terry Simmons, 67 Canterbury Circle, Hyannis, MA 500 GALLON CAPACITY, H-10 LOADING Engineering by: Surveying by: SCALE DRAWN J08. NO, CHAMBERS T Engineering mer& Teny.4 WmnerP.L.S NTS P.T.M. 87-04 x.rs S"A.S. LAYOUT 1 12 West Crossfield Road 22 Long Road Forestdole, MA 02644 Harwich, MA 02645 DATE CHECKED SHEET NO. �i (508) 477-5313 (508) 432-8309 9/30/04 P.T.M. 2 Of 2