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HomeMy WebLinkAbout0034 CIRCLE DRIVE - Health 34 Circle Drive e yaT1T11S i 1 A=288-190 I 1 e r A `�'� C'v� ,:P�w�e,�Q�'�ce�r� � j�y �� /993 i j �� �� � 1 _ W �� � - .� �� w � 2-- r�> - g-- --i- � �� �� � �°� � S �`�� w .�--_ � C�. .ate; � � S !, i ., _ ( I i. i � ---_ i . � I � � i�l 'l � r i i i �---, { ' J `� � n � � r� _ �v � � � f f TOWN OF BARNSTABLE LOC�1I'ION 34 C� rC � I, SEWAGE # - __-- VILLAGE ASSESSOR'S MAP do LOT t INS'TAL'f. ER'S NAME&PHONE PTO_ SEPTIC TANK CAgACTTY n i LEACHING FACILITY: (type) r i 6 (size) / + No.OF BEDROOMS_ BUILDER OR OWNER. PERMITDATE: COMPLIANCE,DATE: Separation Distance Between tbe: { Maximum Adjusted,Groundwater Table to the Bottom of Leaching Facility Feei Private water Supply Well and Leaching Facility (If any wells exist Feet on site or vrithin 200 fit of le=hing facility) Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet f ll= g€acility) 41 Feet Furnished by U `� �� ��� - � 1 1 61 61 � a a F r � O 6N 4� a TOWN OF BARNSTABLE �� �i / ATION ��i (�. ,5j�'/�l�7SEWAGE# LAG ASSESSOR''SS MAP ARCELG'� INSTALL 'S NAME&PHONE NO. SEPTIC TANK CAPACITY ✓ �®�� LEACHING FACILITY:( (size) RO. i NO.OF BEDROOMS OWNER v PERMIT DATE: 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 i No. Fee THE COMMONWEALTH OF MASSACHAETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 4plication for Disposal *pstem Construction 3permit Application for a Permit to Construct( ) Repair Upgrade Abandon( ) ❑Complete System ndividual Components Location Address or Lot No.�7 ����5 0�� Owner's Name,Address,and Tel.No 1,01V1 <C/I OCR Assessor's Map/ParcY,/ 3/ Ins 1�'s Name,Addr ,and Tel.No. /�`� G � Des' ne N e,d ress,apd Tel.No� Ito ��2l12�G `y�i� Type o Building: Dwelling No.of Bedrooms Lot Size 6 i ZS sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided � m gpd Plan Date Number of sheets Revision Date Title / Size of Septic Tank /p®d Type of S.A.S. 6"' Description of Soil Nature of Repairs or Alterations(Answer when applicable) �7� .—/� 5A 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 alth. SigftecL Date� �•�� Application Approved by T Date 9 2 2—1 Application Disapproved by Date for the following reasons Permit No. '2�it(t —3 l6 Date Issued 9 2 2—f j --------------------------------------------------------------------------------------------------------------------------------------- i Fee /Uv _.- No. THE COM WEALTH OF MAS`SAGHUSETTS Entered in computer:�✓✓ Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 0(pplitatlon for Disposal 6pstem (Construction Vermit ' Application for a Permit to Construct Repair �U rade Abandon Complete System v Individual Components PP ( ) P lr) Pg ( ) ( ) ❑ P Y P Location Address or of No. c/olzC f%/ Owner's Name,Addre s,a Tel.No O !C QL r I Assessor's Map/Parce Installer's N ,Ad and Tel No �// /�Ji �' D n �1 e ress d Te N r�Cv � 'i Type of Building: L/)"t r F� Dwelling No.of Bedrooms / Lot Size sq.ft. Garbage Grinder( ) Other Type of Building d✓S No.of Persons Showers( ) Cafeteria( ) ' Other Fixtures C/ { Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title �— Size of Septic Tank Type of S.A.S.10�5 CI_3 r Description of Soil 1 G i i i Nature of Repairs or Alterations(Answer when applicable) 41ece_.2 21�7/- 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 o . alt . Si ne i'��C.-. Date Application Approved by f Date Application Disapproved by Date for the following reasons Permit No. 2 U f/ Date Issued / ' ------------------ ------------------------ ------------------------------------- ----------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance �- a THISE TI IS TO CFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) 1 Abandoned( ' at ieen constructed in accordance a with the provisions of Title , and 1he-P r Di posal Sy`sTem Cons ruction Permit No.-LO t I _3 dated / ' 2 Installer /� Designer #bedrooms Approved design flow (1 gpd The issuance of this permits al��t�b�construed as a guarantee that the system will a'o de igned. Date I Inspector No. ° ' f ' 3I Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal *pstrm ZDnst Talon Jermit Permission is hereby granted to Construct( ) Repair(4 ) Upgrade( ) Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions orspecial conditions. 1 Provided:Construction must be completed within three years of the date of this permit. Date �- - Approved by Town of Barnstable ; '"E'a�.� Regulatory Services Thomas F. Geiler, Director 9 ""S& Public Health Division pTFa ' Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-362-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: 3 Sewage Permit 0Z J-A/1—:5,1 Assessor's Map\Parcel W t!�L�7 ol Designer: 1' Installer: V - C� Address: Address: / On issued a permit to install a (date) (installer) septic system at �� CAMEL 'e, T)24ly ebased on a design drawn by (address) v 1�01.k/ dated (designer) _J� I certify that=the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral reiocat on ollyth= 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 anli 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. OF Mgss9_ DA "ZA�-4 7" (Installer's Srunatur o.- 1140 -51E�`� V SANI TAR�1`� (Designer's Signatur ) (Affix Designer's Stamp Here) PLEASE RETURN TO B RNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF CONIPLiANCE 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 Fotm 3-264doc Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 357 Bumps River Rd Property Address Wendy Driscoll Owner Owner's Name information is required for every Osterville MA 02655 8-18-11 page. City/Town 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. A. General Information 1. Inspector: l Shawn Mcelroy Name of Inspector Upper Cape Septic Service Company Name 29 Atwater Dr Company Address E. Falmouth MA 02536 Cityrrown State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification I certify that I have personally inspected th e sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspetction. Th,e.inspection was performed based on my training and experience in the proper function and m?jntenance-of on sewage disposal systems. I am a DEP approved system inspector pursuant to-Z''ection 16.340 tifa Title 5 (310 CMR 15.000).The system: a -rl ® Passes ❑ Conditionally Passes ❑ Fails Wnspector's h Evaluation by the Local Approving Authority . f -3 r� I re 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. G Lff: t5ins-11/10 _ Title 5 Official Inspection Form:Subsurface Sewagaposal System•Pa/el of 17 • r Commonwealth of Massachusetts ' W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 357 Bumps River Rd Property Address Wendy Driscoll Owner Owner's Name information is required for every Osterville MA 02655 8-18-11 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: System is in good working order with no sign °y g g Ig of failure and operarating at about 75/o capacity. Recommend pumping tank and pit every 2 yrs for maintenance and to prolong life. 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 re pair, 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 exfiltrafion 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. El Y ❑ N ❑ ND (Explain below): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 357 Bumps Rarer Rd Property Address Wendy Driscoll Owner Owner's Name information is required for every Osterville MA 02655 8-18-11 page. CityTrown State Zip Code Date of Inspection B. Certification (cont.) 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: ❑ 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 357 Bumps River Rd Property Address Wendy Driscoll Owner Owner's Name information is required for every Osterville MA 02655 8-18-11 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**. p PP Y 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 1/day flow t5ins•11/10 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 357 Bumps River Rd Property Address Wendy Driscoll Owner Owner's Name information is required for every Osterville MA 02655 8-18-11 page. CitylTown 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`fires" 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 ❑ E 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 357 Bumps River Rd Property Address Wendy Driscoll Owner Owner's Name information is required for every Osterville MA 02655 8-18-11 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? ❑ ® 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 (f 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): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x #of bedrooms): 330 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary_Assessments 357 Bumps River Rd Property Address Wendy Driscoll Owner Owner's Name information is required for every Osterville MA 02655 8-18-11 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 8-2011 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-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 357 Bumps River Rd Property Address Wendy Driscoll Owner Owner's Name information is required for every Osterville MA 02655 8-18-11 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: N/A 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 357 Bumps River Rd Property Address Wendy Driscoll Owner Owner's Name information is required for every Osterville MA 02655 8-18-11 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (f known) and source of information: 1985 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 24 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.): Good condition. Septic Tank(locate on site plan): Depth below grade: 18"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 I` Dimensions: 1000 gal Sludge depth: 12 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 357 Bumps River Rd Property Address Wendy Driscoll Owner Owner's Name information is required for every Osterville MA 02655 8-18-11 page. Citylrown- 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 20 Scum thickness 4" Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and-outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. Recommend pumping for solids. 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•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 357 Bumps River Rd Property Address Wendy Driscoll Owner Owner's Name information is required for every Osterville MA 02655 8-18-11 page. City/Town 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: t 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•11110 .. Title 5 Official InspectionFmrm:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 357 Bumps River Rd �M Property Address Wendy Driscoll Owner Owner's Name information is required for every Ostefyille MA 02655 8-18-11 page. Cityfrown. 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.): Good condition with water at working level and no sign of back-up from pit. 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.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 357 Bumps River Rd Property Address Wendy Driscoll Owner Owner's Name information is required for every Osterville MA 02655 8-18-11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1-1000 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.): Leach pit in good condition with water level and stain line at 16" below inlet invert. 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•11/10 Titie 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 �M r 357 Bumps River Rd Property Address Wendy Driscoll Owner Owner's Name information is required for every Osterville MA 02655 8-18-11 page. Cityfrown 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 357 Bumps River Rd Property Address Wendy Driscoll Owner Owner's Name information is required for every Osterville MA 02655 8-18-11 page. CitylTown 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 �4L1: . � L t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 357 Bumps River Rd Property Address Wendy Driscoll Owner Owner's Name information is required for every Osterville MA 02655 8-18-11 page. CitylTown 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: 30' 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: 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: USGS and town maps show groundwater at 30'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 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 357 Bumps Rarer Rd Property Address Wendy Driscoll Owner Owner's Name information is required for every Osterville MA 02655 8-18-11 page. Cityfrown 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•11/10 Title 5 Official Inspecton Form:Subsurface Sewage Disposal System-Page 17 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 34 Circle Dr Property Address Leon Michelove Owner Owner's Name information is required for every Hyannis MA 02601 8-17-11 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. A. General Information D . 1. Inspector: , I Shawn Mcelroy Name of Inspector Upper Cape Septic Service Company Name 29 Atwater Dr Company Address E. Falmouth MA 02536 Cityrrown State Zip Code 1-508-495-0905 S13971 Telephone Number License Number LU B. Crtification E I cert4that I have personally inspected the sewage disposal system at this address and that the e information reported below is true, accurate and complete as of the time of the inspection. The inspection U.- � was performed based on my training and experience in the proper function and maintenance of on site sewage,dsposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(3;1�0 CMR 15.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 8-18-11 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 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. t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 I r Commonwealth of Massachusetts � v Title 5 Official Inspection Form l; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 34 Circle Dr Property Address Leon Michelove Owner Owner's Name information is required for every Hyannis MA 02601 8-17-11 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 34 Circle Dr Property Address Leon Michelove Owner Owner's Name information is required for every Hyannis MA 02601 8-17-11 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 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): ❑ o 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 pipes) 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: ❑ 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-11/10 TMe 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 f Commonwealth of Massachusetts iu r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 34 Circle Dr Property Address Leon Michelove Owner Owner's Name information is required for every Hyannis MA 02601 8-17-11 - page. Citylrown 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 day flow t5ins-11/10 Title 6 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. 34 Circle Dr Property Address Leon Michelove Owner Owner's Name information is required for every Hyannis MA 02601 8-17-11 page. City/Town 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 I . ❑ ❑ 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 ❑ El the system is located in.0. 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ' M10 34 Circle Dr Property Address Leon Michelove Owner Owner's Name information is required for every Hyannis MA 02601 8-17-11 page. City1rown 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? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ 0 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 facilityowner and occupants if different from owner provided with ® ❑ ( p ) 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 (f 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): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x #of bedrooms): 440 t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 34 Circle Dr Property Address Leon Michelove Owner Owner's Name information is required for every Hyannis MA 02601 8-17-11 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 8-2011 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•11/10 , Title 5 Official Inspecfion Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 34 Circle Dr Property Address Leon Michelove Owner Owner's Name information is required for every Hyannis MA 02601 8-17-11 page. Cityrrown 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: Owner--pumped 2yrs ago Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: Maintenance 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments. wM ' 34 Circle Dr Property Address Leon Michelove Owner Owner's Name information is required for every Hyannis MA 02601 8-17-11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (f known) and source of information: 1980 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 30" 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.): Good condition. Septic Tank(locate on site plan): Depth below grade: 24"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 gal Sludge depth: $ t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 34 Circle Dr Property Address Leon Michelove Owner Owner's Name information is H required for every annis MA 02601 8-17-11 -y page. Cityrrown 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 24 Scum thickness 0 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 16" How were dimensions determined? Tape Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 34 Circle Dr Property Address Leon Michelove Owner Owner's Name information is required for every Hyannis MA 02601 8-17-11 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 34 Circle Dr Property Address Leon Michelove Owner Owner's Name information is required for every Hyannis MA 02601 8-17-11 page. City/Town 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.): D-box in good working order with stain lines above inlet invert. 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.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 34 Circle Dr Property Address Leon Michelove Owner Owner's Name information is required for every Hyannis MA 02601 8-17-11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1-1000 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.): Leach pit holding water at 16" below inlet with stain lines above inlet invert. 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•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 34 Circle Dr Property Address Leon Michelove Owner Owner's Name information is required for every Hyannis MA 02601 8-17-11 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 34 Circle Dr Property Address Leon Michelove Owner Owner's Name information is required for every Hyannis MA 02601 8-17-11 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 . n Q�y rc A t vp Ll l- _0.- t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 q Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 34 Circle Dr Property Address Leon Michelove Owner Owner's Name information is required for every Hyannis MA 02601 8-17-11 page. Citylrown 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: 16' 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: 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: USGS and town maps show groundwater at 16'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 I V Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 34 Circle Dr Property Address Leon Michelove Owner Owner's Name information is required for every Hyannis MA 02601 8-17-11 page. CityTrown 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Town.of B rmstable. P# Department of Regulatory.Services t[ 1 ' Public HealthDivision Date � T I Aster press. 16 q. ems$ 200 Main Street;Hyannis MA 02601 Date Scheduled Time Fee Pd. i oil Suitability Assess�aient for Sew e Disposal • � 6• d, �/� i messed B I tit' �`-' `—' Performed By � LOCATION & GENERAL INFORMATION Location Address . ( Owner's Name l t� ,�r� (0111(tte SO CAP-(-Z� D P,--- 1 q • H�/`•Q-)",/j,//�s :'1�'L� I Address Assessor's Map&4rcel: K6/ at 0I Engineer's Name t, q +V� Lt- NEW CONS1ZtUtON REPAIR Telephone# '�� " °li Land Use ( 111117� Slopes(%) '� J Surface Stones ;I Distances from: Open Water Body > L ft Possible Wee Area ft Drinking Water Well� �' ft i ptainage Way ft Property Line > 1 0 ft Other ft SKETCH:($treet name,dimensiods'of lot,exact locations of test holes&Pere tests,locate wetlands in proximity to holes) 1 . • �(15S•1'GNKG 1. • , zz 4m \ L,J � W�, rfd r `� O Q ENCLOSED X — - J PORCH 0 O w o Iw - -- - oa \ it GARAGE �(15(•IP.P`Ip Uom iw.r sea te n , n ;0 I i ' I j i iI ' 010'(A L•j G b �l�t"� Depth to Bedrock .____ . Parent material(geologic) Depth to Groundwaker: Standing Water in Hole:' Weeping from Pit Pace Estimated Seasonal;High Groundwater DtTERMINATION FOR SEAS O�- AL HIGH WATER TALE Method Used: C L -,j1,') Id, I&C �o-��> 1. In. Depth Observed standing in obs.hole: in. Depth 10 sb11111utllk's: Depth toiweeping from side of obs.hole: ! in, Oroundwnter AdJustment f• f q� ! _ A .A tar. ,.,,--__;AdJ..0roundwaterl eyel. Index Well# Reading Date Index Well levdl --- """ rVI)UJ- PERCOLATION TEST • Dateln�� Observation f I Tittle at 9" Hole# I i �p Depth of Pere ✓ Time at G" l I i Time(9"-6") Start Pre-soak Time.0 End Pre-soak (L— . I Rate MinJlnch Site Suitability Assessment Site Passed• X Site Failed; Additional Testing Needed(YIN) i Original:.Public He$lth Division Observation Hole Data To De Completed on Back--- ***If percola#6n test is to be conducted within 100' of wetland,.-you must first notify the , Barnstable C4#servation Di-dsion at least one(1)wedk prior to beginning. r 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 t►v 11 g p pia, 5 v 0-vi rz-k ►� tit. -kil Ifs DEEP OBSERVATION HOLELOG , Hole# `V Depth from Soil Horizon' Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel) ll0-13 b (A 11-jggJ 7 DEEP OBSERVATION HOLE LOG Hole# Depth from' Soil Horizon Soil Texture Soil Color Soil ther Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Cons istencv.%Gravel DEEP OBSERVATION HOLE LOG Hole#14�— Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) ,(USDA) (Munsell) Mottling (Structure,Stones.Boulders. Consistency. ra I E Flood Insurance Rate Mati: Above 500 year flood boundary No_ Yes 4. Within100 year boundary No_ Yes Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervi u 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 nn I certify that on t (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis w`as performed by me consistent with ' the requir i , se land experience described in 3.10 CMR 1.5.017. Signature Q:\.SEPTICIPERCFORM.DOC r kF a, Jr v Permit Number: Date: -1 Completed by: HIGH GROUND-WATER LEVEL COMPUTATION Site Location: Lot No. Owner: Address: Contractor: Address: Notes: STEP 1 Measure depth to water table to nearest.1/10 ft. ............................. .......... .Date - month/ ay/year STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: OAppropriate index well..............................:..................... M J W ( Water-level range zone ..................................................... . STEP 3 Using monthly report"Current Water Resources Conditions" determine current depth to water level for index well ........................... m th/y ar STEP .4 Using Table of Water-level Adjustments for index well (STEP 2A), current depth to water level for index well (STEP 3), and water-level zone (STEP 2B) 3,� determine water-level adjustment .......................................................................................... STEP 5 Estimate depth to high water by subtracting the water- level adjustment (STEP 4) from measured depth to water levelat site (STEP 1} .........................................................:..................................................... r i_ f� a t� Bch Ch 'e :CotA C dwhtf-0 0>7d ©f AveIll, 1� _AN 3 u� f4 I P � � P y ^ N# d. w. 4. i,�114Cum-, rtVA4� cl, ,LkU^ w�e.l� u,14� r" �4dt �w,� 1, Sa �ec� 6�,M���,�1� 11 7 . F Table 1. Potential water-level rise,in feet,for use with index .. Table 1. Potential water-level rise,in feet,for use with index well.Barnstable Al.W 40 well Barnstable Al W430-Continued. WATER ZONE A ZONE B ZONE C ZONE D ZONE E WATER ZONE A ZONE B ZONE C ZONE D ZONE E LEVEL LEVEL 20•.5 0.0 0.0 0.0 0_0 0.0 26.0 2.8 3.7 5.5 7.3 . 8.3 20-.6 0.1 0.1 0.1 0.1 6.2 26.1 2.8 3.7 5.6 7.5 8.4, 20.7 0.1 0.1 0..2 0.3 0.3 26.2 2.9 3.8 5.7 7.6 8.6 20.8 0.2 . 0.2 0.3 0.4 0.5 26.3 . 2.9 3.9 5.8 7.7 8.7 20.9 0.2 0.3 0.4 0.5 0.6 26.4 3.0 3.9 5.9 7.9 8.9 21.0 0.3 0.3 6.5 0.7 0.8 26.5 3.0 4.0 6.0 8.0 9.0 21.1 0.3 0.4 0.6 0.8 0.9 26.6 3.1 4.1 6.1 . 8.1 9.2 21.2 0.4 0.5 0.7 0.9 1.1 26.7 3.1 4.1 6.2 8A 9.3 21.3 0.4 0.5 0.8 1.1 1.2 26.8 3.2 4.2 6.3 8.4 - 9.5 21.4 .0.5 0.6 0.9 . 1.2 1.4 26.9 3.2 4.3 6.4 8:5 9.6 21.5 0.5 0,7 1.0 1.3 . 1.5 27.0 3.3 4.3 6.5 8.7 9.•e 21.6 0.6 0.7 1.1 1.5 1.7 27.1 3.3 4.4 6.6 8.8 9.9 21.7 0.6 0.8 1.2 1.6 1.8 27.2 3.4 4.5 6.7 8.9 10.1 21.8 0.7 0.9 1.3 1.7 2.0 27.3 3.4 4.5 6.8 9.1 10.2 21.9 0.7 -0.9 1.4 1.9 2_.1 27,4 3.5 4.6 6.9 9.2 10.4 22.0 0.8 1.0 1.5 2.0 2.3 27.5 3.5 4.7 7.6 9.3 10.5 22.1 0.8 1.1 1.6 2.1 2.4 27:6 . 3.6 4.7 7.1 9.5 10.7 22.2 0.9 1.1 1.7 2.3 2.6 27.7 3.6 4.8 7.2 9.6 10.8 22.3 0.9 1.2• 1.8 2.4 2:7 27.8 3.7 4.9 7.3 9.7 11.0 22.4 1.0 1.3 1.9 2.5 2.9 27.9 3.7 4.9 7.4 9.9 11.1 22.5 1.0 1.3 2.0 2.7 3.0 28.0 3.8 5.0 7.5 10.0 11.3 22.6 1.1 1.4• 2.1 2.8 3.2 28.1 3.8 5.1 7.6 10.1 11.4 22.7 1.1 1.5 2.2 2.9. 3.3 28.2 3.9 5.1 7.7 10.3 11.6 22.B 1.2 1.5 2.3 3.1 3.5 28.3 3.9 5:.2 7.8 10.4 11.7 22.9 1.2 1.6 2.4 3.2 3.6 28.4 4.0 5.3 7.9 10.5 11.9 23.0 1.3 1..7 2.5 3.3 ' 3.8 28.5 4.0 5.3 8.0 10.7 12 A 23.1 1.3 1.7 2.6 3.5 3.9 28.6 4.1 5.4 8.1 10.8 12.2 23.2 1.4 1.8 2.7 3.6 4.1 28.7 4.1 5.5 8.2 10.9 12.3 23.3 1.4 1.9 2.8 3.7 4.2 28.8 4.2 5.5 8.3 11.1 12.5 23.4 1.5 1.9 .2.9 3.9 4.4 28.9 4.2 5.6 8.4 11.2 12.6 23.5 1.5 2.0 3.0 4.0 4.5 29.0 4.3 5.7 8.5 11.3 12.8 23.6 1.6 2.1 3.1 4.1 4.7 29.1 4.3 5.7 8.6 11.5 12.9 23.7 1.6 2.1 3.2 4.3 4.8 29.2 4.4 5.8 8.7 11.6 13.1 23.8 1.7 2.2 3.3 4.4 5.0 29.3 4..4 5.9. 8.8 11.7 13.2 23.9 1..7 2.3 3.4 4.5 5.1 29.4 4.5 5.9 8.9 11.9 13.4 24.0 1.8 2.3 3.5 4.7 5.3 29.5 4.5 6.0 9.0 12.0 13.5 24.1 .1.8 2.4 3.6 4.8 5.4 29.6 4.6 6.1 9.1 12.1 13.7 24.2 1.9 2.5 3.7 4.9 5.6 29.7 4.6 6.1 9.2 12.3 13.8 24.3 1.9 2.5 3.8 5.1 5.7 29.8 4.7 6.2 9.3 12.4 14.0 24.4 2.0 2.6 3.9 5.2 5.9 29.9 4.7 6.3 9.4 12:5 14.1 24.5 2.0 2.7 4.0 5.3 _ 6.0 30.0 4.8 6.3 9.5 12.7 14.3 24.6 2.1 2.7 4.1 5.5- 6.2 30.1 4.8 6.4 9.6 12.8 14.4 24.7 2.1 2.8 4.2 5.6 6.3 30.2 4.9 6.5 9.7 12.9 14.6 24.8 2.2 2.-9 4.3 5.7 6.5 30.3 4.9 6.5 9.8 13.1 14.7 24.9 2.2 2.9 4.4 5*9 6.6 30.4 5.0 6.6 9.9 13.2 14.9 25.0 2.3 3.0 4.5 6.0 6.8 30.5 5.0 6.7 10.0 13.3 15.0 25.1 2.3 3.1 4.6 6.1 6.9 30.6 . 5.1 6.7 10.1 13.5 15.2 . 25.2 2.4 3.1 4..7 6.3 7.1 30.7 5.1 6.8 10.2 13.6 15.3 25.3 2.4 3.2 4.8 6.4 7.2 30.8 5.2 6.9 10.3 13.7 15.5 25.4 2.5 3.3 4.9 6.5 7.4 30.9 5.2 6.9 10.4 .13.9 15.6 25.5 2.5 3.3 5.0 6.7 7.5 31.0 5.3 7.0 10.5 19:0 15.8 25.6 2.6 3.4 5.1 6.8 7.7 31.1 5.3 7.1 10.6 14.1 15.9 25.7 2.6 3.5 5.2 6.9 7.8 31.2 5.4 7.1 10.7 14.3 16.1 25.8 2.7 3.5 5.3 7.1 8.0 31.3 5.4 7.2 10.8 14.4 16.2 25.9 2.7 3.6 5.4 7.2 ` e,l 31.4 5.5 7.3 10.9 -14.5 16.4 I f Table 2. Potential water-level rise,in feet,for use with Table 2. Potential water-level rise,in feet,for use with index well Barnstable AlW--247 index well Barnstable Al W-247-Continued WATER ZONE.A ZONE B ZONE C ZONE D WATER ZONE A ZONE B ZONE C ZONE D LEVEL LEVEL 20.7 0.0 0.0 0.0 0.0 25.7 3.3 5.0 6.7 8.3 20.8 0.1 0.1 0.1 0.2 25.8 3.4 5.1 6.8 8.5 20.9 0.1 0.2 0.3 0.3 25.9 .• 3.5- 5.2 6..9 8.7 21.0 0.2 0.3 0.4 0.5 26.0 3.5 5.3 7.1 8.8 21.1 0.3 0.4 . 0.5 0.7 26.1 3.6 5.4 7.2 9.0 21.2 0.3 0.15 0.7 0.8 26.2 3.7 5.5 7.3 9.2 21.3 0,4 0.6 0.8 1.0 26.3 3.7 5.6 7.5 9..3 21.4' 0.5 0.7 0..9 1.2 26.4 3.8 5.7 7.6 9.5 21.5 0.5' 0.8 1.1 1.3 26.5 3.9 5.8 -7.7 9.7 21.6 0.6 0.9 1.2 1.5 26.6 3.9 5.9 7.9 9.8 21.7 0.7 1.0 1.3 1.7 26.7 4.0 6.0 8.0 10.0 21.8 0.7 1.1 1.5 1.8 26.8 4.1 6.1 B.1 10.2 21.9 0.8 1.2 1.6 2.0 26.9 4.1 6.2 8.3 10.3 22.0 0.9 1.3 1.7 2.2 27.0 4.2 6.3 8.4 10.5 22.1 0.9 1.4 1.9 2.3 27.1 4.3 6.4 8.5 10.7 22.2 1.0 1.5 2.0 2.5 27.2 4.3 6.5 8.7 10.8 22.3 1.1 1.6 2.1 2.7 27.3 4.4 6.6 8.8 .11.0 22.4 1.1 1.7 2.3 2.8 27.4 4.5 6.7 8.9 11.2 22.5. 1.2 1.8 2.4 3.0 27.5 4.5 6.8 9.1' 11.3 22..6 1.3 1.9 2.5 3.2 27.6 4.6 6.9 9.2 11.5 22.7 1.3 2.0 2.7 3.3 27.7 4.7 7.0 9.3 11.7 22.8 1.4 2.1 2.8 3.5 27.8 4.7 7.1 9.5 11.8 22.9 1.5 2.2 2.9 3.7 27.9 4.8 7.2 9.6 12.0 23.0 1.5 2.3 3.1 3.8 .28.0 4.9 7.3 9.7 12".2 23.1 1.6 2.4 3.2 4.0 28.1 4.9 7.4 9.9 12.3 23.2 1.7 2.5 3.3 4.2 28.2 5.0 7.5 10.0 12.5 23.3 1.7 2.6 3.5 4.3 28.3 5.1 7.6 10.1 12.7 23.4 .1.8 2.7 3.6 4.5 28.4 5.1 7.7 10.3 12.8 23.5 1.9 2.8 3.7 4.7 28.5 5.2 7.8 10.4 13.0 23.6 1.9 2.9 3.9 4.8 28.6 5.3 7,9 10.5 13.2 23.7 2.0 3.0 4.0 5.0 28.7 5.3 8.0 10.7 13.3 23.8 2.1 3.1 4.1 5.2 . 28.8 5.4 8.1 .10•.8 13.5 23.9 2.1 3.2 4.3 5.3 28.9 5.5 8.2 10.9 13.7 24.0 2.2 5.3 4.4 5.5 29.0 5.5 8.3 11.1 13.8 24.1 2.3 3.4 4.5 5.7 29.1 5.6 8.4 11.2 14.0 24.2 2.3 3.5 4.7 5.8 29.2 5.7 8.5 11.3 14.2 24.3 2.4 3.6 4.8 6.0 29.3 5.7 8.6 11.5 14:3 24.4 2.5 3.7 4.9 6.1 29A 5.8 8.7 11.6 14.5 24.5 2.5 3.8 5.1 6.3 29.5 5.9 8.8 11.7 14.7 24.6 2.6 3.9 5.2 6.5 29.6 5.9 8.9 11.9 14.8 24.7 2.7• 4.0 5.3 6.7 29.7 6.0 9.0 12.0. 15.0 24'.8 2.7 4.1 5.5 . 6.8 29.8 6.1 9.1 12.1 15.2 24.9 2.8 4.2 5.6 7.0 29.9 6.1 9'.2 12.3 15.3 25.0 2.9 4.3 5.7 7.2 30.0 6.2 9.3 12.4 15.5 25.1 2.9 4.4 5.9 7.3 . 30.1 6.3 9.4 12.5 15.7 25.2 3.0 4.5 6.0 7.5 30.2 6.3 9.5 12.7 15.8 25.3 3.1 4.6 6.1 7.7 30.3 6.4 9.6 .12.8 16.0 25.4 3.1 4.7 6.3 7.8 30.4 6.5 9.7 12.9 16.2 25.5 3.2 4.8 6.4 8.0 30.5 6.5 9.8 13.1 16.3 25.6 3.3 4.9 6.5 8.2 30.6 6.6 9.9 13.2 16.5 ((1 I � 7 Table 2. Potential water-level rise,in feet,for use with index well BarnstableAXW-247-Continued WATER - ZONE A ZONE B ZONE C ZONE D •LEVEL 30.7 6.7 10.0 13:3 16.7 30.8 6.7 10.1 13.5 16.8 30.9 6.8 10.2 13.6 17.0 31.0 6.9 10.3 13.7 17.2 31.1 6.9 10.4 13.9 17.3 31.2 7:0 10.5 14.0 17.5 31.3 7.1 10.6 14.1 17.7 31.4 7.1 10.7 14.3 17.8 31.5 7.2 10.8 14.4 18.0 31.6 7.3 10.9 14.5 18.2 31.7 7.3 . 11.0 14.7 18.3 31.8 7.4 11.1 14.8 18.5 31.9 7.5 11.2 14.9 18.7 32.0 7.5 21.3 15.1 18.8 .32.1 7.6 11.4• 15.2' 19.0 32.2 7.7 11.5 15.3 19.2 32.3 7.7 11.6 15.5 19.3 32.4 7.8 1,1..7 15.6 19.5 32.5 7.9 11.8 15.7 19.7 32.6 7.9 11.9 15.9 19.8 32.7 8.0 12.0 16.0 20.0 32.8 8.1 12.1 16.1 20.2 32.9 8.1 12.2 16.3 20.3 33.0 8:2 12.3 16.4 20.5 33.1 8.3 12.4 16.5 20.,7 33.2 8.3 12.5 16.7 20.8 33.3 8.4 12.6 16.8 21.0 33.4 8.5 12.7 16.9 21.2 33.5 8.5 12.8 17.1 21.3 33.6 8.6 12.9 17.2 21.5 Supplement Table 5.. Potential water-level rise, in feet,for use'with index well Mas MIW-29 WATER ZONE A ZONE B ONE C ZONE D LEVEL 5.7 0.0 0.0 0.0 0.0 5.8 0..1 0.1 0.1 0.2, 5.9 0.1 0.2 0.3 0.3 _ 6.0 0.2 0.3 0.4 0.5 - 6.1 0.3 0.4 0.5 0.7 6.2 0.3 0.5 0.7 0.8 6.3 0.-4 0.6 0.8 1;0 6.4 0.5 .0.7 0.9 1 .2 6.5 Y 0.5 0.8 1 .1 1.3 6,6 -0.6 0.9 .1 .2 1 :5 6.7 0.7 1 :0 1.3 .1 .7 6.8 0.7 1 .1 .1 .5 1.8 6.9 0.8 1 .2' 1 .6 2.0 7.0 a 0.9 1 .3 1 .7 2.2 7.1 0.9 1 .4 1 .9 .2.3 7.2 1.0 1 .5 .2.0 2.5 7..3 1.1 1 .6. 9.1 2.7 7.4 1.1 1 .7 2.3 2.8 7:5 1.2 1 .8 2.4 3.0 7.6 1.3 1 .9 2.5 ' 3.2 7.7 1.3 2.,0. 2.7 3.3 7.8 1.4 2.1 2.8 3.5 •7.9 1.5 2.2 2.9 3.7 8.0 1.5 2.3 3.1 3.8 8.1 1 .6. 2.4 3.2 4.0 1 .7 2.5 4.2 8.3 1.7 2.6 3.5 4.'3 8.4 1 .8 2.7 3.6 4.5 8.5 1 .9 2.8 3.7 4.7 8.6 1 .9 2.9 3.9 4.8 8.7 2.0 3,0 4.0 5.0 8.8 2.1 3.1 4.1 5.2 8.9 2.1 3.2 4.3 5.3 9.0 2.2 3.3 4:4 5.5 Supplement Table 5. Potential water-level rise, in feet, for' use-with.index well Mashpee MIW-29 WATER. ZONE A ZONE B ZONE C ZONE D LEVEL . 9.1 2.3 3.4 4•.5, 5.7 9.2 2.3 3.5 4.7 5.8 9.3 2.4 3.6 4.8 6.0 9.4 2.5 3.7 4.9 6.2 9.5 2.5 3.8 5.1 6.3 9.6 2.6 3.9 5.2 6.5 9.7 2.7 4.0 5.3 6.7 9.8 2.7 4.1 5.5 6.8 9.9 2.8 4.2 5.6 7.0 10.0 2.9 4.3 5.7 7.2 10.1 2.9 4.4 5.9 • 7.3 10.2 3..0 4.5 6.0 7.5 10.3 3.1 4.6 6.1 7.7 10.4 3.1 4.7 6.3 7.8 10.5 3.2 4.8 6.4 8.0 10.6 3.3 4.9 6.5 .8 2 10.7 3.3 5.0 6.7 8.3 10.8. 3.4 5.1 . 6.8 8.5 10.9 3.5 5.2 6.9 8.7 11 .0 3.5 5.3 - 7.1 8.8 11 .1 3.6 5.4 7.2 9.0 11 .2 3.7 5.5 7.3 9:2 11 .3 3.7 5.6 7.5 9.3 11 .4 3.8 5.7 7.6 9.5 11 .5 3.9 5.8 7,7 9.7 11 .6 3.9 5.9 7.9 9.8 11 .7 4.0 6.0 8.0 10.0 11 :8 4.1 .6.1 8.1 10.2 11 .9 4.1 6.2 8.3 10.3 1.2.0 4.2. 6.3 8.4 10.5 12.1 4.3 6.4 8.5 10.7 12.2 4.3 6.5 8.7 10:8 12.3 4.4 6.6 8.8 11 .0 12.4 4.5 6.7 8.9 1 1 .2 Supplement Table Potential water-level rise,in feet,for use with index well Mashpee MIW-29 WATER ZONE A ZONE B ZONE C ZONE D LEVEL 12.5 4.5 6.8 9.1 12.6 4.6 6.9 9-.2 11.5 12.7 4.7 7.0 9.3. 11'.7 12.8 4.7 7.1. 9.5 12.9 4.8 7.2 9.6 12.0 13.0 4.9 7.3 9.7 12•:2 -13.1 4.9 7.4 9.9 12.3 13.2 5.0 7.5 10-.0 12..5 13.3 5.1 7.6 1.0.1 12.7 13.4 5.1 7.7. 10.3 12.8 13.5 5:2 7.8 10.4 ' 13.0 18.6 5.3 7.9 10.5 13.2 13:7 5.3 810 .10.7 13,3 13.8 5.4 8.1 10.8 13..5 13.9 5.5 8.2 10.9 13.7 14.0 5:5 8.3 11 .1 13.8 14.1 -5,6 8.4 11.2 14.0 14.2 5.7 8.5 11 .3 14.2 14.3 5.7 8.6 1 1 .5 14.3 14.4 5.8 8.7 11 .6 14.5 14.5 5.9 . 8.8 11 .7 14.7 14.6 5.9 8.9 11 .9 '14.8 14.7 6.0 9.0 12.0 15.0 14.8- 6.1 9.1 12.1 15.2 14.9 6,.1 9.2 12.3 15.3 15.0. 6.2 9.3 12.4 15.5 15.1 6.3 9.4 12.5 15.7 Uj Supplement"Table 6. Potential water-level rise, in feet,for use with index well Sandwich-252 WATER ZONE A ZONE B ZONE C" ZONE D LEVEL 45.9 . 0.0 0.0 0.0 0.0 46.0 0.1 0.2 0.2 0.3 .46.1 0.2 0.3 0.4 . -0.5 46.2 0.3 0.5 0.6 0.8 46.3 0.4 0.6 0.8 .1.0 46.4 0.5 0.8 1 .0 1.3 4.6.5 0.6 0.9 1 .2 1 .5 46.6 0.7 1 .1. 1 .4 1.8 46.7 0.8 1 .2 1 .6 -2.0 46.8 0.9 . 1 .4 1 .8 .2.3 46.9 1.0 1 .5 2.0 2.5 47.0 1.1 1.7 2.2 2.8 47.1 1 .2 1 .8 2.4 3.0 47.2" 1 .3 2.0 2.6 3.3 47.3 1 .4 2.1 2.8 . 3..5 47.4 1 .5 2.3 3.0 3.8 47.5 1 .6 2.4 3.2 .4.0 47.6 1 .7 2.6 3.4 4.3 47.7 1 .8 2.7 3.6 4.5 47.8 1 .9 2.9 3.8 4.8 47.9 2.0 3.0 4.0 5.0 " 48.0 . 2.1 3.2 4.2 5.3 48.1 2.2 . 3.3 4.4 5.5 48-2 2.3 3.5 4.6 5.8 48.3. 2.4 3.,.6 4.8 6.0 y' 48.4 2.5 3:8 5.0 6.-3 . 48.5 2.5 ,=3g~- 5.2 6.5 4$.6 2.7 4.1 5.4 6.8 48.7 2.8 4.2 5.6 • 7.0 48.8 2.9 4.4 5.8 7.3 48.9 3.0 4.5 6.0, 7.5 49.0 3.1 4.7 6.2 7.8 49.1 3.2 4.8 6.4 8.0 7 Supplement Table 6. Potential water-level rise,in feet,.for use with index well Sandwich-252 WATER ZONE A ZONE B ZONE-C ZONE D LEVEL 49.2 3.3 5.0 6.6 8.3 49.3 3.4 5:1 6.8 8.5 49.4 3.5 5.3. 7.0 8.8 49,5 3.6 5.4 7.2- . 9.0 .49.6 3.7 5.*6 7.4 9.3 49.7 3.8 5.7 7.6 9.5 49.8 .3.9 5.9 7.8 9.8 49.9 4.0 6.0` 8.0 1.0:0 50.0 . . 4.1 6.2 8.2 10.3' 50.1 4.2 6.3 8.4 10.5 50.2. 4.3 6.5 8.6 10.8 .50.3 4.4 6.6 8.8 1 1 .0 50.4 4.5 6.8 9.0• 1 1 -.3 50.5 4.6 6..9 9.2 11-.5 5'0'.6 4.7 7.1 9..4 11 .8 50.7 4.8 7.2 9.6 12.0 50.8 4.9 7.4 9.8 12.3 50.9 5.0 7.5 10.0 12.5. 51 .0 5.1 7.7 . 10.2 12.8 . 51 .1 5.2 - 7.8. 10.4 13.0 51 .2 .5.3 8.0 10.6 13.3 51 .3 5.4 8.1 10.8 13.5 51 .4• 5.5. 8.3 11 .0 13.8 51 .5 5.6 8.4 11 .2 14..0 51 .6 5.7 8.6 11 .4 14.3 51 .7 5.8 8.7 1 1 .6 14.5 51 .8 5.9 8.9 11 .8 14.8 61 .9 6.0 9.0 12.0 15.0 52.0 6.1 9.2 12.2 15'3 52.1 6.2 9.3 12.4 15.5. 52.2 6.3 9.5. 12.6 15.8 52.3' 6.4 9.6 12.8 16.0 52.4 6.5 9.8 13.0 w 16.3 -,2.: 3' Table 7. Potential water-level rise,in feet,for use Table 7. Potential water-level rise,in feet,for use with index well Sandwich SDW-253 with index well Sandwich SDW-253-Continued WATER ZONE A ZONE B ZONE C WATER ZONE A ZONE B ZONE C LEVEL LEVEL 45.8 0.0 0.0 0.0 50.8 3..3 5.0 6.7 45.9 0,1 0.1 0.1 50.9 3.4 5.1 6.8 46.0 0.1. 0.2 0.3 51.0 3.5 5.2 6.9 46.1 0.2 0.3 0.4 51.1 3.5 5.3 7.1. 46.2 , 0.3 0.4 0.5 51.2 3.6 5.4 7.:2 46.3 0.3 0.5 0.7 51.3 3.7 5.5 7.3 46.4 0.4 0.6 0.8 51.4 3.7 5..6 7.5 ' 46.5 0.5 0.7 0.9 51.5 3.8 5.7 7.6 46.6 0.5 0.8 1.1 51.6. 3.9 5.8 7.7 46.7 0.6 0.9 1.2 51.7 3.9 5.9 .7.9 46.8 0.7 1.0 1.3 51.8 4.0 6.0 8.0 46.9 0.7 1.1 1.5 51.9 4.1 6.1 8.1 47.0 0.8 1.2 1.6 52.0 4.1 6.2 8.3 47.1 0.9 1.3 1.7 52.1 4:2 6.3 8.4 47:2 0.9 1.4 1.9 52.2 4.3 6.4 8.5 47.3 1.0 1.5 2.0 52.3 4.3 6.5 8.7 ` 47.4 1.1 1.6 2.1 52.4 4.4 6.6 8.8 47.5 1.1 1.7 2.3 52.5 4.5 6.7 8.9 47.6 1.2 1.8 2.4 52.6 4.5 6.8 9.1 _ 47.7 1.3 1.9 2.5 52.7 4.6 6.9 9.2 47.8 1.3 2.0 2.7 52.8 4.7 7.0 9.3 47.9 1.4 2.1 2.8 52.9 4.7 7.1 9.5 48.0 1.5 2.2 2.9 53.0 4.8 7.2 9.6 48.1 1.5 2.3 3.1 53.1 4.9 7.3 9.7 48.2 1.6 2.4 3.2 53.2 4.9 7.4 9:9 48.3 1.7 2.5 3.3 53.3 5.0 7.5 10.0' 48.4 1.7 2.6 3.5 53.4 5.1 7.6 10.1 48.5 1.8 2.7 3.6 53.5 5.1 7.7 10.3 48.6 1.9 2.8 3.7 53.6 5.2 7.8 10.4 48.7 1.9 2.9 3.9 53.7 5.3 7.9 10.5 48.8 2.0 3.0 4.0 53.8 5.3 8.0 10.7 48.9 2.1 3.1 4.1 53.9 5.4 8.1 10.8 49.0 2.1 3.2 4.3 54.0 5.5 8.2 10.9 49.1 2.2 3.3 4.4 54.1 5.5 8.3 _ 11.1 49.2 2.3 3.4 4.5 54.2 5.6 8.4 11.2 49.3 2.3 3.5 4.7 54.3 5.7 8,5 11.3 49.4 2.4 3.6 4.8 54.4 5.7 8.6 11.5 ' 49.5 2.5 3.7 4.9 54.5 5.8 8.7 11.6 49.6 2.5 _ 3.8 . 5.1 54.6 5.9 8.8 11.7 49.7 2.6 3.9 5.2 54.7 5.9 8..9 11.9 49.8 2.7 4.0 5.3 54.8 6.0 9.0 12.0 49.9 2.7 4.1 5.5 54.9 6.1 9.1 12.1 .50.0 2.8 4.2 5.6 55.0 6.1 9.2 12.3 50.1 2.9 4.3 5.7 55.1 6.2 9.3 12.4 50.2 2.9 4.4 5.9 55.2 6.3 9.4 12.5 50.3 3.0 4.5 6.0 55.3 6.3 9.5 12.7 50.4 3.1 4.6 6.1 55.4 6.4 9.6 12.8 50.5 3.1 4.7 6.3 55.5 6.5 9.7 12.9 50.6 3.2 4.8 6.4 55.6 6.5 9.8 13.1 50.7 3,3 4.9 6.5 55.7 6.6 9.9 13.2 1 _ - Supplement Table 6. Potential water-level rise, in-feet, for use with index well Sandwich-252. WATER ZONE A ZONE B ZONE C. ZONE D LEVEL 52.5 6.6 9.9 13.2 - 16.5 52.6 6.7 10.1 13.4 •16.8 52.7 6.8 10.2 13.6 17.0 52.8 6.9 10.4 13.8 17.3 52.9 7.0 10.5 14.0 17.5 53.0 7.1 10.7. . `14.2 ; 17.8 Y 53.1 7.2 10.8 14.4 18.0 53.2 7.3 11 .0 1:4.6 18.3 S 2 5- 3 Table 7. Potential water-level rise,in feet,for use with'index uiell Sandwich SDW-253-Continued WATER ZONE .A ZONE B ZONE C LEVEL 55.8 6.7 10.0 13.3 55.9 6.7 .10.1 13.5 56..0 6.8 10.2 13.6 56.1 6.9 10.3 13.7 56.2 6.9 10.4 13.9 56.3 7.0 ` 10.5 14.0 56.4 7.1 10.6 14.1 56.5 7.1 10.7 14.3 56.6 7.2 10.8 14.4 56..7 7.3 .10.9 14.5 56.8 - 7.3 11.0 14.7 56.9 7.4 11.1 14.8 57.0 7.5 11.2 14.9 57.1 7.5 11.3 15.1 57.2 7.6 11.4 15.2 57.3 7.7 11.5 . 15.3 57.4 7.7 11.6 15.5 57.5 7.8 11.7 15:6 57.6 7.9 11_8 15.7 57.7 7.9 11.9 15.9 57.8 8.0 .12.0 16.0 57.9 8.1 12.1 16.1 58.0 8.1 12.2 16.3 58.1 8.2 12.3 16.4 58.2 8.3 12.4 16.5 58.3 8.3 12.5 16.7 58.4 8.4 12.6 16.8 58.5 8.5 12.7 16.9 58.6 8.5 12.8 17.1 58.7 8.6 12.9 17.2 58.8 8.7 13.0 17.3 58.9 8.7 13.1 17.5 59.0 8.8 13.Z 17.6 59.1 8.9 13.3 17.7 59.2 8.9 13.4 17.9 59.3 9.0 13.5 18.0 59.4 9.1 13.6 18.1 59.5 9.1 13.7 18.3 59.6 9.2 13.8. 18.4 59.7 9.3 13.9 18.5 1 � 4 . L O.0 All ION J SEWAGE PERMIT NO V1_1 LAGS xA iv 7v 1 S c� I N S T A LLER-S NAME i ADDRESS 2 — C0 0 U I L D on OWN k DATE PERMIT ISSUED7 DATE COMPLIANCE ISSUED 9_ ;? �_ C� ,� v No.._.... ..... F�s.......3..../. THE COMMONWEALTH OF MASSACHUSETTS _ BOAR® OF .HEALTH r� OCI ...........OF......... f�il',�7c' ZL / :.... ,� Iirtt#flan for Dispniia1 Works Tnnitrnrtinn 1hrutit Application is hereby made for a Permit to Construct ()) or Repair ( ) an Individual Sewage Disposal System at: . �..�..�r' _........ ' Jl�`� ----------..................................................... .....--•..................... Location-Address _ P} ' /c7i 7 .. ......................... ................................ � o � ..................... ............. Ow r Address W ........................................... ................................................... a st ler Address T. e of Building�� �`� �� q Size Lot.._......,r................ f t U Dwelling Ao. of Bedrooms-------------------------•_.................Expansion Attic ( ) Garbage Grinder ) -Other—Type of Building ............................ .No.__of persons.......................----- Showers ( ) — Cafeteria ( ) a+ Other fixtures ............................... W Design Flow............... .....................gallons per person per day. Total daily flow__..........._..Z Z.® ............gallons. WSeptic Tank—Liquid capacity/ gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No--------------------- Width.............`` S___..���_.. Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.......... Diameter.._. ?°_Q�/�_pth below inlet_....._.......... Total leaching area.Z4.57..sq. ft. Z Other Distribution box ()C) Dosing tank ( ) `-' Percolation Test Results Performed b r � !" !°'6 ?! Date... _ e'! 4A by..; Test Pit No. L __..minutes per inch Depth of Test Pit..... ..... Depth to ground water....X/00�_. Test Pit No. 2....... .......minutes per inch Depth of Test Pit....... .......... Depth to ground water--------'............. t� -••-----•'--------=----------- -"........•-"---'-••..............•--'--'--............._................................................................. O ..ova. •.*- --a� �-- --------------------- -------..... ti Description of Soil......_.._�-................ j v - '...... � ''�� c�� d' "----'--•••'-'•'-'--•-•-'•'-----'-'.....................'-••••-•-.. W --'-'•-----'..._..-----•--------•---•--•'•------------••-----'-••-----•--'----------------'---"--'•-•••.----------'----- -_.....'-'----'•••-----•••--'--•"-...••---------.............------•..... UNature 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 TL I TILE 5 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. 4. • Sied. ... ..........................................--------................. . ..-"--...... '- •------- Date Application Approved BY -'--- ® Date Application Disapproved for the following reasons:--'---'-----'-"-•'-'--'----••---•--•'-----'-•-•----'--------••---------........................................ .............•-•---'--........"--•--•--.............----••'-•---'-'....•-----••...................'-•-'---••--'-'-'•-"•-••---"-'--'-•••'•-•-'-'-------"'--"••-'••---'--------•-•--------'---•-•---- j Date PermitN.o......................................................... Issued-... ................................................ Date ao No.......3 ..... Fxs....... �.-:' u' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �/ .. d-w. 'I..........OF.......... ......................... •-- APPliratiun for Movooal Works Tonstrurtion ramit Application is hereby made for a Permit to Construct ( )Q or Repair ( ) an Individual Sewage Disposal System at: G'��-c% ,Drive ir: ,�o�- .................... ...... __ _ ......... .. ....................•------•-•--.............. Location-Address r A/ or t No. .rG cgs' T 20.. /owhS�sv�71 Q. Owner Address Walll? ... ... t st ler Address /_ / /O t PQ (o Q d T e of Building Size Lot__________ Sq.'fegt f a Dwelling No. of Bedrooms............ ................................Expansion Attic ( ) Garbage Grinder pa Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ) a Other fixtures -----•--•------•---•••-----•---• �",„. W Design Flow______________�,r_..................gallons per person per day. Total daily flow........._._..___Z_ .............gallons. WSeptic Tank—Liquid capacity_���gallons Length................ Width................ Diameter................ Depth................ , Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. x / !o S C• �' Z�'� Seepage Pit No_____________________ Diameter_.__._..�_ a�pth below inlet___.__._______...... Total leaching area.__..._..._:_-'`—..sq. ft. Z Other Distribution box (,C) Dosing tank { ) . / Percolation Test Results Performed b .__ {cGtG2............................../� �� Date_._.._.✓..sec. ....� v ,a Test Pit No 1.' Z_�minutes per inch Depth of Test Pit......�Z�.__.. Depth to ground water.....r_0jq _- (i, Test Pit No. 2......__........minutes per inch Depth of Test Pit........ _......... Depth to ground water........................ •-••--•---------------------------••----------........_.............................---••----....•--......................................................... D Description of Soil.....j-_IF��___ o - +'.. .SuGSei x � V ------------=---••--•--••---•-�-�••'-/• -s---/.•--- � `.Z�'' '1' 'c?�'V'"....................................---................................................ w UNature 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 TIT?:;. 5 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. Sl e } ...... Y_yD A + ..._ Application Approved By....... ---------------------------••.. Date Application Disapproved for the following reasons_................................................................................................................. ....................•--=---....__.._._.....--•-----•------------•----------------•--•--•---__--••-=``.-..-----------•--•---------•-=--------•---••------------------------------------------•------••--- Date Permit No.................................. Issued..........----•-••--- Date THE COMMONWEALTH OF MASSACHUSETTS /G2� BOARD O HEALT ... ......OF........... ' .............. ............................ (err tfiratr- of Tout diFatta THI OISTCE TI , That Indivi,u Slewage Disposal System constructed ( �r Repairedby .._ �'-�'L .-- --- -.........- •-- = = -•- Instal ..... has been installed in accordance with the provisions of T j of The St to Sanitary Cdde as desc�aib�ee,�e in the application for Disposal Works Construction Permit No___:__: ...ul ............ dated....`:`"a. "_Q'"' ,............ THE ISSUANCE OF THIS .CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTI SATISFACTORY. DATE................................. �O ✓6-J= Inspector-•- -----•---•--__...................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEA No......................... FEE .. Mapoutal Nor ii n tr Permission i hereby granted..... =.... -=°U`���------ �l>l� .........................................................L .. to Constr ( • or ep ' ( . ) an Individ . /ge D' sal S . emf 1,!'� Street /? as shown on the application for lsposal Works Construction Perm o........ ..... . at ._.__.__. .��..._P _Q � '.. - • ----•_..._ Board of Health DATE....... . ................................. FORM 1255 HOBBS & WARREN, INC.,y PAW`Il+E¢t5 f .. (' ��c�! •f�.J a � i. i, 0. i.3'� �txl 10.1c, /—., 0 Q 1 N. — p �~r� .� II+ (y: s 7 /Ca 49 ~ s t 3 R -~--{�--�,DISTANCE AS CERTIFIED 1 HEREBYCERTIFYJHATTHE BUILDING.: SITE rL�� SHOWN O�1,THiS RLAN IS LOCATED ON THE L� -GROUND AS SHOWN-HEREON&.THAT'IT LOCUS: CONFORM TO THE ZONING BY LAWS OF THE ✓tire• /�✓!5� — b' P_,U57r� L �yS, WHEN CONSTRUCTED. DATE _ ' REF: = /GZi t� C ; /C2*o _57 cdp e engloeenq PREPARED FOR: r � ✓�. 7' / �Gr�d " CIVIL ENGINEERS LAND SURVEYORS -- REG. LAND,SURVEYOR & SCALD-� Yarmoutli Orleans;MA DATE""���' AI SEPTIC TANK - "U"BOX - - LEACH '° TOP,OF FDN �69;(MSL) „2 QF 1i8T0 1/2. i A-10 i5 WASHED STONE ij //.1G . L.l� c"C3 V,--,11',5 z- ..�_/�. s/¢_.IN O� 7f.. 1Ny y P /OO p G / SEPTIC �l.-O4J TANK ELEV. ;ELEV... ELEV. ELEV. i ELEV. ELEV. OF 1/4 -11/z.r WASHED STONE - � mac»"-o/�^7"G�•S i ,c%.L� T T OLE � G i�6-/d�.� fg-/y7✓L�/L--1.5CpJCe44`y'_,� rFAJ7— TEST B YA/ ,7"t,� ,' E ?l!Y6✓a /h/L L zs• �3.=Ar tic C 7;�/ TEST DATE � �� a+ .0 WITNESS G ®����� / BEDROOM HOUSE T Ft 1 T.H. 2 ELEV.: ELEV. Ge . JS Su � 2Z DISPOSER DISPOSER PERC RATE _ MIN/IN. FLOW RATE �20 (GAL:/DAY) Z2.ca SEPTIC TANK 02c) x (i,$)= REQ'D SEPTIC TANK SIZE y r LEACH FACILITY z :�:✓� Q SIDE WALL , 494� G/p BOTTOM 'G.a> TOTAL r I1 f (21 " is Q USE: LEACHING`77 �:�5✓. tc'sC moo.S �r off' W.4 5.'✓6 T� 57"Cs�t� . WATER ENCOUNTERED (UNLESS OTHE!RWISE`NOTED) 1 ,QATUM�'(MSL)+TAKEN FROM ����✓/�/ __,.__.QU4DRANGLE MAP ,9� n ��`�� N 2 MUNICIPAL VJATER �- ---- ---AVAILABLE �°' JAM �ES C�\ RIPE PfTCH 1/a _PER FOOT _ 4 15ESfGN:LOADING FOR ALL PRE-CAST'UNITS: AHSHO /� 44 WWMAN � @p��p�s`,c flfIIN GI�k7UN0 CQVER Q.VER ALL-SEWAGE FACILITIES:.(1) FT. tad S"�dYMr�tiN' � .Pl PE'JOI NTS SHALL BE.MADE U1/ATt R TIGHT Q �4t�4O 7 CONSTRUCTION-DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. JL S`fATE ENVIRONMENTAL CODE TITLES � � ��� � NAL REG..PROFESSIONAL ENGINEER BOARD OF HEALTH CONTOUR:$ (EXISTING) c' SA�".Y;F�p /. (PROPOSED) O O Off— APPROVED __1DATE _ PMA `F •'�° `�YANNISRORT LEGEND` m o 51.96 PROPOSED CONTOUR 2p o,;;,, S �6 $3 ���\\ Uf �Ass9 4 ® PROPOSED SPOT GRADE �N m O.0 �c C' CIRCLE C) m— DR z A. '� 8 —— EXISTING CONTOUR � 9 c a�h� 9 99♦ o DA�EM. �� + 96.52 EXISTING SPOT GRADE SITE o ENCLOSED 3 No. 1140 W— EXISTING WATER SERVICE '`�, REDW r3 D o P '�`G E pRC►-I � /ST TAR\p0 � TEST PIT SMITH sr. MAR NI SYSTEM TIES ti P SON Ave. BENCH MARK a� TOP OF CONCRETE °J BULKHEAD CORNER LOCUS MAP N.T.S. 20 ELEVATION = 21 .32 / ^ I EXIST. I ,000G BARNSTABLE GIS DATUM s6 ft SEPTIC TANK GENERAL NOTES: Q I I 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL n _ 19 I BOARD OF HEALTH AND THE DESIGN ENGINEER. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS c \ I Ag <�HF OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE + LOCAL RULES AND REGULATIONS. 1 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR \ I GARDENS TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. \ WATER 1 LINE 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING 18 \ 1 FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN ENGINEER BEFORE CONSTRUCTION CONTINUES. C 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. P kw \ \ 1 V V 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF �/ 0FQ 1c, \ \\ 1 z 7 OZ o lt� THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF ��• \ y 1 ^ HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. LL c1� \ Q a\ 1 /�n J Z Cn 7. WATER SUPPLY PROVIDED BY TOWN WATER'SERVICE. 17 LOT \ 8 \ I v/ �I (�j e nep. Porte 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED \\ TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. AREA = 136 O Sf + A\ 1 12 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY \ y\ W ENCL ft THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING —_0$Ep � TH—; CONSTRUCTION. W 1 ► \I PORCH -10. EXISTING LEACHING TO BE PUMPED AND FILLED PER TITLE 5. 0 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION 0 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY M 1 N I \\ \�} TH-2 O AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY I 1T�\ 13. NO PRIVATE WELLS WITHIN 150 Fr. OF PROPOSED LEACHING Q I PAVED I DRIVEWAY 14. ALL PIPE TO BE 4" SCH 40 ® 1/8"/FT (UNLESS SPEC. OTHERWISE) / \\ GgRAGE IL` \�\ 15. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW 7 / \ EXIST. LEACH PIT \ FOR THE USE OF A GARBAGE GRINDER 16. NO WETLANDS WITHIN 100 FT. OF PROPOSED LEACHING 18 �� see note I O �� 17. THERE ARE NO STRUCTURAL LOADS PLACED ON TOP OF EXISTING SEPTIC TANK BY THE PORCH, THERE IS FULL ACCESS TO COVERS. �. PLAN N i PROPOSED SEPTIC SYSTEM UPGRADE PLAN SCALE: 1 in = 20 ft 1+9. 34 CIRCLE DRIVE, HYANNISPORT, MA 20 0 20 40 I Prepared for: Leon Michelove 0 10 20 Engineering by: Surveying by: SCALE DRAWN MEYER&SONS,INC. Eco Tech Environmental 1 =20' DMM MAP: 288 PO BOX 9B 1 LOT.- 190 EAST SANDWICH,MA 02537 (508) 364-0894 DATE: CHECKED SHEET NO. 50e-362-2922 09/15/1 1 DMM 1 of 2 REVISION: 09/21/2011 - GW ADJUSTMENT/LEACHING LOCATION 1 I NOTE: TOIPREVENT BREAKOUT, THE PROPOSED NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS FINISH GRADE SHALL NOT BE < EL:17.58 FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. I T.O.F. EL.=22.81 INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL A 4" DIAMETER INSPECTION PORT OVER OF OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE ONE CHAMBER (MIN.) AND SET TO 3" OF F.G. Q� 'yfS1p F.G. EL.=20.5t 1 y� 9�y F.G. EL.=20.4t F.G. EL: 20.5t F.G. EL: 20.50(MAX.) � f ° 9" MIN COVER/ i No. 1140 L = 19't 36" MAX COVER L = 2(' L = 10'((AX)) INSTALL TWO INSPECTION PORTS (MIN.) C/ E 0 S=1% (MIN.) EL. 18.97 ® S=1% MIN.) ® S=1% MIN. 4"SCH40 PVC 4"SCH40 PVC 4"SCH40 PVC SANI TAR�P� 10" s rr ta" INVERT { I lu INV.=17.97 48"UowD INV.=17.72 LEVEL PROPOSED GAS BAFFLE INV.=17.33 D-BOX 5 ROWS OF 6 UNITS AT 5.0'/UNIT WEDGE = 30.0'/ROW INV.=17.5DB-� INV.= 17.23 SOIL ABSORPTION SYSTEM (PROFILE) EXISTING 1.000 GALLON SEPTIC TANK 64.25" RESTORE VEGETATIVE COVER EXISTING SEWER OUTLET BACKFILL WITH CLEAN PERC SAND TO TOP OF CHAMBERS NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE INVERTS PRIOR TO CONSTRUCTION 2) D-BOX SHALL BE SET LEVEL AND TRUE TO BREAKOUT=TOP ELEV.=17.58 GRADE ON A MECHANICALLY COMPACTED SIX INV. ELEV.= 17.23 BOTTOM ELEV.= 16.91 INCH CRUSHED STONE BASE, AS SPECIFIED EXISTING SUITABLE IN 310 CMR 15.221(2) 2.83' MATERIAL 3) REPLACE EXISTING 1,000 GALLON SEPTIC 5' MIN. ABOVE BOTTOM OF EFFECTIVE WIDTH = 5 x 2.83' = 14.15 TANK WITH 1500 GALLON SEPTIC TANK T.P. EXCAVATION OR G.W. IF FAILED, DAMAGED, OR UNDERSIZED. (5.11' PROVIDED) USE 5 ROWS OF 6 ARC 36LP PROFILE 4) INSTALL INLET & OUTLET TEES ADJ. GROUNDWATER EL.=11.80 _ ADS UNITS-NO STONE AND GAS BAFFLE AS REQUIRED 60 SEPTIC SYSTEM PROFILE TYPICAL SECTION 8» N.T.S. N.T.S. 3.8" DESIGN CRITERIA "PROP IS IN ZONE OF CONTRIBUTION" SOIL LOG END CAP P#: 13401 SECTION NUMBER OF BEDROOMS: 4 EXISTING BEDROOM DATE: SEPTEMBER 9, 2011 SOIL TEXTURAL CLASS: CLASS I SOIL EVALUATOR: DARREN M. MEYER, R.S., CSE. DESIGN PERCOLATION RATE: <2 MIN/IN WITNESS: DON DESMARAIS, BARNSTABLE BOH ARC36 LOW PROFILE (3.8" INVERT) UNITS DAILY FLOW: 440 G.P.D. Elev. TP-1 Depth Elev. TP-2 Depth DESIGN FLOW: 440 G.P.D. 20.4 A 0" 20.3 A 0" MODEL ARC36 LP GARBAGE GRINDER: NO NOT DESIGNED FOR GARBAGE GRINDER)) LOAMY SAND LOAMY SAND " 10YR 4/3 10YR 4/3 LENGTH 64.26 NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT PROPOSED SEPTIC TANK: 440gpd x 200% = 880 gpd (USE EXIST. 1,000G CAPACITY) 19.32 13" A 19.3 12" EFFECTIVE LENGTH 60" TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY LEACHING AREA REQUIRED: (440) = 594.59 S.F. B B DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. SIDE WALL HEIGHT 3.8" .74 LOAMY SAND LOAMY SAND DISTRIBUTION BOX: DB-6 (5 OUTLETS (MINIMUM)) 10YR 6/6 10YR 6/6 OVERALL HEIGHT 8' 17.57 C 34" 17.55 C 33" OVERALL WIDTH 34" MOB* 4640 TRUEMAN BL 1/D PRIMARY S.A.S. HILLIARD, OHIO 4JO26 USE 5 ROWS OF 6 - ADS ARC36 LP (3.8" INVERT) UNITS-NO STONE CAPACITY MEDIUM SAND MEDIUM SAND ADVANCED DRAINAGE SYMMS. INC. 2.5Y 7/3 2.5Y 7/3 PROPOSED SEPTIC SYSTEM SITE PLAN BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.73 SF/LF OF CHAMBER) .PERC 016.22 (CHAMBER UNITS) 30 UNITS x 5.00 LF x 4.73 SF/LF = 709.50 SF 8.4 144" 1 144"PERC RATE <2 MIN/IN. ('Cl' HORIZON) 34 CIRCLE DRIVE HYANNISPORT MA I FOR TESTHOLE 02: > > ^, TOTAL AREA = 709.50 SF GROUNDWATER OBSERVED AT 144" EL 8.30 Prepared for: Leon Michelove Engineering DESIGN FLOW PROVIDED: 0.74GPD/SF(709.50SF) = 525.03 GPD > 440 GPD re q'd INDEX WELL: MIW-29 ZONE: C LEVEL: 8.3 ADJUSTMENT: 3.5 ft. g•En in g by: Surveying by: SCALE DRAWN MEYER&SONS,INC. Eco Tech Ea vironmea&d NTS D.M.M. • I, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 pO BOX 98, (508) 364-0894 to conduct soil evaluations and that the above analysis has been performed by me consistent with the EAST SANDWICH,MA02537 DATE: CHECKED SHEET NO. requirements of 310 CMR 15.017. 1 further certify that I hove passed the Soil Eval. Exam in October, 1999. 508-362-2922 09/1 5/1 1 D.M.M. 2 Of 2 REVISION: 09/2i/2011 - GW ADJUSTMENT/LEACHING LOCATION