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HomeMy WebLinkAbout0019 CONNEMARA CIRCLE - Health 19`-Connemara"Circle U Y Hyannis t k A 291 291 o r o tk NI ° � c � u° .4 °� � ` .. r ., r ¢ c - ❑ ; ° ... ° n o . l�- " ° - v ou � V °e4 J °� D .. ` �I " � Ali � '' ° .• ¢ o - v ° - ° ° o o ° a o _ ° ° ° �: a . ° ° o - ❑ ° .P 4 ° vo $ ° - '• ° .k ° ° ley�'' ° .. ° 4 C e, a �' . - Y • 4° ' F 0 F o ... „ u r. 9 e v o a o n Commonwealth of Massachusetts ,5 Title 5 Official Inspection Form HI Subsurface Sewage Disposal System Form"-Not for Voluntary Assessments t.., 19 Connemara Cir �c`i.n•Ty�' Property Address N1 Maxine Goetschiusa Owner Owner's Name information is e required for every Hyannis MA 02601 6-7-19 page. City/Town. State Zip Code Date of Inspection i4a rill PT;7 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. Inspector Information Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification I certify that] am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000);1 have personally inspected the sewage disposal system at theproperty address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: . 1. ® Passes t 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 6-7-19 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system has a design flow of - 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 4 ,,::� Commonwealth of Massachusetts Title 5 Official Inspection Form 01 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 19 Connemara Cir Property Address Maxine Goetschius Owner Owner's Name information is required for every Hyannis MA 02601 6-7-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary . Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1 System Passes: ® 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 of failure. 2) System Conditionally Passes: ❑ One or more system components as described in the "ConditionalPass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements: If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑N ❑ ND (Explain below): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 i Commonwealth of Massachusetts ,5 Title 5 Official Inspection Form 1 hl Subsurface Sewage Disposal System Form:-Not for Voluntary Assessments 9 p y rY 19 Connemara Cir Property Address Maxine Goetschius Owner Owner's Name information is required for every Hyannis MA 02601 6-7-19 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are•repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipes) 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 El ❑ ND (Explain below): ❑ obstruction is removed ❑Y ❑N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if 'the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts ,w Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 19 Connemara Cir Property Address Maxine Goetschius Owner Owner's Name information is required for every Hyannis MA 02601 6-7-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance:: ** This system passes if the well water.analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 Commonwealth of Massachusetts : Title 5 Official Inspection Form icl Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 19 Connemara Cir Property Address Maxine Goetschius Owner Owner's Name information is required for every Hyannis MA 02601 6-7-19 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ 0 Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within.100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is,less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of.custody must be attached to this form.] ❑ ® The system is.a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems:To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 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,CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 , A ,� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 19 Connemara Cir Property Address Maxine Goetschius Owner Owner's Name information is Hyannis MA 02601 6-7-19 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for all inspections: 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 WA) ® ❑ 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? ® ❑ Wasthe facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 i Commonwealth of Massachusetts Title. 5 Official Inspection Form bl Subsurface Sewage Disposal System Form =Not for Voluntary Assessments 19 Connemara Cir Property Address Maxine Goetschius Owner Owner's Name information is required for every Hyannis MA 02601 6-7-19 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: , Number of bedrooms (design): 2 Number of bedrooms (actual): 2 DESIGN flowbased on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 Description: Number of current residents: 2 i Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No i If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail Sump pump? ❑ Yes ® No Last date of occupancy: 6-2019 Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 118 I,^1h � Commonwealth of Massachusetts F11 6113 Title 5 Official Inspection Form hI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 19 Connemara Cir Property Address Maxine Goetschius Owner Owner's Name information is H annis MA 02601 6-7-19 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: I Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Owner----pumped 2018 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Maintenance t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form. hl Subsurface Sewage Disposal System Form -Not for Voluntary Assessments - TJ1, 19 Connemara Cir Property Address Maxine Goetschius Owner Owner's Name information is required for every Hyannis MA 02601 6-7-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ' ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 2013 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate.on site plan):, Depth below grade: 12"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. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 I , Commonwealth of Massachusetts Title 5 Official Inspection Form ,a1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 19 Connemara Cir Property Address Maxine Goetschius Owner Owner's Name information is required for every Hyannis MA 02601 6-7-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.} 6. Septic Tank(locate on site plan): Depth below grade: 3"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: 6" Distance from top of sludge to bottom of outlet tee or baffle 26" V. Scum thickness .Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? 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. r t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 I , Commonwealth of Massachusetts f Title 5 Official Inspection Form .'°i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 19 Connemara Cir Property Address Maxine Goetschius Owner Owner's Name information is required for every Hyannis MA 02601 6-7-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank (tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day . t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts = Title 5 Official InspectionForm Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 19 Connemara Cir Property Address Maxine Goetschius Owner Owner's Name information is H annis MA 02601 6-7-19 required for every -Y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box (if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 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 field. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 1 Commonwealth of Massachusetts r Pi Title 5- offi:cial Inspection form, 0 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 19 Connemara Cir Property Address Maxine Goetschius Owner Owner's Name information is required for every Hyannis - MA 02601 6-7-19 page. Cityrrown 4 State Zip Code Date of Inspection D. System 16folrmation (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No" Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required):, If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 16-Infiltrators No stone ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 1 A ,� Commonwealth of Massachusetts Title 5 Official Inspection Form t N Subsurface Sewage Disposal System Form -Not for Voluntary Assessments W1 .1. 19 Connemara Cir 'LJo 1 �l Property Address Maxine Goetschius Owner Owner's Name information is required for every Hyannis MA 02601 6-7-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach field in good working order with no sign of back-up into d-box or surrounding soils. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): i t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 i Commonwealth of Massachusetts ov. Title 5 Official Inspection Form Pi Subsurface Sewage Disposal System Form -Not for Voluntary Assessments, 19 Connemara Cir Property Address Maxine Goetschius Owner Owner's Name information is Hyannis MA 02601 6-7-19 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: _ I . Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26%2018: Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts - 1� 3 Title 5 Official Inspection Form �i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments I<P ;;, 19 Connemara Cir Property Address Maxine Goetschius Owner Owner's Name information is Hyannis MA 02601 6-7-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately h7 1 Y r .� � D-3, 13 a 9a t j �M t5insp.doc•rev,7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts f: Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 19 Connemara Cir Property Address Maxine Goetschius Owner Owner's Name information is required for every Hyannis MA 02601 6-7-19 page. Cityrrown State Zip Code Date of Inspection D. System Information (coat.) 15. Site Exam: ,. R ❑ Check Slope - r ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12 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) 0 Accessed USGS database - explain: You must describe how you established the high ground water elevation: Original design plans show no groundwater at 12'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7l2612018 , Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 �'° , Commonwealth of Massachusetts �\. $11. Title 5 Official Inspection Form I� w:, 0 HI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 19 Connemara Cir Property Address Maxine Goetschius Owner Owner's Name information is required for every Hyannis MA 02601 6-7-19 page. City/Town State Zip Code Date of Inspeclion E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tan.'<—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .1 M 19 Connemara Circle Property Address James Goetsc ius Owner Owner's Name 4 t 1 information is r+ required for every Hyannis Ma 02601 11-4-15 page. City/Town State Zip Code Date of Inspection 171117 Iz-1 Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not Matthew F. Gilfoy use the return Name of Inspector key. Excavation Company � Company Name 14 Teaberry Lane Company Address Sandwich Ma. 02644 Cityrrown State Zip Code (508)477-0653 S113640 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority Od � 11-4-15 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. Vs t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal stem•Page 1 of 17 a _ 1' Commonwealth of Massachusetts Title 5 ®fficial Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 19 Connemara Circle Property Address James Goetschius Owner Owner's Name information is required for every Hyannis Ma 02601 11-4-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: I 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): 1 l5ins•3/13 ` 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 r 19 Connemara Circle Property Address James Goetschius Owner Owner's Name information is required for every Hyannis Ma 02601 114-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 19 Connemara Circle _ Property Address James Goetschius Owner Owner's Name information is required for every Hyannis Ma 02601 11-4-15 page. Cityrrown 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 1/z day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 19 Connemara Circle Property Address James Goetschius Owner Owner's Name information is required for every Hyannis Ma 02601 11-4-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No El ® 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. ❑ Z. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 40,0 feet of a:surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under.Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 19 Connemara Circle Property Address James Goetschius Owner Owner's Name information is required for every Hyannis Ma 02601 11-4-15 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? El ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as NIA) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? • ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 2 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 349 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 official Inspection F®rrn Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 19 Connemara Circle Property Address James Goetschius Owner Owner's Name information is required for every Hyannis Ma 02601 11-4-15 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: t 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d see below 9 ( Y 9 (9P ))� Detail: 2013- 105GPD 2014- 134GPD Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: i 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-3/13 Title 5 Offidal Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 1 l Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 19 Connemara Circle Property Address James Goetschius Owner Owner's Name information is required for every Hyannis Ma 02601 11-4-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): i General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑. Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-M 3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 19 Connemara Circle Property Address James Goetschius Owner Owner's Name information is required for every Hyannis Ma 02601 11-4-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: New SAS added to existing tank NOV 2012 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 3" Depth below grade: feet Material of construction: ❑ cast iron ❑ 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): 1'3" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallon 6„ Sludge depth: t5ins•3/13 Title.5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts fo Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 19 Connemara Circle Property Address James Goetschius Owner Owner's Name information is required for every Hyannis Ma 02601 11-4-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 30" Scum thickness 2 Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At time of inspection septic tank appeared to be in working order with liquid level equal with outlet invert. Tank is not in need of pumping at this time. i Grease Trap(locate on site plan): Depth below grade: feet I Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top.of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 19 Connemara Circle Property Address James Goetschius Owner Owner's Name information is required for every Hyannis Ma 02601 11-4-15 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: 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 19 Connemara Circle Property Address James Goetschius Owner Owner's Name information is required for every Hyannis Ma 02601 11-4-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): 0" Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): At time of inspection D-box is in working order with no sign of back up or carry over. 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.): i If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 ` Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 19 Connemara Circle Property Address James Goetschius Owner Owner's Name information is required for every Hyannis Ma 02601 11-4-15 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: j ❑ leaching trenches number, length: j 50'x56'x.92' (16 ® leaching fields number, dimensions: hi-cap infiltrators ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At time of inspection leaching appears to be in working order with no sign of hydraulic failure. Field was dry at time of inspection. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 19 Connemara Circle Property Address . James Goetschius Owner Owner's Name information is required for every Hyannis Ma 02601 11-4-15 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 19 Connemara Circle Property Address James Goetschius Owner Owner's Name information is Hyannis Ma 02601 11-4-15 required for every y 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 -26 O Al - 45' f31 I3' to- q Frond . 6 &L ilewl� t, t Gonntmc.,o. ?I a, t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 19 Connemara Circle Property Address James Goetschius Owner Owner's Name information is Hyannis Ma 02601 11-4-15 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope I ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: Gw 120" � feeee t I i Please indicate all methods used to determine the high ground water elevation: i ® Obtained from system design plans on record If checked, date of design plan reviewed: NOV-13-12 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Plan on file with BOH I • Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 19 Connemara Circle Property Address James Goetschius Owner Owner's Name information is required for every Hyannis .Ma 02601 11-4-15 page. City/Town 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 t t5ins•3/13 Title 5 Official I ispection Form:Subsurface Sewage Disposal System•Page 17 of 17 Town of Barnstable Barnstable Board of Health j*"v'ca�j BARNMAS&`"$`Eg 200 Main Street, Hyannis MA 02601 I 163q `0 2007 f0 MIS a Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi February 20, 2013 Mr. Daniel Ojala, P.E., P.L.S. . Down Cape Engineering 939 Main Street, Route 6A Yarmouth Port, MA 02675 RE v19 Connemara Circle; Hyannis '_, „A" 291 291 ,. Dear Mr. Ojala, You are granted conditional variances on behalf of your clients, James and Maxine Goetschius; to construct an onsite sewage disposal system at 19 Connemara Circle, Hyannis. The variances granted are as follows: 310 CMR 15.405 (1)(a): To install a soil absorption system five (5) feet away from-the property line, in lieu of the minimum 10 feet separation distance required. 310 CMR 15.405 (1)(b): To install a soil absorption system twelve (12) feet away from the foundation wall, in lieu of the minimum 20 feet separation distance required 310 CMR 15.221 (7): To install the soil absorption system greater than 36" below the finish grade. These variances are granted with the following conditions: (1) No more than two (2) bedrooms are authorized at this property. Dens, study rooms, offices, finished attics, sleeping lofts, and similar-type rooms are considered "bedrooms" according to the MA Department of Environmental Protection. (2) The applicant shall record.a properly worded deed restriction, signed by the owner of the property, at the Barnstable County Registry of Deeds Q:\Variances 2013\VariancesOjalaDanielIKonnemaraCircleHyannis2013.doc restricting the property to two bedrooms maximum. A copy of the recorded deed restriction shall be submitted to the Health Agent prior to obtaining a disposal works construction permit. (3) The existing components shall be abandoned properly, in compliance with the State Environmental Code, Title V. (4). The septic system shall be installed in strict accordance with the engineered plans dated November 13, 2012. (5) The designing registered sanitarian shall supervise the construction of the onsite sewage disposal system and shall certify in writing to the Board of Health that the system was installed in substantial compliance with the engineered plans dated November 13, 201.2. (6) The designing engineer shall ensure all variances requested are indicated. both the engineering plan and on the variance request application form, properly listing the applicable code and/or section numbers accurately. These variances are granted because the. proposed plan appears to meet the maximum feasible design standards contained within the State Environmental Code, Title 5 and local Health Regulations. The designing.engineer designed the septic system to be located in an area to attempt to maximize setbacks to wetlands on this small lot. SincerEO yours, l Wayne M Iler, M.D. Chairman I QAVariances 2013\VariancesOjalaDanie119ConnemaraCircleHyannis2013.doc #Irz�r s J y�04 DATE: 3l 12 FEE: t iARNSfABIE, • . MASS. 639. �� REC. BY Town of Barnstable ^v , � SCHED. DATE: Board of Health f 200 Main Street, y t, Hyannis MA 02601 Office: 508-862-4644 Wayne A.Miller,M.D. FAX: 508-790-6304 �p Paul J.Canniff,D.M.D. VARIANCE REQUEST FORM LOCATION Q Property Address: Z/ 0 1 em Q ra - I H a✓�/ � Assessor's Map and Parcel Number: C� a Size of Lot: Wetlands Within 300 Ft. Yes _ Liness Name: No Subdivision Name: aa APPLICANT'S NAME: 8or I U 1A l O/14_U.Oj n# - . Phon�s 0�'J 771 — /_3Qq Did the owner of the property authorize you to represent him or her? Yes _> No PROPERTY OWNER'S NAME /�� CONTACT PERSON (� Name: Cf/►?Q 1' f / a Y/✓I,L (TO P hrc1 1 (,0 Name: b0w� 2 / ✓L2Q✓)f Address: / 1 C0 0 0 e_171 a/_a_. C—I✓'C,� —�144'&'d Address: ��9 f`Z ee r.� J L. Ya-IM0 k.k ,•�� Phone: Phone: VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space needed) QL NATURE OF WORK: House Addition 13 00000 House Renovation ❑ Repair.of Failed Septic System 1 1 Checklist (to be completed by office staff-person receiving variance request application) Please submit copies in 4 separate completed sets. — Four(4)copies of the completed variance request form t`a _--I Four(4)copies of engineered plan submitted(e.g.septic system plans) r na Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) Signed letter stating that the property owner authorized you to represent him/her for this request Cm Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at p�licant�xpense (for Title V and/or local sewage regulation variances only) C:)i W pp Full menu submitted(for grease trap variance requests only) Variance request application fee collected (no fee for lifeguard modification renewals, grease trap variance-,:;,renewaTs[same oNvner/leasee only], outside dining variance renewals [same owner/leasee only], and variances to repair filed sewage d sposal�stems [only if no expansion to the building proposed]) t� Variance request submitted at least 15 days prior to meeting date T VARIANCE APPROVED Wayne Miller;Chairman NOT APPROVED Paul J.Cann IT,D.M.D. REASON FOR DISAPPROVAL 4 tel. (508)362-4541 939 main street rt 6a fax(508)362-9880 yarmouth port mass 02675 down +copes engineering, 1#7C structural design civil engineers&land surveyors Daniel A.Ojala,P.E.,P.L.S. F Arne H.Ojala P.E.,P.L.S. r t Timothy H.Covell,P.L.S. land court December 18, 2012 s: 'y �.�'� Andrew R.Garulay,R.L.A. surveys Barnstable Board of Health . f site planning 200 Main Street Hyannis, MA 02601 sewage system Re: 19 Connemara Circle, Hyannis designs Dear Board Members: inspections The enclosed represents a variance filing for the upgrading of an existing failed septic . system for the existing residence. It is an existing 2 bedroom, with the new design permits based on 3, as per Title 5. We are requesting variances to the foundation and to the road lot line for the placement of a new leaching facility on behalf of our client, due to the limited area(small size of lot and presence,of wetlands). .landscape. architecture No work is proposed, nor is there a real estate transaction involved; the system is in failure (requires regular pumping) and requires upgrading as soon as possible. ffriance from 310 CMR 15.405 (la) leaching,facility to (road) lot line (10' to 5') and ) leaching facility to (locus) foundation(20'.to 12'); & leaching facility to be> 3' <6' below grade. - t Aliner is proposed between the leaching facility and the foundation as required. A ` vent and H-20 components are proposed. i We feel that by granting these variances, the same degree of environmental protection ` can be attained without the need for strict adherence to the Title 5 and Town of Barnstable Regulations.' i Very truly yours, �meOjala,PE, P L S Down Cape Engineering, Inc. i ti i r k� _ • "� tel. (508)362-4541 939 main street rt 6a fax(508)362-9880 yarmouth port mass 02675 down cope engineering, inc. structural design civil engineers &land surveyors Daniel A.Ojala,P.E.,P.L.S. Arne H.Ojala P.E.,P.L.S. Timothy H.Covell,P.L.S. land court Andrew R.Garulay,R.L.A. Surveys December 20, 2012 site planning Dear Abutter: sewage system A public hearing has been scheduled for the Barnstable Board of Health to take action designs on a request for variances from Town of Barnstable Regulations for the subsurface disposal of sewage for the proposed Title 5 septic system at 19 Connemara Circle, . Hyannis. The variances requested are as follows: inspections Variance from 310 CMR 15.405 (1a) leaching facility to (road) lot line (10' to 5') and 1(b) leaching facility to (locus) foundation(20' to 12'); & leaching facility to be> 3' permits but< 6' below grade. I � landscape No work is proposed,nor is there a real estate transaction involved;the system is in architecture failure (requires regular pumping) and requires upgrading as soon as possible. Said hearing will be held in the Hearing Room, South Street, Hyannis, January 15th at 3:00 pm. Plans and the application describing the proposed activity are on file at the Board of Health office, 200 Main Street,Hyannis. It is recommended to check with the Health Department to confirm date and time if you are interested in attending. Sincerely, Sarah B. Offal Down Cape Engineering, Inc. cc: Abutters file Barnstable Board of Health barnboh AbutterReport Page 1 of 1 Board of Health Abutter List for Map & Parcel(s): '291291' Direct abutters(no set distance) and the properties located across the street. Total Count: 6 Close Map&Parcel Ownerl Owner2 Addressi Address 2 Mailing Country Deed CityStateZip JOHNSON, 16 CONNEMARA HYANNIS, MA 291278 RAYMOND H& C133494 JACQUELINE A CIRCLE 02601 291279 LEAF, ERIC W 26 CONNEMARA HYANNIS, MA C132716 CIRCLE 02601 291290 PERRY, BENJAMIN A 340 NORTH ST HYANNIS, MA C94400 JR 02601 GOETSCHIUS, 19 CONNEMARA HYANNIS, MA 291291 JAMES R&H. CIRCLE 02601 C188369 MAXINE 291292 MARA], DEANNE 35 CONNEMARA HYANNIS, MA C184812 CIRCLE 02601 MORSE, RICHARD P MARSTONS 291295 JR&NEWELL, C/O BLEU, FRED 28 PEACH TREE RD MILLS, MA C134218 BETSY 02648 This list by itself does NOT constitute a certified I ist of abutters and is provided only as an aid to the determination of abutters.If a certified list of abutters is required, contact the Assessing Division to have this list certified.The owner and address data on this list is from the Town of Barnstable Assessor's database as of 12/5/2012. i i http://66.203.95.236/arcims/appgeoapp/AbutterReport.aspx?type=BOH 12/5/2012 Town of Barnstable Geographic Information System December 5,2012 291274 291aJ7 #284 291275 291058 #131 291056 291251 ® #151 #141 #289 _ #119 291276 #292 , C2925297 - 291282 • . t #50 291281 291280AS #42 '�291'279•. #34 26 #2#91277 AN �::%:.: 291278.._=_ 291253 CONNEMAR, �R� 291297 #53 291254 #311 291 293 935 - - 291002 #57 1298 ). - Q W - • 2 291303 291256 O #310 #317.- r Z Q " 291299 291294 #24 r 291304 #26 0300 :l 291295 , #338 291256 _ 4` #325 �� #348 •s, ..� �x,. A*290125 290134 #333 ` #16 .. f 290057 0 34#f4 a 2901 #34126 29068 F DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:291 Parcel:291 Board of Health ., N - boundary determination or regulatory interpretation. Enlargements beyond a scale of Selected Parcel Abutter List Type-Direct abutters(no set distance)and the properties located 1"=100'may not meet established map accuracy standards. The parcel lines on this map are only graphic representations of Assessor's tax parcels. They are not true property across the street. Abutters' boundaries and do not represent accurate relationships to physical features on the map f Buffer w.: such as building locations. tel. (508)362-4541 939 main street rt 6a fax(508)362-9880 yarmouth port mass 02675 dOwn cope eftgineeiing MC. structural design civil engineers&land surveyors Daniel A.Ojala,P.E.,P.L.S. Arne H.Ojala P.E.,P.L.S. Timothy H.Covell,P.L.S. land court surveys Andrew R.Garulay,R.L.A. December 20, 2012 site planning sewage system Barnstable Board of Health designs 200 Main Street ' Hyannis, NiA 02601 inspections permits Dear Board Members: ' I hereby give Down Cape Engineering, Inc. permission to represent me landscape in the upcoming public hearing regarding work at 19 Connemara Circle in Hyannis. architecture dO er/Representative i 2,6 or- pA GvefSCi; 'own of Barnstable Departinent of Regulatory.Services r Public Health Division Date •r�OtjytP�tlA 200 Main Street,Hyannis MA 02601 ' Date Scheduled 1h Time d" ® Fee Pd. ` Soil Suitability ,Assessment for S Disp®sal Performed By: - Witnessed By: LOCATION& G-E"Y"+R,"L r`4T.V.MM rION . Location Address p - I CO v\Q yi.t a�� CI Owner's Name �1 02.1 $GA I V.a y a Y\AL'D Address Assessor's Map/Parcel: _l/IIld9' tJt7 Engincer'sNamc �� Cal NEW CONSTRUCTION REPAIR e Telephone# l.S�0� �6 a - Land Use: �• , _ �� Slopes 96 0— �� P ( ) Surface Stones Distance9 from: Open Water Body R Possible Wet Do . �ft Drinking Water Well t Draiitege Way ft Property Line _ft Other ft ' ,IM'TCH:(Street name,dimensions of lot,exact locations of test holes&pare tests,locate wetlands•!n proximity to holes) C_0 � Parent material(geologic) LyV4U Depth to Bedrock 300 Depth to Groundwater. Standing Water in Hole: 410 AJJ we from Pit Fpee Estimated Seasonal Hlgh Groundwater J DETERM-WA.TION FOR SEASONAL HI ._.c„x INr�,T R TABLEMethod Used: Depth Observed standing in obs.hole: •0 Flu, depth to 5011 mottles: ItL Dcpth to weeping from side of obs,hole: In, Groundwater AdJuatment Index Well# Reading Date: Index Welt levol Adj.factor ___,_ Aril,Groundwater level� s Observation PERCOLATION TEST bated Thum iHole# Time at 4" Depth of Perc b b Time at 6" Start Pre-soak Time @ a✓d% Time(9" G") End Pre-soak Rate Mln./Inch Site Suitability Assessment: Site Passed (/ Sitp Filled: Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Back-- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPT[C\PERCPORM.DOC F DEEP-OBSERVATION HOLE LOG Hole# _ Depth from Soil Horizon Soil Texture .Sdil Color Soil• Other S Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. i to .y,%'Gray ell DEEP OBSELI;V&TION HOLLE LOG- Hole# Depth from Sall Horizon Soil Texture Soil Color Soil Othe_ Surface(in.) (USDA) (Munsell Mottlin g (Structure,Stones,Boulders. o sis en. %O ve DEEP OBSERVATION HOLE LOG Hole#. Depth from Sail Horizon Sall Texture Soil Color Soil Othcr Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. -Coilgiotrnry. O e • 1 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface('tn.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. ` Cositn Flood Ins•arance Rate Map- Above 500 year flood boundary No— Yes Within 500 year boundary No Yes ' Within 100 year flood boundary No._ Yds Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed th~pughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? Certification I certify that on V _(date)I have passed the soil evaluator examination approved by the Department of Environm ntal?rotectlon and that the above analysis was performed by me consistent with the required training,expertise and a rience described in�10 CMR 15.017. Signature Dati; Q:11.EfflC�PERCIORM.DOC 1 . TOWAT 0 �ARI�ISTABLE CATLOI`I._ �o-n 2 Nl.a LO y :a 6 y�yt� i S 'ASSESSORS'. PA L 3NSTA.T.Elt` . tAli &pgQidE N0 SSPTLC TANK CAPACTFX : /07�V n d' ?1�CvfWS oizo.' /(O LEACfIIl40 PAC- ROOMS: oZ �iJSLD$R OR OV�cIFR pERMITI}ATE C©MPL�ICE DA"�: . Sepat�t►on Drstance Betwesti:Ebe Feet Maxtaium Adjusted G tliti water Table to the Bottom of L�achMgwFacii�ty �rat#s. Priirate Vater Supply1e11 andTtung:F_ Y. �Y Feet as site or dnttun?AO fit of Ieacbnieg facilicYl Edge of Wetland andle-aching Faa'i►ty(If MY--*We east feet withta 300*het f leachipg facriny) L [ (i Furnished by l cz� Q o F { Or ` 71 TOWN OF-BARNSTABLE �' ne SEWAGE# e401:1-64n ��.LOCATION VILLAGE ASSESSOR'S MAP&PARCEL 1 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY. 066-4, LEACHING FACILITY.(type) (size) NO.OF BEDROOMS OWNER i PERMIT DATE: I. 3 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet _ Private Water Supply Well and Leaching Facility Of 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) 1 co Feet FURNISHED BY /J a ., �h � _ o *. w c' v �.�.�J �.�: 1� �4',�y +� r,, `' // !!,, 3 b rd 6� �0 � lS ( 3 NO. Fee V (/ — THE C MMONWEALTH 001MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 4phration for aisposai *pstem Construction hermit Application for a Permit to Construct( ) Repair(9�Upgrade( ) Abandon( ) ❑Complete System .0Individual Components Location Address or Lot No. 19 Co n ne mo-ro- 01 r. Owner's Name,Address,and Tel.No.3OFr-6-9-�9�8 nt S 3avne5 Assessor's Map/Parcel lro�{-.Sc�1�cJ^� �9 C�vnilevnctl��i. I staller' Nape, �ddres_s,and Tel.No.�''p^�-g028 -8Qa(o Designer's Name,Address,and Tel.No. J�G oc*�o� �� ��tY"uG��U► tnt�r'iSt- y5'. DZke o — Type of Building: _ p n I � S Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No:of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 07 ao gpd Design flow provided J gp Plan Date ol-j- Number of sheets ] pp ,Revision Date O(o l3 Lno� Title �j� i4 pig �9 eo n f)&_ff rQ_ O e H Ua_f) Size of Septic Tank t°, / Type of S:A.S. Fl_eje4 Description of Soil a Nat re of Repairs or Alter tio. (Answer when applicable) i Date last inspecte 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-tZf-o ce the system in operation until a Certificate of Compliance has been issued by this Board of Health. . Si ed Date /C /3 Application Approved by Date Application Disapproved by Date for the following reasons Permit No. 2d (� - (f' Y Date Issued a l 3 No. D 0 13 —U 6 P`I PPa Fee A Entered in computer: THE COMMONWEAL'fiF-0,F.: IASSACHUSETTS , PUBLIC HEALTH DIVISION'=TOWN'.OF BARNSTABLE, MASSACHUSETTS i 9ppIication for Misposai �&pstem Construction 3permit Application for a Permit to Construct( ) Repair''(X Upgrade( ) -Abandon( ) ❑Complete System E111ndividual Components Location Address or Lot No. n e M Q rcL Owner's Name,Address,and Tel.No.,40,9-95-9-29,V8 I�. c�a�niSl :Ta«vwe5 ���-t-S�i05 /9G�w)nE�r,ct�c�d: Assessor's Map/Parcel �� a�/ Installer's Name,Address,and Tel.No.`j O'5-q52 - 9a.(�, I)Qgner's Name,Address,and Tel.No. 5-05 %1 - 1/SV/ B0,401-4 (2,2v54-CbC4 0iA aael✓t ipLte.6) ine-nr-I0- ,.Er+C- ti3ct N►CLi cn St-. MA ONJi- A4 A Type of Building: Dwelling No.of Bedrooms " l i Lot Size /U I, sq.ft. Garbage Grinder( ) �• I Other Type of Building I No.of Persons Showers( ) Cafeteria( ) Other Fixtures ;r' Design Flow(min.required) a gpd rDesigp flow provided JY9 gpd Plan Date l V a 1o,,ICA 13, ado%4- n Number of sheets ) I )Revision Date /C- /3 �J)Ukg �(i�e r Title S- _�t�e I�In�'1 U1C �9 PooneaQt-0. O-1nde 4u,,jrinl Ir k Size of Septic Tank Type of S.A.S. F;JW np aJ,����te)rs Description of Soil, d Nature of Repairs or Alterations(Answer when applicable) fUk iC.' /�/;; , / ./,. ,�„ , �ih p // -//�i� `j ,�.f, �//M PP-dr i ./ i i E(i/ %/6 70/�S //7 Ce S'./, X 5%) r U p� _ _ Z i i�� / 7N_�UCIi TllY �•� ��i,t�: �.LC�.Ci.. n��r.�I,V Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site se age disposal system in K. accordance with the provisions of Title 5 of the Environmental Code and noffo lace the system in operation until a Certificate R Compliance has been issued by this Board of Heal'th Signed / _f _ Date Az/3 t Application Approved by Date / / Application Disapproved by 0 Date for the following reasons Permit No. 7 O Date Issued ay r 3 - - . ��D� TH E COMMONWEALTH OF MASSACHUSETTS 2 �da'`�' �'"'-" BARNSTABLE,MASSACHUSETTS (Certificate of Com'pliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by h -o'iAe at (20 El ioe MO (Q �a�G p N4 n n i S has been constructed in accordance with the provisions of Title j5 and the for Disposal System Construction Permit No.2013- L odated -2 Installer yy(�vIP�I I I �i�i't5�<ULI� 1l7/1 , -L-ri C- Designer Y\y.a)/I ( i. ­nc�✓lpo�i'(.oc° 1hC #bedr oms Approved design flow e y-�%� J gpd The issuance of this permit shall�n}ot Je o strued as a guarantee that the system Will fu�tion-as.designed. Date c� /� Inspector. ) I Q, 1.--=------------------------ -.------.------------------------- .-------------------- - --------------------------------------------- . No,? (I 13 'UVd Fee (JU ' THE COMMONWEALTH OF MASSACHUSETTS . PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Nsposai 6pstem Construction J)ermit Permission is hereby granted to Construct( ) Repair(� Upgrade( ) Abandon( ) System located at 7 �!>r/1�,r�//yy��lam /✓<� ��U/i/I/I/S 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 or special conditions. Provided:Construction must be completed within three years of the date of this permit. / � / - Date / Approved by i c. . 6 Do•-= 1 r 213 v 476 02-01-2013 12: 12 BARNSTABLE LAND COURT REGISTRY DEED RESTRICTION 'WHEREAS, V a11�P�.1 r� 11 C3"�2fScA;tc a of (owners ame) . C0 6 n CM aw► oL rc t!2' - ci✓12co MA (adder) is the owner of darn looted (addross) at MA(hereinafter referred to as and being I=coor a plaentitled "Subdivision of land In ct,I'�vo� 4ne+r MA, Property of eta[, duly recorded In Barnstable County Registry of Deeds In Plan Book r Page ,p ; Or on Land Court Plan Number l 0 9 1 K 1 Jk.o I 1-G7,--. �i r WHEREAS, V a M eJ-i"'H"i ru! �"o��J'C� as the owner of said lot has (oernees namo) ' agreed with the Town of Barnstable Board of Health to.a restriction as to the number of bedrooms which can be included in any home built on said lot as a '. pre-cohdition to obtaining a disposal works construction permit in compliance with 310 CMR 15.000 State-Environmental Code, Title V, Minimum ' Requirements for the Subsurfdce Disposal of Sanitary Sewage; . WHEREAS, the Town of Barnstable Board of Health, as a pre-condition-to granting a disposal works construction permit for a septic system In compliance with 310 CMR 15.200, State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage, and authorizing the issuance of a building permit for the construction of ar single family home on this property, is requiring that the agreement for the-restriction on tSe number of bedrooms in any house constructed on tho lot be put on rocord with the Barnstable County Registry of Deeds by recording this document, dsdr . I ! n NOW, THEREFORE, �does hereby place the (owner's name)• following restr�ctfon on his above-referenced land In accordance with his a h the Tnuin of RRMst" annul nt ue.,t4h 1 run with the-land and be binding upon all.successors in title; I—, n -M arol. i rr Q may have constructed '. (address) upon the lot a house ,nt�lnng no more than 10 (2) bedrooms. es .fYaXine c7T agrees that this shall be permanent deed (owners name) restriction affecting located on MA, and . being shown on the plan recorded in flan Book , Paged Or on Land Court Plan 69099 --,& J' elf - I • For title of see the following deed: Book . , Page . Or land Courf Certificate of Title Number ' 69 Exe d as a se din lament day of�r G/ Jk 0 �s signature lit 12 Owner's signature r Owner's signature COMMONWEALTH OF MASSACHUS�TTS a f . 20/ 3 1 Then personally appeared the ab/ove amed r r� all y .Sir.yy�e5 � /y/2,ri'n t9 r' C i[/S ;•Y: � O' l• � known to me to be the person who oxocuted the-foregoing Instrument and ` x �• acknowledged �, �� ��,�, `�' the same to Ise free act deed, before me, i`•� +•c ^ Z-1 • 3 .a i Notary l Public i 4J ELIZABETH A.RIZZAJUM My commission eipires: Notary Pudic �TM OF wlssAC (date) ' MycowNulonE;plr , -`' Mwch 18.2o1e BARNSTABLE REGISTRY.OF DEEDS i �� � . . , � � -� � _ -� �, , �� -_ :-_\ ► � i� �- . -_ � . c� � 1 ` � � � o r-- O, . � � _ r- ��.� ', i 1� - FEB-15-2013 13:53 From:BORTOLOTTI CONST 5084289399 To:15087906304 P.1/1 FROM :down cape engineering ine FAX NO. :150836298M Feb. 15 2013 12:57pM P1 /t) - a6 Q, ,� '1'6tUffi,a Yr. d�yiga-.i•,.714estut• � 8h�M1�18i.ID, T �sna►a 1 'Pubi}C enitte B.Divistou ���._rays. '� '1'h�a�asie NJLcI���tam, �an¢etur . Z401Vla,un 5>r'c'r-f,�,Y�•�my�iw,�►A2C►USE Clfficc: 5U8-�+!2��lbaa SUti-'r�o 6a04 ts�ilBe>P�G;�6,ni�CG„�e�r �e�_i c 1>tfin�lP,�'Aan lb:o[e: c� `� .� °;eo�weo�e Yr.�ror¢it# • _AflidN€iQAxi4 •{i!�>m 1Pstre+�cl B?caii�t�r.: ��i,J n �_ �' ►�1<G� d')oa�sa�l�a: ��`'�� � _.S�Lri•d�G1lt�+"' AaId>cmiu � �a I..� _ AdiiErer~ee .. .�� . Ora -rJ7 'vas js�uc:d n pen-at to klatfl,ll a in seplie. rXaLaL Rt! C.Qj l .�a� �axea ou fl.dvilp drawn by (LA CCIS) O!'A Pc-. �1.1 dated �• , (de•s�k I (,.:tT!fy abut fllr aepdo system ra['mmo.,rc nbove was ilgtallGd et)bStarlLisally fl eXffditls to thL' 43"S.p,,11, wliirh Tnuy iul.111ile rninur upMo'vc-d actRr,9 nvob. as lateral relQN t.iOn Of the dif&ibntlnn box wad/or sy,ytintmik. 1 u►.:ztify Quit slur 3CIy u, refcv mut{t r-rove wwi irst'alled witL wjnr, chunp3 (i-0. ppatrx thin 101 Inter, r duca't.ioA of the 5AS or Bay venj(i jj xrinctbon oloU 'C,OM QUO.- t of th.-septic !ryA=) j,zt,irl ac.l or(ls►.aee�wiLh SUito f Lnmd Reallfdon5. PlAn r0vilg1j1L o^ uartlfirA sxa4 desiguev to:fnlluw. ��ll Itr U.lA ([171! lr ..tipc�atalta} J CIVIL v' Na 40502 7A DAU1,10,. P4SjnUT'H i31�aaturr.) / (ATT172 P 1 SZh1I11v HCrB) $' s�; �.F,'L(,I►, Ti) iiAfKTTr� CC)1 YArti �?NiLk,&QT �1j�TMD LIPt,• 0TFF 'l'��"• I:� �J,lj,AS-iCt�li �1?� n�ur��.;,Rrvl;ra��..'�►�% �. r,>r, ��4� � r,�'R�tv�����t�1v.. M1 0_vefSCJl; Town of Banasi.ble Department of Regulatory.Services u Public HeOth Division Date 200 Maia Street,Hyannis MA 02601 Date Scheduled 1® O Time A . Pd. l o0 Soil SnitabiliO .Assessment for St: lisp®,sal Performed-By: Witnessed By LOCATION Rr :Ar���It't�il1sIV .Location Address /q n / / C 0 Atv A-1 aye CI r� Owner's Name Address Assessor's Map/.Parcel: p / p %l(d/l Enginccr'sNamc �v,a� NEW CONSTRUCTION REPAIR I V e Telephone# 60e 1 �J 6} — IZLj y Land Use: n Slopes(96) 0— tr1 • — Surface Stoaes q/O k Distance's from: Open Water Body R Possible Wet Area �1 U - • ft Drinking Water Well Dralhage Way ft Property ----- tff—=---- �-- Llnc ��_ft - Other ft SEE"TCH (Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands•In proximity to holes) M r • �J-dJ Parent material(geologic) a J Iq P Depth to Bedrock OY Depth to Groundwater. Standing Water in Hole:_ �� .. Weeping from Pit Face Estimated Seasonal High Groundwater AETER1VdTl�?ATTON FOR SEASONAL HICIF�yA�ERr'��rxB�r�'r Method Used: // Depth Observed standing in obs.hole: 6z-a&Y �Ip/�[yeptJt to soil mottles: Dcpth to weeping from side of obs.hole: ` ItL Index Well# Reading Date: index Well leVal In, Groundwater Adjuatment AdJ.thctor --r--Adl,Groundwater Level Observation PER.COLATZCIN TEST Date Titne Hole# Time at 9" Depth of Pere Time at G" Start Pre-soak Time @ I U; 0 End Pre-soak /0 i d Rate Min./Inch Vh&1A. Site Suitability Assessment: Sita?assed f/ SitgFalled: • Additional Testing Needed(YIN) Original: Public Health Division Observtition Hole Data To Be Completed on Back----- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1) week prior to beginning. Q:\S EPTIC\PERCFORM.D OC DEEP.OBSERVATION ROLE LOG Hole#�_ Depth from Soil Horizon Soil Texture .Shcl Color Soil. Other Surface(in.) (USDA) ,(Mansell) Mottling (Structure,Stones;Boulders. o i ten y %'CraV% 15 2,3 DEL+'P OBSER- VA'ONT ROLE LOO De rh from ?dole P soil Horizon Soil Texture Sol Color Soil Other Surface(i¢.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. • onsis en, %G ve I i DEEP OBSERVATION HOLE LOG Hole#!:. Depth from Soil Horizon Soil Texture Soil Color Soil Other* Surface(in.) (USDA) (lv_'unscll) Mottling (structure,Stones,Boulders. -consiatengy,To p c ]DEEP OBSERVATION HOLE LOG Hole#k Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. • Co si ten F100d Insurance Irate Ma-p: / Above 500 year flood boundary No_ Yes t/ Within 500 year boundary No Yes ' Within 100 year flood boundary No._ Yds . Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas obstrved throughout the area proposed for the soil absorption system? ad If not,what is the depth of haturally occurring pervious matariall. Certification 1 certify that on fie, (date)I have passed the soil evaluator examination approved by the Department of Environm ntal Protection and that the above analysis was performed by me consistent with . the required training,expertise and a rience,describe3 in�10 CIM 15.017. • Signature Dati;L����' . . Q:\3.EPTlaPERCF0RM.D0C TOWN OF BARNSTABLE `TTOI3_�`'J SEWAGE #2yo1 — )/� 3E �-/Y A.✓•✓"-f ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO.AQ c H 13 SEPTIC TANK CAPACITY X t s T t— s LEACHING FACILITY: (typ6 (size);ZJ X /A X NO. OF BEDROOMS n BUILDER OR OWNER PERMITDATE: � �/ COMPLIANCE DATE: b 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 � � � � � � � � � n � � �.� � � � � �^► o Q .p 'J �1 v, - � 1 �Y� } � (W,� r` � O � 6..�� Q I ..��. d �.�.. — Fee v� fr, Igo. 18' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: L/ Yes t, PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZippYication for- 33iopozal bpgtem Conotructiori Permit Application for a Permit to Construct( . )Repair(0)Upgrade(`X)Abandon( ) O Complete System O Individual Components Location Address or Lot No. i R CO M N E M 14 R C A I rU C� Owner's Name,Address and Tel.No.�o S.--7-7C 3337 Ny�NMS , / -4.65 .lgACo 1Z Rir %l CIPCLe Assessor's Map/Parcel /n z i — P Z 91 ss. Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. K70 S—H 72 S—3 3E1 y f}�G�1 �s.✓3; SIJLL I I AA, ENG jp6:tE121 fvf 1 N G ` ? 3� / 6 2 OSfERVI C,LE MASS Type of Building: } Dwelling No.of Bedrooms Z Lot Size [Co oo-sq.ft. Garbage Grinder(N 0 Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 15-2N 0 gallons per day. Calculated daily flow 3 3 gallons. Plan Date ND V. 19, 200 1 Number of sheets I' Revision Date Title S ItE PLAN P(2UPOS'S P SEPTI c SYSIE'M LAPCELADE Size of Septic Tank EX 1ST I&1 (O 00 Qr-A L • Type of S.A.S. 12!)( 25'LEACH. Chp24413ER- cC� b Description of Soil 1 S EE PEl2 M Irt No. 7 2 y-7 - ,f°°j H.h , -t'H. iih&lol s 0-- J:L" LoPM , 1-2 1C4 B1 St. BRP (CPAStsAMD7CYIZ.jj�4 ' ( 4 - 30u J� BrN'#!04 YEI- Codlsts 141yv IoY 2 L� . : 3f9`LLo" C YEL`fsH BPN• CoAPSESAND loyR 6'L Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmen 1 Code and not to place the system in operation until a Certifi- cate of Compliance has been issjued b s d of / Signe Date Application Approved by 1kh Date �! Application Disapproved for the following reasons Permit No. :)0 0) - Date Issued 200 `, �J4�� ,a-:✓.-^c1�.-. _ :•-:i„c.:- rrW 'i ti ,.�'�r6n w:`.:.---•�'+h'�„s�-.:ti:.TC��a.�� ...� - ! :� ^130. Fee l! y V r THE COMMONWEALTH OF-MASSACHUSETTS Entered in computer: ✓✓ .,, Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Zipp[ication for ;Diopoga[ *pgtem Construction permit Applicatiornfor/a`Permit to Construct( . )Repair( )Upgrade O()Abandon( ) ElComplete System O Individual Components -Location Address or Lot No. I a C o N N E M t4.R A CI rGL-L` Owner's Name,Address and Tel.No.sO iT-77 Ny,4111/V15 , 1)1f955 gALI SP RM B i C IPGL� Assessor's Map/Parcel -� In z — P 2.11 t Hyan�rv� ss Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 4-0 S—4 Z S—3 3U y ��Lf1 �a,✓� SuLc 1 VA/1' 1=/V61NfsE21 VV I N G i PWrKtr rt MoPo Type of Building: s Dwelling r No.of Bedrooms Lot Size 100 4 00-sq.ft. Garbage Grinder(N 0 _Other Type of Building No.of Persons Showers( ) Cafeteria( ) O-t tamer Fixtures Design Flow 33 O gallons per day. Calculated daily flow 3 3 l gallons. Plan Date IVO V. 1 9, 200 1 Number of sheets "A Revision Date •Title S ITE PLAN- PROI'OSS D SEPTIC SyS�-t -M uPGrADE Size of Septic Tank EA IST 1 1V4 1000 6•f4 L. Type of S.A.S. I'2. X 2S 1 E'AGN, CAAMRER- Description of Soil, 5,6E PEPM it Na. 76 -Z.4'7 a--P0 -' 7N. 11/Mot = O-� I�.tt �oa�vta 1-2"- 1q" C3. 1 St. BRWC,,gxs�sAN,57A01Z.402 . t9�� - 3A" R , Agrw)sN YEL. C&A",s 54,ye tol 2 G�! a 38'L1,0" C YEL11sN BrA,. CoArSESAAND 7 - s I0yR 'L Nature of Repairs or Alterations(Answer when applicable) �� Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system + in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b s •Lrd of "�t� fi Signe / Date Application Approved by \ �• Date: llblfh.vo Application Disapproved for the following reasons I; r t Permit No. bU - � _ \ Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS . Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded Abandoned( )by at 19 Caiy/Iit/J'lA2q Cl/'GGE , 11YA/ViV15 /3'J4S has been consttvcte in ccordance with the provisions of Title 5 and the for Disposal System Construction Permit N,o' a Oa/-71f dated 2vU Installer Designer The issuance of s permit shall not be construed as a guarantee that the syste wil function a desig�eed. Inspector Gt,, �e,�aAI\ No. D Q 0 1 74 k Fee S(J THE COMMONII`IEALTH 00/MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS biopoga[ *p!gtem Construction Permit Permission is hereby granted to Construct( )Repair( )Upgrade(x)Abandon( ) System located at 19 CONIVE iVl�/'R C I I"Gl..E i and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. ^^ �Q Date: � Approved by l�• U��` TOWN OF BARNSTABLE �- LOCATION l�'! �o�tit�'�''/� 29 � �� SEWAGE #2m> — 74 ' VILLAGE 111Y A ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO.,AQ,-H - 13 e'a SEPTIC TANK CAPACITY C X t.5 T 1^-S LEACHING FACILITY: (type -���/! -y S 2S (size)o2J X tAX NO. OF BEDROOMS n BUILDER OR OWNER PERMITDATE: ����/ COMPLIANCE DATE: �,E & 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 i within 300 feet of leaching facility) Feet Furnished by A c v gC 3-1) q7 j 6) L'OCa TIOt�1`,o *V �� 5EW6,C4E PERMIT UO. f IWSTaLLER*5 W&I%AE ADDRESS x) BUILDER 'S Q L1MF- & DDRE SS DfITE PERMIT 15SUEIC) — %�= 76 — — — DATE COMPLI &MCE ISSUED : c�j �� � � r a � �� � , . .� . �. =o �_ 9 _ � ��„; M.'�-� �. 61, No....... ..... Faa..../-a................ THE COMMONWEALTH OF MASSACHUSETTS }. BOARD OF HEALTH .......�J^'t.............OF........ .. . . R......... ......,.............................. ' I Apphratiuu -fur Di,ipu,ial Workii Tuuutrurtiuu Vrruiit Application is hereby made for a Permit to Construct ( ) or Repair ( ) .an Individual Sewage Disposal System at• _ _ rQ ...........�.tUN--•-• 25,.... etc' c Location- ress '/j or Lot No ��/ "_...'T.....�9.---....cam: '' ` ......----•------------•-------............. ......•----------••-------�r,,�r, d?'e '� �`� . -------- _ Owner ` Address a �. l q: �Q Installer Address Q ' r Type of Buildin Size Lo ......... S feet U - , --- q Dwellin No. of Bedrooms. .._...:.. ................Expansion Attic ( ) Garbage Grinder p, Other—Type of Building ._ ....:..:.... No. of persons.._.__- Showers ( 1 ) — Cafeteria ( ) Q' Otl-ter bxtures ...............:............... . .. ... .. . W Design Flow.... .. ........................_...-_gallons per person per day. Total daily flow...........Z... .....................gallons. WSeptic Tank capacity_-.gallons Length___.___..... Width--_ _ Diameter________________ Depth................ Disposal Trench—No. .................... Width-------------------- Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No..................... Diameter.................... Depth belo inlet____.. ... Total leaching area--__-_._.__.......sq. ft. Z Other Distribution box ( ) Dosing tank ( ) O c2. (o-g--'74. aPercolation Test Results Performed by........................................................................... Date----------------------------------------- Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water........................ f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ W ----- O ..f �� _ Description of S 1 - - "------ ----~ `�.,�..... cc -- ----- . x Vl ------------------------------------------------------------------- W {/ V Nature of Repairs or Alterations—Answer when applicable..................................:............................................................ .................•-----......-----..._...._..-•---------...............----•--•-•--...................._....------....-•---.....__._......._.........--•-•-••-•---•-•--•----.....------•------•-------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article \I of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued by the board of health. 4_ Signe --- ---• --. ..... ....................�. ----------------------•----•-•-- Date Application Approved By......... e ....................••- •-• �r-...._._- .A. .. '�Date Application Disapproved for the following reasons----------------------------------------------------------------------------------------------------------t_... ..........-•-•--•-----------------------------------------------•--......--------•-•--•---.....--•---•-••-•-----•-•-•--------------.._...._.....---•-•------------------•......_•--------------•- Date PermitNo.--...................................................... Issued........................................................ Date 07� . No.................`....... FEa.. ......-�.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ?.............O F..........&.... . ......... .................................... Appliration -for Bhipoiittl Works Tonutrurtion Prrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: hj-!! -S.S. C�t-�N-oLc,1_�....__.ck �( e�e ------------------------------------------------•-----------------------------------------•-••-• Location.tad ress or Lot No.�_ ... - ....... S............................................................ •--------......-------------•�,��-'..='.-- 5..>..._.cA. .------------------ / / Owner ( Address j/ � �! .... • ........ Installer Address UType of Building .� Size Lot..... ---Sq. feet Dwelling No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder (NV `l C4 , `�Other—Type of Building ... =----- No. of persons............................. Showers Cafeteria (• ) Q' Other 4xtures ...................................................... W Design Flow....._._...........................gallons per person per day. Total daily flow..........Z-�v.................gallons. WSeptic Tank Liquid capacity-_- _gallons Length___._ ______ Width..... .......... Diameter................ Depth.._..____._..... x Disposal Trench—No_ ____________________ Width.................... Total Length..................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet_.__.._ _..__..... Total leaching area------------------scl. it. Z Other Distribution box ( ) Dosing tank (• ) U b ' — — 7G. a .Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ �14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_.._..__________.___.... ! .... O Description of So Q.- 1 �`';v a'�',t - f 2 J `� Y-- ._._..._.�/Gc�. .._.S Z x ..................................... --------•-------•-------------------.....-----------•-•--•-••--------......_..--•-•-------....----------------................._..-----........__._._............. V Nature of Repairs or Alterations—Answer when applicable............................................_.__._..____.___._.__._.....__._...-_._._..__._..... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued by the b of health.. igne ......... ...."--• .0ard -•----- V-- --------- - --• •............................... /� � Date Application Approved By.._-...••. = -------- .. ... G�� 1'.7 G..__...... Date Application Disapproved for the following reasons:............................................................................................................ ..........••-•••-•--------•-•---•---•-----•--•.................•----•--..........-•-•--•••-----•---------...--•......•--••••----•----•-•-----..._..-------------•--............--------...---....._...-•- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF............. �(.......... .................. Trdifiratr of 0,11mphaurr T I 0 CERT Y, That the Individual Sewage Disposal System constructed ( or Repaired ( ) by._..- . ".:_1%!!I / -----------------------------------.......----••-------------------------------------------------------------------------------•---------•--- �Insta er atr� ,....�� ... .__l�Yli L� -T/' '............................................................... has been installed in accordance with the provisions of : V 1I o The Stte Sanitary Code as described in the application for Disposal Works Construction Permit No._ 2 -------------- dated.._,_!�-.'.�.3^..� ._�............. THE ISSUANCE OF THIS CERTIFICATE SMALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.... ... ��;?....•. Inspector---. THE COMMONWEALTH OF MASSACHL S BOARD O HEALT I.�............OF........ ..... yb0.....L. ............ .... // No......'� `f.7. FEE...14�............. i�po 1N r L rn tin Vrr it Permission is hereby granted ....rL, J�_ "'.......................................•- to Con str �) or Re �ir ( ) an Individual e�wae D' posal S s m ; at No. :_ .��y ... . if--•------ �- •--tom....--.. .--- -��" Stree as shown on the application for Disposal Works Construction Pe7iy No.�_____J .. .. Dated___ . ----.7----_----•--- / w 7� Board of Health DATE----..a:.."'---------....-----`--------................................... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS rr o'er - - Z� • �. EX�STcN----------------- ,. � 24 !Qo t. zo N i Nam,-72?3 � ZO►J� 1�1J S/LL f1-E.✓'� FEAT 480✓E•.POdD ,�`• SCAL� 1` =aaT& 0-- A-IL.A A/ 2E F�,Q�/VCE :_BEJ�/G LOT 99 A.S 5A10A/N ON LAIv1> COL/Z?7— fi-�c.��v ` 27099 a tlSfa6ET / of¢> N&QESy CEPTiFY Tf-/A.T THE EXIST- w a � GEO � A /NG FOUNDA T/ON 40C4 7 %S' chi: 4 W ". AS SNON/n/gNLJ DOE _ EONF0.e^1 I'V/TN �,, �' . �4 . Ts•/E SU/L D/NG SE TF3AC.�Pf�JI�r,QE MGM . y�S R E�O�. t OF Tf/E TOWN OF Lk-/, �; - _ G��,i_'G� Lid✓ ,�. -,4ffzZ:ZA.V5 tSuQ✓�yob _ Ca20 Gt/EL:L•�"T,�YG02 CO.L�? ' • 9 G!/iGG061/ST. yA2iN0 U.T1l��QT,•rLlA: �� t "],�T r I• r n 3Q U ,L ., mil. .Q• G t CONNL=MA(ZA CIRCLE JW. 'DESIGIv' NOTES Single Family`-2VBedroam I. Water Supply For This Lot is Municipal Water. " No Garbage Grinder 2.Location of Utilities Shown on This Plan Are Approx. Minimum Design:330 gpd At Least 72 Hours Prior to Any Excavation For This Q BRrs ;ti 1� Use Existing I'000 Gal Ion Septic Tank. Project The Contractor Shall Make The Required So. W key — Notification to DIG SAFE-1-888-344-7233. LOCUS —T LEACHING AREA 3.The Contractor is Required to Secure Appropriate Permits From Town Agencies For Construction I o o ` 1 I C- I L-O'T AREA ' EXIST. 330 gpd/0`74=446 s.f.Required Defined by This Plan. t r / 10�,400SF % Sidewall:2(12'+25 )2= 148 s.f. New iD Bottom Area,l2' i D`wAy x 25' = 300 s.f. 4.Instal I Risers as Required to Within 12"of Finished a \ f 446 s.f.Total Provided. Grade. M 3� 5.All Structures Buried Four Feet (4') or More or 1 '8 LEACHING CHAMBER DESIGN .4 $ Subject to Vehicular lobe H-20 Loading. � I AI I Pipes to he Schedule 40 PVC. Use 2 T ' 3y -500 Gallon Leaching Chambers in a 6.Septic System to be Installed in Accordance With 12' x 25' Washed Stone Field as Shown. 310 CMR 15.00 Latest Revision And The Town of o I U Barnstable Board of Health Regulations. (� LXIST. 2- BR . . w/F pw6LL l iv Cr / 7. All Piping tobe Sch. 40 PVC. i LOCUS PLAN �$ I Scale : Ire= 2000' 3Z f " Assessors Map 291 F.G.34.0 F G. 31.0 Parcel 291 Connect to Zoning R B 1- -1 Existing Septic L/ =� �---- Tank 28.5 Setbacks 3 Exist. �I Top El. Front 20 v / ExIST St-�TIG / Side 10' II �piCTalnkn I� a Rear IOr >; Bot.EI.26.5 m /` TANK t I---_—_� 29.7 29.5 / 30 p 6.5' Groundwater Overlay Bedding as -CONNECT TO � g Ground Water at El.20 District: GP -��, @7CISTING Se17TIc / i Per Title 5 Per T.O.B.Groundwater Map • / /' � TANK / � DELVELdPED PROFILE OF PROPOSED SEPTIC SYSTEM Not to Scale 3 I/ • 0 0 / � I J Q Grade W Q J I / � a f Filler -� 0 ; m-n Fa brie 'Compacted FIII 0 f Pa Sloe 0U J 0 �Q t-P W W I ILching 25 /' C amber R MINI / c I 3/4"-I I/2"Double a Chamber QQ���� 1� ♦�, I- J Q -a Z ' ` \ t Washed S1J, ULL �iV1I I� r ��n I \ ' �- 12 011 CML y CROSS,'SECTION OF CHAMBER ' PLAN VIEW ' ) \, NOT TO SCALE • ii Scale: 1 20' u 0 DESCRIPTION OF SOIL: p TH EL@V 31 .0 SEE PQ1ZMI-rNO -7&-241 I O-1 ' LOAM Q LOAM I' I'_2,5' SuCisol� 1 z �ll, SITE PLAN , 2r5= Sr ML_O. SAND S, STRONG BRt.I. COARSE SANDw/CopBLr-S 7.47YRs PROPOSED SEPTIC SYSTEM • S'-!e' t30Nhy "ERA\!EL \9"— {t UPGRADE MEp SANt� t3/coBr34 YL= 1 rZ I./C. SAND AT 8, W�COD13 LES I O V 2 L�(e ,C 'YEL.ISM TbRN, COARSE SANS 19 CONNEMARA CIRCLE So N1 E Co p 8 LES I O Y R S/L HYANNIS, MASS. moo" r3Y sE= 1t / IL /01 t FOR WALTER RIGBY SCALE: AS SHOWN DATE: NOV. ' 2001 'SULLIVAN ENGINEERING INC. Il OSTERVILLE , MASS. --L1 ® .s� T ALL SYSTE SYSTEM PROFILE MARKED WITHC MAGNETIC TTAPEALL OR BE PROVIDE MIN. 20" DIAM. WATERTIGHT (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. NOTES s ACCESS COVERS TO WITHIN 6" OF FIN. GRADE PROVIDE INSPECTION PORTS TO 1. DATUM IS APPROX. NGVD C o TOP FOUND. EL. 35.2' WITHIN 3" OF FINISH GRADE ion \ 2. MUNICIPAL WATER IS EXISTING (RE-ROUTE) 2� SLOPE REQUIRED OVER SYSTEM MINIMUM .75' OF COVER OVER PRECAST 34 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. a PRECAST H-10 O C RISERS (TYP.) \ 4. DESIGN LOADING FOR ALL PROPOSED PRECAST Hyo. E et 20 31.5 4"WSCH40 PVC UNITS TO BE AASHO H-LQ ` lem. Sch. tr ,., PIPES LEVEL 1ST 2' yens 29.6 5. PIPE JOINTS TO BE MADE WATERTIGHT. Loc rte 10" RE-USE EXIST. 14" _ Mitchells TEE SEPTIC TANK** TEE \30.1 'f* 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE �° o 29.22' WITH 310 CMR 15.000 (TITLE 5.) GAS BAFFLE I? °oho°o° o 0.92' 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND V 29.39' 29.22' 28.30' NOT TO BE USED FOR LOT LINE STAKING OR ANY m oin �.:::.r..r .:•, :: . OTHER PURPOSE. West Main St. St. 6" MIN. SUMP 16 H-20 HIGH CAPACITY INFILTRATORS 12" MIN. INT. DIM. (NO 'STONE PROPOSED) 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. ScJddet 6" CRUSHED STONE OR MECHANICAL 9. COMPONENTS NOT TO BE BACKFILLED OR Pie COMPACTION. (15.221 [2]) CONCEALED WITHOUT INSPECTION BY BOARD OF 9.3' HEALTH AND PERMISSION OBTAINED FROM BOARD (1 % SLOPE) ( 1 % SLOPE) OF HEALTH. LOCUS MAP LEACHING 10. CONTRACTOR SHALL BE RESPONSIBLE FOR FOUNDATION- EXIST. SEPTIC TANK 71 D' BOX 2' AND FACILITY VE FIYING (THE LOCATION OF ALL UND RGROUND & NOT TO SCALE *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL s: BOTTOM TH 1 EL. 19.0' OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS 1000 GALLONS AND ITS SUITABILITY FOR.RE-USE. REPLACE WORK. ASSESSORS MAP 291 PARCEL 291 PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM WITH 1500 GALLON SEPTIC TANK APPROPRIATE TO SITE 11. ANY UNSUITABLE MATERIAL(ENCOUNTERED SITE WITHIN ZONE II, GP OVERLAY CONDITIONS IF NOT SUITABLE SHALL BE REMOVED 5' BENEATH AND AROUND THE PROPOSED LEACHING FACILITY. 2 BEDROOM DEED RESTRICTION REQUIRED f 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. VARIANCES REQUESTED UNDER TITLE 5 15.405 (MAX. FEASIBLE COMPLIANCE) SYSTEM DESIGN. AND TOWN OF BARNSTABLE REGULATIONS: (1)(a): REDUCTION IN SETBACK, SAS TO LOT LINE (10' TO 5') GARBAGE DISPOSER IS NOT ALLOWED (1)(b): REDUCTION IN SETBACK, SAS TO FNDN. (20' TO 12'); CONNEMAM CIRCLE SAS TO BE > 3', BUT < 6' BELOW FINISH GRADE PROP. RE-LOCATED WATERLINE (TO BE MIN. 25 10' FROM SEPTIC SYSTEM COMPONENTS) EXISTING 2 BEDROOM DWELLING: NOTE: INSTALLER MUST CONFIRM 4' MIN. CONTIGUOUS x 342 ---W DESIGN FLOW: 2 BEDROOMS ® 110 GPD = 220 GPD SUITABLE SOILS IN AREA OF PROPOSED LEACHING JR- 46 �N USE A 220 GPD DESIGN FLOW FACILITY PRIOR TO INSTALLATION OF ANY PORTION OF .2 0 . 00 �, ' GR SYSTEM. CONTACT ENGINEER IF DIFFERENT FROM 4.38A\EL EXISTING TEST HOLES SHOWN. A=12 85 PAQk.'(N 33.89 SEPTIC TANK: 220 GPD (2) = 440 .03 USE EXISTING SEPTIC TANK** . ou... ., a M Tn w.. PROVIDE 58' OF 40 MIL LINER �� W AND BUGSCREEN (FINAL PLACEMENT BY N x 31.43 CONTRACTOR WITH HOMEOWNER 4.73 SF/LF x 6.25' LENGTH = 29.56 SF PER TEST HOLE LOGS AT 5' OFF SAS IN AREA SHOWN. TOP AT ELEV. 29.6', BOTTOM AT •33.45 CONSULTATION) HIGH CAPACITY INFILTRATOR UNIT EL. 25.6't ARNE H. OJALA PE, SE EXIST. DWELL. 330� GPD/0.74 GPD/SF = 445.9 SF LEACHING LOT 99 ENGINEER: � REQ D WITNESS: DON DESMARAIS, RS 10,510f S.F. BENCHMARK: USE TOP FNDN TOP FNDN.=.: 445.9 SF/29.56 SF/UNIT = 15.1 UNITS DATE: 10/29/12 AT ELEV. 35.2' EL. 35.2' BENCH MARK - SILL AT PERC. RATE _ < 2 MIN/INCH . 2 WALKOUT DOOR EL.=28.1 THEREFORE, USE GRAVELLESS SYSTEM OF (16) .38 j H-20 HIGH CAPACITY UNITS IN FIELD CLASS I SOILS p# 13775 33 86 31.87 r' CONFIGURATION SHOWN . �'� x 28.01 � i BRICK: p 16 UNITS x 29.5 SF = 472 SF > 445.9 SF ELEV. ELEV. .� PA � 1 M4 �O x 29.73 �,9� `L� 472 SF (0.74) = 349 GPD (OK) 0" 4 29.0' 0�, 29.0' 00 co A A x27. 6i 2 LS LS 1 31 \x 24.83 9 MA 6" 10YR 5/2 6„ 10YR 5/2 APPROVED DATE BOARD OF HEALTH B B LS LS 19 TITLE 5 SITE PLAN 10YR 6/4 ' „ 10YR 6/4 I t 2 25.8 x 23.06 20.06 30" 26.5 30 OF 26.5 ISOLATED 7. 7 •` VEGETATED x 28.7�F �R' WETLAND �� 19 CONNEMARA CIRCLE ti \ 24.02 HYANNIS PERC C C N N \\ 1 26.51 ` •k 20.22 .72 PREPARED FOR MCS MCS 85.00 o Mq �\o S . ' BORTOLOTTI CONSTRUCTION/ S� { � DANtELA.9yN s° DANIEL OJAL A °_ ,o A• GOETSCHIUS 2.5Y 6/4 2.5Y 6/4 \ tvu_ s " OJA, \ No.487 No. o-u980 i NOVEMBER 13, 2012 REV. 1/16/13 (NOTES) \ 0' lb f'3 ad�0�,gss F 120 19.0 120 19.0 � off 508-362-4541 „ a: o� ti� �o DANIEL y�� ( fax 508-362-9880 DANIELA. N o OJALA A. downcape.com ,. OJALA vIVIL No.40980 0OWII cape engineering inc. NO GROUNDWATER ENCOUNTERED sAs DIMENSIONS q o.�6502 � 1 ° �01STe� �q SS` civil engineers ScoIe: 1 = 20 S310 �' y0 R\1 / l land surveyors 939 Main Street ( Rte 6A) 12--26 > 0 10 20 30 40 50 FEET DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 ALL SYSTE SL SYSTEM PROFILE MARKED WITHC MAGNETIC TTAP OR BE PROVIDE MIN. 20" DIAM. WATERTIGHT (NOT TO SCALE) COMPRABLE MEANS FOR FUTURE LOCATION. NOTES s ACCESS COVERS TO WITHIN 6" OF FIN. GRADE APPROX. NGVD � c o PROVIDE INSPECTION PORTS TO 1. DATUM IS WITHIN 3" OF FINISH GRADE TOP FOUND. EL. 35.2' 2. MUNICIPAL WATER IS EXISTING (RE-ROUTE) \ MINIMUM .75' OF COVER OVER PRECAST 29� SLOPE REQUIRED OVER SYSTEM 2. 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. _ o c PRECAST H-10 4. Hy°' E Zt RISERS (TYP.) 4"0SCH40 PVC UNITS STO BE AASHO HR L PROPOSED PRECAST Sch. tr 2'0 31.5 PIPES LEVEL 1ST 2' Loc �tevens *' 29.6' 5. PIPE JOINTS TO BE MADE WATERTIGHT. 10" RE-USE EXIST. 14• ;i 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE Mitchells o TEE SEPTIC TANK** TEE 30.1 t* WITH 310 CMR 15.000 (TITLE 5.) 0000,a,00p00 29.22' o GAS BAFFLE °g°o�°o^r°,°q°-°0° 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND 0.92' 29 3g' 29 22' 28 30' NOT TO BE USED FOR LOT LINE STAKING OR ANY m Main OTHER PURPOSE. West Moin St. St. 6" MIN. SUMP 16 H-20 HIGH CAPACITY INFILTRATORS, e 12" MIN. INT. DIM. (NO STONE PROPOSED) 8. PIPE FOR SEPTIC.SYSTEM TO SCH. 40-4" PVC. 6" CRUSHED STONE OR MECHANICAL 9. COMPONENTS NOT TO BE BACKFILLED OR Pie CONCEALED WITHOUT*INSPECTION BY BOARD OF ' COMPACTION. (15.221 (2]) 9.3' HEALTH AND PERMISSION OBTAINED FROM BOARD (1 R SLOPE) ( 1 % SLOPE) OF HEALTH. LOCUS MAP 10. CONTRACTOR SHALL BE RESPONSIBLE FOR FOUNDATION- EXIST. SEPTIC TANK 71' D' BOX 2' LEACHING CALLING DIGSAFE (1-888-344-7233) AND NOT TO SCALE FACILITY I VERIFYING THE LOCATION OF ALL UNDERGROUND & BOTTOM"TH 1 EL. 19.0' OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF ASSESSORS MAP 291 PARCEL 291 *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL **INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT WORK. UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS 1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM WITH 1500 GALLON SEPTIC TANK APPROPRIATE TO SITE 11. ANY UNSUITABLE MATERIAL ENCOUNTERED CONDITIONS IIF NOT SUITABLE SHALL BE REMOVED 5' BENEATH AND AROUND THE PROPOSED LEACHING FACILITY. 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. VARIANCES REQUESTED UNDER TITLE 5 15.405 (MAX. FEASIBLE COMPLIANCE) SYSTEM DESIGN" AND TOWN OF BARNSTABLE REGULATIONS: (1)(a): REDUCTION IN SETBACK, SAS TO LOT LINE (10' TO 5') ���E GARBAGE DISPOSER IS NOT ALLOWED (1)(b): REDUCTION IN SETBACK, SAS TO FNDN. (20 TO 12); CONNEMARA C' PROP. RE-LOCATED WATERLINE (TO BE MIN. SAS TO BE > 3', BUT < 6' BELOW FINISH GRADE 25 to' FROM sEPTlc SYSTEM COMPONENTS) EXISTING 2 BEDROOM DWELLING: . NOTE: INSTALLER MUST CONFIRM 4' MIN. CONTIGUOUS 43 - „� ----"-'W,2- - - _------- DESIGN FLOW: 2 BEDROOMS ® 110 GPD = 220 GPD JR�- SUITABLE SOILS IN AREA OF PROPOSED LEACHING 46 USE A 220 GPD DESIGN FLOW FACILITY PRIOR TO INSTALLATION OF ANY PORTION OF 2 0 . 0 0 4��AVEL SYSTEM. CONTACT ENGINEER IF DIFFERENT FROM 8 5 = EXISTING TEST HOLES SHOWN. A=12 . PAWN33.89 SEPTIC TANK: 220 GPD (2) 440 .030 USE EXISTING SEPTIC TANK** o _ no .. 'r► J :p XA CO ,_FILTER Lc A rH.l N{'• 1�r AND BUGSCREEN (FINAL`PLACEMENT-2BY PROVIDE 58' OF 40 MIL LINER /� W x 31.43 CONTRACTOR WITH HOMEOWNER ' LENGTH TEST HOLE LOGS AT 5' OFF SAS IN AREA SHOWN. �? .33.45 CONSULTATION) 4.73 SF/LF x 6.25 = 29.56 SF PER TOP AT ELEV. 29.6, BOTTOM AT HIGH CAPACITY INFILTRATOR UNIT EL. 25.6't 330 GPD/0.74 GPD/SF = 445.9 SF LEACHING ENGINEER: ARNE H. OJALA' /PE, SE EXIST. DWELL REQ'D Lai 99 DON DESMARAIS, RS 10,51Of S.F. WITNESS: /445.9 SF 29.56 SF/UNIT = 15.1 UNITS BENCHMARK: USE TOP FNDN TOP FNDN. _.� DATE: 10/29/12 AT ELEV. 35.2' EL 35.2' / BENCH MARK - sILL AT < 2 MIN/INCH 2 THEREFORE, USE GRAVELLESS SYSTEM OF (16) PERC. RATE = WALKOUT DOOR EL.=28.1 H-20 HIGH CAPACITY UNITS IN FIELD CLASS ( SOILS- p# 13775 33 �,se 31.87 w CONFIGURATION SHOWN a 28.01 BBRICK•. O ;� ox 29 73 ti9 16 UNITS x 29.5 SF = 472 SF > 445.9 SF ELEV. ELEV. n, 1 4 "' / 472 SF (0.74) = 349 GPD (OK) 0" 29.0' 0" 4 29.0' 00 w 32 ti x 27. 11b A A LS LS 1 31 /x 24.83 9 MA APPROVED DATE BOARD OF HEALTH 6" 10YR 5/2 6" 10YR 5/2 �`' .�.+._... 20.41 B B TITLE 5 SITE PLAN LS LS M ( t 2 25.8 x 23.06 20.06 OF 30" 10YR 6/4 26.5' 30" 10YR 6/4 26.5' ISOLATED VEGETATED x 28.7�F \ ' ' `'A ` WETLAND 19 CONNEMARA CIRCLE •� HYANNIS �• 1 N `'a+ \ 24.02 PERC C C 1 26.51 ` 1 20.22 PREPARED FOR .72 MCS MCS B5.00 BORTOLOTTI CONSTRUCTION/ GOETSCHIUS 2.5Y 6/4 2.5Y 6/4 \ NOVEMBER 13, 2012 �qLSNOFMgss9 � L�NOoff 508-362-4541 444gq fax 508-362-9880 " t7ANIRLA. � DANIEL e�� 120�� 19.0� 120 19.0� o OJALA t A . ee��ng, Inc. downcape.com CIVIL OJALA NO GROUNDWATER ENCOUNTERED SAS DIMENSIONS ,� 2 � No.40380 down cape eng�a �o civil engineers Scale:1 G/STE� t� s Sao �� land surveyors f / "= 20' -13``� 9J9 Main Street ( Rte 6A) 0 10 20 30 40 5o FEET DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 12-261