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HomeMy WebLinkAbout0089 COUNTY SEAT STREET - Health 89:CouMy:Seat',Street Hyannis P A = 291 162 i o i I i I .j 1 TOWN OF B.A_RNSTABLE LOCATION ,�,Z.1� I(y� SEWAGE # ✓I LLAGE A��, � 11V 0 ASSESSOR'S MAP & LO INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO. OF BEDROOMS 7 BUILDER OR OWNER 1 NV PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlan (� f s exist within 300 feet of leaching facility) Feet Furnished by `�� 0 �J 1 t G' O TOWN OF BCARRNSTABLE ,—i OCATION )"T Sty O t e SEWAGE# .. . - 09 VILLAGE 1400A S ASSESSOR'S MAP&LOT 2 — p2. INSTALLER'S NAME&PHONE NO. CA J? COCGj S1eiP G PAJ 1At-.C41, SEPTIC TANK CAPACITY IS�b ri.4 LEACHING FACILITY:(type) 01" SV '_ qey"�ts (size) K NO.OF BEDROOMS BUILDER OR OWNER CL )C�h t-1 PERMIT DATE: v ti �� COMPLIANCE DATE: 0 `p 11 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by m d AIF 2 et Lw o �c k,e)- e M M `aCl h e ie e, .A` No. ��� �, O �� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓ Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2ppliLation for 33isposal Opstem Construction Permit Application for a Permit to Construct( ) Repair(V)/Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components I ocation Address or Lot No. 9 ���y ✓�° T Owner's Name,Address,and Tel.No. f<-4� Assessor's Map/Parcel 1�?11 6-x Installer's Name Ad ess,a_n-�l Tel.No./Da ct/ G i`� Designer's Name,Address,and Tel.No. _- Fo - ��`l/ code C'oSP�"�fG Type of Building: 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) gpd Design flow provided 3�(y' gpd Plan Date /12-ZL' Number of sheets > Revision Date Title Size of Septic Tank /j d� Type of S.A.S. o a Description of Soil Nature of Repairs or Alterations(Answer when applicable) 2- �O Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Healt Signed Date /'14 oz/z Application Approved by Date 3o- Application Disapproved by Date for the following reasons Permit No. ��( '�� Date Issued . , 1 � No. G .. V Fee w THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftplitatioh for Misposal 6pstrm Construction permit Application for a Permit to Construct( ) Repair(V) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components 8'f a�eN/ ,f r�lt J T. Location Address or Lot No. y Owner's Name,Address,and Tel.No. r/o yJ.4 Assessor'sMap/Parcel -,-79// rZ Installer's Name,Ad ess,and Tel.No./. Designer's Name,Address,and Tel.No, c 4s✓e ��SP6�f/G FC r�;G� s u?-773`• tf✓� ./�•4'r �' 5 7'; 1 Type of Building: { Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 33a gpd Design flow provided 3G/}9' gpd Plan Date /A,G�/� Number of sheets / Revision Date Title Size of Septic Tank /� Type e of S.A.S. a I P //� � � Description of Soil C'z slid/uvr //is��o v sv Sa.�� i Nature of Repairs or Alterations(Answer when applicable) f/rre�/ s J O© /s v� l r/o.•r�r-,r S i`f lj !�/ /.t'f a G-� ua>/ �J c-4� Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed i Date /�-,7 c //T �— Application Approved by 1 Date 30- -`Application Disapproved by Date 3 for the following reasons Permit No. ;to1 `y)-} 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 1479' r'10„rlr% has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.2611 dated I' { Installer ow�' Designer 2 #bedrooms Approved design flow ) gpd The issuance of this {permit shall not be construed as a guarantee that the system wil function as designed. , { Date �J s �] Inspector �� J ----------------------l!-----------------------------------------------------------------------------------------------------=------------ No. a V� t Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal *pstem Construction Permit Permission is hereby granted to Construct( ) Repair(,.-r Upgrade( ) Abandon( ) System located at9' Ou 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 i J�must be completed within three years of the date of this permit. (� 6�J Z Date 1 3y T Approved by 02/15/2017 09:47 5087750424 CCSEPTIC MAKILAND PAGE 01/01 Town of Barnstable ' Regulatory Services Thomas F.Geller,Director NASS Public Health Division Thomas McKean,Director 200 Main Street,Hysnni ,MA 02601 Office: 508-962-4644 Fax: 509-790-6304 Installer&PWR=Certification Form Date: "� 7 17 Sewage Permit# .A►ssessees,MaplParcel to//�6 d t Designer.. LWA " Installer: Cr f �o �J 6 e Address: Ma I n J�g Address: On was issued a permit in install a (date) (installer) septic systems at qp ^W lased on a design drawn►,by (ifddress) �a I oL Pt PIJ dated / ab/o designer) . I cer*that the septic system referenced above was installed substantially according to the design,which may include minor approved ebmgcs such as lateral relocation of the distribution box and/or septic tank. 1 certify that the septic system referenced above was installed with major ebanges (i.e. greater than 10'lateral relocation of t3te SAS or any vertical relocation of any component Of the septic system)but in accordance with State&Local Regulations. Plan revision or certified as-built by designer to follow. a OF DANIEL.A. OJALA 3 Sign ). " CIVIL CA No.46502 Sk'��s .(Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN.. TO_. BARNSTABIIE FUBLIC HEALTH DMSION, CERTMCATE OF W I'LIANCE WILL NOT BE.issuED I wiL BOTH THIS FORM AND As-maLT CARDARE RECEIVED BY THE HAVOWAB(Z PUBLIC HEALTH BMSION. THANK YOU Q:Health/&AdDesi Certification Form 3-2.6-04.doe �- Old'- I,SZ ' Town of Barnstable r it Department of Health,Safety,and Environmental Services �7 t►+�►a,,� Public Health Division Date 367 Main Street,Hyannis MA 02601 ia» Date Scheduled _ l0y• a(�rfDMKt� 'Citne � ; � FeeI'd. v - Fr Soil Suitability Assessment for Sewage D'sposal �ctn �e Gc�sa(ye .S Performed By: Witnessed IIy; V• (n1• �y t r ......... . ...........4>><' �.. kr... L.1.1►.�4i - •a a.. .,':.•. Location Addressf (ilM. ^ Owner shame / � . �J lib �ygrl MO Address Assessor'sMap/Parcel: ell 91/ 42 Engineer's Name Lw - `„pe- T NEW CONSTRUCTION {{ REPAIR Telephone# Land Use L a H//t-7 Slopes(%) G—21;__ Surface Stones A,11 e Distances from: Open Water Body -;>l00 ItPossible Wet Area ,`OG R Drinking Water Well �>IObft Drainage Way 7/00 n Properly Line > tl Other R SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) Ccckrf Ny �IS,31 fir„I Tr+z iI5-,C)Parent material(geologic) - C�(4c;a Dina S h > zC)0 ,/� Depth to Bedrock A/ Depth to Groundwater: Standing Water in Hole: /" / Weeping from Pit Face Estimated Seasonal High Groundwater /V/A `•>:,:Si:?: :.'•>s::: '::..............:...:...........:...'.................,;...,.:""'`: :;'.''::".<;....... .',...: •'>;:;:::.,,;...,.%`:'::. ..? '....:• ;...:: ?: >?::E:'$>::;:::,:::P[�: :................... .... NA'X'YQ�;�'.+�:�t., Meu�od used: 'fU" Depth Observed standing in obs.hole: In. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment R. Index Well N _ _ -Reading Date:_ Index Well level Aclj.factor Adj.Groundwater Level T .0 :.{ . :........:............................:. .. . .................Data.:............... Observation Hole N Time at 9" Depth of Perc UJ D Time at 6" Start Pre'-soak Time© Time(9"-6") End Pre-soak Rate Min./inch V1717 e h Site Suitability Assessment: Site Passed Sitc Fniled: Additional Testing Needed(Y/N) /V Original: Public Health Division Observation Hole Data To Be Completed on Back j Copy: Applicant ti • _________ .. ... ....... ......... ... ....... X. ......... -0 '10 . . .... MOM ............ ....... D e pth fir!m) S oil Horizon Soil Texture Soil Other 10YR PIP M. Depth from Horizon Soil Texture Soil 0 or so 11 Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Con'sistency.%Gravel) Depth rrom Soil Horizon Soil Te�iu're Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes, Consistency.%Gravel) Depth from Soil Horizon 1 ex I e Soil Col�*r Soil Other Surface(in.) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency,%Gravel) Flood lnsura�ce Rate Map: , ' � � - r� c ` .� . . ~ . . . ' � � Above mNyear flood boundary Nv__ mn V�_ � Within 5myear boundmy nv> Yes___ Within loo year flood boundary Nv+K _ Yes____ Delith orNaturally Occurring Pervious Material Does ut least four feet nf naturally occurring pervious material exist in all areas observed throughout the � area yropnnod fbrdh000U ohoucoGon system? � l[not,what io the depth nf naturally occurring pervious motexiu|?____+____ Certification 4certifvthatonT (date)l have passed the soil evaluator examination approved by the Department o[Environmental Protection and that the above analysis was performed bvmo consistent with the required training,expertise and experience described in]lOCK8ll 15.017. / -7 GSignature - un: Du�_/ |, / /(/_�� -- ___-______-_-___'----__---__—' __ ' / f COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS F DEPARTMENT OF ENVIRONMENTAL PROTECTI , A AUG 2 3 2003 TOWN OF BARNST ABLE TITLE 5 HEALTH DEPT. OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 89 COUNTY SEAT".HYANNIS,MA 02601 QC(, Owner's Name: SCAPICCHIO Owner's Address: 89 COUNTY SEAT RD.HYANNIS,MA 02601 Date of Inspection: 8/6/03 Name of Inspector: (please print) JOHN GRACI,INC. Company Name: SEPTIC INSPECTIONS Mailing Address: P.O.BOX 2119 TEATICKET,MA.02536 Telephone Number: 508-564-6813 FAX 508-564-7270 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: X Passes _ Conditionall asses _ Needs Furt Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: 8/6/03 The system inspector shall submit opy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspecti n. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments SYSTEM PASSED TITLE V INSPECTION. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. ****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. Titla 5 Tncnantinn Form 6/1 VW)00 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 89 COUNTY SEAT RD.HYANNIS,MA 02601 Owner: SCAPICCHIO Date of Inspection: 8/6/03 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X 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 PASSED TITLE V INSPECTION.RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. B. System Conditionally Passes: _ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. n/a The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: n/a n/a Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): _ broken pipe(s)are replaced _ obstruction is removed _ distribution box is leveled or replaced ND explain: n/a n/a The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the,Board of Health): _broken pipe(s)are replaced _obstruction is removed ND explain: n/a Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 89 COUNTY SEAT RD.HYANNIS,MA 02601 Owner: SCAPICCHIO Date of Inspection: 8/6/03 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(l)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance n/a "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: n/a 1 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 89 COUNTY SEAT RD.HYANNIS,MA 02601 Owner: SCAPICCHIO Date of Inspection: 8/6/03 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all-inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _ X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than %2 day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped nLa. _ X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone I of a public well. _ X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] NO (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large 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. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no X the system is within 400 feet of a surface drinking water supply _ X the system is within 200 feet of a tributary to a surface drinking water supply _ X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone f1 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. A Page'5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 89 COUNTY SEAT RD. HYANNIS,MA 02601 Owner: SCAPICCHIO Date of Inspection: 8/6/03 Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health _ X Were any of the system components pumped out in the previous two weeks? X _ Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection'? X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out? X _ Were all system components,excluding the SAS, located on site'? X _ 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 ? X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Yes no X _ Existing information. For example, a plan at the Board of Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 89 COUNTY SEAT RD.HYANNIS,MA 02601 Owner: SCAPICCHIO Date of Inspection: 8/6/03 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 2 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):220 Number of current residents: 1 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): NO Seasonal use: (yes or no): NO Water meter readings, if available(last 2 years usage(gpd)): n4* O 1269 Sump pump(yes or no): NO Q D Last date of occupancy: n/a COMMERCIALANDU STRIAL Type of establishment: n/a Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings, if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: n/a Was system pumped as part of the inspection(yes or no): YES If yes,volume pumped: 1000gallons--How was quantity pumped determined?HICKEY CESSPOOL Reason for pumping: MAINTENANCE TYPE OF SYSTEM _Septic tank,distribution box, soil absorption system X Single cesspool X Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank Attach a copy of the DEP approval Other(describe): n/a Approximate age of all components, date installed(if known)and source of information: 28 YEARS BY OWNER Were sewage odors detected when arriving at the site(yes or no): NO - A � Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 89 COUNTY SEAT RD.HYANNIS,MA 02601 Owner: SCAPICCHIO Date of Inspection: 8/6/03 BUILDING SEWER(locate on site plan) Depth below grade: 18" i Materials of construction:_cast iron _40 PVC Xother(explain): ORANGEBURG Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): TOWN WATER SEPTIC TANK: (locate on site plan) Depth below grade: 0" Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: n/a Sludge depth: 0" Distance from top of sludge to bottom of outlet tee or baffle: 0" Scum thickness: 0" Distance from top of scum to top of outlet tee or baffle: 0" -41 Distance from bottom of scum to bottom of outlet tee or baffle: 0" How were dimensions determined: n/a Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): n/a GREASE TRAP: _(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): n/a 7 Pag6 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 89 COUNTY SEAT RD.HYANNIS,MA 02601 Owner: SCAPICCHIO Date of Inspection: 8/6/03 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX: _(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: n/a 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.): n/a PUMP CHAMBER: _(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a R Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 89 COUNTY SEAT RD.HYANNIS MA 02601 P Y Owner: SCAPICCHIO Date of Inspection: 8/6/03 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type n/a leaching pits, number: n/a n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a ` leaching trenches, number, length: n/a n/a leaching fields, number: n/a 6' X 6' BLOCK CESSPOOL overflow cesspool, number: n/a innovative/alternative system Type/name of technology: n/a Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): OVERFLOW IS STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.SYSTEM SHOWS NO SIGNS OF FAILURE.OVERFLOW WAS EMPTY AT TIME OF INSPECTION.BOTTOM IS AT 9 FT. CESSPOOLS: X(cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: 1 Depth—top of liquid to inlet invert: 6" Depth of solids layer: 1" Depth of scum layer: 2" Dimensions of cesspool: 6' X 6"' Materials of construction: BLOCK Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): MAIN CESSPOOL AND ALL COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a 4 Page'10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 89 COUNTY SEAT RD.HYANNIS,MA 02601 Owner: SCAPICCHIO Date of Inspection: 8/6/03 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. w JA �k Page 11 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 89 COUNTY SEAT RD.HYANNIS,MA 02601 Owner: SCAPICCHIO Date of Inspection: 8/6/03 SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 12+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record- If checked,date of design plan reviewed: n/a NO Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) YES Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: USGS MAPS AND CHARTS- 12+FT. COMMONWEALTH OF MASACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAI AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET BOSTON MA 02108(617)292-3500 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Govemor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 89 COUNTY SEAT ST HYANNIS, MAg026:01 M298IP023tL002B Name of Owner MR.CITRIANO Address of Owner: 89 COUNTY SEAT ST HYANNIS,MA 02601 Date of Inspection: 6/17100 Name of Inspector: JOHN GRACI I am a DEP approved system inspector pursuant to Section 15.340 of Tdle 5(310 CMR 15.000) Company Name: SEPTIC INSPECTIONS Mailing Address: P.O.BOX 2119 TEATICKET,MA.02636 Telephone Number: 608-664-6813 FAX 608-664-7270 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection.The Inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.The system: X Passes _ Conditionally Passes _ Needs Further Evaluati n Yy the Local Approving Authority Fails Inspector's Signature: Date:6/17/00 The System Inspector shall sub lilt a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS "The inspection is based on criteria defined in Title V code 310 CMR 15.303.My findings are of how the system is performing at the time of inspection.My inspection does not imply any warranty or guarantee of the longevity of the septic system and any of its component's useful life" THE SYSTEM PASSES TITLE V INPECTION.RECOMMEND PUMPING THE EVERY ONE TO TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. revised 9/2/98 Page 1 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 89 COUNTY SEAT ST HYANNIS, MA 02601 M298 P023 L002B Name of Owner MR.CITRIANO Date of Inspection: 6/17/00 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 the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 16.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER.IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well, _ The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless.a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,Method`used to determine distance n/a(approximation not valid). 3) OTHER n/a revised 9/2198 . Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 89 COUNTY SEAT ST HYANNIS, MA 02601 M298 P023 L002B Name of Owner MR.CITRIANO Date of Inspection: 6/17/00 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: X I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. 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. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances.If"not determined",explain why not. n(a The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance attached)indicating that the tank was installed within twenty(20)years prior to the date of the Inspection;or the septic tank, whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. n/a Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken(settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health). _broken pipe(s)are replaced _obstruction is removed _distribution box Is levelled or replaced nta The system required pumping more than four times a year due to broken or obstructed pipe(s).The system will pass inspection if (with approval of the Board of Health): _broken pipe(s)are replaced _obstruction is removed revised 9/2/98 Page 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 89 COUNTY SEAT ST HYANNIS, MA 02601 M298 P023 L002B Name of Owner MR.CITRIANO Date of Inspection: 5/17/00 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow, - X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped Q. - X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. - X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. - X Any portion of a cesspool or privy is within a Zone I of a public well. - X Any portion of a cesspool or privy Is within 50 feet of a private water supply well, X Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility,vrith a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment Because one or more of the following conditions exist: Yes No - X the system is within 400 feet of a surface drinking water supply - X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further information. revised 9/2198 Page 4 of 11 i;e SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 89 COUNTY SEAT ST HYANNIS, MA 02601 M298 P023 L002B Name of Owner: MR.CITRIANO Date of Inspection: 6/17/00 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health. X _ None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period. Large volumes of water have not been Introduced into the system recently or as part of this inspection. _ X As built plans have been obtained and examined.Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. X _ The system does not receive non-sanitary or industrial waste flow. X _ The site was inspected for signs of breakout. X _ All system components,excluding the Soil Absorption System,have been located on the site. X _ The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been determined based on: X _ Existing information,For example,Plan at B4O,H, X _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)1 5.302(3)(b)J X _ The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Subsurface Disposal Systems. revised 9/2/98 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 89 COUNTY SEAT ST HYANNIS, MA 02601. M298 P023 L002B Name of Owner MR.CITRIANO Date of Inspection: 6/17/00 FLOW CONDITIONS RESIDENTIAL: Design flow: 110 g.p.d./bedroom Number of bedrooms(design): 2 Number of bedrooms(actual): Total DESIGN flow: 220 gpd Number of current residents:1 Garbage grinder(yes or no):NO Laundry(separate system)(yes or no): NO If yes,separate inspection required Laundry system inspected(yes or no): NO Seasonal use(yes or no): NO Water meter readings,if available(last two year's usage): n/a gpd Sump Pump(yes or no): NO Last date of occupancy: n/a COM MERCIALIINDUSTRIAL Type of establishment: n/a Design flow: n/a gpd(Based on 15.203) Basis of design flow:n/a Grease trap present:(yes or no): NO Industrial Waste Holding Tank present:(yes or no): NO Non-sanitary waste discharged to the Title 5 system:(yes or no):NO Water meter readings.If available: n/a Last date of occupancy:n/a OTHER: (Describe) n/a GENERAL INFORMATION PUMPING RECORDS and source of information: n/a System pumped as part of inspection:(yes or no):NO If yes,volume pumped n/a gallons Reason for pumping:n/a TYPE OF SYSTEM X 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) _ I/A Technology etc.Attach copy of up to date operation and maintenance contract _ Tight Tank Copy of DEP Approval Other:n/a APPROXIMATE AGE of all components,date installed(if known)and source of information: THE SYSTEM IS 26 YEARS OLD. Sewage odors detected when arriving at the site:(yes or no): NO d revised 9/2198 Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 89 COUNTY SEAT ST HYANNIS, MA 02601 M298 P023 L002B Name of Owner MR.CITRIANO Date of Inspection: 6/17/00 BUILDING SEWER:X (Locate on site plan) Depth below grade: 24" Material of construction: _ cast iron _ 40 Pvc X other(explain) Distance from private water supply well or suction line: n/a Diameter: n/a Comments: (condition of joints,venting,evidence of leakage,etc.) THE SYSTEM HAS TOWN WATER. SEPTIC TANK: X (locate on site plan) Depth below grade: 12" Material of construction`. X concrete_ metal_ Fiberglass_ Polyethylene_ other explain: n/a If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): NO Age: n/a Dimensions: 6'X 6'BLOCK CESSPOOL" Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle: 33" Scum thickness: 0" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: n/a How dimensions were determined: MEASURED Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level In relation to outlet invert,structural integrity,evidence of leakage, etc.) MAIN CESSPOOL AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING EVERY ONE TO TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. GREASE TRAP: _ (locate on site plan) Depth below grade: n/a Material of construction: _concrete_ metal_ Fiberglass _ Polyethylene_other Explain: n/a Dimensions:n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle n/a Date of last pumping: n/a Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) n/a revised 9/2/98 Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 89 COUNTY SEAT ST HYANNIS, MA 02601 M298 P023 L002B Name of Owner MR.CITRIANO Date of Inspection: 6/17/00 TIGHT OR HOLDING TANK: _ (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: n/a Material of construction: _concrete_ metal_Fiberglass _Polyethylene _other Explain: n/a Dimensions: n/a Capacity: n/a gallons Design flow: n/a gallonstday Alarm present: NO Alarm level:N/A Alarm in working order:NO Date of previous pumping: n/a Comments: (condition of inlet tee,condition of alarm and float switches,etc.) n/a DISTRIBUTION BOX:_ (locate on site plan) Depth of liquid level above outlet invert: n/a Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) n/a PUMP CHAMBER: (locate on site plan) Pumps in working order:(Yes or No): NO Alarms in working order(Yes or No): NO Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) n/a sr revised 9/2/98 Page 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 89 COUNTY SEAT ST HYANNIS, MA 02601 M298 P023 L002B Name of Owner MR.CITRIANO Date of Inspection: 6/17/00 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: n/a Type: leaching pits,number:(n/a)n/a leaching chambers,number: (n/a)n/a leaching galleries,number: (n/a)n/a leaching trenches,number,length: (n/a)n/a leaching fields,number,dimensions: (n/a)n/a overflow cesspool,number: (1)6'X 6'BLOCK CESSPOOL Alternative system: n/a Name of Technology: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE OVERFLOW CESSPOOL IS STRUCTURALLY SOUND AND APPEARS TO BE FUNCTIONING PROPERLY.THE PIT WAS EMPTY AT THE TIME OF THE INSPECTION.THE SYSTEM SHOWS NO SIGNS OF FAILURE. CESSPOOLS: _ (locate on site plan) Number and configuration: n/a Depth-top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer. n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater: n/a inflow(cesspool must be pumped as part of inspection)NO Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a revised 9/2/98 Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 89 COUNTY SEAT ST HYANNIS, MA 02601 M298 P023 L002B Name of Owner MR.CITRIANO Date of Inspection: 6/17/00 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) b O � 3ti4 � yv� revised 9/2198 Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 89 COUNTY SEAT ST HYANNIS, MA 02601 M298 P023 L002B Name of Owner MR.CITRIANO Date of Inspection: 6/17/00 NRCS Report name: n/a Soil Type: n/a Typical depth to groundwater: n/a USGS Date website visited: n/a Observation Wells checked: NO Groundwater depth: Shallow_ Moderate_ Deep_ SITE EXAM _ Slope _ Surface water _ Check Cellar _ Shallow wells Estimated Depth to Groundwater 10 Feet+ Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site(Abutting property,observation hole,basement sump etc.) Determined from local conditions Checked with local Board of health _ Checked FEMA Maps : Checked pumping records _ Checked local excavators,installers X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS-10+FEET revised 9/2198 Page 11 of 11 SYSTEM PROFILE ALL SYSTEM COMPONENTS SHALL BE NOTES MARKED WITH MAGNETIC TAPE OR o (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. 1. DATUM IS NAVD 88 Route 28 a ACCESS COVERS TO WITHIN 6" OF FIN. GRADE 2" PEASTONE OR GEOTEXTILE CONCRETE COVERS TO WITHIN 3" GRADE 2. MUNICIPAL WATER IS EXISTING \ TOP FOUND. EL. 40.8' FILTER FABRIC OVER STONE 39.0 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. s o MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 38.0'-39.0' PRECAST H-10 WATERTEST D'BOX FOR LEVELNESS BLOCKS OF 4. DESIGN LOADING FOR ALL PROPOSED PRECAST °c RISERS (TYP.) MIN. 2" WALL THICKNESS PRECAST RISERS UNITS TO BE AASHO H-LQ . .• 2'0 4"OSCH40 PVC MORTAR ALL , PIPES LEVEL 1ST 2' COMPONENTS INVERT IN 35.13 �4' (np) 4' S. PIPE JOINTS TO BE MADE WATERTIGHT. t " 38.1' 10" 1500 GAL H-10 14• _, ° ENDS° °SIDESo 36.0' 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE n° °unt e Hya. E et°°°°° ° °° °°° ° WITH 310 CMR 15.000 TITLE 5. E/em. Sch. t•37.0' TEE SEPTIC TANK TEE ®®®® ®®®® ®®®®_ " ®®® °°o°°°°° tr �` 6.75 6" MIN. SUMP o°°°°°°° ®®In®®®Inr' ®®®®®®®�®�® °°°°°° Locus 5 GAS BAFFLE ;e000000000? 12" MIN. INT. DIM. >g0000000 ®®®®®®®�®®® ® ®®®�® °o°000°o f,te�ens Nor h N ;°o°g°a°o ®��®®®®��® ��®®®®� ,g 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND 35.4 35.23' >°°°°°°°o °o°°°o°° 33.13' NOT TO BE USED FOR LOT LINE STAKING OR ANY Mitch °°°°°°° ° °°° °° 4' LIQ. LEVEL (ACME OR EQUAL) OTHER PURPOSE. S �o°o°o°o°o,°,o°o°o°o°o°o°o°o°o°o°o°ono°o°o°o°o° ` Q .I�In °�o .o ° ° o 0 0 ^_^_^_ _�.�.° ° 3/4"-1-1/2" DOUBLE WASHED STONE 4' MIN. H-10 500 GAL. LEACHING CHAMBERS BY ACME PRECAST OR EQUAL 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. ALL AROUND PRECAST STRUCTURES (2) UNITS REQUIRED 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 25.00' X 12.83' m Moln 9. COMPONENTS NOT TO BE BACKFILLED OR COMPACTION. (15.221 [2]) CONCEALED WITHOUT INSPECTION BY BOARD OF West Main St. e $t. 7.3 4,g to HEALTH AND PERMISSION OBTAINED FROM BOARD % SLOPE Sod ( ) ( % SLOPE) ( 1 % SLOPE) OF HEALTH. i FOUNDATION- 15' SEPTIC TANK 29' LEACHING NO BOTTOM TH-1 GROUNDWATER FOUND 10. CONTRACTOR SHALL BE RESPONSIBLE FOR D BOX 12 FACILITY CALLING DIGSAFE 1-888-344-7233 AND NO VERIFYING THE LOCATION OF ALL UNDERGROUND & LOCUS MAP OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF *THE INSTALLER SHALL VERIFY THE WORK. LOCATIONS OF ALL UTILITIES AND ALL 11. ANY UNSUITABLE MATERIAL ENCOUNTERED NOT TO SCALE BUILDING SEWER OUTLETS AND SHALL BE REMOVED 5' BENEATH AND AROUND THE ELEVATIONS PRIOR TO INSTALLING ANY PROPOSED LEACHING FACILITY. ASSESSORS MAP 291 PARCEL 162 PORTION OF SEPTIC SYSTEM 12. EXISTING LEACHING FACILITY SHALL BE PUMPED i AND REMOVED OR PUMPED AND FILLED WITH CLEAN LEGEND 40' � i 99- EXISTING CONTOUR X 99.1 EXIST. SPOT ELEV. i i -[99]--- PROPOSED CONTOUR REr � SYSTEM DESIGN. [98.4] PROPOSED SPOT EL. c � TH1 �`� GARBAGE DISPOSER IS NOT ALLOWED 1 � , TEST HOLE O�N 3g / s �-54 / Q� EXISTING 3 BEDROOM DWELLING 2 SLOPE OF GROUND / i °R� 11b DESIGN FLOW: 3 BEDROOMS @ 110 GPI = 330 GPD COL) UTILITY POLE Ao USE A 330 GPD DESIGN FLOW yob FIRE HYDRANT f NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING j SEPTIC TANK: 330 GPD (2) = 660 USE A 1500 GAL. SEPTIC TANK PAVED o LEACHING: TEST HOLE LOGS 38 DRIVE EXISTING o SIDES: 2 (25 + 12.83) 2 (.74) 112 GPD / DWELLING BOTTOM 25 x 12.83 (.74) = 237 GPD ENGINEER: DANIEL E. GONSALVES, SE #13587 oy TOP OF FNDN WITNESS: DAVID STANTON, IRS EL. 40.8 TOTAL: 472 S.F. 349 GPD DATE: 1/26/17 USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) 2 MIN/INCH WITH 4' STONE ALL AROUND < PERC. RATE = • CLASS I SOILS P# 15254 a� FIREPIT ELEV. ELEV. 69 PATIO � MA '0" 38.0' 0" 38.0 C APPROVED DATE BOARD OF HEALTH A A CP p LS LS 38 10YR 3/2 10YR 4/2 TITLE 5 SITE PLAN 8„ 10» CH MARK - TOP OF BOTTOM STEP TH2 B B AT RETE LANDING. ELEV. _ .7 38 OF o TH 1 Ls Ls 5 00 89 COUNTY SEAT STREET 16" 1OYR 4/6 36.7' 209p 1OYR 5/6 36.3' 11 HYANNIS, MA C1 C1 SHED PREPARED FOR SiL SiL 37 3211 1 OYR 6/6 35.3' 3410 1 OYR 6/6 35 2, CAPE COD SEPTIC/ CLOUGH C2 C2 _'Z _�-� ' DATE: JANUARY 26, 2017 M/CS PERC M/CS 4�NOFMpSS OF.M yc �"a+ ASS �(H OF MASS ,��ZH OF MASsq off 508-362-4541 DANIELA. '� qc � a� ma's cy fax 508-362-9880 N oa ti� o� DANIEL �� DANIEL 2.5Y 7/3 2.5Y 7/3 /o OJALA � DANIELA. sm A. .. downcape.com CIVIL a`' OJALA o A. OJALA • No. CIVIL OJALA wn cQ,*e engineering ift o No.40980 126" 27.5' 126" 27.5' o �� o No.40980� �o >t o�, FGIs eR�\�� ° e 0 �,SNO �� civil engineers u ors Scale: 1 = 20 oNAL E ASS/ON eNG sR land surveyors NO GROUNDWATER ENCOUNTERED _ ` o y 939 Main Street ( Rte 6A) BCE # 1 7-0 > 6 0 10 20 30 40 50 FEET DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 17-016 C C SEPTIC-CLOUGH.DWG