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HomeMy WebLinkAbout0060 DUNN'S POND ROAD - Health 5 � 60 Dunn's Pond Road Hyannis Ate. 270 '019 ' d p r k iY r All I µp 2 4 IN nri TOWN F B ST LE LIATION ��/i��1 S ��Gi'1 SEWAGE # VILLAGE XdaiS ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY UU � d��s LEACHING FACILITY: (type) (size) NO.OF BEDROOMS 3 BUILDER OR OWNER ~ 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 wetlands exist within'300 feet of/leaching facility) . C- Feet y.Furnished b • r i a ~ E:j E::j U oq A-0- 31 ' A 61-1-.- 36 q6, 1 TOWN OF BARNSTABLE c.00ATION SEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY TOWN OF BARNSTABLE LOCATION Pv <Z(SEWAGE# /0 VILLAGE l�yL,n f\t s ASSESSOR'S MAP&PARCEL 2.7 0—fT INSTALLER'S NAME`&PHONE NO. SC.D SEPTIC TANK CAPACITY' e)( J�*tr r, /-V-00 G I 14 aU D Gq�'X LEACHINGIFACILITY:(type) J 0__ ti L H a 0 (size) J Q:14 NO.OF BEDROOMS OWNER .PVAnG.C;\V _ ; PERMIT-OATE COMPLIANCE DATE; / Separation Distance Between the: t Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any.wells-exist on w i site,,or within200 feet of leaching facility) Feet ,.Edge of Wetland and Leaching Facility(If any wetlands exist within � y k� t � r 300 feet of leaching facility)'" FURNISHED g� x .t 3 � Lo -CO n C/, - �~VA - -67% I No. �— Fee/® ) ' Entered ul computer. THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -'TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01ppfication for Misposai *pstem Construction Permit Application for a Permit to Construct( ) Repair-( Upgrade( ) ASandon_ ) ❑Complete System V ndividual Components Location Address or Lot No. (9 0 Owner's Name,Adqrfss,and Tel.No. Assessor'sMap/Parcel )7C) — I Ci7evn~yS M t-�A e__ G_c;x C Installer's Name,Address,and Tel. Scokf, 7, ,,,v. ta-j utJ (ykrr,,�.rz d ,. G (U(o S M ti Type of Building: �, r 6 �v 36LI OTC Lf Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(r►(j Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 236 gpd Design flow provided 0 t 6 gpd Plan Date Number of sheets , Revision Date Title Size of Septic Tank Gkt S.rk,p,G ►S aC) (gA\, Type of S.A.S. (j ��'b C) Cam.`- C'ACVA C 1 Description of Soil—��r _�C ��,��� J( 2 L/. A..2 _e fattip Nature of Repairs or Alterations(Answer when applicable) /A Q0 a sm) 4Q^,p 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 Date .46 Application Approved by Date t Application Disapproved by Date for the following reasons Permit No.�/� Ov Date Issued 9. Fee Cam' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVI616WITTOWN OF BARNSTABLE MASSACHUSETTS ftplicatioti for disposal 6pstrin Construction 30ermit l � Application for a Permit to Construct( ) Repair-V Upgrade( ) Abandon( ) ❑Complete System Vndividual Components - Location Address or Lot No. (.O Q vn15 90A J Aj Owner's Name;Address,and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No, Designer's Name,Address,and Tel.No. �� ��•�� 1�3 Uld yc.r�.c�u�.2.� � c� ��c��, pcv�. C���1.��r t M Type of uilding: J > l a C9N Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(N6r Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided , gpd Plan Date Number of sheets { Revision Date Title- Size of Septic Tank el� ' Type of S.A.S. Q lam— n r C V\CAMn ,t r� Description of Soil M 4 APT3 ,4 !2 t4.2 el Qtt? 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 Certificate of Compliance has been issued by this Board of Health. igned Date E Application Approved by Date Application Disapproved by Date for the following reasons Permit No. (1—= Date Issued / i -------------------------- -----------------------------------------------------------=------------------------------------------------ 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 rl has been constructed in accordance with the provisions of Title 5 d the for Disposal SystZ Construction Permit 3 dated Installer `r r[1 _ �('� � ,, �/ Designer I #bedrooms Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the syst�- will c`on as ° igne . �►�'"""" Date Inspector ( (\ --------------------------------------------------------------------------.---------------------------------------------' --^'7- -- No. Fee v THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposar 6pstem Construction i3Ermit Permission is hereby granted to Construct( ) Repair(� Upgrade( ) Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be competed within three years of the date of this C Date �(9 � Approved by f "FLPNvn :of:BArnJ stable � Sli€T Regulatory , Services 2iclraM V:Sc Ili,t.,n:terirn Director Y HARNSTA11t B •' P,"Iic I�caltlt Divis at . �'Fotu'+n 'I'htiYrras:.:t�IcKeaii; DieGi«tc►r 6394 200 Maur Stree(, 11y'ar:niris,MA.t12"E t1'1 C)ttic4 08 8624644: Fax 08 790_6304, Ctistallcr 1)csrgnei Certification Darin Date: SewitC;e 1' rn)it# /no Assc`sar';s�lals\Parcel . Ucsigner: rryar .. Cnstatlei; )LO Addi,css: l v ''�J'J :.{ > ' ) Address: r oL(00 Or 14 1�. � \-K _�Gc�_� t' \ ';;Cvj\v_.Vv .s issuccl a peniitt tci instafl:ii: (date}:I (instYllerj s�ptic systctn at v ir.�J PC7 oo a &sign dr4lwri by addres0' Dr V I Certify that:ihC sc' tYc syst'Crtt referenced ab lied,subst mull} ,i6wrdiYig:to the tie gn, which tray incI IC n11" ' alylarCived;changes such:rra t oral relcatattan;ctt tlita,: distribution box.aniel°ot sej io ttirtl:. $Yrlp ont ,€1f 1CC{utre 1Y'was 'inSptCYCd I Lk soak: wrc: found sitiSfiictrlty. 'r .� f f q�/p k C I &afify that:thi sepiI.CI System referenced above was.ipstallUd with inaijor changes (i e. greater than=10, lateral rel6c it oti:of the SAS or any v Le'ticaI reIocation of any component ofihc,si ptie:;systctii) but accordaricc.Nvitli State, & L66il Regufat.rons. flan revision or certified as-built by:designer to,tnllow. Strip out jifrequired)'ms inspected and the soils «�.r%faurtd sattsftic'Eoiy�� ! dert.il that :the system retercticc( above wac construUte(I i jhp,p,t with the'.terms of 01 apptir riblcjMl . �, �,; DAVINU y{r aJ ice; !E ��XII-Ii f E`f.d kiF P3: tlit5t<ill z s �ii tizttutC)_ ! 1rt�3 (\ kIRA, Oil Gcs gnc r s Signature) (Affix.Des ner s Stamp Mere) 1 I'A','AS1?, RETURN 'TO:I3,r1,RNSTA131.F PUBLIC !•1Et1,1:T.U.t DIVISION._CERTIFICATE O1 COMPLIANCE '4VCI:,1.. NO`t' 131s<1SSUTD UN"C'll:; `II;O"C'r'1"1IIIIS" CEOC�1\C J1NCJ r15 BUILT CARD ARE RECEIVED BY THE f3ARNS'1AIII' PUBLIC; H EMITIF DIVISION THANK YOU Q�srpiiclE)cS"i�uier C.eTtilicitti,n Purr t rtel,ts=14-i ,loc. I 4t VARIANCE REQUESTED AT MAY BE GRANTED IMMEDIATELY BY HEALTH AGENT OR HEALTH INSPECTOR. 0 SEPTIC 316 CMR 15.2110) - SOIL ABSORPTION a _ E C OO-T E H°U S SYSTEM TO CELLAR WALL. 20 ft MIN REQUIRED - VARIANCE TO 11 ft SEPARATION REQUESTED. D T§L ��C Ito WATER LINE /Y GAS LINE / OVERHEAD WIR OH C�O E P 51 G P� O M G ti K P P - EpGE MINIMAL Q�\�O�yQI • GRADING n \\vU PROPOSED e e n/�j' u�GGu�L U /r 0ti EA '— 12916 sf +— LA COUR'T PLAN 10614- E op G ASSR MAP 270 PCL 19 oy 51 O \ oy / 0' . fi \ \ 50 THIS IS A \ �p COLOR ��J PLAN \ tr // Q5 p 0 USE COLOR PLAN ONLY (�0 \ FOR INSTALLATION y � �0� ' I \ FULL DETAIL IS BEST VIEIN ED FULLWCOLOR — Of Io I 0?® 6 GAM15AFA ���^� OT \ / A OWED *OAK 15 in *18 in PROPOSED SOIL \`0 o OAK ABSORPTION 2 oAK SYSTEM op —SEE. DETAIL 1 EXISTING ON BACK \ OIL S 50 ABSORPTION SYSTEM TO BE i Et CONNECTED AND pp \ VENT SB" E �O�° REMAIN IN USE. _LSII�� fIV GED� \ PIPE L SEPTIC COMPONENTS FIL A N EXISTING de 1000 GAL SCALE: 1 in = 20 ft SEPTIC TANK DISTRIBUTION BOX® 0 20 40 INSTALLER MAY MOVE TEST PIT VENT PIPE TO A 0 ]0 20 DIFFERENT LOCATION. — - - PRINT ON 8-112 x 14 in %_o9 vu PAPER FOR PROPER SCALE OO 0�N4ABLE GIS DATpM ELEVATION 51.71 THIS PLAN IS INTENDED SOLELY FOR INSTALLATION OF THE SEPTIC SYSTEM DEPICTED ON IT. FOR ANY THE PROPERTY INCLUDING OP Pj� PLACEMENT OF ADDITIONS. SHEDS.CHANGES SHEDS. FENC S OROSWIMMING POOLS, OWNER O F FOON) SHOULD CONSULT WITH A MASSACHUSETTS REGISTERED LAND SURVEYOR. Q SEWAGE DISPOSAL � Q � ' Q DAVIDSS9CyG �P�(HOFMASS9�y SYSTEM PLAN J m O D' . p DAVID GJ -TO SERVE EXISTING DWELLING ° W ° :OUGHANOWR H COUGHANOWR ` " M A R L E N E B A N A C H WEST . Mq�N " No. 1093 No. 461 t•T. v &WALLACE SOUZA NOT V� STAE Q �� s �� DWNER(S) OF RECORD �� ET FGISTE�� s gPPRO � SCALE SA oq o _ RESP 60 DUNNS POND ROAD cQPo HYANNIS, MA 155 Geo Ryder Rd S PROPERTY ADDRESS & Q° HYANNIS, MA Chatham, MA 02633 Davidcou@HotmaiLcom DATE: DECEMBER 4, 2018 LOCUS MAP 508 364-08 4 PG.1/2 JDBtt ETE-43 ,�Bc SOIL . TEST d0G '' ' . DINGN CAL ATION SOIL EVALUATOR: DAVID D. COUGHANOWR. ASE *461 DESIGN FLOW: 3 BEDROOMS X 110 GPD = 330 GPD WITNESSED BY: DONALD DESMARAIS. HEALTH DEPT. SEPTIC TANK: 330 GPD X 2 DAYS = 660 GALLONS TEST PIT NO GROUNDWATER ENCOUNTERED PERC AT 52 in - 2 MIN/INCH IN C SOILS USE EXISTING 1000 GALLON SEPTIC TANK IF IN A DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER SOUND S,TRJCTURAL CONDITION. IF NOT. INSTALL ELEVATION INCHES HORIZON TEXTURE (MUNSELL) MOTTLES NEW 1500 GALLON .SEPTIC TANK. 50.50 0-9 FILL DISTRIBUTION BOX: INSTALL UNIT DEPICTED BELOW. 9-18 Ap LOAM 10 YR 3/2 NONE FRIABLE SOIL ABSORBTION SYSTEM: 47.83 18-32 Bw LOAMY SAND 10 YR 4/6 NONE FRIABLE THE LONG WITH TERM ACCEPTANCE RATE FOR A CLASS BELOW 5 MINUTES ONE 32-132 C MEDIUM SAND 10 YR 5/4 NONE LOOSE 39.50 1 1 1 1 1PER INCH = 0.74 GALLONS PER DAY PER SQUARE FOOT. TEST PIT 2 NO GROUNDWATER ENCOUNTERED iTHE 24 ft x 12.5 ft x 2 ft LEACHING GALLERY 2 MIN/INCH IN C SOILS DEPICTED BELOW CAN LEACH: ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER BOTTOM AREA = (24 x 12.5) = 300 sq. ft. INCHES HORIZON TEXTURE (MUNSELL) MOTTLES 50.55 SIDEWALL AREA = (24+24+12.5+12.5)x2 =146 s ft. 0-8 FILL TOTAL AREA = 446 sq. ft. 8-16 Ap LOAM 10 YR 3/3 NONE FRIABLE FLOW CAPACITY = 0.74 x 446 = 330.04 gal/day 16-32 Bw- LOAMY SAND 10 YR 4/6 NONE FRIABLE 47.88 INSTALL A 24 ft x 12.5 ft x 2 ft GALLERY AS CONFIGURED 39.05 32-138 C MEDIUM SAND 10 YR 5l4 NONE LOOSE BELOW. FLOW CAPACITY = 330.04 gal/dog WHICH EXCEEDS THE 330 gal/dog REQUIRED FOR A THREE BEDROOM DESIGN. 1000 A LL o0 @MR= SANK mama uw o Ilalso= 4-c �SO1L �1 =�i�S` ORP�TIOoN TANK TO BE PUMPED DRY AT TIME OF INSTALLATION � AND EXAMINED FOR STRUCTURAL INTEGRITY. INSTALL NEW PVC OUTLET TEE EQUIPPED WITH A GAS BAFFLE. @w saw amw m amum REPLACE WITH A NEW DRYWELL 1 in 1500 GALLON TANK UNIT 24.0 ft TAPER IF CRACKED. ROTTED c, OR OTHERWISE co�f � COMPROMISED. co w 0 5 U? NOT M TOco u') SCALE STONE 3.5 ft 8.5 ft 8.5 ft 3.5 ft \0 e ft-6 %� A SOO GALLON DRYWELL INLET OUTLET DIMENSIONS & DETAIL INSTALL ONE INSPECTION COVER COVER RISER TO WITHIN THREE INCHES OF FINAL GRADE r---- & INDICATE LOCATION ON AS-BUILT �3 IN DROP LINE FROM 10 in = 14 TO 0; 36 BUILDING �� D-BOX - OpiVl in 48 in j DOD `s usE LIOUID GAS LEVEL BAFFLE 5� uNlTs 102 b in STONE BASE IF NEW CROSS SECTION VIEW SEPARATION BETWEEN INLET & OUTLET INSTALL AN APPROVED GEOTEXTILE TEES NO LESS THAN LIQUID DEPTH FABRIC OVER STONE CROSS SECTION VIEW 28 314 in TO 24 in ■ r 314 In TO S T R 1: U T .O N B O S; SHOhEY • in 1 112 In GRAVEL : DEPTH I V Ee" 1112 In GRAVEL DIMENSIONSr • • >» fi AND DETAIL, •R 2 FEET BEFORE PITCHING, DOW 46 in 58 in 46 in ------ 150 in 12 In INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE. C MIN M STARTING WORK. Lr) FROM S ° -ALL COMPONENTS INSTALLED. SHALL MEET THE MINIMUM N TANK )n TO REQUIREMENTS OF MASSACHUSETTS TITLE 5 SEPTIC SAS CODE (310 CMR 15). O ^ 4; -ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION OF LOW FLOW FIXTURES & APPLIANCES. AND PERIODIC \� 6 In STTOO-NNEE,BAASE PUMPING OF .THE SEPTIC TANK. 21 2� CROSS SECTION VIEW -SEPTIC TANK NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. in S DO NOT PARK OR DRIVE VEHICLES OVER SEPTIC TANK. F L O w p G� 0 F 0 L C� TOP OF FOUNDATION RAISE COVERS TO WITHIN ALL PIPE TO 4 in BE SCH. 40 PVC VENT EL = 51.71 +- b in OF FINAL GRADE AND TO PITCH AT 1/8 in/ft MIN PIPE 50.5 DD—[SOW 3' USE Imm— 7 H-20 MAX RATED EXISTING USE H-20 47.75 UNITS EXISTING 1000 GALLON o00 0000g PRECAST o000 Sao SEPTIC ��Ir�� 46.00 goo a�oo� 000o DRYWELL :0 0ogaaa 47.50 o 00000 00o a EXISTING REFER TO DETAIL BOX S6 in SOILABSOG�3pT� N + 47.67 BASE 96,75 EXISTING TO A SYSTEM —REFER TO O ii fr 48 ft DETAIL BOX Ln 44.75 NO GROUNDWATER BELOW. NO OBSERVED _ 39.05 SEWAGE'DISPOSAL SYSTEM PLAN 160 DUNNS POND ROAD HYANNIS, MA JIDECEMBER 4, 20 88 0 PG 2/2 VARIANCE REOUESTED �� MAY BE GRANTED IMMEDIATELY BY HEALTH AGENT OR HEALTH INSPECTOR. S E P��C US 310 CMR 15.2110) - SOIL ABSORPTION SYSTEM TO CELLAR WALL. 20 ft MIN REQUIRED - VARIANCE TO 11 ft SEPARATION REQUESTED. D O _ U §L§T§ES ito WATER LINE /' GAS LINE CO y/ OVERHEAD WIR OH U PEP 51 ENS / P o O P J E Q G \�G �F P ONE 7,c; MINIMALGRADINGl� PROPOSED `000 r L O 1T 22 Oy EA = 12916 sf+— 5, LAND COURT PLAN 10614-E ASSR MAP 270 PCL 19 oy 51 �' G � a oy - O \ r Z S0 THIS IS A o \ / COLOR L �p% 00 PLAN 0 USE COLOR PLAN ONLY FOR INSTALLATION FULL DETAIL IS BEST VIEED IN FULL wCOLOR Of �0?® / \ � G R / �� �� O *OAK 15 in 0 *18 p in PROPOSED SOIL `0 r OAK ABSORPTION 2 OAin SYSTEM -SEE DETAIL \ t ON BACK \ EXISTING SOIL 50 ABSORPTION SYSTEM TO BE / 4c CONNECTED AND LE GEND VENT. SHE �p�� REMAIN IN USE. L�E GENND � PIPE j SEPTIC COMPONENTS PLANEXISTING GAL SEPTIC TANK ' SCALE: 1 In = 20 ft DISTRIBUTION-8Ox92 0 20 40 INSTALLER MAY MOVE TEST PIT VENT PIPE TO A 0 10 20 DIFFERENT LOCATION. -- PRINT ON 8-112 x 14 in PAPER FOR PROPER SCALE /�O O �pBLE GIS DAlpy ELEVATION f _ 51.77 THIS PLAN IS INTENDED SOLELY FOR INSTALLATION OF THE SEPTIC SYSTEM r0 �� DEPICTED ON IT. FOR ANY OTHER CHANGES TO THE PROPERTY INCLUDING PLACEMENT OF ADDITIONS, SHEDS. FENCES OR SWIMMING POOLS, OWNER OF FOUNDP��� i SHOULD CONSULT WITH A MASSACHUSETTS REGISTERED LAND SURVEYOR, Q Q odTF SEWAGE DISPOSAL _ o �\�NOfMgSs9! uFbggsS, SYSTEM PLAN 2 0 2 O DAVID 'yG 1 DAVID OyG -TO SERVE EXISTING ONELL.INO D. a COUGHANOWR H COUGHANOWR N M A R L E N E B A N A C H K'EST „ No. - - ,ygIN No. 461 ;�� _ ' &WALLACE SOUZA NOT \\\i� SjAEEj Pic �GQ O OWNER(S) OF RECORD TO QP\G, N sN So,�pP v� o cSPA 60 DUNNS POND ROAD SCALP° 155 Geo R der HYANNIS, MA Rd s [, O y PROPERTY ADDRESS & Q HYANNIS. MA Chatham, MA 02633 Dovidcou@HotmoiLcom DATE: DECEMBER 4, 2018 IL O C U S M A P' 508 364-0894 PG.112 JOB ETE-4344 necoe tip COI TEST �LO� _aa DESIGN C AdC ULATIONS SOIL EVALUATOR: DAVID D. COUGHANOWR. ASE #461 ;DESIGN FLOW: 3 BEDROOMS X 110 GPD = 330 GPD WITNESSED BY: DONALD DESMARAIS. HEALTH DEPT.NO GROUNDWATER ENCOUNTERED SEPTIC TANK: 330 GPD X 2 DAYS = 660 GALLONS TEST PIT I PERC AT 52 in 2 MIN/INCH IN C SOILS I USE EXISTING 1000 GALLON SEPTIC TANK IF IN DEPTH SOIL USDA SOIL SOIL COLOR s011 OTHER SOUND STRUCTURAL CONDITION. IF NOT. INSTALL ELEVATION I NEVIP 1500 GALLON SEPTIC TANK. INCHES HORIZON TEXTURE (MUNSELU MOTTLES 50.50 0-9 DISTRIBUTION BOX: INSTALL UNIT DEPICTED BELOW. FILL 9-18 Ap LOAM 10 YR 3/2 NONE FRIABLE SOIL ABSORBTION SYSTEM: 18-32 Bw LOAMY SAND 10 YR 4/6 NONE FRIABLE ITHE LONG TERM ACCEPTANCE'RATE FOR A CLASS ONE 47.83 SOIL WITH A PERCOLATION RATE BELOW 5 MINUTES 32-132 C MEDIUM SAND 10 YR 5l4 NONE LOOSE 39,50 ;PER INCH = 0.74 GALLONS PER DAY PER SQUARE FOOT. TEST PIT 2 NO GROUNDWATER ENCOUNTERED THE 24 ft x. 12.5 ft x 2 ft LEACHING GALLERY 2 MIN/INCH IN C SOILS DEPICTED BELOW CAN LEACH: ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER BOTTOM AREA = (24 x 12.5) = 300 s ft. INCHES HORIZON TEXTURE - (MUNSELU MOTTLES SIDEWALL AREA = (24+24+12.5+12.5)x2 =146 s . ft. 50.55 0-8 FILL P TOTAL AREA = 446 sq. ft. 8-16 Ap LOAM 10 YR 3/3 NONE FRIABLE FLOW CAPACITY = 0.74 x 446 = 330.04 gal/day . - 47.88 16-32 Bw LOAMY SAND 10 YR 4/6 NONE FRIABLE 32-138 C MEDIUM SAND 10 YR 5/4 NONE LOOSE INSTALL A 24 ft x 12.5 ft x 2 ft GALLERY AS CONFIGURED 39.05 BELOW..FLOW CAPACITY = 330.04 gol/doy WHICH EXCEEDS THE 330 gal/dog REQUIRED FOR A THREE BEDROOM DESIGN. ON MUM SEPTI T! 6AZ NK° SOIL ABSORPTION TANK TO BE PUMPED DRY AT TIME OF INSTALLATION T E M o o Norm EXAMINED FOR STRUCTURAL INTEGRITY. INSTALL NEW PVC OUTLET TEE EQUIPPED WITH A GAS BAFFLE: REPLACE WITH A NEW DRYWELL I in I500 GALLON TANK UNIT 24.0 ft TAPER IF CRACKED. ROTTED OR OTHERWISE c?f COMPROMISED.: " j w CV N L NOT TO c� ro SCALE STONE - O � 3.5 ft 8.5 ft 8.5 ft 3.5 ft 8 ft_ 6, in A 500 GALLON DRYWELL INLET OUTLET DIMENSIONS & DETAIL INSTALL ONE INSPECTION COVER COVER RISER TO WITHIN THREE INCHES OF FINAL GRADE I- .- I & INDICATE LOCATION f,3 DROPFLOW LINEION AS-BUILT FROM TO 36 BUILDI pr0D—BOX 6- Opp, in8 inGASQUID VEL BAFFLE 5� uNITs I 102 in 6 rn STONE BASE IF NEW CROSS SECTION VIEW SEPARATION BETWEEN INLET & OUTLET INSTALL AN APPROVED GEOTEXTILE TEES NO LESS THAN LIQUID DEPTH FABRIC OVER STONE CROSS SECTION VIEW _ - — - - - ---_- - 28 # 3/4 In TO 'a 24 in Is �q?!��'�. B U T •' 1-1/2 In GRAVEL :Im EFFECTIVEeI 1/2 in GRAVEL ►: • In .c I DEPTH ri -- - it 46 in 58 in 46 in 150 in I2 In -INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE c MIN STARTING WORK. _ -- Lo FROM —► -ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM N TANK TO OO REQUIREMENTS OF MASSACHUSETTS TITLE 5 SEPTIC SAS CODE (310 CMR. 15). 0 0, K cr -ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION- �b°b� d°�p OF LOW FLOW FIXTURES & APPLIANCES. AND PERIODIC \� 6 In STONE BASE 1 PUMPING OF THE SEPTIC TANK. 21 ;n 2\ CROSS SECTION VIEW -SEPTIC TANK NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. DO NOT PARK OR DRIVE VEHICLES OVER SEPTIC TANK. TOP OF FOUNDATION RAISE COVERS TO WITHIN ALL PIPE TO 4 in BE SCH. 40 PVC VENT EL 51.71 +- 6. in OF FINAL GRADE AND TO PITCH AT 1/8 in/ft MIN PIPE 50.5 DD=BOX 3 _ USE USE H-20 MAX RATED EXIST��0 - 47.75WIIIIIIIIIIIIIIIIlI uNlrs l TING 1000 GALLON oo Qo," PRECAST o00000 0 ��p�0� ��0�� 48,00ooa°o�°°oa DRYWELL oo�oo�0000 47.50 0 0�000� �000a a in EXISTING REFER TO DETAIL BOX STONE SM ABSORPTION + 47.67 BASE 46.75 M �n n T A I IN SYSTEM STEM —REFER TO o EXISTING' 11 ft 48 ft DETAIL BOX 44.75 NO GROUNDWATER BELOW i MOTTLING OBSERVED _ 39.05 SEWAGE DISPOSAL SYSTEM PLAN . 60 DUNNS POND ROAD HYANNIS. MA DECEMBER 4, 2018 0 PG 2/2 r Town df Barnstable P �b ' Department of Regulatory Services e erABiA Public Health Division Date 'Nov MA99 rd7D 200 Main Stroet,Hyanuls MA 02601 . rEll6tKl�Date Scheduled ( �4� Time I Fee Pd LO O /i/��,� ��I Sail SuitabjiliAssessment for Sewage Disposal `�'� i . Performed-By, 54,i11 A (� Cif o t YC A. E . Witnessed By a� LOCATION&.GENERAL INFORMATION Location Address 4 D019 h s pond. fd . Owner's Name Address �d DUVIYt S h'D hd �v"l Engineer's NameY.7�h/rs' Assessor's Map/Parcel: ` / f�ivi� �� . •Cott-�� NEW CONSTRUCTION REP AiR ✓ Telephone w S,,9 3,64 Ind Use F drlve+��. /� i • � 51opos(96) (_J Surface Stones •'� eg t^g.1/e oof Distances firm: Open Water Body ��0 }'-ft Possible Wet Area 1[7 1 ft` Drinking Wat r well t 46 d it it Dmlhagc Way -5 ft Property Line joteft Other ft SIMTCH:(Street name,dimensions of lot,exact locations of test holes&pore tests,locate wetlands•fn proximity to hales) VNt�S tuo.bb Fri T -2 toe,(0' Pt _ 7 r}t t3� Parent material(geologic) �� I tal © w'qS Depth to Pedronk Y)C7 i7 a— r Depth to Oroundwater. Standing Water In Hole: �yd N �- Weeping train Pit Pnoa Estimated Seasonal High Oroundwater r ` a I( `� I A DETERAHNATION FOR SEASONALMIG11 WATER TABLE Method Used: _yY 6+-+ t yn�- • ", Depth Observed standing in obs.hole: In. Depth to soil mottles: qt tN in.- . Detlth to weeping from side of obs.hole: hi. Groundwater Adjustment ft. Index Wc114 Reading Date: Index Wall Imvol Acj4ketdr. Adj.(lreundwater•Leval,.,_ PERCOLATION TEST bold a 3C lg tD R M Observation 1 Hole tI Time at 9" q Depth of Pero Tittle at 6" 1(4 — Slert Pro-soak Tlma® _z)O Time(9"4") -j -f--�-- End Pro-soak — RatoMin./Inch 1�IYi Site Suitability Assessment: alto Passed V Sitp Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back--------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one (1) week prior to beginning. Q:1S EPTICiPERCPORM.DOC DEEP.OBSERVATION HOLE LOG Hole# I Depth from Soil Horizon Soil Texture Sdil Color Sol]• Other Surface(in.) (USDA) (Munsell) Mottling (Stnucture,Stonad;Boulders. >s, c tsistency.2.Oravell �d� e a(•- f� (tea w1 (Z 3! �v n t. 3 2- 13z C, A410� �0 . i 0 R 5A it Loose DEEP OBSERVATION HOLE LOG Hole# �- Depth from Boll Horizon Sall Texture Soil Color 1 Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Conslatenoy. 2-IN C �k 'I wn CA I � � 5/1- DEEP OBSERVATION HOLE LOG Holo# Depth from Soli Horizon Soil Texture Soli Color Boll Other Surface(In.) (USDA) (Munsell) tMottling (Btructurc,Slone,Boulders, Consistency, -t j DEEP OBSERVATION HOLE LOG Hole# Depth from Sall Horizon Boll Texture Sall Color gull Other Surface(In.) (USDA) (Munsell) Mottling (Structura,Scopes;Boulders, Flood Insurance Rate Map: * - .A J Above Soo year Mood boundary No_ Yes Within 500 year boundary No V' - Yes " Within LOD year flood boundary No., .— Yes Depth of Natufally Occurring Pervious Materlal Does at least four feet of naturally occurring porvlous matorlal oxist in all teas observed thrpughout the area proposed for ther soil absorption system? •iCE.s If not,what is the depth of naturally occurring pervious matertall '--�--- C certify yahat ' I certify that on (date)I havepassad the soil evaluator examination approved by the Department of Envlrotimental Protection and that the above analysis was performed by me cotlslstent with the rcequired raining,Impertiso-anrt experience described in q 10 cjvM 15.017. �N OF,ygSo, �-. DAVID �s Slgnatm•e o D. " COU HANOWIR `n p� SENSE 0 Q.MPTICkPBRCPORM.DOC < EVAL�P� Commonwealth of Massachusetts Title. Official Inspection a p tion Form Subsurface Sewage Disposal System Form-Not for.Voluntary Assessments ,� ••'V 60 Dunns Pond Rd. Hyannis, MA Property Address Octavio Cardosa Owner Owner's Name information is required for every Hyannis MA 02601 page. city/Town State _ -ZIP Code 3-11-2014 P Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms _ on the computer, use only the tab 1_ Inspector: (� key to move your ` \I cursor-do not Darrell Stone _`J\ use the return 3 key. Name of Inspector Cape Cod Septic Inspection an Company Name P.O. Box 1466 CAompany Address ' Harwich City/Town MA 02645 State Zip Code 508-240-2500 SI4995 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: ® Pass ❑ Conditionally Passes . +❑ Fails ❑ e s urther E alua k th Local Approving Authority Inspector's Signat re, ' 3-14-2614 - 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. 3 I I li !sins•3113 Title 5 Official Inspection Form: Sewage Disposal system•Page 1 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form . Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 60 Dunns Pond Rd. Hyannis, MA ' Property Address Octavio Cardosa Owner information is Owner's Name . required for every Hyannis r' MA 02601 page. Cltylrown _ 3-11-2014 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: ® Fhave 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: Septic tank was pumped after the inspection 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 thelbox for"yes", "no"or"not determined"(Y, N, ND)for thefollowing statements. If"not determined,"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally,sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins•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 ,•'�� 60 Dunns Pond Rd. Hyannis, MA Property Address Octavio Cardosa Owner Owner's Name information is required for every Hyannis MA 02601 3-11-2014 page. Citylrown 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: fi ❑ 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 M 60 Dunns Pond Rd. Hyannis, MA Property Address Octavio Cardosa Owner information is Owner's Name ' required for every ilyannis page. Cityrrown MA 02601 3-11-2014 B. Certification (cont.) State Zip Code Date of Inspection - 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 a - 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: F• r D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: 'Yes Not «- ® 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 0 ® 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 Y 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 For Subsurface Sewage Disposal System Form-Not for VoluntaryAsm essments M 60 Dunns Pond Rd. Hyannis, MA Property Address Octavio Cardosa Owner information is Owner's Name required for every Hyannis 02601 3-11-2014 MA page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged d or obstructed i g9 e p p (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 tri ybutary to a surface water supply. El ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system,passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence Of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody.must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be 'necessary to correct the failure. , E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no to each of the following,in addition to the questions in Section D. Yes No ❑ ❑ 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 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 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 60 Dunns Pond Rd. Hyannis, MA Property Address Octavio Cardosa Owner Owners Name information is required for every Hyannis = MA 02601 3-11-2014 page. Cltyrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes " No ® ❑ " Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not - available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? j ❑ 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):' 3 Number of bedrooms(actual): 3 DESIGN flow based on 31.0 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 t5ins•3/13 Title 5 Official Ins 9 P Y g _ , . Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection- Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 60 Dunns Pond Rd. Hyannis, MA , Property Address Octavio Cardosa Owner information is Owner's Name required for every Hyannis MA 02601 page. Cityfrown 3-11-2014 State Zip Code . Date of Inspection D. System Information Description: 3 bedroom residential dwelling Y Number of current residents: 4 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection s information in this report.) ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): w 400.64 gpd Detail: 2013- 166,804 gallons 2012 - 125,664gallons Sump pump? -f• - El Yes ® No Last date of occupancy: 3-2014 Date Commercial/Industrial.Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ` ❑ Yes ❑ No Industrial waste holding tank present? • ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts" U • ' Title 5 Official. Inspection' Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 60 Dunns Pond Rd. H annis, MA Property Address Octavio Cardosa Owner Owner's Name information Is Hyannis . . aired for everyMA 02601 �q eve page. Clty/rown 3-11-2014 State Zip Code Date of Inspection D . System Information mation (cont.) Last date of occupancy/use: •� Date Other(describe below): General Information Pumping Records: Source of information: Discount Septic Pumping (508)240-2500 Was system pumped as part of the inspection? ® Yes ❑ No F If yes, volume pumped:. - 1500 t gallons How was quantity pumped determined? Weight Reason for pumping: Maintenance Type of System: . ® Septic tank, distribution box, soil absorption system ' S El 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): ' _ E; t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 I Commonwealth of Massachusetts Imp Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 60 Dunns Pond Rd. H annis, MA Property Address li Octavio Cardosa Owner Owner's Name information is required for every Hyannis MA 02601 3-11-2014 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: 2002 per BoH Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 16"+/- feet Material of construction: ❑cast iron 040 PVC other(explain): Distance from private water supply well or suction line: feet - Comments(on condition of joints, venting, evidence of leakage, etc.): Apparent good condition Septic Tank(locate on site plan): Depth below grade: 11" feet Material of construction: ®concrete ❑ metal ❑ fiberglass g ❑ 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: 1500 gallon Sludge depth: 3" t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official ns lug pection Form Subsurface Sewage Disposal System Form-Not for Volunta Asses ry sments 60 Dunns Pond Rd. Hyannis, MA " Property Address Octavio Cardosa Owner Owner s Name information is required for every Hyannis MA 02601 3-11-2014 ` page. Cltyfrown Inspection State Zi Code Date of P D: System Information (cont.) Septic Tank(cont.) , Distance from top of sludge to bottom of outlet tee or baffle 29" Scum thickness ' ' 1/2" 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 16" How were dimensions determined? Sludge judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Normal liquid level No sign of leakage .SCH 40 outlet tee The septic tank was pumped after the inspection Recommended maintenance pumping eve 2-3 years Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete. ❑ metal ❑fiberglass 9 El polyethylene ❑other(explain): Dimensions: e 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-3113 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 60 Dunns Pond Rd. Hyannis, MA i Property Address Octavio Cardosa Owner Owner's Name information is required for every Hyannis MA 02601 page. City/Town 3-11-2014 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 9 El polyethylene El other(explain): Dimensions: Capacity: gallons Design Flow: " e 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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Y Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 60 Dunns Pond Rd. Hyannis, MA Property Address Octavio Cardosa Owner Owner's Name information is required for every Hyannis MA 02601 3-11-2014 page. i City/Town State Zip Code Date of inspection - D. System Information (cont.) g Distribution Box(if presenfinust be opened) (locate on site plan): Depth of liquid level above outlet invert 011 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.).- Grade to box 17" OK condition 1 Outlet Normal liquid level No scum No sign leakage No sign of failure 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. Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: • ad t5ins•3113 Title 5 Official Inspection Form:Subsurface r Sewage Disposal System Page 12 of 17 j Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewa ge Disposal System Form-Not for Voluntary Assessments °M s 60 Dunns Pond Rd. Hyannis, MA Property Address Octavio Cardosa Owner Owner's Name information is required for every Hyannis MA 02601 3-11-2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: . ❑ leaching pits number: ® leaching chambers number: 2 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 2 (500 gallon)chambers with stone Grade to chamber 24" Bottom 55" Ponding 14" Staining 2"higher No sign of hydraulic failure 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 s 60 Dunns Pond Rd. Hyannis MA Property Address Octavio Cardosa Owner Owner's Name information is required for every Hyannis MA 02601 3-11-20.14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.)` t5ins•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 wM 60 Dunns Pond Rd. Hyannis, MA Property Address Octavio Cardosa Owner Owner's Name information is required for every Hyannis MA 02601 3-11-2014 page. City/Town 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 Kec,< M ( li I _ _ 25 4 5- _ 5 6 I t5ins•3/13 Title 5 Official Inspection Forth.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 M , 60 Dunns Pond Rd. Hyannis MA Property Address Octavio Cardosa Owner Owner's Name information is required for every Hyannis MA 02601 3-11-2014 CI wn page. rro 8 tY State ZipCode ate of Inspection D. System Information (cont.) Site Exam: J v ❑ Check Slope_ El Surface water ® Check cellar El Shallow wells Estimated depth to high ground water: >5 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: 2002 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: Plan on file ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Elevations from design plan Bottom of SAS ELV. 93.0 Bottom of test hole ELV. 87.0 Separation >5' Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 .Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments M 60 Dunns Pond Rd. Hyannis, MA Property Address Octavio Cardosa Owner owners Name information is required for every Hyannis MA 02601 3-11-2014 page. Cltyrrown State ZipCode Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ER Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Hazardous Materials Inventory Sheet Checklist .'Date Physical Street Address-Check database to ensure it exists / Working Phone Number - /__- -Actual Amounts -( ie. gas being used to fuel machines, thinner to AAA clean brushes all count as hazardous materials-no blanks) Storage Information -location of storage, how long is storage for? —�"If none, note that. —�f• Disposal Information •where and who? If none, note that. Applicant Signature -understand what is listed and noted .—Staff Initial -any questions„know who to ask Vehicle Washing/Rinsing? -give a vehicle washing policy and explain it Attach the Business Certificate with your sign off and comments The inventory form should explain what the business consists of and the procedures they are doing. Notes need to be left to explain what you discussed with them. YOU WISH TO OPEN A BUSINESS? For Your.Information: Business Certificates COST $30.00 for 4 ,years. A Business Certificate ONLY REGISTERS YOUR NAME in the Tow (WHICH YOU MUST DO BY M.G.L. - it does not give you permission to operate). You must first obtain the necessary signatures on.this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1" FI., 367. Main St., Hyannis, MA 02601(Town Hall) and - the Business Certificate-that is required by law. g Fill in please: L DATE:( APPLICANT'S YOUR NAME: 1 a v 1� �P H t BUSINESS YOUR HOME ADDRESS: Call TELEPHONE # Home lephone Number: NAME OF NEW BUSINESS YES` NO TY OFUSINESS �IS THIS A HOME OCCUPATION? Have you been given approval from the building division? YES N ADDRESS OF BUSINESS .MAP/PARCEL NUMBER When starting a new business there are several things you must do in order to be incompliance with the rules and re Barnstable. This form is intended to assist o regulations of the Town f u in obtaining o Y in the i Yarmouth g information you may need. You MUST th Rd. & Main Street) to make sure you have the T GO TO 200 Main St. — (corner of Y e appropriate riate P permits p P is and licenses icen town. ses required to legally operate your business in this 1. BUILDING COMMISSIONER'S OFF E This individual has been info d of any mit requirements that pertain to this type of business. Authorized Signature** MUST COMPLY WITH. HOME OCCUPATION COMMENTS: RULES AND REGULATIONS. FAILURE TO 2. BOARD OF HEALTH This individual hMben .nfor o the epmit requirements that pertain to this type of business. Authorized ignature** 11611J.4TGQWYMAU COMMENTS: HAMM==ATM (,$ ITrONS 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: Zs Date: TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: ::��—�'���`� i HW�1ti,!5 BUSINESS LOCATION: 17Z,1w1►i5 04,42 iZD INVENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: S�r `� CONTACT PERSON: /2yZ7 EMERGENCY CONTACT TELEPHONE NUMBER: s � S` 4 =42 MSDS ON SITE? TYPE OF BUSINESS:_7Z>k .II / AJC, INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum _ Antifreeze (for gasoline or coolant systems) 4 _ Misc. Corrosive NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants 4 Motor Oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways &garages Wood preservatives (creosote) Caulk/Grout 0 Swimming pool chlorine Battery acid (electrolyte)/Batteries 0 Lye or caustic soda Rustproofers 0 Misc. Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt & roofing tar PCB-s Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) NEW USED Any other products with "poison" labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor &furniture strippers 12 Other products not listed which you feel ® Metal polishes may be toxic or hazardous (please list): Laundry soil & stain removers (including bleach) Spot removers & cleaning fluids (dry cleaners) Q Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS r 1 T Commonwealth of Massac_ htltietts ' Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 60 Dunns Pond Rd Property Address Keystone Asset Management l� Owner Owner's Name information is required for Hyannis MA 02601 1-25-08 every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. A. General Information 1. Inspector. Shawn Mcelroy Name of Inspector Shawn Mcelroy Enterprises Company Name 29 Atwater Dr Company Address E. Falmouth MA 02536 Cityrrown State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification: I certify that I have personally inspected 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 1-25-08 Inspectors 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 r pd copies sent to the buyer, if applicable, and the approving authority. 4� co *"*"Tyls report only describes conditions at the time of inspection and under the conditions of use 'gghat time.This inspection does not address how the system will perform in the future under '. e same or different conditions of use. f-vJ V S 2[Y t5insp•08M Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 1 Commonwealth of Massachusetts ` Title 5 Official Ins ectioifform Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM ,.•�''y 60 Dunns Pond Rd Property Address Keystone Asset Management Owner Owner's Name information is required for Hyannis MA 02601 1-25-08 every 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: Leach chambers in good condition with water level standing 12"off bottom, and historical stain line at 5" below inlet invert. 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. ❑ 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 exfiftration 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: ❑ 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 t5insp-08106 TrBe 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 2 of 15 r Commonwealth of Massachusetts Title 5 ® 'ic"al Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 60 Dunns Pond Rd Property Address Keystone Asset Management Owner Owner's Name information is required for Hyannis MA 02601 1-25-08 _ every page. City/Town state Zip Code Date of Inspection B. Certification (cunt.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ 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 Heafth): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: 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 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. t5ins 08f08 p• Title 5 Official Inspection Form;Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 60 Dunns Pond Rd Property Address Keystone Asset Management Owner Owner's Name information is required for y H annis MA 02601 1-25-08 every page. City/rown state Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cunt.): ❑ 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 coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6°below invert or available volume is less than %day flow ❑ ® 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. t5insp•08106 Titre 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts • Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,M 60 Dunns Pond Rd Property Address Keystone Asset Management Owner Owner's Name information is required for Hyannis MA 02601 1-25-08 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ 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 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 oa/06 P• Title 5 Official Inspection Farm:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 60 Dunns Pond Rd Property Address Keystone Asset Management Owner Owner's Name information is required for Hyannis MA 02601 1-25-08 every 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? E ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS,located on site? 0 ❑ 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. ® El approximation 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-08/06 Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , 60 Dunns Pond Rd Property Address Keystone Asset Management Owner Owner's Name information is required for Hyannis MA 02601 1-25-08 every page. Citytrown state Zip Code Date of Inspection D. System Information Residential Flow Conditions:. Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes E No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: 12-07 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): t5insp•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments F 60 Dunns Pond Rd Property Address Keystone Asset Management Owner Owner's Name information is required for Hyannis MA 02601 1-25-08 every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) General Information Pumping Records: Source of information: WA 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/Altemative 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): Approximate age of all components, date installed(f known)and source of information: 2002 Were sewage odors detected when arriving at the site? ❑ Yes ® No t5insp•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15 I Commonwealth of Massachusetts Title 5 Official Inspection Form ` s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 60 Dunns Pond Rd Property Address Keystone Asset Management Owner Owner's Name information is required for Hyannis MA 02601 1-25-08 every page. City/Town State Zip Code Date of Inspection D. System Information (cunt,) Building Sewer(locate on site plan): Depth below grade: 18"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints,venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): Depth below grade: 12"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: 1500 Gal • ON Sludge depth: O ~ Distance from top of sludge to bottom of outlet tee or baffle 24" Scum thickness 0 Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? Tape t5insp•08106 Title 5 Official I nspection Form:Subsurface Sewage Deposal System•Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface,Sewage Disposal System Form-Not for Voluntary Assessments 60 Dunns Pond Rd Property Address Keystone Asset Management Owner Owner's Name information is required for Hyannis MA 02601 1-25-08 every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Good condition no recommendations. 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.): 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): t5insp-oafm Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page 10 of 15 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 60 Dunns Pond Rd Property Address Keystone Asset Management Owner Owner's Name information is required for Hyannis MA 02601 1-25-08 every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Tight or Holding Tank(cont.) 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.): 1 "Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No 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. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No t5insp-08/06 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 60 Dunns Pond Rd Property Address Keystone Asset Management Owner Owner's Name information is required for Hyannis MA 02601 1-25-08 every page. City/Town state Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 2-500's ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number,dimensions: ❑ overflow cesspool number: ❑ innovative/aftemative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil, condition of vegetation, etc.): Leach chambers in good condition holding 12"of water. Historical stain line at 5"below inlet invert. t5insp-08/06 Title 5 Official Inspection Form_Subsurface Sewage Disposal System•Page 12 of 15 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 60 Dunns Pond Rd Property Address Keystone Asset Management Owner Owner's Name information is required for Hyannis MA 02601 1-25-08 every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) 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.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ' 60 Dunns Pond Rd Property Address Keystone Asset Management Owner Owner's Flame i information is Hyannis MA 02601 1-25-08 required far y every page. citylrown state Zip Code Date of Inspection D. System Information (coat.) 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. i k t A j ti D31 -F 31` .� t5insp•08M Title 5 More!trispection Form:Subsurface Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts ' itle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 60 Dunns Pond Rd Property Address Keystone Asset Management Owner Owner's Flame information is required for Hyannis MA 02601 1-25-08 every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to ground water: 20 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: ® Checked with local excavators, installers- (attach documentation) ® Accessed USGS database-explain: You must describe how you established the high ground water elevation: Town maps show groundwater at 20'. t5insp-08/06 Tine 5 Official Inspection Form:Subsurface Sewage Pecb g Disposal System•Page 15 of 15 Town of Barnstable ' OF 1HE Tp� yP� Regulatory Services BARNSCABLE, Thomas F. Geiler,Director MAM A,E1639. Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual- number of bedrooms approved at a particular property would-be listed on the "Disposal Work Construction Permit". If you should have any questions regarding this report,please contact the certified Septic System Inspector who conducted the inspection. Commonwealth of Massachusetts 1� = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments iS �M c . Prop plyAddress __p Owner Owne ' Name information is required for _ UM/2 _ �t LaLl'a every page. City o State Zi Code P Date of Inspedion Inspection results must be submitted on this form. Inspection forms may not be altered in any way. . Important: A. General Information When filling out forms on the �� computer, use 1. Inspec only the tab key to move your / �1 cursor-do not use the return Name of pect key C Compare ame Company dressCityffown / 5D State Zlp Code 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 ; C) ✓ V In ector's Si ature Date cJ� r The system inspector shall submit a copy of this inspection report to the Approving m of Health or DEP) within 30 days of completing this inspection. If the system isa h a d system orhas 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. LAT 12/ 06 t5insp-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 o1 15 i F � Commonwealth of Massachusetts Title 5 Official Inspection Form P Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M d005 Pdn Prop y Address Owner Own r' Name information is / required for every page. City/Tow ta� 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: K 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are _ indicated below. Comments: 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. ❑ 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: ❑ 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 t5inspi•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 �I Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ProPAt y Addres Owner Owner's, ame information is C 9 / required for J /// every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ 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: 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 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. t5insp•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 15 1 Commonwealth of Massachusetts T Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �~ V �U Prop y Addres Owner Owne Name information is . required for every page. City/To n State Zip Code Date of InsPecti n B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 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 ❑ 2/" Discharge or ponding of effluent to the surface of the ground or surface waters / due to an overloaded or clogged SAS or cesspool ❑ Id/ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than '/day flow 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 round water elevation. 9 9 n. ❑ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. t5insp•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disp sal System Form - Not for Voluntary Assessments ns PropArty�Add�res / / �yy� Owne Owner %� n6L) 1 /(-� s Name information is required for every page. City w State Zip Code Date of In pec Ion B. Certification (Cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ,L/J Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ Any portion of a cesspool or privyis less than 100 feet but greater than 50 g 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 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 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. t5insp•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Y Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 7MU) Adqress 50694hMn Owner Own r Name information is � ��/ /z required for '// Od every page. City o n State Zip Code Date of In'spectIbn C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No /' l� ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ 2� Were any of the system components pumped out in the.previous two weeks? ❑ L/� Has the system received normal flows in the previous two week period? ❑ Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) F ❑ Was the facility or dwelling inspected for signs of sewage back up? ❑ Was the site inspected for signs of break out? Lil ❑ Were all system components, excluding the SAS, located on site? 1a ❑ 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: LJ ❑ 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•03/08 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 6 of 15 a Commonwealth.of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments s Zd1j),0 Prop ply Address„ // Owner C 61, Ow e ' Name 446 6L,44eo information is ,)required for /,_ o.?-6�/ � � d i7 every page. City o State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): ? Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 3 � . Number of current residents: Does residence have a garbage grinder? ❑ Yes No Is laundry on a separate sewage system? [if yes separate inspection required] El Yes No Laundry system inspected? ❑ Yes 12 No Seasonaluse? ❑ Yes 20 Water meter readings, if available (last 2 years usage (gpd)): Sump pump? ❑ Yes ❑ No Last date of occupancy: /'-2!9 Date - Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings,.if available: Last date of occupancy/use: Date Other(describe): 15insp•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts ` Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M vr� id Prope A0"S0,6 Owner Owner's Mlarne information is 115 required for every page. CityfrowrlJ State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes Z--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): Approximate age of all components, date installed (if known) and source of information: Were sewage odors detected when arriving at the site? ❑ Yes 2-INo t5insp•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15 Y Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 6rt�yA­dd�rs,� ann Pro /� ��j Owner /I(���, J 1"2 Ow*Nameinformation is Af,�Jt// D,j�required fior 6`//�j" �aevery page. City State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan):. Depth below grade: feet Material of construction: ❑ cast iron 210 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): Depth below grade: /G feet Material of construction: concrete ❑ metal ❑ fiberglass ❑ polyethylene El other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No --------------------------------------------------------------------------------------------------------------------------- f l i Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 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 How were dimensions determined? l5insp•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Iwo ;Qln,6 Rd Prope Add ess Owner Own be is N information is required for every 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.): 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.): 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): t5insp•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 a q Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °wM f V ✓ (�fi iy kd Prop y Adeed``res/s��G 'IJU Owner Owners ame information is required for every page. CityFnIo n State Zip Code Date of I spe tion D. System Information (cont.) Tight or Holding Tank (cont.) 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? 2-<es ❑ No Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert (� Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No t5insp•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts w ; Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM k jJ SAny) �d Property ddress G �b v2d1J Owner Owner' r ame information is n C required.for I J every page. Cityfrown ' State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: leaching chambers number: C2 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): t5insp-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15 1 o <� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Proper VAddr Owner's Name ss / ,' Owner information is A2�®1 required for �/�/T every page. City wn State Zip Code Date of Inspection D. System Information (cont.) 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.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.): t5insp•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Prope y Addres L Owner Ow er ame information is AM— required for J� v every page. City/To,,(nj State Zip Code Date of Inspection D. System Information (cont.) 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. � iz'111I e e t5insp•03/08` Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Pro rty Addre Owner Owner' ame L information is required for every.page. CityfT wn State Zip Code Date of Inspection D. System Information (cont.) Site Exam: heck Slope / ;2Surface water �f/`�_e ❑ Check cellar ❑ Shallow wells 1*2 /�yI—t"" Estimated depth to high ground water: z � 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: '0 Date /�e r'. ❑ 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: --7 t5insp•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 TOWN OF BARNSTABLE FL LOCATION tbQ Q gnws 96nd PJ SEWAGE # ,2oe�)- Se?!/ �PILLAGE ^i S ASSESSOR'S MAP & LOT 270 INSTALLER'S NAME&PHONE NO. 8e6inann 5 ee+,c- SEPTIC TANK CAPACITY I 0o LEACHING FACILITY: (type) b W.-A is (size) /e) b NO. OF BEDROOMS -3 BUILDER OR OWNER—.AJt,t�rAve PERMITDATE: COMPLIANCE DATE: -7- 3 d-D . 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 W i 1lHw^v'1 ( FE mow` J i � s No. VD 2 — 1 - - Fee T, THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: V Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE. MASSACHUSETTS 01pprication for �Diopooal bpgtem Con.5truction Permit Application for a Permit to Construct( )Repair(X:kUpgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 60 Dunns Pond Rd. Owner's Name,Address and Tel.No. Assessor'sMap/Parcel Hyannis, MA 02601 William Murray 6 - o t 9 Installer's N e,Addy ss, d Tel,No. Designer's r ame,Address and Tel No. Vm. E. Robinson Septic ServiceCraig .R. Short P.O. Box 1089 P.O. Box 1044 Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of BuildingResidential No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title ` Size of Septic Tank )5-00 Type of S.A.S. 0 X23- ') Description of Soil Nature of Repairs or Alterations(Answer when applicable) install to plans of Craig R. Short #1 -923 dated 7/17/02 Date last inspected: Agreement: hThe 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 jFalth. ' mental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Bo Signed Datep�' I �. Application Approved by Date 4.Z Application Disapproved for the ollowing reasons Permit No. aQd 2— 1) Date Issued 7 a `No. V�2 — 3� Fee �. THE COMMONWEALTH,QF MASSACHUSETTS Entered in computer: L ✓'' c Yes PUBLIC HEALTH DIVISION-TOWN OF BARNSTABLE, MASSACHUSETTS Rpprication for Mig0o9ar *pgtem Con.5truction Permit Application for a Permit to Construct( )Repair(}�}XUpgrade( )Abandon( ) El Complete System El Individual Components 1 Location Address or Lot No. 60 Dunns Pond Rd. Owner's Name,Address and Tel.No. Assessor'sMap/Parcel Hyannis, .MA 02601 Billiam urra Installer's Name,Ad ss, d el,No. Designge.- e!�Ydd&e's a�'nd.Te. o. Wm. io�inson Septic Service raig R. Short f P.O. Box 1089 P.O. Btax 1044 Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of BuildingResidnetial No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank _ 15 L Gv��u✓+ Type of S.A.S. a Soy Gu u C v M 13 kz s-aka '� Description of Soil Nature of Repairs or Alterations(Answer when applicable) Bestall to plans of Craig R. Short #1-923 dated 7/17/02 , Date last inspected: Agreement:. _A.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 Env. onmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by`this B afd o Hfgalth. . Signed Date s` t Application Approved by Date S=o.;? Application Disapproved for.the ollowing reasons Permit No. f)d 2 — K2 Date Issued THE COMMONWEALTH OF MASSACHUSETTS Murray BARNSTABLE, MASSACHUSETTS --Certif icate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired (XX)Upgraded( ) Abandoned( )by Wm. E. ..Robinson Sr. , Septic Service at 60 Dunns Pond Rd. ,, Hyannis, MA 02601 has been constructed in a cordance with the provisions of Title 5 and the for Disposal System Construction Permit No. �-7a�/ dated U Installer Wm. E. Roth®son Sr. Designer Craig R. Short, P.E. The issuance This ermit shall not be construed as a guarantee that the sy will function as de i ed. Date 0-. Inspector V V No. 20o,2—",30? Fee $50.00 Murray THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE, MASSACHUSETTS Mtgogar *pgtem Construction Permit Permission is hereby granted to Construct( )Repair�X)Upgrade( )Abandon( ) Systemlocatedat 60 Dunns Pond Rd., Hvsanis, MA 02601 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:Constructio Date: -7 must be completed within three years of the date of this .2 S U Approved by g�✓311 1.0'C*AT ION _' � � n ,6EWAGE PERMIT NO. la VILLAGE 4° l INSTA L ER'S N E' i ADDRESS UILDER OR OWNER i DATE PERMIT ISSUED DATE COMPLIANCE ISSUED _,�� �, ���_.__- ��� �— - - .., �. a No.....80- �.. FJ.... A9............_ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Town.....oF.......Ba�rnS AUQ......................................................... Appliration for Dispos al . orks Tonstrurtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( x) an Individual Sewage Disposal System at: ---••--Dunn's Pond Rd-,.....li3raxu?is�.iKA .02601 _... .--__ •--_.. ...... ................................................................................................. Location-Address or Lot No. ,Francis Murray__...--•.....................•------.------....--_---. Dunn's Pond Rd.� Hyannis.,-MA -02601 .............-- ----_..... ...............................................---_•••. a A & B Cesspool__Service� „ - 128 Bishops Terracetdd gannist- MA 02601 --- - C Installer Address Type of Building Size Lot............................Sq. feet aDwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) A4 Other—Type of Building ............................ No. of persons....._...................... Showers ( ) — Cafeteria ( ) Q' Other fixtures . ------..•-•-•-•••••- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid'capacity......_.....gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.....................Total leaching area....................sq. ft. Seepage Pit No---------_--------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) a Percolation Test Results Performed by--_---------------------- ---------------------------------------------- Date..................................... a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water--___________-__-___,__. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ --------•-------------------------------------------------------------------------••---------....._.......................................................... Descriptionof Soil...:. Sand.......................................•-•--•---...--•-----------------------------------------------------------------------------.........----•- x w x •--•••-••-••-----------•-•--------------•--•---•---.._.... --••------••--•--•---------........._...---•---------•----------------•••----•-----------•-•-•--••-••-•-....._................-••-•--•••-•-- U Nature of Repairs or Alterations—Answer when applicable.inS al-lat7,9x1..Qf. _. aQOO•-g ,�,0 re ( ..At. .Mane---packed..leach--l?it...(Qverf LOX)------•----------- --------•---------------------------.--.----.----------------------------------------..-.--..-.----- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T I T U 5 of the State Sanitary Code—The undersigned further agrees not to lace the system in operation until a Certificate of Compliance has been is ued by tie boar of It gned.. ..... ..- / -.6/26/8-0------------- D D to Application Approved By..... �� l{d ---------------------------••••-• ••-••-•.•6/2680...---••••-- Date Application Disapproved for the following reasons:............................................................•........................................._.._._... ....................•-•----•-------------------------------...------------•------•--------...------------........_...-_...-------------------------------------------------------------------------•-•--- Date PermitNo................ Q-.................................. Issued_.. .................................... Date No.... ... .L... Fim ""' "'"" ' :«� .«•.f. THE-COMMONWEALTH":OFr MASS ACHUSETTS' , BOARD OF "HEALTH TOftOF...... ...:... $............................. ... AVVItration for UiipnoFai ' orkii Totastrurtion Famit Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal System at: - ....... _'....� $... 02601•---•- ....................... •----••--...-•-------•------- Location Address or �No :tad. ..,.. 'a �Pand �:r. ------ !.. ....02601 .._..--••--•-----------•-----•--- ner a a B @� .C� 7,28 216 TQ��Ad gss 6 i7ef< 0SftE7, Installer Address Type of Building Size Lot----------------------------Sq. feet U Dwelling—No. of B.edrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther-Type of Building ............................ No. of persons............................. Showers ( )'— Cafeteria ( ) Other fixtures .--•-•-••---•-•...--•-•......... - W Design. Flow............... .................._,gallons per person per day. Total daily flow............................................gallons. t� Septic Tank/Liquid capacity............gallons Length................. Width..........:..... Diameter................ Depth................ Disposal Trench No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( " ) Dosing tank ( ) Percolation Test Results .Performed by.......................................................................... Date........................................ a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water.........._............. �%4 Test Pit No. 2...:.:...::.....minutes per inch Depth of Test Pit.................... Depth to ground water......... x ------------------------------------------------......................................................... xDescription of Soil --------•---------------•-••-----------------•.----••-----•---•-•------••-•-•-•••••••--•-•••••----•••-•--••......-•--•-.......••• - W a. U Nature of Re airs or Alter' ons Answer hen applicable 1n'��e3 9.0U 0- 1.fl Q 10� Z Agreement The undersigned agrees to,'install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T I T I S 5 of the State Sanitary Code— The undersigned further agrees not to place the system in. operation until a Certificate of Compliance has been,issued by the boar�ofholoi. P ed- --� - -. .« Application Approved B -. • .................................... - .PP PP Y ><' �� Date Application Disapproved for the following reasons: ---------------------------------------------------------------------------------•----•• ....................... ............... ...I. ---_•--- ---- -•-------•-----••--•-•••-•--------•f•----••---••-------------------•------••. •---•• ----- -I ................................ Date PermiNO..... ----•• ......................................... Issued_ 6. ------------•----------------------- - Date 3 t THE COMMONWEALTH OF MASSACHUSETTS BOARDI.OF, HEALTH z ...................... ..........OF........ db.®........:.........:............................. Trrtifiratr of TompliFanrr t THI" IS TO CERTIFY, That I di idual ewa e Disposal S.-stem const e or.R. P ' � by4XI .�� , g cam, p4, M� '�'1: � .(.__..__ I at................. ....................................................... .....�r ------ ..+7 has�been installed in accordance with the provisions of TLC 5 of The State SanitaryCo cribed in the application for Disposal Works Construction Permit No r__�l�M�.................. dated---------- ..................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® S A GIIARANTEE THAT THE SYSTEM �WILL /FUNCTIO ATISFACTORY. ' DATE �d ....f = Inspector �J • pY• +y'.f 'yy S'_ •ram.. i i .41 W*�' 1 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH bmw�ab ............... .......: 'E #...........0F..-- .. e9.. . . ...............•--.............................. $ No..............f. .. FEE %mop 1 orko (ion tr rut .�a c ede PS 4 Hy is Permission is hereby granted--------•--••:•-••-•--••----• -••- ............................ to Constru � o R ( an I ivid S Disposal S tem Vu4n ' >< y ttc � Fla y atNo:--• •••-•--• ••------ .....•-• -- - " Street as shown on the application for Disposal Works Construction er it .-_......... Dated---------- � b1�.................. Gl .................................... = .2 , oard of "H'th r DATE._... -- -•- ---- - ' FORM 1255 .HOBBS & WARREN, INC.. PUBLISHERS � � n 1 r (AZ ( , � � C Ic lks t r. IN! Q O t 6,..,<>ec-r v:w..:_,K,.. a�C:'.w.cvr_ra..w^....--Q. �{� a.'4a:.""."+'°Mr'.."e'•'y9,+rm.•..�r.w....^— ` 2wrn.�c!r.rn. � � A , j ..._ I SIN t - s r i 3 7U r � E 7lu ` t: t: �s�k►Linas�'' it X-- J It -D-, Tc ,------ -------- Lp fbw i T --l- ----- ------ i FZ -gyp- + - -� x h Ir eL K s cr x , LA i err X z 4_4 ---------- • JI _T­ F7 _T_T_ I T__ I--t! —4- 4 I_41L T F-7 ic _J T T-1 I I I } _ 1. _ ._ { j a _ T- x 1 L_;l 1-J-1xi t-T 7`7 4 T T WL T------ IL - L T_ 4+7/�­ 41 IXI T 4­- - cc T__ T- L-0-ji iL. r 4444 .:0 gk, �i�``;.+i+'effi> IMAM TOP OF FOUNDATION 20 FT. MINIMUM FROM CELLAR SOIL TEST ELEV. _ � � 10 FT. MINIMUM 10 FT. MINIMUM FROM SLAB OR CRAW- SPACE DATE OF SOIL TEST 1 GLEAN SAND SOIL TEST DONE BY P. SMOtT. �. (ASSUMED) CONCRETE WITNESSED BY COVERS LOAM AND SEED ' 4" SCHEDULE 40 PVC PIPE OBSERVATION HOLE 1 ELEV.=_-98.QQ _ i LMIN. PITCH 1/8" PER FT. 2" LAYER OF PERCOLATION RATE _< 2-- MIN./INCH AT -��_4A INCHES • \ 1/8" TO 1/2" LEGEND: DEPTH HORIZ TEXTURE COLOR MOTT. OTHER i � WASHED STONE VENT IS 24. 0&75 MAX. EXISTING SPOT ELEVATION 00,0 4" CAST IRON PIPE 7,75 WL NOT REQUIRED 8" A LOAMY SAND 10YR5 1 NO ROOTS (OR EQUAL MINIMUM - EXISTING CONTOUR - --00---- / FINAL SPOT ELEVATION PITCH 1/4' PER FT. I ? ' FINAL CONTOUR 33 8 LOAMY SAND 2.5Y7/4 I I ! SOIL TEST LOCATION I UTILITY POLE -� 80' Cl MEDIUM SAND 2.5Y6 4 W GRAVEL FLOW LINE 7 TOWN WATER —W��W'= / / RI� ELEV. _ -'TMIN. 20" o ° ❑ ❑ ❑ D ❑ 0 ❑ ❑ ❑ I❑ ❑ c T 10" - t CATCH BASIN ��� 132" C2 ' MEDIUM SAND 2.5YG/8 ELEV. _ _95.87 LEVEL ° o C7 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 1❑ ❑ ! GAS LINE G r o G.O.` ELEV. = 9a_00 -� GAS J 6" SUMP ELEV. _ _y_ o o CLEAN OUT ELEV. _ _ ' ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 0C3 ° 2' o O BAFFLE DIS�IB' t� o o CESSPOOL C.P V ELEV. _ °°° ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ I❑ ❑ °° o 0 LIQUID OUTLET _ _—/ o ° o ELEV. _ _noo BOX (TO BE PLACED ON FIRM tIASE) TO BE WATER TESTED 2 500 GALLON DRYWELLS WITH S ONE IN AN 5 FEET FEET i 9 INCHES IF MORE THAN ONE OUTLET NO WATER ENCOUNTERED AT �ll ELEV. _ _ 87.Q0 6 FEET 24 INCHES 1500 GALLOrJ 7 FEET 29 INCHES (TO BE PLACED ON FIRM BASE) 13' X 25' X 2' TRENCH FORMATION , WELL N/6 ' 8 FEET 34 INCHES SEPTIC TANK, T - Q ZONE N_ 3/4" T 0 1 1/2" CLEAN SOIL ABSORPTION w INDEX _ hL DOUBLE WASHED STONE SYSTEM A DESIGN CALCULATIONS FREE OF FINES & SILT S 1 .ITEM SAS NUMBER OF BEDROOMS 3 SEWAGE DISPCiSAL SYSTEM PROFILE OBSERVEDUSGS W TERROB TABBEE( WA�R BLE ELEV. TOTRAL BAGE ESTIIMAPTOEDAFLOWT _ NO_ 1`40T TO SCALE BOTTOM OF TEST HOLE ELEV. QQ._ ( 110 GAL/9R./DAY X 3 _ OR.) __ _ GAL./DAY REQUIRED SEPTIC TANK CAPACITY _ _ GAL. ACTUAL SIZE OF SEPTIC TANK _lam GAL. SOIL CLASSIFICATION yam_ DESIGN PERCOLATION RATE 15 ,",L_ MIN./IN. EFFLUENT LOADING RATE GAL./DAY/S.F. LEACHING AREA _4 _ SQ. FT. (13'x25')+(78'x2') LEACHING CAPACITY (AREA X RATE) 142A GAL./DAY 477 X 0.74 RESERVE LEACHING CAPACITY _IV&- GAL./DAY NOTES: 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. TITLE 5 AND THE TOWN RULES AND REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO WITHIN 6" OF FINISHED GRADE. I 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. 4. ANY MASONRY UNITS USED TO SR'NG COVERS TO GRADE SHALL BE bjCRTA;az: Nd PLACE. ! 5. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH O\ DEEDED OR ZONING REGULATIONS. OWNER / APPLICANT IS TO (� OBTAIN SUCH DETF` ATION FROM APPROPRIATE AUTHORITY. (` 6. UTILITIES SHO' 'PROXIMATE ONLY, EXCAVi TION CONTRACTOR IS TO CALL �Hr AT 1-888-344-7233 AT LEAST 72 HOURS PRIOR TO -OMMENCING WORK ON SITE. 7. CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS Q ��R SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. ANY VARIATION IS TO BE BROUGHT TO THE ATTENTION OF THE DESIGN ENGINEER (� IMMEDIATELY. �h 8, PARCEL IS IN FLOOD ZONE C___ 9. LOT IS SHOWN ON ASSESSORS MAP _ 27- AS PARCEL J y 10. ALL UNSUITABLE MATERIAL SHALL BE REMOVED FROM UNDER, AND O FOR A MINIMUM OF 5 FEET FROM AROUND THE SOIL ABSORPTION SYSTEM, I E-XIS77NG DNOELLING AND BE REPLACED WITH SAND AS SPECIFIED IN 310 CMR 15.255' (3) \ y LOT 2✓ TITLE 5) IF FULL CELLAR 11.(IEXISTING SEPTIC SYSTEMTO DBEEPOMPED ANDIFILLED WITH SAND „. _ tN O F a SEPTIC is '`9l' R081N OR REMOVED ANK tale yG W A m `� ,� 'hORT y APPROVED: BOARD OF HEALTH CIVIL � ,, CRAWL DECK No 274F` .) i DB r x� D A sv 0. �r,�0:- DATE AGENT S.T PROPOSED SEPTIC DESIGN • TH11" MURRAY S.A.5� �c-)p � 60 DUNKS POND ROAD L 0 T 22 HYANNIS, MASS i REA 72, 916:2� S. -- - CRAJG R SHORT, AX � 235 GREAT WESTERN ROAD • 508— P. 0. BOX 1044 i4470-- 398-8311 SOUTH DENNIS, MASS. 02660 DATE JULY 17, 2002 SCALE 1 = 20' -� LOT 21 REVISED I JOB N0. 1-923 , LOCATION MAP REVISED i SHEET 1 O GG ! _ 0 2002 CRAIG R. SHORT, P.E.