HomeMy WebLinkAbout0163 FAWCETT LANE - Health 163�Fawcett Lane
277-103 Hyannis
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TOWN OF BARNSTABLE
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LOCATION 6 �a "��e T L,4, SEWAGE # ------�-._
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VILLAGE A/V Ot 01 n • S ASSESSOR'S MAP& LOT
i
f INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY: ("e) / (size)
NO.OF-BEDROOMS— ,
bU LDER OR OWNER
FERMIT®ATE,:_—..w..._..,,,,,.,,.—.—..w,.:.,,,.�.,C(7.PUIL.IANCE DATE: —
Separation Distaxrtce Between the:
Maximum Adjusted Groundwater Table to the Bottom of Lt;ac:hing Facility Fee
Private Water Supply Well and Leaching Facility (If any wens exist
on sits or within 200 feet of leaching facility)
Edge of*eland and Leaching FacihW(if any ~sell (Is exist
withi-0 300 fe�leaching c ilityl Feel
— Ll/_6 ` C_,4 CFUriVshedby _
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TOWN OF BARN,STABLE
LOCATION ! 43 F�C-&7roC/WQYWAGE#
VIdAGE ✓ '�h ASSESSOR'S MAP&P CEL,
} INSTALLER'S AME&PHONE NO. d f//
i SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) (size) R,'19
NO.OF BEDROOMS
OWNER f
PERMIT DATE:,!!�6 �/� 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 leachin .facil' ) "� Feet
FURNISHED BY
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No. kACHUSETTSFeeTHE COMMONWEALTH OF MA Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
2pplitation for Mispo al 6pstem Construttion Permit
Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location ddress or Lod No. /�j li / Owner's Name,Address,and Tel.No,��/�
Assessof s' Map/Parcel — �3
lnsjallerWe, dress, dLN D i e ' e A ress d Tel.N .
Type of Building: !�
Dwelling No.of Bedrooms / Lot Size �i�l�f� sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) T D gpd Design flow provided )1/, �/ gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank /°��d Type of S.A.S. i
Description of Soil
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 n.gn
Board ofMe?l
Date enI5 1yZ1
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. _ Date Issued
No. ( C p Faw Fee
' Entered in computer:
THE COMMONWEALTH OF MASSACHUSETTS
PU jI,C HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
. 20plicatlon for bi's o aY 6pstem Lois rc ion Permit
Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) [:]Complete System ❑Individual Components
�,.
Location Address or Lot No. 16'j �LV4/ Owner's Name,Addre �/_—ss idnd Tel.No�' 0WI
Assesso s Map/Parcel
Installer's ame�ddress d N9.�/� /�iJ � Dres�i_ne s We, A ress�and Tel No��' � C�
Type of Building: L/
Dwelling No.of Bedrooms / Lot Size�0,64� sq.ft. Garbage Grinder( )
t
Other Type of Building /rCEx No.of Persons Showers( ) Cafeteria( )
rOther Fixtures
" ��
_ Design Flow(min.required) 7 gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank 1 Type of S.A.S.
t Description of Soil
ter...,...... s
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected: lq
�* 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 (SA-gril
h�sBoard of e It �
4 X;?� - Date
._Application Approved by i f Date
Application Disapproved by Date
for the following reasons
i J
Permit No. TA ..i "; Date Issued
o
,..
I I
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,th,t the On-site Se� e Disposal-system Constructed( ) Repaired(i< Upgraded
Abandoned( )by;�i y%��' � ///f���G� '
at has been constructed'n p nce
T
with the provisions of Title and the for_ 's s Construction Permit No ated
r _ +�
Installer `�' Designer Fy eLfNV ,
#bedrooms l .�` Approved design flow 490 gpd
1 The:issuance of this pe it shall of be construed as a guarantee that the system w'1'' tio n s signed.
Date t(/ Inspector
- -_ -
No. Fee
/// THE COMMONWEALTH OF MASSACHUSETTS
PUB IC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
I "
MispoSal 6pstem Construction Permit
Permission is hereby granted to Construct) Repair(�"Upgrade( ) Abandon
System located at ������r/�
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:Constructio mu c plated within three years of the date of this permit.
Date Approved by /
JUN/30/2011/TAD 08:37 AM SandwichTownOffices FAX No• 1 5C8 833 OC18 P. 001/031
Town of Barnstable
Regulatory Services
Thomas F. Geiler,Director
UARMUNM
\ Pr,, ` � Public Health Division
Thomas McKean, Director
• 200 Main Street,Hyannis,M.4,026ol
Oflicc: 508-362-4644 ,Fax: 508-190-6304
Installer&Desi ner Cert9facation Forrtx
Date: Sewage Permit# ' / Assessor's Map\Yarcel � dD
Designer: �04yyeA �vl �?-�,P Installer: av LI
Address: . . __ .
On em d /Wl//`/`��`" �; .�9 issued
(date) (installer)L4d a permit to install a
l ! ,, �
septic system at l _ , 191�1/ ]T 4N 5 based or;a desip drawn by
(address)
dated L19 fil
(designer)
__x 1 certify that the septic system referetced above was installed substantially according to
the design, which, may include minor approved changes such as lateral relocatioa of the
distributioa box andior septic tank.
l certify that the septic system referenced above was installed with major changes (i.e,
greater than 10' lateral relocation of the SAS or and:vertical relocation of any component
of the septic system) but in accordance with State &Local Regulations. Plan revision or
certified as-built by designer to follow.
OF
(ltzstallet's Si� azure) No. 11 Q
1114 ANITA \
(Designer's Signature) (AfFLN Designer's Stamp Here)
PLEASE RETURN TO BARNvSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF
CONIPLIANCE WILL NOT BE ISSUED UNTIL BOTH TlJIS FQ_&M AND AS-SUIUT CARD ARE
RECEIVED BY THE BAPUNSTABLE PUBLIC HEfkLTN DIVISION, THANK YOU.
Q:HealtbrSepdc!Desigrer Certification Forrn 3.264.doc
�.' J'1;;/20 i20111MCN 09.49 Ali SandwichTownOff ices FAX No. 1 5C8 833 O118 P. 001
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ors ��
J!JtiN/20/2011/MCN 09:49 Ali SandwichTownOff ices FAX No, 1 5C8 833 OC18 P. 002
POW
FLOOR PL 4-yj
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G.. IKE{Q Op Town of Barnstable Barnstable, z ��
A&MmicaCRY
Regulatory Services Department I
+ nARNSTABLE, '
MASS. Public Health-Division m -
a679•
Alfa A 200 Main Street, Hyannis MA 02601 2007
Office: 508-862-4644 Thomas F.Geiler,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
CERTIFIED MAIL# 7006 0810 0000 3525 5392
April 19, 2011,
ATTN: David Holt, Today Real Estate
1533 Falmouth Road,
Centerville, MA 02632
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5
The septic system 163 Fawcett Lane, Hyannis, MA, was last inspected on 4/02//2011,
by Shawn McElroy, a certified septic inspector for the State of Massachusetts.
The inspection of the septic system showed that the system"Failed"under the guidelines
of 1995 TITLE 5 (310 CMR 15.00) due to the following:
• Backup of sewage into facility or system component due to Overloaded or clogged
SAS
• Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS
You are ordered to repair or replace the septic system within Sixty (60) days from the
date you receive this notification.
Failure to repair/replace the septic system within the deadline period will result in future
enforcement action.
R ORDER
HE BOARD OF EALTH
e]OT
mas McKean, R.S., CHO
Agent of the Board of Health
Q:\SEPTIC\Letters Septic Inspection Failures\1-1 SAMPLE 60 Day Deadline.doc
Commonwealth of Massachusetts
Title 5 Official Inspection form
rm
_ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
163 Fawcett Ln
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Hyannis MA 02601 4-2-11
page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
�A. General Information
1. Inspector:
I
Shawn Mcelroy
Name of Inspector
Upper Cape Septic Service
Company Name
29 Atwater Dr
%ur1_1Paity Mutate"
E. Falmouth MA 02536
City/Town 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
EZ information reported below is true, accurate and complete as of the time of the inspection, The insner_.tic n
`= was performed based on my training and experience in the proper function and maintenance of on site
i f, sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
f�. Title (310 CM 15.000).The system:
f; 1
❑.Passes ❑ Conditionally Passes ® Fails
❑ Needs Further Evaluation by the Local Approving Authority
4-2-11
Inspector's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP)within 30 days of completing this.inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the
report to.the appropriate regional.office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving-authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use.
Vt) q/
I I
t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewa Disposal System•Page 1 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Dorm -Not for Voluntary Assessments
M 163 Fawcett Ln
Property Address
Bank Owned (Contact Davin Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is Hyannis MA 02601 4-2-11
required for every y _
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
❑ I have not found any information which indicates'that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are
indicated below.
Comments:
B) System Conditionally Passes:
❑ One or more system components as described in the "Conditional Pass"section need to be
replaced or repaired. The system, upon completion of the replacement-or repair, as approved by
the Board of Health,will pass.
Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not
determined,"please explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
* A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection.. Form
Subsurface Sewage Disposal System Form,-Not for Voluntary Assessments
163 Fawcett Ln
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name '
information is required for every Hyannis MA 02601 4-2-11
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
B) System Conditionally Passes (cont.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ 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):
❑ V "broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
r
'r . ,'i J:
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 mannerwhich will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
f
Commonwealth of Massachusetts -
Title 5 Official Inspection Form
_ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
163 Fawcett Ln
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Hyannis MA 02601 4-2-11
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system„has a septic•tank and soiLabsorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ , The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well".
Method used to determine distance:
f .
*" This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate"Yes"or"No"to each of the following for all inspections:
Yes No
® ❑ Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
El ® Discharge or ponding of effluent to the surfaceof the ground or surface waters
due to an overloaded or clogged SAS or cesspool
® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6 below invert or available volume is less
than 1/ day flow
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 163 Fawcett Ln
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Hyannis MA 02601 4-2-11,
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
"` '" j ❑ '° ® � ` Any'portion' of the SA'S, cesspool or privy-is below higFi ground water elevation.
❑ '® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ E 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,
�F. 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
P,
❑ ❑ 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,ll of a public water supply well
If you have answered "yes"to any question in Section E the system is considered a significant threat,
or answered "yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�M 163 Fawcett Ln
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Hyannis MA 02601 4-2-11
page. City/Town State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate "yes" or"no" as to each of the following:
Yes No
❑ ® Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
❑ ® Has the system received normal flows in the previous two week period?
® Have large volumes of water been introduced to the system recently or as part of
this inspection?
El ® .. Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
❑ ® Existing information. For example, a plan at the Board of Health.
® ❑ Determined in the field(if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CM 15.302(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): 4 Number of bedrooms (actual): 4
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x #of bedrooms): 440
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form.-Not for Voluntary Assessments, ,
163 Fawcett Ln
Property Address
Bank Owned (Contact David Holt @ Today Real Estate.1-800-966-2448)
Owner Owner's Name
information is required for every Hyannis MA 02601 4-2.11
page. City/Town State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents: 0
Does residence have a garbage grinder? ❑ Yes Z No
Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No
Laundry,system inspected? ❑ Yes ® No
Seasonal use? ❑ Yes ® No
Water meter readings, if available (last 2 years.usage (gpd)):
Detail
Ito.
Sump pump? " ❑ Yes ® No
Last date of occupancy: 3-2011
Date
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design.flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present?, a ❑ Yes ❑ No
Industrial waste holding tank present?, ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
163 Fawcett Ln
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Hyannis MA 02601 4-2-11
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
r
General Information
Pumping Records:
Source of information:
N/A
Was system�puffiped'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
14
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑. Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology.Attach a copy of the current operation and
maintenance contract(to be obtained from system owner) and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank.Attach a copy of the DEP approval.
Other describe
t5ins°11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17
Commonwealth of Massachusetts
Title 5 Official. Inspection Form
Subsurface Sewage Disposal System Form -Not,for Voluntary Assessments _
163 Fawcett Ln
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Hyannis annis MA 02601 4-2-11
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:
1983
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 24"- feet
Material of construction:
❑ cast iron ® 40 PVC ❑ other(explain):
Distance from private water supply well or suction line: feet
Comments(on condition of joints,venting,.evidence of.leakage, etc..):
Good condition.
Septic Tank(locate on site plan):
Depth below grade:, 16"feet
Material of construction:
® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
If tank is.metal, list age:.
-years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions:
1000 gal
Sludge depth:
12"
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
w Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
,M 163 Fawcett Ln
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is H required for every annis MA 02601 4-2-11
-y
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle
20"
Scum thickness
Distance from top of scum to top of outlet tee or baffle 6
Distance from bottom of scum to bottom of outlet tee or baffle
16"
How were dimensions determined? Tape
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tank is in good condition with baffles installed and no sign of leakage.
Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping:
Date
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
" Subsurface Sewage Disposal System Form-Not for Voluntary Assessments -
M 163 Fawcett Ln
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Hyannis MA 02601 4-2-11
page. Cityl-rown State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction: '
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity:
gallons
Design Flow:
gallons per day
Alarm present: ❑ Yes ❑ No ,
Alarm level: Alarm in working order:, ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
,M 163 Fawcett Ln
Property Address
Bank Owned (Contact David Holt @ Today Real Estate"1=800-966-2448)
Owner Owner's Name
information is required for every Hyannis MA 02601 4-2-11
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box(if present must be opened) (locate on site plan):
q
Depth of liquid level above outlet invert 0
p
Comments (note if box is level and distribution to outlets equal,..any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
D-box had water at working level and stain lines above inlet invert.
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No
Alarms in working order: ❑ Yes ❑ No
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
163 Fawcett Ln
Property Address
Bank Owned (Contact.David Holt @ Today Real.Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Hyannis MA 02601 4-2-11
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Type:
® leaching pits number: 1-1000 gal
❑ ,v- Teaching chambers ' number.
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Leach pit was holding water at 16" below inlet invert and had stain lines above inlet invert.
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth -top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool.
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�M 163 Fawcett Ln
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Hyannis MA 02601 4-2-11
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy (locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
y 163 Fawcett Ln
�M
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Hyannis MA 02601 4-2-11
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
D
11>
id:g 46 ILL
4/
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
163 Fawcett Ln
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Hyannis MA 02601 4-2-11
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
❑ Check Slope
❑ Surface water'
❑ Check cellar
❑ Shallow wells
Estimated depth to high ground water: 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:
USGS and town maps show groundwater at 20'.
r
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
I
Commonwealth of Massachusetts
W Title 5 official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�M 163 Fawcett Ln
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Hyannis MA 02601 4-2-11
page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
inspection Summary: A B C D
® P rY , or E checked
® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed
® System Information— Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistenc %Gravel
�! to
2 , 132"
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistenc %Gravel)
fuM. L Oil
4
h /32" 71
DEEP OBSERVATION HOLE LOG ' Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency,%Gravel
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency. Gravel)
-
Flood Insurance Rate Map: `
Above 500 year flood boundary. No Yes -___ y
Within 500 year boundary No Yes
Within 100 year flood boundary No- Yes
Depth of Naturally Occurring Pervious Material _
Does at least-four feet of naturally occu aing pervious material exist.in all areas observed throughout the
area proposed for the soil absorption system? e
If not,what is the depth of naturally occurring pervious material?
Certification
I certify that on (date)I have passed the soil evaluator examination approved by the
Department of Enviro mental Protection and that the above analysis was performed by me consistent with
t 'nin ;expertis and xpepence described in 3:10 CMR 15.01 the require� )
Signature Date l `�
Q:I.SEPTICVERCFORM.DOC
I
. - I
Town of BA irnstalble. P# � 3
°F Department of Regulatory Services
• ' Health
Division Date
twereetB. : Public He
a6 y tee$ 200 Main Street:Hyannis MA'02601;
~tFD lA1't�
Date Scheduled r I Time Fee I'd.�
I .
Soil Suitability Assessm' ent for Se e Disposal
• � r��� � Witnessed By: C%<
Performed By. `` ..
C� '
LOCATION & GENERAL iNri ORMATION
J .
Location Address•. Owner's Name E� ,t* - 0% hs JpC•
•�� (sue
Address
&�o°'13
RX/"pis
Assessor's Map/P4rcel: '),-7D /'/ 3 I Engineer's Name ]D�„E
/ j ,`�'
NEW CONSIRUtjON REPAIR x Telephone#
Land Use P Slopes(%) ' 40 0 Surface Stones
Distances from: Open Water Body_IdLft Passible Wet Area 7 0 ft Drinking Water Well ft
Drainage Way �JliO ft Prope.tty Linc ?�� _ft Other ft
SKETCH:(.4 S77.26'35"E 100.00 ,JpOIE es)
FENCE--------t------ ---y------------
I
/to
' P1T
X15T•IfAGH i i / i � ` �� �
Nose 10)
� �_----SAS---sl -ER
�T_'D
- WAT - -
., ---- ER---
OO 24• �63
Q
SW OAK i %SOFT i' J
---\20.2 -- ii',. „'. ,'i i N� i
W
OAK / i N LO (� _
I ----------' ------
-------�--
Ni I TgM (E i ASP ALT I DRI YS Q
3 / M TOP N�2.5 WA 1 N�
z/
E1 EV LL
�Sv pores �� -tn
' - `
9° OAK M J OAK / i i i (0
2 �
—11' 8.49'��
o
+c to eE -
--FENCE
100.00 ce/our- TI,v
t nE01 �
a� Depth to Bedrock /• "c �- ^---
Parent material(geologic) - /
Depth to Grroundwa�dr. Standing Water in Hole: i Weeping from Plt Face �V
Estimated Seasonal,tligh Groundwater
D TERMINATION FOR SEASONAL HIGH WATER TOLE
Meihod Used: I. 10, Depth td spll mottles: In.
Depth Clb�served standing"lin obs.hole: in. Groundwater Adjustment tt
Depth toiweeping from side of obs.hole: i Adj.(iroundwater Level.,,�,�,
Index Well# _ Reading Date: Index Well level -� AdJ•faetOr,T_r.�
- j
PERCOLATION TEST Date Tlme .
Observation � Tiirit:at 9" ----•-----
Hole#
.Jut l_ Time at 6" --
Depth of Pere .N
0
Time 9"-6")
� (
Start Pre-soak Time.@ l ---
�p i`A i
End Pre-soak
C Z Mil � I I
Rate MinJInch
ssed
Site Failed: Additional Testing Needed(Y/N)
Site Suitability Assessment• Site Pa
Original:.Public Ie$lth Division
Observatiod Hole Data To Be Completed on Back—
***If percola#6]a test is to be condTacted within 100' of wetland,you must first notify the
prior to beginning.
Barnstable Conservation Division at least one (1) wedk
LOCATION SEWAGE P RMIT N .
V I L'L A G E
INSTA LLER'S NAME i ADDRESS
c►
U I L D E R OR OWNER
!A: -eb e A AD
I
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED � /
0
3®
� v �
A
O
3
No 62=5 9
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH In
. ..............OF.........................................--.-----.------..------.....................C.
Appliration for Uhi o,ittl Worko Tonotrurtion tirrutit
Application is hereby made for a Permit to Construct ( ) or Repair (/an Iidividual Sewage Disposal
System at:
.................W.3,.....F :(Z , --:.Laa� ..------........ Y �......... :............... - -
LqA
ion-Address or Lot No.
o _�� ... ---------------
---------
---------
............
...
Owner Address
•••-•-•-• e_ �.._.. ...` 1S?u_� ................. .............................................
Installer Address .�
Type of .Building Size Lot...1_�i0.0_0..Sq. feet
I U Dwelling No. of Bedrooms....... ...............................Ex ansion Attic Garbage Grinder
.� g— P ��� ( ) g ( )
'4 Other—Type of Building ............ No. of persons......................... Showers
(� YP g -•--•••-•----•-- P --- ( ) — Cafeteria ( )
04 Other fixtures ---------------------------••••-
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
Septic 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 ( )
Percolation Test Results Performed by.......................................................................... Date........................................
aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.....................--.
Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water...................----.
----------------------------------------- .---......--------..........................................................
0 Description of Soil........................................................................................................................................................................
x
W ----•--------------- -------•----••••-•••--••---••-----•-•---......•••--•--••-------•........................•••••. ----------- ---------------------.....
............---------- ----
UNaturt: Of Repairs or Alterations.—Answer when applicable.._ -...c' -\ 4 ,.. . ?G ` ,.
. ---•••••••\o®Q•••�� . ------ '......
o ._ mot fat s Z' � ------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b sued by the bo d o ealth.
ned �•-• •-- --••••••-•--
............... l.C� .._..._
Application Approved By............. '--�i/a ............................................ ... j�jf �1....... .
Date
Application Disapproved for the following reasons:.....................................................................................................
.....................•-----•----•-•---------------------------•-••---•----..............-•----------...--.••.................•-••••--••••••••••-•••••••••••••••••••••••••---•••••-
PermitNo......................................................... Issued-.....................
�L
No...... FRic........../.19..............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
....................OF ......._.............. .........................
Appliration for Uhipaiial ]Vorkfi Tonstrurtion Vamit
Application is hereby made for a Permit to Construct or Repair (/an Individual Sewage Disposal
System at:
............vlo.s...... L.0L.r'.-P.................. .....xy j........................................*............. ------------
Lopaion-�ddress or Lot No.
............... ........ .......................... ..................................................................................................
Owner Address
...........W.............M. .................. ....................................................Installer Address
Type of Building Size Lot.... feet
...... ...............................Expansion Attic Garbage Grinder Dwelling—No. of Bedrooms---
44 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria
Otherfixtures ......................................................................................................................................................
Design Flow............................................gallons per person per day. Total daily flow.............................0..............gallons.
04 Septic Tank—Liquid capacity............gallons Length................ Width._.............. Diameter..._......_..._. Depth................
Disposal Trench—No...................... Width_._................. Total Length.................... Total leaching area....................sq. f t.
> ...........
Seepage Pit No--------------------- Diameter..................._ Depth below inlet.. Total leaching area..................sq. f t.
Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit\'No. I................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____._..............___.
..........I..................................................................................................................................................
0 Description of Soil........................................................................................................................................................................
x
................................ .......................................................................................................................................................................
.................. .......................................................................................... ..... .....................1•�...........
ems,Q----------------
U Natu of Repairs or Alterations—A saver when applicable. �_j
"itk �: I ...
WAAZ---------A-0.0..0.....1&,A. ......... ......eo,�.....(_IA—,�-K..... . VfNjL...............
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TLITIZ 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has beVsued by the board o ealth.
...........N ............................. 1_3......
D te
Application Approved By..... ....... .... .= = L ----•-----------------------•------•-- ....
ate-------------
Application Disapproved for the following reasons:...............................................................................................................
........................................................................................................0............................................................................................
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF............................................................I.........................
(Sertifiratr of Toutpliatta
TVI)II TO CERTIFY That th Individual Sewage Disposal System constructed or Repaired ( V�
...... .......by-- . ......M. (D.V ...
-------------------------------------*-------------*------- ...........***------ .........
at.........\ ........P_CLW5 .jU.A...... ............-_-----__-Installer
n'taller..............................................................................................
has been installed in accordance with the provisions of TITLPE 5 of The tate Sanitary Code as described in the
application for Disposal Works Construction Permit No.....e.2.-—...�.F 5..P...... dated................................................
THE UE ISSUA ICE F M W � I TNIHISA CERTIFICATE SHALL NOT BE CONSTRUED S GUARANTEE THAT THE
1
SYSTEM F-U,JL� '�TIIO STI S FACTORY.
DATE. Inspector_...
....... .. ...............
........................ .... ........ ... ..............................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
C> pC ...........................................OF............---......................................................................
FEE... ...................
Bisposal Varftg Tonotrurtion famit
Permission is hereby granted....-- .............V ......Lq!......fVAW.AV1r.Q%tX...................................................
to Construct ( ) or Repair an........ Individual Sewage Disposal System
at No.. A(a.!........ W
... ...... ......�•-n.(L..................................................................................................................
Street
as shown on the application for Disposal Works Construction Permit No.............. Dated.._._.....................................
----------------------------------------------
DATE................. .3................................. ::�406a, . Health
FORM 1255 A. M. SULKIN. INC.. BOSTON
HYANNIS
PARCEL ID:
LOCUS:
270/104 163
FAWCETT n
LANE _
m
EXIST. 1 ,000 GAL N
SEPTIC TANK
EX15T. LEACH PIT co S77 26, '� >
qi a
FF 3 .. � ti -<
(NOTE 10) _5 E S ,
100 00 FFP ROTARY
UPOLE �9-
o (r s
a O r
�'/24" AK ' •• '•••' , ------- / LOCUS MAP
000 PARCEL ID: TW OAK , / ..% __-- __WAE`ER ----- ---- /
N 269/06 2 ,, ;, ;, --t_______________ LOCUS INFORMATION
Cj 1 i, i #1 6 3 ,'•i PLAN REF: LCP 22825P SH.1
U TITLE REF: CTF# 126624
i TOF=33.52'�' O PARCEL ID: MAP 270 PAR. 103
J i ;� O —��� IS IN ZONE II
TRI OAK I ' I FLOOD ZONE: "C"
Ap Lu y— i COMMUNITY PANEL: 250001-0005—C DATED:08/19/85
SEPTIC SYSTEM
REPAIR PLAN
8" OAK NNj / ' TBM / - _ % �� ,� LOCATED AT:
TOP N/AfL . - -�` --- / 163 FAWCETT LANE
N /' nsp ports ELEV32.5 /'' ASp - '� ' '� CB DIS
GENERAL NOTES: _• pRr ACT / _-7— i� LL/ / HYANNIS, MA.
-1 -'---__�_--- WA Y / i i /j
1• ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL ~11' __� -- ----- !
BOARD OF HEALTH AND THE DESIGN ENGINEER. 24"OAK��1. 7 PREPARED FOR
2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS 8. 10 OAK / -----__/_ N� ' FEDERAL NATIONAL
OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE vet / ,
LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW:
— 310 CMR 15.405 (1) (B): l'� TH
2 , N� �x. MORTGAGE ASSOC.
1) A 0.76 FT. VARIANCE FROM 310CMR15.221(7) TO ALLOW LEACHING TO BE / % „,J�ARCE ID: �� `��. JUNE 19, 2011
3.76 FT (MAX) BELOW GRADE VS REQ'D 3 Fr. (H20/VENT PROVIDED) FENCE- �17��, 270/f103 `� !
3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR -. ;' AREA—yb,000 F/�F.
DESIGNPENGINEEAND
DAPPROVAL BY THE BOARD OF HEALTH AND THE ---1 10 / Of MAS'S9
4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING 0.00
FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN - DP1Kft�E
ENGINEER BEFORE CONSTRUCTION CONTINUES. r V ME
CB/DISC 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 0 No. 1140
6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF PARCEL ID: UTILITY
THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 270/177 r 'PFCr$TE �
HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. G
7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. r �4NITAR�P
8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED
TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR.
9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY
THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING
CONSTRUCTION.
10. EXISTING PITS TO BE PUMPED, CRUSHED, AND FILLED. D A R R E N M. MEYER, R.S.
11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION P.O. BOX
O X 9 81
12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY n P,�/
AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY 1
13. NO PRIVATE WELLS WITHIN 150 Fr. OF PROPOSED LEACHING � EAST SANDWICH, M A. 02537
14. ALL PIPE TO BE 4" SCH 40 ® 1/8"/FT (UNLESS SPEC. OTHERWISE)
15. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW
FOR THE USE OF A GARBAGE GRINDER (5 0 8)3 6 2— 2 9 2 2
16. NO WETLANDS WITHIN 100 FT. OF PROPOSED LEACHING s
t SCALE: 1"=20'
SHEET 1 OF 2 J 1340
U a.
NOTE: TO PREVENT BREAKOUT, THE PROPOSED DESIGN CRITERIA
NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS FINISH GRADE SHALL NOT BE < EL:30.24
FOR; A DISTANCE OF 15' AROUND THE NUMBER OF BEDROOMS: 4 BR EXISTING/4 BR DESIGN
PERIMETER OF THE S.A.S.
SEPTIC`TANK PROPOSED D=BOX PROPOSED S.A.S. SOIL-TEXTURAL CLASS: CLASS I DESIGN PERCOLATION RATE: <2 MIN/IN
T.O.F. EL.=33.52 INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL A 4" DIAMETER INSPECTION PORT OVER DAILY FLOW: 110 G.P.D. x 4 BR DESIGN FLOW: 440 G.P.D.
OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE ONE CHAMBER (MIN.) AND SET TO 3" OF F.G. GARBAGE GRINDER: NO (NOT DESIGNED FOR GARBAGE GRINDER)
" F.G. EL.=32.0t F.G. EL.=47.50t F.G. EL: 46.5t F.G. EL: 34.0-33.0(MAX.)
PROPOSED SEPTIC TANK: USE EXISTING 1,000 GALLON CAPACITY
LEACHING AREA REQUIRED: (440)/0.74 = 594.59 S.F.
VENT
9" MIN COVER/ DISTRIBUTION BOX: DB-3 (3 OUTLETS (MINIMUM))
L = 10't 36" MAX COVER ,`' L - 25' L = 10'(MAX) INSTAL_ TWO INSPECTION PORTS (MIN.) PRIMARY S.A.S.
® S=J% (MIN.) EL. = 91.8 0 S=1X (MIN.) 0 S=1% (MIN.)
4"SCH40 PVC - 4"SCH40 PVC 4"SCH40 PVC USE 3 ROWS OF 7- 160OBD ADS BIODIFFUSER H-20 UNITS-NO STONE
10" 6 11.2" 7"3..RO .00F
14• INVER BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.73 SF/LF OF BIODIFFUSERS
INV.=30.65 as"uowD , INV.= 30.40LEVEL PROPOSED W7 UNITS AT 6.25'/UNIT = 43.75'/ROW (BIODIFFUSERS) 21 UNITS x 6.25 LF x 4.73 SF/LF = 620.81 SF
GAS BAFFLE D BOX INV.=29.98INV.=30.1 �_ INV.= 29.85 SO BSORPTION SYSTEM (PROFILES TOTAL AREA = 620.81 SF
DESIGN FLOW PROVIDED: 0.74GPD/SF(620.81 SF) = 459.39 GPD>440 GPD req'd
EXISTING 1,000 GALLON SEPTIC TANK
RESTORE VEGETATIVE COVER
EXISTING SEWER OUTLET BACKFILL WITH CLEAN PERC SAND
TO TOP OF CHAMBERS 75"
NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING c. :. ;. • .•' ;•...:.;•
PIPE INVERTS PRIOR TO CONSTRUCTION
2) D-BOX SHALL BE SET LEVEL AND TRUE TO BREAKOUT=TOP ELEV.=30.24
GRADE ON A MECHANICALL COMPACTED SIX INV. ELEV.= 29.85
INCH CRUSHED STONE BASE, AS SPECIFIED IN BOTTOM ELEV.= 28.91 EXISTING SUITABLE
310 CMR 15.221(2) 2.83' MATERIAL U99961M. -H
3) REPLACE EXISTING 1,000 GALLON SEPTIC 5' MIN. ABOVE BOTTOM OF EFFECTIVE WIDTH = 3 x:2.83' = 8.49' I . 76"
TANK WITH 1500 GALLON SEPTIC TANK T.P. EXCAVATION OR G.W.
IF FAILED, DAMAGED, OR UNDERSIZED. (7.11 PROVIDED) USE 3 ROWS OF 7-16" HIGH CAPACITY (H20) PROFILE
4) INSTALL INLET & OUTLET TEES W/ BOTTOM OF TESTHOLE EL.=21.60 _ ADS 16008D BIODIFFUSER UNITS-NO STONE
GAS BAFFLE AS REQUIRED
SEPTIC SYSTEM PROFILE TYPICAL SECTION
16"
N.T.S. Mrs. 11_
SOIL LOG I P#: 13317 I . -34„�
DATE: JUNE 14, 2011 SECTION END CAP
SOIL EVALUATOR: DARREN M. MEYER, R.S., CSE #1614
OF , sf9 WITNESS: DON DESMARAIS, BARNSTABLE BOH
(q n 16,,,, HIGH CAPACITY (H-20) BIODIFFUSER UNIT
c D EN Elev. TP-1 Depth Elev. TP-2 Depth
MEYER
MODEL 16" HICAP
No. 1140 "' 32.60 A LOAMY SAND 0" 32.80 A LOAMY SAND O" LENGTH 76" NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT
32.10 10YR 4/1 6„ 10YR 4/1
B 32.30 6" EFFECTIVE LENGTH 75" TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY
C/$TE B SANDY LOAM SANDY LOAM DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE.
SgNITAR0P� 1oYR 6/8 10YR s/a SIDE WALL HEIGHT 11.2"
/I Iq l 30.27 C1 28" 30.30 C1 30" OVERALL HEIGHT 16"
OVERALL WIDTH 34" 4640 TRUEMAN BLVD
MEDIUM SAND MEDIUM SAND 13.6 CF HILLIARD, OHIO 4JO26
2.5Y 7/3 2.5Y 7/3 CAPACITY
(101.7 GAL) ADVANCED DRAINAGE SYSTEMS, INC.
PROPOSED SEPTIC SYSTEM SITE PLAN
PERC 028.60 0 9
21.60 132" 21.80 132" 163 FAWCETT LANE, HYANNIS, MA
' Prepared for: FNMA
PERC RATE <2 MIN/IN. CC1" HORIZON)
NO GROUNDWATER OBSERVED Engineering by: Surveying by: SCALE DRAWN
DARRENM.MEYER,R.S, Eco-Tech Bnvironmental NTS D.M.M.
• I, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 pOBOX981 (508) 364-0894
to conduct soil evaluations and that the above analysis has been performed by me consistent with the DATE: CHECKED SHEET NO.
requirements of 310 CMR 15.017. 1 further certify that I have passed the Soil Evol. Exam in October, 1999. EAST SANDWICH,MA 0T537
� 508-362-2922 06/19/1 1 D.M.M. 2 of 2
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