HomeMy WebLinkAbout0055 FERNWOOD AVENUE - Health 55 FERNWOOD AVENUE, HYAN%Il
A
e
TOWN OF BARNSTABLE
LOCATION SEWAGE # dd5 ace&
Vi LLAGE ASSESSOR'S MAP & LOT����
INSTALLER'S NAME&PHONE NO. -'
SEPTIC TANK CAPACITY ✓ ay
i
LEACHING FACILITY: (type) 14.Cc mod`' t- (size)
NO: OF BEDROOMS -
BUILDER OR OWNER O STD SQI'i./
PERMITDATE: �COMPLIANCE DATE: G
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
Qs ' Sag
W
No. 9 Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
Zfpprication for ;Diopomf *pztem Construction Permit
Application for a Permit to Construct( j Repair( )Upgrade( )Abandon( ) ,complete System O Individual Components
Location Address or Lot No. ��/k,'OOD 4V—P - Owner's Name,Address and Tel.No.
Assessor's Map/Parcel k h' 5 61J 5-0:7A;:7_
Installer',%.Z�ame,Address,and Tel.No. Designer's Name,Address and Tel.No.
V ` _
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 0 gallons per day. C lculated daily flow - 3\ _ -gallons.
Plan Date US__ Number of sheets Revision Date
Title
Cy—
Size of Septic Tank Type of S.A.S. c, ✓JGL�E�t_-w�.�.
Description of Soil CAM W:�ao / Q
Nature of Repairs or Alterations(Answer when applicable) ✓ t�I ��U
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with,the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issu by t is Board of e th.
Signed Date
Application Approved by Date
Application Disapproved 4forhe-following reasons to
Permit No Date Issued
? No. Fee ff—V
THE COMMONWEALTH OF MASSACHUSETTS fit, Entered in computer:
eY sj
-- PUBLIC HEALTH DIVISION--TOWN OF BARNSTABLE, MASSACHUSETTS
ZIppYication for 3�igooal *pztem Cono'tructibd Permit,..
Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) iZ.Complete System ❑Individual Components
Location Address or Lot No.J 5 Fr/k/00D = Owner's Name,Address and Tel.No.
Assessor's Map/Parcel `V 5 ('�:r� �(i� S0Y\-,
—
Installer'Name,Address,and Tel.No. Designer's Name Address and Tel.No.
1(G>v
S ,o (�cyG7,)- E SAL
Type of Building:
Dwelling No.of Bedrooms _ Lot Size sq.ft. Garbage Grinder( )
Other TI pe of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 3�i gallons per.day. Calculated'daily flow -7; gallons.
Plan Date SC—\�`u s _Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S. ��
i
Description of Soil SA-vu joy
Nature of Repairs or Alterations(Answer when applicable) 5�d
t
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance wif .the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by is Board of H lth.
Signed 1,7 - Date
Application Approved by f �/ c� U v iyl I rar Date
Application Disapproved for the following reasons
,_ e�
Permit No Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
V
Certificate of Comp fiance
THIS IS TO)2YTI Y, th t the On-site S wage Disposal System Constructed ( )Repaired( )Upgraded(X )
Abandoned( )by
at ✓1 L I has be,pfi constructed in accordance
with the prdvq's^ions,ofnTitle 5 a.d the for Disposal System Construction ermit No. ated
Installer JIPA J L� Designer r'1
The issuance of this permit shall not be const ued as a guarantee that t e systeK, wt,l,lun n as designed.
Date � Inspector
THE COMMONWEALTH OF MASSACHUSETTS
U� PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
raig;p0of *p!�tem ngtruction Permit
Permission is hereby granted to Construct( )Repair( t�Jpgrade( )Abandon( )
System located at
a � •
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:Constrt4ction friust be completed within three years of the date of thi ermit.
Date: c'' i 1 ., � Approved by
v
1 ^
9/16/03
Notice: This Form Is To Be Used For the Repair Of Failed
Septic Systems. Only
PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM
0"I, hereby certify that the engineered plan signed by me
dated s concerning the property located at
JS -e-cc��bC�CC a ^a �S meets all of the
following criteria:
• This failed system is connected to a residential dwelling only. There.are.no.commercial or
business uses.associated with the.dwelling.
• The soil is classified'as.CLASS I and the percolation raze is less than or equal to 5 minutes
per inch. The applicant may use historical data to conclude this fact or.may conduct deep
test holes and percolation tests.at the site without a health agent present.
• There is no increase in flow and/or change in use proposed
• There are no variances requested or needed.
• The bottom of the proposed leaching facility will be located no less than five feet above the
maximum adjusted groundwater table elevation. [Adjust the groundwater table using the.
Frimptor method when applicable]
Please complete the following:
A) Top of Ground Surface Elevation(using GIS information) '� E
B) G.W. Elevation �J +adjustment for high G.W.
DIFFERENCE BETWEEN A and
SIGNED : DATE: �7 S
NOTICE
Based upon the above information;a repair permit will be issued for bedrooms
maximum.. No additional bedrooms are authorized in the future without engineered septic system
plans.
gASep6c\percexemp.doc
11/29/2015 02: 16 FAX J 7 - 1@002/002
Town of Barnstable
,M Regulatory Services
Thomas F.Geiler,Director
KAM
A Public Health Division
Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer& Designer Certification Form
Date: 9/01/05
Designer: Shay Environmental Services,Inc. Installer: Robert Segtic Services.
Address: P.O.Box 627 East Falmouth Address: 5 Trenton Street
MA 02536 Yarmouth,MA.
On 8/19/05 Robert Septic Service was issued a permit to install a
(date) (installer)
septic system at 55 Fernwood, Centerville, MA based on a design drawn by
(address)
Shay Envirorunental Services.Inc. dated -August, 18, 2005
(designer)
_XX_ I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system) but in accordance with State & Local Regulations. Plan revision or
certified as-built by designer to follow.
tiZti OF MASS
4,0
off' CARMEN ��,
( al is ignature
SHAY N
No. 1181
CJSTE�'�Q
5' to
(Designer's Signs ure) (Affix Desi p Here)
PLEASE RETURN TO 1BARNNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS--
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
Q:Health/Septie/Designcr Certification Form
• 11 d
SUSsURFACE SEWAGE DISPOSAL 8YSTEM IN8PEC �. ORM
Address of property tJs��r�w�eif>`SL - 'f-��"UqA �4 s
Owners name SUN 2 3
Date of Inspection 1995
PART ]1f
CHECKLIST
Check if the following have been done: `� ,• '�
Pumping information was requested of the owner, occupant, and, 8oard of.
Health.
= None of the system components have been pumped for at 'least' two weeks`
' and the system has been receiving normal flow rates during that
period. Large volumes of water have not been introduced into the
system recently or as part of this inspection,
As built plans have been obtained and examined.. Note if they. are,not
available ,with N/A. "
The facility or dwelling was inspected for signs of sewage back—upoe
A.
' r V The site was inspected for signs of breakout.
V All system' components, excluding the SAS, have been located on �the'rM; � «
site. «r 1 l` .
he tic tank manholes were uncovered, opened, and the`'interi
septic porof
� rEt '
the septic tank was inspected for condition of baffles or�'tees, a�
r� material of , construction,construction, dimensions, depth of liquid, depth of
{�s q* z
4i `
4 «r Y
+` sludge Cum.
g depth of Ns �
• d e
,;
The size .,and location of the SAS :on the site has been, determned,,based
� k 'L> on existinginformation or approximated „by non-intrusive 'methods.
a r The
.r�r
urn R
The facility owner. (and occupants, if different from "owner) �were
�c provided with information on the proper maintenance •of`'SSDS'`
x
t
gt
I
. car
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
SYSTEM INFORMATION
FLOW CONDITIONS
If residential
. number of bedrooms
number of current residents
garbage grinder, yes or no' _
laundry connected to system, yes or no
seasonal use, yes or no
. • k
If nonresidential, calculated flow:
• W
' Water meter readings, if available: �
> 3
iiE
Last date of occupancy ti
d GENERAL INFORMATION
Pumping records and source of information: of
LV nos,-g—
System pumped as part of inspection, yes or no Y4 '
if yes, volume pumped k=
Reason for pumping:
7 c R
ai
,,�s gr
'yyt3
�y� # �Type, of system_ . : ... • .. t k;M� ,a Fx , +` `
k � s Septic tank/distribution box/soil absorption system r
s :ic .>Single pesspool � 1 '
L _stOverflow xcesspool 3 i ry f &F �,
_k Privy
Shared'system ` (yes or no) (if yes, attach previous 4 inspectionM1
{ , a records,4»if any) .
'Other (explain)
��� r.a"Lf'."`" t✓Ya»/r-s' -' .7'". ,`'
a � Approximate age o'f a ll: components. . Date installed, , if known. Source off
sr -7}ads • r , c _"` y3 ray _m
4N information.
�7 �V� r
�fta i t Ott:. , - '•;; _;aR�rtr �t 5y,-r�"�'4r�5a;
�M1 ti
` Sewage odors detected when arriving at the site, yes or no °
1 ti t r M X+
q 'f lf10. d,7' 3' dS7 i?','3•T:`� sr( _ '?.
g! IM
A 1Y53'. yfi i . 1
( )
1+. A
I
5r DIBPOBAL BYBT BUBSURFACZ 8EW7►GE EM INSPECTION TORN
.,
r i t PART 8 .t ��j '.
{ . s BYBTEM INFORMATION continued
`-SEPTIC TANK:
x
(locate on site. plan)
depth below grade:
material of construction: concrete metal FRP other(explain)
"dimensions: '
sludge depth
distance from top of sludge to bottom of outlet tee or baffle �k, � `.
scum thickness . `
distance from top of scum to top of outlet tee or. baffle_ ; , rtts i`
•""'``g 'distance from bottom of scum to bottom of outlet tee or baffleriy'= f
. W Comments: . .
k'f (recommendation for pumping, condition of inlet and outlet tees ors:baffles;
depth,`of liquid level in relation to outlet invert, structural ,integrity, ��
�TEjevidence of leakage, recommendations for repairs, etc.
)
.-
x DISTRIBUTION BOX: ,
` s (locate on site plan) ' Y
depth of liquid level above outlet invert
��aF ents:
:(note if level -and distribution is equal, evidence of solids ,carryover,-,
R� evidence of leakage into or out of box, recommendation for repairs etc.)Ni
r
PUMP� CHAMBER:
.( locata- on site P1an
z PM' Pumps .in working order, yes or no ,.x
". .�/Ksba4�swWr�.f•ta`a - . tys�` _
h Comments: , . !^,.�Y kti�+ ,vae ar ,..e 2 �Y , {4a
•
(note.�condition7of-pump chamber, . condition of pumps and appurtenances
recommendations"`for maintenance or repairs,etc.)
Oo
Y p
4 .
J +itNvh7 ... „.,,:♦,,,. .y,..ypFii3y C�#t,�. ,'rg,i�Y J`4
J
K t'�
yytsq'A'oplK a•. .yt ,.�y.s .,�,i s N _
J+
ay q.
b
wiw-
ENE
I `
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART 8 g.
SYSTEM INFORKATION continued ,
SOIL ABSORPTION SYSTEM (SAS) : ap`
4 5 #s (locate on. site plan, if possible; excavation not required,* butmayfybe,i,�tf' .
approximated by non-intrusive methods)
If not determined to be present, explain:
NCO
TYPe ,
leaching pits and number
leaching chambers and number z
Teaching galleries and number j =
leaching trenches, number, length
y t '
leaching fields, number, dimensions
�w
overflow cesspool, number Gym oz ,C77Z a� f
3 xx , - Comments:
(note condition of� soil,. signs of hydraulic failure, ' level :of' pond`inq 4 x
s' r Kn condition of vegetation, recommendations for maintenance or r'repairs;etc:j�.
i �('M1 Fitt P's
>,..4, CESSPOOLS (locate on site plan) : .}
.k number and configuration (Q,� •`Y
k `" . " depth-top of liquid to inlet invert
r depth of solids layer
depth of scum layer
� P Y •
V ..' ., dimensions of cesspool
, s-;r materials of construction +'
indication of groundwater _ � rir }; kew
inflow (cesspool .must be pumped as } `, 'Ex� `
Y6 . part of inspection)
:q,—
' 3r .Comments:
,_,,(note condition of, :soil,, signs of hydraulic failure,. level,£of pondinq,
= xY n condition of vegetation, recommend
/]r►�t/i ons for maintenance . or.}repairs;
PRIVY: ,.` ►<
ask=
r(locate on site plan)
veymaterials of construction
o- dimensions . �yl e 7 ¢ .
-,Qepth F Of"Solidst �a .., a • `t € `.�i ��v��3,���� � ''kip
.,a' r?hY A 0
!CONYMG/+tS• " ;' Y�"'E'?F;:"'.$ d';Y -+Rq:•m•'4:rt *Fw.a.jw'r:+: .ea•..r r rx rl.yr u' ..an.r. t iXMY "�ti. FAr. r}- � i' ",�y F "
R=(note; conaitionFofti soil, ",signs .of hydraulic»failure, level��of ponainv,
A { f condition of wegetati.on, :;re.commenda_t-ions'for .may ntenance1_or repaiiil,-a
qg
SUBSU"ACE BERAGE DISPOSAL BYBTEM INSPECTION ,FORM
PART B
BYBTEM =NFORMATION ContinueC
SKETCH OF SEWAGE I=SPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarlics f. .
locate all wells within 1001
t }t 2.
2 Z�,'�7FfA, s�,,
A �; r�
_ 4
r Z<,
X;�
t
f f
}k
tir,i
S,� 5
w
r 'YDEPTH'TO .GROUNDWATER r '
4t depth -to groundwater " r
# t •. f ice.. u".+ .,n 3S.ii^ .
hod 'of determination or approximation: AM
:,
f Y 'a�'T _:{n r• - - . M;,r° M.d m dl. 4, sf kG a
� % �k,�'"�`'f t•'. •ark _ r .. }a s-�.r��,���ig-yam '
,
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
FAILURE CRITERIA
Indicate yes, no,- or not determined (Y, N, or .ND) . Describe basis,POfv :,.
determination in all instances. If "not determined"" explain why not)
'Backup_ of sewage into facility? Ra
Discharge or ponding of effluent .to the surface, of the ground or
• surface waters.
static .liquid •level in the distribution box. above outlet invert?t A
't Tt„•'`i t
t� try. .• ; • t s qx '
)
Liquid depth in- cesspool <611 below invert or available volume-,e 2 di
>44 tu.z flow? m
Required pumping 4 times *or more in the last year?
q • 'number of times pumped
,I
Septic tank is metal. cracked. structurally unsound. substantial
a� rr -infiltration.) substantial exfiltration? tank failure imminent? <°
r
4
�' Fty Is any portion of the SAS, cesspool or privy: ', k
below the high groundwater elevation? s
within 50 feet of a surface water? � x
'._t4 within 100 feet of a surface water supply or tributary' to a,y'.' ace
water supply?
s
y n
within a Zone I of a public well? t
? 7s;9
�5{fig. } q .yf¢, $i���k �'•t��„��'"� ,�
is �'*(� } ,��.-
within 50 feet of a bordering vegetated wetland`•or •salt' marsh 1 , r,
ri (cesspools and privies only, D the SAS)? �
su`s.3atu n+ x
rr (4-,' within 50 feet of a private water supply .well.
X ;fM w�9.
� less than 1.00 feet but greater than 50 feet from a priv*te�wat
-supply well with no acceptable water quality analysis?f,41f-thedwell
r has been analyzed to be acceptable, attach copy of well'°water .analy
for col.iform bacteria, volatile organic compounds, . ammonia nitrogen
g M -' and nitrate nitrogen.
W"I
MRAMV
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t, r ° S.aiFg y`• $
i �� `� war �°i Y .. - },',�, ', � *•,�•, '���*� #.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART D
CERTIFICATION
Name of .Inspectore '--e v
Company •Name 6iVA uAz
Company Address �y9 7 M- (�
Certification Statement
I•,aertify that I have personally inspected the sewage disposal system at
this address and that the information reported is* true, accurate and
Complete ,,as of the time of inspection. The inspection was performed and '
kany.'recommendations regarding upgrade, maintenance and repair are f ' _
t y&hi'
-S,6 coMsistent with my, training and experience in .the proper function and
nitenance of on-site sewage disposal ,systems. r �
Chec one: " ,.,�:
• '' IRhave not found any. information which indicates that the fa,system
+� US', Aty(= ;tc adequately protect public health or the environment. as defined ' n
CMR 15.303. Any failure criteria not evaluated are as` statedin,,
,.
the FAX CRITERIA section of this fora.
r I, have determined that the system fails to protect public health" and
the- environment as defined in 310 CMR 15.303. The basis for this3 ; rx''
determination is provided in the FAILURE CRITERIA section of this � ;�
• form.
AX. .. -
r 5 Inspector's Signature
4
ry 1\ :4; 3Fhg�
:Date
r
Original to system owner
A 4
wCopies to: �. y.
�� t Buyer (if applicable) c
`Approving authority a
Ab
.l���t�t fn • .. .. . C }1+#,t� 5{� ti t�'f� i.jj`�
S.aR'}fri: 3. Say ac vps,('
°Xjb- „ N' •. r .� T '"^�„ � add-
r4
Yk
J
No.....� .. ----- Fizs;,),,..................._
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF....... .�. .VT.Lam ..................
Appliratiun -fur Biupuuttl Worbi Tunutriirtiun Prrniit
Application i eby ma for a Permit to Construct ( klo'or Repair ( ) an Individual Sewage Disposal
System at:
®= �- ... -----------------------------------------------------•-- -- ................
1 L ation. res -(o Lor
-- . - -.. o.
--
Address�
W ....... - ----- _ _ - .., � -'d/•" -'`-------------------•------.--.-.--.------•----••-----•---............................
Instal er Address
U Type of Buil n Size Lot.._��..�44.....Sq. feet
Dwelline—NNo. of Bedrooms--_-___----/_------------------------Expansion Attic ( ) Garbage Grinder ( )
`L
P-, Other—Type of Building ---------------------------- 'No. of persons---------------------------- Showers ( ) — Cafeteria ( )
P-' Other fixtures --------- ••-- -------------------------------
Design Flow.................... ......_...___ al1q.0i per person per day. Total daily flow-_________-.. .__— -----_-gallons.
;.
Septic Tank Liquid capacity/aZ ._.. allons Length---------------- Width-..._.._.._... Diameter-----.---------- Depth.----._._--_----
xDisposal Trench—No. .................... Width-------------------- Total Length-------------------- Total leaching area--------------------sq. ft.
3 Seepage Pit No........2—------ Diameter-------------------- Depth below inlet------_�Total lea pingar a._... _.._-. -_-sq. ft.
Other Distribution box ( t ) Dosing tankZ�—�'/ ��os
Percolation Test Results Performed by--------------------------------------------------------------------------
Date----------- ------ --.-..
aTest Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water.--.-.------.__.--._-...
f= Test Pit No. 2___--__---_---minutes per inch Depth of Test Pit.................... Depth to ground water------------------------
- ------------•---------
Descri Description of Soil------------------------a,.
x
U ----------------------------------------------•-•••-••-----------•••-......---••-•--------••--
---------------------------------------------------------------------------------------------------------------------.----------------------------------------------------------------------------------
V Nature of Repairs or Alterations—Answer when applicable..............................t-.__-____---_-__----____-.-_.---.---..._--_--..._-__--..----.---
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article \I of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued th board of health.
igned---- •-•-• . --- ........... •--- ............. --- --------------••-•-•-•-••-_.....
- --- ----------
Application Approved By------- f . . •.•--•------ �u tT
Date
Application Disapproved for the following reasons: ----- ---------- ----------------------------------------------------•----
----•--••-••-•••••.........•-------------•--••---------------••••.--•--•------•-•--•••••-••••-•--•-••--.....--------------------...••----•-----------------------------------..--------------------------
Date
41
PermitNo..............................-•---•-------------•----•- Issued -
Date
t
No....... s v Fus
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
._r
... --_..OF.....X)ct._A-t Tic, L(..�! .C....:C:..,
Appliration -fear Biiipwial or� Tonvtrurtion rrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System,at ��l,tvl.cl..'L°'7� r �:-�lG-tz.-•y-r�G-�
�Lgeatton t�j or Lo
v ------•-_-------•--•---......Address........./_...7
-" s a er Address /� t4 t
Q Type of Build Size Lot........1.................Sq. feet
U Dwelling—No. of Bedrooms------------------------------- ----------Expansion Attic ( ) Garbage Grinder ( )
J
per, Other—Type of Building __________________•__-_--- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
G, Other fixtur-s--7 ---- --------------------- -
w Design Flow...
:3.: allons per person per day. Total daily flow___.._..._.....__.....................gallons.
WSeptic Tank—Liquid capacity------------gallons Length---------------- Width................ Diameter---------------- Depth.__._----._.._.
x Disposal Trench—N.L".�;------ ------- Width-------------------- Total Length-------------------- Total leaching area_..-----------.-----sq. ft.
Seepage Pit No.................. Diameter____________________ Depth below inlet............... Total lea ung area-:..__. ------sq. it.
z Other Distribution box ( t) Dosing tank
aPercolation Test Results Performed by--------------------- ----------------------------------------------- Date------------------------------------....
Test Pit No. 1----------------minutes per inch Depth of Test Pit-..____--___--_..___ Depth to ground water___.--_-_.-----.-_.-__--
G14 Test Pit No. 2................minutes per inch Depth gf Test Pit.-_____-___-•______- Depth to ground water-..--------._--.-___--_.
Ix •----------- - --- = --
�- - ----��; �--- - ---------•-------------------------------- ---------------------------------------------------
Description of Soil--------------------------------- r..............................................--•-•---------•--------------------------------._..----- I
x
U
w
VNature of Repairs or Alterations—Answer when applicable----------------------------------------------------------------------_-_._____---___-----___..
-•-•------------------------------••-------------------------------------.-----------------------..------------•--------------------•-----------•----------------------•--- -------------- ..........
Agreement: ,
The undersigned agrees to install the aforedescrib d 'IndNidu l Sewage nspo ysteni in accordance with
the provisions of Article NI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
/1
/S -C---r�--- �l-- �t....-----------------------------_/7�a .3
Application Approved By. Y--------------------•----•----••---•--•--•---•-----------•--......--=---=
. Application Disapproved for the following reasons:.......... ....................
-----•-•...................•-•--............................Date ...--•-------
...............•--••------•-----.............._...---•-•------......------------------------....--------- ----- ---------------••-•----------•--... •- -------------------
^ `— � Date
Permit No. :...... Issued ------......L-,-/---------------�------
Date
f 4,44
k,:
s THE COMMONW-E-ALTH OF MASSACHUSETTS
1
BOARD OF HEALTH
........'.. :':�......OF......... r:...rr ....................................
Trrfifiratr rrf 601, Ii Atrr
THIS IS TO CERTIFY, That vid S g ppsah System constructed ( KoRepaired ( )
�:, ..�
410 Installer
has been installed in accordance with the provisions of Article XI of T�je State Sanitary Code s de r' in the
application for Disposal Works Construction Permit No:' ,,,._1 U
:-- dated
TIDE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. '
DATE--- ....a. - Inspector...
THE COMMONWEALTH OF MASSACHUSETTSs
BOARD)O,F HEAII TH
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No.' ---------- ----
FEE.........................
Bt >atti, rkli� asfrr = rr if
Permission is hereby granted-----------=-----------------`-__�'}"' ---- ... -------- --- ................ �•- ------.................................
to Construct, ��ORepair, an Individual Sewage Disposal, Systet:; v
M:
Street
as`#s15
how the application for Disposal Works Construction jP it N _ ,�+
Dated 0 --�. �_...
r,-" — Board of Health
\,,.• ,4 DATE--- �D' =----------------------•-•
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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1 20 DRAWN
J08 NO
- SHEET OF
HYANNIS
ERNWoOD A SPA..
1/EN�E N
- - - - - - - . m LOCUS:
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5 FERNWOOD
I R=1241.09 L=120, — — — — — — SMITH ST a AVE
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I , 49.1' LOT 41 LOCUS MAP
I 1 AREA=15,300f S.F. LOCUS INFORMATION
I TITLE REF:LAN REF: 38/919 141/19
PARCEL ID: MAP 289 PAR. 103
ZONING: RB/WP
I FLOOD ZONE: "C"
COMMUNITY PANEL: 250001-0006—D DATED:07/02/92
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CERTIFIED PLOT PLAN
LOT 42
G (FOR' ADDITION)
LOCATED AT:
#55 26.9'
- - • I 55 FERNWOOD AVENUE
5.8' N HYANNIS, MA.
PREPARED FOR
LOT 40
C14 „ ADD/TIpN P 3 CARL P. & JACQUELYN
5.6 A77o = �,
20.5) ' GU STAFSON
AUGUST 31, 2013"�_
OFMEOXISTING VE RTION SEPTIC AREA �I va��-N of�gss9c
HOUSE {' go`' ED\ I PD �Gs
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- - - - - J P�Fs
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120,
LOT 46 i
E. A. S.
LOT 47 SURVEY, INC.
141 ROUTE 6A
GRAPHIC SCALE SALT POND BUILDING
LOT 48 P.O. BOX 1729
so o lo so ao so } SANDWICH, MA. 02563
( IN FEET ) BUS:(508)888-3619 CELL:(508)527-3600
.1 inch = 20 ft. .
SHEET 1 OF 1 J 1.574
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ADDITION/REMODEL
505 sq. ft. Addition
Enlargement of an existing bedroom
oeP i � yzporr- . and remodel of existing bath, adding
one bathroom and an entry deck
PROJECT LOCATION:
55 Fernwood Avenue
Hyannis, MA 02601
1_2� 4W Carl Gustafson, Owner
PREPARED BY:
Robert McKechnie
508-775-7701 Home
508-776-5867 Work/Cell
EXISTING FLOORPLAN
Scale '/4 = F
PAGE I OF G0
Imp, ADDITION/REMODEL
505 sq. ft. Addition
Enlargement of an existing bedroom
and remodel of existing bath, adding
one bathroom and an entry deck
— New a'�1c
-- --- - --- PROJECT LOCATION:
____. --------_._..--- 55 Fernwood Avenue
6 o FRS��u D°azS Hyannis, MA 02601
ium
Carl Gustafson, Owner 4d
• PR��gD Bue--ram
- �^CccsromE-n SkPPct� .
PREPARED BY:
-.` c✓Na Robert McKechnie
508-775-7701 Home
z`ks` 508-776-5867 Work/Cell
PRPOSED FLOORPLAN
Scale '/4" = 1'
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PAGE 2 OF t O.
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*NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. *RAMAfQQ4lILY � I
10' min. from SECTION A -A ALL OUTLET PIPES ntw tff •''" Kfl°"
Existing Foundation house to septic tank MSTRIBUTION sox SNAtl eE -
D-BOX � � be PROFILE VIEW �OF ADDITION TO LEACHING SYSTEM SET LEVEL FOR AT LEAST z PT. /z' cor�EiE COVER !
TOP OF FOUNDATION ELEV. 100.00 (Assumed) 6 in. of inW)odd gr tank com must ate s in. of finished grads
Grade over Septic To* - 99.00 �Orode over D-Box- 99.00 over SAS 99.00 3' of 1 r 1/2' Washed Peast 3 - 5'OUTLET
3/4' to I ';1/2 " Washed Crushed Stone KNOCKOUTS
5.s• CUTLET r; 12' N.E'f r xi �i
S - 0.02 3 ttOlF H-10 4"PVC(CAPPED)WSPECTION PORT TO BE
F 10 EXIST. Sm0.o1 or T. Box 3' Maximum Corer INSTALLED AND TO SE WTM 9'OF GRADE '
.. Greater Top OF System- Elev. -97.00 •-::.' .. r.: „(:'^- F�ntwrMd We
EXIST. PIPE in 8 1250 GAL
ritON EXIST.FOi1N9ATIIii W SEPTIC TANK in t5 S- 0.01'p� foot • 0"Ef/eethe Depth iS5' 4 - SCH. 4O T 1.75" 3
H-10 ' at
5' PLAN SECTION CROSS-SECTION . , I t'� s,• °
CONCRETE niu iUU1tDA o ,o 5 Urtts R &25' 30 ° m -
g s^
0.83' (10 inches) '.-� a
5 on to
SYSTEM PROFILE e in.°' 3/4" "� ' i 6 t 31.25 3 HOLE H-10 DISTRIBUTION BOX
Not to Sc01e d compacted stone c u N • r 37.25' NOT TO SCALE
I ,
e i u u rn tep e
Effective Length ti2st61iairrtrtayScoreary�3JiU1ur ;
6 in.of 3/4'-1 1/Y in 11 ® SAIL ABSORPTION SYSTEM (SAS) GENERAL NOTES
compacted °tons ao Effective ' INFILTATROR 'HIGH CAPACITY (H-20 t_OADING>/ GEORGE O'BRIEN
NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6' BELOW GRADE -J 12 1. Contractor is responsible for Digsofe notification, Verification of Utilities
z (OR EQUIVALENT) Not to Scale and protection of all underground utilities and pipes.
w Bottom of Test Pit = Elevation 87.50 NOTE: OVERALL HEIGHT OF INFILTRATOR IS 18" /EFFECTIVE HEIGHT IS 10" 2. The septic tank and distribution box shall be set
level on 6" of 3/4"-1 1/2" stone.
♦Obs. Groundwater - Test Hole lac 2 Elev.= None Observed 3. Backfill should be clean sand or gravel with no
stones over 3" in size.
4. This system is subject to inspection during installation
Design Calculations by Carmen E. Shay - Environmental Services, Inc.
5. The contractor shall install this 'system In accordance
Number of Bedrooms: 3 Equivalent to 330 Gal./Day with Title V of the Massachusetts state code, the approved plan
Garbage Grinder. No and Local Regulations.
Leaching Capacity Proposed: 330 Gal./Day Minimum 6. If, during installation the contractor encounters any
Septic Tank : - 2 x 330 Gal./Doy = 660 USE EXIST. 1250 GAL Septic Tank. soil conditions or site conditions that are different
SOIL ABSORPTION AREA: Using percolotion rate of C2 min./inch from those shown on the soil log or in our design
Bottom Area: 0.74 gal/sq. ft. x 370 sq. ft. - 273.8 gallons installation must halt & immediate notification be
Sidewoll Area: 0.74 gal./sq. ft. x 78 sq. ft. = 58 gallons made to Carmen E. Shay - Environmental Services, Inc.
Providing: = 331.80 gallons 7. No vehicle or heavy machinery shall drive over the
septic system unless noted as H-20 septic components.
Use: (5) INFILTRATOR HIGH CAPACITY H-20 UNITS, HAVING A 0.83' (10 INCHES) EFFECTIVE DEPTH, 8. Install Tut-rite gas baffles or equals on all outlet tee ends.
TO BE USED WITH 4.0' OF WASHED STONE ON THE SIDES, AND 3.5' OF WASHED STONE 9. All Distribution Lines shall be 4' diameter Schedule 40 NSF PVC pipes.
ON THE ENDS. NO STONE UNDER. F.E' D IV TACO O� A ,�� 7� 7 T T- 10. All solid piping, tees & fittings shall be 4" diameter
' ^ 1. Y 1 v ( / Schedule 40 NSF PVC pipes with water tight joints.
P E R C 0 LAT I 0 N TEST co 11. Municipal Water is Connected to ALL OF The Residence and Abutting
40 FO�T RIGHT OF WAY
ca ( ) Properties .Within 150 Feet.
co
Date of Percolation Test: AUGUST 8, 2005 + 9 THE PROPERTY LINES ARE APPROXIMATE AND
_--_-- 1 r--------------- ------------------------------------- ______ COMPILED FROM THE SURVEY PLAN GENERATED BY
Test Performed By. CARMEN E. SHAY, R.S., C.S.E. --------------- I � __ __
Results Witnessed By. WAIVER (per Barnstable B.O.H.) --- --- �yTl i/ I �� R = 1241.09' _ - -- GEORGE CLEMENTS, P.E OF BRIDGEWATER, MA
EXCAVATOR: Shay Env. Svcs. ENTITLED "SUBDIVISION PLAN OF LAND IN HYANNIS, MA",
/ I I
-- DATED DATED AUGUST 19, 1928 (PLAN BOOK 38 PAGE 91)
Percolation Rate: Less Than 2 MPI ® 48"
I r L = 120.00 i
- --' ��J \ AND IS NOT INTENDED TO BE A SURVEY. PLOT PLAN
Test Hole j Test Hole / I I i �� IT SHOULD BE USED FOR NO PURPOSE OTHER THAN
No. 1 No. 2 _ _ i I r 1 / THE SEPTIC SYSTEM INSTALLATION,
DEPTH SOILS ELEV. DEPTH SOILS ELEV. MARKPROECT BENCH
d 9a50 0 98.50 TOPJOF FOUNDATION i EXIST. j /ff 11 EXISTING LEACH PITS TO BE PUMPED OUT AND REMOVED
Sandy Loam, sandy Loom I DRIVEWAY
ELEV.. = 100.00 (Assumed) NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE
10_.YR 3/2 10 YR 3/2 I i t' - 1 1 I
,� I 1 LOT #41 I 1 FROM THE EXISTING LEACH PITS TO BE DISPOSED
Ae 97.751 0 -9' Ae 7.75 _� -� I 1 I 1 OF AS PER BOARD OF HEALTH SPECIFICATIONS.
_. -, - w_98 - f5,485_Square Sandy - Sandy __. - - - >.,a, -, _.�_.. _ __� I__ _, _Feet)+/
WamLoam i I d j TH ERE`ARE- NO `ARE PRESENT-WITHIN 200'`OF THE-PROPERTY _
10 YR 5/e 10 1R 5/e
9"- 28' Be 96.17 9'- 24' Be 96.50 I I 1 ASSESSORS MAP 289 PARCEL 103mR
Medium Medium
Sand Sand I
2.5Y8/4 I 15Y8/4
28 42 G 28"- 48
Medium Me um i i ,'� i i k6 104X 1 DENOTES PROPOSED
2.Sond ZSand EXISTING -_- _-- SPOT GRADE
LOT ##42 3 BEDROOMI I i DENOTES EXISTING
4Y- 132 48'- t32 EXIST. 1 I I LOT ##40 X 104.46
GARAGE HOUSE SPOT GRADE
PROROSEDI i
#55• FU*RE ; ; Pt PROPERTY LINE
AD f ITION II o-6�[- PROPOSED CONTOUR
Perc #1 � (Growl bpace) wtio f
Depth to Perc: 38" to 56" Enclosed :��Pa
I / I ` - - - - - EXISTING CONTOUR
Perc Rate= 2 MPI Porch --- -----� �� -97
OBSERVED H2O Elev. = None Observed 2
SHED ® DEEP TEST HOLE &
EXIST. 0 ;37.25' 6'
' PERCOLATION TEST LOCATION
3-2e OtAM. ACCESS MANHOLES 1250 gal. .- 6 FOOT STOCKADE FENCE
,G -0• Septic Tank
0
D-Bo Y tea
b Failed ai • ' 1
Leach Pit Leach Pit 1 _ P LOT P LAN
TEST HOLE #2 _ TE$T HOLE #1 15.25' HE 1
°� 1zo.00' ELEV_��838^ ELF=� §Q OF PROPOSED SEPTIC SYSTEM UPGRADE
rp THE ACCESS COMERS FOR THE SEPTIC TANK, E
h DISTRIBUTION BOX ANO LEACHING COMPONENT ----- - - \•�
SHALL BE RAISED TO WITHIN 6" OF
FINISHED GRADE. 9a --- 99 PREPARED FOR
MR . CARL GUSTAFSON
STEEL REINFORCED PRECAST CONCRETE INSTALL TUF-TITE GAS BAFFLES OR EQUALS
PLAN VIEW ON ALL OUTLET TEE ENDS \�`
f3-2e REMOVABLE COVERS AT
#55 FERNWOOD AVENUE
•min clearance LOT #48
9i£T e'mA,� 2' min. inlet to outi.t e.1e„ ,1 eeET LOT ##46
1r}'� LOT #47 HYAN N I S, MA
LW�ievd- OUTLET --�`- ..
tC wee ,e IILLJIII
5'-7-
" '5' -0.
Ef
4'-0'min.$ PREPARED BY:
N
bar ,,,.err Liquid depth s.., O C
=� A N ti CARHEW E. SHA Y
•- .�,i.-�i y •a.xt•..t, i!♦.-T.. V_ '� --. a "� ..: A•t •4
' ENVIRONMENTAL SERVICES, INC.
0 20 40 50
CROSS SECTION END-SECTION P, P.O. BOX 627
EAST FALMOUTH, MA 02536
TYPICAL 1250 GALLON SEPTIC TANK gNITAa� TEL/FAX 508-539-7966
. .NOT TO SCALE
SCALE: 1 "=20' L 1"=20' DRAWN BY: CES DATE: AUGUST 11, 2005
- (H- 10 LOADING) PROJECT#SD788 FILENAME: SD788PP.DWG SHEET 1 OF 1