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0050 GROUSE LANE - Health
�}yt o�rµ,3�i+ ♦f�'4`�sh:�Y`f yannRis4y�Y%a �Y� l� lJ �y9,MrkE� l . �r w �.'a Y,t, � �Y M1t,� s'NSf�' r^ s A n TOWN OF BARNSTABLE LOCATION SO GrwsC. L0 SEWAGE# 'ZOI C.•a o3 VILLAGE ��v A, J ASSESSOR'S MAP&PARCEL ZG% - Z SH INSTALLER'S NAME&PHONE NO. 4r Q EXCciVp.4 i On y77-01.63 SEPTIC TANK CAPACITY /Sd0 qc1 LEACHING FACILITY. (type) s 00 4o►, (size) 13 X Z-< x Z NO.OF BEDROOMS OWNER / PERMIT DATE: S • 2 5•f L COMPLIANCE DATE: 01 /2-Al 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 d O Q c CQ d 0 • N V -N �- -M p Q cn c a 1 aco8 -asp Commonwealth of Massachusetts Title 5 Official. Inspection Form r Subsurface Sewage Disposal System Form -Not for Voluntary Assessments /'F 50 Grouse Lane Property Address Robert Malicia Owner Owner's Name information is required for every West Hyannisport Ma 02601 3-2-2021 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. Important:when filling out forms A. Inspector Information 08 O� on the computer, Brett Hickey use only the tab key to move your Name of Inspector cursor-do not B&B Excavation use the return Company Name key. 374 Route 130 Company Address Sandwich 11164 Ma 02563 City/Town State Zip Code r�eta (508)477-0653 S113747 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above;the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ❑■ Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails Brett Hicke Digitally signed by Brett Hidey y Date:2021.03.10 08:54:48-05•00' 3-2-2021 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Please note:This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. l t51nsp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 Commonwealth of Massachusetts -- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments - 50 Grouse Lane Property Address Robert Malicia Owner Owner's Name information is West Hyannisport Ma 02601 3-2-2021 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary i Inspection Summary: Complete 1, 2, 3,or 5 and all of 4 and 6. t 1) System Passes: ❑■ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: The system was in working order at the time of inspection. 2) 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): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 50 Grouse Lane Property Address Robert Malicia Owner Owner's Name information is West Hyannisport Ma 02601 3-2-2021 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes(cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed 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): ` 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal -System Page 3 of 18 Y 9 Commonwealth of Massachusetts Title 5 Official Inspection Form r $ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments - 50 Grouse Lane Property Address Robert Malicia Owner Owner's Name information is West Hyannisport Ma 02601 3-2-2021 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No El El clogged of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ El Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t51nsp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 50 Grouse Lane Property Address Robert Malicia Owner Owner's Name information is West Hyannisport Ma 02601 3-2-2021 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ O Liquid depth in cesspool is less than 6"below invert or available volume is less than Y2 day flow ❑ .0 Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ E] Any portion of the SAS,cesspool or privy is below high ground water elevation. ❑ a Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ❑ Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ [D Any portion of a cesspool or privy is within 50 feet of a private water supply well. F ❑ El 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.] ❑ El The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems,you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 50 Grouse Lane Property Address Robert Malicia Owner Owners Name information is West Hyannisport Ma 02601 3-2-2021 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (Cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat,or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each.of the following for all inspections: Yes No El ❑ Pumping information was provided by the owner,occupant, or Board of Health ❑ El Were any of the system components pumped out in the previous two weeks? 0 ❑ Has the system received normal flows in the previous two week period? ❑ 0 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) ❑ n Was the facility or dwelling inspected for signs of sewage back up? El ❑ Was the site inspected for signs of break out? El ❑ 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: El ❑ Existing information. For example,a plan at the Board of Health. ❑ O Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts �y Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments t 50 Grouse Lane Property Address Robert Malicia Owner Owner's Name information is West Hyannisport Ma 02601 3-2-2021 required for every St page. City/Town ate Zip Code Date of Inspection D. System Information 1. 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): 348/GPD Description: 2 Number of current residents: Does residence have a garbage grinder? ❑ Yes 91 No Does residence have a water treatment unit? El Yes ❑ No If yes, discharges to: on to ground Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes i■❑ No information in this report.) Laundry system inspected? ❑ Yes No Seasonaluse? ❑ Yes Q No See below Water meter readings, if available(last 2 years usage(gpd)): Detail: 2019- 68,816gallons 2020- 97,988gallons Sump pump? ❑ Yes 9 No current Last date of occupancy: Date I t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts - --- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 50 Grouse Lane _ 1 , Property Address Robert Malicia Owner Owner's Name information is west Hyannisport Ma 02601 3-2-2021 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: NA 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 Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Owner- last pumped 5-31-2019 � Was system pumped as part of the inspection? ❑ Yes ❑■ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t51nsp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments t (� 50 Grouse Lane Property Address Robert Malicia Owner Owner's Name information is required for every west Hyannisport Ma 02601 3-2-2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: 0 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 I 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: 2016 per plans I Were sewage odors detected when arriving at the site? ❑ Yes ❑■ No 5. Building Sewer(locate on site plan): 1'6" Depth below grade: feet Material of construction: ❑ cast iron ❑■ 40 PVC ❑other(explain): Distance from private water supply well or suction line: Town water feet Comments (on condition of joints, venting, evidence of leakage,etc.): i t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments "v� 50 Grouse Lane Property Address Robert Malicia Owner Owner's Name information is West Hyannisport Ma 02601 3-2-2021 required for every page. City/Town State Zip Cade Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 611 Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No 1 Dimensions: 500gallons 911 Sludge depth: 27n Distance from top of sludge to bottom of outlet tee or baffle 2n Scum thickness 611 Distance from top of scum to top of outlet tee or baffle 15" Distance from bottom of scum to bottom of outlet tee or baffle measured How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): The tank was in working order at the time of inspection. The tank is in need of pumping at this time and should be pumped every two years for maintenance. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments j50 Grouse Lane Property Address Robert Malicia Owner Owner's Name information is required for every West Hyannisport Ma 02601 3-2-2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): NA Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): NA Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t51nsp.doc•rev.7/26/2018 Tithe 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection - Form i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 50 Grouse Lane Property Address Robert Malicia Owner Owner's Name information is west Hyannisport Ma 02601 3-2-2021 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches,etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened)(locate on site plan): Orr 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.): The id-box was in working order at the time of inspection. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments l 50 Grouse Lane Property Address Robert Malicia Owner Owner's Name information is West Hyannisport Ma 02601 3-2-2021 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): NA *If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System,(SAS)(locate on site plan,excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: (2)500 gallon chambers El leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number,dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t51nsp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form —<i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 50 Grouse Lane V, Property Address Robert Malicia Owner Owner's Name information is west Hyannisport Ma 02601 3-2-2021 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System(SAS)(cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The SAS was in working order at the time of inspection. Leaching was dry when viewed with no evidence of past backup. 12. Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): NA 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.): t5insp.doc•rev.7/26/2618 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 4 Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 50 Grouse Lane Property Address Robert Malicia Owner Owner's Name information is West Hyannisport Ma 02601 3-2-2021 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: NA Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form +� ire Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 50 Grouse Lane Property Address Robert Malicia Owner Owner's Name information is West Hyannisport Ma 02601 3-2-2021 required for every page. City/Town Satet Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: hand-sketch in the area below ❑ drawing attached separately VN Pq __j t t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 50 Grouse Lane Property Address Robert Malicia Owner Owner's Name information is West Hyannisport Ma 02601 3-2-2021 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑� Check Slope ❑■ Surface water ❑■ Check cellar ❑■ Shallow wells Estimated depth to high ground water: No GW @ 10'feet Please indicate all methods used to determine the high ground water elevation: El Obtained from system design plans on record 2-24-2016 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: A plan on file at the local Board of Health was used to determine high groundwater. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official InspectJon Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts ---= Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ° 50 Grouse Lane 1p. Property Address Robert Malicia Owner Owner's Name information is West Hyannisport Ma 02601 3-2-2021 required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: 0■ A. Inspector Information: Complete all fields in this section. Q■ B. Certification Signed&Dated and 1, 2, 3,or 4 checked , �■ C. Inspection Summary: 1,2, 3,or 5 completed as appropriate 4(Failure Criteria)and 6(Checklist)completed ❑■ D. System Information: For 8:Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15:Explanation of estimated depth to high groundwater included t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 Town of Barnstable °dTHEr Regulatory Services ti Thomas F. Geiler, Director URN MAS& 6 Public Health Division: 9� s t6'' Thomas.McKean,Director -200 Main Street, Hyannis, MA 02601 Office: 508-86ZA644 Fax: 508=790=6304 Date: ' 9- I Z-11. Sewage Permit#:Zo1C,- off Assessor's Map/Parcel 2G8- ZSR Installer& Designer Certification'Form Designer: F(_ er4 nJy i r-ewnea-lo 1 Installer: ' Address: 'P p. �oJC 81 Address: 1 y --r _S r r-t ice?— Yoi'mtw��.DoC"� �orc5w� lc. On �J L Z4,2 EX ion was issued a pernut to install a (date) (installer) septic system at_SO GroLiSC. L)J based on:a design drawn by (address) dated R•2y-1 L (designer) - 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 distriWtion box and/or septic tank. Stripout (if required) was inspected and the soils Were found satisfactory. 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. Stripout (if required) was inspected and the soils were found satisfactory. 1�t OF DAVID D. taller's i ) fIAHERTY JR- No. 1211 7 / p. /STE�� S (Design is Signature (Affix Desiga �.-.a�np Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEAI;TH 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. gAoffice formAdesignercertification form-doc ITN ; Department of Regulatory Stirvli-es Public Health Division Date 8 I D (O xsyy 1 Alf)Main Stttt't Hy nnis MA 02601 Date schedu ccl.__ � l'imc ( ��� �ce Pd.. c� � D" CC k: :Soil Suitability ty A swain, t j� Sewage Disposal ,_ ..'... _�.....� ift-'1Vitnecseclf£�:....4.✓�../.1 / V _PsrtflnncdIip: 0.6 LOCATION p ,yph�.y'g;;*�g+#y g ggtt��q�(('�� ��ggar� ,UVi...r'�3.ki9N&GENERAL 8Af.FORMA 95,. W I_ss:ation r\ddrcss 6`y'Y'�Zl7.�^`°�e^�;,..,•1V,g �j�¢� �rC�.� C.ha».,Naena L''� As5^.sscft c b5apil?arcrt l £ Yngineer's Isanac 017 // ,1MCONST"kti'(."Cl *,' RE;PAlli. 1,And'Cm. ._ :._...:.._.....F£?✓�.,... __ ,,.:_., .: S ehws t )_ _ Satiuca Snores_? . [Hs2rncrs from C3pc:a.Winter"Hcut5' ......_it. Possible Wci_Arca -ft. .Dnoting LVatcr\Vets 7?raiaysc-t'sit Preytty L"uac SKETCH:(shto'&nzm�dinarunans of 1rii,exaei loantr,m of test ly)les&prre teats tonate wetlands in p mirriaty to inaiesj r',: (CP! 'atrrit tnstcrial it;cn Ett;as3 ( 0���t w'^"ll f)cpth to AeArz:i:k... ... .._.. . L ay?w Groundwater simding W'atrr-in Itnlc: ' we'Jaing firma Pit 11. C ETEIMINATION FOR SEASONAL HIGH WA TFR TABLF. J)eptta YJfis nt rvrsdmg na of�ho- .-. _ in. B prh to coil rrxtttle.: 1)epits ttr iveegtrigfrom i,je of ob&_fa6Ea- _..- __in, GratmdW_atc_r AdjuArrnt. I?, - iade'x'V1e11W RtAingWit: Indtxf:Wellte.;.l Adyfsctor Adi G undtt wLvLmnei___ _ Y'.I�s�dsi.C3I.A'C`ION'9"ES T3acr', G/ 4� i33�ervptiirn. 7/J `llutcaty __ (/U_...._._._._ riejttfa utr'f'Lrc' 8..... .._. 1'arne atb" S€nxtlresusr'r7irne.�4� ]VIO .. rind Pie•.wk . I{=47n Aach 42 Stte Sr.tnhrtity Asscsagtta3t:.,life N=sex1 Sr e baiter':; .Axl$aGonnt`E'a 3r Nrceed tYiN' O igiml:Public lEedth Itt+vWon £Dbscrvatimi:Elul Daut l'o CSt~C 7mpletal cm back- ---- **'*if perrolation test is to be conducted within 00'of wedantt,you most first notify the Barnstable Conservation Division at least one Q)week prior to beginning. ...................--- _..___. __ ��td f f7FlEP OBSERVATION LOG FTt►,L 1 T-0,from St.l t oriz+itr SOil9'eMWa S:rii Caolur Soil otho Surlacc(in.) (U DA) (Mnhsoli) Motdiug (Suuuturr,Sarnci,:Houlkts: rr YQ - - . --._._ t.. ._ _... _ .. DEEP OBSERVATION HOLE LOG flole.# vgAh trant Suss linnw, suit T"Oum Suit COor Suit tlirset Surrauc(in.) (USDA) 4Msrsarlil Mninins 7Sirut�€urc,Stones,IIvuldcs. _.._.............__ _ , Gm s My't lu fAv51a ._........ DEEP OBSERVATION HOLE LOG HoleW Deeth from Soil Muir. %.it Te wre, Suii i;nivr suit Swfaace(in.) - (USDA)... lMumiell) Mottling 45icu;atzra,Stivies„'ticssdilrrs, ffFFP OBSERVATION HOLE LOG 11010 Myth€rsm 4iis'l itsrixoa Snit TextWC, Sail C',oh r Snit Othd Saa ce(in) £t.€SDA) (Mutisr,4l) Ibmlinas tStrortw„Stxrnati,tlrndders. .....__.............._...... ---------`---------- Flood Insurance Rare;!'lain f bo--r.500 psor flood bouadwy h �Xin........ tSsz3snjGtlXrasboundary Nu.�/YM—. wititut 100yw:'t1mdt.=bry Na YsaW_____ Depth of Naturally tBticxzrr sup:�'erv6a€as.rv7afetisil t7cxs si 14aSt lot€r Crt t.rtrr-tt ally aru urran;;pert/ 7 na1 exist in all areas obsm cd throughout the area proposed fir the sail absorption sysitm? Irnot,what is the dcpilt at nattrrallyoccurring per icru:material? Certl Sation I certify that an Z(date)I have passed the sari evaluator examination approved by(tic Del ar°ument of ErW rort ntal protection and that the above analysis was peribbried by me consistent tv th. the:required trat it Xperti, and ,perience ticscrib in 31C1 CM11 M0111 Signature._ � T3nicy.Gl.._-' ..(..... Q:MIvrt�TERCroxMDOC No. �U ' FeeUf) 3 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2pplita.tion for 7Upgra aY 6pstrm Construction VQrmit Application for a Permit to Construct( ) Repairde( ) Abandon( ) []Complete System � ndividual Components Location Address or Lot No. 50 rUU6,P,. Owner's Name,Address,and Tel.No. Assessor's Ma /Parcel � ° _r `aJ1 u� 1509-. / G� p a-�e �� � �+A� � b 3 tP �`�{�0 J Installer's Name,Address,and Tel.No. De si ner's Name,Address,and Tel.No. 60 /3tQ 4eXCQVot011 1)8--'/77-D( 7 Type of Building: Dwelling No.of Bedrooms �,3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) a Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date 8 lz4 I Number of sheets Z Revision Date Title '51¢e r" Sr-w nio Plan Size of Septic Tank l d yy Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 0 500 !D 6% Hf-�o(i-,box, (Z) 5QD Qa/14n 14to ch��,rI begs 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 Boar f ealth. Sign 1 1 Date 8`25—1 o Application Approved by Date Application Disapproved by Date for the following reasons Permit No. 20�6 — 3U Date Issued 2 tooNo. G(b Q 3 4 . .; t i Fee THE COMMONWEALTH OF MASSA:"CHUSETTS Entered in computer: S PUBLIC HEALTH DIVISION - TOWN OE BARNSTABLE, MASSACHUSETTS Rpplication for M1 6pstetn Construction Vermit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) [:]Complete System ndividual Components Location Address or Lot No. So 1rou"'e, 0-rLA - Owwnee�r''ss Name,Address,and Tel.No. / r Assessor's Map/Parcel a fp g� •2 S b ,A A 1) " "^'L��/"tGu�u(` 50�- 3 6 Y- L !�& Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 50 9" 13t0 covcdton 509-y77-0663 ahcer y nV/ron/Wola,36z- /6 o 7 Type of Building: Dwelling No.of Bedrooms �J Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 0 gpd Desig^nn flow provided 3 ( gpd Plan Date O '.Z Number of sheets G. Revision Date Title .51 k e F SCu/000 Plan Size of Septic Tank X / d!/ Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) J 00 _)V 1,9 -6 -,boX (2) Soo 9a/1aTL Mo chornba—s 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 e th. p w Signe Date O -2,S-1 4, Application Approved by Date Application Disapproved by VV Date ,r for the following reasons Permit No. o 04 /U 3 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 O by 1�t (3 E 1,L G y CL 1t)n at 5D 6 rD 1)5 e-- Lwi-p_ has been constructed in accordance with the p s hionsoff Title 5 anr4k for Disposal System Construction Permit No.)" IG -3 Q 3 dated Installer ZO V Designer #bedrooms Approved design flow j l j 30 -gpd The issuance of this permit shall not be construed as a guarantee that the system will ncti nja 1 designed. + P Date E 1 Inspector (.1Z A. ----- - --- - --- --_- --- - - - _ ------ ------- r---------------------------- ----------Fee------ No. ca b 3 l p , THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction 3dermit Permission is hereby granted to Construct( ) Repair( ) Upgrade( . ) Abandon( ) System located at V ('�`0 L)5 e L�Lnp 7 y cos and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date /i2 r Approved by �J �� TOWN OF BARNSTABLE LOCATION _Sp PC)cC LrJ SEWAGE#_201 L- 3 o3 VILLAGE van n i l ASSESSOR'S MAP&PARCEL Z(G$ - Z S$ INSTALLER'S NAME&PHONE NO. �Xe0. -�i on y�7-OG53 SEPTIC TANK CAPACITY /S'pp 9CL LEACHING FACILITY:(type) SpC)9 a, (size) -3 NO. OF BEDROOMS OWNER ' PERMIT DATE: S- Z 5'•f L 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 Al- B►" y � 3 82. 39 S-p (�rvL� �aae Z A3- zs�g 63 yy'G B a 3o y '' EAR A4- R . IN �R . T 1�J?A1P LOCATION / SEWAGE PERMIT NO. 1,5Z r20Use VILLAGE INSTA LLE 'S NAME i ADDRESS BUILDER OR OWNER d ell _ g D A T E P E RMIT I S S U E D } DATE COMPLIANCE,. 17SSUED 9✓ ��� s A o Jc� No.82= 3 ....... F .. .�.44................ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH -•....................Toxn.........OF.......Barns t an e..........--------.------...------...................... Appliration for Disposal Works Toustrurtinn thrmit Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal System at: • . �..G ruse �n,.+..�d� ...HYa ua 5P.Or.t.,...1`.`'A_.02672----••------------------••-•--------.....---......---•------------------------=------.....------- Location-Address or Lot No. ................................. 0- :..Hyannisport,............... 02672 Owner Address ..__A__&__B_.Cesspool-_Service......................................... 128 Bishops Terrace, Hyannis, MA 02601 Installer Address Type of Building Size Lot.............................Sq. feet U Dwelling No. of Bedrooms......................3....................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type'of Building ---------------------------- No. of persons........................--_ Showers ( ) — Cafeteria ( ) Pa Other g fixture ----------- Design Flow...:__ ..•-- .s ----------------gallons per person per day. Total daily flow............................................gallons. W • WSeptic Tank—I,iquid 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........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water...-_.-_-_-..---.-.._--. -------------------------------- -----------------------------------------------•---•--••----------•••---------•-------•---••••-----••--------•---•••--.•..-- Descriptionof Soil Sand-----------------------------------•--•...........----------------------------------------------------------------------------------------------•---- U ----------•---•---------------------------------------•-------------------•--------.-------------------------- W •-••------------•----•- •-----------------------••----•--------•-•••---•-•--•--•-•••--------•--••---------•-•-----......--------•----•---•-----------------------------------------------------------•- UNature of Repairs or Alterations—Answer when applicable...installation_.of.-a._l_,_000__gal_jo.U,•__RM_-past st one packed..leach._pit_________________________ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TI'=- 5 of the State Sanitary Code— The undersigned f ther Frees not to place the system in operation until a Certificate of Compliance has been issued/by the!bid ea Si ed.0/� ....... �'--- ---•--- . n. ----912a�•-82--------- /�D Application Approved By-- ----.. --•..................................................-- .............9`=d� Date Application Disapproved or t e following reasons----------------•------------------------------------------------------------------------------------------•--•. ....................................................----•--•---------•----------•---...-•-•-•------•--•--------•-----•-••-••-----•---- ••----•-•-•-......••. -----••---•---------------•------------ Date Permit No---------8?--K 3--)----•-.......•--•-•-----• Issued................. 1-8------------------------- Date - P No.£2-.� ...... F ... .AQ.............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............... Town.........OF........Bar.Mtabj.e....................................................... Apli irtttion for Dinpoiial Works Tonotrnrtion runfit Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal System at: ...... ,J:A.02672................................. .._....... .. ....mior � 1 , d n Location-Ay� or Lot No. .obert. Vgalicia..------•-----•------------------• --•--•---..._ isport�..... ---•-026?2 Owner Address ........................................ 12£Z.. hop __a ezace.,..Hyannis i1A. 02601 Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.....................3. _._..Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons................2--------- Showers ( ) — Cafeteria ( ) QOther 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 to ( ) Percolation Test Results Performed Y ..............................................•.........•••• Date......................................... Test Pit No. 1................I ch Depth of Test Pit.................... Depth to ground water--_----______-___ --__. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ GY --------------------------------------------------••---•----------------•-------•--•--•-•--......---........................................................ 0 Description of Soil.........Sand x W U Nature of Repairs or Alterations—Answer when applicable...installation--of-a...1,OOQ-_ llQrl,...pM: cast .....$t\!ilX__•P4.Qke.d_.pi a&Qh_P1t A............................................................................................................................................. � Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT1E 5 of the State Sanitary Code— The undersigned rther agrees not to place the system in operation until a Certificate of Compliance has been issued/by the b'-d -'hea '. ` j Si ed :. 6�-�P 91Z2_......._ t Application Approved B#te A -••••-...........•••-•--•.................•.........-•••-----•--•. -••••-......_.91 ......... Date Application Disapprovedowing reasons-----------------------•----•---------------------------------•-----------------•--------------------••-••--•-•- --••••-•.............................••....•••--••••••••-•-•••••-••••••••-••-•--•••-•---•••••-••••-•••••.••••-•-•-••-••••••••---•---------••----•••-•-•--------•---•--•••••-••••----•••••-••---••-•----- Permit No......... f Issued 9/2j=.82 Dau Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............................T own....O F.......Barnstable ................................................................... �rr�i�irtt#.e of faunt��ittnre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (X) by.....A.&..B. eesgQ01_.s�rr e,...128._E1srsips--xe ace,..:lS3►ar� ...A....AZa1............................................. at......50._Grouse L•n., W. Hyannisport, -VA ..OM�i -- Robert ^ialicia has been installed in accordance with the provisions of TIJLE 5 of The State Sanitary Coe described in the dated ....... ..._.2 t32 application for Disposal Works Construction Permit No.._____.._,�`'3__ ......... .................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL UNCTION SATISFACTORY. . DATE....... 2........................................................... Inspector............................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH To .......OF,...Barnstable .......................................:. 5.00 No.........82-d. �- FEE....................... Diap astt1 nrk ��an r Uan �ernti# Permission is hereby.granted....................A- & B Cesspool,•SeryiCe to Construct. ( ) or Repair ( an Individual Sewage Disposal System Grouse Ln.,••W,•- yannisport,.._N'A....0262 fto?+ert..1"a4cist at No. r� •---- Street as shown on the application.for Disposal Works Construction Permit. ... ..3/_. _ Dated.._.__9/*�?------------------- .............•.-- ...... e�-f -•"-------------------------••------.------•-•-----•------. 82 Board of Health DATE.................................. /••-•/••••••••••........•-••••••---•_... FORM 1255 HOBBS & WARREN. INC., PUBLISHERS ' COVERS TO BE WATERTIGHT AND SEPTIC SYSTEM PROFILE PrF TOP OF FOUNDATION BROUGHT TO WITHIN 6" OF FINAL GRADE Flaherty Environmental Services. EL. 56.0' EL. 55.0' (not to'scale) INSP. PORT W I 3" OF GRADE CLEAN SAND P.O. BOX 81 2" of 1" to b DOUBLE WASHED EL. 54.0 Yarmouth Port, MA 02675 --�— PEAS I UN UR GEOTEXTILE 4" 5O$.362. 1657 CAST IRON or EQUIVALENT FILTER FABRIC ' �+ MIN. PITCH 1/4" PER FOOT 4"SCHEDULE 40 PVC PIPE 4" SCHEDULE 40 PVC PIPE FLOW LINE ENT IF REQUIRED fArst 2'to be%'veil 40' 2% --► 5' 1% 4�' °' L 52.7't L. 53.0't 14" • �•��0.. 0., ° 'O O�� 0°0°°°0°c EL.52.75' —� —� - °o°o°o°o°o0 ° p lam'o o C7 p' p o°o°o°o°c EL. 52.5' o 0 0 0 0 0 0 0� ��_ �® o 0 0 0 �f•' EL. 51.53' r °0°0°0 0°0°0°0° °°°°°°0°c EL,51.T t ° o°o°o°o°o°o° o® r�pIr��1a� ®� o°o°o°o°e 2.0' 10'min.(2.590)—► GAS BAFFLE °o�0 00o�o°o�°�o� a®t m=RRi d acococ0 C EL. 51,5 o 0 0 0 0 0 0 0 ��] Q H_20 0 0 0 o EL.49.5 (D eox) 1`6"CRUSHED STONE OR SOIL ABSORPTION SYSTEM , .,:••q.''•.;`'a!�{;.a••,; ` , MECHANICALLY COMPACTED (2) 500 GALLON CHAMBERS 6' (DATUM: ASSUMED) .f----J 3„ WITH 4'STONE AROUND IN A — 1500 GALLON SEPTIC TANK a to 1, DOUBLE WASHED STONE 12.83'W X 25.01 X 2'D CONFIGURATION (PROPOSED) BOTTOM OF TEST HOLE EL. 43.5' LOCATIONMAP , 54 55 USGS ADJUSTMENT: N/A GROUNDWATER ELEV: N/A N rH 10, 122.69' LOCUS {f © o PR[IP S.T. o ~ DECK BENCHMARK: Cra/ Ville Beach Rd. 1.2' 10 TOP OF FNDN 9 SHED EL. 56.0 NTS EXISTING 3 BR jN OF Af4 qj DWELLING ya sqp 54 DA D /RIVEWAY/ R. 12 .LOT 7 •� `�15,478 SF"± SglVtTTR P� / MAP 268 LOT 258 1219 J g ^ \ t DATE:8/2412016 REVISED: R� 55 O PARKING StTE AND SEWAGE PLAN FOR B & B EXCAVATION, INC./ ROBERT 1, MALICIA 50 GROUSE LANE SCALE : 1 30' BARNSTABLE, N/A REF.'PS 248 PG 59 PAGE 1 OF2 .......... ....................................... ........................... ....... ........ ....... ........................................... .................................................................................................................... .... . ..... ........... ............................................................................................................................................ ......................... . ...... . ....................................................................................................................................... ................................. GENERAL NOTES DESIGN CAL CULA TIONS SYSTEM DETAIL Flaherty Environmental Services P. 0 . Box 81 1. ALL PRECAST COMPONENTS TO BE H-10 Yarmouth Port, MA 02675 RATED UNLESS OTHERWISE SPECIFIED. NUMBER OFACTUAL BEDROOMS 3 I 774.994. 1166 ALL COMPONENTS WITH ANY ANTICIPATED VEHICULAR TRAFFIC TO BE GARBAGE DISPOSAL UNIT NO H-20 RATED. 2. THE DESIGN OF THIS SYSTEM DOES NOT TOTAL ESTIMATED FLOW (110 GAUBRIDA YX 3 BR) 330 GAL./DAY;ALLOW FOR THE USE OF A GARBAGE GRINDER. REQUIRED SEPTIC TANK CAPACITY 660 GAL. 3. MUNICIPAL WATER IS AVAILABLE. — 4. ALL CONSTRUCTION TO CONFORM WITH SIZE OF SEPTIC TANK 1500 GAL (PROPOSED) 310 CMR 15.000 AND ALL OTHER APPLICABLE LOCAL, STATE AND FEDERAL SOIL CLA SSIFICA TION 1 25' CODES AND REGULATIONS. 5. INSTALLER/CONTRACTOR TO REVIEW& DESIGN PERCOLA TION RA TE <2 MINANCH VERIFY ALL ELEVATIONS AND DETAILS AND REPORT ANY DISCREPANCIES TO 1 EFFLUENT LOADING RATE 0.74 GAL.IDA YIF T2 7 DESIGNER PRIOR TO CONSTRUCTION OR 0 0 12.83' LEACHING AREA ASSUME ALL RESPONSIBILITY (2)x(25.0'+ 12,83)(2) = 151SF 6. INSTALLER/CONTRACTOR IS 25.0'x 12.83' =320 SF RESPONSIBLE FOR MAINTAINING SAFE 471 SFx 0.74 =348 GPD WORK AREA, VERIFYING ALL UTILITIES AND NOTIFYING "DIG SAFE" USE(2)500 GALLON CHAMBERS WITH 4'STONE (1-888-344-7233) 72 HOURS PRIOR TO AS DIAGRAMMED IN A 25.O'X 12.83'X 2'CONFIGURATION CONSTRUCTION. 7. ANY CHANGES TO OR DEVIATIONS FROM RESERVE LEACHING CAPACITY NIA THIS PLAN MUST BE APPROVED IN WRITING BY FLAHERTY ENVIRONMENTAL SERVICES AND.LOC4L BOARD OF HEALTH. 8. FINISH COVER OVER COMPONENTS IS NOT TO EXCEED 3'PER 310 CMR 15,000 (NTS) UNLESS SHOWN PER PLAN. 9. ALL ABANDONED SEPTIC SYSTEM COMPONENTS TO BE PUMPED DRY AND SOIL EVAL UA TION , FILLED WITH CLEAN SAND OR REMOVED TESTHOLE#1 AND REPLACED WITH CLEAN SAND, Evaluator- David D.Flaherty Jr.,RS,REHS -VI 10.ALL COMPONENTS TO BE PROVIDED SE#2755 BOH WIthess. David Stanton,RS WITH WATERTIGHT ACCESS PORTS Date: August 18,2016 WITHIN 6"OF FINISH GRADE. 11.ALL SEPTIC TANKS, DISTRIBUTION TH-I ELEV.54.01 BOXES AND PIPING TO BE INSTALLED WATERTIGHT. 0"-10" A LS 10YR 311 12.NO KNOWN WETLANDS OR WELLS WITHIN 100 FEET OF PROPOSED 10'-29" B LS I0YR618 LEACHING. 13.THIS IS NOT A CERTIFIED PLOT PLAN AND UNDER NO CIRCUMSTANCES IS THIS PLAN TO BE USED FOR ZONING OR 29"-126" C CS 2-5Y 614 PERC<2.1,11rch N OFMgSsq SITE AND SEWAGE PLAN BUILDING PURPOSES. DA 14.LOT IS SHOWN AS ASSESSOR'S MAP 268 7 certify that on November 12,2002,l have passed FOR the examination approved by the Department of B & 8 EXCAVATION, INC.1 LOT 258. Environmental Protection and that the above analysis c) F R 15.LOCUS PROPERTY IS LOCATED WITHIN has been performed by me consistent with the 21 10 50 GROUSE LANE ' ROBERTJ. MALZCIA AN A UIFER PROTECTION DISTRICT G.W ELEV NIA required training,expertise,and experience described Q In 3 10 CMR 15.018(2).- Q 1�1 S (ZONE II). BOTTOM TH-1 ELEV. 43.5' / TS BARNSTABLE, NA 1� NIT Rk PAGE 20F2 ................................................ ........ ........................................................ ..................................................................................................................................................... .................................................................... ................................................................. .................................................. ......................... ....................................................... ................................................................. ................................................