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HomeMy WebLinkAbout0035 GUNWALE ROAD - Health 3 5 Gunwale' Road`'` ! Hyannis A=268 - 195 D 8 a �I III N I� 1 p S u Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage.Disposal System Form- Not for Voluntary Assessments 35 Gunwale Rd ° Property Address T George and Nancy Layhe -I-,- Owner Owner's Name t= information is required for every Hyannis Port MA 02547 Date of Inspection of Ins -� page. City/Town State Zip Code Dapection , Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information (3 0l3 filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not Darrell Stone use the return Name of Inspector key. Cape Cod Septic Inspection °'ICE Company Name P.O. Box 1466 Company Address Harwich MA 02645 City/Town State Zip Code 508-240-2500 S14995 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP a proved system inspector pursuant to Section 15.340 of Title 5 (310 CM 6.000).The system- ® Pass s on ' ' asses ❑ Fails ❑ N d F rther ua y e Local Approving Authority 5-12-2018 e Signat 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. Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 l5ins•3113 VS Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 35 Gunwale Rd Property Address George and Nancy La he Owner Owner's Name information is Hyannis Port MA 02547 5-9-2018 required for every State Zip Code Date of Inspection page. City(rown 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): o- Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 t5ins•3/13 J , Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form Not for Voluntary Assessments �M 35 Gunwale Rd Property Address George and Nancy Layhe Owner Owners Name information is Hyannis Port MA 02547 5-9-2018 required for every y page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ 'Y ❑ N ❑ ND (Explain below): Al C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is,not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 t5ins•3113 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 35 Gunwale Rd Property Address George and Nancy Layhe Owner Owner's Name information is Hy MA 02547 5-9-2018 Hyannis Port required for every State Zip Code Date of Inspection page. City/Town 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 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. 3. Other: .i D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes ' No 0 " ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 t5ins•3113 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 35 Gunwale Rd Property Address George and Nancy Layhe Owner Owner's Name information is Hy annis Port. MA 02547 5-9-2018 required for every State Zip Code Date of Inspection page. Cityrrown 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: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered"yes" to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary,Assessments . 35 Gunwale Rd Property Address George and Nancy La he Owner Owner's Name information is Hy MA 02547 5-9-2018 Hyannis Port required for every State Zip Code Date of Inspection page. Cityrrown C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? � ® Has the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or as part of ❑ ® this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ 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. ® El approximation in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: 3' 3 Number of bedrooms (design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 t51ns•3/13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 35 Gunwale Rd Property Address George and Nancy Layhe Owner Owner's Name information is required for every Hy annis Port MA 02547 5-9-2018 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: 3 bedroom residential dwelling - 0 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? El Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? El Yes ® No 3-2018 Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts v Title 5 Off icial Inspection Form m-Form Not for Vol untary Assessments i � o Subsurface Sewage Disposal System rY M 35 Gunwale Rd Property Address George and Nancy La he Owner Owner's Name information is Hyannis Port MA 02547 5-9-2018 required for every State Zip Code Date of Inspection page. cityrrown D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Unknown Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/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): Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 8 of 17 15ins-3/13 '<C\ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 35 Gunwale Rd Property Address George and Nancy Layhe Owner Owner's Name information is Hy annis Port MA 02547 5-9-2018 required for every page. City/Town State Zip Code Date of Inspection D. System Information (coat.) Approximate age of all components, date installed (if known) and source of information: 2007 per 80H --- Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 18"+/- Depth below grade: 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.): Apparent good condition Septic Tank(locate on site plan): 12" 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 1000 gallon Dimensions: 8" Sludge depth: t5ina•W13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 35 Gunwale Rd Property Address George and Nancy La he Owner Owner's Name information is H annis Port MA 02547 5-9-2018 required for every 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 24" A11 Scum thickness �F Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 13" Sludge Judge 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.): Grade to inlet and outlet cover 6" Normal liquid level No sign of leakage Sch 40 outlet tee Recommended next maintenance pumping within 1.5 years Recommended maintenance pumping every 2-3 years 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 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 t5ins•3/13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 35 Gunwale Rd Property Address George and Nancy Layhe Owner Owner's Name information is Hyannis Port MA 02547 5-9-2018 required for every page. Cityrrown 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 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 t5ins-3/13 Commonwealth of Massachusetts ' W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 35 Gunwale Rd Property Address George and Nancy La he Owner Owner's Name information is Hyannis Port MA 02547 5-9-2018 required for every State Zip Code Date of Inspection page. Cityrrown D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): 0" 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.): Grade to box 28 Cover 7 OK condition 1 outlet Normal liquid level No sign of leakage No scum No sign of failure Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Title 5 Official Inspection Form:Subsurface Sewage Disposal system-Page 12 of 17 t5ins-3/13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 35 Gunwale Rd Property Address George and Nancy Layhe Owner Owner's Name information is required for every Hy annis Port MA 02547 5-9-2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 6 ❑ 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.): 6 Cultec recharger 180's with stone (38x6x2") Grade to cultec recharger 32" Cover 1" Bottom 52" Dry No sign of hydraulic failure Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 35 Gunwale Rd Property Address George and.Nancy La he Owner Owner's Name information is Hyannis Port MA 02547 5-9-2018 required for every 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.): Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 15ins•3/13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments m't 35 Gunwale Rd Property Address George and Nancy La he Owner Owner's Name information is Hyannis Port MA 02547 5-9-2018 required for every page. Cityrrown 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 REAR . 3 . i L �i t.nsp. �orE 3 ( A I B 22- io - Q 2 125- 0 1 21-1- 2 3 I 22 - i0 34-4 { 4 S b- 5 26 � I I i b i � Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 t5ins-3/13 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form Not for Voluntary Assessments M 35 Gunwale Rd Property Address George and Nancy La he Owner Owner's Name information is Hyannis Port MA 02547 5-9-2018 required for every page CitylTown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells >5 Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record 2007 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: Plan on file ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Elevations from design plan Bottom of SAS ELV. 33.17 Bottom of test hole ELV. 14.0 GW Adj GW ELV. 16.8 Separation >5' Before filing this Inspection Report, please see Report Completeness Checklist on next page. Title 5 official inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 l5ins-3/13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 35 Gunwale Rd Property Address George and Nancy La he Owner Owner's Name information is Hyannis Port MA 02547 5-9-2018 required for every page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, 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 S Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 l5ins-3/13 TOWN OF BARNSTABLE LOCATION 3-5 6u,,j&-e. k= SEWAGE# z� JILLAGE 4n�, ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO.f,••w+. G Se/vmt SW r7S$77(,, SEPTIC TANK CAPACITY ./=D (mil/off LEACHING FACILITY.(type)6,X' Cv4eu feCkcrq tr (size) t/3 a X d,4 NO.OF BEDROOMS 3 OWNER PERMIT DATE:�I$%) 7 COMPLIANCE DATE: �/Kho� �a Separation Distance Between the: r . Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 03 �� 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 7 3 64f W > G C, Q.lof f I to of Lpt to d _ 4 vb -r© m J TOWN OF BARNSTABLE LOCATION 3S G c�A w C, 1 e- IRCk • SEWAGE # %iLLAGE ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /6 U U / LEACHING FACILITY: (type) h /<= Id c k /�i (size) l e-al II n X NO.OF BEDROOMS 3 BUILDER OR OWNER Mrs N c-.iA c-v L-a V 1 e. PERMIT DATE: DATE: .9 S- Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by w: I I i I. W S . � s Rc i THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M A , FL D�4 SOILTEST LOG DATE EVALUATOR: DAVID D. COUGHANOWR. R.S. WITNESSED BY: DONALD DESMARAIS. HEALTH DEPT. PERC NUMBER: 11746 _ } TEST PIT I NO GROUNDWATER ENCOUNTERED, }} PARENT MATERIAL: PROGLACIAL OUTWASH 14�� PERC AT 62 in - 2 MIN/INCH IN C SOILS ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING - - 38.50 0-6 Ap LOAM 10 YR 2/2 NONE FRIABLE 6-40 B LOAMY SAND 10YR 4/6 NONE FRIABLE '26..50 3 40-120 C MEDUIM SAND 10 YR 6/4 1 NONE LOOSE ` NO GROUNDWATER ENCOUNTERED TEST PIT 2 PARENT MATERIAL: PROGLACIAL OUTWASH_ _ . T �t� 2 MIN/INCH IN C SOILS ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR ;SOIL OTHER - (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING 0-B Ap LOAM 10 YR 2/2 NONE ;• FRIABLE 6-36 B LOAMY- SAND 10YR 4/6 4NONE LOOSE 35.58 38-134 C MEDUIM SAND 10.YR 6/4 .. NONE._ _ LOOSE. 27.56 ueptn nom----Zou nonzon' -5ou-vexture- _` Nou-Color 6011 utner Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistencx,%Oraven DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. PConsistency, 4 Flood Insurance Rate Mau: I Above 500 year flood boundary No— Yes Within 500 year boundary No Yes Within 100 year flood boundary No Z Yes es De th of Naturally Mcuft!"BePervious Material Does at least four fee a f 71ya aq ring pervious material,oxist in all areas observed throughout the area proposed for t m? —Lee-5 If not,what is the of nat�ra ly o ng pervious material? Cn _ Certification " COUGHANOWR I certify that on �1 5 {d ave passed the soil evaluator examination approved by the `Department of Envir ert '• and that the above analysis was performed by me consistent with . "the required training,exp`eF AL perience described in 310 CMR 15.017. #: Signature z,�-4 L5 C Date Q:\SEPTICVERCFORM.DOC Town of Barnstable P# Department of.Regulatory Services Public Health Division Date M i639 �� 200 Main Street,Hyannis MA 02601 �FDMA'tA x.;- Date Scheduled 5A/� Time Fee Pd. Soil Suitability Assessment for Spmge Disposal Performed By: I O ®, `+°a)fs C1 AWW ZZ LSt-- Witnessed By: LOCATION& GENERAL INFORMATION Location Address r � Ge N Owner's Name/�ye �Y�Gl�Gl S l Address 35 Cbv�h wn t o �c{ L(yaah�5 �UL9A D2rp©Q Assessor's Map/Parcel: �, \� Engineer's Name JAvi tl^ ( a wowr— NEWCONSTRUC ION REPAIR Telephone# tl 3&4_C/O q4 Land Use ��VI� `1( Slopes(%) Surface Stones o h Distances from: Open Water Body VOO$ ft Possible Wet Are. 600+ ft Drinking Water Well �w+ ft Drainage Way (;0 ft Property Line 10 + ft Other n SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) GUNWALE ROAD I N GROUNDWATER ADJUSTMENT EXISTING GROUNDWATER LEVEL BASED ON TOWN OF BARNSTABLE I I f GIS DEPARTMENT RECORDS. 9 INDICATED GW 14.00 I INDEX WELL M1W-29 ZONE C I READING DATE MARCH. 2007 ® I 1 READING 7.8 ❑ ADJUSTMENT 2.6 16. I0 � � ADJUSTED GW 16.8 ARM Ft. Parent material(geologic) 1 1CiCf Q1 v" Depth to Bedrock n®t e Depth to Groundwater. Standing Water in Hole: A19 i,I4 f Weeping from Pit Face VA®� Estimated Seasonal High Groundwater @� ✓ y DETERMINATION FOR SEASONAL HIGH WATER TA13LE Method Used: Sf?f., g h o W e— - Depth Observed standing in obs.hole: in. Depth to soil mottles: In. Depth to weeping from side of obs.hole: - e in, Groundwater Adjustment Index Well# Reading Date: Index Well level� n Adl.factor, Adj.Groundwater Level PERCOLATION TEST Tline tc) 2M �. Observation i Time at 4" I�1 Hole# Depth of Perc l�� h Time at 6" Time(9"-6") Statt Pre-soak Time @ End Pre-soak `y I Rate MinJlnch Site Suitability Assessment: Site Passed Site Failed: `Additional Testing'Needed(Y/N) _ Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation n Division at least one(1)week prior to beginning. Q:ISEPTICIPERCFORM.DOC e No. �,.4�' a ke 0 0.00 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS es 01pplication for �Diqoal bp5tem (Cun.5trurtiun Permit Application for a Permit to Construct( ) Repair(X) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No.7 9 0—0 5 4 2 35 Gunwale Rd, Hyannis George Layhe Assessor'sMap/Parcel 268/195 35 Gunwale Rd, Hyannis Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. 3 6 4—0 8 9 4 Wm E Robinson Sr Septic Eco-Tech PO Box 1089 Centerville 43 Triangle Cir, Sandwich Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage GrindergO ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Install a new Title 5 leach system to plans of Eco-Tech- ETE-2593 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. L .s J�✓ S' ned Date V Application Approved b Date r r/0 -7 Application Disapproved by: Date for the following reasons Permit No. Date Issued —/ �' / 1 00.00 � No. `--+W Fee 1 _ Entered in computer: THE COMMONWEALTH OF MASSACHUSETTS Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS _ Zipplication for �Bizpogar *p$tem eoigtru' rtion permit Application for a Permit to Construct( ) Repair(K) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No.7 9 0—0 5 4 2 35 Gunwale Rd, Hyannis George Layhe Assessor'sMap/Parcel 268/195 ti, 35 Gunwale Rd, Hyannis Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No.3 9 4—0 8 9 4 Wm E Robinenn Sr Septic Eco-Tech PO Box 1089, Centerville 43 Triangle Cir, Sandwich Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder-1p ) Other Type of Building + No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd. Design flow provided gpd Plan Date Number of sheets Revision Date Title -Size of Septic Tank Type of S.A.S. �. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Install a new Title 5 leach system to plans of Eco—Tech— ETE-2593 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. S'gned >Ae Date ✓� V Application Approved by_ � Date Zf Application Disapproved by: ,Date for the following reasons Permit No.- "J 7 Date Issued -------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Layne Certificated Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( X ) Upgraded ( ) Abandoned( )by Wm E Robinson Sr Septic 35 Gunwale Rd Hyannis- at � y has been constructed in accordance u/ with the provisions of Title 5 and the for Disposal System Construction Permit No.��//�� 7 / 5 3 dated Installer i U�'��`ti$�^rl Designer ac." jdirlfJ,,l-� #bedrooms ? Approved design flow �j ''>cE> gpd The issuance of this permit shall nbt be construed as a guarantee that the syste winf"` 11 fu ct'• as es' tied. Date I _..._.-�'y. Inspector, No. aq�?? -)5.?1 Fel 0 0.0 0 ———— Layhe r THE COMMONWEALTH.OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS lioo!gal *raem Cow6truction Permit Permission is hereby granted to Construct ( ) Repair ( X-)--Upgrade ( ) Abandon ( ) System located at 35 Gunwale Road, Hyannis 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 conC ons. Provided: Construction must be completed within three years of the d this pe Date `� /� �� / Approv Ar Town of Barnstable y�P,oFtHE r°w�o� �•4 Regulatory Services Thomas F. Geiler,Director BARNSTABLE, MARS- g Public Health Division 1634.901. ArEp ° Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: _6 — Designer: Eco—Tech Installer: Wm E Robinson Sr Septic Address: 43 Triangle Cir Address: PO Box 1089 Sandwich Centerville On /4)g_ Y� Wm E Robinson Sr Septicwas issued apermit to install a (date) (installer) septic system at 35 Gunwale Rd, Hyannis based on a design drawn by (address) Eco-Tech - dated 04-09-07 (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 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. IN OF MAS�o w a DAVID yc D. (Installer's Signature) COUGHANOWIR y No. 1093 ISTE��O �J SgNI T n R`PN (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE 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/Septic/Designer Certification Form I FLOW PROFILE AT, ALL PIPE ELEVATIONS SPECIFIED ARE INVERT ELEVATIONS EXPRESSED IN DECIMAL FEET NOT FEET AND INCHES. TOP OF FOUNDATION RAISE COVERS TO WITHIN SIX INCHES OF FINAL GRADE ALL PIPE TO BE EL = 39.65 +- INSTALL ONE INSPECTION RISER FOR LEACHING GALLERY SCHEDULE 40 PVC TO WITHIN 3 INCHES OF FINAL GRADE AS INSPECTION PORT AND TO PITCH AT AND INDICATE LOCATION ON AS BUILT. 1/8 in/Ft MIN. 38.50 -BQX 3 ft 2" LAYER OF 1/8" /3 DROP MAX 1/2" STONE 0/ FLOW LINE .. = II 35.50 10 3/4"-1 1/4" 14 RECHARGER STONE 1 48" GAS�� 160 BAFFLE M OF 36.20+- 6 in i _V SOIL OABSORPTION EXISTING STON 35.20 BEACHING SYSTEM EXISTING g/j�jE 35.1'� EXISTING 35.3'� GALLERIY EXISTING (END VIEW) 33.17 5.00 ft + 1000 GALLON SEE DETAIL ON REVERSE EXISTING SEPTIC TANKT 11.3 ft 3.4 ft 6 ft ADJUSTED Y 16.80 SEASONAL HIGH GROUNDWATER N « m m m F Z rn �� > 0 F-Z C-) z 0 > 0 m m / 0 i �u _ I , co c* I rn VEp O � RI VEW�9 Y I mo � I a ' m� m W O � vw m co y In m 20 + ► -R Lyl f ' o W'lTER -� n M LINE ' y y y Cp I m� r �ao� 0 �fs ' N f� a -,DEC oT W � VED G` ;1' Fo (D pz a m !� ORI VEW�9 Y�1�E y w w N Sll�s� _�� - > m 0 v ^BOG' G°MMpy�L F— � m 10355 �___� y �1 n CD 0 0 m 0 0 o f � � FZY o � , Zx 0wo �r a�� Z � 0 � � 3 . S��� n o m o Z-i C Fq ,I p (n Fq O 1,1 m Slla 0�33�7 ti ti rn ' mti x 3�'ARl '� n�I y O ym� 3 r 3oA� �I n� X �� 4n-Docn� L N �T' 'C =Z n�Z c���� °° zw f �oZm 03�m-- 0) 0 IN, �� m�i� O y ZfQ 1 . m (� o�o�z (J �z ® ® cn° Rr1 z m o_ G) =C� (D 0 u m m ,DozID N O OD fV � � D CJl n =ooro w CD CY) >my�o A W fTl 3 z-j Z fil >Cn� > y Oy nm'ozz rn m z ° rn 0 w N -- ,ram y O 0 �m� o o �mn m c a U m G) m cn y a .. m� p N 'mzm:K �] N 3 0 nIrn rn0 = z0 moom Iyyy V ) 2 U)U)C»z , a C U) -i > to N N rij' . CD n X_ O 0 > m OD Ln m a Zn 4 Z Z 3NV-7 NIHd-700 cn�000� m crnn z 9 r 0 N w w m� z O O N o �3�0� rn N w ° z r m m N N n y� -� s �0 m Z o m "(jo 0 co m 0 m > avow O o6mma W l9 Gl O O Z � � J O m wvbd y 0) f�l z cn o o r' n A vM o��c0nz 3 _� o o s3lvdrd o�o� moCwz Z car m��03M Z v DATE OF S 0 I L TEST LOG SSOIL E ALUATOR: - DAVID D. COBUGHANOWR. R.S. t DESIGN CALCULATIONS WITNESSED BY: DONALD DESMARAIS. HEALTH DEPT. PERC NUMBER: 11748 1 DESIGN FLOW: 3 BEDROOMS X 110 GPD = 330 GPD TEST PIT I PAARENOTUMAATERIAL:EPROGLACIRALD OUTWASH SEPTIC TANK: 330 GPD X 2 DAYS = 660 GALLONS PERC AT 62 1n - 2 MIN/INCH IN C SOILS USE EXISTING 1000 GALLON SEPTIC TANK IF IN SOUND STRUCTURAL ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER CONDITION. IF NOT, INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED) (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING DISTRIBUTION BOX: USE 3 OUTLET D-BOX. 38.50 _ 0-6 Ap LOAM 10 YR 2/2 NONE FRIABLE SOIL ABSORBTION SYSTEM: A 43 Ft x 6 Ft x 2 ft LEACHING GALLERY CAN LEACH 6-40 B LOAMY SAND 10YR 4/6 NONE FRIABLE Abot = ( 43 x 6 ) = 258 of , 35.17 Asdw = ( 43 + 43 + 6 +6 ) x 2 =196 sf 40-120 C MEDUIM SAND 10 YR 6/4 NONE LOOSE Atot = 454 sf 28.50 Vt 0.74 x 454 = 336 GPD USE A 43 ft. x 6 ft. x 2 ft GALLERY. Vt = 336 GPD > 330 GPD REOUIRED TEST PIT • 2 NO GROUNDWATER ENCOUNTERED PARENT MATERIAL: PROGLACIAL OUTWASH 1000 GALLON SEPT-IC T-A-W LEACHING GALLERY NOT TO a 2 MIN/INCH IN C SOILS DIMENSIONS AND DETAIL NOT TO SCALE USE EXISTING H-10 UNIT SCALE CONSTRUCTION DETAIL ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER CULTEC RECHARGER 180 UNIT ST0 7 (INCHES) HORIZON TEXTURE (MUNSELLI MOTTLING EXISTING SEPTIC, TANK IS TO BE PUMPED 43.0 Ft 38.75 DRY AT THE TIME OF INSTALLATION AND m � 0-6 AR LOAM 10 YR 2/2 NONE FRIABLE• IS TO BE EXAMINED FOR STRUCTURAL s w INTEGRITY: INSTALL A NEW PVC OUTLET m m 8-38 B LOAMY SAND 10YR 4/6 NONE LOOSE TEE EOUIPPED WITH A GAS BAFFLE. 35.58 38-134 C MEDUIM SAND 10 YR 6/4 NONE LOOSE 2.5 rt1. 38.0 Ft z.5 ft 27.58 . � 43.0 Ft GROUNDWATER ADJUSTMENT TAPER�� CROSS SECTION VIEW NO GROUNDWATER EXISTING GROUNDWATER LEVEL BASED ON TOWN OF BARNSTABLE 5 Ft- I4IN GIS DEPARTMENT RECORDS. 6 In EFFECTIVE FECTIVE EPTH 14 ,^ INDICATED GW 14.00 24 in CULTEC RECHARGER ; INDEX WELL M1W-29 Iae uNlr (END VIEW) ZONE - C READING DATE MARCH. 2007 Ie READING 7.6., �1 ADJUSTMENT 2.8<, '• 8 {£_6 In A'�'�' 1.5 Ft 3.0 Ft Ls Fe N-O T E S ADJUSTED GW 16.8 6.0 Ft INLET OUTLET END END 1) GARBAGE GRINDER NOT ALLOWED WITH THIS DESIGN. 2) SEPTIC TANK TO BE PUMPED DRY AT TIME OF SYSTEM REPAIR AND CHECKED 3 IN DROP FOR STRUCTURAL INTEGRITY. INSTALL PVC OUTLET TEE FITTED WITH GAS BAFFLE. —> /l FLOW LINE LH 3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REOUIREMENTS FROM OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15). BUILDING 10 in 14 o BOX 4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES 46 in BEFORE EXCAVATING FOR SYSTEM. LIQUID OAS LEVEL BAFFLE 5) EXISTING -LEACH PIT 'TO BE PUMPED. COLLAPSED. AND FILLED OR REMOVED. 6) ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON. FINES AND .DUST, IN PLACE. NOT TO SCALE SEWAGE DISPOSAL SYSTEM PLAN Z) LINES EXITING D-BOX TO RUN LEVEL FOR 2'-0" BEFORE PITCHING DOWN: " CROSS SECTION VIEW 8) ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION ,OF'LOW .FLOW,•'FsIXTURES —TO SERVE EXISTING DWELLING AND APPLIANCES. AND BIANNUAL PUMPING OF -'THE-,SEPTIC :-TANK; 9) SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. DO NOT ! GEORGE AND NANCY LAYHE PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM.. `�, } „„E' 'c 35 GUNWALE ROAD HYANNIS, MA 10)--'INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE STARTING,,WORK;` EEO ENVIRONMENTAL 11) SEPTIC TANKS SHALL BE INSTALLED LEVEL AN.D'TRUE TO- GRADE',ON A LEVEL STABLE BASE THAT HAS BEEN MECHANICALLY COMPACTED AND ON, TO WHICH 43 TRIANGLE CIRCLE SANDWICH MA 02563 SIX INCHES OF CRUSHED STONE HAS BEEN PLACED TO MINIMIZE UNEVEN SETTLING. ETE-25931 APRIL 9. 2007 1212