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HomeMy WebLinkAbout0117 HAMDEN CIRCLE - Health 117 H y.• 291-316 H'VAN�OS l i I' 'I r i i k i Commonwealth of Massachusetts W Title 5 Official Inspection Form " Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 117 Hamden Circle Property Address Patti Spencer Owner Owner's Name information is required for every Hyannis Ma 02601 6/4/18 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: forms When fillip out f A. General Information S� 13 on the computer, use only the tab 1. Inspector: key to move your cursor-do not Michael DiBuono use the return Name of Inspector key. DiBuono Sewer and Drain Company Name 35 Content Ln Company Address B Cotuit MA 02635 City/Town State Zip Code 508-364-9587 S113522 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a.DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 6/11/18 In ector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Jveo t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments GSM 117 Hamden Circle Property Address Patti Spencer Owner Owner's Name information is required for every Hyannis Ma 02601 6/4/18 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System contains a 1500 gallon septic tank. As well as a concrete distribution box and a 10' x 42' pipe in stone field. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is-less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 I Commonwealth of Massachusetts .W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments � 117 Hamden Circle Property Address P Y Patti Spencer Owner Owner's Name information is required for every Hyannis Ma 02601 6/4/18 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 117 Hamden Circle Property Address Patti Spencer Owner Owner's Name information is required for every Hyannis Ma 02601 6/4/18 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and 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: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 r Commonwealth of Massachusetts u f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments nM 117 Hamden Circle Property Address Patti Spencer Owner Owner's Name information is Hyannis Ma 02601 6/4/18 required for every y page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® 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 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 117 Hamden Circle Property Address Patti Spencer Owner Owner's Name information is required for every Hyannis Ma 02601 6/4/18 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Ha ve e large volumes of water been introduced to the system recently or as part of a 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. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 117 Hamden Circle Property Address Patti Spencer Owner Owner's Name information is H required for every annis Ma 02601 6/4/18 Y page. City/Town State Zip Code Date of Inspection D. System Information Description: 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? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage 168 Gpd 9 ( Y 9 (gpd))� Detail: Sump pump? ❑ Yes ® No 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 W Title 5 Official Inspection Form z a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 117 Hamden Circle Property Address Patti Spencer Owner Owner's Name information is required for every Hyannis Ma 02601 6/4/18 _ page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Pumped in 2016 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): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M e 117 Hamden Circle Property Address Patti Spencer Owner Owner's Name information is required for every Hyannis Ma 02601 6/4/18 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: installed 9/13/04 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 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.): System is vented at the roof line Septic Tank(locate on site plan): Depth below grade: 1.5 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1500 If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: t5ins-3/13 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 °M 117 Hamden Circle Property Address Patti Spencer Owner Owner's Name information is required for every Hyannis Ma 02601 6/4/18 _ 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" Scum thickness Distance from top of scum to top of outlet tee or baffle 42" Distance from bottom of scum to bottom of outlet tee or baffle " Sludge stick How were dimensions determined? Tape Measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments GSM , 117 Hamden Circle Property Address Patti Spencer Owner Owner's Name information is required for every Hyannis Ma 02601 6/4/18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 117 Hamden Circle Property Address Patti Spencer Owner Owners Name information is required for every Hyannis Ma 02601 6/4/18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert level and at normal level Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* 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: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 117 Hamden Circle Property Address Patti Spencer Owner Owner's Name information is required for every Hyannis Ma 02601 6/4/18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 1 10'x42' ❑ 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.): 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 v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 117 Hamden Circle Property Address Patti Spencer Owner Owners Name iinformation is required for every Hyannis Ma 02601 6/4/18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 117 Hamden Circle Property Address Patti Spencer Owner Owner's Name information is required for every Hyannis Ma 02601 6/4/18 page. CityfTown 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 117 Hamden Circle Property Address Patti Spencer Owner Owner's Name information is required for every Hyannis Ma 02601 6/4/18 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water Check cellar ❑ Shallow wells Estimated depth to high ground water: 10+ feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 4/4/04 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: Test hole data on plan Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 6/7/2018 Assessing As-Built Cards LOCA77ONJ,,12 N/�r✓t���1 C,rc/r sswAGE a aoo Y- `/37 V1I LADE Ip�UctN.U/S ASSESSOR'S MAP&LOT a9I - INSTALLER'S NAME&PHONE NO. I RMeS C YAr-e SEPTIC TANK CAPACITY___)/!566 ff 66l, LEACKNO FACH M'Y:(type) L&QC h,NG F t/1(size)_ /0f A' q / NO.OF BEDROOMS _ BUILDER OR OWNER 64w C, �y- PERMITDATE: COMPLIANCE DATE: q C Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility S' 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�IcwhingfacieFeet Furnished byf! 0"r 3 ' 0.0 e Ic IF A I n Q 3 /may iE 37 ,O F 3 ' (/"' http://www.townofbarnstable.us/Assessing/HMdisplay.asp?mappar=291316&seq=1 1/2 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 117 Hamden Circle Property Address Patti Spencer Owner Owner's Name information is required for every Hyannis Ma 02601 6/4/18 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 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate Of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( Upgraded( ) Abandoned( )by Q z rJ l v� +a �r��✓�/ j or 4 ,1,� at 4—( _A'f r � ,�•• � � �c9 s V Cy has been constructed in accordance with the provisions of Title 5 and tthh+e' for Disposal System Construction Permit No. Zo I &.3q dated . Installer: �.�c�.; J �C-,�J�/ �tz.��r Designer #bedrooms Approved design flow 3 y gpd The issuance of this permit shall not cons a guarantee that the system wi function a es Date 5�� /�7 Inspector --------------------------------------------------------------------------------- f J \ 35 Content Ln i I Cotuit Ma, 02635 �`1OICE J mike@capecodtitlefive.com Date Invoice# (508)364-9587 6/1/2018 873 To _ Arline J Falls 456 Marstons Ln Cummaquid,Ma 02637 Terms Due on receipt Item Quantity Description U/M Rate Amount System install Title five system install Install new 12,800.00 12,800.00 3 bedroom septic Deposit -10,500.00 -10,500.00 Additional to contract Added and over and above contract 985.00 985.00 Removal of fill and storage.trucking and hauling. Thank you for your business! Please make checks payable to DiBuono Sewer and Drain. Total $3,285.00 Town of Barnstable Health Inspector pQTHE rph Office Hours Regulatory Services 8:30—9:30 Thomas F. Geiler,Director 1:00—2:00 9�A "9. ,�� Public Health Division TED � Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-63C AMNESTY PROGRAM APPLICANT— SEPTIC QUESTIONNAIRE 1. General Information: Size of Property: a-a� Address: r Map aql Parcel'-N Name: Phone #: 2a. How many bedrooms exist at your.property now? 7 2b. Are you planning to add any bedrooms? A O If yes, how many? 2c. How many bedrooms total are proposed at this property (including the amnesty unit)? 2d. Please include a copy of the floor plans for the entire property - showing the existing rooms in the home plus the proposed amnesty apartment and/or addition. Please label . each room clearly on the plans. 3. Is the dwelling connected to public sewer? YES or ND If th'e dwelling is connected to,public sewer,slap questions#4 throu h#9'be ow;; ' 4. Location of dwelling is INSIDE or OUTSIDE a Zone of Contribution to public supply wells? 5. Is the dwelling connected to an ONSITE WELL or to PUBLIC WATER? 6. Is a disposal works construction permit on file? YES or NO 6a. If yes,how many bedrooms were approved according to this permit? Bedrooms. 7. Were any building permits obtained for construction of additional bedrooms? YES or. NO .8. Is there an engineered septic system plan on file at the Health Division? YES or NO 9. Has the septic system been inspected by a DEP certified inspector within the last two years? YES or NO ---------------------------------------------------------------------- ------------------------ D FOR OFFICE USE ONLY The Public Health Division has no objection to bedrooms at thi property, Special Conditions: �/ 7 cG Signed: Date: O;/health/wpfiles/amnestyapp � @ U m m k c C ' C-1 ! P. 1 COMMUNICATION RESULT REPORT ( MAR. 8.2006 8:40AM ) TTI BARNSTABLE BOARD OF HEALTH FILE MODE OPTION ADDRESS (GROUP) RESULT PAGE ---------------------------------------------------------------------------------------------------- 101 MEMORY TX ECNMC DEU OK P. 1/1 -----------------------------------7---------------------------------------------------------------- REASON FOR ERROR , E-1) HANG UP OR LINE FAIL E-2) BUSY E-3) NO ANSWER E-4) NO FACSIMILE CONNECTION Town of Barnstable Health Inspector Office Hours Regulatory Services 8:30—9:30 Thomas-F.Geiler,Director 1:00—2:00 9, Public Health Division r e M k Thomas McKean,Director 200 Main Street,Hy$nnis,MA 02601 -Office: 508-862-4644 Pax: 508-790-63C AiVTNESTY PROGRAM APPLIC —5EPTIC QUESTIONNAIRE I. General formation: size of property: Qa Address: Map o9/ ,Parcel / Name G Pholae 9: 2a. How many bedrooms exist at your property.now? 7 I 2b. Are you planning to add any bedrooms? If yes,how many? 20. How many bedrooms total are proposed at this property(including the amnesty unit)? 2d. Please include a copy of the floor plans for the entire property-showing the existing rooms in the home plus the proposed amnesty apartment and/or addition, Please label , each zoom Clearly on the plans, TOWN OF BARNSTABLE E .e W&_kReo J 17 H q pKA&A1 C ,<% SEWAGE # o`�G�b y'. y 3 7 VILLAGE j4V etNitJ iS ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO. T19meS C 1/4Cf g"6$ 5•39 -CO18 SEPTIC TANK CAPACITY IS66 bad, 11 i ` LEACHING FACILITY: (type) �. enc h�mG �e i4 (size) f 0� �Y yc1 NO.OF BEDROOMS 3 _ BUILDER OR OWNER T 6" c, X'W PERMITDATE: C9~,)6 " !�_�COMPLIANCE DATE: q G� Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of.Leaching Facility Z 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 fee of leaching facilipA, Feet Furnished by OD Z o n C LW � a 0 .� �. No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ye PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE, MASSACHUSETTS Zipprication for Migo5al *p.5tem Com5truction 3permit Application for a Permit to Construct(+pair( )Upgrade( )Abandon( ) LplComplete System ❑Individual Components Location Address or Lot No. //7 Rot rn AJ C;P Owner's Name,Address and Tel.No. Jzly-TA5A/,� 40-f 9q ��a 1 C .f /7Zarc��.ty�✓ y Assessor's Ma /Pazcel ,,QQ �175 �yP ND�3T_vne0 �1t�. D�Co ct� /Qtr �f Installer's Name,Address,and Tel.No. T19mrS C LtoL&e Designer's Name,Address and Tel.No. NO PA�aN G h�Sm As Box rs,-,-r fe /� UaC yy Jo MA s-t I�i Lo t?,0 �6a✓im l.,Th ma 0')'C- S78 S 2�9 -00/8 Sob <'e/S-19A0 Type of Building: Dwelling No.of Bedrooms Lot Size d Do a sq.ft. Garbage Grinder( ) Other Type of Building,S� o Q At'A No.of Pers ns Showers( ) Cafeteria( ) Other Fixtures Q Design Flow l �1'a�i�JI PC gallons per day. Calculated daily flow�, 0 /tPG,kutP gallons. Plan Date — Number of sheets Revision Date Title ,x) Na H Size of Septic Tank 7-.00 60 Type of S.A.S. edc-4•%ud• Fe IOX 9a Description of Soil t' V!& Nature of Repairs or Alterations(Answer when applicable) (LA,vh k �" 1 envu,e I I ,4j, 4;e 7 'c �c.�Srry/�1• �,tai t l at,9 XXct c l,, -sQ 02 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 f Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue by this Board of He Signed Date 7 Application Approved by Date Application Disapproved for the following reasons Permit No. �' Date Issued .,-,�.n�q„�.rrx 1;.,,� a..'i'- + '. '�" ;V';.� ✓`r.'.�}�.y, ^t;�.�-...t��;pr. �y,•y;'37tS�� +'-"'1:-►w..a`-'4 �.�-i'f`rY "�' �-,�. No. v Fee .. - THE COMMONWEALTH OF'MASSACHUSETTS Entered in computer: ^ Y A Ye PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,, MASSACHUSETTS \� \ 01ppYfcation for 13iqogaY *p.5tetn Congtructfon Verinit Application for a Permit to Construct(Y)Repair( )Upgrade( )Abandon( ) L7Complete System ❑Individual Components Location Address or Lot No. //7 0►rn t i e 's Name,Address and Tel.No. H ,?A) ✓,s 0-r 9Q �! a hW C . ma ry IF.� %'y�a Assessor's Map/Parc y7s Nr ST piu7�✓il`1 /a tU, O�G 31 )9d � 3/Ca SIC8 -- ��--7101 In aller's Name,Address,p4 Tel No T/9M,-s Designer's Name,Address an*No.,_N�•-o I'Ma /'OZ/yl a a LQo r ('oS�P I^��SST( �{ /✓la. C I C�C, )0 MA,-SA V i rC.� L Sd S 539 -ca i8 S"o8 - t�A Type of Building: k 3 Lot Size 16 ed/ s ft. Garba e Grinder Dwelling No.of Bedrooms q. g ( ) ,1 a m. Other Type of Building- %•��D1 V No.of Person Showers( Cafeteria( _) Other Fixt/urres Design Flow !U'� >�/o s% PCB gallons per day. Calculated daily flow 3� �6fn 1�i{u''c� gallons. Plan "Date k d-y - O Numb r of sheets a Revision Date Title Im sv A)a Size of Septic Tank �S'DO n Type of,S.A.S. led` '"A4 ';Pl /�It y Description of Soil' F�� /OGt�'ytt� J 4 i C u M XQ,Z , ature of pairs€or Alterations(Answer when applicable) uY✓!l �sTa It �J,%D �ADI;c �'y�r�nt (.17i t k 1Q�h i !��'_ �X ) e9�r�9 -a C��." Jlj y � L• 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 %f Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been is,sue by this Board of He Signed t c Date �C7 6 Application Approved by 4 �/ 1 Date Application Disapproved for the following reasons A Permit Noc Date Issued 1/1 THE COMMONWEALTH OF MASSACHUSETTS V-1 BARNSTABLE, MASSACHUSETTS (Zertificate of (tom fiance y THIS IS TO CER:T_LF�I;((,t at he,O i e Sew,agee Disposal System Constructed( k) Repaired ( )Upgraded( ) Abandoned( )by f I d Q ��J has been constructed ij accordance wwl'the provisions of Title 5 and the for Disposal System Construction Permit No. u y" VJ7 dated /- v / a 11staller Designer :The issuance of this pe t shall not be construed as a guarantee that the s stem wills n ttion as/d)si ned. Date of 1 PION. Inspector No.� � /� �1 =— —=—=--=----------------Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE,. MASSACHUSETTS ?i9;Po2;a1 *pgtem (fongtruction J)ermit , Permission is hereby/ to Mqtffiq )-Rep i�( gd ) Bandon System located at / tl J / V and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must b�e�cco pleted t in t ee years of the date of thi e t Date:_ /� �f Approved by 1 Town of Barnstable r' Regulatory Services Thomas F.Geiler,Director • �sxsreeu, • '� Public Health Division " Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: 2'06— Sewage Permit# Assessor's Map\Parcel � � 31 167-qq Designer: �OVMAJ.3 Installer: T.4,64 YS C /`lCt(,�e Address: OW Address: g'co j9OX na�-iN; lUl� 0 F6ire'5`rAk/r On 34y� tS C Ad ce was issued a permit to install a (date) (installer) septic system at /j Ha J"w C` , based on a design drawn by (address) ll rkKA (-65$5 rACA AJ dated Au 4 , `7; 0 6OV. / ( esigner) V 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. e OF �AS`f9 (Installer's Signature) � cy. NORMAN o GROSS0AN No. 12705 `n CIVIL (Designer'sSignature) (Affi �� ere) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH D 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 Fonn 3-26-04.doc a •iFfj r: f%:i iY/!> il:;i`Er•!.;%/'.•Y/i%.a%/.••f°' .:: ::i f r:�ii#<Y F.%.:•.: :: f::f>:•i'T's, tibtr=tts Engimering carp. •:X:/tip::`{.;!•�;,'Liiyi!•:i�titi<r4i.`: >;::•'r� ............... :.....:....... CONSULTINu ENGINEERS 716 County Street,Taunton MA 02780 Tel.(508)822-6934 Fax.(508)880-7811 Client: Joe Harvey Job No. Inst. 04-788 10 Marsh View Rd. Date: 7/29/2004 East Falmouth, MA 02536 Report No.GS4198A Project: Hamden Corner, Hyannis Sample Obtained By: Client Combined Hydrometer and Sieve Analysis Report Dry Sieve Analysis Hydrometer Analysis of the of the Total Sample Portion Passing the#10 Sieve Sieve % Pass. Size MM Sieve Size MM % Pass 3.0" 100.0 76.100 No. 10 2.00000 100.0 1.0" 100.0 25.400 No. 18 1.00000 78.2 1/2" 98.0 12.700 No. 35 0.50000 31.9 3/8" 97.6 9.510 No. 60 0.25000 8.6 No.4 95.2 4.760 No. 140 0.10500 1.9 No. 10 89.7 2.000 No. 270 0.05300 1.6 0.05343 1.4 0.03783 1.2 0,03094 0.7 0.02188 0.7 0.01547 0.7 0.01095 0.2 0.00775 0.2 0.00548 0.2 0.00387 0.2 0,00274 0.2 0.00141 0.2 Percent of Total Sample For Triangle Classification Retained on the No. 10 Sieve Based on Material passim the No. 10 Sieve % Retained (2mm) = 10.3 % Sand 98.4 • Silt 1.4 •Clay 0.2 Remarks: D.Anio IAZ& Technician ChristopheeM.White P.E. Laboratory Director TIBBETTS ENGINEERNG CORP. Soil Grain Size Analysis Usina ASTM D-422 U.S. Standard Sieve Size --D- Total Sample Curve —,A— Mat. Pass. #10 Curve 100 II 100 #270 �6 #60 #35 #18 .10 #4 3 8" 2".3j 4".�" 15"_2" 3 - 90 90 . 80 80 70 70 60 60 50 50 i� 4-1 40 40 4-1 U U a 30 30 . 20 20 10 10 AIJ 0 0 .001 .01 .1 1 10 100 Grain Size in Millimeters Job No. Inst. 04-788 Date: 7/29/04 Project: Hamden Corner, Hyannis, MA Report No. GS4198A Permit Number: Date: Completed by: HIGH GROUND-WATER LEVEL COMPUTATION Site Location: ,-�, Lot No. Owner: Address_. / !4"75 IR/K-)� -S-r C PViLC Contractor: Address: Notes: STEP 1 Measure depth to water table f to nearest 1/10 ft. ............................ .. Date O� /O� 11.41 ................................................ month/day/year STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: U Appropriate index well.................................................... Z © Water-level range zone..................................................... STEP 3 Using monthly report"Current Water Resources Conditions" determine current depth to 01 0, lz+-z waterlevel-for index well........................... month/year STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A),current depth to water level for index well (STEP 3), and water-level zone (STEP 28) p determine water-level adjustment.......................................................................................... �' J STEP 5 Estimate depth to high water by subtracting the water- level adjustment(STEP 4) from measured depth to water levelat site (STEP 1) ................:......................................................................7..................... Figure M—Reproducible computation form. 'f5 TOWN OF BARNSTABLE _LOCATION—1J SEWAGE # .,P00 y y37 fi VILLAGE &�Lc A- ASSESSOR'S MAP& LOT �91 — INSTALLER'S NAME&PHONE NO. T,9rn es C N g-a 9 „cx�P� �.� g SEPTIC TANK CAPACITY — t6 a 1 j, LEACHING FACILITY: (type) a/ F.e f� i � (size) l0 X ya NO.OF BEDROOMS BUILDER OR OWNER 64sA C. 4- PERMITDATE: 0,5 " COMPLIANCE DATE: C` Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility _ .Feet Private Watei Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 fee of leaching faciliq�J�� Furnished by 't .Feet 25 �" ► , �o�, ,mar 30 10 F Of lov 3 , 61 a Town of Barnstable P /01 # Department of Regulatory Services • wuvsrnsrs Public Health Division Date d M,ss.0J9. m 200 Main Street,Hyannis MA 02601 ♦� rfD IAP�A Date Scheduled D Time Fee Pd. Soil Suitability Assessment for Se age isposal 1 Performed By: Witnessed By: LOCATION & GENERAL INFORMATION Location Address Owner's Name Tct7lu -II7 {�,�G�PA Ct�cl.e Address Assessor's Map/Parcel• o)/_3(� Engineer's Name NEW CONSTRUCTION REPAIR Telephone# Land Use _ -rt��T2���i't4,�Slopes(4°) B Surface Stones Distances from: Open Water Body> 3 ft Possible Wet Area'Z CO ft Drinking Water Well y�ft Drainage Way > r� ft Property Line ft Other 1 ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) i- I � TOD tort Parent material(geologic) Depth to Bedrock '�__1 — Depth to Groundwater. Standing Water in Hole: t ' IS I A� Weeping from Pit Face 0" Estimated Seasonal High Groundwater � Sl DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: C.C- ft14 01 C> �a c 08S• in. Depth Observed standing in obs.hole: in. Depth to soil mettles: > N Depth to weeping from side of ob .hole: ►r?o� 6 v in, Groundwater Adjustment Index Well# 7-3 0 Reading Dater Index Well level Ad).factor 4-! Adj.droundwater Level_-s PERCOLATION TEST gate, Observation Time at 9" m-®- Hole# Depth of Perc Time at 6" Start Pre-soak Time @ _ Tmi:(9"-V) End Pre-soak , PCT-Tf_CHr5`0 Rate MinJlnch 4 NArk--(S1 S V3 T 1133 CTS C 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 Division at least one(1) week prior to beginning. Q:\SEPTIC\PERCFORM.DOC DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) ® G (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel 7� ri L iAb v" o (2 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel w DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Mottling (Structure, Boulders. Surface(in.) (USDA) (Munsell) M g (S ,Stones Consistency. ravel Flood Insurance Rate Man: Above 500 year flood boundary No_ Yes _ Within 500 year boundary No✓ Yes Within 100 year flood boundary No ✓ Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? .. If not,what is the depth of naturally occurring pervious material? Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,expertise and experience described in 310 CMR 15.017. �j Signature , Date � Q:\SEPTIC\PERCFORM.DOC iJ LO CA'T`10N SEWA'G E PERMIT NO. VI-1. LAdE IN.STA LLER'S NAME S ADDRESS B U I'L D E R OR OWNER ) R DATE PERMIT ISSUED I> D A T E COMPLIANCE ISSUED . , (� 1 �. �� � � �. ® � , . �`�. 1 Z ,� C�'j ' � � ., '� � � _,. � �-_ ,' 1 � � � �� �, �v _ ,. . �� , - _: ��a� 701 No...........� .............. Fizz ...... THE COMMONWEALTH OF MASSACHUSEXI:TS BOARD OF HEALTH ae .................... Appliration -for 43iiiVosal Workii Tatistrurtiou Vrrutit Application is hereby made a Permit to Construct or Repair an Individual Sewage Disposal System at .............. ................... ---------C. ............... . .. ......... Location-Add s or LotE. .. . . ... .. . . . ..................... Va5r�. . . I ........................... Owner Own.1 I Address ........................... -;a e ------------------jrxwag�--- .......... . ....... Ins�er ------------------------------ Address Type of Building An Size Lot../67).f.-g-7...Sq. feet U Dwelling—No. of Bedrooms------------j............................Expansion Attic Garbage Grinder ( ) PL4 Other—Type of Building ---------------------------- No. of persons-.---_--_----_-___--_-----_- Showers Cafeteria ( ) 04 Other fixtures ----- -- --------------------gallons. Design Flow---- ---------- ..................gallons per person- p- t y Total daily fl 0-w-.........L P4 Septic Tank—Liquid capacity-/&Wgallons Length Length................. Width..- --------- Diameter----- ...... De Trench— o. .................... Width_-_.--I------------ Tora'l Length-----------p......4. Total leaching area-------------- -----sq. ft. Seepage Pit No------)------------ Diameter................ Depth below inlet....... ..... Total leaching area-X13..sq. ft. Z Other Distribution box O Dosing tank ( ) - Percolation Test Results Performed by.- 4-1--------- Date-----/__JV---777*#-7/ Test Pit No. I----------------minutesperinch Depth of Test Pit........_.__..._.... Depth to ground water-.-.-__-_.---.--_....... (i Test Pit No. 2................minutes per inch Depth of Test Pit......_......_...... Depth to ground water....._...._.__---_-----. O Description of Soil-------------_-& ....... - - ---------------------------------------------------------------------------------------------------- U ......................................................................................................................................................................................................... ----------- -------------------------------------------------------------------------------------------- ----------------------------------------- -------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable.............___----------------------------------------- ---------------------------- ............................................­Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of It zdth Sign ........n .......... ................................ Date Application Approved By........ -------- . ......L.4f ......................... ... I....?_7......... Date Application Disapproved for the following reasons:---------------------------------------------------------------------------------------------------------------- .........................................................................................................................................................................:............................... Date PermitNo......................................................... Issued........................................................ Date ------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS 1 BOARD OF HEALTH . VV11'r ttion -for Uhipoott1 Works Totuarurtion Vamit Application is hereby'`made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage 'Disposal System at Clow ..................Im ...... ......... ...... .. { Location•Address , a or Lot"Yvo e _:I---. r, ••••-•••••--••••••- s`sir }71 "1��'?••••••••-•••••••••••••••••• c �^� Owner Address f Ins Address d Type of Building `, Size Lot.. _ ....Sq. feet U Dwelling—No. of Bedrooms----------�___............................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building _________________`:.,_-_____ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q' Other fixtures, ----------------------------------------------------- W Design Flow_________________r4 ____________gallons per person per ay. Total dail flow._.... ,_._e,:__-------- gallons. WSeptic Tank—Liquid capacityJr. gallons Length...__L�....... Width._<��_....._.. Diameter-----.__._____ Depth.---_-_.-.__. x Disposal Trench—No_ ____________________ Width...... _. _..:_-__ To al 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, szrEIt____/_ .as � _..__.____ Date_. �¢" __'.__ 'r ^' ` W Test Pit No. 1----------------mtnutes per inch, 'Depth of Pest Pit.................... Depth to ground water....__.._____..____---- �14 Test Pit No. 2................ininutes per inch Depth of 'test Pit.................... Depth to ground water..._-._..:_.__--_____--. ----•----•----------- _---- - O Description of Soil ��"= ••••----��. . Al--------------- ------------------•-------•------- --- ----------- - ------- - x ------ W U N,ature of Repairs or Alterations—Answer when applicable._...___________-------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Agreement: `The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health Sig d s'rar ' A Date A pl cation Approved B Wit_.:_ !3 ?. ._________- PP PP Y -------------------------- '�g . ... 1� Date Application Disapproved for the f ollow'fng reasons:--•-••-------------------------------------------------•--------------___________-•--------•--•----------------- ••..__....•---------------•••---••-••-----_...---•--••---••-----------....•-•-•--•••-________._______.___._._---.._._•--••-----------______._..______-------------------•-•-•--------------------------- ,( Date IPermit No;"vi.................................................... Issued...................................••••••••••••••••••••. 1 Date 1 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Taft firatr of IWITompliaorr THIS IS TO CERTIFYiThat the Individual Sewage isposal S stem constructed (6�or Repaired ( ) by , . •---•--•_____________________.............. t - Installet - at-------i`,••- - --- has been installed in accordance with the provisions of r ?�le XI The State Sanitary Code as described in the application for Disposal Works Construction Permit No '-. ,g--------------------- dated- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL`FUNCTION SATISFACTORY. `l - DATE. Z -- ... Inspector ------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF H,F=.ALTLJ ...�.r ., f No. FEE f Bi-spaotti ork-o Tomitrurtion Vrrmit Permission is hereby granted �' 'C`C +'_ _ �_ 1t . _! . . _ "7 -✓ to Construct (.. ) or Repair ( ) an Individual Sewage Disposal System ; r atpp d . i j °�: f Street as shown on the application for Disposal Works Construction Permit ________ ___ ___.,Dated-__. v_`'..............7 Board Health DATE...... ...-1/4 ------------------•_.________-_- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS Y 1 fl , 1 I m i i � f I c- s r - y1 ( - f i e T A7: 6 o i � s i 7 ! � f 7 It lbo I � 1 I Lot 94 26 34 28 30 3\ 107.00' \ I — 34 LOT 49 z - ( 29j,-316 ) / 10;000+/- S.F. 1 / I Deck 26 Existing r., 3 Bedroom Dwelling Lot too l House#117 Lot 98 Pu p-outs Remove 28 _ / of Ex�ting C¢ssp of / \ 150 GAL. \ N I D-B 7 CATV I S.T 32 Relocate Existing � \Wa Service to i t I 1D om Field I Vent with 129.2 42.0'\ ` _IStrip-out _ _ Charcoal Filter \ Relocate Existing 1�9.0 Gas Line 30 HAMDEN CIRCLE LEGEND Exist. Spot Elev............. 35+3 - - - Exist. Contour................ 36 - - - - Prop. Spot Elev.............. 35.9 ` Prop. Contour................. 36 Setback Dimension........ 13' Perc. Test Location........ Prop. Water Service...... W REVISION DATE BY La or �V® Cr OF 86 14YAN SITE & SEWAGE , , -0 C lit gi EAST ► MAC n exnkRd ��$ �t�� DISPOSAL PLAN c�oSsMA+� , ►o. ,�. (Y,- 'Conno L civil_ ° d t LOT 999 #117 HAMDEN CIR. CISTEK40 �G�.l►`�``� ch�,, M ,:a v� BARNSTABLE, MA. .kt o s� APPLICANT: ENGINEER: N6RMAN •' John C. & Mary Ann Taylor Norman Grossman, PE, RLS No. 1`nI" 475 Pine Street 10 Marsh View Road LOCUS MAP Centerville, MA 02632 East Falmouth, MA. 02536 SCALE : 1" = 2000' 508-548-1920 MAP SEC PAR LOT FLOOD ZONE ELEV. MAP SCALE DATE SHEET NO. PLAN NO. 291 316 99 C --- 1250001 0005C 1" = 20' Aug. 4, 2004 1 OF 2 H-795-1 SEPTIC SYSTEM PROFILE FIRST FLOOR NOT TO SCALE ELEVATION FIN. GRADE AT FIN. GRADEOVER FIN. GRADE OVER VENT WITH FOUNDATION SEPTIC TANK FIN. GRADE OVER SOIL ABSORPTION SYSTEM CHARCOAL TOP FOUNDATION 31.8 32.0 DISTRIBUTION BOX 31.0 FILTER ELEVATION 32 8 + + 32.0 + + + RISER SET TO W/I + ++ 8"OF FIN. GRADE INVERT AT + ++ " 29.50 3„ 2"DOUBLE-WASHED FOUNDATION 28.70 — + r6Mp 1/8 3/4"PEASTONE(VERIFY IN FIELD b ' '`PRIOR TO START + + + 2900 �' IP OF INSTALLATION) + 29.25 / � /�/�//��// + + 1500 GALLON 28.63 28.25 � %� + + � 28.80 // r/ �' + SEPTIC TANK , + + + H-10 LOADING 4 7 HOLE DIST. BOX 10 27.70* -BASEMENT FLOOR + GAS BAFFLE ON OUTLET TEE 10+1 = 11 Effective Length ELEVATION + + 42+ 1 =43' Effective Width + ++ o00000000000 � 0000000000 , H-10LOADING 11 x 43=473 S.F. 000V00000000000oao000oc` TO BE SET ONALEVEL 473x0.74 =350G.P.D. + + AND STABLE BASE 42' + + + + + SEPTIC TANK SET LEVEL AND TRUE TO GRADE ON 6"CRUSHED STONE BASE ON j 3 0' 7 DIST LINES s o o c 36 3 0 MECHANICALLY COMPACTED NATURAL MATERIAL .. —l> `> l 1 SOIL EVALUATION DESIGN DATA DATE OF TEST: JULY 16, 2004 LEACHING FIELD LOGGED BY: J.E. LANDERS-CAULEY (Not to Scale) NUMBER OF BEDROOMS..... WITNESSED BY: DAVE STANTON G.P.D./BEDROOM................................ 110 G.P.D.TOTAL DAILY FLOW............................ 330 G.P.D. TOWN OF: BARNSTAB'LE SOIL ABSORPTION SYSTEM pERC RATE: <5 MIN/IN GARBAGE DISPOSAL..........................NO SOIL CLASS: I ( 0.74 GALS./S.F.) NOTES: LEACHING REQUIRED........................ 330 G.P.D. GROUND WATER: NONE ENCOUNTERED LEACHING PROVIDED........................ 402 G.P.D. 1. ELEVATIONS BASED UPON MSL DATUM. SEPTIC TANK REQUIRED................... 1500 GAL. 2. TOPOGRAPHY BASED UPON BARNSTABLE GIS. rIMORMA" � TEST PIT #1 TEST PIT#2 3. PROPERTY LINE INFORMATION FROM LCC 14034 M. SEPTIC TANK PROVIDED................... 1500 GAL. 0" El. = 29.2 0�� 4. NORTH ARROW NOT TO BE USED FOR SOLAR ORIENTATION.5. ALL PIPING TO BE CAST IRON OR SCHEDULE 40 PVC. ,SSMANSIDEWALL AREA................................. 218.3 S.F. 6. ALL SYSTEM COMPONENTS TO BE INSTALLED IN ACCORDANCE ,12 MBOTTOM AREA.................................... 326.2 S.F. f WITH SEC TITLE V AND LOCAL BOARD OF HEALTH REGULATIONS. IVIL 7. NO CHANGES TO LOCATION/ELEVATION OF SYSTEM COMPONENTS 9 . EO 4Q TOTAL AREA........................................ 544.5 S.F. G� "' WITHOUT WRITTEN APPROVAL OF ENGINEER AND BOARD OF HEALTH. �� FOSTcR TOTAL AREA X 0.74 G.P.D./S.F...........402.9 G.P.D. 72" FILL �Soop 8. 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