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HomeMy WebLinkAbout0202 HAMDEN CIRCLE - Health 202 HAMDEN CIRCLE Hyannis A = 290 - 322, J D O ° O I f O o I No. n r V O 3 Fee v THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: . PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes i 01pplitation for Mispoliar 6pBtent Construction 3dermit Application for a Permit to Construct(y Repair(4 17pgrade( ) Abandon( ) ❑ stem Complete Sy stem y ❑Individual Components Location Address or Lot No.�G~49-411 Owner's Name,Address,and Tel.No. GNe_1'C1,f,_, 11A#%, onAea Assessor's Map/Parcel l 3 2 Z Installer's Name Add less,and Tel.No.j'Og-?K'U-'7 r� Designer's Name,Address,and Tel.No.Sdg 3Gz:Z q22 V05 GpG7 O� 1 l�vvvU 5 0/g rv'! ZZ: 5.�qn Type of Building: DwellingNo.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) 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) .;rZ2,1r1,91/ /?pcv p,c S" he; 4,05 iG 0&4?0 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. Sign Date Application Approved by Date ' Application Disapproved by Date for the following reasons Permit No. Date Issued "9- 0 TOWN OF BARNSTABLE LOCATION SEWAGE # a/dam b 7z VILLAGE_ fl4&Y1/3 ASSESSOR'S MAP & LOT IIYSTAL:LER'S NAME&PHONE N0. .����y2�-y�38 c%sed� U.�l3� f SEPTIC TANK CAPACITY /DOD LEACHING FACILITY: (type)/s P/D 0/ )gaS,6 '5 (size) NO. OF BEDROOMS .3 BUILDER OR OWNER Ge-e_Tc�%O .:vid4 h i4ro PERMITDATE: 3 ,2.2_ /D COMPLIANCE DATE: o% Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching faci ). Feet Furnished by gaf/1.o�2i Croy k�ca� Po�q' 1 VI ,fC:•�� �I `-yyam� • �^�1. ..�,_ No. V Cl ' �.t„ �., Fee THE COMML- JWEALTH OF MASSACHUSETTS Entered in computer:. ,Wes ' PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE MASSACHUSETTS, -' ftplication for Wspo'sal 6pstem CollstrUctlott,permit Application for a Permit to Construct(/, Repair(L)-'Upgrade( ) Abandon( ) El complete System ❑Individual Components Location Address or Lot No.' t7 1-14100-e`j 'Y Owner's Name,Address,and Tel.No. Assessor's Map/Parcel ✓��/ 3,2 2 4114P*n j3 Installer's Name Address,and Tel.No. 5 U L-? 0-7 5^2. Designer's Name,Address,and Tel.No.���_3 G2_ !2 7 2 2 ✓os�Ah T)z s 0r4rv^�`a9 � q� �i-- ?� G t4�iy! /7 /2:� ?/J�vs ruffs ,%/ J r'lr%!�fil L' Type of Building: - Dwelling !No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) t Other ' Type of Building a No.of Persons Showers( ) Cafeteria( ) Other Fixtures 0 Design Flow(min.required) gpd Design flow provided gpd Plan Date i4 Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil 4 Nature of Repairs or Alterations(Answer when applicable) ��_�Tj.4// C2yuu dl S� //�' f7 /l 670 12 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. E Sign Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. c)G7/Q 07 � Date Issued � °�- /0 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed(4+ Repaired( ,-).--- Upgraded( ) AbanJ9n�i1� )by /05, ,11, at e 4/Q✓11_k1--7 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.QW _C7Cdated Al:�, �D Installer ,l� f C � ��. �� S Designer #bedrooms 3 G'X/S 1 Approved design'flow,r, , gpd The issuance of this permit shall not be construed as a guarantee that the system wil �fu' nc/tioh as designed. (} Date 3 t �Il Inspector ,J/ V h d, :/b r 1 /� -----------=-=-=-----===- Fee - No. �/1/ v - THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION BARNSTABLE,MASSACHUSETTS Bisposal 6pstem Construction i3ermit Permission is hereby granted to Construct(4-)- Repair(v)` Upgrade( ) Abandon( ) System located at .913:� 1W H14k,y,eke l and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must plea d within three years of the date of this permit. J r CJ Date =� Approved by,- Jun 02 10 02: 57p p. 1 Towh of Barnstable Regulatory Services Thomas F. Ceiler, Director • 11AHXQ rAZ" � g Public Health Division Thomas McKean, Director v 200 Maim Street, Hyannis, MA 02601 Office: 50S-362-464 Fax: 508-790-030•t Installer& Desi2ner Certification Form Date: IG _ Sewa;;e Permit# 2010 �.y7ZAssessor's MapTarcel IhsiKncr: Y ✓ _° ��f�"l Installer: V/,5� Address: Jn Address: �'l��ivyi!-�Z �� 011 3— 2 2— l0 _ c%S �i Oe ggyA-Os was issued a permit to install a (clue) / (installer) septic system at �f-> f I 4�(JE h1 rq Qi:L L _based on a design drlwn by //////JJJJ (address) 2 (Mfet/ dated �( (c eSI!?ner) I certify that the septic system referenced above was installed Stlbstantially accort-11110 I0 the design, which may include minor approved changes such as lateral rc!ocalsun of tot• distribution box anal;or,ehtic tank. _ I certify that the septic system referenced above was installed with tIlajor ch;ru ses (i.e. grafter than 10' WCral relocation of the SAS orally vertical relocation o any comporicnt of the septic sysiem) but in.accordance with State S., Local Regulations. Plan revision or certilicd as-built by dcsigner to Fellow. OF �a�1iw-L- D M (Installer's Swriature) No. y' (Desiancr's Signature) (Affix lll:Sll;Tle:'S Stamp Here) PLEASVI RETI)RN TO BARNSI'ABLE PUBLIC HEALTH 1.)1VISION. C: RTIFICk"IT 01 CONIPL,IANCF, Wll,l'. NOT RK ISSUED UNTIL HO'1'il THIS FOR:vl AND \RF, RFCEIVYI) BY THE BARINST, BLF PUW..1C 11F,Al,TH DIVISION. 'I HANK YOU., t): (.t.-rwicsaon Fonn 3-26-41doe DEEP OBSERVATION HOLE LOG Hole# _. _ Depth from Soil Horizon Soil Texture Soil Color Soil Other Structure,Stones,Boulders. .Surface(in.) (USDA) (Mansell) Mottling ( onsistenc g'o Gravel A' =fo DEEP OBSERVATION HOLE LOG Hole# Depth from _, Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistences %Grave! v'i Scl � 3r� ►� DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel DEEP OBSERVATION HOLE LOd Hole# 1% Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, ra IFlood Insurance Rate Map: 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 perv'o terial exist in all areas observed throughout the area proposed for the soil absorption system? v lv,S If not,what is the depth of naturally occurring perviks mat ia14 Certification �, I certify that on t. (date)I have passed the soil evaluator examination approved by the Department of Enviro mental Protection and that the above analysis was performed by me consistent with the requir t ' in expertise and experience described in 3:10 CMR 15.01 . Signature Date 1 Q:\.SEPTICVERCFORM.DOC w � i i Town of Bi-nstable. P#TSB Department of Regulatory Services Public Health Division bate YASfb & tee$ 200 Main Street;Hyannis MA 02601 • ��fD µA'1� '• . Date Scheduled l U 'Time Fee Pd. I I Soil Suitability Assessment fog- Sewage isposal Performed By: Witnessed By: ' i LOCATION & GENERAL INFORMATION Location Address . Z d 2 t Ln Yt.pe� /' Owner's Name N 1 G4 I PH e f J N A CT (mil Address Z Z. Ni S : 1ti►-4 o26o/ HYol-101VIS A11A Assessor's Map/P4iccl: aR (/2 2-2 Engineer's Name •/ I S8 Z— 2� LZ NEW CONS1RUl�`I'ION REPAIR � � Telephone# ,� Land Use �r 17 ^/�� — Slopes(%) "'l , Surface Stones c Distances from: Open Water Body ft Possible Wet Area 21�6 ft Drinking Water Well 7 L ft 1 ft Other ft ))rainage Way ft Property Line ' -�-."..ate holes) SKETCH:(street name,dimensioos'of lot,exact locations of test holes& �n nroxitnity to Existing LeoohPit / (Note 10) t49,90 \ \ \\\ S�tin9tan000G P \ tk n ®b \ Pk \ a \\ '-Al U,; 1 I „ I , Li(=Water Lf 414 4Iv 1'J L) Depth to Bedrock • ry I Parent material(geologic) IA Depth Depth to Groundwater. Sta i Weeping from Pit Estimated Seasonal High Groundwater DtTERM N TION FOR SEASONAL BaGH WATER TABU Method used: ! Depth to sail mottles: ln• e th Orb erved standing in obs.hole: n, Dep n U P • � ; in. ©roundwnter Adjustment Depth toiweeping from side of obs.hole: A�,{aeto►,�.�-s Adj,d�undwater l evel,,.,e, Index Well# Reading Date Index Well level . . I PERCOLATION TEST Date Observation I Tine at 9" N - Hole# t• ti W Time at G' .-- Depth of Pere Time(91'.6�) Start Pre-soak Time.@ - End Pre-soak I�S.L j 'Rate MinJInch )� Additional Testing Needed(YIN) site Suitability Assessment: Site Passed x Site Failed: __--- — Original:.Public 7101th Division Observation Hole Data To Be Completed on Back--- >k* n test is to be conducted within 100' of wetland,:you must first notify the If percolagp Ro,-nctnhle Conservation Division at least one(1)we&prior to beginning. i COMMONWEALTH OF MASSACIIUSE'VI'S z EXECUTIVE Or,FICI+, OF ENVIRONMENTAi-AFFAIRS r DEPARTMENT OF ENVIRONMENTAL PROTECTION ti< a ' RECEIVED 350 MAIN STREE F WEST YARMOITI'11,MA ra 509-775-2800 J U L 0 6 2001 TOWNBLE EA DEPT. TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM. PART A CERTIFICATION Properly Address: 202 1IAMDEN CIIZCLE HYANNIS,MA 02601 Owner's Name: "TOM.GIU ENLAW Owners Address: 202 HAMDEN CIRCLE i1YANNiS,MA 02601 Date of Inspection JUNE 20,2001 Name of inspector:(please print) JAM.-."S D. SEARS Conipany Name: A&B Canco Mailing Address: 350 Main Strcel West Yarmouth,MA 02673 Telephone Number: 508-775-2800 CERTIFICATION STATEMENT 1 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(lie 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: X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails inspector's Signature: Date: --�'�—�� -0/ The system inspector shall sub►ni(a copy of(his 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 101 000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of lie DEP. The original should be sent to the system owner and copies sent tot he buyer, if applicable,and the approving aulhority. Notes and Comments ****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. Tille 5 lnspeclion Form 6/1.5/2000 1 I e Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 202 HAMDEN CIRCLE HYANNIS,MA 02601 Owner: GREENLAW,TOM Date of Inspection: RUNE 20,2001 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CUR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: N/A 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. Answer_yes,no or not determined(Y,N,ND)in the 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 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. ND explain: 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 obstruction is removed distribution box is leveled or replaced ND explain: 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 obstruction is removed ND explain: Title 5 Inspection Form 6/15/2000 2 Page 3 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 202 HAMDEN CIRCLE HYANNIS,MA 02601 Owner: GREENLAW,TOM Date of Inspection: DUNE 20,2001 C. Further Evaluation is Required by the Board of Health: N/A 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 salt marsh 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 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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: Title 5 Inspection Form 6/15/2000 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINIJED) Property Address: 202 HAMDEN CIRCLE HYANNIS,MA 02601 Owner: GREENLAW,TOM Date of Inspection: JUNE 20,2001 D. System Failure Criteria applicable to all systems: N/A You must indicate"yes"or"no"to each of the following for all inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in pit less than 6"below invert or available volume is less than''/,.day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped X Any portion of the SAS,cesspool or privy is below high ground water elevation N/A Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply N/A Any portion of a cesspool or privy is within a Zone 1 of a public well N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well N/A 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.) NO (Yes/No)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: N/A To be considered a large system the system must service a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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—fWPA)or a mapped Zone I1 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 is 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 CUR 15.304. The system owner should contact the appropriate regional office of the Department. Title 5 Inspection Form 6/15/2000 4 J Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 202 HAMDEN CIRCLE HYANNIS,MA 02601 Owner: GREENLAW,TOM Date of Inspection: NNE 20,2001 Check if the following have been done. You must indicate"yes"or"no"as to each of the following Yes No X Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks? X Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection? X Were as built plans of the system obtained and examined?(If they were not available note as N/A) X Was the facility or dwelling inspected for signs of sewage back up? X Was the site inspected for signs of break out? X Were all system components,excluding the SAS,located on site? X 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 X 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)has been determined based on: Yes No X Existing information. For example,a plan at the Board of Health. X 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(3Xb)] Tide 5 Inspection Form 6/15/2000 5 f - Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 202 HAMDEN CIRCLE HYANNIS,MA 02601 Owner: GREENLAW,TOM Date of Inspection: .TUNE 20.2001 FLOW CONDITIONS RESIDENTIAL Number of Bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CUR 15.203(for example: 110 gpd x#of bedrooms: 330 Number of current residents: 5 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): YES Seasonal use(yes or no): NO Water meter readings,if available(last 2 years usage(gpd)): 2000 61,400 CU.FT./2001 76,000 CU.FT. Sump pump(yes or no) NO Last date of occupancy: PRESENT COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: N/A Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: gallons—How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM X 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) Tight tank Attach copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: 1978 Were sewage odors detected when arriving at the site(yes or no): NO Title 5 Inspection Fonn 6/15/2000 6 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 202 HAMDEN CIRCLE HYANNIS,MA 02601 Owner: GREENLAW,TOM Date of Inspection: JUNE 20,2001 BUILDING SEWER(locate on site plan): N/A Depth below grade: Materials of construction: Cast iron _ 40 PVC _ other(explain) Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK(locate onsite plan): X Depth below grade: Material of construction: X concrete metal fiberglass polyethylene _ other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1,000 GALLON PRE CAST Sludge depth: 2" Distance from top of sludge to the bottom of outlet tee or baffle: 33" Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle: 4" Distance from bottom of scum to bottom of outlet tee or baffle: 17" How were dimensions determined: TAPE AND PAST REPORT Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): INLET AND OUTLET BOTH HAVE TEE IN PLACE.TANK AT WORKING LEVEL.NO SIGN OF OVER LOADING SEEN IN TANK.TANK AND COVERS 4"BELOW GRADE. GREASE TRAP(located on site plan) N/A Depth below grade: 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: Continents(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Title 5 Inspection Form 6/15/2000 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 202 HAMDEN CIRCLE HYANNIS,MA 02601 Owner: GREENLAW,TOM Date of Inspection: JUNE 20,2001 TIGHT or HOLDING TANK: N/A (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of constriction: concrete metal fiberglass polyethylene other(explain) Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no) Alarm level: Alarm in working order(yes or no): Date of last pumping Continents(condition of alarm and float switches,etc.): DISTRIBUTION BOX: X (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 0 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.,): DISTRIBUTION BOX IS 16"X 16",3'BELOW GRADE. ONE LINE IN,ONE LINE OUT. BOX IS CLEAN AND SOLID.NO SIGN OF OVERLOADING OR SOLID CARRYOVER SEEN. PUMP CHAMBER: N/A (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Title 5 Inspection Form 6/15/2000 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 202 HAMDEN CIRCLE HYANNIS,MA 02601 Owner: GREENLAW,TOM Date of Inspection: JUNE 20,2001 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: Type X leaching pits,number: 1 leaching chambers,number: leaching galleries,number leaching trenches,number,length leaching fields,number, dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) ONE(1)1,000 GALLON PRE CAST PIT.PIT IS 42"BELOW GRADE WITH COVER AT 18"BELOW GRADE. 30"WATER IN PIT,NO HIGH STAIN LINE. CESSPOOLS: N/A (cesspool must be pumped as part of inspectionX 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 or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation etc.): PRIVY: N/A (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 Inspection Form 6/15/2000 9 a Page 9 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 202 1lAMDEN CI.RC1,1 -IYANNIS,MA 02601 Owner: GItI ENI.,AW, IOM Date of Inspection: RJN1 20,2001 SKETCH OF SEWAGE DISPOSAL SYSTEM 1'rovide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. I.,ocale all wells within 100 feet. Locate where public water supply enters the building. �.a3, ,�• �----__-=---_._tea �,\ a g 0/13 Title 5 Inspection Form 6/1.5/2000 10 r c Page 11 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 202 HAMDEN CIRCLE HYANNIS,MA 02601 Owner: GREENLAW,TOM Date of Inspection: JUNE 20.2001 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to groundwater 23.6 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observation site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation X Accessed USGS database-explain: You must describe how you established the high ground water elevation: 5-01 USGS DATA AIW 230 WELL AT 23.6 Title 5 Inspection Form 6/15/2000 11 SEPTIC PUMPING AND INSTALLATION 350 Main St. • W. Yarmouth, MA 02673 • 775-2800 Heating&Plumbing,Fire Sprinklers February 29, 1996 �� 4' REcc�ivEO RE: 202 Hamden Circle, Hyannis MAI MAR 8 1996 UNOFli tTABtc �, ►�uilot�t To Whom It May Concern: ; On February 28, 1996, A & B Canco replaced the distribution box at the above referenced address. This septic system now passes D.E.P. guidelines as defined in 310 CMR 15.303. Sincerely, James\D. Sears Septic Inspector JDS:era T ,-FaLL) Commonwealth of Massachusetts a all Executive Office of Environmental Affairs Department .of Environmental Protection William F.Weld 1i Gowmor Trudy Coxe Secretary,ECEA David B. Struhs Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM MAP# 19 PART A PAR#2,?,2 CERTIFICATION �/fJo,e� Gerf�uc(e Property Address:0?0,2 I-IAMbeA( G12ele 1 (4no jS Address of Owner:.2l7 T e AVe Date of Inspection: a_aa 9(0 (If different) /(lo, r orcT/11 2�5� FL 3370 3 Name of Inspector: 7fime5 2). Seg2S y Company Name, Address and Telephone Number: A & B Canco 350 Main Street West Yarmouth, MA 02673 (508) 775-2800 CERTIFICATION STATEMENT 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: _ Passes ,[ Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: � Date: .2—a?a—9(p The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 110,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection The original should be sent to the system civ,ner and topic, to thu bu)e:, if applicable and the appro,ing au'�ority. INSPECTION SUMMARY: Check A, B, C, or D. A) SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B) SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes,inspection. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not) ,AL The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 8/15/95) 1 One Winter Street • Boston, Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500 A i' Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 04002 14yc4i AW C1 eo%) orn n/5 Owner: GerYea o e J.Aj o .Q Date of Inspection: B]SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed ✓ distribution box ism replaced op, reepA Ir-CO The system required pumping more than four 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 obstruction is removed 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 the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND 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. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ lhP wsier-n nas a septic tank and Suu aUSurNuun sy5iem and is within 103 fee, to a surfacE water suppl) or trlJutary to a surface water supply. _ The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. _ The systen, has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. D) SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an 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 of cesspool. (revised 8/15/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: aDo? hi 9"DW, I ec e +nno Owner: 6�efc-rn de— /,q Date of Inspection: o7-Za_gy D] SYSTEM FAILS (continued): 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 112 day flow. 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a 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 I 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The design flow of system is 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety, and the environment because one or more of the following conditions exist: 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 11 of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 8/15/95) 3 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 0?402 IMM De#J 0 2cLe 14 y,I n rS Owner: C64tTrv4e_ b1i0rP. Date of Inspection: Check if the following have been done: ZPumping information was requested of the owner, occupant, and Board of Health, `y4r ✓ None of the system components have been pumped for at least two weeks and the system hasYbeen receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow The site was inspected for signs of breakout. t/ All system components, fttcluding the Soil Absorption System, have been located on the site. V The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. t� The faciiiiy o\%i-c: is d uccupar-,t�, if dlffereni fro :;r,ner; v,ere prodded v,•ith information on the proper maintenance of Sub- Surface Disposal System. (revised 8/15/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: '20� � � C1/ZC-/e Owner: Ger2?f v p Li9J o!'Pi Date of Inspection: 2—.2 0.-9(P FLOW CONDITIONS RESIDENTIAL: Design flow: 33D aalll s Number of bedrooms: Number of current residents: Garbage grinder(yes or no): N6 Laundry connected to system (yes or no):1Ve S Seasonal use (yes or no):Np_ Water meter readings, if available: Ald (JS"e- —M.)Q 4e-A2S Last date of occupancy: !a y 199� COMMERCIAUIN DUSTRIAL: Type of establishment: Design flow:_ allons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as pan of inspection: (yes or no)�)b If yes, volume pumped. gallons 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) Other(explain) APPROXIMATE AGE of all components, date installed (if known) and.source of information: I97$ Sewage odors detected when arriving at the site: (yes or no) 10 (revised 8/15/95) 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: o24-2 /4AMJ36N 04'adc Owner: L-r2v v �CAJo e, Date of Inspection: a2_aa`(,, SEPTIC TANK:[ (locate on site plan) Depth below grader Material of construction: concrete _metal _FRP —other(explain) Dimensions: lying -,Ri-A4tj ,ARP As-T Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle:33" Scum thickness: D" Distance from top of scum to top of outlet tee or baffle: �9 Distance from bottom of scum to bottom of outlet tee or baffle: /.P/o0 -rez_ Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) ®crrf2+ -tom q(Ze ik) _0IAC2 jjj�Vj]petr¢I it6116000 &TTOM �1-2_ tee Dose ha5cshoc P1 Sia1e� rn 4 GREASE TRAP:_ (locate on site plan) Depth below, grade: Material of construction: _concrete _metal _FRP _other(explain) Dimensions: Scum thickness: Distance from top of scum to too of outlet tee or baffle: Distance from bottom n; «,im to hnttnrn' Of outIPt te? or bailie' Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (revised 8/15/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: o20c2 pfq/rt 1)?n Ct rd'e-) NyRnm-s Owner: de -trJDei oic Date of Inspection:a_a.p,—gf, TIGHT OR HOLDING TANK:_ (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP—other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distributic^ ;, ec;u::' e%idence cf solid, car-.over, evidence of leakage into or out of box, etc.) 5i6e- Moles e- /- iaG D- oS6)c )eeds Ta Re, OCee.4irP 0r A lRcel"'. PUMP CHAMBER:_ (locate on site plan) Pumps in working order.(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) I (revised 8115195) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: C^e2TruDC' kfij 6 k, Date of Inspection: �2 a_1_96 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number: leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) me o GA LLo 04 Precasr pT abelow 6rApe �02' l��se,� 4ovelc. is /8�� ae-low 6'-A = CESSPOOLS: _ (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 (cesspool must be pumped as part of inspection) Comments: (note condition of soil, sign; 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.) (revised 8/15/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: airc-&G j t-1+iAhnrir Owner: &et"Tz,(D e XJ9 101 e, Date of Inspection: 2.2_910 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' o �3 r DEPTH TO GROUNDWATER Depth to groundwater: feet method of determination or approximation: i (zevised 6/15/95) 9 TOWN OF BARNSTABLE TION 49A /A #Z £N �'/4 SEWAGE # VIL GE /5/ �S ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. q�r-� 775-6264-- -SEPTIC TANK CAPACITY �� ���" 3/ e 04,4 LEACHING FACILITY:(type) (size) NO.OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER O OWNER 7-0 ' £ DATE PERMIT ISSUED: r2 DATE COMPLIANCE ISSUED: 7 ' VARIANCE GRANTED: Yes No 1 w O � A . 0 O` _ 4� O .�� LOCATION SEWAGE PERMIT NO. dllzalloii,-1 eigczie7 .fit V i,L AGE )+ '.y, /JN i �S IN.ST LLER'S NAME & ADDRESS B U I'l DE R OR OWNER DATE PERMIT ISSUED DATE C0MPLIANCE ISSUEDt�- . 1 . .:� .. . Fl�a..... �-............... THE COMMONWEALTH OF MASSACHUSETTS BOARD j' WEALTH ... ... ..................OF......................................................... Appliration -for Ui,ipuiittl Workii Towitrurtion Vrrutit Application is hereby made for a Permit to Construct (. ) or Repair ( ) an Individual SewagZisposal SNh . ` ���-�-- ------. _ �L�ocaattio�n- dr s or Lot No. Of� 6wn r Address ��- W . ••-- •• ..... •••••• -••-•---- ----- ---------------�•••--• � . . .................. Installer Address U Type of Building Size Lot._J.01,e1 .....Sq. feet Dwelling—No. of Bedrooms.--__-_-_--3...........................Expansion Attic ( ) GaAage Grinder ( ) aOther —Type of Building ---------------------------- No. of pet-soils------- ---------------- Showers ( ) — Cafeteria ( ) dOther fixtures --------------- ------•---------•-----------------------------------•-----------------------•---------- ---------------------------•------- W Design Flow..................s��---0...............gallons per person per day. Total daily flow------------ gallons. WSeptic Tank—Liquid capacitv.I gallons Length................ Width-.__------_-_. Diameter................ Depth---------------- x Disposal Trench—No. .................... Width---------------.---- Total Length.................... Tota e chinearge�a.. _.--------.-----s ft. Seepage Pit No____ _______________ Diameter_�__ _._ Depth below leP ea ,gjUr q. e sc ft. z Other Distribut'. ( ) Dosing tank ( ) ;)" G - %- >7 Percolation Test Results Performed by-------------------------------------------------------------------------- Date---_..----._-__.--.---.----------------- Test Pit No. I................minutes per inch Depth of "Pest Pit.................... Depth to ground water.-.._----_-._--.--.--._. fXq Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water......------_-- P4 .................. --- f ---- - O Description of Soil--.-___-.__.-__._--_-�_.. ./�_ZP_ � V --•----...-----•---------------•------•---._-----•-•----------------------------•--------------••---------.----------•------•-----•----------------------.-•--•-•-•------------------------------------- W UNature 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 hak by the board of h. .4 nedZ-� � '2 Date Application Approved By--•-•--.----- -- f -�� -7-�------- / Application Disapproved for the following reasons:._________. -•-•-••--•---•-------•-------------•-------------------------•--------•---------Date -•----------- ------------------------------------------------------------------------------------•--•- ------------------ Date PermitNo......................................................... Issued....................................................... Date -7 N 1 o....... ............ ti. r Fizic 4.................. THE COMMONWEALTH OF MASSACHUSETTS BOARD —U-21-F—HEALTH . ... ..................OF......................................................................................... Apphration -for Bitipoiial Works Tomitrurtion Vanift Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal Sys a Z" .............................................................................. Locati No d)diy2r, r LOT No. S ........ ... wner Address . .. . ...... ................. .....................W..... Installer Address Type of Building Size Lot.]-0.40......Sq. feet U Dwelling—No. of Bedrooms.......... -----------------------------Expansion Attic Garbage Grinder ( ) Other—Type of Building -------------------------­- No. of persons 6----------------- Showers Cafeteria ( ) Otherfixtures ----------------------------------------------------------- ----------------------------------------- ........ ... ...... ....................... Design Flow____________________- ._.0----------------gallons per person per day. Total daily flow------------13 -- ---------- ...gallons. P4 Septic Tank—Liquid capacity/fogallons Length................ Width..___........_. Diameter._.......--.-___ Depth...--__---...... x Disposal Trench No_ .................... Width_____--__._____.._.. Total Length-._______-.-_______ Totap Ching area-------------- -----sq. ) ------_------- Diameter./-$...... Depth below inle 'r (OVIVI24F--------------sq. ft. Seepage Pit N( Other Distribution box Dosing tank > 7 Z Percolation Test Results Performed by--------------------- ......................................... .......... Date---------------------------------------- Test Pit No. I----------------minutes per inch Depth of Test Pit_.._-_____________-- Depth to ground water-. ---.._-----._-.----- f14 Test Pit No. 2................minutes per inch Depth of Test Pit.-_____-_______-____ Depth to ground water__._.--.._-.__-.____-. - P� ---------- ---------------------------------------------------------------------------------- V0 Description of Soil---------------------- ---------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - -- -- ------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------- UNature of Repairs or Alterations—Answer when applicable..--------e---------------------------------------------------------- ----_------------------- -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------........ 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 *ssued by the board �of �e?,-, h. 10/ g ined,S ...... ------- Date -------- --------------------------- ....7—Z--- - ---- ---- Application Approved By--------------- Date Application Disapproved for the following reasons:----------------------7-------------------------------------------------------------------------------------- ----------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------- Date PermitNo........................................................ Issued--------...------------ ...........I...................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD Ok HEALTH .....✓. .. ......OF............. ..... ............................ (11,rdifirate of Tompliaurr TIP,! IFY, That tye;,Indi�idual Sewage Disposal System constructed �S S TO Z7 or Repaired by------b----------............ . ... ... ............... ------------- ------------------------------------------------------------------------------- ---- - --------------------------------------------------------------------------------------------------- /...... .. --------�p --------- ---- 04' 1­1) has been installed in accordance wlt� the provisions of E/W &i9ej XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No - ------- --------------- dated'...7=-/-F....7-7------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. PATE............................................................................. Inspecto r..................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD' OF_ HEALTH . .. ..... .. ........................... .......... .......OF--------- ................... No......................... FtE._.. a all�1WUjvr1kt=vnskwurjton Prrmit ranted________! ... ................................................................... Permission is hereby nted to Constriep or an I ividu Di 0. System Mei;Xa , sp N X';.. ... )o-rSy System --------------------------------- at ----------------------------------- as shown'on the application for Disposal Works Constructionreef o "llated....7�/_,f PVnit N ---- ........ .... ...........6-.0 ... .................... Board of Health DATE..-X_!Z16.7f A....................................... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS 1 y LEGEND p J PROPOSED CONTOUR PROPOSED SPOT GRADE- . AVE• -- 98 -- EXISTING CONTOUR. + 96.52 EXISTING SPOT GRADE COUNTY SEAT ST. W— EXISTING WATER SERVICE Fi SITE TEST PIT � � y i 0 NAMDEN CIRCLE Existing Leochpit C� (Note 10) 4; 00 LOCUS MAP N.T.S. 108.45 ft 40 gp' GENERAL NOTES: \ 149 O Z �O I. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL � BOARD OF HEALTH,AND THE DESIGN ENGINEER. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS \ \ OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE LOCAL 'RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: r \ Exla�ting 1,OOOG fi \ sepft tank - 310 CMR 15.405 (1) (B): ��� TH-2 �j \� \ 1) A 2.7117T. VARIANCE FROM 310CMR15.221(7) TO ALLOW LEACHING TO BE 5.71 FT BELOW GRADE VS REQ'D 3 FT. (H20/VENT PROVIDED) \ � 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLEO PRIOR r Q TO INSPECTION AN APPROVAL� 0 BY THE BOARD OF HEALTH AND THE 0-0 \ \ DESIGN ENGINEER. \ 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING r.�,a \' �TH-1 �� jt \ FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN ENGINEER BEFORE CONSTRUCTION CONTINUES. r 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. Mro PO't I \ I \ t 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF I \ \\ I ) THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD;OF y� EXIST l r HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. y. D V,,E 1 I I 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. L�'N I co 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED TOP \ I TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR, / I I OF F I 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO .VERIFY E� - 45. 76DN 11 I C THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR .TO BEGINNING CONSTRUCTION. 1 —_ BENCH MARK 10. EXISTING LEACH PIT TO BE PUMPED, CRUSHED AND FILLED PER TITLE V. 42 s, I P 1D ,� I I I PAINT SPOT N 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION ,, F� A VED DRY VE W j �I�?-'—� I j. DRIVEWAY 12. THIS PLAN IS TO BE,USED FOR SEPTIC SYSTEM PURPOSES ONLY AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY '� L O T 6 31 I 1 ELEVATION = 41 .9 7. 13. NO PRIVATE WELLS WITHIN 100 FT. OF PROPOSED LEACHING 1 i BARNSTABLE CIS DATUM 14. ALL PIPING TO BE 4" SCH 40 ® 1/8"/FT (UNLESS SPEC. OTHERWISE) AREA = 100 2 4/s f + I , 15. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW 1 L I' 98.25 ft / FOR THE USE OF A GARBAGE GRINDER * 16. NO WETLANDS WITHIN 100 FT. OF PROPOSED LEACHING D EDG---__�_____40� 3s E OF PAVEMENT - DF } D DID F •. CLE O "ass Da PROPOSED SEPTIC SYSTEM UPGRADE PLAN a 202 NAMDEN CIRCLE, HYANNIS, MA " No. 1140 MAP.291 Prepared for: Gretchen laiennaro SURVEY REFERENCE: _ 'IGISTE LOT.• 322 Engineering by: Surveying by: SCALE DRAWN PLAN OF LAND BY S.R. SWEETSER, PLS NIThO LCP.•C162660 DDARRENM,MEYER,R.S. Eco-Tech Bbvlrommemtel 1 11=20' DMM DATED: APRIL 10, 1972 v (508) 364-0894 DATE: SHEET NO. IO I v EAST SANDWICH,MA02537 CHECKED 60e-362 2922 03/09/10 DMM 1 of 2 46'-0" 26'-0" 1 r f 3'-6" 14'-0" g•'6" ) T-0" A A 6 A 171, NEW STORAGE - l � EXIST. DECK A6 DN. I I I I I I I I I © REMOD. I EXIST. KITCHEN � BAT 3N. 'x6'8" :! Op EXIST. A :E RAT OR BEDROOM I i ® NEW BEAM ABOVE DN. CLOS. 4 NEW 3.�, ; I — o ----- a GARAGE NEW REMOD. A DINING LIVING EXIST. I BEDROOM 4 9'0"x TO"O.H.DOOR W/TRANSOM. 9'0"x TO"O.H.DOOR W/TRANSOM I C CONC. APRON j 26'-0" - I , IECC2009 RESIDENTIAL ENERGY EFFICIENCY DETAILS FLOOR PLAN CLIMATE ZONE 5A(USE.EITHER PRESCRIPTIVE VALUES OR RESCHECK CALCULATION LEGEND: ,!,, TABLE 402.1.1 (MINIMUM PRESCRIPTIVE INSULATION&FENESTRATION REQUIREMENTS) ©SMOKE DETECTOR FENESTRATION SKYLIGHT CEILING WOODFRAMEDWALL FLOOR BASEMENT WALL BASEMENT SLAB CRAWL SPACE WALL EXISTING WALLS ©CARBON MONOXIDE DETECTOR I,FACTOR U-FACTOR R-VALUE R-VALUE R-VALUE R-VALUE R-VALUE R-VALUE r--� CONSTRUCTION TO BE REMOVED 0.35 0.60 38 20 30 10/13 10(2 FT.DEEP) 10/13 ® HEAT DETECTOR NEW CONSTRUCTION NOTES: 1' 1.R-VALUES ARE MINIMUMS&U-FACTORS ARE MAXIMUMS. 2.10/13 MEANS R=15 CONTINUOUS INSULATED SHEATHING ON THE INTERIOR ORIEXTERIOR � OF THE HOM E OR R 13 CAVITY INSULATION AT THE INTERIOR OF THE BASEMENT WALL 3.REFER TO IECC 2009 CHAPTER 4 FOR ALL INSULATION&ENERGY REQUIREMENTSTHE' ERRORS ROMISSIONS ISSISHAON AREFO NIFANY SCALE DRAWING NO.: COTUIT BAY DESIGN, LLC NEW ADDITION/REMODELING FOR• ERRORS ORRPOSIBLE FOR THE COON THESE DRAWINGS PRIOR TO START OF CONSTRUCTION.THE BUILDING CONTRACTOR 1/4" - 1'-0" WILL BE RESPONSIBLE FOR THE CONTENT 43 BREWSTER ROAD C TM SE COMMENCES GS WITHOUT CONSTRUCTION. A I E N N A R O RESIDENCE S I ID E N C E COMMENCES WITHOUT NOTIFYING THE Al MAS H P E E ,MA. 02649 DESIGNER OF ANY ERRORS OR OMISSIONS- DATE " J i1 GG DTHESE ESIGNER OF ANY ERRORS OR FOR THE USE WNER P H. (508 2/4- i V V TH THE DRAWING REQUIRES THEW USE N (] THESE DRAWINGS REQUIRES THE WRITTEN 11/1"/2013 CONSENT OF THE DESIGNER UNDER THE 1 ARCHITECTURAL COPYRIGHT PROTECTION _FAX (508) 539-9402 202 HAMDEN CIRCLE HYANNIS, MA - ACT OF 1 M. t 14'-0" 8'-11" 7'-0" T-0" 2'-10" 2'-10" 3-3" F I A . A 6/ O O 6 0 NEW- 45'-0" 2'4" MASTER 4 3-6" BATH TILED 4' O 4 F o OW B (VENT BATH FAN TO OUTSIDE) I. A6 , 1,�.. 2'1 m x B LIN 2'0"X 6'8" oB fV 4 v NEW sC�N. � - `' HALL© zo © ---- N © 2'6"x 5'8" I 6 T-5" 4'7" 5'-0" 7.5" 5 NEW ° MASTER I BEDROOM L� Q 4 I N Q fV ° CLOS. I I ACCESS c PANEL PANEL r _ 4 R 'v 9I F-cl I C I C 4 B . A6 2'-10" 2'-10" T-2" it T-2112" 12'-W - V-91/2" 4s 0" SECOND FLOOR PLAN WINDOW SCHEDULE TYP MANUFACTURER'S UNIT ROUGH OPENING REMARKS A ANDERSEN TW2446 2'-6 1/8"x 4'-8 7/8" DOUBLEHUNG B A251 2'-4 7/8"x 2'-0 5/8" AWNING C TW24310 2'-6 1/8"x 4'-0 7/8" DOUBLEHUNG D TW2442 2'-6 1/8'x 4'-4 7/8" DOUBLEHUNG I 1.CONTRACTOR TO VERIFY ALL WINDOWS WITH OWNER AND ROUGH OPENINGS WITH WINDOW MANUFACTURER PRIOR TO ORDERING OF WINDOWS , 2.ANDERSEN 400 SERIES WINDOWS WHITE EXTERIOR W/FINELIGHT BETWEEN GLASS GRILLES.LOW-E HP 4 GLAZING W/SCREENS&STANDARD HARDWARE THE DESIGNER SHALL BE NOTIFIED IF ANY. SCALE : C/�1 E • DRAWING NO. : COTUIT BAY DESIGN, LLC NEW ADDITION/REMODELING FOR: ERRORSC'OR OMISSIONSARE FOUND ONJV/•1` DRAWING V WILL BE DRAWINGSIBLE PRIOR TO START OF T CONSTRUCTION.THE BUILDING CONTRACTOR 1/411 � 1 1-011 43 BREWS TER ER ROAD IN THESE DRAWINGS FGRTHED IONNT IN THESE DRAWINGS IF CONSTRUCTION ' COMMENCES WITANY ARE NOTIFYING THE MASHPEE ,MA: 02649 IAI EN NARO RESIDENCE OF THE R OFOWNER NOTEERRD. AS OTHER USE OF DATE THESE DRAWINGS ARE SOLELY FORTHE USE PH. (508� Z74-1166 THESE THE DRAWINGS AWING RED.ANY OTHER dO CONSENT OF THE DESIGIRESTHE NDER T REN 11/19/2013 CONSENT OF THE DESIGNER UNDER THE A2 ARCHITECTURAL COPYRIGHT PROTECTION FAX (50 ) 539-9402 202 HAMDEN CIRCLE HYANNIS, M ACT IF,�". ! 1 NOTE: TO, PREVENT BREAKOUT, THE PROPOSED NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS FINISH GRADE SHALL NOT BE < EL:36.79 FOR A DISTANCE OF 15' AROUND THE - PERIMETER OF THE S.A.S. SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. I T.O.F. EL.=45.76 INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL A 4" DIAMETER INSPECTION PORT OVER OF MASS OUTLET AND SET TO 6 OF FINISH GRADE SET TO 6 OF GRADE ONE CHAMBER (MIN.) AND SET TO 3 OF F.G. F.G. EL.=42.Ot F.G. EL.=39.50t F.G. EL: 42.0t F.G.F EL: 42.0-42.5(MAX.) VENT l D M E No. 1140 9" MIN COVER/ L - 1O'"t L 55' L e 10'(MAX) INSTALL TWO INSPECTION PORTS (MIN.) O S-1� (MIN.) 36" MAX COVER ® $=1X (MIN.) ® 5-176 (MIN.) NITAR�a� 4"SCH40 fo PVC 4"SCH40 PVC 4"SCH40 PVC [; 10" 8 I ( o 14• 11.3" TO. "\INV..= 37.50 ae"LIQUID INVERT LEVEL INV.=37.25 PROPOSED INV.=36.50 GAS BAFFLE D-BOX 3 ROWS OF 5 UNITS AT 6.25'/UNIT + 0.75' WEDGE 32.0'/ROW DB-3(H-20) INV.= 36.40 INv.=36.70 SOIL ABSORPTION .SYSTEM (PROFILE) EXISTING 1.000 GALLON SEPTIC TANK RESTORE VEGETATIVE COVER EXISTING SEWER OUTLET BACKFILL WITH CLEAN PERC SAND 75" TO TOP OF CHAMBERS NOTES: 1) CONTRACTOR SHALL VERIFY.ALL EXISTING ::.,:...•.. PIPE INVERTS PRIOR TO CONSTRUCTION BREAKOUT=.TOP ELEV.=36.79 2) D-BOX SHALL BE SET LEVEL AND TRUE TO INV. ELEV.= 36.40 , GRADE ON A MECHANICALLY COMPACTED SIX INCH CRUSHED STONE BASE, AS SPECIFIED IN BOTTOM ELEV.--7 35.46 EXISTING SUITABLE 310 CMR 15.221(2) 2.83' /`' MATERIAL MAE 3) REPLACE EXISTING 1,000 GALLON SEPTIC TANK 5 MIN. ABOVE BOTTOM 1 76,. owl T.P. EXCAVATION OR G.W. EFFECTIVE WIDTH = 3 x 2.83' = 8.49' WITH GALLON SEPTIC TANK IF FAILED, (5.21' PROVIDED) USE 3 ROWS OF 5 160OBD H2O DAMAGEEDD,, OR LESS THAN 1,000G IN CAPACITY. BOTTOM OF TESTHOLE EL.=30.25 _ ADS BIODIFFUSER UNITS-NO STONE PROFILE 4) INSTALL INLET & OUTLET TEES AS REQUIRED _ W/ CONTOURED WEDGE SEPTIC SYSTEM PROFILE TYPICAL SECTION 1s" 1 N.T.S. H.ca t 11.2" DESIGN CRITERIA SOIL , LOG P#: 12847 NUMBER OF BEDROOMS: 3 BR EXIST. DATE: FEBRUARY 23, 2010 j-� 3411 SOIL EVALUATOR: DARREN M. MEYER, R.S., CSE. #1614 SECTION END CAP SOIL TEXTURAL CLASS: CLASS I . WITNESS: DAVE STANTON, BARNS. BOH DESIGN PERCOLATION RATE: <2 MIN/IN I TP- 1 Depth Elev. TP-2 Depth 16"" HIGH CAPACITY 16008D (H-20) BIODIFFUSER UNIT DAILY FLOW: 110 G.P.D/BR. 4234. DESIGN FLOW: 330 G.P.D. . 34 A 0" 42.25 -A o" LOAMY SAND LOAMY SAND MODEL 16" HICAP GARBAGE GRINDER: NO (NOT DESIGNED FOR GARBAGE GRINDER) 1OYR 3/2 . 10YR 3/2 LENGTH 76" NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT PROPOSED SEPTIC TANK: USE EXISTING 1,000 GALLON CAPACITY 41.92 B 5" 41.75 B 6" EFFECTIVE LENGTH 75" TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY LOAMY SAND LOAMY SANG LEACHING AREA REQUIRED: (330) = 445.94 S.F. SIDE WALL HEIGHT 11.2„ DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. 10YR 6/6 10YR 6/6 .74 t OVERALL HEIGHT 16" . 92 09 . DISTRIBUTION BOX: 3 OUTLETS (MINIMUM) H2O LOADING 39. ct 39" 38. ct 40" Ems. 4640 TRUEMAN BL VD OVERALL WIDTH 34" HlLLIARD, OHIO 43026 PRIMARY S.A.S. 13.6 CF USE 3 ROWS OF 5 - 16" ADS 16008D BIODIFFUSER H-20 UNITS-NO STONE MED. SAND MED. SANG CAPACITY 2.5Y 6/6 PERC 037.50 2.5Y 6/6 (101.7 GAL) ADVANCED DRAINAGE SYSTEMS, INC. AND EXTENDED 0.75' W/ CONTOURED WEDGES PROPOSED SEPTIC SYSTEM SITE PLAN BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.70 SF/LF OF BIODUFUSER) (BIODIFFUSERS) 15 UNITS x 6.25 LF x 4.70 SF/LF = 440.63 SF 202 HAMDEN CIRCLE, HYANNIS, MA (CONTOURED WEDGE) 3 ROWS x 0.75' x 4.70 SF/LF = 10.58 SF ' 30.34 144" 30.25 144" TOTAL AREA = 451.21 SF PERC RATE <2 MIN/IN. ("C" HORIZON) _. Prepared for: Gretchen laiennaro DESIGN FLOW PROVIDED: 0.74GPD/SF(451.21 SF) = 333.89 GPD > 330 GPD req'd . NO GROUNDWATER OBSERVED Engineering.by: Surveying by: SCALE DRAWN t DARRENM.MEYER,R.S. Roo-Tech 11;nviVAMdn e! NTS D.M.M. • 1, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 pOBOX981 (508) 364-0894 to conduct soil evaluations and that the above analysis hoe,been performed by me consistent with.the E,4ST SANDWICH,MA 02537 DATE: CHECKED SHEET NO. requirements of 310 CMR 15.017. 1 further certify that I hove passed the Soil Evol. Exam in October, 1999. 50B352-2922 02/23/10 D.M.M. 2 Of 2 f ! t i VA UAL J L. M.t ile 2 A,.,/, Crc 4c�L.-ru _-- 1.2 lit----i I J?ICA=�I L- t —i T- ,.' ,.,• - - -- --f�:`-='r— i- - - 4' - Ill O Wd•- �'_ y LZ•, L IQUtD LEVEL T TYDIG/s►L SEPTIC T�► I.t_ TyPi CAS C:ISTR.t DUT I Ot a BOX- ► 0-F T"o 15�LE ►.j or Tp Ste+,LE I rtNIS6A (;�q2Avs %A Gmno Fl1.+1s 6a•..Qdic -Tile oc V-OLxj v i.. i�� � � �'C, � ce. w�9���►1C�ry1,Zr �� 71T������1�YT���lT�1T�``�7 � _ u i „e��.' L to ar i►Y. t !? M4.o a E►e� Italti►pbt.Ctso Co..0 DIST gOJt , v }+ % J0 '4 5-ra Va ——� e S ( `J 1E PrT C T-AlJ 1< TT� BET i y i a v f ;� 1 M it r a�"tY+►d{ 4w V, s7X K24 v—;2— S Y"ATE Nor TO 3[-A Lj y � ov 14 N � • O /a o < L �? /9.Y D ry1-5 V Of SC ALE OATS ! SHEET • �tp� ORAWN BY CNKO v Aftip ST rL,AN NO , r, r ` . }