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HomeMy WebLinkAbout0038 HAWTHORNE AVENUE - Health 38 Hawthorne Avenue Hyannis A = 286— 008 !f f 1 f 1 1 a k Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 38 Hawthorne Ave. , Property Address McPherson Owner Owners Name information is required for every Hyannis Port MA 02601 3/24/21 page. Cityrrown 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. A. Inspector Information 54 I5dgLf Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 City/Town State Zip Code 508.272.6433 13010 Telephone Number License Number B. Certification i n I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails aAl�& 3/24/21 Inspector nature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note:This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 38 Hawthorne Ave. Property Address McPherson Owner Owner's Name information is required for every Hyannis Port MA 02601 3/24/21 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old"or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. "A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts �. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u, 38 Hawthorne Ave. Property Address McPherson Owner Owner's Name information is required for every Hyannis Port MA 02601 3/24/21 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 Commonwealth of Massachusetts ,if Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �a 38 Hawthorne Ave. Property Address McPherson Owner Owner's Name information is required for every Hyannis Port MA 02601 3/24/21 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: "*This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No El E Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool 99 P ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts �. Title 5 Official Inspection Form I� Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 38 Hawthorne Ave. Property Address McPherson Owner Owner's Name information is required for every Hyannis Port MA 02601 3/24/21 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 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 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 water supply 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 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form j Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 38 Hawthorne Ave. Property Address McPherson Owner Owner's Name information is required for every Hyannis Port MA 02601 3/24/21 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ® ❑ 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? ❑ E Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑, Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑I 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)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 38 Hawthorne Ave. Property Address McPherson Owner Owner's Name information is required for every Hyannis Port MA 02601 3/24/21 page. Citylrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 5 Number of bedrooms (actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 Description: 5 bedroom permit and plan on file at BOH Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: 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 d 192 GPD 9 ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: occupied Date l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth.of Massachusetts �. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 38 Hawthorne Ave. Property Address McPherson Owner information is Owner's Name required for every Hyannis Port MA 02601 3/24/21 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. 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 Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: No recent pumping per owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts �. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 38 Hawthorne Ave. Property Address McPherson Owner Owner's Name information is required for every Hyannis Port MA 02601 3/24/21 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. 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): Approximate age of all components, date installed (if known)and source of information: 2006 per BOH record Were sewage odors detected when arriving at the site? ❑ Yes ❑ No 5. Building Sewer(locate on site plan): Depth below grade: 2feet 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts �. re Title 5 Official Inspection Form �a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments v .� 38 Hawthorne Ave. Property Address McPherson Owner Owner's Name information is required for every Hyannis Port MA 02601 3/24/21 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 1 ft at inlet 2ft at outlet feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) H-10 septic tank appears to be structurally sound, outlet cover raised to 3" of grade If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500g 6„ Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle >12 Scum thickness 1" Distance from top of scum to top of outlet tee or baffle >2" Distance from bottom of scum to bottom of outlet tee or baffle >2" How were dimensions determined? measured Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping suggested every 3yrs to prolong the life of the system I t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts lsa Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 38 Hawthorne Ave. Property Address McPherson Owner Owner's Name information is required for every Hyannis Port MA 02601 3/24/21 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 7. 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 Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 AN Commonwealth of Massachusetts ,ip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 38 Hawthorne Ave. Property Address McPherson Owner Owner's Name information is required for every Hyannis Port MA 02601 3/24/21 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan):. 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.): H-10 D-box is 18" below grade, cover raised to 6" of grade, no adverse conditions t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments •� 38 Hawthorne Ave. Property Address McPherson Owner Owner's Name information is required for every Hyannis Port MA 02601 3/24/21 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 9 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 38 Hawthorne Ave. Property Address McPherson Owner Owner's Name information is required for every Hyannis Port MA 02601 3/24/21 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 9 infiltrators per BOH record, infiltrators were video inspected, they are end loaded, damp at this time, no indication of past hydraulic failure, bottom of chambers is approximately 4' below grade 12. 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 Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts �. ,F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 38 Hawthorne Ave. Property Address McPherson Owner Owners Name information is required for every Hyannis Port MA 02601 3/24/21 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts �. ro Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 38 Hawthorne Ave. Property Address McPherson Owner Owner's Name information is required for every Hyannis Port MA 02601 3/24/21 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately Scf,le t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts ,IF Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments •� 38 Hawthorne Ave. Property Address McPherson Owner Owner's Name information is required for every Hyannis Port MA 02601 3/24/21 page. City/Town State Zip Code Date of Inspection D. System Information (cont.). 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to Ihigh ground water: 8 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: 2006 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: 4'seperation per 2006 compliance ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe!how you established the high ground water elevation: See above Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Tdle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 38 Hawthorne Ave. Property Address McPherson Owner information is Owner's Name required for every Hyannis Port MA 02601 3/24/21 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6 (Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 a { r TOWN OF.BARNSTABLE LOCATION �� t•C1C11Q '' t ;,:SEWAGE VILLAGE ASSESSOR'S MAP &-LOT A PU .;.;INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY ®o 1 LEACHING FACILITY: ��'1�1(type) (size). NO.OF BEDROOMS BUILDER OR OWNTER PERMITDATE: �f COMPLIANCE DATE: -- Separation Distance Between the: »' T Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet _ Private Water Supply Well and Leaching Facility (If any wells exist , on site or within 200 feet of leaching facility) - Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility)=; Feet Furnished by - r. LtA r R� q V �. No. (p L1 J r Fee V� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for Migogal 6p5tem Con5truction Permit Application for a Permit to Construct( ) Repair(✓�Upgrade( ) Abandon( ) Complete System ❑Individual Components Location Address or Lot No. J? �'(q/ Owner's Name,Address,and Tel.No. z�'d aes s 4sqll Assessor's Map/parcel Installer's Name Address, d Te. o. Designer's Name,Address and Tel.No. Xot 1-o7Gj1 L'd�� 939 do` 4 Type of Building: r Dwelling No.of Bedrooms J Lot Size f 1d0 sq.ft. Garbage Grinder ( a Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min,re wired) gpd Design flow provided gpd Plan Date ® Number of sheets Revision Date Title <5 Size of Septic Tank / ,.J��� Type of S.A.S. // /S . Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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. gned Date ��� Application Approved b Date Application Disapproved by: Date for the following reasons Permit No. Qn®CO 41 Date Issued N0.4 / 1// Fee !V Entered in computer: U. THE COMMONWEALTH OF MASSACHUSETTS Yes p PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS , - application for 3319;tlOgal i§p5tem Con5tructi0u permit a Application for a Permit,to Construct O Repair(✓�Upgrade(, ) Abandon O l_1.Complete System ❑Individual Components j 1 ...�• Location Address or Lot No. Owner's Name,Address,and Tel.No. Assessor's Map/parcel `,..• Installer's Name Address,a d Tel: o. Designer's Name,Address and Tel.No. I �i Type of Building: C t Dwelling /�✓No.of Bedrooms Lot Size 400 sq.ft. Garbage Grinder ( � g Other Type of Building /'�e7 G/C No.of Persons Showers( ) Cafeteria.( _ Other Fixtures Design Flow(min.re wired) //,A0 gpd Design flow provided j C��' (� 1 gpd Plan Date �_/ �b Number of sheets Revision Date - Title S .S f d C�,o�G© 3 Size of Septic Tank / / J r0� Type of S.A.S. 77 Description of Soilq - or Nature of Repairs or Alterations(Answer when applicable) ,.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. igned Date Application Approved by Date 7 Application Disapproved by: Date for the following reasons Permit No. no[0 412 Date Issued / THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On--s'te��Seewage Disposal System Constructed ( ) Repaired Upgraded ( ) Abandoned( )by O/ (.p�s at Q G!J ©/'dj� /f ke has been constructed in accordance f l l with the provisions of 11:5 an he for Disposal System'Construction Permit No. c9�G ) 7 dated - I ( 7 ! . Installer Gam' - °" i 4. Designer �- #bedrooms I Approved design flow J gpd The issuance of this permit shall/not be construed as a guarantee that the system wi func o&e�`g� Date' '/ j Inspector —No. � (D 7 �-_ --------------- ----------Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Dis�po5at *p5tem Construction Permit Permission is hereby granted to Construct ( ) Repair ( � Upgrade ( ) Abandon ( ) System located at 3 i 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: Constructi n mu t be completed within three years of the date ofof M 1 Date AP]? roved b. 1 3/17/2021 ShowASbuilt(1700X2800) TOWN OF BARNSTABLE LOCATION 53 4%- -rme A,,Q SEWAGEawo�rIy'T Gc VQ.LAGE C4x^htSpc C- ASSESSOR'S MAP&LOT a INSTALLER'S NAME&PHONE NO. 16"1119 SEPTIC TANK CAPACITY f p. D (�(�nz��h S LEACHING FACILITY:(type) / Ir'1t r' NO.OF BEDROOMS. (5 BUILDER OR OWNER c PEP-MITDATE: I"0i COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted GroundwatetTableto the Bottom ofLeachingFacility Feet Private Water Supply Well and Leaching Facility(If any wells exist + on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) - Feet Furnished by t ��r s C1 = rl�a6� h3"-4(1 _3=77 f A �,,r t r https:Hitsqldb.town.barnstable.ma.us:8431/Home/ShowAsbui It?mp=286008&sq=1 1l1 FROM :down cape engineering inc� FAX NO. :15083629880 May. 19 2006 12:12PM P2 t` "down of Barnstable Regulatory Services Thomas F. Geiler,Director Public Health Division Thomas McKean,Director ZOO Main Street,Hyannis,MA 0201 Office: 568-962-4644 Fax: 509-790-6304 Installer&DesignerCertification Form Date: //q O Sewagc Permit# 26 jy7 Assessor's MapWarcel Designer: 4 t�►� �R, q r1 P e✓� Installer: G r ® / ► t Address: Address: q�j9 on was issued a permit to ingtall a (date) (installer)— -- septic system at � � l�it�+1 r-r�A _ e. _-.-- based on a desip drawn by (address) n1� GtJ dated ` - 03 6,WW . Wsigner} 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. flan revision or certi ed as-built by designer to/ I follow. 4Z\4 OF 14,4 9 ARNE H 4JAL4 (Installer's Signature) U CIVIL No. 30792 GfSTe (Designer's igna Marc) (Affix Designer's Stamp Here) PLEASE &ETURN TO BARNSTABLE PUBLJC HEALTH DIVISION. CORT JFWATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL R-0 THIS FORM ANI) AS-JBIJILT CARD ARF. RECEIVED BY THE BARNSTABLE PUBLIC HE14LTH DIVISION 'THANK YOU. Q:Health/Septic/Designer CcrtificaliunForm 3-2644.doc FROM :down cape engineering inc FAX NO. :15083629880 Apr. 06 2006 O7:15AM P2 ,- 09/05/06 WED-07:20 IeAX 609 219 9138 McPherson 001. Av- - 'l a 4c�.ruzi s .�0r+ �u UP— '� + Ci c�Q off.-aa�esc�S • dZ�—�l�h�.�"�--�. FROM :.down cape engineering inc, FAX NO. :15093629980 Apr. 06 2006 07:15AM P3 picot-, CLO 1 —17 I ►��{c Lei 100[t 8S'l" 619 609 %V1 M90 NON 90/90/6o FROM :down cape engineering inc, FAX NO. :15083629880 Apr. 06 2006 07:15AM P4 04/03/08 'RON 08:37 FAX 808 219 9138 McPherson 2001 (312�-) f "rrp'Y )GI T(-IA J �1 i�fl �OT-1 "..� op _i a ..�. .. J. I i l � i • - z • ..._._.... ...................... . : . . ....... . I .-_.--.-_.-... SYSTEM PROFILE TEST HOLE LOSS NOT TO SCALE) PROVIDE INSPECTION PORT WITHIN LISA LYONS, RS i . , ACCESS COVER TO WITHIN 6" OF FIN. GRADE � , ACCESS COVER (WATERTIGHT) TO 6" OF FINISH GRADE ENGINEER: /14.0' MINIMUM .75' OF COVER OVER PRECAST /� WITHIN 6" OF FIN. GRADE 2% SLOPE REQUIRED OVER SYSTEM , D. DESMARAIS IRS IRVING 1 1.75 WITNESS: RUN PIPE LEVEL 2" DOUBLE WASHED PEASTONE DATE: 12/15/05 I' ,7Z- * FOR FIRST 2' PARK PROPOSED 1500 11.0, PERC. RATE _ < 5 MIN/INCH 11.75' GALLON SEPTIC 11 .50' /// W oo CLASS I SOILS P# 11175 TANK (H- 10 ) GAS \ 10.58CDC> ' lit, LOCUS BAFFLE 10.77' o000 10.60 MIN 0.58' ( 2 % SLOPE) �6" CRUSHED STONE OR MECHANICAL oo�0 000"�3 10.0, COMPACTION. (15.221 [2]) [� ELEV. E2� DALE DEPTH OF FLOW = 4' (2.2 y; SLOPE) ( 1 % SLOPE) 3/4" TO 1 1/2" DOUBLE WASHED :NONE 0" 14.1' 0" A 13.0' SQUAW 1sLnNo RO. TEE SIZES: A ' INLET DEPTH = 10" LS LS OUTLET DEPTH = 14" 10„ 1OYR 3/2 12„ 10YR 3/3 LOCATION MAP NTS FOUNDATION 20' SEPTIC TANK 32' D' BOX 4 LEACHING 5' B B FACILITY LS ASSESSORS MAP 286 PARCEL 8 **THIS IS A PROPOSED MINIMUM 26„ 10YR 4/6 11 .9, LS ELEVATION FOR NEW EXIT INVERT. PLUMBER TO CONFIRM FEASIBILITY SIEVE SAMPLE TAKEN TH 2, C LAYER: PRIOR TO INSTALLATION OF ANY *PLUMBING IS PROPOSED TO BE C1 10YR 4/6 SIEVED OUT AS A MED/FINE SAND PORTION OF SEPTIC SYSTEM. RE-ROUTED TO EXIT AT APPROX. 38" 9.83 , (CLASS 1) AREA SHOWN. PLUMBER TO CONFIRM USE ADJ. GROUNDWATER AT ELEV. 5.0' PERC MS FEASIBILITY PRIOR TO INSTALLATION OF ANY PORTION OF SEPTIC SYSTEM 25Y 5/6 C GROUNDWATER ADJ. DATA: 70" . WELL: MIW 29 ZONE: A \��iy t 24.4 ADJ: 1.5' <S 'L C2 MS/LS / P ED MS 1 RIVE 114" oss WATER 3.50' ' 4,s o ,L 21.6 � 120.p0, 127" Des WATER 3.52' / O+ 2 '� -- 2.5Y 6/6 LS TIE ROSE/ 2.5Y 6/6 „N J CONC. GARDEN 132 3.1 132 2•0' / o � PATIO 18.E NOTES: � 21. - - / EXISTING DWELLING �� � � + 16. .3 / (ON POSTS) 21. 23.1 SEPTIC DESIGN: APPROX. NGVD 0 1 \�,�• � � (GARBAGE DISPOSER Is NOT ALLOWED ) 1 . DATUM IS 2 `b Exisr. �+ EXIST. rn D'-SIGN FLOW: 5_ BEDROOMS ( 1 10 GPD) = 550 GPD 2. MUNICIPAL WATER IS EXISTING 1 1 LINE INTO �/ CHIMNEY 2�.9 N 550 �1 G! ` GR7UP•n �s N USE A GPD DESIGN FLOW 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. '10" CEDA S'_PTIC TANK: 550 GPD 2 1100 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H- 10 16 - + 14,2 ( -)15 5. PIPE JOINTS TO BE MADE WATERTIGHT. + 21.7 USE A 1500 GALLON SEPTIC TANK + 14, RE-RO + 0•6 UTED 1 .z 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. PLUMBING±* LE-ACHING: ENVIRONMENTAL CODE TITLE V. � r'O SIDES: 2(62.25 + 10.83) (.58) (.74) = 62•7 7. THIS PLAN IS FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT z // 15 � 17.o TO BE USED FOR ANY OTHER PURPOSE. ® / �� 2 r4`� -',9 80TTOM: 62.25 x 10.83 (.74) = 498.9 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. 1 8" DAR TOTAL: ` 758 S.F. 561.6 GPD 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT is. INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED N �� �� 10" CE R + 11 3 USE (9) STANDARD INFILTRATORS WITH 4 STONE AT FROM BOARD OF HEALTH. �Q /�h 1 w SlI)ES AND 3' AT ENDS 10. PUMP & REMOVE (OR FILL W/CLEAN SAND) EXISTING SEPTIC SYSTEM / A 0 r 11.7' TH TH ^ / 9 + �� 5' REMOVAL OF UNSUITABLE SOIL.. / REQUIRED AROUND PERIMETER OF / ,3 LEACHING FACILITY, DOWN TO LEGEND TITLE 5 SITE PLAN / 8 8 3.1 SUITABLE SOIL LAYER. REFLACE J 72 WITH CLEAN MED•=SAND. 100.0 PROPOSED SPOT ELEVATION OF f 5 �Q 77 38 HAWTHORNE AVENUE + 6.a 2 2 100x0 EXISTING SPOT ELEVATION IN THE TOWN OF: o f? 60 0 100 PROPOSED CONTOUR BARN STABLE f V � 6 8 PROVIDE APPROX. , OF 40 MIL ( HYANNISPORT) LOT AREA ATS' OFF SAS IN AREA 1100 18,00± SQ. FT + 5.7 100 EXISTING CONTOUR SUSAN MCPHERSON SHOWN. TOP AT ELEV. 11.0', PREPARED FOR: BOTTOM AT ELEV. 7.0' + 6.6 6 6.1 i 4 .600 88 5 + 4.6 5 20 0 20 40 60 '6 v Z__X BOARD OF HEALTH L=17;4't \ I-63 X�-x 4 I-Xa _-- + ,6 _ MA _ R=10 t �. CO X APPROVED DATE SCALE. 1 - 20 DATE. JANUARY 3, 2006 h 108.2't _X-_X 3.8 off 508-362-4541 _ - -4- 3.3 fax 508 362-9880 BENCH MARK - TOP OF �Q� eA`sHOFt'��ss '` OFs EA VE I S9� CONC. BOUND EL. = 8.1 { 5.70 Q NUE down cape engineering, inc. ��� At.� ARNE H. CIVIL OJALA CIVIL_ ENGINEERS No. 307 2 4 No.2s3� LAND SURVEYORS , . �o�SF �S ��°��w oP S000 `O '�'' vE r20Ac 939 vain st, yarmouth, rya 02675 05-,285 ARNE H. OJALA, P. ., P.L.S. DATE