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HomeMy WebLinkAbout0017 KEATING ROAD - Health �17 ,Keating Road ^-Hyannis s - - fit„ Y t.. - �a U @f �..t•., z .`' F w. Ki qv 04 s r,a v - � � - � � ^ 6 r. o. Y�, � � - ' c _ �' , �- � ,' - r,i � . - �, • -, � �� ? J� .+ fay 'F • � � L v - `r � f ` �c Y' � d a � n+' V n ' ,^ f. a,�`� - _. .. .�.� � � y t _ F L F .. _ }'+ ' ..�' • � c' O ro' j d �F+ ` r .. } F ' - .� 4{ � - • ., ,... '� � y �k' - , In f � ``�. I N V. ..F c ._ � �._ � � � n t '� - �' -� a �V .. 5 V �� �� c _ � - � .i ,. c No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2ppfication for )Disposal *pstem Construction permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ❑Complete System ❑Individual Components Location Address or Lot No. _ Owner.'ss Name,Ad4rress,and Tel No Assessor's Map/Parcel 3v(o 1poV I ]ler's Name,Address,and Tel. o. ' 1)17 5% Designer's Name,Address,and Tel.No. ` on Type of Building: Dwelling No.of Bedrooms i 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) fJ Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance-of afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environment ijzl•E d and not to ce the system in operation until a Certificate of Compliance has been issued by this Board of Health Signed -- Date G [• �/ Application Approved by Date �3 Application Disapproved by Date for the following reasons Permit No. _�0 — (0 Date Issued E(—6 r ..�.--� --Or,_ •e,+:+Vrnn�� .mow.-vie_•„ No. 1 P Fee n �. THE COMMONWEALTH OP MASSACHUSETTS ,'`Entered in computer: • r PUBLIC HEALTH DIVISION :TOWN.OF BARNSTABLE, MASSACHUSETTS Yes ftpiication for Mis00041.*pstern O'onstrurtton i9ermit f Application for a Permit to Construct( ) Repair( ) Upgrade( ) A6aridori'(K ❑Complete/System ❑Individual Components ' Location Address or Lot No. J 7 .�r y� j� Owner's Name,Address,and Tel No60 . $�79 Assessor's Map/Parcel 3v(o & Installer's Name,Address,and Tel.No. -�/ r9 5 Designer's Name,Address,and Tel.No. Type of,Buildingr t Dwelling No.of Bedrooms `Y y '' Lot Size sq.ft. •• Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( I Other Fixtures Design Flow(min.required) gpd Design flow provided gpd 1 Plan Date '° Number of sheets Revision Date ' Title°. 4 Size of Septic Tank - Type of S.A.S. • Description of Soil Nature of Repairs or Alterations-(Answer.when applicable) ,Q Date last inspected: Agreement: , d 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-C do a and not to pace t�he,sy tem in operation until a Certificate of Compliance has been issued by this Board of Health: r \ Signed Date Application Approved by Date �3 Application Disapproved by Date for the following reasons Permit No. D -- (, Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site-Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) i Abandoned by A p C Un at v` i �y� ( S has been constructed in accordance G with the provisions of Ti le 5 and the for Disposal S stem Construction Permit No. -7 013--790 dated Installer n / Designer #bedrooms /y /T Approved design flow , gpd ' The issuance of this permit shall not be construed as a guarantee that the system wi`lli fi tionass designed. �F� (% �t�/ 0 f{� Date iIV j � , Inspector it /���fN No. aZ C�1 3."0? /O Fee THE COMMONWEALTH OF MASSACHUSETTS _ PUBLIC HEALTH DIVISION=.BARNSTABLE,MASSACHUSETTS Disposal Opstem Construction j3erutit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon System located at / h ,oly �, 114111- o.'s-71 S t/ i and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of permit. lc 6-1� 2 Date Approved by • U � ry TOWN OF BARNSTABLE LOCATION SEWAGE ; Y VILLAGE ASSESSOR'S MAP & OT INSTALLER'S NAME&PHONE NO. Y/ 7-41 °J SEPTIC TANK CAPACITY Z57A LEACHING FACILITY: (type) a size) E NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within.300 feet of leaching facility) Feet Furnished by bT—n ! .�v i No;- ' 03 Fee& THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: • :� .. -Yes " PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 0(ppYuation for Mig o at *pgterrY �Congtruction Verinit Application for a Permit to Construct( , )Repair( )Upgrade( )Abandon( ) Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel 2 S'p+"M lE Installer's Name Address,and Tel.No. Designer's Name,Address and Tel.No. NA ��5 ryO� a�Ce - Type of Building: Dwelling No.of Bedrooms Lot Size J Lj 066 sq.ft. Garbage Grinder(Il� Other Type of Building ®cam No. of Persons - a Showers( `�Cafet�a Other Fixtures — L_A-, a��� I+=-jC&*•cA3 Design Flow ` gallons per day. Calculated daily flow 33 5 O -gallons. Plan Date AS 10 Number of sheets � Revision Date Title OoSs�C� �=tC_ Size of Septic Tank���OO ' t�1e:rJ �—T,i.1i� Type of S.A.S Description of Soil OCN Nature of Repairs or Alterations.(Answer when applicable) —Nrl, h\ qI Date last inspected: Agreement: The undersigned agrees to ensure the construction and mai enance of the afore described on-site sewage disposal system in accordance with.the provisions of Title f the Enviro a Code and not to place the system in operation until a Certifi- Cate of Compliance has been issu�by oard of •us Signed Date Application Approved by Date 1 2 G Application Disapproved for the following reasons Permit No. wZ� Q Date Issued G L r No. U 4j 6'03 - 1 Fee sry 4 —__ ° ,e THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:•. Yes PUBLIC-HEALTH DIVISION -TOWN OF BARNSTABLE,-MASSACHUSETTS 01pprication for Migpogal *pgtem Congtruction f ermit TApplication for a Permit to Construct( . )Repair(V)Upgrade( )Abandon( ) J Complete System 0 Individual Components # y Location Address or Lot No. tj C. Owner's Name,Address"-and Tel.No. Assessor's Map/Parcel � Installer's Name Address,and Tel.No. Designer's Name,Address and Tel.No. odnat V';shsr S+SPY �C�utvo-r-, + Type of Building: - Dwelling No.of Bedrooms 3 Lot Size'I I ,C66 sq.ft. Garbage'Grinder(� Other Type of Building 0C--,2_ No.of Persons Showers( ''� Cafetiia 'Other Fixtures -ccrtc1J Jta1� -Fiv,.lUtz J +h = Design Flow� 1 ho - gallons per day. Calculated daily flow'_ ��J S O gallons. Plan-Date `" �� \ ;S G 4 Number of sheets Revision Date Title _a Size of Septic Tank er a0 :7Fk- t yk3 " •Type of S.A.S" a0-.1nvf7-C.,y Description of Soilo�xc t �y Natu a of Repairs or Alterations(Answer when applicable) (N � _ Y Date last inspected: R r 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 Envirogme�Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by t card of -6,R6.. Signed Date Application Approved by` r. Date Application Disapproved for Re following reasons Permit.No 'W04.0- 6 03— Date Issued i- THE COMMONWEALTH OF MASSACHUSETTS w BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTLFY, that the On-site Sewage Disposal System Constructed ( ) Repaired)Upgraded ( ) Abandoned( )by i. atLh4 f2 has been constructed in accordance r. with the provisions o Title 5 and the for Disposal System Construction Permit No. a ooq—44 Z dated Installer % Designer/ \ The issuance of thisI;permit shall not be construed as a guarantee that the\sys-tem_ willfu ction s designed Date ti q �,C `t-�f Inspector 1 No. 00 U— / Fee. I . THE COMMONWEALTH OF MASSACHUSETTS .„71 » PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS rp. ` Migpogal *pgtem �ongt uction permit Permission is hereby granted to Construct( )Repair d0 Upgrade( )Abandon ryK. Systemlocated)at and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty-to * " comply with Title 5 and the following local provisions or special conditions. .,.- Provided:Construction must be completed within three-years of the date of tits pe it.\ Date: I /7) / Approved by ( '1n TOWN OF BARN5TABLE i LOCATION SEWAGE VILLAGE /W ASSESSOR'S INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY.- .� Sect C LEACHING FACILITY: size) NO.OF BEDROOMS / ER OR OWNER BUILDER J . 22 PERMrrDATE: COMPLIANCE DATE:'.: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within.300 feet of leaching facility) Feet Furnished by { ) 0% i i" Town of Barnstable °Ft"E � Regulatory Services Thomas F. Geiler, Director • BARNSI'ABLE. MASS. Public Health Division A'f0N1A�p Thomas McKean, Director 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer.& Designer Certification Form Date: Designer: � V . �1G Installer: Address: �: , ��; co Address: ,IV On e was issued a permit to install a ,:. (date-) (i aller) septic system at , aC)01 ST based on a design drawn by (a ess) dated \ ` � _T_, ( igner) 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 t in accordance with State & Local Regulations. Plan revision or cert' d as-built b designer to follow. '` ' ' �jNQf iygssy. Installer' i9fiattire) �o� .'C�RhA.EN` � E u .SHAY Cn No.' 1181 (Designer's Signat re)' (Affix De ere) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVIS N. CERTIFI:CATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form < '\ COMMONWEALTH OF 1_VL•kSSACHliSETTS Y EXECUTIVE OFFICE OF ENVTRON:.rE�r_iI. iFFAI?S �R. C DEPARTMENT OF EN-VIROIVMEN-TAL PROTECTToti TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSNfEN TS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A 3 p plj a . 1'CERTIFICATION Property Address: �rnT ✓� °� � aNv�,. Od 60/ Owner's Name: ca �s • r Owner's Address: v,n� 60 • Date of Inspection: %� - -p/ Name of Inspector- (please print) 11G e-/ 11-09h-B 11 Company Name: AQVI-jO of Mailing Address: O O_X , Telephone Number. lac uCn CERTIFICATION STATEMENT I cerd&that I have personal ly y inspected the sewage disposal system at this address and that the inforrnai?otueporte, below is true, accurate and complete as of the time of the inspection.The inspection was performed based oil my cc e_,� training and experience in the proper function and maintenance of on site sewage disposal systemsJI am a cDPapproved system inspector pursuant to Sectio 340 of Title (310 CDfK 15.000). The s�-stm: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority, Fails Inspector's Signature: Date: ,�-10- 0� The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or N DEP)within 30 days of completing this inspection.If the system is a shared system or has a desi-an fll orT of 10.000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional o f ice of:ue DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable. and The apnro =_ authority. _ Notes and Comments """"This report only describes conditions at the fime of inspection and under the conditions of use at that time.This inspection does not address bow the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 pave 1 ' Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLL7-N RY"ASSESSMENTS SUBSURFACE SE«'AGE DISPOSAL SYSTEM I\TSPECTiON FORA-1 PART A CERTIFICATION(continued) Property Address: / /] e�i-t i✓1 /°( Gn✓t /7 Od 6O1 Owner: �� ,�,��= Date of Inspection: Inspection Summary: Check A.B.C.D or E/ALWAYS complete all of Section D A. Syst asses: I have not found any rnformahon which indicates that any of the failure criteria nescribed i 310 CNiR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below-. Comments: i B. System Conditionally Passes: One or more system components as described in the"Conditional Pass''section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health; will pass. Answer yes;no or not determined(Y.N,\'D)in the_for the following statements. If"not deter~w.ied"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 \T explain: Observation of sewage backup or break out of high static water level in the distribution box due to broken er obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection i f approval of Board of Health): ' broken pipe(s)are replaced obstruction is removed distribution box is Ieveled or replaced N9D explain: The system required pumping more than 4/times a vear due to broken or obstructed pipe(s). The pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed NTD explain: Tile C Tnencr+inn L t n _ Paae 3 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESS:TENTS SUBSURFACE SEWAGE DISPOSAL'SYSTEIM I SPECTTOIN FOR-I PART A CERTIFICATION(continued) Propert-y Address: �Bq�irt Ac � • oZ 6 0/ Owner•S-, Date of Inspection: - -p C. Further Evaluation is Required,by the Board of Health: /1/ Conditions exist which require fiuther evaluation by the Board of Health in order ro determine if the sys-ern is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 C11R 15.303(1)(b)that the system is not functioning in a manner which will protect public health.safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 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 enNironment: _ The.system has a septic tank and soil absorption system(SAS)and the SAS is vdrhin 100 et 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 I of a public rater s-apply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply v ell. 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 fac;ity and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than�ppm pro«ded that no other . failure criteria are triggered.A copy of the analysis must be attached to this form 3. Other: i i Page 4 of 11 OFFICIAL INSPIECTION FORM—NOT FOR VOLUIN-T-4.RY"ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: / `/'fear-r i✓l 111 Owner: le Date of Inspection: —O D. Svstem Failure Criteria applicable to all systems: You must indicate "yes"or"no"to each of the following for all inspections: Yes \�o sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded 0- clogged SAS or cesspool _Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or esspool 5 iquid depth in cesspool is less than 6"below invert or available volume is less than day flow- :c Required pumping more than 4 times in the last year NOT due to clogged or obstruloted pipe(;). \j?mbe- �f times pumped Any portion of the SAS;cesspool or privy is below high ground eater elevation. �4 y portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. any portion of a cesspool or privy is within a Zone 1 of a public well. portion of a cesspool or privy is within 50 feet of aprivate 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 coliforin 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 c ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] (Yes/No) The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CNM 15.303;therefore the system fails. The system owner should contact the Board ol. Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must sen•e 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 n 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—B.,PA} o-,-,_. Td Zone II of a public water supply well =_ If you have answered"yes"to any question in Section E the system is considered a sioni:-.5cant treat• or yes"in Section D above the.large system has failed,The owner or operator of any large s�-stern con< dL_red a significant threat under Section E or failed under Section D shall upgrade� 15.304. The system owner should contact the appropriate regional ooffce the Dephe system 1n aceorcance -,-i= artment• T;rlo C Tncnnrr;nn 1=nr.+. �ii ci�nnn ' I Page 5 of 11 OFFICIAL, INSPECTION FORM,'NOT FOR VOLL�'TARY ASSESSI'1rENTS r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 'r PART B r CPIECI LIST' Property Address: ea?ih ��J t Owner: So«/✓A 6 +� , A r . Date of Inspection: Check if the following have been done.You must indicate yes or r"no"3S to each of the follon�nsr YPs o , Pumping information was provided by the owner,occupant or Board of Health v V�'ere any of the system components pumped out in the'previo>'s two weeks? • 1 i J Has the system received normal flows in the previous two week period? j � —� Have large volumes of water been introduced to the system recently or as part of this insoec:'on Were as built plans of the system obtained and examined?(If they were not available note as „ . ,. t Was the facility or dwelling inspected for signs of sewage,back up? Was the siteninspected for signs of break out? .Were all system components;excluding the SAS, located on site? I Were the septic tank manholes,uncovered.opened,and thelinterior 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 ?roper maintenance of subsurface sewage disposal systems? ` The size and location of the Soil Absorption System(SAS)on the site'has been determined based on: Yes no i — ' 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 approxi= ioi of di_tance is unacceptable) [310 CMR 15.302(3)(b)] i T;tlo � Tncrc.•r;l.n Tr...+.. Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSIIENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION- FOR7V7 PART C SYSTEM INFORMATION Property Address: f'� ✓I c rl i /19� O�Lod Owner:Jo, Date of Inspection: FLOW CONDMONS RESIDENTIAL 'NT-amber of bedrooms(design): Numb,,of bedrooms(actual):� DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x''of bedrooms): Number of current residents: 0 Does residence have a garbage grinder(yes or no):�O Is laundry on a separate sewage system(yes,or no):/!1V iif yes separate inspection required! ` Laundry system inspected(yes or no):,Yp Seasonal use: (yes or no),I� Water meter readings; if a able(last 2 years usage(gpd)): Sump pump(yes or no): / Last date of occupancy: &,/:;oy - T_ CO�'Lti7ERCIAL/Ii'DUSTRIAL • Tv pe of establishment: Design flow(based on 310 CVL4 15,203): gpd Basis of design flow(seats/persons/sgf(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): GEti�ERAL nTORVIATIO' Pumping Records Source of information: !l/L!/ S �0-7 �O �i e �.12 —0 L-1-e•�� Was system pumped as part of the inspec n(yes or no):,L4Z- If yes, volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYP 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) _InnovativeiAlternative technology.Attach a copy of the current operation and maintenance co-tra:,: beobtained from system owner) ` _Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all components; date installed(if know and source of info lion: Were sewage odors detected when arriving at the site(yes or no):L0 T41. Tn enortinn T=n,•..., Ut ern nnn" Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLU RY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR f PART C SYST/EM INFOR.MATION(continued) Property Address: Owner:Soy Date of Inspection: O� F BUZLDL\TG SEWER(locate on site plan) Depth below grade: X� Materials of construction: --40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,-venting-.evidence of leakage,etc.): SEPTIC TA\TK:_(locate on site plan) Depth below grade: Material of construction:_cam oncrete . 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: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: � Scum thickness: eSS- Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to botto 1pe­ outlet tee or baffle: O How were dimensions determined: ,�& Qr/i Comments.(on pumping recommendations;inlet and tlet tee or baffle condition, su-uctural inte`-ray. liquid levels as r ted to outlet invert; evi nce of leaka/ge,.e C/! )✓-? /rJ l/IO G T T�1 T/�Q, �h L�/ C1 N I /✓J CO PI . /191/7, Q eG GREASE TRAP:4�-Gocate on site plan) 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: Comments (on pumping recommendations;inlet and outlet tee or baffle condition. sa-uct'sra, 'M, .� Fr_id it e; as related to outlet invert; evidence of leakage,etc.): Page 8 of i 1 k, OFFICIAL IN7SPECTION FORM NOT FOR VOLU\TARY ASSESS AfENTS SUBSURFACE SEWAGE DISPOSAL; SYSTEM LNSPECTT01-' FOP--NI PART C - Al SYSTEM INFORMATION(continued) Property Address: Owner: .51(v OotGo/. { Date of Inspection: f TIGHT or HOLDI\TG TANK: tank_must be pumped at time of inspectioz)(locate on site plan) Depth below grade: �- Material of construction: concrete metal_fiberglass_polyethylene omer(eplain): I Dimensions: Capacity: gallons. /. Design Flow: gallons/day Alarm present(yes or no) Alarm level: r Alarm in working order(yes or no): + t s ' ,-Date of last pumping: Comments(condition of•alarm;and float switches,etc'):' - < DISTRIBUTION BOX:' (ifpresent must be opened)(locate on siteplan) a Depth of liquid level above outlet invert:Comments(note(note if box is level and distribution to outlets equal;any evidence of solids carryover; aL-r•evidence of leakage> to or out of bo etc.): 40X eve /, !l/o ;° �S©/c % lt-o Z-eGl�s PU ZP CHAINM R: /!/ (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.'): i • -i t. .fix, l,. r r ti 1 . z Title Tncnorfinn r.,,.T,., 41 V7nnn 0 Page9of11 OFFICIAL INSPECTION FORIN7—NOT FOR VOLUNTARY ASSES SNIENTS SUBSURFACE SEWAGE DISPOSAL SYSTEYI INSPECTION FORM Y ax i-c: • _ /SYSTEM INFORINIATION(continued) Property Address: . ! /��a[�<<'1` R / d Owner: Date of Inspection: SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why. Type >� �� l/0 • leaching pits,number:_ � `'! �" `1:11"'i It,"eP,s' leaching chambers,number: reaching 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 or t,egeta;_on, etc.): "N T /a i G uI 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 or no): Comments(note condition of soil, signs of hydraulic failure;level of pondine. condition of vegetation. etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: r Depth of solids: Comments(note condition of soil; signs of hydraulic failure,level ofponding. condition of we0reta-1-i"e- etc.';: T;rle : TT enarr;nn T �� 411 eMnnn Q t, Page 10 of 11 .I OFFICIAL INSPECTION FORM-I�'OT FOR VOLi�1TARY ASSESS�IE TS SUBSURFACE SEWAGE DISPOSAL SYSTEM TINSPECTIOT FORM PART C SYSTEM INFORMATION(continued) Property Address: ePA'V117 t G � o1 kill If/ 6.0/: t , ONN,ner: So+IV c Date of Inspection: — —O ; .SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the se-,vage disposal system including ties to at least two permanent reference land-narks or t benchmarks. Locate all',vells xvithin 100 feet. Locate where public water supply enters the building. ' `i , Y, F j r�\r a 3 r;+to c Paae 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLLT.T'_a,.RY ASSESS--ITE\-'S SUBSURFACE SEWAGE DISPOSAL, SYSTEM INSPECTION FORIr P_AnIr C n /SYSTEM INFOR 4ATION(continued) Property Address: Owner:SG ra Date of Inspection: SITE EXAM Slope Surface water 4 Check cellar Shallow wells Estimated depth to ground water A2 feet �o 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: 1 Observed site(abutting property/observation hole within 150 feet of SAS)' Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must d cribe ow you established the hiah a ound eater eleva 'on: ' r T;tlo � T^cnortinn Fn,•m �n ci�nnn 1 i ' 10' min. from *NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. SECTION A -A ALL ouTLFr PIPES fR01d THE DISTRIBUTION BOX SHALL BE 12' CONCRETE COVER c a 1ng t.* an01C�, Existing Foundation [house to septic tank SET LEVEL FOR AT LEAST z FT. p ro -. TOP OF FOUNDATION ELEV. 100.00 (Assumed) Septic tank covers must be PROFILE VIEW OF LEACIIING SYSTEM �; - within 6 in. of finished grade _. - - - Grade over Septic Tank - 99.00 �Grade over D-Box- 99.00 ode over SAS - ELEV- 99.00 - 3 5'OUTLET 2 _ ,� 3' of 1/R' - t/2' Washed Peoetone KNOCKOUTS ° ,r+ 3/4' to 1 1/2 - Washed Crushed Sion • OUTLET c I l 12' INLET S 0.02 3 HOLE H 17 KeM1n�IJ O 18• NEW 5=0.01 w Greater DIST. BOX 3' Moxkn� Cover Top of SAS-Elev.=96.75 ` -•' 2' D y '. x EXIST, PRE � ^ 1,500 GAL. _ s� 0-Ot' per foot o o �15.5 - 4" - SCH. 40 Te 'r t.75' _ ,' OCo� 17• �.�4- fRaN Ex1sr, fDl1NDATTON rn SEPTIC TANK 5 4 4' O •-qK, I' "-10 C_e.0.. 0) Do o 20 0 0 C3 Effective Depth o 'C3 0 0 o PLAN SECTION CROSS-SECTION „ Y' CONCRETE FULL FOUNOA W II +p 0 2 tfnits a 8.5' = 17' i o ri , SYSTEM PROFILE 6 h.of 3/4'-1 1/2" 4) a N 3.5- J 3.5' L•• 3 HOLE H-10 DISTRIBUTION BOX compacted atone o i 25' NOT TO SCALE � Not to Scale - c 12' II Effective Length �ft i - EFfecttve Width > ED NO-Pend kt4*y 9.G.mWy 0 M 4"V1Efl c c c o SOIL ABSORPTION SYSTEM (SAS) 6 in.of 3/4'-1 1/2• GENERAL NOTES compacted atone o 500 - C H=10 LEACHING UNITS / WIGGINS PRECAST NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE m 1. Contractor is responsible for Digsafe notification Bottom of Test Hole 1 Elev.- 89.00_ Not to Scale and protection of all underground utilities and pipes. vObs. Groundwater - Test Hole 1 Elev.= NONE OBSERVED 2. The septic tank end distribution box shall be set level on 6" of 3/4"-1 1/2" stone. 3. Backfill should be clean sand or gravel with no stones over 3" in size. 4. This system is subject to inspection during installation PERCOLATION TEST -/ by Carmen E. Shay Environmental Services, Inc. __ _------ 5. The contractor shall install this system in accordance ® __ ____ with Title V of the Massachusetts state code, the approved plan Date of Percolation Test: OCT. 21, 2004 ; /, -- ��_ _ -_--_-- and Local Regulations. Test Performed By. CARMEN E. SHAY, R.S., C:S.E. 7 - , _-_ - - .R OA Results Witnessed By. WAIVER ( per Barnstable B.O.H.) i , T��A �'I�G 6. If, during installation the contractor encounters any EXCAVATOR: Shay Environmental Services, Inc. i� -�y- OF Wp`(� soil conditions or site conditions that are different Percolation Rate: Less Than 2 MPI ® 30" j CATCH (40 FOOT RIGHT -------- from those shown on the soil log or in our design BASIN _ __--_---------- installation must halt & immediate notification be - - -- --- l ----- made to Carmen E. Shay - Environmental Services, Inc. Test Hole �� `98, ---� ® 9a 7. No vehicle or heavy machinery shall drive over the No. 1 \\ \ �-��`` `� / septic system unless noted as H-20 septic components. DEPTH SOILS ELEv. \ \ I ------ ---`- 8. Install Tuf-Tite gas baffles or equals on all outlet tee ends. 0 99.00 \ '--- I i ,- � 9. All Distribution Lines shall be 4 diameter Schedule 40 NSF PVC pipes. � �'�-' I Saney 5\\ i Flailed 10. All solidpiping, tees & fittings shall be 4" diameter 10 Y 3/2 \ -�/ Loamy ' 65-00' Leach Pit P 2' Schedule 40 NSF PVC pipes with water tight joints. 0"-6" A 98,50 t 11. Municipal Water is Connected to ALL OF The Residence and Abutting I O Properties Within 150 Feet. �----- I I _-..' --•1 Sand I I 1 ;.. c:I 3 10 YR s/s I l { _ THE PROPERTY LINES ARE APPROXIMATE AND Mee. I I COMPILED FROM THE SURVEY PLAN GENERATED BY 6"-30" 96.50 1 8' = i2 ALL CAPE ENGINEERING OF HYANNIS, MA ENTITLED Sand I D-Box CERTIFIED PLOT PLAN OF #17 KEATING ROAD, HYANNIS, MA" 2.5 Y 8/6 4 - TE HOLE #1 DATED DATED OCTOBER 9, 1987 30"-120' C, 89.00 0 AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN GARAGE EL : .= 99.00 _ IT SHOULD BE USED FOR NO PURPOSE OTHER THAN (SLAB) 00 �2' LOT #16 THE SEPTIC SYSTEM INSTALLATION. c �0Q• - 1500 gat. EXISTING LEACH PIT TO BE PUMPED OUT AND W Septic Tank REMOVED TO FACILITATE NEW SEPTIC SYSTEM INSTALLATION PROJECT BENCH MARK SAND e NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE TOP. C FOUNDATION ELEV. _ 100.00 (Assumed) 40 Mil Liner To Extend FROM THE EXISTING LEACH PIT TO BE DISPOSED EXISTING From Elev. 96.00 to 92.50 OF AS PER BOARD OF HEALTH SPECIFICATIONS. Perc ff1 3 BBDROOft__ - and TO 'feet beyond foundation _,_ --" NO WETLANDS ARE PRESENT WITHTf1 "OF THE-PROPERTY Depth to Perc: 30" to 48" HOUSE �'F 9$ Perc Rate= Less Than 2 MPI ASSESSORS MAP 306, PARCEL 004 /Ole �o Groundwater Not Observed No Observed ESHWT (Full LEGEND Foundation) '� ADJUSTED H2O Elev. = None - DECK °< ------------- F�Q 3 24- oiAM. ACCESS MANHOLES . `�6 104X 1 DENOTES PROPOSED SPOT GRADE DENOTES EXISTING roo' --- ---9 x 104.46 SPOT GRADE LOT #18 M -= of T INLET 6,% -- PL PROPERTY LINE - " - __ 96P PROPOSED CONTOUR THE ACCESS COVERS FOR THE SEPTIC TANK, DL ___ ------- DISTRIBUTION BOX AND LEACHING COMPONENT t _ ---` - - - - - -9% EXISTING CONTOUR SHALL BE RAISED TO WITHIN 6" OF 7 \\ STEEL REINFORCED PRECAST CONCRETE FINISHED GRADE. �� l LOT ##y 7 PLAN VIEW INSTALL TUF-TiTE GAS BAFFLES OR EQUALS 11,000 Sq,lare Feet +/- i ® DEEP TEST HOLE & ON ALL OUTLET TEE ENDS g2' PERCOLATION TEST LOCATION 3-24' RDIOVIABLE COVERS _- _\ i - - yp A = 6 FOOT STOCKADE FENCE 3' min. clearance INLET 8- +„�^ I--Lmh. inlet to outlet 6'min. __ "-------•---� \ f.'• f Liquid Feyel OUTLET IN la'min raFr R Q V I '" 5' . , 'S' -T EDGE OF �7 ^$ ' 4'-0' min. �E1�'VD \ ,>. 1 l� O I PLAN Liquid depth \ \ fl 7 _ OF PROPOSED SEPTIC SYSTEM UPGRADE - �,� • �,-_ � � - � ��! �' PREPARED FOR CROSS SECTION END-SECTION DAN I E L SALVATO E E TYPICAL 1500 GALLON SEPTIC TANK ��' ,'6 AT o� ','' # 17 K EATING ROAD NOT TO SCALE H- 10 LOADING ���/ ,' �,��` HYANNIS, MA Design Calculations F. 4 tN M PREP ED BY: Number of Bedrooms: 3 Equivalent to 330 Gal./Day (330 Gal./Day Min. per Title V) C`� / ,' , 9p47 ' ` T T E. TT Garbage Grinder: No l,�l// /Ly.1�/ lNl t� Leaching Capacity Proposed: 330 Gol./Doy Minimum (Min. Per Title V) �i Septic Tank : - 2 x 330 Gal./boy = 660 USE NEW 1,500 GAL. Septic Tank. �� 0 20 40 50 RONMENTAL SERVICES, INC. SOIL ABSORPTION AREA: Using percolation rate of <2 min./inch g8I 1 1 Bottom Area: 0.74 gal/sq. ft. x 300sq. ft. = 222.00 gallons 4 'P P. BOX 627 Sidewall Area: 0.74 gal./sq. ft. x 148 sq. ft. = 109.50 gallons LOCAL UPGRADE VARIANCES REQUESTED: s ,TTVIZ EAST FALMOUTH, MA 02536 Providing: = 331.50 gallons - gN1TA.RAP ' 1. Request a varaiance to reduce the distance from the SAS to the SCALE: 1 "=20' '. TEL/FAX : 508-548-0796 UseB U PRECAST 500-C UNITS, HAVING A Il' .EFFECTIVE DEPTH, Foundation from 20 feet to 15.0 feet for Maximum Feasitle•Complicnce. SCALE: 1"=20' DRAWN BY: CES ATE: OCTOBER 25, 2004 TO BE USED WITH 3.5 OF WASHED STONE ON THE SIDES AND 4' OF WASHED STONE ON THE ENDS. A 40 M1 Rubber liner to Be installed as Shown. PROJECT#SD651 FILENAME: SD651PP.DWG SHEET 1 OF 1