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Home My WebLink About0028 LEONARD ROAD - Health 28 Leonard Road, Hyannis _ A=268=015 TO",.01 STABLE �.oC �oN 8E�WAGE tTIU'AflE y a n n ;S ASSflRl�# .c LOT 3htSTl .L S NAM&.PHORE NO 7777 SE�I`IG'T'AIyK GAPACTI'X LEACIENG FACH: Nfl ��BBI3F�flOI+RS 3 BtJEL SR OR fl�l R F TI3 T CdNdPLIm., M BATE; �eparatzan DWool.Between the Maxinum Adjusted Crottndwater.'I'alte to the Battam bf Leacti�ng Fat'l�ty . €et We Privai��Yate%supply well and Lttaa caitty {If aaylls exss . t on.site ae;wtttun Z( feet of Ieng facility) Edge'of�AlEtland and'Leaclietigaalty{if any wetlands exist wittu:t 340 feet f`teactuttg f } feet_' .,9e kI TOWN OF BARNSTABLE up LOCATION 1,-bi1grJ rd- SEWAGE# VILLAGE *yqhv1% ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. 3A K OlAk-kIt-A 777 -3S1- 0k SEPTIC TANK CAPACITY 1006 LEACHING FACILITY. (type) CkRm her S (size) NO.OF BEDROOMS OWNER :S!e cC°f��j ►--e PERMIT DATE: COMPLIANCE DATE: J e 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 r 1 G I p e� �. No. !N Fee ! V THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftpliLatlon for Misposal 6"M Construction Fermat Application for a Permit to Construct( ) Repair( ) Upgrade Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot NoQ�r Owner's Name,Address,and Tel.No. Assessor's Map/Parcel i D 325-5 C,S+e")I I 1� -I I&- Installer's Name Address and Tel.No. Designer's Name Address and Tel-No. 7 '� �f 74-353, sohn C_-�i1Lh CT ro5f�/ TresI le s Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) '3 v gpd Design flow provided 3 gpd Plan Date Number of sheets Revision Date Title ( 4 h i Size of Septic Tank 1000 Type of S.A.S. DO y� C aH. S Description of Soil Nature of Repairs or Alterations(Answer when applicable) kl� 15 4 S 4—, - o�c 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 Heal Signe Date tP Application Approved by Date 60 3 Application Disapproved by Date for the following reasons Permit No. d c/ Date Issued 2-9 No. 6N ry (l1 k} y Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION'- TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pp4cation for,posal 6pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade Abandon( ) ElComplete System O Individuat Compoiients Location Address.or Lot No. r-of Owner's Name Address,and Tel.No. Assessor's Map/Parcel ;,- / JPSS ( �S �P.J }11 la` ynn S i 27C4o- Installer's Name,Address,and Tel.No Designer's Name,Address,and Tel.No. -7 74—�3 3,�TT �x�C�S _s� CGI r�k Type of Building: 44 7 Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 1303,9 , gpd Design flow provided 3 fir) gpd Plan Date `7 6 Number of sheets Revision Date Title / Size of Septic Tank ,10n(_) l ( Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) ?-V-, 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. Signed Date (o Application Approved by v Date Application Disapproved by Date for the following reasons Permit No. C) l V Date Issued �j U THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On/-site Sewage Disposal systeiil7egnstructed( ) ' Repaired( ) Upgraded Abandoned( )by at j k L. ,/ /� �if v c.�,h, 5 arc has been constructed in accordance ' with the provisions of Title 5 and the for Disposal System Construction Permit No.2 dl d dated 6 -7 2- 2v Installer 51.1 /,, �� :. c,r� Designer f v, ,h.Po<<vA or 1, C; 1 „ #bedrooms Approved design flo 1,y gpd The issuance of this permit shall not be construed as a,guarantee that the system wj 1 funEt o as desig ` n (� Date � Inspector t ( 1, llt 3- ?�! - p 6 No. .. V 0?0" i b - -Fee (C THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS ;. ]Bisplosa1 *pstetn Construction Permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) System located at L n n c7 Vii I - j and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with s Title 5 and the following local provisions or special conditions.' >.: Provided:Construction must be completed within three f Years of the date of this permit. �,....•• ` ( p Date', �'} 'l Approved by Y'. �^��"'� Iro ham° ` ';141 VAN ar a A E S y 44( 12" rr' r I� Lt��Lt�` � YICfs '' g yd W k 3 ;S T' Pa Y„ .. B ti ib5liN.'ihtl1.11 `' €fit { Z i y/ - rr+ OKA gt�x �' � �`IIU"T3`dIn 111:(Sit�►�J�tY�C(.`1t � i �..: t IIIN 0- �Q l it-tl ` �'of is h�i� $1 - �s ,&c VIA �r ,r' �A°E A, MIr ' ��iY' r'�'i �'lek'11, '€ SY c i. 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Spay Ian tS�S 6 m cp,yl�a� rti ryitl&i ilea j)dot tia ai ck`6#I�7i�c�R, � tar dit�+lb5t�ri�nt+ � t� ItUC1�ttPr.p 4f7�5bin Ti�tnstllir� �ti+ tlnlbi sly tpCIcYS 4ormanS +pst3Cklili[r. a � Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 28 Leonard Rd Property Address Jessica Cisternelli Owner Owner's Name information is required for every Hyannis MA 02672 11-24-14 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. General Information �I a Q 1. Inspector: do Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 11-24-14 I spector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. I I 0 t5ins•3/13 Title JOfficial VF.,.: bsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 28 Leonard Rd Property Address Jessica Cisternelli Owner Owner's Name information is required for every Hyannis MA 02672 11-24-14 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: System is in good working order with no sign of failure. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain.. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 28 Leonard Rd Property Address Jessica Cisternelli Owner Owner's Name information is required for every Hyannis MA 02672 11-24-14 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal'System Form -Not for Voluntary Assessments 28 Leonard Rd Property Address Jessica Cisternelli Owner Owner's Name information is required for every Hyannis MA 02672 11-24-14 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form m Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 28 Leonard Rd Property Address Jessica Cisternelli Owner Owner's Name information is required for every Hyannis MA 02672 11-24-14 page. CityrFown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 1 0,000g pd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts - Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �7 28 Leonard Rd Property Address Jessica Cisternelli Owner Owner's Name information is required for every Hyannis MA 02672 11-24-14 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® -❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts T Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 28 Leonard Rd Property Address Jessica Cisternelli Owner Owner's Name information is required for every Hyannis MA 02672 11-24-14 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 11-2014 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 28 Leonard Rd Property Address Jessica Cisternelli Owner Owner's Name information is required for every Hyannis MA 02672 11-24-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Owner--pumped 5 yrs ago Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Maintenance Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 28 Leonard Rd Property Address Jessica Cisternelli Owner Owner's Name information is required for every Hyannis MA 02672 11-24-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1996 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 24"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): Depth below grade: 18"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) I If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gal Sludge depth: 12" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 28 Leonard Rd Property Address Jessica Cisternelli Owner Owner's Name information is required for every Hyannis MA 02672 11-24-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 20" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 28 Leonard Rd Property Address Jessica Cisternelli Owner Owner's Name information is required for every Hyannis MA 02672 11-24-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 28 Leonard Rd Property Address Jessica Cisternelli Owner Owner's Name information is required for every Hyannis MA 02672 11-24-14 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): Good condition with water at working level and no sign of back-up from field. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form = Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9 p Y rY �M 28 Leonard Rd Property Address Jessica Cisternelli Owner Owner's Name information is required for every Hyannis MA 02672 11-24-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: Infiltrators ❑ 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.): Leach field in good condition with no sign of back-up into d-box or surrounding stone. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 28 Leonard Rd Property Address Jessica Cisternelli Owner Owner's Name information is required for every Hyannis MA 02672 11-24-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts 01 Title 5 official Inspection Form t. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 28 Leonard Rd Property Address Jessica Cisternelli Owner Owner's Name information is required for every Hyannis MA 02672 11-24-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately ckc AE.L . a 47 F _ } - _ d Y. v 36 d t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 28 Leonard Rd Property Address Jessica Cisternelli Owner Owner's Name information is required for every Hyannis MA 02672 11-24-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: , 12'+ 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: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database- explain: You must describe how you established the high ground water elevation: Original design plans show no groundwater at 12'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 28 Leonard Rd Property Address Jessica Cisternelli Owner Owner's Name information is required for every Hyannis MA 02672 11-24-14 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE I-OCATION a8 Lr-owA2S1 koAn SEWAGE # VILLAGE.. " � ASSESSOR'S MAP& LOT --d A INSTALLER'S NAME&PHONE NO. E i(bVr SQnd 5�VIc '7:Z V 2-7 7 SEPTIC TANK CAPACITY l SCsn S� LEACHING FACILITY: (type) ,a Qlxd4, (size) xZ� NO.OF BEDROOMS 3 > B4MBER OR OWNER , PERMITDATE: /cl/_COMPLIANCE DATE:1 /tee Separation Distance Between the: ' Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by i }� � .. r � T � d.�. � � t - r� �'�' 4 ` � � �, o � � aye a � � �; ' � � No. Fee 40 . 00 THE COMMONWEALTH OF MASSACHUSETTS a '$ PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppitCatton for Mtoponl *pztem Com5trurtiun 3permit Application is hereby made for a Permit to Construct( )or Repair(x )an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. 28 Leonard Rd Steve MacConnell Hyannis Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. W.E. Robinson Septic P.O. Box 1089 Type of Building: Dwelling No.of Bedrooms 3 Garbage Grinder(n9 Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Description of Soil sand � A r5 he sh_ � install a 1 , 500 gal septic Na an f Re i or I r a° i( e e w eap tca lee e 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 Envir mental Co and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Bo of eaallth. Q, J Signed Date Application Approved by A Application Disapproved for the following reasons Permit No. Date Issued a .�+5.,. ,.. . .. _��. .1•_.. R-"=,'�_,,.- .� �r..,,..�:•rt.sw�-+ci,t+'1F"r's•'. a.:a.�-'... �-�• ".«. . ....s..:»�a+c .tr r. .�la:/.-t-» � ,. Y 'r �..a��,��..�:`,•a� No. Fee 4 0.0 0 TkIE COMMONWEALTH OF MASSACHUSETTS , PUBLICrHE•ALTH DIVISION TOWN'OF BARNSTABLE,MAS`SACHUSETTS" Rp rication for Migaal- *pztem Cori!5tructiott Permit Application is hereby made for a Permit to Construct( )or Repair(x )an On-site Sewage Disposal'System at: Location Address or Lot No. Owner's Name,Address and Tel.No. 28 Leonard Rd Steve MacConnell Hyannis Installer's Name, dd ess,and Tel.No. Designer's Name,Address arid'Tel.No. W.E. RoAbnson Septic. 6 P.O. Box 1089 ron t erY J Uca y Type of Building: Dwelling No.of Bedrooms 3 Garbage Grinder(not Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures i, _ Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title' aw;;A sand scription of Soil �A install a 1 ,500 gal septic NaTgilci eW�ey8ilca le) r 3 low-le- Date last inspected: ;r ' Agreement: :t The undersigned agrees to erisuie the construction and maintenance of the afore described on-site sewage disposal system in.accordarice with the provisions of Title 5 of the Envier Co and not to place the system in operation until a Certifi- cate of Compliance has been"issued by this Bo o ealth. Signed , Date 9 Application Approved by Application Disapproved for the following reasons r Permit No. 7 6 -s '`t { Date Issued of a •i c " THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Certificate`of Comviiattce THIS IS TO�CCERTIFY,tha the On-site Sewage Disposal System installed( )or repaired/replaced(x)on by W.E. Robinson Septc for Steve MacConnell as 28 Leonard Rd Hyannis has been constructe in a cordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 9 L `-s 7 dated .? G Use of this system's conditioned on compliance with the provisions set fo elow: . No. 96 ,7 Fee 40.00 i THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS xigogal &p.5tem Cott,5tructiott Permit Permission is hereby granted to W•E. Robinson Septic Service to construct( )repair( )an On-site Sewage System located at AddLeonard Rd Hyannis and as described in the above Application for Disposal System Construction,Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. All construction mus be co pleted within two years of the date below. �� Date: Approved by • t 1 I CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONS11UC7•ION I'EltMI'1' (IVI'1'11OU'I'DESIGNED PLANS) hereb `certify that the application for disposal works construction permit signed by me dated concerning the 1 property located at meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • 'The observed groundwater table is 14 feet or greater below the bottom of the leaching racilily • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. SIGNED DATE: / LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER lAttach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted). JJ I _ r Y F 1 r Ch a S:- I 1 LEGEND 67 _ _ EXISTING CONTOUR �1j, :_ c t. 28 Leonard Road , `• ; ' 10 min dllve-tome i--- x 100.98 EXISTING SPOT GRADE �;•_-.-- f_- S BENCHMARK r t l leonary P7 i - -flHl>b`- OVERHEAD WIRES d�r� I .. - .,, ��u w ,•t•- COR. BOTT. STEP . G EXISTING GAS SERVICE ? I _'dm _ -..�.- _'' --;--- I ' i• f. ';...---`;-- EL.=101.26 •,� , W EXISTING WATER SERVICE TEST PIT EXISTING SEPTIC TANK BENCHMARK TOP OF TANK, EL.=98.54 IN OUT=97.20t VERIFY �f" ItI, oN FOO. �� p x la! 9100.20 TP-1 ' LOCUS MAP 100.Q r- 10' GENERAL NOTES: NOT TO SCALE xx 1 100.67 + Q Q O y9: 51 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL PROPOSED S.A.S. BOARD of HEALTH AND THE DESIGN ENGINEER. 1 1 1_ 2-500 GALLON CHAMBERS 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS DECK B 1 ° SURROUNDED W/4' STONE OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE TO. 1 LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: �T�o1' 101, 1 ,.,1 , 1 X 100,501 I " 310 CMR 15.405(b) - LOCAL UPGRADE APPROVAL 1 :'I 1) An 8' variance, S.A.S. to cellar wall, for a 12' setback. 1 EXISTING S.A.S DE x 100.59 j� � 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR i TO BE REMOVED TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE SPA BH IN E DECK 1 (SEE.NOTE 11) DESIGN ENGINEER. � 1`L T��I '1 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING O x 100. 3 UJ FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN O O _ p Y ENGINEER BEFORE CONSTRUCTION CONTINUES. N O 0p C 100:75 00 0 tf 5. ALL ELEVATIONS BASED ON AN ASSIGNED DATUM. N EX/STING p 04 p i 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 0 HOUSE(jf28) 0 THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF N T.O.F.=101.3f N HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. Z 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. RI 7 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. 1 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS x 100 AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE ` 100:67 �z 100.83 +, DIRECTED BY THE APPROVING AUTHORITIES. 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY 100.41 , THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING LOT 8 0 of CONSTRUCTION. PAVED 100: 8 P�� 414 sp 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS c, DRIVEWAY 10'000f S.F. � � � yG IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND PETER T. REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). MCENTEE N 12, AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE OQP� 100.10 �100.00, v No CIVIL INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. N 68'58'00" W _ _ i- c`O 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND Rf6/S1� � NOT CONSIDERED TO BE A PROPERTY LINE SURVEY. F /0 L�G\ 14. THE ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED SEPTIC 100.13 100.01 99.89 99.76 99.64 99,51 99t32 SYSTEM COMPONENTS NOT SHOWN ON THE PLAN PROPOSED SEPTIC SYSTEM UPGRADE PLAN - LEONARD ; LOAD 28 LEONARD ROAD, HYANNIS, MA Prepared for: JTC Constractors, 1 Buttercup Ln, S. Yarmouth, MA 02664 OWNER OF RECORD Engineering by: SCALE DRAWN Job. N0. CISTERNELLI, JESSICA C Engineering Works, Inc. 1"=20' P.T.M. 196-20 277 OAKLAND ROAD 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. PARCEL ID: 268=015 1 WEST H•Y:ANNISPORT, MA 02672 (508) 477-5313 6/17/20 P.T.M. 1 Of 2 NOTE: TO PREVENT BREAKOUT, THE PROPOSED PROPOSED SEPTIC TANK FINISH, GRADE SHALL NOT BE < EL. 97.0 FOR A DISTANCE OF 15' AROUND THE PROVIDE RISER WITH FRAME & COVER OVER PERIMETER OF THE S.A.S. INLET & OUTLET MANHOLES AND SET OUTLET RISER PROPOSED D-BOX SHED TO FINISH GRADE. OUTLET COVER SHALL BE SECURED INSTALL RISER & COVER PROPOSED S.A.S. 43.1' TO PREVENT UNAUTHORIZED ACCESS. SET TO 6" OF GRADE INSTALL RISER & COVER OVER ONE CHAMBER AND 33.1' _ T.O.F--101.3t SET TO 3" OF F.G. TO SERVE AS INSPECTION PORT ; -0 F.G. EL.=100.6t F.G. EL.=100.Ot F.G. EL.=100.1f � F.G. EL.=100.2t �/� � MAINTAIN 2% SLOPE OVER S.A.S. DECK � � j� 5 M �� 0 1 N L = 6' L = 16'(MAX.) I (n S=1% (MIN.) p S=1% (MIN.) 4"SCH40 PVC 4"SCH40 PVC 2" LAYER OF 1/8" TO 1/2" DECK D -f-T6" w DOUBLE WASHED STONE RL110"I 6 aaa�aaB (OR APPROVED FILTER FABRIC) DECK ---- 74" 2' EFF. aaaaaaa BH R NS 8 10' EXISTING 48" LIQUID DEPTH aaaaaaa --3/4" TO 1-1/2" DOUBLE �v LEVEL ADD GAS PROPOSED 2.6' 4.8' 2,g' WASHED STONE 4' BAFFLE INV.=96.87 _ INV.=96.70 INV.=97.20 any EFFECTIVE WIDTH = 10' (VERIFY) 3 OUTLETS INV.=96.50 EXISTING Cy SEPTIC TANK H-10 2-500 GALLON LEACHING CHAMBERS WITH STONE AROUND AND BETWEEN CHAMBERS AS SHOWN INSTALL PIPE HOUSE(#28) H-10 RATED BETWEEN CHAMBERS T.O.F.=101.3f TOP CONC. ELEV.= 97.3t NOTES: BREAKOUT ELEV.= 97.00 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPES & INV. ELEV.= 96.50 aBaaa aBaOO aaaaa INVERTS EXITING HOUSE, PRIOR TO INSTALLATION. aaaa aa66a aaaa 2) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE BOTTOM ELEV.= 94.50 4' ENDS 8.5' 4' 1 SEPTIC LAYOUT ON A MECHANICALLY COMPACTED SIX INCH CRUSHED 4' OF NATURALLY OCCURRING STONE BASE, AS SPECIFIED 310 CMR 15.221(2). PERVIOUS MATERIAL EFFECTIVE LENGTH = 29.0' 3) INSTALL INLET & OUTLET TEES AS REQUIRED. 5' ABOVE GROUNDWATER 4) A GAS BAFFLE SHALL BE INSTALLED ON OUTLET TEE LEACHING SYSTEM SECTION MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. NO GROUNDWATER, EL.=88.6 - 3/4" TO 1-1/P DOUBLE WASHED STONE 3" LAYER OF 1/8" TO 1/2" ®E3 E3® 0 SEPTIC SYSTEM PROFILE DOUBLE WASHED STONE EO®®EO®®®®E3®E3 33" r IX ®®®®®®®®®®® (OR APPROVED FILTER FABRIC) N > Z ®QZE®®®®®®®® SOIL LOG 102" DESIGN CRITERIA DATE: JUNE 12, 2020 (REF#TPT-20-111) SOIL EVALUATOR: PETER McENTEE SE-1542 4" KNOCKOUT NUMBER OF BEDROOMS: 3 BEDROOMS WITNESS: DONALD DESMARAIS R.S.HEALTH AGENT 20" DIA. COVER SOIL TEXTURAL CLASS: CLASS I (LOADING RATE=0.74 GPD/SF) ELEV. TP- 1 DEPTH ELEv. TP-2 DEPTH 4" KNOCKOUT / 4" KNOCKOUT 58" 0"DESIGN PERCOLATION RATE: <2 MIN/IN -- 99:6 A 99.8 A 4". 0 DAILY FLOW: 330 GPD LOAMY SAND LOAMY SAND DESIGN FLOW: 330 GPD 10YR 4/2 10YR 4/2 4" KNOCKOUT GARBAGE GRINDER: NO-not allowed with design 99.1 B 6 99.3 B 6 LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF LOAMY SAND LOAMY SAND 500 GALLON CAPACITY, H-10 LOADING 10YR 5/4 10YR 5/4 .74 GPD/SF 96.9 32" 96:8 36" CHAMBERS EXISTING SEPTIC TANK: 1000 GALLON CAPACITY C PERC C PROPOSED D-BOX: 1 INLET, 3 OUTLET (MIN.), H-10 RATED 30"/48" USE 2-500 GALLON LEACHING CHAMBERS IN SERIES WITH PROPOSED SEPTIC SYSTEM UPGRADE PLAN STONE AROUND AND BETWEEN CHAMBERS (10.0' x 29.0') M-C SAND M-C SAND 28 LEONARD ROAD, HYANNIS, MA 2.5Y 6/4 SIDEWALL AREA: 2(10.0' + 29.0') X 2 = 156.0 SF 2.5Y 6/4 Prepared for: JTC Constructors, 1 Buttercup Ln, S. Yarmouth, MA 02664 BOTTOM AREA: 10.0' x 29.0' = 290.0 SF TOTAL AREA:............................................................. 88 .446.0 SF Engineering by: SCALE DRAWN JOB. N0. .6 132" a8.8 132" Engineering Works, Inc. N.T.S. P.T.M. 196-20 PERC RATE <2 MIN/IN: "C" HORIZON 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. DESIGN FLOW PROVIDED: 0.74 GPD/SF(446.0 SF) = 330.0 GPD NO GROUNDWATER ENCOUNTERED (508) 477-5313 6/17/20 P.T.M. 2 Of 2