HomeMy WebLinkAbout0016 LINDA LANE - Health 16 Linda Lane
Hyannis
I A= 248-160
l
TOWN OF BARNSTABLE
LOCATION �C� ,Ll�v ,LA® SEWAGE # l/
W' LAGE /r Y ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO.
as a
LEACHING FACILITY: (type) L (size)
NO. OF BEDROOMS
BI IIMDER O OWNER
PERMITDATE: COMPLIANCE DATE:
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
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LOCATION SEWAGE#
VIL]AGE���y,��'��, _ASSESSOR'S MAP &LOT �"lG�
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACIUN: (type)A (size)
NO.OF BEDROOMS
BUILDER OR OWNER 'T A
PERMITDATE: COMPLIANCE DATE:
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 o leaching cili Feet
Furnished by
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TOWN OF BARNSTABLE
LOCATION Ito SEWAGE# . ®t
VILLAGE VA-,4 ASSESSOR'S MAP&PARCEL aye - (y0
INSTALLER'S NAME&PHONE NO. L o.ux, �i,,,(4, If JrJ
SEPTIC TANK CAPACITY. /3'0 a f�
LEACHING FACILITY:(type) (size)
f l NO.OF BEDROOMS y
OWNER kjnwnu �
PERMIT DATE: j Zo 9 COMPLIANCE DATE: (P/ F5/20 L(
Separation Distance Between the: z
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility N0 `� �e— W 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 eAP4 r�`t�Q L� ✓�J3i3 ��GC�
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No. gCO Fee
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THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
01ppliLatlon for Disposal 6pstem Construction permit
Application for a Permit to Construct( ) Repair V-) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. C.a-t G !44.9-nr f Owner's Name,Address,and Tel.No.WAjr+e C4 r+5sa d1
Ho (,q-ne
Assessor's Map/Parcel 2 4$ (0 0 ! 4-2�713
Installer's Name,Address,and Tel.No. t 5':� Coe►M e4-'4K- Designer's Name,Address,and Tel.No. ELo - I ec 4
7 �� ? 3
Say.�(w;L� ✓h�9
Type of Building: j
Dwelling No.of Bedrooms 1 Lot Size r 00 0 ;� sq.ft. Garbage Grinder( )
Other Type of Building-. S�tiy�. ta yr, 1�; No.of Persons .Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 4, gpd Design flow provided gpd
Plan Date ►(,("- Z'o,<< Number of sheets ( - Two-Si J cd Revision Date
Title j(p L, vtc 4 Lw-,.k 1� n.,�•�
Size of Septic Tank t S Oy !j vi-t 14-to Type of S.A.S.CZ
Description of Soil
�. pip", cz'p 3 2 ,,
Nature of Repairs or Alterations(Answer when applicable) 14--to 0'66 2A(- �►L l
—7'rsv x_ (bCz e��,� —r��¢,..rt.t. t c�' 1-1 -0A 4A Aj)_S
Date last inspected: ®�
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordanc I e with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
c
Compliance has been issued by this Boar �Heth.
Signed , Date
Application Approved by Date 5, �l
Application Disapproved by Date
for the following reasons
Permit No. 9-01 — 1 f Date Issued
No. O�r � �-" Fee—mn/
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION,-TOWN OF BARNSTABLE, MASSACHUSETTS Yes
ftplitatlon for MispoBal *pstem Construction Permit
Application for a Permit to Construct( ) Repair V-) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address,and Tel.No.W Ayrne C t,f+S5 a ►j
- 16 G�Z�d�r Lane
Assessor's Map/Parcel -Z 4 g b
Installer's Name,Address,and Tel.No. 1 j,3 CoM E.�,1yL Designer's Name,Address,and Tel.No. c o _ T e c 4
C'4Oc-L id-e lift/ -/Sts 41 rr0__34, �e. � 3� - n �SY `l rJ,-0rgIC C,'.�i}
AiA
Type of Building:
;•f - Dwelling No.of Bedrooms Lot Size q osq.ft. Garbage Grinder( )
Other Type of Building 5;�,, �T No.of Persons Showers( ) Cafeteria( )
Other Fixtures
# t
Design Flow(min.required) 1 gpd J Design flow provided gpd
Plan Date YAA.,, V t_ 2� Number of sheets I - Two-e, Revision Date
Title It,
Size of Septic Tank 1 5 c)o c,4 e !d- !y Type of S.A.S.CZ
,
Description of Soil
n ha3tq
9
Nature of Repairs or Alterations(Answer when applicable)11 &)eW j.1-43 /)'7 6 S A.� hC nyo 1A
���- l�o k (� r/k t l �>> 'r f.Q,►.�/ +a t la 1�i -C%A O N" /l�� S / •.'ksv
r
Date last inspected:
Agreement: „
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordancre with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
-
Compliant-has -
been issued by this Board of Health.
Signed Date
Application Approved by �. .�► Date
Application Disapproved by Date
for the following reasons
i
Permit No. O�t� Date Issued S
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFiY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded( )
Abandoned.( )by (_�o✓1a�t c ' C ✓!�.`�c � I k-(_
at I I= Ie t-j s� 0�,,9.^-, ,, ; � has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No.901 1- 1571 dated � •��"
Installer ,n,,,,_L"Q� L--b�o� 0 e S LL L Designer��[o - 1 CL(,
#bedrooms Approved design flow -1 y , q 0i gpd
The issuance of this permit hall of be construed as a guarantee that the system wi�Y"fa`n 4oli a igned.
Date ( Inspector
----- ------------- --------•---------------------------------------------------------------------
No. golt " 15 Fee _
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Mlsposal *pstem Construction Permit
_-Permission is hereby granted to Construct( ) Repair(V Upgrade( ) Abandon( )
System located at_I d3—1 34 44 (-,-A-.4-�4,„„, 5
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 this permit.
Date�'�� I Approved by
Town of Barnstable
Regulatory Services
_ Thomas F.Geiier,Director
. I
' Public health Division
a Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Once: 508-8624644 Fax: 508-790-6304
Installer&Designer Certification Form
Date: ( - 1 -Zotf
Designer: �)fl y 1 Q D. CDOGH A JOW IZ Installer: �O o) ds
Address: 4-J T !A-Q6 L C 6R Address: F, o 13 o� 7 �,3
On die 44 0 f(5= was issued a permit to install a
(date) (installe )
septic system at tj 9' based on a design drawn by
(address)
NOD 0. COVGHt�NOL41Z dated_
(designer)
I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system) but.in accordance with State & Local Regulations. Plan revision or
certified as-built by designer to follow.
IN 6FMgSS
� q
�o DAVID �yG�
o D.
COUGHANOWR
(18"er s Sign e) No. 1093
G/STER�o
gNITARkNN
(Designer's Signature) (Affix Designers Stamp Here
PLEASE RETURN TO BARNSTABLE FUBLIC HEALTH.DMSION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT RECEIVED BY THE BA STAB' PUBLIC HEALTH DIVISION.
THANK YOU.
Town of Barnstable P#
Department of Regulatory Services
BAMSUB Public Health Division16 Z�
200.Main Street,Hyannis MA 02601 Date
Date Scheduled- �f /�
Time— Fee Pd.
Soil Suitability Assessment f or S wtage Disposal
Performed By: � �0,j6 H ow>Z P
'-� Witnessed By:
LOCATION& GENERAL FORMATION
Loca7Add �'�a
IPA -� Owner's Name
tile. CAl
�wSso„1
Address �� �,.�•�
Assesarr eL °L a(�IEngineer's NameNEW CTION REPAIR
-A-1Telephone# f -1
Land Use p 11-Z—I
1'q �`
�1
+ Slopes(96)1 V ' 'Surface Stones �D q 2
Distances from: Open Water Body 100 ft possible Wet Area too +
—_____ft Drinking Water Well �D� ft
Drainage Way 150 + ft Property Line 104
ft Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&Pere tests,locate wetlands in proximity to holes
1p`2
ub.Ci: �C
Ldr z
L
ck --
0
tiD.oc>rb
� tNO 4
Parent material(geologic) ry Odfi k Gi4dli 5 Depth to Bedrock e
Depth to Groundwater. Standing Water in Hole: V 14 a Weeping from Pit Race lot,C e
a �
Estimated Seasonal High Groundwater
I
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used: r D'tf l e 5
Depth Observed standing in obs.hole: in. Depth to still moUlcs: YlDtie G 13 Z Depth to weeping from side of obs.hole: �A 0 A {n, Groundwater Adjustment fr.Index.Well# Reading.Date: Index Well level- AdJ;factor
Adj,Groundwater Level,,,
PERCOLATION TEST ]bate S a I I ,�
Observation
f Hole# Time at 9"
.Hole
of Pero '76 /h
Time at6" �-�- 5
Start Pre-soak Time Q
190
End Pre-soak Time(9"-6") -�1f h
ii ��
4
s Rate MinJlnch
,+f Site Suitability Assessment: Site Passed Site Failed:
Additional Testing Needed(Y/N)
Original: Public Health Division + Observation Hole Data To Betornpleted on Back---=-----
***If percolation test is to be conducted within 100, of wetland,you must first notify the,
Barnstable Conseirvation Division at least one(1) week prior to beginning.
Q:ISEPTIGIPERCFORM.DOC
=" +
Y
DEEP-OBSERVATION HOLE LOG Hole#
7��
Soil Horizon Soil Texture
Sdil Color Soil G� c (USDA) (Munselp Other
Mottling (Stnucture,Stones;Boulders.
/1 P qkk LO�j,y1 ���� �l Misistenc y %Craven
mad to-LOAMY 4'�6
1`13 to qiz 67
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture
Surface(ia.) �, Soil Color Soil Other
• f (USDA) (Munsell
Mottling (Structure,Stones,Boulders.
'Ap' on i en go to e
�►ubl
- 3� e
.3Z- 132 Madj, 13 qj 6l3
DEEP OBSERVATION HOLE LOG Hole#
[Zurfkce(inj
pth from Soil Horizon Soil Texture
Soil Color Soil Other
(USDA) (Munsell) Mottling (Structure,Stones,Boulders.
it
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Flood Insurance Rate May:
Above 500 year flood boundary No—
Yes—Z Ir
Within 500 year boundary No✓ Yes +
t Within 100 year flood boundary No. 1! Yes
Depth of Naturally Occurrina Pervious Material i
Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the
area proposed for the soil absorption system?
If not,what is the depth of naturally occurring pervious material?
Certification J
I certify that on �c�✓ l �j (date)I have passed the soil evaluator examination approved by the
Department of Environmental Protection and that the above analysis was,performed by me consistent with .
the requir. ining,a rose a ex rience described in 310 CMR 15.017. .
_J L/C � u, zit
SI nature r'�'� 7 �
g Date�_
Q:\s.tPTIC\PERCFORM.DOC
COMMONWEALTH OF MASSACIIUSETTS
m
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS `
DEPART,IIENT OF ENVIRONMENTAL PROTECTION.---- a- _ .
ONE WINTER STREET. BOSTON. NIA 02108 617-292-5500
WILLIAMF.V1EI.D A j �r TRLD CORE
Go�•emo! 350 MAIN STREET oiyy .j t�� S n ecrgta
WEST YARMOUTH,MA t d o�
ARGEO PAUL CELLUCCI �.�G� 508-775-2800 ��y992 fDAV1D B.STR/UtiS
Lt.Governor OF�Jq� cp Commissioner
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORA e�
PART A %
CERTIFICATION I �
MAP 248 PAR 160
PROPERTY ADDRESS: 16 LINDA LANE,HYANNIS ADDRESS OF OWNER:
DATE OF INSPECTION: AUGUST 25, 1998 ANNE DUPLIN
NAME OF INSPECTOR: JAMES D.SEARS
I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 9310 CMR 15.000)
COMPANY NAME: A&B Canco
MAILING ADDRESS: 350 Main Street,West Yarmouth,MA 02673
TELEPHONE NUMBER: (508)775-2800 .
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,
accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper
function and maintenance of on-site sewage disposal systems. The system:
X PASSES
CONDITIONALLY PASSES
NEEDS FURTHER EVALUATION BY THE LOCAL APPROVING AUTHORITY
FAILS
INSPECTORS SIGNATURE: D DATE: AUGUST 26, 1998
The system Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this
inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall
submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the
system owner and copies sent to the buyer,if applicable and the approving authority.
INSPECTION SUMMARY: Check A, B, C, or D:
A] SYSTEM PASSES:
X I have not found any information which indicates that the system violates any of the failure criteria as defined in
310 CMR 15.303. Any failure criteria not evaluated are indicated below.
COMMENTS: SITE OVER ALL PASSES, INSPECTION OF SYSTEM IS BASED ON CONDITION OF SYSTEM
AT THE TIME OF THE INSPECTION.THERE IS NO GUARANTEE ON THE LIFE OF THE SYSTEM.
B SYSTEM CONDITIONALLY PASSES:
N/A One or more system components as described in the"Conditional Pass"section need to be replaced or
repaired. The system,upon completion of the replacement or repair,as approved b the Board of Health,will
pass.
Indicate yes, no,or not determined(Y, N,or NO). Describe.basis of determination in all instances. If"not determined",
explain why not)
The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of
a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)
years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally
unsound,shows substantial infiltration or exfiltration,or tank is failure is imminent. The system will pass
inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board
of Health.
(revised 04/25/97) Page 1 of 10
DE,'on the World Wide Web:http://www.magnet.state.ma.un/d
. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(CONTINUED)
Property Address: 16 LINDA LANE,HYANNIS
Owner: DUPLIN,ANNE
Date of Inspection: AUGUST 25, 19911
B]SYSTEM CONDITIONALLY PASSES(continued)
Sewage backup or breakout or high static water level observed in the distribution box is due to
broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. The system will
pass inspection if(with approval of the Board of Health). Describe observations:
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
The system required pumping more than four times a year due to broken or obstructed
pipe(s). The system will pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
C]FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
N/A Conditions exist which require further evaluation by the Board of Health in order to determine if the system
is failing to protect the public health,safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS
NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND
SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER
SUPPLIER,IF APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A
MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
The system has a septic tank and soil absorption system(SAS)and the SAS is within
100 feet to a surface water supply or tributary to a surface water supply.
The system has a septic tank and soil absorption system and the SAS is within a Zone
1 of a public water supply well.
The system has a septic tank and soil absorption system and the SAS is within 50 feet
of a private water supply well.
The system has a septic tank and soil absorption system and the SAS is less than 100
feet but 50 feet or more from a private water supply well,unless a well water analysis for
coliform bacteria and volatile organic compounds indicates that the well is free from
pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen and
nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance
(approximation not valid).
3) OTHER
(revised 04/25/97)
Page 2 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 16 LINDA LANE,IHYANNIS
Owner: DUPLIN,ANNE
Date of Inspection: AUGUST 25,199tt
Dj SYSTEM FAILS:
You must indicate either"Yes"or"No"as to each of the following:
N/A I have determined that the system violates one or more of the following failure criteria as defined in
310 CMR 15.303.The basis for this determination is identified below. The Board of Health should be
contacted to.determine what will be necessary to correct the failure.
Yes No
Backup of sewage into facility or system component due to an overloaded or clogged
SAS or cesspool.
Discharge or ponding of effluent to the surface of the ground or surface waters due to an over-
loaded or clogged SAS or cesspool.
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged
SAS or cesspool.
Liquid depth in cesspool is less than 6"below invert or available volume is less than''Y2 day flow
Required pumping more than 4 times.in the last year NOT due to clogged or obstructed pipe(s)
Number of times pumped
Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater
elevation.
Any portion of a cesspool or privy is within 100 feet of surface water supply or tributary to a
surface water supply.
Any portion of a cesspool or privy is within a Zone I of a public well.
Any portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private
water supply well with no acceptable water quality analysis. If the well has been analyzed to be
acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,
ammonia nitrogen and nitrate nitrogen.
E)LARGE SYSTEM FAILS:
You must indicate either"Yes"or"No"as to each of the following:
The following criteria apply to large systems in addition to the criteria above:
N/A The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a
significant threat to public health and safety and the environment because one or more of the following
conditions exist:
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
mapped Zone II of a public water supply well)
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater
treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department
for further information.
(revised 04/25/97)
Page 3 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 16 LINDA LANE,IHYANNIS
Owner: DUPLIN,ANNE
Date of Inspection: AUGUST 25, 199t)
Check if the followinghave been done: You must indicate "Y " r"N h f h following:
c to es o o as to each o the
Yes No
N/A Pumping information was provided by the owner,occupant,or Board of Health.
X None of the system components have been pumped for at least two weeks and the system
has been receiving normal flow rates during that period. Large volumes of water have not been
introduced into the system recently or as part of this inspection.
N/A As built plans have beE:n obtained and examined. Note if they are not available with N/A.
X The facility or dwelling was inspected for signs of sewage back-up.
X The system does not receive non-sanitary or industrial waste flow.
X The site was inspected for signs of breakout.
X All system components, including the Soil Absorption System,have been located on the site.
X The tank manholes were uncovered,opened,and the interior was inspected for condition of tees,
material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.
The size and location of the Soil Absorption System on the site has been determined based on:
X The facility owner(and occupants,if different from owner)were provided with information on
the proper maintenance of Sub-Surface Disposal System.
X Existing information. Ex.Plan at B.O.H.
X Determined in the field(if any of the failure criteria related to Part C is at issue,approximation
of distance is unacceptable)[15.302(3)(b)]
(revised 04/25/97)
Page 4 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 16 LINDA LANE,HYANNIS
Owner: DUPLIN,ANNE
Date of Inspection: AUGUST 25, 1998
FLOW CONDITIONS
RESIDENTIAL:
Design flow: 440 g.p.d./bedroom for S.A.S.
Number of bedrooms: 4
Number of current residents: 2
Garbage grinder(yes or no): NO
Laundry connected to system(yes or no): YES
Seasonal use(yes or no) NO
Water meter readings,if available(last two(2)year usage(gpd): 1997 370,000 CU.FT./1996 320,000 CU.FT.
Sump Pump(yes or no): NO
COMMERCIAL/INDUSTRIAL:
Type of establishment:
Design flow: gallons/day
Grease trap present:(yes or no):
Industrial Waste Holding Tank present:(yes or no)
Non-sanitary waste discharged to the Title 5 system:(yes or no)
Water meter readings,if available:
Last date of occupancy:
OTHER:(Describe)
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
N/A
System pumped as part of inspection:(yes or no) YES
If yes,volume pumped: 1,000 gallons
Reason for pumping PART OF INSPECTION
TYPE OF SYSTEM
Septic tank/distribution box/soil absorption system
X Cesspool
X Overflow cesspool
Privy
Shared system (yes or no)(if yes, attach previous inspection records, if any)
I/A Technology etc. Copy of up to date contract?
Other
APPROXIMATE AGE of all components,date installed(if known)and source of information:
UNKNOWN
Sewage odors detected when arriving at the site:(yes or no) NO
(revised 04/25/97)
Page 5 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 16 LINDA LANE,IHYANNIS
Owner: DUPLIN,ANNE
Date of Inspection: AUGUST 25, 1998
BUILDING SEWER: N/A
(Locate on site plan)
Depth below grade:
Material of construction cast iron 40 PVC other(explain)
Distance from private water supply well or suction line
Diameter
Comments:(condition of joints,venting,evidence of leakage,etc.)
SEPTIC TANK: N/A
(Locate on site plan)
Depth below grade:
Material of construction X concrete _ metal _ Fiberglass _ Polyethylene _ other(explain)
If tank is metal,list age Is age confirmed by Certificate of Compliance (Yes/No)
Dimensions:
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle:
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:
How dimensions were determined _
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,
structural integrity,evidence of leakage,etc.)
GREASE TRAP: N/A
(locate 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:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,
structural integrity,evidence of leakage,etc.)
(revised 04/25/97)
Page 6 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 16 LINDA LANE,HYANNIS
Owner: DUPLIN,ANNE
Date of Inspection: AUGUST 25, 1998
TIGHT OR HOLDING TANK: N/A (Tank must be pumped prior to,or at time,of inspection)
(Locate on site plan)
Depth below grade:
Material of construction concrete metal Fiberglass Polyethylene other(explain)
Dimensions:
Capacity:
Design flow: gallons/day
Alarm level: Alarm in working order _ Yes; _ No
Date of previous pumping: _
Comments:
(condition of inlet tee,condition of alarm and float switches,etc.)
DISTRIBUTION BOX: N/A
(locate on site plan)
Depth of liquid level above outlet invert:
Comments:
(note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc,)
PUMP CHAMBER: N/A
(locate on site plan)
Pumps in working order:(Yes or No)
Alarms in working order(Yes or No)
Comments:
(note condition of pump chamber,condition of pumps and appurtenances,etc.)
(revised 04/25/97)
Page 7 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 16 LINDA LANE, HYANNIS
Owner: DUPLIN,ANNE
Date of Inspection: AUGUST 25, 1998
SOIL ABSORPTION SYSTEM(SAS):X
(locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods)
If not determined to be present,explain:
Type:
leaching pits, number:
leaching chambers,number: _
leaching galleries, number: _
leaching trenches,number,length:
leaching fields,number,dimensions:
overflow cesspool,number, 1
alternative system:
Name of Technology:
Comments:
(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
OVERFLOW-BLOCK POOL, DRY,COVER 18"BELOW GRADE, POOL 7'6"DEEP,ONE LINE IN NO TEE.
WALLS ARE CLEAN.WATER MARK 20"UP FROM BOTTOM, NO SIGNS OF BEING HIGHER.
CESSPOOLS:X
(locate on site plan)
Number and configuration: 1
Depth-top of liquid to inlet invert: 20"
Depth of solids layer: 6"
Depth of scum layer: 0"
Dimensions of cesspool: 7'8"
Materials of construction: 13LOCK
Indication of groundwater: NO
inflow(cesspool must be pumped as part of inspection)
Comments::
(note condition of soil,signs of hydraulic failure, , level of ponding,condition of vegetation,etc.)
MAIN POOL,COVER 10"BELOW GRADE, POOL HAS TWO INLETS ONE OUTLET NO TEES. NOTE:OUTLET
LINE SAME LEVEL AS INLET,OUTLET LINE SHOULD BE LOWERED.
PRIVY: N/A
(locate on site plan)
Materials of construction: Dimensions:
Depth of solids:
Comments:
(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
(revised 04/25/97)
Page 8 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 16 LINDA LANE,HYANNIS
Owner: DUPLIN,ANNE
Date of Inspection: AUGUST 25, 1998
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100(locate where public water supply comes into house)
1/o.
O 0- 0
(revised 04/25/97
Page 9 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 16 LINDA LANE,HYANNIS
Owner: DUPLIN,ANNE
Date of Inspection: AUGUST 25, 1998
Depth to no groundwater 11 1/2 feet
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained fro Design Plans on record
X Observation of Site(Abutting property,observation hole,basement sump etc.)
Determine it from local conditions
Check with local Board of health
Check FEMA Maps
Check pumping records
Check local excavators,installers
Use USGS Data
Describe in your own words how you established the High Groundwater Elevation.(Must be completed)
NOTE: HAND DUG TEST HOLE, NO WATER AT 10'.TEST HOLE 2'6"BELOW BOTTOM OF POOL.TEST HOLE
NOTED ON PAGE 9.
(revised 04/25/97)
Page 10 of 10
t
A -
VARIAr rICE REQUESTED STREET
_a MAY BE GRANTED IMMEDIATELY BY HEALTH AGENT OR HEALTH INSPECTOR PINE S
us
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0 o Z n REQUIRED - VARIANCE TO A 13.7 f t A
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a o a ®_ Tic SEWAGE DISPOSAL SYSTEM PLAN
(0tt, XI -TO SERVE EXISTING DWELLING
® PL Ai1 N NOTES
0 0�
EST. WAYNE AND MARY CHASSON
LL 0
LL 4) EXISTING CESSPOOLS ARE TO BE PUMPED, OWNER(SI OF RECORD
IL II
SCALE: 9 In = 20 ft COLLAPSED AND REMOVED. EXCAVATE v 16 LINDA LANE
® ALL ASSOCIATED CONTAMINATED SOILS IN 1995
O ® � V V ( v 20 0 20 40 VICINITY OF PROPOSED LEACHING. AND �� '� HYANNIS. MA
0= REPLACE WITH CLEAN MEDIUM SAND PER TITLE 5. ON1��� PROPERTY ADDRESS
0 10 20 INSTALL A 4 Ft WIDE 40 MIL POLYETHYLENE ASSESSORS MAP 248 PARCEL 160
LINER AS INDICATED ON PLAN. 43 TRIANGLE CIRCLE .
SANDWICH MA 02563 PLAN BDOK 165 PAGE 41
INSTALL A CLEANOUT PLUG TO GRADE NEAR 508 364-0694
FLAGSTONE PATIO. DATE,: MAY 16. 2011
s _joe E T E—3 4 7 6 PAGE 1 :OF 2 VERSION:
1._
DATE TEST: MAY 11. 2011 SOIL TEST LUG SOIL EVALUATOR:" DID D. CM A R.S.
WITNESSED BY: OONALO DESARA[S. HEALTH DEPT. DESIGN CALCULATIONS
PERC NUMBER: 13270
DESIGN FLOW: 4 BEDROOMS X 110 GPD = 440 GPD
SEPTIC TANK: 440 GPO X 2 DAYS = 880 GALLONS
1 NO
GROTUNDDWATER ENCOGNTE ALD OUTWASH INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED)
TEST PIT
PERC AT 56 Im - 2 MIN/INCH IN C SOILS DISTRIBUTION BOX: USE 3 OUTLET H-20 D-BOX.
ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER SOIL ABSORBTION SYSTEM: INSTALL 13 ADS HIGH CAPACITY BIODIFFUSERS (1600BO)
(INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING 13 UNITS x 6.25 FL / UNIT = 81.25 L.F.
56.15 81.25 L.F. x 7.90 S.F./L.F = 641.88 S.F.
0-9 Ap SANDY LOAM 10 YR 3/3 NONE FRIABLE 641.88 S.F x .74 G.P.O. / S.F. = 474.99 GPD
9-32 B LOAMY SAND 10 YR 4/6 NONE LOOSE USE 13 HIGH CAPACITY BIODIFFUSERS AS CONFIGURED ON PLAN.
53.48 32-132 C MEDIUM SAND 10 YR 6/3 NONE LOOSE — VL = 474.99 GPD > 440 GPO REOUIRED
REFER TO DER APPROVAL LETTER TRANSMITTAL a W000052 FOR CERTIFICATION
45.15 OF ADANCED DRAINAGE SYSTEMS BIODIFFUSER SYSTEMS.
NO TEST PIT 2 PAARENOTUNDWATER MAATERIAL: PROGLAC ALD OUTWASH
2 MIN/INCH IN C SOILS
ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER 1500 GALLON SEPTIC TANK DISTRIBUTION BOX
(INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING DIMENSIONS AND DETAIL NOT TO
66.15 -- - --- - - '- USE-SHOREY--ST-9800-H-lo SCALE DIMENSIONS AND DETAIL USE SHOREY DS-3 H-10
0-9 Ap SANDY LOAM 10 YR 3/3 NONE FRIABLE
9-32 B LOAMY SAND 10 YR 4/6 NONE LOOSE
53.48 32-132 C MEDIUM SAND 10 YR 6/3 NONE LOOSE TAPER
12 in
w /VDT TO
45.15 SCALE N®�
FROM - •
0 0 O ,� TANK ®o ;' STO
AS
0 S ft- 0 0
0 8 In
NOTES ,� 6 an STONE BASE
Isis !� 6 CROSS SECTION VIEW
1) INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE STARTING WORK. �t�
2) SEPTIC TANKS SHALL BE INSTALLED LEVEL AND TRUE TO GRADE ON A LEVEL qg'
STABLE BASE THAT HAS BEEN MECHANICALLY COMPACTED AND ON TO WHICH 10 ft-Q !Py
SIX INCHES OF CRUSHED STONE HAS BEEN PLACED TO MINIMIZE UNEVEN SETTLING.
3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REOUIREMENTS
OF MASSACHUSETTS TITLE 5 _SEPTIC CODE (310 CMR 15), INLET CENTER OUTLET
._" , d. , EMI® COVER Ens®
4) INSTALL`E.R TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES 75
BEFORE EXCAVAT&LNG FOR ,,SYSTEM.
v... �3 IN DROP
L®!N LINE
5) EXISTdIN_G CESSPOOLS- TO BE PUMPED, COLLAPSED, AND REMOVED. FR®� _ —►
6) ALL,STONE ATO,:BE DOUBLE WASHED AND FREE OF IRON. FINES AND DUST IN PLACE. BULGING 90 In = 94 ` TO
:t
f r in D-BOX
7) ECO TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION OF LOW FLOW FIXTURES 48 an I� 76 -1
AND 'APPL.IANCES. -AND BIANNUAL PUMPING OF THE SEPTIC TANK. LIQUID GAS
LEVEL BAFFLE PROFILE
B) SYSTEWIS NOT DESIGNED `T`O'. WITHSTAND VEHICULAR LOADING. DO NOT
PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM.
16'
SEPARATION BETWEEN INLET AND OUTLET TEES 11
SHALL NOT EXCEED LIQUID DEPTH
CROSS SECTION VIEW 34
SECTION END CAP
16•" HIGH CAPACITY (H-20) BIODIFFUSER UNIT
MODEL 16-HICAP
SEWAGE DISPOSAL SYSTEM PLAN LENGTH 76
NOTE:UNIT CONFIGURATION AND AVAILABILITY SIB.£CT
PAGE 2 OF 2 EFFECTIVE LENGTH 75' DI CHANGE WITHOUT F NOTICE.AL PRCT DETAIL MAY
- DIFFER SLIGHTLY FROM ACTUAL PRCCUCT APPEARANCE.
SIDE WALL HEIGHT 11.2'
WAYNE AND MARY CHASSON DVERALL HEIGHT 16
OVERALL WIDTH 34- 4640 TRUIEMAN BLVO
16 L I N D A LANE 13.6 GF ® HILLIARD.GHIG 43026
CAPACITY 1101.7 GAJ 11 AUMCED ORANAGE SYSTEMS,M.
HYANNIS. MA
MAY 16. 2011 ETE-3478