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HomeMy WebLinkAbout0028 LINDA LANE - Health 28 Linda Lane Hyannis P A."=.248 3011 0 M � G I; r I} TOWN OF BARNSTABLE LQCATION 99 Linclo.. Lane. SEWAGE# 09609- I$S- f� Y, a nn s VILLAGE ^ -- ': ASSESSOR'S MAP&PARCEL 3o/ - a',l8 1114STALLERS NAME&PHONE NO. B B EXcama i o✓� 5�77- nGS3 SEPTIC TANK CAPACITY /000 Uaa//bA LEACHING FACILITY:(type) a - Tr enehes (size) x 3 x 3a- NO.OF BEDROOMS 3 OWNER 'dos �ornSara. PERMIT DATE: - G-/9 -o9 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 A b NO n W I � � I �o � Fee i" Entered in computer: THE COMMONUIIEALTH OF MASSACHUSETTS Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ft0rAtion for Misposal *pstem ConstrUttlon 3pCrmit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ',Z �Q L(;L(LQ_ Owner's Name,Address,and Tel.No. Soe C30nb"CL Assessor's Map/Parcel 249 30F V1 I S L CG } 1(l e Installer's Name,Address,and Tel.�¢ signer's N e,Address,and Tel.No. ,3b 2-4 6141 3 +ten -K6 bPr+EL 1 LFb�/ 11\ L94;W • to i t7 Q.a�t l.t19 Type of Building: Dwelling No.of Bedrooms Lot Size 1�� U�v sq.ft. Garbage Grinder( ) Other Type of Building .No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3 gpd Design flow provided �— / gpd Plan Date &t IQ (U 9 Number of sheets Revision Date Title 'Tl-+to ,5 ik la n Size of.Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date p�119 la 5 Application Approved by - Date V m _� Application Disapproved by I Date for the following reasons Permit No. > _ �a Date Issued .... ,. ,ufw+.,.:+'i,,'"M:.-r'+:R"'�„y"....,+wny►^.n.+�m,_.. .�.-� �.. __.,.. ._...,.h,....+..w...c ..-..,...t `"..n°","+.r++bhwr+v�:�a+',ysr-t.Is7+.� ,.,:d•....ra� .2:`^''+rr••a ti w-.-,..r-^'�++ , r5z, 4 No. q^ ti� �� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: . 1Z PUBLIC HEALTH DIVISION -TOWN OF�BARNSTABLE, MASSACHUSETTS Yes fpplication for Misposal 6pstent Construction Permit- Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 2 9 L i kcJ G L Cl a-,Q.,. Owner's Name,Address,and Tel.No. Toe f3c", 16c" c'- Assessor's Map/Parcel 2 Ll k .3o I ` -r of(�V) Installer's Name,Address,and Tel.No._�L'— `t 77 ' 0 bt)-!D Designer's Name,Address,and Tel.No. 3L Z. 9 6 4 1 13-fi B �xc fkv�i�C,t"1— IeG Ge( 1 6 1 Lf:C, Y ! Utah � P0— C I10 4 r�C_))_Ln —t1,ar 5 -+ C � MA \ r,rcvr� t•hG �r1 aA Type of Building: Dwelling No.of Bedrooms 13 Lot Size '�4 �.�. sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 gpd Design flow provided 3 L/ gpd Plan Date Number of sheets Revision Date Title 1 14 1 F l t 1 Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) t Date last inspected: } Agreement: a 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 �ofHe`alth:. w« Signed U U•61 _%_W_LL&Cj Date W I cj j i i Application Approved by - Date 6—1� 'D / Application Disapproved by Date for the following reasons Permit No. ®2 �a 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( ) Abandoned( )by __6`1 EX L n'V of+i G n at L t i<,C� t L cc LQ_ has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer --:)(J�7j� r 1 (`T I Designer lJU C.0 r1 _6 -) e nc-k t ;{' F f I n C, J 1 ..� #bedrooms t Approved design flow 33(.) gpd The issuance of this permit shall not be construed as a guarantee that the system will flu cti-n as designed. ( t / Date ��( � �!V Inspector __ .- -�7_ __--__.-- --------- ---•------------•----------• _ Fee No.. OG C1i� g THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION=BARNSTABLE,MASSACHUSETTS Disposal 6pstenr construction Vermit 11 Permission is hereby granted to Construct( ) Repair Upgrade( ) Abandon( ) System located at5 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-` Ca Date Approved by 11 FROM :down cape engineering inc FAX NO. :15083629880 Jun. 25 2009 01:15PM P1 1, M Towns of Barnstable Regulatory Services Marrarnnr�, a Thomas F. Gedcr, Director 6¢ Public Health Divi.sjon a Thomas McKean, Director 200 Main Street,ITY-arunis,MA 02601 Office: 508-862-4641 Pas: 508-790-6304 hilatafler& Designer Certifications Form i)aata:: a�f Q Sewage Permit# C DOa I Assessor's 1Viap\Paarec➢. �D/ °� 0- Designer: o W L Iraxtaaller: fit. / ✓at. e-,� Address: 1��..._.�Gt`r �...._. Address: ! H On _ _ _ was issued a permit to instaal,l. a (date) (installer) septic staller) septic system at _ �.� �4. �.Q� -�--� based on a.design drawn by / o (address) dated 17 -- . (des' ner) i certify that the septic systern,rel:eren.ced above was installed suhoantially according to the design, which may inchide rninor approved changes such as lateral relocation. of the . distribution box Find/or septic mak. 1 certify that the se;ptie system referenced above was installed with major changes (i.e. greater than, 1,0' lateral relocation of the SAS or any vertical relocation cif any component of the septic system) but in accordance with State & Local Regulations. Pan revision or certified as-built by designer, to..fotlow. SH OF 444Ss10. - ..._, .n ARNE H (TnstalJ.e.r s Signature) '� oJALA CIVIL No. 30792 (De"sagnerl , ignature) (Affix "A6., . _'tatup lien:) .P'.IXAtiE RETURN TO EQiRNSTABLE PIJIII,IC HEALTH DIV•ISIO (_;1 ➢dTIFICATF OF I COMPLIANCE WILL NOT BF ISSTTFYj ITiiTTIL Bo'm THIS FH)DtTi!I ANT) As-RUU,,,T CARD AI& i RECEIVED BY THE BARNSTABLE PUBLIC fTRAl-..,'I'll DIWSION. THANK YOU. Q:Hcalth/Septic/Desi�oer Certification Form 3-20-04.cioc i TR-ANS. NO,: CI'I TOWN: APPLICANT: e VZ ADDRESS: � li1�o/�- �N . ���.-► DESIGN]FLOW: gpd REVIEWED BY: DATE: N/A OK NO GEI�IET�L if r �1• .'l� y �F���I.titi^�< f, j?�. 4 tk�l �/ `� �``���'t�,°.Y!�1,yam#4-,,�'.�� `}- �r .<�ift-it.:K Legal boundaries denoted [310 CMR 15.220(4)(a)] Street, Lot, tax parcel number and lot number noted on plan [310 CMR 15.220(4)(u)] Locus Provided [310 CMR 15.2204(t)] Plan proper scale? (1"=40' for plot plans, 1"=20' or fewer for components) [310 CMR 15.220(4)] Easements shown [310 CMR 15.220(4)(b)] System located totally on lot served [310 CMR 15.405(1)(a) for upgrades]- if not, a variance is required [310 CMR 15.412(4)] Location of impervious surfaces (driveways, parking areas etc.) [310 CMR 15.220(4)(d)] Location all buildings existing and proposed 310 CMR 15.220(4)(c)] Location and dimensions of system components and reserve areas. [310 CMR 15.220(4)(e)] System Calculations [310 CMR 15.220(4)(01 daily flow septic tank capacity(required and provided) soil absorption system(required and provided) whether system designed for garbage grinder North arrow [310 CMR 15.220(4)(g)] Existing and proposed contours [310 CMR 15.220(4)(g)] Location and log of deep observation holes (existing grade el. on each test) [310 CMR 15.220(4)(h)] Names of soil evaluator and BOH representative [310 CMR 15.220(4)(h) and (i)] Location and date of percolation tests (performed at proper elevation?) [310 CMR 15.220(4)(1)] Percolation test results match loading rate? [310 CMR 15.242] Certification statement by Soil Evaluator [310 CMR 15.220(4)(j)] , Observed and Adjusted groundwater (method for adjustment given or indicated) [310 CMR 15.103(3) and 310 CMR 15.220(4)(n)] Address Sheet 1 of 7 N/A OIL NO Location of eve water supply, ublic and private, [310 CMR Lo everyP 15.220(4)(k)] within 400 feet of the proposed system location in the case f of surface water supplies and gravel packed public water supply within 250 feet of the proposed system location in the case within 150 feet of the proposed system location in the case o/ of private water supply wells Location of all surface waters and wetlands located up to 100 ft. beyond setbacks listed in 310 CMR 15.211 and any catch basins located within 50 ft. [310 CUR 15.220(4)(1)] - Water lines and other subsurface utilities located[310 CMR V/ 15.220(4)(m)] (if water line cross see 310 CMR 15.211(1)[11) Profile of system showing invert elevations of all system components and the bottom of the SAS [310 CNM15.220(4)(o)] Stamp of designer [310 CMR 15.220(1) and 310 CMR 15.220(2)] Stamp of Registered Land Surveyor(required if construction activities within 5 ft. of lot line) [310 CMR 15.220(3)] Test Holes adequate (two in each of the primary and reserve / unless trenches as permitted in 310 CMR 15.102(2) or as approved for an upgrade under LUA at 310 CMR 15.405(1)(k)] Test hole adequate to demonstrate four feet of suitable material? [310 CMR 15.103(4)] Test Holes adequate to confine adequate groundwater separation? 1310 CMR 15.103(3)] Benchmark within 50-75' of system [310 CMR 15.220(4)(q)] Materials specifications noted? [various sections of 310 CMR 15.0001 System components not> 36" deep (unless Local Upgrade Approval or LUA requested) [310 CMR 15.405(1(b)] Address Sheet 2 of 7 N/A OK NO Size OK? [310 CMR 15.223(1)] Inlet tee located ten inches below flow line [310 CMR 15.227(6)] Outlet tee 14" or 14" + 5" per foot for increase ft depth [310 CMR 15.227(6)] Outlet tee with gas baffle or approved filter [310 CMR 15.227(4)] Note regarding installation on stable compacted base [310 CMR 15.228(1)] Separation between inlet and outlet tees (no less than liquid depth) [310 CMR 15.227(2)] Inlet/Outlet elevations at least 12" above high groundwater (except as described 310 CMR 15.227(5)) or permitted for upgrades under LUA [310 CMR 15.405(1)(k)] Minimum cover 9" (Tanks buried more than 9" must have risers on all openings and on the d-box) [310 CMR 15.2228(1) and 310 CMR 15.232(3)(f)] Three access covers (inlet and outlet must be 20" or greater) - middle access at least 8" (by 7/07) [310 CMR 15.228(2)] Access to within 6 " of grade - one port for systems<1000gpd, two for systems>1000 gpd [310 CMR 15.228(2)] All at-grade covers secured to unauthorized access? [310 CMR 15.228(2)] > 10 ft from building foundation [310 CMR 15.211(1)] Buoyancy calculation Required/Done [310 CMR 15.221(8)] H-20 Where appropriate? [310 CMR 15.226(3)] Setbacks from resources [310 CMR 15.211] oe � �` ,-aurx�+avn,ya�[rmr• .vuvcs c Required when other than single-family dwelling or flow>jwith gpd [310 CMR 15.223(1)(b)] First compartment 200% daily flow; Second compartment daily flow [310 CMR 15.224(2) and(3)] "U" pipe through or over baffle, outlet of each compartme gas baffle or approved filter [310 CMR 15.224(4)] Address Sheet 3 of 7 N/A OK NO 1` Located at least ten feet from any water line? [310 CMR 15.222(2)] Disposal piping at least 18" below water line(when water and sewer cross, see 310 CMR 15.211(1)[11) Cleariouts required/provided? [310 CMR 15.222(8)] Thrust blocks specified in force mains? 310 CMR 15.221(6)(c)] Slope of sewer line not less than 0.01 (1/8"/fli) 0.02 preferable [310 CMR 15.222(6)] Proper pitch on all runs? (.005 within gravity-distributed trenches and beds) [310 CMR 15.251(9) and 310 CMR 15252(2)(c)] Siphon problem/ (leachfield below pump chamber) Endcaps or vent manifold specified? Size and orientation of discharge holes specified? (not smaller than 3/8" not larger than 5/8") [310 CMR 15.251(8) and 310 CMR 15.252(2)(h)] Materials specified (310 CMR 15.251(5) specifies various pipe l types allowed) Stable compacted base [310 CMR 15.221(2) and 310 CMR 15.232(2)(a)] Splash plate or baffle tee required on inlet/provided? (when pressure sewer to d-box or steep pitch of gravity sewer) [310 CMR 15.323(3)(a)] Riser if deeper than 9" [310 CMR 15.232(3)(f)] Inside minimum dimension 12" [310 CMR 15.232(2)(b)] Minimum sump 6" [310 CMR15.232(3)(e)] Watertight cover if<2000gpd); waterproof manhole if>2000gpd [310 CMR 15.232(3)(d)] Capacity(emergency storage above working=design flow)? [310 CMR 231(2)] Proper setbacks [310 CMR.15.211 (same as septic tanks)] Watertight 20-in minium access manhole at least 20"MUST BE TO GRADE [310 CMR 15.231(5)] Service components accessible (not too deep with piping, discomlects accessible) Alarm floats - alarm on circuit separate from pumps specified? Exceeds two units must have two pumps operating iln lead-lag mode. [310 CMR i5.231(6) and(e)] Stable Compacted Base [310 CMR 15.221(2)] Buoyancy calculations needed? Provided? [310 CMR 15.221(8)] Address Sheet 4 of 7 Y N/A OK NO Calculations correct? 4 feet of naturally occurring material demonstrated? [310 CMR 15.240(1)] Required separation to groundwater? [310 CMR 15.212)] Aggregate specified as double washed [310 CMR 15.247(2)] System Venting required/provided? (system under driveway or >36" deep) [310 CMR 15.2411 . Inspection ports specified and within 3"final grade? [310 CMR 15.240(13)] Breakout requirements met? (No violation of breakout elevation within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and Guidance Document] Chambers and Gal. in trench configuration supplied with inlet � pP every20 ft. [310 CMR 15.253(6)] Each structure with one inspection manhole(if>2000 gpd must be to grade) [310 CMR 15.253(2)] Aggregate I'minimum- 4'maximum. [310 CMR 15.253(1)(b)] 2' sidewall credit maximum [310 CMR 15.253(1)(a)] In bed configuration, inlet yy every 40 sq. ft. [310 CMR 15.253(6)] Width 2'minimum 3'maximum [310 CMR 15.251(1)(b)] 100 feet-maximum length [310 CMR 15.251(1)(a)] Minimum separation 2x effective depth or width whichever greater (3x if reserve between trenches) [310 CMR 251(1)(d)] Situated along contours [310 CNM 15.251(2)] Breakout OK? [310 CMR 15.211(1)[4] and Guidance Document] EJIDS (laan s : ® f�P1d50®Og z minimum 2 distribution lines [310 CMR„15.252(2)(a)] Maximum separation between lines 6' [310 CM R15.252(2)(d)] Maximum separation between lines and outside of bed 4' [310 CMR 15.252(2)(e)] Aggregate depth below discharge pipes 6" minimum, 12" maximum. [310 CMR 15.252(2)(g)] Separation between beds 10'minimum. [310 CMR 15.252(2)(f)] Bottom area used in calculations only [310 CMR 15.252(2)(i)] Address Sheet 5 of 7 [ I I �t N/A OIL NO F,IaCIF�PJL�ilE1tiII�VO���±;� ?sure Dosed Systean ? Provided pump and pipingulations as required [310 CMR 15-220(4)(r)] Pressure dosing required on all systems>2000gpd or alternative systems under remedial approval [310 CMR 15.254(2) and I/A Remedial Use Approvals] If used in gravelless system-make sure jet is directed as not to scour soil interface [Guidance Document] Inspections once per year (systems<2000 gpd) or quarterly (>2000gpd) good to note on plan [310 CMR 15.254(2)(d)] Construction in fill -Did the plan specify that the fill shall meet the specification of 310 CMR 15.255(3)? FEngmecr anter and/or retaining wall ? [Guidance Document] ous barrier installation must be supervised by 0 CMR 15.255(2)(b)] g wall must be designed by Registered Professional 10 CNIR 15.255(2)(a)] pe not exceed 3:1 ? [310 CMR 15.255(2)] ut requirements met? [310 CMR 15.252(2) and Guidance Document] At least 5 ft. from impervious barrier to edge of SAS (10 ft. recommended) [310 CMR 15.255 (2)(e)] terse Check DEP Approval letters for credits and design conditions If used with pressure dosing do not allow pressure discharge to scour soil interface y Was DEP Approval Letter provided and/or have you reviewed the letter for conditions? Is the technology being properly applied and does it meet all DEP Approval Conditions? Is there a note on the plan regarding the requirement for perpetual maintenance agreement? Any alarms involved on separate circuits Did the applicant submit n operation and maintenance manual? Has applicant submitted a copy of a maintenance e } Are the variances listed on the plan? [310 CMR 15.220 RLS Stamp necessary on plan if a component is within five feet of property line [310 CMR 15.412(4)] New construction or increased flow proposed- [Refer to 310 CMR 15.414] Address Sheet 6 of 7 x� w N/A OK NO Is the system in a Designated Nitrogen Sensitive Area(Zone H for a public supply well)? [310 CMR 15.214, 310 CMR 15.215 and / 310 CMR 1.5.216 - also refer to Policy regarding upgrades of such existing systems] Is the system proposed on the same lot as served by private well ? [310 CMR 15.214(2)] Are the nitrogen loads proposed in compliance? [310 CMR 15.216(1)] Pumping to septic tank ? [ 310 CMR 15.229] Shared System [310 CMR 15.290] Address Sheet 7 of 7 Town of Barnstable S P#_ Department of Regulatory Services a :g ttAANerAB� 1 Public Health Division Date 9 � 200 Main Street,Hyannis MA 02601 Date Scheduled b 6 Time lb M Qt) tee Pd. 1 Soil Suitability Assessment for Sewage isposal Performed By: - Witnessed By: - + 9 LOCATION&GENERAL INFORMATWN hcation Address .T Owner's Name Joe 13e1 fl bctre) .Zy 4(ncicl �ctne P' n l� t..` yv n Address Z LindaLa, NyA Assessor's Map/Parcel: LIS-1 ( -. Engineer'sName oLon(6, �•��1_ NEW CONSTRUCTION REPABt 7 t 1 J Telephone# y .,2_145 Land Use ^Flo Q Slopes M. —Z .12I Surface Stones e! /l f Distances from: Open Water Body. n1_14— ft possible Wet Area �,�//�—� ft Drinking Water Well v ft Drainage Way�L�j�—. {t Property Line /D' 7—' ft Other ft i SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests;locate wetlands I.proxim ty to holes) /10 10 \ 2° Parent material(geologic) (�l"U ��/�+ - t,' Depth to Bedrock-�J Depth to Groundwater. Standing Water in Hole: ON4_ � - - Weeping from Pit Face Estimated Seasonal High Groundwater NC-1) � DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: G Depth Observed standing in obs.hole: Depth to weeping from side of obs.hole: V1^� in. Depth to soil mottles: in Index Well# tn, Groundwater AdJustmen In Reading Date: Index We111eVel__ Ad,factor•,,,,,m,� • J AdJ.OrnundwaterLevel•,,,,, Observation PERCOLATION TEST bate 1 Time ION - Hole# „ 1 t Time at 9" /D O� Depth of Pere - Time at 6" S[art Pre-soak Time @ 10't.U0 1 Time(9".6") _ End Pre-soak ZIP) Rate Min./Inch Site Suitability Assessment:-Site Passed_� Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100'of wetland,you must first notify the. Barnstable Consefvation Division at least one(1)week prior to beginning. QAS EPTIt1PER C FO R M.DOC DEEP.OBSERVATION HOLE LOG Hole# � Depth from Soil Horizon Soil Texture .Sdil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. .. Consistency,%OrayeI DEEP OBSERVATION HOLE LOG Hole# 2— Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. consigtenry.% ravel 5y %y --- G,v r1 DEEP OBSERVATION HOLE LOG Hole# . Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mensell) Mottling (Structure,Stones,Boulders. Con i toGravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Sol] Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Cohsi t n I Flood Insurance Rate Map: Above 500 year flood boundary No_ -Yes Within 500 year boundary No— Yes Within 100 year flood boundary No— Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all.areas observed throughout the area proposed for the soil absorption system? -A� M If not,what is the depth of naturally occurring pervious material? Certification I certify that on �(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 required training,expertise and experience described in 10 CMR 15.017. Signature / Date Q:\SEPT1CTBRCFORM.DOC RM.DOC COMMONWEALTH OF MASSACHUSETTS REM EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION-7--.-- AUG 2 8 2003 TOWN OF BARNSTABLE HEALTH DEPT. TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: `l O' CO Z—,r,o MAR ., "-"1"4 09601 PARCEL 0 11 Owner's Name: G o i /ems Owner's Address: f n ejC1 /—,:;I �� LOT Anc- N f Q/ Date of Inspection: 30 Name of Inspector. (please print) Company Name: L "' - Tc'-C Mailing Address: O O C ,) sle -Asf d 6 qj Telephonic Number./So 2 7 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 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 on 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Fur7e,, valuation the Local Approving Authority Fails Inspector's Signature ¢_ 4 .—Date.—, The system inspector shall submit/Cop-v 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. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: of z l h d—� `-& Owner: 141C r Date of Inspection; X/101 03 Inspection Summary: Check A,B,C,D or E I ALWAYS complete all of Section D A., Sys�te Passes: !/ 1 have not found an information which indicates that an of the failure criteria Y y a described in 314 CMR 15.330.3 or in 310 CMR 15.304 exist, Any failum criteria nQt evaluated are indicated below, Comments: 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,ND)in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with 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. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipes)or due to a broken,settled or uncven chstribution bQx, System will pass inspection if(with . ,-, approval of Board of Health): broken pipe(s)are replaced — obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 tunes a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: r Page 3 pf I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: :;2 Owner: /�/C( OT Date of Inspection: 3o p 3 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 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and = the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,-provided that no other - failure criteria are triggered A copy of the analysis must be attached to this form 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMEATS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1-41 c+✓�vt / ©,- C b/ Owner: P1G le G Date of Inspection: 30 D. System Failure Criteria applicable to all systems: You must indicate``yes"or"no"to each of the following for all inspections: Yes _ V/ acicap 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 logged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or spool quid depth in cesspool is less than 6"below invert or available volume is less than''/2 day flow Required pumping more than 4 times in the last year NOT due to(;logged or obstructed i gg-.. _ p_pe(s). Number — �f times pumped y 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. 4/ Any portion of a cesspool or privy is within a Zone 1 of a public well. �y 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 eater than 50 feet from a greater private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal 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.] A/4�Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. _ You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no _ the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone I1 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system 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 CNIR 15.304.The system owner should contact the appropriate regional office of the Department. ` Page 5 of 11 OFFICIAL!NSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: L-I ?Cj-1, L 41 �/f ` o�,�f. �A D� Co� Owner: /"/ le ci --T Date of Inspection: bo C) 3 Check if the following have been done.You must indicate`yes"or"no"as to each of the following: Ye$/No Pumping information was provided by the owner,occupant,or Board of Health L/Were any of the system components pumped out in the previous two weeks V _ 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 es 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: Yes no L 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(3)(b)) Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: G, Cam► G Owner. �G le eA Date of Inspection: 0 0�7 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual):3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms). 3�� Number of current residents. a' Does residence have a garbage grinder(yes-or no):l'O Is laundry on a separate sewage system(yes or no): L1,D[if yes separate inspection required] Laundry system inspected(yes or no),,i O Seasonal use: (yes or no): //10 Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no): Last date of occupancy: L,L4 COMMERCIAVINDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): apd Basis of design flow(seatslpersons/sgft etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no):_ Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: /L C'�✓ ->Lq L /lH ;9�J Was system pumped as part of the inspection(yes or no): If yes,volume pumped:_gallons—How was quantity pumped determined? Reason for pumping: Uc tank,distribution bo soil .,_ TYP F SYSTEM —ep' x, absorption system — _Single cesspool Overflow cesspool —Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if own)and urce f information: /v-eW o/cfe✓ Were sewage odors detected when arriving at the site(yes or no): ��• Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: �� "' `ic, 41 Owner: �/ G �'ti Date of Inspection: 3 0 BUILDING SEWER pocate�qn site plan) Depth below grade: /L // Materials of construction:C,cast iron z' PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:_'�(locate on site plan) l/ Depth below grade: Material of construction:_ ncrete_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) �x Dimensions: Sludge depth: Distance from top of slue to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or bale: Distance from bottom of scum to bottom of�oe, tee or baffie: How were dimensions determined: r/�� vt Comments(on pumping recommendations,inlet and outlet tee or b&e condition, structural integrity,liquid levels as rel,4ed to outlet invert,evide of leakage, tc. 01"� GREASE TRAP•/ Oocate 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 bale: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): I ci f Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART.C SYSTEM INFORMATION(continued) 1/7 Property Address: Owner. el Date of Inspection: 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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: y(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert:41ao�"-10 Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into)ar out of box,etc.y�� / �� /I 4 PUMP CHAMBER /(/(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.): r TJ Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: d G-,h C J`i L- -,,/ Owner. / le:57 -�� Date of Inspection: 0 0 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: _ Type T aching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): rG,vt C �� Vl✓1�_ 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 ponding,condition of vegetation,etc.): PRIVY:�ocate 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.): f - Page 10 of 11 OFFICIAL INSPECTION FORAM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM EVFORMATION{coati) PtMmly Add►tse: Owner. 2 / DOr-oi:7aspection, SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks..Locate wells within 100 feet:L,oeate where public water supply enters the baihiing. 3 o 67- �4 I Page 11 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: �?l Z—(�' �� z Cl/ '1' " gyp/ Owner: AG lPG Date of Inspection: ZZ 0 0 7 SITE EXAM Slop Surfpce water Check cellar Shallow wells Estimated depth to ground water SS-Meet 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: Qbserved site(abutting property/observation hole within 50 feet of SAS) Checkedwit�sic. nardof Pam-explain: Gr� Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: �^ You must us de ribe how you established high and w to elevation: I r S. r G� rOliZ 60 yl Ir-v7f 01 7-al 07 i0000 r � Q7 0 0 Q ,Tt � I000 � `a t t 0 0 o a �r repo r A wd 9 �' ro ?-.> TOWN OF BARNSTABLE C- L .tiT'IO1r::�d8 �Adt� ' it Ale SEWAGE # VILLAGE S ASSESSOR'S MAP & LOT _1 6 l �?STALLER'S NAME&PHONE NO. )2 S— 3 3 3 X owe.o m ez ce SEPTIC TANK CAPACITY /'S C cd Ale I LEACHING FACILITY: (type) (size) 19ML lde)e) NO.OF BEDROOMS 3 BUILDER OR OWNER C.o- e M e. e. . PERMUDATE: 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 `� �11 4 (�" � . ' �. t� � W .d r �/'"� �� ��� � . � . ti. � ` ��\ � �� �� ���� �� � � 1 �' t' a� o �, �, � - I! LOfCKTION E W A G E PEjJWT NO. aw VILLAGE �-- - I✓1 ova .4a S � �� _ _�_ �Lo d INSTALLER'S NAME 8 ADDRESS �' V'�� Trucking e 2ulld07,ing A7 1 G _ - _ — o ea "r,.er do1, iVp1 71f CCi Hyannis, Muss. 775-0828 8 U I'L DE R OR OWNER DATE PERMIT ISSUED DAT E : COMPLIANCE ISSUED 50e 3 a � �� .� �� � �, � � �� � ` � � �, >> '� . �� � N � .��. :� . �, '�,� . :� No. '�®—� Fee 5 0.0 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Zippfication for ;Migpoga1 *pgtem QCongtruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 28 L 0 u i s e McLean Owner's Name,Address and Tel.No. 28 Linda Lane Hyannis,Mass. Louise McLean Asseswr's.Map/Parcel A 5 O 301 28 Linda Lane Hyannis,Mass. Installer's Name,Address,and Tel.No. 5 0 8-7 7 5-3 3 3 8 Designer's Name,Address and Tel.No. 5 0 8-7 7 5-3 3 3 8 J.P.Macomber & Son Inc. J.P.Macomber & Son Inc. Box 66 Centerville,Mass. 02632 Centerville,Mass. 02632 'lope of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) 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 Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Replacing caved in 1000 g a l l o n septic tank with a 1500_gallon septic tank. 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 Certifi- cate of Compliance has been iss by ' Board of Heal . Sign Date8/1 4/0 0 Application Approved b Date — Application Disapproved for&follo g reasons \ Permit No. 1060 Date Issued i TOWN OF BARNSTABLE , C- LOCATION dB AAI,e SEWAGE # ,�000.- VILLAGE ; �; IVAAWI S ASSESSOR'S MAP & LOT �L� INSTALLER'S NAME&PHONE NO. _??S-- 3 3 3 Y lniko P*7 ez2. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) �► r3 /� (size) NO, OF BEDROOMS 3 BUILDER OR OWNER L,o-�, M c- c�•.� PERMITDATE: - t C�COMPLIANCE DATE: I.S -ed jSeparation 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 - i Furnished by 5�( �o �b i No. 1 _ $ 5 0.0 0 ? Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS' 01pprication for �Digoml *p!5tem Cottgtruction Vermit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System O Individual Components~ Location Address or Lot No. 28 LiMadae McLean Owner's Name,Address and Tel.No. 28 Linda Lane Hyannis,Mass. Louise McLean Assessor's Map/Parcel 301 0 / 22 Linda Lane Hyannis,Mass. I taller's Name,Address,and Tel.No. 5 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.No. 5 0 8—7 7 5—3 3 3 8 .P.Macomber & Son Inc. J.P.Macomber & Son Inc. Box 66 Centerville,Mass. 02632 Centerville,Mass. 02632 Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) 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 Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Replacing caved in 1000 gallon sePtio tank with a 1500 gallon septic tank. Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenanceof the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Erivirorimental Code"and not to place the system in operation until a'Certifi- Cate of Compliance has been iss ed by Board of Heal h. Sign e0_7 ' Date8/14/0 0 i Application Approved b Date e Application Disapproved for th follo ' g reasons Permit No. 100 Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance �- THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired(XX)Upgraded( ) Abandoned( )by J.P.Macomber & Son Inc. at 28 Linda Lane Hyannis.,Mass_ has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No dated Installer J.P.Macombeer& Son Inc, Designer J-P.Macom er & Son Inc. The issuance of this permit shall not be construed as a guarantee that the syste will unction as designed. Date J�f' —" S' Inspector Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS i!5 ogaY *pgteut Cou.5truction Vermit Permission is hereby ranted to Construct( )Repair(XX)Upgrade( )Abandon( ) System located at Linda Lane HYannigplAass. 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 this permit. Date: - f _OZ2 Approved by I �` I/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMTr (WITHOUT DESIGNED PLANS) I, Joseph P.Macomber Jr. hereby certify that the application for disposal works construction permit signed by me dated 8/1 4/0 0 concerning the property located at 28 Linda Lane HYannis,Mass. meets all of the r following criteria: • The failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. • There are no wetlands within 100 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • There is no increase in flow and/or change use proposed ro sed • There are no variances requested or needed. • The bottom of the proposed leaching facility will n2 be located less than five feet above the maximum adjusted groundwater table elevation. (Adjust the groundwater table using the Frimptor method when applicable) /= If the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed leaching facility will M be located less than fourteen (14) feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) B) G.W. Elevation ' 4 +the MAX. High G.W. Adjustment. 7 DIFFERENCE BETWEEN A and B AN,, /.-/ SIGNED : DATE: 8/14/00 w' (Sketc oposed plan of system on back). q:hulth folder,Bert r" C �. ,Ai i v �.r pjp� [I .�. f x ,J 1 � � �• i �s •' ALL SYSTEM PROFILE MARKED HCOMPONE BE NOTES PROVIDE MIN. 20" DIAM. WATERTIGHT (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. 1. DATUM IS APPROX. NGVD (GIS SPOT EL.) ACCESS COVERS TO WITHIN 6" OF FIN. GRADE -- - \ TOP FOUND. EL. XX.X' PROVIDE INSPECTION PORT TO WITHIN 3" OF FINAL GRADE 2. MUNICIPAL WATER IS EXISTING o 53.75' 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM PRECAST H-10 4. DESIGN LOADING FOR ALL PROPOSED PRECAST RISERS (TrP.) 4'�SCH40 PVC UNITS TO BE AASHO H-1Q 53.9' PIPES LEVEL 1ST 2' 50.75 3' MAX 5. PIPE JOINTS TO BE MADE WATERTIGHT. ��cc 2" PEASTON,�jj OR GEOTEXTILE EXISTING FILTER f"AB C OVER STONE 0.75 MIN 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE 10" 1000 GAL H-10 14 " WITH a TEE SEPTIC TANK TEE 52.5'f* 6" MIN. SUMP °o°o° o°o°o°o°o°o°o°°°o°°°o°o°o°o°o°o°o°o°o° 0°0 °0°° 310 CMR 15.000 (TITLE V.) \e RE-USE)** 0°0000000000 12" MIN. INT. DIAM. '/ oO°OOOOOOO°°°°°O°OOOOO°OOOOOOOOO°°oOOOOO°O°°°°°°° °°°°°°°°°°°°° GAS BAFFLE °°°°°°°°° 50.25 0°0°0° o °o °o °o°o °o o °o°o°o° o 0n0no�°^°_ 2.2.° O ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° 481 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND o 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 \a ° ° °O°O°O°O°°°O°O°O°°°°°O°O°O°O°O°O°O°O°O°O°O°O °°O°O°°°°°°°°°O 50.47' 50.3 NOT TO BE USED FOR LOT LINE STAKING OR ANY °0+•0 o,o 0 0 0 0 0 VON O6" DOUBLE SINASHEDET AT 03/4" S 1 1/2" STONE� OTHER PURPOSE. • o 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0O0 0O°O°O°O°O°°° °°°°°° °°°° °°°°°°°° - 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. oio, o 0o�o_n_n_q_o_� 0 0 0 o n n_n_ n_o.o o �r(2) 32'x�' 'x2' EEP TRENCHES 6" CRUSHED STONE OR MECHANICAL 5' 9. COMPONENTS NOT TO BE BACKFILLED OR o COMPACTION. (15.221 [21) CONCEALED WITHOUT INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED FROM BOARD OF HEALTH. BOTTOM TH 1 EL. 43.1' 10. CONTRACTOR SHALL BE RESPONSIBLE FOR LOCUS MAP CALLING DIGSAFE (1-888-344-7233) AND ( 6.5% SLOPE) SLOPE) VERIFYING THE LOCATION OF ALL UNDERGROUND & NOT TO SCALE SCALE 1"=2000'f OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF FOUNDATION- EXIST. SEPTIC TANK 31' D' BOX 7p LEACHING WORK. ASSESSORS MAP 301 PARCEL 248 FACILITY 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE REMOVED 5' BENEATH AND AROUND THE SEPTIC UPGRADE ONLY (NO CONSTRUCTION *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL **INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT PROPOSED LEACHING FACILITY. PROPOSED) UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS 1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM WITH 1500 GALLON H-10 SEPTIC TANK IF NOT SUITABLE. 12. EXISTING LEACHING FACILITY SHALL BE PUMPED LEGEND- AND EGENDAND REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. 99- EXISTING.CONTOUR PROVIDE 14' OF 40 MIL LINER VARIANCES FOR SEPTIC SYSTEM REPAIRS WHICH MAY BE x 99•1 EXIST. SPOT ELEV. AT 5' OFF SAS IN AREA IMMEDIATELY GRANTED BY THE BOARD OF HEALTH AGENT OR SHOWN. TOP AT EL 50.6. BY HEALTH INSPECTOR 99 PROPOSED CONTOUR BOTTOM AT EL. 46.6' (ENGINEER TO INSPECT PAPERWORK AND HEARING REDUCTION PROPOSALS APPROVED �9g 4) PROPOSED SPOT EL. ) BY THE BOARD OF HEALTH REVISED DURING A PUBLIC 54.12 HEARING HELD ON MARCH 10, 2009 TH1 18 2) FAILED SYSTEMS ONLY : SEPTIC SYSTEM COMPONENT TO TEST HOLE 110.00' FOUNDATION SETBACK, IF AN IMPERVIOUS LINER IS DESIGNED AND INSTALLED. 2' SLOPE OF GROUND x 4.12 SYSTEM DESIGN.- UTILITY POLE 8" 0 WH. 12" x 54.40 54 ly FIRE HYLAANT TH 1 O OA PIN OAK GARBAGE DISPOSER IS NOT ALLOWED NOTE: NOT ALL SYMBOLS MAY APB IN oRAwlNc DESIGN FLOW:' 3 "BEDROOMS 0 110- GPD`= 330 GPD z + BENCH MARK - CORNER OF USE A 330 GPD) DESIGN FLOW TEST HOLE LOGS 10. - e , o ® 9 e^�VQ, "LKHEAD EL. 56.3 SEPTIC TANK: 330 GPD (2) = 660 ENGINEER: ARNE H. OJALA, PE, SE '`'- 0 54.78 o RE-USE EXIST. 1000 GAL. SEPTIC TANK** DECK O WITNESS: DAVID W. STANTON, RS 3.41 x 54.73 O LEACHING: DATE: JUNE 17, 2009 SIDES: 2[2 (32 + 3) 2 (.74)] = 207 GPD < 2 MIN/INCH EXISTING DWELLING BOTTOM 2[32 x 3 (.74)] = 142 GPD PERC. RATE _ TOP FNDN. EL. 56.S o cs 0 -Q CLASS I SOILS P# 12598 po 55.13 TOTAL: 471 S.F. 349 GPD / USE (2) 32' LONG x 3' WIDE x 2' DEEP LEACH TRENCHES ELEV. ELEV. 53.51 WITH 4" PERF. PVC PIPE AND DOUBLE WASHED STONE oftV 53.2' 0" 53.8' 55. 8 55.64 A q / 55 LOT 3 11,000E SF LS LS 55.15 MA 4„ 1OYR 6/2 8„ 1OYR 6/2 53.31� ^? APPROVED DATE BOARD OF HEALTH Bw Bw / 54 z� TITLE 5 SITE PLAN LS LS o 110•p0, �x 53.26 OF 10YR 5/6 10YR 5/6 53 36" 50.2� 36" 50.8' -x .83 - 28 LINDA LANE .10 .41 2 CENTERVILLE L.1NpA BAN PERC PREPARED FOR MCS MCS B&B EXCAVATION/BOMBARA JUNE 18, 2009 2.5Y 7/4 2.5Y 7/4 o off 508-362-4541 s fax 508-362-9880 o ALA. �G� o IVfi downcope.com o D L.A.�`t 1 °� DANIEL � > 6/r ( � � � OJALA down cope engineering, Inc. 120 43.2 120" 43.8 , Nc. 19 j ` Q�. 4 \ s x civil engineers Scale: 1"= 20' p, e� .� �`���`� 9 �, �� �- land surve ors NO GROUNDWATER ENCOUNTERED �/���� � ,s�- .e� � ����., y ( QNA, 9J9 Main Street ( Rto 6A) 09- >26 a 10 x 30 40 5o FEET DATE DANIEL A. OJALA, P E7% L.S. YARMOUTHPORT MA 02675 09-126b&b.DWG