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HomeMy WebLinkAbout0030 MARK'S PATH - Health 30 Mark's Path Hyannis P A = 271 094005 w TOWN.OF BARNSTABLE LOCATION 3() MS P4`I--I SEWAGE# VILLAGE Oq Ai, 4 I`L_ASSESSOR'S MAP&PARCEL cZ1 j' f -. -D INSTALLER'S NAME&PHONE NO. OceeL--r 8. ocAtL (/SpS1111- 0877 SEPTIC TANK CAPACITY 1000 gg2j . LEACHING FACILITY.(type)Ica,. CAkA01AWS (size) 62.83 �S NO.OF BEDROOMS 3 (� OWNER h?J:J}qe- at Jo MA eU 1 ),JTE5 PERMIT DATE: I p 1 t g 2( COMPLIANCE DATE: I I O Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom.of Leaching Facility t-�O ® 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) 2 Feet FURNISHED BY OLA-2 00 . r , 5 0 . 7- - A Z 3 ► 13 V -r At -35:7 30 Zq.� d A — � 7-0 1 .O No. Fee °THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 0[ppliLatlon for MI8jposal *pstem (Construction Permit Application for a Permit to Construct( ) Repair A Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Addressor Lot No. 30 6yJRKs P4 r 4 HV Owner's Name,Address,and T 1.No. Assessor'.s Map/Parcel a 1 ,<o ��►. MA �( !S Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 50 V5",;L73-C 377 festfr � oZ-1,� 111 Type of Building: Dwelling No.of Bedrooms 3 Lot Size �J sq.ft. Garbage Grinder( ) Other Type of Building i yp g ��j['����`��,, No.of Persons Showers( . ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided 3gc1`Lj gpd Plan Date Number of sheets / Revision Date Title 3t) t-14kKS ('t�4-rH Y4A4VIS Size of Septic Tank I j(3P0 OACJ 1JS Type of S.A.S. -x CH444 Description of Soil CeAA E= AO i — ✓ t� g 6t57 Nature of Repairs or Alterations(Answer when applicable) Q!S; GX 1<7_ e.l6. a 600 G4-Q_',Q&) 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 Enviro ental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of4eal / 1 Signed �2 C Date I® "'t 3 Application Approved by Date 6� - r Application Disapproved by Date for the following reasons Permit No. 0 Date Issued No. Fee a r' THE COMMONWEALTH OF MASSACHUSETTS Enterednicomputer: r+ PUBLIC HEALTH DIVISION - TOWN OFSARNSTABLE, MASSACHUSETTS Yes 0(pplitatlon for MispoBAY 6p6tem Construction Permit Application for a Permit to Construct( ) Repair A Upgrade( ) Abandon( ) ❑Complete System ❑Individual Componens at Location Address or Lot No. 0 ST(4 W 'Owner's Name,Address,and Tel.No. -. R taTt`F<JR -I— SO m4Rl F FON/T6 ; Assessor's Map/Parcel �� —.05 !►: ,n MAkk� P142`4 RV,* l.5 , Installer's Name,Address,and T`eel.'No. Designer's Name,Address,and Tel.No. 502-; 73•©377 G �1tJ�Er.let.k�aG �. rr 3(.3 W l T Z -PAgr4 5 AP .o uTrO Type of Building: c f Dwelling No.of Bedrooms Lot Size .0 S y sq,,ft. Garbage Grinder( ) Other Type of Building tZ Ell pr3 }r L No.of Persons /�F Showers( ) Cafeteria( ) Other Fixtures Y Design Flow(min.required) 330 gpd Design flow provided 3q9,44 gpd Plan Date �p,'Z I Number of sheets „ Revision Date t Title .3(3 M.4p,��� Size of Septic Tank t Oaf � � Type of S.A.S. Description of Soil oA R54F ; rA?j A.tit' ✓&ZrL `f S 65- 04AAJ Nature of Repairs or Alterations(Answer when applicable) L)!S 5&rlG. T)+Nk. 'T'D 1UdW 1-1-�c) D,-43,00 T-p &*L o&) I'l okU W IM 416607 x9P ,4C-k&QCd*_75 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 t place the system in operation until a Certificate,of. Compliance has been issued by this Board VWealth�.Signed ,: , / I Datet '"�.®r Application Approved by T ,( , Date r 4 Application Disapproved by Date for the following reasons b Permit No. U�' t"` �' Date Issued I rrl f .. THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CEERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired O. Upgraded( ) Abandoned( )by PG Q -r e ©u p. cio at 3 o l M W� PAM4 has been constructed in accordartpe �� y� f with the provisions ��of,,,,,Title 5 and the for Disposal System Construction Permit No. U !1— dated t o f 1 I Installer O+,ac."."x 0 d0R. �.ot,/ Designer LTG l��i1X�t (X1CT °xm— #bedrooms Approved design flow 330 gpd The issuance of this permit shall not be construed as a guarantee that the system will functio as designed. Date �/Fj! / Inspector i ------------- No. U' / Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS -Misposal *pstem Construction Permit Permission is hereby granted to Construct( +) q�Repair(�) �[t Upgrade( ) Abandon( ) System located at' (� K.. PW ! I T X my(S 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 prossions or special conditions. Provided:Construction must be completed.within three years of the date of this permit. .-"'" Q � � Date to— (C.1 h►•� � Approved by "Jr Town of Barnstable Regulatory Services a r Richard V. Scali, Interim Director IARNSfABLE. Public Health Division ►+ °. Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: 11-11-21 Sewage Perm RN Z021 3$7.-Assessor's Map\Parcel 271/94-05 Designer: JC Engineering,Inc. Installer: Robert B. Our Co., Inc. (RBO) Address: 2854 Cranberry Highway Address: 363 Whites Path East Wareham,MA 02538 South Yarmouth,MA On 101 i ZI RBO was issued a permit to install a (date (installer) septic system at 30 Mark's Path based on a-design drawn by (address) JC Engineering,Inc. dated 10-8-21 (designer) X 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. Strip out (if required) was inspected and the soils were found satisfactory. 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. Strip out(if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed i iance with the terms of the I\A approval letters(if applicable) C JOHN L 6G�� C14URCHILL,IIt, ( to er s nature) CML 4� 41 o�. (D ner's Signature. (Affix.De t p Here) PL E RETURN TO ARNSTABLE PUBLIC HEALTH D SION. CERTIFICATE OF. COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doe { 24=0" --5'40' 10=0" --4•_1'.-2'4'x4'-0' 2=4 00'OLX&ck 16-2• "Re ts: 12'-4 W 1 o I 14:9. iv OF o :3,-1" A O \x Or )O x new bath / +; w X 9 x � N x i y n? existing slid r `X O I X � stonpe sna -.� to I � iv new living room area w x 4'--O" r----9'-11" M--0" MRS GEORGE Builder. TIMOTYH GRAY Finish baserrwif Buildup 6 Rwmodwnp he 70 irrks Pop "rwrm rl I COmmorwedtth Of MOSSOChuseffs ,John Grad ExeeutNe Office of ErMromwlintal Affairs John Title V Septic Inspector Department of P.O. Box 2119 Environmental Protection Te(508)08) 5 MA 02536 564-6813 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM �O PART A CERTIFICATION 'f" qt Property Address: 30 MaTA Path Hyannis Address of Owner: ` 7 Date of Inspection:6124197 (If different) TRl 199 l w Name of Inspector:John Graci Mrs.George Qp Company Name,Address and Telephone Number: 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 This Inspection Is based on criteria defined in Title V _ Conditionally Passes code 310 CMR 15.303.My findings are of how the system is performing at the time of the Inspection.My Inspection does _ Need7;erFurtheraluation By the Local Approving Authority not Imptyanvwarrantvorguaranteeof the longevitvofthe Falls septic system and any of its components useful life. Inspector's Signature: Date: 6124197 , The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. 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: Aj SYSTEM PASSES: X I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B) SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes,no,or not determined(Y, N,or ND). Describe basis of determination in all instances. If "not determined", explain why not.) The septic tank is metal, cracked,structurally unsound, shows substantial infiltration or exfiltration,or tank 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 11115195) One Winter Street • Boston,Massachusetts 02108 . FAX(617)556-1049 • Telephone(617)292-5500 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ` PART A II CERTIFICATION(continued) Property Address: 30 Marks Path Hyannis Owner: ,Mrs.George Date of Inspection:6124197 _ Sewage backup or breakout or high static water level observed in the distribution box is due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): 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: 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 PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone 1 of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria volatile organic compounds indicates that the well is free from pollution for that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm. 3) OTHER Dj SYSTEM FAILS: 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. Backup of sewage in facility or system component due to an overloaded or clogged SAS or cesspool. 6 Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged cesspool. SAS is in hydraulic failure. (revised 11115195) 2 , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 30 Marks Path Hyannis Owner: Mrs.George Date of Inspection:6124197 DJ SYSTEM FAILS(continued) 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 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Numbers 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 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. 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: The following criteria apply to large systems in addition to the criteria: 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: 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) 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 11/15195) 3 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 39 Marks Path Hyannis Owner: Mrs.George Date of Inspection:6124197 Check if the following have been done: X Pumping information was requested of the owner,occupant, and Board of Health. -!-None of the system components have been pumped for at least two weeks and the 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. GaAs built plans have been 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,excluding the Soil Absorption System,have been located on the site. X The septic tank manholes were uncovered,opened, and the Interior of the septic tank was Inspected for condition of baffles or tees,material of construction,dimensions, depth of liquid, depth of sludge, depth of scum. X The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. x The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11115/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 30 Marks Path Hyannis Owner: Mrs.George Date of Inspection:6124197 RESIDENTIAL: FLOW CONDITIONS Design flow: 330 gallons Number of bedrooms: 2 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: nla Last date of occupancy: n►a COMMERCIAL/INDUSTRIAL Type of establishment: nla Design flow:0 gallons/day Grease trap present:(yes or no) No Industrial Waste Holding Tank present:(yes or no) No Non-sanitary waste discharged to the Title 5 system: (yes or no) No Water meter readings,if available: nla Last date of occupancy: Na OTHER:(Describe) nla Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System was last pumped two years ago. System pumped as part of inspection: (yes or no)No If yes,volume pumped: 0 gallons Reason for pumping: nla TYPE OF SYSTEM X Septic tank/distribution box/soil absorptions system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous.inspection records,if any) Other(explain) APPROXIMATE AGE of all components,date installed(if known)and source information: 12 years old. Sewage odors detected when arriving at the site:(yes or no) No (revised 11115/95) 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . PART C SYSTEM INFORMATION(continued) Property Address: 30 Marks Path Hyannis Owner: Mrs.George Date of Inspection:6124197 SEPTIC TANK: X (locate on site plan) Depth below grade: 3.5' Material of construction:X concreate_metal_FRP_other(explain) Dimensions: L 8'6'H 5'7'W 4'10' Sludge depth:2' Distance from top of sludge to bottom of outlet tee or baffle: 25' Scum thickness:4' Distance from top of scum to top of outlet tee or baffle:4' Distance form bottom of scum to bottom of outlet tee or baffle: 16' 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.) Septic tank and all components are structurally sound.Recommend pumping system every two years for maintenance. GREASE TRAP: (locate on site plan) Depth below grade: n1a Material of construction: _concrete_metal_FRP_other(explain) Dimensions: n1a Scum thickness:n1a Distance from top of scum to top of outlet tee or baffle:nla Distance from bottom of scum to bottom of outlet tee or baffle: Na 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.) Na (revised 11H5195) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 30 Marks Path Hyannis Owner: Mrs.George Date of Inspection:6124197 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: rUa Material of construction:_concrete_metal_FRP_other(explain) Dimensions: Na Capacity: n1a gallons Design flow: n1a gallons/day Alarm level: n1a Comments: (condition of inlet tee,condition of alarm and float switches, etc.) rda DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: n1a Comments: (note if level and distribution is equal, evidence of solids carryover,evidence of leakage into or out of box etc.) n1a PUMP CHAMBER: (locate on site plan) Pumps in working order.(yes or no) Comments: (note condition of pump chamber,condition of pumps and appurtenances, etc.) n1a (revised 11115195) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 30 Marks Path Hyannis Owner: Mrs.George Date of Inspection:0124197 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: nia Type: leaching pits,number: 1,000 gallon leach pit leaching chambers,number:n1a leaching galleries,number: n1a leaching trenches,number, length: n1a leaching fields,number,dimensions:n1a overflow cesspool,number:n1a Comments:(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) The leach pit appears to be functioning property,however pit is unaccessabie due to electrical lines over cover. CESSPOOLS: (locate on site plan) Number and configuration: n1a Depth-top of liquid to inlet invert: n1a Depth of solids layer: n1a Depth of scum layer: nia Dimensions of cesspool: n1a Materials of construction: n1a Indication of groundwater: n1a inflow(cesspool must be pumped as part of inspection) nia Comments:(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.) n1a PRIVY: (locate on site plan) Materials of construction: n1a Dimensions: n1a Depth of solids: n1a Comments:(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.) nia (revised 11115195) 8 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 30 Marks Path Hyannis Owner: Mrs.George Date of Inspection:0124197 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' 10 C� DEPTH TO GROUNDWATER Depth to groundwater:12 feet method of determination or approximation: USGS Maps and Charts (revised 11115195) 9 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION 4 h Sy RECEIVED MAY 13 2004 TITLE 5 TOW HE�ALTBH DEPT.BLS OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 30 Marks Path,Hyannis Owner's Name:Alice George Owner's Address: 30=Marks Path,Hyannis,MA 02601 Date of Inspection: 04/27/04 MAP 22) Name of Inspector:Brian T.Axon PARCEL Company Name:A&K Septic Systems Plus LOB' Mailing Address:565 Carriage Shop Road East Falmouth,MA 02536 Telephone Number: 508-540-6706 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 Section 15.340 of Title 5(310 CMR 15.000). The system: X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority- _ Fails .Inspector's Signature: _ Date: 04/29/04 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. Notes and Comments: System functioning fine.There is no evidence of failure criteria. System consists of 1000 gallon tank with d-box and leaching pit.Electric and gas lines over pit.Did not dig but ran video camera and d-box v looks fine. ""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:30Marks Path,Hyannis Owner:Alice George Date of Inspection: 04/27/04 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X 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: 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 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 obstruction is removed distribution box is leveled or replaced ND explain: 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 obstruction is removed ND explain: R 7 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:30 Marks Path Owner:Alice George Date of Inspection: 04/27/04 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 C1bdR 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 160 feet but 50 feet or more from a private water supply welly*.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 ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:30 Marks Path Owner:Alice George Date of Inspection: 04/27/04 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _ X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool — x Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool x Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool x Liquid depth in cesspool is less than 6"below invert or available volume is less than'h day flow — x Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped x Any portion of the SAS,cesspool or privy is below high ground water elevation. x Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. x Any portion of cesspool or privy is within a Zone I of public well. x Any portion of a cesspool or privy is within 50 feet of a private water supply well. x 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 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.] x (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 4 _ _ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone R 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. Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:30 Marks Path Owner:Alice George Date of Inspection: 04/27/04 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health VA1T_ v ui'a�of il1V J''JLVLI VV111�V11VL1LJ j./LlI11tIV•J VYL 11a ti4,Yr v'rivu.�i viv vi�n.a�.i? �t IS.....41....E.a,...�.�........,...7. �1..,..., .,�1..� .,+.......�,....1.....,.:...t _ u•L•L.lµa�jV vv1L•auw va vuwL vvvu lla•.aVuuvw w uaV uyuwaaa IVvvaala) vi'u•i'tTua L'va'LaaaS'uauYvvuvu? 1...:1a..1...... ..CaL., �.,... 1.a..'»—A .1 :.• .17/Tf ai........,,�....,,� :l..i.l„ AT/A.ATA ♦I V1V NJ VU..L F YL1J VL L11V Jy'JLVIII VV&µ LV "ILU VAK111111VL1: `ll L11Vy' YYV1V ILVL L V"µ V1 11VLV WJ I'II L.1 LEA W=e1>e f... it .....L.�oll:.s.. .,..�...s..s...7.G.� ..f.. 1..>.+1. ? TT7........11 ..a,.... «.. ...1..A:....A... Q A Q 1..:..• _A 'a,. A _� �1 V1V 41l J�'JLVlll VV111�V11V11LJ, VAV1L14111g L1lV U'1V, IVVLLLVU Vll J1LV iU..,....♦1.,.�.•..m�..s,....l..,....,.e.L.:.l.......,.......,.+�.,..d ----A --A s3....:.a....,.:...,.,..f�1...s...+l.:.........,,s....l C�al.... condition of the baffles or tees.material of construction.dimensions. den_th of lia_uid.deoth of slud_ae and den_th of ;i..r? A •11t1J LI1V 14V11L1�' VYY ILVI `µa1Ll VVVVk/lIl1LJ lr U14W—---1 la Vl11 V W11Vr��rV Y1uV4 W1LIl 11 V1111LLLIVlI Vll t11V Fr:•'=:1__s r sr �i_L a L CI=tSriaG� ?b�!4 e.i1jWp. ? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no _ Existing information.For example,a plan at the Board of Health. X _ 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:30 Marks Path Owner:Alice George Date of Inspection:04/27/04 FLOW CONDITIONS RESIDENTIAL 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 Number of current residents:2 Does residence have a garbage grinder(yes or no):no Is laundry on a separate sewage system(yes or no):no[if yes separate inspection required) Laundry system inspected(yes or no):no Seasonal use: (yes or no):no Water meter readings,if available(last 2 years usage(gpd)):038660 Sump pump(yes or no): no Last date of occupancy: current COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): jwd Basis of design flow(seats/persons/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: no information available Was system pumped as part of the inspection(yes or no):no If yes,volume pumped: --How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool _Privy _Stared 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 known)and source of information: 1986,owner Were sewage odors detected when arriving at the site(yes or no):no Page 7-of 11 OFFICIAL INSPECTION FORM--NOT FORNOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL- SYSTEM-INSPECTIONFORM- PART-C .SYSTEM IN:FORMATION(continued) Property Address: 30 Marks Path- Owner:Alice George Date of Inspection: 04/27/04 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction:_cast iron _40 PVC_other(explain): Distance from-private water supply well-or suction line: Comments(on condition ofjoints,venting;evidence of leakage, etc.): SEPTIC-TANK -x locate on site plan) Depth below grade: 3.5' Material of construction: x concrete_metal_fiberglass_polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions:standard 1000 gallon tank Sludge depth: 2" Distance-from-top-of sludge'to-bottom of outletue`or baffle: 23" -Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle: 10" Distance from bottom of scum to bottom of outlet tee or baff3e:20" How were dimensions determined:-field instruments Comments(on pumping-recommendations, inlet-and outlet-tee or baffle condition, structural-integrity;liquid levels as related to outlet invert,evidence of leakage,etc:):-Recommend pumping every two years. Structural integrity is fine.Liquid levels in relation to tees are fine. GREASE TRAP:-NA(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(on pumping recommendations, inlet and-outlet-tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Page-8-of ll OFFICIAL- INSPECTION FORM--NOT FOR'YOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM-INSPECTION-FORM PART-C SYSTEM INFORMATION'(continued) Property-Address: 30 Marks Patin Owner:Alice George Date of Inspection: 04/27/04 TIGHT or HOLDING TANK:- NA (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:- g (if presentmust-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.): Distribution is equal:No evidence of solids carryover or any evidence of leakage: PUMP-CHAMBER: NA(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.): e Page-9 of I OFFICIAL INSPECTION FORM-NOT FOR-VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART-C SYSTEM INFORMATION(continued) Property Address: 30-M—arks Path- Owner.-Alice George Date of Inspection: 04/27/04 SOIII:ABSORPTION SYSTEM(SAS): x (locate—on—site-plan;excavation-not required) ff-SAS not located explain why: Type .X .leaching.pits,.number: -1 leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: Dverftow_cesspo o1,-.number: innovative/alternative system Type/name of technology: Comments(note condition ofsoil,,.signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): Condition of soil'and vegetation is fine.Electric and gas lines appear to be over pit.Ran video camera to d=box and there is no sign of solids carryover.Everything looks fine. CEISSPOOLS:_NA (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: NA (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): �. Vage 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS- SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM -PART-C SYSTEM I�Ti FORMATION.(continued) Property Address:30 Marks Path Owner:Alice George Date of Inspection: 04/27/04 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 all wells within 100 feet. Locate where public water supply enters the building. G��uy� a 3 _ A d o E13 41 9 a' 41l Page 11 of 11 q - OFFICIAL- INSPECTION FOR?4—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM -PART-C SYSTEM JINF'ORTNIATION(continued) Property Address: 30 Marks Path Owner:Alice George . Date of Inspection: 04/27/041 SITE EDAM Slope r°' Surface water Check cellar Shallow wells = Estimated depth to ground water 20+feet Please indicate(cheek)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: 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) _x Accessed USGS database-explain: You must describe how you established the high ground water elevation: USGS groundwater maps indicate groundwater at 20+feet. tI�I f ------- GMar LOCATION SEWAGE PERMIT NO. # VILLAGE INSTALLER'S NAME i ADDRESS B UILDER OR OWN ER i ' DATE PERMIT ISSUED -7- DAT E COMPLIANCE ISSUED 4 �_�� w � o � No.... _:_J . .......Fsa. THE COMMONWEALTH OF MASSACHUSETTS .� BOAR® OF HEALTH ..............OF...... ..................................... Applilratiaau for Dispasa1 Works Towitrurtion omit Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at: • -�.1.%�+��.. ..............� - --••--•------ ........ ................................... ---------------------------------- Location-Address or Lot No. ..........-•--•-------.........................................•--•••--•--•-•------••------•--•-- ..........-•...................................................................................... e e - Address af' _........ n 1 ..................................... ----------------------•---...........------............ Installer Address Type of Building Size Lot.fl Z �.____..._..Sq. feet Dwelling—No. of Bedrooms.._..._..._................... ........Expansion Attic ( ) Garbage Grinder (No) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures -----------------•-•---••-----•--- . W Design Flow............$—S...................... per person per day. Total daily flow_______----7-q-0....................gallons. WSeptic Tank—Liquid capacityAVP...gallons Length "_.. Width¢`!t?_�"... Diameter................ Depth. � `.._- x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.........I---------- Diameter,...rAf'___-___- Depth below inlet,?e.k.7_..... Total leaching area..A.;F%-----sq. ft. Z Other Distribution box ( ) Dosing tank ( ) a Percolation Test Results Performed Date___. ......... a Test Pit No. 1......�......minutes per inch Depth of Test Pit....l ........ Depth to ground water..�/o_.. f=, Test Pit No. 2................minutes per inch Depth of Test Pit-______.•.•_____-_-• Depth to ground water------ . O tLOFly��ii ----•---••--------------------------------------•-------------•-----•-•-•--...--••------•----......-----....._....-•---•......•-------•- , Description of Soil-- --�-� �vop..j o !✓1...._4`._30.10 8 -4-11 ................ ......... ROGER yG . .....3 >" ®/44 11 ?�oaTs.�� r1.�IIO t` C�.e.��eaC.. .....--_ Ut - ----•-•------•----------------•-•-------------------••------------------•-------- c� MINHf�JEWICZ ....z—__�-------------------- - o.30420 U Nature of Repairs or Alterations—Answer when applicable.__.___........................................................... G� Agreement: The and rsi ed agrees to install the aforedescribed Individual Sewage Disposal System cco da with 1 J the provision f� TLC 5 of the State Sanitary Code— The undersigne further agrees n t to place the syst m in�/ J opera ' u ti�ertificate of Com lia e ha n is d b the oard health. P P � �41.;, A� Signed .. Dat Application Approved By............. ....... ----- ---•------------•------------------ -------•--- Date Application Disapproved for the following reasons:.......................................................... ---••-----------•----•---------------•---•••••--•-••- -•--•-•--------------•------------------------•-----••-----------------------------------....---------•----•••-•-----•-••-------••-•--------•---•••------------ ---------- ------••=••---•---••-•---•- o Date Permit No....._.P'�— � � 2 -----• Issued----------------_ 1`S ..25 D t. No......Q""-^•J FEB.............................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .............OF.....Vol* A».4,.................................... ApplirFation for Ubtipaaal Hlorkg Tomitrurtiuu Prrutit Application is hereby made for a Permit to Construct ()() or Repair ( ) an Individual Sewage Disposal System at: !ef-d-0---.__•�6!"y'saW,r f�5-------- -•--...---•--...-!Cs " .. ...................................................... Location.Address or Lot No. -------------------__----........... ............................................. ..........--...................................................................................... Owner Address -----------------•----•----•-' � y_ Installer Address UType of Building Size Lot./_`/.�"' .......Sq. feet Dwelling—No. of Bedrooms,.......................................Expansion Attic ( ) Garbage Grinder (Nd) Other—Type e of Building No. of persons............................ Showers � YP g ---------------•------------ P a ( ) — Cafeteria ( ) Otherfixtures -----------------------------------------------------------------------------------------------------------------------------••--------------------- W Design Flow..._____._414 ______________________gallons per person per day. Total daily flow........... ' Q__________.__________gallons. R Septic-Tank—Liquid capacityl.V4---gallons Length 'O''___ Width¢Jd"__. Diameter---------------- Depth_✓­10c". W x :Disposal Trench—No ____________________ Width.................... Total Length.....................Total leaching area....................sq. ft. % Seepage Pit No......... Diameter____!.__._.....:-Depth below inlet+ .. .7_..._ Total leaching area_. _S__._.sq. ft. Z n' Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-_�' ,P€. t 'ra!�? � 15� � *t Date___ _"'_ " ------ ,� Test Pit No. 1.....$......minutes per inch Depth of Test Pit.___ &......... Depth to ground water___,O.v �. (s Test Pit No. 2................minutes per inch Depth of Test- Pit.................... Depth to ground water.----------- 'A OF O Description of Soil-_sQ_"'- --- ? 4e4A9 4-ow.-Jo" 8 ,�/ I.dsvclg' Rl7C�ER : �G C lr?4b!. t-3a" ' i �I. '"-.-�?�,!....V_,�T!_..47t►;, ��!!/O e <.-AO.t.C�., .•-- w _:f�.911L v� a` Z. 1. . ?- 1 .•...----..-•.-•.................. ......•---------••------•-•--•-•------------....------------------.................._._.._.._.. -�® MICH d- ...N' "420 Q fA U ,t. - Nature of Repairs or Alterations—Answer'when applicable------------------------------------------------------------------------ C! it. •---•- . . 4v� 3~ ................................................................................ !__________________________________________________________________________ Agreement: r , The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in ac o anc m. the provisions of r77T�:. 5 of the State Sanitary Code—The undersigned further agrees not to place e system i / operation until a Certificate of Compliance has been issued by the board of health. iSigned------•--•-----------------•--------...------.......-•---------....-----•......-•-•-- Y Date Application Approved By................. .: -�.. - " Date Application Disapproved for the f o owing reasons------------------•-=----- ----------------------------------•-----------------------------------------.----- --•....---•-•. -•••................••--••--•---•--•-----•-•••••••-••••................................................................---••-----....................... -•-- •------•••-•..._..-- Date Permit o......_©...._. . ~..14 Issued....... ate THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH t� ..........................................O F..................................................................................... T rtifirFatr of TuutpliFaurr THIS IS TO C - F� Y,Fhat the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by-••-•---•---•-•----•----•---••-•--....•-••-••-••••............................. .... ------ �...•-. at....................................................... •----- -----------•......•••--=•-Installer.................. ....-••---•----•-•-•--. has been installed'in accordance with the provisions of 'PI-LE j of The State anitary Code s des ibed in the application for Disposai Works Construction Permit No------- ��-__.____. da.ted_.----- ........... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE S A GU AN THAT THE SYSTEM WILL FUNCTION SSATISF�CPjORY. DATE.......................... .-.----- ...... -.................. Inspector.........................................---•----- TH�,COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH /c{C� ..............................ar.--.................................................................................. No......................... FEE........................ t r 4tr ion rrutit Permission is hereby granted..........-- .. ••--•••••-•••••--•----........•--•••......--••---------------•--.......................................................... to Construct ( or Repair (, ) Indi idua ewage Disposal System fy.. at No............�. �•--��.. Street as shown on the application for Disposal Works Construction Permit"No. __` �?Dated_.__.___7_.......�.._.....__. ---------••------•-------•-•--•---•------ ---------- DATE .._ 1 Q s----•--•---•................................... Board of Health ..... .. • ..------ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS 4 - FINISH GRADE OVER D-BOX= 55.1 t _ , , PROP.VENT WITH CHARCOAL FILTER TO ABOVE GRADE _ + FINISH-GRADE OVER CHAMBERS- 55.2 - 54.8 , „ „ L NOTES T.O.F. EL. 56.1 ° 314 TO 1-1/2 DOUBLE WASHED - SLOPE @ 2/o MIN.OVER SYSTEM PROVIDE EXTENSION RISER REMOVABLE WATER TIGHT COVER OVER STONE TO CROWN OF PIPE ;, 1. UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION WITH COVER OVER INLET& RISER TO WITHIN 6 OF FINISHED GRADE F.G. SCHEDULE 40 PVC INSPECTION PORT WITH ACCESS " METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL FINISH GRADE OUTLET TO WITHIN 6' OF � �� ° 2 OF 1I8 TO 1/2..DOUBLE WASHED + MIN SLOPE 1 Jo BOX TO F.G. (SEE NOTE 21) CODE AND ANY APPLICABLE LOCAL RULES. FND. EL.= 55.0 t F.G. OVER TANK EL.= 54.$f 5 DIA. OUTLET(S) STONE OR GEOTEXTILE FILTER FABRIC ..__ --_ -------- ..- 2. APPROVED BY THE BOARD OF HEALTH AND THE -.� ---- -- ANY RANGES TO THIS PLAN MUST BE C DESIGN ENGINEER. f , P H- 0 RISERS N G LACE 2 SE S O TOP OF SAS- 50.60 ,� A„ - PROPOSED 4" 4.1'MAX: 4•6 MAX. ALL CHAMBERS w/ 3. 4 SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL EXISTING � _ SEE NOTE 23 ' _ + ` ;fl: ;Ff N _. :.. x SCR.40 PVC SEE SEE NOTE 23 PIPED INLETS TO SYSTEM UNLESS OTHERWISE NOTED. f w.P��� ,, P�� ,�...3 � :��..� �..� I BREAKOUT EL 50.10 f SEWER PIPE � WITHIN 6"OF F.G. 4. T PREVENT BREAKOUT THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN DROP MAX ' 6 3 3 9 L 50 t -- 2 DROP MIN ELEVATION=50.10'FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A MIN.SLOPE��% PROVIDE WATERTIGHT o „ / JOINTS P. � 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF 13 4 PVC W FROM •✓ CN ) - t 0 C� 0 0 0 0 0 Q o THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. SEPTIC TANK 4 PVC OUT TO o 0 CONTRACTOR TO PROVIDE ------.- LEACHING FACILITY 0 j� j� (� 00 o 5. SLOPE ALL SOLID PIPE AT 1.0%'MINIMUM: 14 SPECIFIED DROP BETWEEN o N T AND OUTLET CONTRACTOR SHALL 1 oo °° C 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. 1 LE O CONTRACTOR C + 2 �---7 Lj OUTLET TEE- 49.97 MIN. 49.50 - i_i Q o 0 0 0 o SHALL VERIFY SIZE 48 VERIFY CONDITION OF ; � o0 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK IN TEES °° o 0 00 AND CONDITION OF EXISTING GAS BAFFLE 6 .CRUSHED STONE FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION.SYSTEM 1S AS o -� o0 0 o EXISTING SEPTIC AND REPLACEOVER MECHANICALLY o NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH TANK NECESSARY COMPACTED BASE 4.0' _� 4.0, - � AND DESIGN ENGINEER. $.5 �P) 4.0 4.0 5 OUTLET DISTRIBUTION BOX - 4 83' 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM. SEE BENCHMARK ELEVATION SHOWN TO BE INSTALLED ON A LEVEL STABLE 25.0' (TYP-) ON PLAN. BASE. FIRST TWO FEET OF OUTLET GROUND WATER ELEV.= < 42.50� 4.7.60' 12.83' 9• CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION PIPES TO BE LAID LEVEL. THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING'WORK ON SITE AT 5 MIN- - _ CHAMBER END 2 500 CAS-LO CHA BS 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES EXISTING 1,000 GALLON CONCRETE SEPTIC TANK VIEW CROSS SECTION IE *CONTRACTOR VERIFY: � TO THE DESIGN ENGINEER. � TYPICAL CHAMBER PROFILE TO VERIFY EXISTING �+ - -- s , 2 .t nz SEPTIC `! Zo DETAILS ELEVATION PRIOR ��-�A��Y ���•��� '� ) 10. . ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC.STRUCTURES SHALL BE MADE WATERTIGHT. I'ti@CTI�`Y EI`;IC�I��EER IF I�II`EEI�EI�IT. NOT TO SCALE NOT TO SCALE NOT TO SCALE _..... -. .._.._ COMPLIANCE WITH DEEDED OR ZONING 11. NO DETERMINATION HAS BEEN MADE AS TO COM L NCE E O �r REGULATIONS. OWNERiAPPLlCANT IS TO OBTAIN SUCH DETERMINATION FROM jh T T ` ! f) APPROPRIATE AUTHORITY. i : PERC NO. 21 260 r , 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS LOCATED INSPECTOR- David W. Stanton(BOH) UNDER MORE THAN 3 FEET OF COVER OR LOCATED UNDER PAVEMENT, DRIVES,OR 11 EVALUATOR: Michael Pimentel EIT CSE WITHSTAND H-20 LOADING. PROPOSED TWO 2 TRAVELED WAYS IN WHICH CASE THEY SHALL �. F : ,: ;,. .,� � �r C.S.E.APPROVAL DATE. Oct 9 500-GALLON H-20 LEACHING +� •. ( . ► 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. CHAMBERS w/STONE +► .;,,_ + :.° / ; September 28 2021 .. � . l DATE. p , ' � II_ ► 14. WHERE REQUIRED CONTRACTOR SHALL REMOVE ALL LOAM SUBSOIL AND UNSUITABLE w . ; TEST PIT#. 1 MATERIAL 1N AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHINGFACILITY.'. O ! _ REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY i ) ELEV TOP 54.50 , FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). O , . ELEV WATER= <42.50' i , 1 '4 J .� 1 # ,..• t. >; 15: CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN CO TRAC L PERC RATE= CONTINUATION F WORK. �` o " „ SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUA O O O ge� �� / �` '� � PROPOSED 4 SCR. �0 PVC VENT, �:; � �i ,, �, i ,., f k ,, i •� . EXACT LOCATION PER OWNER k s _ 1 . . I �e► . „ , DEPTH OF-PERC- 6 PROPOSED PROJECT IS LOCATED WITHIN. h` - r DEAD * 2 \ r_ t r E ASSESSOR'S MAP 271 LOT 94-05 f �NI� ��, - � � , ` ri "'� �,� �� . � TEXTURAL CLASS. 1 �' OWNER OF RECORD: ARTHUR J.F. PONTES&JO MARY PONTES t ADDRESS: 30 MARK'S PATH Benchmark 1 ,,r \ 1 0 HYANNIS MA 02601 { Loam 'Sand ,, i ,: \ P 71 ;, .r Y Nail Set in 13 Tree' � _ _ < _,!. ,. . MA 2 a r , / PROP. H-20 ,'- LOCUS . 10Yr3t1 Elev. =55.00 TP 1 .; . ..- _ LOT 94-04 ' �► �> � � • : ,� ' FEMA FLOOD ZONE X o .. , _ ... 6 54.00 A rox. MSL _ D-BOX ,moo , pp •-" . `°' *,.{ ' `� e �� COMMUNITY PANEL# 25001 C0562J 54x5' .� :\ . r , B Loamy Sand 3) Ss o , TP2 - / 2 h 9 . 10Yr 5/6 17. DEED REFERENCE. BOOK 18933, PAGE 199 1. . � a , �6y i 2411 18. PLAN REFERENCE. PLAN BOOK 384, PAGE 99 54x5 56, gyp• fit` ` . T ORIGINAL CONDITION. 19- ALL DISTURBED AREAS SHALL BE RESTORED O O G CO _ q it *. 20- PROPERTY LINE INFORMATION IS ONLY APPROXIMATE THIS PLAN IS TO BE USED ONLY Il \ 30 1, ,�a 4 , FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY i -v � F THIS N OTHER_ F R U O PLA O ER THAN INTENDED C _ �. O SES S H ITS _2 _ I 0 ► n: „ �, POSITION PLACED IN A VERTICAL POST ON T A - Coarse Sa nd 21. A 4 PERFORATED SCR. 40 PVC PIPE SHALL BE LACE C O w J . � I�,- C t _- T THIN OF FINISH IZADE'A s74. . 2.5Y 6/6 DEPTH OF THE BOTTOM QF THE SAS AND EX SEND O 3 G \ 9 ° REMOVABLE THREADED CAP SHALL BE PLACED ON THE TOP TO ALLOW FOR INSPECTIONS. ° ,. --� � ... ,�- � �_ _ ..• ::: _ ..,., ° ( N� (15-20%gravel) E IS"['lt'�G LEACI i?NG PIT T BE PUMPED,MPED, ,,� ly '{ � l� � 22. OWNER I APPLICANT I CONTRACTOR SHALL BE RESPONSIBLE TO OBTAIN ANY AND ALL FILLED�"�t'CLEAN ��� � � c° � I��`!! , REQUIRED PERMITS AND APPROVALS FOR THIS PROJECT. SAND & ABANDONED �, al r LOCUS PLAN. a ro.x. loc. only) = r t i I 23. IN ACCORDANCE WITH 310 CMR 15.401-15.406,THE FOLLOWING LOCAL UPGRADE . „_ APPROVALS ARE REQUESTED FROM 310 CMR 15.221(7): � s � + I� SCALE. 1 1000 1 SLAB 55.8 ? 1. A 1.1'WAIVER 3.0'-4.1' FOR THE MAXIMUM COVER OVER THE H2O D-BOX. 144 42.50 ( ) C 2 1. `WAIVER '-4. ' F THE MAXIMUM COVER OVER THE H 20 SAS. ,, 1 ( .) A 6 (3 0 6) OR E U O E S I GARAGE 1 No Mottling, Standing or Weeping Observed „ 1, 1 I 18 , �55 DESIGN TEST T DATA I� . �, I - PERC NO. 21-260 sr i • 50xO EXISTING SPOT GRADE r->, INSPECTOR. David W. Stanton(BOH) NUMBER OF BEDROOMS(EXISTING) 3 �. \ EVALUATOR: Michael Pimentel, EIT,CSE -- 50 --�-- EXISTING CONTOUR !I } i 110 DESIGN FLOW GAL/DAY/BEDROOM 1' TOF=56.1't t 114 t, C.S.E. APPROVAL DATE: Oct. 27, 1999 \ 1 1 I TOTAL DESIGN FLOW 330 GAUDAY 50 PROPOSED CONTOUR SLEEVE SEPTIC PIPE DATE: September 28,2021 WITHIN 19 OF WATER o _ 50 PROPOSED SPOT GRADE -..� T DESIGN FLOW x 2fl0 /o - 660 GAUDAY 2 Q I 1 I, I , TEST PIT#. MAP 271 �. �.. I , � LINE CROSSING 3Q l kk � USE EXISTING 1,000 GALLON SEPTIC TANK ELEV TOP= 54.50' GAS EXISTING GAS LINE LOT 94-06 i EXISTING to = ELEV WATER= <42.50' 3-BlrC33�C7C��J! �� o a f T,0'C EXISTING UNDERGROUND UTILITIES _ <2 rrun./in h DWELLING 1 w o v PERC RATE c I " o M -- - W W EXISTING WATER LINE I o, INSTALL 2 500 GAL. CHAMBERS w/ STONE t I ao DEPTH OF PERC= Csoil ;1 L EXISTING 1> 0 � SIDEWALL CAPACITY ' I 1 TEXTURAL CLASS:` f TEST PIT LOCATION �. . I Alm CN S P (LENGTH + WIDTH) (2 SIDES) (2'HIGH) (0.74 GPD/S.F.) = GALtDAY TAN°y TO E USED 25A'+12.$3' 2 2' 0.74 GPD/S.F. -112.0 GAL/DAY �'fl, e ���{I IN TI-III; DESIGN � ( ){ ) C ) { ) EXISTING 1,000 GALLON SEPTIC TANK V 01 54.50' PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE E-2 MAP 271 � BOTTOM CAPACITY Loamy Sand [ LOT 94-04 1 (LENGTH x WIDTH) (0.74 GPD/S.F.) = GAUDAY 10Yr 3/1 19" { I (25.0'x 12.83') (0.74 GPD/S.F.) _ 237.4 GAUDAY 6„ 54.00' PROPOSED H-20 DISTRIBUTION BOX B Loamy Sand © PROPOSED 500 GALLON H-20 LEACHING CHAMBER 1 OYr 5/6 �'l I TOTALS. 24 52.50' ' 1 � H 2_ MAP 271 TOTAL NUMBER OF CHAMBERS v0 TOTAL LEACHING AREA 472.2 S .FT. DATE BY APP'D. _ DESCRIPTION 0 LOT 94-05 Q 11,2$5t S.F. TOTAL LEACHING CAPACITY. 349.4 ..GAL./DAY PROPOSED SEPTIC SYSTEM UPGRADE Co. o PREPARED FOR: z r" Coarse Sand ROBERT B. OUR CO., INC, C 2.5Y 6/6 NOTES: I � (15-20%gravel) LOCATED AT 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF i EACH SEPTIC SYSTEM COMPONENT. 30 MARKS PATH HYANNIS MA 02601 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF THE , CONSISTENCY WITH TEST PIT PROPOSED LEACHING FACILITY TOENSURE SWING-TIES DATA SHOWN ON THIS PLAN. REPORT TO ENGINEER AND LOCAL BOARD OF SCALE: 1 INCH = 10 FT. DATE: OCTOBER 8, 2021 NOT CONSISTENT WITH TEST PIT DATA. 144" 42.50' 0 5 10 20 40 FEET HEALTH!F SOILS ARE Oof n DESCRIPTION HCA HC-2 0 33 No Mottling, Standing or Weeping Observed t�' r N6 0� 3.) PROPERTY IS LOCATED WITHIN THE WELLHEAD PROTECTION OVERLAY JOHN �, PREPARED BY: CORNER OF STONE 1 40.5 36.5 't8 a O DISTRICT AND A MASS DEP ZONE II. RESERVED FOR BOARD OF HEALTH USE R CHUB LL JR. y JC ENGINEERING, INC. *Perk rate taken from original permit L CORNER OF STONE 2 50.9 37.6 Na. 1807 CRANBERRY HIGHWAY ` C ) 4.).SWING TIES SHOWN ON THIS PLAN ARE PROVIDED ONLY AS A COURTESY #85-148 on file�nnth the Barnstable Board 285�1' C E FOR THE INSTALLER. INSTALLER SHALL VERIFY SWING TIE MEASUREMENTS of Health A A A 0253$ CORNER OF STONE(3) 43.5 14.9 EAST W REH M, M IN THE FIELD PRIOR TO INSTALLING THE SYSTEM. CONTRACTOR SHALL SITE PLAN M 508.273.0377 CORNER OF STONE(4) 30.T 11.8' NOTIFY ENGINEER IF MEASUREMENTS APPEAR TO BE INCORRECT. --- SCALE: 1"=10' Drawn By: MCP Designed By:MCP Checked By:JLC JOB No.5907