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HomeMy WebLinkAbout0016 MARYALICE LANE - Health 16 Maryalice Road Hyannis A= 291 072 �I I a �I TOWN OF BARNSTABLE LOCATION IQ SEWAGE# eIC)l8-O!,�-3 VILLAGE ,A ASSESSOR'S MAP&PARCEL 1 —0-7 `Z INSTALLER'S NAME&PHONE NCSDo�o3k,-, SEPTIC TANK CAPACITY f $S-00 N t°-`LJ \ - LEACHING FACILITY:(type) C�^c nnnvt (size) 1'a;a►� �3.5 NO.OF BEDROOMS L OWNER -c!- 'e PERMIT DATE: 3`Lo--1 f3 COMPLIANCE DATE: Separation Distance Between the: ^?o j e Ccf- PAC Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY J o)e,S A I r r TOWN OF BARNSTABLE � rNO. ATION AGE ��hny5 ASSESSOR'S MAP&PARCEL o�� r �� WgiKEEMS NAME&PHONE Na ��rr��te �'(;o��,G� Lj�er rnI IC TANK CAPACITY ,''"S,��i�� CHING FACILITY: (type) O `"' a-I®Lv �SS'R�1 (size) /ate OF BEDROOMS C OWNER., PERMIT DATE: COM#kF[�E DATE: !d 731/6(0 Separation Distance Between the:) Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY r Mary Alice Road 36 29 45 65 41 a New Old No. ­ / �0 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 4phration for Bispo8al 6pstrm Caristruttion Permit Application for a Permit to Construct( ) Repair(�ade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.fG%✓k�/a lit e i Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 2 v do /0 r,✓-e- Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 1 )fcky,,) Type of Building: Dwelling No.of Bedrooms 6/ es; ,J Lot Size /3/$ (, sq.ft. Garbage Grinder( ) Other Type of Building f e3 iJ pr N J No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date 'X-1 G ( j Number of sheets Revision Date Title Size of Septic Tank 1�(9© Type of S.A.S. COO csi)ON) Description of Soil Nature.of Repairs or Alterations(Answer when applicable) t aC��r'1`I Gt "e"o l e oo G C1(�t",IN) elf((�1 (C � 0 �[ � 0)C C I\)V `�i SCM cn eM!ice C(n�.N�Itt�v f S CaZ� �1 Ll r 5i'FwV P I ', ,gZk Z2:3.S Date last inspected: \Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in awcordance 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. Sigped Date Application Approved by Date r .'r 1 Application Disapproved by Date for the following reasons Permit No. f --� Date Issued l No. C�D/ -d 5 ""'3 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ---'' Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftplitation for Disposal *pstrm Construction Permit Application for a Permit to Construct( ) Repair(1) Upgrade( ) Abandon( ) ElComplete System ❑Individual Components Location Address or Lot No./G A4o or,Il t t' kip';—• 4 Owner's Name,Address,and Tel.No. Assessor's Map/Parcel .2 / _0 2 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. �L.fi.? .4/t t rJ T^,c } 7/C 5 NSin�r,P�r.,.i ✓'4 u - A.aI - i Type of Building: Dwelling No.of Bedrooms tl�f.SI!A) Lot Size /�./{"(, sq.ft. Garbage Grinder( ) Other Type of Building d p s y mfj+t C f No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) a/0() gpd Design flow provided L/ -1/,h/ gpd Plan Date gel- i G - 1,05 Number of sheets '2._ Revision Date Title Size of Septic Tank ►'T0(:) Type of S.A.S. <-00 q C'e16 j r IA�CjR � Description of Soil Nature of Repairs or Alterations(Answer when applicable) 14( S ( �\] r� 1t 1)ri 1-1/1)ll 1 ri-022 rdt ri 1 1 6/mil r In C.-- 6 f C 142 I� � Gl < <rb 6261 P 1 2.qi)r _2 �.S � r _ . Date last inspected: Agreement: f 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 of Health. Signed't_ '" Date -ram. Application Approved by Date '" A k9 Application Disapproved by Date for the following reasons Permit No. ` J -- Date Issued 1 �9 , - - THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( -T' Upgraded( ) Abandoned( )by 1 a.�IG� A l�ji""j _ at 1 ri NA e y F %r. ! _e_-j,c Jt`t lvd q+f% has been constructed in accordance / with the provisions of Title 5 and the for'Disposal System Construction Permit No /�-� dated Installer� )ttc-,A t��.y� '1 ,.,s Designer. #:7AI J 4r,J #bedrooms v.k Approved dessignAow ALP 7 gpd The issuance of this permit shall not be construed as a guarantee that the syste,40w ill function as designed. f Dat°°e--A_ .,,.. a 7//q / C Inspector"- --- --------------- ---------- ------- -- ---------------- ---------- - ------------------------ No a' 7f Feed J THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS F. Disposal *pstem Construction Permit Permission is hereby granted to Construct( ) Repair(Vf' ' Upgrade( ) Abandon( ) System located at 1 U M r.r u u �s r P l ... ) ,i e �� rr,�W;S r � r 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. .9 Date // A Approved by oF� Town of]Barnstable r# ' Department of Regulatory Services + 's C uSTAB te Public Health Division Date I Z 200 Main;Street,Hyannis MA 02G0+1 y..,�. tw ' Pw� Date Scheduled. � If Time FeePd. � Sol Suitability Assessment,fog- Se : me e Disposal Perford v: h"J'e•- m cc;► ee- P& sb—Is-gz Witnessed By- . \QQ4 LOCATION& GENERAL INFORMATION Location Address 140 MAY` Owner's Name ` Y � ►�� Cry �Ia,Yw_ ek fer o� �1 J�I1ldl! S' Address. wlRry ��t(R Lv� Assessor's Map/Parcel: t—C y Q Vt`� S j MA QZ6 o Z� — Z Engineer's Name F=�J t n�����9 `' A ` NEW CONSTRUCTIOTV REPAIIt _ tt Telephone# s�'j y— ,4 7"7—S 3 `W�`� Land Use,` Fe.S i Jko ,^^ Slopes(0/q) -�._I Surface Stones fq Distances from: Open:Water'Bbdy: ft Possible Wet.4rea /° ..ft Drinking Water:Wel1�U y .f1 Drainage:Way j f� ft Property Line ft Other ft. SKETCH:(Street name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands en proximity to holes) r - I Perent.material(geologic) �V °L�� Depth to Redrock.. Depth to Groundwater. Standing Water in Holes_A) Weeping:from Pit Pnce, l4 Estimated Seasonal High Groundwater DETERNIINATION FOR SEASONAL HIGH WATER TABLE Method Used:. Depth Observed standing in obs.hole: in. Depth 10 Soil mottles; in. Depth to weeping from side of.obs.'hole — in; Groundwater Adjustment ft. index Well tf Reading Date: index Well level Ai1i,Pictor,,,,,,,,,— Adj.Croundwater level. T - PERCOLATION TEST bate Mine Observation Hole# 1 + — Time at h" _. Depth of Perc VNT Ay\c,1 S f Tithe at 6" Start Pre soak Time @ 24-,R► - Ix 'r'ime(v-6")'. ,- ...._.�...�. 1: ,rs 4— Z�a ' n End..Pre-soak • ere �S�" �' Rate Min:/Inch Z L Z Site Suitability Assessment: Site Passed v Site Failed: Additional Testing Needed(YM); Original: Public Health Division Observation Hole Data To Be Completed on Back----------- Offt percolation test is to be conducted Within 1.00' of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTl.0.PERCFORM..DOC DEEP,OB 11 SERVATION HOLE LOG Hole Depth from Soil Horizon Soil Texture. Soil Colon Soil Other Surface:(ia.) (USDA): (Mansell) Mottling {Structure;:Stoneg,Boulders. o i ten :"ravel If Q- ]DEEP OBSERVATION HOLE LOG Hole# "L Depth from Soil Horizon Soil Texture Soil Color' Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Cons•sten % ,-rave S4l.-d Uct, L01 tr-f l•z BEEP OBSERVATION HOLE'LOG Hole 3 �.QA Depth from Soil Horizon Soil Texture Soil Color Soil. Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders:. Consistency, Grave 2I )fi1 )� .,b—? f�l bu vtol Qaw, LOA,l(LS/ e-TI .Kzct DEEP OBSERVATION HOLE LOG, Hole.# Depth from. Soil Horizon Soil Texture'' Soil Color Soil other Surface(in) (USDA) (Mansell) Mottling (Structure,Stones;Boulders. on"i ten / 9 Z- Flood Insurance Rate Man: ^O Above 500 year flood boundary No Yes Within"500 ycai boundary No �< Yes,,,;,. Within 100 year-flood boundary No; Death 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,soii absorption system? 4Cam..,.;.._ If not;what,is the depth of naturally occumng°pervious material? r Certification. I certify.that pn ( (date)I'have passed the soil evaluator exam ninatio approved by the Department of Environmental Protection and that the above.Analysis was performed'by me consistent with the required tra ng,expertise and.experience described i0IQ,CMR 15.0 Signature: L Dat / QAS•EPTICIPSRCF0,9M.D0C. E Town of Barnstable Regulatory Services Richard V. Scali, Interim Director = BARNWABLE. MASS. Public:Health Division. O° 1639. `0 '0reornp'�s Thomas McKean, Director 200 Main Street,Hyannis,MA02601. 1 - Office: 508-862-4644 Fax: 50.8-700-004 1 Installer & Designer Certification Form. Date: 1� 6 Sewage Permit# fjiF', -C)53 AsseIsor'sMap�Parcel �'9 1 -o7-Z Designer: any,, ee ;n� Wo,-its, Inc • Installer: Address: I W C'b Address: I `� —V�6)C' �V( �1 On 3--C-p-— I -PA,)3<aWv1 ( V- c-- was issued a permit to install (date) (installer) septic system at I( Mci r, Al�c Q- (-,.,,v.L ..based on a design,drawn by. v (address) Eyt� i nex�.n9 WcirLu I C , dated 2�<<e 1(� J 3!!q �! (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes!such as lateral relocation of the distribution box and/or s-epti:c 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 sails were found satisfacto,17. I certify that the system.referenced above was construe nce with the terms of the 1\A approval letters(if applicable) %OF & PETER T. 1Vol McENTEE; aZ CIVIL staller's Signature) ni0.381oe • �G�/&TER1 (Designer's Signature) (Affix D sigaf7 famp Nere) PLEASE RETURN TO BARNSTABLE :PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. TITANIC YOU. QASeptic\Dcsigncr Certification Form Rev 8-14-13.doc f i �v COASTAL engineering co. February 7,2018 Peter McEntee Engineering Works, Inc. 12 W.Crossfield Rd Forestdale, MA 02644 RE:Grain Size Analysis—Sieve Test(Alternative to PercTest) 16 Maryalice Lane,Hyannis,MA ' Dear Peter, I Below are the results of the particle size analysis from the sample submitted for the;above referenced property.The analysis was performed in accordance with the procedures outlined.in ASTM D6913:Standard Test Methods for Particle-Size Distribution(Gradation)of Soils Using Sieve Analysis. Sand Silt Clay Portion Passing#10 96.0% 3.5% 0:5% Sieve USDA Soil Textural.Classification: Sand MA 310 CMR 15.243 Soil Classification: CLASS I - Based upon the DEP's Title 5 Alternative to Percolation Testing Policy for System Upgrades,the following effluent loading rates apply: Uncompacted Soil: 0.74 gpd/sf Compacted Soil: 0.15 god/sf Should you require additional information or need further testing services,please do not hesitate to contact our office. .Sincerely,. Chr McEntee, EIT j Orleans,I Sandwich I Nantucket �. . .. r• 1 CLIENT: Peter McEntee SAMPLE NUMBER: 1 DATE: 2/6/2018 PROJECT NUMBER: N/A TIME: 8:30 AM MUN.SELL COLOR: 10YR 4/4 DRY WEIGHT OF SAMPLE(grams): 370.3 SOURCE OF SAMPLE:- ^` Test Pit SAMPLED ANALYSIS PAN WEIGHT(grams)- 172.4 BY: PTIVI: BY: CPM Cumulative Cumulative Project U.S. Weight Percent Percent Sieve Openings Weight Percent Manual Sieve Retained Retained Passing Retained Retained Specifications Inches Millimeters Mesh (grams) (grams) ASTM D6913 2.52 64.000 0.0 0.0 0.00 0.00 100.00 0.19 4.750 4 19.6 19.6 539 5.29 9431 0.08 2.000 10 25:1 44.7 6.7& 12.07 87.93 0.02 0.425 40 226.2 270.9 61.09 73.16. 26.84 0.00 0.015 200 86.1 357:0 23.25 96.41 3.59 0.00 0.000 Pan 12.9 369.9 3.49 99.89 0.00 Passed Mesh Sieve TOTAL 369.9 .100 # 90 � ' � �-� t � � I If I i ip31 so 70 3. 60i it ��. # tl ! i tI ? 1 i # -O.-Samplel {{ # 64 mm 40 -410 f{ 11 }} c`+ 30i 13i Ili # - p t # -F-#40 26 10 0 i 100.00 10.00 1.00 0.10 0.01 Particle Diameter(mm) CBL GRAVEL SAND. SILT OR CLAY CRS MEDIUM FINE e Orleans I Sandwich I Nantucket y s . � Q C A T ION SEWAGE PERMIT NO. K-z S�1 *?iI I L L A GE INSP LLER'S NAME i ADDRESS R U I L D E R OR OWNER- _ DATE PERMIT ISSUED DATE COMPLIANCE ISSUED .� {':L,; `; B �� , Z� � � � y �. � �� i +.:� � i _ � � i :� .• ��,; + �0 . � � j �� 1 � ! :� Il E t 1 � �� + f ( � ��� ;�, . . i � .,.-. ... •� .Y Town of Barns ;able r# 1S5( 3 4. Departmentbf Regulatory Services s Public Health Division Date I Z it �; 1"1 t63q �e� M Main Street,Hyannis MA 02601 �n1 � Date Scheduled cam--' Time ( � Fee Pd, Soil Suitability Assessment for Sei e Disposal Performed By: pof"_ II G lt-ee �(� su ��j l2- Witnessed BY, 'L.00ATION&GENERAL INFORMATION Location Address �r Mto-t^y ,A I'%ee A , 5 Owner's Name !el6�Y1R t'1 IQ M s3 i S S'� Address 1�Ci 1NI Oc VY C,-9— v� i-i ot v1 iA,s IM A OZ,60 t Assessor's Map/Parcel: 2� ( _-7._Z., - Engineer's Name�` NEW CONSTRUCTION R15PA-IR _ Telephone i. _50I.- 4 71—S3 1 Land Use' G. Slopes:(%) Surface Stones N u� Distances from:. Open Wateefl6dy ft Possible-Wet Area Drinking WaterWell�f�M .ft Drainage Way N 1 ft Property Line.. . i ft Other ff. SKETCH:(Street name,dimensions of Im exact locations of test`holes&perc tests;locate wetlands fin proximity to holes) ' $w. ( ° 40N it Or �iJe YALI eE LA ry t�' Parent.matcrial(geologic) �VS+ Depth.to Bedroclt /V'�r"1 Depth to Groundwater. Standing Water in:Hole: �� Weeping from 'it Fite A LO Estimated Seasonal High Groundwater I3z`� DETERARNATION FOR SEASONALBIGH WATEY TABLE Method Used:, Depth Observed standing in obs.;holei »>in. Depth to Soil tMottlgs;, lit: Depth to weeping from side of obs.hole: - in, Groundwater AdJustrilent ft Index Well# Reading Date Ind'ei Well level :, Attl.Eltt ei �;� Adj.ClroundwaterUvel, PERCOLATION TEST bate---- . Time Observation Hole tl ;.�V e Time at 0" ti r °. , .5 Tune at 6" Depth of Pere ` . f Stan_Pre-soak Time @� _— 2' fl e� time'(9" z Endit-soak n. ; 5 -Q�1cA Rate Minlinch. _ Site Suitability Assessment Site Passed -I Site Fated: Additional Testing Needed(Y� - Original: Public Henith Division Obseryt tion Hole Data To Be Completed on Back--------- *If percolation test is to be conducted within 100' of wetland;;you.must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPf lC1PERCFORM.DOC DEEROBSERVATION HOLE LOG Hole.# Depth from Soil Horizon. Soil Texture: Soil Color Soil Other Surface in, (USDA) (Ivlunsell) Mottling,i '(Sttttcture,stores,Boulders. (_ ) tsten ` ravel, wd ,�taa to'C�.`��t s .. 21e3 z Ste. z--S-71 6 DEEP OBSERVATION HOLE LOG Hole# "Z Depth from Soil Horizon Soil Texture Soil Color` Soil . Other surface(id.), (USDA) (Munse)l): Mottling (structure,Stones,.Boulders. Consistency,%Gravel) / ._ I k ff}EEP.OBSERVATION HOLE LOG Hole# Depth from Soil_Horizon Soil Texture Soil•Color Soil Other . Surface,`(ia) (USDA)' (Munscll} Mottling (Structure,Stones,Boulders. an i to c G DEEP OBSERVATION BOLE LOG Hole# Depth:rxom, Soil Horizon soil Texture Spit Color soil Other Surface(in.} (USDA) :(Munsell) Mottling (Structure,Slopes,Boulders. o .. ten bak rVCsite 3 `� Fl '- • Observntian Hole Data To Be Completed on Back,----------- *, Above' o °es b S`�o a condactec Sv Yn-100' of avetland,you.roust first notify the If percoa> Barns�lhle06ii Divl 1016t:lmtoue(j)week prior to beginning. �Bp boundary No Depth of Naturally Occurrine Pervious Material; s Does at least four feet of naturally occurring pervious material exist in ail areas observed throughout the area proposed'for the soil absorption sy - If not;what is the depth of naturally.occurring:pervious material'?;,.._,_ Certification I cert7fy that on iLAa (dated I have passe�3 the soli evaluator examination approved by,the D ertflN h tof.Environmental Protection and.that the; above analysis:was performed'by me.consistent with the required tra' 'ng,expertise and experience described in 10 CUR 15.0 ,7. Dat • Signature , Q.\SEt?'i 0I ERCMRMMOC t Commonwealth of Massachusetts Title 5 Official Inspection Form ®Q� Subsurface Sewage Disposal System Form - Not for Voluntary Assessmen A�� ° 16 Mary Alice Lane `M Property Address (V Chelsea and Martin Flynn '' Owner Owner's Name / ., information is V required for every Hyannis MA 02601 March 17, 2016 .'' page. City/Town State Zip Code Date of Inspection Inspection results.must be submitted on this form. Inspection forms may not be altered in any, way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information , / on the computer, //�;�f use only the tab 1. Inspector: key to move your cursor-do not David B. Mason use the return Name of Inspector key. David B. Mason r� Company Name 4 Glacier Path Company Address ram East Sandwich MA 02537 City/Town State Zip Code 508-367-1617 S1287 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority March 17, 2016 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,-000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under' the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 � Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 16 Mary Alice Lane Property Address Chelsea and Martin Flynn Owner Owner's Name information is required for every Hyannis MA 02601 March 17, 2016 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The observations noted in this inspection report only indicate the condition of the system as observed on Marh 17, 2016 at noon which does not guarantee the contiued operation the system beyond that date of the observed condition. Increase in flow can cause failure of the system. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 r I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 16 Mary Alice Lane Property Address Chelsea and Martin Flynn Owner Owner's Name information is required for every Hyannis MA 02601 March 17, 2016 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 16 Mary Alice Lane Property Address Chelsea and Martin Flynn Owner Owner's Name information is required for every Hyannis MA 02601 March 17, 2016 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No" to each of the following for all inspections: Yes No ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 'h day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 16 Mary Alice Lane Property Address Chelsea and Martin Flynn Owner Owner's Name information is required for every Hyannis MA 02601 March 17, 2016 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified ' laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑T the system is within 400 feet of a surface drinking water supply ❑ ` ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional.office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 16 Mary Alice Lane Property Address Chelsea and Martin Flynn Owner Owner's Name information is required for every Hyannis MA 02601 March 17, 2016 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® 0 Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual). 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 16 Mary Alice Lane Property Address Chelsea and Martin Flynn Owner Owner's Name information is required for every Hyannis MA 02601 March 17, 2016 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes X No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d Yes 9 ( Y 9 (gP ))� Detail: 2014; 41,250 gallons and 2015 ;30,750 gallons Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 16 Mary Alice Lane Property Address Chelsea and Martin Flynn Owner Owner's Name information is Hyannis MA 02601 March 17, 2016 requi y red for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Board of Health Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1000 gallons How was quantity pumped determined? Truck sight glass Reason for pumping: maintenance and groundwater determination Type of System: ❑ Septic tank, distribution box, soil absorption system ® Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ® Other(describe): primary cesspool with two (2)overflow leaching pits t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments GSM , 16 Mary Alice Lane Property Address Chelsea and Martin Flynn Owner Owner's Name information is required for every Hyannis MA 02601 March 17, 2016 page. City[Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: built in 1965 date of leaching pits unknown Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 13 inchesfeet Material of construction: ® cast iron ❑40 PVC ❑ other(explain): 10+ Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 16 Mary Alice Lane M Property Address Chelsea and Martin Flynn Owner Owner's Name information is required for every Hyannis MA 02601 March 17,`2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Primary cesspool is acting as a septic tank with effluent level with outlet invert. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness I Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 16 Mary Alice Lane Property Address Chelsea and Martin Flynn Owner Owner's Name information is required for every Hyannis MA 02601 March 17, 2016 _ page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No I t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 16 Mary Alice Lane Property Address Chelsea and Martin Flynn Owner Owner's Name information is required for every Hyannis MA 02601 March 17, 2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): No distribution box exists Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: observed with camera t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 16 Mary Alice Lane Property Address Chelsea and Martin Flynn Owner Owner's Name information is required for every Hyannis MA 02601 March 17, 2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 2 ❑ 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.): primary cesspool acting as septic tank with two(2)overflow leaching pits. Leaching pits are 1000 gallon and are dry without indication of ponding or damp soil and no excessive vegetation growth. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration 1 primary with 2 overflow pits Depth—top of liquid to inlet invert 3 inches Depth of solids layer 2" Depth of scum layer 3" Dimensions of cesspool 6'x6' Materials of construction block Indication of groundwater inflow ❑ Yes ® No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form.- Not for Voluntary Assessments M 16 Mary Alice Lane Property Address Chelsea and Martin Flynn Owner Owner's Name information is required for every Hyannis MA 02601 March 17, 2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Primary cesspool is configued as a cesspool with outlet PVC pipes to each leaching pit. Primary cesspool is full and the overflow leach pits observed with camera are dry. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 16 Mary Alice Lane Property Address Chelsea and Martin Flynn Owner Owner's Name information is required for every Hyannis MA 02601 March 17, 2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 16 Mary Alice Lane Property Address Chelsea and Martin Flynn Owner Owner's Name information is required for every Hyannis MA 02601 March 17, 2016 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: 18 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Groundwater Contour Map ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Groundwater Contour Map Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 16 Mary Alice Lane Property Address Chelsea and Martin Flynn Owner Owner's Name information is required for every Hyannis MA 02601 March 17, 2016 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Assessing As-Built Cards Page 1 of 2 TOWN OF BARNSTABLE LOCATION ce S&WeE VILLAGE_ ASSESSOR'S MAP&PARCEL off/ - R1F8 NAME&PHONEnnNO. SEPTIC TANK CAPACITY C QSS//60/ 1000 LEACHING FACILITY:(type) d ��'�mw S�oc>/ (size) /aQo of NO.OF BEDROOMS OWNER 0 PERMIT DATE: C0M#btikWE 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 Mary Alice Road v f 36 45 85 41 New Old http://www.townofbarnstable.us/Assess7 —mg/HMdI splay.asp.mappar-291072&seq-- 1 3/21/2016 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS d DEPARTMENT OF ENVIRONMENTAL PROTECTION OW V TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 16 Mar_Alice Road Hyannis MA 02601 a ; Owner's Name: Estate.of Shirley Flynn `t Owner's Address: Same i `yam • Date of Inspection: October 31,2006 Job#06-294 Name of Inspector: PATRICK M.O'CONNELL Company Name: SEPTIC INSPECTION SERVICES CO. r� Mailing Address: 189 CAMMETT ROAD MARSTONS MILLS MA b2648 ',�- Telephone Number: 508-428-1779 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: ����`` „.,9►�U��ii OF/``���P��N �,9 _X_ Passes Conditionally Passes ! P hl (n Needs Further Evaluation by the Local Approving Authority = M :rn Fails = —, u �n Inspector's Signature: rV) Date: 10/31/06 %,it FRTLF.1E�'pQ ITJSPEG; • =FoCIN1�� 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: Cesspool pumped as part of inspection,Overflow pit has approximately 18"of effective leaching.System is functioning properly under current conditions and meets all current requirements. ****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. r Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENT S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 16 Mary Alice Road,Hyannis Owner: Estate of Shirley Flynn Date of Inspection: October 31,2006 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _XX_ 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: Page 3 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 16 Mary Alice Road,Hyannis Owner: Estate of Shirley Flynn Date of Inspection: October 31,2006 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 ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 16 Mary Alice Road,Hyannis Owner: Estate of Shirley Flynn Date of Inspection: October 31,2006 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_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 a cesspool or privy is within a Zone I of a 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.] _No_(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 II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. Page 5 of 1 I OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 16 Mary Alice Road,Hyannis Owner: Estate of Shirley Flynn Date of Inspection: October 31,2006 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 _X_ Were any of the system components pumped out in the previous two weeks`? _X_ _ Has the system received normal flows in the previous two week period ? _ _X_ Have large volumes of water been introduced to the system recently or as part of this inspection _X_ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) _X_ _ Was the facility or dwelling inspected for signs of sewage back up? _X_ _ Was the site inspected for signs of break out? _X_ _ Were all system components,excluding the SAS, located on site? X_ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? X_ _ 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 _X_ _ 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)] I Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 16 Mary Alice Road,Hyannis Owner: Estate of Shirley Flynn Date of Inspection: October 31,2006 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): n/a• Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): n/a(cesspool) Number of current residents:4 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): Seasonal use:(yes or no):No Water meter readings, if available(last 2 years usage(gpd)): Two years total: 130,500 gal.=178 gpd. Sump pump(yes or no): No Last date of occupancy: Currently Occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd " 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: None available Source of information: Owner Was system pumped as part of the inspection(yes or no): Yes If yes,volume pumped: 1000 gallons-- How was quantity pumped determined? Reason for pumping: Cesspool inspection. TYPE OF SYSTEM _Septic tank,distribution box,soil absorption system _Single cesspool _X 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 known)and source of information: Original cesspool installed in 1965 and overflow pit installed in 1983. Were sewage odors detected when arriving at the site(yes or no): No . f Page 7 of I 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM,INFORMATION(continued) Property Address: 16 Mary Alice Road,Hyannis Owner: Estate of Shirley Flynn Date of Inspection: October 31,2006 BUILDING SEWER:XX (locate on site plan) Depth below grade: 6" Materials of construction:_X_cast iron _40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints, venting,evidence of leakage,etc.): SEPTIC TANK: No (locate on site plan) Depth below grade: Material of construction: 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: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: STICK WITH HINGE FLAP. Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): GREASE TRAP: No (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 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 16 Mary Alice Road,Hyannis Owner: Estate of Shirley Flynn Date of Inspection: October 31,2006 TIGHT or HOLDING TANK: No (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: No (if present must be opened) (locate on site plan) Depth of liquid level above outlet invert: 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.): PUMP CHAMBER: No (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.): Page 9 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 16 Mary Alice Road,Hyannis Owner: Estate of Shirley Flynn Date of Inspection: October 31,2006 SOIL ABSORPTION SYSTEM(SAS): XX (locate on site plan,excavation not required) If SAS not located explain why: Type _leaching pits,number: leaching chambers,number: leaching galleries,number: _leaching trenches;number, length: _leaching fields,number,dimensions: _X_overflow cesspool,number: Two pits _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.): One overflow Dit had previously failed newer pit has approximately 18"of effective leachine CESSPOOLS: XX (cesspool must be pumped as part of inspection) (locate on site plan) Number and configuration: One with two overflow pits. Depth—top of liquid to inlet invert: 8" Depth of solids layer: 8" Depth of scum layer: 4" Dimensions of cesspool: 6x6 Materials of construction: Block Indication of groundwater inflow(yes or no): No Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Blocks are intact and liquid level is at bottom of outlet pipe PRIVY: No (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.): r Page 10 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 16 Mary Alice Road,Hyannis Owner: Estate of Shirley Flynn Date of Inspection: October 31,2006 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. Mary Alice Road 36 29 45 65 41 qW New Old Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 16 Mary Alice Road,Hyannis Owner: Estate of Shirley Flynn Date of Inspection: October 31,2006 SITE EXAM Slope None Surface water None o e Check cellar Dry Shallow wells None Estimated depth to ground water: More than 15 feet 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: 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: USGS topo map and town GIS You must describe how you established the high ground water elevation: Town groundwater contour map shows water below el.25 and topo map shows property above el.40. No.. .�1_� L®.f.� FEs. o..a.......... THE COMMONWEALTH OF MASSACHUSETTS BOARD QF HEALTH ....OF.... .e .. y/../..! .�L. ............................... Appliratiun for Diupuuttl Workii Tunutrurtiun Vamit Application is hereby made for a Permit to Construct ( ) or Repair (4<an Individual Sewage Disposal System at: 01 ...�� !9�Y. .l! ...............I..;.. ..... .............................................•-•-- --••••---••--•--------.._..................... Location-Address or Lot No. Owner Address Installer Address dType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms___.. ...........................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of ersons........___..........__.___. Showers — yp g p ( ) Cafeteria ( ) Q, Other fixtures ......-•---••.....--•-•----••••• _... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) `.� Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ L% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ •-------•-------------------•-......----•--•----..................--•--••-•---..........................-----•----....---•--•-------•-•--••••••--...-•--•••-- 0 Description of Soil........................................................................................................................................................................ x V W U Nature of Repairs or Alterations—Answer when applicable..._ � 0___.--S ./-..•�. O tc�� ... .................... -------------------------------•----•-----.-•--••-•--••••----•-•-•---•---•-•--•-•--•............•--•----.............----••...••----•-•---••----••-•--•-••---•-••-•••••••--•••-••-•----........---...... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i ed by the board of 1of 1 eal ' �Q............. �� .Signed........ .. .... � zf^ Date ApplicationApproved By.................................................................................................. ........................................ Date Application Disapproved for the following reasons:................................................:.............................................................. ................•••-••-••-....---••--•-•-••-••----...•--•.....----•-•-•----••-•---•-•.............•-•............_--••--•----•--•-...-•-•--••---•...••-••-•---•-•-------•-••--•---••----•-••-•--••-.-••-- Date PermitNo............................................•-------••... Issued........................................................ Date FEa.. ............. THE COMMONWEALTH OF MASSACHUSETTS r` BOAR® F HEALTH r&44C ...OF..... -- .- K4 Js �le. .r----------------------------- .Appliration for Diilio,ial Work,i Tomitrurtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair. (41< Individual Sewage Disposal System at: 1... .r t' 4 --------------- , '--- ........................................................ Location-Address or Lot No. . _ ........ ,�, ......................•------.... ................................................................................................. / Owner Address C...........Z_e9*&eS.i►_ ............................ •-------•........................•----•---•---••---.... Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms-_.__ ___________________________Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ........................____ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures -------------------------------- ------•----•----_...- W Design Flow..........................................._gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter-------------... Depth................ x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-_______-_-,....... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ L% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a •-•••-------------------------------•--•._.._..-•------------------••----•----------••-•••----•_...•......... •--------- •--•--------• ------- •---------- 0 Description of Soil........................................................................................................................................................................ V •----------------------------------•--•--•-----------------------...--------------•---------•-------.......-----------------------------•-•-------------•----....._..------.....--•-•-•----••---•-__---- W UNature of Repairs or Alterations—Answer when applicable.____ __�'4.2tv_...__. _ ao...__._.Zf�fI�---- --:-!ate.................. .............-..................................................................................................................---------------------.•.--------------._._.._._.._..........._..•--•---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLZ 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i ed by the board of health. Signed........ ..... ..... --•-19' s Date ApplicationApproved By........................ •----------------------------•-•---.._..--•----.._........._....-•--_.._. ........................................ Date Application Disapproved for the following reasons________________________________________________________________________________________________________________ --------------•------------..........-------•-----...-------•---------------_.._..--•---•------........._'-----•---------_••--_._....•-----------...----•-••-------------=•-----••-•--------------•_----- Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS .� BOARD OF HEALTH .........1..'04.e!/.f­.*.............OF.... t ,- ,4.1..)` .-�� 4z .............. .......... (9rdif iratr of Toutplittnrr THIS TO CERTIF , That the Individual Sewage Disposal System constructed ( )ror;Repaired by............. 2 ..✓@ ..------- t9-"`°'��.�.D'.��''------------------------ ...,.. ,p Installer atl6 /�t ,c � .f�= -------------------------------------•--------•------____---•---•---- - has been installed in accordance with the provisions of T TLC 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated......................,.......................... THE ISSU C OF THIS CERTIFICATE SHALL NOT BE CO T A GBJARANTEE THAT THE SYSTEM WI ION SATISFACTORY. DATE._�... Inspecto THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No. ...................... FEE...____-___............. Dillpooal orko Tonstrnrtion OpIrrmit Permission is hereby granted.. -•----•--. .t�3 - _ `--..................................................... to Construct ( ) or Repair (4.)3n Individual Sewage Disposal System atNo...... s.". it ,!..4 •-- •-•---...---••--.------------------------------•-------•---•----------------•--•------------•- •---............_ Street as shown on the a plicatio for Disposal Works Construction Permit No: . ;•;. ..... Dated.......................................... Board of Health D ATE.ZY --- - ..--- FORM 1255 A. M. SULKIN, INC., BOSTON f �D f d -99 --EXISTING CONTOUR N LOCUS Vtneyprd74 x 100.98 EXISTING SPOT GRADE a, ` W EXISTING WATER SERVICE arya ice n Pve o 1' OVERHEAD WIRES ;� NE«Hpm shre ---�H. a Geor e C� o TEST PIT y grlsto� Ave P FND BENCHMARK Pve FENCE LINE 102.58 LEGEND ` N 82*05.20„ E P- TP- G0 Seat S x I + a gg.69' 101,40 33ti5' 10 c� Rd 101.26 x 33 5 rPROPI S'A' `. , Skatin A ? ►"r �L_ . : o b �� LOCUS MAP x • VE AREA i ; �� x ` NOT TO SCALE .� RESER �•:::...•:•• , . .:�y_� 102.68 101,32 d N 101.48 J::+: �' : I 1 EXISTING LEACH PIT 00 (FROM RECORD AS-BUILT) EXISTING CESSPOOLS TO BE REMOVED GENERAL NOTES: (FROM RECORD AS-BUILT) SEE NOTE 11 101.79 W 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL TO BE PUMPED, FILLED WITH P BOARD OF HEALTH AND THE DESIGN ENGINEER. SAND AND ABANDONED OR 101.81 PROPOSED REMOVED �---- -_ 2• ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS SEPTIC TANK N OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE PATIO LOCAL RULES AND REGULATIONS. EXISTING CESSPOOL 101,80 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR (FROM RECORD AS-BUILT) 101.60+ x 101.69 x p TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE 101.95 DESIGN ENGINEER. TO BE REMOVED � � �► SEE NOTE 11 LLj ,�� 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING BM FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN _� 102,4 �O p ENGINEER BEFORE CONSTRUCTION CONTINUES. C st V 101.47 ' 5. ALL ELEVATIONS BASED ON on ASSUMED DATUM. + m 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF iv 101, OWNER TO NOTIFY THE LOCAL BOARD OF O EX/STING .00 THE CONTRACTOR OR Z 101.14 /HOUSE#16� 101.62 : PI HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. x T.O.F.=10Z.06f 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 101, 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. � 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS \ x `I AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE 101.6 'S HE APPROVING AUTHORITIES. � BY T DIRECTED D REC x WALK � ' ''' 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY 101,56 :, . RK � -� N UTILITIES PRIOR TO BEGINNING BENCHMARK '.,:.o ....., THE LOCATION OF ALL UNDERGROUND , COR./BOTT. STEP �� 01,82 "� CONSTRUCTION. EL.=102.41 < 101.30 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS LOT m x 100,10 IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND D -75, REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). --� 13,156 fSF ,� x 101,19 "- IP FND \ '/ 12 AS NSEPEC EDQ NG BY I ESISGNIPUT EONGINOEERUPRIORABLE TO BACKERILAL. LS SHALL BE ``59+•7.. 100,92 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND � 20' 11V U.P.� NOT CONSIDERED TO BE A PROPERTY LINE SURVEY. L�jQ.78 s $ 14. THE ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED SEPTIC SYSTEM COMPONENTS NOT SHOWN ON THE PLAN R=397.'a5, - OF MqS edge of pavement 100,23 100.33! 100,26 PARCEL ID: 291-072 o� PETER T. yG� 99.27 LANE PROPOSED SEPTIC SYSTEM UPGRADE PLAN McENTEE MARYALICE 16 MARYALICE LANE, HYANNIS, MA v CIVIL "' No. 35109 Prepared for: D. A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 R£G1StE OWNER OF RECORD Engineering by: SCALE DRAWN JOB. NO. ELDREDGE, ELAINE Engineering Works, Inc. 1"=20' P.T.M. 304-17 16 MARYALICE LANE 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. HYANNIS, MA 02601 (508) 477-5313 2/16/18 P.T.M. 1 Of 2 t t M " k NOTE: TO PREVENT BREAKOUT, FINAL GRADE SEPTIC TANK SHALL NOT BE AT, OR BELOW, EL.=98.5 ,EXISTING INSTALL RISERS & COVERS OVER INLET & FOR A DISTANCE OF 15' FROM THE EDGE HOUSE(#16) OUTLET AND SET TO 6" OF FINISH GRADE PROPOSED D—BOX OF THE PROPOSED S.A.S. INSTALL RISER & COVER PROPOSED SAS T.O.F.=102.06f i SET TO 6" OF GRADE INSTALL RISER & COVER OVER ONE CHAMBER AND T.O.F=102.O6t SET TO 3" OF F.G. TO SERVE AS INSPECTION PORT F.G. EL.=102.0t F.G. EL.=101.8t F.G. EL.=101.9t F.G. EL=102.0t fMAINTAIN 2% SLOPE OVER S.A.S. L = 27' i 3'(mox.) a L = 10' L = 23' 1 ® S=1% (MIN.) ® S=1% (MIN.) ® S=1% (MIN.) 2" LAYER OF 1/8" TO 1/2" ^ �q '� 4� 4"SCH40 PVC 4"SCH40 PVC 4"SCH40 PVC DOUBLE WASHED STONE �^ 10,11 as as (OR APPROVED FILTER FABRIC) Vk 14" 8 B00a® INV.=98.75 48" LIQUID aBaa�aa ---3/4" TO 1-1/2" DOUBLE LEVEL ADD PROPOSED 4' 4.8' 4' WASHED STONE G AS BAFFLE INV.=98.40 INV.=98.23 SA� INV.=98.50 X EFFECTIVE WIDTH = .12.8' _ _ 16 MOW. AM 3 OUTLETS INV.=98.00 T PROPOSED SEPTIC TANK 3-500 GALLON LEACHING CHAMBERS -,0 1 SURROUNDED WITH STONE AS SHOWN N PROP. S.A.S. CONNECT TO EXISTING SUITABLE SEWER PIPE H-20 RATED 3" LAYER OF 1/8" TO 1/2" r AT HOUSE, AT OR ABOVE, INV.=99.02f(verify) DOUBLE WASHED STONE �L---------- TOP CONC. ELEV.=99.1 t (OR APPROVED FILTER FABRIC) I"--33.5' =i NOTES: BREAKOUT ELEV.=98.50 INV. ELEV.=98.00 !25. a 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPES & aa-!85' IN 0 SEPTIC LAYOUT INVERTS EXITING HOUSE, PRIOR TO INSTALLATION. eass BOTTOM ELEV.=96.00 2) SEPTIC TANK & D-BOX SHALL BE SET LEVEL AND 4' 3 x ' 4' TRUE TO GRADE ON A MECHANICALLY COMPACTED 4' OF NATURALLY OCCURRING EFFECTIVE33.5' SIX INCH CRUSHED STONE BASE, AS SPECIFIED PERVIOUS MATERIAL IN 310 CMR 15.221(2). 5' (MIN.) ABOVE G.W. 3 INSTALL INLET & OUTLET TEES AS REQUIRED. LEACHING SYSTEM SECTION ®®®® 0 ®®® BOTTOM OF TEST PIT, EL.=91.1 s 3/4" TO 1-1/2" DOUBLE 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE WASHED STONE ®®®®®® ® ®®®® 33" AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. Of Ea®Ea®Ea® Ea ®EO N Z ®L3-®®®® ® ®Ell®® SEPTIC SYSTEM PROFILE 102" DESIGN CRITERIA SOIL LOG DATE: JANUARY 2, 2018 (REF#15,563 4" KNOCKOUT NUMBER OF BEDROOMS: 2 (PERMITTED), 3 (ASSESSED)' 4 DESIGN SOIL EVALUATOR: PETER McENTEE PE(SE�1542) 20" DIA. COVER WITNESS: DONALD DESMARIAS R.S.HEALTH AGENT SOIL TEXTURAL CLASS: CLASS I (LOADING RATE=0.74 GPD/SF) ELEV. TP-1 DEPTH EL6. TP-2 DEPTH 4" KNOCKOUT 1___" 4" KNOCKOUT 58" DESIGN PERCOLATION RATE: <2 MIN/IN 102.1 q 0„ 102.2 q 0„ DAILY FLOW: 440 GPD SANDY LOAM - SANDY LOAM DESIGN FLOW: 440 GPD 10YR 4/2 • 101 4 10YR 4/2 101.3 B 10' B 9" 4" KNOCKOUT GARBAGE GRINDER: NO—not allowed with design SANDY LOAM SANDY LOAM LEACHING AREA REQUIRED: (440 GPD) = 594.6 SF 10YR 5/6 10YR 5/6 99.9 2s" 100:1 25" 500 GALLON CAPACITY, H-20 LOADING .74 GPD/SF C C CHAMBERS PROPOSED SEPTIC TANK: 1500 GALLON CAPACITY SAMPLED FOR PROPOSED D—BOX: 1 INLET, 3 OUTLET (MINIMUM), H-10 RATED SIEVE N.T.S. USE 3-500 GALLON LEACHING CHAMBERS IN SERIES PROPOSED SEPTIC SYSTEM UPGRADE PLAN SANSURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES MED. 6/6 MED. SAND 2.5Y 6/6 �. 2.5Y s/s 16 MARYALI C E LANE, HYAN N I S, MA - SIDEWALL AREA: 2(12.8' + 33.5') X 2 185.2 S.F. BOTTOM AREA: 12.8' x 33.5' = 428.8 S.F. s1.1 132" s1.2 132" Prepared for. D. A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 PERC RATE <2 MIN/IN. C" HORIZON Engineering by: SCALE DRAWN JOB. NO. TOTAL AREA:.............................................................. 614.0 S.F. NO GROUNDWATER ENCOUNTERED Engineering Works, Inc. N.T.S. P.T.M. 304-17 DESIGN FLOW PROVIDED: 0.74 GPD/SF(614.0 SF) = 454.4 GPD NOTE: AN ADDITIONAL SOIL EVALUATION SHALL BE PERFORMED AT 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. TIME OF INSTALLATION FOR THE+ INCREASE IN DESIGN FLOW. (508) 477-5313 2/16/18 P.T.M. 2 Of 2 1 M I 1 0 _ N G f � � f I �w I e Q i t J ! I 1 � a f x QUIZ 5garlone`- 6 Pleasant Hill Ln. Hyannis, MA 02601 { I s , I i 6 U l j � I i Uf � �d O =0 rn m ------------ Awjcq Z4 yf Ci ILA')VL- c U e(7 --J]11 z � 2 o Luiz 5goftne 6 Pleasant Hill Ln. Hyannis, MA 0260'i 0�< 4 /n y1 i } 19 1� 1 � I l� q J � e2 VJ Wi-i Sganone 6 Pleasant Hill Ln. Hyannis, MA 02601 t r /boo Arvoll- 5W.o�, �2 f� -� �" Cuiz Sgarione� 6 Pleasant Hill Ln ^�� 1 Hyannis; MA 026C 10 I PA t i 1 i ,I I I -- Linz Sgarione 6 Pleasant_Hill Ln. f-yannis, MA 02601 j. i ooA --- -- - -- ----- C,,,+V Pi GT 1 1 i -Tj~ h �� V I i k Y4 (go DOM 4b a w �'`t ,/ 4A UL { I I I I I