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HomeMy WebLinkAbout0021 MEGAN ROAD - Health 21 'Megan Road Hyannis t A = 292 260 R i y v a x 0 9 a i Commonwealth of Massachusetts . 19V� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 21 Megan Road Property Address Jack and Joyce Williams Owner Owner's Name information is required for every Hyannis MA 02601 5-2-14 page. Cityrrown State Zap 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 A. General Information filling out forms on the computer, �,(N OF . use only the tab 1. Inspector: _�. 9�y key to move your a p • G cursor-do not DAMES U' = use the return .lames Sears key. Name of Inspector �* �;. CapewideEnterprises,LLC ; �•..o o:•� Company Name 153 Commercial Street ��FrSr,NSFE��```°� Company Address _ MashQee MA _02649 _ City/Town State Zip Cade 508-477-8877 S1623 Telephone Number License Number B. Certification 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 5-3-14 nspedor'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. Ohs•3113 Me 5(Mdel h one Sutuurtace ewage Oisposel ystem•Page 1 of,17 86'd d66:L0 t7I 170 AelN Commonwealth of Massachusetts r� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 21 Megan Road Property Address I - Jack and Joyce Williams Owner Owner's Name inforrnatiorl is required for every Hyannis MA 02601 5-2-14 page. Citylrown State Tip 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: 13) 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 efltration 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): ' s x t5ins•3h3 Title 5 Official Inspection Form:Subsurtace Sewage Disposal System Pape 2 of W 6l-'d d61,10 t,1, t0 ABN I Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 21 Megan Road Property Address Jack and Joyce Williams Owner Owner's Name information is required for every Hyannis MA 02601 5-2-14 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumpsialarms not operational. System will pass with Board of Health approval if pumpsialarms are repaired. :1 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 pipes)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 I 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 i5ins-31;3 TRIe 5 Official bnspection Foim Subsurface Sewage Disposal System-Page 3 of 17 OZ•d d6 VLO t7 6 t,0 A8M Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 21 Megan Road Property Address - Jack and Joyce Williams Owner Owners Name information is required for every Hyannis MA 02601 5-2-14 page. City[Town State Zip Code Date of Inspection B. Certification (cost.) 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. r 3. Other. . T. { 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 0 0 Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ 0 Liquid depth in anespat is less than 6" below invert or available volume is less than Y2 day flow X EWchl j IC !Sins-3113 Till®5 OBidal Uisperiian Form:Subsudam Sewage Disposal System-Page 4 of 17 d lZ' dOZ:LO b l•b0 AeW r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 21 Megan Road Property Address Jack and Joyce Williams Owner Owner's Name information is required for every Hyannis MA 02601 5-2-14 . Page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4'6mes 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. ❑ 0 Any portion of a cesspool or privy is within a Zone 1 of a public well. 4 ❑ ® 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 servih'g 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 q ❑ ❑ 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 11 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. 15ins.Y13 Title 5 Of idal Inspeamn Farm:Subsurface Sewage Disposal System•Page 5 of 17 ZZ'd d0Z:L0 b i,t,0 AeIN Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for.Voluntary Assessments F Y, 21 Megan Road Property Address Jack and Joyce Williams Owner Owners Name information iso' required for every Hyannis MA E 02601 5-2-14 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no" as to each of the following: Yes No , i ® ❑ 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? El ® 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? ElWas the facility owner,(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS) on the site has been determined based on: ® ❑ Existing information. For example,a plan at the Board of Health. ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)) D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 t5ina•3/13 Tift Offida Ins pectin Form Subsurface Sewage Disposal Syslam•Page 6 of 17 d £Z' d lZ:LO b 1.ti0 AaW Commonwealth of Massachusetts Title 5 official Inspection Form ' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 21 Megan Road Property Address Jack and Joyce Williams Owner Owner's Name information is i required for every Hyannis __ MA 02601 5-2-14 page. CityfTovvn State Zip Code Date of Inspection D. System Information Description: The system is a 1000 Gal. Tank D Box and five infiltrators. 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 ID No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage na 9 ( Y 9 (gPd))= Detail Sump pump? ❑ Yes ® No Last date of occupancy: Present Date CommerciaUlndustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seatslpersonslsq.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•3tl3 Title 5 Official Inspection Form:Sutsurface Sewage Disposal System-Page 7 of 17 t Z,d dZZ:LO t7I. b0 AIR Commonwealth of Massachusetts Title 5. Official, Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 21 Megan Road _ Property Address - — Jack and Joyce Williams Owner Owner's Name information is required For every Hyannis _ MA 02601 5-2-14 _ page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of oocupancy/use: Date Other(describe below): s General Information Pumping Records: Source of information: 2006/20101 201 3 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: i Type of System: f ® 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'ank. Attach a copy of the DEP approval- El Other(describe): t5ins•3113 Title 5 official Inspection Form:Subsurtaos Sewage Disposal System•Page 8 of 17 9Z'a dZZ:Lo j7 l•t,0 AeW Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 21 Megan Road Property Address Jack and Joyce Williams Owner Owner's Name information Hyannis _....._.._._ MA 02601 5-2-14 required for every � _ page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Tank NA/ D Box and leaching 2005/Permit#2005- 125 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 30" feet Material of construction: ® cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet - Comments (on condition of joints, venting, evidence of leakage, etc.): Pipeing is cast iron from house and all other pipeing is 4"PVC SCH 40 Septic Tank(locate on site plan): 22" 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: 1000 Gal. Precast Sludge depth: 1" t5ms•3f13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 9 0117 9Z'd dZZ:LO b l b0 AeN Commonwealth of Massachusetts _ Title 5 Official; Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 21 Megan Road Property Address Jack and Joyce Williams Owner Owners Name information is y required for every Hyannis MA 02601 5-2-14 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cunt.) Distance from top of sludge to bottom of outlet tee or baffle 29' 0" Scum thickness Distance from top of scum to top of outlet tee or baffle t3" Distance from bottom of scum to bottom of outlet tee or baffle 18,. How were dimensions determined? Asbuilt-Tape-Plan Sludge Judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working IeveL Tank and covers at 22"below grade_ Inlet baffle, outlet tee. No sign of leakage or over loading. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: { Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3113 Title 5 Official Inspection Fran:Subsurface Sewage Disposal System•Page 10 of 17 LZ,d d£Z:L0 t,L t,0 AeW Commonwealth of Massachusetts POW Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments _ 21 Megan Road Property Address -- Jack and Joyce Williams Owner Owner's Name information is required for every Hyannis MA 02601 5-2-14 page. Cityfrown 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 t51ns-U13 Title 5 Of idal Inspection Form:Subsurface Sewage Disposal System-Page 11 ar 17 8Z'd d£Z:LO b l b0 Ae" Commonwealth of Massachusetts Title 5 Official Inspection Form -- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 21 Megan Road Property Address —_._.—.. ._._......._._. Jack and Joyce Williams Owner Ownets Name information is required for every Hyannis MA 02601 5-2-14 page. Cityrrown State .Tip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 — -. -- — Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 16"xl6"-38"below grade w/cover at 20". Box is clean and solid w/two line's out_ No sign of over loading or solid carry over. Pump Chamber(locate on site plan): Pumps in working order_ ❑ Yes ❑ No* Alarms in working order. ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 o1 17 6Z'd d£Z:LO b l,b0 AeIN Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 21 Megan Road Property Address Jack and Joyce Williams Owner Owners Name information is y required for every Hyannis MA 02601 5-2-14 page. City/Town State Zip Code Date of Inspection D. System Information (Cont.) Type: ❑ leaching pits number. ® leaching chambers number. 5 ❑ 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.): Leaching is five infiltrator chambers wtV stone. Chambers are clean. No sign of over loading or solid carry over 1'water in chambers. Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool -- - - Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3113 Title 5 Official Inspection Form;Subsurfane Sewage Disposal System.Page 13 a117 0£'d dt7Z:LO b i, b0 AeN Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 21 Megan Road Property Address Jack and Joyce Williams Owner Owner's Name information is y required for every Hyannis MA 02601 5-2-14 page. Cityfrown State Zap Code ©ate of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: --- ---- -- Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 15ins•3113 Title 5 Official hlspedion Form:Substnface Sewage Disposal System•Page 14 of 17 l£'d dtiZ:LO t,L t,0 AeA Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Farm -Not for Voluntary Assessments 21 Megan Road Property Address _ --- Jack and Joyce Williams Owner Owner's Name information Hyannis MA 02601 5-2-14 required for every � 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 beInchmarks. 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 s �i-c-k ...0 z o Pr t5ins•3113 Title 5 Official Inspedok Form:Sut)suriece Sewage Disposal System-Page 15 of 17 Z£'d dbZ:LO t,l t0 AeW Commonwealth of Massachusetts Title 5 Official. Inspection Form ' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 21 Megan Road Property Address Jack and Joyce Williams Owner Owner's Name information Is required for every Hyannis MA 02601 5-2-14 page. CityrFown 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 11+ 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: 4-4-05 Date ❑ Observed site (abutting propertylobservation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: T.H.on design plan 4-4-05 no G.W. at 11'. Bottom of chambers at 5' below grade. Bottom of chambers at 6'above T.H.depth. i Before filing this Inspection Report, please see Report Completeness Checklist on next page. Oirs•W3 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 o117 E£'d d5Z:L0 b 1. 170 AeA Commonwealth of Massachusetts UTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 21 Megan Road Property Address Jack and Joyce Williams Owner Owner's Name Information is required for every Hyannis MA 02601 5-2-14 page, Citylrown 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 i I t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 b£'d d5Z:L0 t,6 tr0 ReW No: Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 2pplication for 30wpont *p!tem Con.5truction Permit Application for a Permit to Construct(-. )Repair(Upgrade( )Abandon( ) O Complete System El Individual Components Location Address or Lot No. l �Y1�51 ISO f}GPctp hn(S Owner's Name,Address and Tel.No. i 1' 7, j pin n Leg,\K_A►4 5 Assessor's Map/Parcel 2cj Z ���� ZI vn-5 14n /Z6 t,l-n.l"V%;5 `MA 7 7 s=6 21 Installer's Name,-Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Z Lot Size I/ 3Sr3 sq.ft. Garbage Grinder( ) Other 'Type of Building Sincle! 4,*-1y No.of Persons 3 Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 3 0 gallons per day. Calculated daily flow 3 3� •q o -gallons. Plan Date Number of sheets I Revision Date Title 2 t M e-j Size of Septic Tank Type of S.A.S. Description of Soil �_ Nature of Repairs or Alterations(Answer when applicable) F6d W Q"fi Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with.the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by th' oard of Healt . Signe a 11 Date q-5- Lo o) Application Approved by ME VM U kr1W Date S Application Disapproved for the following reas61 Permit No. _ Date Issued u No: Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS s ZIppYfcation for Migofsal *patent Construction Permit Application for a Permit to Construct( ; )Repair(Upgrade( )Abandon( )f ❑Complete System ❑Individual Components r Location Address or Lot No. a( iYte�Wv� 20 A d , { Ahn iS' Owner's Name,Address and Tel.No. �r3z Assessor'sMap/Parcel -ZS2 ', -24 M a514-, 2,� 14-c ft-7V1'sS ✓►�h 7757-b�(21 Installer's Name,Address,and Tell.No. Designer's Name,Address and Tel.No. CVew A2 ���efQr3cS C°g2rY/ems f 5#4, t=r4r'rryr� .(`► 5�7`j=��i(�. Pv• 11a < toz Type of Building: Dwelling No.of Bedrooms Z Lot Size lit 35 3 sq.ft.- Garbage Grinder( ) Other Type of Building 'G 4m\le f4d 4I�, No.of Persons 3 Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 3 O gallons per day. Calculated daily flow 31 •7 gallons. Plan Date t�- Zo >' Number of sheets 1 Revision Date Title 7-1 M e 5 p., 2 9 Size of Septic Tank � Type of S.A.S. Z410144b _5 Description of Soil gQk5_� Nature of Repairs or Alterations(Answer when applicable) 1`rc� Q,fi Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by th' oard of Healt . . Signe Q r Date _S" Z o o Application Approved by l / U/1 11 AW _> Date Application Disapproved for the following reaso s Permit No. .... _� Date Issued .---------------------------- -- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the Op-site Sewage Disposal System Constructed ( )Repaired (K)Upgraded{ ) Abandoned( )by a o at `Q 1 \/a VNINN S has been constructed in accordance with the provisions of Ti 5 and the for Disposal System Construction Permit No. "- dated Installer (c4crn-o LQ- Designer f i _ V The issuance of-/t 's p rmit shall not be construed as a guarantee thatCe e y em'i 1 function as designed. ` Date 7 7���� Inspec . •-- � —® .__. � / / ®--®®®----------------- No /Fee /( ./ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS lie;pozar *pgtem Construction Permit Permission is hereby,g anted to Construm( , Re�ppa�i ( )U grade(, )Abandon( ) System located at /x f 1 I �1� f� ,� -Al �J and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Constructi6n��t e completed within three years of the date of th Approved by perrrii / Date: ) �_ '� r � _ 9/16/03 Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems.Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM L - c,H we ,hereby certify that the engineered plan signed by me dated T1 D5 ,concerning the property located at , meets. all of the following criteria: • This failed system is connected to a residential dwelling only. There are no.commercial or business uses,associated with the.dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or.may conduct deep test holes and percolation tests at the site without a health agent present. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will-be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the. Frimptor method when applicable] Please complete the following: A) Top of Ground Surface Elevation(using GIS information) B) G.W.Elevation +adjustment for high G.W.a. _ DIFFERENCE BETWEEN A and B Q4,1- SIGNF�D: `ZrrYe DATE: 0 NOTICE Based upon the above information,a repair permit will be issued for bedrooms maximum.. No additional bedrooms are authorized in the future without engineered septic system plans. q:lsepdc\percexemp.doc l4 Permit Number: Date: Completed by: HIGH GROUND-WATER LEVEL COMPUTATION Site Location: E;C,ez6 —4ZA , 4 , N,,)y `j Lot No. Owner: Address: 3.-,m19 Contractor:__15'"Y 61\50. `i��t'`�• Address:.?.b, (�Sgx t-o Notes: STEP 1 Measure depth to water table tonearest 1/10 ft. .............................................................................. .Date '4 o9 month/day/year STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: 0 Appropriate index well.................................................... MIZ*9 O8Water-level range zone ..................................................... STEP 3 Using monthly report "Current Water Resources Conditions" determine current depth to water level for index well ........................... 310,5 , month/year STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A), current depth to water level for index well (STEP 3), and water•level zone (STEP 28) determine water level adjustment ............................................ STEP 5 Estimate depth to high water by subtracting the water• level adjustment (STEP 4) from measured depth to water level at site (STEP 1) ........................... ;.............................. I l; Figure 13.—Reproducible computation form. 15 t ?1 OF hA.°.I`�ST�SLE i_G:.r►i1UN /1'� �Q 4� �d SEWAGE # JQb,S- VILLAGE A"1J ASSESSOR'S MAP& LOTZ9Z INSTALLER'S NAME&PHONE NO. La.p� w:d.� �h 4' , �o Sc S/As, W d S SEPTIC TANK CAPACITY /000 / LEACHING FACILITY: (type) /n 1=•('FM To r (size) V )e NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility No Feet :'rivate Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) N`� Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) �� Feet Furnished by Ra a7 • � � r�3 34. 7' 133 3s. y; v° i No.--- 1--------- FErc:. ..... ...`—t.......... THE COMMONWEALTH OF MASSACHUSETTS BOARD F H TH t- go''LAI-\-—-------------OF........ ... .. Appliratinn for 43ispos al Works Tnntrnrtinn Prrutit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal N System at: Location-Ad ess or Lot No. ------------- � M— ner -"------............................... --•-••----•-............--•---........ --•------------•-----•--............................ - Address ------------------------ W a Installer Address� ' d Type of Building Size Lot---------------------------- feet U Dwelling—No. of Bedrooms----------........................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) C4Other fixtures -------------------------------- -- - -----------•----•----.-•---- W Design Flow............... ................gallons per person per day. Total daily flow.......... -_ .______.__.____gallons. WSeptic Tank l Liquid capacity............gallons Length................ Width.......--_.__-_ Diameter----------- Depth.--..........--- x . Disposal Trench—No..................... Width-------------------- Total Length-------------------- Total leaching area....................sq. ft. 3 Seepage Pit No-------I__.......... Diameter.................... Depth below inlet................_--- Total leaching area------------------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-------------------------------------------------------------------------- Date........................................ Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water--._-_-__-_-____--_----. (� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--------- _________---. 0 - -- Description of Soil--------------------`'��-- f` . ....`. -- -- r-��1 .. ... ------------. ------ ---------- -- ------------ x -------:- U ........................................................--------------------•------••---•--------------•••••-•••••-•--------•-•------••--•---------------•-------••------------•------ W -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable_--------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees,not to place the system in operation until a Certificate of Compliance hasanissy the bird o ealth.� - - -------Signe ��l ................. Sign Application Approved B / Date Date Application Disapproved for the following reasons:-----------_----------------- -----------------------------------------------------------Da,t,e--------- .. --------•--•-•-------------------------------------------------------•-----•------------•----------------------------------•••-•-•--•--•-•-----•---------••---•....----- --•-------••----------------••- Date Permit No------------------•--•-•-----------...-----------....... Issued.- -c.7 /�•2--•-•--------- THE COMMONWEALTH OF MASSACHUSETTS S _ l BOAR® OF M.-EIALTH -------_ _-................. I Appliration' for Elhip tittl Workil Touldrnrtion rnmit Application is hereby madg.for a Permit to Construct ( ) ) or Repair ( ) an Individual Sewage Disposal System at: :t Location' dress or Lot No. ---------- :... a ----s----------------------------•-------------- ................................................... wner Address rWa --•---•--••. . Ea t Installer Address d Type of Buildi g r. Size Lot............................Sq. feet U Dwellin —No. of Bedrooms......... _ ___________________Expansion Attic Garbage Grinder Q, Other—Type of Building ____________________________ No. of persons________________::__________ Showers ( ) — Cafeteria ( ) 0.i Other fixtures ...................................................... W t Design Flow_______________G _________________gallons per person per day. Total daily flow......... 1 ._ -pi__--------------gallons. WSeptic Tank 4-Liquid capacity-----------:gallons Length................ Width________________ Diameter---------------- Deptli___________-_--- x Disposal Trench—No_ .................... Width-------------------- Total Length-------_---_----- Total leaching area_______.____________sq. ft. Seepage Pit No......1,------------ Diameter____________________ Depth below inlet.................... Total leaching area------------------sq. ft. Z Other Distribution.box. ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ ,� Test Pit No. 1................minutes-per inch Depth of Test Pit____________________ Depth to ground water-----------------___---. �14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ •-----------------=--------- ..................... ------------------ O Description of Soil____________________ 4. --- - -- x U --•--------•••-••••--•••-••-------•....••-•-••-----••-•••-••-•-••••---•--••----•----•-•-••--•--_•-•-•••••--_•-•••--•...----•----••-•------•--••••-._...-••••--_••-------•-----_--_-•-------------------- W VNature of Repairs or Alterations—Answer when applicable-------------------------------------------------------------------_____________________________ -_---•-••••-----------------•••••••••--•-------•---•-...••---------•••-•••___•_-_---•-••-_-••-•---•-----•--_•__---_-•-----...-••------••------•-------•------=••--------------------------••-_-_•--_--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of,the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has n, ub is y the b and health. /s /W . , Signedrw- _-••-• ........................... ................................. r` Date Application Approved BY f"'� �j a --------- Application Disapproved for tlae,f ollowing'yecisons-=--------------•---------=------ ------ ---------=------------------------------------------------------------ -•--•-••••__••--•--_--_•---•-•---------=----•-----_-_--••••-•••-••-•--_--.._..__•--=-----•-••---•-•-- —7 Date Permit No. Issued. ;r .., .............. •. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH p s -.....OF..°' r :t t.� ..{.•.....- ....... Terfif irate of Toutphattrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed,.•) or Repaired ( ) _4 rf _ - �� Installer , atr�, - �r_ - € - r .: -------------------------------- ---------/;` _ r ; has been installed in accordance with the provisions of Article I of The State Sanitary Cede as described in the application for Disposal Works Construction Permit No. ___________________________ dated-___... ___________________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL.FUNCTIgN SATISFACTORY. � DATE � �� � - -------------•- Inspector. ` `------4;`.� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH I , • �.��-y,,,.,��.._-aye., ......................-•--•--•----- F g-J 1 No` = EE ,...f_..°.... 13inputia1 Workii Tontitrndinn rrtnit Permission is.hereby granted-t •:� °. r.' y- ,t�� .--------------- -------- ....................... 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F:ca,. y3'4'M` -as ri �2y".'"� ,�,.'.,,�"' - �. "T -,.�.' .� r�4 ¢ra-.,'. _�GF ._3x*�r? "+,'•� `w .'fr�F'a# '�-^xF� `•s --3 .4 + _r+. '= `Hi: TJ }- -�. ' �./�,'�ya;/,;�� mot+. '+' - i n =cF-4 xc --- ,vr- —r--4"� r ,.2. -r '-'i "�-EK3 1 ,,eye , fir.,-,-,'+..�'a y -:V-1-,a^ 1 {— rc. .r M��' •` .-;'"x'_A�cs+ti�- -,.rv. ,r^� ,fi" s.�„�„ "Ty aL� r' +Y• 3t- „r E� - � �a� .a„^ jy'F"tc •e� . �,. � k�,,•.�`��-ta< ,� - ` �, -`ems;,# S �s4� -- "�` »'� ,,,y*'" ., ,4 ." �",u r'..�� ) jSJ/• . , t� 4 a f � fifi s A` t t$ I , - �} Y # .-. s,4 it P - i c ,✓,Z !i ry.•f .. gyp_ - w�;r}� r '$ z* _ -f 3 .-.' r� A y .,_ems "N + 1' 4 244. -i.. {-'" , 1 5 0 . � �F7HE�•� k i BASBSTAX i NAM �•� BUILDING INSPECTOR �o MaY a• APPLICATION FOR PERMIT TO ' '"��� �............�...... ........... ..... ' ......................................................... TYPE OF CONSTRUCTION ..... ................................................................................................................. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit accordi tom the following information: location .....!�../�� ....�����o',S Ls.®�L-OGr� ............................. . .............................. Proposed Use ..`- .4...... /07 ...... 1. �`�, .......................... .............I......................... Zoning District .. 2 Fire District ...1�7 ! ✓/1J/ ........................................... ..... ..'... ... Name of Owner ................ ....�'i.......Address .. ��G.� ��'�, 7. G` i® � !✓ Name of Builder .............................................,/............. .. ...Add-Tess. .... .:.........•... Nameof Architect ..................................................................Address ...:................................................................... ............ /�f ./ Number of Rooms � .:.....Foundation ... .. .. Exterior ....................................... .........................................Roofing ...... .. ... ... .. .............................................. Floors ....441�4�.......... .....Aa..............................Interior ...... ...,r.......................... .................................. Heating �. .. ............................ ...............Plumbing ......./........................................................................ Fireplace ............ ..................................................................Approximate Cost ....... .......................................... J j Definitive Plan Approved by :Planning Board __ __ -��______19_ / 6 61 Diagram of Lot and Building with Dimensions / frxy l -"r SUBJECT TO APPROVAL OF .BOARD F HEALTH � JDI J ® p OO � I hereby agree to.' conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Nam ................... ......... .................... Town of Barnstable Regulatory Services Thomas F. Geiler,Director * BARNSTABM • 9� M� � 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: 4/07/05 Designer: Shay Environmental Services, Inc. Installer: Capewide Enterprises, LLC Address: P.O. Box 627 East Falmouth Address: P.O. Box 763, MA 02536 Centerville, MA On 4/05/05 Capewide Enterprises, LLC was issued a permit to install a (date) (installer) septic system at 21 Megan Road, Hyannis, MA based on a design drawn by (address) Shay Environmental Services, Inc. dated 04/05/05 (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. OFF 144S�ti CARMEN ( taller's Signature) o E. v SHAY No. 1181 0 sTe SANITAR\Pa (Designer's Signature) (Affix Designer p Here) 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. THANK YOU. Q:Health/Septic/Designer Certification Form -7 7 7_'­I .- I.'_1I _ ,11 _I ­ I­�I,_1II.-­I�1I 7 ,� 7 7� 17 _ �- ,!-1 7 � �I- I �"" 1 � �I 1IVI.�1 I 1 I I I II I . I �I I,III1 - � , ,I I lII I- -"I 1 I II II,1III.II,I II I" I � I I � II,1 I � II 1I I1­I I 1 � II I�I1,II I1Il I I : �� I ��I�I,1 III'IIl I.I I� III � - , II,L I '"II­ II 1Il1�1I-II III l 1I� - ,- ­1 I1 I ­ I II 1 e11 I � 1 1 ...:,l ,� _,1 I,II1:II II I II­ "I�_ 1 �IIII II I I�I I,II1 , I I1 I�II III I I I I � I I I II� I I I `I I1 1 I 1 � ., ,I �­1I�1IJI�� I� � I., I.I I I IIII,I II 1 � 1 I1 I I I1I 1I I I I� I1 I1IIII'I I � I 11 I.1 � I I �1 . 1 �. 1 I _ 1 1: � _"'� , , 11- �' � � i � , � I` , r - , ­ ,)" 1- , ; �rI , -1 , , I �1�II I I1I I , I ,I I II 1 1I 1I _ �-- I II I. I .I II� II 11 I I.I "VEN EOast24 Inches tan omIx y iA 11SECTION AH 4 P.V.4 SCEULE C.AR TO BE 0NOTE, ALL PS EE ' lSchedue 4P W ol Olt �, ,,�, �� 0 VCChor6odor Fer ) �' OUTLET PS I PPES FROM THE ALL i 10min. from 1� to sPR OIFADIINTOLEAHGSSE. DTO CIN YTM DS1N BXALK 5 -��naion tank ou ouseep le CONCRE ;T'COVER -ATSL 1SET LEVEL OR AT F � Mort D-BX cormt F LE2 -O be,I I k mod ,r s - �'Af _3 I v o 8 " s easee 'wihn 6 in ffi ,,0,t . o nshed ade gr � , 1 . o " re f=6 in fk ,wd * r - � Ig 3/4 1 1W sh _ - V��- :­,� ,to 2 ashed Crued Ston S w I II ove tic 99�00 Grode over D-Sox ". over . , ,v -CSep 50 SAS 100.00 1I � , ,.,,k �j ­ ,' r r4 VC T 1�GAPPED C POR TO BE ' .INSPETO N , � A OUTLET � 4 jIwSmAND To� �" i; OF �TALaE6 K w OR DE ? ' - 14!0� 10 3OH-10HLE I T E16v. -96.48 ,� � �Load ;� ,m , ' , .X Y McwnuCoverT. BO N I - _ I- T )OFSwem- Ele. 96. �op ) t ;.I ; TI . J 1 EXIST. O1 or I �'� . 2 af I'm r 1V r' *,,ST, PIE 1 000 GAL. iEXI S0.01 foot � A I __ f i Z" - I 'i 4 40TR s SCH, " /EXIST. rONMA:M !FROM PC TANK �L SETI� , ,��0 k ! ,0 1 = . �,it @ 5 Uns6.25 I30 ­P ,LAN SEC I0 to CSS-SECO 1 "I) TI � 10. m. 1 I I;� � !A IVA - - � 13 1CONCRETEFUU MV. 3 11 0 /Z 0.83 10 .inches 4 0 , * II 312 �h 5 � . I N ' . .�3 HOE H T I. 6 inof3/4-1 1/2 L 10 DISTRIBUION BOX " e e 1 37.�5 t NSYSTEM PROFILE V comactd stone -4 Stl ectiv t Effeeg Awn NOT SCA . T TOLE v. iNat to ale (Sc I0 , _ �. pBSO .Rd 5 1 & W, NXOwwy*j �4 ; r 1 Z R c �2i ' * I4) 1 0 INFILTATROR HGH CAPA Y (H0 A - ; I CIT -2LODING)/ GEORGE OBRIEN6 n.of 3leI 1/2 0 GENERAL NOTES 1 rFfective Vk"octed stoneV � - Not l ORE DIVAE iI I 1-Contractor i rHA R WI 6 OW sesponsible for DI safe notfiNOTE. ALL C WPONENTS MUSTVEISERSTOTI BELGRADE cation Iottmf T I .Bo oestHo ev-Woo MeE iN RA TOFH hFILRATOE S 18 FFECTVE EIGHT IS 1 d r E IH 0 election of all undergroundutiltiesand pipes.n / p 2. an distrbution bx hatosl be set lee n6of 3/4 -1 2 tone. 3. Bocfll Sh ld beclan r ea with no toe isns over 3 n size. Iion alculctione This system is subject to nspection ng-in stallaton bCarmen E. ha virml EnonentaServices Ina.y , Mr le V yI Number f Bedrooms_ 2 Equvolent to 220 Got./Da 330:Gal./Do 1 . The Con5 tractorshal nPERCOLATIIO TEST l istall .this system in accordance r idr NGaa n : og : I with VTtl hf te Massachuse tttate ode the rov i ped Ian Mmi itachinC Proosed. 0 G /Dnium Mn. Pe Te VLe apacit 33aa �g yp y and Lo R calegulations. i i= 6 IST. 100 GA ank.Se tic Tank 2 x�330 Gal./Da 60USE EX 0LSeptc Ty in !6 Idurn istallaon -a o: y SOIL : onsevent �O R n rclationrate of mn./nc iI A gp sol ti Date of Percolation Test: APRIL 4 2005 f ottm Area 74 al/sqft x370 s t 273.8 lons B : - q ggTest Performed'B CARMNE. SHAY R.S. C.S.E. I from hown on sol lo or n our desgn Iy g SidwallAra: .74oL ft. x 7 ft. = 5 llons I 8 s 8aS- q q iResults Witnessed By. WAIVER er Banstable B.O.H. g g lnstalation halt mme noao p & f e Providin 31.80 allonsxa ironmntal Svcs. g g made t o Carmen E. Sha ­ Environmental Services Inc. i /i y , PercolatonRate: Less a nch m 7. N vehicl or mio eheav achne shall drve over the- ryy R G . Ee A N , i. i septc system unles notse as H-20 se componend tc is pW TO BE SE M 4.0 OF WASHED STONE ON THE SIDES AND 3.5 OF TH 8. InstallTuf-Tite fas bafles or equals on l le e n g oiouttteeds. __ - ON THE ENDS. NO STONE UNDER, 9. All istribi nDutonLies shall e 4 iamer 4b d te Schedule 0 NSF PVC ipes.Test Hole p 10. ll solid ipin fttiA tees & ings shall be diameterNo. 1 I k_ _ .:'Schedule 4 NSF PVC ipewi r is tghtonts.DEPTH OILS ELEV. j I -l-11-- ­.. .. 11 , Munical r iWates Connec t A F ThtedoLLOe Residence and Abutein 0 99.00 p g f 80.26 operties Within 150 Feet i Sand Loom i I 0 YR 3/1 . LOT 132 TH ROPERTY1 - A/0 EP LINES ARE APPROXIMATE AND 3 0837 I ICOMPLED ` ROM PAN YBT _ F ABLE SURVEYCONSULTANTS f4,0 �, E ED LOT . LAN OF'LOT 132 "40 Sqar Fet SandyoomLi EGAN ROAD HYANNIS MA ! DATED JULY APRIL '1 19710YR 5/8 1 8, 3 _10AN OT � I -- _ N BE A SURVEY PLOT PLAN 3 - 2 8 96.67 �8 ____ IT SHOUD BEP _ OSE OTHER THAN: STEM I , ILoam HE SEPTIC INTAAION.I Sand � =I 26Y76 1 95.67 40 EXISTINGLEACH IT PC P E UMPED AN w 73.5 TOB OUT D i Med-cae FI I� LLEN PLACE. I Sand 1 r ANY R I- NOTE STIP _ DO NN j. 2.5 , . FROM TH ISTE NG PTI M T � EX SECSYSTEO BE :DISPOSED40132 88.00 01 M i1 OFAS PER OAR F T BDOHEALH SPECIFICATIONS. CATIONS. --- ­ � 7R � AREPET bDS RSWTHIU200 OF THE_:PROPS RTY 1 iI , f �fASSSO S MA292 RCEL 1 , 260 j I I Y LEGEN Per 1i a 1 R = min /incPerc ate 0 - -37.2 294 5 r rvGroundwate NotObseed 0T0vmn Reired �;ADJUSTED H2OH20 Ele . = No Adsetqu �.�� � � l-3 -too __� -; 1 ENOTE EX! TING SX 04.46 r K P box I _ PL PORTY IN E LE I aled each Pt L I I , o 6 PI , IEC BENCH MARK 30.5 i -I I of TOP OFFONDA too UTION I i= EXISTING CONTOUR IELEV. ; 100- 97Ee'ST 000 oL C g Se Tank TEST HOLE 1T �PEE TSTD E HOLE & I H ELEV. 98.00 I2-18 DAM. ACCESS MANOLES , PER COLATION TEST LOCATION a DE � !�. ; -,L . .- I EXISTING ! _ . -- * IOZ BEDROM I INLET - I - HOUSE �OU- T 1 I t T Q I L0 P LN '1 :12 I I THE ACCESS COVERS FOR THE SEPTIC TANK I DISTRBUTION BOX AND LEACHING COMPONENT � I .- , 7 ! 7 :� SET EEEPER THAN 6 IN04ES BELOW FINISHED7�2 O PROPOSED SPTIC i _- , GRAD SHAH BE RAISED TO M74N 6 OF I I I "� SYSTEM UP RA ;EFINISHEDED GR ADE I IT REINORCD NCR ETE , ' , � JI 1PR P IN TUF­TITE GA BAFFLES OR EQALS � r <I 3 HOLM WI - - LLIAMS / 1 FV3-24 KENO ABLE 00VE?S : Lz _ i � AT -- I 0 9 -- I � �.� -_% �i ,, iy.:. : 9 I 21 MEGA mn. 8__3 cearance --_ ET -,r ! n t et �2' ineto out 0 9INLET- I - 7 OUTLET - 3 ' t - HYAN al- _ I NIS MA Z ' 1 7- -6 -- :E 4-O* mim -- PREPARED BY-- 0.son. Xqid th ILiqudp I I _ � - --- I 95 ARE : , , A ITV . Sff - S _. _', NVIRONM Y RS- 0 E INC. I4 1 E 0 END-SECTI ON 0 20 40 50 P.O. 627M 1 _ 1E U4V OAD- i P I1 3 EAST rALM A1 OUTH, V 02536 I 11s 14 F -0OOTIGOW . R A N _ VIAR iTYPICAL 1000 CALLON SEPTIC TANK T TEL/FAX 508-539-7966 TNO TO SCALE CAL --2O DRAWN BY: CES DATE: APRI 5 0 I L205 " Ar , SCLE 1 =20 CT 7 IAM P S[) 17 FLENE: SD717P .DWG SHEET 1 OF 1 � . ' �1 , __ 1 - , - , " "� , ' , , , I I1 I II �III�1 'I ,I I 1l I I.I I�I 1 I1 II 1 ��IIl I II I, �I ,