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HomeMy WebLinkAbout0156 MEGAN ROAD - Health Ya= _ 156 MEGAN RD (HYAITS � A= i I� m a a No. Z0 I ( 'f Fee l W.a THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplitatiott for Misposar Opstem Construction Sperm t Application for a Permit to Construct( ) Repair(k Upgrade( ) Abandon( ) Complete System ❑Individual Components Location Address or Lot No. (54, M T! k.D RV Owner's Name Address,and Tel.No. P Aa l S sc c c.So M to HNt 41)VK' Assessor's Ma /Parcel Installer's Name,Address,and Te No. 502r"411 -92 11 Designer's Namb,Address,and Tel.No. 509-2-13--0 3j 7 7 �AO�tc�rfj6 Yue;5 L,(�-_ J� Type of Building: Dwelling No.of Bedrooms Lot Sized `� sq.ft. Garbage Grinder( ) Other Type of Building IZ Qs t1>W rU4 _ No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided 3qRa 4 gpd Plan Date 9°--1 "PILO(j Number of sheets l Revision Date Title 5(e K r�j ko ki) Size of Septic Tank 1 1 Q 00 - Type of S.A.S.�� ®b Ce� � Description of Soil mc-7)i U AA - coofag-6 5AA-�,,r7 � ' I �4�T" PL4AJ Nature of Repairs or Alterations(Answer when applicable) L_)S C- C-_)�ISTd OG [0D0 &—d-4i_X ) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signen Date Application Approved by r Date Application Disapproved Date for the following reasons Permit No.ZQl 9r 7 - Z 7 t Date Issued 8(It ( Zo/! r ` m. C No. � 2? Y� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Zipplication for Disposal 6pstem Construction 3permit Application for a Permit to Construct( ) Repair()� Upgrade( ) Abandon( ) [Complete System ❑Individual Components Location Address or Lot No.4:uO M G kU E"V Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel No. gQ$-k('1-1 -$8'1'7 Designer's Name,Address,and Tel.No. Sp%—'A"73—0'37'7 CAP&W(t>6 55 C44.1 JG e x rt,x t r *W G sz-' S P 8 Gt/ Type of Building: Dwelling No.of Bedrooms 3 Lot Size 12!7%fi sq.ft. Garbage Grinder( ) Other Type of Building f2 G;q f be0Y rj 4f. No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) © gpd Design g flow provided p �3 q9.q 74 gpd Plan Date 9 ►11 -PLO 1�5 � Number of sthe�et`s'^y 1�r '( Revision Date Title ( J CO M GL:.(� j lZ O Ab H 7 f"11�+N(5 Size of Septic Tank �O pQ 614-t.- Type of S.A.S. Description of Soil M G t71 U#ti " C OA4 R S6 554uD CQ 361/ l 5�T • ('L4 Aj 'S J Nature of Repairs or Alterations(Answer when applicable) kj:�L � !t/�� 1Ji�L.L.A� C'IC \ } Date last inspected: ; Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in {' accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Si Date Application Approved by Date �� r5 Application Disapproved , Date for the following reasons Permit No.wl qj Z 1 Date Issued a b 00/-; d� r THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance w THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(y Upgraded( ) 1 Abandoned( )by CAP6 %1�(bG GVE&UA LSEI? 44C at `56 M EGAIV F)R7) Hy&&)(S has been constructed in accordance �,/ with the provisions of Title 5 and the for Disposal System Construction Permit NogWj�' / dated rn If/-'7ot I Installer CAPER) i;; Lt &-S US—' Designer #bedrooms Approved design flow a gpd The issuance of this permit shall n t be construed as a guarantee that the system ill functi a e i ed. Date 1 l� 1 Inspector ----------- ------------------------ --------------------------------- �'?w ---- NO. 46 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH,6IVISION-J�X-RNSTABLE,MASSACHUSETTS ` Disposal 'pst "construction 3pPrmit Permission is hereby granted to Construct( ) Repair(` Upgrade( ) Abandon( ) System located at �L �'• t^ ) and as described in the above Application for DisposalSstem Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provision or special,conditions. Provided: /Construction must be completted within three years of the'date of this permit _ZZ0_ Date I �'/ 7fi,l `I Approved by r 8/20/2015 16:04 5082730367 I «�"V I VV vv I Town ofiarnstable Regulatory Services Thomas F.Geiler,Director •�6 • Public Health Division M 1639, Thomas McKean,Director 200 Main Street,; Hyannis,MA 02601 I Office: 508-862-4644 Fax: 508-790-6304 8-2-0 -I 5 / 25q Date: Sewage Permit# Assessor's Map/Parcel •21� Installer&Designer Certification Form i GA c'�(iic'!e ���Ee(�cCSe S Designer: �cn e c CO ; Tin c j Installer: P Address: zi'5 4 C(w\Qerf! A&Lvny Address: I r 3 Comm�rc�'a l Stree t Ew.k cuacdnom VIA 0153E u y I On $' l �t Capc�+aiGtE C�Ez�"P<is�s was issued a permit to install a (date) (installer) septic system at 5(o H e90•/ Roaj, based on a design drawn by (address) I G EnSineexi n5 , Toc_ dated (designer) I V 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. Strlpout (if required) was inspected and the soils were found satisfactory. 1 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. Stripout (if required) ected and the soils were found satisfactory. 6 �' JOMN r. CNURCHILL JR. " (1n ler's Signa re) Iv1l i •lea I I esigner s Signature' (Affix De ghW1W9MffY Here) P ASE RETURN TO ARNSTABLE PUBLIC HEAL DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL 110THS O AS- . BUILT CARD ARE RECEIVED BY THE,13 STABLE PUBLIC HEALTH DIVISION. THANK YOU. I I gAoffice formMesignmertirication Fortn.doc j i i I �I i Tow of Barnstable P#. lHl?Co I Departitnent of Regulatory Services • �er LA f Public Health Division Date t439 200 Main Street,Hyannis MA 02601 ' • ffl)1116'1 A Date Scheduled Time Pee Pd. x� Soil Suitability Ass-essm" ent foir Se �e I�ispos t Performed.By:. Mte"AILL 7tnetEMrE1_,EIT, CSE Witnessed By: LOCATION& GENERAL INFORMATION A Location Address B 5(. MC—E- AI j ) Ro nY Owner's Name -TOSS C-'C,�® MAA { 1"1 L61-59 trt� 7`Ye, Address fjC(� N1c-C�a4iJ •NYA11IU! Assessor's Map/Parcel: Engineer's Name CApG7 -DjS �-Us NEW CONSTRUCTION. REPAIR _ Telephone it Land Use _REs109r.trtAL Slopes(9'0) 1— °/o Surface Stones— N/A Distances from: Open Water Body i5O ft Possible Wet Area ft Drinking Wafer Well >t5o f[ Drainage Way >t0 ft Property Line >t0 ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&Pere tests,locate wetlands in proximity to holes) Sew czkka�•eci.: ���� Parent material(geologic) DUrWASA 'P(.AtN 7 • Depth to Bedrock Depth to Orouudwater. Standing Water in Hole: 12C'" Weeping from Pit Fpee t26" Estimated Seasonal High Oroundwater to DETERMINATION FOR SEASONAL-IIIGT�f WATER TABLE Used: _"011[eer o85eavgrrdn Depth Observed standing in obs.hole: > 12b ill Depot to weeping from aide of obs.hole: Ih, Depdt to sell mottles: _ > 12f, 111, Oroundwater Adlutltment K IA Index Well 0 — Reading Date: — Index Well level____V_,_-_ _ ...-. . . _ A i�,factor A:Q.grnundwtiter Leval PERCOLATION TEST Dflte 7-Z2-15 ,x�„� io a wt Observation Hole# 1 _ Time at 4" Depth of Perc 30�-V9 Time at G" Start Pre-soak Time @ M:ooTime(9"-V) End Pre-soak �D:/`/AM _ Rate Miit./luch 2 Mot Site Suitability Assessment: Site Passed. e—S Site Failed: — Additional Testing Needed(Y/N) N Original: Public Health Division Observation Hole Data To Be Completed on Back--------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1) week prior to beginning. Q:\SEPTTIC\PERCFORM.DOC DEEP-OBSERVATION ROLE LOG Hole# t ?z Depth from Soil Horizon Soil Texture Sdil Color Soil• Other Surface(in,) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. or i tency %'arayel) 41 A Lo*►,Af SAND 1 o"YQ 'all — Logany sAr-tO to YQ,s�� - 30 C nneo-Cogtse S DEEP OBSERVATION]HOLE LOG ' Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in_) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistencv.%Oravell rs : . (DEEP OBSERVATION BOLE LOG ]Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Muoselq Mottling (Structure,Stones,Boulders. Consistency,%O DEEP OBSERVATION HOLE LOG Dole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stories;Boulders. Consistoncy. Flood Insurance Rate Map: Above 500 year flood boundary No— Yes Within 500 year boundary No Yes _ Within 100 year flood boundary No. Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Yes If not,what is the depth of naturally occurring pervious Certification I certify that on. 127-9 9 (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise and ex I nce described in 10 CMR 15.017. �� - Date � 7-( S - Signature ' QAS.EPTiC\PERCPORM.DOC r } COMMONWEALTH OF MASSAC;HUSErrs EXx,C;I:PTIVE OFFICT, OF ENVIRONVI -ENTAL.Am>, m:. DEPARTMENT OI`'ENVIRONMENTAL PRROTE CT I1; N TITLE 5 O:FFICW'.'.NSPEC'£},ON FORM—NIA'£ FOR VOLUNTARY ASSESSINIE;'�" CS SUBSURFACE SEWAGIZ,DISIPOSAL SYSTEM FORM PmtT A CERTIFICATION yy� Properly Address: _ �6 �r' . R Owner's Name: Owner's Address: Date of Inspection: Name of Inspector: lalea a print:) � & Coriipany Name:� � f�,�� JI- ;Mailing,Address: Telephone Number:. CERTIFICATION STATEMENT 1 certify tat 1 have personally inspected the sewage disposal system at this address and that the informa:':a! repvntW below is true,accurate,and complete as of the time of.the inspection. The inspection was performed bcmtt' cn my gaining and experier.cu in the proper function and maintenance of on site sewage disposal systems. 'I siai a 317P approved system in:opiector pursuant to Section 15-340 or Title 5(310 CMR 15.000). The system: . Passes Conditionally Poses Needs Further:evaluation by the Local Approving Authority+ _ Fails Inspector's Signature: � Date: _ b 0' The system inspectors a:l submit,,&copy of this inspection report to the Approving Authority(Boani of J-(r:alth ur DEP)within 30 days o:'c=pletirii;this inspection.If the system is a shared system or has a design flow iir 10,0Lo gpd or®-eater,the ins:ps:c-.or and the system owner shall submit the report to the appropriate regional office! rfthe DEP. The original sh;30d be sent to the system owner and copies sent to the buyer,if applicable,and Vat y:provimo; authority. Notes and Comments , . ""This report only describes conditions at the time of inspection sod under the conditions of u:ae,r: :h.at time, This inspection doers not address how the system +rill perform in the future under the same or di Tereart conditions of use. Title 5 Inspection Forn 5/15-2000 page ; Palle 2 of l l CION FORM ..NOT CDR VO 1NARY SSESiENT1jOFFICLI.INSPE z SU't3�9 ]RFAC'E SEWAGE DISMSAL SYST�INSPEC.TIoN l�01.i M :PART A CERI EFIt1:ATION(contiatved) Property Addrevr.: L56 CA& _ Owner: r n Date of Inspect Iois: I���-s- Insiptetion Sun nstry: Checic A,H,C,D or E/ALI!fAn coaPlew am at s e ,I'mr 0 , A. System Pasriee: A� I have ntr litund any ntformation which indieens,that any of the failure criteria describedi in i o(::IVCF; 15.303 or in 310 CZAR 15.304 exist.Any fitilure criteria not evaluated are indicated below_ Comments: B. System Car:dltionally ps,nes. __ One or more system components as described in the"Conditional P s" section need to l;e re: .aced or repaired. The syt-:er-4 upon cor:apletion of the replacement or repair, roved b the Board o;kit!i th wil us. P Y pi us. yes, no c not deterrnu-ed(Y,N,ND)in gjy f e following statements. if"not determ .ed"ple,ase explain. The septic tank is metal and over 20 y old' or the septic tank(whether metal or riot) i:;strr, turt,11le unsoland,exhibits substantial infiltration or Itratior or'tank i5 hire is immineat System will;rags i ;spec:de;et.if the exisrng tank is re 3%,E�ced with a cornpl ' septic tank as Approved by the Board of Health.•A rrrctal septic tsirtl: will pass i:as n if it is st uett:rally sound,not leaking and if Certificate,crf ':ot��tiarnc:r -indicating that the mak'is less der 0 years old is avai fable. ND explain: Observatid o obsicted pipe(s)or,,af aae l:ackup or break am oriitigh s>a�water level in the distribution bcx d: to.tniki:ri-or a to a bt�oken,.sac�l,or 4 iaQbox-:5 apprtBuat-4 Boardprl Health): y3tem will pam tiara.i +;wilts broke+pjWs3 Mn Mph=d - _ obstruction is tam,wed . distribution box is lave Ad or replaced ? D ex:pi n: _P�/ The system required pumping more t 4 ti r.a,��e to broken or obst acted pipes j, �'�,� syrterr; u ill. spection if(1 h approval of the Board ofHealtb): �_broken pipKiy ire mjlace+ Obstruction is removed AID explain: 2 F Page 3 of 11 1 s: OFFICIAL. ITfSPECTI;ON FORM-NOT.FOR VOLUNTARY ASSESS'CIN'','I'S SUBSURFACE SWAGE DISPO.;A.L SYSTEM INSPECTION FO1Z'd PAir A CERTMCA'rI:ON(continued) Property Address:. Owner: rnL.g C,e Date of Inspection: _�1 C. Further Evalusti an is Required by the Board of Fl atith: Conditions a:i.�;which require further evaluation 15) the Board of Heal order to determirie ;if:!it s!wgrx, is failing to protect public health, safety or the enviroaateat 1. System will liras unless Board of Health deterntities in a rdance with 316 CMR 15.303(R)l It) that t1h.e system is Got f:toctioning in a manner which will pro public health,safety and the enviroiniiient: Cesspool tjr prfvyn Althin 50-feet of a surfaj, water Cesspool or'19rivy is%ithin.50 feet of a erkag vegetated wetland or a salt marsh Z. ''system will lelii t,mess the:Flo d of Health(ane Public Water Supplier,if any)determines system is functio:aiog in a msttt r that protects the public health,safety and environment: _ The sys't�:m has a tic tank and soil absorption system(SAS)and the SAS is within 100 Fa::;c Faj surface water,supply tributary to a surface water supply. , The systt:m s a septic=A and SAS and the:SAS is within a Zone! of a public,water:;u:ap I;,. _P -The Sys dv has a septic,tank and SAS and the SAS is within 50 feet of ayprivate waur.sttp:>1;r The soar:has a septi:=k and SAS and the SAS is less than 100 feet but 50 feet or more: ii,,::11 a: private ter.,apply well**. Method used to detennine distatice 3 s system ;asses if the well water analysis,perfsrmed g a-DEP'certified laboratory,forcciih: -v, ba aria and v)hitile orgatlit:st*mpouvds*ilidkatet'jn.i"t5e wail is free from po111ttion from that fa' iliiy awl e presence of ammollit nilvIen and nitrate nitroi;en is equal to or less than 5 ppr-provided tha, eri c�tht..r failure criteria a-e triggered, it copy of the analysis must be attached to this form. 3. Other: 3 L — - Palle 4 of 11 OFFIt 14L INSPECTION FORM•-NOTFOR VOLIMTARY ASSZSSI�,IEINT'S SUISIURFACE SEWAGE DISPOSAL SYSTEM IIgi.C.'I'YONJ*0i'1;.M PART A CERTIFICATION(continued) Property Addres;t: P�CAa iti 9G� a1'Rer: en DaitE Of ltnlpecti]Itl: / 97/A/ D. System Fail tire Criteria ;applicable to all sysutma: You mad iadicti--'yea"or,�j on to each of'tbe f0llo.wing for WLinspectitms: Yes No Bacicip of sewage;into facility or system component due to overloaded or clogged SAS, 'cemprc i Disct.arge or ponafing of effluent to the sns:�ace of ground or surface waters cluea:o;art ,jverlosulsti or clogged SAS or cesspool "nr0' Stati. liquid level in the distribution box above outlet invert due.to as cverJoeded or cl:i; ;ed S�►,:►or cessRooi f Liquid depthin cesspool is less-than 6"below invert or availablt vohsU4 is leis thr is',6 d; flow Rtqu'red puaarspinp;more than 4 times in Oe last year IYCT due to clogged or obstrux ted 1, ze(s).Number Of Tints pumped _ Any E'ortion of the SAS,cesspool or priv;r is below high groundwater elevation. Any rvtion of cesspool or privy is within; 100 feet of a surface water supply or tributas^r i a surf3u,e water supply, Any :action of a cesspool or privy is within a Zone 1 of a public well. Any;:o:-tion of a cesspool or privy is within So feet of is private water supply well, Any portion of a cesspool or privy is less:oars 100 feet but greater than so feet from pri . t water supply well with no acceptable water quality analysis. [This system passes if the wall°AY; yr anotF.sis, perfisrssied at a DI.P certified laboratory, for coliform•bacteria and volatile org.knX ;�>misouluis indicates that the well is free from polhstion from tkat facility and the presence of au omocsil, ;nitragren and nitrite nitrogen is equal t,s or teas than S psptoss,provtlpi that so otlaer;;;iia:rr,wtsrria are trip,jered. A copy of the analysis most be attached to tbis form.j (Yes/No) flit system fiWl. 1 have determined that one or more of,the above failure criteria`v it as descrilmd in 310 Cart it ,�a ; 1 S.303,t�erefat+ee m,e sytstetss friar.Ti,e sysxesn owner shasdd ooatm; the Bakst of Healtls to detertnin�: what will be neceasarl•to correct the failure, X,. T�arse Sytteass ,,. , . to be considered a large system the system mast sa.vc a wi ' gpd. design flow of 1A WI gpd :o 15,00(i You must indicate either"yes"or"no".to each of the f4J1V kng: ("Me hollowing cri!er:a apply to large systems in addith;a to criteria above) Yes no the syste n is within 41;10 feat of a s seiag waur simply the syste n :s within 2Go feet of to a stnfaee drinking water supply _ the systes 0s located irl a ogen sensitive area Tterim, Wellhead Protection Area—IV,rPA! x a m::spped.Zone If c f ai public was: supply well v 1f you Ixavt answers,d'°yes" any question ins Section E the System is considered a significant thre.st, ai ans•jae;;vec' yes"in Section D,sb,sve a large system has failed.71e owner or operator of any large system cc;ns�.ic red a significant threat ur.der action E or failed under Sections D shall upgrade the system in accordance;wit.'. 15.304, The system o4vner shoulc,contact the appropriat:regional office of the Department. 3 10.C; 7; 4 r r Page S of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSN111:11NITS SUBSURFACE .SEWAGE DISPOSAL SYSTEM INSPECTION FORM PA.P:T B n�C]HEC:[CLIST Property Address:_ t 3� �'c �c Owner: L pr;jZ�� Date of Inspection: Check if the followimi`have been done.You must indicate"yes"or"no"as to each of the followintL Yes 2`to Q� Pumping information Isms provided by the owner,occupant,or Board of Health the system+:Omp®ttents pumped mit In the previous two weeks Has the,sy.-.:era received normal flows in the previous two Wet'e'k period ? ____ 4 Have large volumes of water been introduced tc,the system recently or as part of this insae,:ti:.r ? Were as built plans of the system obtained and examined?(If they were not available note id A; Was the lilt:iG.ry or dwelling inspected forsigns of sewage_back up? _ Was the sit: inspected for signs of break out? MWere all ;;yste.rrt companents,excluding the SA),located on site Were the se l)tic tank manholes uncovered,open+:d,and the interior of the tank inspected;,`or S t!: a ::oneiti+. of ttie ba�fl1es or tees,r talerial of construction,dimensior%,depth of liquid,depth of sludge and depth of s ::;.tn? . � 4 _ Was the fsciliry owner{and occupants if differatt from Owner)provided with inforination on is i' prope- mintemunce of subsil<: ace sewage disposalystetru.? T , - i The size an<l.fixation of the Soil Absorption S331:91n(SAS)on the site has been determined 1WLi,:,1 Cc: Y,f� no „ Existing inf)rtnation. For example,a plan at the Board of Health. IDetermined in the field (if any of the failure criteria related to Part C is at issue approximittior: ► distan.e is unacceptable)1310 CAR 15-3021'')(b)J S Pale 6 of t I OFFI4:IhL, INSPECTION FORM-•NOTFOR VQL,UNTARX ARSE'k'.i!+ENT'► SUBSURFACE SEWAGE DIISPOSAI.SUM INSPECTION F10 11M PART C SYSTEM INFORMATION Property Addrins: Owner: Date of Wspoctou: FLOW COMMONS Nwmber ofbedttPcros(design):a Number of bedrooms(acttW):3, DESIGN flow tlased on 3 t0 t- 15.203(for eumple: 1 I gpd x 0 of bedrooms): �. Number of eurrimt residents: �,� Dons residence tare a garbage grander(yes or no): Is laundry on a, Wuaie sewayie system(yes or no):e!�7 Laundry system inspected or no); [if Yes separate inspection requited] (yes Seasonal,use:(yt�s or no): 9b � Water meter rea:.ings, if available(last 2 yars usage,(gird)): /U 7 1C7 Sump pump(ye!;or no) �I � Lase date of occilpatncy: CO:MSMERCLA IANDUSTRIAL Type of estabiishmert, Design;low(ba:.-;d.on 310 AC ;fR .203)•. , Basis of design flow(seatsipe ns/sgtetc.): '-� Grantee trig present(yes or o;, Industrial waste 1 thin nk present(yes or no): Non.-sanitary waiae 'scharged to the Title S system(yes or no): Water meter read,ef s,if available: Last date of panty/use: OTf1'E deu 1:e): GENERAL INl?ORMATION Pumping Records ,� Source of informslticn: q�3 ; �l Was system puml ed as part f the inspection(yes or rjo):A If yes,, volume pumped:-gallons--How was qu.aeDtity petn>Ped deteermined? Reason for pumpi:1g TY lr OF SYST'17M Septic tank,d:svibution bmt,soil absorption Mtn Single cesspoi)l Overflow ces:pc.ol Privy __. Shared systerr (;,,es or no)(if yes,attach pirevioos i-aspeetion rwzrds,if any) Innovined from /Alsyst-ri. o sve rectLnology.Attacd.a cagy faf tibe o��aid maarteaance o mtn, t(to be obtained from syst:a owner) ___,Tight tarok -Attach Attach a copy of the DEP apprm,al Ocher(deserib:): Approximate age of a.11 componen , date instal! (if k rown)ands ce of infornsation: Were sewage odor= donected whern arriving at the site()es or no): 6 Page 7 of l 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESS, 11 !i C.5 SUBS L RFACE SEWAGE DISPOSAL SYSTEM INSPECTION FCiF.'%'i PART C SYSTEM INFOWAATION(continued) � ` Property Address: 6 �� ' Owner: Date of Inspection:- .L _ BUILDING SEW13.(locate on silx plan) Depth below grade: 11 Materials of construction:_cast iron K 40 PVC_otw(explain): Distance from private water supply well or suction line:_ Comments(on coedit on of joint:, eventing, evidence of leakage,etc.): SEPTIC TANK:j� (locate on site plan) Depth be:ow grade: t` K Materia.1 of construe tion:JLconcTt:te_metal fibe,jlass,polyethylene _other(explain)--_ _ _�' If tanks Metal list;Ig.:;:. Is age confirnred by a Certificate of Compliance(yes or no):certificate) (at2kct a. :c 3),of Dimensions: ----�-----�� rttt-------���------ •. Sludge depth: _ N Distance from top o!s.''udge to boixom of outlet tee or baffle: 6 Scum thickness: •�!__ . Distant+:torn top o'sc:um to top of outlet tee or baffle: IQ N- Distance &om{botto,n of scum to!)ott:om f outlet to or bIffle: 'v How were dimensions determined: Comments (on pumping recommendations, islet and outlet tee or baffle condition, structural integri�y, li(ioid !e•veh as related to oat et ir,v�:rt, evidences cif leakage,C c.): << ,A Aok - GREASE TRAP:__(locate on sitw.plan) Depth below grade: Material of construction:—concrete metal ber0.15s._._polyethylene' other . (explain): --- Dimensions: _ Scum thickness: Distance from top of;c:iun Zt! f outlet tee or baffle-Distance from botton, �tfsottom of outlet tee or ba;,1le' ` Date of last pumping:Comments(on pumpiA recommendations, inlet and outlet tee or baffle condition structural integriny, li tji.i lcroels as related to outlet ' ert,evidence of leakage,etc.): 7 t .Pase 8 of 11 OFFICiL4L INSPECTION FORM-NOTIOR VOLUNTARY ASSES ISN'I Exrs SUBISL)RFACE SEWAGE DIS143SAL SYSTEM INSPECnON 1F011,A :PART C SYSTEM INFORMATION(cond=ed) Property Address, Owner:`."Em rk TIGHT or HOLDING TA.�7:C.: (tank must P.roped a time of iaapwft kiotiatie o t lice Ella:i Depth below Stale: Material of construction: concrete metal fiberglass ,polyethylene other(,:xplt t): Dimensions: Capacity: '�--- allons Design Flow-. _._. _rgallonslday ; Alarm present(yea or no) �_� Alarm level:_ arm: working order(yes cr no): Date of last pumpirit Comments(condit� of alarm and float switches,etc.I. ®lS'I'112I13U f 10`t ;EtOX.„(if present must be openedXlocate on site plan) Depth of liquid level above outlet invert: Comments(note if tiox is IeveP and distribution to owlets equal,any evidence of solids carryover,,an evidence of leakage into or o::t of box,etc.): ox Li PU31IP G1tiA1b4E E Ft: (lcZcbiGber, ' Pumps in workinit order(yes c Alarms ixr�working order. (yes l Comments(note Goudiaon oasdbw of as d appwwaz es,etc.): 8 � Page 9 of 11 OFFICIA1 I'NSPEC'nON FORM—No'F FOR VOLUNTARY A.SSESSME, i S SUBSU'FACE SEWAGE DISPO,,;i►L SYSTEM INSPECTION FORM PART C . . SYSTEM INFO"IATION(continued) Property Address: L15 e ' WL�$ Owner' Date of Inspection. SOIL ABSORPTION SYSTEM (SAS); (locate on.site plan,excavation not required) If SAS:mot located ezp le,n why: T e leachittg.pits,t:usnber.,,�2 leaching chamiu s,number. _ leaching galleries,,number: leaching trenches,t.umber,limo: _ leaching fields: number,dimensions: overflow cesspoc l,.nutnber: inn ovativefalte'n;1ti ve system Typelname of technology: Comment€,(note condi:ion of soil, signs of hydraulic failure,level ofponding,damp soil, condition ofv!.P.-aciott, etc.): _ � PeL it L- %co-i4Y WL � , CESSPOOLS: _ (cesspool must be pum s part o:riupection)(locate on site plan) Number and configutati:on: Depth—top of liquid to inlet invert: Depth of solids layer: -- Depth of scum layer - Dimensions ofceupao.:_ infl Materials.of construct is n. Indication of groundM . now(}gas or no): "�-- Cot:ttnents(note aotyrltion of soil,q,ib�ss ofhytfrau!@c Wiwi, level pfponding,condition ofvegetatioii,,K;;.1 PRIVY: .(locate o.� site plan} Materials ofconstructioI: r Dimensions: — — Depth ofsolids: _ Comments 'note can Eimn of o si—ms oflt i ydraulic fitaiure:,level of Pond ing, condition of vegetation,sac. _ 9 G Page! 10 of 1 I OFFICIAL INSPECTION FORM—;NOT ' LTN TAXY-AcMSS bI.EN'rS; 'Sill:;SiURFACl: SEWAGE DISPOSAL,SYSTEM VQWECn0N l OV''vd VARTC SYSTEM INFORMATION'Ovatinued) Pro9perty Addrols:: !$'b h!. Owner:.. Date of Inspee"ve.. . Sxr6TCH OF S 1:141AGE DISPOSAL SYSTEM Provide a sketch af'the sewage:disposal system including ties to at least two permanent reference ian; taar•ks e:,r. bettt:,Wwrks•Uxt at all wells within I00 feet.Locate where public water supply enters the building, 10 i i Page 11 of 11 OFFICU►I,,>iNSPEt'TION FORM--?[0T FOR VOLUNTARY ASSESSI'vll il,r1 cm. SU1331 JILFACE SEWAGE DISPOS.-AL SYSTEM INSPECTION Ft 111,kt f PART C SYSTEM WORMATION(continued) Property Adelrea: — ow®er m sr Date of lospectiott: - SITE EXAM Sly Surfhee water Check:cellar Shallow wells Estirniated depth to gromd water *feet Please indicate(check)all methods used to determine tat high pound water elevation: Obtained from:system design plans on record-if ctieeked,date of design plan reviewed: Observed sitr.(iabutting property/observation hole within 150 feet of SAS) Checked with I»cal Board of Health-explain: ,_•—•_ Checked with local excavators, installers-(attach docutnentation) Accessed USGS database-implain: You roust describe hied y u est2Lblished the high rouisd t eleva ' n: T.O.F. EL.= 52.8'± FINISH GRADE OVER D-BOX= 49.5�± FINISH GRADE OVER CHAMBERS= 49.0' - 49.5' GENERAL NOTE S PROVIDE H.D.P.E. RISER SLOPE @ 2% MIN. OVER SYSTEM 3/4"TO DOUBLE WASHED w/COVER TO WITHIN 6" REMOVABLE WATER-TIGHT COVER OVER STONNEE T TO CROWN OF PIPE 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION OF F.G. (TYP OF 2) RISER TO WITHIN 6"OF FINISHED GRADE 4"SCHEDULE 40 PVC INSPECTION PORT WITH ACCESS " " OUBLE WASHED METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL @ FND. EL.= 51.5± F.G. OVER TANK EL. 51 ,1 5" DIA. OUTLET(S) FINISH GRADE MIN SLOPE 1% BOX TO F.G. (SEE NOTE 21) STONE OR GEOOEXTI E I B FILTER FABRIC CODE AND ANY APPLICABLE LOCAL RULES. = '± _ - -- ---- - -------- --- . ----- 2 ANY CHANGES TO IS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE 20"MIN.ACCESS 1 DESIGN ENGINEER. TOP OF SAS- 47M 33� PLACE RISERS ON ALL COVER(TYP.OF 3) PROPOSED 4" 9"MIN. 9"MIN. CHAMBERS WITH EXISTING 4'° 9 36"M,qX• � 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL SEWER PIPE PVC SEWER PIPE 46.50 36"MAX. BREAKOUT EL= 47.00INLET PIPES TO 6 OF SYSTEM UNLESS OTHERWISE NOTED. FINISHED GRADE 6" 3" 3" DROP MAX " PROVIDE WATERTIGHT 4. TO PREVENT BREAKOUT,THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN 2" DROP MIN 3 97\\- *4 SLOPE L = 33+ JOINTS(TYP.) ELEVATION =47.00' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A 4" PVC IN TR '�" 145 SEPTIC TANK I 1j'1_____4"PVC OUT TO o \ \ Q 0 0 ��� \ O o0 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. \ LEACHING FACILITY o0 00 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. 00" 46.87� MI'N. 6" 46,70' 2' oo °o°oo6- THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. CONTRACTOR 48 CONTRACTOR SHALL LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK SHALL VERIFY SIZE VERIFY CONDITION OF GAS BAFFLE 6"CRUSHED STONE 00 0 \ oo FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS AND CONDITION OF EXISTING TEES OVER MECHANICALLY o0 00 o NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH EXISTING SEPTIC AND REPLACE AS COMPACTED BASE AND DESIGN ENGINEER. TANK NECESSARY 5 4.0' 8.5'(TYP) 4'0, 4.0' 4 83' 4.0' OUTLET DISTRIBUTION BOX 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM OF 50.00'ESTABLISHED ' TO BE INSTALLED ON A LEVEL STABLE 25.0' (TYP ) ON A NAIL SET IN THE FENCE, AS SHOWN ON PLAN. BASE. FIRST TWO FEET OF OUTLET 44.50' GROUND WATER ELEV= < 38.50' 12.83' 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION EXISTING 1 ,000 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. 5'MIN. THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT CROSS SECTION VIEW 2 - 500 GALLON CHAMBERS CHAMBER END VIEW 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES SEPTIC TANK PROFILE 1- TYPICAL CHAMBER PROFILE CHAMBER ^• n � TO THE DESIGN ENGINEER. CONTRACTOR TO VERIFY EXISTING ELEVATION PRIOR 1�, "TEES TO BE CENTERED DISTRIBUTION I B�„�T I O N [:7'�X DETAIL L"HAlvl B E R DETAILS TO ANY WORK & NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE DIRECTLY UNDER RISERS NOT TO SCALE NOT TO SCALE 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONCRETE ----_--_�__._--_-__-- _ _. _- _ - STRUCTURES SHALL BE MADE WATERTIGHT. p + TEST PIT DATA 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING r PERC NO. 14761 REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM r: R INSPECTOR: David W.Stanton, IRSAPPROPRIATE AUTHORITY. • EVALUATOR: Michael Pimentel, EIT, CSE` 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS • LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE > ! C.S.E. APPROVAL DATE: Oct. 1999 THEY SHALL WITHSTAND H-20 LOADING. 58 Jul 22,2015 • • DATE: y 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. ' TEST PIT#: 1 I r 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE ELEV TOP= 49.00 MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. ELEV WATER= <38.50' REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, U.P. p FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). y- • PERC RATE _ <2 min./inch �\ * 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN 'I iI DEPTH OF PERC = 30"-48" SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. ` * y� C14I TEXTURAL CLASS: 1 16. PROPOSED PROJECT IS LOCATED WITHIN: \ Fz LOCUS ASSESSOR'S MAP 219 PARCEL 259 o_ MAP 291 XISTING 1,000 GALLON a '" - PARCEL 258 SEPTIC TANK TO BE OWNER OF RECORD: JOSE CELSO MAIA 0 UTILIZED IN THIS DESIGN Benchmark ZONE 2 r l" 0' 49.00 ADDRESS: 156 MEGAN ROAD Nail in Fence Post ',� +` 4" Fill HYANNIS, MA 02655 EXISTING LEACHING PIT Elev. =50.00' 48.67' S7g°4g " TO BE PUMPED, FILLED Approx. M.S.L. �. � . A Loamy 10Yr 3/1 d FEMA FLOOD ZONE X 1g �28 E WITH CLEAN, COARSE 8" 48.33' COMMUNITY PANEL# 25001C0566J / a"` -�34' SAND, AND ABANDONED / 17. DEED REFERENCE: L.C.0#180600 y4. 51-- (TYP OF 2)7 ROPOSED INSPECTION PORT Loam Sand B WITH ACCESS BOX y 10Yr 5/6 ROr'OSED 2-500 GALLON LEACHING " 18. PLAN REFERENCES: L.C. PLAN#27099-B(SHEET 4) �n 20 OAK 30 46.50' D �O p / / - CHAMBERS WITH AGGREGATE o R Perc 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. O S /� MAP 291 �' 48„ o / 0 0' / �k�., j 45.00' 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY Az p ^ oo PARCEL 259 #156 ° \ / I FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY /N � � 12,749 S.F.t EXISTING _ �49 k� _ a k�k t FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. u / P 2 2' `k, ► Med.-Coarse Sand Q o J 3-BEDROOM C LP DWELLING O - ;,; O -^ 49x0'IT OAK 2.5Y 6/6 (w 4S TOF = 52.8'± L h. - j TP 1 49x0' Q / ✓ ~� �\ 4jo 1.9' +ri, : 2 CO LOCUS PLAN LEGEND 0"OAK � - - SCALE: 1"= 1000' 126-1 38.50' x50.0 EXISTING SPOT ELEVATION AS PROPOSED TELEPHONE I P DECK D-BOX �g"°� A x48.6 o No Mottling, Standing or Weeping Observed POST PATIO `'� I VRQ MAP 291 ___ __-_-- -----._.__._ __ ____-------�_-__._------_--- _ - - 50 - - EXISTING CONTOUR � "�^ ORI�E •� o ./ o .,� 1VE AREA N � PARCEL 68 DESIGN DATA TEST PIT DATA TELE G OF GRaVE�D� ^° GRAVEL DRIVE- o ^ � � ^ � PERC NO. 14761 50 PROPOSED CONTOUR ED x48.8 co NUMBER OF BEDROOMS (EXISTING) 3 ; INSPECTOR: David W.Stanton, IRS - GAS - - - EXISTING GAS LINE 77° . °' ! EVALUATOR: Michael Pimentel, ❑/H/W EXISTING OVERHEAD UTILITES 16�Z SS"_ ` x48.4 NUMBER OF BEDROOMS (DESIGN) 3 Oct lggg CSE Ogg i C.S.E.APPROVAL DATE: j DESIGN FLOW 110 GAUDAY/BEDROOM TELE - EXISTING UNDERGROUND TELEPHONE LINE MAP 291 _ FENCE I-rYP) X DATE: July 22,2015 TOTAL DESIGN FLOW 330 GAUDAY _ TEST PIT#: 1 W EXISTING WATER LINE PARCEL 260 DESIGN FLOW X 200 % = 660 GAUDAY _ ELEV TOP= 49.00' -X-X-X-X-X- EXISTING FENCE LINE USE EXISTING 1,000 GALLON SEPTIC TANK ELEV WATER= <38.50' PERC RATE TEST PIT LOCATION _ SWING-TIES SCALE: 1" =20' INSTALL 2 - 500 GAL. CHAMBERS w/ AGGREGATE I DEPTH OF PERC EXISTING 1,000 GALLON SEPTIC TANK DESCRIPTION HCA HC-2 i TEXTURAL CLASS: 1 SIDEWALL CAPACITY LP EXISTING LEACHING PIT CORNER STONE(1) 41.9' 55.1' (LENGTH + WIDTH) (2 SIDES) (2' HIGH) (0.74 GPD/S.F.) = GAUDAY - CORNER STONE(2) 54.3' 50.0' (25.0'+ 12.83')(2 ) (2' ) (0.74 GPD/S.F.) = 112.0 GAUDAY 0" 49.00' PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE Fill CORNER STONE (3) 64.4' 62.8' BOTTOM CAPACITY 4" 48.67' ❑ PROPOSED DISTRIBUTION BOX LENGTH x WIDTH 0.74 GPD/S.F. GAUDAY Loamy Sand CORNER STONE(4) 54.4' 66.9' ( ) ( ) A (25.0'x 12.83') (0.74 GPD/S.F.) = 237.4 GAUDAY 8„ 10Yr 3/1 48.33' �O PROPOSED 500 GALLON LEACHING CHAMBER B Loamy Sand TOTALS: 10Yr 5/6 REV. DATE BY APP'D. DESCRIPTION TOTAL NUMBER OF CHAMBERS 2 30" 46.50' -_ TOTAL LEACHING AREA 472.2 SQ.FT. PROPOSED SEPTIC SYSTEM UPGRADE TOTAL LEACHING CAPACITY 349.4 GAL./DAY PREPARED FOR: #156 C-2 EXISTING (2 12g3, 3) Med.-Coarse Sand CAPEWIDE ENTERPRISES 3-BEDROOM =o. ;. C 2.5Y 6/6 DWELLING LOCATED AT TOF = 52.8'± O O 156 MEGAN ROAD o - HYANNIS, MA 02655 NOTES: C-1 SCALE: 1 INCH = 20 FT. DATE: AUGUST 7, 2015 38.50' 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF EACH SEPTIC (1 126 0 10 20 40 80 FEET SYSTEM COMPONENT. 4) No Mottling, Standing or Weeping Observed �� "SS i�fiu�r� JOHN, `-�'� PREPARED BY 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF THE PROPOSED RESERVED FOR BOARD OF HEALTH USE CHURc L�JR. «� JC ENGINEERING, INC. LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST PIT DATA SHOWN ON THIS PLAN. iL REPORT TO ENGINEER AND LOCAL BOARD OF HEALTH IF SOILS ARE NOT CONSISTENT WITH N a i8o 2854 CRANBERRY HIGHWAY TEST PIT DATA. "�� c;S-r SWING TIE & SEPTIC DIMENSIONS PLAN EAST WAREHAM, MA 02538 SITE PLAN _ _ 3.) PROPERTY IS NOT LOCATED WITHIN A DEP APPROVED ZONE 2 OR ESTUARINE 508.273.0377 WATERSHEDS. "- SCALE: 1"=20' Drawn By: BSM Designed By:MCP Checked By:JLC JOB No.3178 SCALE: 1 -20