HomeMy WebLinkAbout0012 MELBOURNE ROAD - Health 12 Melbourne Road
A = 268 — 237
Hyannis
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O'Connell, Timothy
From: Roger Loyer <rwloy33@gmail.com>
Sent: Wednesday, December 19, 2018 9:23 AM
To: O'Connell,Timothy
Subject: 12 melbourne rd. hyannis building permit
Attachments: first floor floorplan.pdf; basement floorplan.pdf
Mr O'connell,
Please review the attached floor plans that I am providing for building permit TB-18-3942 .1 just discovered that
the health department denied the permit request due to lack of floor plans.
I assume the need for floor plans has to due with Title 5 compliance potentially being challenged by the '
addition of a 3 season porch .
The basement bedroom, while technically not livable space due to the lower ceiling height, does meet all other
requirements for a bedroom with heat, ventilation, electric outlets and proper egress. The play area does not
have proper egress and so it it not used for sleeping accomodations at any time. The home has been inspected
annually by the health department with regard to a rental permit.
Please advise if with the addition of the 3 season porch we will still be in compliance of title 5 requirements. If
not what is the policy of the town with regard to filing a deed restriction with regard to bedrooms and, if that is
allowed, do you have sample language?
Thank you for your consideration,
Sincerely,
Roger (and Marjorie) Loyer
f
1
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APPLICANT: LOYER TOWN: :HYANNIS
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FLOOD- PANEL.. 250.01C 0568 J FLOOD ZONE: "X" DATE MAP REMSED 7/16 f 14 .
I HEREBY CERTIFY THA rHls'tN3R AC-- INSP cT10N F'",HAS B y PREPARED FoR DATE: 4/27/15 SCALE 1" = 30
MLL1AM RAvos MORTGAGE :CDMPANY, LLG DEED REF: 25813-41 PLAN REF: 250=43
THE L•OCATfON OF Trip OWc1.LlNG SHOWN' DO=S NOT F;tl h,T;il`g A SPECIAL Fl..'000:4A:ZAP.O ZONE.
A TAPED IN SF COON;THE ON WIT G APPEARS r0 CONFORM'TO'f'HE LOCAL:ZONING BYLAWS IN Urr ECT THE.STr'A1CT'JP•ES-SHOW: ON THIS!WTGk--#NS?'CT!Oh PLAN ARE L'Oia1't�D?Y TAPE SIJ�l'
-?.T THE Tit.SE OF CONSTRt1CT10N-Y,+.T}+ P-5a_CT TO HORIZONTAL DIMENSIONAL SETBACV P.EO'J!RaIENTS ONLX.-NO B.STRUIS�T SUR�'f W;.S P�,FO.''vi�}A,1'P 14CkilOAtS a'i0�#.p�c .�rPR.4�fta.;T OR IS Dz—vPrT FROM %4OLATION ENFOR,._MNET ACTION UNDER Mh GENERA'_LAWS CHAPTER 40A. AN INSTRUMENT SURVEY!S NECESSARY FOR PREC9' .nET. Pt�€ATIt7Pd OF':3%J'.�iN'G l:N`4TfOh'S
5`CTLON 7:R'cFE WCE DIED SU3,,+'ECT TO AND ilii;THE"BENEFIT OF ALL RIGHTS,RIGHTS OF WAY. AND ENCROACHMENTS,IF ANY IST,�L'TriE WAY A�.r?OSS ppOpEFiTY J.*tS.1fiN�cE"t1�D
EASEMENTS. RESERVATIONS ANJ FwS Ft^TIONS OF rCORD, IF ANY iHZR:SHALL BE. AND INSOFAR SURVEY COMPANY INC. SHALL NOT BE HELD?SABLE FOR DAMe,r,:s RESULTING FROk,ANY t'SSE
AS THE SA}RE ARE 0:LEGAL.FORCE AND EFFECT. OF THIS PLAN FOR PURPOSES OTHER-THAN MORTGAGE !t34ECTcw.
TELEPHONE: 508-428-0055 YAN EE LAND SURVEY C�MPAN�; INC'
.:FAX: 508--420-5553
119 ROUTE 149, Marstons Mills, MA 02648
yankeesurvey@comcast.net www.yankeesurvey.net 83637 JM
bath
bath
kitchen
Bed 1
Living
Bed 2
12 melbourne rd main floor
Bed 3 bath
mechanical
Unheated play space
12 melbourne rd basement space
E,
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
12 Melbourne Rd.
Property Address !
Frank Kostos
Owner gym,
Owner's Name r;�
information is Hyannis MA 02601 4/3/2015
required for every y ;w
page. Cityfrown State Zip Code Date of Inspection FTC
4o
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,
use only the tab 1. Inspector:
key to move your
cursor-do not Paul Martin
use the return Name of Inspector
key.
Neighborhood Waste Water
1�1 Company Name
350 Main St
Company Address
W.Yarmouth MA 02673
Citylrown State Zip Code
508-775-2820 S15016
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. l 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
4/9/2015
Inspector's Signature
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. i W"YJ e
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17
r
Commonwealth of Massachusetts
lugTitle 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
12 Melbourne Rd.
Property Address
Frank Kostos
Owner Owner's Name
fQR1atiO"is
required Hyannis MA 02601 4/3/2015
re
page. City/Town state Zip Code Date of Inspection
B. Certification (cunt.)
Inspection Summary. Check A,B,C,D or E/always complete all of Section D
A) System Passes:
® 1 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:
System in working condition.
S) 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•3113 Title 5 official Inspection Forth:Subsurface Sewage Disposal System•Page 2 of 17
I
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
12 Melbourne Rd.
Property Address -- - - - --
Frank Kostos
Owner Owner's Name
information is required for every Hyannis MA 02601 4/3/2015
page. Cityrrown state Zip Cade Date of inspection
B. Certification (cunt.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes(cunt.):
❑ 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
12 Melbourne Rd.
Property Address
Frank Kostos
Owner Owner's Name
information is Hyannis MA 02601 4/3/2015
required for every
page. Citylrown 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'inspection:
Yes No
❑ Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ 0 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 %day flow
t5ins•3/13 Title 5 Orfiaal Inspection Forth:Subsurface Sewage Disposal System•Page 4 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
12 Melboume Rd.
Property Address
Frank Kostos
Owner owner's Name
information is required for every Hyannis MA 02601 4/3/2015
page. City/Town State Zip Code Date of Inspection
B. Certification (cunt.)
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.
❑ Z 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
❑ ❑ 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.
t5ins-3113 Title 5 Official Inspection forth:Subsurface Sewage Disposal System-Page 5 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
" 12 Melbourne Rd.
Property Address - -
Frank Kostos
Owner Owner's Name
information is required for every Hyannis MA 02601 4/3/2015
page. Cttyrrown 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?
E ❑ 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.
❑ ® Determined in the field(if any of the failure criteria related to Part G 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): 110x3=
330gpd
t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 6 of 17
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
12 Melbourne Rd.
Property Address
Frank Kostos
Owner Owner's Name
iequired fo is Hyannis MA 02601 4/3/2015
required for every
page. Cityrrown 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 ❑ No
Seasonal use? ❑ Yes ® No
Water meter readings, if available(last 2 years usage(gpd)):
Detail:
Sump pump? 0 Yes ® No
Last date of occupancy: our ent
CommerciaUlndustrial 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
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
12 Melbourne Rd.
Property Address
Frank Kostos
Owner Owner's Name
rnf0R1atiOis
n
required for every Hyannis MA 02601 4/3/2015
page. cityrro" 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: No Records
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
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/Aftemative 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):
t5ins•3H3 Title 5 official Inspection Forth:Subsurface Sewage Disposal System-Pape 8 of 17
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
12 Melbourne Rd.
Property Address
Frank Kostos
Owner Owner's Name
information is Hyannis MA 02601 4/3/2015
required for every
page. City/Town State Zip Code Date of tnspedion
D. System Information (cont.)
Approximate age of all components, date installed(if known)and source of information:
2011 Per BOH records.
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
1'4"
Depth below grader tee"
Material of construction:
❑cast iron ®40 PVC ❑other(explain):
Distance from private water supply well or suction line: +10'
feet
Comments(on condition of joints, venting, evidence of leakage, etc.):
Line checked with sewer camera and was found to be clean, properly pitched with no sign of root
intrusion.
Septic Tank(locate on site plan):
6"
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: 1,000
Sludge depth: 6-8
11
t5ins•3113 Title 5 OfBdal inspection Forth: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
yt 12 Melbourne Rd.
Property Address _
Frank Kostos
Owner Owner's Name
information is required for every Hyannis MA 02601 4/3/2015
page. City/Town State Zip Code Date of Inspection
D. System Information (cunt.)
Septic Tank(cost.)
Distance from top of sludge to bottom of outlet tee or baffle
Scum thickness
4-6"
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? Estimated
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
1,000 Gal tank in good overall condition. PVC tees in place and clean.Tank at normal operating level.
Both covers 6" below grade. Recommend service of tank.
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 W
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
12 Melbourne Rd.
Property Address
Frank Kostos _
Owner Owners Name
information is Hyannis MA 02601 4/3/2015
required for every City/Town
page 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 worsting 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
t5ins-3113 Title 5 Official tnspection Form:Subsurface Sewage Disposal System-Page 11 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
12 Melbourne Rd.
Property Address ~^^^
Frank Kostos
Owner Owner's Name
information is Hyannis MA 02601 4/3/2015
required for every y
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 off
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.):
H-10 DB-3 with 1 line in and 2 lines out in good condition. Box is clean and level with no solids
carryover. No sign of overloading or hydraulic failure. Cover 6"below grade.
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 wonting order, system is a conditional pass.
Soil Absorption System(SAS)(locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins•3/13 Title 5 Official Mspection 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
'< 12 Melbourne Rd.
Property Address __..
Frank Kostos
Owner Owner's Name
information is
required for every Hyannis MA 02601 4/3/2015
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
® leaching chambers number: 12
❑ 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.):
12-Arc 36.High_capacity H-20 chambers in 2-30.5'x2.87'Trenches. Minimal liquid in units at time of
inspection. No sign of overloading or hydraulic failure.
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 Forth:Subsurface Sewage Disposal System-Page 13 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
12 Melbourne Rd.
Property Address
Frank Kostos
Owner owner's Name
information is Hyannis MA 02601 4/3/2015
required for every
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.):
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 Forth:Subsurface Sewage Disposal System-Page 14 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
y 12 Melbourne Rd.
Property Address
Frank Kostos
Owner Owner's Name
information I
required for every Hyannis MA 02601 4/3/2015
page. Cityfrown 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 Forth:Subsurface Sewage Disposal System•Page 15 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System form Not for Voluntary Assessments
12 Melbourne Rd.
Property Address
Frank Kostos
Owner Owner's Name
information is Hyannis MA 02601 4/3/2015
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cunt.)
Site Exam:
® Check Slope
® Surface water
® Check cellar
® Shallow wells
Estimated depth to high ground water: +12'
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:
❑ Checked with local excavators, installers-(attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Hand auger to 12'with no groundwater encountered. Bottom of leaching max is 6'. Minimum of 6'
separation.
Before filing this Inspection Report,please see Report Completeness Checklist on next page.
t5ins.3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 16 of 17
' Commonwealth of Massachusetts
Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
'< 12 Melbourne Rd.
Property Address
Frank Kostos
Owner Owners Name
information is Hyannis MA 02601 4/3/2015
required for every
page. City/rown 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 BMMSTAKX
LOCATION_/ ijo,,ru� fIn SEWAGE# 6?1-317
VILLAGEAS NEAP dt PARCEL 44 9/, 37
MAUER'S NAME&PHONE NO. Chc4sc+jif eC k,,o-, 3,f a 2116
SEPTIC TANK CAPACITY iow
LEACFMdGPACKHY(Vw) 1-1 Arc 3L NC (size)
NO.OF BEDROOMS
OWNER IZeS-v %ccjorLD
PERIFTDAT&: 1-Z3 - it COMPLIANCE DAM:
ScpmzbmDzt3omBcmo=tbc
MmdmM Adjuated GrmmdwaWr Table to the Bottom dLewhivgFwft .T Feat
Private Water Supply Wen-d L—hmg F--ffiy(If aW wdb exist on
site of withm 200 feet of k=hn f c ty) !�I A Feet
Hdw of Wed-d and L�F-"y(Ifany wetland exist wilhia I
- 300feetoflearlinm ) /A Fed
FtWJ SLIFDBY
t
R'1 .2 ' S
i
Q� N
.3-S` .2y�
A i
C-y al 6 4
i
i
littp://town.barnstable.ma.us/Assessing/HMdisplay.asp?mappar=268237&seq=2 3/30/2015
TOWN OF BARNSTABLE
LOCATION t.). M el 03o wrN-P, M) SEWAGE# et(j t l -3 ii
�/VILLAGE ! a h n 1 -5 ASSESSOR'S MAP&PARCEL .2,6& Z.23-7
INSTALLER'S NAME&PHONE NO. C�tiSe- + mtec�ON+ 6;,a,-2 356 �,!l6
SEPTIC TANK CAPACITY J 000
LEACHING FACILITY:(type) I-2• Arc 3 PC 92® (size) � , 3m,3`�k ��6 i'+,p,,ll.-�
NO.OF BEDROOMS 3
OWNER 05-t/ ®;r.,r Z o ri
PERMIT DATE: 1-13 - iJ COMPLIANCE DATE: Oc-B 6 '2ov
Separation Distance Between the: ,
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility s Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) A A Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching faci ity) A Feet
FURNISHED BY
�^ LA '
`t
No. I ^� l ! Fee ��✓ ,
—THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS es
01pprication for �Dtgpogal *pgtem Congtruction Permit
Application for a Permit to Construct O Repair( p Upgrade(c<Abandon O ❑ Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address,and Tel.No. Sd k- !3 �I Yo Po
is Mt4 .6Gv/,n- fZd H �/7 Ir ROSO" qI /Ze_
Assessor's Map/Parcel � 4h7-0 l 1
6j0i?ae o/ o sod j/D- OOKI
Installer's Name,Address,and Tel.N = Des'gner's Name,Address and Tel.No.
~; Cplgje, P M 4ZRCh i1r►� S UN nT.1oGWs
3o uShory d nr� �T 4�a 6� 3 to COTO �T R�, SpirdWICA-)
Type of Building: _ ,,�
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder (,//6C,�
Other Type of Building No.of Persons Showers( ) Cafete ' ( )
Other Fixtures
Design Flow(min.required) 3-3 U D e gpd Design flow provided 416 7. y :5 —`�, ']y)gpd G-p p
" Plan Date q f"h r t f Number of sheets —CyjU Revision Date -
Title
Size of Septic Tank f Ij)Q® Type of S.A.S. p4,fU I- C
Description of Soil J1. W L41"45 j®L J IV a F11
Nature of Repairs or Alterations(Answer when applicable) C- 7'/_G n S7 L
ill-Ahs Y /91frvc/gr-j S'P�%rc yST�� /�� .P"�-INs
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signed Date
Application Approved by f Date
Application Disapproved by: Date
for the following reasons
Permit No. pCU 3 Date Issued �� 3 It
No. i 5 = Fee 1 o
HE COMMONWEALTH OF1,4ASS"ACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION f- TOWN OF BARNSTABLE, MASSACHUSETTS— /
Application for Xh5potaY 6p.5tem Cow6tructiou Permit
Application for a Permit to Construct( ) Repair( )r Upgrade(✓Abandon O ❑ Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address,and Te1..No. SJ /3 (/0
7� /V-fl E �� , /�' r '/%Oi/ f f�0�'' / t,1Ct%
~ ��� '
Assessor's Map/Parcel a �t'-s/ / 7�,,,.!
Installer's Name,Address,and Tel.No.. Designer's Name,Address and Tel.No. 3 O �
CH19se t rye F)�c/, fi/3 .fr9C - I/f! I
so fi rw 1,evU : . , > % s ci Cc,7c,; oJ. 5,v
Type of Building:
Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( A116w-e V
Other Type of Building No.of Persons Showers( ) Cafete j/( )
Other Fixtures
= y5, aT
Design Flow(min.required) ] �; �,. �, Q gpd Design flow provided y(a 7• y S r (6, T G/)gpd G-p P
Plan Date `a! t-1 1 1 1 Number of sheets 1,V\f 0 Revision Date
Title
Size of Septic Tank Type of S.A.S. t t_
Description of Soil %? 1 S off• OW lm�'I 5 �, rJ�� '� 8-,
Nature of Repairs or Alterations(Answer when��applicable) S P 17 7/ <—
' %sc A)J'
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 r
b Signed Y7 r �l ) , 'i� `�rL' e Date
Application Approved by hn� jy,��t.;v Date i
Application Disapproved by: Date
for the following reasons
Permit No. l 1 ( � J Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
(En'tif irate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded :(�)
Abandoned( )by
at Rd has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. dated
Installer (2 T d) e., (`/ -2/IT .�1; C . Designer P# /91Sn.,C IAA 7C- s�lr/t }(/:i! OJ' >�?S�j/1 I
#bedrooms v Z Approved design flow gpd
The issuance of this permit hall n,t be construed as a guarantee that the system 'iTrluiinit io a 4d signed.
Date l Inspector !--
- - - ----- - - - - - --------_-- - - ... _ _-------
No. OIR Fee ---
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH=DIVISION -.BARNSTABLE, MASSACHUSETTS
=i.500al 6pgtem Construction Permit
Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( t/) �bandon ( )
System located at / /�1 r) U,1%;I7 C_ /1'r ),/ #M,/)
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty
to comply with Title S and the following local provisions or special conditions.
Provided: Construction must be completed within three years of the date of this permit. QQ
Date ✓ Approved by (-C�-
Town of Barnstable
Regulatory Services
Thomas F.Geiler,Director
XAM 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:A Sewage Permit#,2d//—-3/ �7 Assessor's MaplParcel.-?4P 2-3 J
Designer: �/�/ -�1-�71i�rZQ%�G1' Installer: C
Address: e141114*1 Address:
On was issued'a permit to install a
(date) (installer)
septic system at fZ Zlel&o r� ,f i�.,l based on a design drawn by
(address)
dated
.(designer)
_ZI 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. A,W� 6/�yjjB�/ll/o�!��'
aS
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.
�N OF t4qSS,
AMY ,cv �
VON HOVE
to ler's Signat(tre) #loss
SR V I T ARN P�
(Designer's Signature) (Affix Designer's Stamp 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 3-26-04.doc
Town of Barnstable. p#
°+ Department of Regulatory Services
• ' Public Healh Division Date �J
g i 200 Main Street,Hyannis MA 02601
J.
1 ) ,
Date Scheduled /� /•< 'Time. Fee Pd.
,foil Suitability Assessment for Se a Disposal
Performed sr. /0� a/" ! Witnessed ay.
i
LOCATION
7�&GMVRkL INFORMATION
L Z �
Location Address •� el�plr'Ie Owner's Name �S'e/ b/lI
Address /Z
Assessor's Map/PVcet: 7 Engineers Nam %ice y 114
NEW CONMUOTION REPAIR I Telephone* ;Z'7-4
Land Use ASrArC /2�/ Slopes(96) _ Surface Stones / AQ
Distances from: Open Water Body ft Possible Wet Ara N/� Drinking Water Well ft F~
Drainage way ft PMpetty Lime ft Other ft
SKETCH: but mama,dmcwsiodsbf so4 exact locations of ft� holes&perc tests,locate wetlands in pmodtnity to holes)
i
EA
i .
! /,Or
•Para,t material(gedit►gIc) ��/ i Depth ro Bedroeic •�
Depth to Owundwakdr: Standing Water In Hole:' I Weeping from Pit Fate
Estimated Seasom
a1 high Groundwater
Dt TION FOR SEASONAL HIGJI WATLR TALE
Method Used re"G I'
obs.hole: Deed►tt►sol1 MOOM In.
Depth abaern standing in I in.� Oroundwnter A u uncut ft• /�
Depth tolweepiug from side of .ho• ! , fhetar Adl.Cmsundwater Level.,•,&)-1 _
Index Well# W Reading Date index Well level fir•
l �
PERCOLATION TEST Date f" "/ T4w_4' 9.
Observation' I Tiete at 9" .—l----
Hole#
79me at 8'
Depth of Perc
Start Pre-malt TStme.C9, 7y�_ , Ora Jim s r�
End Pre-soak
c / (/J i
Race Mm./Inch A '
enC Site Passed_ Site Failed; Additional Testing Needed Cf"
Site Suitability Assegsm
originat:Public Hef 1H,Division
Observatiod Hole Data TO Be('completed Ott Back
j• '
***If percola 4n testis to be conducted within 100,of wetland,.you most first notify the
$9rnstable C 4servation Division at least one(1)wedk PAOt•to beginning-
1
DEEP OBSERVATION HOLE LOG Hole#
Depth from .Soil Horizon Soil Texture Soil Color Soil , Other
Surface(in.) (USDA) (MUMdl) Mottllag (Stu"Win,BOOM
L '
5z /D.�
7 '
.2S
DEEP OBSERVATION HOLE LOG Hole# 24—
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) _ (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency.
01,
DEEP OBSERVATION HOLE LOG Hole#
Depth from' Soil Horizon Soil Texture Soil Color Soil ' Other
Surface(in.) (USDA) (Munsell)' Mottling (Structure,Stones,Boulders.
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
consistency.I Gravel)
Flood Insurance Rate May: `.
Above 500 year flood boundary No_ Yes
Within 500 year boundary No-LZ Yes
Within 100 year flood boundary No L01*0 Yes
Death of Naturally Occurring Pervious Material
Does at least four feet of oattually occurring pervious rial exist.in all area observed throughout the
area proposed for the soil absorption system?
If not.what is the depth of natttrally occurring p us material?
Certification /
I certify that on /l! (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. and experience ribed m 3:10 CUR 15.017.
Signature
No. ................. Fs�.. J......
THE COMMONWEALTH OF MASSACHUSETTS
(� BOARD OF HEALT
l ....OF..........
Appliratinn -for Bitipmal Workii Tontitxnrtinn Vrrntit
a3 9�
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
;# Ayst at:
-- -•••--.. =---------•--:-- ..... ------------------------------------------
V ion-Addres or Lot No.
................
nor -•-----------------------------------Address._..__.---- •--------•---•--•-'-•----
Installer Address
�] L
UType of Buildin'g/ Size Lot-/4. ......._.l----Sq. feet
Dwelling—k No. of Bedrooms............................................�......................Expansion Attic ( ) Garbage Grinder ( )
a4 Other—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
Q' Other fixtures . - - ------------------ �--f=
---------- ---- - - -
-
W Design Flow................ ___ ____ __.............. allons per person per day. Total daily flow..... --------------gallons.
P4 Septic Tank 4 Liquid capacity/ - - ailons Length________________ Width_.___..-._ _._-_ Diameter---------------- Depth___-___------.
x Disposal Trench— o_____________________ Width.....
______ __ _ T ta ength. __-___-______-- Total leaching area....................sq. ft.
Seepage Pit No.... ___________ Diameter/�.... e o to et._.._... ____'_.__ 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............___-__-_-_--
�14 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water__-__________-_____-_-
•-------------------------------
Description of Soil--------- -------------------------------- •_�
x
U
W -------------------------------------------------------------------------------------------------------------------------------------------------- ------------------ --------------------------
UNature 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 NI of the State nitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Complianc has been issued by the board of health.
gned-- ------�- ----- Y • ---•-•---•----
D�ate
Application Approved By------------ ------ -....... - - - --------- Da:
Application Disapproved for the following reasons:..................................... -------•--•-•-••------------------------------------•----------
-•------••-••--•---------------------------------------------•-----._._...--••---__...--•------•-••-•----.____-•--•-•---•••••• .........................................................................
J+! Date
Permit No........................................................ Issued--•••••.I r° — -
D e
No.... .... Fina.j�.... .......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALT
....OF.......... ....................................
Applirtttiuu -fur Biipuiittl Workii Tontitrurtiuu Vrrmit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
Syst at: /�rJ
=" •-----
IPo ation-Address y or Lot No.
...............ti. f_' ._.__..........._....._.__.._._.._...._...._.._.._._.__•.___.__........_....._.__......._.._......
dca / Address
.....___ = ..._....._...._... ----------------------•-•-•---•-----._. ........----..............•----•--•--•-----Installer Address
QType of Building/ Size Lot.��_.B_. �.�.....Sq. feet
U Dwelling k No. of Bedrooms---_--__-.-.�_______________________Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ___------------------------- No. of persons............................ Showers ( ) — Cafeteria ( )
a' Other fixtures ................ �
W Design Flow................: .+ ... llons per person per day. Total daily flow----- 0......................gallons.
r P q 1 / :-- - e g- ---- Diameter---------------- Depth................
Disposal Trench Li tNo ca�acity___ Width.
Lent T to. engthl� _ Total leaching ------sq. ft.
x �
6v�
Seepage Pit No____ ____________ Dtameter� _._... Depfh� e ow inlet_......_.__.._:_____ Total leaching areal------__-_--_-sq. it.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by------------------------------------------------------------------------- Date•--------------------------------------
a Test Pit No. 1----------------minutes per inch Depth of "Pest Pit-------------------- Depth to ground water.__--_---.-_...._-.-__--
�14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-_.._.__-__.---.--_-----
P4 ------------------------ ------- ---------- ------^.....................• l
D Description of Soil---------------------------------------- -= :� L2u. ry ------- : .
x P � , ��
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 been issued by the board of health.
/ /- _..
igned /�•!- .� __ � s Jam- -� T ''*E'er
D to
Application Approved By. •---- �' -�------ = ".;E`=V -
- ------- ----- ---7
Dat
Application Disapproved for the following reasons:---------------------------------- /...............................-...................................
-.---•---•------------------------------------------------------------------------------•---------------•...------------------------------------------------- -----------------------------------------
te
Permit No......................................................... Issued. ...........
- ..
at
THE COMMONWEALTH OF MASSACHUSETTS
BOARD /fOF HEALTH
.......-.............OF..........(/'y ..Fw� -r�L .1 ....................................
Tntifirtttr of Tomplitturr �,�-
T "bS IS TQ CEIR" IFY That the In�ilvi faal a e Disposal System constructed ( ) or Repaired ( )
by - .C - = ��° E�r•'. -2�.f
Iirstall r f
> w ita
has been installed in accordance with the provisions of Article X_ of he State Santtary Code as describe -m the
application for Disposal Works Construction Permit No..._-----__ ��-- ------------- dated._.-_-�! ! 4' ._._.
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILLf FUNCTION SATISFACTORY.
DATE...... / �!' .......................................... Inspector-----Z;1---------------------- ---------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OFFS HEALTH
......... .�` �..I.......O F..........;':'.... . Lz.I........................................... u`tf_
No.......------�--------- FEE........................--__.....
�i��u�ttl urk� C�uu,�t� r, "uu �rrmit
Permission/is�ereby granted--- - --- ._(----k...----- �—-----------------------............................
to Constru:. t'�) or pair (� n Ind vid al Sewage Disposal System
}t
at No < ;�' ----•-•• t -mil r/ -'I-L,p � - ` /.!l (------ - ---
lv Street -S•'----j� e ----,---
as shown on the applicatio/for posal Works Construction )r it No.-._l_�' ____ Dated_-_-�/z i Board of Health
DATE---FORM 12�55 HOBBS & WAR PUBLISHERS
� 4'a
M
s 16.
bo
4{ _
Route28 ��5tMa1 y _ ASSESSOR'S MAP: 268 GENERAL NOTES:
"_.PARCEL: -237 .
e°t m 1. VERTICAL DATUM: Assumed
iaA, , REFERENCE: PL. BK. 250 PG. 143 I � 2. MUNICIPAL WATER Is AVAILABLE.
FLOOD ZONE: C Town of Barnstable - 3. SCHEDULE 40 PVC PIPE TO BE USED THROUGHOUT SYSTEM
ROaa Can lew' d poi #2500010008 D (7/02/92) l oa UNLESS OTHERWISE NOTED.
LOCUS N N 4. ALL PRECAST& PLASTIC UNITS TO CONFORM TO
co Groot m AASHTO: H-10 &20
5. PIPE PITCH-1/4 PER FOOT UNLESS OTHERWISE NOTED.
a 6. ALL CONSTRUCTION DETAILS TO BE IN CONFORMANCE WITH MA
Craigville Beach Roa ENVIR. CODE (TITLE 5)AND LOCAL REGULATIONS.
7•. CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES PRIOR TO
LOCUS MAP N.T.S. Benchmark set: CONSTRUCTION.
Left corner step LEGEND:
EL.= 94.72 (Assumed) PROPOSED CONTOUR
+� 99 Edge of abut. drive PROPOSED SPOT GRADE
ti o,° x 88.16 40 EXISTING CONTOUR
Q. � . S 11 E �°�'99 39 � 48'14 E
of
— 30.23 EXISTING SPOT GRADE
'
99,38 9 8` 1X7
TEST PIT
_ 97.52 Stockade Fenc EXISTING WATER SERVICE
o n
Q !� I 9ESE10' �9.113 IP/F�ND oX WORK LIMIT LINE
d I x 94,7 2.87\ i 90.09 -
O x 101.70 / 98 4 O :� 18'
n. T 94.74 E �x 87,78
D �9 9 3 1 #12:.. 22' 2 P IN ❑I� I � OF #4ff9
p j 1 o x 10 0.58
TOF=101.09 E TH-2 I „ �� AMY L. yG TERRY
cn co x 15' �Y 89.17 of ,$ VON HONE �} ANN
(Assumed) step
I 93, ��'�t Re-use existing 1000 gallon H
Z - rX WARNER „
Lot 39 0\ > I Septic Tank. No, 1068 No. 38721
100,06 101XI6 10,044±Map 268 S.F. Main Line* _O- _ 91.67 I '� !ST
Parcel 237 100,30 Kitchen& _ i I I A
Bath Sink x 93,8 _ 6' - I NOTE: Pump and remove failed�/
O N Fri
100.337 _ Y i. 9�, 2❑AK I leach pit. All contaminated O ��
_ —0 �� 6 � I� material within 5'of proposed
100.34 f°`� '
�\ ,' o- TOF Lower 3N zDeck [o TH_1 89.38 teach trenches to be removed.
J 1 0 9 9'9.9 =97.38 ZAbove= o I 6 88,01
cm '
W 1 100,47 _ rq
.6 2,4 91.42 tic1q ti NOTE: This plan is to be used for septic
99,44 T94 61 T � 604 x FT T� E' Do
5 70 / �i rn o system purposes only and is not to be
G. I Ppved, 98,06� �`
100 72Dnve. 98.69 94, 4 93 N H❑u Y�I considered a property line survey.
�02 100,53 x o �98,64 X \x 92,
�� / O^ N \ 97 87I x 95.19 Shed I x \,' I 12 MELBOURNE ROAD, HYANNIS, MA
oX z \ / II i
101,35 \ x 1 90,57 V H
MEG�SET \ 99.20 x 96.25 \ \\ PREPARED FOR:
104.00 100,91 x IP/FND 100.00 92,56 associates Rose DiGregorio
P 12 2 7/I \ SEPTIC SYSTEM DESIGNS
G-A8 MAIN 10&68 82048114�,w Chain fink fence
\ c/o Antoinette Raymond
9 �,4 6 \ Sandwich,MA 0263
1 x ` \ 90,9'6 \ 508.833.00418 Camassa Terrace
100.42X �9 �9 �9 �� k90,05
o � �- g Worcester, MA 01604
Q NOTE. 5 removal of unsuitable soils around and below Surveying by:
leach trench to an approximate dep h of 2's(to C layer) Terry A. Warner. P.L.S.
22 Long
may be required along easterly edg�s of trenches. Harwich. MARoad 02645 DATE REVISED SCALE SHEET NO.
Replace with clean fill per Title 5 requirements. (508) 432-8309 Q9/17/11 1" = 20' 1 Of 2
p,
"+ .rr= Provide Riser over D-box NOTE:All components to be marked-with NOTE:To prevent breakout,final grade
'T.O.F.(Full with Walkout) of EL.90.3 to be carried out a minimum
EL. 101.09 s. to within 6",of final grade ; magnetic tape or similar prior to final qovpr. 15' beyond edge of leach facility.
(Cover to be watertight)
(Lower Fnd. EL.97.38 F.G. EL:94.6-99.9± F.G. EL:93.5± F.G. EL:93.0± Maintain Min.2%slope over leach facility to prevent ponding
Existing I F.G. EL:93.0±
.a Install risers w/covers over inlet and Clean Fill per Title 5 Specifications Inspection Port within 3"to grade
q. outlet to within 6 of final grade
Existing Main Line .Q L=10'± (Access Covers min.20"diam.per Code) `•' Natural) Occurring Suitable Sand
Min. EL.92.6± :v....:.:•;; 4"SCH 40 PVC L=6 y g 0"Per Un t R eat Length
" 4"SCH 40 PVC H 4 Top of Unit/Breakout EL 90.29
All lines exit below @S=5.5°/a(2%MI 6 > 4"SCH 40 PVC
1 @S=10.5%(1%MIN)
slab floor. Possible 6' @5=7.6%(0.5%MIN) 0.89' Eff.Depth
2nd line for kitchen EL.92.05± EL.91.8 EL.91.01
Install Gas Baffle EL.91.17
Bottom EL.88.96
& bathroom sinks PROPOSED DB-3 EL.89.85 Use 12(2 Rows of 6 units)Biodiffuser Arc 36HC
from fnd. to tank. H-10 DISTRIBUTION BOX H-20 with End Caps without Stone in a Trench 5.0'
EXISTING 1000 GALLON more t
more t t than one outlet
Water tested to Configuration set 6'apart minimum
verify flow into (Install PVC Inlet&Outlet Tees) W for levelness if SEPTIC SYSTEM PROFILE (30.5'x 2.87'x 0.89'Each Trench)
septic tank. H-10 SEPTIC TANK - EL. 3.96
PRECAST CONCRETE ADDITIONAL NOTES N.T.S. Adjusted Groundwater
SOIL LOG 1. Contractor to confim soil suitability prior to installation. Contact BOH and Design DESIGN CRITERIA
Sanitarian in the event of varying soils from original soil test. Number of Bedrooms: Existing 3 Bedrooms
SOIL EVALUATOR: AMY VON HONE, R.S. S.E.#2517 7
INSPECTOR: DON DESMARAIS, R.S. , BOH 2. Failed leachpit to be pumped and removed. Remove all contaminated soils within 5'DATE: SEPTEMBER 15,201111:00 AM of proposed leach facility. Soil Type: Class f' Design Percolation Rate: Cl min/Inch in C1 Horizon
PERCOLATION RATE: <2 MIN/INCH IN C1 i
PERMIT#: 13420 3. Water line to be sleeved at any sewerline crossings and within 10'of any septic Daily Flow: 110 G.P.D./ Bedroom x 3 =330 G.P.D.
components, as needed, per Water Departmenfirequirements. Design Flow: 330 G.P.D. (Min. Required)
TH - 1 TH - 2
4. Septic Tank and Distribution box to be placed on 6" crushed stone or compacted, level
EL.92.46 EL.92.82 h Garbage Grinder: Not Allowed
base.
Leaching Area Required: (330)/0.74= 445.95S.F.
Fill Fill FLOOR PLAN
9" 91.71 7" 92.24 SWI NGTI ES
A/E j N.T.S. Septic Tank Required: 330 G.P.D.x 200% = 660 G.P.D
Sandy Loam Sandy Loam Minimum 1000 Gallon (Existing)
1811
10YR3/2 90.96 10YR3/2 23' N, Open Kitchen Use 12 Biodiffuser Arc 36HC Units (H-20) in a Trench Configuration:
B 1g, 91.32 Bath Bath /Dining 2 Rows of 6 Units Each with End Caps, Stoneless: 30.5'x 2.87'x 0.89'
Sandy Loam 28' it
10YR5/8 Sandy Loam #12 Effective Leaching Area:
27" 90.21 10YR5/8
C1 25" 90.74 TOF=101.09 Ste Bedroom Bedroom Living 7.79 SF/LF x 5.0'/Unit = 38.95 SF/Unit (Per DEP General Approval Letter)
Coarse Sand Perc (Assumed) Q 1 2 Room 445.94 SF/38.95 SF/Unit= 11.4 Units. Use 12 x 38.95 SF/Unit=467.4 SF
2.5Y7/4 @ C1
54"To I Coarse Sand
2.5Y7/2 1 li � Design Flow Provided: 467.4 SF(0.74) =345.87 GPD
102" Ad'.Water 83 96 1St Floor 12 M ELBOU R N E ROAD, HYAN N IS, MA
- Deck
PERC RATE:<2 MIN/IN.(ClAbove V H Horizon) I
144" 80.46 24 gallons @ 8:30 minutes 40' slider PREPARED FOR:
' Bath o associates Rose DiGregorio
150" 79.96 120" $2.82 U) SEPTIC SYSTEM DESIGNS
No Groundwater Observed " a' c/o Antoinette Raymond
18, `-
320 Cotult Road
Groundwater Observed in TH-1 @ 144": Use CCC Frimpter Groundwater Adjustment Method o Sandwich,MA 02563 8 Ca massy Terrace
0041833 08. .
MIW-29,August 2011,Zone C(8.32'),Adj=3.5' Family Room/ 5 Worcester MA 01604
Observed Water @ EL.80.46/Adjusted Water @ EL.83.96 Bedroom 3 '
I,Amy L.von Hone, R.S., hereby certify that 1 am currently approved by the DEP pursuant to Surveying by:
Terry A. Warner. P.L.S.
310 CMR 15.017 to conduct soil evaluations and that the above analysis has been Walkout Basement 22 Long Rood
performed by me consistent with the requirements of 310 CMR 15.017. 1 further certify that Harwich. MA 02645 DATE REVISED SCALE SHEET NO.
I have successfully passed the Soil Evaluator's Exam on November, 1994. (508) 432-8M9 09/17/11 1" = 20' 2 Of 2