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0061 MITCHELL'S WAY - Health
61 Mitchel I's Way. . Hyannis P A = 290 157 A l as v-e TOWN OF BARNSTABLE 1 LOCATION `�� �.�,e SEWAGE# l - ` VILLAGE ,,, a ASSESSOR' MAP&PARCEL INSTALLER'S NAME&PHONE NO.��.Oca9ti1 SEPTIC TANK CAPACITY k6 LEACHING FACILITY: (type�i,.A-.�,y-���.,`�. �J (size) Q'Y r A \l,-7a x y NO.OF BEDROOMS OWNER_FL) PERMIT DATE: SO ((0 COMPLIANCE DATE: s` 1 O( \'� Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED D o Q Qj 9.) 4 or- E ` � r No. '''"'"'^^`"""'' 1 J 1 Fee THE COMMONWEALTH OFMUUUUUUASSACHUSETTS Entered;nco pater: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pprication for Disposal 6pstrm Construrtion Permit Application for a Permit to Construct( ) Repair( ) Upgrade V<Abandon( ) ❑Complete System [ Individual Components Location Address or Lot No. 6 fy-) \CV.� C--JJ k- Owner's Name,Address and Tel.No.R 0 -GA3 " S Assessor's Map/Parcel Installer's Name Address,and Tel.No. �-` S Designer's Name,Addrq5s,and Tel.No. ��3 "-3 v; s 02,5 Type of Building: Dwelling No.of Bedrooms Lot Size •2 3 Ac Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) ? d gpd Design flow provided gpd Plan Date tj+y. Number of sheets Revision Date fp�pV � ?_ Title / Size of Septic Tank pe of S.A.S. a�s���r Description of Soil Nature of Repairs or Alterations(Answer when applicable)0 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. Signe Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. — Date Issued No. Fee Q l/ THE COMMONWEALTH OF MASSACHUSETTS Entered in co puter: Yes PUBLIC HEALTH DIVISION_- TOWN OF BARNSTABLE, MASSACHUSETTS application for Disposal-6pstrm ConBtrUttion permit Application for a Permit to Construct( ) Repair( ) Upgrade Abandon( ) [:]Complete System C Individual Components Location Address or Lot No. Fjj ;Name Address and Tel.No. :�0 -CP 3 (S- Assessor's Map/Parcel 2 9,O ` C��Ll nstaller's Name Address,and Tel.No. $n2-` i -ASS Designer's Name,Addre s,and Tel.No. �� Type of Building: Dwelling No.of Bedrooms Lot Size 3 AC r� 'Garbage Grinder( ) Other Type of Building �S , No.of Persons Showers( ) Cafeteria Other Fixtures Design Flow(min.required) 3 gpd Design flow provided 3 gpd Plan Date_�j p r cl., �( , 1� `- Number of sheets O Revision Date per, r ` �, �1 ©(7 Title Size of Septic Tank (�� C��`{���`t ,� pe of S.A.S. ,�J.�—� y;L Description of Soil Nature of Repairs or Alterations(Answer when applicable)-- dd hz c,� L Date last inspected: Agreement: Y The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal systemYin 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. Signe Date 7 Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued f - ---------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certifirate of Compliance rt. THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded(� Abandoned( )by ��,pcQ�1 '7 at 6 � VV\ �;� �_`� �� �J,o -has been constructed in accordance l n With the provisions of Title 5 and the for Disposal System Construction Permit No /7: dated 5 //J� - / Installer c,pc_!�A caj -T Designer C'A,%Z�vj _�-- r- ..`�E ,,�,t, #bedrooms Approved design flow _ gpd The issuance of this permit shall not ye conssttped as a guarantee that the systeff ill fun on si ned. Date �Q/ Inspector --------------------- /-------------------------- ---'-1 ----------------------------------------------------------------------------- No. ')n/'�'i — !�� Fee Zr G THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstem Const ittion permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( L_� Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be ompleted within three years.of the date of thi permit, Date �/� Approved b �. Utz a�a � F° e -2�. 135 U DEED RESTRICTION Whereas,Donovan D. Fraser and Rose Marie Fraser(hereinafter the"Owners"), are the ,., owners of property located at 61 Mitchell's Way, Barnstable County,Massachusetts, by N deed dated April 10, 2014 and recorded in the Barnstable County Registry of Deeds on April c 25, 2014 in Book 28105,Page 341, said land being shown on the Town of Barnstable Assessor's Map as Map 290,Parcel 157, and more particularly described on .Exhibit"A" attached hereto and incorporated herein. Whereas, Owners of said Lot, have agreed to a restriction as to the number of bedrooms x which can be included in any dwelling existing or constructed in the future on said Lot as a pre-condition to obtaining a permit for the installation of a new septic system; Whereas,the Town of Barnstable Board of Health, as a pre-condition to granting the permit for the installation of a new septic system in accordance with 310 C.MR 15.000: The State Environmental Code, Title 5, is requiring that the agreement for the restriction of the number of bedrooms in any dwelling existing or to be constructed on the Lot be put on record with the Barnstable County Registry of Deeds by recording this document. Now Therefore, Owners do hereby place the following restriction on the above referenced " land in accordance with this agreement with the Town of Barnstable Board of Health, which d restriction shall run with the land and be binding upon all successors in title: a, The property located at 61 Mitchell's Way, Hyannis,Massachusetts, and described aon the attached Exhibit"A", may have a dwelling containing no more than three (3) bedrooms. Owners hereby agree that this shall be a permanent deed restriction affecting the above described premises. FOR TITLE, see deed recorded with the Barnstable County Registry of Deeds in Book 28105,Page 341. ' a 3 WITNESS my hand and seal this day of April, 201.7. Donovan D.Fraser Rose Marie Fraser COMMONWEALTH OF MASSACHUSETTS Barnstable, ss: On this ct'I"day of April, 201.7, before me,the undersigned notary public, personally appeared Donovan D. Fraser,proved tome through satisfactory evidence of identification, which was RAQ lL- ,to be the person whose name is signed on the preceding document, and acknowledged to me that he signed it voluntarily for its stated purpose. MICHELLE ALDRICH Notary Public Notary Public . My Commonwealth of Massachusetts Commission Expires September 14,202`; My Commission Expires: 9I1 i�23 COMMONWEALTH OF MASSACHUSETTS Barnstable, ss: On this 2c?'6day of April, 201.7, before me, the undersigned notary public,personally appeared Rose Marie Fraser, proved to me through satisfactory evidence of identification, which was DL , to be the person whose name is signed on the preceding document, and acknowledged to me that she signed it voluntarily for its stated ' purpose. � MICHELLE ALDRICH ° Notary Public ComrnonwealthofMassachusetts Notary Public My Commission Expires September 14,202;: My Commission Expires: `Z I Cy 12X Exhibit"A" Property description The land, together with any buildings thereon, situated in Barnstable (Hyannis),Barnstable County Massachusetts, described as follows: Containing 14,276 square feet more or less and being shown as LOT#7 on a plan entitled, "Plan of Land-Hyannis-Barnstable,Mass., as surveyed for Joseph D. &Delores E. Daluz, Scale: 1 inch =40 feet, February, 1973 Whitney&Bassett—Architects&Engineers Hyannis,Mass." and duly recorded in the Barnstable County.Registry of Deeds in.Plan Book'275, Page 96. BARNSTABLE REGISTRY OF DEEDS John F. Meade, Register Town.of Barnstable y o Regulatory.Semces ;Richard V.Sca m h,Inteh Director 9 .; Public,ftealfh DiAsion Thomas'M'X an,.Director 200 Main Street,Hyanni-WMIA 0260.1 Office. 5.;0$-562-46.44 � Fax: 5.0$=790-6304 ;Installer&`�Desianer. Cer i&ation Form- Date: Sewage-Permit# ,.Io%7 « I, Assessor's.MaplParcel. 0 Designer: ` t t Installer: n ,terz.� Address: P U CII/ Address:�� �'a Qom( �osr i ire OQb as issued a pernut to install a: (date) (installer) h/I l septicsystem;at _CG/- ,5 "` 7�- based on a design drawn by (address) da`ted.,. 7— (designer), A� x i certify that'the septic system referenced above.was installed:substantially according the design, w6 h may uiclude minor_approved changes such as lateral-relocation of the distiibt on box and/or,septic tank. Strip.out (if required) was inspected and the soils were:.found.satisfactorv: _ _ 'I certify that septic system referenced above was installed-with major changes (i.&. greater than 10' lateral relocation:of the SAS or.any vertical relbeation of any component; of the sexic'systetn) but in accordance with State R Local Regulations. Plan revision-or certified as=built by designs to follow: Strip out(if required)was inspected and the soils were found satisfactory': I;certify that`the system referenced above was construct a with the 'of the IAA approval,letters(if applicable) . (Iis$aller's Signature)_ _ - ; 99+4 rk (Designer s.'Signature) (Affix Designer amp Here) .PLEASE::RETURN TO B TABLE PUBLIC HEALTH DIVISION. CERTIFICATE, OF COMPLIANCE WILL N T BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE-RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.. THANK YOU. _ Q\SepticOesig er Cwificatiod Forth Rev 8-14-13.doe r Town of Barnstable Barnstable Board of Health j WWca j .uwsrAH� _ Q 9 K,►ss. g 200 Main Street, Hyannis MA 02601 1% 2007 Office: 508-862-4644 Paul J.Canniff,D.M.D. FAX: 508-790-6304 _ Junichi Sawayanagi Donald A.Guadagnoli,M.D. May 1, 2017 Mr. Darren Meyer P.O. Box 981 E. Sandwich, MA 02537 RE ;61t Mitchell s Wa ` H annls� s t }k='.r � r r A 290'157 U Y * Dear Mr. Meyer, You are granted a conditional variance on behalf of your clients, Donovan and Rose Fraser, to construct an onsite sewage disposal system at 61 Mitchell's Way, Hyannis. The variances granted are as follows: Section 360-1 of the Town of Barnstable Code: To install a soil absorption system 66 feet away from a pond, in lieu of the minimum 100 feet separation distance required. Section 360-1 of the Town of Barnstable Code: To install the distribution box 61 feet away from a pond, in lieu of the minimum 100 feet ., separation distance required. Section 310 CMR 15.211: To install the leaching facility 16 feet away from the foundation wall,.in lieu of the minimum twenty (20) feet setback required. Section 9(D) of the DEP Standard Conditions for Alternative S.A.S.: To allow 39,3%'reduction in the leaching area size: These variances are granted with the following conditions: (1) No more than three (3) bedrooms are authorized at this property. Dens, study rooms, offices, finished. attics, sleeping lofts, and similar- type rooms are considered "bedrooms" according to the MA Department of Environmental Protection. Q:\WPFILES\MeyerFraser MitchellsWay Variance 2017.docx [s (2) The applicant shall record a properly worded deed restriction, signed by the owner of the property, at the. Barnstable County Registry of Deeds restricting the property to three (3) bedrooms maximum. A copy of the recorded deed restriction shall be submitted to the Health Agent prior to obtaining a disposal works construction permit. (3) The septic system shall be installed ,in strict accordance with the revised engineered plans dated April 25, 2017. (4) The designing registered sanitarian shall supervise the construction of the onsite sewage disposal system and shall certify in writing to the Board of Health that the system wa`s installed in substantial compliance with revised engineered plans dated April 25; 2017. These variances are granted .because the proposed. plan appears to meet.the maximum feasible design standards contained within the State Environmental Code, Title 5 and local Health Regulations. The registered sanitarian designed the septic system to be located in an area to attempt to maximize setbacks to wetlands. Sin erely yours, Paul . an , M. . Chairman Q:\WPFILES\MeyerFraser MitchellsWay Variance 2017.docx DATE FEB: * BARNSTABM MASS �ee-- 639.��� REC.BY:�Ct�- MA'I Town of Barnstable $CHED.DATSs ,.,*L2- . Board of Health 9_0 17 200 Main Street, Hyannis MA 02601 Office: 508 862 4644 Paul J.Cannily D.M.D. FAX: 508-790-6304 JunichiSawayanagi Paul J.Canniff,D.M.D. VARIANCE REQUEST FORM LOCATION , Property Address: S Assessor's Map and Parcel Number: �� Size of Lot:_ Q Wetlands Within 300 Ft. Yes Business Name: No Subdivision Name: APPLICANT'S NAME:DWEO M EK-Mea(ASO(AS &Phone 60$ 30 -- 33! Did the owner of the property authorize you to lepresent him or her? Yes No PROPERTY OWNER'S NAME CONTACT PERSON Name::DONOVA-Q V�f, Feq-SER, O kizAoj M Name: Address: t,P /` t I I C.N OLI S W Ay Address: P O 6W .S ftT(fl yv Phone: 121 4143 3 Ci 31 1!� Phone: S09 36o - 3 1/ 'S37 EMAIL: Me 4frAAd$oP7S +,+Ie S�� qNW i I_!o✓�VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space needed G 1,05 NATURE OF WORK: House Addition 0 House Renovation C] Repair of Failed Septic System l/ hecklist (to be completed by office staff-person receiving variance request application) i Please submit copies in 4 separate completed sets. Four(4)copies of the completed variance request form Four(4)copies of engineered plan submitted(e.g.septic system plans) Completed seven(7)page checklist confirming review of engineered septic system plan by submitting engineer or registered sanitarian Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) Signed letter stating that the property owner authorized you to represent him/her for this request Applicant understands that the abutters must be noted by certified mail at least ten days prior to meeting date at applicant's expense(for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) ' Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same owner/lessee only], outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems[only if no expansion to the building proposed]) i _ Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Paul J.Canniff,Chairman NOT APPROVED Junichi Sawayanagi REASON FOR DISAPPROVAL Donald A.Guadagnoli,M.D. C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\BMQD49H2\VARIREQ Rev Jan2017.DOC ■ Com61&WitemS—,.2,and 3. A: Slgnatu ® Print your'Fiame and address on the reverse ❑Agent so'that we can return the card to you. X `"` ❑ dressee ■ Attach this card to the back of the mailpiece, B.' eeived by(Printed Name) C. D of Delivery or on the front if space permits. - Z 1. Article Addressed to: D. Is delivery address different from item 1 es If YES,enter delivery address belo ❑No �y 00( II I IIIIII IIII III I I I I II I IIII II II IIII I II I II I I III 3. 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' - ❑CeFtifled MeltRestrlcted Delivery $ R O P 6tv►9 1 "` 0 ❑Rehm Receipt(electronic) $ (� ❑Adak Signature Required $ r µr:t�. O ❑CertlHed Mail.ResMcted Delivery $ o.a�y7B(q'd�/7 ❑Adult Signature Restricted Delivery..$. "V _ - ❑Adult Signature Required ,$ 1 v_'' '�• >~ C3 'Postage r ❑Adult Signature Restricted Delivery$ v $ $4 '49 p Postage e . � Total Postage and Fees... ,. � ,•. $ $6.S9" q g� o Total Postage and Fees - Y - , L Sent To a Q . $ $6.59 + h L - r 'mil\ !i ' � �' . ts� gent TO tl7 S sa y�;tdaPt xro.,or Fs ffix--Mo � D a LO R-Cs D O or Streei -daiit:7Vo.-- Ffa fox lYc�A W�y V�i1.L i cr(yarere z%P+d+ '"` P Town of Barnstable Regulatory Services Richard V. Scali, Interim Director ' u ' Public Health Division ►`� Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 4-, Homeowner Certification Form fowAlternative Systems Property Address: 61 Mitchells Way Assessor's Map\Parcel: 290/157 Property Owners dame: Donovan & Rose Fraser In accordance with Massachusetts DEP alternative system approval letters, the following certification information is required by the Owner of record. The Owner of record must place an "x" in the applicable box next to each line certifying the information. Yes N\A [9 ❑ I have been provided a copy of the Title 5 I/A technology Approval letters. (15 page Standard Conditions letter and the specific technology letter) ❑ ® I have been provided with the Owner's Manual ❑ N I have been provided with the Operation and Maintenance Manual ❑ 1� For—gystems installed under a Remedial Use Approval, I agree to fulfill my responsibilities to provide a Deed Notice as required by 310 CMR 15.287(l 0) and the Approval ❑ ® For Systems installed under a Remedial Use Approval, I agree to fulfill my responsibilities to provide written notification of the Approval to any new Owner, as required by 310 CMR 15.287(5) ❑ ❑ If the design does not provide for the use of garbage grinders, the restriction is understood and accepted 19 ❑ Whether or not covered by a warranty, I understand the requirement to repair, replace, modify or take any other action as required by the Department or the LAA, if the Department or the LAA determines the System to be failing to protect public health and safety and the environment, as defined in 310 CMR 15.303 agree to comply with all terms and conditions above. Property Owners printed name pe -- A 4 6 1� Property Owners Signature Date Note: This form' must be submitted along with the septic system disposal works permit application for all I\A systems including new construction, remirsW rades, with and without aggregate- (stone) and with conventional design criteria or credited design criteria. QASepticUA homeowner certification.doc Permit Number: Date: Completed by: HIGH GROUND-WATER LEVEL COMPUTATION Site Location: �_ r •` Lot No. Owner: Address: Contractor: Address: Notes: STEP 1 Measure depth to water table ( to nearest 1/10 ft. ................................................... ....................................... ...... ...°..................... .Date month/day/year STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: OAppropriate index well.................................................... OB Water-Itvel range zone ..................................................... STEP 3 Using monthly report "Current Water Resources Conditions" determine current depth to water level for index well ........................... 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 2B) determine water.-level adjustment ........................................ STEP 5 Estimate depth to high water by subtracting the water- level adjustment (STEP 4) from measured depth to-water. levelat site (STEP 1) .......................................:.........-......................................................,..... `'� Commonwealth of Massachusetts Executive Office of Energy &Environmental Affairs Department of Environmental Protection One Winter Street Boston, MA 02108.617-292-5500 Charles D.Baker Matthew A.Beaton Governor Secretary Karyn E.Polito Martin Suuberg Lieutenant Governor Commissioner Standard Conditions for Alternative Soil Absorption Systems with General Use Certification and/or Approved for Remedial Use Revised: February 3, 2016 These Standard Conditions apply to Alternative Soil Absorption System(Alt: SAS) technologies for disposal-only as well as for technologies providing both treatment and disposal. Currently these approved alternative technologies include the following, Alt. SAS Disposal-Only; • Contactor,Field Drain Contactor, and Recharger Chambers, by Cultec, Inc. • Biodiffuser&ARC Chambers,by Infiltrator Systems, Inc. • Infiltrator Chambers,by Infiltrator Systems,Inc. - - • Eljen Mantis M5,by Eljen Corp. Alt. SAS Treatment with Disposal -Patented Sand Filters, • Eljen GSF Geotextile Sand Filter System, by Eljen Corp. 0 Enviro-Septic Wastewater Treatment System,by Presby Environmental, Inc. • Advanced Enviro-Septic System, by Presby Environmental, Inc. • Simple-Septic Wastewater Treatment System, by Presby Environmental, Inc. An alternative SAS may be appropriate for new construction, increases in flow, or for the upgrade of an existing failing, failed, or nonconforming system where reducing the disturbance of the site is desired. Alternative Disposal-Only technologies approved by the Department may be substituted for conventional SAS's allowed under Title 5. The alternative Chamber technologies,when compared to conventional Title 5 chambers,.provide options from some of the Title 5 requirements such as offering plastic instead of concrete chambers and eliminating the need for stone aggregate around the chamber while allowing higher loading rates and reduced effective leaching area. Other options include Chambers installed with aggregate meeting the requirements of Title 5, however Alternative, Chambers used with aggregate are not allowed higher loading rates which must remain the same as required by Title 5'for conventional chambers with aggregate. In addition to alternative Chambers, disposal-only approved Alt. SAS technologies also include the Mantis M5 pipe and sand System design: This information is available in alternate format.Gall Michelle Waters-Ekanem,Diversity Director,at 617-292-5751.TTY#MassRelay Service 1-800-439-2370 MassDEP Website:www.mass.gov(dep Printed on Recycled Paper Standard Conditions for Alternative Soil Absorption Systems Page 2 of 15 General Use and Remedial Use Approvals Last revised February 3,2016 Alternative Treatment with Disposal technologies approved by the Department refer to alternative leaching systems that have demonstrated higher removal of organics and suspended matter prior to the percolation of wastewater into underlying unsaturated pervious soils when compared to conventional leaching systems. Higher loading rates are allowed.than would be permissible with a conventional design and additional relief from.other design standards is permissible for upgrades. A System approved under these"Standard Conditions'consists of a septic tank conforming to the requirements of Title 5, either conventional or I/A approved, followed by the Alt. SAS which may provide for a reduced effective leaching area. The use of an approved Alt.SAS, subject to these Standard Conditions, requires among other things: • A Disclosure Notice in the Deed to the property for installed Systems according to the following: • when installing an Alt. SAS Disposal-Only System (chambers or Eljen Mantis M5) a Disclosure Notice in the Deed to the property is not required; when installing an Alt. SAS Treatment with Disposal-Patented Sand Filters System under the General Use Certificate a Disclosure Notice in the Deed to the property is not required; 4 • when installing an Alt. SAS Treatment with Disposal-Patented Sand Filters System under the Approval for Remedial Use a Disclosure Notice in the Deed to the property is required in accordance with 310.CMR 287(10); Certifications by the Designer and the Installer(310 CMR 15.021(3)); • Notification within 24 hours by the System Owner to the Local Approving Authority (LAA) of any System failure; • When System requires pumping prior to the SAS, 24-hour emergency wastewater storage capacity above the elevation-of the high level alarm; • System Owner Acknowledgement of Responsibilities, in accordance with these standard conditions and the Technology:Approval's Special Conditions. This Approval does not address the use of the following alternative SAS's,which are covered under separate Title 5 I/A Program Approvals: a) Drip Dispersal Systems b) Bottomless Sand Filters Definitions and,References The term "System" refers to the approved technology in combination with the other components of an on-site treatment and disposal system that may be required to serve a facility in accordance with 310 CMR 15.000. The term"Approval" or"Certification" refers to these Standard Conditions; the Special Conditions contained in the Technology Approval, the General Conditions of 310 CMR 15.287, and any Attachments. r Standard Conditions for Alternative Soil Absorption Systems Page 3 of 15 General Use and Remedial Use Approvals Last revised February 3,2016 The phrase "new construction" always refers to construction of a new facility or any increase in actual or design flow to any existing system above the approved capacity. The phrase "upgrade of a system or the term "upgrade" or the term"remedial site" refers to an repair, modification, or replacement of a whole system or a component of an existing failing, failed or nonconformtng system wT ere there is no increase•in the actual or design flow to the system. - The Conditions contained herein MUST be-read in conjunction with any Special Conditions that are technology-specific. r P I. , Purpose 1. These Standard Conditions shall apply to all Alt. SAS technologies identified in a General Use Certification or a Remedial Use Approval as either a Disposal-Only technology or a Treatment with Disposal technology as listed above. In addition to the Special.Conditions contained in the technology-specific Approvals, the System,, shall comply with all these"Standard Conditions for Alternative Soil Absorption° Systems", except where stated otherwise in the Special Conditions. 2. The sale, design, installation, and use of the System shall be subject to these requirements for all systems that submit a complete Disposal System Construction Permit(DSCP) application after the effective date of these Standard Conditions. Existing systems and systems for which a complete DSCP application was submitted - prior to the effective date of these requirements shall not be subject to the design and installation requirements, however, the System Owner, the Service Contractor, and the Company shall be subject to all other requirements contained herein. 3. With the other applicable permits or approvals that may be required by Title 5,the Approval authorizes the installation and use of the System in Massachusetts. All the provisions of Title 5, including the General Conditions for Alternative Systems (310 CMR 15.287), apply to the sale, design, installation, and use of the System, except those provisions that specifically have been varied by this Approval. 4. Provided that the Local Approving Authority (LAA) approves the System in conformance with the Department's Approval for the System, Department review and approval of the site-specific System design and installation is not required unless the Department determines on a case-by-case basis,pursuant to its authority at 310 CMR 15.003(2)(e), that the proposed System�requires Department review and approval. II. Design and Installation Requirements 1. Where any contradiction may exist in design standards between the Company guidance and the requirements of Title 5 or this Approval,the design shall meet the. standards of Title 5 and this Approval unless the Company guidance is more stringent. Standard Conditions for Alternative Soil Absorption Systems Page 4 of 15 General Use and Remedial Use Approvals Last revised February 31 2016 In accordance with 310 CMR 15.240(6), absorption trenches should be used whenever possible. Accordingly, approved Disposal-Only and Treatment with Disposal Alt. SAS Systems shall be used in trench configuration whenever possible, unless a different configuration is allowed by the Approval(s) Special Conditions. 3. -The Alternative System shall include a properly sized and constructed septic tank, designed in accordance with 310 CMR 15.223-15.229 or approved as an Alternative technology per 15.280-15.288, connected to the building sewer and followed in series by the approved Alternative Soil Absorption System. A 1,000 gallon septic tank may be allowed in accordance with the provisions of 310 CMR 15.404(3)(a). 4. The Alternative System shall be installed in a manner which does not intrude on, replace, or adversely affect the operatiori.of any other component of the subsurface sewage disposal system. 5. The Designer shall be a Massachusetts Registered Professional Engineer or a Massachusetts Registered Sanitarian, including when designing systems for repair; provided that such:Sanitarian shall not design a system with a discharge greater than 2,000 gallons per day. 6. For new construction or increases in flow,the System shall be subject to the following: a) The System may only be installed in soils with a percolation rate of up to 60 minutes per inch (MPI); b) A site evaluation, in compliance with 310 CMR-15.100 through 15.107, must be approved by the Approving Authority and the site must meet the siting requirements for new construction; - - c) 'The record drawings, approved by the LAA, must clearly indicate an area for a.full- sized conventional primary SAS an&a full-sized conventional reserve area that are for the sole purpose of on-site sewage disposal; d) Where the System ha`s reduced'the effective leaching area, as allowed by the Standard Conditions, the installation shall not disturb the site in any manner that would preclude the future installation of the conventional full-sized primary SAS without encroaching on the reserve area; and e) Except for the installed SAS, the System Owner shall,not construct any permanent buildings or structures or disturb the site in any manner that would encroach on the area approved for a full-sized conventional primary SAS or the area approved for a full-sized conventional reserve SAS. 07. For the upgrade of a system, the„installation of the proposed System shall be subject to the following: a) The System may only be installed in soils with a percolation rate of"up to 90 minutes per inch (MPI);. b) Prior to approving the installation of the System,the LAA must determine there is no increase in the actual or proposed design flow; f Standard Conditions for Alternative Soil Absorption Systems' Page 5 of 15 General Use and Remedial Use Approvals Last revised February 3,2016` c) Prior-to;Local Approval of the System,the Designer shall show on the plans the maximum available area for a conventional system (without reserve) designed in v I� accordance with the standards of 310 CMR 15.100 through 15.255. d) The proposed System must include the approval by the LAA for the upgrade or replacement of all other existing components, as necessary,to comply with the standards of Maximum' 'Feasible Compliance (MFC) of 310 CMR 15.404; e) The record drawings, approved by the LAA, must clearly indicate an area for the best feasible replacement system that could be installed in the event that the proposed Alternative Soil Absorption.System fails or it is determined that it is not capable of providing equivalent environmental protection; f) When evaluating the best feasible replacement system that could be installed in the event that the proposed Alternative Soil Absorption System fails or it is determined that it is not capable of providing equivalent environmental protection,the Designer shall consider these options in the:following order: i. a conventional system designed-in accordance with the standards of 310 CMR rt 15.100 through 15.255 that can be built feasibly, with the exception of providing a reserve area(15,248); ii. a conventional system that can only be built feasibly under a Local Upgrade Approval (LUA); iii. where a conventional system cannot be built feasibly under a LUA, a Bottomless Sand Filter, in conjunction with a Secondary Treatment Unit; iv. where a System can only be built feasibly with variances, a System that has been demonstrated to vary the design requirements of 310 CMR 15.000 to the least degree necessary and have the least effect on public health, safety; welfare and the environment(the System may be an Alternative System with, variances); or v. a tight tank. f) The installation of the proposed.System shall not disturb the site in any manner that would preclude the future installation of the best feasible replacement system that could be installed to replace the proposed System. Components of the proposed System may be sited in an area for the future installation of the best feasible replacement system, provided that it does not render the area unusable for a potential.future replacement system; and g) Except for the installed SAS, the System Owner shall not construct any permanent buildings or structures in the area for the best feasible replacement system that could be installed to replace the proposed.System and the System Owner shall not disturb the site in any other manner that would preclude the future installation of the best feasible replacement system. 8. Alternative Design Standard to 310 CMR 15.242(1)(a)Effluent Loading Rates . For new construction or increases in flow,the required effective leaching area may be reduced up to 40 percent when using the loading rates for gravity systems of 310 CMR 15.242(1)(a),provided: Standard.Conditions for AlternativeSoil Absorption Systems Page 6 of 15. General Use and'Remedial>Use Approvals Last revised February 3',2016 a) no variance is�,rmhied for a reduction in depth Ito groundwater; b), no variance is granted for a reduced depth of pervious material; and a c) a minimum of 460 square feetof effectiveIeaching area shall be installed if any proposed reduction in the leaching area would result in less than 400 square feet f� of effective leaching area; (Facilities with small flows that would not require 400 _ '\ sq.ft: of effective.leaching urea, whendesigned°`in accordance with Title 5, may be 3 > built:with less than 400;sq.,,ft.provided that no'reduction ineffective leaching area is taken). 9: Alternative Design Standard-to 310 CMR 15.242(l)(a) and 15.245(4), Effluent Loading Rates - For the upgrade of a system,the System shall be subject to the following: oFor•soils with a percolation rate of 60 minutes or less per inch,the size of the SAS • ` ay be sized with 40 percent less effective leaching area than required when using'`} the-loading rates`for-gravity systems of 310 CMR'15.242(1)(a); b),,For soils with a percolation rate of betweeni 60 and 90 minutes per inch,the size of the SAS maybe sized.with 40 percent less effective leaching area than required y -when.using the loading rate of 0.15 god/square foot-as.specified by 310 CMR 15.245(4); c) 'Unless allowed under the Special Conditionsyfor the Technology, no additional' :.. reduction in the effectivejeaching'area.,is allowed under an LUA or a"variance`that ` A would,result in a reduction greater than'40%o of that which would be required under 310 CMR 15.242(i)(a) and 15.245(4), respectively. Any other deviations.to design" standards,except the effective leaching area, may be granted under LUA or a & variance; and ,. d) A'minimum of•400 square feet of effective leaching area�shall be provided if any proposed reduction in the leaching area would result in less than 400 square feet.of "effective leaching.area. Where 400 square feet of effective leaching is not,feasible, the greatest effective leaching area shall be installed provided that no more than'a 40 percent reduction is taken.:` 10. Specific Conditions for Treatment with Disposal Alt. SAS Technologies a) The-us e of aggregate.as specified in'310 CMR 15.247 is not allowed with Patented Sand Filters. b) Unless determined$necessarybythe`Designer or`Company,the System shall not, be used with pressure.distribution for'any design,flow. When installed for a facilit)µwith a design, w`.of 2 000 gpd or greater, approved Patented Sand Filter Systems are exempt from,the requirement for pressure distribution under 310 w CMR-15.23t. c)- Patented Sand Filters°sfiall not be installed in a Nitrogen Sensitive Area(NSA)to r: serve facilities with actual or design flows of 2,000 GPD or greater since those facilities require installation of a Recirculating Sand Filter(RSF) or equivalent technology. Patented Sand Filters may be installed as a disposal-only alternative Standard Conditions for Alternative Soil`Absorption Systems Page 7 of 15 General Use and Remedial Use Approvals ' Last revised February 3,2016 technology when used in addition to an appro"ved Secondary Treatment Unit (reduction of BOD/TSS). When a Patented.Sand Filter is used in this type of , septic system design, only"the reductions permitted in the Secondary Treatment Unit's(STU)alternative technology approval, such as a reduction in SAS size,' depth of naturally occurring pervious material or depth-to groundwater, are allowed. d) For upgrades only,a reduction in the :depth to groundwater and/or a reduction.in r, the pervious material may betaken in accordance with Section II, paragraph 5 of '? the Standard Conditions for Secondary Treatment Units Approved for Remedial t Use. In no case, shall the'reductions allowed under the Standard Conditions for" ' Secondary Treatment.Units.be combined with any reduction provided by this Approval, the alternative technology's Remedial Use Approval Special Conditions or with any reduction;that may be.allow.ed under the procedures of ° Local Upgrade Approval or'variance procedures of 310 CMR 15.401-415. , I Specific.Conditionsfor'Disposal=Only Alt. SAS;Technologies a) In a NSA,°as defined in 310 CMR 15.2I5,°Alternative Systems serving facilities r, with actual or design flows of 2,000 GPD or greater must include treatment,with a.. =a RSF or equivalent•technology, as required by 310 CMR 15.202(1.). Under this'm Approval, Disposal-Only Alt: SAS technologies shall not be installed in an NSA- to serve facilities with actual or design flows of 2,000 GPD or greater unless installed in conjunction with'a.RSF or equivalent technology. b) For.new construction or upgrades, a reduction in the effective leaching area may be taken in accordance.with the'conditions and limitations imposed by the "approval of the Secondary Treatment Unit employed. (approved Alternative z Chambers maybe installed with or without aggregate for the disposal of effluent; from an approved SecondaryTreatment Unit,see paragraph I I(e) below.) For' upgrades only,•a reduction in the depth to groundwater and/or a reduction in the pervious material,tray be taken•in-accordance with the conditions and limitations- imposed by the Remedial Use Approval of the Secondary Treatment Unit employed. In no;case, shall the reductions allowed under the Secondary Y Treatment Unit approval be made less stringent., In,no.case, shall the reductions allowed under the Secondary Treatment Unit approval be combined with any reduction provided by this Approval,or combined with any reduction that may be allowed under.the procedures of Local Upgrade Approval or the variance procedures of 310 CMR 15.401..-415. 5 c) For the*upgrade of.a system;,installations without secondary treatment are entitled to reductions in depth to groundwater or depth of naturally occurring pervious, material only to the limits that niay'be:allowed.by the LAA under the procedures of Local Upgrade Approval or the'variance procedures of 310 CMR 15.401-4151. r d): The use of aggregate as specified in-Title 5, 3°10 CMR 15.247 is not required. . Standard Conditions for;Alternative Soil Absorption Systems Page 8 of 1.5 General Use and RemedialUse.Approvals v Last revised February 3,2016 . � L Chambers Specific Standard Conditions,, e); The installation,of approved Alternative Chambers with aggregate is allowed provided that it complies with the aggregate,requirements of 310 CMR 15.241. + However,when approved Alternative Chambers are installed with aggregate the '1 reduction in effective leaching area provided by Standard,Conditions II (8) and a< (9)is not allowed: Only when upgrading a system, approved'Alternative Chambers installed with,aggregate may be allowed a reduction in effective leaching area(up to 25%)under.the limitations and procedures of a Local Upgrade Approval (310 CMR.15.401-405). f) Effluent pressure distribution shall be provided for actual or design flows of 2,000 gpd or greater and's.hall be designed i11 n accordance with Department guidance.., The effluent load= ng rates provided in 310 CMR 15.242(1)(b) for pressure distribution may be,utilized,.but no.reduction,in-the effective leaching area as may . be provided under this Approval may be taken when using the loading rate, for, pressure distribution,as�stated in`the.regulation. ' 12. All System control units,valve boxes;.distribution piping,�conveyance lines and"other."' System appurtenances shall be designed and installed to prevent freezing. When pumping s.required to a distribution box or to a SAS pressure distribution tank,the System pump'chambers/tanks shall be equipped with sensors and high-level alarms to protect against high.water due to pump failure,pump control failure, loss of power, system freeze ups,.backups, etc.,Emrgency storage shall be provided'when pumping to discharge is employed,-including but not limited to,pressure distribution Emergency storage capacity for.wastewater above the high level alarm°shall be provided equal to the daily design flow of:the System including an additional allowance for the volume of alldrainage which may flow back into the System when pumping has ceased: 14. System control panel(s),including alarms.and controls shall„be mounted in a location l( always accessible to.the operator",(Service-Contractor). Any System malfunction and high water alarms shall be readily visible'at d audible for the`facility occupants and the Service Contractor and shall be connected`to circuits separate from the circuits serving the operating equipment and pumps 15. The System shall not include any relief valve or outlet for the discharge of wastewater s` to prevent flooding of the system,=back up or break out. 16. Any System structures with exterior piping connections located.within 12 inches of or , lower-than the Estimated Seasonal'High Groundwater elevation shall°have the connections made watertight with neoprene.seals or equivalent. 4 17. In compliance with 310 CMR 15.240.(13),.a minimum of one (1) inspection port shall 2 be provided within the SAS consisting of a perforated four inch pipe placed vertically down to the elevation of the SAS interface with the underlying unsaturated pervious soils to enable monitoring for ponding. The pipe shall be capped with a screw type Standard Conditions for Alternative Soil Absorption Systems Page 9 of 15 General Use and Remedial Use Approvals Last revised February 3,2016 cap and accessible to within three inches of finish grade. (A locking cap at-grade.is preferred) Facilities with multiple SAS's shall have an inspection port in each. 18. Upon submission of an application for a Disposal System Construction Permit (DSCP),the Designer shall provide tothe Local Approving Authority: a) proof that the Designer has satisfactorily completed any required training by the Company for the design and installation of the Technology; b) certification of the design by the Company for any residential system with a design of 2,000 gpd or more or for any proposed non-residential system or if required by the Special Conditions for an approved Technology; c) certification by the Designer that the design conforms to the Approval, any Company Design Guidance;and 310 CMR 15.000; and d) a certification, signed by the Owner of record for the property to be served by the Technology, stating that the property Owner: i. has been provided a copy of the Title 5 I/A technology Approval,the Owner's Manual, and the Operation and Maintenance Manual, and the Owner agrees to comply with all terms and conditions; ii. for Systems installed under a Remedial Use Approval, the owner agrees to fulfill his responsibilities to provide written notification of the Approval to any new Owner, as required by 310 CMR 15.287(5); - iii. if the design does not provide for the use of garbage grinders, the restriction is understood and accepted; and iv. whether or not covered by a warranty,the,System Owner understands the requirement to repair,replace, modify or take any other action as required by the Department or the.LAA, if the Department or the LAA determines the' System to be failing to protect public health and safety and the environment,y as defined iri 310`CMR 15303. 19. The System Owner and the Designer.shall not submit to the LAA a DSCP application for the use of a Technology under this Approval if the Approval has been revised, reissued, suspended, or revoked by the Department prior to the date of application. The Approval continues in effect until the Department revises, reissues, suspends, or revokes the Approval. 20. The System Owner shall not authorize or allow the installation of the System other than by a locally approved Installer and, if required by the Company, a person certified or trained by the Company to install the System. 21. Prior to the commencement of construction, the System Installer must certify in writing to the Designer, the LAA, and the System Owner that(s)he is a locally approved System Installer and, if required by the Company, is certified by or has received appropriate training by the Company. 22. The Installer shall maintain on-site, at all times during construction, a copy of the approved plans, the Owner's manual,the O&M manual, and a copy of the Approval. ♦ i 1 ( .. o Commonwealth of Massachusetts. Executive Office of Energy S Environmental Affairs µ Department. of Environmental Protection One Winter Street Boston, MA 02108.617-292-5500 Charles D.Baker Matthew A.Beaton Governor Secretary Karyn E.Polito Martin Suuberg Lieutenant Governor Commissioner APPROVAL FOR GENERAL USE Pursuant to Title 5, 3.10 CMR 15.000 Name and Address of Applicant: Infiltrator Water Technologies, LLC. P.O. Box 768 6 Business Park Road Old Saybrook, CT 06475 Trade name of technology and model: High Capacity chamber, High Capacity H-20 chamber', Quick4 High Capacity chamber, Quick4 High Capacity HD chamber, Quick4 Plus High Capacity chamber (8- . inch invert), Quick4 Plus High Capacity chamber (13-inch invert), Standard chamber, Quick4 Standard chamber, Quick4 Standard HD chamber, Quick4 Plus Standard chamber (5.3-inch invert), Quick4 Plus Standard chamber (8.0-inch invert), Quick4 Plus Standard LP (Low Profile) chamber (3.3-inch invert), Quick4 Plus Standard LP (Low Profile) chamber (8-inch invert), Infiltrator 3050 (Storm Tech SC-740) chamber, Equalizer 24 chamber, Quick4 Equalizer 24 chamber, Equalizer 36 chamber, Quick4 Equalizer 36 chamber, Quick4 Equalizer 24 LP(Low,Profile) chamber(6 inch invert), and Quick4 Equalizer 24 LP (Low Profile) chamber(2 inch invert) (hereinafter the "System"). Schematic drawings of the System and a design and installation manual are a part of this Certification. This approval allows the installation of the above identified chambers without aggregate. Transmittal Number: X259183 Date of Revision: February 19,2015,modified June'12,2015 Authority for Issuance Pursuant to Title 5 of,the State Environmental Code, 310 CMR 15.000, the Department of Environmental Protection hereby issues this Certification to: Infiltrator Water Technologies, LLC., P.O. Box 768, 6 Business Park Road, Old Saybrook, CT 06475 (hereinafter "the.Company"), for General Use of the System described herein. The sale, design, installation, and use of the System are conditioned on compliance by the Company, the Designer, the Installer and the System Owner with the terms and conditions set forth below. Any noncompliance with the terms or conditions of this Approval constitutes a violation of 310 CMR 15.000. June 12,2015 David Ferris,Director Date Wastewater Management Program Bureau of Water Resources This information is available in alternate format.Call Michelle Waters-Ekanem,Diversity Director,at 617-292-5751.TTY#MassRelay Service 1.800439-2370 MassDEP Website:www.mass,gov/dep - Printed on Recycled Paper 4, Infiltrator Chamber,Infiltrator Water Technologies. Page 2 of 6 Approval for General Use—June 12,2015 I. Design Standards 1. The models listed in Table 1 are covered under this Certification. Table 1: Chamber Dimensions Dimensions Invert Model W x L x H Height Inches Inches Equalizer 24 15 x 100 x 11 6 Quick4 Equalizer 24 16 x 48 x 11 6 Quick4 Equalizer 24 LP (6-inch invert) 16 x 48 x 8 62 Quick4 Equalizer 24 LP (2-in6 invert) 16 x 48 x 8 2 Equalizer 36 22 x 100 x 13.5 6 Quick4 Equalizer 36 22 x 48 x .12 6 Standard Chamber 34 x 75 x 12 6.5 Quick4 Standard 34 x 48 x 12 8 Quick4 Standard HD 34 x 48 x 12 8 ` Quick4 Plus Standard 5.3-inch invert) 34 x 48 x 12 5.3 Quick4 Plus Standard (8-inch-invert) 34 x 48 x 12 8 .Quick4 Plus Standard LP(3.3-inch invert) 34 x 48 x 8 3.3 Quick4 Plus Standard LP (8-inch invert) 34 x 48 x 8 83 Infiltrator 3050 or StormTech SC-740 51 x 85.4 x 30 22.254 High Capacity Chamber 34 x 75 x 16 11 High Capacity H-20'Chamber 34 x 75 x 16 11 Quick4 High Capacity 34 x 48 x 16 11.5 Quick4 High Capacity HD 34 x 48 x 16 11.5 Quick4 Plus High Capacity(8-inch invert) 34 x 48 x 14 8 Quick4 Plus High Capacity(1 3-inch invert) 34 x 48 x 14 13' ' This approval allows the use of the.high capacity H-20 chambers but makes no determination as to-the chambers meeting the H-20 loading requirements. 2 Includes Infiltrator MultiportTM invert adapter attached to the side of the end cap. 3 Includes Quick4 Plus Periscope adapter.attached to the top of the Quick4 Plus All-in-One 8 Endcap. ,4 Only systems installed wit h this invert height shall be allowed to use the effective leaching area associated with this model in Table 2. ' s Includes Quick4 Plus Periscope adapter attached to the top of the Quick4 Plus All-in-One 12 Endcap. 2. The•System is an open bottom leaching unit molded from polyolefin resin. It can be installed without aggregate or distribution pipe as an absorption trench or as a bed or field. If the System is installed with stone aggregate then the "Effective Leaching Area" in Tables 2 and 3 is not applicable, and must be designed in accordance with the provisions of 310 CMR 15.000. Infiltrator Chamber,Infiltrator Water Technologies, Page 3 of 6 Approval for General Use-June 12,2015 3. The total effective.leaching area for any Chamber Model shall be calculated by multiplying the Effective Leaching Area per square foot of chamber times the total length of chamber from end cap to end cap including end caps. 4. For new construction or upgrades;the applicant can size the System in a trench configuration, using the effective leaching areas presented in Table 2. Tablet: Effective Leaching Area in Trench Configuration for New Construction and Remedial Sites' Effective Effective Model Leaching? Leaching Area Area SF/LF SF/LF Equalizer 24 3.76 N/A Quick4 Equalizer 24 . 3.90 N/A Quick4 Equalizer 24 LP (6-inch invert) 3.90 N/A Quick4 Equalizer 24 LP (2-inch invert) 2.78 N/A Equalizer 36 4.73 N/A Quick4 Equalizer 36, 4.73 N/A Standard Chamber 6.53 N/A Quick4 Standard. 6.96 N/A Quick4 Standard HD 6.96 N/A Quick4 Plus Standard(5.3-inch invert) 6.20 N/A Quick4 Plus Standard (8-inch invert) 6.96 N/A Quick4 Plus Standard LP (3.3-inch-invert) 5.65 N/A Quick4 Plus Standard LP (8-inch invert) 6.96 N/A Infiltrator 3050 or StormTech SC-740 N/A 6.71 High Capacity Chamber 7.79 N/A High Capacity;H-20' Chamber' 7.79 N/A Quick4 High Capacity 7.93 N/A Quick4 High Capacity HD 7.93 N/A Quick4 Plus High Capacity (8-inch invert) 6.96 N/A Quick4 Plus High Capacity(13-inch invert) 7.93 N/A '.Effective April 21,2006, 310 CMR-15.251(1)(b)maximum trench width is 3 feet. '.Effective leaching area is equal to 1.67(bottom width+(2x invert height))for Systems 3 feet or less in width. 8. Effective leaching area is equal to 1.0(3`+(2x invert Height))for Systems with a width greater than 3 feet. 9. The maximum trench width allowed to calculate effective leaching area is 3 feet. 5. Systems installed on remedial sites shall be allowed to utilize the effective leaching areas presented in Tables 2 or 3, or additional reductions in soil absorption system may be allowed. In no instance shall the reduction in the soil absorption system required in 310 CMR 15.242 exceed the maximum reduction allowed for alternative systems approved in accordance with 310 CMR 15.1284. V. Infiltrator Chamber,Infiltrator Water Technologies. Page 4 of 6 Approval for General Use—June 12,2015 6. For new construction or an upgrade,the applicant can size the System in bed or field configuration, using the effective leaching areas presented in Table 3. Table 3: Effective Leaching Area for Bed or Field Configuration New Construction and Remedial Sites Effective Model Leaching10 Area SF/LF Equalizer 24 2.09 Quick4 Equalizer 24 2.23 Quick4 Equalizer 24 LP (6-inch invert) 2.23 Quick4 Equalizer 24 LP (2-inch invert) 2.23 Equalizer 36 3.06 Quick4 Equalizer 36 3.06 Standard Chamber 4.73 Quick4 Standard 4.73 Quick4 Standard HD 4.73 Quick4 Plus Standard(5.3-inch invert) 4.73 uick4 Plus Standard(8-inch invert) 4.73 Quick4 Plus Standard LP (3.3-inch invert) 4.7 Quick4 Plus Standard LP (8-inch invert). 4.73 Infiltrator 3050 or StormTech SC-740 - 7.10 High Capacit Chamber 4.73 High Capacity H-20' Chamber 4.73 Quick4 High Capacity 4.73 Quick4 High Capacity HD 4.73 Quick4 Plus High Capacity (8-inch invert) 4.73 Quick4 Plus High Capacity (13-inch invert) 4.73 10. Effective Leaching area is equal to-1.67 times bottom width only. 7. When the System is used with a_secondary treatment unit approved in accordance with 310 CMR 15.28.4.or_15.288,`additional reductions in soil absorption system may be allowed. In these situations the reduction in the SAS cannot exceed the maximum allowed under the secondary treatment units approval. In no instance shall the reduction in the soil absorption system area required in 310 CMR 15.242 exceed.the maximum reduction'all'o'w_4 for alternative systems approved in accordance with.•310 CN4R 15.284. II. Special Conditions 1. The System is an approved Alternative Chamber for use as an Alternative Soil Absorption System. In addition to the Special Conditions contained in this Approval,the System shall comply with the "Standard Conditions for Alternative SAS with General Use Certification and/or Approved for Remedial Use" (the r y Infiltrator Chamber,Infiltrator Water Technologies. Page 5 of 6 Approval for General Use—June 12,2015 'Standard Conditions'), except where stated otherwise in these Special Conditions. 2. New Construction This:,Certification is for the installation of a System to serve new construction or an existing facility.with a proposed increase in.flow, for which a site evaluation in compliance with 310 CMR 15.000 has been approved by the Approving Authority and the site meets the siting requirements for new construction, as provided in Paragraph 6 in section I1 Design and Installation Requirements of the Standard Conditions. 3. Remedial Site This General.Use'Certification also applies to the installation of a System for the upgrade or replacement of an existing failed or nonconforming system, provided that the facility meets the siting requirements for upgrades, as provided in Paragraph 7 in section II Design and Installation Requirements of the Standard Conditions 4. ' The System shall be exempt from the minimum inlet spacing requirements of 310 ' CMR15.253: 5._ The System shall have a minimum of one inspection port through the top of one of the chambers.-The inspection port shall be capped with a screw type cap and accessible to within three inches of finish grade. 6. When the System is',installed in trench configuration, then the system shall comply with these requirements: a) Length (each trench) 100 feet maximum (310 CMR 15.251(1)(a)); b) Width (each trench) 2 feet minimum to 3 feet maximum (310 CMR 15.251(1)(b)). -Chambers greater than 3-feet wide, when specifically approved, are subject to other Special Conditions and limitations; c) The minimum separation distance between any two trenches shall be two times the effective width or depth of each trench, whichever is greater, or where the area between trenches is designated as reserve area,three times the effective width or depth of each trench, whichever is greater(310 CMR 15.251(1)(d)); d) The effective`leaching area shall be calculated using the bottom area and a maximum of two feet (per side) of side wall area for each trench (310 CMR 15.251(1)(e)) ` e) Trenches shall be situated, where possible, with their long dimension perpendicular to the slope of the natural soil. Where possible they shall follow the contour lines (310 CMR 15.251(2)); , f) Trenches constructed at different elevations shall be designed to prevent effluent from the higher trench(es)_ flowing into'the lower trench(es) (310 CMR 15.251(3)); g) The area between trenches may be designated as system reserve area only where,the separation distance between the excavation sidewalls of the primary trenches is at least three times the effective width or depth of each trench, whichever is greater(310 CMR 15.251(4)) - Chambers greater than 3 feet Infiltrator Chamber,Infiltrator Water Technologies. Page 6 of 6 Approval for General Use—June 12,2015 wide, when specifically approved, shall be separated by three times the actual° width and are subject to other Special Conditions and limitations; and h) Effluent distribution lines exceeding 50 feet in length shall be connected and venting provided in accordance with 310 CMR 15.241 (310 CMR 15.251(11)). 7. When installed in trench configuration,.approved Alternative Chambers greater than 3 feet wide: a) shall be installed with a minimum separation distance between any two trenches of two times the actual width of the chamber, or where the area between trenches is designated as reserve area, three times the actual width of the chamber; and b) shall only be entitled to a maximum effective width of 3 feet for the purposes of calculating total effective leaching area. 8. When installed in a bed or field configuration, the System may be installed without distribution piping, but must comply with the following requirements in 310 CMR 15.252: a) the use of leaching beds or fields is restricted to systems with a calculated design flow of less than 5,000 gpd per leaching bed or field (310 CMR 15.252(1)); ° b) the maximum length of chambers in series shall be 100 feet(310 CMR t 15.252(2)(b)); {` c) separation distance between adjacent beds/fields shall be ten feet(310 CMR 15.252(2)(0); and d) the effective leaching area shall include only the bottom area, not the sidewalls (310 CMR 15.252(2)(i)) 9. For Systems constructed in fill and installed,the System shall be installed as specified in 310 CMR 15.255 Construction in Fill, except the minimum 15 foot horizontal separation distance to be provided between the soil absorption area and the adjacent side slope shall be measured horizontally from the top of the chamber.- 10. The System is exempt from 310 CMR 15.287, specifically items: (5) requiring written notification of alternative system prior to property transfer, (6) need for a certified operator, (9)need for an operation and maintenance contract with an operator and (10) deed"notice requirement. McKenzie, Marybeth From: McKenzie, Marybeth Sent: Thursday,April 20,2017 9:17 AM To: 'meyerandsonstitle56gmail.com' Subject: 61 Mitchells Wy, Hyannis , Hello Darren, Hope all is well.-A couple of things that need attention in regards to the plan that was submitted for the variance request: The top of the existing septic tank is the same elevation as the final grade (22.7),there should be a minimum of 9" coverage. If that is the true grade then that needs to be added to the variance request. Also, note#3 on the plan`replace existing tank with a 1500 gallon if failed......The problem with this is that if the tank does need to be replaced then it must be included in the variance request, due to being less than 100'from the BVW, So. the director wants the tank verified that it is in good condition and will be used,so that note needs to be removed from the plan. If the tank is replaced then you need to add it to the variance request and watch the pitch because the plan' shows 5' from adj ground water which needs to be maintained. If there is a large revision needed then you need to get the plans in 10 days prior the meeting or it may have to go onto next month's agenda. If you have any questions please call. I will be in the office 3:30 to 4:30, happy to help. Regards, Marybeth McKenzie.R.S. .G. r . 1 Apri14, 2017 Re: Septic System Upgrade 61 Mitchell's Way, Hyannis, MA To Whom it May Concern, I grant permission to Darren Meyer of Meyer&Sons, Inc.to apply as necessary for any and all variances and approvals through the Town of Barnstable Board of Health and Conservation Commissions for the purpose of obtaining approval of plans to upgrade the existing on-site sewage system located at 61 Mitchell's Way, Hyannis, MA Sincerely, Rose E. Fraser, Property Owner IMMEDIATE ABUTTERS OF ASSESSOR'S MAP ® PARCEL •�Q i i Map O--`-- b Parcel { &7 M,Rke-U5 WAS/ Address• M l T L(, W&} Map-? Parcel s 0 6A, M t - Name: t o yo y, or (3 A-(1-(JST-Ajj, / Address: _60 /VI Aserri o kS AA& b y Map 3 0 L Parcel a�3 �9�o M t Tdrt�& Ay Name: TO S F-f)1A C)PVt,LA L \J 9, Address: 2—S S- 13 E A&CES W A Y f4 y&LnJ Nl fit- O Z&O j Map _ Parcel a 'f p A4 t RifE j,s Name• 5��� ��p�'�'���S � , � �°J Address: t fy",J'5 AIA Dam Map Parcel Name: . Address: DATE ABUTTERS WERE IDENTIFIED: q ! -t / P 1 7 SIGNATURE 61 Mi#chetts Way Floor Plan S3 { CAII � Towni al .of Brnsia.ble - ,� ' ,�` x - ,�y�' Departiment�of Regina¢ry Services MAM _ Public ~Health Division Date Z (. - 16 200 Main Street,HyannisiMA 02601 - Date Scheduled y 1 'Time ' Fee Pd. T _ art Suita U. A sessment- - ty - r for Se geqispqad g Performed'By:" _.. rWitnes§ed By: LOCATION& GENERAL INFORMATION _ Location Address ' Owner's Nam , T\ GI Ut I1 S Address Assessor's Map/Parcek, 0 / *�' J Englneei'S Name `f NEW CONSTRUCTION O .t` —5a y� REPAIR ` i Telephone# iand jJse ��l�/t Slopes(96j — °, Surface Stones t. " Distances from: Open,Water Body. I®� ft Possible Wet AreaR Drinking Water Well 4 s Drainage Way G ft;Y Pro art Une P .Y ft ,Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holed&perc tests,locate wetlandsn proximity to holes) i Parent material(geologic) 0� Depth to Bedrock - Depth to Groundwater. St ding Water in Hole: Weeping from Pit'FAce ltl 7 Estimated Seasonal High Groundwater Ltr�Z Y ETERNIINATIONYOR SEASONAL HIGH WATER TABLE ' Method Used: Depth Observed standing in obs.hole: 1 J lo. Depth to soil mottler A in.- Index Depth to weeping from side of obs.hole F ' hi ©roundwatt!r AdJusttnent in. Inde Well# Reading Date: Index Well level (.A factor A��,Adj. droundwater Levri Il '" EIIOI�ATI®N TlES7l'' buip" ' Observation - t Hold# Time at 9" Depth of Perc (� f Tltne at 6 Start Pre-soak Time @ rr Titno(V-6") s End Pre-soak �'-6 l - , Rae � . v. t Min./Inc h Site Suitabili Assessment: Siie Passed i h' , � ,_- Site Failed:' f 'Additional Testing Needed(Y/IV) 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:ISEPTICIPERCFORM.DOC- DEEP-OBSERVATION HOLE LOG Hole# --�— Depth from Soil Horizon Soil Texture Sdil Color Soil. Other Surface(in.) (USDA) (Munsell) Mottling .(Stnucture,Stones,Boulders. onsistency.%Oravell / DEEP OBSERVATION HOLE LOG Bole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. CpUsiltengy,%Gravel) '2+ 431j l /� DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones:Boulders. Cons' 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? If not,what is the depth of naturally occurring pi— us matorial? Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environ ental Protection and that the above analysis was performed by me consistent with the required tr ini xpertise nd xperie�ncee described in 310 CMR 15.017 Signature V Da g te Q:VSEPTIC\PERCFORM.DOC Commonwealth of Massachusetts �5-- W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 61 Mitchells way Property Address Robert Owens Owner Owner's Name / information is required for every Hyannis Ma 02601 9/23/2013 _ page. City/Town State Zip Code . Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any.. way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: (� r key to move your cursor-do not Sean M. Jones �1 I use the return Name of Inspector. key. S.M.Jones Title V Septic Inspection -� Company Name 74 Beldan Ln. I Centerville Ma 02632 City/Town State Zip Code 774-248-4850 smjonestitle5@gmail.com SI4522 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this addresv nd that thq information reported below is true, accurate and complete as of the time of the ins Riion. The-53spea4n was performed based on my training and experience in the proper function and mal',fenance ofgn sib sewage disposal systems. I am a DEP approved system inspector pursuant tc Section 15 3a40 0 Title 5(310 CMR 15.000).The system: :r ► a ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority t" 9/23/2013 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. V aol�s/p t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ° M 61 Mitchells way Property Address Robert Owens Owner Owner's Name information is required for every Hyannis Ma 02601 9/23/2013 - Y page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 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: The dwelling located at 61 Mitchells Way Hyannis is served by a Title V septic system consisting of a 1000 gallon septic tank, distribution box and a 600 gallon precast leach pit.The system was found to be in proper working condition at the time of inspection. 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 exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 61 Mitchells way Property Address Robert Owens Owner Owner's Name information is required for every Hyannis Ma 02601 9/23/2013 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N FIND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect.public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 61 Mitchells way Property Address Robert Owens Owner Owner's Name information is required for every Hyannis Ma 02601 9/23/2013 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 61 Mitchells way Property Address Robert Owens Owner Owner's Name information is required for every Hyannis Ma 02601 9/23/2013 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3/13 Title 5 Official Inspection 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 61 Mitchells way Property Address Robert Owens Owner Owner's Name information is required for every Hyannis Ma 02601 9/23/2013 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 ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (if they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gpd t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 t Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 'y 61 Mitchells way Property Address Robert Owens Owner Owner's Name information is required for every Hyannis Ma 02601 9/23/2013 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 1 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 Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: 2011 =65,000 total = 178 gpd 2012= 58,000 total = 159 gpd Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -.Not for Voluntary Assessments �M 61 Mitchells way Property Address Robert Owens Owner Owners Name information is Hyannis Ma 02601 9/23/2013 required for every y page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: 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/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 61 Mitchells way Property Address Robert Owens Owner Owner's Name information is required for every Hyannis Ma 02601 9/23/2013 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: original system installed 6/4/1990 per town records Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 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.): Joint were ok, no leaks, vented through the roof Septic Tank(locate on site plan): 2" 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 gallons Sludge depth: 6" t5ins-3/13 Title 5 Official Inspection,Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts d Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 61 Mitchells way Property Address Robert Owens Owner Owner's Name information is required for every Hyannis Ma 02601 9/23/2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 3" Scum thickness 3„ 6-1Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 101, How were dimensions determined? opened covers, took measurements 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 does not need to be cleaned now but should be done soon and again every 2 years for proper maintenance. water level was even with outlet, tank was not leaking and was structurally sound. 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 Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 61 Mitchells way Property Address Robert Owens Owner Owner's Name information is required for every Hyannis Ma 02601 9/23/2013 page. Citylrown 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 da 9 P Y 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 61 Mitchells way Property Address Robert Owens Owner Owner's Name information is required for every Hyannis Ma 02601 9/23/2013 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 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Distribution box was in good condition, no rot, water level was even with outlet invert. 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °M 61 Mitchells way Property Address Robert Owens Owner Owner's Name information is required for every Hyannis Ma 02601 9/23/2013 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Type: 1 y�(e ® leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach pit had 6" of standing water with no obvious stain line higher. 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-3/13 Title 5 Official Inspection Form: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 °M 61 Mitchells way Property Address Robert Owens Owner Owner's Name information is Hyannis Ma 02601 9/23/2013 required for every y 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 i Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 61 Mitchells way Property Address Robert Owens Owner Owner's Name information is required for every Hyannis Ma 02601 \ /23/2013 page. Cityrrown 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 °FQo� d ❑z A-i 3 a A'Z O3 &Z 3� A-.3 u� 3'1 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments G M , 61 Mitchells way Property Address Robert Owens Owner Owner's Name information is required for every Hyannis Ma 02601 9/23/2013 page. City/Town 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: 7.8 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: Groundwater elevation was determind by hand augering a hole to the water table. Groundwater was encountered at 7.8'feet below grade. The bottom of the leach pit is 5.5' below grade leaving a separation of 2.5' between bottom of the leach pit and the actual groundwater elevation. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 61 Mitchells way Property Address Robert Owens Owner Owner's Name information is required for every Hyannis Ma 02601 /23/2013 Ci /Town State Zip Code Date of Inspection page. tY P P 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 1' ALLON pvo¢ ao SiiP�L ©O t+0 C ell T-AP YC OD0,70 4' �poveev Z.S 1 � Gw t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 r J. Doyle Associates P. O. Box 595 W.Falmouth, Ma. 02574 Tel: 508-563-1994 To: Mr. William Fletcher April 14, 2003 5508 Chanteclaire Sarasota,Fla. 34235 Subject: 61 Mitchell's Way---Hyannis Dear Mr. Fletcher, In Janu ary of this year we s ary y were asked by Mr. Joseph Daluz to look into the conditions of the existing subsurface sewage system at your residence known as 61 Mitchell's Way, particularly with respect to a Title 5 Official Inspection Form completed by Mr. Mark Polselli of Enviro-Tech Company indicating a failure of the leaching system due to a portion of the system. being located below the adjusted high groundwater elevation. This office and Mr. Daluz contacted Donna Miorandi of the Barnstable Health Department, who recommended that we perform a deep hole soils test in her presence in order to determine the elevation of the observed stable groundwater at the site. On 1-31- 03.Mr. Daluz, Mrs. Miorandi and I witnessed as Rodney Fisher excavated a test pit at the S.A.S. location, and I recorded the measurements we performed at the time. I determined the groundwater in the test hole to be El. 15.9, the same as the elevation of the surface of the adjoining Aunt Betty's Pond, Mr. William Lieberman, my associate, who drafted the original Site/Sewage plan for this property, indicated to me that it. is not recommended to use the groundwater adjustments delineated in"Technical Bulletin 92-001" on a lot-by-lot basis when sites are adjacent to wetlands, marshes, and water bodies. This was the type of adjustment made in the Enviro-Tech inspection form, although Mrs. Miorandi indicated that the incorrect zone of range may have been used. We do not feel that the method used to determine the projected high groundwater at the site.realistically maps the actual groundwater levels. The deep hole test we performed was done so at a time of the year which would result in higher groundwater levels. The groundwater level that we determined agreed with the level of the pond. The,level of the pond that we determined at this time agreed with the level of the pond as'determined by Mr. Lieberman, PE some years ago and shown on his former site plan. Also, the groundwater level determined d by Mr. Lieberman on his former site plan essentially agreed with the surface of the pond. My research of the file at the Board of Health resulted in finding that the Inspection Form by Enviro-Tech has,in-fact,been_entered_to:therf-le�We suggest that you contact Enviro-Tech regarding a reconsideration of their report, andlor contact another inspector as an alternatives This office insists on remaining impartial with respect to naming any potential inspectors. M Mr. Daluz also inquired as to the size of the sewage system versus the number of bedrooms in the residence. During my research I found that the Barnstable Assessors Department had the residence assessed for 3 beedrr ooms(per-haps you.should-obtain a print- out of that). The original Site Plan on-file at the Health Department delineates a sewage system designed-for 2ybedrooms by Mr.Lieberman, which indicates_a,:flow diffusor" system. This is not the type of system that currently exists-at the_site A cylindr;al leach pit actually east a t e site as wa—witnessed by us as well as the Enviro-T_eca oneli. This leaching pit is of suitable size to-support a 3 bedroom system.This leads me to conclude that the system was upgraded at some point to allow for the third bedroom. At last I would like to say that I performed sufficient field surveying to prepare a worksheet showing the existing elevations and structures with respect to the locations of the property lines and the pond. Please note that my opinion is that any relocation, alteration or expansion of the existing sewage system will probably result in a filing with the Conservation Commission and the Barnstable Board of Health. If you have any questions you can certainly contact me through Mr. Daluz at any time, thank you. Y rs truly, John P. Doyle,PLS May 18, 2003 ry To whom it may concern, On 12/16/02 myself Mark Polselli DBA-Envio-Tech inspected the septic system at 61 Mitchell's way Hyannis MA.At that time a handauger test was used to determine a groundwater elevation of 8.6. It was discussed at that time with the Barnstable BOH and the owner of the property that the high groundwater adjustment seemed inaccurate�since the adjustment of 4.7 would bring the water level over the street and halfway up tic foundation of the house. No occurrence of this level of flooding had ever been observed in this Iocation.The septic system was failed at that time using the Frimpter method to determine high groundwater. No other failure criteria"were triggered during the inspection'and thesystem was in good condition. After discussing the reason for failure with the owner of the house and thc BOH,the owner asked if I would re-inspect the septic system at a later time,if it appeared that the water level in the creek and pond did not rise as 4.7 adjustment suggested-. I a greed this would be a fair and appropriate thin to do. Also I thought it would help clear up any future confusion if a health agent from the Barnstable BOH witnessed the results of my groundwater test. On 5/5/03 I re-inspected the peel septic system A handauger test located groundwater at 7.8.Health inspector Donna Miorandi witnessed this elevation. The hig h groundwater adjustment for this location and the May reading MI W29 zone C was 0.7. The high groundwater adjustment varied 4.0,while the true groundwater elevation only changed 0.8. Groundwater levels were near record high levels at the time of the second test and the pit had a seperation of 2.5 above the groundwater and a 1.8 separation above the Adjustment . S.A.S.is above high groundwater. I am submitting a passed septic system report for the reasons have stated in this letter. Any concern or questions regarding this matter will get my immediate attention and response Sincerely Mark Polselli Mark Polselli office(508)775-7744 `oFtHKE►oy Donna Z. Miorandi, IRS Health Inspector (508) 255-3050 -, P i MAS&�Lp Town of Barnstable cell (508)280-7790 { t639 +gee Department of Health,Safety& TED Environmental Services E —^EC Office Hours: PUBLIC HEALTH DIVISION 4,0 gX J 8:00-9:30 a.m.Dail �� 1:00-2:30 y 200 Main Street,Hyannis,MA 02601 SEPTIC INSPECTI NSr O�b p.m.Daily TEL:(508)862-4644 FAX:(508)790-6304 MASS-LICENSED; Email:donna.miorandi@town.bamstable.ma.us D.E.P.} CERTIFIED • Y r' V COMMONWEALTH OF MA.SSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS b DEPARTMENT OF ENVIRONMENTAL PROTECTION RECEIVED MAY 2 2 2003 OF TITLE S TOWHEALTH DEPT.BARNSTABLE OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A / CERTIFICATION Property Address: 61 �j Tc ii���s (✓ter(�/ rr✓JiS ��/� C21 1O/ Owner's Name: Owner's Address: S- eor' Fr2 rr�✓ d�,w� Date of Inspection: Name of Inspector. Wease print) Company Name- & /6%O-- Mailing Address: o SOS /a . Ctrs Telephone Number: CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of 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 SS oa 15.340 of Tide 5(310 CINIR 15.000). The system: �� passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Gvvt_ Date: S /� �� 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 applicabl authority. e,and the approving Notes and Comments ****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 of use. p Page 2 of I I y • l OFFICIAL INSPECTION FORM—NOT FOR VO LUN TARY ASSES SMENTS ENTSSUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORMM PART A CERTIFICATION (continued) Property Address: /- �virli (�vZ 6y' Owner: /- le , lc Date of Inspection: Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A_ Syste asses: I have not found any information which indicates that any of the failure criteria described in 310 Ch1R 13.303 or in 310 CNIIt l i.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional repaired. Pass"section need to be replaced pm The system,'upon n p ced or �' completion mpletton of the replacement or repair,as approved-by the Board of Health,will pass. Answer yes, no or not determined(Y,N,ND)in the for the following statements. If"not determined"please The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due obstructed pipe(s)or,due to a broken,settled or uneven distribution box System will to broken or approval of Board of Health): ..- pass inspection if(with brokenpipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system %ill Pass inspection if(with approval of the Board of Health). broken pipe(s)are replaced obstruction is removed ND explain: Page 3ofII OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOFNI PART A, CERTIFICATION (continued) Property Address: �/ Owner: —�,, Y Date of Inspection: 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 is failing to protect public health safety or the environment. system 1. System will pass unless Board of Health determines is accordance with 310 CNIR 15.303(1)(b) that the system is not functionin; in a manner which will protect public heath,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 vretland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier,if any) determines that the System is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface'water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is'within a Zone I of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrite nitrogen is equal to or less than 5 ppttt.provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Page 4 of l l OFFICIAL INSPECTION FORM.— NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: fjCG. l� G Owner Date of Inspection: r- p D. System Failure Criteria applicable to all systems: You must indicate" •es',or"no" to each of the following for all inspections:�' o _uupections: Yes No/ V ackup of sewage into facility or system component po nt due to overloaded or clogged SAS or cesspool D[scharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or - _logged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged cesspoolSAS or � [quid depth in cesspool is less than 6"below invert or available volume is less than/:day flow Required pumping more than 4 times in the last ear NOT of times pumped y �e to clogged or obstructed pipe(s). Number l/_/Any portion of the SAS,cesspool or privy is below high ground water elevation. �Y portion of cesspool or privy is within 100 feet of a surface NVater supply or tributary to a surface ater supply. Any portion of a cesspool or privy is within a Zone I of a public well Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well «ith no acceptable water quality analysis. (This system passes if the well water analysis, Ncrformc ' DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates r.:.:. .ne well is free from polluti on on from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large sv tem the system mustserye a facility with a design flow of 10,000 gpd to 15,00o gpd- You must indicate either"yes"or"no" to each of the following: (The following criteria apply to large Systems in addition to the criteria above) yes no _ the system is within 400 feet of a surface:drinking water supply - _ the system is within 200 feet of a tributary to a surface drinking water supply _ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well , If you have answered"yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the l---ge system has failed The owner or operator.of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. Page 5 of I l v OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTENI INSPECTION FORM PART B CHECKLIST Property Address• �( i TG h¢!lS C✓Gt Owner: Date of Inspection: 03 Check if the following have been done. You must indicate`ves" or"no"as to each of the following: Yew No Pumping information was provided by the owner;-occupant, or Board of Health ere any of the system components pumped out in the previous two weeks t� _ ,F4as the system received normal flows in the previous ttivo week period Have large volumes of water been introduced to the system recently or as part of this inspection f Were as built plans of the system obtained and examined? If• _ ( they.were not available note as N/A) ^. Was the facility or dwelling uupcted for signs of sewage back up Was the site inspected for si of break out �_ v � Were all system components,excluding the SAS, located on site _ Were the septic Link manholes uncovered opened, and the interior of the tank inspected for the condition of the es 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%ith 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. Determin ed in the field(if any of the failure criteria related to Part C is at issuea pproxiniabon of distance is unacceptable) (310.CNiR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTENI INSPECTION FORM PART C / SYSTEM INFORNIATION Property Address: 04'3 Gd co 4 Owa er- de Fe- Date of Inspection: S C FLOW CONDITIONS RESIDENTIAL • Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CNN 15.203 (for example: 110 gpd x#of bedrooms): a (� Number of current residents: 0 Does residence have a garbage grinder(yes or no): A'v Is laundry on a separate sewage system Cves or no):IVJ(if ves separate inspection required] Laundry system inspected(yes or no): 9., Seasonal use: (yes or no): ( �f Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no): /Ua Last date of occupancy: 03 r CONL IERCIAL/ INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgR,etc.) Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no):_ Water meter readings,if available: Last date of oc.^lpanry/use: OTIRER x): GENERAL L`fFOR1NIATION' Pumping in Records Source of information: ywv+ e ° Od — ` Q (tiv�e� Was system pumped as part of the inspection es _ � (Y or no): If yes,volume pumped:_--gallons—How was quantity pumped determined? Reason for pumping: TIE10F SYSTEM Septic tank,distribution box,°soil absorption system _Single cesspool - Overflow cesspool _Privy _Shared system(yes or no) (if yes, attach previous inspection records. if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owmer)* _Tight tank —Attach a copy of the DEP approval Other(describe): Approximate age of all compon_ennts, to installed(if known)and sours of infortt ttio ©� a�` 0� ,�� f�� 9 v -ice Were sewage odors detected when arriving at-he site(yes or no): �/� - Page 7 of 1 I „ J • OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C //'' SYSTEM INFORMATION(continued) Property Address- (� / zvf I /e�� (,(/G y Owner: Fre.�G � Date of Inspection: BUILDING SEWER(locate on site plan) Depth below grade: / Materials of constru!-aon. _cast iron � 40 PVC_other(explain):Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage, etc.): SEPTIC TAN b.�(Iocate on site plan)_ Depth below grade: Material of construction:_✓concrete_metal fiberglass_polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by,a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: Sludge depth: ' Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to tap of outlet tee or baffle: . Distance from bottom of scum to bottom ofpu et tee o,��le: How were dimensions determined: /`"o e A' 5 c� Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels aslated to outlet invgrt,evidencle of leakage CA✓ 1 n ✓)cJ /7p 2 /PeS G'vi Rw /✓1 Op� ( Ova O GREASE TRAP:J (locate on site plan) Depth w below.grade: • .:._...._. . �._ �... ' Material of construction:_concrete metal fiberglass_polyethylene other (explain): — _ _ Dimensions: Scum thickness: Distance from top of scrum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, as related to outlet invert, liquid levels evidence of leakage,etc.): Page 8of11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY A SSESSNI SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORMNTS PART C SYSTEM INFORMATION(continued) Property Address: /of / c �� l &Va 69 Owner. e.�c ; Date of Inspection: 5 TIGHT or HOLDING TANK:!!✓ (tank must be pumped at time of inspection)(locate on siteplan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: Design Flow: gallons Alarm present(yes or no): gallons/day Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches, etc.): 7� DLSTRIB(;irv^;10C`;: (if present must be opened)(Iocate on site plan) Depth of liquid level abov_ invert: �� r Comments (note if box is le-.ci r;d distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into out of bow etc.)• C1 le.(/<. 0 PUMP CHAMBER: /V (locate on site plan) Pumps in working order(yes or no): r: Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Page 9 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTENI INSPECTION FORM PART C �SYSTEM I/NFOR1MATION(continued) Property Address: Owner- G 7/ Date of Inspection: SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) Q ) If SAS not located explain why: !tp leaching ..its,number- leaching ` �/ t,✓ c p chambers,number. leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool, number- innovative/alternative stem T ry name of technology: o Comments(note condition of soil, signs of hydraulic failure, of ponding,damp soil,c etc.): ondition of vegetation// // Gi w lC CESSPOOLS: (cesspool must be pumped as part of i 'on nspecti )(1oca to on site plan) ` Numbcr and configuration: Depth—top of liquid to inlet invert: LAepul of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no) Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation.etc.): II 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.): Page 10 of 1 t J . OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTENI INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: C,C,-// S� �rvl��rl /l% ` C/�EO/ Owner: /-12 G t� Date of Inspet-tion: SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to,at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet. Locate where public water supply enters the building. I ' 10 i /-Tj 3,a , 11-3 - 3 Y 1 � 1 r Page I l of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C / SYSTEEM/ INFORINIATION(continued) Property Address �( /` ��C�vG/f �it/gG 4 _ Owner. Date of Inspection: SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check) all methods used to determine the high ground water elevation: i Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: " You ust desc 'be h you establis4ed the/h�igk ground water glee Non: rn R CG/H , 1-Cl � CreLi111::41a v - S, 5- e !S G! old 'o O N roF /��k! d3o - 7 o,o L9 ��o me O .. • .,- ...... z ® FJ Q G CJ 1v COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROT �NC gzlel I .e DEC 1 3 20 02 TO HEALT{,p�prABLE .r TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM CER MC TION FAILED INSPECTION t t , Is Property Address: r c. e (Ale,- Qd 6,0 MAP 2- t Owner's Name• a r`► —I o��y, Owner's Address: PARCEL Date of Inspection: C_4�27 /02 LOT ` • Name of Inspector. Wease print) / ` GtN Company Name: L-41 L---%51,1 Mailing Address:_ o c d �' C Seal Telephone Number. So - — P , CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true.accurate and complete as of the time of the inspection.The inspection was performed based on m. 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: s Passes Conditionally Passes Further Evaluation b� the Local Apprrning Authority'Djoeds Fails Inspector's Signature Date: 1.,- l.e_ The system inspector shall submit a copy of this inspection report to the Approving Authonty Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a' flow of 10.000 gpd or greater.the inspector and the system owner shall submit the report to the appropriate regional otfice of the DEP.The original should be sent to the system owner and copies sent to the buyer. if applicable. and the approving authority. . Notes and Comments "This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address• h ! 1, c G ;l/ UV c.( �t�•�� � - Owner. /6 C- ?� Date of Inspection: 10V!d a ' Inspection Summary: Check A.B.C.D or E/ALWAYS complete an of Section D A. System Passes: I have not found any information which indicates that aay of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass" section need to be replaced or repaired The system.upon completion of the replacement or repair.as approved by the Board of Health.v►ill pass. Answer ves.no or not determined(Y.N.ND)in the for the following statements. If"not determined'please v explain The septic tank is metal and over 20 vears 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 sepuc tank will pass inspection if it is structurally sound..not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(;)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 obstrucuon is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health) 4 ,= broken pipes)are replaced obstruction is removed ND explain: F• Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address• �� �c�G�l G✓g 160 e Ownr. Date of inspection: /oL /d102 C. Further Evaluation is Required by the Board of Heslth: /I/ Conditions'exist which require further evaluation be the Board of Health in order to determine if the s}'stem is failing to protect public health safety or the euvironmeat. 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 bealth,safety and the ensirooment: - _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering,vegctated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier.if any)determines that the system is functioning in a manner that protects the public health.safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supphy,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 supph _ 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 supph well". Method used to determine distance "This system passes if the well water analysis. performed at a DEP certified labomtor%. for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facihr%- 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 cope:of the analysis must be attached to thus form. 3. Other. i Y Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION,(continued) Property Address. C� f' 47, �'G.4l� (Vav2 / A Owner. le`tom i Date of Inspection: oL of fza, D. ,System Failure Criteria applicable to all systems: You must indicate'yes" or"no"to each of the following for all inspections: Yes .No �/ packup 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 dogged SAS or cesspool !/ Static liquid level in the distribution boxabove outlet invert due to an overloaded or clogged SAS or of _ Q� I depth in c=pool is less than 6"below invert or available volume is less than%:day flow r/ Required pumping more than 4 times in the last year NOT due to clogged or obstructed ptpe(s). Number of times pumped Arty 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 supph•or tributary to a surface ter supply. _ � ruon of a cesspool or privy is within a Zone 1 of a public well. 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 qualin•,analysis. [This system passes if the well water analysis. performed at a DEP certified laboratory,for colifor n bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CNIR 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. Lar ge Systems: To be considered a large system the system must serve a facility with a design flow of 10.000 gpd to 15.000 gpd• You must indicate either"ves' or"nb'' to each-of the following-' (The following criteria apply to large systems in addition to the criteria above Yes no _ the system is within 400 feet of a surface drinking water suppl} the system is within 200 feet'of.a tributary to a surface drinking water supple the system is located in a nitrogen-sensitive area(Interim Wellhead Protection Area—1WPA)or a mapped Zone II of a public water supply well If you have answered"yes" to any question in Section E the system is considered a significant threat, or answered yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CNN 15.304.The system owner should contact the appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B /CHEC LIST . Property Address: c 4 Owner. G� Date of Ins 'Pam'on: Check if the followine have been done.You must indicate"ves" or`no"as to each of the following: s Pumping information was provided by the owner.occupant,or Board of Health _ Were anv of the system components pumped out in the previous two weeks Z- Iias the system received normal flows in the previous two week period 1,, Have large volumes of water been iuvoduced 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 es 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 e.size.and location of the Soil Absorption System (SAS)on the site has been determined based on: Yes no Existing information. For example,a plan at the Board of Health. _ Deternuned in the field(if ariv of the failure criteria related to Part C is at issuc approximation of distancc is unacceptable) (310 CMR 15.302(3)(b)] Page 6 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C /* SYSTEM INFORMATION Property Address: lInt 4-c 4e�l L.icc mo 15, AVX OV 60/; Owner. �� Date of Inspection: l� oaL FLOW CONDITIONS - RESIDENTIAL Number of bedrooms(design): a2 Number of bedrooms(actual): DESIGN flow based on 310 C� 15.203(for example: 110 gpd x#of bedrooms): Number of current residents: Does residence have a garbage grinder Cues or no): Is laundry on a separate sewage system(_yes or no)-wv [if yea separate inspection required] Laundry system inspected(yes or no): 1tr4, Seasonal use: (_yes or no): ,-�f. Water meter readings.if available(last 2 veais usage(gpd)): Sump pump(,yes or no): A/'0 Last date of occupancy: COMMERC ALANDUSTRIAL Type of establishment: Design flow(based on 310 CUR 15.203): gpd Basis of design flow(seats/persons/sgft.etc.): Grease nap present wes or no):_ Industrial waste holding tank present(yes or no) _ Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: DN 1�e + C/o Was,system.pumped as part of the mspecuon Ives or not: . If yes.volume pumped:. : pllons-How was quantity pumped determined? Reason for pumping: TYP F SYSTEM Septic i — epu tank distribution box. soil absorption system Single cesspool —Overflow cesspool Priw . . Shared system-(yes or no) (if ves. attach precious inspection records. if any) _Innovative/Alternative technology. Attach a copy of the current operauon and mamtenancc contras (to be obtained from system owner) Tight tank Attach a copy of the DEP approvdl ' _Other(describe): Appioximate age of all composts. date tnstmlled(if known)and source i ormauon: Were sewage odors detected when arri%ing at the site Cves or.no):�/'D Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. PART C SYSTEM INFORMATION (continued) Property Address: Owner. Date of Inspection aC BUILDING SEWER(locate on site plan) Depth below grade: . Materials of construction:_cast iron 4� PPVC other(evlam): Distance from private water supply well or suction line: Comments(on condition of joinu ventin&evidence of leakage. SEPTIC TANK Z(Iocate on site plan) Depth below grade: Material of construction:4Zc"oncrt to_metal fiberglass_polyethylene _other!explain) If tank is metal list age:_ is age confirmed by a Certificate of Compliance(ryes or no): (attach a copy of certificate) 5x�Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: � �� r �� Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of op d t tee r baffle:., How were dimensions determined: Comments(on pumping recommendations. inlet and outret tee or baffle condtuon. structural integrit)-, liquid levels as relate outlet i&ert.eviden a of lealtzg , etc.): GREASE TRAP: (locate on site plan) e . Depth below grade: Material of construction:_concrete_metal fiberglass_polyethvlene other (explain): — — Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet.tee or baffle: Date of last pumping - Comments ion pumping recommendations, inlet and outlet tee or baffle condition_ structural imcgntn. Liquid levels as related to outlet invert.evidence of leakage. etc.): Page 8 of 1 I r OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM _;. PART C SYSTEM/INFORMATION(continued) Property Address: Owner. Date of Inspection: /11- 0- .O� TIGHT or HOLDING.TANK:A/(tank must be pumped at time of inspection)(locate on site plan) 5 , Depth below grade: Material of construction: concrete " metal fiberglass_ lvethylene other(explain): Dimensions: Capacity: Gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches.etc.): DLSTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal.any nidence of solids carryover.am•evidence of leakage into or out of box. etc.) - �m level. :/ -V L , PUMP CHAMBER f7/(locate on site plan) Pumps in working order(yes or no): Alarms in working order wes or no); Comments(note condition of pump chamber.condition of pumps and appurtenances.etc.): I Page 9 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address` l TG�ei`l t Gt/a / ro ` Owner: •—�G`1`c Date of Inspection: / d SOIL ABSORPTION SYSTEM(SAS): (locate on site,plan,excavation not required) If SAS not located explain why- Type,.,' leaching pits,:number; �✓`-�{ �1//a `f leaching chambers,number: leaching galleries,number: leaching trenches number,length:. leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Typelname of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): // � (� /'40HOliK /— � ��; a.�I�- Lf �� CAD a= 7 CESSPOOLS: (cesspool must be pumped as of' on ocate on i.P� �specu )(1 site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: ocate/1/ n(1 o 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.): Page 10 of 11 OFFICIAL INSPECTIONFORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM'INFORMATION(confinued) P>ropert.Aaartss• j_ � 0 ter, Oa.G,I;L Owner. Date of Inspection: lat ZI-1-Laz SKETCH OF SEWAGE DISPOSAL SYSTEM, . Provide a sketch of the sewage disposal system including ties to at least two permanera reference landmarks or benchmarks.Locate all wells within 100 feet. Locate where public water supply enters the building. - o ' 11Y-31 3 Lo ` —p2 / / l•f t� Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C / A�SYSTEM INFORMATION (continued) Property Address: Owner. e- Date of Inspection: 02 U SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water �)'C feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: 5Yous"t describe how you establi ed the high ground w�a r d '2evatio Gi cr rD i�. l G7GrtTGC� Q�t✓1e'ly e�`(�j�/ To F d3o G t000 � 0 0 0 0 0 c E , /40 le J+Ci 11do;� ASSESSOR'S MAP NO.a9 p-t-1�7 PARCEL I/ LOCATION SEWAGE PERMIT uNO. V I L L A C E INSTA LLER'S NAME A ADDRESS BUILDER 0R OWNER i DATE PERMIT ISSUEDL�. r.-� DATE COMPLIANCE ISSUED -~ y-- 5� � L � '_I S �' �� .'� ,� �� � �� a =i v o �� ��! . ~ . FEE , - --~ THE COMMONWEALTH oF MAssAoxuSsTrs° -' ������ ���� ���� HEALTH ����" "" "�� �~" ...........................................OF...... ......... _........... ................................. ��� °� ���/��lirau�iou� �x«� xwmi��»��««�l Works To4witrum'tion rautit Application is hereby made for u Permit uo Construct ( \ or Repair ( ) an Individual Sewage Disposal System U1 L' o ---��'LLL���r�-��-��'l��J����-------------�-------' --'�2��--'�7�--'��I'��l-yl�'(.--.....���'�--I � c°=�" 'Aa ,�" =L� m" \ | ......................_.......................................................................... __________________________________________________ Address Installer Address Type of Building_ . Size Lot............................Sq. feet DwellioQle—' No. of Bedrooms----.��.............................Expansion Attic ( ) Garbage Grinder (--) Other—Type ofBuilding ::�n..... No. of persons............................ Showers ( ) -- Cufetcriu (--) Otherfixtures ----_-_—_—._--_-_-''--_--..--__---------'----_------------------_ ` Design Flow........ .......................gallons per person per day. Total daily flow............................................gallons. Septic Tank—Liquid cayacdy----..4galloua Leucth—.------ Width................ Diameter----........... Depth................ Disposal Treuch--No. .................... Width.................... Total I-eug8z--------' Total leaching area..—...-''-'--aq. f t. Seepage Pit No--------------------- Diaoeter.----.-- Depth below iulet---------- Total leaching area.--.-'---ag. ft. Z (�tberl��t�botixnbox ( ) Dosing tank ( ) ^- Percolation Test Results Performed bv--------------.-------------------' Date........................................ Test Pit No. l................minutes per inch Depth of Test Pit------ ....... tn ground water----__-_- Teu Pit No. 2......... ......minutes per inch Depth of Test Pit.................... Depth ro ground water--------_-- ---..-'_--.---_-------'__'___---------'-'-_--'---'_-'-'--------------'-'----- 0 Description of Soil.. ..........................................................�_-...P'--......................................................................................................................... | Z '--------------------'---'-----'-----'--'--'------'------'------------------'---- � | U Nature of Repairs or Alterations--Answer when applicable--_.-----_.---.--'----__------.---_--_- ---'------'---'-------''------------------------------'------'------'--------'-----'----- Agrccneot: The undersigned agrees to instal) the aforedescribed Individual Sewage Disposal System in accordance with the provisionsof]TTlE 5 of the State Sanitary Code— The undersigned further agrees not m place the system in oP�u6uu until u Certificate � Compliance bu b issued b � `\ ^ "^u ' ^ � f��~ ^^""��� * " -----'----' "=--..-''-----'--- '---_ -`�-� ------_------- ----~ »^� Application Approved 8y ""=Application � Disapproved for the following reasons:............................................................................................................... ........................................................................................................................................................................................................ THE COMMONWEALTH OF MASSACHUSETTS' BOARD OF HEALTH ----------- -........ ............-----OF...................... ..... , llpfirFatiou for llhip s of Works Tonstrurtiou rrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: k f y- .---..... .. �r ..................... ................ i Location-Address or Lot No. .............................................. -----------•-••---............................... -•-----•••-------••--------•-------•---...------................................................. Owner „�...- - Address S�UJ c 1 f l/y� . Installer Address Type of Buildin Size Lot............................Sq. feet Dwelling2No. of Bedrooms.......... .............................Expansion Attic ( ) Garbage Grinder (— } Other—a Type of Building ------ No. of persons.-----------------.......... Showers ( ) — Cafeteria (— ) dOther fixtures --------------------------------• -----------...--------------------------------...------------------....................................... W Design Flow........a- ........................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching-area....................sq. ft. Seepage Pit No--_---------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ p" .-•-•---•••------------------•-----••-•--•-•--•-•--•-•••---••--•---•--=------•-----••----------•-•--......................................................... C) 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 p 5 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. Signed...................................................................................... .......................... Date Application Approved By-•-.---• ........... Date- Application Disapproved for the following reasons:...............................................--------------•---------------------.._.._...-----•---••-------. ---------•----•..........................................•--•------------.....•••-•----.....--••----•-•-.-•--•-•---•-••••••-••-•----------•-•-----••--•--•-•------•----•---••••••---•--•••--•••......--- C' Date PermitNo........ I...----�-�--7---.....-•-------------- Issued....................................................... LS_.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .....................................OF..................................................................................... Trrtif iratr of T.uutpliFattrr THIS IS TO CE TIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( } by........<•'� --....... - ... ................................................................................................... Installer j at............. �/ f ------7----• ------> . .... ..........��� -°--- - •l .................................................. has been installed in accordance with the provisions of TI j of Th tate Sanitary Code as described in the application for Disposal Works Construction Permit No------- -_-_J_ --- dated-----------..................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE -SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH/ -L:fib..t..........OF..........P:xlr,..i.r.: a6O :(•t..2�.......:......................... No...U../...=:.J.[.. :.. FEE........ .............. Disposal Work.5 T-1uuutratirru truth Permission is hereby granted........4.f_:..t ._rt_ ...........&� . ._,. to Construct ( ) or Repair ( ) an X__14/c-- idual Sewage Disposal System at No .. - F fix,. +1`=�.1:.. . Street as shown on the application for Disposal Works Construction Permit No Dated.......................................... ----•-••-----------------------------------•-----------...-•-•------•-•----------..............----.----- Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS - - APPLICATION FOR PEPZCC`LATION `1'ES`I' AND Ot SER`r TION PIT: ;E _ DATE 2 6 :ANT -Q FEE ;S r TELEPHONE NO. /(Non-refundable ) ,ER 'YY1 ' Jal TELEPIJONE NO. ` ,2 - 2 ;CHEDULED (Applican ' s nature ) e • • • • • • • • • • • • • • • • • • • • • e • • • • • • • • e • • • o • •.• 0 • • • • 0 0 0 0 • • • e • e • o • • • • • • e • • • • • • • SOR'S biAP LOT NO: w070 SOIL LOG -VISION NAME �7 DATE 2--7- Q6 TIME /J ae), 3ION AREA: YES✓NO 1 Ll 1 /mend 1 � 1� _ 3U_ENG_INEER 1ATER V. PRIVATE WELL 13 M �l c_Pe-C a u BOARD OF HEALTH �T�'�.�1 C�3-IT ClJ1y ST EXCAVATOR (Street name,etc• ,dimension_s of lot, exact location of test holes and percolation tests, locate wetlands in proximity to test holes ) NOTES: r r6 Lor. � � gy , e DtTeH 276y ' r �9 • ,Q 17 7 a LATION RATE: '< 114 -2 t�'� HOLE NO: 7 ELEVATION:. TEST HOLE NO: ELEVATION: ` 2 :S av iz)w T®? SUSS®16e 2 3_ _ 4 ®t at N T® C Q#*% ..s E 4 5 6 6. 7 �n/eiT� L_EUGL kt131� F�27 8 Wa'rE�. rNG 8 9 a, 9 10 l u P 1 S��a 10 11 1.1 12 C t� 12 13 13 1.4 14 15 15 4 16 16 aLE FOR SUB. SURFACE' SEWAGE• LEACHING. _ RING FIELD ,,\ LEACHING PITS t LEACHING TRENCHES TABLE FOR SUB-SURFACE SEWAGE. REASONS: ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION NAL: COMPLETED IN ENTIRETY BY P. E. AND RETURNED TO BOARD OF HEALTH RETAINtD BY APPLICANT 4 i ASSESSOR'S MAP N0.',290—d$?PARCEL LOCATION � G SEWAGE PERMIT NO. ' l VILLAGE i / . 44A A- INSTA LLER'S NAME A ADDRESS . I a — R U I L D E R. OR OWNER bu .� DATE PERMIT ISSUED ,��� DATE COMPLIANCE ISSUED -- /-- �� � I �� , �y ' f \ 44t�- - EL=21.7 ;=\, LEGEND HYANNIS TREES TO BE REMOVED PROPOSED CONTOUR PROPOSED SPOT GRADE o Co P S FT SOL REMOVAL EXISTING CONTOUR . - \ ITCHELL'S WAY O�� /��� + 96.52 EXISTING SPOT GRADE LOCUS ���1 `' Al ` lV O W EXISTING WATER SERVICE AUNT LOT 5 TEST PIT BETTY'S P ul TH-2 ` N N ` T. Do -o ti _ \ \ SEP NI�� :'`; LOT 6 `'�° - -. _ f' PARCEL ID: % LOCUS MAP COR. STEP - _- LOCUS INFORMATION = EL=23.0 - -_ �6 ��'� � r PLAN REF: 275/96 /� \ TITLE REF: 28105/341 � _ \\!i\ \\ `\ MADEP REQUIRED PARCEL ID: MAP 290 PAR. 157 #61 -_ ' �o�� ,� 400 SO FT FOOTPRINT FLOOD ZONE:" "X" LOT 7 = _ _ - W PARCEL ID: = TOF=23.5 _ _ �� COMMUNITY PANEL: 25001CO568J DATED:07/16/1.4 290 157 SEPTIC- SYSTEM AREA=.33±ACRES REPAIR PLAN # �, LOCATED AT: 61 MITCHELL'S WAY VIA F� -, HYANNIS, , MA. PREPARED FOR Bvw ; � DONOVAN D. & ROSE MARIE 4 B5W _,__ C' #0-------------#3w s , 2w �,'' ;= _ ERASER _ _$ #�..��� 00 � B 2W ��\ ,'i APRIL 4, 2017 #� REV:04/18/17 REV:04/25/17 WETLANDS FLAGGED _ ��. �� i f PARCEL ID: BY: BRAD HALL �.�� J # : % �� 308/273-002 �� ofsf9 Q AK % �� + D RR PLANKS \\ i' PA. ,. TO BE REMOVED �' o. 1140 AUNT BETTY'S S4#ITAVI�POND 6 VARIANCE REQUESTS — MAXIMUM FEASIBLE COMPLIANCE PER 310 CMR 405� (1)(b) & BARNSTABLE BOH REGS• 1) A 4 FT. VARIANCE FROM..310 CMR 15.211 & BARNSTABLE BOH REG. TO ALLOW LEACHING TO BE 16 FT. FROM DWELLING VS. REQUIRED 20 FT. MEYER & SONS, INC. ,� PER BARNSTABLE BOH REGS: GRAPHIC SCALE 1) A 34 FT. VARIANCE FROM BARNSTABLE BOH REG. TO ALLOW PROP. LEACHING P.O. BOX 981 20 0 10 20 40 so TO BE A MIN. OF 66' FROM WETLAND VS REQUIRED 100 FT. EAST SANDWICH, MA. 02537 2) A 39 FT. VARIANCE FROM BARNSTABLE BOH REG. TO ALLOW DISTRIBUTION PH: (508)360-3311 BOX TO BE .A MIN. OF 61' FROM WETLAND VS REQUIRED 100 FT. FAX: (774)413-9468 ( IN FEET ) STAN AkRD C)NDITIONS FOR ALTERNATIVE S.A.S. meyerandsonStItle5@gm.ail.com 1 inch = 20 ft. 1) VARIANCE FROM�9(d) OF THE STANDARD CONDITIONS FOR ALTERNATIVE S.A.S. TO ALLOW 39.3% REDUCTION OF LEACHING FOOTPRINT DUE TO LIMITED SPACE. 'SHEET 1 OF 2 J#1903 NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL: 21.21 FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. ' T.O.F. EL=23.50t SEPTIC TANK PROPOSED D-BOX - GENERAL NOTES: INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & ,COVER PROPOSED S.A.S. INSTALL A 4" DIAMETER INSPECTION PORT OVER 1. ALL CHANGES To THIS PLAN MUST BE APPROVED BY THE LOCAL OUTLET AND SET TO 6' OF FINISH GRADE SET TO 6" OF GRADE ONE CHAMBER (MIN.) AND SET TO 3" OF F.G. BOARD OF HEALTH AND THE DESIGN ENGINEER.F.G. EL: 22.15 (MAX.) ' F.G. EL.=Z2.8Of' ~F.G. EL.=23.5f F.G. EL: Z2.3Of 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE LOCAL RULES AND REGULATIONS. 9" MIN COVER/ 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR 36" MAX COVER a L = 15' L = 1O'(MAX) INSTALL TWO INSPECTION PORTS (MIN.) TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE ® S=1% (MIN. DESIGN ENGINEER. 4"SCH40 PVC) _ - 22.70 : ® SCH4 (MIN.) ® SCH4 (MIN.) 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING 4"SCH40 PVC 4"SCH40 PVC FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 10" t; ENGINEER BEFORE CONSTRUCTION CONTINUES. 11.3" TO INV.=21.65 14 INVERT S. ALL ELEVATIONS BASED ON ASSUMED DATUM. 48"U0!/lD INV.=21.40 INV.=20.82 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF l� LEVEL PROPOSED THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF GAS BAFFLE 4 ROWS OF 6 UNITS AT 4'/UNIT = 24'/ROW HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. D-BOX INV.=21.08 T� INV.=21.25 DB 5 7. DWELLING IS SERVICED BY MUNICIPAL WATER SUPPLY. - SOIL `ABSORPTION_ SYSTEM (PROFILE) 8.ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED EXISTING 1.000 GALLON SEPTIC TANK H 0 - TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE RESTORE VEGETATIVE COVER LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO STARTING WORK. EXIST. SEWER OUTLET BACKFlLL WITH CLEAN PERC SAND 10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND REMOVED PER TITLE 5. TO TOP OF CHAMBERS REPLACE WITH CLEAN MEDIUM SAND PER TITLE 5 REQUIREMENTS. 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION NOTES- 1) CONTRACTOR SHALL VERIFY ALL EXISTING 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY PIPE INVERTS PRIOR TO CONSTRUCTION BREAKOUT=TOP ELEV.= 21.21 AND IS NOT'TO BE CONSIDERED A PROPERTY LINE SURVEY 2) D-BOX SHALL BE SET LEVEL AND TRUE TO INV. ELEV.= 20.82 13. NO KNOWN PRIVATE WELLS WITHIN 100 FT. OF PROPOSED LEACHING GRADE ON A MECHANICALLY COMPACTED'SIX BOTTOM ELEV.= 20.54 EXISTING SUITABLE 14. ALL PIPING TO BE 4" SCH 40 0 1/8-/FT (UNLESS SPEC. INCH CRUSHED STONE BASE, AS SPECIFIED IN 2 83' MATERIAL 15. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW 310 CMR 15.221(2) 5' MIN. ABOVE BOTTOM OF FOR THE USE OF A GARBAGE GRINDER. 3) INSTALL INLET & OUTLET TEES W/ T.P. EXCAVATION OR G.W. EFFECTIVE'WIOTH = 4 x 2.83' 11.32 16. REMOVE ALL UNSUITABLE SOILS 5 FT AROUND LEACHING TO EL. 18:22 'GAS BAFFLE AS REQUIRED (5.05' PROVIDED) OR TOP OF "Cl" LAYER AND REPLACE WITH CLEAN MEDIUM SAND ADJUSTED GROUNDWATER: EL:15.4 USE 4 ROWS OF 6 INFILTRATOR QUICK 4 PLUS STD LP (3.3" INVERT) UNITS-NO'STONE PER TITLE 5. SEPTIC SYSTEM PROFILE TYPICAL sECTIO N.T.S. KTA DESIGN CRITERIA SOIL LOG P#: 15279 DATE: FEBRUARY 27 2017 NUMBER OF BEDROOMS: 3 BEDROOM DESIGN SOIL EVALUATOR: DARREN M. MEYER, R.S., DESIGN FLOW: RESIDENTIAL: 3 BEDROOMS 0 110 GPD/BR = 330 GPD WITNESS: DAVE STANTON, BARNS. HEALTH DESIGN PERCOLATION RATE:'<2 MIN/IN SOIL TEXTURAL CLASS: CLASS 1 (0.74 GPD/SF) GARBAGE GRINDER: NO (not designed for garbage grinder) ' Elev. TP-1 Depth FJev. TP-2 Depth DISTRIBUTION BOX: USE DB-5 (H20) 21.80 0" 21.80 FILL FILL 0" OF ,yqs 20.30 A 18" 20.30 A 18" SEPTIC TANK: 330 god x 200% = 660 god RE-USE EXIST. 1,000G SEPTIC TANK Q S� LOAMY SAND LOAMY SAND ' • y�� `•. �y 10YR 3/1 10YR 3/1 LEACHING AREA REQUIRED: (330)/.74 445.94 S.F. o� A REN- M. G 19.80 24" 19.80 24" 8" ' f 40 N B LOAMY SAND B LOB SAND e-- PRIMARY S.A.S. 18.22 C 43" 18.22 C 6/8 43" USE 4 ROWS .OF 6 - INFILTRATOR QUICK 4 PLUS STD LP (3.3" INVERT) REGisl PERC ® MEDIUM MEDIUM SECTION 3 3" UNITS- WITH NO STONE SOITAR�a� EL. 16.75 SAND SAND INVERT END CAP BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.73 SF/LF OF CHAMBER) 2.5Y 7/4 2.5Y 7/4 (CHAMBER UNITS) 24 UNITS x 4.00 LF x 4.73 SF/LF = 454.08 SF INFILTRATOR - QUICK 4 PLUS STD LOW PROFILE CHAMBER ' TOTAL AREA = 454.08 SF 13.80 96" 13.801 96" DESIGN FLOW PROVIDED: 0.74GPD/SF(454.08SF) = 336 GPD > 330 GPD req'd PERC RATE <2 MIN/IN. ("Cl" HORIZON) PROPO SEPTIC SYSTEM UPGRADE PLAN GROUNDWATER OBSERVED AT 95" EL. 13.89 61 1 SEPTIC WAY, HYANNIS, MA WELL: AIW-230,.ZONE C. LEVEL 22.10, AM 1.6' Prepared for: Fraser Read Rooter Exc. 24 x 11.32 = 271 sq. ft. provided vs. required 400 sq f{. ADJUSTED GROUNDWATER ELEV. 15.49' P , 271/446 = 60.7% prov. or 39.3% reduction, which is less than the System Design and Site Pion by: SCALE DATE REV. DATE MEYER&SONS,INC. N.T.S. 04/04/17 04/18/17 40% reduction allowed by 9 (d) of the MADEP Standard Conditions for • 1, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approvedby MADEP pursuant to 310 CMR 15.019 PO BOX 981 Alternative Soil Absorption Systems. to conduct sal evaluations and that the above analysis has been performed by me consistent with the EASTSANDWICH,MA02537 REV. DATE REV. DATE SHEET NO. p y requirements of 310 CMR 15.017. 1 further certify that l•have passed the Soil EvaL Exam in October, 1999. 508362-2922 04/20/17 04/25/17 2 of 2 , EL=21.7 LEGEND HYANNIS 5 F"T• SOL REMOVAL PROPOSED CONTOUR ® PROPOSED SPOT GRADE EXISTING CONTOUR ITCHEIL'S WAY + 96.52 EXISTING SPOT GRADE LOCUS N O 0 5 LOT 5 G � �. �� W— EXISTING WATER SERVICE AUNT a 11 11 i'�' ® TEST PIT BETTY'Sco �P v i j TH-2 1 N TH-1 - - N �� T. SEPTIC —NIZ� LOT 6 PARCEL ID: LOCUS MAP 290/156 _ BM: _= COR. STEP - LOCUS INFORMATION — � " EL=23.0 — '�� ��'� MADEP REQUIRED PLAN REF: 275/96 —_ 400 SO FT FOOTPRINT —_— "� r/� ��•� r � l TITLE REF: 28105/341 PARCEL ID: •MAP 290 PAR. 157 #61i`('J %i9 ZONING: "RB" LOT 7 =_ �t►" FLOOD ZONE: "X" PARCEL ID: = TOF=23.5 _ _ C. COMMUNITY PANEL: 25001CO568J DATED:07/16/14 ARE 9°33±ACRES = -= ----- — SEPTIC SYSTEM CO R Cow LOCATED AT REPAIR PLAN cs► _- , 61 MITCHELL'S WAY Fcr "_ - HYANNIS, MA. PREPARED FOR BVW ` '6 ow ` � � DONOVAN D. & ROSE MARIE # ^' ____ . ---8_____________#3" 2 �'f`" - FRASER [� p A••.•• BVw ` APRIL 4, 2017 REV. APRIL 7, 2017 7S ° _\ PARCEL ID: �� OFs `' # ; �°� j 308/273-002 �' ��` G� DA �� B ✓ O 0.;114 �CI ESN #ITAR j AUNT BETTY'S POND VARIANCE REbUESTS - MAXIMUM FEASIBLE COMPLIANCE f i� ' PER 310 CMR 405 (1)(b) & BARNSTABLE BOH REGS: - i 1) A 4 fT. VARIANCc FROM 310 CMR 15.211 & BARNSTABLE BOH REG. TO ALLOW MEYER & SONS, INC. LEACHING TO BE,' 16 FT. FROM DWELLING VS. REQUIRED,20 FT. P.O. BOX 981 GRAPHIC SCALE i PER BARNsrAel_E t� REGS: - _ 1) A 34 FT. VARIAN,E FROM BARNSTABLE BOH REG: TO ALLOW PROP. LEACHING EAST SANDWICH, MA. 02537 20 0 10 20 40 80 TO BE A MIN. 0-' 66' FROM WETLAND VS REQUIRED 100 FT. PH: (508)360-3311 2) A 39 FT. VARIANCE FROM BARNSTABLE BOH REG. TO ALLOW DISTRIBUTION FAX: (774)413-9468 BOX TO, BE A MIN. OF 61' FROM WETLAND VS REQUIRED 100 FT. ,.� meyerandsonsinc4gmail.com . _ ( W.FEET --CON�j�p -�1S--FOR-ALTERNATIVE A'S � - 1 inch = 20 f STAND ARD1) VARIANCE FROM 9(d) OF THE STANDARD CONDITIONS FOR ALTERNATIVE S.A.S. TO ALLOW 30% SEDUCTION OF LEACHING FOOTPRINT DUE TO LIMITED SPACE. SHEET'1 0F 2 J 1903 I NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL: 21.21 T.O.F. EL.=23.50t FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. GENERAL NOTES: INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL A' 4" DIAMETER INSPECTION PORT OVER 1. ALL CHANGES To THIS PLAN MUST BE APPROVED BY THE LOCAL OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE ONE CHAMBER (MIN.) AND SET TO 3" OF F.G. BOARD OF HEALTH AND THE DESIGN ENGINEER. F.G. EL.=22.80t F.G. EL.=22.7t F.G. EL: 22.30t F.G. EL: 22.15 (MAX.) 2. ALL WORK AND MATERIALS SHALL. CONFORM TO THE REQUIREMENTS ' OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE LOCAL RULES AND REGULATIONS. 9" MIN .COVER/ 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFlLLED PRIOR TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE 36' MAX COVER L = 15' L 10'(MAX) INSTALL TWO INSPECTION PORTS (MIN.) DESIGN ENGINEER. ® SCH4 (MIN.) EL = 22.70 ® S=1% (MIN.) 0S=1X (MIN.) a 4. ANC-CONDITLONS ENCOUNTERED DURING CONSTRUCTION DIFFERING 14 4"SCH40 PVC �r 4"SCH40 PVC 4"SCH40 PVC FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN ENGINEER BEFORE CONSTRUCTION CONTINUES. 10' 6 11.3" TO 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. INV.=21.65 14 INVERT 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF L �"uoulo INV.=21.40 INV.=20.82 LEVEt PROPOSED THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF GAS BAFFLE 4 ROWS OF 6 UNITS AT 4'/UNIT = 24'/ROW HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. INV.=21.08 7. DWELLING IS SERVICED BY MUNICIPAL WATER SUPPLY. INV.=21.25 pB-S SOIL ABSORPTION SYSTEM (PROFILE 8.ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED EXISTING 1.000 GALLON SEPTIC TANKS TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE RESTORE VEGETATIVE COVER LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO STARTING WORK. EXIST. SEWER OUTLET BACKFlLL WITH CLEAN PERC SAND 10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND REMOVED PER TITLE 5. TO TOP OF CHAMBERS REPLACE WITH CLEAN MEDIUM SAND PER TITLE 5 REQUIREMENTS. ;• ;,•;, . _ „, . 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY. PIPE .INVERTS PRIOR TO CONSTRUCTION BREAKOUT=TOP ELEV.= 21.21 AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY 2) D-BOX SHALL BE SET LEVEL AND TRUE TO INV. ELEV.= 20.82 13. NO KNOWN PRIVATE WELLS WITHIN 100 FT. OF PROPOSED LEACHING GRADE ON A MECHANICALLY COMPACTED SIX. BOTTOM ELEV.= 20.54 EXISTING SUITABLE 14. ALL PIPING TO BE 4" SCH 40 ® 1/8-/FT (UNLESS SPEC. ) INCH CRUSHED STONE BASE, AS SPECIFIED IN 2 83' MATERIAL - 15. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW 310 CMR 15.221(2) 5' MIN. ABOVE BOTTOM OF FOR THE USE OF A GARBAGE GRINDER. 3) REPLACE EXISTING 1,000 GALLON SEPTIC TANK T.P._EXCAVATION OR G.W. EFFECTIVE_WIDTH 4 x_2.83' 1.1.32'.- . . 16. REMOVE ALL UNSUITABLE SOILS 5 FT AROUND LEACHING TO EL_ 18.22 _-.4.._._ ._ . . _ . WITH 1500'GALLON SEPTIC TANK IF FAILED, (5.05 PROVIDED USE 4 ROWS OF 6 INFILTRATOR QUICK 4 PLUS OR TOP OF "Cl""C1" LAYER AND REPLACE WITH CLEAN MEDIUM SAND DAMAGED, NOT H2O LOADING, OR UNDERSIZED. ADJUSTED GROUNDWATER: EL:15.4 - STD LP 4 (3.3" INVERT) UNITS-NO STONE PER TITLE 5. 4) INSTALL INLET & OUTLET TEES W/ GAS BAFFLE AS REQUIRED SEPTIC SYSTEM PROFILE TYPICAL SECTION N.T.S. MI5 SOIL LOG P#: ,15279 DESIGN CRITERIA DATE: FEBRUARY 27 2017 NUMBER OF BEDROOMS: 3 BEDROOM DESIGN SOIL EVALUATOR: DARREN M. MEYER, R.S.,' DESIGN FLOW: RESIDENTIAL: 3 BEDROOMS ® 110 GPD/BR = 330 GPO WITNESS: DAVE STANTON, BARNS. HEALTH DESIGN PERCOLATION RATE: <2 MIN/IN SOIL TEXTURAL CLASS: CLASS 1 (0.74 GPD/SF) Elev. TP-1 Depth Elev. TP-2 Depth GARBAGE GRINDER: NO (not designed for garbage grinder) 21.80 0" 21.80 0" DISTRIBUTION BOX: USE 08-5 (H20) FILL FILL OF ,�s � 20.30 A 18" 20.30 A 18" SEPTIC TANK: 330 gpd x 200% = 660 gpd USE EXIST. 1,000G SEPTIC TANK � J " L0�S3A/NO LOAMY�SAND 8" LEACHING AREA REQUIRED: (330)/.74 = 445.94 S.F. �R 19.80 B 24" 19.80 B 24" LOAMY SAND LOAMY SANG No. 1140 "' 1DYR 6/8 10YR 6/8 PRIMARY S.A.S. 18.22 G 43" 18.22 C 43" USE 4 ROWS OF 6 - INFILTRATOR QUICK 4 PLUS STD LP. (3.3" INVERT) PERC 0 MEDIUM MEDIUM SECTION 3.3' UNITS WITH NO STONE QIVITAR,� EL 16.75 SAND SAND INVERT BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.73 SF/LF OF CHAMBER) 2.5Y 7/4 2sY 7/4 HEIGHT END CAP (CHAMBER UNITS) 24 UNITS x 4.00 LF x 4.73 SF/LF = 454.08 SF ��� INFILTRATOR - QUICK 4 PLUS STD LOW PROFILE CHAMBER 13:80 96" 13.801 96" TOTAL AREA = 454.08 SF PROPOSED SEPTIC SYSTEM UPGRADE PLAN DESIGN FLOW PROVIDED: 0.74GPD/SF(454.08SF) = 336 GPD > 330 GPD req'd PERC RATE, <2 MIN/IN. (-Cl- HORIZON) GROUNDWATER OBSERVED AT 95" EL_ 13.89 61 M ITCH ELL'S WAY, HYAN N I S, MA 24 x 11.32 = 271 sq. ft. provided vs. required 400 sq ft. WELL: AIW-230, ZONE C. LEVEL 22.10. ADJ 1.6' Prepared for: Fraser/Re d Rooter Exc. ADJUSTED GROUNDWATER ELEV. 15.49' 271/400 = 67% prov. or 33% reduction, which is less than the - System Design and Site Plan by: SCALE DRAWN DATE 40% reduction allowed by 9 (d) of the MADEP Standard Conditions for • 1, Doen M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.617 MEYERO 98 S1 ,INC. N.T.S. rn DMM 04/04 17 to'conduet'sat evaluations anE that the above-ana - - REV:-DATE Alternative Soil Absorption Systems. requirements of 310 CMR 15.017. 1 further yha hos peen passed thed-by Evol.Exam in Otober, - F�4ST8ANDtN%CHtifAi92537 CHECKED SHEET-N0.certify that I have passed the Soil Evol. Exam in October, 1999. 04/07/17 DMM 2 Of 2 r t - -71 - -$-.- �. SOIL L 0 G is j t' •^ram y. .a °EGG Gc c u' r'd ' ST7rAf Z['c, f tL NO. 1 ND. 2 �j Q f .y� p t f?c' pjlf) _ `L'V / ✓ L ✓ 0SITE PLAN f p 13 t{I A tf j :`l � - _r}�j- 1 �i ►J Q`� 01- Z,,8 v 'r t.' v v � —.._— ____ ! . «.Y 17L6v.J Ft otJ 9 11 ►.ulD 605541L ✓ 1 J� h v �� 0(.4 }2 `U�°E 4 I t ♦ WAWA,.�r Tit 4 f1 5 ` --- TOP OF FOUNDATION EL.: _-- Z5, _:_ _ 6 Olt, 9 IN EL 10 IN.EL. 2l.2 IN.EL. _ 11 ie— IN.EL. `� f �r 4 INAL 12,i o> A�4 f 12 -- O/B W/ 6" SUMP ,� ; - 13 - � - z ,;. ,J 14 � 4 LIQUID LEVEL - ��o� ��F�����2� ��.vw -� ,; � 3�a�rzr'• � 4 �� r ,. a 4 _ r 15 PERC TEST RESULTS PRECAST SEPTIC TANK WITH M1>7E e i A. rr�� f}i!_ ,s Q400,l?�r �� ._rw 2 J Y , ?° PERC RATE: - - CAST IN PLACE INLET AND 4 4 - _ _ , . >n, r , ',,' WHITdESSED B To�., rAe e OUTLET T 'S PER TITLE .___ _.___ ._ r___ ..__.' _....�._, �_._ `_ ...:_ :- , � L, � ,�� �,-�_;��< T,, �_ �--�= -_ BOARD OF HEALTH SIZE r c 1az� Lit t, ATE: - . l' PROFILE OF PROPOSED SEWAGE SYSTEM , ' SYSTEM DESIGNED BY THE TOWN OF _ , .� � E___ REGULATIONS AND �� -' �,�' �'{ ` I ` �� �`�,w , " i STATE TITLE V FOR SUBSURFACE DISPOSAL OF SEWAGE . SCALE 1/4 - 1 0 t N . B . = 4 ' 1• ALL PIPES SHALL BE SCHEDULE 40 P.V.C. SEWER PIPE 2. ALL PIPES SHALL BE SLOPED 1/4 " PER FOOT - EXCEPT FOR IPA. � THE FIRST 2 FEET OUT OF THE 0 / 8 WHICH SHALL. BE LEVEL \\� t 3. DESIGN FLOW ___ __ BEDROOMS AT 110 GALDAY PER BR . ;�-z ?__ GAL/DAY ' SEPTIC TANK SIZE l Q_ X ! ° � = _ � GAL . ' USE of ") GAL. W/°~> __ GARBAGE DISPOSAL LEACHING SYSTEM . USE � � �:n tea- �► � o� __ T , ► f ov EFFECTIVE AREA : SIDE a ► L� � � K � ' ' iso cy/ �,o �� � � � TOTAL FLOW . 0 4, ��w ;c --------------- TOTAL REQ'0 FLOW ?�,Q.._ X ��p._ -'_? o Wlu?2 GARBAGE DISPOSAL 3so - Zzo` RESERVE F L 0 W.__.__�.___ 1' 1 REFERENCE PLANS •'1 qo APPROVED BY ' BOARD OF ALTH 14 � j DATE • .._-.__ __ _,_____. _ 1 { P R 0 P E RT Y OWN E R : ._.__.:.-- _W, 4 _,� ._ . _. - _. ...._ _ : --_.____ N J • DOM 51 tit GLE FA M DVJE%, 1 G IV LOT D rr t 4�` _ . ��1 1 L L 1 1\1V� �_ 1 l (j f2 N\I-11�I } _ 23 5 '11nn'oE,� LAtiC A�2.'N STAY'�L� , Mn o2 G �a R �17- 2f-2�9Z •� j/ y 4. i+•.4 i SOIL LOG plc o Ct =r c� ' T; `s"j `" ° ' EL NO. 1 N0. 2 � - SITE PLAN 10 1) ,F F v 5o 2- , to C t `, r __ 3 ---- w� -—; �r �- -- fw h Some is4,8 -- ------a ,� TOP OF FOUNDATION Et.: -z A k, 4,0 '�L_ ' " IN.fL e o ....• �7-�.`x'� `.� .. iN.E . .__2!�? . L2 12' � - t 10 !��- __ l I N.E l. , � O/B W/ 6"� SUMP •• • LDW �Y1F{JSo2 . 'Lr-yi 14 4 LIQUID LEVEL F mow` . n . - 14Ll -- LA rr - i le a._ La� °_.° as `..fr+ .aa—se • _ EL -s-�- - �t/-I!)✓r_ t:_ IMP�i� if'd0 `. �, r j �- i � ,q 01 PERC TEST RESULTS PRECAST SEPTIC TANK WITH _ ---- -- -- MACES A. l� rt�c f� rr.o004> � �. < L � r+ __ _-_. k - . ��; PERC RATE . �,�, Aj _ - I CAST IN PLACE INLET AND � c_n��`� 1._. �.( ":, _ ; Y , :. : �+�'�, fr WHITNESSED BY: To�_r� OUTLET T S PER TITLE V_ �_.___._ ._w__ _ __ _� ____ _ ____ ,�,� �, u,:w ��?,,.�n_r,. -:,�3� __ BOARD OF HEALTH i SIZE : I � od G, L_ � DATE : __ 5-7G 5 i �1- L�-vA`r»J'� PROFILE OF PROPOSED SEWAGE SYSTEM { SYSTEM DESIGNED BY THE TOWN OF REGULATIONS AND j STATE TITLE V FOR SUBSURFACE DISPOSAL OF SEWAGE . SCALE 1/4"- 1 0" N . B . 1. ALL PIPES SHALL BE SCHEDULE 40 P.V.C. SEWER PIPE 2. ALL PIPES SHALL BE SLOPED 114 " PER FOOT EXCEPT FOR o � �►a � � / � � / �, �� � THE FIRST 2 FEET OUT OF THE 0 / 8 WHICH SHALL BE LEVELS 3. DESIGN FLOW _ BEDROOMS AT 110 GALDAY PER BR . r�_. GAL/DAY p u F SEPTIC TANK SIZE _ ' � . I , , � X � J -� - , J GAL USE GAL. Wi - -- GARBAGE DISPOSAL , LEACHING SYSTEM : U SE _ � � L_ � L.,�, l�. �.. H , , _. ,' fk„�•'�'� iLL- '.:,�.' , i F , r r); l- \ , �`ti `� / ` .+5�- ` EFFECTIVE AREA . SIDE _1 > lo +_2v .�`. _.` .._ � 50 BOTTOM TOTAL FLOW --� •r TOTAL RE 'O F LOW _? .Q ._ X !�n_...T___z_?�. ____ W GARBAGE DISPOSAL - -- -_ RESERVE F L 0 W GALIDAY REFERENCE PLANS i i I. BOARD OF HEALTH DATE PROPERTY OWNER : �, , F ; VD SEVVAGE ti rF i • - �.. 1 I( r 1 i /' 1,�to�� D A T L-• ..__ _ _ ._ _ t. f;+�1 t + \mot T�. ► ��ivy, 1 ,r- I E rZ r'\AINI ' ."�''~"" 23 5 1 1MC3t 1.AN r __._.._ _ .__- _ -------_ , _._ .�_�.. ____ .. ._. ____...__ �. __.___�____ -a___ .. -r _�_�.._. _ _ ._ M___•�,_.__._.s �.r_ _ _ :___ ._ __ __ - _ — - ._ Vv. Q AV --N C"C�r L t , Mn _02 G r_ A