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Home My WebLink About0194 MITCHELL'S WAY - Health 194 Mitchell's Way a u Hyannis .. At 290 - 143NONNI 4 r Town of Barnstable oF'SHE ram, Regulatory Services Richard V. Scali, Interim Director * BARNSTABLE, *� MASS. g Public Health Division Argo 39. Thomas McKean, Director 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: 5 20 Ib Sewage Permit# 2016— 112 Assessor's Map\Parcel o 1 3 Designer: _t oNaLn i" ZAkesle1 Installer: Z)C"/, /S Address: 69,i E"",y��.-�E-�,e�,�� I�,rc. Address: 1��, _3ox 879 On_J-/J13 >g tARLe' was issued a permit to install a (d te) (installer) septic system at 19N AA yTc_0 ElC k�l AT based on a design drawn by (address) � QL tL��cn cKl dated /! (designer) f I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in compliance with the terms f the ro 1 letters (if applicable) ' - IN of MAssgcy RONALD F. am (Installer's Signature) o BUKOSKI CIVIL � No.32024 1PG/STER�� Designer's Signature) (Affix D mp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc TOWN OF BARNSTABLE LOCATION J44 NJLTCHFLJ- o WAy SEWAGE# 261,6-//? VILLAGE 0,iA,1,41S ASSESSOR'S MAP&PARCEL 290 1Y3 INSTALLER'S NAME&PHONE NO. �ENN/S E,42�L- (�D� 13(-46Y! SEPTIC TANK CAPACITY Fxixri„r(�DDD GAl, LEACHING FACILITY: (type)(2),f00 6 Q3 yG.L' Aat size) 26'1) 'J K 17 '�'1n1 NO.OF BEDROOMS 7'k)Q - /tq 1NiM u,N Drt-16,7( i Hat-,E OWNER E PERMIT DATE: 4_�/16 COMPLIANCE DATE: .S Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 6 0 Feet Private Water Supply Well and Leaching Facility(If any,wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY T%,r / IS . MNRER TON1,1gN 1'W' N15'BZ�PE - 1M .IEBLMi1D AS '. . EINIBH ONROE D,SURROUNDED y A BiVNn,�OH U ESE 'Di 00 —= HED STONE 1 Septic System:As-Built Em o BE NEMO E p. Ties O o ADIN 7 5 °' ; ,�qO F�Oi D DE N .. . : N�EN NE�e� -10 2 o� BDiN O EaS PO D�Da 12.2 DND E E P D,u N. ADOUT EEDN DE w EwE ED B[)our AE 27.0 55 • NNEW .�. ,NDDDDEDN ,p„ BE 21 2 y m .1 #194 AG37.3 FUEE6 9EMENT BG 29.2 _ 1 _ v E 4 jl! . Ne�pBE.BT VBD.W UP. WAY .. MITGHELVS No. f l I r FEE Vim/ COMMONWEALTH OF MASSAC14USETTS F Board of Health, Barnstable MA APPLICATION FOP, DISPOSAL SYSTEM[ CONSTRUCTION PE LT Application for a Permit to Construct( ) Repair( Upgrade(X) Abandon( - ❑Complete System a Individ*Components Location 194 Mitchell's Way Owner's Name Heather J. BaS t Map/Parcel# 290 Address 50 Main St., Sandwieh'4MA 02563 Lot# 143 Telephone# (508) 888-1281 IV Installer's Name Dennis Earle Designer's Name CGE Engin. , Ronald Bukoski Address P.O. Box 876, Sandwich, MA 02563 Address P.O. Box 456, Sagamore, MA 02561 Telephone# (508) 631-5849 Telephone# 508 833-2250 Type of Building Residence Lot Size+/— 10,019 sq.ft. Dwelling-No.of Bedrooms Two — Min. Design Three per Title 5 NO Garbage grinder ( ) Other-Type of Building N/A N J'A 7.°"CITI. ,i n 1-0 V-01 No.of persons Sho ers ( ),Cafeteria ( ) Other Fixtures N/A l.J Y wSPJ/aprylJ��J1yr+'Tc. ^c�/�7P ' k, ,-J. �✓i3 �b Design Flow (min.required) 330 gpd Calculated design flow 220 Design flow pr vi ed 366 gpd Plan: Date 4/5/16 Number of sheets One Revision Date Title Septic System Upgrade, 194 Mitchell's Way, Hyannis, MA 02601 " Description of Soil(s) 0-9" A, L.S.; 8-38" B, L.S. ; 38-138" Cl, Sand, 10-20% Gravel. No GW / Mottling. Soil Evaluator Form No. Barnstable Name of Soil Evaluator Ron Bukoski Date of Evaluation 3/29/16 DESCRIPTION OF REPAIRS OR ALTERATIONS Abandon failed leaching pit. Install new DB-5 D-Box, H-20 load rated and H OF/ygSS The undersigned agr s to install the above described Individual Sewage Disposal System in accor th the ns of TITLE 5 and further agrees to t o pl s em in operation until a Certificate f Co fiance h bee 'o KO SKI Health. Signed I Date p. �' CIVIL m -No.32024 ,i j F I YW'" C t �J� ✓ � 9 � � Ras.^'k,�s`a-i pg.« .. �/l'1'� No. !/ +x £ "" FEE12) {J�J bl ta e I° Board of Health, Barns MA. `t l:.;` 11 �1 APPLICATION FOP, ➢ ISPOSA L SYSTEM CONSTRUCTION PEE#MIT Application for a Permit to Construct( ) Repair( ).Upgrade(X) Abandon( - ❑Complete System M Individual Components Location 194 Mitchell's Way Owner's Name Hpathpx J. Bassdtt Map/Parcel# 290 Address 50 Main St., SandwicY'j MA 02563 Lot# 143 Telephone# (508) 888-1281 Installer's Name Dennis Earle Designer's Name CGE Engin. , Ronald Bukoskl Address P.O. Box 876, Sandwich, MA 02563 Address P.O. Box 456, Sagamore, MA 02561 Telephone# (508) 631-5849 Telephone# (508) 833-2250 Type of Building Residence Lot Size+/— 10,019 sq.ft. Dwelling-No.of Bedrooms TWO — Min. DeSign Three per Title 5 NO Garbage grinder ( ) Other-Type of Building N/A t l ^ 7,° i v 1 ^ 1 U�� N,o.of persons Showers ( ),Cafeteria O Other Fixtures N/A W i' % �V�PrI(uo02j ��Ur+ u�c�//7 ..l)( A ��/13A, Design Flow (min.required) 330 gpd Calculated design flow 220 Design flow provided 366 gpd Plan: Date 4/5/16 Number of sheets One Revision Date Title Septic System Upgrade, 194 Mitchell's Way, Hyannis, MA 02601 Description of Soil(s) 0-9" A, L.S.p 8-38" B; L.S. 1 38-138" Cl, Sand, 10-20% Gavel. No GW / Mottling. Soil Evaluator Form No. Barnstable Name of Soil Evaluator lbn BUkOSki Date of Evaluation 3/29/16 DESCRIPTION OF REPAIRS OR ALTERATIONS Abandon failed leaching pit. Install new DB-5 D-BOX, H-20 load rated, .and 4_.Q4 S_talzda -3-r++3 lt- in-i/ .-a-$ted-oo�f r t-ior�----- - s "6 r`�w. (2 Sid I1:�, r I_ ,,-&.f -0:M 12. k3 2S- t The undersigned agr es to install the above described Individual Sewage Disposal System in accordanc a y ions of TITLE 5 and further agrees to/''o o pll Jr$�t`he s,y'stem in operation until a Certificate of Compliance has been iss ti ealth. Signed ( f'� DateRONALD F. G� ' KOSKI lou d 3 ),/1 " CIVIL co h 1LC%�i l t a - 24 ll f�5 �j r� No. f .0 6 P 9 ,FEE COMMONWEALTH Of MASSACHUS ETTS _ Board of Health, Barnstable , MA. CERTIFICATE.OF COMPLIANCE Description of Work: C Individual Component(s) ❑Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ),Repaired ( ),Upgraded,Abandoned ( ) by: Dennis Earle at 194 Mitchell's Way, Hyannis, MA 02601 has been installed in accordance with the pr visions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. ).v 1 1. - f f Z- ' dated 1 Z / Approved Design Flow , C� (gpd) Installer Designer: Inspector: 1 L Date: h The issuance of this permit shall not be construed as a guarantee that the system will function as designed. ' } No. i o !il FEE i) COMMONWEALTH OF MASSACHUSETTS Board of Health, Barnstable MA DISPOSAL SYSTEM CONSTRUCTION PERMIT_. Permission is hereby granted to; Construct( ) Repair( ) Upgrade ) Abandon( ) an individual sewage disposal system at 194 Mitchell's Way, Hyannis, MA 02601 as described in the application for Disposal System Construction Permit No o/ ID - 111 dated L4 1 t Provided: Construction shall be completeld�within three years of the date of this permit. All to al conditions must be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date I l�I Board of Health 1 IA -P K 1 � f v V Commonwealth of Massachusetts q1 City/Town of Barnstable Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal A. Facility Information Heather J. Bassett Trust Heather J. Bassett 50 Main Street Sandwich MA 02563 T: (508) 888-1281 Owner Name 194 Mitchell's Way Hyannis 290/143 Street Address Map/Lot# Barnstable MA 02601 City State Zip Code B. Site Information 1. (Check one) ❑ New Construction ®Upgrade ❑ Repair 2. Soil Survey Available? ® Yes, ❑ No If yes: MA GIS/Soil Survey 1993 EaA Source Soil Map Unit Eastchop loamy fine sand Excessively Drained Soil Name Soil Limitations Glacial Outwash Outwash Plain Geologic/Parent Material Landform 3. Surficial Geological Report Available? ® Yes ❑ No If yes: 1991 USDA 1 in. = 5 miles EaA Year Published/Source Publication Scale Map Unit 4. Flood Rate Insurance Map Above the 500-year flood boundary? ® Yes ❑ No Within the 100-year flood boundary? ❑ Yes ® No If Yes,continue to#5. - 5. Within a velocity zone? ❑ Yes ® No MassGIS Wetland Data Layer: 6. Within a Mapped Wetland Area? ❑ Yes ® No Wetland Type 7. Current Water Resource Conditions (USGS): 4/16* Range: ❑ Above Normal ® Normal ❑ Below Normal Month/Year 8. Other references reviewed: MA GIS *USGS Reference Well MA Al W 306, Measurement Date 4/7/16 APR li '16P11 t5form11.doc•rev.3/15 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 1 of 8 a Commonwealth of Massachusetts City/Town of Barnstable Form 11 Soil Suitability Assessment for On-Site Sewage Disposal UV'P C. On-Site Review (minimum of two holes required at every proposed primary and reserve disposal area) Deep Observation Hole Number: TP-1 3/29/16 1000 hrs Partly Cloudy, 43 F Date Time Weather 1. Location Ground Elevation at Surface of Hole: 99.40 Assumed BM Latitude/Longitude: 41.651507 / -70.300299 feet Description of Location: Residential 2. Land Use Lawn None <1% (e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones(e.g.,cobbles,stones,boulders,etc.) Slope(%) Grass Outwash Plain Vegetation Landform Position on Landscape(SU,SH,BS,FS,TS) >150 Drainage Wa 3. Distances from: Open Water Body 9 Y >50 Wetlands >150 feet feet feet Property Line 25 North Drinking Water Well >150 Other feet feet feet 4. Parent Material: Glacial Outwash Unsuitable Materials Present: ® Yes ❑ No If Yes: ® Disturbed Soil ❑ Fill Material ® Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock 5. Groundwater Observed: ❑ Yes ® No If yes: Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: 12-14 ft Below Grade +/-87 Assumed BM inches elevation t5form11.doc•rev.3/15 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 2 of 8 f Commonwealth of Massachusetts City/Town of Barnstable 1 Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (continued) Deep Observation Hole Number: TP-1 Coarse Fragments o Soil Horizon/Soil Matrix:Color- Redoximorphic Features Soil Texture /o by Volume Soil Depth(in.) Layer Moist(Munsell) (USDA) Soil Structure Consistence Other Cobbles Depth Color Percent Gravel &Stones ) 0-9 A 10YR3/2 N/A Loamy Sand 9-38 B 10YR5/8 N/A Loamy Sand Loose Not Suitable 38-138 C1 10YR6/4 N/A Sand 10-20 0 Single Grain Loose Suitable for SAS Additional Notes: t5forml 1.doc•rev.3/15 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 3 of 8 Commonwealth of Massachusetts P itCity/Town of Barnstable Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (continued) Deep Observation Hole Number: TP-2 3/29/16 1000 hrs Partly Cloudy 43 F P Date Time Weather I 1. Location Ground Elevation at Surface of Hole: 99.40 BM Latitude/Longitude: 41.651507 / -70.300299 Assumed 2. Land Use Residential None Level (e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones(e.g.,cobbles,stones,boulders,etc.) Slope(%) Lawn -Grass Outwash Plain Vegetation Landform Position on Landscape(SU,SH,BS,FS, 3. Distances from: Open Water Body >150 Drainage Way >50 Wetlands >150 feet feet feet Property Line 32 North Drinking Water Well >150 Other feet feet feet 4. Parent Material: Glacial Outwash Unsuitable Materials Present: ® Yes ❑ No If Yes: ❑ Disturbed Soil ❑ Fill Material ® Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock 5. Groundwater Observed: ❑ Yes ® No If yes: Depth Weeping from Pit Depth Standing Water in Hole Estimated Depth to High Groundwater: 12-14 feet +/-87 Assumed inches BM t5forml 1.doc-rev.3/15 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 4 of 8 Commonwealth of Massachusetts City/Town of Barnstable Form 11 Soil Suitability Assessment for On-Site Sewage Disposal C. On-Site Review (continued) Deep Observation Hole Number: TP-2 Redoximorphic Features Coarse Fragmentso Soil Soil Horizon/Soil Matrix:Color- Soil Texture /o by Volume Depth(in.) Soil Structure Consistence Other Layer Moist(Munsell) (USDA)) Cobbles (Moist) Depth Color Percent Gravel &Stones 0-9 A 10YR3/2 N/A Loamy Sand Not 9-38 B 10YR5/8 N/A Loamy Sand Loose Suitable Suitable 38-138 C1 10YR6/4 N/A Sand 10-20 0 Single Grain Loose for SAS Additional Notes: t5forml 1.doc•rev.3/15 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal -Page 5 of 8 \ Commonwealth of Massachusetts City/Town of Barnstable Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal D. Determination of High Groundwater Elevation 1. Method Used: Obs. Hole#TP-1 Obs. Hole#Tp-2 ® Depth observed standing water in observation hole > 138 >138 inches inches ® Depth weeping from side of observation hole > 138 >138 inches inches ® Depth to soil redoximorphic features (mottles) >138 >138 inches inches ❑ Depth to adjusted seasonal high groundwater(Sh) (USGS methodology) inches inches Index Well Number Reading Date Sh = Sc—[Sr X(OWc—OWma),)/OWrl Obs. Hole# Sc Sr OWc OWmax OWr Sh Obs. Hole# Sc Sr OWc OWmax OWr Sh E. Depth of Pervious Material 1. Depth of Naturally Occurring Pervious Material a. Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? ® Yes ❑ No b. If yes, at what depth was it observed? Upper boundary: 38 Lower boundary: >138 inches inches c. If no, at what depth was impervious material observed? Upper boundary: Lower boundary: inches inches t5forml 1.doc•rev.3/15 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal -Page 6 of 8 Commonwealth of Massachusetts City/Town of Barnstable Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal F. Certification I certify that I am currently approved by the Department of Environmental Protection pursuant to 310 CMR 15.017 to conduct soil evaluations and that the above analysis has been performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. 1 further certify that the results of my soil evaluation, as indicated in the attached Soil Evaluation Form, are accurate and in accordance with 310 CMR 15.100 through 15.107. 3/29/16 Signature of Soil Evaluator Date Ronald F. Bukoski/SE 270 6/30/16 Typed or Printed Name of Soil Evaluator/License# Expiration Date of License Mr. David Stanton Barnstable Name of Board of Health Witness Board of Health Note: In accordance with 310 CMR 15.018(2)this form must be submitted to the approving authority within 60 days of the date of field testing,and to the designer and the property owner with Percolation Test Form 12. t5form1l.doc•rev.3/15 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 7 of 8 Commonwealth of. Massachusetts City/Town of Barnstable : Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal 4. Field Diagrams . Use this sheet for field diagrams: s971 TWO 500 GAL.LEACHING CHAMBERS - OBSERVATION PORT N�5°4'LA� SURROUNDED BY 4'OIN GALLERY CONFIGURATION wIRISER TO WITHIN 3"OF F 3(4-1 :.FINISH GRADE %9s .. DOUBLE.WASHED STONE (25.0'L x 1283'.W)'.. EXISTING 18'OTREE LEACHING PIT- - - `- -LEANING-TO .�.- , ABANDON PER .. : - BE REMOVED �^ 1 '.TITLE 5 _ r. FINISH GRADE TO MATCH f.. F .- � EXISTING GRADE-LOAM 'AND SEEDED .. SHED-. �:SHRU 1 99 q01 Q 1 NEW.CONCRETE G DB-9 D-BOX TP - . H2O RATED wIWATERTIGHT RISER TO WITHIN 6'OF FINISH .. .. GRADE_ CEDAR EXISTING 1 000-GAL _• / CONCRETE SEPTIC TANK O I+10 RATED 00 00 :. .-. ASSUMED D B.M.100ED .. .. - - ASSUM 2 WHITE qO '•�5T 05 BULKHEAD \- �xSB B 1 A N _ WOOD DEC - v #194 FU. m LL BASEMENT \9ti 'Z ON N?\ U90 I:P ON OOA E� 'S WAY M� CN Form'!11 —Soil Suitability Assessment for On Site Sewage Disp osal Page 8 of 8 t5form1 l.doc,-.rev.3/15 f 194 Mitchell's Way,Hyannis,MA March 29,2016 Field Report 01 Page 1 of 2 xi,/ '+ ,�,, ' �✓ � sue-, �.. � (,Gg � � � �'�*=� '�� - �'+t � � T ,e P,:fs. f- I` ;_.. r,t �� ,•s2 ,�; ; ►+i. . ie�- to n ,ram '.�. ��+� `� � ��'� �� +� � tt�,�{�•`1�t � �� ' .��'IW�''_�4�� "��.�..�i- > a.��' �d' �c/.6��5Lt�16►, ��s'i�w�' Photo 1: TP-1 &TP-2 soil samples increasing in depth from right to left. TP-1 & TP-2 Soil Profiles Depth Soil Bottom Soil Color Notes (in.) Horizon Elev. Description (Surface: 99.40) 0-9" A 98.65 Organic 10YR3/2 Lawn w/Topsoil and shallow Topsoil— soil profile disturbance from Loamy Sand past construction. 9-38" B 96.23 Loamy Sand 10YR5/8 Unsuitable for SAS. 38- 138" Cl $7.90 Sand 10YR6/4 Mostly medium Sand, 10- 20%c-f Gravel.,<2% nonplastic Fines. Suitable for SAS. No groundwater,weeping,or soil mottling encountered. High groundwater is deeper than 138 inches below grade,elevation 87.90 ft. Percolation Test Depth: 43-61 in.below grade. 'Percolation Rate in C1: <2 min/in., 24-gal of water 1.0 minutes, 12 to 9 in,drop— 1 min 38 sec. CGE Engineering,Inc. 194 Mitchell's Way,Hyannis,MA March 29,2016 Field Report 01 Page 2 of 2 A" �r ems- T3 R1.1 K c I « C i• i 9 . t ba 1 Pf AN" �'7` a $'� +i•: " x�'";'"*ii�tM�.6r'. C nk tl� �. - a*z � i. �" GCS -�y $ `1 J1 'v t " ,r _a Photo 2: TP-1. COE Engineering,Inc. Commonwealth of Massachusetts City/Town of Barnstable W Percolation Test Form 12 �M Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage Disposal. DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with the local Board of Health to determine the form they use. Important:When filling out forms A. Site Information ^ on the computer, use only the tab Heather Bassett key to move your Owner Name cursor-do not 194 Mitchell's Way, Map 290/ Lot 143 use the return key. Street Address or Lot# Barnstable/ Hyannis MA 02601 City/Town State Zip Code Dennis Earle T: (508) 631-5849 Contact Person(if different from Owner) Telephone Number B. Test Results 3/29/16 1008 a.m. Date Time Date Time Observation Hole# TP-1 Depth of Perc 43 -61" Start Pre-Soak 10:08 End Pre-Soak 10:18 -24 Gallons Time at 12" 10:18 Time at 9" 10:19 & 38 Seconds Time at 6" Time (9"-6") Rate (Min./Inch) <2 min/in. Test Passed: ® Test Passed: ❑ Test Failed: ❑ Test Failed: ❑ Ronald Bukoski P.E. LSP CGE Engineering Inc., T: (508) 833-2250 Test Performed By. Mr David Stanton, Barnstable Board of Health Witnessed By: Comments: Soils to be verified at time of Soil Absorption System (SAS) excavation/ bottom inspection. t5form12.doc•06/03 Perc Test•Page 1 of 1 a I . c� Town of Barnstable P 8 ' Department of Regulatory Servtcea s - ''Public Health D' , Y1Slori Date iaAM. �p fe39� 200'Matn Street,Hyannis,MA 0260] q. lflt Mitt� :Date Scheduledo Time I+'0e Pd. Sa►zr Sr� ta�izlrty Assessment for Sew e Iarsposal Performed By I�/l&Ai.r) ,tIxhS d! Witnessed By._ LOCATION&.GENERAL M4 ORM�.TION Laeation'Address n , Owner's Name �� 'lrq eK a S.5 • �,ll,ll t.) _ Address Assessor's Ma /Parcel: - 90':,-/y3 ' R / Engineer's Name NBW CONSTRUCTION REPAIR. P� Telephone# .}(j F J Land Use. ;i' W F; J1 Slopes(96) ):�L. [x. , - Surface Stones Distances from: Open Water Body: ? 15t� ft Possible Wet Aren �• 1 ri'l� $ Drlaking Water Well : ft ,.Dmlhage Way >Etd ft .Property.:Line 2S h . 0 t • `ft ar ` SKETCH:(Street name,dimensions of lot exact.locations of test holes&pero tests,locate wetlands en proximity to holes) q � ycl (4.Ie 'Y 15'122S E 125.17 W ORR - i ? :' ' ' e 1 n fi E r & Parent material(geologie)•,(,&Ai iAI. tZurni;y f4.. Depth to0 edi-ock 1�11n` i�J1f'7�r�s9 t"15 t4 Depth to Oroundwatei.. Standing Water in HOW: j.3 . . Woeping.frotrl Pit Once 1� � Estimated Seasonal Hlgh(]roundwatcr 11 y DETERMINATION FOR SEAS ON HIGHW,A.T.UR TA.UL]$ Method Used ES�cZ .�-tlPni :Depth Observed standing in obs hole: 5'l J�7�'• (u, 4epth to soli mottleel De{lth.to weeping from side of obs.hole €2 lu flrtiundWater AdjuMltdent .:. Index Well-# Reading Date:` Index Well level':___ „ Ai�,ActbY Adj.amundwater1aval, PER At VEST COEATIO Observation Holo# Thtie at:2" _ Depth'of Pc,o Time of 6" _ • ��Ill ,. StattPro-soakTimo_C� Time(911611j '. EndPro-saak 10,:. Rate Min:/Inch tia_- 4 Site Suitability Assessment -Slto Pessed Sltp Filled: Additional Testing Needed(YM) Original:`Public Health DiAsion Observation Hole Data To Be Completed on Back ***If percolation testis.to be conducted within 100' of wetland,you must first notify the• Barnstable Conseirvation Division.at'Ieast.one(1).week prior to beginning. Q:�SBPTIC�PBRCPORM.DO.0 DEEP.OBSERVt1,TION HOLE LOG Hole# .- TT-Depth from Soil Horizon Soil Texture Shcl Color Soil• Other Surface(in.) (USDA) (Mansell) Mottling (Stnuctum,Stoneg;Boulders. 0 lsistency.96'aravoll 11 �,()Abw SLOV 10), l� Dn)f , _lTA3 R S100 ® \jp, clqM7 r 0A. S a as 71 r DEEP OBSERVATION HOLE LOG Hole# 'o s-2 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. 3/ • AI'ffd�� Pf•L'C_t fl.•r DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Sall Color Soil Other Surface(In.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders, Consistangy. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Sall Other Surface(in.) (USDA) ;Mansell) Mottling (Structure,S�opeB;Boulders. Flood Insurance Rate Map: Above 500 year flood boundary No— Yes Within 500 year boundary No '! Yes.:_,r Within 100 year Flood boundary No. Yes ._ Depth of Naturally Occurring Pervious Materlal Does at least four feet of naturally occurring pervious mtiterial exist in all areas observed thrpughout the area proposed for the soil absorption system? '' If not,what is the depth of naturally occurring pervious material? Certification I certify that on Y (date)I have passed the soil evaluator examination approved by the Department of Envirotimental Protection and that the above analysis was performed by me consistent with . the required training,expertise and experience described In 10 CMR 15.017. Signature { • !�7;a - Date Q-. EPTIC\PBRCPORM.DOC R 194 Mitchell's Way,Hyannis,MA March 29,2016 Field Report 01 Page 1 of 2 .!C{} •} , -;1w ate_ � '.+ "''� � ' x�5 .. -1 'a. ♦ Se.a JSF3"•r'.yI` �. �P -�Ltj ),. i 'h'^d..- ".y / t r�`�{ k ,. tti� h-�� Photo 1: TP-1 &TP-2 soil samples increasing in depth from right to left. TP-1 & TP-2 Soil Profiles Depth Soil Bottom Soil Color Notes (in.) Horizon Elev. Description (Surface: 99.40) 0-9" A 98.65 Organic 10YR3/2 Lawn w/Topsoil and shallow Topsoil— soil profile disturbance from Loamy Sand past construction. 9-38" B 96.23 Loamy Sand 10YR5/8 Unsuitable for SAS. 38- 138" C1 87,90 Sand 10YR6/4 Mostly medium Sand, 10- 20%c-f Gravel,<2% nonplastic Fines. Suitable for SAS. No groundwater, weeping,or soil mottling encountered. High groundwater is deeper than 138 inches below grade,elevation 87,90 ft. Percolation Test Depth: 43-61 in.below grade. Percolation Rate in C 1: <2 min/in.,24-gal of water 10 minutes, 12 to 9 in.drop-•-1 min 38 sec. CGE Engineering,Inc. 194 Mitchell's Way,Hyannis,MA March 29,2016 Field Report 01 Page 2 of 2 ,�,Wg�fi �•�L.�` �'y. ,� •,� e s ... q Lam. i � _off �a 10 STY .•ice wi - Y t S , Photo 2: TP-1. CGE Engineering,Inc. SEPTIC SYSTEM DESIGN CRITERIA I FLOW LINE GRADES BARNSTABLE MUNICIPWATER TIGHT RISER WATER TIGHT RISER PROPOSED AS-BUILT �T �,� cAP�cooy�royrF'y, AIRPORT 1) Soil evaluation-refer to soil evaluation and percolation test report prepared by CGE Engineering,Inc.,March 29,2016,performed TO WITHIN 6"OF DISTRIBUTION BOX WITH TO WITHIN 6"OF MIN,2^LAYER 118-12"a L V :' MA FL b Ronald Bukoski, PE,LSP,and witnessed b Mr.David Stanton,Barnstable Board of Health. FINISH GRADE LF.G.= TIGHT FINISH GRADE DOUBLE-WASHED STONE OR A INV. AT FOUNDATION NOT EXPOSED F� yRa y y Y TO WITHIN 6" FILTER FABRIC OVER SAS. F,G=99.66t RADE 9L R�TF 2) The property is not located within a Zone 11 of a Public Water Supply, No known Public wells are located within 400 ft. No known BASEMENT F.G.= 99.66' B INV. INTO SEPTIC TANK(EXISTING) 97.84 Private Wells are located within 150 ft of the proposed Soil Absorption System(SAS). Town water is provided to the site and ' 2%SLOPE ?O NORTWNORTHEAST -r C INV. OUT OF SEPTIC TANK 97.59 fgou+a+R°A° �r surrounding properties. No known Title 5 restrictions or limitations are associated with the upgrade of the existing failed leaching pit. EXISTING F.G.= ea.1o• m 3)General soil profile at TP-1 &TP-2. Surface elevations 99.40 ft,based on assumed Bench Mark(BM 100.00)NE corner of EXISTING 4"DIA,SCH40 PVC I (,� D INV. INTO DISTRIBUTION BOX(2%SLOPE) 96.37 Basement Bulkhead. 7 TLEVELMIN. !C E INV. OUT OF DISTRIBUTION BOX 96.20 40 PV K �M W TP-1 & TP-2 Soil Profiles A EXISTING ®® O �- ® D 1y� MRC„PLL�s 1,000-GALLON LL --� DOUBLE WASHED F INV. INTO CHAMBER 96.00 " ao° LU a a . ®®IJ® ®® �+o o . STONE A . Depth Soil Bottom Elev. S01) Color Note3 B SEPTIC TANK •° °, ° d° E o o a a o N s• (in.) Horizon (G.S.) Description C "r I G,H G BOTTOM OF CHAMBER 94.00 F t 99.40' D -- 3 ---a GAS BAFFLE F � FFECTIVEWIDTH=42.83' H BOTTOM OF STONE 94.00 1 ' 0-9 A 98.65' Organic Topsoil- 10YR3/2 Lawn w/Topsoil oo mo.°°°o °o ,mo .° .v�,o.•e '1 J HIGH WATER TABLE BELOW 87.90 SITE Loamy Sand 6^MIN.314"-112^ � ' �`�� CRUSHED STONE 9-38 B 96,23' Loamy Sand 10YR5/8 Unsuitable for SAS. SYSTEM PROFILE TWO500 GAL.LEACHING CHAMBERS K TOP OF CHAMBER 96.75 ;LOCUS MAP NOT TO SCALE 38-138 C1 87.90' Sand 10YR6/4 Mostly medium Sand, 10-20%c-f Gravel, NOT TO SCALE <2%nonplastic Fines.Suitable for SAS. ` LEGEND No groundwater,weeping,or soil mottling encountered. High groundwater is deeper than 138 inches below grade,elevation 87.90 ft. Percolation Test Depth: 43-61 In,below grade. Percolation Rate In Cl: <2 min/in.,24-gal of water 10 minutes, 12 to 9 in.drop-1 10495 EXISTING ELEVATION min 38 sec. ---- W.G.E- EXISTING UTILITIES 4) Estimated Hydraulic Loading: Type of Establishment: Residence with two bedrooms. Minimum design-three bedrooms at 110 gpd-Minimum design required PLAN VIEW 330 gpd. No increase in design flow is proposed. w CROSS SECTION 22" \ x99.60 PROPOSED FINISHED GRADE � 14"POLYSEAL INLET 1 5) This system is not designed for a garbage disposal. W 4.1`- $3 OBSERVATION PORT o�2�Q�0 TWO 500-GAL. LEACHING CHAMBERS 6) Septic Tank: Existing 1,000 gallon septic tank. Overall condition to be verified at time of construction and replaced if necessary 3-4"POLYSEAL OUTLETS w/RISER TO WITHIN 3" OF , N.�5 IN GALLERY CONFIGURATION 100 PROPOSED CONTOUR with a 1,500 gallon,concrete H-10 septic tank" WITH SPEED LEVELLERS + 1„ " FINISH GRADE SURROUNDED BY 4 OF 3/4-1Z,F 2 N G N Xg�,gO DOUBLE-WASHED STONE 7) SOIL Class 1, perc. rate<2 mInAnch. , REVISIONS , { 4 (25.0 L x 12.83 W) 8) Proposed primary leaching area: Absorption System:25.0'L x 12.83'W,using two,500-gallon concrete Chambers(H-10 load :.::::, :..::•::';:'::; 4 No. Revision Date rated)surrounded by 4 feet of double-washed 3/4-1 1/2-inche stone. DISTRIBUTION BOX DETAIL EXISTING 1., SAS changed to 500-gal.Precast Concrete chambers Apr 112016 18"0 TREE 9) Total leaching area: Bottom:25.01 x 12.83'W=320.75 sq.ft. DB-3, H-20 LOAD RATED, 3-OUTLET H-20 LEANING - TO f= LEACHING PIT- Sidewall: ((25.0'L+12.83'W)2)2=151.32 sq.ft. NOT TO SCALE BE REMOVED '� '� ABANDON PER Total Area: 472.08 sq.ft. SPECIFICATIONS: � g9.1 9g 11 TITLE 5 1. CONCRETE STRENGTH 5,000 PSI AT 28 DAYS 10) Leaching capacity: State Environmental Code,Title 5,310 CMR 15.242 Effluent Loading Rate for a Class 1 soil with a 2.CEMENT, PORTLAND TYPE II PER ASTM C150-81 F FINISH GRADE TO MATCH -93 Percolation rate of 2 min/in.is 0.74 gpd/sq.ft. 3. REINFORCEMENT PER ASTM C1227 .93 4. 15"RISER SECTIONS EXISTING GRADE- LOAM Leaching capacity: 472.08 sq.ft x 0.74 gpd/sq.ft=349.34 gpd and is greater than the required design flow of 330 gpd. AND SEEDED SHED SHRU O 11) Al system components and construction shall be performed in accordance with the Massachusetts Sanitary Code Title 5,310 TP-1 / CMR 15.000 and Barnstable Board of Health Regulations. Any change to this plan must be approved by the Barnstable Board of C 9g'�� O 1 NEW CONCRETE DB-3 D-BOX, Health. The Barnstable Board of Health must be notified a minimum of five working days,or as required,prior to the start of C construction. To obtain the Barnstable Board of Health Certification,the following inspections must be completed by the Barnstablev► /� H2O RATED w/WATERTIGHT Board of Health or Design Engineer of Record: CEDAR A '- RISER TO WITHIN 6" OF FINISH a.) Excavation of unsuitable materials(absorption system bottom inspection), E GRADE AS-BUILT CERTIFICATION b.) Upon completion of placing backfill materials, ggXA7 C.) Upon installation of the system with all components exposed for inspection and preparation of the As-Built Plan,and P-2' '1 1 HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE,THE d.) Final site grading with secured manhole covers as required. NOTE: gO�XAO '• • EXISTING 1,000-GAL SUBSURFACE SEWAGE DISPOSAL SYSTEM SHOWN HEREON HAS BEEN SITE PLAN IS FOR SEPTIC SYSTEM UPGRADE ONLY, AND SHOULD NOT BE LAWN CONCRETE SEPTIC TANK, CONSTRUCTED IN CONFORMANCE WITH THE STATE ENVIRONMENTAL 12 The contractor shall notifyDI Safe prior to start of any excavation work In order to verify the locations of existing underground CONSIDERED A PROPERTY LINE SURVEY OR CERTIFIED PLOT PLAN. �j %'' , H-10 RATED AND REGULATIONS.CODE,TITLE 5,AND TOWN OF BARNSTABLE BOARD OF HEALTH RULES g p /' utilities. Underground utilities as shown on the Site Plan should be considered approximate locations and vedfled In the field at the 24"0 WHiTE 2'aS a D B'M.100.00 time of construction. PINE " O ASSUMED The contractor Is solely responsible for construction site safety and maintaining safe and stable slopes. Depending upon the Xg9.65 g X6 X9 BULKHEAD excavation depths below grade,the excavation sidewalls should be flattened or braced)to meet current OSHA requirements,or A those specified in local,state and federal regulations. The contractor's responsible person,as defined in 29 CFR Part 1926,should 9gX5a B evaluate all excavations as part of the contractor's safety procedures. CGE Is not assuming responsibility for construction site safety or the contractor's activities;such responsibility is not being implied and should not be inferred. WOOD DECK RONALD F.BUKOSKI,P.E.,LSP DATE 13) Excavation of unsuitable soils within the footprint of the Soil Absorption system to a minimum elevation of 96.23 should be anticipated, and deeper if necessary. Excavation of any unsuitable soils encountered should be removed and replaced with soil ENGINEER'S CERTIFICATION consisting of clean granular Sand,free from organic matter and deleterious substances. Mixtures and layers of different Classes of N soil shall not be used as Fill. The Fill shall not contain any material larger than 2 Inches. A sieve analysis, using a#4 sieve,shall be > 1 HEREBY CERTIFY THAT,TO THE BEST OF MY KNOWLEDGE,THE performed on a representative sample of the Fill. Up to 45%by weight of the Fill sample may be retained on the#4 sieve. Sieve o SUBSURFACE SEWAGE DISPOSAL SYSTEM SHOWN HEREON HAS BEEN analysis also shall be performed on the fraction of the fill sample passing the#4 sieve;such analyses must demonstrate that the d N DESIGNED IN SUBSTANTIAL CONFORMANCE WITH THE STATE material meets each of the following specifications: w �� ENVIRONMENTAL CODE,TITLE 5,AND TOWN OF BARNSTABLE BOARD N '', OF HEALTH RULES AND REGULAT Seise Effective Particle %That Must 0 FULL BASEMENT N o�s' OF�Ss9Oy� Size # Size(mm) Pass Seive AS-BUILT s0 4.75 so 10-100 COMPONENT TIES: -' RONALD F. 100 1.15 0-20 > o BUKOSKi {° 200 0.075 0-5 Points Distance clvlL 00 �No. 32024 GENERAL NOTES: (ft.) '�= �► nor TES AD RONALD F.BUKOSKI,P.E.,LS DAT Record Owner: Heather J.Bassett Trust BD Heather J. Bassett, 50 Main Street,Sandwich,MA 02563 Telephone: (508)888-1281 AE Assessors'Reference: Map 290, Lot 143 BE03 SEPTIC SYSTEM UPGRADE Area: 0.23 A 194 MITCHELL'S WAY Flood Zone: FEMA, Barnstable Map 25001C0568J,Zone X,July 16,2014. Outside 500-year Flood Zone. BF HYANNIS, MA 02601 SUGGESTED SYSTEM MAINTENANCE CF Z oy QUO PREPARED FOR: 1)Provide a permanent septic system chart/plan at a location near the building sewer exit which shows the as-built location of the BG septic tank,distribution-box,and the primary leaching area. CG N \ Heather J. Bassett Trust, Heather J. Bassett, 2) Suggested System Inspection: At a minimum, an annual inspection of the septic tank should be performed by a qualified 50 Main Street, Sandwich, MA 02563 person. The septic tank should be pumped at the owners expense every one to three years,subject to use or when the combined t A depth of the sludge at the bottom of the tank plus the depth of scum at the top of the tank is greater than 1.0-foot. ENGINEERING FiRM: VARIANCE REQUESTS 20"QICOVER + oo U.P. CGE Engineering, Inc. No variance is requested from The State Environmental Code Title 5: Minimum Requirements for the Subsurface Disposal of Sanitary Q®® ® ®® Sewage, 310 CMR 15.000 or Barnstable Board of Health Regulations. R 1 og PIS��LI S CIVII ♦ Geotechnical ♦ Environmental DATE.04/11/16 SECTION PRECAST CONCRETE CHAMBER 4"0 KNOCKOUT NOT TO SCALE (TYPICAL) CONTACT PERSON: RONALD F. BUKOSKI, P.E., L.S.P. 500-GALLON CAPACITY, H-10 LOAD RATED ADDRESS: 21 HILLTOP DRIVE, P.O. BOX 456 SAGAMORE, MASSACHUSETTS 02561 10 TELEPHONE: (508)833-2250 M SPECIFICATIONS: PLAN VIEW SITE PLAN CV 1. CONCRETE STRENGTH 4,000 PSI AT 28 DAYS 2.CEMENT, PORTLAND TYPE li PER ASTM C150-81 3. REINFORCEMENT:6 X 6 X 10 GAUGE WIRE MESH. ++ , DRAWING NO. 1 SCALE 1 _ 10 DR. BY:Jse CKD,BY.RFB '{ .-t CAD FILE NO: 160311 HYANNIS PROJECT NO:160311 SHEET 1 OF 1 i c e