HomeMy WebLinkAbout0300 MITCHELL'S WAY - Health � a�
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TOWN OF BARNSTABLE
LOCATION . �0 l?�> Li�'/��,� G1��c1 SEWAGE # 2ooC
ti'.fL;LAGE� ASSESSOR'S MAP & LOT 291-,fo:
INSTALLER'S NAME&PHONE NO. 1 B
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SEPT?C TANK CAPACITY /DOO
LEACHING FACILITY: (type) :S� �C- �G�iO�Jh�hS (size)
NO.OF BEDROOMS _3
BUILDER OR OWNER /s9/= �t9rLi is�oTD`!
PERMTTDATE: -/%'D(o I COMPLIANCE DATE: 7- 2/- 1:96
Separation Distance Between thel�
Maximum Adjusted Groundwater Table and 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 leachi/ng f�accility) Feet
Furnished by�.oQ, l 7�c` c�✓trry
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No. (J�� Fee �®
THE COMMONWEALTH OF'MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION'-TOWN OF BARNSTABLE.,MASSACHUSETTS
ZippYication for Migoml *pztem Construction Permit
Application fora Permit to Construct{40epair( grade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No.*,;o® Owner's Name,Address and TeL No.
Assessor's Map/Parcel
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Installer's Name,Address,and Tel.No. Jp$—yQp—97.1g Designer's Name,Address and Tel.No.
das eA DEG 8o4rrO S gwev;,46,9^4 f dt/O!"IPG�
Type of Building:
Dwelling No.of Bedrooms 2 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Re airs or Alterations(Answer when applicable) -- —'�
ail
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system,
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi
sate of Compliance has been issued by thi oard of Health.
Sign d Date
Application Approved by Date 7 1
Application Disapproved for the following reasons
Permit No. Date Issued
.. �_ ._.- ...-,-.. .., .r"*.,... ..r••y...r.. �.- -`-r..'°''ti^'Si.: ..w,/�},.. ti• _ 1 rW = Y:.+.-... :c ., w Yr.:�-...•. .ter .J: ..
No. c) 0 a "�^ Fee
THE=C&MONWEALTH OF MASS&HUSETTS';. Enteredlin computer:
V . Yes
4 ff PUBLIC HEALTH DIVISION,:*, ( •OF BARNSTABLE SSACHUSETTS
application for Migogar *p!5tem Cbn.5truction Permit
Application for a Permit to Construct( air.( grade( )Abandon( ) EJ Complete System ❑Individual Components
Location Address or Lot No. O ! lE f O��w/p4er's Name,Address and Tel.No.
V 1�� �l��
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. S"08—yZ�'`�7� Designer's Name,Address and T N SO 77--J-3
clasepti 0� (5i4/"NdS �l✓Es%Nhti/^/dll� ruo/ cy
$�ci��.y,..�if• /?c� /yJ,av'sT'o�/s ��%�,5` /2 tv. �ro.rs�%•E/� �o� ,..fru�aidic.lj . ";
Type of Building: *.
Dwelling No:of Bedrooms 2 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No. of Persons Showers( ). Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Natu,�e/of Rey`airs or Alterations Answer when applicable) �hST� ,v"' �, L 6
qH'Yj Gt/i 7�di � IF
Date last inspected:
Agreement: J
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage,disposal system
in accordancewith the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has b ?Ai u b
�-
y t osar�of-He . V
Signed ` Date
Application Approved by Date 7 hT
Application Disapproved for the'following reasons f
K Permit No. Date Issued l
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY that the On-site Sewage Disposal System Constructed ( 4-1 Repaired ( '�Upgraded( )
Abandoned( )b V0,5 e{o
at .hAa �rwr �=' S !.f/la�J c��Hr1/S has-been constructed 'n c (dance
with the provisions f Title 5 and the for Disposal System Construction Permit No.,�� � �"': dated 7 �� ` ��
Installer JOSep� ���y�- Designer AA 6 tq '��"!ti
The issuance of this permit s all trot be construed as a guarantee that th ystem I fil •tt n designed.
Date Inspector
No=`6,-'_ 3 �
�,y +-y --- -------- ------=-- =Fee > ®
\ THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE; MASSACHUSETTS
s,
Miopogar *p.5tem Con!6truction Permit
Permission is•hereby granted to Construct( Repair�(//� lu,grade( )Abandon( )
System located at �® lgr rdl 1. �
y/l461%/S
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes'his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided: Cora cti n .ust be completed.within three years of the date of this pe I.
Date:_ Approved by -�
f
07/25/2006 10:11 5084775313i ENGINEERING WORKS PAGE 01
I '
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Town of Barnstable
Regulatory Services
p b i Tkowas F. GeQer,DireeW
Public Health Division
Thom"McXAs a,Director
_._,_ _...... M 14 elm Ur*K Hyannis,MA 02601
Q'Ifte 30i-MI 46", i Fax, M 190-6 W
UMLLI ate:■ins=t+lft ea 1Fgg
Date; 2 Sewage parmitai _-._.��. �..._ Atwcaar's Mopkrol!TIIA �
C�eeiraer: P;W .�4F Installer: J oe S�►r+'_ ..c_(
Addtrtts: _ .) --Willi L �• 4mrsss:
1 vim,
o e �S 2�_ '�a c was ISSW!u permit to ina-tall a
(date). ..,, ,crj C S
septic system at._SQo0M1�'G�^• C 1WS„w bgsod on a design drawn by
ic
3-C k. lacdireea)
_ 6
✓_t ,_ dated -� t L.._ �.._.
is�esignei)
1 comfy that the ieptac system referenced ab)ve was installed substarlia?lyy according tc
the dt,sign, which traay include minor approved changes such as latmd rtdoaataan of the
distribunon box,aInaldi septic twu c.
. I certify that ftiseptic s-stcm r�rferenced sbove was installed with rna or chaages (i.e.
gr U'r than 10' lateral r;Qa'tion of the SAS or any ,ertical relocation (if any component
of the septic systcrtt)but in accordance with State& Local Regulations. Plan revision.or
certified ar•built by designer to fallow, Mtn,
� s K or 4i
(itaatalle is Sigraatu ) C+vrt H
a No 9s,�ti
a
igneei igaahire)7�— (AMix Designer'R SM4i Here)
XLL&_-. &I—v1fQ...>C1rt.�'�,YAIMETAaLc MILL .J U3'H Dtv MON.— !:JhtlVY19AUW..2E
,IIi9Li.,&AM AM
BgS� r'�7aP MARINST41H, .'JUIll I:N>< LTH j2:v uaa T M e
`t,flMlttvSepttcrt)vai�ar CaenRcation Form 1.2e•Aa.eoc I
A 2 yCommonwealth of Massachusetts
r� R.
Title 5 Official Inspection Form
? hI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
r (. -v
300 Mitchell's Way
Property Address
Josue Anderson
Owner Owner's Name
information is required for every Hyannis MA 02601 9-26-19
page. City/Town State Zip Code Date of Inspection
w
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.
A. Inspector Information
Shawn Mcelroy
Name of Inspector-Up M
per Cape Septic Services
Company Name
P.O. Box 73
Company Address
E. Falmouth x, MA 02536
City/Town State Zip Code
1-508-495-0905 S13971
Telephone Number License Number
B. Certification
I certify that:) am a DEP approved system inspector in full compliance with Section 15.340 of Title 5
(310 CMR 15.000);1 have personally inspected the sewage disposal system at theproperty address listed
above;the information reported below is true, accurate and complete as of the time of my inspection; and
the inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that
the system:
1. ® Passes
2. .❑ Conditionally Passes
3. ❑ Needs Further Evaluation by the Local Approving Authority
4. ❑ Fails
9-26-19
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 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 form should be sent to the system owner and copies sent to
the buyer, if applicable, and the approving authority.
Please note: 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.
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18
< Commonwealth of,Massachusetts
Title 5 Official Inspection Form
I-I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
300 Mitchell's Way
Property Address
Josue Anderson
Owner Owner's Name
information is required for every Hyannis MA 02601 9-26-19
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary
Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6.
1) System Passes:,
® I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
System is in good working order with no sign of failure.
2) 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):
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18
c Commonwealth of Massachusetts
3 Title 5 Official Inspection Form
li
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
300 Mitchell's Way
J"
Property Address
Josue Anderson
Owner Owner's Name
information is
required for every Hyannis a MA 02601 9-26-19
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
2) -System Conditionally Passes (cont.):
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
❑ 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 Jf(with approval of Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑Y ❑ N ❑ ND (Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s) are replaced ❑Y ❑N ❑ ND (Explain below):
❑ obstruction is removed ❑Y ON ❑ ND (Explain below):
3) 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.
a. 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:
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18
1
Commonwealth of Massachusetts
r� Title 5 Official Inspection Form
:
w:
? C� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
300 Mitchell's Way
Property Address
Josue Anderson
Owner Owner's Name
information is required for every Hyannis MA 02601 9-26-19
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
❑ 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
b. 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 ot•ier failure criteria are triggered.A copy of the analysis.must
be attached to this form.
c. Other:
4) 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
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18
Commonwealth of Massachusetts '
,w Title 5 Official; Inspection Form
P I,4 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
300 Mitchell's Way
Property Address
Josue Anderson
Owner Owner's Name
information is required for every Hyannis MA 02601 9-26-19
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
4) System Failure Criteria Applicable to All Systems: (cont.)
Yes No
❑ ® 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
❑ ® 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 water supply
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 2000 gpd-
❑ ® 10,000 gpd.
0 ® 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
t system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
5) 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 CA.
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
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18
Commonwealth of Massachusetts .
r� .t Title 5 Official Inspection Form
wa
C-'i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
r <.>
300 Mitchell's Way
Property Address
Josue Anderson
Owner Owner's Name
information is required for every Hyannis MA 02601 9-26-19
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
If you have answered "yes"to any question in Section C.5 the system is considered a significant
threat, or answered "yes"to any question in Section CA above the large system has failed. The
owner or operator of any large system considered a significant threat under Section C.5 or failed
under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner
should contact the appropriate regional office of the Department.
6. You must indicate "yes" or"no"for each of the following for all inspections:
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?
® ❑ the Were as built plans of the system obtained and examined? If were not.
( Y
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?
® ❑ Wasthe 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)]
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
wig
hI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
300 Mitchell's Way
Property Address
Josue Anderson
Owner Owner's Name
information is required for every Hyannis MA 02601 9-26-19
page. City/Town State "Zip Code Date of Inspection
D. System Information
1. Residential Flow Conditions:
Number of bedrooms (design): 3 Number of bedrooms (actual): 2
DESIGN flowbased on 310 CMR 15,203 (for example: 110 gpd x#of bedrooms): 330
Description:
Number of current residents:
1
Does residence have a garbage grinder? ❑ Yes ® No
Does residence have a water treatment unit? ❑ Yes ® No
If yes, discharges to:
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No
information in this report.) -
Laundry system inspected? ❑ Yes ® No
Seasonal use? ❑ Yes ® No
Water meter readings, if available (last 2 years usage (gpd)):
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: 9-2019
Date
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18
Commonwealth of Massachusetts
P
Title 5 Official Inspection Form
i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
300 Mitchell's Way
Property Address
Josue Anderson
Owner Owner's Name
information is required for every Hyannis MA 02601 9-26-19
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
2. 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
Water treatment unit present? ❑ Yes ❑ No
If yes, discharges to:
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
Last date of occupancy/use: Date
Other (describe below):
3. Pumping Records:
Source of information: N/A
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
J`r.
300 Mitchell's Way
Property Address
Josue Anderson
Owner Owner's Name
information is required for every Hyannis MA 02601 9-26-19
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
4. 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):
Approximate age of all components,,date installed (if known) and source of information:
2006
Were sewage odors detected when arriving at the site? ❑ Yes ® No
5. Building Sewer(locate on site plan):
18"
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.):
Good condition.
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
300 Mitchell's Way
Property Address
Josue Anderson
Owner Owner's Name
information is H annis MA 02601 9-26-19
required for every y
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
6. Septic Tank (locate on site plan):
Depth below grade: 12"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: 1500 gal
Sludge depth:
12"
Distance from top of sludge to bottom of outlet tee or baffle
20"
Scum thickness
3"
Distance from top of scum to top of outlet tee or baffle
5"
Distance from bottom of scum to bottom of outlet tee or baffle
13"
How were dimensions determined? Tape
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 is in good condition with baffles installed and no sign of leakage. Recommend pumping for
heavy solids.
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18
Commonwealth of Massachusetts
I � ;w Title 5 Official Inspection Form
10111 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
;,
300 Mitchell's Way
Property Address
Josue Anderson
Owner Owner's Name
information is required for every Hyannis MA 02601 9-26-19
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
7. 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
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
8. Tight or Holding Tank (tank must be pumped at time of inspection)(locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity:
gallons
Design Flow: gallons per day
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Fora
i'l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
300 Mitchell's Way
Property Address
Josue Anderson
Owner Owner's Name
information is required for every Hyannis MA 02601 9-26-19
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
8. Tight or Holding Tank (cont.)
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
9. 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.):
Good condition with water at working level and no sign of back-up.
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18
Commonwealth of Massachusetts
1 � ,w Title 5 Official Inspection Form
a i,i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
300 Mitchell's Way
Property Address
Josue Anderson
Owner Owner's Name
information is required for every Hyannis MA 02601 9-26-19
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
10. 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.
11. Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Type:
❑ leaching'pits number:
® leaching chambers number: 5-LC6 chambers
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18
Commonwealth of Massachusetts
r� 4. Title 5 Official Inspection Form
w.�
i-'i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
300 Mitchell's Way
Property Address
Josue Anderson
Owner Owner's Name
information is required for every Hyannis MA 02601 9-26-19
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
11. Soil Absorption System (SAS) (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Leach field in good working order and empty at inspection with no sign of back-up.
12. 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
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18
Commonwealth of Massachusetts
3, Title 5 Official Inspection Form
i,i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
300 Mitchell's Way
Property Address
Josue Anderson
Owner Owner's Name
information is required for every Hyannis MA 02601 9-26-19
page. City/Town State Zip Code Date of Inspection
D. System Information cont.
Y (cont.)
13. 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.):
t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
a
300 Mitchell's Way
Property Address
Josue Anderson
Owner Owner's Name
information is required for every Hyannis MA 02601 9-26-19
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
14. 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 belcw:
® hand-sketch in the area below
❑ drawing attached separately
CLC
f
1
10
serf
_ f
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18
L
Commonwealth of Massachusetts
,'. Title 5 Official Inspection Form
0) Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
300 Mitchell's Way
Property Address
Josue Anderson
Owner Owner's Name
information is required for every Hyannis MA 02601 9-26-19
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
15. Site Exam:
❑ Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow wells
Estimated depth to high ground water: 12
feet
Please indicate all methods used to determine the high ground water elevation:
® Obtained from system design'plans on record
If checked, date of design plan reviewed: Date
® Observed site (abutting property/observation hole within 150 feet of SAS)
® Checked with local Board of Health -explain:
® Checked with local excavators, installers- (attach documentation)
❑ Accessed USGS database - explain:
You must describe how you established the high ground water elevation:
Original design plans show no groundwater at 12'.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18
Commonwealth of Massachusetts
3, Title 5 Official Inspection Form
w.�
Ci Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
tir, > 300 Mitchell's Way
Property Address
Josue Anderson
Owner Owner's Name
information is required for every Hyannis MA 02601 9-26-19
page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
Complete all applicable sections of this form inclusive of:
® A. Inspector Information: Complete all fields in this section.
® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked
® C. Inspection Summary:
1, 2, 3, or 5 completed as appropriate
4 (Failure Criteria) and 6 (Checklist) completed
® D. System Information:
For 8: Tight/Holding Tank—Pumping contract attached
For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached
For 15: Explanation of estimated depth to high groundwater included
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18
L
Town of Barnstable P# 1 13 q
Department of Regulatory Services
„A 61A ; Public Health Division Date ` (�
iti y 200 Main Street,Hyannis MA 02601
3
Date Scbeduled Vy Time C l Fee Pd.
rt
Soil Suitability'Assessment for Sewage Disposal
Performed By: Ft�' r M C&0_"— Witnessed By�y,`�X 1&'QW
LOCATION& GENERAL INFORMATION
Location Address '
Owners Name tOl
Address
Assessor's Map/Parcel: 2 q l_j U 4, L o- Y6 b Engineer's Name j2e*Cr " A'�C '
NEW CONSTRUCTION 6 REPAIR Telephone# �� 4_3 7— 5 S 12
Land Use 9&54 l@ in k`, Slopes(%) \- ' Surface Stones /W® o
Distances from: Open Water,Bodyft Possible Wet Area ft Drinking Water Wellft
Drainage Way ft Property Line �. ®Y � • ft Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands?n proximity to holes)
��
Cn r'
. �_j'
C 99 inks
w
Parent material(geologic) Depth to Bedrock �� rC t=
Depth to Groundwater Standing Water in Hole: A4X L Z4 t/ Weeping from Pit FQce,-_ -.,L-JJA ,
Estimated Seasonal High Oroundwater. (2A t t
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used:Depth Observed standing in obs.hole: /kOp _ in, Depth to sail mettles: At/A
Depth to weeping from side of obs.hole: in. Groundwater Adjualment tt.
Index Well# Reading Date: Index Well level„� Ad).factor, Adj.fitoundwater level
PERCOLATION TEST Dite L('Im.. Time I Lti_w h
Observation
Hole# h Time at 9"
tt `t
Depth of Perc r A � Time at 6"
Start Pre-soak Time @711 L lime(9"-6") ---
r
End Pre-soak (teak
F Rate Min./Inch
Site Suitability Assessment: Site Passed _ Site Failed: Additional Testing Needed(Y/N)
' Original: Public Health Division Observation Hole Data To Be Completed on Back---- -----
***If percolation test is to be conducted within 100' of wetland,you must first notify the.
Barnstable Conservation Division at least one(1)week prior to beginning.
Q:\SEPTICIPERCFORM.DOC
DEEP.OBSERVATION HOLE LOG Hole# I
Depth from Soil Horizon Soil Texture
Sdil Color
Surface(in.) (USDA) Soil Other
(Munsell) Mottling (Structure,Stones;Boulders.
o i tenc v 1
� -S
-�w LS 7tiP
��4 � "
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture
Surface(in.) Soil Color Soil, Other(USDA) (Munsell) Mottling (Structure,Stones,Boulders.
to YX
�6 - 7,
S4I%d 2 . 6�
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture
Surface(in.) Soil Color Soil Other
(USDA) (Munsell) Mottling (Structure,Stones,Boulders.
---------------
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture
Surface(in.) Soil Color Soil Other.
(USDA) (Munsell) Mottling (Structure,Stones;Boulders,
nsi n
Flood Insurance Rate Map.•
Above 500 year flood boundary No Yes
Within 500 year boundary No yes
Within looyear flood boundary No-,K Yes '
Depth of Naturally Occurrine 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? ` J
If not,what is the depth of naturally occurring pervious material?
Certification
• I certify that on oat� •
(date)I have passed the soil evaluator examination approved by the
Department of Environmental Protection and that the above analysis was performed by me consistent with .
the required tramini,expertise and ex erience described in 310 CMR 15.017.
Signature Cam---. �j
Date -1 I �1
Q:SEMCNPERCFORM.DOC
L04ATION -,00 SEWAG-E PERMIT NO.
/3. ' #-�' o
VILLAGE
INS A,L _LE`R'/S� /111AME A+ A0D91ESS
D U DER OR OWNER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED /�.`Ve4
V7
J �
N ,
.00000
o L�
No. - Frzs.... .Q�
LTH
/ THEBO/"'OR®A® OFHEALTI-I TS ,
a < �
ApplirFatiun for DiipuuFal Workii Tiati rttrtiun Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair of �) an Individual Sewage Disposal
System at: '
--....A _----8--•--�l�j........... . . ../.-Z7e �11.-14---. ......-----
� t�
r , / r LLocat A ot...N�o
..
..... .... ......... /• . ..ti .. ! ,&.:).......
/c resse ......._. •••.•.--••l Z � _.... ! Ot ._. . ....�....
� Allier Address
* Size Lot.
Building
�}.�.I✓%%may.
feet
Dwelling—No. of tedrooms......... ..............................Expansion Attic (�'� Garbage Grinder ( )
Other—Type T e of Building No. of persons t� YP g ----�----------------- P 5..�-------------- Showers ( ) — Cafeteria ( )
dOth'�pr fixtures ....... !_!!�_1...............................................................................----------•--------------------------------•-•-•
W
Design Flow...._`=� ......................gallons per person er day. Total daily flow.................___.........._....__....__gallons.
WSeptic Tank—Liquid capacity�.��"'gallons Length ..... .... Width...C!_•W DiameteiA' !`fl.... Depth.._!d_ '
x Disposal Trench—No. .................... Width.................... Total Length....__..__y Total leaching area------------ .__. sq. ft.
Other DiSeepage stribution box ( ) Diameter-- Dos g tato Depth)Uelow inlet......b........ Total leaching area.. f. sq. ft.
~' Percolation Test Results Performed by..--,�� �i� ......".%J'aj............... Date------- .......
Test Pit No. I...2,.40...minutes per inch Depth of est Pit.................... Depth to ground water_.___..�,5tr
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....................
x . ..... - h . r ODescriPtion of Soil........ - -- -----------------------------------------------
V — ti .
x Nature o-- Repairs or Al a�ionsG• :/,l_....- --`-...--•----------------------•----------------------------------------------------------------------------.
U pAnswer when applicable.---------------------------------------------------------------------------------••-•••••.•...
--------------- p �-
Agreement: •. Y`��9�
The undersigned agrees to insta the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iITIE 5 of the Sta e Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance as en ' ed by the boa f ealth.
Sig !'�
Signed ll'. ............................
.�"-_�y.... ���y�•
fDatyApplication Approved By........_.. ....................:..•• "' `�` C.) fte
Application Disapproved for the following reasons-................................................................................................................
---------------------------------•------............------------------------------------....------------.-•-••-----••----•-•----••-•----•--•---••----••••••----••••------•---••-----••••--•••••...--.---
Date
PermitNo......................................................... Issued-.......................................................
Date
No..............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
................................OF..........:..............
Apptirtttiou for Disposal Works Toustrurtiott "amit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
................-........_...................................................................... --•--------•-•-----••--------------•------•------------•-••-•--•-------•--.._.._..--•-•-•---------
Location.Address or Lot No.
......................—........................Ownerr Add--.... ....•--•-----•--......•................... ..........................•-----------•---•---•------•ress ..........................................
W
Installer Address
Type of Building Size Lot............................Sq. feet
�-. Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
dOther fixtures --•--•-------------------------------------••----------•-•----•••-••--••--•----•---•--------•---•-------......-•-....••-•-•---•------..........--•...
W Design Flow............................................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. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-.-._....-..---.--..--.0-4
fro Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.....---....---.........
a' -----------------------------------------------------------•---...---------.........---••------••--..................................... ------------------
ODescription of Soil.......................................................................................................................................................................
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 TITLE 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........................•------------•---------.......-•-------•--......----•-..---•-- ................................
Application Approved BY .
4!
� -- ••- .....�y. .......................•-------•------- --•-----------
------------i /- t!
Application Disapproved for the following reasons:..............................................................................................................
_
---------------------------•-•-•---•-----.....--•-•----------•----•---•-------.......------..........--•
Date
PermitNo......................................................... Issued-.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF.....................................................................................
Cnrrtifiratr of Trrmplittttrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by--- - =------------------••---------•-••-------•--- -•--......------------------. -----------------•-•-----•-•-•-----•-----------:...--....---------........--------•--•---------
_ / Installer
-- -----------------•------
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit NO.---.i................................... dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE Z l fl Inspector.... .................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...........................................OF............................................----.....................................
No..�._...._._:�__�.... FEE........................
Disposal Works Tlamitrttrtiou rrutit
Permission is hereby granted--------- .t-t r.....................
•-------------------------------------------------------
---------•-.... ----------
to Construct ( 4 or_Repair ( ) an Individual Sewage Disposal System
at No.----- ....I-A- `�5 ...`.J..z 1�S �.1�<v
..............•..._•--- •----.----- ------....---------------------•-----•-----------------------------------..........-----
Street
as shown on the application for Disposal `'storks Construction Permit No.?�.�........ t�dr`�.....................................
............................-•---�---G-•-----------------....---•---•--._....--•-----•--..._.._....-------
Board of Health
DATE................................................................................
FORM 1255 A. M. SULKIN, INC., BOSTON
o
i 9
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OAT
30 t ► ._38`r
T �
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OF Ss 99
ZH (9
W
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No.10951 O 4 `0
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.0 •Q�CIv/lQ� �4i M w. L oTSIT / s
ON
6
'`ssro ���
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79,5
RUNE". ", o 9 „ . .....
BhucE
1
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LEGEND
sh
EXISTING SPOT ELEVATION OX0
BISTIPIO` CONTOUR ® --- CERTIFIED PLOT PL:AN_
FINISHED SPOT ELEVATION
`FINISHED CONTOUR 0
NOTE: The location of any existing Undeu-round sewerage, 1N r
wells, or other utilities shown on this Plan is approx-
imate only as determined from records and/or verbal ♦ -`
i;n£ormation; -.The contractor is responsible for the �� '"'' � "�� +
verification of the- existing locations in the fielid.; gCAI.E� '� DATE e:`M... 4
l DREDGE ENGINEERIIVQ CCA IIV_ ,fi:R nSrAR E ?
CLIENTot .- I CERTIFY THAT THE PROPOSED
EaI3TERl REGISTER J08 NO.RV0 a BUILDING SHOWN ON THIS
PLAN {
CIVIL. LAND )CAA CONFORMS TO THE ZONING 'LAWS
DR,BY'7z
NO NF�ER R OF BARNSTAf3L E'" M 5
712 MAIN STREET CH. ®Y�. ' t
HYANNIS, MASS
SHEET.L� OF ='- ATE REG. ' LAND SURVEYOR
4
.77
IK
lz
CA q
_ (.'• oa . � �►a o o va U O o f
o �� ..y _ h � r a � ` U j yaw14
� � � • w • tee • ♦ � � � It
ft
V ��•
`,' L.
\ V
� � tim �W W q were
a ockr'
vo Z
• y .. '`
14
rl
ki
-14
41\ TS
Qr
rr
La u
v w .
�y
ry 2 C 0 . d' �`�" roRis
UN
c
aew yhaHW� P
,�• 14
4kfj
Q�
V
in
*I
� � oZo ?
;.ems
r f`( r rrr i I f;c.�r°rl,c r; "ba t c
IIIrr! ""MIND I I VCI. CUMPUTATIUN a.
Site L oc�l t ion
Owner: No.
f� -_... ��)�.P,)r/ _ Add r (, --
s s ,
Contractor:
----
Notes: — ' ——
STEF' dcl)lli t(:r wrrlcr ae
to
table t
. .. t I/lU ft: _
t
. . . . . . . . . . . . . . . . . . . . . . .
-
•
d a I
STEP 2 U_; irig Water-Level Ran( e Zone and Index We I flap locate
site and dr t e rm i ne: fur,
A) Appropriate index well �J/(ri
_J� ."
ty
E{) Water-level -- -
ranyc zone I 4
—
STEP
3 USind nx�nt.hly report Current
l '
Wai:er Resoure.Cs Conditions"
dc..tcrrnirle current depth to L✓kn_
water level for index well r
_.._._..._._... rno y r
STEP ' 4 Usi.ng Table, cif Water level l
- - ,
Adjc�' tmrnI {r�r i►7c{e_x wr
,tr>
r'earat 4.11. F>C lr ".try p
watG►. level for index we) l
(STEP 3) , and water-lc�.vel
zone (STE:P. 2B) determine
- sl
water- eve adjustment -
_S1'EP S Estir-late d(•pth to high water r`+}
Y 3 tliG waI er•_
level adju.:tnr( nt (STLf' 4)
f roil illeasurc-d der{nth to watcr I ....,__._._.
-'- 1 at si le (STEP l ) s
�a
1 ( '
1
j I
t
ov
�1
� r
00. iJ
y 3
7 Alji.
a
pisY�,99,L4 I'd
c{ h p y N AY
3d fT
or /I1 �r
OF.. 9y,�
p
W �9
4-
0 ORSE
to No 1o851
p�,crV/ LoT 6
F
44
Gar RoRI_RT "�'K1'�b �---- N�Z°35,00„w 9. ;
FLraazr C L L v./
ft Sul ,
LEGENID tj
EXISTING SPOT ELEVATION OxO
EXISTING "`CONTOUR --- 0 CERTIFIED PLOT PLAN
`FINISHED' SPOT ELEVATION [ �-
FINIS�OI~D CONTOUR ® UT
NME:. 'The- location of. any exis r ing underground sewerage,
bells, or other utilities shown .on this plan is approx- 1N
imate only as determined from records and/or verbal
information. The contractor is responsible for the
u,erification of` the existing locations in the field. SCALE. "= o GATE
LDREDGE ENGINEER/NO CO. IN ,c�,�^'sT�.���
CLIENT '' I` CERTIFY THAT THE . PROPOSED' .
' EGIST,ERE REGISTERED JOB.N0. 4
BUILDING SHOWN ON THIS PL AN `
' �',
CIVIL LAND CONFORMS TO THE .ZONING LAWS:;,
DRY BY 7z
NO FEE R OF BARNSTABLE ,
712 MAIN STREET CH. By,
gy
NYANIV 1 S AAA9S. :---- -
SHEETS OF ATE REG. 'LAND ` SUFtVfwYOR
LOCA'X'ION 3C e C S 0-�.; _St-WAGE,►� ,:....:,
VMLAIO A ES S.OIVS MAP LUT
zNTA . :i ��sr slogs taro
EMC TANK CAPACITY oZro
L& G 1PACII.ITSP s t e) (size)
�LD o�m lz
pBRIWlB -DA'X'E.
�S�ptuatio���tat�e BeEv�eert kBtni . .
Maxlmdin. gated 0rdoWw'ger Uble la e tmiWrh L t. Iflff,fkility. �...... ,,.,,......-_.. . l F
i��tvaEe J'atae Su +ly ltsfl twd L.4o upo f acility:Of eny walls'cxist
� a�eit�ae wlt�ia 7Ap feat aF toitsbrrt�'F�cUity) ��#
Esl t�cyf'Wet"d_utd l.e icinit�� +ec,Afty.(1 +,y wellancis exis4
fee R
:iOoott:300 feet Fleac,itas ftadilx )..: r ...�.�
#shod:
443
w (1_
su /
1 VI O
V"
M
O
PROPOSED CONTOUR
e eVl 1 ? T dqe +; r 9 ]
....... PROPOSED SPOT GRADE
t /.�/.�....... ....... .
9
_�'� �' •y`Y C� •• - r' - EXISTING CONTOUR '
S 74 4040 O ��; f EX/STING SEPTIC TANK - �' - LOCUS °a
E ! _ - TOP OF TANK EL.=104.57
7 •- + 96„52 EXISTING SPOT GRADE
S 00 INV..(OUT)=103, 18 \ �t~
• ------- � '4i W— EXISTING WATER SERVICE
'� _ •3 ! 7700, 0.H• ({�/ EXISTING OVERHEAD WIRES
-'�- ® TEST PIT North s
0.
}
STREET MAIN ST
2 `� •.f *L �'`•.� 'ter � /f,\ ;y: Jael
",; = �,�, ' , LOCUS MAP N.T.S.
EXISTING S.A.S. 'jt 1
TO BE PUMPED & ✓ � / > w, `�, `�`� �r ; -� c;
FILLED WITH SAND - `\ EX/ST/NG``� "�, ;' k � , GENERAL NOTES:
PTO '1 s DWELLING (#300) r ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL
\ TOF=107.28 G ` ''` BOARD OF HEALTH AND THE DESIGN ENGINEER.
~ \ � .�, 'eo 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS
(Assumed):w w ,, y ,_ O \ OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE
LOCAL RULES AND REGULATIONS.
Benchmark Set ~ G k ` " ~ C'A
3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR
vj =ti, mow, z �' TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE
Right cor. bulkhead \ ,.,;` <ci ty N DESIGN ENGINEER.
4 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING
D.=106.43 (Assumed) `�� ;ham_ , \, v; FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN
cj ENGINEER BEFORE CONSTRUCTION CONTINUES.
5. ALL ELEVATIONS BASED ON ASSUMED DATUM.
6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF
\ �.. THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF
HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION.
7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE.
iy' 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED
\ TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR.
e w
,BACK OF HOUSE;';: r ; - — '- ,.. , _ ,
2 1 _ ,,`kf :' 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE
i '� THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING
CONSTRUCTION.
9\ Lot B 10, WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS
l " 4 n �' IN THE AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF THE S.A.S.
Map 29 i `k AND REPLACE WITH CLEAN FILL AS SPECIFIED IN 310 CMR 255(3).
Parcel 3a4
\ \ 15,582f S.F. ,
\ vt \ 0.36f' AC.
T`K
0.
\ •O `\ \ i FLOOD PLAIN DESIGNATION
A"/ Community—Panel No. 250001 0005 C
OF
\\\. \\ �,� \ �J Map Revised: August 19, 1985
6+. \\ ''9 SF \\ P��� SSq� �$ Zone „C„
PETER T. BOA \ 6 .l� ,�t10�
McENT
CIVILEE "' \i(,Y 0� , j ,C> PROPOSED SEPTIC SYSTEM UPGRADE
No. 35109 ern,' e, 300 MITCHELL S WAY, HYANNIS, MA
RECJSjER ` , Prepared for: Jacqueline Washington, y, y
ESS/ N L�N6
� � 300 Mitchell's Way, H annis, MA 02601
Engineering by; Surveying by: SCALE DRAWN J08. N0.
,^ Enghleelfngftib Warner Surveying 1"=20' P.T.M. 186-06
S.A.S. LAYOUT /�1 t��� �, 12 West Crossfie 0 Ha Rood Long Road
( Forestdale, MA 2644 Harwich, MA 02645 DATE CHECKED SHEET N0.
{{ (508) 477-5313 (508) 432-8309 7/17/06 P.T.M. 1 Of 2
R
f�
I;.
NOTE: TO PREVENT BREAKOUT, THE PROPOSED
FINISH GRADE FCR A DISTAN EHALL OF 5' AROUND THE
3.0
EL.105.2t F.G. EL.105.2t f
F.G. EL: 104.5t FINISH GRADE = 106.0 (MAX.) PERIMETER OF THE S.A.S.
a / 1 MAINTAIN 2% MIN SLOPE OVER LEACHING AREA
A / PROVIDE 4" SCH 40 PVC INSPECTION PORT
INSTALL RISERS OVER.INLET & OUTLET 1 WITH SCREW CAP SET TO FINISH GRADE
' TO WITHIN 6" OF FINISH GRADE I SOLID PIPE
L =18'(MAX)
a L =22' PERFORATED PIPE
4" SCH -40 PVC 4" SCH 40 PVC
—T 6" - - 2" LAYER Of 1/8"
e L48"
0 S= 1% MIN. 6 ®�® TO 1/2" DOUBLE
14" ® S= 1% (MIN.) WASHED STONE
LIQUIDINV.=103.t8t.(EXISTING) LEVEL 12" EFF. 4' 3' 41 3/4"-1 1/2"
ADD GAS (EXISTING) D-80X DOUBLE WASHED
INV.=102.86 DEPTH
BAFFtE EFFECTIVE WIDTH = 11' STONE
EXISTING 1000 GALLON SEPTIC TANK INV.=102.69 INV.=102.50
NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING
PIPE INVERTS PRIOR TO CONSTRUCTION.
GRADE ON A MECHANICALLY COMPACTED SIX
2) D—BOX SHALL BE SET LEVEL AND TRUE TO TOP CONC. ELEV.=103.3 —BREAKOUT ELEV.=103.0
INCH CRUSHED STONE BASE, AS SPECIFIED IN INV. ELEV.=102.50 ®®®O®®® ,
71/2• 310 CMR 15.221(2). ®®®®®®®
J-5"DIA. INLETS 5-5"DIA. OUTLETS 3) INSTALL INLET & OUTLET TEES AS REQUIRED, BOTTOM ELEV=101.50
.
'�7' 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE 1.5' 5 UNITS x 6' = 30' 1.5'
I ?" " AS MANUFACTURED BY TUF—TITE, ZABEL OR EQUAL
Is v2• 5' MIN. ABOVE MAX. SEASONAL EFFECTIVE LENGTH = 33'
SEPTIC SYSTEM PROFILE HIGH GROUNDWATER ELEVATION
a BOTTOM OF TP-1, EL.=94.5 LEACHING SYSTEM SECTION
N.T.S.
FILL SIDE KNOCK—OUTS
WITH MORTAR Top mew Section
A
WIGGIN DB-5B o -PETER T.
DISTRIBUTION BOX SOIL `LOG CD
McENTEE
-- - DATE: JUNE 129, 2006 (Ref.# P-11341) DESIGN CRITERIA avlL
No.CIVIL
N.T.S. 35109
SOIL EVALUATOR: PETER T. McENTEE.C.S.E.
INSPECTOR: DONALD eDES MARAIS, BARNSTABLE B.O.H. NUMBER OF BEDROOMS: 2 BEDROOMS po �'FO/ST���� ��
104.8 SOIL TEXTURAL CLASS: CLASS 1 f SSIO
Elev, TP- 1 DD Eiev. TP-2 Depths DESIGN PERCOLATION RATE: <2 MIN/IN j
- ---------,
105.2 0" DAILY FLOW: 220 G.P.D. ✓- t�,
104.8 Q
- 4' KNOCKOUT ! A SANDY LOAM A SANDY LOAM DESIGN FLOW: 330 G.P.D.
20"ow COVER I 1OYR 3/3 ' 10YR 3/3
I 104.1 8" 104.7 6" GARBAGE GRINDER: NO
CD
B LOAMY SAND li B SANDY LOAM EXISTING SEPTIC TANK: 1000 GAL. CAPACITY
4'KNOCKOUT 4'KNOCKOUT I " 102 8 10YR 5/8 24" 102.5 10YR 5/8 32„ LEACHING AREA REQUIRED: (330) = 445.9 S.F.
I C1 M—C SAND C1 M—C SAND .74
-------------------- 4_KNOCKouT--__--__-; 10YR 5/4 .l 10YR 5/4
101.8 36" USE 5—LC-6 LEACHING CHAMBERS IN SERIES
I— 72" C2 46„ 99.7 C1 66" SIDEWALL AREA: 2(11' + 33') X 1' = 88 S.F.
PLAhI VIEW MED. SAND M_C SAND BOTTOM AREA: 11' x 33' 363 S.F.
2.5Y 6/3 52„ 451 S.F.
77 2.SY 6/3 TOTAL AREA:
• -------------- ---------------, --- 66»
® ® ® ® ® ® ® 2z ® ® ® , 99.3 C3 _ 92" DESIGN FLOW PROVIDED: 0.74(451.00) = 333.74 G.P.D.
INVERT � I n10YR 4/4D � 97.5 Cl
12" '; ® ® ® ® ® ® ® i I 20%GRAVEL PROPOSED SEPTIC SYSTEM UPGRADE
92 MED. SAND
f 72" r - 36" J 97 1 C4 2.5Y 6/4 300 MITCHELL'S WAY, HYANNIS, MA
END VIEW M—C SAND
SID VIEW 10YR 4/6
WIGGIN LC-6, H-10 LOADING 94.5 124" 94.9 123" Prepared for: Jacqueline Washington, 300 Mitchell's Way, Hyannis, MA 02601
Engineering by: Surveying by: SCALE DRAWN JOB. NO.
LEACHING CHAMBER NO G.W. ENCOUNTERED Englneeift#Orkr Warner Surveying N.T.S. P.T.M. 186-06
PERC RATE < 2 MIN/IN. (24 GAL/7 MIN) 12 West Crossfield Road 22 Long Road DATE CHECKED SHEET NO.
Forestdcle, MA 02644 Harwich, MA 02645
N.T.S. (508) 477-5313 (508) 432-8309 7�17�06 P.T.M. 2 of 2
t