HomeMy WebLinkAbout0390 MITCHELL'S WAY - Health 00
390 Mitchell's Way
Hyannis.. P
A =. 291 045
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TOWN OF BARNSTABLE
L ATION 390 M C6Q S W SEWAGE # 0�
VZ'11—AGE 14i jo-j3 fi ASSESSOR'S MAP & LOT
INSTALLER'S NAME&-PHONE NO. e�aDg w,d-2 Cn+. a F Y dF
SEPTIC TANK CAPACITY l o o O
LEACHING FACILITY: (type) 5- in (size) I 0 Y :3A
NO.OF BEDROOMS
BUILDER•OR OWNER Q v
PERMITDATE: COMPLIANCE DATE: (Z Kam- *
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility �l 7S- 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''eiust
within 300 feet of leaching facility). Feet
Furriished by LLC
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TOWN OF BARNSTABLE
L&Ci. TION 390 PUCA//3 I W V SEWAGE #
VII-LAGE 114iz 1 9 ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. X lyey,',4 4 /175119 e.cAan.3
SEPTIC TANK CAPACITY Asl-j (So-/ %h
LEACHING FACILITY: (type) �P/I .li� e2e (size)
NO. OF BEDROOMS
;MR-OR OWNER XV 764 �lrfli/c.'S
P*€ .DATE: COMPLIANCE DATE:->
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 4 J 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 eaching facility) Feet
Furnished by Xvw l/
G
f
J
No. c �� Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: c/
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
2.pplitation for Nsposal *pstpm Construction permit
Application for a Permit to Construct( ) Repair`N4 Upgrade( ) Abandon( ) ❑Complete System ZIndividual Components
Location Address or Lot No. 39�® ( 11�G � 1a�4 Owner's Name,Address, d Tel.No,,
Assessor's Map/Parcel y5
Installer's Name,,Address,and Tel.No. �`z` Designer's Name,Address,and Tel.No. 3e<5`331
Type of Building:
Dwelling No.of Bedrooms Lot Size a, t4U,c > Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) a Q gpd Design flow provided 7,�2 gpd
Plan Date 3 Number of sheets Revision Date
Title
Size of Septic Tank O ��` Z'h� 5' pe of S.A.S. mil CAP!
Description of Soil 7SC—_,—,!n
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.
Sign Date F, '
Application Approved by ` Date „L
Application Disapproved by Date
for the following reasons
Permit No. �O 2- 0 f-r Date Issued 3 a
Fee
9 N�
No. :. G'�. v e t
THE COMMONWEALTH OF MASSACHUSETTS Entered in compute.__._,
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
�Applicatlott for Misposal 6pstettt Construction Prm t
Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System Zindividual Components
L o cation Address or Lot No. 3��j l�\'i�G -=\�$�tJ.o( Owner's Name,Address,and
Tel.No.
27
Assessor's Map/Parcel ` �� ��� ���� , V �� t
Installer's Name,Address,and el.No. Designer's Name,Address,and Tel.No.
Hype of Building:
Dwelling No.of Bedrooms Lot Size (G1. t§zy.€h Garbage Grinder( )
r-
Other : Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures 1WPOi4d 0Z()Z,ij X14
Design Flow(min.required) ?3�] gpd Design flow provided 7 gp'd W
Plan Date ' ('] Number of sheets Revision Date
Title
Size of Septic Tank e of S.A.S. ; rp,
Description of Soil 1 -moo
Nature of Repairs or Alterations(Answer when applicable)
4-+ w
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
w '''Compliance has been issued by this Board of Health. 1
Sign ✓ Date -Z, 1 ("
Application Approved by 1 Date
s
Application Disapproved by Date
for the following reasons
Permit No. 0 2 -1 U&T Date Issued o
------------------------------------------------------------------------------ --------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded
Abandoned( )by ,� t--
at ? \ 1 has been cons d'�M"accordance
49
with the provisions of Title 5 and the for Disposal System Construction Permit No.2 o 2 d, dated A 0
Installer � i�--�`' k��t�"f:. � Designer V�J1�P�r l`-#• -n.�,G r,r'
WW' _W#bedrooms Approved design flo, 7 ?o gpd
The issuance of is pe it shall not be construed as a guarantee that the system will tur]ctil as des'gne
Date 7 -71 Do Inspector
' -- ---------------------------------------
-------------- - - - --- -
No. Ct () - C�A Fee tl `
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS R
Misposal 6pstem Construction permit
Permission is hereby granted to Construct( ) Repair(t/f Upgrade( ) Abandon( )
System located at �<:� �) 1 r ��o_ C��_k A
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 completed within three years of the date of this permit.
Date- ? f Approved by 'J
1
Town of Barnstable
� E Regulatory Services
Richard V. Scali, Interim Director
* STABLE,: Public Health Division
s63Q Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Homeowner Certification Form for Alternative Systems
Property Address: 3 c( O
Assessor's Map\Parcel:
Property Owners Name:
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 'Y' in the
applicable box next to each line certifying the information.
Yes
N\A
LY ❑ 1 have been provided a copy of the Title 5 I/A technology Approval letters.
(1 5 page Standard Conditions letter and the specific technology letter)
❑ D/I have been provided with the Owner's Manual
❑ YI have been provided with the Operation and Maintenance Manual
❑ IFor Systems installed under a Remedial Use Approval, I agree to fulfill my
responsibilities to provide a Deed Notice as required by 310 CMR 15.287(10)
and the Approval
❑ 1 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
L1� ❑ 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
I , agree to comply with all terms and conditions above.
Property OWners printed name
L. ��'A'� . 5�c
roperty Mvners 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, repairs\upgrades, with and
without a22re2ate (stone) and with conventional design criteria or credited design
criteria.
QASeptic\IA homeowner certification.doc
Town of Barnstable
Regulatory Services
Richard V. Scali, Interim Director '
��ws r • FY 1
MASR Public Health Division
16;p.
" Thomas,McKean,DirectorF;
200 Main Street,Hyannis,MA 02601 `+
Office: 508-862-4644 Fax: 508-790-6304
Installer& Designer Certification Form
Date: 31 6 Sewage Permit#QCNx Y ?T Assessor's Map\Parcela-n—( 6�(�
Designer: ,� IYLC Installer:
Address: 3 �01 Address:
Sy�1• " v/ l V—t ft
�rz-<3�
was issued a permit to install a
(date) (installer)
septic system at 0 17—at� based on a design drawn by
(address)
2
`�`�►� dated
(designer)
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
of the IAA approval letters(if applicable)
?� OF
a
ns Her's Signature
. 1140 j J
ere
(Designer's Signature) (AffixWO
)
PLEASE RETURN TO B TABLE PUBLIC HEALTH ERTIFICATE
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
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Commonwealth of Massachusetts
_ Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
390 Mitchels Way
Property Address
JDS Realty Group
Owner owner's Name
informatin
required forts Hyannis MA 02601 10/25/09
every 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.
Important:
Whenfilling out A. General Information
When
forms the
computer,
r,use 1. Inspector
only the tab key
to move your Michael Kellett
cursor-do not Name of Inspector
use the return
key. Aardvark Environmental Inspection
Company Name
P.O. Box 896
Company Address
East Dennis MA 02641
City/Town State Zip Code
508-385-7608 S13742
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5(310 CMR 16.000).The system:
® Passes ❑ Conditionally Passes ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
10/30/09 o
Inspector's Signature Date
P N
The system inspector shall submit a copy of this inspection report to the Approving Authoritp-(Bo4i
of Health or DEP)within 30 days of completing this inspection. If the system is a hared s y—�f�em
has a design flow of 10,000 gpd or greater, the inspector and the system owner hall subm`•it the
report to the appropriate regional office of the DEP. The original should be sent to the Sys m oVMr
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.
II
USGS•12/07 Title 5 Official Inspection Form:Subsurface Sewage isposal Syste •P3ge if 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
390 Mitchels Way
Property Address
JDS Realty Group
Owner Owner's Name
information is Y required for Hyannis MA 02601 10/25/09
every 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:
® 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:
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, will pass.
Answer yes, no or not determined (Y, N, ND) in the ❑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.
ND Explain:
❑ 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
❑ obstruction is removed
USGS-12107 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
390 Mitchels Way
Property Address
JDS Realty Group
Owner owners Name
information is required for Hyannis MA 02601 10/25/09
every page. Cityrrown State Zip Code Date of Inspection
B. Certification (cant.)
B) System Conditionally Passes(cont.):
❑ 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):
❑ broken pipe(s)are replaced
❑ obstruction is removed
ND Explain:
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
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.
USGS•12J07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15
r
Commonwealth of Massachusetts
lugTitle 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
390 Mitchels Way
Property Address
JDS Realty Group
Owner Owner's Name
information is required for Hyannis MA 02601 10/25/09
every page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
C) Further Evaluation is Required by the Board of Health (cont.):
❑ 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 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 Y2 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.
USGS-12J07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
390 Mitchels Way
Property Address
JDS Realty Group
Owner Owner's Name
information is Y required for Hyannis MA 02601 10/25/09
every page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
D) System Failure Criteria Applicable to All Systems (cont.):
Yes No
❑ ® 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.
USGS•12107 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
390 Mitchels Way
Property Address
JDS Realty Group
Owner Owner's Name
information is y required for Hyannis MA 02601 10/25/09
every page. Cityrrown 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?
0 ® 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)]
USGS-12107 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15
L
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
390 Mitchels Way
Property Address
JDS Realty Group
Owner Owner's Name
information is required for Hyannis MA 02601 10/25/09
every page. Cityrrown State Zip Code Date of Inspection
D. System Information
Residential Flow Conditions:
Number of bedrooms(design): 3 Number of bedrooms(actual): 4
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
Number of current residents: 0
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No
Laundry system inspected? ❑ Yes ® No
Seasonaluse? ❑ Yes ® No
Water meter readings, if available(last 2 years usage(gpd)):
Sump pump? ❑ Yes ® No
Last date of occupancy: 08/09
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:
Last date of occupancy/use: Date
Other(describe):
USGS-12107 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15
I
Commonwealth of Massachusetts
_ Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
390 Mitchels Way
Property Address
JDS Realty Group
Owner Owner's Name
information is required for Hyannis MA 02601 10/25/09
_
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
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)
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
Approximate age of all components, date installed (if known)and source of information:
08/08/06 per BOH
Were sewage odors detected when arriving at the site? ❑ Yes ® No
USGS•12107 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15 x
l
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
'r 390 Mitchels Way
Property Address
JDS Realty Group
Owner Owner's Name
information is Y
required for Hyannis MA 02601 10/25/09
every page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
Building Sewer(locate on site plan):
Depth below grade: f1e t
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.):
Septic Tank(locate on site plan):
Depth below grade: .
et
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 gal
Sludge depth:
3"
Distance from top of sludge to bottom of out tee or baffle
28"
Scum thickness
4"
Distance from top of scum to top of outlet tee or baffle
6"
• Distance from bottom of scum to bottom of outlet tee or baffle 15"
4
How were dimensions determined? measured
USGS•12/07 Tito 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15
Commonwealth of Massachusetts
a - Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
'< 390 Mitchels Way
Property Address
JDS Realty Group
Owner Owner's Name
information is Y required for Hyannis MA 02601 10/25/09
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cunt.)
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
The tank was sound and tight with tees in place and liquid at outlet invert.
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.):
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):
USGS•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M '"t 390 Mitchels Way
Property Address
JDS Realty Group
Owner Owners Name
information is required for Hyannis MA 02601 10/25/09
every page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
Tight or Holding Tank(cont.)
Dimensions:
Capacity:
gallons
Design Flow:
gallons per day
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
Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert even
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.):
The box was level and tight with no sign of carryover.
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No
Alarms in working order: ❑ Yes ❑ No
USGS•12107 Tide 5 Official Inspection forth:Subsurface Sewage Disposal System•Page 11 of 15
Commonwealth of Massachusetts
UTitle 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
390 Mitchels Way
Property Address
JDS Realty Group
Owner Owner's Name
information is required for Hyannis MA 02601 10/25/09
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.):
Soil Absorption System(SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Type:
❑ leaching pits number:
❑ leaching chambers number:
® leaching galleries number: 5
❑ 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.):
The system has infiltrators in a10'x38'field of stone. there was no liquid visible in the observation
tube.
USGS•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15
N Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
�e 390 Mitchels Way
Property Address
JDS Realty Group
Owner Owner's Name
information is required for Hyannis MA 02601 10/25/09
_
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
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.):
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.):
USGS•12107 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15
r
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M '"t 390 Mitchels Way
Property Address
JDS Realty Group
Owner Owner's Name
information is required for Hyannis MA 02601 10/25/09
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
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. 4
3�
37 3�
sz
USGS-12107 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 15
r
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
'y< 390 Mitchels Way
Property Address
JDS Realty Group
Owner Owner's Name
information is required for Hyannis MA 02601 10/25/09
every page. Cityrrown 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: 20.0
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:
USGS maps show an elevation of over twenty feet.
USGS•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 15
��lnd✓� 'f"1/"v r�I e ``� �Qr,�no.n� f �✓► Le m-09 7600
of
Or
�h-
1,17
71
------------
310
i
No. X 0 f , Fee
THE COMMONWEALTH OF MASSQ".4.�.'H-U ETT?S Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE- MASSACHUSETTS .
ZIppYitation for Mi5poeal 6peum,con5truttion Permit
Application for a Permit to Construct( )Repair(X)Upgrade( )Abandon.( ) O.Complete System XIndMdual Components
Location Address or Lot No. 3�() Wol: Owner's'Name,Address and Tel.No.
\41 tart N►5 1 NL t'► V
Assessor's Map/ParcelePciy 1�c�
a9 i 045
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
C: G 670'r, i LLC �irlP+'1 Sc�scS�
A2_6-4oZ8 S'��i-�9Cctp
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size 'v�)'bOO sq.ft. Garbage Grinder(l�/
Other Type of Building N� No.of Persons At Showers( ✓) Cafeteria(✓5
.Other Fixtures Lp rpyToey kn-rritr.A SoAle l.a_%te
Design Flow '336 gallons per day. Calculated daily flow. 80 gallons.
Plan Date Woa, 1 I ZDOt,, Number of sheets J Revision Date
Title r S u SLe M I�rXI t'r'►c�B
Size of Septic Tank X t-nr, i .epo Qo�, Type of S.A.S. 5 1MV1 t.TL> "ice -S _M��
dX 3-+ X I
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) e�ka czc_ A r\
'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-
cate of Compliance has been iss by ;s I and of Health.
Signed �. Date
Application Approved by ti Date j
Application Disapproved Q the following reasons
Permit No. �',-� R Date Issued L13 1_06
No. D 006 3 7 7
:< Fee Alk)
T4"COMMONWEALTH OF MASSRAICO;�U tETTS Entered in computer: '
a' Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS
01pprication for Zigaal *pgtem Congtruction permit
'! Application for a Permit to Construct( . )Repair( XUpgrade( )Abandon( ) 0 Complete System >ndividual Components
r Location Address or Lot No. Owner's Name,Address and Tel.No.
Assessor's Map/Parcel Z
i
691 045 3 Fr eQ.rnan Rc\
Installer's Name,Address,and Tel.No. g Designer's Name,Address and Tel.No.
C(aQE W% E COT, y t_.l-C ; `J N P,e Ei•y J, SRJCS.
42�-4028 a. S�9-�9c��
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( VAI
Other, Type-of Building N R No.of Persons Ar, Showers( V)j Cafeteria(
Other Fixtures L e S
Design Flow �J 3 h gallons per day. Calculated daily flow 31 , n gallons.
Plan Date ta%Nc�. 1 , 2 UOto Number of sheets Revision Date
Title SO o
Size of Septic TankF'x i 5i-, I ,ran nn\Nul '?ype of S.A.S. J S �t�J�, -pp,ca-t nc�s -i jZrt-,X
' ) O , x. ,3-4iXi'
Description of Soil 4 Qac �m n\en
Nature of Repairs or Alterations(Answer when applicable) \P
Date last inspected
a Agreement:
The undersigned agrees to ensu e,the construction and maintenance of the afore described on-site sewage disposal system
tl 1< n/5 ,.
in accordance with the provisions-of Title 5 of`fie,E6ironmental Code and not to place the system in operation until a Certifi-
\cate of Compliance has beetrissue by t 's Bo'azd'of Health.
Signed ... -' Date
Application Approved by �r U Date
Application Disapproved f the following reasons
Permit No. Date Issued-3 wti
•
-, THE COMMONWEALTH OF MASSACHUSETTS.
BARNSTABLE, MASSACHUSETTS #
Certificate of Compliance ~
THIS IS TO CE,R+TIFY, that the On-site Sewage Disposal System Constructed ( ) Repaired ( )Upgraded( �)
C�bandoned( )b (.Cc_
has been constructed in accordance
Utl
with the provisions of Title 5 and the for Disposal System Construction Permit No. Q&% dated
VP-
yinstallerrc,..¢ Designer v
The issuance of this permit shall of be construed as a guarantee that the l stem wi' nction as designed.
Date - Inspector
No. 3W - Fee 6)0
THE COMMONWEALTH OF MASSACHUSETTS
PUBLICHEALTH DIVISION - BARNSTABLES MASSACHUSETTS
"llizpont *pgtem Construction Vermit
Permission is hereby granted to Construct( )Repair( )Upgrade(Abandon
System located at, G 1 JAA -
,
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: Construction ust be completed within three years of the date'of t,ts-p it.
Date:_ f - /�
_ - Approved by
Town of Barnstable
f tHE Tp�
do Regulatory Services
Thomas F. Geiler, Director
• BARNSTABLE,
9�A 1639. � Public Health Division
Thomas McKean, Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer & Designer Certification Form
Date:
Designer: Shay Environmental Services Inc. Installer: CiO2�'3
Address: P.O. Box 627 Address:
East Falmouth, MA 02536
o, 5 _ , �t` r c1 S\ , was issued a permit to install a
(date) (installer)
septic stem at % '
p Y ��\ k�based on a design drawn by
(address)
Shay Environmental Services Inca dated
(designer)
VI 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.
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.
V ?
o CARMEN
' taller's Si ature) o E.
U 5 VIAY N
No. 1181
0
��GtSTER�
S 0
(\:—(9�'signer's Signature) (Affix Des p Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
Q:Health/Septic/Designer Certification Form
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE`OFFICE OF ENVIRONMENTAL AFFAIRS
F DEPARTMENT OF ENVIRONMENTAL P ED
5� SEP 4 2002
TOWN OF BARNSTABLE
HEALTH DEPT.
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 390 Mitcheils Way Hyannis
Owner's Name:Antonio Francis
Owner's Address: Same
Date of Inspection:8/7/02
Name of Inspector:Timothy Lovell
Company Name: Accurate Inspections
Mailing Address:550 Willow Street MAP
W.Yarmouth,MA, Z ®� r
Telephone Number:508-771-3700 PARC�
LOT •
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 Section 15.340 of Title 5(310 CMR 15.000). The system:
X Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
s
Inspector's Signature: 45� ate: 8/7/02
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.
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.
i{
i,
s7
Page 2 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE IDISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address:390 Mitchells Way
Owner:Antonio Francis
Date of Inspection: 8/7/02
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
X I have not found any information which indicates that any of the failure criteria described in 310 CMR
iO3 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes:
_N/A 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.
Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please
explain.
_N/A 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 infiltration 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:
N/A 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
Obstruction is removed
Distribution box is leveled or replaced
ND explain:
N/A_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
Obstruction is removed
ND explain:
S ,
Page 3 of 11
OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address:3901VIitchells Way
Owner.:Antonio Francis
Date of Inspection: 817/02
C. Further Evaluation is Required by the Board of Health:
_N/A 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:
_N/A_Cesspool or privy is within 50 feet of surface water
N/A Cesspool or privy is within 50 feet of a bordering vegetated 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:
_n/a 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.
_n/a_ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
_n/a The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
n/a_ 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 welly*.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 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:
Page 4 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address:390 Mitchells Way
Owner:Antonio Francis
Date of Inspection: 817/02
System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for A inspections:
Yes No
_x_Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
_x_Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
-x_Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
_n/a _Liquid depth in cesspool is less than 6"below invert or available volume is less than'/z day flow
—x_Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
Of times pumped
_x Any portion of the SAS,cesspool or privy is below high ground water elevation.
xi Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface W
water supply.
_x Any portion of a cesspool or privy is within a Zone 1 of a public well.
_x_Any portion of a cesspool or privy is within 50 feet of a private water supply well.
_x_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 coliform 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.]
no_(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: N/A
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`des"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 H 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.
r
Page 5 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address:390 Mitchells Way
Owner:Antonio Francis
Date of Inspection: 8/7/02
Check if the following have been done.You must indicate'yes'or"no"as to each of the following:
Yes No
x Pumping information was provided by the owner,occupant,or Board of Health
_x^Were any of the system components pumped out in the previous two weeks?
_x _Has the system received normal flows in the previous two-week period?
x Have large volumes of water been introduced to the system recently or as part of this inspection?
x_ —Were as built plans of the system obtained and examined?(If they were not available note as N/A)
_x_ _Was the facility or dwelling inspected for signs of sewage back up?
_x _Was the site inspected for signs of break out?
_x —Were all system components,excluding the SAS,located on site?
_x_ _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?
x 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:
Yes no
_x _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)13 10 CMR 15.302(3)(b)]
{
Page 6 of 11
OFFICIAL INSPECTION FORM--NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address:390 Mitchells Way
Owner:Antonio Francis
Date of Inspection: 8/7/02
FLOW CONDITIONS
RESIDENTIAL
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
Number of current residents:_3
Does residence have a garbage grinder(yes or no):_no_
Is laundry on a separate sewage system(yes or no):_no_ [if yes separate inspection required]
Laundry system inspected(yes or no):_n/a_
Seasonal use: (yes or no):_no_
Water meter readings,if available(last 2 years usage(gpd):
Sump pump(yes or no):_no_
Last date of occupancy:_Current
COMMERCIAL/INDUSTRIAL n/a
Type of establishment:
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sgft,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 occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: Barnstable sewer Facility 1998
Was system pumped as part of the inspection(yes or no):_no_
If yes,volume pumped:_gallons--How was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM
_X_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/Altemative technology. Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
—Tight tank _Attach a copy of the DEP approval
Other(describe):
Approximate age of all components,date installed(if known)and source of information:
9/11/85
Were sewage odors detected when arriving at the site(yes or no):_no_
Page 7 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:390 Mitchells Way
Owner:Antonio Francis
Date of Inspection: 817/02
BUILDING SEWER(locate on site plan)
Depth below grade:—2'
Materials of construction:—cast iron _x_40 PVC—other(explain):
Distance from private water supply well or suction line:_50'
Comments(on condition of joints,venting,evidence of leakage,etc.):
No evidence of leakage,joints look to be tight,venting ok
SEPTIC TANK:_x (locate on site plan)
Depth below grade:_12"
Material of construction:_x 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: 1000 gallon tank
Sludge depth: 3"
Distance from top of sludge to bottom of outlet tee or baffle:_28"
Scum thickness:_1/2 "
Distance from top of scum to top of outlet tee or baffle:_8"
Distance from bottom of scum to bottom of outlet tee or baffle:_16"
How were dimensions determined: in the field tape 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.):
Tees are in place,tank looks structurally sound,liquid level are at invert out,no evidence of leakage
GREASE TRAP:_n/a 0ocate on site plan)
Depth below grade:—
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:
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
Page 8 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:390 NEtchells Way
Owner:Antonio Francis
Date of Inspection: 817/02
TIGHT or HOLDING TANK:_n/a (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/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.):
DISTRIBUTION BOX:_x (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.):
Box has no evidence of leakage,liquid level is at invert out,no evidence of solid carry over
PUMP CHAMBER (locate o site plan)
—n✓a— nit
P )
Pumps in working order(yes or no):
Alarms in working order(yes or no):
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
Page 9 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:390 Mitchells Way
Owner:Antonio Francis
Date of Inspection: 8/7/02
SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required)
If SAS not located explain why:
Type
_x_Leaching pits,number:_1
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.):
8 W diam.X 6'deep leaching pit,liquid level is 4'below invert in,no scum line evidence that its been any higher,no
damp soil,no ponding,vegetation normal,sandy gravel soil
CESSPOOLS:_n/a (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 or no):
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
PRIVY:_n/a (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 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:390 Mitchells Way
Owner:Antonio Francis
Date of Inspection: 8/7/02
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.
Water lii
Back of Home
35'6"
29'4"
59'6"
37'9" 38'5"
41'10"
Page 11 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:390 Mitchells Way
Owner:Antonio Francis
Date of Inspection: 8/7102
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water_14'+_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)
—x Accessed USGS database-explain:_plate 2
You must describe how you established the high ground water elevation:
Information provided by Ca Cod Commission Well Data—Well MIW-29 water level adjusted for July 02 is
elevation 8.50 Topo indicates existing surface is about elevation 22.0 bottom of leaching pit would 4pprox.13.5
would give you a 5' separation to ground water.
LEVY, ELDREDGE & WAGNER ASSOCIATES, INC.
ENGINEERS-LANDSCAPE ARCHITECTS-PLANNERS
LAND SURVEYORS
889 WEST MAIN STREET
CENTERVILLE,MASSACHUSETTS 02632
(617)775-2244
July 27,1987
Town of Barnstable
Board of Health
367 Main Street
Hyannis, 'MA: 02601
Subj : Septic System
Lot 28 Mitchell 's Way
Dear Sir:
Please be advised that the Septic System at
subject location was essentially built according to
the Proposed Plot Plan dated September 6, 1985 .
Very truly yours,
LEVY, ELDREDGE& WAGNER ASSOCIATES
rulCA
A. evy, P.E.
PAL/mlw
1164cn
88 WAVERLY STREET FRAMINGHAM,MASSACHUSETTS 01701
. ;✓s `,,�,� Q TOWN OF BARNSTABLE
• lam' 1 U�''
LOCATION ',,fi SEWAGE
r
VILLAGE _^,q ro t yi ASSESSOR'S MAP & LOT J�
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY '0 to
LEACHING FACILITY:(type) �1_" G:'L� dt? l (size) �% K
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER 1-f"A jAlCty
DATE PERMIT ISSUED: '�-
S
DATE .COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
.........Town.................._0F................Rarngtab-he
A 1irFation for Disposal parks Tonstrurtiu�� n Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
.Lot #28 Mitchell Play---•---•--••-••••.................... Yann. .�.-..M�
-- -. .... ..........................................
Location-Address or Lot No.
John Rosario 4Q0-„N� �h � �•, �
....... - ................. .................
-Owner pp Address
...................... Harivi oh•-•-----•------------....-•--•-••---•-----------•--•-----••---•-......•..---
Inst r Address
Type of Building Size Lot---1q.,•Q.Q--------Sq. feet
U Dwelling—No. of Bedrooms.__....3..................................Expansion Attic ( ) Garbage Grinder ( )
'4 Other—T e of Building ranch............ No. of persons.................•......._...Showers 2 — Cafeteria
Otherfixtures -------------------------------•-•----------------------•-•••------•-••--•--•-------•--...............--•.....••• ...................................
Design Flow.......55...............................gallons per person per day. Total daily flow______330_--__.•-•-_•••••.............gallons.
WSeptic Tank—Liquid capacity..l 000�ailons Length---8 r6'.'_. Width 4_�.Q". Diameter................ Depth...5'8'.'..
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No--------------------- Diameter....._6.1--__-___• Depth below inlet...... ............ Total leaching area.... 66......sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by-----Eldredge... ngineering•..-•.--__._ Date----9./5/85...................
W
a Test Pit No. 1___.._2_e.Qminutes per inch Depth of Test Pit....l 3_.......... Depth to ground waternone...eneounterec
Test Pit No. 2.......2 j&minutes per inch Depth of Test Pit----AZ.......... Depth to ground waternoile---encounterec
O Description of Soil.........0'..__-_..2v' loam & topsoil-•_•-
----....
v22 t•_------_---•••----medium---Yellow_ sand
W 8 - 13 medium white sand
--------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------•-••....................
V Nature 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 TITI.L 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a.Certificate of Compliance had bee •s Nd by the board of health.
Signed_ ..,1---- -- ----------
APPlication Approved BY ---•-- --• . -- --•••----••-•---- 1c).r�
Date
Application Disapproved for the lowing reasons-------------------------------------------------------------------------------..................................
..............................•••-•-•-•-••..---•-----•--•----•--------•-•------••.....---------••--•-•--........._...........••-----•---•---••--•---•----•••-•••-•-••--•-••.......---••------•-------•---
Date
Permit No............1.6 9ay-------------------- Issued.......................................................
Date
t T,
THE COMMONWEALTH OF MASSACHUSETT$
BOARD OF HEALTH
A.
OF..................
Applirattla'o for Disposal Works Tun,strurtiun umi
t Application is hereby made for;a Permit to.Construct ( ) or Repair ( ) an Individual Sewage Disposal's
System at: I
.. , 3 ••-4P`�`v�:._...P.i i�3 �` �_..i� F.................................... I* r .....--...........................................•
Location-Addr ss ' j�' t'i� or Lot No.
dO.ltlr---R{3 V. ............................................................. - ......- ---
Owner
1aI Cle SVle`Lddress
.Y-B`-.'---..x �_ i c`11"1i •---------------- --------------------•-•------•--•---- -._------
Instaler
Type of Building/- Address
Size Lot_ �...)...........Sq. feet
U I Li
Dwelling—No. of Bedrooms........ .................•....•..._____..Expansion Attic ( ) a�b , Grinder ( )
Other—Type'of Building a yp g ... aRe_h_....._..___ No. of persons............................ Showers (2) — Cafeteria ( )
Other fixtures ... =
W
Design Flow--------515..............................gallons per person per day. Total daily flow_-__----&B-D-............................gallons.
Septic Tank—Liquid capacity...:=tC,,(gallons Length-__- Width-,a..J.Qt±. Diameter__--_--______- Depth....cp.BtL.
x Disposal Trench—No..................... Width.................... Total Length_-----._---.-_---__ Total leaching area....................sq. ft.
Seepage Pit No.........I---------- Diameter.......G!........ Depth below inlet......G+......... Total leaching area....2.6.6......sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by"__;--ri,1.4dn&d"_e•-.U+ig-4-pl.eep nb•-•-••-•--. Date....jg/5rC85•..................
Test Pit No. I-------2___(lminutes per inch ` Depth of Test Pit__....13.......... Depth to ground waterytCn-&--ene�)untere
Lrr Test Pit No. 2........2.,.Qminutesper inch, Depth of Test Pit___..12.......... Depth to ground watert}o-ue...eneountere
a --••••••-------------•••-•-••-•••••-......•-•-••-•••--••---•---.....•-•..........-•-••---------_---..........................................................
O Description of Soil.........�0'........2 z'--l oa-m..t----t tGP&O-1-1.....................................................................................
v ---------------------- �-...... ...8.........t»ed- -um---3-a1-1ow...&a-n-d..................................................................................
VW -•-•••-----•---- ------------------------�------�-----1,3------ugodi-ua---wh -�-e---,-sallcd-------------------------------------------------------------------------------------
Nature 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 TI'IE 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.
....,u...u,'.:^• Date--•--.........
Application Approved By....... `
•. •----- --- ..... r
Application':,Disapproved for t,e ollowing reasons-----------------------------•--- .....................
------------------------------------------------------------•-------------..._.•_.....------------------•--=----•-------•-------•••-•-•••-•-••--••----•••--•---•--=•••--••--•--••......---•••••--.......
Date
PermitNo....................•---•.....--•------------ =....•. Issued.......................................................
' Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH R
........Tow-n.....................OF................Ba-r-Ia'stabl-e.....................................
Tntifirat a of Tout-Plianq
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed j( ) or Repaired ( )
by------------------:=II-1QL1X4•j'VMCM4r. .:� '` •--•-- JA ---- ---•------------------- ----------------•-••--•-------------------
Installer
at.....................]I
T �}T 7f ?G9Il Lri t�'i2t 2 iJi�y i )ra -n -s---ief-A-•---------_•-------------------------•- --•-•--•---------.------------_------_
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
Works for Disposal orks Construction Permit N 1................... dated-------:........................................
THE ISSUANCE OF THIS CERTIFICATE SHA T BED NSTRIIED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE:............ -...-. 1--�6 �•�•--•--•------•-------.. Inspector........- .....Z_ ......................
2-SIGN'NG ENGINEER MUCT SUPERVIS-
'TALLATiON AND CERTIFY IN WRITING
-iE SYSTEM WAS INSTALLED IT�HT00.MMONWEALTH OF MASSACHUSETT
':o:ADANCE TO PLAN. BOARD OF HEALTHJ �-�-Q
T•own................. .OF..........13arnn ta1al� .......: ---• l
�• FEE. lbw.......
Disposal Works TwOnutrttrti.un Prrutit
Permission is hereby granted........I?o: t� CI �- _ 3 t,a` t ..------.... =
to Construct ( X) or,Repair ( ) an Individual Sewage Disposal-System
at a . r � , ,
�aa mci s.rl sc4•-•,�ra-y- ;�.�a raX1
Street "
as shown on the application for Disposal Works Construction Permit _ia,.,f..._ Dated.......................................... 1
......................... -------f,
M>%.... l f ... . oard f I
v e
DATE..--•---------:-�-•----•------- `----"•�' :---�----- --'•..-- --...--- ,..
FORM {1255 A.'" SU L'KIN, INC., BOSTON
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LEGEND ELDa�DGE N
EXISTING SPOT ELEVATION OAO ��;�,.. No 19387 CERTIFIED PLOT PLAN
EXISTING CONTOUR --- ® ---
FINISHED SPOT EL .;•.
FINISHED CONTOUR �` L�
NOTE:. The location of any existing unde_ r :sound sewerage, IN
wells;., or other utilities shown on t}:is plan is approx-
imate 'only as determined from records and/or. verbal
information. .The contractor is. responsible for the
verification_ of the existing locations in .the field, SCALES / � DATE
. �.DRE® ENGINEERING CO. NC) C40ENT. i CERTIFY THAT THE PROPOSED
E4iSTERE REt3►ST@RED JO® N0. 8`'r 1. BUILDING SHOWN ON THIS PLAN
CIVIL LAND CONFORMS TO THE ZONING LAWS j
cI�ER R oft.SY �--M OF BARNSTABLE , MASS. ✓�- v
: ?12 MAIN STREET. CH. BY, -- _
—=% r
HYA NN I S, MASS. SHEETi OF G-. DATE REG. LAND SURVEYOR
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LEGEND HYANNIS
PROPOSED CONTOUR Raves 28
® PROPOSED SPOT GRADE
EXISTING CONTOUR
+ 96.52 EXISTING SPOT GRADE
W— EXISTING WATER SERVICE
TEST PIT SITE
5 I 390 WCHELLS WAY
Y ' O0, j SCALE: 1"=20' A
65 97. _
97.8 TP-2
t.-�—3 o wE M'vN ST
?97.4 o 0
LOCUS MAP
97.8
98.3 T13M = EL. 99.0 LOCUS INFORMATION
TOP OF CONC. WALL PLAN REF: 167/085
LQ 'yIST'NG L�CH�NG TITLE REF: 30834/063
^ PARCEL ID: MAP 291 PAR. 045
1� PROPERTY IS IN ZONE II
FLOOD ZONE: PROPERTY NOT IN FLOOD ZONE
SEPTIC SYSTEM
98.4 97. w REPAIR PLAN
0 98.0 Q LOCATED AT:
0 390 MITCHELL S WAY
98.0
99.
HYANNIS, MA
@ E�• 9`�•5 PREPARED FOR
�• I NAMARAJ PANDIT/
READ ROOTER� y
Y R00 E EXC.
MARCH 16 2020
OFss9�
L O T 28 DARKEN M. y�
AREA = 0.30 acres t 1 �< F MEYER
No. 1140
i �
Gl E�
Sf
rip $IN I TAVL
'� - V�► r MEYER & SONS, INC.
? ���S
�H P.O. BOX 981
EAST SANDWICH, MA. 02537
PH: (508)360-3311
FAX: (774)413-9468
meyerandsonstitle50gmail.com
f
o SHEET 1 OF 2 J 1894
ELEV. TOP NOTE: PLACE MAGNETIC MARKING TAPE OVER ALL COVERS
FOUNDATION: BRING ALL COVERS TO WITHIN 3" OF FINISH GRADE
(Existing) t FINISHED GRADE (98.0)
= 99.50���F.G.EL: 98.6 F.G.EL: 98.60 F.G. EL: 98.0 -•-•�
\\ MAINTAIN 2% MIN SLOPE OVER LEACHING AREA
a
.Y
t7 �` F.G.EL• 97.80 I INSTALL INSPECTION PORT
•+• • TO WITHIN 3" OF FINISH GRADE
6" 1 !
} 10"I 14 7dl
6S= 190 (MIN.)
TEE'S ARE TO BE INV. 9 --
:6 4" SCH 40 PVC
INV. 96.50
r INV. 95.95
EXISTING OUTLET BAFFLE '
E PROPOSED DB-3 3 5' S X 6.25 3.5'
<.. � DISTRIBUTION BOX INV. 95.56 awl
INV. 96.75L (1-120) EFFECTIVE LENGTH = 38.25'
EXIST. 1,000 GALLON SEPTIC TANK
OF
GAS BAFFLE TO BE INSTALLED ON ��� Mgsf9� BREAKOUT
OUTLET TEE AS MANUFACTURED BY D yGr
NOTES: TUF-TITE, ZABEL, OR EQUAL TOP CONC. ELEV.= 95.98 ELEV.= 95.98
1) CONTRACTOR SHALL VERIFY ALL EXISTING 1140 INV. ELEV.= 95.56
PIPE INVERTS PRIOR TO CONSTRUCTION
2) D-BOX SHALL BE SET LEVEL AND TRUE TO -ST
GRADE ON A MECHANICALLY COMPACTED SIX ANITAR�p� i )
INCH CRUSHED STONE BASE, AS SPECIFIED IN l.�b BOTTOM EL. 94.65 4' 2.83 FT. 4'
310 CMR 15.221(2) 1
3) REPLACE EXISTING 1,000 GALLON SEPTIC TANK EFFECTIVE WIDTH = 10.83'
WITH 1500 GALLON SEPTIC TANK IF FAILED, SEPARATION 5.05 FT.
DAMAGED OR UNDERSIZED. SEPTIC SYSTEM PROFILE
4) INSTALL INLET & OUTLET TEES W/ ADJ. GROUNDWATER EL: 89.60 _ SOIL ABSORPTION SYSTEM (SECTION
GAS BAFFLE AS REQUIRED
(INFILTRATOR HI-CAP CHAMBER)
SOIL LOGS GENERAL NOTES: DESIGN CRITERIA
DATE: AUGUST 1, 2006 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL NUMBER OF BEDROOMS: 3 BEDROOM DESIGN
BOARD OF HEALTH AND THE DESIGN ENGINEER. ( / )
SOIL EVALUATOR: CARMEN SHAY, R.S., CSE
2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS SOIL TEXTURAL CLASS: CLASS I 0.74 GPD SF
WITNESS: DON DESMARAIS, BARNSTABLE HEALTH DEPT. OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE DESIGN PERCOLATION RATE: <2 MIN/IN
LOCAL RULES AND REGULATIONS. DAILY FLOW: . 110 G.P.D. X 3 BR = 330 G.P.D.
3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR GARBAGE GRINDER: NO n g garbage grinder)
TP-2 Depth TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE (not designed for arba a rinder
98. TP-1 Depth 8.0Elev DESIGN ENGINEER. SEPTIC TANK: 330 d x 200% = 660 d USE EXISTING 1,000 GAL. SEPTIC TANK
98.0 0" 98.0 0" 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING gP gP '
P SANDY LOAM p` SANDY LOAM
FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN LEACHING AREA REQUIRED: (330)/0.74 = 445.94 S.F.
IOYR 3/2 10YR 3/2 ENGINEER BEFORE CONSTRUCTION CONTINUES.
97.50 Bw 6" 97.50 B 8" 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. USE FIVE (5) INFILTRATOR HI-CAPACITY UNITS, 11" (0.91") DEPTH W/
SANDY LOAM SANDY LOAM 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF , ,
10YR s/6 10YR 5/6 THEHEA CONTRACTOR
TRACTORFOR OR INSPEC TO TIONS DURING THE
BOARD OF 3.5 STONE ON ENDS & 4 STONE ON SIDES: 38.25 L x 10.83 W x 0.91 D
95.33 C 32" 95.33 C 32" 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. BOTTOM AREA: 38.25 x 10.83 = 414.24 SF
PERC TEST 8.ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED
O EL 93.50 MEDIUM MEDIUM TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. SIDE AREA: (38.25 + 10.83) X .91 X 2 = 89.32 SF
SAND SAND 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE TOTAL SQUARE FEET PROVIDED = 503.56 vs. 445.94 REQ'D
2.5Y 7/4 2.5Y 6/4 THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING
CONSTRUCTION. DESIGN FLOW PROVIDED: 0.74(503.56 S.F.) = 372.63 G.P.D. vs. 330 G.P.D. req'd
10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND FILLED PER TITLE 5.
11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION
88.0 120" 88.0 120" 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY PROPOSED SEPTIC SYSTEM UPGRADE P LA N
AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY
PERC RATE <2 MIN/IN. (•C2• HORIZON) 13. NO PRIVATE WELLS WITHIN 15V OF PROPOSED LEACHING. 390 MITCHELL'S WAY, HYANNIS, MA
GROUNDWATER OBSERVED AT 114% EL 88.50 14. NO WETLANDS WITHIN 100'.OF PROPOSED LEACHING.
WELL: AIW-230 ZONE: D. LEVEL- 21.3 15. ALL PIPING TO BE 4" SCH'40 O 1/8"/FT (UNLESS SPECIFIED) Prepared for: Pandit/Ready Rooter Exc.
ADJUSTMENT: 1.1 FEET. ADJUSTED GW: 89.80 16. REMOVE ALL UNSUITABLE SOILS 5 FT. AROUND LEACHING TO EL 95.56 Design and Site Plan by: SCALE DRAWN DATE
OR TOP OF C LAYER AND REPLACE W/ CLEAN MEDIUM SAND PER TITLE 5. MEYER&SONS,INC. N.T.S. DMM • 03/16/20
PO BOX 961 REV DATE
EAST SANDWICH,MA 02537 CHECKED SHEET NO.
508-3622922 DMM 2 of 2
_ ----- r
Swltrht�YosrQ� 1 � ��
SECTION A -A ALL Cull ET PEE FRaE LIE :
0151R6U11011 BOX SHAM EE
TE:
10' min. from 'NO All- PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. PROFILE VIEW OF ADDITION TO LEACHING SYSTEM SET &FOR AT tEAs12 FT. 12' OONCREIE COVER
house to septic tank
Existing Foundation Seplic torte mrwt f» n 6 In. of Mdod grade _ 3-'S'OtnLET +
D-BOX � rr�t be _ -,�_•_ J z
T.O.F. ,7
elev. = 100.00 6 in. of RnMW grade 3" of 1 1 Y Washed Peoeton Ial000couls i 4 �tr
Groda over 0-sou-8650 over SAS- 9400 3/4" to 1 1/2 - 111W d Crushed St i. +?
Cnrda ow Saptk Tank-9
0
.00 /�O� , e
OUTIET 12' MET dy
4'PVC(CAPPED)INSPECTION PORT TO BE `. W fi 390 MitcEiells Way
S= 0.02 3 HOLE Tap OF Systarrr Elev. -M.20 IISTALLED AND TO BE VAI MI 6.OF GRADE
o t2. 5••001 a gryatK (H-10)DIST eooc 3'Moakrarrr Cover A 0"EffwtM Daptlr is i E3erarst llls
Exisr. PIPE q EXIST. 1,000 GA s• 010" 1 ,' `tn :� canan+ara tl -,
FROM FULNDATXN � SEPTIC rANK 10' PLAN SECTION CROSS-SECTION
5• 0.83 (10 inches) _ r
5 LWts 8 625' - 3T
caNCRE1E FULL 'e II a rn 3' 3,
31.25 3 HOLE H-10 DISTRIBUTION BOX
1 • o�i NOT 10 SCALE a u a.y►bT '
SYSTEM PROFILE
Not to Scale o 3.5' 3.5' I II Effective Length
Effects van' o SOIL ABSORPTION SYSTEM (SAS)
GENERAL NOTES
NOTE: ALL COMPONENTS MUST HAVE RISERS TO "THIN 6- BELOW GRADE 6 Inor 3/4-1 1/2- 5' STRIPOUT ALL AROUND INFILTATR7R HIGH CAPACITY (H-20 LOADING)/ GEORGE O'BRIEN
yATION ,33 0 1. Contractor is responsible for Digsafe notification, Verification of Utilities
ed elan° Z Bottom of Tat Hole 1 Ow.-BB.00 m r (OR EQUVALENT) Not to Scale and protection of all underground utilities and pipes.
Note: Remove soil down to med sand layer & replace with ``' OrwAxi rotar 0baarved - ELEV BB•50 NOTE rvERALL HEIGHT OF tNFILTRATOR Is 18" /r FFECnVE HEIGHT Is 10" 2. The septic tank on j distri ution box shall be set
(elev. 95.33) & replace with clean coarse sand w/perc. level 11 6 of be ea t a stone.
v Obs. Groundwater - Test Hole 1 Elev.= 88.50 r(Ad j. Per CAPE COL'_ COMMISSION = 1.1' = ELEV'. 89.60) 3. Backfill should be clean sand or gravel with no
rate less than or equal to 2 min./in. before & after placement PROJECT ADJ. Groundwater = ELEV. 89.60 stones over 3" in size.
4. This system is subject to inspection during installation
by Carmen E. Shay - Environmental Services, Inc.
PERCOLATION TEST 5. The contractor shall install this system in accordance
with Title V of the Massachusetts state code, the approved plan
Date of Percolation Test: AUGUST 1, 2006 MI T CHELL ' S7 R7-A Y
and Local Regulations.
Test Performed By. CARMEN E. SHAY, R.S., C.S.E. 6. If, during installation the contractor encounters any
Results Witnessed By. Donald Desmarais (Barnstable B.O.H.) (40 FOOT RIGHT OF WAY) soil conditions or site conditions that are different
EXCAVATOR: CAPEWIDE ENT., LLC from those shown on the soil log or in our design
j Percolation Rate: Less Than 2 MPI 0 32" installation must halt & immediate notification be
I made to Carmen E. Shay - Environmental Services, Inc.
� Test Hole Test Hole
7. No vehicle or heavy machinery shall drive over the
98-------- ------
-----� \ septic system unless noted as H-20 septic components.
No. 1 No. 2
DEPTH SOILS El"
DEPTH SOILS ELEV o > 85.82' ��\ \ 8. Install Tuf-rite gas baffles or equals on all outlet tee ends.
p s8.00 0 9! LOT ,28' % 9. All Distribution Lines shall be 4 diameter Schedule 40 NSF PVC pipes.
Sandy Loom Sandy Loam I >
10. All solid piping, tees & fittings shall be 4" diameter
12,300 Square Fsgt +/ r •�3� Schedule 40 NSF PVC pipes with water tight joints.
10 YR 3/2 10 YR 3/2 I \ 11. Municipal Water is Connected to ALL OF The Residence and Abutting
I
Aa 97.50 0•-6- Aa 97.50 - ---
I _ Properties Within 150 Feet.
Lawn
sandy sandy
LOOM PROJECT BENCH MARK THE PROPERTY LINES ARE APPROXIMATE AND
10 YR 5/6 10 YR 5/11 TOP OF FOUNDATION EXIST. EXIST. �`.� I COMPILED FROM THE SURVEY PLAN GENERATED BY
6"- 32" Bs 95.33 6-- 32• Be 95.33 ELEV. = 100.00 (Assumed) IDRNEWAY - DRIVEWAY I BSC GROUP OF YARMOUTH, MA
Medkern/Coars Medium/Coarse I I ENTITLED CERTIFIED PLOT PLAN OF LOT #28 MITCHELL"S WAY,
Sand sand 390 I �� AND HYArISISNOTA DATED INTE INTENDED TOEBE A SURVEY PLOT PLAN
23 Y 7/4 25 Y 7/4 I IT SHOULD BE USED FOR NO PURPOSE OTHER THAN
3Y- 120 C, 32"- 1 C, ��
EXISTING H
THE SEPTIC SYSTEM INSTALLATION.
3 BEDROOM EXISTING LEACH PIT TO BE PUMPED OUT AND FILLED IN PLACE
I HOUSE
1
I i } NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE
LOT #29 fl ) l FROM THE EXISTING LEACH PR TO BE DISPOSED
OF AS PER BOARD OF HEALTH SPECIFICATIONS.
- --
DECK � �- � `�- `THERE ARE NO WETLANDS ARE-PRESENT"WITHIN 200' OF-THE PROPERTY
99------ ,� r
Perc 1 -------------------- ! C9
r O I d: ASSESSORS MAP 291 PARCEL 045
Depth to Perc: 36- to 54" I O 1
Pere Rate= 2 MPI I I EXIST. 1,000 GAL
AIW230/ZONE D INDEX = 21.3 for 7/06 � I I SEPTIC TANK p LEGEND
ADJUSTMENT = 1.1 FEET w L J
L_
OBSERVED H2O:Elev. = 114" or ELev. 88.50 C4 7.25' ( ' O � 104X 1 DENOTES PROPOSED
2-18-CM. ACCESS MANHOLES i�• -"''�•'-� ; •:• ��. �� SPOT GRADE
at'3.. �I
t, e e e ' DENOTES EXISTING
�_. D-Bo i'L-'=i.'•`:,i:. X 104.46
Failed SPOT GRADE
o Leach Pit 8' '
`1 E� -1 TEST HOLE2 9� ��� �a PL PROPERTY LINE
r� \ 98------ _�`-------
OUT ET p0 PROPOSED CONTOUR
- ELEV.= 98.0 r
c» Iv/11
IM ACCESS COVERS FOR 1NE SEPTIC TANK TEST HOLE #1 _�-y `I;y• `d' ------97 EXISTING CONTOUR
DI5IRIB nION BOX AND LEACHING COMPONENT r
-, _` .--?T S- �-:'�=r►-.a SET DEEM IMAM 6 MCHES BELOW FMISHED ELEV.= 98.00 65.00 1
• :z - '•- " GRAMSHALL BE RAISED TO 1IIiINN 6.OF
STEEL REINFORCED PRECAST CONCRETE n"?SHED MADE ® DEEP TEST HOLE &
PLAN VIEW ' "`' 'E'F-'TIE I °R E°""Ls PERCOLATION TEST LOCATION
3-24-RE>t1
�-�y .--. 6 FOOT STOCKADE FENCE
�- +co�ERs� AJ 7 . .PA UL �Pi
.LA CE
A' Lr rf (40 FOOT RIGHT OF WAY) '
mh. olearance '� tT MUR
MLtT e• mM�- 2•mh kdat to outlet e.
°ULOT P LA �lNote: Remove soil down to el. 95.33 (Estimated) do
s• -r E� - r-o-mti• y s• -r replace with clean coarse sand w/perc. rate less than or
ar,elm - _- 1.4a1e daPth or equal to 2 min./in. before & after placement OF PROPOSED SEPTIC SYSTEM UPGRADE
J ate: SYSTEM SITED AT HIGHER ELEVATION THAN TEST HOLES. PREPARED FOR
ems- 4-10" STRIPOUT MAY BE WAIVED BY DESIGN' ENGINEER IF MORE FAVORABLE G E RALD O D E FR E ITAS
CROSS SECTION END-SECTION SOIL CONDITIONS PRESENT & 'UPON INSPECTION BY DESIGN ENGINEER AT
TYPICAL 1000 GALLON SEPTIC TANK #390 M ITC H ELL'S WAY
NOT TO SCALE HYAN N I S, MA
Kitchen Bath Bath Bedroom -
Design Calculations GARAGE Dining q
Number of Bedrooms: 3 Bedroom EXISTING p. PREPARED BY:
Garbage Grinder. No � f� � Y • R �/, d Y
Leaching Capacity Required: 330 Gol./Day (MIN. PER TITLE V) �i " L �' �`a �`
Septic Tank : - 2 x 330 Gel./Day = 660 USE EXIST. 1,000 GAL Septic Tank. Living Room U S NVIRONMENTAL SERVICES, INC.
SOIL ABSORPTION AREA: Using percolation rate of <2 min./inch Bedroom Bedroom
Bottom Area: 0.74 gal/sq. ft. x 370 sq. ft. = 273.8 gallons ��
Sidewail Area: 0.74 gal./sq. ft. x 78 sq. ft. 58 gallons TEFti P.O. BOX 627
g 0 20 40 50 saN,rAR,a�' EAST FALMOUTH, MA 02536
Providing: = 331.80 gallons
TEL/FAX : 508-539-7966
Use: (5) INFILTRATOR HIGH CAPACITY H-20 UNITS, HAVING A 0.83' (10 INCHES) EFFECTIVE DEPTH, 3 BR HOUSE FLOOR SCHEMATIC
TO BE USED WITH 4.0' OF WASHED STONE ON THE SIDES, AND 3.5 OF WASHED STONE SCALE: 1 =20 DRAWN BY: CES DATE: AUGUST 1, 2006
ON THE ENDS. NO STONE UNDER. SCALE: 1"=20' PROJECT#SD946 FILENAME: SD946PP.DWG SHEET 1 OF 1
a
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