HomeMy WebLinkAbout0473 OAKLAND ROAD - Health 473 Oakland Road, Hyannis
272_404-�
e
TOWN OF BARNSTABLE
LOCATION V7 044AW SEWAGE# 201Y .s
VILLAGE j. ASSESSOR'S MAPS�.&''PARCEL
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY /OQ)
LEACHING FACILITY:(type) S� Q2y'f�G((S (size)
NO.OF BEDR MS .3
OWNERToAly-lyl0
PERMIT DATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist on°
site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) Feet
FURNISHED BY
IN)
co
J
TOWN OF BARNSTABLE
LUC 0 'Y 1� 0Q 1. f— d A4 SEWAGE #.: S',
VILLAGE_ '`���°' ` ASSESSOR'S MAP & LOsT7 z 7 Z—/p
INSTALLER'S NAME&PHONE NO. �® sr w � /
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) o`�-"'�- C (size)
NO.OF BEDROOMS
BUILDER OR OWNER
PERMIT DATE: -,1 COMPLIANCE DATE: 6
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bo 'om of Leaching Facility Feet
Private Water Supply Well and Leaching Fa ' 'ty,.(If any wells exist
on site or within 200 feet of leaching f ility) Feet
Edge of Wetland and Leaching Facility any wetlands exist
within 300 feet of leaching facili Feet
Furnished by
.Cu 2
• �l
TOWN OF BARNSTABLE
LOCATION �73 oiFG9v� /�� SEWAGE #
iVU,LAGE 111A-1/1 ASSESSOR'S MAP & LOT a7a y i
<INg R'S NAME&PHONE NO. 6Z�72�P-1S'72
SEPTIC TANK CAPACITY ef55,4wG
LEACHING FACILITY: (type) G4F5XPcZ9t- (size)
NO. OF BEDROOMS 3
B R-OWNER � 65;!:Vll s9 IvZ--,oge,6°�L �w ll
PERMITDATE: COMPLIANCE DATE:.
Separation Distance Between the:
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 leaching fa J i y) Feet
Furnished by �$� :�-
y!
S�
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y� �
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0
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a
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TOWN OF BARNSTABLE
L6CATION'Y?:3 t9 a.fc I a m d R-d, SEWAGE #
VILLAGE �J-un VLrU i ASSESSOR'S MAP 6z LOT
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) (size)
NO. OF BEDROOMS 3 IxRtVA ETL OR PUBLIC WATER
BUILDER OR OWNER A)Q IS&-/-, Ar
m
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
� _ _ �
o
. ,Y
� ��
4
},
1
•r � •1'
y ' Aoo Tim - SCRFE14 PORC4
F'R o NT }BAR D
Ilia Town of Barnstable #
Department of Regulatory Services /''�
D AeLA Dace
3 6 F Public Realth Division ,7�
T1�1&9- .
200 Main Street,Hyannis MA 02601
r¢o n+ud a .
lay
Date Scheduled _ o/ ✓
Time Fee;<'cl:
SOU Suitability Assessment for° Set e D spy®
Performed By:
Witnessed By:
O _
LOCATION&i ENERAL Il l ORMATI N
Location Address �! ✓ L�u/� � Owner's Name
?/p G � Address ���
Assessor's Map/Parcel: �2 7 2 104- Engineer's Namee� V &/X_/A/
NEW CONSTRUCTION REPAIR Teleplione# i '�Z �3
Land Use A P ( )
���� / `` Slo es 96 L Surface Stones
Distances from: Open Water Body �6
P Y ft Possible Wet Area nlf ft . Drinking Water Well "r/u rgl�r
Drainage Way 4 D — ft Property Line V F� ft Otlrc
4AAZ 406-Stnl�+Re�hrO 30`{,q ft
0IMTCH: (Street name,dimensions of lot,exact locations of test holes&Pere tests,locale wetlands in proximity to boles)
fTl
�s
w +_Ll le lr c,STI�,SG� :"1 � r.>
Parent material(geologic) Z� tA41,)?$h Depth to Bedrock _ -VA
Depth to Groundwater. Standing Walerin Hole: AJUP k Weeping ftorn Pit R11ee N14
l /
Estimated Seasonal High Groundwater �' �2
DETE,RMANA-TXON FOR,SEA.SONAL 41GH WATER TABLE,
Method Used:
Depth Observed standing in obs.hole: ��" ly, Depth to loll mottles:
Dcplh to weeping fromside of obs-hole: In, l3raundWl ter Adjustment T'^T ft.
Index Well It Reading Date: Index Well level Adj.factor. Adj.CJruundwatcrLevei
PERCOLA.TION TEST Date t(4m '1'I►ua 'I ld
Observation S t
Hole It ?j
'flute at 9" ,
Depth of Pere
Time at G' 1
Start Pre-soak Time @ 5
End Pre-soak
Rate Min./Incl, C.
Site Suitability Assessment: Site Passed_ _.. Site Palled: Additional Testing Needed(Y/N)
Original: Public Health Division Observation Hole Data To Be Completed oil Back----------
"4117 Percolation test is to be conducted withh000' of wetland,you must first-notify the
Barnstable Conservation Division at least one (1) weelc prior to beginning.
d:NsErrIc-WARCF0 RM.DOC
DEEP.OIfBSERVATION DOLE,,LOG 'Hole It l IV s'!9
Deptit from So Horizon Soil Texture .Shcl Color Soil.
Other
Surface(in.) (USDA) (Munsell) Mottling (Stnucture,Stones;Boulders.
-/ / onsistencv.%Oritval)
y7 Zero /� C�a••rr 7-a S�
Sand /
l�y`r'Zo` Ot
U�l D v 4ccl1 t e_W4
DEEP OPSERVATION HOLE LOG Hole# 'Y
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling
(Structure,Stones,Boulders. .
o sisten % ravel
4„r Q oa�"y�►� 7�5 YR ak14111
zo`'—l20" G1 Vs lo `L(Z - a*l raves)
V-14. Z".i, `( 7/4- �
t
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color 'Soil Other
Surface(in-) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Con t to cy.%Orayal)
' r✓� w
DEEP OBSERVAT16N HOLE LOG IIole�t
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders,
Cans tan b a
f
•T
Flood Insurance hate Map:
Above 500 year flood boundary NO— Yes_
Witliln 500 year boundary No Yes
Within 100 year flood boundary No— Yes
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervlou materlal exist in all areas observed throughout the
area proposed for the soil absorption system?
If not, what is the depth of naturally occurring pery us matorlal? �
4
Certification
I certify that on A r, /'//.S(date)I have passed the soil evaluator examination approved by the
Department of Environmental Protection and that the above analysis was performed by me consistent with .
the required training,expertise an ex rience described in�10 CNM 15.017.
Signature Date 7
Q:\S.ElYTlC\PFRCF0RM.D0C
No. c3�p -2c;L Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
01pplitation for Disposal *pstem Construction permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. Y73 "<1 D Owner's Name,Address,and Tel.No.
~Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
L Qwrlsk��, 3"06
Type of B ding:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 330 gpd Design flow provided K;' / gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
�T
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 t lace the system in operation until a Certificate of
P Y P
Compliance has been issued by this Board of Health.
Date
Application Approved by Date Jr �-
Application Disapproved by Date
for the following reasons
Permit No. �f 7 �_ Date Issued 519 3/
r
No. y �•� Fee bb
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: j
PUBLIC HEALTH DIV]SI"Otj-TOWN OF BARNSTABLE, MASSACHUSETTS Yes
17
Rpplitatlon for Disposal *pstem Construction Permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. Y73 W rl iCD Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel gng
r .
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
Type of B Ading:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
.., Other Type of Building pour-e-- No.of Persons Showers( ) Cafeteria'( )
Other Fixtures
Design Flow(min.required) 330 gpd Design flow provided �jr� gpd
-' Plan Date Number of sheets , :'r Revision Date
W, J
Title fl/.lt�4- %;
Size of Septic Tank/ CS L Type of S.A.S. 02 t 64'- f2 t lll✓!6r
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) r'?
Date last inspected:
.. L
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
ccordance with the provisions of Title 5 of the Environmental Code and t place the system in operation until a Certificate of
f
Compliance has been issued by this Board of Health.
Date
Application Approved by Date .5
Application Disapproved by y Date
1
for the following reasons
Permit No. /� /J
7 Date Issued 3
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 G 4v �3 Az"2 ^
at /3 t� /r� � has been constructed in accordance
with the provisio f Title 5 a d the for Disposal System Construction Permit No?�`f / �' dated
�h� S n Designer i
Installer 11
#bedrooms 3Approved d sig w _� gpd
The issuance of this perm' sh 1, of a co trued as a guarantee that the system w' d- ig, ed.
Date Inspector
. : lAl
--------------------------------------------------------------------------------------
No. �u I"� _ J
Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS
Disposal *pstem, Construction Permit
Permission is hereby granted
�to7 Construct( ) Repair( V) Upgrade( ) Abandon( )
System located at
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Construction rust be c mpleted within three years of the date of t is permit.
Date co y Approve
Town of Barnstable
,THE A Regulatory Services
Thomas F. Geiler,Director
MAM L& * Public Health Division
Thomas McKean Director
eo�r
200 Main Street, Hyannis,MA 02601
Office: 508 862- 644 Fax: 518-110-6114
x Date: Sewage Permit# D/ Assessor's Map/Parcel
Installer & Designer Certification Form
Designer: F�--�S ,,Sc1eJC`f �(- Installer:
Address: �� t1}c 1`1 Z`7 Address: ZV�_O
�( On t"�.kAEV— was issued a permit to install a ,
(date) (installer)
septic system at 4 e:�L_A ►SD 4_V based on a design drawn 'by'
(address) OZ!! �
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. Stripout (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. Stripout (if requ ected and the soils
were found sa 'sfactory. ��'�� �S4
DAVI D
D.
� F6.AHERTY, JR.
x (In all ignature) No. 1211
c1ST0'
S'4NITAR\P .
(Designer's Signature) U (Affix Designer's Stamp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
gAoffice forms\designercenification form.doc
�., NX
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yesd
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ,sV
2pprtcation for Migooal *pgtem Con5truction 30ermit
Application for a Permit to Construct( . )Repair(X )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No.
Asses o s l ap , egnd Rd. Hya Joanne Lepore
Installer's Name,Address,and el.6 0. Designer's Name,Address and Tel.No.
Wm. E. Robinson Septic Service
P O Box 1089, Centerville
Type of Building:
Dwelling No.of Bedrooms 4 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.
Descriptionlof Soil Rand
Nature of Repairs or Alterations(Answer when applicable) Title-5 septic system
consisting of a tank D-box and 3
chambers with stone all around ali / 'j
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by this B ar f Health. 17
Signed " 6 Date
Application Approved by Date
Application Disapproved for the following reasons
r
Permit No. �` Date Issued i A
f r
ot
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Ye�
r PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS �.--
`` 01pprication for �Ngpogal *p5tem Congtruction Permit
Application for a Permit to Construct( )Repair(X )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No.
As4s7o3's?ft/P,a1cs1nd Rd. Hyan s Joanne Lepore
_kj
Installer's Name.,Address,an 1.Xdol 1 7
Designer's Name,Address and Tel.No.
Wm. E. Robinson Septic Service -- c
A Centerville
Type of Building:
Dwelling No.of Bedrooms d 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
an
Nature of Repairs or Alterations(Answer when applicable) m-isi_-5 septie system
- r
S Rg e i— chrb ,
G c1. ,7
';
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 issued by this Board f Health.
Signed�/ Date es
Application Approved by Date
Application Disapproved for the following reasons
Permit No. Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Lepore Certificate of (Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired ( X)Upgraded( )
Abandoned( )by
. E . Robinson SeptjQ
at—_71 Cj g l- a has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. aated,!_ Z a- nl/
Installer yam o 1=o Rob}}7snnSr. Designer
The issuance of this permit shall not be construed as a guarantee that the syst m ill function as signed. `
Date > i Inspector
————————————————————--—- ———
No. 'l 1 Fe4 5 9
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
lwi5po5al *pfStem Construction Permit
Permission is hereby granted to Construct( )Repair(X )Upgrade( )Abandon( )
System located at d 7 3 Qa k l an d Rd „ .
T
E and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to
5
comply with Title 5 and the following local provisions or special conditions.
Provided:Cons ctio ntst be completed within three years of the date of t is pe 1i.
Date: L+l Approved by
1
t
r-
tr6�94 -
NOTICE: This Form Is To Be Used. For the Repair Of Failed
Septic Systems Only.
C_ERTMCAMON OF SKIMTCH AND APPLICATION FOR A DISPOSAL
WORKS CONSTRUCTION PERMIT(WTfHOUT DESIGNED PLANS)
L Will iain E_ Robinson,S, cenifY dw the appliecation fir disposal works
construction permit igped by me dated ti"A i) 0 . concam*the
property located at 473 Oakland Rd. , Hyannis. ,MA meets all of the
following criteria:
The failed is aonneaed to a readendal dwelling only. There am no commercial or business
uses I with the dwdbn&
The soil is ck ssi as CLASS i and tLc patina roe is lets Wan or cquai to:5 mimues psr inch
Therc arc no wedands wuhin 100 feet of dw proposed septic kyncm
There arc noI1pnvatc weds vvuWn 150 rest of die proposed septic.s}xml
There is no in flow and/ordWmW in use proposed
• There are vaxiswm tEQnes60d or needed.
• Ile 6ottnn�l . prof bclb-W will ma be bcmed less than five foe above the
maximum advisted gToondwater table elevauok (.Adjust the gronjutwater table using the Frimptor
method w applicabte(
• If the S.�LS.will be locaied with 250 I=al-any'veSctaied wedands.the bottom of the p aposed
lewhind facr'ln3►will not be located less than fourteen(14)feet above the maximum adjusted
grtamd4ater table elevation
complete the
A) Top of Giou nd Surface Elara>ioi(using GIs inaxmadmi (U
B1 G.W.Elevation z the'.MAX- ffi&G.W.Adjtsumtt
DIFFERENCE BETWEEN a and B 117
—
SIGNED: DATE:
(Skewh proposed Plan of system on backj-
sr hearth folder_can
•s
1
IN
r�
cl
4
.—°uc
c
6 TOWN OF BARNSTABLE
5
23 Q .�, f ' C�7 ': SEWAGE:#
LOCATION �L .
Nab ASSESSOR'S MAP & LOT Z -/o�/
ASSESSO g.
VILLAGE Z
INSTALLER'S_NAME&'PHONE NO. ✓1-s t
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) --'� C (size)
�i
NO.OF BEDROOMS
� BUILDER OR OWNER
PERMITDATE: �=b / COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bo om of Leaching Facility Feet
Private.Water
Supply Well and Leaching Fa ' •ty (If any wells exist
on site or within 200 feet of leachingf _ihty) Feet
_ .
Edge.of Wetland.and Leaching Facility any wetlands exist
within 300 feet of leaching facili
Feet
Furnished by
}I
t'
t
T \
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`-v 9
� J_
� a
CERTIFIED SEPTIC SYSTEM REPORT
LOCATION
473 OAKLAND RD .
HYANNIS, MA 02601
MAP 272 PARCEL 104
PREPARED FOR
SELLER
MR. NELSON A. BELANGER, III
473 OAKLAND RD.
HYANNIS, MA 02601 '.
N .j 0
BUYER ' oF 199?
MS . JO—ANN LEPORE
470 MITCHELL 'S WAY
HYANNIS,- MA 02601 >'
PREPARED BY
HILLIARD HILLER
P .O . BOX 250
CENTERVILLE, MA 02632
508-778-1472
Commonweatm of Massachusetts
Executive Office of Environmental Affairs
Department of
Environmental Protection
AM F.Wald Trudy c
oxe
YY —V t
Gorsrtnr 5ic�
Argeo Paul Colluecl Davidc8' Strom s
U.dorsmor
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Property Address: �73 d'KC4 elO X di yyA'U'vd Address of Owner.
Date of Iaapectioo: 12/9l9G (If different)
Name of Inspector. //
Company Name,Address and Telephone Number-• /6�lJ B-'X �7 So
sv8- -7749 2 a
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true. arrurate
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and
ma;+�*•*���of=-site sewage disposal systems. The system:
V Passes
_ Conditionally Passes
_ Needs Further Evaluation By the Local Approving Authority
_ Fails Inspector's Sipau wrc 7Date: I/s�/y
The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of compleLing 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 tha appropriate regional oT=e of the Department of Environmental Protection.
The original shoe1d be sent to the system owner and copies sent to the buyer, if applicable and the approving authority.
INSPECTION SUMMARY:
Chsc611 C,or D:
Al S'YS=PASSES:
y I have not found any information which indicates that the system violates any of the failure citeris as defined in 310 CMR 15-303.
Azy Lthue criteria not evaluated are indicated below.
BI SYSTEM CONDITIONALLY PASSES:
One or more system components need to be replaced or repau-ed• The system,upon completion of the replacement or repair,passes
iaspemaa.
Iadirara yes,tw,cr oot determined(Y, N, or ND). Describe basis of determination in all instances. If-not determined-, explain why sat)
_ The septic tank is metal. cracked• structurally unsound. shows substantial infiltration or e%filtr ation. or tank failure is
;nmi ent. The system wit pass ::speawn S:he enrsung septic tank is reoiaced with a`onforming septic tank as approved
by the Board of health.
(revised 11/03/95) 1
�i9�rs .23 � 7 l���i� ��/���/z 4�,r/
One Mll im Street • Boston,Massachusetts 02108 • FAX(617) 556-1049 • Telephone(61T)292-5500
w
' �Pm1ed On RQcvcNE Papr.
SUBSURFACE SEWAGE DISPOSAL SY9TEM INSPECTION FORM
PART B
-CHECKLIST `
Property AAdre.c 'o
Owner h.Q y%Gsvd 6�G/��/6Ell
Date of Inspection:
'Check if the following have been done:
/4/Pttmping information was requested of the owner, occupant. and Board of Health.
None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates
during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection.
L—As built plans have been obtained and examined. Note if they are not available with NIA.
-t—Tbe facility or dwelling was inspected for signs of sewage back-up.
fThe system dots:not receive non-sanitary or industrial waste flow
The site was inspected for signs of breakout.
cl_All system components, excluding the Soil Absorption. System. have been located on the site.
�k5Sff7�L
aft manholes were uncovered. opened. and the interior of the septic tank was inspected for condition of baffles or
tees, material of catstructian, dimensions, depth of liquid, depth of sludge,depth of scum.
/!The size and location of the Soil Absorption System on the site has been determined based on existing information or
apprvumated by non-intruxive methods.
The facility owner(and occupants, if different from owner+ were provided with information on the proper maintenance of Sub-
Surface Deposal System.
(revised 11/03/95) 4
f
r
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
P'ropetty.Address
Owner. /�� ,(/LL 5�,�� /�, GfJ•�/�stlC
Date of Inspection: I XAF 9,
FLOW CONDITIONS
RBBIDENTIAL-
Dedpl dow_pllons
Number of be&*=. J
Number of as- residents:
Garbage Vindar(3~or no):LX
Lwmdry manected to system(yes or no):2-19
Sessoaal we(yes or no):A,,�
Water meter reading:, if available:
Last data of oornpaacy:
COMMERCIALMMUSTRLkU
Type of establishment:
Deep flow. - *11=s/day
Grasse trap present:(yes or no)—
Industrial Waste Holding Tank present: (yes or no)_
Noa+ankary waste discharged to the Title 5 system: (yes or-no)—
Water meter readings,if available:
Last date of oampeacy:
OTHER(DaK71e)
Last date of oanpaaey-
GENERAL INFORMATION
PUMPING WORDS and of informatio :
$ 1/87 8/A-/8f� 2/y 8� ��/%s/,� �/,3/ems
Syatem Pumped as part of inspection: (yes or no) vo
if yes,whine pumped: gallons
Ewan for pumping
TYPE OF SYSTEM
Septic tank/di rmijutwn bo:/scil absorption system
Sine aeaspool
✓ Owrdow carpool
Privy
MmId system(yes or no) (if yes. attach previous inspection records, if any)
Other(a rplain)
APPROXWTE AGE of all camponents.date installed(if)crown) and source of information: 010e,6
70 /,
Sewage odors detected when arrmag at the site: )yes or not �U
(revised 11/03/95) 5
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Prop"Address
Owner. /'7.Q ,vim G/3,c�GL.2
Date of Inspection: 11211i _
SEPTIC TANK_C C;5�5
(loots on site plan)
Depth Wow Breda: .s
Yatanol of construction: ✓==ate_metal_FRP_ctheriexplam)
Dim.aricas:
8>sidge deptkL ,.
Distance fmm top of sludge to bottom of outlet tee or baffle: s,3
Scam thiclmesa:_ �t-
Dineen from top of scum to top of outlet tee or baffler
Distance from bottom of scum to bottom of outlet tee or baffle: /7
Comments:
(rommmandation for pumping, condition of inlet and outlet tees or bailles, depth of liquid level in relation to'outlet invert, str^ucival integrity,
evident,of leakage. etc.) " i A,Z-X r T/L.f: c%r/f/S 7,11
T��
GREASE TRAP:_
(fonts on site plan)
Depth below grads:
ugsrial of construction: —concrete_metal_F?t? _othenexplain,
Dimensions:
Scam thirkasss:
Distance from top of scum to top of outlet tee or baffle:
Distance hom bottom of swim to bottom of outlet tee or baffle:
Comments:
(raummendation for pumping,condition of inlet and outlet tees or baffles. depth of'.:quid level in relation to outlet invert, structural integrity,
evidence of leakage, etc.)
(revised 11/03/95) 6
c
� J
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION.(continued)
Property Add,w,
Owner-
Date of Ingmc io=
SOIL ABSORPTION SYSTEM (SAS):
Ooota on site Plan,if poeable;mcavation not required. but may be appr—imated by non-intrusive methods)
If not detnmiaed to be present,arplain:
Type:
leeehiag pits, number._
lasehing chambers,number._
lnehing pd]eriee, numben
leeching trenches,number,length:
leeching Salds, number,dimensions:
overflow cowpool, number._
Comments:(note condition of soil. signs of hydraulic failure. level of ponding, condition of vegetation etc.) l� ,(✓2> 7Xyiti
CESSPOOLS:_
(locate an site plan)
Number and configuration:
Depth-top of liquid to inlet invert:
Depth of solids
layer-
Depth of==layer-
Dimensions of ownpooL-
YateriaL of amurmaction:
Indimttioa of gevtmdwster
inflow(cmffpool must be pumped u part of inspection)
Comments:(note aomdition of soil.signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
c�BIVY:_
(bate as site plan)
Materials of annsezvmo= Dimensions:
Depth of solids:
Comments(note condition of soil signs of hydraulic failure, level of ponding, condition of vegetation. etc.)
(revised 11/03/95) 8
4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address 6/7 3
Date of Iaspeation:
SKETCH OF SEWAGE DISPOSAL SYSTEM:
in hw6 ties to at Last two permanent references]aadmaris or benchmarks
beau an wwa1L within 100'
Li
I
I
I
� I
DEPTH TO GMUNDWATER
Depth to Qv®dwam 0 !- feet
metal of dsw==.ta.or appm-=tic-:
6. ` 7 G d vL 15
d �Gr/i r�G Shot../5 Th`A Gdil r�E!1 o3�.t �!� T/t.� S iT.t' Tb
y5G5 w���rloy /S 64 Mel
(revised 11/03/95) 9
LOCUS DATA
N
CURRENT OWNER JoANN LEPORE LOT 1110
La—
OCUSPLAN REFERENCE 206-57 i' LDEED REFERENCE 10588-325 ABANDON EXISTINGLEACHING AREA IN .ZONING DISTRICT RC-1 ACCORDTITLE S.ANCE WITH 7a 34 �„ 129t
FLOOD ZONE C J LOT 10 / / LOCUS MAP
i 15 614f S.F. NOT TO SCALE:
ASSESSORS MAP 272 \ ,� /
PARCEL 104 \ — — i MAP 272 / // / 14-0108
BENCHMARK _, PARCEL 104
OVERLAY DISTRICT ZONE II — GP CORNERBULKHE OF CONC. 58—. — /
LOT AREA 15,614f S.F. ELEV=59.00
SITE 8c SEWAGE
REPAIR PLAN /BLUETONE
4/ J _USE 6cSBLOCK77- RE
EXISTING ATIO /
OA KL A ND ROAD 1,500 GALLON
IN SEPTIC TANK.
473
HYANNIS, MASS 10.1, , 3 BEDROOM
DATE: APRIL 16, 2014 DWELLING
�3 4' DT #2 TOF 59.31
M
3` 32.1, �� // / I MAP 272
OWNER/APPLICANT. N b / / / PARCEL 106
58 ry 4,
JoANN LEPORE 3,
#473 OAKLAND ROAD 40' ( w / O
HYANNIS, MA 02601
PR00PO9E0D 10.,. . SAS o/N/w -
S.A.S. 1—�11_0, 9TH #1 \ U P .
SHEET 1 OF 2 r r \ / / � ass
HYDRIANT ��°� EDWARD9c��N
PREPARED BY: To
J c�
E A S SURVEY, INC. �� /� �,} ,/ I �o pNo. 89E0
141 R T. 6 A N ,8 34'20' E 12 s . i TE
SANDWICH , MA 02563 �� /ti , 0 40
PH. (508) 888-3619' s� LOT 9
CELL (508) 527-3600 _ GRAPHIC SCALE:.
EAS.SURVEY@YAHOO.COM / 1 INCH_= 20 FEET
SYSTEM DESIGN
RAISE COVERS TO WITHIN 6" OF FINISH GRADE
i, ONE RISER TO WITEXISTING DESIGN FLOW
TCF = 59.31 FINISH GRADE OF FINISHED G ADEIN 6" 3 BEDROOMS AT 1 00 GPB/D 3.3-2 GPD
GRADE 58.50 ELEV. 58.0 FINISH•GRADE
ELEV. 58.0 REQUIRED SEPTIC TANK
ELEV. 58.10 GROUND ELEVATION 58.00
O Top
=
330 x_2 _ _ ___660 GAL.
TOP ELEV 55.80 a SEPTIC TANK PROVIDED = 1,500-GAL.
EXISTING 4" PVC 30'f�S=0.017 EXISTING TO REMAIN
- SCH 40 M-' "MAX 4' PVC SCH 40 10'C�S= 0.01 p O p O O o o 00000 o ( )
XISTING INV•= o o SIZE OF LEACHING FACILITY REQUIRED .
56.00 10"TEE 14"TEE INV•= 0 0 0 0 O 0 0 0 0 0 i
� .� TO REMAIN 55.80 0 00 00 0 o O 00 00 w DESIGN PERC RATE -_ <2 -`MIN. INCH
5'-7 INSTALL /INV.=!55.27
0 0 O O 0 /
GAS BAFFLE OUTLET LONG TERM APPL. RATE-0.74-GPD/S.F.
„
4'-6 1/2 � TWO 5-0 x8'-6"x2'-10 CHAMBERS
4'-1" LIQUID LEVEL DB3 S.A.S. (11:0' x 29.0') o SIZE OF LEACHING SYSTEM PROVIDED:
INV.=55.00
1 a 330 + 0.74 SF/GPD = AIL S.F. MIN. REQ.
DATUM: INV.=55.10 L
53.00
aL o t is vi USING H-20 CONCRETE LEACHING CHAMBERS
VERTICAL DATUM: WITH 4' OF STONE ALL AROUND
MSLt / BARNSTABLE GIS EXISTING 1,500 GALLON � � 45.9
BENCH MARK USED: SEPTIC TANK TO REMAIN BOTTOM (11.0' x 29.0') 319 S.F.
CORNER OF CONC. BULKHEAD SIDE WALL (11.0' + 29.0') 2x2 = 160 S.F
ELEVATION 59.00 CONSTRUCTION NOTES: 479 S.F.
14-0108 ,' a 00000 0 o 00000 zo 479 S.F.x 0.74 G/SF = 354 GPD
1. CONTRACTORS / INSTALLERS SHALL VERIFY GRADES AND 00000 00000 1 354 GPD PROV > 330 GPD REQ. = 24 GPD RES.
99^ ELEVATIONS AND SITE CONDITIONS PRIOR TO COMMENCING N 0 0 O o o O O O iv
SITE CSC. SEWAGE . WORK ON THE SITE. , O O O O O 0 NO- (GARBAGE DISPOSAL / GRINDER ALLOWED)
2. DETERMINATION HAS BEEN MADE AS TO COMPLIANCE
REPAIR PLAN WITH
��
WITH DEEDED OR ZONING REGULATIONS. OWNER / APPLICANT 'j' 3 0 5.0' 3 0
IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. Pj 14319
7� 3. VEHICULAR TRAFFIC, PARKING OF VEHICLES AND PLACING 11.0'
MATERIALS OVER THE SEPTIC TANK, DISTRIBUTION BOX AND D.T.H. #1 lb D.T.H. #2 91
S.A.S. AREA IS PROHIBITED SIDE VIEW DATE: 4-7-14 DATE: 4-7-14
OA KL A ND ROAD � GROUND ELEV. 57.9 GROUND ELEV. 58.0
GENERAL NOTES: � I CERTIFY THAT I AM CURRENTLY APPROVED BY THE NO GROUNDWATER NO GROUNDWATER
IN, 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. 'k DEPARTMENT OF ENVIRONMENTAL PROTECTION TO CONDUCT
H YA N N I-S MASS TITLE V AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS SOIL EVALUATIONS AND THAT THE RESULTS OF MY SOIL A A
FOR SUBSURFACE DISPOSAL OF SEWERAGE. EVALUATION ARE ACCURATE AND IN .ACCORDANCE WITH 310 LOAMY SAND LOAMY SAND
A POINT OVER TANK TEES SHALL BE
ACCESS PORTS BROUGHT FINISH
WITHIN 12' OF FINISH GRADE. CMR 15.1 THROUGH 15.107. 10YR 4/3 „ 10YR 4/3
DATE: APRIL 16, 2014 ACCESSIBLE WITHIN 3' OF FINISH GRADE, WITH ANY REMAINING 4 4"
2. AT LEAST ON CC
3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE _� EDWARD A STONE, CERTIFIED SOIL EVALUATOR LOAMY SAND LOAMY SAND
OWNER APPLICANT: CAPABLE OF WITHSTANDING H-10 LOADING UNLESS . 7.5YR 5/6 7.5YR 5/6
OTHERWISE SPECIFIED.
JoANN LEPORE 4. THE EXCAVATION CONTRACTOR SHALL VERIFY THE LOCATION try EL. = 56.4 18" EL. = 56.4 20"
OF ALL UTILITIES PRIOR TO ANY EXCAVATION.
#47 3 O A K LA N D ROAD 5. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE moo`' DAVID DTH #2 TEST DEEP
OR WITHIN 6" OF GRADE SHALL BE MORTARED IN PLACE. C-1 C-1 48"
H YAN N I S, MA 02601 6. FINISH GRADE SHALL HAVE A MINIMUM OF 0.02 FEET PER o a R. COARSE SAND COARSE SAND
FOOT OVER THE S.A.S. AND DISTRIBUTION BOX. H , ] (�
10YR 6/6 10YR 6/6
7. SEPTIC, TANK SANITARY TEE'S SHALL BE CONSTRUCTED OF N 21 INDICATES 10% GRAVEL 10% GRAVEL
SCHEDULE 40 PVC AND SHALL EXTEND A MINIMUM OF 6 BOVE A F P-1 48" ' PERC TEST 120': 120"
C-2 C-2
THE FLOW LINE AND SHALL BE ON THE CENTERLINE AND ���sTEA �-
SHEET 2 OF 2 ►T " "
LOCATED DIRECTLY UNDER THE CLEAN OUT MANHOLES. NO MOTTLING MEDIUM SAND MEDIUM SAND
8. THE INLET PIPE INVERT ELEVATION SHALL BE NO LESS THAN NO WEEPING 2.5Y 7/4 2.5Y 7/4
PREPARED BY: 2 INCHES NOR MORE THAN 3 INCHES ABOVE THE INVERT I
ELEVATION OF THE OUTLET PIPE. 144" INDICATES ADJ. GROUNDWATER NO G.WATER NO G.WATER ,
E A S SURVEY INC. 9• THE SEPTIC TANK SHALL HAVE A MINIMUM COVER OF 9 INCHES` NO OBS. GROUNDWATER EL. = 45.9 144' EL. = 46.0 144'
10. THE OUTLET SANITARY TEE SHALL BE EQUIPPED WITH A GAS
BAFFLE, 4 INCHES IN DIAMETER AND CONSTRUCTED OF 4" PVC B.O.H.
11. ALL PIPES SHALL BE SCHEDULE 40 PVC SEWER PIPE AND NO OBSERVED GROUNDWATER DONNA MIORANDI
141 R T. 6 A
SHALL BE SLOPED 1/4 INCH PER FOOT MIN. EXCEPT FOR THE
P. O. B 0 X 1729 SOIL EVALUATOR
FIRST TWO FEET OUT OF THE DISTRIBUTION BOX WHICH SHALL DEPTH TO BOTTOM OF HOLE 144" ED. STONE
B
SANDWICH MA 02563 12. C BAC OPERATOR.
CHANGES RODNS OR REVISIONS TO SEPTIC DESIGN REQUIRE NOTIFICATION
VARIANCES REQUESTED RODNEY FISHER
TO EAS SURVEY INC. FOR B.O.H. AND'DESIGN ENGINEERS REVIEW SOIL TYPE:
PH. (508) 888-3619 AND APPROVAL. NONE PERC RATE: <_2 MIN. PER INCH
CELL (508) 527-3600
13. MAGNETIC TAPE ON ALL COMPONENTS. LOADING RATE: 0_74 GAL/SF/MIN