HomeMy WebLinkAbout0065 ORR'S AVENUE - Health `65 Orr's Avenue
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Hyannis
A = 291 192
TOWN OF BARNSTABLE
LOCATION �orJ O rrs AYenu c SEWAGE# =F 1 8
VILLAGE ASSESSOR'S MAP&PARCEL 147
INSTALLER'S NAME&PHONE NO. 7
SEPTIC TANK CAPACITY ON�, r
LEACHING FACILITY:(type. IM (size) XZ5.
NO.OF BEDROOMS w 3., Ps 3 1
OWNER /
PERMIT DATE: S T,12.1 COMPLIANCE DATE: ,j.
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 le hi g th cility) Feet
FURNISHED BY
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No. �Z� � 0 1 Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in com user:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
ZIpplitation for MispoSal 6pstem ConstCULtion permit
Application for a Permit to Construct( ) Repair( ) Upgrade Abandon( ) ❑Complete System Xlndividual Components
Location Address or Lot No. S W5 A lle, Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel Al 119, 041-Illn,j 60va—
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
awhy�< Extaom 2 O soS•lR -�� �'
Type of Building: ff 3`l 315,)rvvns /
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building Q k%JL No.of Persons Showers( ) Cafeteria( )
Other Fixtures ^ /�
Design Flow(min.requ. ed) 220 gpd Design flow provided S 2. gpd
Plan Date Number of sheets Revision Date
Title 6 r(A 4b& S A. G
Size of Septic Tank ��( Type of S.A.S. f t�
Description of Soil
S . J
Nature of Repairs or Alterations(Answer when applicable)
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*evironmental C e and not to place the system in operation until a Certificate of
Compliance has been issued by this Board o
Signe Date
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. *2--d;2. Date Issued 1 2
^b 16
No. r ± Fee �UV .
THE COMMONWEALTH OF MASSACHUSETTS Entered in compute /
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 1
2pplication for gisposaf *pstpm Construction Permit
i
Application for a Permit to Construct( ) Repair( ) Upgrade(X Abandon( ) ❑Complete System ®Individual Components
Location Address or Lot No. lu ► A vc Owner's Name,Address,and Tel.No. t-+
Assessor's Map/Parcel t �„ q.�O h v) 1 + e r- c
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
Type of Building: gy ;( d rao^f
Dwelling No.of Bedrooms `- Lot Size ; sq.ft. Garbage Grinder( )
Other Type of Building `, b�?: No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) L. gpd Design flow provided l G gpd
Plan Date , Number of sheets Revision Date
Titlepli4 Wax fif- Ntw(tt ��'�1f. ll'� t� U 10.tc. Get i-:�, dat'i'.f AV
Size of Septic Tank ,(,(Ft:- Type of S.A.S. ti is f
Description of Soil r _
A.
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected: {
Agreement: i f A 1 I !
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 HealtK. Vi
Signe . ,a Date a 1141 t
Application Approved by .40 Date
Application Disapproved by Date y
for the following reasons
Permit No. -Ike, Date Issued S�/•� �j�?.l
' t
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
at has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. r"�� dated �? /Z19
t: ,;j r ,
Installer (A Li i h i'1.l 4y (((. i t{ hk� Designer ' `u �":1�trt V[r�*-•��' r'-'ti.
r
#bedrooms Approved•desig fl.,o,, _ gpd
The issuance of this perniif sha 4o be construed as a guarantee that the system will function as designed.
Date 1',/ i � � Inspector 5,.
No. 2 6 f<— A ! Fee OAtr
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Disposal *pstem Construction Permit
Permission is hereby granted to Construct( ) Repair( ) Upgrade( A) Abandon( )
System located at
^V
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:Constructiio'n'Emust be completed within three years of the date of this permit.
Date J ��Tz Approved by a".
•
Town of Barnstable
THEr
a Inspectional Services
� 1ARNSTAHLE.
Public Health Division
o�q ,off Thomas McKean, Director
plFO is 200 Main Street,Hyannis,MA 02601
Office: 508.862-4644 Fax: 508-790-6304
Installer& Designer Certification Form
Date: Sewage Permit# _ AssessorQI
s NIapAParcel,.�)CI `
CZ, i�
Designer: �G>c1��_.c� �� e:U Installer: ' tb_fi(
Address: V\,D\\o,--d Z6 Address:
Onv �was issued a permit to install a
(date.) Installer)
septic system at Cs�J U��13 A;veoQe , 1 based on a design drawn by
(address)
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.c,
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 to compl�nce with the terms of
U(Instaill,
pproval letters(if applicable)aSignatugre)
e) S
'?CGISTEer's (Affix Desig ere)
PLEASE RE' 'URN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BO'rH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTA:BLE PUBLIC HEALTH DIVISION.
THANK YOU.
lttov4dcpts%IEALTIMEW6R conncdSEPT1:1Dcsisnet Certification form Rev&I4•I3,f)OC
4ee" OF BARNSTABLE
LOCATION L-a s �'�� �t S�� SEWAGE #
VILLAGE -t-��( ��.k�. S ASSESSOR'S MAP & LOT
ap
rt INSTALLER'S NAME 6t PHONE NO. A & B CANCO 775-6264
rc
�:. SEPTIC TANK CAPACITY 1 6'Zr o Cp c,
E LEACHING FACILITY:(type)n1 •.t w S�a-y a (size)
NO. OF BEDROOMS 3 PRIVATE WELL O UBLIC WATER
BUILDER OR OWNER
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED: ,-l3
VARIANCE GRANTED: Yes No �/
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No.... FEs.... .._
THE COMMONWEALTH OF MASSACHUSETTS MAP Z- _
-�- BQA R D OF HEALTH PARCEL • � � Z
Appliration for Disposal Works Tonstrnr#iun Permit
Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal
System
5.......... -------------- ---------- .6..---- .........................................
wi��N1 Location-Address or Lot No.
......... •-...-•--- ............................................... -•-----•-•--•------•-•------•--•••-••..........-•---•..........------•------••---.....--------••--
&.9vne, - Address
W _................................... � ._.. _r_._ ._.......__.......... _.................................................................................................
' " ller Address
e of Building Size Lot.17
7 ..
U Type g -"F; � !....................Sq. feet
Dwelling—No. of Bedrooms.•........•.................................Expansion Attic ( ) Garbage Grinder (MG
'4 Other—Type e of Building ............... No. of ersons............................ Showers
G.i YP g ------•-•---- P ( ) — Cafeteria ( )
Other fixtures ...................................
v ----,----------------------------------------------3-30----------------------------
W Design Flow l� gallons per rgr/�y. Total d��Y`�ow..............
--..-.--•----------- -- �i
0
WSeptic Tank—Liquid'capacity.l._.._._.gallons Length................ Width.y.._........ Diameter---------------- Depth........ ..
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage , z_ P g 3--.sq. ft.
See e Pit No..................... Diameter.._....1....._.... Depth below inlet__.....�l..L..._..... Total leaching ar
Z Other Distribution box (py_ Dosing t ( )�
aPercolation Test Resul�,Z Performed by...... '_..�"... '.. ® ....y�,-----------•---• Date.... ..../� ..
Test Pit No. l:.G.Z_minutes per inch Depth of Test Pit...1. . Depth to groun water-__7.� �`.
GZ4 Test Pit No. 2................minutes per inch Depth of Test Pit...b:F...... Depth to ground water. �`..�.j/.
..B .---- --/d 8_
� --
. � ..... ff
c -- --•-- ....
VNature 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 iITLL 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
Signed..-. C v C a/(4° -•--�-- �_
U 0 ate o
Application Approved By...... � � %�+ . .. o ¢
Date
Application Disapproved for the following reasons:-•------•-------•--•-------------•----------•---•--•----•---------------------...-----•------•-••------••------
........................................................
--------------•--••......•--••••-•---------•-•---...-- . ------........-----------•-----•----------------------......-•----........................-----...Date•------•--•---
Permit No......... ..... ................
.. Issued.......................................................
Date
• � 1
Fxs...... J
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
i `.....U- ... ---......OF........../....��......Si �.
App iratiou for Diopoottl Works Tonstro.r#inn ramit
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
System at:
.............. -- ........................................... .......................... ................................................
Location-Address or Lot No.
......................_.......................................................................... ................••-•••-----•-•--•-•-••••---•-----•--•.........••----..........................•...
Owner Address
W
�• Installer� Address
Type of Building Size Lot.'_Z/.........•..........Sq. feet
�-, Dwelling—No. of Bedrooms................................ .....Expansion Attic ( ) Garbage Grinder (gyp
PL, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
al Other fixtures ---------------------------------- "t..,. -,
W Design Flow.............................................gallons per��eday. Total dai flow ga�l�ons_t
WSeptic Tank—Liquid*capacity:._..---.gallons Length__...!'_.... Width.�.�/....... Diameter................ Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area___. sq. ft.
Seepage Pit No ....... Diameter....._ ....... Depth below inlet...... Total leaching ar .! q.s ft.
Z Other Distribution box (?4) -Dosing tank
( ) . .
� e. C V .� / i Y 45 r'✓
Percolation Test Resu tts— Performed by.....................................................:.................. Date.................__........._
Test Pit No. 1...._._........minutes per inch Depth of Test Pit... .............. Depth to ground water_.__..__.___.-----
ri, Test Pit No. 2.............minutes per inch Depth of Test Pit--l'_�_.�___. Depth to ground water.�.l ........___.
O script'on of Soil_ `• T _ .,,fs:. .----=—
..
.....7—6,
.----..._ `.
------ ----
x ..y...........I............................................................................... ......•••.
U 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 TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
' operation until a Certificate of Compliance has been issued by the board of health.
Signed..... .._-•-• -----•--•------.----- •------------- rX
----------
� �_._....----•-• ................,, ate
Application Approved By....... .._��7!, .... .; -i_--------------------------------------------------' _ ..
Date
Application Disapproved for the following reasons-------------•--------------...---•-•-------------------•--------------------------------._......-•----••......
...........................•-••-•-•---•.....-----^.._.__...... . -------••--------...------------------------•----•-•-------------•--•---•-•---•--------•-----.... ......---------
Dat
PermitNo.....................` .................. Issued-.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.......�r..�. V......OF/.4 .&C�........................
(9rrtifiratr of Tootpliattrr
THIS, -I,.S 0 IF )WI divadual Sewage Disposal System constructed (/or Repaired ( )
by. ....................... -------•-------------- -------- - ---- ------ --.--------•-..._..--------.--•---------
at.•-••-•-•�.�-......._� &.1.1—-- �............. �n��>���_> H� I�A
been installed in accordance with the provisions of TI 5 oT State Sanitary Code as de cr' din the
application for Disposal Works Construction Permit No.._ j_33� I .......... dated.... .................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE...................•..... `1..-. _ _:-. ........................... Inspector........................
� ,-.--...--•-•-.....--•••-•.......••.......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD ,-OF HEALTH
No.l�/' .................................
�!... .-..�.._. FEE............................
RsVooal Works ot o �it rrmit! _ qN ........Permiss>on Is ereby granted... �- r
............................................................
to Construct !L ro) epa' ) an Indivi -u wage i'spf sal S st
at No.. .1 r .. ll-10�.
-•-.... - - -----------•----------•---------------
Street ., � _ ++��
as shown on the application for Disposal Works Construction Permit No. Dated..{ ,_ _ 7..-
•---•-•----------------------------------------------------------------•------••--......-•-...---..-----
Board of Health
DATE_
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS
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— CO.%i1i0-WEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL: AFFAIR,'
= DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE WINTER STREET. BOSTON h1A 02105 (617) 292.550u
TRUDY CORE
Secretary
ARGEO PAUL CELLUCCI DAVID B STRL'HS
Governor Commissioner
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A'
CERTIFICATION
Prop"Address: 65 Orrs Ave . , Hyannis , MANameofOwner Carrie Nickolson
Address of Owner: s ame
Date of Inspection: g
Name of Inspector:(Please Print)Wm. E . Robinson S r .
I am a DEP approved system inspector rsuant to Section 15.340 of Title 5(310 CMR 15.000)
Company Name: Wm. E . Robinson eptic Service
Mailing Address: PO Box 0 9, Centerville , MA
Telephone Number: �8 0
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 inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sew a disposal systems. The system:
asses
Conditionally Passes
_ Needs Further Evaluation By the Local Approving Authority
Fails
Inspector's Signature: Date:
The System Inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within thirty (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 Department of Environmental Protection. The original should be sent to ttre
system owner and copies sent to the buyer, if applicable, and the approving authority.
NOTES AND COMMENTS
9
AUG 2 0 1999
TOWN OF BARNSTAB(.E
i HEALTH DEPT ,b
A ti
f�
revised 9/2/98 Page Iof11
ij ✓r;ried on Recycled Paper
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION Icorrtinued).
"roperty Address: 65 Orrs Ave . , Hyannis
.)wrw: Carrie Nickolson
Date of Inspection:
INSPECTION SUMMARY: Check A, B, C, or D:
A. pSYSTEM PASSES:
J I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure
v criteria not evaluated are indicated below.
COMMENTS:
B. S STEM 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.
Indicate es, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If "not determined-, explain why not.
_ The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of
Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or
the septic tank, whether or not metal, is cracked,structurally unsound, shows substantial infiltration or exfiltration, or tank
failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as
approved by the Board of Health.
Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)
or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of
Health).
broken pipe(s) are replaced
obstruction is removed
distribution box is levelled or replaced
_ The system required pumping more than four 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
ti
revised 9/2/98 Page 2ofII
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 65 Orrs Ave . , Hyannis ,
Owner: Carrie N,ickolson
Date of Inspection:
C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the
public health, safety and 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 THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
_ Cesspool or privy is within 50 feet of 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 AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a
private water supply well, unless a well water analysis 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. Method used to determine distance (approximation not valid).
3) OTHER
revised 9/2/98 Page 3of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A v
CERTIFICATION (continued)
Property Addre 65. 0rrs Ave . , Hyannis t
Owner: ffarriv Nigckolson
Date of Inspection:
D. S STEM FAILS:
You mu t indicate either "Yes" or "No" to each of the following:
I have determined that one or more of the following failure conditions exist as described'in 310 CMR 15.303. The basis for this
eterminat,on is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure.
Yes o
Backup of sewage into facility-or system component due to an 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 1/2 day flow.
_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped_.
Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
Any portion of a cesspool or privy is within a Zone I of a public well.
Any portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no
acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
E. RGE SYSTEM FAILS:
You ust indicate either "Yes" or "No" to each of the following:
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public
health and safety and the environment because one or more of the following conditions exist:
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)
The wner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional
office of the Department for further information.
revised 9/2/98 Pagc4of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
r'roperny Address: 65 Orrs Ave . , Hyannis
Owner: Carrie Nickolson
Date of Inspection:
Check if the following have been done:.You must indicate either "Yes" or "No" as to each of the following:
Yes No .
_ Pumping information was provided by the owner, occupant, or 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.
• z
V _ As built plans have been obtained and examined. Note if they are not available with NIA.
_ The facility or dwelling was inspected for signs of sewage back-up.
_ The system does not receive non-sanitary or industrial waste flow.
_ The site was inspected for signs of breakout.
_ All system components, excluding the Soil Absorption System, have been located on the site.
_ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles
or tees, material of construction, 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. For example, Plan at B.O.H.
_ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of,distance is unacceptable)
(15.302(3)(b))
_ The facility owner (and occupants,if differerg from owner) were provided with information on the proper maintanancs of
Subsurface Disposal Systems.
revised 9/2/98 Page 5of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Iroperty Address: 65 Orrs Ave . , Hyannis
owner: Carrie Nickolson
Date of Inspection: r—41- -9
FLOW CONDITIONS
RESIDENTIAL:
Design flow: '34�,0 g.p.d./bedroom.
Number of bedrooms(design): Number of bedrooms (actual):_
Total DESIGN flow 3 G d
Number of current residents
Garbage grinder(yes or no): fl
Laundry(separate system) (yes or no):&�; If yes, separate inspection required
Laundry system inspected (yes or no)
Seasonal use (yes or no): /i.,O 1998 30, 750 gal.
Water meter readings,if available (last two year's usage(gpd):
Sump Pump(yes or no):,2—L10 �, 1997 31 , 500 gal.
Q
Last date of occupancy: 7-9 7
COMMERCIAL/INDUSTRIAL:
Type f establishment:
Desig flow: qpd I Based on 15.203)
Basis f design flow
Greas trap present: (yes or no)_
Indust ial Waste Holding Tank present: (yes or no)_
Non-s nitary waste discharged to the Title 5 system: (yes or no)_
Water meter readings,if available:
Last ate of occupancy:
O R:(Describe)
La ate of occupancy:
GENERAL INFORMATION
PUMPING RECORDS n ,source of information:
System p ped as part of inspection: (yes or no)= d
If yes, volume pumped: . gallons
Reason for pumping:
TYPED 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)
I/A Technology etc. Attach copy of up to date operation and maintenance contract
Tight Tank Copy of DEP Approval
Other
APPROXIMATE AGE of all components, date installed(if known)and source of information:
Sewage odors detected when arriving at the site: (yes or no)
revised 9/2/98 Page 6(if II
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
►rop"Address: 65 Orrs Ave . , Hyannis °
Owner: Carrie Nickolson
Date of Inspection:
BU DING SEWER:
(Loc eon site plan)
Depth elow grade:_
Materi I of construction:_cast iron_40 PVC_other(explain)
Distan a from private water supply well or suction line
Diame r
Comm nts: (condition of joints, venting, evidence of leakage,etc.)
SEPTIC TANK:_
(locate on site plan)
t�
Depth below grade:
Material of construction:_concrete_metal_Fiberglass _Polyethylene_other(explain)
If tank is metal,list age_ Is age confirmed by Certificate of Compliance_(Yes/No)
Dimensions: to °t
Sludge depth: 'd1-1— �V 'sr
'
Distance from top of sludge to bottom of outlet tee or.baffle:(z_
Scum thickness: I .L'
Distance from top of scum to top of outlet tee or baffle: ,1
Distance from bottom of scum to bottom of outlet tee or baffle: b
How dimensions were determined: rS 1P!''
'omments:
(recommendation for pumping, condition of inlet and outlet teal sr baffles epth of Ili evel in relation to outll t invert, structural integrity,
evidence of leakage,etc.) ��"a--L] �i a f `�� �` � ���-S' IL" 1f4/' G �J
GR SE TRAP:
(local on site plan)
)Datee
elow grade:_
of construction:_concrete metal_Fiberglass Polyethylene_other(explain)
ons:
ickness:
from top of scum to top of outlet tee or baffle:
from bottom of scum to bottom of outlet tee or baffle:
last pumping:
nts:
endation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity,
e of leakage,etc.)
revised 9/2/98 Page 7or11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Aroperty Address: 65 Orrs Ave . , Hyannis
Owner: Carrir Nickolson
Date of Inspection:
TIG T OR HOLDING TANK: (Tank must be pumped prior to, or at time of, inspection)
(locat on site plan)
Depth elow grade:_
Materia of construction:_concrete_metal_Fiberglass_Polyethylene_other(explain)
Dimens' ns:
Capacit gallons
Design ow: gallons/day
Alarm resent
Alarm evel: Alarm in working order: Yes_ No_
Date f previous pumping:
Co ents:
(co dition of inlet tee, condition of alarm and float switches, etc.)
DISTRIBUTION BOX: (/
-locate on site plan)
Depth of liquid level above outlet invert:
Comments:
(note if level and distribution is equal, evid olids carryover, evidence of leakage into or out of box, etc.) -
PUMP CHA BER:_
(locate on s e plan)
Pumps in orking order: (Yes or No)
Alarms in orking order(Yes or No)
Comment
(note con ition of pump chamber, condition of pumps and appurtenances, etc.)
revised 9/2/98 Page 8of11
I
. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
4operty Address: 65 Orrs Ave . , Hyannis
Owner: Carrie Nickolson
Date of Inspection: /
SOIL ABSORPTION SYSTEM(SAS): t/
(locate on site plan, if possible;excavation not required,location may be approximated by non-intrusive methods)
If not located, explain:
Type:
leaching pits, number:
leaching chambers, number:_
leaching galleries, number:_
leaching trenches,number, length:
leaching fields, number, dimensions:
overflow cesspool, number:_
Altemative system:
Name of Technology:
Comments:
(note condition of soil, signs of hydrauli ilure, level ponding, damp soil, condition of vegetati e .Cs
/ti " r w��
CESSP, LS:-`
(locate on to plan)
Number an configuration:
Depth-top o liquid to inlet invert:
Depth of soli layer:
)epth of scu Iayer:
Dimensions of cesspool:
Materials of co struction:
Indication of gr undwater:
inflo (cesspool must be pumped as part of inspection)
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc,)
PRIVY:_
(locate on s to plan)
Materials of onstruction: Dimensions:
Depth of sot ds:
Comments:
(note condi on of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
revised 9/2/98 Page 9ofII
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C t
SYSTEM INFORMATION(continued)
'roperry Address: 65 flrrs Ave . , Hyannis
)caner: Carrie Nickolson
Jate of Inspection: Q-1
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent reference landmarks or benchmarks
locate all wells within 100' (Locate where public.water supply comes into house)
L 9
3c1
t
�rcda T-
revised 9 2 98
Page 10 of I I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
roperty Address: 65 Orrs Ave , Hyannis
Carrie Nickolson
Date of Inspecbon: G/ Q
NRCS Report name
Soil Type_
Typical depth to groundwater
USGS Date website visited
Observation Wells checked
Groundwater depth: Shallow Moderate Deep
SITE EXAM Slope
Surface water
Check Cellar
Shallow wells
Estimated Depth to Groundwater 1A Feet
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
Observed Site(Abutting property, observation hole, basement sump etc.)
Determined from local conditions
Checked with local Board of health
Checked FEMA Maps
Checked pumping records
Checked local excavators, installers
Used USGS Data
Describe how you established the High Groundwater Elevation. (Must be completed)
revised 9/2/98 Page 11of11
GENERAL NOTES
1. Contractor is responsible for Digsafe notification, Verification of Utilities
and protection of all underground utilities and pipes.
2. The septic tank and distribution box shall be set
level on 6„ of 3/4'-1 1/2" stone.
3. Backfill should be clean sand or gravel with no
stones over 3" in size.
LOTS #6 & 7 4. This system is subject to inspection during installation
by Carmen E. Shay — Environmental Services.
17,1 f2 Square Feet +/— 5. The contractor shall install this system in accordance
PROJECT BENCH MARK with Title V of the Massachusetts state code, the approved plan
and Local Regulations.
TOP OF FOUNDATION 6. If, during installation the contractor encounters any
ELEV. = 100.00 (Assumed) soil conditions or site conditions that are different
! -----, from those shown on the soil log or in our design
CHAIN LINK installation must halt & immediate notification be
20 2� I j FENCE made to Carmen E. Shay — Environmental Services.
7. No vehicle or heavy machinery shall drive over the
I*•'-'" `• ' t I I septic system unless noted as H-20 septic components.
8. Install Tuf—Tite gas baffles or equals on all outlet tee ends.
DECK
t:.',. ••'••I j GRAVEL j 9. All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipes.
2 1•- .•• •,� � 1 PARKING 10. All solid piping, tees & fittings shall be 4" diameter
E:• `' '► T-2S t I I Schedule 40 NSF PVC es with water tight joints.
TEST H LE #2 t 1 EXISTING 1 1 t pipes g
ELEV.= 99.00 �;;t j I I I 11. Municipal Water is Connected to ALL OF The Residence and Abutting
r, ,I 2 BEDROOM I I t
Properties Within 150 Feet.
SOUSE
TEST HOLE #1 FULL FOUNDATION I I 1 THE PROPERTY LINES ARE APPROXIMATE AND
i
ELEV.= 99.00 I t I COMPILED FROM THE PLAN BY ROBIN WILCOX, PLS
/ #65 t r---------7-----
ENTITLED PLAN OF LOTS 6&7 ORRS AVENUE, HYANNIS, MA
DATED JANUARY 28, 1988
99 ---- - - I -------------- AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN
Failed , j� j IT SHOULD BE USED FOR NO PURPOSE OTHER THAN
Leach Pit iR i GRAVEL
EXIST. I THE SEPTIC SYSTEM INSTALLATION.
O 1000 al. 'y�Ol PARKING j EXISTING LEACH PIT TO BE PUMPED OUT AND FILLED IN PLACE
NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE
Septic ank 1 GRAVEL 1 t? I FROM THE EXISTING CESSPOOL/LEACH PIT TO BE DISPOSED
------------- 1
j DRIVEWAY i q i --`9$
"''C� OF AS PER BOARD OF HEALTH SPECIFICATIONS.
GRAVEL ---
I
-,I DRIVEWAY
---------------+I---------- ------- I-____---
98--- III
PLOT PLAN
I 1 i i " I �•
lk
------------- ---- ------ 1- ,-_
OF PROPOSED SEPTIC SYSTEM UPGRADE
--------------- ----- ----------------- PREPARED FOR
A VE1VCTjO ELISSA HOOVER
(40 FAT RIGHT OF WAY) 6 5, 0 R R ST AV E N U E
ASSESSORS MAP 291 PARCEL 192
HYANNIS MA
+�+ LC ksn„om„caa
PREPARED BY:
O
°° :to o . ,i'�; t i SHA Y ENVIRONMENTAL SER VICES
,A
S
�^ Living Room R�co'Yswe°® 0 20 40 50 " �! ` 1 0 .0. Box 1576
Bedroom
MASHPEE, MA 02649
Gts1.
S ��a TEL/FAX 508-294-7498
2 BE HOUSE FLOOR SCHEMATIC z
J SCALE: 1"=20' SC 1 '=20' DRAWN BY: CES DATE: MAY 20, 2021
(Description Provided By Owner)
PROJECT#65 ORRS FILENAME: 65 ORRS AVE. wg SHEET 1 OF 2
LN
1
_ 10' min. from *NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C.
EXISTING Foundation house to septic tank Septic tank covers must be
within 6 tn. of finished grade D-BOX cover must be SAS cover must be SECTION A A
within 8` of GRADE within 8• of GRADE
Grade over Sepik Tank - 99.00 /—Grade over D-Box - 98.00 over sas - 99.00 PROFILE VIEWOF LEACHING SYSTEM
S = 0.02 HOLE /�•to r r/a • t►aNMd fh�eAed 80one 'N f/e•- f/s• �aen.a ra.aw
TOP OF SAS - 96.50
S0.01 (H-10) DIST. BOX f INSPECTION cover must be
a
H 12' within 6 in. of finished grade
EXIST, PIPE N EXIST 1,000 GA S. 0.010` er foot
FROM FOUNDATION W 40'
11
SEPHCITOANK ,n 15' o o � "�
II o"e.m. ai o 0 0
CONCRETE FULL FOUNDATIO m II o o O o 0 0
I o 0 00 0 0 0
p1 to 4' A—B' 4' 0 0 C3 o c
2 Units 2 8.5' -- 29,5'
SYSTEM PROFILE ' ; fs. 8 5' P OVIDED ¢' 7'' ¢*
Not to Scale w Ta Effective Width
c c > 1 $ Effecttvi'Length
NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE 6 In.of 3/4•-1 1/2•
compacted stone m S❑IL ABS❑RPTI❑N SYSTEM (SAS)
Bottom_ of Test Hole Elev.= 88.00 500 - C H-10 LEACHING UNITS / WIGGINS PRECAST
� ~ Not to Scale
2-18 DIAM. ACCESS MANHOLES ALL OUTLET PIPES FROM THE
S. PERCOLATION TEST °SET�L FOR T�2 FT. 12•
CONCRETE COVER
`�'•-''i.s.��. s•� _e._.�,c�' •...,� .t�..� 3— 5` OUTLET 'a'r..°+••6...c;.. 2
Date of Percolation Test: MAY 19, 2021 4.1 �' KNOCKOUTS r
NOT TO SCALE Test Performed By. CARMEN E. SHAY, R.S., C.S.E. — -15.5• '• { ' it INLET
Results Witnessed By. DAVID STANTON - BARNSTABLE BOH r auTL�
INLET /1 1 a EXCAVATOR: SHAY ENVIRONMENTAL SERVICES 4 ':; 6• B
/ � / ov T Percolation Rate: Less Than 2 MPI ® 36" "'' '�'• 2
�- i 1s 4• - SCH. 40 T 1.75•
THE ACCESS COVERS FOR THE SEPTIC TANK.
.., DISTRIBUTION BOX AND LEACHING COMPONENT Test Hole Test Hole PLAN SECTION CROSS—SECTION
�.• ,r-ti:fir,,. SET DEEPER THAN 6 INCHES BELOW FINISHED N O. I N O. 2
•`f'` GRADE SHALL BE RAISED TO WITHIN 6• OF
STEEL REINFORCED PRECAST CONCRETE FINISHED GRADE. DEPTH SOILS ELEV. DEPTH SOILS ELEV. 3 HOLE H-10 DISTRIBUTION BOX
PLAN VIEW INSTALL TUF-TITE GAS BAFFLES OR EQUALS 0 99.00 0 99.00 NOT TO SCALE
Sandy Sandy
3-24• REMOVABLE COVERS Loam I Loam
1) 10 YR 3/2 10 YR 3/2
_i •.:....� 4• �. .r:,: 0"- 6• An 98.50 0"- 6• 98.50 PLOT P LAN
3" min•clearance '
INLET B'_min.- 2"min. Inlet to outlet 6'ram. 1T fINLET T'• Sandy Loam { Sandy Loam
Uquf�level OUTLET
10•rah. 1a 10 YR 5/6 10 YR 5/6
-- _ _ F P UPGRADE 5' _7• 5' 7• _ 0 PROPOSED' SEPTIC SYSTEM UPG E
•:i 6• 36" Be 97.00 6" 36• � 97.00
a a..� r' 1' L41qud depth Mad. Med. PREPARED FOR
bo 25Y Sen;4 25Y;4 ELISSA HOOVER
• � •:�. w' 2 20
T
•• r.�••.:• •,••t . �. .. 36" 84 Ox Gravel 92.00 �" 84" %Grovel 92.001 A
8'_0• 4' -10' Med. Mad. 65 ORRS AV E N U E
CROSS SECTION END—SECTION Sand Sand
2.5 Y 7/4 2.5 Y 7/4 ASSESSORS MAP 291 PARCEL 192
TYPICAL 1000 GALLON SEPTIC TANK 84"-132" `5%C°ve' 8800 84"-132" 459C°ve' 6.00 HYAN N I S MA
Design Calculations Number of Bedrooms: 2 Equivalent to 220 Gal./Day
Garbage Grinder: No PREPARED BY:
Leaching Capacity Proposed: 330 Gal./Day Minimum (Min. Per Title V) Y � O t.,,• L�•
Septic Tank - 2 x330 Gal./Day = 660 USE EXIST. 1000 GAL. Septic Tank. L:: Cj1' Lj1R EW E. SHAY
y.
SOIL ABSORPTION AREA: Using percolation rate of <2 min./inch Pero #1 1 ' Ad `�ri_ Uvt V,
Bottom Area: 0.74gal/day/sq. ft. x 325 s ft. = 240.5 gallons/day da Depth to Perc: 36" to 48" �' ENVIRONMENTAL SERVICES
q• g / y
Sidewall Area: 0.74 gal./day/sq. ft. x 152 sq. ft. = 112.48 gallon/day Perc Rate= G2 MPI
Providing: = 352.98 gallons/day Groundwater Not Observed P.O. BOX 1576
No Observed ESHWT MASHPEE,
o MA 02649
�
ADJUSTED H2O Elev. = None 'Q�G15���c` �.`
c� TEL/FAX 508-294-7498
Use: (2) 500 H-10 CONCRETE CHAMBERS, HAVING A 2' EFFECTIVE DEPTH, n
�\
(5' W x 8.5' L) TO BE USED WITH 4' OF WASHED STONE ON THE SIDES AND SCACE " N A SHEET 2 DRAWN BY: CES DATE: MAY 20, 2021
4' OF WASHED STONE ON THE ENDS.
PROJECT#65 ORRS FILENAME: 65 ORRS AVE. wg SHEET 2 OF 2
�J
20 FT. MIN.
TOP of Fou D. SOIL T E S T
EL. = LS". 10 FT MIN. DATE OF SOIL TEST �� 8
WITNESSED BY 7^
COVERS
CONCRETE 4" SCH. 40 PyC PIPE CLEAN SAND PERCOLATION RATE =--7 MIN INCH
MIN PITCH ►/8� PER FT.—\ OBSERVATION HOLE I OBSERVATION HOLE 2
CONCRETE 2" LAYER OF ELEV.s 1 ELEV.= '
4" CAST IR N PIPE 12 COVERS
(OR EQUAL,j MIN. I,/8 I/2 WASHED °
PITCH 1/4 PER FT. STONE 7—o
— fb' r
FLOW LINE EL = 9' U FE
GU Gir.�v��p 3fe � � G2A�•rL /�
10 l _ Br
MIN. ' - N _oA2S� Cca•92x
EL = 9� / LEVEL L=
EL=
EL.
CSC
D I S T. EL.
o�BOX °o ° j WATER AT EL.= WATER AT EL.=
G / SSG �� to
3/4 11/2 0 090 o 0
GALLON WASHED STONE 1411 ° ° o DESIGN CALCULATIONS
SEPTIC TANK
y G o EL =
PRECAST LEACHING NUMBER OF BEDROOMS
I BASIN OR EQUIV. GARBAGE DISPOSAL UNIT
6 DIAM. _ TOTAL ESTIMATED FLOW
( ''/f' GAL./BR. /DAY z BR.) GAL./DAY
SEWAGE DISPOSAL SYSTEM PROFILE �, /z ��"9 I REQUIRED SEPTIC TANK CAPACITY GAL.
r /, �?i
NOT TO SCALE 0 ACTUAL SIZE OF SEPTIC TANK GAL.
BOTTOM OF TEST HOLE OR USGS PROBABLE WATER TABLE EL = LEACHING AREA REQUIREMENTS
{� 09SERVED WATER TABLE ( / / ) EL.= SIDEWALL AREA bAL./S.F
`g BOTTOM AREA GAL./S.F
LEACHING CAPACITY ( BOTTOM t SIDEWALL) GAL.
01
LEGEND RESERVE LEACHING CAPACITY ��0 O GAL
ell / / EXISTING SPOT ELEVATION OOXO
1
EXISTING CONTOUR — —— — 00— --—
i I FINAL ONTOURVATION — NOTES
f I. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.Q.E.
I ; SOIL TEST LOCATION TITLE 5 AND THE TOWN OF RULES AND
UTILITY POLE REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE .
/ TOWN WATER W ===W
�1 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO
If
CATCH BASIN ® ) WITHIN 12 OF FINISHED GRADE .
j 3. EXISTING AND FINAL GRADES SHALL REMAIN ESSENTIALLY THE SAME.
4. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE
OF WITHSTANDING H- 10 LOADING UNLESS THEY ARE UNDER OR
WITHIN 10 FT OF DRIVES OR PARKING AREAS. H-20 LOADING
MIN. FRONT SETBACK _ _ _ SHALL BE USED UNDER OR WITHIN 10 FT OF DRIVES OR PARKING.
MIN. REAR SETBACK 5. ANY MASONARY UNITS USED TO BRING COVERS TO GRADE
V-44 Y MIN. SIDE SET13ACK SHALL BE MORTARED IN PLACE.
i f I 6. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH
Al DEEDED OR ZONING REGULATIONS. OWNER /APPLICANT IS TO
OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY.
' i, t"1 ;,;�, ,, ,9 APPROVED :P R V E BOARD F HEALTH
,( �s �� �� � 0 D BO D 0
ICA
DATE AGENT
`'°
PROJECT LOCATION,
1
N Q 9 y G
N
j i 0 APPLICANT:
/ � � � ,►�r �� sr
4 � J 0
�.o f I 00 of R j / t`� 4�
� , ROBIN W. WILCOX
PROFESSIONAL LAND SURVEYOR
203 SET UCKET ROAD
385-6478 SOUTH DENNIS, MASS. 02660
I y'X j / SCALE DATE, �N 26/ .�
I Lam �
1LOCATION MAP J0� N0'O/� Z - '� SHEET 0F