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0684 PITCHER'S WAY - Health
684 Pitchers Way 271-173 Hyannis l i I i i I C/ TOWN OF BARNSTABLE LOCATION, / /"/ �1�'S SEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL INSTALLER S NAME&PHONE NO. ����� SEPTIC TANK CAPACITY LEACHING FACILITY.(type),-,2 NO.OF BEDROOMS OWNER 0 A A Qt v n C PERMIT DATE: COMPLIANCE DATE: I 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 f 'lity Feet FURNISHED BY 54' O a s y Town of Barnstable P# S 7 Department of Regulatory Services Public Health Division Date U 1 t+1KtA� 200 Main Street,Hyannis MA 02601 Date Scheduled Time Fee Pd._( 00 Soil Suitability Assessment for - Se ge ispo Z Y1 � �� C SPerformed By: Witnessed By: ( ✓r �� r g LOCATION& GENERAL INFORMATION Location Address r_ /1 r C S Owner's Name R�C,�,44 l Address e;,- L Assessor's Map/Parcel: Z l I72 Engineer's NameC/1rn,,;��1J NEW CONSTRUCTION REPAIR Telephone# 50$-273-037 7 Land Use 5tnoi t Epmil y r25ld�I�p 1 Slopes(%) 2 - 1-1 Surface Stones Distances from: Open Water Body ft Possible Wet Area _ ft Drinking Water Well ft Drainage Way ft Property Line 1_Oft Other ft SKETCH:.(street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) Sei' �N1�d �1 Parent material(geologic) U� ""S Depth to Bedrock •713 O 1os 3 1 Depth to Groundwater. Standing Water in Hole: 7130t�bg S Weeping from Pit Face 7 130"loss Estimated Seasonal High Groundwater -7 t 3 c7a 5 DETERNIINATION,,FOR SEASONAL HIGH WATER TABLE Method Used: Dtt2ek Qwserun 4ti:vr Depth Observed standing in obs.hole: `7130 _ _in. Depth to soll'mottles: 7 136 In. Depth to weeping from side of obs.hole: '7 12 in, Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adl.factor Adj.Groundwater level PERCOLATION TEST bate s-26-o 9 Thne rc Art: Observation Hole# Time at 9" Depth of Perc 3 q y� s Time at 6" Start Pre-soak Time @ 0:2Q Aq Time(9"-6") - End Pre-soak I o:27 A)y - - Rate MinJInch 2 Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTICIPERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# 1 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munselq Mottling (Structure,Stones;Boulders. t1 n isten ravel Df�(ai A �S �aY( all �� �" 5/b - 30a13U G 25 t 6l6 DEEP OBSERVATION HOLE LOG Hole#_Z Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. consistency,%Gravel) (0 LS 30-t304• C, h-C s 2.5Y 6l� DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munselq Mottling (Structure,Stones,Boulders. Consistency. Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil . Other Surface(in.) (USDA) (Munselq Mottling (Structure,Stones;Boulders. • o en Flood Insurance Rate Map: Above 500 year flood boundary No Yes Within 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 pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Yes _- If not,what is the depth of naturally occurring pervious material? ...._ Certification I certify that on j (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 and erience described in 310 CMR 15.017. . Signature Date 5-27-0 7 Q:\S.EvnCVERCFORM.DOC No. f 100 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ptlficattan for Migpo$al brae li conotruction verlutt Application is hereby made for a Permit to Construct( )or Repair(/)an On-site Sewage Disposal System at: Location Address or Lot No. �(,� �� y��`Jc �Cy Owner's N Addres and Tel.No. ���/ y G l� a 'IG�fvr� Assessor's Map/Parcel t� 9 G Go-' Installer's Name,Address,and Tel.No. '! 1 ✓ Des! ner's Name,Address and Tel.No. -7 3_ Type of Building: Dwelling No.of Bedrooms Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 1112 gallons per day. Calculated daily flow -3 3'0 gallons. Plan Date lii Z 7 Number of sheets / Revision Date Title Description of Soil Nature of Repairs or Alterations(Answer w4en applicable) 17!!,51ell /©�01�� /� `8W— Date last inspected: Agreement: The undersigned agrees to ensure the construction 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 issue by s d of ealth. / ` Signed Date Application Approved by Date E-1-A Application Disapproved for Me follo ing reasons Permit No. Date Issued 173 V=No. !J Fee 7 � — d as. -= THE COMMONWEALTH OF MASSACHUSETTS `PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZppYication. for ioizpaal *pgtent Conotructiott erriYit r Application is hereby made for a Permit to Construct( )or Repair(�n On-site Sewage Disposal System at: Location Address or Lot No. b Owner's Nam ,Address and Tel No.yet�; Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 77/ 3 Type of Building: Dwelling No.of Bedrooms 3 Garbage Grinder(Wo Other Type of Building 2Ld?X,1' No.of Persons Showers( ) Cafeteria( ) Other Fixtures ti " Design Flow gallons per day. Calculated daily flowG� gallons. Plan Date 3 4,47 Number of sheets f Revision Date Title Description of Soil "i Nature of Repairs or Alterations(Answer when applicable) i Date last inspected: ` Agreement: The undersigned agrees to ensure the construction 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 issue by 's .eard of Health. SignedM. Date Application Approved by Date Application Disapproved for th folio ing reasons Permit No. Date Issued {" — THE COMMONWEALTH OF MASSACHUSETTS 7 //73 BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal.System installed( )or repaired/replaced( on by Installer Aer ?" i^7il_r at f /7- - ry' A y h / has been constructed in accordance with the provisions of Title 5 and the for Disposal System ConstructigvPernut No. dated—r— I" Dates ` ;. Inspecto A THE ISSUANCE OF{THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYS- TEM WILL FUNCTION SATISFACTORY. J No.-- - ----_----------------�—/ --- -- ———— Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Mf Spool *pgtem Con.Wuction 3permit Permission is hereby grante to �� 4G G';?'�°l �• Gr`G / r`7 . to construct( )repair(van On-site Sewage System located at No.# '� / Gl�iorS j street and as described in the above Application for Disposal System Construction Permit. Z c lc-G No. ' Date The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. All construction must be completed within three years of the date below. Date: . - Y!, Approved by Board of Health �f. s f 'R�CAT ION SEWAGE PERMIT NO. VILLAGE INSTA LLER'S NAME & ADDRESS B U IN DER OR OWNER DA.T E F.KJERMIT ISSUED r DAT E CQMPLIANCE ASSUED 7� J 1 V v VV Y FILE COPY COMMONWEALTH OF MASSACHUSETTS bx 4 f EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION c� IVIAr Z7 i �7M sVe�s PARCEL • 1'13 LOT. TITLE 5 OFFICIAL:INSPECTION.FORM.-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORMT PART A CERTIFICATION Property Address: 684 Pitchers Way Hyannis,MA.02601 Owner's Name: Richard Gorrell RECEIVED Owner's Address: Same Date of Inspection: 3/2/2004 MAR 10 2004 TOWN OF BARNSTABLE Name of Inspector: (please print) Brad J.White HEALTH DEPT. Company Name: Windriver Environmental Mailing Address: 107 North Main Street Carver,MA.02330 Telephone Number: (508)866-2576 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 Fails Inspector's Signature: Date: 3/2/2004 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 System Passes ****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. Title 5 Inspection Form 6/15/2000 page 1 Pg I i Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 684 Pitchers Way Hyannis,MA.02601 Owner: Richard Gorrell Date of Inspection:3/2/2004 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 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: System Passes.No evidence of hydraulic failure. 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 breakout 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: 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: Till. 2 . Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 684 Pitchers Way Hyannis,MA.02601 Owner: Richard Gorrell Date of Inspection:3/2/2004 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. 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 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: Ti41A G Tnon +;—T mm(./1 f/7AAn 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 684 Pitchers Way Hyannis,MA.02601 Owner: Richard Gorrell Date of Inspection: 3/2/2004 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all 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 X 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. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface 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: 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"yes"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 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. T;+IA c T-.,.+;-R.,r.,,All ci)nnn 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 684 Pitchers Way Hyannis,MA. 02601 Owner: Richard Gorrell Date of Inspection: 3/2/2004 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. X _ 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(3)(b)] T41. G T-.,i-Vi -All 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 684 Pitchers Way Hyannis,MA.02601 Owner: Richard Gorrell Date of Inspection: 3/2/2004 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):440gpd Number of current residents: 1 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): Yes Seasonal use: (yes or no): No Water meter readings,if available(last 2 years usage(gpd)): 118 gpd Sump pump(yes or no): No Last date of occupancy: Current COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sqft,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: Approx 1996 per owner 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 No 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: Septic tank believed to be original(1977 approx.) New Leaching.pit installed 3/28/1996 Were sewage odors detected when arriving at the site(yes or no): No T41.G 6 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 684 Pitchers Way Hyannis,MA. 02601 Owner: Richard Gorrell Date of Inspection: 3/2/2004 BUILDING SEWER(locate on site plan) Depth below grade:36" Materials of construction:_cast iron X 40 PVC_other(explain): Distance from private water supply well or suction line: N/A Comments(on condition of joints,venting,evidence of leakage,etc.): Building sewer is in good condition. No evidence of leakage. SEPTIC TANK: X (locate on site plan) Depth below grade:24" 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: 8' x 5%2"x 5'-8" Sludge depth:2" Distance from top of sludge to bottom,of outlet tee or baffle: 33" Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle: 11" Distance from bottom of scum to bottom of outlet tee or baffle: 16" How were dimensions determined:Measure Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Inlet and Outlet tees in good condition.Tank has no evidence of leakage in or out of tank.Liquid level is normal. GREASE TRAP:_(locate 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.): T41. 1;T--t;n 17-Ail,iInnn 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 684 Pitchers Way Hyannis,MA.02601 Owner: Richard Gorrell Date of Inspection: 3/2/2004 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/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: N/A (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 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.): PUMP CHAMBER: (locate.on site plan) 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.): T;rlo�q T„—'fr —17^—4/1 c11)nnn 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 684 Pitchers Way Hyannis,MA. 02601 Owner: Richard Gorrell Date of Inspection: 3/2/2004 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: Type X leaching pits,number: 2 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.): Soil is dry.No signs of hydraulic failure.Vegetation is normal.No evidence of ponding to the surface.Pit A —has 4'from pipe to standing water. 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 or 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.): Page 10 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 684 Pitchers Way Hyannis,MA.02601 Owner: Richard Gorrell Date of Inspection: 3/2/2004 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. F2croC � I C b o eFaQ g \. DEC V— L 1 . a3` 32-U T;fl. 1;T--t;—Fin,-.,,A/1,;/1/1M 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: 684 Pitchers Way Hyannis,MA.02601 Owner: Richard Gorrell Date of Inspection: 3/2/2004 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 5'+ feet Please indicate(check)all methods used to determine the high ground water elevation: X Obtained from system design plans on record-If checked,date of design plan reviewed: 8/28/1996 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: Groundwater was determined from the certificate of compliance dated 8/28/1996.Maximum adjusted groundwater table and bottom of leaching facility 5'+ T;tIA S Tnenarf;nn Fn,-m�ii�i�nnn 11 T�WN OF BARNSTABLE / LCi:��±" ION ��� / ` ^ �� SEWAGE # feL VFIAGE ASSESSOR'S MAP & LOT L 3 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY —Jnad Gr✓t LEACHING FACILITY: (type) Pi4 (size) X/el t NO.OF BEDRO BUILDER O WNER iac/f� PERMTTDATE: _l Z "7�J COMPLIANCE DATE: " Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility S fi 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�hing f� "ty)� Feet:. Furnished by r W v� u, ��� 'S No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -:TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2ppfitation for ]Disposal *Pstem Construction permit Application for a Permit to Construct( ) Repair grade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ¢ �o� (� Owner's Name,Address,and Tel.N� � Assessor's Map/Parcel Y / J Installer's e,Ad an Tel.No ///faTit ` Designer's_Name Address and Type of Building: Dwelling No.of Bedrooms Lot Size ,, // � sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) ® gpd Design flow provided gpd Plan Date v Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. e Description of Soil 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 the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board o a h. ed S Date �Q Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issuedfit �Vs _ Fee .d THE COMMONWEALTH OF MASSACHUSETTS % ' Entered in computer: i PUBLIC:HEALTH DIVISION -'TOWN OF BARNSTABLE, MASSACHUSETTS Yes 10, ftplitation for ]Disposal 6pstem ConstrUttlon i9ermit Application for Permit to Construct( ) Repair(K Upgrade(: ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. S �' � �� Owner's Name,Address,and Tel. Assessor's Map/Parcelh 1 V I, 1 Installer's Name,Address,,an Tel.No d NDesigner's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size /� sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) ,R Other Fixtures -' Design Flow(min.required) gpd Design flow provided �'��, gpd Plan Date i v Number of sheets Revision Date Title Size of Septic Tank ,/CpDO Type of S.A.S. � ,� � �, %F7 E .� Description of Soil 1 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 the Environmental Code and not to place the system in operation until a Certificate of w_.. Compliance has been issued by this BoaArd'66' Hiilthe .. / —Date ; /Q Application Approved by � 5 Date Application Disapproved by Date for the following reasons Permit No. Date Issued I 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 l /'� �. has been cons cted' acc dance i with the provisions of Title 5 and the for Disposal System 411onstruction Permit No. dated Installer Designer #bedrooms / Approved design fl�flow 30 gpd The issuance of this permit shall not be construed as a guarantee that the system wil funcfiion� designed. Date__ f� � �o Inspector , No. G .,•�'' v�_ ______.._---___._,__._.,__��.__.____•-___._..---------_.,.....z-->---_..�----•--=_'_ 'Fee . 0D,--_ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION�BARNSTABLE,MASSACHUSETTS Misposaf .4pstem Cowkrtfrtion hermit Permission is hereby granted to Construct( Repair ) Upgrade( ) Abandon( ) System located at 4 v z2� 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:Cons t ctio , s be completed within three years of the date of this permit. Date (/ Approved by ( 7q a Y , 1q ' No. Fee THE COMMONWEALTH OF MASSACHUSETtS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Application for 33igo$al 6p!5tem CCow5trUction Permit Application for a Permit to Construct( ) Repair(,4 Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. � RT-c k e.,(S LJ,A y Owner's Name,Address,and Tel.No. F,(d Assessor's Map/Parcel 27 17 1 3 I Installer's Name,Address,and Tel.No. (-,Q f ewJ,JJ e &'�?k_1P_?o Designer's Name,Address and Tel.No. J-G ch Iu wk �UJ`(2jgojj6 1P0 Roy, 7b3 Zkyy ',z,,���+�r CZ_wrc✓koll.e ivl Kok- Z73- 6377 ���arcG�4v" Type of Building: Dwelling No.of Bedrooms 3 Lot Size oZ� l S i- sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided 3'(c*• 3 gpd Plan Date 5--Z 7-2,099 Number of sheets Revision Date Title 694 PiT0 (_t5 t, A,•1 Size of Septic Tank 1,000 reK,s Ir�111 Type of S.A.S.( 2, Gyg -rice vi i , if Description of Soil —�� rLA-An C Nature of Repairs or Alterations(Answer when applicable) S>L6 1 e V3-e .-1 )-t3Z)X I Date last inspected: 210 c 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 f Health. Signed Date Application Approved by �� Date Application Disapproved by: Date for the following reasons C Permit No. 9-0647 Date Issued "7' 67 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewa e Disposal System Constructed ( ) Repaired ( �. Upgraded ( ) Abandoned( )by"� �ya f1 e w e SLR �� �e S LL C at 6814 �i�c•L.2d S C.J. � yl.�,i.�� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. p-001— / I dated -�^-0 Installer rq4Z0j_A_ L� Designer #bedrooms Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector No 167 1' I i i y Fee mered in computer: THE COMMONWEALTH OF.MASSA`CHUSET1% '� p Yes r PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Application for Digpogar 4tem C0115truct on Permit Application for a Permit to Construct( ) Repair(fig. Upgrade( ) Abandon( ) ❑ Complete Seem El Individual Components Location Address or Lot No. &S IJ Pi TL k e,(S W+A y Owner's Name,Address land Tel.No. ��k o m ed Assessor's Map/Parcel Installer's Name,Address,and Tel.No. G Q1P¢tiJ,c� /��f�! Designer's Name,Address and Tel.No. T(_ gnp14'"Ih1 �GO � ��L� Co t3,ox 7b3 ZZjYCr^n�.Iy tl,u•, �ro?M Z73- 0377 Type of Building: Dwelling No.of Bedrooms 3 Lot Size 1 oZr 9 1,S �- sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3 O gpd Design flow provided 3 gpd Plan Date . _S-2 7- ?.ocx'y Number of sheets Revision Date Title bp,`•t P;fc k,-15 on, Size of Septic Tank'"l 0 0 0 ,s � Type of S.A.S.( Description of Soil O IV44i t C ' ',AP 30'� Nature of Repairs or Alterations(Answer when applicable) i '�,�r �� T,/aM t,, i u y�C�J 1� -,Zj / I e Date last inspected: 21b 4 Agreement-, The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance wttlrthe 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. Signed Date 40 Application Approved by . - Date •'>`•-< Application Disapproved by: Date for the following reasons "`'+ Permit No. 1� _ f 5 1 Date Issued & 6 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewa a Disposal System Constructed ( ) Repaired ( yL.) Upgraded ( ) Abandoned( )by C�+t�P2�4 (Q.,� (�`?1_!All I (f") c at (a(9 -1 ei T-c."d 3 W t %v t , has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. °�C� S dated (� x _07 Installer(,4p.udcLL (*',,, f p f jy t Designer - #bedrooms Approved design•flow 1' 1 t gpd The issuance of this permit shall not be construed as a guarantee that the system will function as designed!s; Date < + 3 x Inspector .- C. 5V t No. a66 ( — 1151 Fee f � THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION — BARNSTABLE, MASSACHUSETTS lwigpotal 6pttem Construction Permit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) System located at (0 NL( e i t C.L.�.d s C,�� t.�.-, join in� 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 must be completed within three years of the date of this permit. Date Approved by \I } a o o `ID di di Tj 7 Q X LL o H 0 — Z d40 d r CL of t v tAQ � 7rr J � NIA C v 1 } v � MHz ti Lon � CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION 1'LIU1tl'l'(�VI'T110U'I'DESIGNED PLANS) certify that the application for disposal works construction permit signed by me dated KI Zleel , concerning the property located at meets all of the following criteria: /Thcre are no wetlands within no rest of the proposed septic system /Thcre arc no private wells within ISO rcet or the proposed septic system .✓ The observed groundwater table is 14 reel or greater below the bottom of the leaching racility ��There ere is no increase In flow and/or change in use proposed are no variances requested or needed. SIGNED: i DATE: �`��� LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER (Attach a sketch plan or the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submittal]. sr� Y ti Y- �, �cs.v. '. r- �,. F.$" x ytj5,�'''�'sy ..� >•+s`w '.� -5 Ce y.�}, '' gr t'1.., "t 7 d i .` . u•t �' � S r.:"�..5: r,.,.�+^ u•_ �>,5.5- �:.."dd r� MP:�Y1 >�'-..,.1 i..� .,�, �. � '� �;.:r, .f. � �:✓ :.w ..F,.�; 't � ,:.� � > r :::. rf' s�.'.-. fi s �y,��,�,. �Y2�s�.= "P� � ;^ fv-r�,�� ;.�C'� n�v,� e ,�v, ,. a .�> 5� a,��r� '�.€�`•,..�,: Y ;✓� `u��4".;`:�,. a���' i*""'�� �;v" .����',.� � �+=;,�' �,�;' v,.. ..s� ..� �Y�3Y+.,N...Y sa�.l�ux. i...,E. .. � .e..v�4�,a���1ttJ ��W'jC .44s5d4�� 44� i� .v�'sk��.y .-... .tllm.. r... a79 A.L :: a A3�t'4 aay.as. e� � n, .......�r fv�r...1..'��.u,S.�". ...re� �.a�. .4✓.:' Town of Barnstable Regulatory Services �. Thomas F.Geiler,Director • snnrtarABL& '& �,� Public Health Division Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862464 4 Fax: 508-790-6304 Installer & Designer Certification Form Date: 01 0 Sewage Permit# D�/=/J`� Assessor's MaplParcel 3 Designer: Installer: Address: kiwlv4vAddress: C� On was issued a permit to install a (date) (installer) septic system at 1 �Q 1-efi6ils, Rm y based on a design drawn by (address) 61164 l 'e KI VI 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 andi'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. F c�0 R N R ,'A(Installer's Signature) Noz 1140 l /"/ MAXli� NI TAW 64 (2-14 (Demgaftft Sign a ) (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. Q:Heal th/SeptidDesi gner Certification Form 3-26-Odoc No. 7.....---- Fizz...f.. .................. THE COMMONWEALTH OF MASSACHUSETTS BOARD F HE T _ ......OF....... ... .I W Applirahou -fur Bitipogal Worse C omitrurtion Vamit Application is hereby'mad'e�f'or a Permit to Construct or Repair ( ) an Individual Sewage Disposal Syst ocahon- d es� _, �- of No: ....... ••... I---4----------------------"--------- ---------------------------- -----�--- ----------- - ....... eq A r ss a ..................4 1.�........ ....... .. ........•------- ............................. .............................. .......... . - -----------•-----•-----•-----------------.- Installer Address Q Type of Building Size Lot_/� ...._ ........Sq. feet Dwelling—No. of Bedrooms--------- ----------------------_--__.Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ,_---_______ W Design Flow.__._.._....�?®O______________----_-gallons per person per day. Total daily flow--------- -__--____--.----....gallons. WSeptic Tank—Liquid capacity/ Ions Length-----------_--- Width................ Diameter.......-........ Depth._._-_-.----- x Disposal Trench—No. - idth___.; ---:... Total Leng ------ _. Total leaching area....................sq. ft. Seepage Pit No.....1 _. ter..: p leaching area 1. e t e o 'r eT�-y� ---. Total leachin irea.. sc it. z Other Distribution box ( Dosing tank ( ) �C —,? T 7'7 a Percolation Test Results Performed by-------------------------------------------------------------------------- Date---------------------------- ---------- Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water..-.---.._-.-_--__.----- i fs, Test Pit No. 2----------------minutes per inch Depth of Test Pit_.---_----.--__-__-_ Depth to ground water............------------ O xDescription oil i._�.. - ---- a4.�--- ---- ----- --------------------- --------------------- w -------- ••-- r ' . - ------ �- - ----------------------------------- ---------------------------_-------- �' ------ -------------------------------------------------------------------------------=------------------------------------------------------------------------------------------------------------------------ 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 Article XI 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 hoard of health c Signed = ---- �* ;&�--------------- -----------------•-•------------ A Application Approved B Date t7 7 PP PP y---------- .�- -.. ..-•-•• =� ._.._... ----------------- -. ��r^.... Date Application Disapproved for the following reasons----------------------------------------------------------------------------------------------------------------- ........•-----•-------------•----•----•-----------------••-••-----------•••--------•-•--•••......-------- ------------------ Date PermitNo........................................................ Issued...................... ................................. Date ----------------•-- NO.----•--•--....-• Fizic ..��.................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH y Appliratiun -for ]i�i jaiqa1 Warkii Tansitrurtion Pprutit Application is hereby'made for a Permit to Construct :.(' Repair ( ) an Individual Sewage Disposal System at}: �-y »----r.F Z f -----------------?f r'zF�c//�� (./... �—' / ��-'r.'.r"✓U-Y'C./t✓.,..- f� n---,.--• --�-- •-------------------------- /'�� Location-Add.ess �� dr Lot No. ---------------------------------• Qwner. fj ddiess t ......... ...... ............ ------------------- A' Installer Address U Type of Building Size Lot. __9�)._______Sq. feet Dwelling—No. of Bedrooms---__-___/_______________----.__..--__Expansion Attic ( ) Garbage Grinder ( ) per., Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q' Other fixtures .../7 ------------------------ W Design Flow------------:�__O----------------------gallons per person per day. Total daily flow.........?q__0..._.._._........._.gallons. WSeptic T:uik—Liquid capacit�d__ lions Length---------------- Width______.-_---._ Diameter................ Deptli.__.-----..----- xDisposal Trench—No..................... Widtli._._, ________._... Total Length----- _----------- Total leaching area....................sq. ft. Seepage Pit No..... U✓ ____'I a p ,� ........... Total Total leaching area..................sq. ft. I�1 eter_.-2._- '"z-Dehllo�v, tnl __ Z Other Distribution box ( Dosing tank ( ) 1/- �� _ 7_ 7-7 Percolation Test Results Performed by..------ •----•-•------•--------•------- Date----.---_-•-----------------•---------. Test Pit No. 1----------------nunutes per inch Depth of "lest Pit-------------------- Depth to ground water.----------------...___. (3:1 Test Pit No. 2................minutes per inch Depth of Test Pit.._.--..--..._______ Depth to ground water------------._-..-.-____ 9 -------------- --------------------- ----------• . Of' �� :' e 11� ;L I----•--•----f-- x Description f Soil__ f = / {P� - ---- -- - ---------- ------------------- 1 9 -- ----- f °- !'` a. /'ric.=.,.�Y Gs�. -------------------------- w � = x --------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------- 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 Article XI 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 ,' -v- -_Et��-8i.4* // -- •------------------------------- Date Application Approved By------- � ------ --- Date Application Disapproved for the following reasons----------------------------------------------------------------------------------------------------------------- ..........................................-•------•--•----------••------------------------------------•.............----------------•----•-----------------•-----------------•------......---------•--. Date PermitNo......................................................... Issued----_---------------- ................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...oF..... ,. - ..........:..:.......:.......................... 10.1lextif iratr of Tuutphaurr THI S TO CERTIFIThat the Individual Sewage Disposal System constructed j(�r Repaired ( ) by .._.. 4 Yj ... ------.--•-----•••----------•-- ----------------------•--•-------------------•------------------•----------------------•-•------••-- Installer ------------------------------------------------------------- has been installed in accordance with the provisions of�Ap c e XI/of The to Sanitary Code as described in the application for Disposal Works Construction Permit No. -..-2Z--------------------- dated_ -7-7_.__.__...__._._._ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUPLAS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. f DATE 1)92 .. ..... "2 Inspector--- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1 ,7707 -........................OF.....r).(2,4........ .. No........ � ---------- FEE Z�5.---•---....._. Di_sVviitt1 Norkii ClIottstrttr t in frrutit Permission is hereby granted----------- �G- . f. . to Construct o o Repair an Individual Sewage Disposal S i (fr')} P ( ) g P� Y ---- r; t . �. ---------- -- - --- "r✓ j�� Street as shown-on the application for Disposal Works Construction P it No____ ______ ______ Dated__i3-. �'_-.7.�.__.__........ � 12 --------------•--- Board of Health DATE. FORM 1255 HOSES & WARREN. INC., PUBLISHERS G a 7- / �o 7" � /� I,OG6 6A4,P1T� o co G At sEPT%GTAmr, L� s� i� y' f ff i� V t , �CL7- f *+ r € j CEIZTt F tEU P 1_b"f" P�--•h.lJ LOGATIot.,t H YA N N cscAL 1 .N= .30` TEATt✓ /Ii f 71 r G6R`Ct 1j -r"AT Tt-1r-- Fc vNOATiOrA-5 cvWQ i?t-At.l R FEtZ�ct.iGE GaAAPt_YS WIT" Tws 5 t vE.0 wE-- L o T I '7 A Wr.> SE"T%3,ACtG {ZEQviiZeAAawT'S GG TNC Zo W U of tQC-- aaxTE� �. t2EGi5"!�'� fG-At•1U 5uevcYo2s Tt-115 D'i;..At-1 IS JUT BA.SE'D OW A'&•1 OSTE2V11_t.6 o IbCASSf ti•ASMUAAEt iT '5UQVE`1' 4 T'Ae cOF�S�TS 540wt.x> APPt_i CANT t bT 6� uSEc> To Dm:TEQMi%4& LOT t_i t4=5 C P E WIDE,E D i~vf C'0 _ - --- e r PROVIDE PRECAST CONCRETE PROP.VENT WITH CHARCOAL GENERAL NOTES T.O.F. EL.= 60.0'± EXTENSION RISER WITH CONCRETE /-FINISH GRADE OVER D-BOI 59.3 ± 4"SCHEDULE 40 PVC MIN. SLOPE 1 % FILTER TO ABOVE GRADE COVER TO WITHIN 6"OF F.G. OVER FINISHED GRADE OVER DIFFUSERS = 59.40' - 60.23' INLET AND OUTLET COVERS. REMOVABLE WATER-TIGHT COVER OVER INSPECTION PORT WITH ACCESS BOX TO SLOPE @ 2%MIN. 1 UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION FINISH GRADE RISER TO WITHIN 6"OF FINISHED GRADE WITHIN 3-OF F.G. (ONE PER TRENCH) METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL @ FND. EL.= 58.3'± FINISHED GRADE OVER TANK EL. = 58.7'+ /-5"DIA. OUTLET(S) CODE AND ANY APPLICABLE LOCAL RULES. N THI PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. PROPOSED 4" 9"MIN. EXISTING 4" 36"MAX. 9"MIN. 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL SEWER PIPE PVC SEWER PIPE 54"MAX. TOP OF SAS B.O. = 55.73' SYSTEM UNLESS OTHERWISE NOTED. (SEE NOTE 21) 6' 3"DROP MAX PROVIDE WATERTIGHT 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN 3" 2" DROP MIN 3" 9" MIN.SLOPE @ 1 JOINTS(TYP.) ELEVATION =55.73' FOR A DISTANCE OF 15"AROUND THE PERIMETER OF THE SAS. UNLESS A 10" 4" PVC IN FROM 1 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF 14" \-*55.9'± SEPTIC TANK 4' PVC OUT TO O17711771 1.33' 16"TYP THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. LEACHING FACILITY 0.90, (TYP.) 1 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. 10 nJTYP 10.75"TYP CONTRACTOR CONTRACTOR SHALL 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. OUTLET TEE 55.60' MIN. 55.43' SHALL VERIFY SIZE 48" VERIFY CONDITION OF i I I EXISTING TEES �1 55.30 \-54.40 (LAID FLAT) -2.875'(34.5-) 5.75' 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK AND CONDITION OF 22"ZABEL FILTER 6"CRUSHED STONE 5.0' (TYP.) FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS EXISTING SEPTIC AND REPLACE AS MODEL#Al 801-4x22 OVER MECHANICALLY (TYP.) NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH TANK NECESSARY (GAS BAFFLE ON COMPACTED BASE 5'MIN. 11.50' AND DESIGN ENGINEER. BOTTOM) 5 OUTLET DISTRIBUTION BOX 30.0' (TYP FOR BOTH TRENCHES) 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM OF 60.00'ESTABLISHED TO BE INSTALLED ON A LEVEL STABLE ON A NAIL SET IN AN 12"PINE TREE AS SHOWN ON PLAN. BASE. FIRST TWO FEET OF OUTLET GROUND WATER ELEV.= < 49.17' 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION EXISTING 1,000 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT CROSS SECTION VIEW BIODIFFUSER (PROFILE) BIODIFFUSER (END VIEW) 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES *CONTRACTOR TO VERIFY EXISTING ELEVATION PRIOR SEPTIC TANK PROFILE DISTRIBUTION BOX DETAIL 12 ARC 36HC (#3616BD) B I O D I F F U S TO THE DESIGN ENGINEER. ERS TO ANY Wr"RK & NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE NOT TO SCALE NOT TO SCALE 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONIC. STRUCTURES SHALL BE MADE WATERTIGHT. 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING TEST PIT DATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM �. '' •. 0 a PERC No. 12578 APPROPRIATE AUTHORITY. j . �' � INSPECTOR: David W.Stanton, R.S. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS EVALUATOR: Michael Pirnentel, E.I.T. LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE Oct. 1999 THEY SHALL WITHSTAND H-20 LOADING. C.S.E. APPROVAL DATE May 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. C3 26 2D09, DATE:- ZONE 2 TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. I ELEV TOP= 60.00' REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, i ELEV WATER= <49.17' FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). C14i PERC RATE <2 min./inch15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN J�IVE 0) ui STONE D 0 SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. DEPTH OF PERC 30"-48" 16. PROPOSED PROJECT IS LOCATED WITHIN: CSi PROPOSED INSPECTION PORT WITH 0 oACCESS BOX TO GRADE (TYP OF 2) TEXTURAL CLASS: 1 ASSESSOR'S MAP 271 PARCEL 173 0 C1 C; OWNER OF RECORD: ANTONIO LOURENCO z 6 1 ADDRESS: 684 PITCHERS WAY PROPOSED TOTAL 12 ARC 36HC BIODIFFUSERS 3 011 60.00' PROP. 4" PVC VENT PIPE; HYANNIS, MA EXACT LOCATION PER OWNER A(6 BIODIFFUSERS EACH TRENCH) Loamy Sand TP 1 OYr 3/1 0 60.0 6' 59.50'PROPOSED DISTRIBUTION BOX .0, B Loamy Sand FEMA FLOOD ZONE C ! ' ., • COMMUNITY PANEL# 250001 0005 C -EXISTING LEACHING PIT TO BE 1 OYr 5/6 VPUMPED AND FILLED WITH CLEAN, % 17. DEED REFERENCE: DEED BOOK 19445, PAGE 98 160.0 COARSE SAND (TYP OF 2) 30" 57.50' SHED Perc 18. PLAN REFERENCE: PLAN BOOK 302, PAGE 92 610 LP, Benchmark 48" 56.00' a n \ ,f' 59 Nail Set in 12"Pine 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. Elev. =60.00' 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY Approx. M.S.L. I FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY MAP 271 C Med. -Coarse Sand FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. 0 2.5Y 6/6 PARCEL EXISTING 1000 GALLON 21. IN ACCORDANCE WITH 310 CMR 15.401 -15.405,THE FOLLOWING LOCAL UPGRADE 12,915 S.F.± SEPTIC TANK TO BE UTILIZED AS PART OF THIS DESIGN APPROVAL IS REQUESTED FROM 310 CMR 15.221 (7): (1.) A 1.5'WAIVER(3.0-4.5')FOR THE MAXIMUM COVER OVER THE LEACHING FACILITY. MAP 271 LOCUS P LAN - #684 PARCEL175 f X SCALE: I"= 1000' EXISTING 1 130" 49.17' 3-BEDROOM .................. No Mottling, Standing or Weeping Observed DWELLING DECK TOF 60.0'± DESIGN DATA TEST PIT DATA LEGEND X PERC NO. 12578 58 7, . / i INSPECTOR: David W.Stanton, R.S. 50xO EXISTING SPOT GRADEX NUMBER OF BEDROOMS(DESIGN) 3 EVALUATOR: Michael Pimentel, E.I.T. 50 EXISTING CONTOUR X1 DESIGN FLOW 110 GAUDAY/BEDROOIM I C.S.E.APPROVAL DATE: Oct. 1999 50 PROPOSED CONTOUR MAP 271 TOTAL DESIGN FLOW 330 GAUDAY DATE: May 26, 2009 DESIGN FLOW X 200 % 660 GAUDAY O/H/W EXISTING OVERHEAD UTILITIES X PARCEL174 USE EXISTING 1,000 GALLON SEPTIC TANK TEST PIT#: 2 /1�5� j� BIT. DRIVE t ELEV TOP= 60.00' W EXISTING WATER LINE /x ELEV WATER <49.17' j PERC RATE 1 TEST PIT LOCATION ZZA (3 INSTALL 12 - ARC 36HC (#3616BD) BICIDIFFUSERS EXISTING 1,000 GALLON SEPTIC TANK >< 4) DEPTH OF PERC Fo o TEXTURAL CLASS: 1 X (2 SYSTEM CAPACITY PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE (TOTAL L.F.OF BIODIFFUSERS)(7.8 SF/LF)(0.74 GPD/SQ.FT.) GPD 13 PROPOSED DISTRIBUTION BOX 0 -X-X M n 1 (60.0')(7.8 SF/LF)(0.74 GAUSQ.FT.)= 346.3 GAL. LEACHING 0. DAY 60.00' > A Loamy Sand PROPOSED ARC 36HC(#3616BD)BIODIFFUSER 6 OYr 1 3/1 59.50' < 1 IT] TOTALS: M zi i. B Loamy Sand TOTAL NUMBER OF BIODIFFUSERS: 12 I OYr 5/6 TOTAL NUMBER OF COUPLINGS: 0 30" 57.50' TOTAL LEACHING AREA: 468.0 SQ.FT. TOTAL LEACHING CAPACITY: 346.3 GALJDAY RomDATE DESCRIPTION ------ HC-2 PROPOSED SEPTIC SYSTEM UPGRADE HCA PREPARED FOR: #684 NOTE: C Med. -Coarse Sand CAPEWIDE ENTERPRISES EXISTING 2.6Y 6/6 EFFECTIVE LEACHING AREA OF 7.80 SF/LF OBTAINED FROM THE 3-BEDROOM DEPARTMENT OF ENVIRONMENTAL PROTECTION APPROVAL LETTER DWELLING "MODIFIED CERTIFICATION FOR GENERAL USE" ISSUED TO LOCATED AT TOF = 60.0'± NOTE: ADVANCED DRAINAGE SYSTEMS, INC. ON OCTOBER 3, 2003 (LAST 684 PITCHERS WAY MODIFIED JULY 23, 2008). TRANSMITTAL NUMBER=W000052. HYANNIS, MA 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF EACH SEPTIC SYSTEM COMPONENT. SWING-TIES (SCALE: 1"=20') 130" 49.17' SCALE: I INCH = 20 FT. DATE: MAY 27,2009 0 10 20 40 80 FEET DESCRIPTION HCA HC-2 No Mottling, Standing or Weeping Observed 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE J C)H.N'j CHUIRCH11 L 1�1 PREPARED BY: LOCATION OF THE PROPOSED LEACHING FACILITY TO ENSURE BIODIFFUSER CORNER(1) 53.2' 44.2' 1 J CONSISTENCY WITH TEST PIT DATA SHOWN ON THIS PLAN. RESERVED FOR BOARD OF HEALTH USE R. JC ENGINEERING, INC. No REPORT TO ENGINEER AND LOCAL BOARD OF HEALTH IF SOILS BIODIFFUSER CORNER(2) 51.6' 56.8' 1 60 2854 CRANBERRY HIGHWAY ARE NOT CONSISTENT WITH TEST PIT DATA. BIODIFFUSER CORNER(3) 62.8' 66. EAST WAREHAM, MA 02538 BIODIFFUSER CORNER(4) 64.1' 55.6' 508.273.0377 SITE PLAN 3.) PROPERTY IS LOCATED WITHIN A DEP APPROVED ZONE 2. Designed By:MCP By: JLC 618 Drawn By: MCP SCALE: 1" =20' 1-------------------------- .............