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0064 QUAKER ROAD - Health
64 Quaker' R®acl Hyanhis `V 31'0?296� J t i d a e '� 1 TOWN OF BARNSTABLE LOCATION SEWAGE# 7-D!'e _ a- ,VILLAGE/J)edi Orl ASSESSOR'S MAP&PARCEL 310 hik INSTALLER'S NAME&PHONE NO. G-peWie_(r, C_v%+,o rj0v�iS . SEPTIC TANK CAPACITY /5-00 LEACHING FACILITY.(type) 25 , ArG 34 HG- f db(size) /�,e��,C oZ�.0 NO.OF BEDROOMS OWNER /d Cc A eiVV% T Cto PERMIT DATE: 8 _17- 20 1 o COMPLIANCE DATE: MSeparation Distance Between the: ao WRier . Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility eV00Uv1+ rL1 .t 1134 Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching.facility) A11A Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) 1 Feet FURNISHED BY A Der-k r)ver any OPee,Vie. C-366 � a Ak G-5=86.7 13 a-13.� .0 ®®5 Q�7=710 ® � 13-3E 71 Fees computer:in com THE COMMONV;lEALT�i OF MASSACHU'SETTS Enteredp PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplication for Oigonl *paem Cow5tructiou Permit Application for a Permit to Construct(el-IRepair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot N \cat (p(p QU-CAC9 r (2<3 Owner's Name,Address,and No. Assessor's Ma /Parcel 3�o h v bO 5 AAA Installer's Name,Address,and Tel.No.. Designer's Name,Address and Tel.No. -:-e �Ij (rs 0-1 R Pw_� .o tiR_,Rj 0 z(e 3.S- o-5 F tw ter. �r/� s G 6 OTT Type of Building: Dwelling No.of Bedrooms Li Lot Size d d I S-0 rrf sq. ft. Garbage Grinder ( ) Other Type of Building Q 2 S _V-f\j0( No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided yyy gpd Plan Date — L _ I y Number of sheets 1 Revision Date Title Size of Septic Tank \:OC7 Type of S.A.S. d.S 4yt ,3(P I(Q Description of Soil SQQ, \Q� Nature of Repairs or Alterations(Answer when applicable) I~ K ' 'p�'^'"�, y 'i 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 B of Health. p Signed CC Date O ' « 2-o L o r Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. a©10 1 35 la�,_ Date Issued � 16 fin,/ /� No.e Co o 4 Fee THE COMMONW ALTH OF MASS'ACHU'SETTS Entered in computer: Yes :`PUBLIC HEALTH-MVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 1� ° Application for �Digpool 6p5tent Construction Permit Application for a Permit to Construct(PI Repair( ) Upgrade( ) Abandon( ) ❑ stem Complete Sy stem y ❑Individual Components Location Address or Lot N (0(4 (o(r r t?,) Owner's Name,Address,and Tel.No. \� \cAAIS �h toc� 1 �\� \�o�F�`` Ic>\ e..d� Assessor's Map/Parcel lA Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 0 '& C v�\,--,'Pfr,SP� iC' v.S c�r )3 S,( C',a.,6 t r"t l�k j V;U '� Q <�N c�.tiK. Fel UZ�� S cLtwdY ACM b c7l . Type of Building: " Dwelling No.of Bedrooms 9 Lot Size a7d, O sq. ft. Garbage Grinder ( ) i Other Type of Building C� c S V\U No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided �/y�/ gpd Plan Date - , - I u Number of sheets 1 Revision Date (Title r� Size of Septic Tank S OCJ Type of S.A.S. 5 f)rC 3(p Ilp Description of Soil Nature of Repairs or Alterations(Answer when applicable) SQ 1 ,c Y e�en V- t7jy r ,A- ti) eg3—l\.� i Date last inspected: Agreement: s °' 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 Bqx4 of Health. Signed Date 2 C� Application Approved by r Date Application Disapproved by: Date for the following reasons i M Permit No. �( Q/(� �^ �j Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal SystemConstructed ( /j Repaired ( ) Upgraded ( ) Abandoned( )by C ,nl-(An C, SQ S at G U+ U to has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 9Ac/®-- dated �R) Installer 0 e,•0..Q w�r � to 4 LDr ' C-Q, Designer i C !C1 e t►. -e V L,Q #bedrooms yApproved design IIA y gpd The issuance oft is p' it shall not be construed as a guarantee that the system winfun4ibn as de igned. �f Date ! � a- Inspector 457 • � . . . . . . .� . .�-- Fee ..��}�---- --�--.-.- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION — BARNSTABLE, MASSACHUSETTS Biqa al 6pgtem Congtruction Permit Permission is hereby granted to Construct ( � Repair ( ) Upgrade ( ) Abandon ( ) System located at fit( 1 (o (o J and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this 1pel Date h:7 ("j Approved bye U5/18/2012 03:47 5082730367 7114V r. VVI/vui �;• Town of Barnstable 04 Regulatory Services Thomas F. Geiler,Director BAANGrABt.S, : Public Health Division A�en�• Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Ofticc: 5ON-862-4644 Fax: 508.790.6304 Date: Sewage Permit## Assessor's Map/Parcel '101 2 9 6 Installer& Designer Certification Form Designer: 'IC Engtoee.'Co�, T,nc , Installer: CQ�ew,A� EnFe,�ectse_� GI-C Address: 26.5y Ccon%aeCcv litjhw!/ Address: t S 3 eo✓n �e-rC,ql Ecasi kJOce.inan' HA- 61538 tvl 5��ea ►"A �Z � Oil .1-7 /ZO S as issued a permit to install a (dat ) (Installer) � septic system at 61/+ ko Quaker k-<l based on a design drawn by (address) 1G L-1)2i Neriil� TAG_ dated Auyus4 l2, ZotZ (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. _ I certify that the septic s stem referenced above installed with major ch anges (i.e. • greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State &Local Regulations. Plan revision or certified as-built by designer to follow. Stripout (if req .nspected and the soils were found satisfactory. ,,OFyt� joi-N 1. use —�-- IR. (I1 etaller's Sign ure) No Ie'IL 1307 esigner's Signatur (Affix esi ees Amp Here) PLEASE RE,ETURN ' O 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. i .n�liro G r as�daai;;ucr�urtili::nian Cann.doc Town of Barnstable P# (3o )- L/ Department of Regulatory Services BARMABI E, : Public Health Division Date 7 C� RUSS. 200 Main Street,Hyannis MA 02601 t Date Scheduled C v Time Fee Pd. Cud Soil Suitability Assessment for Sewage Disposal Performed By: MPC41A�1 R ye_1 P k -EL 1. CSC t , Witnessed By: !1/� v�g, �� Rf V LOCATION & GENERAL INFORMATION Location Address / i` 'IVW � Owner's Name )�n, �� IdGt IIoM2m 101 c� 1 v h✓t Address i3o BcisFol itvi, liyolafs HA Assessor's Map/Parcel: I t1 r Engineer's Name CPr Vj;1b VJ'C L tl^�tllez:t NEW CONSTRUCTION l REPAIR Telephone# Land Use do 6tk FtzMik ALwtk in\ Slopes(%) I'-2— Surface Stones Distances from: Open Water Body ft Possible Wet Area It Drinking Water Well — ft Drainage Way ft Property Line 7 16 ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands in proximity to holes) Sze ouyuw -, / .7136" l,�s Parent material(geologic) Depth to Bedrock Depth to Groundwater: Standing Water in Hole:_ 7 i 3 i+�og_3_ Weeping from Pit Face 7 13 6 Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL RIGH V ATER TAB E Method Used: O�CeG� b(pSz:Cn{loY► Depth Observed standing in obs.hole: !36_ in. Depth to soil mottles: _- 7�3 6_ _ in, Depth to weeping from side of obs.hole: 7 136 in, Orouudwater Adjustment ft• Index Well# — Reading Date: Index Well level Adj,faCtdr __._ Adj.Groundwater Level_= ..PERCOLATION::TEST Dote �-_Y�� 7t'i►ua 4 Observation Hole# 1" Time at 9" fi Depth of Perc 30 ifyb' Time at 6" A Start Pre-soak Time @ I 1 (V An Time(9"-6") End Pre-soak 11 1 &H Rate Min./Inch 4,7 Site Suitability Assessment: Site Passed �2 5 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:\SEPTIC\PERCFORM.DOC DEEP OBSERVATION HOLE LOG Holie# t Depth from Soil Horizon Soil Texture Soil Color Surface(in.) Soil Other (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel) S 2,5Y"A _ C 96-13C C-Z 'o S 2 5 DEEP OBSERVATION II'OLE LOG Hole# 2- Depth from Soil Horizon Soil Texture Soil Color Soil Surface(in.) Other (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel �1'3a i3 LS 30 96 C-i CS ` '• 10-2 0 fo(vvi(eS gd-!3b C-2 M5 2.e5 i b/b DEEP OBSE°RVATI`ON HOLE LOG H6 e# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel I DEEP OBSERVATION HOLE-LOG Holo# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consisten y, o Gravel) Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes.__✓_ Within 500 year boundary No Yes e 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? `l e 5 If not,what is the depth of naturally occurring pervious material? Certification I certify that on �y'?7"�'9 (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 a exp ' nce described in 310 CMR 15.017. Signature Date Q:\SEPTIC�PERCFORM.DOC COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PR OTV430MED ik!AP �- PriCI _" `Z'9 AUG 1 9 2004 0T 41 TOWN OF BARNSTABLE HEALTH DEPT. TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSUIRVAf:P SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address• 64, 114&Of- �P.14 Owner's Name: -- Owner's Address: O a" 4� Date of Itrspgc#ii�n; ,��4- Name of Inspector•,(plente pant) Company hameS Mailing Address: a Telephone Number; �a' iCERTITICA.TION STATEMENT I certify that I Save 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 taaining and GxperiznLSC in flit pcopor fanction and ri aintonancc of on site sowaso daaposal systerna.I am a DEP approved system inspector Pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: V Pass ti ally Passes rther Evaluation by the Local Approving Authority 0 Inspector's Signatures Date: The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of'Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority, Notes and Comments ""This report only describes eonditions at the time of lnsptction and under the candMons of use at that time.This inspection does not address how the system will perform in the hture under the some or different cobditions of use. TO �19t/d IJdA Eb866E9809T 99:60 t,00Z./ZT/80 Page 2 of 11 OVVICIAL INSPECTION FORM-NOT FOR VOLlilN7CE1RY ASSESSMENT$ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address, &4-6 C14.M,k S, t)J. Owner; hr, fi�o 161 A' Date of tgspectlon; 't Q+ iaespcctnoar Summary: Check A,B C,D or E/ALWAYS complete all of Section D A,• S tem Passes; 7I have nut rvwi l any information which indicates that any of the failure criteria described in 310 CATR 15.303 or in 310 CMR 15,30$exist.Any failure criteria not evaluated are indicated below. C®ntments: INTO A" OF 7 ANk TS "f RE" U 10 r L. 1Z LtXAYCI> —Tffr-- -"ArAiK MN -THEF FIC-1—b r 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 aad 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 Certifxcato of Compliance indicating that the tank is less than 20 years old is available, ND explain: _ Observation of sewage backup or bulk out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with approval of Hoard of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced NT)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 nf the Board of Health): broken pipe(&)are replaced obstruction it removed ND explain, N 3E)Vd I9d11 EbE66E98091 99:60 b00 ILZ180 Page 3 of i t OFFICIAL INNF tr'CTION FORM-NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) trolkerty Addresa t,` c Owner: r.h at+ Date of lnspecdon: D4- C. Further Evaluations 1s 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 CM1115.303(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 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 naiad sail absorption system(SAS)and the SAS is within 100 feet of surface water supply or tributary to a surface water supply. r� The system has a septic tattle and SAS and the SAS is within a Zorie 1 of a public waster 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 thati i 00 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,peri'brtthed at a PEP certified laboratory,tar coliform bacteria and volatile organic compowTids indicates that the well is free from pollution from that facility and the presence of xmroonia 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 forth. 3. Other: co 39dd i9dn 99:60 VOLE/ZT/KA I Page 4 of 11 OFFICIAL INSPECTION FORM v NOT )i+'OR VOLUNTARY ASSES$MENTS SUBSTIRFACK SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 4_ 61AA 6r Pig MA oz&01 Owner• ._ Date of Inspection: D. system Failure Criteria applicable to ail systomso You MILL indicate"yea"or"no"to each of the following for;ll inspeotiotta. Yob No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponditag of effluent to the surface of the grotmd or surface wat.�rs due to an overloaded or clogged SAS m—cvsspool 6 Static liquid level in the distribution box abovo outlet invert due to an overloaded or clogged SAS or cesspool Ne Liquid deptlt hi cospWi is less 111ml Cs"below invert or avaitable volume is less than'14 day flow Required pumping inure than.4 tittles in the last year NC81'due to clogged or obstructed pipe(S).Number of times pumped Any portion of the SAS,cesspool or privy is below high ground water elevation. _ .Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well.. �_ rc Any portion of a cesspool or privy is within 50 feet of a private water supply well. r 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.lThis system passes if the well water analysis, performed at a DEP certified laboratory,for eoliform bacteria and volatile organic compounds indicates that the well is free from poilutioe from tbxt facility god the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that net other failure criteria are triggered.A copy of the analysis most be attached to this furor.] (Yes/No)The system fj&'I have determined that one or more of rite above failure criteria exist as described in:10 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to cornet the failure. E. Large sterns: � Systems: To be considered a large system the system must serve a facility with a design slow of 10,000 gpd to 15,000 ip You roust 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 i8 within 400 feet of 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 trapped Zone 11 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 sny large system considered a significant threat:under Section E or failed lender Section,f3 shall upgrade the system in accordance with 310 CMX 15,304,The system owner should contact the appropriate regional office of the Department. VO 39Vd MdA EbE66cseosl 99".6© tloK/�T/8© Page 5 of 1 I UFFRAAA INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART D CHECKLIST Vroperty.address: 6 — 0.Ar- 'U , i MA owner; S q O"ji: VateofYnaspccttoro: NNE Check if the following have been done.You most indicate"ycs'or"no'.as LU cadl of die t'Oltvwillg. eww ww�n.�r�r�rw.w w+.a - >m w a i rrr er m rri �® Yes No _ Pumping information was provided by the owner,occupent,or Board of Health jx Were any of dw system componeuts piutved out in the ptevious two weeks? K. Has the system received nartnal flows in the previous two week period 7 T Have large volumes of water been introduced to the systettt recently or as part of tl*inspectiou? J)k Were as built plans of the system obtain d and examined?(If they were not available cote as XlA) NO 7LANs AIkE AV IJ-A•24E . - — Was the facility or dwelling Inspected for signs of sewage back up 7 X y Was the site inspected for signs of break out? ?� Were all system conVonents,excluding tine SAS,located on site? IC _ 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,diutensions,depth of liquid,depth of sludge and depth of scum? :c _ Wa_a the facility owner(and occupants,if different from owner)ttmvided with infbrtration on the groper at mntenance of subsurface sewage disposal systems? The size and location of the Ml Absorption System(SAS)on the site has been determined based on: Yes no X Existing information.For example,a Plata at the Board of Health, Y _ Determined in the field(if any of the failure criteria related to fart C is at issue approximation of distance is unacceptablc)(310 CMK)5,302(3)(b)j 99 9t�d IJdA CV6668980ST 99:60 t,@KI?Zf80 Page 6 of 11 OFFICIAL, INSYtCTION FORM—-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM FART C SYSTEM INFORMATION Property Address: �w�kcr ' A h` MA oa&ot Owner: A^,,[ C. oate of Inspection: od-_ - FLOW CONDITIONS RESYD ENTIAL Number of bedrooms(design). (0_ 'Number of bcdiuu::'.s(actual):. + DESIGN flow based on 310 Cult 15.203(for example: 110 gpd x#of bedrooms): +40 Number of current residents: + _ laces residence have a garbage grinder(yam or nu). Is laundry on a separate sewage system(yes or no):Mo [if yet separate inspections required] Laundry system inspected(yes or no):ND Seasonal use:(yes or no): NO Water meter readings,if available(last 2 years usage(gpd)): NIA Sump pump(yes of ho):&J6 Last date of.occupancy: --_ COMMERCIALIINDUSTRIAL Type of establishment: Design fluky(based on 310 CM1R.15,203): Basis of design flow(seats/persons/sgft.etc.): _., -- Grease trap present(yes or no): Industrial waste holdipg Uok present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Writer meter readings,if available: Last date o€occupancy/use:r _ OTHER(describe): GENERAL INFORMATION Pumping Records Y Source of information:_N/!t _ Was system pumped as part of the inspection(yes or no): AId if yes,volume pumped:__,__gallons -How was quantity pumped determined? Reason forpurnpirg:__N Ar TYPE OF SYSTEM Septic tauk,distribution box,soil absorption systeru Single cesspool Overflow cesspool ` —Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) _�Innovative(Altemative tehnology.Attach a copy of the current operation and maintenance contract(to be obtained from systems owner) Tight tank Attach a copy of the DF.P approval Other(describe): Approxima a of all components,date installed(if known)and source of information: 2- Were sewage odors detected when arriving at the site(yes or no): 9© 39Vd MdA EVE66EGeOST 9S:60 roe.ZUT/60 Page 7 of 11 OFFICIAL,INSPECTION FORM—NUT FOR R Vt)LIJNI'ARY'ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SXSTRM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: t-4 -6 6, w a V^�. 00 1 Owner: A'%A 1+ Date of Inspection: v f BUI]LIDING SEWER.(locate on site plan) k Depth below grade:—A — Materials of construction:_cast iron s< 40 PVC other(explain): Distance from private water supply well or suction line: ►�ZAL Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:✓(locate on site plan) Depth below grade. l Material of construction: X concrete metal_fiberglass,_polyethylene r,,,,,�other(explairr} if tank is metal list age._ is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) ` _ Dimensions: 16(006. L. 10t!z" Sludge depth.: I " — - Distance from top of sludge to bottom of outlet tee ar baffle: 3 Scum thickness:_IL_ <, Distance from top of scum to top of outlet tee or.baffle: Distance from bottom of scum to bottom of outlet tee ox baffle:A/7� How were dimensions determined: , Macstk.LI_� Comments(on pumping recommerdations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): GREASE TRAP:_(locate on site plan) Depth below grade: Material of construction: _concrete___,metal_llberglass__polyethylene ,,,other (explain):_- —Dimensions: Scum Scum thickness: Distance from tog of scum to top of outlet tee or batffir: Distance from bottom of scum to bottom of outlet tee or baffle: Dee 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.): L9 39Vd I'JdPti 6b6666S2091 99:60 h100Z,IZ T/80 f Page 8 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENT'S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address,-. 64..-&r, 0...44- PJ Owner:- At,- Date s !a of Inspection: T>GUT or HOLDING DING TANK; (tank must be pumpcd at tinec of on rite plan) Depth below grade; Material of cVnstrulAiVAI 4011or0te_znotal-fiberglass Polycthyleno other(explain): Dimensionsi C-Apmjty: � gallons Design flow-T - gallonslday Alarm present(yes or no): Aiarm level: Alarm in working order(ycs ur itu); Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION Bf3%:M' (if present merit be opened)(locate on site plan) Depth of liquid level above outlet invert:V' 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(mote condition of pump chamber,condition ofpumps and appurte0ances,etc.): r I91JA CVE66E9809T 99:60 i70OZ/LI/en- I Page 9 of I l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE )DISPOSAL SYSTEM INSiPECTION FORM PART C SYSTEM INFORMA'nON(continued) Property Address; —66 _6 .4.v fV . _�26C9i Owner; /aS►►`,K r k a Date of inspection: $ R t SOIL ABSORPTION SYSTEM (SAS): (locate oa site Asian,excavation not required) If SAS not located explain why: Type leaching pits,number. leaching chambers,number: leaching galleries,number:_ leaching trenches,number,length: leaching fields,number,dimensions: .............-__--- overflow oaspool,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.): CESSPOOLS: (cesspool must be pumped as part of inspectiorn)(loo$to on site plan) Number and configuration- Depth--top of liquid to inlet invert: Depth of solids layer: TT� Depth of scum layer: tnimem'donc ofeemponl. . . .__._ ,,,-,,,— Materials of construction: indicatlon of groundwater inflow(yes or no): C:ornrnente(note condition of soil,signs of hydraulic failure,level of ponding,Condition of vegetation,etc,): PRIVY, �(locate on.site plan) AIateriala of construction: Dissensions: —- Depth of solids: Comments(note condition of soil,sighs of hydraulic failure,level of ponding,condition of vegetation,etc.): 60 -99vd IrJd11 £t66h69609t 99:60 b0017%LZrr80 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFI7PMATION(Continued) Property Address: 4ee R& Uwaer: Anrwa } Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties W at least two permanent reference landmarks or benchmarks,l:c -atc all wells widil}z 100 feet.Locate where public water supply enters the building. 4g`-5 j I 0? 39Vd I5d(1 EbE6555o^I35L 95:60 ba©z/LT180 i Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INP'ORNIATION(continued) Property Address: 64 G'6 o � Owner. AK,, tit o Date of Inspections SUE.EXAM[ Slope Surface water Check cellar shallow wells Estimated depth to ground water l2' feet Please indicate(check)all methods used to detemine the high ground water elevation: Obtained from system design plans on record a If checked,date of design plan rrVICWC(1: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of health-explain:_�, — Checked with local excavators,installers-(at=b documentation) -Accessed USGS database-explain: ,,,,,� _� You must des sibe how you established the high round water elevation: �}S G S s > +e S 1��f 4 tT 391d z9dn 99:60 VOOZ/Zt/se 9 /8 sf a 04 31 `04 OP 0 COMMONWEALTH OF MASACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAI AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET BOSTON MA 02108(617)292-3500 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Govemor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 64& 66 QUAKER RD HYANNIS, MA 02601 M310 P384 L55 Name of Owner JEFF LYONS INDIGO MANAGEMENT Address of Owner: BOX 611 HYANNISPORT MA.02647 Date of Inspection: 7/7/00 Name of Inspector: JOHN GRACI I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: SEPTIC INSPECTIONS Mailing Address: P.O.BOX 2119 TEATICKET,MA.02536 Telephone Number: 508-564-6813 FAX 608-564-7270 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 sewage disposal systems.The system: X Passes _ Conditionally Passes _ Needs Further Evaluation the Local Approving Authority Fails Inspector's Signature: Date:7/11/00 The System Inspector,shall sub it 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 the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS "The inspection is based on criteria defined in Title V code 310 CMR 15.303.My findings are of how the system is performing at the time of inspection.My inspection does not imply any warranty or guarantee of the longevity of the septic system and any of its component's useful life." THE SYSTEM PASSES TITLE V INPECTION.RECOMMEND PUMPING THE SYSTEM EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. revised 9/2/98 Page 1 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 64&66 QUAKER RD HYANNIS, MA 02601 M310 P384 L55 Name of Owner JEFF LYONS INDIGO MANAGEMENT Date of Inspection: 7/7/00 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: X I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. 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. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances.If"not determined",explain why not. n/a 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. Wa 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 Will 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 , r u� revised 9/2198 Page 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 64&66 QUAKER RD HYANNIS M 0 p y A 2601 M310 P384 L55 Name of Owner JEFF LYONS INDIGO MANAGEMENT Date of Inspection: 7/7/00 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, :; 1 _ 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,,ynless 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 n1a (approximation not valid). 3) OTHER n/a revised 9/2/98 Page 3 of 11 ,i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 64$ 66 QUAKER RD HYANNIS, MA 02601 M310 P384 L56 Name of Owner JEFF LYONS INDIGO MANAGEMENT Date of Inspection: 7/7100 D. SYSTEM FAILS: You must 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 determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No i X Backup of sewage into facility or system component due to an 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. i 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 1/2 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 Q. X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. X Any portion of a 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 I 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.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. LARGE SYSTEM FAILS: 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: 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 X the system is within 400 feet of a surface drinking water supply i - X the system is within 200 feet of'a Vibutary to a surface drinking water supply X 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 owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further information. i j I revised 9/2/98 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 64& 66 QUAKER RD HYANNIS, MA 02601 M310 P384 L55 Name of Owner: JEFF LYONS INDIGO MANAGEMENT Date of Inspection: 717/00 Check if the following have been done:You must indicate either"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 - 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. X - As built plans have been obtained and examined.Note if they are not available with N/A. X _ The facility or dwelling was inspected for signs of sewage back-up. X - The system does not receive non-sanitary or industrial waste flow. X _ The site was inspected for signs of breakout. X _ All system components,excluding the Soil Absorption System,have been located on the site. X _ 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: X _ Existing information,For example,Plan at B4O,H, X _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)1 5.302(3)(b)] X _ The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. revised 9/2/98 Page 5 of 11 .,SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION i t Property Address: 64& 66 QUAKER RD HYANNIS, MA 02601 M310 P384 L55 Name of Owner JEFF LYONS INDIGO MANAGEMENT Date of Inspection: 717/00 FLOW CONDITIONS RESIDENTIAL: Design flow: 110 g.p.d./bedroom Number of bedrooms(design): 4 Number of bedrooms(actual): Total DESIGN flow: 440 gpd Number of current residents:3 Garbage grinder(yes or no):NO Laundry(separate system)(yes or no): NO If yes,separate inspection required Laundry system inspected(yes or no): NO Seasonal use(yes or no): NO Water meter readings,if available(last two year's usage): n/a gpd Sump Pump(yes or no): NO Last date of occupancy: n/a COMMERCIAL/INDUSTRIAL Type of establishment: n/a Design flow: n/a gpd(Based on 15.203) Basis of design flow:n/a Grease trap present:(yes or no): NO Industrial Waste Holding Tank present:(yes or no): NO Non-sanitary waste discharged to the Title 5 system:(yes or no):NO Water meter readings.if available: n/a Last date of occupancy:n/a _ OTHER: (Describe) n/a GENERAL INFORMATION PUMPING RECORDS and source of information: n/a System pumped as part of inspection:(yes or no):NO If yes,volume pumped n/a gallons Reason for pumping:n/a TYPE OF SYSTEM X Septic tank/distribution box/soil absorption system _ Single cesspool _ Overflow cesspool _ Privy _ Shared system(yes or no)(if yes.attach previous inspection records,if any) _ I/A Technology etc.Attach copy of up to date operation and maintenance contract _ Tight Tank Copy of DEP Approval Other:n/a >` APPROXIMATE AGE of all components,date installed(if known)and source of information: 1997 PERMIT 97471 Sewage odors detected when arriving at the site:(yes or no) NO revised 9/2/98 Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 64&66 QUAKER RD HYANNIS, MA 02601 M310 P384 L55 Name of Owner JEFF LYONS INDIGO MANAGEMENT Date of Inspection: 7/7/00 BUILDING SEWER:X (Locate on site plan) Depth below grade: 18" Material of construction: _ cast iron X 40 Pvc _ other(explain) Distance from private water supply well or suction line: n/a Diameter: 4" Comments: (condition of joints,venting,evidence of leakage,etc.) THERE IS TOWN WATER SEPTIC TANK: X (locate on site plan) Depth below grade: 12" Material of construction: X concrete_ metal_ Fiberglass_ Polyethylene_ other explain: nla If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): NO Age: n/a Dimensions: 1500G L 10'6"H 5'6"W 5'8 Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 32" Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: n/a How dimensions were determined: MEASURED Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) k_ THE SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING NOW EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. i�dl• GREASE TRAP: _ (locate on site plan) Depth below grade: n/a Material of construction: _concrete_ metal_ Fiberglass _ Polyethylene_other Explain: n/a Dimensions:n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or-baffle n/a Date of last pumping: n/a Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) nla r. revised 9/2/98 Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 64& 66 QUAKER RD HYANNIS, MA 02601 M310 P384 L55 Name of Owner JEFF LYONS INDIGO MANAGEMENT Date of Inspection: 7/7/00 TIGHT OR HOLDING TANK: _ (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: n/a Material of construction: _concrete_ metal_Fiberglass _Polyethylene _other Explain: n/a Dimensions: n/a Capacity: n/a gallons Design flow: n/a gallons/day Alarm present: NO Alarm level:N/A Alarm in working order:NO Date of previous pumping: n/a Comments: (condition of inlet tee,condition of alarm and float switches,etc.) n/a DISTRIBUTION BOX:X (locate on site plan) e iI31 Depth of liquid level above outlet invert: n/a Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) n/a PUMP CHAMBER: _ (locate on site plan) Pumps in working order:(Yes or No): NO Alarms in working order(Yes or No): NO Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) n/a revised 9/2/98 Page 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 64&66 QUAKER RD HYANNIS, MA 02601 M310 P384 L65 Name of Owner JEFF LYONS INDIGO MANAGEMENT Date of Inspection: 717/00 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: n/a Type: leaching pits,number:(n/a)n/a leaching chambers,number: (6)INFULTRATORS leaching galleries,number: (n/a)n/a leaching trenches,number,length: (n/a)n/a leaching fields,number,dimensions: (n/a)n/a overflow cesspool,number: (n/a)n/a Alternative system: n/a Name of Technology: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE SAS APPEARS TO BE FUNCTIONING PROPERLY.THE SOIL PROBED DRY IN LEACH AREA,SYSTEM SHOWS NO SIGNS OF FAILURE. CESSPOOLS: _ (locate on site plan) Number and configuration: n/a Depth-top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer. n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater: n/a inflow(cesspool must be pumped as part of inspection)NO Comments: , (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a it PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a revised 9/2/98 Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 64& 66 QUAKER RD HYANNIS, MA 02601 M310 P384 L55 Name of Owner JEFF LYONS INDIGO MANAGEMENT Date of Inspection: 717/00 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) AA M -�3 Ac 3a it a revised 9/2/98 Page 10 of 11 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 64& 66 QUAKER RD HYANNIS, MA 02601 M310 P384 L55 Name of Owner JEFF LYONS INDIGO MANAGEMENT Date of Inspection: 7/7/00 NRCS Report name: n/a Soil Type: n/a Typical depth to groundwater: n/a USGS Date website visited: n/a Observation Wells checked: NO Groundwater depth: Shallow_ Moderate_ Deep_ SITE EXAM _ Slope _ Surface water _ Check Cellar Shallow wells Estimated Depth to Groundwater 12 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 X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS-12+FEET revised 9/2/98 Page 11 of 11 TOWN OF BARNSTABLE LOCATION C� E!� ICJt SEWAGE # VIL.LAG'h- ASSESSOR'S MAP & LOT -ao---vz j INSTALLER'S NAME&PHONE NO._R�s� Saq SEPTIC TANK CAPACITY _ / �� c..nD LEACHING FACILITY: (type) i J (size) NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: , - 1 — COMPLIANCE DATE: ' Separation Distance Between the: Maximum Adjusted Groundwater.Table and Bottom of Leaching Facility Feet ;,r 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 300 feet of leaching facility) Feet t crushed by t. vio 0 I . i r � �i'i , TOWN OF BARNSTABLE LOCATION QU SEWAGE # 31 ?-9 VILL,AGE U a S — M R ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (.type) �l�� (size) NO.OF BEDROOMS BUILDER OR OWNER( - 1�.ID PERMTTDATE: '" COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by , e fig•, �` V`� V�I Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: d es PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS ZIppYication for Mioogal *pgtern Comaruction Vertu Application for a Permit to Construct( )Repair(✓)Upgrade( )Abandon( ) 'K Complete System ❑Individual Components Location Address or Lot No.(044-1(2 &,32_)Cer W Owner's Name,Addresses and Tel.No. Assessor's Map/Parcel `31�—�C�/(J _ l��wwI5 T 0^� � 1 Inst er's Name,Add and Tel.No. Designer's P.e,Address and Tel.No. -e✓ (F)-pp v- IV Type of Building: Dwelling No.of Bedrooms "4 Lot Size sq. ft. Garbage Grinder( ) Other Type of Building flr otf:�K No.of Persons Showers( ) Cafeteria( ) Other Fixtures �/ 2 Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank �50b Type of S.A.S.—a—'sAr�, GtiPGt'T� �wyL�l., Description of Soil t.E Q S 4AJ n 4 Nature of Repairs or Alterations(Answer when applicable) ''W STA\` =8ch� �5 y V l �.�,.Ca�C�c CT i 4Lt Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b this Bo Signe Date 9_2 57 Application Approved by Date Application Disapproved for the following reasons 'No. f Date Issued � . 4 ,- r•."iNo. G Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ' PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE. MASSACHUSETTS?,0,- 2pplication for 3Digpo2;a1 *pgtem Construction Permit,, Application for a Permit to Construct( )Repair(✓Upgrade( )Abandon( ) Complete.System ❑Individual Components r Location Address or Lot No. Owner's Name,Address and Tel:No. 0 Assessor'sMap/Pazcel 3`v�aC�/_ r;^� (L ' E i tee. Installer's Name,Addre and Tel.No. �[J Designer's Name,Address and Tel.No. Al ' Type,of Building: Dwelling No.of Bedrooms —t Lot Size sq.ft. Garbage Grinder( ) Other Type of Building 0,toy No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow `lQ gallons per day. Calculated daily flow 7 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank %<50b 5 ,►A-k inJ Type of S.A.S. i sk--, Cti O c i j y Description of Soil 1= n S)l ti (1 Nature of Repairs or Alterations(Answer when applicable) -=`W 5T ra1k I SCE!J!LN`0 KJ �aK `�r''c �Cc.rfkt2 1L.Tr ,-\0(ZS slneC 1 L10 �3V. �c✓ N -' 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 Title15 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this'Bo •.of-Healt. a Signed Date 9_a 7 i Application Approved by Date Application Disapproved for the following reasons z Permit No. 0- Date Issued _ r1 -----.----------------------------f;-- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS QCertif icate of (4COMPtiance THIS IS TO CERTIFY, that the Sewage Disposal System Constructed( )Repaired( )Upgraded 1; ✓) Abandoned( )byn�c. at to to " -7 to 1Ajr.wj tnl%S has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector + ------------------------------------ No. / Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -`BARNSTABLE., MASSACHUSETTS lwitpogar *pgtem on0tructton Permit Permission is hereby granted to Construct( )Repair( UpgradI,e--,,( )Ab on( ) System located at �v Cs1 t, tcc� 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:C/onnstruction must be completed within three years of the date of this Date: stI � 7 / Approved NOTICE: This Form is to be used for the Repair of Fails / Septic Systems Only CEItTI.FICATION OF SKETCH AND APPLICATION FOR A DISPOSAL �VUIt[{S C UNS'1'ttUC't'IUN I'EItNjjr(�VjrllUUl' DESIGNED I'LANS1 l � A5 , hereby certify that the application for disposal works construction permit signed by me dated concerning the property located at 66--We d-V°� �' ` � meets all of the following criteria: • There ore no wetlands within 300 feet of the proposed septic system There are no private wells within 150 feet of the proposed septic system The observed groundwater table is 14 feet or greater below(he bottom of the leaching facility. There is no increase inflow and/or change in use proposed • There are no variances requested or needed. DATH: SIGNED LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER (AUach a sketch plan of the proposed system. Also if[lie licensed installer posesses a certified plot plan, this plan should be submitted]. r4 t f COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVII om NTAL AFFAIRS DEPARTMENT OF ENviRoNmmAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (817)-292-5500AG 9 © •. WU L=F.WELD TRUDY CORE --'Goveraor �; Secretary AR.GEO PAUL CELLUCCI `` .�gg� AVID B.STR.LTHS Lt. Governcr Commissioner ��N 2 � jOW N�eNQEP p6�E 1.r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSP s FORM PART A CERTIFICATION Property Address:" Q.t w klwl A17t ,,�„� Address of Owner C.C�N ,-S Date of Inspection: p 1s�/�/y (If different) �b 6�/C Name of Inspector: ,ey+at\ e_ e, us , Company Name, Address and Telephone Number. `C^ 6 CERTIFICATION STATEMMEVT—'Mk* SOca,-Vr)_ 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 ir,the proper function and maintenance of on-site sewage disposal systems. The system: _ Passes Conditionally Passes _ t\eed—Further Evaluation By the Local Approving Authority „ Faits inspector's Signature: ��C ���r Date: v� The System Inspector shall submit a copy of this inspection report to the Approving Authority 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 the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: J��R,^ITr q 7,vj Check A, B, C, or D: A] SYSTEM PASSES: 00/MA I have not found any information which indicates that the s stem violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. BJ SYSTEM CONDITIONALLY PASSES: One or more system components need to be replace or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes, no, or not determined (Y, N, or ND)_ Descri basis of determination in all instances. If"not determined", explain why not. The septic tank is metal,cracked, stru rally unsound, shows substantial infiltration or exfiltrtion, or tank failure is imminent. The system will p;kss insp ion if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 11/03/95; J 7 e 1 t S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property.Address: 6 Rd Owner: �i2) G" *— Date of Inspeetior������.� Bl SYSTEM CONDITIONALLY PASSES (continued) t Sewage backup or breakout or high static water level observo in the distribution box is due to broken or obstructed pipe(s) or due to a broken,.settled or uneven distribution bo . 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 ye r 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 Cl FURTHER EVALUATION 15 REQUIRED BY THE BOARD OF HEA TH: Conditions exist which require further evaluation by the Bo rd of Health in order to determine if the system is failing to protect the public health, safety and the environment. }) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DET RMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND 5 FETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surfa a water Cesspool or privy is within 50 feet of a bor' ring vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEA TH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETEIMINES THAT THE SYSTEM iS FUNCTIONING IN A MANNER T AT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil a sorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. _ The system has a septic tank and soil sorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil bsorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil sorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water anti sis for coliform bacteria and volatile organic compounds indicates that the we!I is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 Ppm. 3) OTHER (revised 11/03/95) 2 ( SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A 6� CERTIFICATION (continued) i Property Address:C6. ova-1� 12 / Owner: . l l>2 Date of Inspection: D] SYSTEM FAILS: _ I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303: The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. 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] LARGE SYSTEM FAILS: 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: 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 owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 11/03/95) 3 v } f a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 6-4 t600 1-111e. L,'" Owner: � t�a2 i C_ Date of Inspection: Check if the following have been done: Pumping information was requested of the owner, occupant, and Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. 12(-As built plans have been obtained and examined. Note if they are not available with N/A. 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. �1 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 or approximated by non-intrusive methods. , The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub- Surface Disposal System. ( (revised 11/03/95) 4 Y • , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C / SYSTEM INFORMATION Property Address: Owner: rt- Date of Inspection: 0 5- 2 6 C7 FLOW CONDITIONS RESIDENTIAL: Design flow: 440 allons Number of bedrooms:-04 Number of current residents:-i4£�. Garbage grinder (yes or no):N� Laundry connected to system (yes or no): Seasonal use (yes or no):_N Water meter readings, if available: `0( Last date of occupancy: -1 COMMERCIAUI N D USTR I AL: Type of establishment: Design flow: gallons/day 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: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: �a���M �ay�o<A TOE Nl!�� Syste pumped as part of inspection: (yes or no)_ If yes, volume pumped: ¢allons Reason for pumping: TYPE OF SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Other (explain) r..�c.J).�. APPROXIMATE AGE of all components, date installed (if known) and source of information: io�, Sewage odors detected when arriving at the site: (yes or no) ? (revise= 11/03/95) 5 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ,4 CC SYSTEM INFORMATION (continued) Property Address:6-4 ©vc.k,L Owner: � ��L z-, --- 7 Date of nI spection: SEPTIC TANK: (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP—other(explain) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: 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: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) GREASE TRAP:K)O (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP —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: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C �6 SYSTEM INFORMATION (continued) Property Address:�� 4y4 &4 kA--� Owner:,t, LA'/L " r— Date of Inspection: US/ � � � TIGHT OR HOLDING TANK:Oc—' (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP —other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: 00 (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) PUMP CHAMBER: NJ (locate on site plan) Pumps in working order:(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 11/03/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C �66 SYSTEM INFORMATION (continued) Property Address: 6 (� Owner: �— u�� �'c- T— / Date of nl specfion: c -5-12 SOIL ABSORPTION SYSTEM (SAS): S (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number: leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetati n,et C e t9ec G �2 J CESSPOOLS: �) S (locate on site plan) Number and configuration: �\ ���� • Depth-top of liquid to inlet invert: Depth of solids layer: r Depth of scum layer: ('G,it Dimensions of cesspool: L.7,6 _ Materials of construction: Cpt.-c'n-:- 'e Indication of groundwater: 1JO inflow (cesspool must be pumped as part of inspection) PC] - tiK:r-� Comments: (note condition of soil, signs of hydraul'c failure, level of po in , condition of vegetation, etc.) t S4111c - \ PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: t Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 11,'C3/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: �� vc� (/,,� �� ly 4 U K" Owner: `� �. w2r'ri G�T- Date of Inspection: ©s�2 6- SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' R � DEPTH TO GROUNDWATER Depth to groundwater:"_feet method of determination or approximation: LA (revised 11/03/9.) 9 � c Q C�l 'C� TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE L'�.,..[tvb� ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) /` i,, - (size) .W YtL_ NO.OF BEDROOMS Bt,MD,ER OR OWNER PERMITDATE Cl- 1 — _ COMPLIANCE DATE: --3 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on.site or within 200,feet of leaching facility) Feet -Edge of,Wetland and Leaching Facility(If any wetlands exist. within 300 feet of leaching facility) Feet Furnished by S � 133 3 31 - A � T.O.F. EL.= 51 .0'± INISH GRADE OVER D-BOX= 48.3± 4"SCHEDULE 40 PVC MIN. SLOPE 1 % PROPOSED PVC VENT FINISHED GRADE OVER BIODIFFUSERS= 47,8' - 48,3' GENERAL NOTES SLOPE @ 2% MIN. PROVIDE EXTENSION RISER REMOVABLE WATER-TIGHT COVER OVER INSPECTION PORT WITH 1. UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION WITH COVER OVER INLET& RISER TO WITHIN 6"OF FINISHED GRADE PER ACCESS BOX WITHIN METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL FINISH GRADE � OUTLET TO WITHIN 6"OF F.G. , 3"OF F.G. (ONE PER ROW) @ FND. EL.= 50.4 F.G. OVER TANK EL. = 49.7± 5"DIA. OUTLET(S) CODE AND ANY APPLICABLE LOCAL RULES. _ -- 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. ---EXISTING 4" PROPOSED 4" 9"MIN. 9"MIN. 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL - - PVC SEWER PIPE 36 MAX. 36 MAX. TOP OF SAS/B.O. = 45.33 SEWER PIPE i SYSTEM UNLESS OTHERWISE NOTED. ��n 3"DROP MAX '± PROVIDE WATERTIGHT 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN MIN s�oaE��,�,: 6 3 2"DROP MIN 3" 9" L=55_ MIN.SLOPE 1% JOINTS (TYP.) ELEVATION =45.33' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A � 0" 14 I 4"PVC IN FROM _ 1.33' Q 16„ 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S. AND THE TOP OF *45.9 ± SEPTIC TANK 4"PVC OUT TO 0.90' (TYMIE1P.) f5tt"(n'P) THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. O LEACHING FACILITY + 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. CONTRACTOR CONTRACTOR SHALL ' 12" 6" , 44.90' �--44.00' laid flat 2.875'(34.5")--I 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. SHALL VERIFY SIZE 48" VERIFY CONDITION OF OUTLET TEE 45.23 MIN. 45.06 ( ) (TYP.) 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK i AND CONDITION OF EXISTING TEES GAS BAFFLE 5.0' FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS 6"CRUSHED STONE (TYP.) 5'MIN. 14.375' EXISTING SEPTIC AND REPLACE AS OVER MECHANICALLY REQ'D NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH TANK NECESSARY COMPACTED BASE 25.0' AND DESIGN ENGINEER. 5 OUTLET DISTRIBUTION BOX (TYP.) 8. ELEVATIONS BASED ON APPROXIMATE MEAN SEA LEVEL DATUM OF 51.00' TO BE INSTALLED ON A LEVEL STABLE GROUND WATER ELEV= < 36.67' BIODIFFUSERS (END VIEW) ESTABLISHED ON TOP OF A LANDING CORNER AS SHOWN ON PLAN. BASE. FIRST TWO FEET OF OUTLET 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION EXISTING 1 ,500 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. 25 - BIODIFFUSERS (PROFILE) THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT CROSS SECTION VIEW (E `ADVANCED DRAINAGE SYSTEMS, INC.) 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES SEPTIC TANK PROFILE 25 - ARC 36HC ##3616BD H-20 BIODIFFUSERS TO THE DESIGN ENGINEER. 'CONTRACTOR TO VERIFY EXISTING ELEVATION PRIOR DISTRIBUTION BOX DETAIL \ !1-0 ANY WORK & NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE NOT TO SCALE NOT TO SCALE 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT. - 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING NOTES: eH TEST PIT DATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM O ` 2 PERC NO. 13024 APPROPRIATE AUTHORITY. 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF #66 O INSPECTOR: David W. Stanton, R.S. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS EACH SEPTIC SYSTEM COMPONENT. EXISTING DECK a EVALUATOR: Michael Pimentel, E.I.T. LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE 2-BEDROOM 0 • THEY SHALL WITHSTAND H-20 LOADING. ♦ 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF THE DWELLING UNIT EXIST C.S.E.APPROVAL DATE: Oct. 27, 1999 7 • a� Q 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. •.. p SH r a DATE: August 4,2010 PROPOSED LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST PIT `�- ?a ED Q ZONE 2 TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE DATA SHOWN ON THIS PLAN. REPORT TO ENGINEER AND LOCAL BOARD OF #64 z SC a MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. HEALTH IF SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. EXISTING s' U ELEV TOP = 48.00' REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, 2-BEDROOM 0 ca ELEV WATER= <36.67' FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). 3.) CONTRACTOR TO VERIFY THAT BOTH DWELLING UNITS' SEWER FLOW ARE DWELLING UNIT DIRECTED INTO EXISTING 1,500 GALLON SEPTIC TANK PRIOR TO COMMENCING TOF=51.0'± 8 • a PERC RATE _ <2 min./inch 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN 2 DECK ) SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. WORK. a DEPTH OF PERC= 30"-48" 16. PROPOSED PROJECT IS LOCATED WITHIN: (1 r'O aNa 4 TEXTURAL CLASS: 1 ASSESSOR'S MAP 310 PARCEL 296 HC OWNER OF RECORD: ILDA HOMEM TOLEDO ADDRESS: 130 BRISTOL AVENUE LOCUS 0" 48.00' 3) Fill HYANNIS, MA 02601 4" 47.67' r ' B Loamy Sand FEMA FLOOD ZONE C (4 2.5Y 6/6 COMMUNITY PANEL# 250001 0005 C _-- ; 30" ,� 45.50' 17. DEED REFERENCE: LAND COURT CERTIFICATE#190758 MAP 310 SWING-TIES SCALE: 1"=20' ! Perc :_ PARCEL 298 # i 48" 44.00' 18. PLAN REFERENCE: LAND COURT PLAN NO. 21173 F X . DESCRIPTION HC SC Coarse Sand r� X C-1 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. X_ 2.5Y 6/6 FENCE STY X-k_ BIODIFFUSER CORNER(1) 43.5' 48.8' ,� (10-20%gravel& 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY P) X x X X10-�N76°4g.40"w cobbles; tight matrix) FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY k _-A BIODIFFUSER BIODIFFUSER CORNER(2) 55.3' 34.7' FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. aQ STp�,tE©RI 142. X_X�}�_ ip �) 96" 40.00' VE m X� BIODIFFUSER CORNER(3) 71.4' 46.4' �✓ 21. IN ACCORDANCE WITH 310 CMR 15.401 -15.405, THE FOLLOWING LOCAL UPGRADE X-, W / N o ' X`X X_X- BIODIFFUSER CORNER(4) 62.7' 57.8' iC,Trrr ! APPROVAL IS REQUESTED FROM 310 CMR 15.223(1): 0 _ Medium Sand (1.) A WAIVER FROM PROVIDING A SECOND TANK IN SERIES WITH A MINIMUM EFFECTIVE 12 0 STONE / k�k\k�\ X-X 1 C-2 2.5Y 6/6 LIQUID CAPACITY OF 100%OF THE DESIGN FLOW OF 440 GPD. co ° R01) � LOCUS PLAN N (loose) z -1-0 /� �� \ ��\ MAP 310 SCALE: 1"= 1000'zQ J / \ BIT. DRIVE �9 �-� PARCEL 296 136" 36.67 a 4 Q / \ f 22,508 S.F.± o MAP 310 No Mottling, Standing or Weeping Observed er �Q o / �H \ x F PARCEL22 DESIGN DATA LEGEND TEST PIT DATA #66 X 1 PERC NO. 13024 '- EXISTING x STONE p NUMBER OF BEDROOMS (DESIGN) 4 (i.e. 2 UNITS @ 2 BEDS EACH =4) INSPECTOR: David W.Stanton, R.S. 50x0 EXISTING SPOT GRADE t✓ 2-BEDROOM DEC� � � 1 RIVE 110 EVALUATOR: Michael Pimentel, E.I.T. U.P.#5 �p,,\,',w DWELLING UNIT I ` DESIGN FLOW GAUDAY/BEDROOM w x EXIST. TOTAL DESIGN FLOW 440 GAUDAY C.S.E.APPROVAL DATE: Oct. 27, 1999 - 50 - - EXISTING CONTOUR SHED DESIGN FLOW X 200 % = 880 GAUDAY DATE: August 4,2010 50 PROPOSED CONTOUR #64 2 C X �? USE EXISTING 1,500 GAL. SEPTIC TANK(1st TANK>200%DESIGN FLOW) TEST PIT#: 2 50 PROPOSED SPOT GRADE EXISTING q U X X X PROPOSED DISTRIBUTION BOX NO 2nd TANK IN SERIES PROVIDED* ELEV TOP= 48.00' 2-BEDROOM 5 X _ ❑/H/W EXISTING OVERHEAD UTILITIES 0 PROPOSED TOTAL 25 ARC 36HC (#3616BD) H-20 'SEE GENERAL NOTE 21 FOR WAIVER REQUEST ELEV WATER- <36.67' DWELLING UNIT 12 2" BIODIFFUSERS IN FIELD CONFIGURATION TOF=51.0'± DE K �26 rwiN 2 EXISTING WATER LINE PERC RATE _ DRIVE ` 433. ° PROPOSED INSPECTION PORT WITH ' INSTALL 25 ARC 36HC (#3616BD BIODIFFUSERS (H-20) ; DEPTH OF PERC = TEST PIT LOCATION Q9 B.H ACCESS BOX TO GRADE (TYP OF 5) ) 1 TEXTURAL CLASS: 1 -_ I k � 48.0 TP 1 SYSTEM CAPACITY EXISTING 1,500 GALLON SEPTIC TANK / / ' EXIST. SAS (APPROX. �( �"� O LOCATION ONLY) k O �w (TOTAL L.F. OF BIOS)(4.8 SF/LF)(0.74 GPD/SQ•FT.)=GPD MAP 310 (125')(4.8 SF/LF)(0.74 GAUSQ.FT.)= 444.0 GAL. LEACHING/DAY 0" 48.00' PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE ACE 16 Fill J Z'48 0 3 PARCEL 21 4" 47.67' 0 PROPOSED DISTRIBUTION BOX 2 �- Y �� V , \ Q TOTALS: B Loamy 2 5Y 6/6 d PROPOSED ARC 36HC(#3616BD)H-20 BIODIFFUSER Benchmark \ p 1 ' Landing Comer V O `z", w SZ6 / TOTAL NUMBER OF COUPL BIODIFFUSENGS TOTAL NUMBER OFRS. 0 30" 45.50' Elev. =51.00 Approx. M.S.L. °4g'40-E cn PROPOSED 4'" PVC VENT PIPE; TOTAL LEACHING AREA: 600.0 145'91, NO EXACT LOCATION PER OWNER TOTAL LEACHING CAPACITY: 444.0 - - - Coarse Sand REV. DATE BY APP'D. DESCRIPTION EXIST. 1,500 GALLON SEPTIC TANK TO i C-1 (10-0%gravel& PROPOSED SEPTIC SYSTEM UPGRADE BE UTILIZED AS PART OF THIS DESIGN k cobbles;tight matrix) (CONTRACTOR TO VERIFY FLOWS FROM PREPARED FOR: BOTH UNIT'S ARE DIRECTED INTO TANK) 96" 40.00' CAPEWIDE ENTERPRISES X NOTE: MAP 310 X X X -<- MAP 310 EFFECTIVE LEACHING AREA OF 4.80 SF/LF OBTAINED FROM THE PARCEL 20 DEPARTMENT OF ENVIRONMENTAL PROTECTION APPROVAL LETTER C-2 Medium Sand LOCATED AT PARCEL 295 "MODIFIED CERTIFICATION FOR GENERAL USE" ISSUED TO 6/6 (loose) 64 & 66 QUAKER ROAD ADVANCED DRAINAGE SYSTEMS, INC. ON OCTOBER 3, 2003(LAST (loose) MODIFIED FEBRUARY 18, 2010). TRANSMITTAL NUMBER=W000052. HYANNIS, MA SCALE: 1 INCH = 20 FT. DATE: AUGUST 12, 2010 136" 36.67' 0 10 20 40 80 FEET No Mottling, Standing or Weeping Observed -- _-_. PREPARED BY. yr RESERVED FOR BOARD OF HEALTH USE �� c�;-;i;:; ,,:;„L �F; JC ENGINEERING, INC. 2854 CRANBERRY HIGHWAY EAST WAREHAM, MA 02538 / 58.2777 SITE PLAN � _ _0 3.03 _ SCALE: 1"=20' Drawn By: MCP Designed By:MCP Checked By:JLC JOB No.1859