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0097 QUAKER ROAD - Health
97 QUAKER RD.;"HYANNIS' ,1 e a f� I rf :,•:.TOWN OF BARNSTABLE LOCATION 9:1 Q6 SEWAGE#_.ZOZ-1 1 VILLAGE H�J S ASSESSOR'S MAP&PARCEL ���� I� INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY j. I� LEACHING FACILITY:(type) t Z 131C 33,5 NO.OF BEDROOMS OWNER PERMIT DATE: : COMPLIANCE DATE: J Z Separation Distance Between the: 1� Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility ITTZ®(9 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 leachin facility) 2 Feet FURNISHED BY VE-(Af -! e . O -J o - � I W w `6' W TOWN OF BARNSTABLE LOCATION ©U0J ¢.v 200a SEWAGE# WILLAGE y ASSESSOR'S MAP & LOTJW—J8 R46T R'S NAME&PHONE NO; 0�[O SEPTIC TANK CAPACITY LEACHING FACILITY: (type) ®�T\111 (size) NO. OF BEDROOMSop 3 �� 1�8&R-9R OWNER PERMIT DATE: - COMPLIANCE DATE:=_ Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 209 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet .Furnished by ,1' No. l Ll Fee /rw THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 21pplitation for Misposal *pstrm ConstCULtion Vrrmit Application for a Permit to Construct( ) Repair( ) Upgrade K Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 7 OVA Owner's Name,Address,and Tel.No. PC) 60x 'A b 6 a21 Assessor'sMap/Parcel 310 ��,j ����� 1/1C• Tk Eiva* ►'Vlp� Ua)y Installer's Name,Address,and Tel.No.,$708—y-27— SS 77 Designer's Name,Address,and Tel.No. 73 0,371 ( )berg 9 Ou2, 1 nG 341?W k49 Tuk S. •C> fni'leeZ11 I WO CQ44viberry �-Iwjr Type of Building: (J Dwelling No.of Bedrooms �7 Lot Size 17i603 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) Llq gpd Design flow provided � gpd Plan Date �o o�i Number of sheets t Revision Date Title Size of Septic Tank �06) Type of S.A.S. Vrvc�5� htV I _FC11i �r® Description of SoilG � 'PI Nature of Repairs or Alterations(Answer when applicable) ��D ,j00 � � Sp ` (,r+''1� Ae� -x D- 06X new o ij - a Pre'C "C 11 sAe 91 w� Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Application Approved by Date Z` Application Disapproved by Date for the following reasons ,J Permit No. '1 Date Issued li"'iCir..i+.ti•' T••_,.1�7n;> "....tFy qj. "1�' ;Y J' Xti t" "y ,,uP+,� � _ i"v�+.lr`^^�:.T• 1q„�. -rtis.'�Ai`' +.._rK'N�) ! - ._ _ ��' r I l t � Fee No. ,, . THE COMMONWEALTH OF MASSACHUSETTS Entered in compute (/' PUBLIC HEALTWDIVISION -.TN OF BARNSTABLE, MASSACHUSETTS Yes OW " 01pplitation for iAtlO 'aY ?pStetii.ConstrUction Permit 0 Application for a Permit to Construct( ) Repair( ) Upgrade XQ Abandon( ) ❑Complete System ❑Individual Co Fp�onents Location Address or Lot No. Owner's Name,Address,and Tel.No. PO gOx t�i St t Assessor's Map/Parcel -310 kick T R Store'* HMO% 'LVI ,. Installer's Name,Address,and Tel.No.,:rcV—W77�-PS 77 Designer's Name;Address,and Tel.No. s(,5g-�7f=43�T "r}g out?, Inc 363W,k%* k�k s% YCAV T.C• oee4 i*N iWO C244-i bertr F Type of Building: Dwelling No.of Bedrooms L Lot Size,,,.,T77 b6 sq.ft.i Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �� gpd Design flow provided gpd Plan Date ""' tb X 21 - Number of sheets l Revision Date »._.. Title Size of Septic Tank c'�OOt� � � Type of S.A.S. Vrscc,& 6ravi FACA 11; 1 t - Description of Soil M Q - s,,A ko t A0 d1 Gl .7�1� pl kn 1 Y, e' r Nature of Repairs or Alterations(Answer when applicable) Q �pQ .� Lr i�o^ f'7' �p ' t_ Cwlr j rl,e v -90 �= 30X , new �' �0 1 � - 0 Pre cf.a G.eatti, ►� C-500 'PI Date last inspected:. ' Agreement: .. The undersigned,agrees to insure 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 operafion until a Certificate of Compliance has been issued by this Board of Health. "s ` Signed Date '".1 Application Approved by '". '4:..-°`Date - Application Disapproved by 7 Date for the following reasons _ X' 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(?0 Abandoned( )by 9O11Qr-1 ll� Ir*L at d Od & Syj) has been constructed.in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. UZ I +' 'dated - Installer {) /`� (_ �� T�L Designer (— F1A4 160,21 f►Q � �lrrll ) #bedrooms Approved d * n flow gpd The issuance of this //permit shall n t be cons trued as a guarantee that the syst will ta &esi:ne�5. ' Date 4• ,//V c Inspecto __.__-.-..____-____. Fee O.Z) THE COMMONWEALTH OF MASSACHUSETTS CAPUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS ,v MispoBal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair( ) / Upgrade(K) Abandon( ) System located at q :, Q o4m llt e �D A ( ► H U G.�f n 0� 1 � 1 A 60 1 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:Constrluct* n mus be completed within three years of the date of this permit. ` Date �I f� Approved by. r ti Town of Barnstable IKE ` Regulatory Services Richard V. Scali, Interim Director • 13ARN5+1'KBi.E. � h•.:) i Public Health Division f6fp 1 Ns ► ° Thomas McKean,Director ' 200 Main Street,Hyannis,MA 02601 i. Office: 508-862-4644 Fax:- 508-790-6304 Installer& Designer Certification Form Date: 6-21-21 Sewage Permit# Z3Z.i`" Q Assessor's Map\Parcel 310/313 Designer: JC Engineering,Inc. Installer: Robert B. Our Co.,Inc. (RBO) Address: 28.54 Cranberry Highway Address: 363 Whites Path East Wareham, MA 02538 South Yarmouth,MA 9 On RBO was issued a permit to install a (date) (installer) ae tic system at 97 Quaker Road based on adesign._drawn by (address) JC Engineering,Inc. dated 4-10-21 flast revised 4-22-21 (designer) X I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS, or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed i lance with the terms of the I\A approval letters(if applicable) oF 4Qssq a cy L Mi!lRGHILL Ja N ns aller's nature) CML •off 41 o�. (D r►er's SignaturVARNSTABLE (Affix De f p Here) PL SE RETURN TO PUBLIC HEALTH D SION. 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. QASeptic\Designer Certification Form Rev 8-14-13.doc COITITONIA EALTH OF TNLASSACHtiSETTS EXECUTIVE OFFICE OF ENVIR.0NN1TE NTAL:AFF--AIRS I ! DEPARTMENT OF E�TVTRONMENTAL PROTECTION" -� - -_�. >� TITLE s OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSNIENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATIONT Property Address: 97 Q(4Gilke,,- AHN/f ,4 Oa 60l i Owner's Name: �Q✓`� er sSe Owner"s Address: 49 N t4r,4-er Nrlt w Date of Inspection: 7 O C`9 Name of Inspector: please print) Rr Company Name: k IVVI Mailing Address: Telephone Number:f ozJ7 co cn r.- CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the in%orrnation-.ported below-is true,accurate and complete as of the.time of the inspection.The inspection was performed based on m. training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Se�cti 15.340 of Title 5(310 CYIR 15.000). Tne system: passes Conditionally Passes \reeds Further Evaluation by the Local_Approi�ing Authori e Fails n Inspector's Signature: rlal✓q�e LA Date: = r /� The system inspector shall submit a copy of this inspection report to the Approving Authorit-, ("Board o-i Heart:^ DEP)within 30 days of comnletina this inspection.If the system is a shared systen i or has a desi�to . or l G;^ 0 d or greater, the inspector and the system owner shall submit the report to the appropriate recioral o_ ce of t he. gP P Y T , P rP ' DEP.The original should be sent to the system owner and copies sent to the buyer, if an_placable, and one anpro": authority. nee cis � �-,�, ►� Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. V"� O l I-7 Title 5 Inspection Form 6/15/2000 page I r Page 2 of 11 OFFICI.4.L IN,TSPECTION FORM—NOT FOR VOLU`--,N'T_A-RY"ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORNI PART A Q CERTIFICATION (continued) Property Address: / Ni Owner: 9 /`7 Seim ev- sh s Date of I spection: Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. Sys Passes: I have not found any information which indicates that any of the failure criteria described n 310 CN_'R 15.303 or in 310 CVIR 15.304 exist.Anv failure criteria not evaluated are indicated below. Comments- B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system;upon completion of the replacement or repair; as approved by the Board of Health, v, 11 pass. Answer yes;nc or not determined(Y,N,'-N in the for the followina statements. If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or nor) is structurally unsound; exhibits substantial infiltration or exfiltration or tank failure is imminent. System xt ill 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 Connpliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the disiribut on box due ro rokcm or obstructed pipe(s)or due to a broken; settled or uneven distribution box. System will pass insp aion i- :vit approN,ai of Board of Health): brokenpipe(.$)are replaced obstruction is removed distribution box is leveled or replaced \D explain: The system required pumping more than 4 times a year due to broken_ or obstructed nice; Tine s sitm-• 11 pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed i MD explain: j jt T;+Ie C T-,....., :-- Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSES SAIENTS SUBSURFACE SEWAGE DISPOSAL SYSTEI2INSPE•CTION FORM i PART A CERTIFICATION(continued) Property Address: f 7 Q� �✓b°y �� r N I Owner /1°�`�1►$✓ Date of Inspection: /7 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 C11R 1-5.303(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 Rater Supplier, if any)determines that the system is functioning in a manner that protects the public health,safety and en0ronment: 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,eater supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private ,ater supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feez 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 oJiform. bacteria and volatile organic compounds indicates that the well is free from pollution f om that fa.ili and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 npm. prov,ided chat no other . failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: Page 4 of 11 OFFICIAL, INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM Ili':SPECTTO FORAT PART A CERTIFICATION(continued) Property-Address: 9/ 690,,�,kf4, q c Od 6 0l Owner: 1 i 1 #41W111— Date of Inspection: i B3 D. System Failure Criteria applicable to all systems: You must indicate "yes"or"no"to each of the following for all inspections: Yes -No ckup of sewage into facility or system component due to overloaded or cloQ�ed SAS or cesscool scharge or ponding of effluent.to the surface of the ground or surface waters due o an overloaded or ,eloQQed SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged S A S or �esspool ,Li-quid depth in cesspool is less than 6"below invert or available yolu ne is less t~an da tlov Required pumping more than 4 times in the last year NOT due TO clogged or obstructed f times pumped y y portion of the SAS, cesspool or privy is below high ground water elevaTion _ � Anv portion of cesspool or privy is within 100 feet of a surface water_u iy oi tnbutary to a surface p P P PP . 1eater supply. Any portion of a cesspool or pri,ry is within a Zone 1 of a public well. y portion of a cesspool or privy is within 50 feet of a private water supply.�ell. t, Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet ti-om a prig a ie water supply well with no acceptable ;,ater quality analysis. [This system passes if the«yell Rater analysis.. performed at a DEP certified laboratory.for coliform bacteria and volatile organic compounds indicates that the vvell 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.] A —(Yesl'o) The system fails.I have determined that one or more of the above failure criteria e .ist as described ni 310 ClvfR 1:).303,therefore the system fails.The system oixTe;s`oalc 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 apd to 15;000 gpd You must indicate either"yes"or"no"to each of the follo-vying: (The follox wing 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 syTstem is within 200 feet of a tributary to a surface drinking rater supply- ,he system is located in a nitrogen sensitive area(Interim Wellhead Protc Zone a of a public water supply well If you have answered"ves"to any question in Section E the system is considered a signi��ca-t ~meat. or "yes"in Section D above the large system has failed. The ovmer or operator of any large sysr=-, o_,;' e significant threat under Section D or failed under Section D shall upgrade the s�stem_n acco a ; .c _ _? 15.304. The system owner should contact the appropriate regional of of the Deb:ar men_ Page ; of 11 OFFICIAL, INSPECTION FORA-NOT FOR VOLEIT_ARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM I\SPFC"ITO\ FORM P ART B CHECKLIS Property Address: Q�4 k n, Date of Inspection: / Check if the following have been done.You must indicate "ves"or"no"as to each of the follovy, nE:: Yes ;��Pumping information was provided by the owner,occupant,or Board of Health Were any of the system;components pumped out in the previous two weeks V Has the systein received normal flows in the previous-mo week period v Have larCe volumes of grater been introduced to the s}stem recently or as par ot tl�i: inspectijil'? r/ Were as built plans of the system obtained and examined?(If they were not availa le nbte as` "A ✓. Was the facility or dwelling inspected for signs of sewage backup Was the site inspected for signs of break out Were all system components;excluding the SAS,located on sit,- Were the septic tank manholes uncovered,opened;and the interior of the tank inspected f e-the-on •of the baf es or tees; material of construction,dimensions, depth of liquid,depth of sludge and depth of scum _ Was f different from owner provided with informa-ion on lh r opt, as the facility,owmer.(and occupants i )p _ maintenance of subsurface sewage disposal systems The.size and location of the Soil Absorption System(SAS)on the site has been dete:-rnined b_� c o__: - Yes o Existing infor_ation.For example, aplan at the Board of Health. _ Determined in fie field(if any of the failure criteria related to Part Cis at issue roio-_i____.o. o_ ',_t=_,_t is unacceptable) [310 CMR 1 5.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY -kSSESS:IH TS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Qt^r.A✓ell— RC Owner: /�v''li ✓ tS Date of inspection: 0� F O«'CO DITION S RESIDENTLAL Number of bedrooms(design): Number of bedrooms(actual): 3 330 DESIGN flow based on 310 C_R 15.203 (for example: 110 gpd x r of bedrooms): \umber of current residents: Does residence have a garbage grinder(ves or no): �Q Is laundry on a separate sewage system(yes or no):/r V [if Nees separate inspection required; Laundry system inspected(yes or no): Seasonal use: (,-es or no): Water meter readings, if av i ble(last 2 years usage(gpd)): Sump pump (yes or no): Last date of occupancy: CONIMERCIAL/IND STRI_AL Type of establishment: Design flow(based on 310 CVIR 1 .203): gpd Basis of design flow(seats persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):_ Non-sanitary-waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENER-AL INFORMATIO\ Pumping Records Source of information: Was system pumped as part of the ins ction(yes or no): If yes,volume pumped: gallons--How was quantity pumped determir_ed? Reason for pumping: TYP SY"STE1= . _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) _Inno�-ative(Aiternative technology. Attach a copy of current operation.and maintenanc cow ac (_o Of obtained from system owner} y Tight tank _Attach a copy of the.DEP approval Other(describe): Approximate age of all components; date installed(if known)and source of inl`o=_jion: TQ, ir,nZ_ Were sewage odors detected when arriving at the site(ves or no): /!/O T+1� G 1 �—+: V,.__ c;icrnnnn 6 Pare; of 11 OFFICIAL INSPECTION FORM— NOT FOR VOLUITARY ASSESS% EATS SUBSURFACE SEWAGE DISPOSAL SYSTEM n--SPECTION FOR1I PART C SYSTEM INFORMATION(continued) Property Address: vt a wP` Owner: /ePq'e Date of Inspection: BUILDING SEWER(locate on site plan) Depth below grade: aS �� Materials of construction: ast iron _✓40 PVC_other(explain): Distance from private water supply we'1 or suction line: Comments(on condition of joints; venting,evidence of leakage;.etc.): SEPTIC TALK: —(locate on site plan) Depth below grade: Material of construction: _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 cope of certificate) y Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or bafflz: ri Scum thickness: 6 i� Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottoo of outlet tt e or baffle' _ How were dimensions determined: f o' fie Comments(on pumping recommendations.inlet and outlet tee or baffle condition.structural inreg-ii:v. lin �c ie els as r ated to outlet invrt.evidence of leak ae.etc.): / J /pp 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 strucrLzl as related to outlet invert. evidence of leakage,etc.): Page S of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Y A,RT C SYSTEM INFORNIATION(continued) ProperLy Address. 9'1� Q� 6"�'� R� L4 h Owner: /eoii ev S Date of Inspection: / f/ TIGHT or HOLDING T \TK: (tank must be pumped at time of inspec-rion)(locate on site plate-?) Depth below grade: Material of construction: concrete metal fiberglass _pol-vethylene othe_(explainl: Dimensions. Capacity. Qalions Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in workin-order(yes or no): Date of last pumping: Comments(condition of alarm and float switches;etc.): DISTRIBUTION BOX: 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 tarn,-over, an-,, _v idenc:of leak a� nto or out o#�box, etc V .): ON vet xe so%�s X-V PUl'IP CHAMBER:/V (locate on site plan) Pumps is working order(yes or no): Alarms in working order(yes or no): Comments (note condition of pump chamber, condition of pumps and appurtenances; etc.): i c Page 9 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTENI INSPECTION FOR-i PART C ^7 SYSTEM INFOR'N-IATION(conti ued') Property Address: / QLAG'keet-- Date of Inspection:_ /� SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits, number:_ leachinc,chambers,number: (� leaching galleries;number: � 'I" leaching trenches, number,length: ' leaching fields; number, dimensions: a �a overflow cesspool,number: innovative,'altemn tive system Type/name of technology: Comments Onote condition of soil, signs of hydra/ulic failure.level ofpondiina; damp soil. condition of vege:aron. etc.): o . rG CESSPOOLS: /V (cesspool must be pumped as part of inspection)(locate on sit_plan) Number and configuration: Depth—top of liquid to inlet invert:_ Depth of solids layer: Dennh of scum laver: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow.(yes or no): Comments(note condition of soil,signs ofhydraulic failure;level ofponding. cor_diiion of�-,2--- PRIVY: (locate on.site plan) Materials of construction: Dimensions: - Denth of solids: Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of ve fla-ior. e- . Taal., Z t_.__ Page 10 of 11 OFFICIAL INSPECTION FORM-,NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTE'_N1 INSPECTION FORM PART C SYSTEM INFOR IATION lcon.inuec Property Address ���� ie Owner: /L'd"1�2✓ Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent referep_ce landmark_or benchmarks. I ocate all-,ells within 100 feet.Locate where public water supply enters the building. l Cove✓ T;tl. : T ..o .. ,s <;i c+�nnn 1O Page 11 of i l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORN'IATiON(continued) Property.Address: Q�a�� v`C Owner:��2v��ey Se Date of Inspection: SITE EXAINI Slope Surface water Check cellar Shallo-,v wells Aj ki-r— Estimated depth to ground water f feet �o.r �Iti N Please indicate(check) all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site (abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must deCribe l�o-v you established t�e h'Qh ground water e�vation: .S 7tEw� i vi 5 &/fie ✓ G 1 , Town of Barnstable �. Regulatory Services It I; �'1 Thomas F. Geiler,Director, :Public Health Division plFa: � Thomas McKean,Director 2.00 Main Street,Hyannis;MA 02601 Office. .508-862-4644 -a 5 0 8- 9 0-5 Installer & Designer Certification :Form r, 1 Date: � ii � r•,1 Designer: J Installer: I Address: Address: 41-X Z:-L L VV t,' 2 S On was issued a permit to install a (date) (installer) septic system at ' 'yf' `- - `V '�' based on a design drawn by (address) dated ' zn i L P ' (designer) I certify that the septic system referenced above was installed substantially,according to the design, which may ir:clade uor approved changes such as lateral reloca--on of the distribution box and/or septic tank_ I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State&Local Regulations. Plan retisior or cent fled as-built by designer to follow. Signature) ad J`iv _� , t:J. ! V lJ 1 r f ( (Designer's Signature) U, ----("Affix Designer's Stamp PLEASE RETURN TO BARNSTA.BLE PUBLIC HEALTH DMSION. CERT11jCATE OF COMPLIANCE WELL NOT BE ISSUED INTL BOTH -THIS FORM AlN� As_ BUH,TCARD. ARE RECEIVED B'1 THE.RWNSTABLE PUBLIC FIEALT_H Dn-,SfON. '.NI YOU. U: .'1d2iiuJ`. "sCJcSi s G��'� SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVFRY 'i7 ■ Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. ceived by( noted Name) C. D e of qelivery ■ Attach this card to the back of the mailpiece, or on the front if spacepermits. 1tf� D. Is delivery address different from item 1? es 1. Article Addressed to: If YES,enter delivery address below: ❑No Mr. Gilman Deassis 97 Quaker Road Hyannis, MA 02601 3. Service type ❑Certified Mail ❑Express Mail ' i ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number :' ' ' . ; ' l'70�5 1160 DOOO E'1' ' 1413 (transfer from service label) _ �F PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid LISPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this,b6x, V PUBLIC HEALTH DIVISION "" ° .b TOWN OF BARNSTABLE 200 MAIN STREET HYANNIS, MASSACHUSETTS 02601 I I I I lilt!l1tf 7``1II11{L11111l{{lt{s1�!!1{{11}}{{11 {{tilji{{tJ III III 113j 31II I M • ra Ir F II A L —rq A- O Postage $ .3 C3 Certified Fee C3 O S ( �¢� ark o Return Receipt Fee (Endorsement Required) C3 Restricted Delivery Fee p (Endorsement Required) �/Sp rq S ra Total Postage&Fees $ Lfl Sent To lti Sheet,Apt No.; ---------------------- or PO Box No. ------------------ C/ry State,ZIP+4 0,96 o> :r, ,r Certified Mail Provides:n A mailing receipt (asienaa)zooZeunp'ooeewJojsd n A unique identifier for your mailpiece n A record of delivery kept by the Postal Service for two years Important Reminders: o Certified Mail may ONLY be combined with First-Class Maile or Priority Maile. e Certified Mail is not available for any class of international mail. n NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. e For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3e11)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPSe postmark on your Certified Mail receipt is required. e For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted-Delivery". , is If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. Internet access to.delivery information is not available on mail addressed to APOs and FPOs. Town of Barnstable yP o� Regulatory Services Thomas F. Geiler,Director • MRNSTA13M 9� t639. Public Health Division ptfD MAC s Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 April 6, 2006 Mr. Gilman Deassis 97 Quaker Road Hyannis, MA 02601 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, Title 5 The septic system owned by you located 97 Quaker Road,Hyannis,MA,was last inspected on March24th, 2006 by, Robert J. Bortolotti, a certified septic inspector for the State of Massachusetts. The inspection of your septic system showed that your system has "Failed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: D-Box is 4' to grade and full to cover at time of inspection. Leaching pit was filling up while probing pit. You have 2 years from the date of the system failure to bring the system into compliance. If there are any questions about this reminder,please feel free to contact the Barnstable Health Department. BARNSTnE HEAL DEPARTMENT homas A. McKean, R.S., C.H.O. Agent of the Board of Health \ COMMONWEALTH OF^1VIASSACHUSETTS z EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS. DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A. CERTIFICATION Property Address: s ( ,r Owner's Name%A ,, > Owner's AddreDate of Inspect Name of Inspectors ]ease rint) - �-� • 0; e rCompany Name � � Mailing Address: Telephone 1 9/f ?11; CERTIFICATION STATEMENT ►� =- I certify that I have personally inspected the sewage disposal.system at this address and that the info ation reported` below is true, accurate and complete as of.the time of the inspection.The inspection was performed im sed on my training and experience in the proper function and maintenance.of on site sewage disposal systems. a DEP' approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: _ Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's.Signature: Fm -� "�" 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 • I ****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. a e- I Title.5 Inspection Form 6/15/2000 p g 1 r . � � t Page 2 of 11 , OFFICIAL INSPECTION.FORM—NOT FOR VOLUNTARY ASSESSMENTS` SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:9 Owner: Date of inspection:. r 0 Inspection Summary: Check A,B,C,D or E./ALWAYS complete alL of Section D A. System Passes: i I have not found any infunnation 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: I B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced.or repaired.The system,upon completion of the replacement or repair;as approved by the Board of Health;will pass. Answer yes,no or not determined(Y,N;ND)in the ! for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old'* or the septic tank(whether metal or not)is structurally unsound, exhibits substantial.infiltration or exfiltration or.tank failure is imminent:System:will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. . *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. . ND explain: Observation of sewage backup:or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken;settled or uneven distribution box. System will pass inspection if(with approval of Board.of Health): I 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 pipes)are replaced obstruction is ret>toved I ND explain: _ - 2 Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIONFORM PART A CERTIFICATION(continued) Property Address: m rV 0 . Owne&.gAi Date o Inspection: C. Further.Evaluation is Required by the Board.of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system` is failing to protect 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 l 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 co.liforrn 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: f. 4 { 3 Page 4 of I I OFFICIAL:INSPECTION-FORM—.NOT FOR VOLUNTARY-ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART A. CERTIFICATION(continued) Property.Address: Owner: Date of Inspection: D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No 47 _ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓�Discharse 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 %day flow Required pumping q. p p e more than 4 times in.the last year NOT d Qo y due to clogged or obstructed pipe(s).Number of times pumped ed Any portion of,the SAS,cesspool or privy is below high ground water elevation. An onion of cesspool or_ � Y P privy is within l00 feet o a P p �'}' f 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. — V/Any portion of a cesspool or privy is within 50 feet of a.private water supply well. Any portion.of a cesspool or privyis.less than 100 feet but greaterthan.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.] __)�Y(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.s stem owner should contact the Y h Board of Health to determine what will be necessary to correct.the failure. f E. S Large stems: Y To be considered a large system the system must serve a facilitywith a design flow of 10,000.gpd to 15,000 gP d. 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.. p PP Y 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. 4 Page 5 of I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART.B CHECKLIST Property Address: 99( . mt" a Owner. d� 1 Date of Inspection: , Check if the following have been done.You must indicate"yes" or"no"as to each of the following: Yes Ito Pumping.information was.provided by the owner,occupant, or Board of Health Were any of the system components pumped out in the previous two weeks.? Has the system received normal flows in the previous two week period? ZHave large volumes of water been introduced'to the system recently or as part of this inspection? Were as built plans of the system obtained and examined? (If they were not available note as N/A) _ Was the facility or dwelling inspected for signs of sewage back up? ` h/ Was the site inspected for signs of break out? t� Were all system components, excluding the SAS, located on site Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of the baffles or tees. material of construction, dimensions, depth of liquid, depth of sludge and depth of scum?. _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no Existing information. For example, a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)]. 5 Page 6 of l l OFFICIAL INSPECTION.FORM NOT FOR,VOLUNTARY:ASSESSMENTS SUBSURFACE SEWAGE'DISPOSAL SYSTEM INSPECTION FORM PART.C SYSTEM INFORMATION Property Address:(9 L� 19 Owner° Date of Inspection: FLOW CONDITIONS RESIDENTIAL t, Number of bedrooms.(design): Number of bedrooms(actual): DESIGN flow based on 310 CliR 15.203 (for example: 11.0 gpd x;#of bedrooms)-2 Number of current residents: (� Does residence'have a garbage grinder(yes or no):�a Is laundry on a separate sewage system (y s or no).)&.[if yes separate inspection required] Laundry system inspected(y ,or no):, � Seasonal use:(yes or no): . , 70 Water meter readings, if available(last 2 years usage(gpd)): Sump pump(yes or no):AN40.. : Last date of occupancy: s1 4an"&1�12ZOZA4,_I'l 1 COMMERCIAVINDUSTRIAL. A Type of establishment: Design flow(based on 310 CMR 15.203.): gpd Basis of design flow(seats/persons/sgft,etc.): V 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: , / Was system pumped as 6art of the i spection(yes or no): If yes, volume pumped: gallons--How was quan ity pumped determined?. Reason for pumping: TYYE OF SYSTEM Septic tank distribution.box soil absorption system P rP y _Single cesspool _Overflow cesspool _Privy Shared system(yes.or no)(if yes, attach previous inspection records,if any) Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach.a copy of the DEP approval Other(describe): oximate age of all components,.date installed(if known)and source of information: Were sewage odors.detected when arriving at the site(yes or no): ✓ C) 6 Page 7 of 17 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART G SYSTEM.INFORMATION(continued) Property Address: l Owner:41 ,,7 Date of Inspection: BUILDING SEWER(locate on site )Ah Depth below grade:,. Materials of construction:_cast iron 40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints, venting,evidence of leakage, etc.): SEPTIC TANK:Zoocate on site plan) _ Depth below grade: Material of construction: oncrete_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) ll� Dimensions: Sludge depth: - Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: — U Distance from top of scum to top of outlet tee or baffle- Distance from bottom of scum to bottom of utlet tee or baffle: How were dimensions determined: ,( *a a. 4 4 P ,oA4—f' '1 Comments(on pumping recommendItions, inlef and outlet tee or baffle condition, structural integrity, liquid levels related to outlet invert, evide ce of leakage, etc.): e . - GREASE TRAP (locate on site plan) r 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.): 7 Page 8 of I OFFICIAL_INSPECTION.EORM NOT FOR,VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: r Owne Date of Inspection: _)00 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(loc.ate on.site plan) Depth below grade: Material of construction: concrete metal iiberglass_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.): 4 DISTRIBUTION BOX: (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 kage into of utof box�et�): , f 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.): Page 9 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address; 9 awd{m Owner:Pnsp'ection: 1 e ( y Date of SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required) If SAS not located explain why: 1 Y7eaching pits,number: 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, p a .�6� 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.): r PRIVY:(locate on site plan) u Materials of construction: ,3 Dimensions: Depth of solids: Comments (note condition of soil;signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 1 _ i 1 9 Page 10 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART•C SYSTEMINFORMATION(continued) Property Address: Owner. Date o Inspection: b� SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benclunarks.Locate all wells within I00 feet.Locate.where public water supply enters the building. 8 , ga.11an 0 �- 10 Page 11 of i l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Ad ress: Owner: Date o Inspection: 7n7o, C)OO�7 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the,high.ground water elevation: Obtained from system design plans on record-If checked, date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with.local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high groundwater elevation: eo Q c i 1l �-n } Permit Number: Date: Completed by: HIGH GROUND-WATER LEVEL COMPUTATION Site Location: Lot No. Owner: ' a� 5�/S Address: y Contractor:_ :5511r' Address: 1111ol/vj13�/ YL'� r Notes: ; r=. STEP 1 Measure depth to water table. .: . . _ // to nearest 1/10 ft. ........... Date ............................... month/day/year STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: A Appropriate index well ... � Z OWater-level range zone ...................................................... STEP 3 Using monthly report"Current - Water Resources Conditions" o determine current depth to ZIP! water level for index well ........................... QL�6 month/year STEP 4. Using Table of Water-level Adjustments' for index well (STEP.2A),current depth to water level for index well (STEP 3), and water-level zone (STEP 213) determine water-level adjustment ............................... ...................:. . 1� STEP 5 Estimate depth to high water by subtracting the water level adjustment(STEP 4); from measured depth to water p :level at site (STEP 1) ..:..............:.....,.........._.................. !r Figure 13.—Reproducible computation form. 15 ''•{ TOWN OF BARNSTABL I OCATIOt,J �41 ��( c� Ro�7 SEWAGE VILLAGE //Y n i✓A/i.5 ASSESSOR'S MAP&PARCEL 310��/3 INSTALLERS NAME&PHONE NO. R I G h' ��i✓S% �-'a Y 7 S` i3 d2 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 3 3d io��/; �Tk'A7aG2ize) oZS)( I NO.OF BEDROOMS OWNER —Y r PERMIT DATE: 3 a 6$ COMPLIANCE DATE: . Separation Distanc Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY 1 U` x n � ro 1 yNo. ®©(0^ `7 Fee aV. ' Entered in computer: THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 3tlphratton for Migoal �§pgtem Cuttgtruction Verna Application for a Permit to Construct( ) Repair Upgrade( ). Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. Owner'. Name,Address,and Tel.No. c n Assessor's Map/Parcel :3 f,0 3 r 3 C 7 �` ss 1 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 4A Lo rr Y�sFe�s 2�► A/ //aF-yr.A- I S—'v 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) 3 gpd Design flow provided, gpd Plan Date �® t' Number of sheets Revision Date Title Size of Septic Tank /5 se t-S r j Type of S.A.S. 3CX"&0Z-/t=17 1-4.4' e Description of Soil vov — 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 Boar Health. Signed • _ Date 3 Application Approved by Date Application Disapproved`by: Date for the following reasons I� Permit No. Date Issued No. . x Fee a.a "- i'"➢ ,Entered in computer: 1 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTkI 'JIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Z[pphration for �Digaar 6p5tem Cori.5truction Permit Application for a Permit to Construct( )�,Repaire) Upgrade O Abandon O Complete System ❑Individual Components Location Address or Lot No. p / -S Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 3 /d/ 3 Qd,9 4 -. -L Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. f�A e/� Ci sG a�vs- Zit r✓ �t !~Y off. s�a F ? ~' �- r Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 236 gpd Design flow provided 3 gpd Plan Date tf /�<✓ 6 Number of sheets Revision Date Title Size of Septic Tank /5 X i r / o " Type of S.A.S. .3 -3C-&-0 f r2 q 0.L - 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 1 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, Health. • " Signed . '/' T% r'-- <' Date �✓ ? d Application Approved by ? Date Application Disapproved by: Date for the following reasons k Permit No. Date Issued —————————= ——————————— THE COMMONWEALTH OF MMSSACHUSETTS t BARNSTABLE, MASSACHUSETTS Certificate of Compliance "* THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded ( ) [bandoned( )by i2- c at J ✓ Ai 4 /CGS' `Y��'�'/fhas^been constructed in accordance /ith the provisions of Title 5 and the for Disposal System Construction Permit No`.,�go� ay3 dated 30 �'. Installer C Designer 2 2 I&I X i t-- #bedrooms Approved design flow .ga gpd The issuance of this peerrmti,shall of be construed as a guarantee that the system will-functi esigned. Date J1 °' Inspectoa I. —=--- =—[�—,� Fee----- — ------------ --- — --�——— /� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS ltgo$al i�pgtem Con5tructtou Permit Permission is hereby granted to Construct ( ) Repair ( L) Up ade ( )/ /Abandon ( ) System located at `7 ? Z e� '• t..2 �7 /7 / 4 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 permit. Date 1J b(9 Approrved by r ' f Town Of Barnstable H ° a6 r Regulatory Services Thomas F.Geiler,.Director • ax....... EE, �A Public Health Division Trp � Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office:.508-862-4644 Fax: 508-790-6304'. Installer&Designer Certification Form Dater aj f Designer: -I '"l 2 Installer• Address: . Address: X l on. ' d /"�Q�l� (" s. was issued a permit to install a (date) (installer) P septic system at V �"� p � 7 � ��� � based on a design drawn by (address) Dkt4t,A1\ tr dated }( (designer) 1 certify that the septic system referenced above was installed substantially according to the design, which may include minor approved-changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State&Local Regulations. plan revisio - or certified as-built by designer to follow. I�A OF y� q DJ a er's Signature) YER No. 1140 �S G/ST0L . t qNl TA0' (Designer's Signature) Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF C2 LIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE.BARNSTABLE PUBLIC REALTH DIVISIQN. TRANK YOU. Q:Health/Septic/Designer Certification Form Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM I, hereby certify that the engineered plan signed by me dated concerning the property located at 17 QV A1&6- - meets all of the , following criteria: • Two soil evaluations excavated for detailed examination(no hand augering) and two percolation tests shall be conducted. • This failed system is connected to a-residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will-be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] Please complete the following: A) Top of Ground Surface Elevation(using GIS information) 4e B) G.W.Elevation 2� +adjustment for high G.W. _ ��� 1 h w� 0 DIFFEREN TWEEN A and B ! ' SIGNED :_ U _ DATE: NOTICE Based upon the above information,a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. gASeptic\percexemp.doc 1 ' r I ate,. lt'1 ilm Him ®A 9 VA 71 rri S . _ f r � � C 1 i m fr` r, 1 1 i II t 3 b d i r � 1 �l V a a ------------- T j } 1 1 � C1 uo iCID Lo .� �T.-�.t Ar � o a I I h � 9 I {{y i COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAI AFFAIRS John Graci b DEPARTMENT OF ENVIRONMENTAL PROTECTION DEP Title V Septic Inspector. ONE WINTER STREET BOSTON MA02108(617)292-3500 P.O.Box 2119 TeaTicket,Ma. (508)564-6813 TRUDY COXE Secretary { ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 97 QUAKER RD. HYANNIS MAP 310 PAR 313 Name of Owner MRS.DEANNA FINLAY Address of Owner: SAME Date of Inspection: 10/18/99 Name of Inspector:(Please Print)JOHN GRACIF `� I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) OC r �`tJ 2 Company Name: n/a 1999 Mailing Address: n/a '' "•►�V Telephone Number: nla CERTIFICATION STATEMENT I ur I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is fri71',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 The Inpection is based on criteria defined in Title V _ Conditionally Passes code 310 CMR 15.303.My findings are of how the system Is _ Needs Further Evaluation By the Local Approving Authority performing at the time of the Inspection.My inspection does _ Fails not Imply any warranty or guarantee of the longgevity of the septic system and any of Its components useful life. Inspector's Signature: Date:10/20/99 The System Inspector shaisubmit 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. i NOTES AND COMMENTS f THE SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING THE SYSTEM EVERY ONE TO TWO YEARS TO PROLONG THE SYSTEM' USEFULL LIFE. revised 9/2/98 Pagel of 11 • I I e ' i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 97 QUAKER RD.HYANNIS MAP 310 PAR 313 C Owner: MRS.DEANNA FINLAY Date of Inspection:10/18/99 i INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: 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. COMMENTS: System passes Title V inspection . 1 B. SYSTEM CONDITIONALLY PASSES: { Wa 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& 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. n1a 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 Wa 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 I i < i a its revised 9/2/98 Page 2 of 11 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A . CERTIFICATION(continued) Property Address: 97 QUAKER RD.HYANNIS MAP 310 PAR 313 Owner: MRS.DEANNA FINLAY Date of Inspection:10/18/99 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER.IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well, The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,Method used to determine distance n/ar(approximation not valid). 3) OTHER Wa . A revised 9/2/98 n Page 3 of 11 Y' t: I l SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 97 QUAKER RD.HYANNIS MAP 310 PAR 313 Owner: MRS.DEANNA FINLAY Date of Inspection:10/18/99 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 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. 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 n/a. 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 ompounds, ammonia nitrogen and nitrate nitrogen. X The liquid level in the SAS is over the invert pipe,is in Hydraulic Failure. 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 X the system is within 200 feet of a tributary 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. 4 revised 912/98 Page 4 of 11 }R; i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST i Property Address: 97 QUAKER RD.HYANNIS MAP 310 PAR 313 Owner: MRS.DEANNA FINLAY Date of Inspection:10/18/99 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 f 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 Mudge,depth of scum.The size and location of the Soil Absorption System on the site has been determined based on: s 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)1 X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of I SubSurface Disposal Systems. I { revised 9/2198 Page 5 of 11 ` SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 97 QUAKER RD.HYANNIS MAP 310 PAR 313 Owner: MRS.DEANNA FINLAY -' Date of Inspection:10/18/99 FLOW CONDITIONS RESIDENTIAL: Design flow:-M g.p.d./bedroom Number of bedrooms(design): 4 Number of bedrooms(actual):-4 Total DESIGN flow: 44Il Number of current residents:4 Garbage grinder(yes or no):NO Laundry(separate system)(yes or no): .M If yes,separate inspection required j Laundry system inspected(yes.or no):-= Seasonal use(yes or no):JIQ Water meter readings,if available(last two year's usage(gpd): n1a Sump Pump(yes or no): NQ Last date of occupancy: n/A COMMERCIAL/INDUSTRIAL Type of establishment: n& Design flow: n/a gpd(Based on 15.203) i Basis of design flow: n/a Grease trap present:(yes or no):JM Industrial Waste Holding Tank present:(yes or no): NQ Non-sanitary waste discharged to the Title 5 system:(yes or no):Na Water meter readings.if available:nLa !' Last date of occupancy: n& OTHER: (Describe) n(a Last date of occupancy: nla GENERAL INFORMATION j PUMPING RECORDS and source of information: Dta System pumped as part of inspection:.(yes or no):NQ If yes,volume pumped n/A. gallons Reason for pumping: Wit TYPE OF SYSTEM f XSeptic 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: Wit I APPROXIMATE AGE of all components,date installed(if known)and source of information: 1g70 WITH A NEW PIT INSTALLED IN 1986 PERMIT 8s-866 Sewage odors detected when arriving at the site:(yes or no): NQ revised 9/2/98 Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 97 QUAKER RD.HYANNIS MAP 310 PAR 313 Owner: MRS.DEANNA FINLAY Date of Inspection:10/18/99 BUILDING SEWER: (Locate on site plan) Depth below grade: 22' Material of construction:_ cast iron X 40 PVC _ other(explain) Distance from private water supply well or suction line: TOWN Diameter: Wa Comments: (condition of joints,venting,evidence of leakage,etc.) n1a i SEPTIC TANK: X (locate on site plan) l Depth below grade: IC Material of construction:X concrete_ metal_ Fiberglass _ Polyethylene _ other(explain) n1a If tank is metal,list age Is age confirmed by Certificate of.Compliance(Yes/No): No n1a Dimensions: L 8'6"H 5'7"W 4'10" Sludge depth: E Distance from top of sludge to bottom of outlet tee or baffle: 22 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: JE ' How dimensions were determined: MEASURED i 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.) j SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND RECOMMEND EVERY ONE TO TWO YEARS GREASE TRAP: 1 .(locate on site plan) Depth below grade: Material of construction:_concrete metal_ Fiberglass _ Polyethylene_other(explain) ` Wa Dimensions: nla Scum thickness: n1a I: Distance from top of scum to top of outlet tee or baffle:_n1a Distance from bottom of scum to bottom of outlet tee or baffle n(a i Date of last pumping: nLa Comments: r (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, . Iva f revised 9/2198 Page 7 of 11 �_ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:97 QUAKER RD.HYANNIS MAP 310 PAR 313 Owner: MRS.DEANNA FINLAY Date of Inspection:10/18/99 TIGHT OR HOLDING TANK: NO (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: nta Material of construction:_ concrete_ metal_ Fiberglass _Polyethylene_ other(explain) nLa Dimensions: nta Capacity: Wa gallons Design flow: n(a gallons/day Alarm present: NO Alarm level:jaLa- Alarm in working order:Yes—No—: NO Date of previous pumping: nLa Comments: (condition of inlet tee,condition of alarm and float switches,etc.) n& DISTRIBUTION BOX: _ (locate on site plan) 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.) PUMP CHAMBER: Mt2 (locate on site plan) Pumps in working order:(Yes or No): MO Alarms in working order(Yes or No): MO Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) nLa revised 9/2/98 E Page 8 of 11 LL F � 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 97 QUAKER RD.HYANNIS MAP 310 PAR 313 Owner: MRS.DEANNA FINLAY Date of Inspection:10/18/99 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: nta Type: leaching pits,number: 2-1000 GALLON LEACH PITS leaching chambers,number: 11La leaching galleries,number: 111da 1 leaching trenches,number,length: n1a leaching fields,number,dimensions: n& overflow cesspool,number: n& i Alternative system: DIA Name of Technology: jiLa Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE LEACH PITS ARE STRUCTURALL SOUND AND FUNTIONING PROPERLY THE NEW PIT HAD 2'OF LEACHING LEFT AT THE TIME OF THE INSPECTION_ I CESSPOOLS: _ (locate on site plan) Number and configuration: nta Depth-top of liquid to Inlet invert: n& Depth of solids layer: nta Depth of scum layer. n(a Dimensions of cesspool: Wa Materials of construction: nLa Indication of groundwater: nla inflow(cesspool must be pumped as part of inspection)n&. Comments: (no'e condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) nta PRIVY: _ t (locate on site plan) Materials of construction:n& Dimensions:nIa Depth of solids: nLa i Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) Wa revised 9/2198 Page of 11 n j SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) I Property Address: 97 QUAKER RD.HYANNIS MAP 310 PAR 313 Owner: MRS.DEANNA FINLAY Date of Inspection:10/18/99 i i 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) n/a . I IJ ;C Qec� ag D � 0 a AAAg al Rg�C AD i3A � B13 revised 9/2/98 Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 97 QUAKER RD.HYANNIS MAP 310 PAR 313 Owner: MRS.DEANNA FINLAY Date of Inspection:10/18/99 NRCS Report name: n& Soil Type: n& Typical depth to groundwater: n/a USGS Date website visited: n& Observation Wells checked: MQ 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 I Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS revised 9/2198 Page 11 of 11 _-LOCATION' SEWAGE PERMIT NO. 97 VILLAGE INST ER'S NAME&ADDRESS BUILDOR OR OWNER DATE PERMIT ISSUED 10l � �s DATE COMPLIANCE ISSUED 1 q S5 vl f6 a , o Al P _ t r No.............._-....... THE COMMONWEALTH OF MASSACHUSETTS BOARD 0 HEALT 01 ------ .....-..---OF.-......j......_................................................... Appliration for Disposal Works Tonstrurtion thrmit Application is hereby made for a Permit, to Construct or Repair ( Ao��an Individual Sewage Disposal System at: .................. ............................................................................................ L i ' dr ss Lot o. ocatio .41V ....................... ..... ......................... ..... ....................... .. . ..... ........ . wnor ddr 00 -7 A*& Installer ..... Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms______________________________ __ _Expansion Attic Garbage Grinder PL4 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria Other fixtures ----------------------------------- --------------------------------------------------------------------------------- ...........***---------------- Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid*capacity............gallons Length________________ Width__.__.________.. Diameter__-____.________ Depth____.________... Disposal Trench—No_ ____________________ Width_____...__._____._._ Total Length...__._.___.._._____ Total leaching area....................sq. ft. Seepage Pit No_____________________ Diameter.______.._._.____.__ Depth below inlet_______._......._.__ Total leaching area..................sq. f t. Z Other Distribution box Dosing tank Percolation Test Results Performed by......................................................................... Date........................................ ,-4 Test Pit No. I................minutes per inch Depth of Test Pit__________.__._.____ Depth to ground water..___..__.._._____._._.. Test Pit No. 2................minutes per inch Depth of Test Pit___.._._..________._ Depth to ground water...___._.._________._._- ............................................................................................................................................................. 0 Description of Soil.......................................................;.....................I............................................................................................ W I, U ........................................................................................................................................................................................................ ................................................................................................................ -7------------------------------------------------—------------------------------- U Nature of Repairs 0 Iterations Answer when applicable-----e, ....7;k --— W................. ................�;...........................................----------- ........... Agreement: The undersigned agrees to install the aforedescribed I4idual Sewage Disposal System in accordance with the provisions of TL 1 Ti!Z- 5 of the State Sanitary Code— nder M* ned fur er ag es not t I lace the system in operation until a Certificate of Compliance has bee is ed eb rd th. // � Signed-.-... ... ....... ... ........... ... ... ......... ........... .......................... Date ApplicationApproved By......................................................... ..................................... ........................................ Date Application Disapproved for the following reasons:.............................................................................................................. ......................................................................................................................................................................................................... Date PermitNo.1 13------------------7----- Issued..................................................... Date No.._.P. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF, HEALTH .....OF......... .. ../� !>y.:_ �-�.....-•--------••--•-•------ Appiiratiott for Disposal Works Tonstrurtioat Prrutit 'Application is hereby made for,a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: J . Locatio - dress or Lo�o. / G=.�?i f= fs'/ ���!t�... "9 cif - - 9_�ti _. :�:-.s� i�� ...--••--••• ._....-•-....._._.. •-•..... a C ddre Vl/e � `/ s �� /� � �..�. f Installer Address � Type of Building Size Lot...........................S q. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building ............................ No. of persons............................ Showers — Cafeteria a 1 Other fixtures .................................. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter.---.........--. Depth................ Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed bY..........-..-............................................................ Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit................--.. Depth to ground water........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit...--.......----.... Depth to ground water------.--_-------.---. •-----------------------------------------------•----•----••---..............................._.............................................................. 0 Description of Soil........................................................................................................................................................................ x U -•--•••---••••-•-•-••-•-••--•---••••-•.....--•----------••-•-••••••-••------•-••••------••---•-•••••---....-••-•--•••----•--•---...---•------•------••------•------•----•---•-----•-•-------...•--..---- W ••••••-•---•----------------••-•--••••••••••••••••-••-••••-•-------••••---------------•...-•----•-----•--••- ---- --------------•------------------•--------------. U Nature of RepairsIterations / Answer when applicable..:�-�-!v�4� "�....e®.. sY/�T� �a "Ail ............... .. _ %v ........................................................................ Agreement: The undersigned agrees to install the aforedescrib;;F?p d d"�idual Sewage Disposal System in accordance with the provisions of'I'!L- 5 of the State Sanitary Code— nders gned fur :er ages not to-place the system in operation until a Certificate of Compliance has been is ed the b Ord t, f/ ___ G .... .... ...Signed....... Date ApplicationApproved By...................................................•............................................ ........................................ Date Application Disapproved for the following reasons:---•---••---------------------------•-------------------------•----•--------------•--•--•-•---------•-----••--- .................•-•...---••-------...........---••--•----------•-••---•-..............••--•---•---....--•----------•....-•-••-•-----•••----------•-••-•-----•--•---------•-•---•••-•••••---•--••..-•••- Date Permit Nord..------jr -uv� ------------------------------- � Issued-..................� I THE COMMONWEALTH OF MASSACHUSETTS �+�J� BOARD O HEALTH �/i ,r- TertifirFate of Tooth hattre TH�S 0 CERTIF�, T��e Indivi Seyva e Disposal System constructed ( , ) or Repaired --------------••••-•-••...... . ..... - ............... at stiller ........................................... � --•---•-• •.. has been installed in accordance with the provisions TITIE 5_of The State Sanitary Coded as des�3ibe ' the application for Disposal Works Construction Permi i o...1 _l s ............ dated-._.'........................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRIJ ED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE......... ............. -••---••-•--•---••----•-•• Inspector.................. THE COMMONWEALTH OF MASSACHUSETTS s.V71 BOARD 7; 9ALTH ] 9 3 No.......... .....:...::. FEE........................ .�� Permission is herebyranted /.�-vsr!G` 1�=_� �' ------...�%•"`=g to Constr t ) epair�`e.�an '' dual Sewa is sal ystem - x Street C as shown;on,the.application for Disposal Works Cons ion Permit No..................... Paw ..--..... .................. Boa of Health DATE....... --•--•7..................................................... FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS j .. 132 ASSESSORS MAP : �I(� NOTES: TEST HOLE LOGS PARCEL: �j�3 1) THE INSTALLATION MUST BE IN SUBSTANTIAL COMPLIANCE WITH S( T '�A THIS PLAN, 1995 MASSACHUSETTS TITLE V & TOWN OF '1 p SOIL EVALUATOR L. YV,e1�8r FLOOD ZONE : WITNESS: $ RA°ff�l-�R BOARD OF HEALTH REGULATIONS. �.. � 1�6T �.6�VT 28 REFERENCE: LG'P 115 &0 DATE: 2) THE INSTALLER SHALL VERIFY THE LOCATION OF UTILITIES, 28 PERCOLAT I N R TE: i, SEWER INVERTS AND SEPTIC COMPONENTS PRIOR TO Pd �' INSTALLATION. NORTH �------ i _. _._..----------_- � J. S �.�1 L �R t Tom' 0 TH- 1 EL. Z6 TH-2 F4-, q-1,30 3) THIS PLAN SHALL BE USED FOR SEPTIC SYSTEM INSTALLATION lie e (�Dr� 0 F LA�N� �A�N`7, wa2v 69wS INL _ _ . _—_P n wA� ONLY, AND SHALL NOT BE USED FOR PROPERTY LINE S /� IRS " A �°�My (0 �3( DETERMINATION. y �► Sp�►,trA y Sq,�p 2 Duero `N la lv�S I*33 S 2 - ".6 J 4) ALL PIPING TO BE 4" SCHEDULE 40 @ 1/8 "/ FOOT. (UNLESS Lo kh� L� 1 oyp-!1/ SPECIFIED OTHERWISE) sj"�W'q 10Y91%,, a SAND � 5) THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A LOCATION MAP�> .T,-5) /. �'� � GARBAGE DISPOSAL.. " R fib►v M 6) SEPTIC TANKS AND DISTRIBUTION BOXES (WHEN INSTALLED) _ o7 C a' MUST BE PLACED ON A MECHANICALLY COMPACTED BASE OR ON A BASE OF 6"OF CRUSHED STONE. Y f3 3 1 4�► 3' � 6tn L6k pry FN5 nM pens wsr o" u ].23 144 ?,7,I CAW ogpoE va'� No 6w O VEN ��u- �G�- 'fliL� V. - i 1 - SEPTIC SYSTEM DESIGN 4, b W6TC j_Qt7 wl t 4 150 9F Pot- LEkrt7Nq , FLOW ESTIMATE 0. AW 0 havol 77 fLZ of, RuvAio -- — --- .. \ BEDROOMS AT l I O GAL/DAY/BEDROOM - `/ N GAL/DAY \ 15 SEPTIC TANK \ D 33D GAL/DAY x 2 DAYS - �loO GAL \ -7 SHED USE41)0 GALLON SEPTIC TANK I` SOIL 'ASSORPT I ON SYSTEM \H of 4f,4s 0 o DA E , (14 t%i LT?_Km?_ Soso- UN ITS \-I L Ft 71MuB n� � S DES o F /_25 t,._X. �� . , _. -- _ _ .._T_ _ �40M ER..-_ N - -- . , _ ' . 1140 ) tab 2 c m S OO DE AREA i. 25 2C1 X 2 x 6 7� - �sTea �l • �•.. V NITAR%B(JTTOM AREA: ZS k 12.1(p x 0>7y 22$ r, ft �ITS \ 33S &P \ jr, aay,61) 33 G 6,p Ip p SEPT I r -SYSTEM SECT IONta U� (o or t7n,sh rode wJ,N �eri' ti I \ I E !' TI !ON I4� 36 r,4G \ EXIST s mff(e� tf/o.7 . ESL ING - lot �r a I OOb GAL YG ToP OF FNON z - SEPTIC TANK !tiR LrC' JJ6K, ' - 5 33+ rn E� 0 �(r5T7N r i it \ `\ I D6-3 �--- C2� L. x 12.1(o LtiC-z 0) i \ rn \ 6,A5T o � I be CkoSSgc-�cTl or/ I I �-t NG \ z ` . -3oM/14, of < \ \ < / L \ o - SITE AND SEWAGE PLAN At sk LOCAT I ON : q7 'oy't-I[aiZ F-D MA Ja ��� -p �__ - 108.25 F' - —r T PREPARED FOR : A-g4Q4 COA67- w�kv1 $ ��s DGE OF PAVEMENr O DARREN M. MEYER, R.S. SCALE: I - A �RO12•I(o _DATE; O -210-06 uAKER P.O. BOX 981 : �1 EAST SANDWICH MA 02537 W DATE HEALTH AGENT Ph: (508) 362-2922 I l TOF - 50,6'± � � FINISH GRADE OVER D-BOX - 49.5'± ' - � PROP. VENT WITH CHARCOAL FILTER TO ABOVE GRADE PROVIDE EXTENSION RISER OVER - FINISH GRADE OVER CHAMBERS = 49.5 49.1 GENERAL NOTES 24" MIN. ACCESS INLET& MIDDLE COVER TO WITHIN F.G. OVER H-20 RISER WITH WATERTIGHT SLOPE @ 2% MIN. OVER SYSTEM 3/4"TO 1-1/2" DOUBLE WASHED 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION �FINISHED GRADE � STONE TO CROWN OF PIPE @ FOUNDATION = 49.7't (TYPICAL FOR 3) 6"OF F.G. &OUTLET TO F.G. TANK EL.= 49.7 ± FRAME AND COVER TO GRADE H-20 CONC. RISER WITH WATERTIGHT METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL --- CAST IRON FRAME AND COVER TO INSPECTION PORT WITH ACCESS 2 OF 1/8"TO 1/2" DOUBLE WASHED CODE AND ANY APPLICABLE LOCAL RULES. 9" MIN. 5" DIA. OUTLET(S) GRADE OVER ALL PIPED CHAMBERS BOX TO F.G. (SEE NOTE 21) 36" MAX. STONE OR GEOTEXTILE FILTER FABRIC 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE f _ - 4"SCHEDULE 40 PVC - - -- DESIGN ENGINEER. 4" SCH. 40 PVC TO 9"MIN. MIN SLOPE 1% 9" MIN. TOP OF SAS = 46.50' 3. 4" SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL MIN.SLOPE 2% 6" 3" 2„DROP MIN. DISTRIBUTION BOX „ " 36" MAX. � _ c - -___3-- DROP MAX. 3 9 3 9 4 PVC TEE 36 MAX. SYSTEM UNLESS OTHERWISE NOTED. MIN.SLOPE @ 1% 45.5 - BREAKOUT EL= 46.00 5'± PROPOSED 4" - - - - 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN SCH.40 PVC o L=26'+ ELEVATION =46.00' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A 14" 14" 46.35' PROVIDE WATERTIGHT o 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S. AND THE TOP OF LCONNECTION 4" PVC IN FROM JOINTS (TYP.) o oowP THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. 46.7 ± TEES SHALL BE SEPTIC TANK 4" PVC OUT TO 0 O 0 O = 0 0 CENTERED OUTLET TEE O LEACHING FACILITY 4-CD °00 ° 0 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. UNDERNEATH 48 oo 0 0 0 0 0 0 0 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. 46.60' COVERS M ZABEL FILTER 46.00' M N.121# 6 45.83' 2� oo o o o� 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK 00 CDC)GAS BAFFLE MODEL#A1801-4x22 FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS 1500 GAL. 500 GAL. 6" CRUSHED STONE o 0 0 0 0 o 0 6 ( 0 0o NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH 11.1'TO FND. (48 HRS DET.) (24 HRS DET.) OVER MECHANICALLY o0 COMPACTED BASE AND DESIGN ENGINEER. 6" CRUSHED STONE 4.0' 8 5' (TYP) -� 4 0' 4 0' 4.0' 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM. BENCHMARK ELEVATION OF 50.00, OVER MECHANICALLY 5 OUTLET DISTRIBUTION BOX 4.83' COMPACTED BASE TO BE INSTALLED ON A LEVEL STABLE 33.5' (TYP.) ESTABLISHED ON TOP OF A NAIL SET IN 18" OAK TREE AS SHOWN ON PLAN. BASE. FIRST TWO FEET OF OUTLET , GROUND WATER ELEV.= < 38.10' 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION PROPOSED 1500/500 GALLON TWO-COMPARTMENT SEPTIC TANK (H-2O) PIPES TO BE LAID LEVEL. 43.50 12.83' THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT LENGTH 13'-0" WIDTH 7'-0" DEPTH 6'-2" 3 - 500 GALLON H-20 CHAMBERS CHAMBER END VIEW 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES CROSS SECTION VIEW 5 MIN. TO THE DESIGN ENGINEER. SEPTIC TANK PROFILE ACME/Sho ey)r H-20 DISTRIBUTION BOX DETAIL TYPICAL CHAMBER PROFILE H-20 CHAMBER DETAILS 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT. NOT TO SCALE NOT TO SCALE NOT TO SCALE 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING --- ---� -� REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM TEST PIT DATA APPROPRIATE AUTHORITY. J PERC NO. N/'u 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS LOCATED �, t7 INSPECTOR: Not required UNDER MORE THAN 3 FEET OF COVER OR LOCATED UNDER PAVEMENT, DRIVES, OR EVALUATOR: Darren Meyer TRAVELED WAYS IN WHICH CASE THEY SHALL WITHSTAND H-20 LOADING. PROPOSED 4" SCH. 40 PROPOSED THREE (3) C7 C.S.E. APPROVAL DATE: Unknown 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. ' 500-GALLON H-20 LEACHING PVC VENT; EXACT CHAMBERS w/ STONE ; xro DATE: May 12, 2006 LOCATION PER OWNER MAP 310 0 .� i t„. 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE ' TEST HOLE#: 1 &2 MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. 49x4' \\ X LOT 314 r ELEV TOP - 49.70' REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, � IZONE I I � � ELEV WATER- < 37.70' FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). k __ � -il-� = PROPOSED - 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN k \yam 49 INSPECTION PORT PERC RATE - < 2 min./inch SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. M aI X-X X X X X X-X X FENCE b 16. PROPOSED PROJECT IS LOCATED WITHIN: LL X- _ _ 49x1 N f '� � DEPTH OF PERC = 34"- 52" X X k * ASSESSOR'S MAP 310 LOT 313 _ X x--X-X X X-X-X-X-X X-X C14x - - S88°45' 00"E Z i- - X X X x_ 166.82' _ +/� TEXTURAL CLASS: I OWNER OF RECORD: VICTOR CHAVES, TRUSTEE OF THE BROOKSHORE REALTY TRUST k 0l °- k 20 o TP 1 TP 2 x ADDRESS: PO BOX 490621 U / i \49 \� ,�. , 0" 49.70' EVERETT MA 02149 k (5 49x4 -�., �► Loamy Sand k 49x1 49x1' 4) , * A 10Yr 3/2 FEMA FLOOD ZONE X LOCUS ��,, g I _ 6ft 49.20 COMMUNITY PANEL# 25001CO566J k49x6 -CRUSHED STONE DRIVE- Ct I 17. DEED REFERENCE: L.C.C. #188253 / o0 X MAP 292 I o �� B Loamy Sand LOT 175 0 «-- 10Yr 5/8 18. PLAN REFERENCE: L.C. PLAN#21173-F X 49x5 18 3) HC-1 I 34" 46.87' 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. - - ► Perc 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY x �0• 33.5' CHIM. ' 52" 45.37, FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY o k (6 I4$ t3 FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. ai cv k 49x4 49x6 DECK TOF=50.6'± 1 21. A 4" PERFORATED SCH. 40 PVC PIPE SHALL BE PLACED IN A VERTICAL POSITION TO A o ' k PROPOSED H-20 `'�8, \ 1 Medium Sand DEPTH OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3" OF FINISH GRADE. A __--. / EXIST. DISTRIBUTION BOX k C 2.5Y 7/3 REMOVABLE THREADED CAP CHALL 3E PLACED ON THE TOP TO ALLOW FOR INSPECTIONS. co SHED k __ ► 22. OWNER/APPLICANT/CONTRACTOR SHALL BE RESPONSIBLE TO OBTAIN ANY AND ALL 0 REQUIRED PERMITS AND APPROVALS FOR THIS PROJECT. WALK ' �� LOCUS PLAN � Benchmark x 49x8 #97 \\ 23. OWNER PREFERS THE INSTALLATION OF A NEW 1500/500 TWO-COMPARTMENT SEPTIC TANK / TH-1 11.1' EXISTING ' IN LIEU OF UTILIZING THE EXISTING 1,000 GALLON TANK. THE TWO-COMPARTMENT TANK IS Nail Set in 0' Oak 49x7 \\ 3-BEDROOM \ ; ► SCALE: 1"= 1000' NOT REQUIRED PER TITLE 5 FOR THIS PROJECT, BUT IS SIMPLY A PREFERENCE BY OWNER. k Elev. = 50.00' 49x7' DWELLING \ ►pQ 144 37.70' kApprox. MSL [_ - '__ p No Mottling, Standing or Weeping Observed I- -- - -50 - _ _\ 49xT \ W W W W > w __ - - TEST PIT DATA x \ (1 ' APPROX. LOC. wv ,W DESIGN DATA LEGEND / CRUSHED (2 W W -4V 33.5' A PARKING ARE � � / I ► PERC NO. 21-69 / NUMBER OF BEDROOMS (EXISTING) 3 INSPECTOR: Donald Desmarais (BOH) 50x0' EXISTING SPOT GRADE EXIST. 1,000 GAL. SEPTIC k I TANK TO BE PUMPED & / o ► NUMBER OF BEDROOMS (DESIGN) 4 EVALUATOR: Michael Pimentel, EIT, CSE -- - _ 50 - EXISTING CONTOUR I REPLACED w/ NEW 1500/500 o o DESIGN FLOW 110 GAL/DAY/BEDROOM C.S.E. APPROVAL DATE: Oct. 27, 1999 r PROPOSED CONTOUR / cw RESERVE GAL. 2-COMP. H-20 SEPTIC / " Cl) TOTAL DESIGN FLOW 440 GAUDAY March 23, 2021 TANK AS SHOWN // ' DATE: r0 175-0-1 PROPOSED SPOT GRADE 1 / / ► DESIGN FLOW x 200% = 880 GAUDAY TEST PIT#: 1 &2 x I , HC-2 I / USE PROPOSED 1500/500 GALLON 2-COMPARTMENT SEPTIC TANK ELEV TOP - 49.10' - GAS EXISTING GAS LINE / I � PROPOSED 1500/500 O/H/W EXISTING OVER-HEAD WIRES � TH-2 / GALLON 2-COMPARTMENT / ► / ELEV WATER= < 38.10 1%� -7 H-20 SEPTIC TANK 0/H/w 49x7' / �jH/W o ► PERC RATE _ <2 min./inch* W W EXISTING WATER LINE /H/W ► I INSTALL 3 - 500 GAL. H-20 CHAMBERS w/ STONE DEPTH OF PERC = "C" soil TEST PIT LOCATION EXISTING THREE (3) 3050 EXISTING _ I OAS OAS ,w � 0A/W SIDEWALL CAPACITY TEXTURAL CLASS: I PROPOSED 1,000/500 GALLON k / INFILTRATORS (25'x12'x2') PER GARAGE _ 50� \ 1 A$�` _� 0/H/W _ (LENGTH + WIDTH) (2 SIDES) (2' HIGH) (0.74 GPD/S.F.) = GAUDAY O O O TWO-COMPARTMENT H-20 SEPTIC TANK o / AS-BUILT CARD (SEWAGE (33.5' + 12.83' 2 / ) ( ) (2' ) ( 0.74 GPD/S.F.) = 137.1 GAUDAY #2006-243) TO BE ABANDONED BOTTOM CAPACITY 0 Loamy Sand 49.10' PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE _ MAP 310 / ► (LENGTH x WIDTH) (0.74 GPD/S.F.) = GAUDAY A 4 10Yr 3/1 48 77' Q PROPOSED H-20 DISTRIBUTION BOX PORTION OF THE SOUTHERN X X X X-X-X-X-LX X-X X-X-X-X-X-X-X X-X� - - / LOT 313 // O (33.5 x 12.83) (0.74 GPD/S.F.) = 318.1 GAUDAY O PROPOSED 500 GALLON H-20 LEACHING CHAMBER X _ / a MASSACHUSETTS TELEPHONE � X X-X-X-X-X \ 17,603±S.F. � ► Q' 3 TOTALS. B Loamy Sand COMPANY EASEMENT FENCE X X-X- -X-X-X-X-X X X ► 1z �O TOTAL NUMBER OF CHAMBERS 3 10Yr 5/6 TOTAL LEACHING AREA 615.1 X X X X X X-X-X-X-X / / Q TOTAL LEACHING CAPACITY 455.2 GAQL./DAY 36" 46.10' 1 4-22-21 MCP JLC Added reserve&THs 1 &2 performed by others on 5-12-06 X-X-X-X X X X X / ► � 3 REV. DATE - BY APP'D_ DESCRIPTION / ► Cr b Zt PROPOSED SEPTIC SYSTEM UPGRADE 165.59' / I N88°45' 00"W PREPARED FOR: I Med. to Fine Sand ROBERT B. OUR CO., INC. C 2.5Y 6/6 LOCATED AT NOTES: MAP 310 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF EACH SEPTIC SYSTEM LOT 312 SWING-TIES 97 QUAKER ROAD COMPONENT. HYANNIS, MA 02601 DESCRIPTION HC-1 HC-2 -----_-- - ------ 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF THE PROPOSED LEACHING 132" 38.10' SCALE: 1 INCH = 10 FT. DATE: APRIL 10, 2021 FACILITY TO ENSURE CONSISTENCY WITH TEST PIT DATA SHOWN ON THIS PLAN. REPORT TO SEPTIC COVER IN (1) 30.1' 27.2' ���{ of ASS o s �0 20 ao FEET ENGINEER AND LOCAL BOARD OF HEALTH IF SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. No Mottling, Standing or Weeping Observed SEPTIC COVER OUT 2 36.8' 33.9' - - JOHN L. tiG O `��^ PREPARED BY: RESERVED FOR BOARD OF HEALTH USE * Perc rate taken from test pit performed by v CHU CHILL JR. -,4 �' JC ENGINEERING INC. 3.) PROPERTY IS NOT LOCATED WITHIN THE GROUNDWATER OR WELLHEAD PROTECTION OVERLAY CORNER OF STONE (3) 30.7' 50.9' DISTRICTS, DEP APPROVED ZONE II OR THE ESTUARINE WATERSHEDS. Darren Meyer, R.S. on May 12, 2006 as NO. 41807 2854 CRANBERRY HIGHWAY CORNER OF STONE (4) 33.0 62.2 shown on plan entitled"Site and Sewage 4.) SWING TIES SHOWN ON THIS PLAN ARE PROVIDED ONLY AS A COURTESY FOR THE INSTALLER. SITE PLAN 82.3' Plan", dated May 26, 2006 on record with ��' EAST WAREHAM, MA 02538 CORNER OF STONE (5) 65.3' INSTALLER SHALL VERIFY SWING TIE MEASUREMENTS IN THE FIELD PRIOR TO INSTALLING THE the Barnstable Board of Health. 508.273.0377 SYSTEM. CONTRACTOR SHALL NOTIFY ENGINEER IF MEASUREMENTS APPEAR TO BE INCORRECT. SCALE: 1"= 10' CORNER OF STONE (6) 64.1' 74.1' Drawn By: MCP Designed By:MCP Checked By: JLC JOB No.5627