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0019 SAINT CATHERINE AVE - Health
19 Saint Catherine Ave Hyannis A, = 291 060 i r rj I TOWN OF BARNSTAABLE LOCAe"ION / J C •r`'` SEWAGE# ASSESSOWS MAP&LOT - WSTALI ER'S.14A &F1Ifltdii6 SBIpITG�'A iK CAPACTI'Y r LEACfIING FACT ' f '� C4�1 t b e g {sage) 3 . �vtx DE oil o�rr zt Sepazation I3isWce 3etvreen c t Maxunum Adjusted Groundwater Table to tfie Bott Leacfimg Faciia ty Feet Pnvaw�aterSu € PP�Y i7deli atidLeac sa Fsciiity {.f may 61i weir on'stte ar vintid 200 fet df le�chissg, act fy} Feet Edge of�Alzt�and,end Leactug Facility(If any wetIad ust v✓itwn-300 feet of tf ping facility) " Feet:.- Famished � � X � ,(,teen�o4sSe i f 37' P-F- aa'6 7 {o 9-6- Commonwealth of Massachusetts Title,5 Official Inspection Form - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments qM 72 Saint John St Property Address Rollin Steiner Owner Owner's Name information is required for every Hyannis MA 02601 6-11-14 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. General Information 1. Inspector: I �Y Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below pis true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of ` Title 5 (310 CMR 15.000).The system: Passes ❑ Conditionally Passes. ❑ Fails ❑ Needs F her al ion by t ocal Approving Authority 6-11-14 Inspector's Signature, Date i 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. ****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. t5ins-3/13 Title 5 Official Inspe o F r :Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection" Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 72 Saint John St Property Address Rollin Steiner Owner Owner's Name information is required for every Hyannis MA 02601 6-11-14 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Ahi failure criteria not evaluated are indicated below. Comments: System is in good working order with no sign of failure. B) System Conditionally Passes: ❑ One or more system components.as described in the "Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. y Check the box for"yes", "no"or"not determined" (Y, N, ND) 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. ❑ Y ❑ N ❑ ND (Explain below): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts ,w W Title 5 Official -inspection Form I� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 72 Saint John St Property Address Rollin Steiner Owner Owner's Name information is Hyannis MA 02601 6-11-14 required for every y . page. CityTTown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ 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): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 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 t5ins•3113 Title 5 Official Inspection Form'Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments � 72 Saint John St Property Address Rollin Steiner Owner Owner's Name information is required for every Hyannis MA 02601 6-11-14 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent 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: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for.Voluntary Assessments ,M 72 Saint John St Property Address Rollin Steiner Owner Owner's Name information is required for every Hyannis MA 02601 6-11-14 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more.than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ' ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent 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 I` and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑' ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply . ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection 'Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title.5 Official Inspecbgn.Formi Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form " Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , 72 Saint John St Property Address Rollin Steiner Owner Owner's Name information is required for every Hyannis MA 02601 6-11-14 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes"or"no" as to each of the following: Yes No ❑ ® 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? ❑ ® Have 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? ® ❑ Was the site inspected for signs of break out? ® ❑ 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: ® ❑ 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(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 2 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 72 Saint John St Property Address Rollin Steiner Owner Owner's Name information is required for every Hyannis MA 02601 6-11-14 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 6-2014 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): . Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts " a Title 5 Official Inspection, Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 72 Saint John St Property Address Rollin Steiner Owner Owner's Name information is required for every Hyannis MA 02601 6-11-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ❑ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 i f- Commonwealth of Massachusetts Title 5 Official inspection Form , Subsurface Sewage Disposal System Form Not for Voluntary Assessments M 72 Saint John St Property Address Rollin Steiner Owner Owner's Name information is required for every Hyannis MA 02601 6-11-14 page. City/Town State Zip Code Date of Inspection D. System Information (cost.) Approximate age of all components, date installed (if known) and source of information: 1995 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 22"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): Depth below grade: 12"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gal Sludge depth: 12" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts ' Title 5 Official Inspectiom, Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 72 Saint John St Property Address P Y Rollin Steiner Owner Owner's Name information is required for every Hyannis MA 02601 6-11-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 20 Scum thickness 211 611 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. ------------ Grease Trap (locate on site plan): Depth below grade: feet 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: Date t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 i Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 72 Saint John St Property Address Rollin Steiner Owner Owner's Name information is Hyannis MA 02601 6-11-14 required for every H y ' page. City/Town State Zip Code Date of Inspection D. System Information (cont.) , . Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 72 Saint John St Property Address Rollin Steiner Owner Owner's Name information is required for every Hyannis MA 02601 6-11-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Good condition with water at working level and no sign of back-up from field. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 n Commonwealth of Massachusetts = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 'G'M 72 Saint John St Property Address Rollin Steiner Owner Owner's Name information is required for every Hyannis MA 02601 6-11-14 page. City[Town State Zip Code Date of Inspection , D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 1-30x2x2 ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach field in good condition with no sign of back-up into d-box or surrounding stone. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): i 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 ❑ No t5ins•3/13 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection, Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments C G M 72 Saint John St Property Address Rollin Steiner Owner Owner's Name information is required for every Hyannis MA 02601 6-11-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts A W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 72 Saint John St Property Address Rollin Steiner Owner Owner's Name +' information is required for every Hyannis MA 02601 6-11-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 4e . I J, _A-D - 3Y Ai ' t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts f Title 5 Official. I nspection' Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 72 Saint John St Property Address Rollin Steiner Owner Owner's Name information is required for every y H annis MA 02601 6-11-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 10 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed- Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database- explain: You must describe how you established the high ground water elevation: Original design plans show no groundwater at 10'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 72 Saint John St Property Address Rollin Steiner Owner Owner's Name information is required for every Hyannis MA 02601 6-11-14 y page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file i t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 19 St Catherine Ave Property Address Elizabeth Kennedy Owner Owner's Name information is required for every Hyannis MA 02601 3-6-14 ' page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. General Information t �` 6� 7 I 1. Inspector: ,r Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 a Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification I certify that I have.personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ' ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority - 3-6-14 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 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. ""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. J/1 [/1 t5ins•3t13 Title 5 Official Ins ecfion Form:Subsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 19 St Catherine Ave Property Address Elizabeth Kennedy Owner Owner's Name information is required for every Hyannis MA 02601 3-6-14 page. City/Town State Zip Code Date of Inspection B. Certification (cost.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System is in good working order with no sign of failure. a 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. - Check the box for"yes", "no"or"not determined" (Y, N, ND)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. ❑ Y ❑ N ❑ ND (Explain below): , r J t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 19 St Catherine Ave Property Address Elizabeth Kennedy Owner Owner's Name information is required for every Hyannis MA 02601 3-6-14 page. Cityrrown. State Zip Code Date of Inspection B. Certification (cont.) , ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ 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): ❑ broken pipes) are replaced ❑ Y ❑ N ❑, ND (Explain below): T ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 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. I. 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 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 I Commonwealth of Massachusetts .. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 19 St Catherine Ave Property Address Elizabeth Kennedy Owner Owner's Name information is required for every Hyannis MA 02601 3-6-14 page. City(Town State Zip Code Date of Inspection B. Certification (cont.) 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 e y and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent 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: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® "Discharge or ponding of effluent,to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins-3M 3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form'-Not;for Voluntary Assessments 19 St Catherine Ave 4M f, Property Address Elizabeth Kennedy Owner Owner's Name information is required for every Hyannis MA 02601 3-6-14 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) t y Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS;cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or Y ❑ ®, tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. '❑ ® ' Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑l ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This •r system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent 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 • and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with.a design flow of 2000gpd- '' 10,000gpd. s The system fails. I have determined that one or more of the above failure ❑ ® criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. • For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a'surface drinking water supply, ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area'—' IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 19 St Catherine Ave Property Address li ab t E z e h Kennedy Owner Owner's Name information is Hyannis . MA 02601 3-6-14 required for every y page. City/Town - State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or" non as to each of the following: Yes No ^� Z - ❑ 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? ® F ❑ Has the system received normal flows in the previous two week period? ❑ ,: ® Have 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 fit❑ available note as NIA ® ❑ ` Was the facility or dwelling inspected for signs of sewage back up? ® ' •`❑ F ' Was the site inspected for signs of break out? ® ❑ 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? ® El 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: ® ❑ 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(5)] D. System Information J Residential Flow Conditions: Number of bedrooms(design): ' " 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for.example: 110 gpd x#of bedrooms): 330 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 i Commonwealth of Massachusetts W Title 5 Official e Inspection Form, • Subsurface Sewage Disposal System Form,-Not for Voluntary Assessments-: M ' 0 19 St Catherine Ave 1 + - Property Address Elizabeth Kennedy Owner Owner's Name information is required for every Hyannis MA 02601 3-6-14 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 1 Does residence have a garbage.grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection El Yes ® No information in this report.) ' Laundry system inspected? El Yes ® No Seasonal use? A ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No ' Last date of occupancy: 3-2014 Date Commercial/industrial Flow Conditions: w Type of Establishment: ,Design flow(based on 310 CMR 15.203): Gallons per day(gpd) -Basis of•design flow-(seats/persons/sq.ft., etc.): Grease trap present? _ ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ,, ❑ Yes ❑ No Water meter readings, if available: t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 1 Commonwealth of Massachusetts W Title 5 Official Inspection. Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 19 St Catherine Ave ' Property Address Elizabeth Kennedy Owner Owner's Name information is required for every Hyannis MA 02601 3-6-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Owner--pumped 2012 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Maintenance Type of System: ® Septic tank distribution box soil absorption system stem P Y ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑t 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 ) an to be obtained from system owner( y d a copy of latest inspection of the I/A system by system operator under contract • tank.Attach a c f th❑ Tight g copy o e DEP approval. ❑ Other(describe): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , 19 St Catherine Ave Property Address Elizabeth Kennedy Owner Owner's Name information is required for every Hyannis MA 02601 3-6-14 page.e. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 2004 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 18" at tank inlet feet Material of construction: ' ® cast iron ® 40 PVC ❑ other(explain): ` Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): Depth below grade: 12"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gal Sludge depth: 12° t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 official Inspection form Subsurface Sewage Disposal System'Form -Not for Voluntary Assessments 4c °� 19 St Catherine Ave Property Address Elizabeth Kennedy Owner Owner's Name information is required for every Hyannis MA 02601 3-6-14, page. Cityfrown State Zip Code Date of Inspection D. System Information (cost.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 20" Scum thickness 1 Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle w • . Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts ry W Title 5 Official Inspection, Form, Subsurface Sewage Disposal System Form,-Not for Voluntary Assessments 19 St Catherine Ave . Property Address Elizabeth Kennedy Owner Owner's Name information is required for every Hyannis MA 02601 3-6-14 page. City/Town• State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: .. Capacity: gallons Design Flow: " gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 1 Commonwealth of Massachusetts Title 5 Official. Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 19 St Catherine Ave Property Address Elizabeth Kennedy Owner Owner's Name information is required for every Hyannis MA 02601 3-6-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Good condition with water at working level and no sign of back-up from chambers. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-W 3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M '( 19 St Catherine Ave Property Address Elizabeth Kennedy Owner Owner's Name information is required for every Hyannis MA 02601 3-6-14 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) ' Type: ❑ leaching pits number: ® leaching chambers number: 4 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number;dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding,damp soil, condition of vegetation, etc.): Leach chambers in good ocndition with no sign of back-up into d-box or surrounding stone. 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 ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System°Page 13 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System"Form -Not for Voluntary Assessments 19 St Catherine Ave Property Address Elizabeth Kennedy Owner Owner's Name information is Hyannis MA 02601 3-6-14 required for every H y ' page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions , Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 19 St Catherine Ave Property Address Elizabeth Kennedy Owner Owner's Name information is required for every Hyannis MA 02601 3-6-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately Crew cv,zs . r y 1 f R_ r F A -4 -If(` 9,e� -3d 3 7" Y PJ k t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of.Massachusetts r Title 5 Official Inspection Form e Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 19 St Catherine Ave Property Address Elizabeth Kennedy Owner Owner's Name information is required for every Hyannis MA 02601 3-6-14 page. City/Town' State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water , ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12'feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database- explain: You must describe how you established the high ground water elevation: Original design plans show no groundwater at 12'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 v Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 19 St Catherine Ave Property Address Elizabeth Kennedy Owner Owner's Name information is required for every Hyannis MA 02601 3-6-14 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3M3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 McKean, Thomas From: McKean, Thomas Sent: Tuesday, February 15, 2005 12:21 PM To: Dillen, Elizabeth Cc: Shea, Kevin Subject: Amnesty Applications The Public Health Division reviewed multiple applications this morning and the following were approved or disapproved: 65 Marsh Lane, Hyannis Connected to Town Sewer APPLICATION OVED for 3 bedrooms as requested 19 Saint Catherine Avenue, Hyannis 3 bedrooms existing, four(4) bedrooms total requested, property is located within a nitrogen sensitive area, 0.33 acr Disposal works construction permit issued 12/30/2003 for three(3) bedrooms Four bedrooms would violate the State Environmental Code, 310 CMR 15.214, NITROGEN LOADING LIMITATION Provision APPLICATION DENIED An Option To Be Provided: Eliminate one of the bedrooms (refer to no door five feet opening policy) 464 Oakland Road, Hyannis 3 bedrooms existing, 3 bedrooms total requested, located within a nitrogen sensitive area, 0.36 acre However, submitted floor plans show four(4) bedrooms (including private"office" and studio apartment) Four bedrooms would violate the State Environmental Code, 310 CMR 15.214, NITROGEN LOADING LIMITATION Provision APPLICATION DENIED NOTE: Also the existing cesspools are approximately 41 years of age. An Option to be Provided: Eliminate one of the bedrooms (refer to no door five feet opening policy) 324 Nye Road, Centerville 3 bedrooms existing, 4 bedrooms proposed, located within a nitrogen sensitive area, 0.49 acre lot NOTES: Assessed as 3 bedrooms, septic system designed for 3 bedrooms, submitted floor plans are not labeled Four bedrooms would violate the State Environmental Code, 310 CMR 15.214, NITROGEN LOADING LIMITATION Provision APPLICATION DENIED Required for Future Review: Labeled floor plans An Option to Be Provided: Eliminate one of the bedrooms (refer to no door five feet opening policy) 90 Head of the Pond Road, Marstons Mills 3 bedrooms existing, 3 bedrooms requested, property is located within a nitrogen sensitive area, 1.36 acre lot- sufficient for 4 bedrooms max. However, submitted floor plans show 3 bedrooms plus a private'office" room, plus a private"music room"totals 5 bedrooms Septic system designed for three bedrooms according to the disposal works construction permit issued in 1984 Five bedrooms would violate the State Environmental Code, 310 CMR 15.214, NITROGEN LOADING LIMITATION Provision APPLICATION DENIED Options Provided: (a) Eliminate two of the private rooms (refer to no door five feet opening policy), or(b) eliminate only one of the private rooms (refer to no door five feet opening policy) plus have the septic system inspected by a DEP certified inspector 1 Town of Barnstable Health Inspector oFINE Office Hours P� o Regulatory Services 8:30-9:30 Thomas F. Geiler,Director 1:00—2:00 • BARNSrABL6, 9� "9: ,�� Public Health Division ArenMp'�a Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 AMNESTY PROGRAM APPLICANT— SEPTIC QUESTIONNAIRE 1. General Information: Size of Property: Address: P Map c4" _Parcel Name Phone 9: 771 -Sj lO 9 2a. How many bedrooms exist at your property now. 2b. Are you planning to add any bedrooms? If yes,how many?. 2c. How many bedrooms total are proposed at this property(including the amnesty unit)? 2d. Please include a copy of the floor plans for the entire property- showing the existing rooms in the home plus the proposed amnesty apartment and/or addition. Please label . each room clearly on the plans. 3. Is the dwelling connected to public sewer? YES or NO �`��If tli'e�dwelling is connected to�purlc sewer,skip-question§#4 through#9below,;, 4. Location of dwelling is INSIDE or OUTSIDE a Zone of Contribution to public supply wells? 5. Is the dwelling connected to an ONSITE WELL or to UBLIC WATER? 6. Is a disposal works construction permit on file? YES or NO 6a. If yes,how many bedrooms were approved according to this permit? Bedrooms. 7. Were any building permits obtained for construction of additional bedrooms? YES or NO 8. Is there an engineered septic system plan on file at the Health Division? YES or NO 9: Has the septic system been inspected by a DEP certified inspector within the last.two years? YES or NO --------------------------------------------------------------w OFFICE USE ONLY The Public Health Division has no objection to bedrooms at this property. Special Conditions: Signed: Dvate: Q;1health/wpfileslamnestyapp _�� � I I � � I � � � � � � � � � � � � I I � � ' � i � u TOWN OF B.ARNSTABLE LOCATION .5 A.11V f C �� �Ty R��c �r AGE # A 6 o �3 VILLAGE f��A AIW/S ASSESSOR'S'MAP& LOT 2 — l o INSTALLER'S NAME&PHONE NO. P M A C G y1 R e g S off l SEPTIC TANK CAPACITY A So o' LEACHING FACILITY:jtyp�� (size) NO. OF BEDROOMS K BUILDER OR OWNER Jt PERMITDATE: L a 3 0 COMPLIANCE DATE: (� Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility ( an Facili If wells exist Y 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 it O • ct. I i TOWN OF BARNSTABLE (r V P` E L LOCATION A //V% C_ e.R/iv C *SEWAGE # G 3-F VILLAGE h'yA NN/S_ ASSESSOR'S MAP & LOT 21 10 INSTALLER'S NAME&PHONE NO. MAC&/t lged' 4- 3 o)/ SEPTIC TANK CAPACITY LEACHING FACILITY: (type) y L e " (size) NO.OF BEDROOMS _ BUILDER OR OWNER PERMITDATE: I i 3 o COMPLIANCE DATE: 1 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching.Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by �� � , d:�.� _ a . F I; i; Y� \ yy� V ��� � � � ��- � a� / � � � � _ �G" ,.,�: Y / y ��-� ,� , ; e ' o \ t l 3 �3 ,. No. goo � � = Fee \ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: s PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pprication for Miopool *potem Congtruction Vertnit Application for a Permit to Construct( . )Repair(,)/)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Addressor Lot No. 19 S t. C a.t h e/Z-i n e 4 v e. Owner's Name,Address and Tel.NO-Da v id Kennedy Asegors p/�arce'1az�3. 02601 19 St. Ka.then.i.ne A.ve. n Installer's Name,Address,and Tel.No. 508 4 2 8—5 5 2 9 Designer's Name,Address and Tel.No. 5 0 5-2 7 3—0 3 7 7 L3�z "ce vacate i.btelt 87 Pond 3t. aC Eng.inee z ing Inc. 5 Roundh.itg 4 0�stenv i �e Na,6-s. 02655 Blvd. Cant Na2eham Na,3,3. 02538 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 , 90 gallons per day. Calculated daily flow 330 gallons. Plan Date 2e C. a 0 Number of sheets Revision Date Title Size of Septic Tank 1500 6,14i Type of S.A.S. L '-6 "CHa-16c ea - �/- Q IX/" Description of Soil Al A-f,- .50, / j r !1 J/1,7 Nature of Repairs or Alterations(Answer when applicable) Ow Z 4 4 :n g s a 4 4,Q Q o 4. $ra 4 t ri 6,94.49 i- 7500 g a i i o a 3P_12t.4o tank. I-di A I a 19 aI I nn Onx_ 4_!r h" lPonrhinq chan29e2.3/2acked in ' =;° i z".6-t one 4 ' on .6 ides 1/', ' on ends, i ' undea. Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issu 'by this Bo of Heal Sign d Af Date VeC, 6, Application Approved by Date 64- 3-:3) C-`3 Application Disapproved for the following reasons Permit No. o > 3 Date Issued ''No- `��f+ �"""n`: Fee 5 n, 00 THE COMMONWEALTH OF MASS. C"HUSETTS Entered in computer: L� PUBLIC-HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Yes 4plication for 30tzpaar bpgtem Conotruction Permit Application for a Permit to Construct( )Repair(k"i Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 19 S t. C a t h e z i n e 4 v e, owner's Name,Address and Tel.No.7 a v i d Kennedy As e so'rs I p�arce'lab4..7 02601 19 .St. Kathelt ine Ave. _221-060 Kuann.iz Na.,3.s. 02601 Installer's Name,Address,and Tel.No. 5 0 9 5 4 2 8-5 5 2 9 Designer's Name,Address and Tel.No. 5 0 5-2 7 3-0 3 7 7 �zuNce Nacatiibtez 87 Pond zt. �� Fngr�nee�ing Inc. 5 12oundh.iP,P .stezviPPe P1a�s�s. 02655 /Wvd. Eaat Na2eham Ma6a. 02538 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- .� C3 gallons per day. Calculated daily flow > � gallons. Plan Date '"I'L C. = I- G' i Number of sheets / Revision Date Title Size of Septic Tank r c >!, Type of S.A.S. r - r 'rr;,.f , t s !i. '> �X li i. Description of Soil 5— Nature Nature of Repairs or Alterations(Answer when applicable) 01;f f ;n r, r n A A n n IN P A. T n A n P P:n n /-1500 ga2.Pon 3ep.t io tank. iox. I-LC 6' .P_n_ach.ina J chamPe.,zenac,ke.d .in 4t 0)6 1�2'eton,e 4 ' on z-ide.6 1 ' on ends. 1 ' unde/z. Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been ued by this Board ofHealth ` Signed Datee�. " Application Approved by�- c Date Application Disapproved for the following reasons 'h Permit No. 3 " Date Issued / 13 G' F 3 ————————— ————————————————— —————— -- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certiffcate of.-Complian THIS IS TO CERTIFY.,=that the On-site Sewage Disposal System Constructed( )Repaired( j/)Upgraded( ) .xd.....,,.. )by i. i. 4a"';2�0m&e�z R 13`0,.n Znc. at 19 .0 i_ Cn i h o a 1 n o i o. has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.�2,0 d dated I G Installer @ JP 10_ (1 rr road ea R Ann T n r Designer 7_C' F n o.H-o o a i n rr 1 The issuance of this ,permit shall not be.construed as �guarantee that the system will function as designed. Date 1 �� �)L� X ' "` Inspector" L Fee THE COMMONWEALTH OF MASSAGHUSETTS PUBLIC HEALTH DNISION - BARNSTABLES MASSACHUSETTS =*aal *p.5tem Congtructio_n Permit Permission is hereby granted to Construct( )Repair(j Upgrade( )Abandon N Systemlocatedat f9 St'.-Ca#hQa-,i.rr-o_ 4ve, f�unrz,z _n Art 1 and as described in the'abo've Application for Disposal System Construction Peririit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special condi/tio'nss.'. i Provided:Construction ust be completed,within three years of the ated of this p Date: ��/'r� Approve y_- w��� LOCATION OF PROP RTY LINES MAY NOT BE ACCURATE STANDARDLEGEND o --- ___ ____;X #220 X GROUNDWATER PROTECTION KEY NOTE:not all symbols wHlappear anamop #22 ;- - ____ 'Z=::Z GOLF COURSE FAIRWAY WELLHEAD PROTECTION EDGE OF DECIDUOUS TREES MAP 2 '- -- 1248 P 29�1 X _------ +Y� -- ---- ----WP OVERLAY DISTRICT r O 24 '-- '- -------- 22 � --------- enr: GR- __ EDGE OF BRUSH #23 29 I GP GROUNDWATER PROTECTION r- - : ORCHARD OR NURSERY x OVERLAY DISTRICT 2 x _ _ 4 2 AP, V-V--p-v EDGE OF CONIFEROUS TREES x--x AQUIFER PROTECTION MAP 29I AP--------- - AP 1 li M� 91 If - 269 - -- -- -- - - OVERLAY DISTRICT r -, MARSH AREA t `__, X # 6 X —•••— EDGE OF WATER #24�__- - ---_ x MAP 291 DIRT ROAD - ------- MAP 291 160 , _ ❑ --x t - - 161 DRIVEWAY I M' E— PARKING LOT ,MAP 291 _ X' #8� PAVED ROAD o D j 11�-�' MAP 91 _ r 270 '- ---- - I #31 2 6 #244 X AP — - — DRAINAGE DITCH #2 - - X � — _ — — — — - PATH/TRAIL __ i __ I PARCEL LINE** MAP 291 0 MAP 29 I 2 7 1 MAP 326 -E--- MAP# PARCEL NUMBER 2 --- -__ 21 # 7 - #252 Q MAP 2 03 — HOUSE NUMBER - X ---- MAP 2 I "-- --_ # 2 FOOT CONTOUR LINE I M 291 .� r NAP 291 O 15 —E�— 10 FOOT CONTOUR LINE MA 291 .272 X / .'#5 Elevation based on NGVD29- 48 -- #260 - ' --- ____ o �4.9 SPOT ELEVATION 65 x �o STONE WALL MAP 290 M X P 29 _ -X—X- FENCE P I 2 7 �° MP 291 MAP 29 I RETAINING WALL 2 I � 1 10 T -rr RAIL ROAD TRACK L-=� © STONE JETTY SWIMMING POOL M . 291 PORCH/DECK BUILDING/STRUCTURE DOCK/PIER_ MAR 29 284, 29I MA 291 HYDRANT M - # 151 X P 291 P 291 105 5 / # I I a VALVE O MANHOLE # 131 _ O POST O� FLAG POLE T O W N O •F B A R N S` T A B L E O E O O R A P H 1 C 1 N F O R M A T 1 O N S Y S T E M S U N I T o SIGN ® STORM DRAIN N PRINTED SCALE:IN FEET =welrSetem topography,and **NOTE:The parcel lines are only graphic representations DATA SOURCES:Plonimetda(man-made features)were interpreted from 1995 aerial photographs by The lames m UTILITY POLE n TOWER ed to meet National of property boundaries.They are not true locations,and W.Sewall Company.Topography and vegetation were interpreted from 1989 aerial photographs by GEODw v ' 0 50 1OO rds at a scale of do not represent actual relationships to physical objects Corporation. Plonimetrics,topography,and vegetation were mapped to meet National Map Accuracy Standards LIGHT POLE OELECTRIC BOX 1 INCH=100 FEET* on the map. at a scale of 1"=100'.Parcel lines were digitized from FY2004 Town of Barnstable Assessor's tax maps. -Z/Z 03nSSI 39NVIldW09 31Va 1 03flSS 1 W113d 31V a V3NM0 HO 83a11n8 Oj X/70 --tzA.0 SS3VaaV I 3WVN WA3 11 V1SN1 39V111A ON 1IWV3d 39VM3S� / NQlIVu? •Ol ��'ry. �. 1 � r _ /�.� � � � ` i /� e� � � � L � �'. i n ��� ;� - No......................... _ FEE.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD-OF HE LTH �®�/<✓_ Applirutinn for Dispao t Works Tomitrurtinn 1hrutit Application is hereby mac Joe for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal"," , Sys.t�em/�at .. .�!....C�?�!.. L .......... .................... ........................�.P.:�.�-----i •--- ----------.----..........------. c 'ion Address o LotNo. t./ Owner Address W Pd! r✓_ ..!�u2/ 7 L ._1.. ........................... �, ✓ ....la.'�1 .... .._.. 5 ............................. Installer Address ' Type of Building e Lot.&4:.'F&V.__...Sq. feet _ V Dwelling— ----•Expansion Attic Garbage Grinder 1 g No: of Bedrooms — Other—T; e,.9f Building ............. No. of persons............................ Showers / Cafeteria a' Other fiztu s . ...... WDesign Flow.... :::.........; ..........gallons per person per day. otal daily flow........ .N..... ......................gallons. WSeptic Tank—Liquid capacity/'...gallons Length....,:.......... idth._.._..._._..... Diameter................ Depth................ xDisposal Trench—':No. :.................... Width.................... Total Le gthl..r._......___.._. Total leaching area._..._._._.. .._.sq. ft. Seepage Pit No }_-_�.__.._.: Diameter.../P�- ....... Depth Belo inlet-b________________ Total leaching area�.�!........sq. ft. z Other Distribution box (;.� Dosing tank'( ) Percolation Test Results Performed by... ✓�r .£`! ��� ---- f �.... ---•-- Date..... ,aa Test Pit No. 1 1�.�-_-.minutes per inch Depth of Tes Pit....................epth to ground water ------ .... f= Test Pit No. 2............._._minutes;per inch Depth of Tes Pit.................... Depth to ground water.... a / xDescription of Soil_..� SO - v� ------ ...............••••...................•--•--•-•----•--••-•---••••-•-•----•-•-.....••--••-•-•----•._...........--- U ..r..�.�.. � - -----••-- •---•--••----•••--...•---•...._..--•...-•--•--•--•-•-•-••---••••••-- •----- ------ y� -�, Id v :s ... t` . _��-!`�r_ ............................................................--------- U Nature of Repairs or Alterations—Answer when applicab e_...: ............................................................................ ..---------•---------•....................).•--••-----•--•••--•••---•-•-••-•-••••----..............•••........•-•-------•--•••------•-•-•-••-••-------•-------------•-------•--•--••..............•---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iI;'L p 5 of the State Sanitary Code— The'iindersigned further agree not to place the system in operation until a iCertificate of, Compliance°has been issued by the ard o lth ti�' k = Sign ! l�Sl ..............• D - �'r _ ..__ at e Application Approved B D. Application Disapproved for the following reasons---------------•--------•••......---------------=-------------•--------_----------------•----•------....----...._ ••-•-•-•----••-•••••---•••-•-•---••••-••-•--••-••....._................................................................................................................................................. Date Permit No......................................................... Issued---Z: _A� ^`` .. -- f Date y'.?ti 41 No.................... Fs$ �.................. THE COMMONWEALTH OF MASSACHUSETTS BOAR F cNLTH ...... ................OF..... .......................................--------............._..----•• Appliration for Eli Voii al 19orkfi Tonstrnrtio' frrmit Application is hereby mad fora Permit to Construct ( ) or Repair .( ) an Individual Sewage Disposal S stt Y .............. ......................... /. ........................... 'y Lo ion Address or Lot ANo •�- i . L. g1.f1ti . . el.., Y:J.l lYtr!.............. r r Owner Address - .Rz.... 1�: /� ../;� iG+!Y�ti _-_-t�/ � •6 %�i2...... ., M Installer e Address Type of Building e Lot../K lO..V_..___-_Sq. feet U Dwelling No. of Bedrooms._ Expansion Attic ( Garbage Grinder " l w- ------------------- a Other—T e of Building _______________ No. of persons.............................. Showers — Cafeteria Otherfixtu . • --••-•-•------------------..........-•--•---•-• - W Design Flow_________________:.._.._ :...__._.________gallons per person per day. Total daily flow......... ..............:.__.._gallons. WSeptic Tank—Liquid'capacity/ __gallons . Length................. Width................ Diameter................ Depth................ x . Disposal Trench—No. ..................... Width.................... Total Length.___ __.___......_. Total leaching area.._.._ _._._ sq. ft. Seepage Pit No._......_ ...... Diameter..../. !.....:... Depth below inlet___._...._: Total leaching area.4A' .sq. ft. Other Distribution box Dosing tank Percolation Test Results Performed by__ � ... % �.%�*tepth ._._._--- Date__: _ _ _ ; Test Pit No. 1__ minutes per Inch Depth of Test Pit...'*..'........I to ground water & Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water____1 ?!s' ._, °�fl �° ; ................. t :___..._......._____............................................................................. - O Description of Soil t -Pq -•------•-------------------•-•• - --________....--- ------------------- - se ......................................a� - -------"' 4'.....�---.:�.� �� � ---------•----------------------...-•--•---•- U Nature of Repairs or Alterations—'Answer when applicable------- ________________________ .------.--------------------------------------------------------------------------------------------------------- ...... ----------._....---------------._..........---...... ............... Agreement lo, The undersigned agrees: to(install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'TTLE, 5 of the State Sanitary Code—The undersigned further agree not to place the system in operation until a•Certificate of C mpliance. has b�een issued by�the boards of th b - Sign(d �f Application Approved.By �; y,#h '•Z= -------- Dat - Application D spproved-f'or'the following reasons:. -----•-- -------------------------•------•-•----•-------------••----•-•------•--•. . ....... a , • .........................................................................................................................................._..._._..................._.............___.................... F 3 Date PermitNo..................................................... - Issued-......................... ....................... - Date THE COMMONWEALTH OF M:ASSACHUSETTS BOARD HEALTH 'hF/ ........_OF........... ........... .....t......... Tutifiratie of Tomplianu TIUS IS TO C RTIFY, h`,t they d idu Sewage Disposal System constructed, ( or Repaired ( ) by "P ------------ _ ------------ ....................................----•-----• -• ................. Insta :r has been installed in accordance with the provisions of r ojf he State Sanitary Code as describe$ in the G-�)...---- --•--- dated--- application for Disposal Works Construction Permit N .__ , THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST E® AS A GUARANTEE THAT THE a SYSTEM WILL FUNCTION SATISFACTORY. < --DATE::.... �c ------.....-•----....--•.....--- Inspector--- .......................................... t , TH£<4( E3M�v1 TN `AETFfcOP"MASSACHUSETTS 'i BOARD HEALTH 'l 1��`` ... ....OF... . ''��1.... ............................................. . No.....:......�G r�: FEE.._�::.$--.:........ •. <: iI�r1IFal k� ftiltruth"Permission i hereby granted..-------- . .•-- _._.. to Construct ( or Rep ', ( ) a ndivldualci S as e D�isPosal ys at No.. «r /, r ...... ,.. -; j�` '�a f. .. ... �::��.............. 1`'E,' Street �. as shown on the application for Disposal Works Construction P No._ _:'. �_____ <�Dated..____ 5 y'7 4 ....� . _ . ............................_ -•: Board of Health ' DATE----- ..........................._ • ---..................................... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS - ,,A..�' - No......................... FEs.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....... .................................OF..................................................... ApplirFa#ion for Disposal Murks Tontrttrtion rumi# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ................__.............................................................................. ......-•--••••-••-•••----•••-•----•-'---••-••-----••--.......-----..........--••-•............---- Location-Address or Lot No. ......................_»........................................................................ .................................................................................................. w Owner Address ..................... ......... Installer Address UType of Building Size Lot-------------------_--------Sq. feet Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Buildin a Other—Type g ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ------------------------------------•-----------•-------•-----------••---•-•------------------••......-•••-'•••--- w Design Flow............................................gallons per person per day. Total daily flow......................._....................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---_............ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area____..----__._..-.--sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water........................ fX4 Test Pit No. 2................minutes per inch Depth of Test Pit:................... Depth to ground water........................ a •----•--•-•.................••-••-•--••-••.....-••••-•••....•••••-•....--•••-........._...--•-.........._...............--•••-•-'-••-•••..................... 0 Description of Soil-...................................................................................................................................................................... x w UNature of Repairs or Alterations—Answer when applicable............................................................................................... •--------------------------------------•----------••---......._....--------....-----...........----..........------------------.---------------------------------._....-------------•---•'----••....--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed...................................................................................... Date ApplicationApproved By.................................................................................................. Date Application Disapproved for the following reasons-----------------------------------------------------------------------------•---------------------....•••....... Date PermitNo......................................................... Issued.. ..................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........................1.7...............OF...................................................................................... Trtifiratr of TontpliFanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by-------------------------------------------------------------------------- ------ ------------------------------------------------------------------..__....--'- Installer at...........................................----------------- --•--------------- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated_-...__---.---.____----......................... TIME ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM-WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................O F...-----............................................................................. No.---•.................... FEE........................ i po atl ork Tuonstr ion anti# Permissionis hereby granted.............................................................................................................................................. to Construct ( ) or Repair ( ) an Individual Sewage Disposal System atNo........................................................................................................-------•-•--------•---•------•••-••-•----•-••••-••----•••---•••--••'••................. Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... ---------------•----......_..--------...----------------------------...-----'-•••...-••-........--_...._ DATE. ---------------•---------•----------.........................••.............. Board of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS • 'S ' t. No......................... F:ms............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................O F......................................-----...--------........-----....................... Appliratinn for Bispoii al Works Toustrnrtinn rrntit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ................__......_...................................................................... --__..-•---...•--••••-•----•--•--•............-•--•-•-------••-•-•--•-......_..................--• Location-Address or Lot No. ......................».......................................................................... .....................................................•............................................ Owner Address W Installer Address 4 Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Ga Other fixtures ..-----•---••-•-•••----••-•-•-•• . w Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ 04 Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......--.............--. a •-•••---•---------•--••••••••-......•••-•---•••••--•••......••-••---•-•-----•--•••••-•-••-•---•-_...•••-•.............................•••••......•--•-••----- 0 Description of Soil........................................................................................................................................................................ x c, •-•-•-------•••-••••---...•••-•-••••-•--••-•---••--•••-•---•-•-••-•-•...•------•-•-•-----•--•---••-----••---••-------•--•---••------•--•......-•---•-•...........................•-••---•------••--••-•- w U Nature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of�iTLz p of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed...................................................................................... .......................... Date ApplicationApproved By-------••----•-----•---•--•-••-•-•-------•._....•••-••-••--•-•-•----••-•......-••-----•--•--•-••. ........................................ Date Application Disapproved for the following reasons:.............................................................................................................. .....•-•-•......•---•-•--•--•-•-••---•-------•-••-•--•••-..........•-••--------•-----•-•••••-•-------•-........................•-----•----•-•--•••---------••----••--•••---••-•--•---•--•-•-------•--•••. Date PermitNo.......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.................................................................................... Trrtifirtttr of Tnntliaanr�e THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by.............................................................................................• --•-••.......-•--•--•-••.....•-•..........--•---•-•-•---•...--•--._-- ------------.....---- Installer at...................................................................................................................................................................................................... has been installed in accordance with the provisions Of TITLE j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector..................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................OF..................................................................................... No......................... FEE........................ Disposal Works Tnnntrttrtuan rrntit Permission is hereby granted.............................................................................................................................................. to Construct ( ) or Repair ( ) an Individual Sewage Disposal System atNo............................................................................................................................................................................................... Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... ......•--------------------------------------•--------------------------.....----........._......-_...._ Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN, INC., PUBLISHERS t t a oil 14 `Srq•rE: xSI.N i 1 i i A 1' t 1 1 I tr+ t I t+i # • d} Tl�r s t na4 ' t}q:r S C Y Y; x` /✓D g . .Z 3 3 O. �--� a I {1 C �� r ?i 0I"A ct r�i tt It + Rrra 1-4 l 2. oto 0{ ) t T 4 4 0 1 - ,' tar Cr.� t ;i - .` - x � t r ( - t '•,} ki�,�fit"S'a f1.l ��#W' -, r �a } r 1 r��t f y l ,s l+�{ ,*�•tlfy aC '.',� a' t O ` �� H/ - I tix�' F ,sSp{rlhY J`{t `S t �W4 tr � � f#�Y S.t 1• �., Y + O 0 is�. ®�er�' ,, � •M,1 a }T <i '`IK It�lt i J 's i�1s zaEt r5N joL•n •, rl1C e't{ , i �• _� '' t '" K y_G rH �.- i I+ ,f ,,yi }y�3i a J I f— �' F. r i c• i,t v y k Y�i: rn 7tqJh ; #tF! r .•I LY 4t r � T# T .,`is _ J '47- �Zt ..�4• \ k is rs �,' !r 7 y" t 7�t• }i'•a irsi'N* + ',�Sril4 xt Va " k r • ,} sd +R s± e 4�L t I, + t 0 0 ' s .*: y • t , 't iTt ik:: I r =R yam„ :. �� d •� 'J C t:.. •4 ` '•t-fir ' �y A 4r $rct ¢V' V - - Iv Y� 1,.Gw '• t S �. < N • es { ZS7 .V3 1 tt a c <r�'� 'l �i - !4}r th. +g,+ t -r a 't �t '�-� 6�rT�� 00, Di J M s C,, wt A't e ro sy 't X. • + t;' . - rSes i f .� I r 7} C z fd �, It E# 11 1 ..w E T. 1 {, 1 t '.r �•ZU 'd V r s'•r ! " �,aY"g E s irT Adz i a sk � i�xr��r ,.t't >+trpi s kT. i . ..p, o' • y y 0 rZ 4M1"1 { L r �.. 6r� �` 8 3 z 7 �A, �J '� J Q' i �i� 7t-lq r pp it" Cat }Itl ,+{� 3 a }/— � � Y,;- , • s S. d: }�} � ,j 'n" sr"�r#- A'tCr,.;,r�'rai s t. •'�' y #} �` Y -r l ,•/ Ii/V �a �/ 4�1 r k., L(ytt ,� ,t �I •.. l t3Oft":". -- ,+ ` ,Y,y �� ' '9r'�! ; . a. i 5 { �"�� s ' t'•�`` r , f • k t �+.ETy{�M til*�e s V t A r�'x'• i t tlfi E' (4-t }\' �, `•• � •• ,' t t #,dx y S,k �'' Et r k- 4 tj, Sty t) a .:�• � s. �, +,a ,{ t 'y•« at � y t.k t �� 'a34 ,e -`, r ' ..�, `ttP`.. • f 3.I: . s!ay6����n - .t, - - A".r{ ` �e•i s i f::ti ° lY Y a t w1'a.�•? uv., OF t h a 'fit E�ka 1 F '' +' it t ! •'��,�- gss9 s �. ROBERTi.P. T E,•f E?eT..,�Nl t �• 1r ; C.7 'BUNIKIS N0.221,62 w it y Y I� e .i� t ' C � Q/ . . • ,Yl,y+r..�w� s.. itT,r �•t Ci '�w � \ e a 'P G '`t' J .'J; 1 t r.- r � 3 7= �+ 't LEGEND o�FsMEa��� SONA►:� CERTIFIED, ' PLOT . FLAN t EXISTING SPOT, ELEVATION Ox0 ,, 'EXISTING CONTOUR — -:0 cl}�N =R0 4 r ('1NiSHED SPO.T� EI:�E-VATl-ON 0 0 — - l �- �-T / t F t Ott, �-FINISHE®S CONTOUR" 0 — - /%e�/✓f!/�s a � + �E Si M A•P?ROVED,= BOARD . OF�HEALTH !N r a' a TA 2 •OAT:E' AGENT SCALE:. / �D. DATENO�il� jl I. CERTIFY THAT THEE :.'P6tOPy0S t� �®cE En�ci�vEE�e�G co i�v ,..,,p -- -1 CLIENT � G> ' EGISTERE REGISTERD. EI JOB N0. 7.g0.3 Z BUILDING SHOWN ON .THIS PLA� CIVIL LAND CONFORMS TO THE • ZON►NG 1, }•� E.PiG'INEER SURVEYORS — OF BARNSTdBL , " MASS. - 33VNOq. MAIN .ST 712 MAIN ST. CH. BY _ 3 . O; MOUTH, MASS. HYANNIS, MASS. / � carts ! SHEETS F --- :w"0 DATE RE,G. LAND SUFt t M Ali. /V 0 .7Z A6 t 6 <OR 4i A Hily e AffrM jp W_ 4, ID 4SAPA-�PJ -AIA GNQR&r v m OT.. 0-4.V Y CAST 7' /IVOAI, co JYMMKI y �7 25% �V/m A- 0011iliF C 1_,FA M -5'ANAS) ILL eACAe L149411D LEVEL IR01V =/Pz OF //a D1577. WA5HeD 57-OIVAE AAAK 4 PER P7. S,&,Frr1C r_ 314 0 WASNAFP 57,0NE 7 -5.=AEoC'A6 0,jo 0 0 s 0170 0170R e(P411V IAIVZA-r &ZIEVA714INS :,,fI—le V..(T /AtyzR7- Fr FT. VIA c SEE/,V`4�FT .WP7/C -r.4NK 14,10 "Cr SEPTIC 7AN.A4 2 5, P7- 1A14,F7'4Pll57)?14011T101V' BOX 9 5-' GROUND WATER TAjALE -rl 0/V o m 0V7LE7,D157_Rl0irr10N BOA v P. 1 =7 INLET LEACHING 400,11 PASR"AlL SKS7WM r- ATID MIL A SEAoc CH11VCw-, VT I-Al A CAL-E DRslatv cdq I r. 1c, c, NUMBER 4SER of 4YEDmo 401ws 3 Cw4,RdA4G-lTjP15R05A-L UOV/7 SOIL. LAG Ws ro 7,A 4 esr,144-r,-D FLOW V SO/4 ?EST SOIL-7-=S7-02 497 A, 6vr,4A-4CqllV6 P'17-5� ;��,oA 7e 40.=_5 0,/-I_ TZ-5 7 NUA48E ebe '0 = 'L C/ By aorrom Ls4cA(1,v&,P,-R p/r 7 w Ar MJ)VIINCH ALL 7'0r.41__,LZACH11VCr .AREA sap RAlrle Z_ ,es:.,qvR 4E4orN1,ov6 AREA SQ _J0 -7 16 &fA 40 K BE UNIMS 62, Z. V vr� S_ V 7w . TOP OF FOUNDATION PROVIDE PRECAST CONCRETE EXTENSION 5" DIA. OUTLET(S) ELEV.= 43.2 RISER WITH CONCRETE COVER TO WITHIN REMOVABLE CONCRETE COVER FINISH GRADE OVER CHAMBERS = 42.50 - 42.83 GENERAL NOTES TO WITHIN OF FINISHED GRADE SLOPE @ 2% MIN. OVER SYSTEM 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION 6"OF FINISH GRADE OVER OUTLET COVER. 4"SCHEDULE 40 PVC MIN SLOPE 1% 3/4"TO 1-1/2" DOUBLE WASHED STONE TO CROWN OF PIPE METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE FINISH GRADE @ FND. EL.= 42•5' FINISH GRADE OVER TANK EL.= 42.50' FINISH GRADE OVER D-BOX= 42.501 2"OF 1/8"TO 1/2" DOUBLE WASHED STONE ENVIRONMENTAL CODE AND ANY APPLICABLE LOCAL RULES. F2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD 20" MIN. ACCESS COVER OF HEALTH AND THE DESIGN ENGINEER. (TYPICAL FOR 3) 6 IN TOP OF SAS = 40.33' PLACE RISERS ON ALL CHAMBERS 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL 3 "MAX. 36"MAX. 9" MIN TO 6"OF FINISHED GRADE BE USED IN DISPOSAL SYSTEM UNLESS OTHERWISE NOTED. PROPOSED 4" 39.50 36" MAX. BREAKOUT EL = 40.00� 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN SCHEDULE 40 PVC ELEVATION =40.33' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS MIN.SLOPE�2°k 6" 3" 2" DROP MIN. PROVIDE WATERTIGHT N ON PLAN. 3" DROP MAX. 3" 9" JOINTS (TYP.) A 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF Ijopo o THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. 10" 4"PVC IN FROM � � � O ppp O pp 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. 14" 4,0•50' SEPTIC TANK 4' PVC OUT TO o �o 41 .90' R A GARBAGE DISPOSAL. 40.75� " LEACHING FACILITY oo o0 00 0 0 0 00 77. LOCAL BOARDTHIS SYSTEM IS NOT OF HEALTHGNED AND DESIGN ENGINEER OBE NOTIFIED PRIOR TO 12 2' o 0 0 0 0 0 00 0 0 0 0 0 0 0 o po C) o CD CD 0 CD opo BACK FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR o p o 0 0 00 00 0 0 0 0 0 o p o 0 48" OUTLET TEE 40• MIN. 39.83 0 CD p o 0 0 o p o 00 op o p o o p cS�p o o po 0 CD p o 0 opo 00 D 0 o p p p oo p p ooC) 00 opp p CD p p o p CD o 0o INSPECTION. SYSTEM IS NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING GAS BAFFLE 6 CRUSHED STONE o0 o p o 0 0 00 o p o 0 000 0 0 0o p o 0 0 0 0 0 0 0 0 00 0 o p APPROVAL FROM BOARD OF HEALTH AND DESIGN ENGINEER. OVER MECHANICALLY - 8. ELEVATIONS BASED ON ASSUMED DATUM OF 42.00 MSL OBTAINED 26'± COMPACTED BASE 1.5 6 0, � 1'S 4 0' 3 0� 4.0' g. CONFROTIRACTOR SHALL V CATCH BASIN ERIFY IFY ALL UTE AS TILITY LITY LOCATIONS PRIOR TO CONSTRUCTION PIPE LENGTH 5 OUTLET DISTRIBUTION BOX 27.0' (NP.) THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE 6"CRUSHED STONE TO BE INSTALLED ON A LEVEL STABLE 31 .72' //Mottlin OVER MECHANICALLY BASE. FIRST TWO FEET OF OUTLET Z7.50' GROUND WATER ELEV.= l g) 11.01 AT 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY COMPACTED BASE PIPES F BE LAID LEVEL. DISCREPANCIES TO THE DESIGN ENGINEER. PROPOSED 1500 GALLON CONCR TE SEPTIC TANK 4 - "LC 6" CHAMBERS 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONCRETE LENGTH 10.5' WIDTH 5.66' DEPTH 5.58, CROSS SECTION VIEW 5'MIN. STRUCTURES SHALL BE MADE WATERTIGHT. . TYPICAL CHAMBER PROFILE LC - 6 CHAMBER DETAILS CHAMBER END VIEW 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR SEPTIC TANK PROFILE DISTRIBUTION BOX DETAIL NOT TO SCALE ZONING REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH NOT TO SCALE NOT TO SCALE DETERMINATION FROM APPROPRIATE AUTHORITY. • _ r,� •-, - 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS . is * • t+1� • ` TEST PIT DATA LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE THEY SHALL WITHSTAND H-20 LOADING. MAP 291 r 131 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND • • • , AGENT: FINES. MAP 291 PARCEL 61 (�1 • EVALUATOR: John L. Churchill Jr. P.E. • . +. 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND PARCEL 270 . ore Q DATE: December 8, 2003 UNSUITABLE MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF • 4 • !I 1#:PIT� TEST LEACHING FACILITY. REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN r! _ COARSE SAND FREE FROM CLAY, FINES OR OTHER UNSUITABLE MATERIAL IN ELEV TOP= 41.72' ACCORDANCE WITH 310 CMR 15.255(3). a ` M 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN 1 S810 ' ,r• , ELEV WATER= 120"Mottling SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. MAP 291 �\ 3630"E w @ PERC RATE_ <2 Min/In 16. PROPOSED PROJECT IS LOCATED WITHIN: 120.001 u.P.# sa ASSESSORS MAP 291 PARCEL 060 720/5 = c%j • DEPTH OF PERC= 32"-50" PARCEL 60 4 f- . . 14,400 S.F.± - CV) w •. OWNER OF RECORD: DAVID H & ELIZABETH A KENNEDY JR. MAP 291 W x I Z �s ,/� TEXTURAL CLASS - ---1 ----- ADDRESS: 19 SAINT CATHERINE AVENUE o . if HYANNIS, MA 02601 PARCEL 271 `-"' o J •/Ie 0 41.72 ov E� i v • 00 ;• Loamy Sand FEMA FLOOD ZONE C co C%j 0 A PROPOSED 1500 Z �\ : 91, 409T. 10YR 3/2 AS SHOWN ON COMMUNITY PANEL# 250278 0045 C GALLON SEPTIC TANK HC(1) W �- . ° �' 17. PLAN REFERENCE: * ( 1. SHEET 2 OF SUBDIVISION PLAN#14034-H, DRAWN BY WHITNEY&BASSETT, SURVEYORS„ (1) # 19 CS B Loamy Sand g8 72' DATED JUNE 1963 16.3' EXISTING ' * a 10 YR 5/6 2. SAINT CATHERINE AVENUE TOWN LAYOUT, MARCH 31, 1977 r " DISTRIBUTION OXD 3-BEDROOM / LLI q 30 39.22' ,� ��� 18. DEED REFERENCE: I DECK DWELLING - • ��, - " 1. CERTIFICATE NO. 131389 PROPOSED FOUR"LC-6" 261' ' K C (2) TOF-43.2' / /••• Perc 32 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL.CONDITION. LEACHING CHAMBERS �' 120, Q •• �t5 50" 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS!PLAN IS TO BE USED ONLY (4) j DRIVE LU �� Medium Sand FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY (3)` co z }O C 2.5Y 6/6 FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. CB/DH N 12.01 J 20%Gravel (FND/HELD) HC (2) LL► p 20.0' / 10"TREE GARAGE / o Z Q o B.M. 120" Mottling Observed 31.72' EXISTING CESSPOOL TO BE _ M o I w (� �� Catch Basin Grate 7.5 YR 5/6 PUMPED AND REMOVED ov o ? o N W Ass =40.00' LOCUS PLAN No Groundwater or . o �-/ Q z Assumed REMOVE UNSUITABLE MATERIAL AND 10 p' 11•01 (5) � a Weeping REPLACE WITH CLEAN TITLE V SAND � / 0 co SCALE: 1" = 1000' 168" 27.72' 3-10" / `* Lu OAK O IRON N81036' SHED `, ;�l W ' DESIGN DATA LEGEND PIPE 30"W MAP 291 120.001 TP 1 -L EXISTING CONTOUR 5 TREE r 1 ? 1.72 /� -- -- (� -- - PARCEL 272 4-10" / ® 50 PROPOSED SPOT GRADES OAK PROPOSED CONTOUR ,I NUMBER OF BEDROOMS (ASSESSORS) 3 -.-40-J� NUMBER OF BEDROOMS (DESIGN) 3 MAP 291 DESIGN FLOW 110 GAUDAY/BEDROOM E/T/C - EXISTING OVERHEAD UTILITIES TOTAL DESIGN FLOW 330 GAUDAY PARCEL 59 CB/DH DESIGN FLOW X 200 % = 660 GAUDAY W EXISTING WATERLINE (FND) USE PROPOSED 1500-GALLON SEPTIC TANK TEST PIT LOCATION Q Q Q PROPOSED 1500 GALLON SEPTIC TANK SWING TIES INSTALL 4 - "LC 6" CHAMBERS WITH 1' OF STONE 4"SOLID SCHEDULE 40 PVC PIPE DESCRIPTION HC(1) HC(2) BELOW ❑ DISTRIBUTION BOX SEPTIC TANK IN (1) 18.6' 31.8' �O LC-6 LEACHING CHAMBER SEPTIC TANK OUT(2) 26.6' 27.0' SIDEWALL CAPACITY D-BOX(3) 36.3' 22.5' END CHAMBER(4) 38.0' 25.9' (LENGTH +WIDTH)(2)(2' HIGH) (.74 GPD/S.F.) = GAUDAY (27.0'+ 11.0') (2)(2') (.74 GPD/S.F.)= 112.5 GAL/DAY END CHAMBER(5) 55.8' 29.1' BOTTOM CAPACITY (27.0'x 11.0') (.74 GPD/S.F.) = 219.8 GAUDAY REV. DATE BY APP'D. DESCRIPTION PROPOSED SEPTIC SYSTEM UPGRADE TOTALS: PREPARED FOR: DAVID KENNEDY TOTAL NUMBER OF CHAMBERS: 4 TOTAL LEACHING AREA: 449.0 SQ.FT. LOCATED AT CB/DI TOTAL LEACHING CAPACITY: 332.3 GAL./DAY 19 SAINT CATHERINE AVENUE (FND) HYANNIS, MA 02601 RESERVED FOR BOARD OF HEALTH USE SCALE: 1 INCH = 20 FT. DATE: DECEMBER 21, 2003 NOTE: 0 10 20 40 80 FEET �1 LOCUS LOCATED IN THE TOWN AQUIFER OVERLAY BUT YM OFM PREPARED BY: NOT IN THE DEP APPROVED ZONE II ��or�CHUURCH LLcy`a�w JC ENGINEERING INC.�R No a 807 2854 CRANBERRY HIGHWAY EAST WAREHAM, MA 02538 SITE PLAN - 508.273.0377 SCALE: 1"=20' 21Z.113 Drawn By: JC Designed By:JC Checked By:JLC JOB No.595