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HomeMy WebLinkAbout0592 SCUDDER AVENUE - Health 592 SCUDDER AVENUE, HYANNIS A= 287 014 y � F. i I f j t TOWN OF BARNSTABLE LOC�'JION SEWAGE# VILLrAGEI ,, y,hpe1ASSESSOR'S MAP&PARCEL -.Y112/ y3� INSTALLERS NAME&PHONE NO. 9—s '515 SEPTIC TANK CAPACITY /J®0 LEACHING FACILITY:(type) 46-3.30 (size) /.2-X 60 7 XI-Y, NO.OF BEDROOMS OWNER PERMIT DATE: /�0�,5'-OY" COMPLIANCE DATE: w. 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 0 ® 9 � Y r t . No. ter. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Ye Application for ]Bi9;poga1 *pgtem Con0truction Permit Application for a Permit to Construct( ) Repair( ) pgrade Abandon( ) ❑.Complete System ❑Individual Components Location Address or Lot No. 5 qa U va Owner's Name,Address,and Tel.No. J//AG^i cJr4 09.vDA C94 Assessor's Map/Parcel 8 7 (JVA f6 -77.30 d K �-)v jozvp, _57'Z.0ifz;,ge 6_3/ Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size p'_574—A'=A3sq.ft. Garbage Grinder � Other �Ty�e of Building /���'/�'G1JC�' No.of Persons ° - Showers( ) Cafeteria�10 Other Fixtures Design Flow(min.required) $� gpd Design flow provided �� gpd Plan Date /v21l d Lo:Z Number of sheets Revision Date f Title S&laT6 e S P Size of Septic Tank % �'�Q Type of S.A.S. IP 4f04 7r4C CEAcd� to C_ Description of Soil Al l7v __5 4—A S A0 6�7 � Nature of Repairs or Alterations(Answer when applicable) U c R*T e - Date last inspected: LAY a TO 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 e 5 of the Environmental a an no place the system in operation until a Certificate of Compliance has been issued by s oar of ealth. �1 r Signed ° '�!( ate 6 Application Approved by ate Application Disapproved by: Date for the following reasons Permit No. Date Issued •ter:; —————_——— ———————————————————-- i _ �- .`^�...�.d '..,,-e•.T._.�-,,.C,,c-,•^,,, F- .,�.�. ,�, �`"`.v'�.rr•i.9.-'t,�w 'M1-.: >.�ar1'b"",,r,4r., . l � -- 1 ,r ti �V No. ��raf Fee if THE COMMONWEAL TH_OF MASSACHUSETTS Entered in computer: Ye PUBLIC HEALTH DIVISION- TOWN OFBARNSTABLE, MASSACHUSETTS 2pplication for ;h5po5al TVs; Cem Construction Permit ;. Application for a Permit to Construct( ) Repair( ) pgrade Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. ,J�9� SG(UrJ� V Owner's Name,Address,and Tel.No. r Assessor's Map/Parcel �$7 Q 11 ®ry( � 77.33 FOKZy7W.AjL-yA. Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 5`F` .4)rr, W 2 AJ y C— E-�t►�,.vE .Jc�— Type of Building: O Dwelling No.of Bedrooms Lot Size `5� D;sq.ft. Garbage Grinder Other fiype-of Building 1� rjE}��^ No.of Persons �' Showers( ) Cafeteria(Aj a Other Fixtures Design Flow(min.required) _11T$`0 gpd Design flow provided gpd Plan Date i a l�a Number of sheets Revision Date 4j4- s; Title T/C .S S r 6W Z)r AMA GE 5f� - Size of Septic Tank /S.0® Type of S.A.S.' eUCTEC LEdG6! ee ,ls(, �5 Description of Soil _54.A/fl"b /Yu r' Nature of Repairs or Alterations(Answer when applicable) K D j 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.th'e)provisions of T, le 5?f the Environmental o e an no place the system in operation until a Certificate of Compliance has beenssued by s card of ealth. 7 Signed � 0 r ate `R lie/,-0 ,/ Application Approved by C ate• / Application Disapproved by: Date t for the following reasons Permit No. �^ Date Issued ——————————— ————————— ——————=———————————-- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance r THIS IS TO CERTIFY,that the On-site Sew a Di posaI System Constructed ( ✓) Repaired ( ) Upgraded ( ) Abandoned( ) F C- Q' �/�i?'h' PS r • P�9)/ �`yv IO I>L/ ©'h S�- hays)been constructed in accord ce with the provisions of Title 5 and the for Disposal System Construction Permit NoA007777 �/` 3 dated Installer Designer #bedrooms Approved desi ow gpd WI The issuance of this permi shall n t be_ o strued as a guarantee that the system wi !u on a esigne . l t: / /� ❑� Date r Inspector / '--- --'{--/---------------- ---�—.---------- No. ?, Fee— 15 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS x1i5pozal *p5tem Construction J)ermcit Permission is hereby granted to Construct ( vl� Re ai ( ) Upgrade ( ) Abandon ( ) System located at 117Lj/9&L�1/ 4,11 I ' and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction must be c m�leted wit,in three years of the date of this p > Date Approved by ` _ a � Y f Town of Barnstable Regulatory Services Thomas F. Geiler,Director 1ARMABIA hUmg Public Health Division iG3q.. �0 Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: 2 z9 5- Sewage Permit# ZOO7-JC73 Assessor's Map\Parcel 267 Giy-ooz . . Designer: Sdzv,h e n A l.J;l s cn41 P.e. Installer: 1,ny,y, tfi Cun -t Address: 113ati�doe Address: P.o, r3 7o Y i�7 &Jar+ Zf. E- -&Vn,ts 02g.01 VMarsly"s 11'Iills. C72is�lB' On / J?-s Zoo &chQIa Ifi C-cin st'. was issued a permit to install a (date) (installer) septic system at. 59 Z Se u cQcQer- A we . U-f4mur Rrt based on a design drawn by (address) r S1m12&,.,., A Cat esvH dated IZ1I0/Zc)a7 (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of4he T distribution box and/or septic tank. j r.? I certify that the septic system referenced above was installed with major ch.nges (i e. greater than 10' lateral relocation of the SAS or any vertical relocation of any c mponent of the septic system)but in accordance with State & Local Regulations. Plan revision or certifi a tii iit,Vy designer to��11ow. w" t? p* STEN A1.J..YN (Installers Signature) + Rd�+.3"J311I. esigner's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form 3-26-04.doc � 2 007-0 5, Town of Barnstable P 4. �TME �o Department of Regulatory Services eAar+srAe[.E. : Public Health Division, Date y MA88. t61q, Cep 200 Main Street,Hyannis MA 02,tl1 PrEDMA�A Date Scheduled Time Fee Pd.. Soil Suitability lssessment for Sewuge Dispos' l .o . Performed By: r/L 6///SCyI, Witnessed ByLa,�/l//K Zoj z�0� / l LOCATION & GENERAL INFORMATION Location Address 5-�Z SC vc/44R. e w n� Owner's Name A y1 C4�j C y-*Y t r /7 1''a fa• G�rk 8 Address �bco vo\nt In po,- - Assessor's Map/Parcel: Moo 28 7/PcoI 6I4j-00 2 Engineer's Name 5, � W I (co.. NEW CONSTRUCTION REPAIR Telephone# t Land Use Slopes(%) Surface Stones Distances from: Open Water Body It Possible Wet Area It Drinking Water Well ft Drainage Way It Property Line It Other tt SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) � C,.- .•. ..�\. , r^� , `ram - J ' _ 9Li f!N , ----� N _ �.u/ :•r{p;%�, •,,�; //�� .. r:'" ,._ iin:^� —�..pn,—r rw--�.w y, ..'.V 1. l o f : . Parent material(geologic)�I o c t t( Depth to Bedrock Depth to Groundwater: Standing Water in Hole: Weeping froni Pit-Face. Estimated Seasonal High Groundwater r DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles:' Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level— �r PERCOLATION TEST Date Time /dX0 1401 Observ<<tion ._ . Hone#.-?.F._....,� ,,.._. _. -___._/� _ _•� — — - Time at 9'__ !O:2 S•- �/©.�" Depth of Pere G4/ Time at 6" /Q :3 Q :t7 Start Pre-soak Time a 10-Ds D' 3 5 Time(9"-6") o" •:,M1•l End Pre-sonk /O,'Zo 24 1,!6 Rate Min./Inch Site Suitability Assessni6t:" $ite Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division of least one (1) week prior to beginning: Q:HEALTH/W P/PERCFORM Ilk Z07—O5? DEEP OBSERVATION HOLE LOG Hole#_ Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling. (Structure,Stones,Boulders, Consistencv.° Gravel) wAC'bG/ems DEEP OBSERVATION-HOLE LOG Hole#_ Depth from Soil Horizon Soil Texture. Soil Color Soil Other Surface(in.) (USDA) (Munsell)' . Mottling (Structure,Stones,Boulders. _ Consistency.%Gravel)' /D Gz 4./yy` G' ✓!'1G� Sand �o `'� SAS ' '—' . . DEEP OBSERVATION.HOLE LOG Hole# 3 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Con istenc ° a el C ivt��, Sam . 10 yle W& &2 C ►'�c�; tc rope �/� -- DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Con i tei c %Gravel) 0- 7" o 50,.J 4 ok.++ o /IG a !- 'Fro" � Vhs�, s��� I � qlC -e13 Flood Insurance Rate Map: Above 500 year flood boundary No Yes Within 500 year boundary No Yes Within 100 vear flood boundary No . Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas-observed throughout the area proposed for the soil absorption system? y�S If not,what is the depth of naturally occurring pervious material? Certification 1 certify that on y /IF9.5' (date)1 have passed the soil evaluator examination approved by the Department of Envirorunental Protection and that the above analysis was performed by the consistent with the required training,expertise and experience described in 310 CMR 15,017. signature C�� Date Q:HEALTH/W P/PERCFORM t "TOWN OF BARNSTABLE =LOCA-1.10 59 0'1 _SEWAGE # VLL6AGE 1 Luc �ntSppCk ASSESSOR'S MAP & LOT $-7 01 '` INSTALLER'S NAME&PHONE NO. A0,1 SEPTIC TANK CAPACITY II /U f�C� 1 LEACHING FACILITY: (type) C o,�o lu)067. slit ' Stf` NO. OF BEDROOMS BUILDER OR A t1 Fc�S�t E 2 PERMITDATE: COMPLIANCE DATE: - Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 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 — .. H on cs I S cj i 1 e. .Wax; =. Fee---,/— BOARD OF HEALTH TOWN OF BARNSTABLE Zipplicat ion for Well CongtructionVermit Application is hereby made for a permit a Construct (ZAlter ( ), or Repair ( )an individual Well at: Location — Address 7 Assessors Map and Parcel Address Installers Driller—'—�— -- Address Type of Building Dwelling r I11� .-- --- - --- —- Other - Type of Building--=—___—____________ No. of Persons---.--.---- Type of Well _PVC--q- ----------- Capacity-- — - ---——--- --- Purpose of Well n. ti �h. Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate Co pliance ha been issued by the Board of Health. Signed _ �O /� date Application Approved By �` ( _ date Application Disapproved for the following reasons: ----- ------------—_—_____ _--_ .� _ — -- --------------/--------------------- date ---- Permit No.w (7v S^—_U f=- --- Issued-- ,)--2,/6'J date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) Installer at—_— — -- ------- — - - ------------------ — - ---- - has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. -------.-----_____Dated--------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE---_ ,__-- _ Inspector--------------_--__-_ r i No.—;-—�---- !v Fee--- BOARD OF HEALTH `TOWN OF BARNSTABLE Applicaf ton A rurt[on ermit Application is hereby made for a permit to Construct (ZAIter ( ), or Repair ( )an individual Well at: Location — Address / Assessors Map and Parcel Address Ice-CF1Pf W�-lL. Installers Driller)----- Address Type of Building Dwelling-6m-----— - - - —-- — Other - Type of Building-------__—_____________ No. of Persons--------------_------- -----_ Type of Well — Purpose of Wellpl _--Jj(:Z.kv—__—____ Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate .o Co• pliance ha been issued by the Board of Health. Signed , —— — �X �� • ,._.�� date T Application Approved BY ______________ date ' Application Disapproved for the following reasons: date Permit No.1= S''-_U _- --_-- Issued_44)-we 3—--------- ------------------------- date ---------------------------------------------- -------_--------------- BOARD OF HEALTH TOWN OF BARNSTABLE C ertif irate ®f Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) by---- -- -------------------------------------------------- --------------------- Installer at— -- -- ------- --------- - ------------------------------------------------------------------------- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. --------------------Dated—'� THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. r DATE___-- --- — - --- Inspector--------------------------------- --------------------------------------------------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Veil Con5tructionpermit °° No. -W�O�S ��yr7 Fee— - — Permission is hereby granted �_ to Construct (�I), Alter ( ), or Repair ( ) an Individ al Well at: No. -: - - _-, c ------------------------------------------------- l � Street as shown on the application for a Well Construction Permit w2 (fl. rat No.- ------------ Dated— , . ?�U- ----------------------------------------- - �' - � --=-- - ------------------------ - / Board of Health DATE -- No. Fee--- - -- -- -- ---,-------- BC' RD OF HEALTH TOWN 1 BARNSTABLE Zipprication err Con5tructionpermit Application is hereby made for a permit to Construct (ZAlter ( ), or Repair ( )an individual Well at: .-� -�- --___«?�-- Location — Address Assessors Map and Parcel C VZ.fCf Owner;c— 7 L(—QAPL "_n 1! Address jInstallerk+ Driller--' -- u— Address Type of Building Dwelling�-Q ----- ---- -- Other - Type of Building No. of Persons------------- -- ---_-- Type of Well �yC' - �, —-- Capacity------------ ------- --- — Purpose of Well5,� .rL—__ Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate . C pliance ha been issued by the Board of Health. Signed -- a`-`t 200 date 0. Application Approved By date Application Disapproved for the following reasons: - - — ---------------- date Permit No. I.GoY- U V 0f= -- Issued- 1�-2/US' -_--- -------- _date BOARD OF HEALTH TOWN OF BARNSTABLE Certifitate ®f Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) bY—_ _-—___ _----— — -- --- -- ------- --- - ------ Installer athas been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. --.--___--_Dated---=--------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE-- _ — - Inspector—__----- ------ ------ BOARD OF HEALTH TOWN OF BARNSTABLE VrIl Con5truct ion Permit y .: No. -fir__ G_t)S =��(t7 Fee- Permission is hereby granted ';� '^ � "_C LS)R �� / to Construct (�, Alter ( ), or Repair ( ) an Individ al Well at: Street as shown on the application for a Well Construction Permit No.- W p G 0 C,�� V Dated- �1 -- ---- -------------------------------------- -- == A — -�—IZ ---------------------_..----- ( Board of Health DATE u —__— i COMMONWEALTH OF MASSACHUSETTS c� ,t EXECUTIVE OFFICE OF ENVIRONMENTAL AFF LRS DEPARTMENT OF ENVIRONMENTAL PR TiECTIOA �: 0 )ru ONE WINTER STREET. BOSTON. MA 02108 61;•292• �'0'0 �Cff� WILLIAV F. WELD I0 to" 4 1998 Governor �(Ty FPiT�(f TRl DY COXE I Secretan ARGEO PAUL CELLUCCI A !D B.STRUHS Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM L" Commissioner PART A S CERTIFICATION Property Address: 3-92 kk�G�.'s 19v1 Hyp�ti�s Nrt /d Address of Owner: Date of Inspection: y--jf_gg (If different) Name of Inspector: 7-0 �,, 0 1 am a DEP approved system ins ecfor pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: T lin Al hf a[ �►��� `pj[le Mailing Address: Ira 4 f , Telephone Number: CERTIFICATION STATEMENT I cenify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: k-11-Passes Condunonally Passes 'seeds Further Evaluation By the Local Approving Authority Fails Inspector's Signature: � Date: 1-Z/ 99 The Svstem Inspector;allsubmit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this .inspection. If the system is a shared system or has a design flow of-10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: A) /SYSTEM PASSES: k!/ I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: BI SYSTEM CONDITIONALLY PASSES: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not. The septic tank is metal, unless the owner or operator has'provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04/25/97) Page 1 of to DEP on the Word Wide Web* http:/Avww.magnet.state.ma.us/dep i.� Printed on Recvri.-I P.— SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: $192� Owner: gpAj /pSi1r Date of Inspection: BJ SYSTEM CONDITIONALLY PASSES (continued) _ Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced _ The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER ., WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. _ The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation.not valid). 3) OTHER (reviiad 04/25/97) Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1-9� fcc.114� Owner. �Hh /Osf y Date of Inspection: y/5-98 D) SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be neces$ary to correct the failure. Yes No Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or cfggged 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 172 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _ Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface waver supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well wafer analysis for cohiorm bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E) LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significX4 threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area-IWPA) or a mapped Zone ll of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater tream ent program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04/25/97) Page 3 of 10 P t I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: j�9;1 Owner: Date of Inspection: Check if the following have been done: You must indicate either "Yes" or"No" as to each of the following: Yes No Pumping information was provided by the owner, occupant, or Board of Health. _ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout. — /N GIi p�i H . _ All system components, ex,FleeFirtg�/�te Soil Absorption System, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: _ The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. ° o-� _ Existing information. Ex. Plan at B.O.H. Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) [15.302(3)(b)] ;ravimad 04/25/97) Page 4 of 10 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 074"4 ap--7' Owner: RAI Date of Inspection: y�/S 98 FLOW CONDITIONS RESIDENTIAL: Design fiow: y g.p.d./bedroom for S.A.S. Number of bedrooms: Number of current residents:_ Garbage gri:.der (yes or no):�-f Laundry corrected to system (yes or no): Seasonal use tyes or no): 410 ,�5'97S Water meter readings, if available (last two (2) year usage (gpd): 9� Sump Pump Ives or no):—&(Q Last date of occupancy: k i;d COMMERCIAUINDUSTRIAL: Type of establishment: Design flo,.+•:_-9allons/day Grease. trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ water meter readings, if available Last date of a-cupancv: OTHER: .Describe; Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of inspection: (yes or no)_ If yes, volume pumped gallons 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) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: Sewage odors detected when arriving at the site: (yes or no)_ (revised 04/25/97) Page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 517 Owner: ��h ',Ca e Date of Inspection: BUILDING SEWER: (Locate on site plan) Depth below grade: �� Material of construction: _cast iron 40 PV _other (explain) Distance from private water supply well or suction hri, Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK:_ (locate on site plan) Depth below grader material of construction: concrete _metal _Fiberglass _Polyethylene —other(explain) If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No) Dimensions: Sludge depth: 12" Distance from top of sludge to bottom of outlet tee or baffle: /?" Scum thickness: 6 �1 Distance from top of scum to top of outlet tee or baffle:,�• Distance from bottom of scum•to bottom of outlet tee or baffle: How dimensions were determined: 9'- i�")T Comments: (recommendation for pumping, condition of inlet ynd outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) -f G 4,,k s ve. ✓e cr Q GREASE TRAP: n& (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene —other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (revised 04/25/97) Paga 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: �7 S�rr Date of Inspection: y/S-g8 TIGHT OR HOLDING TANK: !Tank must be pumped prior to, or 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/da� Alarm level: Alarm in working order_ Yes; _ No Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: 4--- (locate on site plan; Depth of liquid level above outlet invert: 6 Comments: mote if level and distribution is e ual evidence of so ids carryover, evidence of leakage into or out of box, etc.) -06 A Covl� PUMP CHAMBER:_ (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order (Yes or No) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 04/25/97) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: (— Owner: / G��n�✓�o!- Date of Inspection: SOIL ABSORPTION SYSTEM (SAS):_ (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type. leaching pits, number: leaching chambers, number:__ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition of soil, signsr of hydraulic failure, I vel of pondin condition of vegetation, etc.) CESSPOOLS: _ (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 (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) i 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.) (revised 04/25/97) Page 8 of 10 I y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 5-,7,�4 Owner: A* Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells wells within 100' (Locate where public water supply comes into house) .QUO we qra G N (revised 04/25/97) Page 9 of 10 S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: �9 'SGc���lsF "� �`74iefH�J/Jvr� Owner: Date of Inspection: Depth to Groundwater ' Feet Please indicate all the methods used to determine High Groundwater Elevation: ✓ Obtained from Design Plans on record g c Observation of Site (Abutting property, observation hole, basement sump etc.) ✓Determine it from local conditions Check with local Board of health Check FEMA Maps / Check pumping records ✓ Check local excavators, installers 4"' Use USGS Data 1• Describe in your own words how you established the High Groundwater Elevation. Must be completed) 9raPe4 v►ot .4�5/ 3 7,7 mwfro Zile e 2'.S S /s bg7i,P.-e.e w -bo o w. .eA C -- A,,A /!r 74Vf 41, 1 a-)� I (revised 04/25/97) Page 10 of 10 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS a .".',DEPARTMENT OF ENVIRONMENT�,� PROTECTION TITLE 5 OFFICIAL INSPECTION FORM—.NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PARTA CERTIFICATION iJ,tip' Property Address:_ � 5C14 elo1 "Qr Ay/ ,I A/C'k)`' s 0), Owner's Name: #noi fv i1e., Owner's Address:.. �q2 Scg dgh, qi_e Date of Inspection: Oa Name of Inspector: (please print) JOAA 1. A?lf Company,Name: 041h 1-9a 1f0 041V cc S«v7e, Mailing Address:. 2 w % 51, Telephone Number: re)S--1>2 f• 7:179 CERTIFICATION STATEMENT` I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of.the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP ,;. approved system inspector pursuant to Section 15.340 of Title.5(310 CMR 15.000). The system: A. Passes Conditionally Passes ;� Needs Further Evaluation by the Local Appioving Authority Fails / Inspector's Signature: Date: 2e-' ao The system inspector shall su mit 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,4f applicable,and the approving authority. ' Notes and Comments' .,7 r' This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 %"'+' 1 Page 2 of l l OFFICIAL INSPECTION FORM-N tV0R'Vb1LUNTARY:ASSESSM�.N S- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPk(�",I'ION FORM PART A ., f,,A. .:. CERTIFICATION(continued) Property Address: Jq? Sc-We, /i,t _ lHN�t Yt �ti • Owner' H v37e-.- Date of Inspection: 4Z-20—00 Inspection Summary: Check A,B,C,D or E/ALWAYS completi'i9 ot$s S1*.R A. System Passes: have not found any information which in 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: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"sectidpxeed to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by 11 oard of Health,will pass. . Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined'please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank faihure is imminenL 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` ertificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break;oul 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 obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more thad4 times a year due to broken or obstt�t`t'54 pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Pa;e3of11 ' OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS { SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART)( CERTIFICATION.(continued) Property Address: Owner: in tlo-'05 T r Date of Inspection: Ji-20—Da C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in orde't'"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 silt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within.100 feet of a surface water supply or tributary.to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is:within 50 feet of do ' ate water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet b'yt► 0 feet or more from a private water supply well**.Method used to determine distance **This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of I 1 OFFICIAL INSPECTION FORM—NOT.FOR VOLUNTARY ASSESSMENTS i SUBSURFACE SEWAGE DISPOSAL"SYSTEM INSPM-LONYORI PART:A ; CERTIFICATION(rontinued) Property Address. • ffY9h Syo � - Owner: Date of Inspection: D. System Failure Criteria applicable to all systems:. .....;, ,' You must indicate"yes"or"no"to each of the following for all inspections Yes No 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 •Z Liquid depth in cesspool is less than 6"below invert or available volume is.less than '/2 day flow Required pumping more than 4 times in the last year NOT due to clogged'or obstructed pipe(s).Number of times pumped Any portion of the SAS,cesspool or privy is below high ground water elevation. __cG Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Ll Any portion of a cesspool or privy is within a Zone I of a public well. _ V Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater thaif'50•feet from a:private water supply well with no acceptable water quality analysis. [This system passgs if the aveawater analysis, performed at a DEP certified laboratory,for coliform bacteria and 6i!the organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less,than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.J N(Yes/No)The system fails.I have determined that one or more of the above faillie 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 tocon=t the failure. E. Large Systems: ` To be considered a large system the system must serve a facility with a design flow of.10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following:. (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply _ the system is within 200 feet of a tributary to a surface drinking water supply' the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large.system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART B `CHECKLIST Property Address: 5-9:2 3t14/o/lr Alt Owner: Date of Inspection: Check if the following have been done.You must indicate"yes"or"no"as to each'khe following: Yes No _ Pumping information was provided by the owner,occupant,or Board of Health Y 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? v _ Was the site inspected for signs of break out? V _ Were all system components, tic the SAS,located on site? . 1�_ 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)providedirth information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no V Existing information.For example,a plan at the Board of Health. t- _ Determined in the field(if any of the failure criteria related to Part Cis at-'issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] 5 Page 6 of 11 OFFICIAL INSPECTION.FORM-NOT FOR`YOLUNTAkY,;ASSESSMENTS . SUBSURFACE SEWAGE DISPOSAL-SYSTEM INSPECTION FORM. PART C SYSTEM INFORMATION Property Address: �g S ck��ir fj?✓t Owner: 9hil ! 'yffr Date of Inspection: go —0 v FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): y4149 Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#'of bedrooms): i10 Number of current residents: �2- ';.��;• Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system(yes or no): AL2 [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no):_.A& Water meter readings,if available(last 2 years usage(gpd) 2 A0 q Q. � � !'�'OP� •�''�u�'"}��i������1 Sump pump(yes or no): Last date of occupancy: o ec COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gnd Basis of design flow(seats/persons/sqft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no):_ Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: �a s� �^ 1 c� ._r 95 Was system pumped as part of de inspection(yes or no): If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: Alain TYPE OF SYSTEM t/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) _Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known)and source of information: Were'sewage odors detected when arriving.at the site(yes or no):.& y. rtiri 6 ' A Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: 9/1-1 o � Date of Inspection: //— 20 —00 , BUILDING SEWER(locate on site plan) Depth below grade: 341 Materials of construction:_cast iron 40 PVC_other(explain): Distance from private water supply well. on line: A1# �,�►rr Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:_(locate on site plan) Depth below grade: /5 .Material of construction: concrete metal_fiberglass_polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes`ormo):_(attach a copy of certificate) Dimensions: /O 4 " X S"z' Sludge depth: 0" Distance from top of sludge to bottom of outlet tee or baffle: 2 f* Scum thickness: Distance from top of scum to top of outlet tee or baffle: -7" Distance from bottom of scum to bottom of outlet tee or baffle:_b �'.,�►p" How were dimensions determined: 1, rtf dr Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of.leakage etc.): , y Se4t, 2 GREASE TRAP:&_(locate on site plan) Depth below grade: Material of construction:_concrete_metal_fiberglass polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: ti Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): J«V 7 Page 8 of I I .�� OFFICIAL INSPECTION FORM—NOT°FOR VOLUNTA4Y ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECSTION FORM. PARS,C. . Y SYSTEM INFORMATION(continued) Property Address: pqtSGh��i jw> Owner: tr Date of Inspection: f/—2 0--v TIGHT or HOLDING TANK: A q (tank must be pumped at time of inspectioukkrate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene+ �_other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: Ll"* (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): / e 19— -e 2 ' 2: � -c-,C- 6r � ,,^ 0"A t PUMP CHAMBER: (locate on site plan) f"I►p, Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):' 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTAI ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued),. Property Address: /2 5e H,,44-- ✓� .,rHHi S Dim - Owner: Ann dos�'ty Date of Inspection: SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: 1 leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: ;Ao 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.): // / / y L pL7Lh /7/� I DO(7 �f/�?CLt S�COHGY d�� V/J�0�+4144 e, CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,conditiyp of vegetation,etc.): PRIVY: (locate on site plan) •i} Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 rYri Page 10 of 1 l OFFICIAL INSPECTION FORM—N61,1OR VOI UNUAY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART:C { SYSTEM INFORA7iATION(continued) Property Address: crd or Owner: AlinN Date of Inspection: !J—2 D —00 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. r4 all r � 10 • Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTAR&,ASSESSMENTS SUBSURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: �9Z Gy !y ✓t Z&A4 f 44 t t, Owner:__X_i1j, Date of Inspection: //—20 —00 SITE EXAM Slope 4o/-i 5 Surface water Check cellar Shallow wells Estimated depth to ground water;N,y feet Please indicate(check)all methods used to determine the high ground water elevation:' Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS // Checked with local Board of Health-explain: `toa f_ Checked with local excavators,installers-(attach docume tation) Accessed USGS database-explain: �n,� s gf" �vcvN ���f�. �n�v* el-oaf!ti s B9rv�.N� You must describe how you a;tablished the high ground water elevation: Lv e = 7 S" d.�' h �w2•Cr ca ati�/a .,��-iT man �ti tyr ",Q� I litS% HiR!(j �1G1�✓�� L�Qf�A/li�+S /j�ls+/'f �! YDk r �j lVe,-1114 P'tat j. 11 l•Q, �y�AT'10N ��� �'��' / � ` SEWAGE • PERMIT NO. -VILLAGE INSTALLER' NA ME & ADDRESS ® UILDER OR OWNER DA T E PERMIT IS U E D DAT E COMPLI'ANCE ISSUED tip ro Y, M1 ��� r ................ TFJE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �� ----1. .................of. . ------..---...-----.._............... y- Appilration for Dhivvii ai Work,5 Tonitrurtion rrnttf o Application is hereby made for a Permit to Construct (" ) or Repair ( ) an Individual Sewage Disposal System at: ..... s z....��- -.... -------0 PT-------------------------------------------1- .... ... IFoication�-Addr ss or Lot No. Owner Address W a ....................................... ...................... ...... .................... ....--••-•--••--------....------•---••-----........_..........•---...........••....._.....•------- Installer Address U Type of Building Size Lot..... 'J_r1-CQ.Sq. feet Dwelling—No. of Bedrooms.............................................Expansion Attic ( ) Garbage Grinder aOther—Type.of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtu es --__-.•--•-•---.. .-.._. d -- -----------•-------•----------------------------------------------------------------------------••-- ----....._..-•------ Design Flow..................... �...... .._ gallons per person per day. Total daily flow-______..__...............3......�.._..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.___--__-/......._. iameter.......�2..... Depth below inlet.........C ....... Total leaching area..33.9.._sq. ft. Z Other Distribution box (r') Dosingtank ( ) '—' Percolation Test Results Performed by._. ? y�3i71.i Date ®f I a 1 Test Pit No. 1.....z-....minutes per inch Depth of Test Pit....... Z . Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.................... W ..........-............................................................................................................................................... 0 Description of Soil................................. V -------------------------------------------------------- --- � _...---------- ----------------------------- ...............•----------- 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 TITU 5 of the State Sanitary Vde— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b ""y board of health. ---- •• •••-•------....-•-•-•......•-•----------•--.---- ...... •-----• ---.....-- PP PP y-----••. -•••----•----------•••••............. ......----._ ---2...... •-- A Application Approved B .._ _ ------------------------------- ................... Date Application Disapproved f o th f ollowing reasons-------------•------------------•--------------------------------------- ....................................... ........................-................................................................................................................................................................................ Date PermitNo................................................... Issued------------------ -----•-------•-------- --------•---•-•--•...._-•-------•--•- Date ----- --�---- ---- THE COMMONWEALTH 'OF MASSACHUSETTS BOARD OF "HEALTH ...................OF...... t"14M...... -... ♦ ppliration for UiipnsFal Works Tomitrnrtinn ranfit Application is hereby made for a Permit to Construct O or Repair ( ) an Individual Sewage Disposal System at: V.J�•_�' �. 6 Jam" 1 F Location.Address or Lot No. t/ {.� _.— -------------'--- {.................... ......---------•-•--•-•----•-------•............-----^---......... ..... Owner Address W Installer Address d Type of Building Size Lot_.._�-_.�... ...........Sq. feet U Dwelling—No. of Bedrooms.............. ..........................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 04 Other fixtu es... •----------------- w Design Flow.................... .._.,r......gallons per person per day. Total daily flow____.._..........•.......:: .b--....gallons. WSeptic Tank—Liquid capacityf>W__gallons Length................ Width................ Diameter-----........... Depth................ x Disposal Trench—No. .................... Width.. _......_...... Total Length........... __.--- Total leaching area....................sq. ft. Seepage Pit No________ _____ Diameter....___l _._... Depth below inlet.................... Total leaching area..�.--�__ ... ft. Z Other Distribution box ( ) Dosin tank ( ) _ _ '�' Percolation Test Results Performed by.... _.... � ........................................'�N . Date...��_.��.�..��_�........__. 0.01 .._-:---- �4 Test Pit No. 1.---22 ....minutes per inch Depth of Test Pit.......t•:�. Depth to ground water..__..`........._. Gq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ••-----•----------------•------•--•••---••------•-•--••-•-•-•-----•-••••-•--......•••--...._................................................................. 0 Description of Soil................................ - :�,-------------------------------------------------------------------------------------------------------------- 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 ode—The undersigned further agrees not to place the system in operation until a Certificate of Compliance ha y oard of health. i .n- Application Approved BY---- , .. Date Application Disapproved f r t e following reasons---------------------•------••---------------•---............................................................... .................•-••------------•-----------------•-----------•-•---------------•---------.....------------•--•---•-•---•-•--••--•------•----•-------•----••-•-•••-----•••--••-•---•-•-•••----•••.----- Date PermitNo................................................--------- Issued_..................................................... - Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH •, .)J.................OF..........-e..................I rl� c Tntifiratr of Toutplittnre THIS IS TO CERTIFY, That the In ' lduaj Sewa Disposal System constructed ) or Repaired ( ) by ._... . .......... . :. . ----•...µ Y� ( ..............•--_._...._ Installer a - •.- �1 .......... . ---- ---•--- -- ••••-- w has been installed in accordance with the provisions of T F 5 o The State Sanitar a -dam ribed in the application for Disposal Works Construction Permit No. _^ _ __________________ datet --- THE ISSUANCE 9F THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL UNOTION SATISFACTORY. Y�DATE.1111114 = Inspector__.. .... ------------------•---------------...--••••--•----•---••--••-_••... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF Noe._....°:j.,��..�.... FE&o................. Permission 's her y granted............................. ------ to Con orb epair f a dividual ewage Disposal System r � atNo .... --" !"-1--•---------------•--•...........C.---...---•......--•---•--------------------- -- t�--•-----------•------------... "�----...•............ " Street 4 U/ ! / 5�, J-7 �/ as shown on the application for Disposal Works Construction Permit No.... . ............ Dated........................................... ......................•%....... . . •--..... Board of Health DATE...............................................` FORM 1255 A. M. SULKIN, INC., BOSTON T Y Existing - - - - Terrace Existing - " Living Room .. - Existing Bath - Existing ' Kitchen - Existing Hall SETBACK LINE I - Existing - Main Entry - - Existing Living Room Existing uP Dining Room ------------ BREN(IN CE111NG L..ndryy R - .I Master Bedroom 76ack ng ntry GAB FNiEP1ACE 101 10.T ~W LLS 1 CPO ®BD TO BE Hall DEMOD l UP i BREANINL F---- 102 UP REHINGE EXISTING REUSE IXASTING Fri STAIRSNEWLANGINGr-MasterClo et OWER SEATr Existing TGmoowN Master �! Garage _ BDBRABOME Bath 0 aosEr ` - CABGIE7RY - - _ .NOTE RELOCATE E%IGRNO HEATER EXKUSTAWAYERDMNEYI ADDITION TO THO NEW LOCATION 222 Third Street,Suite 3212 1�8n= 1�'011 AF Cambridge,MA02142 Craig Residence Main Floor Plan 4 11/30/07 OMNI592 Scudder Avenue fa si621.1477x: p r; Hyannisport, Massachusetts a r r h i t c.r t c 1 I P www.LDa-architects.com i I . - i Existing • - Bath. . _ Existing OPEN �.O Bedroom TO mm 1 P'i Existing -Closet Existing t Bedroom - Existing - Hall - z A3.t A]2 1 3 2 , OPEN OPEN TO k_^ u TO 'aON . `W REt i3 h Existing - - - Bedroom w+ REaN . NEWFREEDOM GREY `. COPPER ROOF - - NEW FALE DFFRAA .- CONCREfE r r� - !NEW FREEDOM GREY - - �' wwEt+ROOFwc . - N 0. New Attic Existing- Elf6TINGGWNOAAII - Bath. - NEWSECRDNDFG f R TOMATCN TWG PN.I OOMI SINRATRC - - RCCESG Existing ' r r t.:� r �:,• �• 'rz. ``.'. Study D NEWFACE [J OL iAPMwGb CONCRETE . - A ExsTwc FAGS � - DFRmsn t � ' 222 Third Street,Suite 3212 / 1/$''= 11-011 Cambridge,MA02142 Craig Residence Second Floor Plan 2 N R 11/30/07 tel: 617.621.1455 592 Scudder Avenue t fax:617.621.1477 Hyannisport, Massachusetts ��"`°"�.� _. a r•r h i r o r t.c I I P www.t_Da-architects.com I 'yam.., ....--•^ � �� .� �e i, - ► r`; , i;; 6 � .. 4 It t t A. rt` CL f'. FRtM GI W OVER LFAC= TROM Is 3Q0-34.0 4 ° OOIPACIED FILL 0 d SET COVER TO 6' BELOW GRADE 9' (�1) Cow NS1XL OIE NSPWM PORE N • M © o; '`a 36' (n mc) Cap► A0001100M W M MANUFACTURERS • RFAOMMDID 110NS • DOUBLE WSI ESW G K.. CN#*IE B • I f'INISHED GRADE OVER D. BOX - 34.5 � IEACHIG ••' 4' Sm 40 PVC ♦ CIMIBER NV N-28A • 24' EFFECTIVE • DEPTH DOE �' °• INSTALL TEE ON NIET FIRST 2' (TO BE LEVEL) a�,5 eb ; 4-ry i6- STONE 4'TO 1-1 DOUBLE ^- I J2- �4 . 40 PVC BASE • INVERT N - 28.4 .♦ • SnE 1' . NV OUT_ ` EXISINC SOLS 10 BE ROOM TO THE 'C HO MUC �� � STONE � / �� � 4 6.8 �! o • ► 5' YN - SEE WISTRUCIION NOTE /5 HEREON. _ _ / , - 6.5 i' s. J r;• Yr . r. NO GROUNDWATER ELEV 17.5 / , 421 / // _ 45 0 7D 47.2 ' STONE B4SE `�,.� ` ` _ / - �t 1 I I �, 43,3/ - 0 * BOX NIS BRUSH ;/ - gi.6 CE / 4 ' / gTOCK/►D� S 4 48.6 NIS \ GOT G r .r i x 33.4 i/ PLAN BOOK PAGE 81 / �� 1.4• ' G �� /' � LOCUS MAP Scale: 1" = 20W' i N/F wNt2:Nj A. woLFTNGT0IN 38,5 . 39.7 1 4 51 f14 \ rr 2.9 /33,9 i' 38.6 �,�' / �/ � G/ CL CL r r <, , / x 4' • 649.2 2G 4 / BRUSH %/ 479.76 ®�� SPIGOT / �/ / �� x h�.5 / 4 49.4 ICV' , r C' / / �lK 47.1 11 5 1 O l i' i ' i' 7.5 1 WA 0 j / c°.i ��� x 28,d �� / r , S .' .'' _��x�#1. / r TO H ' 33.9 / f G / 4 .9 / r i SHU OFF \/ z Rq / ' k' a 7.9 BRUSH , 3 7 4 , tr 4 .0 g 30.5 34.8�� �, ��. r 1• pl, LP• r i 1 / / i 1 r p.Pr• .55 � a / 29.9 x 3 �'� i' x 3 38.�� G r / 1 r I / r 1 ,L8 ' ' !r x 2914 29.2 -11 / / 38.9 / 4 ,5 ` AY j 1 %' W / W ICV® 4 IT151.0 r 30,2 J .' .� ,i x 37.9 , ORI r 1 r !� `, ' / i / i `BI�)MINWS ; / 29.5 - / ' i'/ ik 35,8 G ' ' \ r 1 �� �1 x 4 \�` H / -� 'OH % N OH I / ;18.5 28.¢_ T ►�5' - _ ��' ��' '�' i % / W r l� i i H`I'�- _ A 4 ,0 r i rn o 52.1 gyp► ' 3$.68P� 1 -__ ---_ _ ______ - _ J i,33� G 9 x 37 / �- e W x) 4 .9 01'iW?� �,/Wr 3A ---- � rr/ r I / r • 1 �27.9 �/ i ICV 30.1 �� - � - „� _ -- �.� 7. 1 ICV 3 �,/ ; OH OHr f1B , i .4 -- f 1 �-� W ,' , � x3 x ---------------- TBM: MAG. NAIL SET i I OH / _�,- -- _ ,6 �' EL 37.51 NGVD ` JK 38.4 1 � `OIF�� % � ' �/� �r �r >�'47 / C ' - / LIGHT . , / f 1 x TP,#1 x ?) / ' ,, ,� 35y = ( POST (LP) W-� , , , r ► / 4 .2/ l r r I ,2'9.8 1 I � � / , � 34.�? �; -� � 7.2 37.E � OH � x C, , / ' ' / \ 1 / 9538 �� / LOT 2 r �i PLAN,WOK 32'3r PAGE a1 / i ,/ / , 3 9 W i _ 6.9 r G / IRRIGATION / r ' , '�' / ----------'' / 51 / 1 405 3 fO'/ , 1 1 C 37.8 P• / CONTROL ' ,' / 1.54 AGES / ' i' ' i /' , 1 369' 1 1�2 W 37,5 VALVE-(I k. ---- PER REOORD PLAN ,' , , r F� 1 ST FAIRWAY i /' / / 7 % JG / / x 4 .2 �, ' x 4 ' • / , 4 •5 i i x .2 1 . � � W • 37.51 � / / / Y4 21 � � 1 �' 3 2-STORY �� 4 . �i'� i/ x �I .8 �� ' / 1 J 1.8 1 ,� 54.3 J x 27,1/ / / I i ' x � } r NOi AY ,B7 x x w O��38.6 C.ONC' 1 i , x 3 ,' ,x 4 0 4 9' x,' , ,-Sr 4 .1 it S 1 - / 37.1 .7 F.F.E•s39.5 � ` '38.o i G��' ;' ' �. �% , �' , 1� ; i / / 86 i/ L �/� i �� 37J6 , ' 1 1 r _ U 19 54 ,' O #592 / / ., 6. `/�� '�� 32�/ % - - - - '� �G i '// '/, / - - - - 132.40' - - - - 54.E 3 .1 `0 lN�►��"" _ ptaE O F ) S /i' a i '� 44.3 S 88'31'44• W 133.94 to N/F HYANNISPORT CLUB"-- � �' 338. �\\ �9�} / 1 � �s� ` BLUE -E•= 8 5 i W ✓ / k 3 .1 / / x �5.8 $TONE R�MOVE j5(ISTiNG `TEE AND LVT PIPE- - Ano .7 /pEps-roNE , 1 / PLUG E�ISTING OU�(LET. / PARKING / x 4 .8 1 x 30.1 w ' �"' ' , \`� ` / ` :.::.� '�rr' AREA ; '' LEGEND/ABBREVI�►TTONS x 3 .6 I - 37.3 �T G WI►►1 :::': :: :..: Zi STONE 3 i 37 4 N : : :: ':::. 36 WALK /' �,,- k� = UTILITY POLE,/GUY WIRE 3s.5 �........ :.....:::::::..':. :.: = CONTOUR$ �1MP EXISTING LEACH PETS AND ::•::•;::•::•::::::::::::::::............. Jam,' ' - ........ .... . x 36.7 FTLIL-WL H CLEAN SAND. y x:. } ;:.`:. _____-- . = SPOT GRADES 3PR '� TBM: STAKE SET �)6'9 ADDITION ► o- O = TREES & SHRUBS , orb _ x r EL = 36.63' NGVD rr � r-''r - x 3 .6 ° = MAG NAIL o+�� JOHN �o �;���'�i ilr A'^,S�,;� i 3 .6 A 3 _ s •o r r' !� � = TEST PIT � a �TEF• 37 38. OVERHEAD WIRES E IS �^ 1 G ' 30.2 ' 1 i f r` r --- LOT 1 UK-UK = UNDERGROUND ELECTRIC sna � r , r ISTE Uelfj • -• = WATER LINE -'*�L pp 1 1 r �.• -� PLAN BOOK 325 PAGE 81 N/F CONSTANCE B. McPHEE7ERS J , , r ; d'�•.� • -• = GAS LINE �.. _ 1 37.9 FND = FOUND r 31.27 r I r $3 r 1 F.F.E. 3�z'---_ -36 12• = FINISH FLOOR ELEVATION I 1.8 �3.6 1 __------- EP = EDGE OF PAVEMENT / - FINISHED GRADE -- 36"MAX.-9"M N ��������COMPi4CTED FlLL�������� CB DH p = CONCRETE BOUND/DRILL HOLE � L��: ' 2" LAYER DOUBLE WASHED -1- = TOP OF CHAMBER = TREE LINE 592 SCUDDER AVENUE -�• 3 34.1 . . . . . . . . . . . . . . . . . . . .3/4'-1-1/2' STONE i/8" TO 1/2" 'n ICV = IRRIGATION CONTROL VALVE UBLE WASHED STONE 4 OR FILTER FABRIC (6 PIPE INVERT HYANNIS PORT, AMY 02"7 ' 34,6 34.9 DIST. UNE IN iv 3/4" TO 1-1/2" 24" EFFECTIVE DEPTH PRUMM FM m DOUBLE 6" STONE BASE V RI GINIA C■ CRAIG & ANDREW B■ CRAIG 111; TRUSTEES 1 41 4 4 --I 4 39 4 1iTLE 47/ NOT 1TO SCALE DE90 t�®MI.E �Iy Septic System Upgrade GENERAL NOTES : PLAN VIEW PLASTIC LEACHING CHAMBER DETAIL NOT TO SCALE SEWER INVERT OUT OF SEPTIC TANK SEWER INVERT INTO D►STRiBUTION BOX 28.4 BAXTER NYE ENGINEERING & SURVEYING 1.) LOCUS AREA IS COMPRISED OF BARNSTABLE ASSESSORS MAP 287: 8.) COMMUNITY PANEL NUMBER 250001 0006 D SEWER INVERT OUT OF DISIRIBUiION BOX 28.2 BARNSTABLE ASSESSORS MAP 267; PARCEL 014-002 THE �� INSURANCE RAZE MAP DEFINES THIS AREA As ZONE C. SEWER INVERT INTO LEACHING CHAMBER Registered Professional Engineers and Land Surveyors DEED BOOK 14804; PAGE 70 AN AREA OF MINIMAL FLOODING. LOT 2 O PLAN BOOK 325 PAGE 81 7.) LOCUS N WITHIN HYANNIS FIRE DISTRICT BOTTOM OF LEACHING CHAMBER � � y OWNER/APPLICANT: VIRGNIA C. CRAIG At ANDREW B. CRAIG III. TRS. 8.) ENVIRONMENTAL INFORMATION. NO GROUNDWATER OBSERVED TO ELEVATION 17.5 78 North Street- 3rd Floor,Hyannis, Massachusetts 02601 V.B. CRAIG REV. TRUST At A.B.SUITE III TRUST •SITE IS NOT WITHIN AN A.C.EC AREA OF CRITICAL ENVIRONMENTAL CONCERN). Phone - (508) 771-7502 Fax - (508) 771-7622 7733 FORSYTH BOULEVARD - SUITE 1650 ( ST. LOUIS. MO.. 63105 •SITE IS NOT WITHIN AN AREA OF ESTIMATED HABITAT OF RARE WILDLIFE PER NHESP MAP OCTOBER 1. 2006 'ESTIMATED HABITATS OF RARE P-IZ015 fC. Low WEeIVW FOR USE WITH THE MA WETLANDS PROTECTION ACT REGULATKNS 310 CMR 10). SOIL EVALI W. BARNSTABLE 20 0 20 40 BOARD OF HEJII.TH AGENT Z) PROJECT BENCHMARK: DATUM NGVD 1929 -SITE DOES NOT CONTAIN A CERTIFIED VERNAL POOL PER NHESP MAP OCTOBER 1. 2008 �w �� P.E.RM 14 - FIRM MAP 250001 0008 D 'CERTIFIED VERNAL POOLS.' DONNA MORANDI R.S. mmmw HYDRANT BONNET BOLT O ENTRANCE OF .STE IS NOT WITHIN A PRIORITY HABITAT PER NHESP MAP OCTOBER 1. 2006 TEST PIT 1 TEST PIT 2 TEST PIT 3 TEST PR 4 SCALE IN FEET HYANNISPORT CLUB AND IRVING AVE. EL - 66.66 *PRIORITY HABITATS OF RARE SPECIES' FOR SPECIES UNDER m G.S.E - 29.5 G.S.E. - 30.2 G.S.E. = 30.2 G.S.E. - 31.5 THE MASSACHUSETTS ENDANGERED SPECIES ACT. REGULATIONS (321 CMR10) NITROGEN LOADING LIMITATION: NA SCALE: 1" = 20' TBM: - SPIKE SET N UTILITY POLE f19-52 RESIDEl11TUL 5 BEDROOMS Apt 10MR 3/4 ; SANDY LOW Ap; 10YR 3/3 : SMDY LOAM Ap; 1OMR 2/2 : SMDY LOAM Ap; 10MR 3/3 ; SVW LOAM EL - 44.14' (NGVD) 9.) i. ALL SYSTEM COMPONENTS SHALL BE INSTALLED N ACCORDANCE WITH TITLE V OF THE r 110 GPO/ 3) ZONING INFORMATION •TIE OWIRAM SHALL CONTACT DIG SNE(AT 1-W-W-SAfi)NO URITY COIF NS 10 LOCAIE STATE SANITARY CODE DATED MARCH 31, 1995, AS AMENDED THROUGH THE DATE OF THIS TOTAL DESIGN FLOW - 550 GPO • ZONING DISTRICT: RF-1 ALL E7Q5`IN6 U1I/lE�AT LEAST 72 HOURS Pfl�t TO 1FE START OF ODMSiRUCROl1 1FE L00I110110F PLAN. & ANY LOCAL RULES do REGULATIONS APPLICABLE. GARBAGE QWW � INCIDDED) - N/A 8 : 1OYR 5/6 ; SANDY LOW 8 : IOMR 5/5 : SMDY LOW B : I MR 4/6 . SANDY LOAM B ; 10MR 5/0 : SANDY LONM EASING II11IS=IAD IF067MC71lRE UMQ OWUI S AND LINES ARE SIA NN N AN AFFN=iUE 2. ANY CHANGE TO THIS PLAN MUST BE APPROVED N 1MRIiNrG BY THE ENGINEER. ElEYAT10N • OVERLAY DISTRICT. AP - AQUIFER PROTECTION W MY, WY NOT BE LYTED TO WE SHOW MM AND iWE KM RESMIED BIl51D ON DE "FORMATION MUST NOT BE CHANGED WITHOUT WRITTEN IN PRIOR APPROVAL BY THE ENGINEER. PERC RAZE f5 t�l. NCI: MINIMUM CURRENT ZONING REQUIREMENTS RAL40LE UMY RBONOs NOiED NETELIIL IW OOIFti01CIDR A01EES TO BE FILLY RBFQX DIE FTXI - ! (q,A S 1) 14 16- 16' 16' DATE: 12110107 LiAR - 0.74 GPD/S.F. ANr AID ALL DYN6E5 IFIOt II61IT BE OCOt9011ED!N TIE OONIRICR>R"S FTIILIIE W LOcivE SAD C1 : t0'MR 5/6 : MED. SAND CI : TOMB 5/7 : MEA SAND C1 : 10rR 5/3 : TIED. SAND Ct : 1OIMR 5/3 : MID. SAND MINIMUM AREA: GE' 0 S F. /FOG7RWILIIE Mp URLIES ENACILY. F FIELD CO IRM OFFERS FWU RAN IiOI91OK THE INN. LEACHING ARFA OF SAS REOMREM WITH coamo WON COOKS MINIMUM FRONTAGE 20' OOIVIRACTT>tt SHALL IDIFY THE EN6'IlEETI YEDNTELY FOR Fr0.SSBE REDESIGN. 3. WREN CONSTRUCTION IS COMPLETED. PRIOR TO BAd(FILLING. NOTIFY THE BOARD OF IIEJILIH MINIMUM WIDTH: 125' AGENT FOR INSPECTION. 550 Goo/ 0.74 GPD/S.F• - 784 S.F. MIN. 6D' 6Y 84- 80' FRONT YARD - 30' SIDE & REAR YARD - 15' •EIN= SEPTIC SYSTEM WDIONTION 09DMED FROM TOM OF AARINSTADI,E BOW OF 4. ALL SANITARY DISPOSAL SYSTEM PIPING TO BE 4' SCHED 40 PVC. UNLESS OTHERWISE PROPOSED 29mi C2 : 1OrR 5/6 : MEIX C2 ; IOMR 5/5 : MED. SAND C2 : 1OVR 6/3 : RED. SAID C2 : 10M 6/2 : MED. SM 4) A TITLE SEARCH WAS NOT DONE FOR THIS SITE; SHOULD ONE i ALTH AS-�BINLT CARD NO. W209 DATED 6-21-87. NOTED HEREIN. 6 - CULTEC LEACHING CIMMBERR UNITS WITH COBBLES BE REQUIRED IT SHALL BE PERFORMED BY OTHERS • 1NATER LINE AND APPUT IMW NFdIWTION IS WED ON A PLAN /55M PROVIDED BY WITH 4' OF STONE ON SM 4' OF STONE Ai ENDS, 6- STONE 84% 144- (a& 17.5) 144- (ELEV 1&2) 44- MEV 1&2) 144- (E11:V 19.5) THE HrANNS MK1ER OEPAR'11ENT VIA FAX DATED 10/11/07: 5. EXCAVATE IINSWTABLE MATERIAL AS NOTED, TO THE C HORIZON' . FOR A HORIZ SDEIMALL AREA: (47' + 12�2 X 2 DEPTH - 236 SF SP 5.) THE PROPERTY LINE INFORMATION SHOWN IS BASED ON CURRENT 12 BQTMM AREAREA, >r = SF DISTANCE OF 5' SURROUNDING THE LEACHING FIELD, AND REPLACE WITH CLEAN SAND PER 310 �. � 564 BY I DATE I REMARKS AVAILABLE RECORD INFORMATION CONSISTING OF PLANS AND DEEDS. •GAS Lff NFORMATION PER YAP PROVIDED Br IVSW ENERGY AND FIELD LOCATION OF CMR 15.255 TO THE TOP ELEVATION OF THE SAS. DRAWN THE EXISTING FEATURES SHOWN HEREON WERE OBTAINED FROM AN GAS METER BY BAXI'ER NYE ENGI�EFRFK:! SLIRVEYNG ON 10/17/07. TOTAL EFFECTIVE ���' ARFJ4 - 800 SF BY: MM IDESIGNED BY: ICHECKED BY: MWE DRAWING NUMBER ON THE GROUND FIELD SURVEY PERFORMED BY BAXTER NYE 6. INSULATE ALL PIPES AGAINST FREEZING AS REQUIRED WHEN LESS THAN 3' OF COVER. SYSTEM DESIGN CAPAC�� 800,` 7� �,474 GPO - 592 GPD ENGINEERING A: SURVEYING ON OCTOBER 16 & 17, 2007. BUILDING •ELECTRIC LINE FFOINKIM F'ER NSIAR ElECIRIC PLAN PROVIDED VIA FAX ON IOMI07 AND ���}�1L , ' ' �� PERC O 54 (ELFV 25.0) PERC O 60' MD 252) LOCATIONS TO CORNER BOARDS. FEED LOCATION OF UTILITY POLES BY SAXTER NW OVGMEOM a SURVEYING ON 10/17/07. 7. THE SEPTIC SYSTEM DESIGN DOES NOT INCUJDE GARBAGE GRINDER DISPOSALS. SEPI TANK S121W 4W x f' - BBO GAL LUTE- d WAN LUTE- d W/IN 0: 200E 2007-052 Serve worksht 2007-052SP.DWG USE EXISTING 1500 GALLON UK CLASS I SOL CLASS I SDI. 2007-052 I � S I � t i v. N t a :t r ci P'll n ICI' t` i {i+� '-• i'• r > r /' f IA The Svb3So� t , Ono -E" Per o I { 4 { r.- � _.fry.• .N.. y. � � i a A i s TA N`'sir _ � rZ,F„,�n,7 �L - �G-G� �i"Y.i ��(,.�✓�Rs� - �.�Y'��a' '�L/1!�°�" -MAf= j(1 t • .,...E,.�' ✓; 7 ✓ ,i�"''t+o- ,j i✓` t e...r "ri �1!f . 4 $� �� £✓/{ .�+ ��jj �j, .�fit; r' �.�- ` .' o�! ?ti-?.t I. .7 It 1� Ir1..� "�° � �..� �.:"1� - !` C'e'. '" ;� ► �,,.t •d!.►;' ', s•;` �,' ''s �� C r• C' t t`tl 1 �� �. G �`�A• .s-! •- .-+Cr ikE Ii ��.3 b�'f �tom.. •3}.�....i l?r�. ' � `_ � }� aq�� !�% d "t �..'�..IF�' �+... •� � _., � ^t.n�.,..,, '�."'.....-_ ay. ` r�..,.:^,