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HomeMy WebLinkAbout0033 SHOREY ROAD - Health 33 Shorey Road Hyannis A=267-.167 UPC 17734 No.2;153CR two , ,� h �, �' �� H� �, � TOWN OF BARNSTABLE LOCATION YA.req }Ld SEWAGE# VO1 /0 a VILLAGE 1f17jQi'ilytJ -ASSESSOR'S MAP&PARCEL , INSTALLER'S NAME&PHONE NO. C'�ew�fl�? gnkrpn 0--i yZ�' yoa2F SEPTIC TANK CAPACITY /000 &/0 f 1c t s� LEACHING FACILITY:(type) 1f/0 ZC Sv C) (size) 16105- J( 33•J_ NO.OF BEDROOMS OWNER Lc�.I-�n �M • ¢c�c.A. PERMIT DATE: Ll 2 9 wog COMPLIANCE DATE: (o I I ct Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility AFV If 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 u-c S G O c h o b s 8 N ... h. W � No. 007 1 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Tipprication for )Digpogar *pgtem Cougtruction Permit Application for a Permit to Construct O Repair(Upgrade( ) Abandon O ❑ Complete System ❑Individual Components n CLocation Address or Lot No. �� �j (+ r�7 1-®� Owner's Name,Address,and Tel.No. l Assessor's Map/Parcel ei owl Z.67 y 7 �� ���©wb�®®k �� .� X4 a/770 e Installer's Name,Address,and Tel.No. G4p � �`1 Designer's Name,Address and Tel.No. Q� C¢ " "� y6 y v�( P of �v� �z � COUGH W(�LVi2 �S Vfi �j JT>t��M t Ci Type of Building: �] Dwelling No.of Bedrooms "► Lot Size t t �0 sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures �(� Design Flow(min.required) �® gpd Design flow provided `'G�'�' 3/ gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank t00f-'i ���� Type of S.A.S. St)- I� �-^C_ L— rc,-- Descriptioni of Soil l opp'0 1, C B/!I, KO �L�l� - WO qrp Ut141yff 0 Y' dv Pn rcD v -�erc Nature of Repairs or Alterations(Answer when applicable) �v k P f "� �fi1 C 'NI K Itew te fok eg l kor y P er,40" 1 lays Date last inspected: �� l Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Wmkh. Signed Date (0 Application Approved by Date 07 Application Disapproved by: Date for the following reasons Permit No: Date Issued `�� N o. -.�� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in eompn1. PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Application for Wgoogal *p5iem Cow5truction 30ermit -> Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or;Lot No. 'j kQrey R oeeq Owner's Name,Address,and Tel.No. A ! t f / Assessor's Map/Parcel 1-47 RYq&1WI 7 1 01 BAI�O 6 Y _Installer's Name,Address,and Tel.No. CAp&�i� � '�� Designer's Name,Address and Tel.No. ;�� 3 G4 6W ;P. 0 40Y "7 �Rv�b Cnt��tMNQ'✓IZ �S ' G4-K,"4e VIAwr q3 Tr;qh tP CI Sqkjo(w,t c �, Of4 O�S6 Type of Building: Q Dwelling No.of Bedrooms —1 Lot Size 10 t 4�00 sq.ft. Garbage Grinder (, ) Other Type of Building No.of Persons r,.a y. Showers( ) Cafeteria( ). .Other Fixtures ( ' Design Flow(min.required) 440 , gpd Design flow provided '`,� 0.3 7 d gp Plan Date Number of sheets Revision Date n .,.Title l Size of Septic Tank (Oo"S% fv i Type of S.A.S. ( /� `� •� V I (`ti►.. Descriptions of Soil ToPe',t, 1 el S 00 !.f 0 004 1y(q ©r / tMOf1-(• a� P�rco��l�c'�c� Nature of Repairs or Alterations(Answer when applicable) p u dh .Of I C 190c ' t M 51 q(j n<<v teed elfk Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of pew(h. Signed Date l� ''�b 0 Application Approved by — Date y Application Disapproved by: Date for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS j Certificate of Comphauce THIS IS TO CERTIF(,Y,that the On-site Sewa a Disposal System Constructed ( ) Repaired ( Upgraded ( ) Abandoned( )by L;-A ez--j-4- G�L• ''t> at has been constructed in accordance = with the prop ssions of Title 5 and the or Disposal System Construction Permit No. a t "�U? dated �'� o Installer 60's �6"1 L\ - Designer #bedrooms Approved design floA L D gpd The issuance of this permit sh 11 not be construed as a guarantee that the system 1 fu J )as designe Date 0 Inspector (� l -- -------, ----- --—_------—---_—__--_---_----_- No. "'"' 4 "' — Fee / THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION — BARNSTABLE, MASSACHUSETTS I'aigpogal *pgtem Com5tructtou- J)ermtt Permission is hereby granted to Construct ( ) Repair (V) Upgrade ( ) Abandon ( ) System located at korid and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. Date Ll `�-g _0 App Y roved b ( 1 _� 4 t��, TRANS. NO.: CITY/TOWN- APPLICANT: A ► ADDRESS: ko 6-b DESIGN FLOW: p gpd REVIEWED BY: DATE: N/A OK NO 3 ta.vn<:�� Legal boundaries denoted [310 CMR 15.220(4)(a)] r/ Street, Lot,.tax parcel number and lot number noted on plan [310 CMR 15.220(4)(u)] Locus Provided [310 CMR 15.2204(t)] 1/ Plan proper scale? (1"=40' for plot plans, 1"=20' or fewer for components) [310 CMR 15.220(4)] Easements shown [310'CMR 15.220(4)(b)] V. System located totally on lot served.[310 CMR 15.405(1)(a) for upgrades]- if not, a variance is required [310 CMR 15.412(4)] V Location of impervious surfaces (driveways,parking areas etc.) [310 CMR 15.220(4)(d)] Location all buildings existing and proposed 310 CMR / 15.220(4)(c)] r/ Location and dimensions of system components and reserve areas. [310 CMR 15.220(4)(e)] System Calculations [310 CMR 15.220(4)(0] daily flow septic tank capacity(required and provided) soil absorption system (required and provided) ✓ whether system designed for garbage grinder North arrow [310 CMR 15.220(4)(g)] Existing and proposed contours [310 CMR 15.220(4)(g)] z/ Location and log of deep observation holes (existing grade el. on / each test) [310 CMR 15.220(4)(h)] Names of soil evaluator and BOH representative [310 CMR 15.220(4)(h) and (i)] Location and date of percolation tests (performed at proper elevation?) [310 CMR 15.220(4)(1)] Percolation test results match loading rate? [310 CMR 15.242] Certification statement by Soil Evaluator [310 CMR 15.220(4)(j)] Observed and Adjusted groundwater(method for adjustment given or indicated) [310 CMR 15.103(3) and 310 CMR 15.220(4)(n)] i Address � �7 �Vl�/l'�'� �`r Sheet 1 of 7 i N/A OK NO Location of every water supply,public and private, [310 CMR 15.220(4)(k)] within 400 feet of the proposed system location in the case of surface water supplies and gravel packed public water supply within 250 feet of the proposed system location in the case within 150 feet of the proposed system location in the case of private water supply wells Location of all surface waters and wetlands located up to 100 ft. beyond setbacks listed in 310 CMR 15.211 and any catch basins located within 50 ft. [310 CMR 15.220(4)(1)] Water lines and other subsurface utilities located [310 CMR ✓ 15.220(4)(m)] (if water line cross see 310 CMR 15.211(1)[1]) Profile of system showing invert elevations of all system components and the bottom of the SAS [310 CMR15.220(4)(o)] iR� Stamp of designer [310 CMR 15.220(1) and 310 CMR 15.220(2)] Stamp of Registered Land Surveyor(required if construction / activities within 5 ft. of lot line) [310 CMR 15.220(3)] V Test Holes adequate (two in each of the primary and reserve unless trenches as permitted in 310 CMR 15.102(2) or as approved for an upgrade under LUA at 310 CMR 15.405(1)(k)] Test hole adequate to demonstrate four feet of suitable material? [310 CMR. 15.103(4)] V Test Holes adequate to confirm adequate groundwater separation? , [310 CMR. 15.103(3)] Benchmark within 50-75' of system [310 CMR 15.220(4)(q)] Materials specifications noted? [various sections of 310 CMR 15.000] System components not> 36" deep (unless Local Upgrade Approval or LUA requested) [310 CMR 15.405(l(b)] Address JWc�/`e�/ ��� Sheet 2 of 7 N/A OK NO SEP JEICTANK a =4 r �� f ..m< _ r .,.., .,sd,,..:..•r.+szw ,n, Size OK? [310 CMR 15.223(1)] Inlet the located ten inches below flow line [310 .CMR 15.227(6)] Outlet tee 14" or 14" + 5" per foot for increase ft depth [310 CMR 15.227(6)] Outlet tee with gas baffle or approved filter [310 CMR 15.227(4)] Note regarding installation on stable compacted base [310 CMR 15.228(1)] ✓' Separation between inlet and outlet tees (no less than liquid depth) [310 CMR 15.227(2)] Inlet/Outlet elevations at least 12" above high groundwater (except as described 310 CMR 15.227(5)) or permitted for upgrades under LUA [310 CMR 15.405(1)(k)] Minimum cover 9" (Tanks buried more than 9" must have risers on all openings and on the d-box) [310 CMR 15.2228(1) and 310 / CMR 15.232(3)(f)] Three access covers (inlet and outlet must be 20" or greater) - middle access at least 8 (by 7/07) [310 CMR 15.228(2)] Access to within 6 " of grade - one port for systems<1000gpd, two for systems>1000 gpd [310 CMR.15.228(2)] All at-grade covers secured to unauthorized access? [310 CMR 15.228(2)] > 10 ft from building foundation [310 CMR 15.211(1)] / Buoyancy calculation Required/Done [310 CMR 15.221(8)] ✓ H-20 Where appropriate? [310 CMR 15.226(3)] ,/ Setbacks from resources [310 CMR 15.211] �1tiCompartmenTanku ��....a =� "` � s 7 , ,Je Required when other than single-family dwelling or flow>1000 / gpd [310 CMR 15.223(1)(b)] V First compartment 200%daily flow; Second compartment 100% daily flow [310 CMR 15.224(2) and (3)] "U" pipe through or over baffle, outlet of each compartment with ✓ gas baffle or approved filter [310 CMR 15.224(4)] Address '��Y 1� Sheet 3 of 7 t N/A OK NO-, Located at least ten feet from any water line? [310 CMR / 15.222(2)] V Disposal piping at least 18" below water line (when water and sewer cross, see 310 CMR 15.211(1)[1]) �✓ Cleanouts required/provided ? [310 CMR 15.222(8)] Thrust blocks specified in force mains? 310 CMR 15.221(6)(c)] Slope of sewer line not less than 0.01 (1/8"/ft) 0.02 preferable [310 CMR 15.222(6)] Proper pitch on all runs? (.005 within gravity-distributed trenches and beds) [310 CMR 15.251(9) and 310 CMR 15.252(2)(c)] 1/ Siphon.problem/ (leachfield below pump chamber) V/ Endcaps or vent manifold specified? Size and orientation of discharge holes specified? (not smaller than 3/8"not larger than 5/8") [310 CMR 15.251(8) and 310 CMR 15.252(2)(h)] J 1/ Materials specified (310 CMR 15.251(5) specifies various pipe types allowed) TISRTBTTION BE)X F �. :_ .. Stable compacted base[310 CMR 15.221(2) and 310 CMR 15.232(2)(a)] Splash plate or baffle tee required on inlet/provided? (when pressure sewer to d-box or steep pitch of gravity sewer) [310 / CMR 15.323(3)(a)] V Riser if deeper than 9 [310 CMR 15.232(3)(f)] Inside minimum dimension 12" [310 CMR 15.232(2)(b)] Minimum sump 6" [310 CMR15.232(3)(e)] ✓' Watertight cover if<2000gpd);waterproof manhole if>2000gpd [310 CMR 15.232(3)(d)] pi1MPME HANI"BE12S s � , Capacity(emergency storage above working=design flow)? [310 CMR 231(2)] Proper setbacks [310 CMR 15.21 t(same as septic tanks)] Watertight 20-in minium access manhole at least 20" MUST BE TO GRADE [310 CMR 15.231(5)] Service components accessible (not too deep with piping, disconnects accessible) Alarm floats - alarm on circuit separate from pumps specified? Exceeds two units must have two pumps operating in lead-lag mode. [310 CMR 15.231(6) and(8)] Stable Compacted Base [310 CMR 15.221(2)] Buoyancy calculations needed ?Provided? [310 CMR 15.221(8)] Address � ��`� ��� Sheet 4 of 7 T c N/A OK NO � S® ABS®RPTION SI�`STEMS�(=SAS) GENERAL Calculations correct? 4 feet of naturally occurring material demonstrated? [310 CMR 15.240(1)] Required separation to groundwater? [310 CMR 15.212)] Aggregate specified as double washed [310 CMR 15.247(2)] System Venting required/provided? (system under driveway or >36" deep) [310 CMR 15.241] Inspection ports specified and within 3"final grade? [310 CMR. / 15.240(13)] Breakout requirements met? (No violation of breakout elevation within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and / Guidance Document] �.s Chambers and Gal. in trench configuration supplied with inlet every 20 ft. [310 CMR 15.253(6)] Each structure with one inspection manhole (if>20.00 gpd must be to grade) [310 CMR 15.253(2)] Aggregated' minimum- 4'maximum. [310 CMR 15.253(1)(b)] 2' sidewall credit maximum [310 CMR 15.253(1)(a)] V/ In bed configuration, inlet every 40 sq. ft. [310 CMR 15.253(6)] v" BENCHES 310 CMR 1,5 251� .Y � � ., � _ 1-0 AU _. Width 2'minimum 3"maximum [310 CMR 15.251(1)(b)] 100 feet -maximum length [310 CMR 15.251(1)(a)] Minimum separation 2x effective depth or width whichever. greater(3x if reserve between trenches) [310 CMR 251(1)(d)] V, Situated along contours [310 CMR 15.251(2)] Breakout OK? [310 CMR 15.211(1)[4] and Guidance Document] minimum 2 distribution lines [310 CMR 15.252(2)(a)] Maximum separation between lines 6' [310 CM R15.252(2)(d)] 1/ Maximum separation between lines and outside of bed 4' [310 CMR 15.252(2)(e)] Aggregate depth below discharge pipes 6" minimum, 12" maximum. [310 CMR 15.252(2)(g)] Separation between beds 10'minimum. [310 CMR 15.252(2)(f)] Bottom area used in calculations only [310 CMR 15.252(2)(1)] Address l 5preY keg Sheet 5 of 7 t, a N/A OK NO Pressure Dosed System ? Provided pump and piping calculations as required [310 CMR 15.220(4)(r)] Pressure dosing required on all systems >2000gpd or alternative systems under remedial approval [310 CMR 15.254(2) and I/A Remedial Use Approvals] If used in gravelless system -make sure jet is directed as not to scour soil interface [Guidance Document] Inspections once per year(systems<2000 gpd)or quarterly (>2000gpd) good to note on plan [310 CMR 15.254(2)(d)] Construction in fill Did the plan specify that the fill shall meet the specification of 310 CMR 15.255(3)? Impervious barrier and/or retaining wall ? [Guidance Document] Impervious barrier installation must be supervised by designer [310 CMR 15.255(2)(b)] ' L/ Retaining wall must be designed by Registered Professional Engineer [310 CMR 15.255(2)(a)] Side slope not exceed 3:1 ? [310 CMR 15.255(2)] Breakout requirements met? [310 CMR 15.252(2) and Guidance Document] At least 5 ft. from impervious barrier to edge of SAS (10 R. recommended) [310 CMR 15.255 (2)(e)] ravelesssstem�If�Appoacletter�j � � � � � s Check DEP Approval letters for credits and design conditions If used with pressure dosing do not allow pressure discharge to scour soil interface - ��ter�atcv�eepta�,�S; stem;L�/A�Apprfo=vcil�Lettersl�.,��,. . Was DEP Approval Letter provided and/or have you reviewed the letter for conditions? Is the technology being properly applied and does it meet all DEP Approval Conditions? V/ Is there a note on the plan regarding the requirement for / perpetual maintenance agreement? V Any alarms involved on separate circuits Did the applicant submit an operation and maintenance manual? Has applicant submitted a copy of a maintenance LX •,/ +�Z Ww'. G X T d - '+`" � '�E "�^';, E enJu,- 5 Kf Are the variances listed on the plan ? [310 CMR 15.220 (4)(q)] RLS Stamp necessary on plan if a component is within five / feet of property line [310 CMR 15.412(4)] ✓. New construction or increased flow proposed [Refer to 310 CMR 15.414] Address � �� !�-p�`� Sheet 6 of 7 y N/A OK NO ... � �* Yam' ,�•� f�,z S' "� ' '�+ � - za�. '"� a „� •� `. �• °�,y� k ,oFxt :'fir ` '�Y RNatrogen�Sensatavetlreas � fi � ,� � � � ?L Is the system in a Designated Nitrogen Sensitive Area (Zone H for a public supply well)? [310 CMR 15.214;310 CMR 15.215 and 310 CMR 15.216 - also refer to Policy regarding upgrades of such existing systems] Is the system proposed on the same lot as served by private well ? [310 CMR 15.214(2)] Are the nitrogen loads proposed in compliance? [310 CMR 15.216(1)] Pumping to septic tank ? [ 310 CMR 15.229] Shared System [310 CMR 15.290] 1 Address 33 �����r `� Sheet 7 of 7 I ' r • vv V J . 1 N � 0 C � Town of Barnstable Regulatory Services • s►xtrSTABI ; Thomas F. Geiler,Director 1 . �, Public Health Division HIED ,. Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 , Fax: 508-790-6304 Installer&Designer.Certification Form I Date: I.T-me t L 2001 Designer: ( V1 D C©U6(� L)6W'2 l� �_ �- S Installer: L� .a.,�'�� �,�•�/ ,��2 S Address: R140 LL,� C�'1Z Address: �� 3�x't�3 S ko w lc�-1 oZ�3 - C. .,kr� dVA 0ZG3 L On was issued a permit to install a (date) (install ) septic system at � shore-/ boa d based on a design drawn by (address) NV ID L b U G H tJoI.�R, dated �S , D / (designer) V I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. of MgSs�c DAVID. yGN o� D. Iri abler's Signa e) u, COUGHANOWR N No. 1093 n �FG/STEREO sgN17AR\P� (Designer's Signature) (Affix Designer's Stamp Here) PLEASE:.RETURN,TO.BARNSTABLE PUBLI,,C HEALTH_DIVISION.. CERTI-FICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. -,*'THEr� Town of Barnstable Barnstable ANAmMtV �~ y Regulatory Services Department eaCi BARN SCABUM, 163F 16 Public Health i - 10 �wvision m � D 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644. Thomas F.Geiler,Director FAX: 508-790-6304 \�� Thomas A.McKean,CHO CERTIFIED MAIL# 70081830000205009687 5/18/2009 Ari Gatt 33 Shorey Road Hyannis, MA 02601 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 33 Shorey Road, Hyannis MA was last inspected on April 20, 2009 by Robert Paolini, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool You are ordered to repair or replace the septic system within One (1) year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF T E BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health F Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 33 Shorey Rd. Property Address Ari Gatt Owner Owner's Name information is required for Hyannis Ma. 02601 4/20/2009 every 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. Important: A. General Information /� I iJ n When filling out \, �i43 forms on the J v computer, uses 1. Inspector: only the tab key to move youfl Robert Paolini cursor-dotnot Name of Inspector use the return , key. Capewide Enterprises,LLC. Company Name r� P.O.Box 763 Company Address Centerville Ma. 02632 rerwn City/Town State Zip Code (508)428-4028 S14454 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 rr aintenao''e',e 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 ® Fa7Is CD 0 Need her Evaluation b the Local Approving Authority (Jx p m P 4/20/2009 Inspe is Signat re 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. [,bj q/p , t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form l Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 33 Shorey Rd. Property Address Ari Gatt Owner Owner's Name information is required for Hyannis Ma. 02601 4/20/2009 every 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. Any failure criteria not evaluated are indicated below. Comments: - The septic system is in hydraulic failure.New leaching needs to be installed. 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): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts 0 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 33 Shorey Rd. Property Address Ari Gatt Owner Owner's Name information is required for Hyannis Ma. 02601 4/20!2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 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•09/08 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 33 Shorey Rd. Property Address Ari Gatt Owner Owner's Name information is required for Hyannis Ma. 02601 4/20/2009 every 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 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•09/08 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 33 Shorey Rd. Property Address Ari Gatt Owner Owner's Name information is required for Hyannis Ma. 02601 4/20/2009 every 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 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•09/08 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 33 Shorey Rd. M Property Address Ari Gatt Owner Owner's Name information is required for Hyannis Ma. 02601 4/20/2009 every 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? Z. ❑ 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): 3 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 qh y til Commonwealth of Massachusetts W Title 5 Official Inspection Form - Subsurface.Sewage Disposal System Form - Not for Voluntary Assessments ^M 33 Shorey Rd. Property Address Ari Gatt Owner Owner's Name information is required for Hyannis Ma. 02601 4/20/2009 every page. City/Town State Zip Code Date of Inspection D. System Information Description: The septic system consists od a 1000 gallon septic tank,distribution box and a 1000 gallon leaching pit. Number of current residents: unknown Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2008:78,000 9 ( Y 9 (gp ))� 2008:78,000 Detail: 2007:145gpd. 2008:214gpd. Sump pump? ❑ Yes ® No Last date of occupancy: unknown 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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts F W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 33 Shorey Rd. Property Address Ari Gatt Owner Owner's Name information is required for Hyannis Ma. 02601 4/20/2009 every 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: 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 l/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): l5ins-09/08 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 33 Shorey Rd. M Property Address Ari Gatt Owner Owner's Name information is required for Hyannis Ma. 02601 4/20/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1990 Were sewage odors detected when arriving at the.site? ❑ Yes ® No Building Sewer(locate on site plan): 1 Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 20'+ feet Comments (on condition of joints, venting, evidence of leakage, etc:): Joints appear tight.No evidence of Ieakage.System vented through the house vents. Septic Tank (locate on site plan): 1' Depth below grade: 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 gallon Sludge depth: 811 t5ins•09/08 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 9 of 17 tt;' s - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 33 Shorey Rd. Property Address Ari Gatt Owner Owner's Name information is required for Hyannis Ma. 02601 4/20/2009 every 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 24" 9 Scum thickness Distance from top of scum to top of outlet tee or baffle 4" Distance from bottom of scum to bottom of outlet tee or baffle 5" How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease Trap (locate on site plan): Depth below grade: 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•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form I o Subsurface Sewage Disposal System Form = Not for Voluntary Assessments M 33 Shorey Rd. Property Address Ari Gatt Owner Owner's Name information is required for Hyannis Ma. 02601 4/20/2009 every 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.): Pump septic tank every two years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears to be structurally sound. 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 33 Shorey Rd. Property Address Ari Gatt Owner Owner's Name information is required for Hyannis Ma. 02601 4/20/2009 every 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 Stain line above 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.): Box is Ievel.Box has one outlet lateral.Evidence of solids carryover into leaching pit.Evidence of leakage out of box. 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.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09/08 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 33 Shorey Rd. Property Address Ari Gatt Owner Owner's Name information is required for Hyannis Ma. 02601 4/20/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1-1000 gl. ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensiions: ❑ 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.): Sandy soil.Leaching pit had 2' of water at time of inspection.Stain line observed above invert.Heavy solids observed on top of invert pipe.Leaching pit is in hydraulic failure. 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 l5ins-09108 Title 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 ,M 33 Shorey Rd. Property Address Ari Gatt Owner Owner's Name information is required for Hyannis Ma. 02601 4/20/2009 every page. Cityfrown 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-09/08 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 33 Shorey Rd. Property Address Ari Gatt Owner Owner's Name information is Hyannis Ma. 02601 4/20/2009 required for H y , every page. Cityrrown 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 11 �� I � II i I t i yip v .Z t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 33 Shorey Rd. Property Address Ari Gatt Owner Owner's Name information is required for Hyannis Ma. 02601 4/20/2009 every 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: Bottom of leaching 16.4' 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: As-Built Card ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: USED:USGS Observation Well Data.USED:Technical Bulletin 92-000-01 plate#2 annual ranges of groundwater elevations. Before filing this Inspection Report, please see Report Completeness Checklist on next page. tEins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 1. •V. Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 33 Shorey Rd. Property Address Ari Gatt Owner Owner's Name information is required for Hyannis Ma. 02601 4/20/2009 every 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 Z Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Town of Barnstable Department of Regulatory Services /�� BAMKAMMIK : Public Health Division - Date_ Pt �A 039 200 Main Street,Hyannis MA 02601 j lF0 tdA't . Date Scheduled 1154-4 - - f Time Fee Pd. Soil Suitability Assessment for Sewage Disposal Performed By: DkV1D �, CDVC�HA-UOV p Witnessed By: D01'111 A jjybp LOCATION& GENERAL Location Address �� STToRE L �4 b �'O NRMATION n N Address 33 J ffol>e ce kOAD Assessor's Map/Parcel: 'ZG 7/16 7 Engineer's Name rQl NEWCONSTRUC770N REPAIR �'rUt p COuGN/��,I�Jw2 (� Telephone# Land Use 4�.E51 L7 L-ki T I L l Slopes(%) Surface Stones ON(_ I Distances from: Open Water Body. �f _ft Possible Wet Area 1 t ft Drinking Water Well i CO+ e i �- - Drainage Way �-L ft Property line 1 0"f 1 ' - Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&Pere tests,locate wetlands 1`n proximity to holes SHOREY 4 --- __ 100.00 fE ROAD GROUNDWATER ADJUSTMENT j EXISTING GROUNDWATER LEVEL ml BASED ON TOWN OF BARNSTABLE �I I N GIS DEPARTMENT RECORDS. I� INDICATED GW 15.00 I 7- I'. INDEX WELL MIW-29 ® ZONE C READING DATE APRIL, 2007 I r® I READING 7.0 PI I ADJUSTMENT 1.7 L I _ ADJUSTED GW 16.7 Parent material(geologic) t"1'..QUA C 1 kL, O VT1J ft_s(J Depth to Bedrock Depth to Groundwater: Standing Water in Nole:,V M G Weeping from Pit Race Estimated Seasonal High Groundwater see aJotje --� DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: e a bI V e Depth Observed standing in obs.hole: Depth to weeping from side of obs.hole: in. Depth to soil mottles: in. GroundwnterAdJustment In. Index Well# Reading Date:_ Index Well level ft. Add,factor Add,Clrtundwater Level PERCOLATION TEST b (�3 it,�M Observation �e Hole# �, I Time at 9" 'n Depth of Pero Time at 6". Start Pre-soak Time @ ��:V Z � ----....-- Time(9"-6 End Pre-soak yl 08 Rate MinJInch Site Suitability Assessment: Site Passed Site Failed: ) �j �qL Additional Testing Needed(Y/N)- _ Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100'of wetland,you must first notify the Barnstable Conservation Division at least one(1) week prior to beginning, Q:SEPTICIPERCFORM.DOC SOIL TEST LOG DATE OF TEST: - MAY 23p=2007`-� SOIL EVALUATOR: DAVID D. COUGHANOWR. R.S. _ WITNESSED BY: DONNA MIORANDI. HEALTH DEPT. PERC NUMBER: _ .11762 �- �--a- T E S T PIT 1 NO GROUNDWATER ENCOUNTERED PARENT MATERIAL: PROGLACIAL_OUTWASH PERC AT 54 In - 2 MIN/INCH IN C SOILS ELEVATION DEPTH SOIL I USDA SOIL SOIL COLOR SOIL OTHER (INCHES) -HORIZON TEXTURE ' '(MUNSELL) MOTTLING 38.00 _ - 0-6 Ap LOAMY SAND 10 YR 2/2 NONE FRIABLE ..6-40•— -B-----#-- L-GAMY SAND- -10 YR 4/4- NONE FRIABLE _ 34.67 40-132 C ME[5IM=SAND ]10 �YR=S/4 NONE _�. LOOSE a. .-. 27.00 Ytr i T E S'T PIT -2- ELEVATION DEPTH SOIL t USDA SOIL SOIL' COLOR SOIL OTHER 44 (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING 38.10 0-8 Ap - = LOAMY SAND 10 YR 2/1 NONEI FRIABLE 8-40 B__. LOAMY SAND 10 YR-4/4- -NONE-¢ FRIABLE - 34.77 40-132 C MEDUIM SAND 10 YR 5/4 _NONE4_ .LOOSE ---; 27.10 .•_ 7,7, y 7,,J,�-,... Other Depth from Soil Horizon Soil Texture Soil Color Soil Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. o Gravel DEEP OBSERVATION HOLE LOG Hole# Soil Other Depth from Soil Horizon Soil Texture Soil Color Mottling (Structure,Stones,Boulders. Surface(in.) (USDA) _ (Munsell) g Consi ten ra Flood insurance Rate Map: / Above 500 year flood boundary No _ Yes _v__ Within 500 year boundary Noy Yes .� Within 100 year flood boundary No '/ Yes Depth of Naturall �t}u 'n Pervious Material Does at least f Hof to occurring pervious material exist in all areas observed throughout the area propos ' system? Ye If not,what depu to a ccurring pervious material? _. .. " COUGHANOWR Certificati I certify that V ate)I have passed the soil evaluator examination approved by the Department of �dr AL plc ection and that the above analysis was performed by me consistent with the required train and experience described in 310 CIVIIt 15.017. .,,A„�. R�. LSE Date �1a 2 2.©o SignaturetQ �_-- Q_1SEpTIC�pFRCFORM.DOC i TOWN OF BARNSTABLE LOCATION `����� SEWAGE # �I VILLAGE Ll ASSESSOR'S MAP Cz LOT .��J�—A0 v INSTALLER'S NAME PHONE N®. L� , /9m SEPTIC TANK CAPACITY LEACHING FACILITY:(t ) /�y . ype (slse)�� NO. OF BEDROOMS_;2g PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: -- - DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No ` zy 2�, e � , 1 / J 3 N ro TOWN OF BARNSTABLE I:OCATION,_?, �Xo=_!�f_Rd SEWAGE # �'� .� VILLAGE._/, �� n,'S /��ri ASSESSOR'S MAP & LOT �7���� INSTALLER'S NAME PHONE NOe SEPTIC TANK CAPACITY LEACHING FACILITYAtype) /�7` (size) CJt/ NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED- DATE COMPLIANCE.ISSUED: _:7Z,,F& VARIANCE GRANTED: Yes No 1 �, �L� _ �'' �, � � � . „ ,� �� ; ` .� _ , .� . . 30 No.. .. - Fps....�....-------.00 THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE (p7 7 ApplirFation for Uispoii al Works Tnnitrurtinn ramit Application is hereby made for a Permit to Construct ( ) or Repair �X) an Individual Sewage Disposal System at: 33 Shorey Road Hyannis •- -• _..--...... •---•-... ...... -------•-------------- --•---------------------------•---------------- ......-...-.-:.-•-------------------------.------ Location-Address •-or Lot No. Anthony De_ race------- r....---•--------------------- Owner Address W J.P.Macomber Jr. -------------- ........ Installer Address d Type of Buildi Size Lot----------------------------Sq. feet n V Dwelling—No. of Bedrooms-----------.-•2_•--------------- -----Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of ersons•---•---_-__•___••_.•__-____ Showers — yp g p ( ) Cafeteria ( ) a' 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........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water•____-__--_-_------_-__. (� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a 0 Description of Soil.............an rave U ---------•---------•--....--•••---•--•-------•----.....---•-•••--•••--------•-•-••---------••---•-•--------••-------••------•- UW •----••-•--•----------------••------------•---•---••-----•-•----•--•---•--•••---------•----------•------••------•-•••--------•-•-•----••••----•--•---•-•••---•---•••----•-••••-••-••-----•-------------- Nature of Repairs or AltegLtio s—Ans r when a licable_.. •________ ____-------•_•_----•---------•------------------ ....1-1��J0...ga1Zon TeacYi pig ••••----------•---•-•-•-------•-••----- ------------------------------------------•--•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued by the and I f health. Signed ......................... ....... --8 Application Approved By ... --- ...-. Application Disapproved for the following reasons- --- ---------------- ----------------------------------------------------------------------- --------------------------------- --------------------- ?1p� .........................-- --- ------ Daze PermitNo. --- ......... ----------------------------------- Issued ........................Date....................................... ate------------......------. ----------- No.._ .._....... Fins .... �...... . ............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF -HEALTH ,,/'� jf • TOWN OF BARNSTABLE Appliration for Disposal Works Cnnnstrnrtion rumit Application is hereby made for a Permit to Construct ( ) or Repair (KX) an Individual Sewage Disposal System at: Phn„*otr PraaA vanrii e _ ...Loc�tion-Address .•........................•...... .......................................--or Lot No. fi.w..fhnretr Tlr�.rrv.ni+.n nse^-was:;. .::. ....................................................... .................................................................................................. Owner Address T T C ..... ............ ..................................................... ... ......---•• <--se..,c a ter.,- Installer Address d Type of Building-,. Size Lot............................Sq. feet Dwelling -No. of Bedrooms........... .............................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................. Showers ( ) — Cafeteria ( ) Otherfixtures ------------------------------------•--•--•------•----------•---•-•----•---------•---...---•--...._........................-•--••--•--------•---•--. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. W Septic Tank—Liquid capacity..._.....gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—,Nod................... 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........................................ I, W Test Pit No. 1................minutes per inch Deptli,oaf Test Pit.................... Depth to ground water_-.__-_______-_____-,-.- fst Test Pit No. 2................minutes per inch Depth of Test Pit......................... Depth to ground water........................ Ra' ................ ----------• -----•----------------------•--•••-_._.. .--------------------------•--••--•--••••...--•-•--••-•------........_....-- 0 Description of Soil........... a_L?ji..R+:..Gn nee..----•-••..............•--•-•--- xI ---------------------------------•--••----•--•- V •--•-----•-•-•----••....................•--•------••--------•------•--...--•••---••-•--........•-------•••-•-•- W .................................•--------•-------------•-----------•------•----•--•----•--•--•--••--------------------------------•-------------.........---•----•------......._..------------......•. U Nature of Repairs or¢Alterati��Answer when applicable............................................................................................... 74 _._.....-•---------------------------•- -----_....7..........................._a wn...;rn.12 nn- 1 eA Ch n1_t.,...............................-•••--------------... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental 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 .... . , 1. �1 _... . ------------------------ ....... � . Application Approved / � -. ------------ ............... - IV Date Application Disapproved for the following reasons- --------------------------------------------------------------------------------------------------------------------------- ------- -----------------------.................. --- Permit No. .../.. .r ,/ %. !. Issued --------------------..................... .... Date THE COMMONWEALTH OF MASSACHUSETTS s BOARD OF HEALTH TOWN OF BARNSTABLE Gextifira e of C11umylian.ce THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired XXX ) by..........T...T...11 f.».^.^---:^.L.ems---.-.T.y........................................................................................................................................... W 1 •Dlac VrabG� v� • Installer at ........7.J.....�r�..h,r 'tyr....a�.cnad-----Hyannis............................................................................ ......................--..----_ has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. .. .!r-. q.............. dated .........7... '�Q'�......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT EE CONSTWUED AS A GUARANTEE`THAT�THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.....0 ^ -- ................ Inspectors::''....+ _........ . ..".... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 90_ �� TOWN OF BARNSTABLE No.r..._........�...P... FEE......,... ..=- --� Disposal Works Tuns#rnr#ilan "permit Permission is hereby granted........T- P zM-C.C� jjy!,....--••..................•-•---•---•--•--..............----.... to Construct ( ) or Repair 1� ) an Individual Sewage Disposal System at No ?_,? �hrt�rse�Rr 12nn�r4 v!anni G+ / Street ��., / as shown on the application for Disposal Works Construction PPe�rm�it N0.91.6—.......... Dated..... .} ! ......... Board�ofZHealth ✓``L- G DATE................ :. h......._. .....................•--•----.....---- FORM 36508 HOBBS Q WARREN.INC.;PU13LISMERS EL-O W PROFILE ALL PIPE ELEVATIONS SPECIFIED ARE INVERT ELEVATIONS ALL PIPE TO BE EXPRESSED IN DECIMAL FEET NOT FEET AND INCHES. SCHEDULE 40 PVC TOP OF FOUNDATION RAISE COVERS TO WITHIN SIX INCHES OF FINAL GRADE AND PITCH AT 1/8 Inn//ft MIN. EL = 39.25 +- INSTALL ONE INSPECTION RISER FOR LEACHING GALLERY TO WITHIN 3 INCHES OF FINAL GRADE AS INSPECTION PORT AND INDICATE LOCATION ON AS BUILT. 38.00 ❑-BOX 3 ft 3" DROP MAX FLOW LINE TEE 35.00 ' 10 14' 48" GAS PRECAST PRECAST BAFFLE DRYWELL 6 in BOTTOM OF L - STONE SOIL ABSORPTION EXISTING 34.33 LEACHING SYSTEM EXISTING BASE EXISTING 34.50 GALLERY EXISTING 1000 GALLON 34.25 (END VIEW) 32.25 5.00 ft + SEPTIC TANK SEE DETAIL ON REVERSE EXISTING 6.5 ft of 6.5 ft 12.5 ft b) 7.5 ft ADJUSTED F 16.7 SEASONAL HIGH GROUNDWATER wN � day 0 O IOplwy yr- � 3x � . � ivm Z� m uJ Z� Oyy vl 3� n co 6. y Z n = Y z m `- Z 0 CD vvrnn maOZ > o � O z 'V aD 1a —1 _ m i w m 0) \ J cn F. O � �J Zcj mr I c :zz �u .0 cp r no m� n �t-~ o N ' mo . /. 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F--0z>0 m N 3oA�rn y ny y X ��y f N�-�dSI m�Mocn N � O o • x o MO ml <a 3m�� I � n � z (11 N o 0 0� m z�7 p Cfl > -u 2 �n Y m O m m c* o � 0 �� co N .-a] O ❑ � > Vim' ' no. y � zA � � y yr -{ � z m30fT1m o m mmz y v J r h, m..o < rn o (n-< f�l z n CO m o �,��' Z r f�l rn O 0 c)mu co z m G� 0 -� cn _ ��+0 3o CD o - o o ? ' ' I o yo;-0 O 0 n 3 0 (n -<y I <m Zm U) zo��� ? 0 n �O � --1 (n� cn Z m n o r-._:n cn. r- > m fTl r- n m �7 y .. co c,nMz 0) hO n 3 3 m->3 < ❑ O m c� o p rim--�zo r zz Dl A cn ��C)mm Z 30 a D O SOIL TEST LOG DESIGN CALCULATIONS r DATE OF TEST: MAY 23. 2007 SOIL EVALUATOR: DAVID D. COUGHANOWR. R.S. DESIGN FLOW: 4 BEDROOMS X 110 GPD = 440 GPD WITNESSED BY: DONNA MIORANDI. HEALTH DEPT. PERC NUMBER: H762 SEPTIC TANK: 440 GPD X 2 DAYS = 680 GALLONS TEST PIT 1 NO GROUMATERIAL:D ENCOUNTER LD OUTWASH USE EXISTING 1000 GALLON SEPTIC TANK IF IN SOUND STRUCTURAL PAR PARENT In - ?_ MIN/INCH IN C TWAS CONDITION. IF NOT, INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED) SOILS DISTRIBUTION BOX: USE 3 OUTLET D-BOX. ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING THE LEACHING GALLERY DEPICTED BELOW CAN LEACH 38.00 0-6 Ap LOAMY SAND 10 YR 2/2 NONE FRIABLE AInot = (33.5 x 10.5) + (2 x 29) + 0.5 x (4.5 x 2) = '414.25 sf A s d w = (3 3.5 + 10.5 + 4.9 2 + 2 9 + 12.5) x 2 = 16 0.8 4 s f 6-40 B LOAMY SAND 10 YR 4/4 NONE FRIABLE A L o L = 595.09 s f 34.67 40-132 C MEDUIM SAND 10 YR 5/4 NONE LOOSE V t 0.7 4 x 595.09 = 440.37 G P D 2�.00 USE A THE LEACHING GALLERY DEPICTED BELOW. Vt = 440.37-. GPD > 440 GPD REQUIRED TEST PIT 2 LEACHING GALLERY CONSTRUCTION DETAIL 500 GALLON DRYWELL ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER DIMENSIONS AND DETAIL (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING SHOREY PRECAST CONCRETE 500 GALLON DRYWELL USE H-10 UNIT 38.10 LEACHING UNIT OR 0-6 A LOAMY SAND 10 YR 2/1 NONE FRIABLE EOUIVALENT STON7 INSTALL ONE INSPECTION . P RISER TO WITHIN THREE INCHES OF FINAL GRADE 8-40 B LOAMY SAND 10 YR 4/4 NONE FRIABLE AND INDICATE LOCATION 34�� k 29 Ft ON AS-BUILT CARD. 40-132 C MEDUIM SAND 10 YR 5/4 NONE LOOSE Q 92 m 27.10 m 4J Q Q 34 4- 0�� In � o0000Lq 0c::j �0000 GROUNDWATER ADJUSTMENT m o00000000a EXISTING GROUNDWATER LEVEL RASED ON TOWN OF BARNSTABLE 4.0' 8.5' B. 8.5' 4.0' GIS DEPARTMENT RECORDS. 33.5 F t 102 in INDICATED GW 15.00 ZO Ex WELL C1w-29 LEACHING GALLERY READING DATE APRIL. 2007 CROSS SECTION VIEW READING 7.0 USE SHOREY PRECAST 500 GALLON LEACHING DRYWELL (H-10 LOADING) ADJUSTMENT 1.7 ADJUSTED G W 16.7 2 in PEA-STONE 2 in PEA TONE NOTES1-3 C3 28 3/4 In T 24 In In EFFECTIVE 3/4 In A 26 1) INSTALLER T.O OBTAIN DISPOSAL WORKS PERMIT BEFORE STARTING WORK. -1 2 In GRavE DEPTH 1-1 2 In GRAVEL In 2) SEPTIC TANK TO BE PUMPED DRY AT TIME OF SYSTEM REPAIR AND CHECKED FOR STRUCTURAL INTEGRITY. INSTALL PVC OUTLET TEE FITTED WITH GAS BAFFLE. 58 in f 46 In 3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REQUIREMENTS OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15). 150 in INSTALLER MAY ELECT TO SUBSTITUTE AN APPROVED GEOTEXTILE 4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES FABRIC IN PLACE OF THE PEASTONE LAYER SPECIFIED. BEFORE EXCAVATING FOR SYSTEM. SEWAGE DISPOSAL SYSTEM PLAN 5) EXISTING LEACH PIT TO BE PUMPED. COLLAPSED. AND REMOVED *' 6) ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON. FINES AND .DUST-IN PLACE. -TO SERVE EXISTING DWELLING 7) ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION OF LOW FLOW FIXTURES Rl_1TH M. DEGRADE AND APPLIANCES. AND BIANNUAL PUMPING OF THE SEPTIC' TANK: :.,,. 1 ��., 8 G. NOT) SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. DO ` 33 SHOREY ROAD HYANNIS. MA ,PARK OR DRIVE VEHICLES . OVER SEPTIC SYSTEM. ECO-TECH ENVIRONMENTAL 9) SEPTIC TANKS SHALL BE INSTALLED LEVEL AlND- TRUE TO GRADE ON.. A r LEVEL STABLE BASE THAT HAS BEEN MECHANICALLY COMPACTED.. AND'ON-"'TO WHICH 43 TRIANGLE CIRCLE SANDWICH MA 02563 SIX INCHES OF CRUSHED STONE HAS BEEN PLACED TO MINIM'LZE UNEVEN SETTLING. ETE-2615 I MAY 25. 2007 1212 ,