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0249 STRAIGHTWAY - Health
y .t f --•249,'Straightway 268-279 Hyannis i i it T r TOWN OF BARNSTABLE LOCATION SEWAGE# Z z' 10 V)LLAGE 14t knh l I ASSESSOR'S MAP&PARCEL AW- 09 9 INSTALLER'S NAME&PHONE NO. to co(Q L�'n �r,l� ✓iI yab' O;iP SEPTIC TANK CAPACITY /D0j) LEACHING FACILITY.(type) J�f_) Y1 0 � D Ar- (size) l q,. ( )e 20 NO.OF BEDROOMS OWNER J Q a i vt f PERMIT DATE: ' Z c. G COMPLIANCE DATE: Z 2 3- Z 0 i cZ 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 e.,z Y�5 P� L� c�CTJ G1 CZ C', 20 Ra va�fi� P � a�ra�j�J Commonwealth of Massachusetts P WV , / W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ri 1- °�M 249 Straight Way ; Property Address p, Kim & Lester Grooms Owner Owner's Name ° information is � required for every Hyannis Ma 02601 9-27-17 a 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:When filling out forms A. General Information J 14- a U o3 on the computer, use only the tab 1. Inspector: key to move your cursor-do not Brett Hickey use the return Name of Inspector key. B&B Excavation reb Company Name 374 Route 130 _ Company Address Sandwich Ma 02563 City/Town State Zip Code (508)477-0653 S113747 Telephone Number License Number B. Certification 1 certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 9-27-17 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 4oj9ed Us Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °wM 249 Straight Way Property Address Kim & Lester Grooms Owner Owner's Name information is required for every Hyannis Ma 02601 9-27-17 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: System was in working order at time of inspection. 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 249 Straight Way Property Address Kim & Lester Grooms Owner Owner's Name information is required for every Hyannis Ma 02601 9-27-17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 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 249 Straight Way Property Address Kim & Lester Grooms Owner Owner's Name information is required for every Hyannis Ma 02601 9-27-17 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 Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent•to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °7M 249 Straight Way Property Address Kim & Lester Grooms Owner Owner's Name information is required for every Hyannis Ma 02601 9-27-17 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �qM 249 Straight Way Property Address Kim & Lester Grooms Owner Owner's Name information is Hyannis Ma 02601 9-27-17 required for every Y page. Citylrown State Zip Code Date of Inspection C. Checklist Check if he following h v "ta e been done. You must indicate es" or"no" a f i y s to each o 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? El E Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ❑ ® Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface Y sewage disposal systems? P 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) 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 456GPD t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments � M 249 Straight Way Property Address Kim & Lester Grooms Owner Owner's Name information is required for every Hyannis Ma 02601 9-27-17 — page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d See below 9 ( Y 9 (gP ))� Detail: 2015-46,376gallons 2016-53,856gallons Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: NA 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °7M ,5 249 Straight Way Property Address Kim & Lester Grooms Owner Owner's Name information is required for every Hyannis Ma 02601 9-27-17 page. Cityrrown 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: Date of last pump is unknown 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: r ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): l5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 249 Straight Way Property Address Kim & Lester Grooms Owner Owner's Name information is required for every Hyannis Ma 02601 9-27-17 _ 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: New SAS added to existing tank in 2010 per COC Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 4,feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: Town feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 3 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: 1000gallons Sludge depth: 2 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 249 Straight Way Property Address Kim & Lester Grooms Owner Owner's Name information is required for every Hyannis Ma 02601 9-27-17 - 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 34" 11 Scum thickness 0 Distance from top of scum to top of outlet tee or baffle NS Distance from bottom of scum to bottom of outlet tee or baffle . NS 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.): Tank was in working order at time of inspection with liquid level equal to outlet invert. Tank is not in need of pumping at this time but should be pumped every two years for maintenance. Grease Trap (locate on site plan): Depth below grade: NA 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 249 Straight Way Property Address Kim & Lester Grooms Owner Owner's Name information is required for every Hyannis Ma 02601 9-27-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.).- Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: NA 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.): I *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 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 249 Straight Way Property Address Kim & Lester Grooms Owner Owner's Name information is required for every Hyannis Ma 02601 9-27-17 _ page. CityFrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 11 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.): D-box is in working order at time of inspection with liquid level equal to outlet invert. D-box did not show signs of back up. 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.): NA If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: I t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 249 Straight Way Property Address Kim & Lester Grooms Owner Owner's Name information is required for every Hyannis Ma 02601 9-27-17 - page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 19 hi cap Bio Dills. 14.4'x20' ❑ 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.): Leaching was in working order at time of inspection with no sign of hydraulic failure. Field was dry when viewed. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration NA Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3113 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 249 Straight Way Property Address Kim & Lester Grooms _ Owner Owner's Name information is required for every Hyannis Ma 02601 9-27-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: NA Dimensions Depth of solids Comments(note condition-of soil; signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 249 Straight Way Property Address Kim & Lester Grooms Owner Owner's Name information is Hyannis Ma 02601 9-27-17 required for every -y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: 0 hand-sketch in the area below ❑ drawing attached separately A A4.28'5" A5.41' 81.31' 132-347' B3-18'5" 134.18' 135.21'5" Cl-23' C2-25'5" C3.55'4" C g i Driveway 4 5 Driveway l5ins•3/13 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 249 Straight Way Property Address Kim & Lester Grooms Owner Owner's Name information is required for every Hyannis Ma 02601 9-27-17 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: No GW @ 134"' 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: 2-2-10 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Plan on file with BOH. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 249 Straight Way Property Address Kim & Lester Grooms Owner Owner's Name information is required for every Hyannis Ma 02601 9-27-17 page. City/Town State Zip Code Date of Inspection j E. Report Completeness Checklist i E Inspection Summary: A, B, C, D, or E checked E Inspection Summary D (System Failure Criteria Applicable to All Systems)completed Il E System Information— Estimated depth to high groundwater E Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 I'oWn of Barnstable Regulatory Services Thomas F. (Teller, Director d VA MABAm , •' Public Health Division Ei. Thomas McKean Director 200 Main Street, Hyannis, MA 02601 Office: 508••f 62.4644 Fax, J Date; Sewage Permit# tow - c�3� Assessor's Map/Parcel ,�;� a•_�`i Installer & Designer Certification Form Designer; S_e."_._E�1�V111:L-.."��`'� , TV)c...... Installer: C..a0c°w;Ck . L-r11rcc t r af. ^, Atldresy; 1 y f c tc:Ir,�>cr rx ►� iw�y....,...... Address, t A y 1 W c•1 c.�r�,wl A U 7, 3 :4 z 7 o;T 7 _.... Un (installer) was issued a permit to it a (data) septic Sytiten'l at based on_..._._.,..._....,.... a design drawn by C Ery,����.r��e_cir ' 'Lv1C__r_.._-__. dated fe\0ruo 7_ , 2.CiG (designer) �..------ .. ......---..._.._..... v� I certify that the; Septic system referenced above wets installed substantially a.ecc�rding io the design, which May include minor approved changers such as lateral relocation oftl,lc distribution boar and/car septic tank. Stripout (if requited) was inspected and the sc•.ils N•t.re fi>und satisfactory. 1 certit'y that the septic systern referenced above was installed with major change; greater than 10' lateral relocation of the SAS or any vertical relocation of any compommt of tlic septic system) but in accordance, with State & Local Regulations, Plan revision or cc;rtified as-built try designer tci fellow. Stril)out (if required) .: ' is ,ectc(i and the sods were f{)und satisftwtory'. JpHN C41 R.1 a .,._•lhrc:... . C till / .IVit. )etitl�nEr s Sit;iiature (Affrx f.)!ct gn Cici=c) P C SE C:F RETURN TO )ARNS"FABLE PUBLIC IIEAL t1� D V1SI )N. (vv, tr�I(' TI, O 'LIANC +' W1L1 N T BE ISSUE Tails I+ORM AND AS- BU1L' ARD ARF. R1;ClC, V1'I)DY 'i'� �'' Lam'•-•'• r X Hr BARNS' ABL r PUBLIC Jj A[ F it`.ofl'ico InrmsnJcslgt,C Cerhticauor R,nn duc ZA A 7 RRC 11 hJ T?J�7 W T-1 N7^1 r I.1-4 nis! 7T 04 T Gi 7_ J 7_Q7J No,i 0 03 —5 Fee �✓ `'� ' THE COMMONWEALTH OF MASSACHU§ETTSI Entered in computer: es PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ZIpplication for Migpozdl *p!5tem Con0truction Permit Application for a Permit to Construct( ) Repair V) Upgrade( ) Abandon( ) ❑ Complete System ®Individual.Components Location Address or Lot No. "L40A S-rf"�TLA}A-e 11 z�igy►n�S Owner's Name,Address,and Tel.No. "Td, Assessor's Map/Parcel Installer's Name,Address,and Tel.No. crs ;a� Plkrrs3'S Designer's Name,Address and Tel.No. 100 Rux 74.3 z45-/ "Y - t L-c b�wr��L,.,.,, .mot Type of Building: Dwelling No.of Bedrooms Lot Size %f /0 6 4- sq. ft. Garbage Grinder ( ) Other Type of Building ,5 i� r No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank I D Do !iA C LX-s 6k Type of S.A.S. STD,riSS 9,b d2C.,o4s Description of Soil � P441n C 40 30 Nature of Repairs or Alterations(Answer when applicable) 6-x%5iki r"it TO /1.Q11' tip.,! S hsvu2i�s s LcC. 1 Date last inspected: `?101® Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Sign Date 3' Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. �' 't: _Date Issued ell �o9►,gry��C1 03 ram— �q Fee 0 N c) ` A r ., % F W THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 1 PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS,' Yes `ZIppYicatiou for 3i5po5al *pgtem Coin.5truction permit x Application for a Permit to Construct( ) Repair') Upgrade( ) Abandon( ) ❑.Complete System &Individual Components Location Address or Lot No. Z�� S 1(P•ij�T�}n�� nis Owner's Name,Address,and Tel.No. Sa" fi Assessor's MapfParcel •' ) Installer's Name,Address,and Tel.No.(f412 6W.c�o !�f Gf��3 C} Designer's Name,Address and Tel.No, ,.( ' RJX, 7 b 3�nw 2 s ��G✓oar cr,y lgco y C `C.�•��'(/'�-1 (�. 0 0 - m Type of Building: Dwelling No.of Bedrooms Lot Size //, /V 6 sq. ft. Garbage Grinder ( ) Other Type of Building 111" r 1� hmNtf No.of Persons Showers( ) Cafeteria( ) Other Fixtures t' Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank 1 a OO !�A I- -ex.t,i b� Type of S.A.S. 6rOCIASS Ro d+,4evIS Description of Soil ,o 30 r c 77 Nature of Repairs or Alterations(Answer when applicable) rwv k T 0 t 1 5 ta4eJ5 L eAGC.4,1hJ + Date last inspected: / Agreement: ; The undersigned agrees to ensure the construction and maintenance of the'afore described on-site sewage disposal system iri accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed - , /� Date Application Approved b .. , a Date 0 PP PP Y ` Application Disapproved by: Date for the following reasons Permit No. ,° o! C) 'ram Date Issued 3,176) r THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS I i Certificate of Compliance J THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (YQ Upgraded ( ) Abandoned( )by 4 p�tJ,t�t 4i fern , C S L(-c— at �(� T4a,I /it&c/�, has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. V 0'/0 �� � dated Installer �t�Q Q`1 s{I % 'c Designer " •�f- t!~2a�1✓4 t. r #bedrooms 3 Approved�de i'gflo�� Q gpd The-issuance of thi permilt shall not be construed as a guarantee that the system ion n as designe,. Date Inspector t-'+---J� V No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS Migogat *pgtem Cow5truction permit Permission is hereby granted to Construct ( `) Repair ( Q� Upgrade ( ) Abandon ( ) System located at and as described in the above Application f'or Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions: Provided: Construction mus be completed within three years of the date of this perini . �. Date 3L ( S / 1 Approved by I No. � _1 wO +4 Fee ^' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: s PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Rpplication for �Diopozaf *pgtem Con!5truction Permit Application for a Permit to Construct( )Repair( �)Upgrade( )Abandon( ) O Complete System El Individual Components Location ddres or Lot�vo. a�'6 �7 Owner's Name,Address and Tel.No. ,n�}�1 ��at51��w� Assessor's Map/Parcel IQ• (09, �{ 775 3ng ' 'p 5)--g7oo r Installer's Name,Adddress,and Tel.N � DesigneRIME ' e Address and Tel.No. 5?,old-c�o;3 r aYu 6o n Ran er�� �y, & o&(cs Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 0 Ff),�ia� 54 ajlk +w© 500 ova►1©n ��y weld Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued WhBod of h. ' O� Sign( Date Application Approved by Date Application Disapproved for the following reasons Permit No. _DO Ll^ Date Issued 'd- 1 )c`) THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired O Upgraded ( ) Abandoned( )by J at C40 {-4, has been constructed in accordance with the pr visions of Title 5 and the for Disposal System Construction Permit No. dated ( Installer C) _�� C,p G_�1 Designer C C The issuance of this permit shall not be construed as a guarantee that the system will function as designed. ' Date Inspector t' ------------- W V . Fee ry THE•COMMONWEALTH OF MASSACHUSETTS % Entered in computer: Y . PUBLIC HEALTH',DIVISION-TOWN OF BARNSTABLE., MASSACHUSETTS ,Y _ Yicatton for Zigogar &p.5tent Congtructiori Permit - Application for a Permit to Construct( )Repair( �)Upgrade( )Abandon Complete System .El Individual Components Location ddres or Lot No. 0�.(0 a` Owner's Name,Address and Tel.No. ay�l �� M[9} tu)4t, 17�1f�a , , 5 osla� Dq��ilvo. Assessor's Map/ParcelL� %I CID yll 5 Installer's ame,Address,and Tel.N 576-355's Designer's ,�`� o. �� Name}A�d�dress and Tel.No. (1.IciCOY►11:7fY'aXl�.`Jo 11 �On COCO c.4tp� k 130� b Type of Building: Dwelling No.of Bedrooms L'o't Se sq. ft. Garbage Grinder( ) F Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil . f Nature of Repairs or Alterati ns(Answer whe applicable) 111..1k CU'L -Fw0 500 �QJLGYJ DfL, Date last inspected: Agreement: The undersigned agrees to ensure the construction and mainteriance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b` ,.this Bo Yd of HHeea h'= ~' s Signed fi' Date Application Approved by Date a 1G`I Application Disapproved for the following reasons': ?4 ' Permit No. c,LQ 0 t' ` ` r' Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired Upgraded( ) Abandoned( )by 0 1CK Q m 6 Q Q_KA '5011 at a � �� c a�A,'1 l9s.kl qI XRO(5 , Y12.a has beenconstructed in accordance with the provisions of Titl j5 and the for Disposal System Construction Pe tt No. dated Installer V10� T W -i� t Designer�l'1 ► GC The issuance of this permit shall not be construed as a guarantee that the system will function as designed.- Date Inspector r, No. l ^E'� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS lwigpogar *pgtem Construction Permit Permission is hereby gr C led to Construct( )Repair()� )Upgrade( )Abandon( ) System located at 'rc� and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this p`rt. Date:_ /U • -Approved�by e� Town of Barnstable P# A) 04 SHE Tph P� ti Department of Regulatory Services Public Health Division Date anrwsrnar.e. MAC' 1639• mmq 200 Main Street,Hyannis MA 02601 pTEO MA't A Date Scheduled I o Time I Fee Pd. Soil Suitability Assessment for Sewage Disposal Performed By: l�N r4 l���CI ► I�t I Witnessed By: ✓i 14 .-) . Cj LOCATION & GENERAL INFORMATION Location Address (j GJ �-1 J Owner's Name 5r bil? Address GrN!'! Assessor's Map/Parcel: G�- 7 Engineer's Name NEW CONSTRUCTION V REPAIR Telephone#Land Use Slopes Surface Stones Distances from: Open Water Body�0 ft Possible Wet Area o tt Drinking Water Well klo ft I Drainage Way r+ ft Property Line 77 ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) r AGI _ mil' �AftAftlq To Parent material(geologic) U L1`I"WAf Depth to Bedrock Depth to Groundwater: Standing Water in Hole: N / `Weeping from Pit Face I T Estimated Seasonal High Groundwater p r`0 6 1 1 1 l>P 1[9 r w� q r 4 e (,u)q DETERMINATION FOR SEASONAL HIGH WATER TABLE Y"A P Method Used: h Drd5 Depth Observed standing in obs.hole: in. Depth to soil mottles: i►�• Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft• Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level_ PERCOLATION TEST Date (0 Time 10 1 C Observation Hole# Time at 9" Depth ofPerc O� Z Time at 6" Start Pre-soak Time @ 10 t S Time(9"-6") End Pre-soak I L.2_ &�V �)a I t7 A.)b i t 41r rrt,wv'• Rate Min./Inch Z_-Z '�lNC� �� C AJ( A)s Site Suitability Assessment: Site Passed y Site Failed: Additional Testing Needed(YM) 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 Division at least one 1 week prior to beginning. Barnstable Conservation ( ) Q:HEALTH/W P/PERCFORM DEEP OBSERVATION HOLE LOG Hole# 1 Depth from Soil Horizon Soil Texture Sail Color Soil Other Surface(In.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders, Dnnsistenc. 11 Cal aver. ..___._-. kb 16"r k�� low j Iltid 'y�S/�3 lira 30r 7ir DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Sail Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) _ DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface m. (USDA) (Munsell) Mottling (Stricture,Stones,Boulders. ( ) Consistency.%Gravel) DEEP OBSERVATION HOLE LOG Hole# Other Depth from Soil Horizon Soil Texture Soil Color Soil Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) Flood Insurance Rate Map: ✓ Above 500 year flood boundary No_ Yes Within 500 year boundary No_ Yes Within 100 year flood boundary No— Yes Depth of Naturally Occur rinsr Pervious Material Does at least four feet of naturally occurring pervious matet ial,exist in all areas observed throughout the area proposed for the soil absorption system? Yes If not,what is the depth of naturally occurring pervious material? Certification �� I certify that on 0• 1fq3(date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required tr ' ,expertise and experience described in 310 CMR 1.5.017./ rr Signature � Date Q:HEALTH/W P/PERCFORM t — � L L^�\CATIOq � SECyA G E PERgIT 130. d;ILLAGE. ALz7 � IWST�A LLER' %!!qA E 6 ADDRESS 0 U I L D E Cl 00 0Vp ER DATE '` PERMIT ISSUED DATE COMPLIANCE ISSUED �� � r " l e" f � � r No..............1—..... FimB. ......... ........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH T0 teo;/,V---......OF........ C........................ Appliration for Uhipooal Worku Tonotrurtbatt Prrutit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: ;X ...............��T&22516:Z . ...W�_e............................... ........ .40................... ..... ........................ Locatio dress s or Lot No, ................ lAld. . .... k_'OAD..... Owner —I - Address Installer Address Type of Building Size -----Sq. feet U oms..........%3 ........................Expansion Attic Garbage Grinder (.4/0) Dwelling—No. of Bedro 9 PL4 Other—Type of Building ............................ No. of persons---_----------------------- Showers — Cafeteria Otherfixtures ...................................................................................................................................................... Design Flow.............*55........ ...........gallons per person per day. Total daily flow..........._%3.%2_0...................g-41ons. P4 Septic Tank—Liquid capacity/!VOgallons Length_3.7.'A;' ... Width_" ._e// Diameter__Y---*'.4.... Depth..,i'." Disposal Trench—No. .................... Width............__..... Total Length___.........._...... Total leaching area...................sq. ft. Seepage Pit No-------/------------ Diameter---- d.;----------- Depth below inlet....46............ Total leaching area...,2A292...sq. f t. Z Other Distribution box (Al Dosing tank Percolation Test Results Performed by._...2C_4w. ....�.//e/p Z................... Date..Z�/.. as Test Pit No. 1.."-�.Z..minutesperinch Depth of Test Pit.____dam.__... Depth to ground water. Test Pit No. 2................minutes per inch Depth of Test Pit..___............... Depth to ground water.__..................._. ............................................................................................................................................................ 0 Description of Soil..............0. Z-/.......................................................................... U�4 a.z"_......................... ..................... ..... ......44iv ......................................... -------------I...................... ................................................................................................................................................................. 'T: U Nature of Repairs or Alterations—Answer when applicable............................................................................................... .......................... ............................................................I............................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of 7' T' �,7 1_-- 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be n issued by the board o health. ,Sigtm ......................... . ..... .....yeo Application Approved By . ... ..... .. . ..................... Date .................. Date Application Disapproved for the following reasons:......................................................................................_........................ ....................................................................................................................................................................................................... Permit No.. Issued-...//, e—'Cle Date . .......................................... No.............. ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7. 04(11�/� OF. . ............................. ...............--------.......------------------......................._........ Appliratiun for Disposal Works Toustrurtiun rrmff Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: �-t--�.-�•�-�{.� ---•--- ...............': /�/1' i s��!r/f !'✓ 7 ----..._�f -L-�-� ..------- --.....•.�...�..L.............. Location-Address or Lot No. ....--••..............».....................................................................•.... ...........................••-•-••--........:.._.................................................. Owner Address a�• '`"' ...............................................................- •--- ' •••-•--------••--•--•---...........•••---•••••-•................................................, Installer Address Q Type of Building Size Lot..f.:'_. ......Sq. feet U Dwelling—No. of Bedrooms..........3.................. _Expansion Attic ( ) Garbage Grinder (A10) a Other—Type e of Building ............... No. of ersons....._.__.._._.............. Showers p., yp g -•--••-••---- p ( ) — Cafeteria ( ) 44 Other fixtures ---------------------------------- ' W Design Flow...............5%tr.....................gallons per person per day. Total daily flow......... _ ....................gallons. W Septic Tank—Liquid capacity/4240.gallons Length_9 /.0C. Width.l< f Diameter.!:'.ate Depth.:.__ ` x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No------/----------- Diameter.....1?.. ...... Depth below inlet............... Total leaching area.. '.._.=...'...sq. ft. Z Other Distribution box (Al Dosing tank ( ) Percolation Test Results Performed b �� ._._ _r / f . ..---.•:.'-_...... W Y " = ---------•- Date.= - -:... Test Pit �?o. 1__` r minutes per inch Depth of Test Pit______.__�_._.__ Depth to ground water... ....!c:?......._.. LZ, Test Pit No. 2................minutes per inch Depth of Test'JPit.................... Depth to ground water........................ r O Description of Soil--------------�--` ..........f / .� - [ t 'G"` - 5 /' !•x -----------------------------•-••-----•--- ------------------- -------------- ---------------•-•---•--------------•--------------------.----------•-----------.-•-•............................................. W =-----------------------------I'll-------------- ---------------------------------------------------------------------------------------------------U Nature of Repairs or Alterations—:Answer when applicable.___---.............: :........................................................................ ------------------------------------------------------------------------------------•--.......-•--•-----•-------------------......---------•--•--•••----............................................... Agreement: .j The undersigned agrees to install the aforedescribed Individual Sewage Disposal(System in accordance with the provisions of L: :.' .r 5 of the State Sanitary Code— The undersigned further agrees not to place the,system in operation until a Certificate of Compliance has been issued by the board of health. Sig, d Date Application Approved BY......f � "...................... Date Application Disapproved for the,,jollowmg reasons..---- V----------------------------------------------------------•-----------------------=-------------- ..........-.................................................................................................................................. Date PermitNo......................................................... Issued.............................................1=......... F; Date THE COMMONWEALTH OF MASSACHUSETTS -per BOARD OF HEALTH .........L...®CCJi!..._......OF...... .................. (9rdifiratr of ToutpliFanrr THIS IS TO CERTIFY, That the I idual Sew, e isp Sal Systems constructed ( or Repaired ( ) by.. ---•------ --•-------- -'"'•-------�� sue: .�T��Y. — mac, ' ------------------------------------- `' Installer �b� s ai has been.--installed in accordance with thwisions of TI ' S of The State Sanitary e 's d scribed in he application for Disposal Works Construction Permit No.... ~ .............. dated__= y ...�____1j.-A�_.... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WI L FUNCI�I,OH SATES-FACTORY. DATE. - e Inspector - --- 777�--------- THE COMMONWEALTH OP MASSACHUSETTS BOARD' OF `HEALTH: No......................... FE ............... Dispasat or ns#r io rrmi# Permission is hereby granted..:"........ ........... •.----• .......j"------ .......... ............................ to Constru ( r pair ( an Individual e a e D' al S te> +. at treet as shown on the application for Disposal Works Construction Per o-------_ - _ Dated_, 4~i� Board of Health / ,/ DATE............. `��`"" FORM' 1255 HOBBS & WARREN. INC.. PUBLISHERS �, k CST c '7—)E'C, 141 /-97-9 /i ez 14 l�. f.� �.r• " "Z+ —•� .Ip�. Q l ! d` �'..rfa' V(f����.•s....,�JJC..�N..1ft!`'f �t....�;E.y; A0 \ 1 jp+ ram.. - g /ever � 1 2� s Mi/v/NIc//t/l SOLE _ , W 5 u/Z--o1'vG S ETC3ACA::-- e C.4 L F- 4./ = C EAU/.��MF�/T�' H'' `� � • P2 o DO SF_D 1 -5 BE._DI20oM.S SE P T/G 5 y5 TAM CONS T2(./G T/ON SHA J , GOnJF02M TO MA SS . DES A7L OW 3-30 GAL/L7A Y ENV/20NML-NTH([. COOS T/TLL Y AZyJ 7',/=ai?-� -ArlI2.47E M/A./ TOP OF 'yE'�L T'y TZ�G UL A T/O/A/S P20006 E V L MA1U L101 E Co✓E,--:, To &x TE&!D 7'p ✓/OUS CO t/E,2 TO .a2E VENT /n/E5 W/ Tf-!/N /' /A/F/L 7/2.4 T✓AJ-C f / , S ron✓E „� 30X "/A//N1Un/ - �'M1rnJ y 3,.M,A/ 4/. DIA T�Z -- —�c--- —z-- P/TGf-/ FLOr,✓ L,N� ri�T 4' 1 M/'V Di TCt/ — !4"007— /O"M/N /4•, �q �f OOT w 2 M/N l�iTt�i J/ D/A. 'Y- Cis/ Mi,t1c .`'r /4„/Gaon '>•- WA5NE0 /n/vE e r /-k L r /A/vEeT ' _ Ca P-A C / TY A 2 O un/O TA.�/� 'r�t`. w5 � EL-EV• �WATG�T/GNT� /N(/ElzT r/- Bo7Ta� �F ,v vE zr A(6 GABA6E Zo' M/A.1/M U1L f 6 ,n , 7ri _ rr --G / IAJ — ----- - -- ?/c � SEATiG TAN/AC� L7/�T2/8G>T/ON 80X D GOiIICTZE7'F t M ;Con/ce� T,y 3000 psi / 3 r� C V/: toy-/ � . ✓ „ �`� �: r*STEEL 20000 } O LOAD C, fig . 1eF/LL.c3bt"OU7)WA.t=.P�.+!r�T��� 4�,C/V- WAY n1oT 7-00 aE LOCA;F�> Ave RT �j�J�'LS• O l/�G S YS T�M (Jn/L E 5 S H- � � 20 °''°�'='�•�s IJE.S/G�1 L OA L�/�/G /5 USED. r � TJ-11S F7LA&/ /S R AS S1 /Clli/lk'.l A,ti/D T.� Ll/.'_0,'tip S TF-,,nC 1 OF / �—IL / //�1 IAA TE /-/EAL-7A-/ AL�Ems/T DATE aE' /. .�•a"' . _ '*�_ (.' �= .'� A OV.-aL- ALWAYS DIG SAFE PRIOR TO CONSTRUCTION--UTILITY LOCATIONS SHOWN INCOMPLETE. JOB NO. 804-20 NOTES Desilva.dwg 00 1. LOCUS IS A.M. 268, PARCEL 279. `O 2. ELEVATIONS SHOWN ARE ASSIGNED. v\e� let(- 63. LOCUS IS IN FLOOD ZONE C ON FIRM DATED JULY 2, 1992. Oak fi a 4. ALL PIPES TO BE 4" SCH 40, AND PITCHED AT 1/4" PER FOOT. (UNLESS NOTED) a. BOARD OF HEALTH REQUIRES R.J. CADILLAC 5. MUNICIPAL WATER IS AVAILABLE. LOTS WITHIN 100' ARE ON TOWN WATER. ? 6. COMPONENTS TO BE AASHTO H-10, UNLESS NOTED. f a; TO INSPECT SEPTIC SYSTEM PRIOR TO BACKFILL. 7. INLET TEE TO PROJECT DOWN 13", OUTLET TEE DOWN 14". a 8. IF TWO OR MORE LINES, WATER TEST D-BOX FOR EQUAL FLOWD-BOX PIPES TO BE La• 9. DEPTH OF(COMPONENTS NOT VTO EXCEED 3EL FOR FIRST, RO VENTING MUST BE PROVIDED. Ga�`d�ew`ck NOT TO COVERS: BUILD UP COVERS: 1 ON TANK, 1 ON D-BOX, 1 ON LEACHING SCALE 10. STONE TO BE DOUBLE WASHED 3/4 TO 1 1/2" WITH 2" MIN. 1/8 TO 1/2" PEA STONE ON TOP. LOCATION MAP 11. IF UNSUITABLE SOILS, OR SOILS DIFFERING FROM THE SOIL LOG ARE FOUND, CONTACT THE BOARD OF HEALTH, OR R.J. CADILLAC. 12. IF AN OVERDIG IS CALLED FOR BELOW, FILL MATERIAL FOR 5' AROUND AND UNDER LEACHING IS TO BE CLEAN GRANULAR SAND MEETING SPECIFICATIONS OF 310 CMR 15.255(3). TEST HOLE 1 13. PUMP AND FILL ANY EXISTING CESSPOOLS. REMOVE ANY CLOGGED SOIL, BLOCK, AND STONE IN LEACH AREA, AND DISPOSE OF AS DIRECTED BY HEALTH AGENT. DEPTH (inches) ELEV.(feet) 14. ALL CONSTRUCTION TO MEET TITLE 5 AND LOCAL REGULATIONS. 0 44.0 Fill N/F TEST HOLE DATE: October 14, 2004 10" E layer 15 2 LANE BENCH MARK--TOP & CENTER OF PERFORMED BY: Ron Cadillac, Soil Evaluator 16" loamy sand SEPTIC TANK= 45.81 ASSIGNED WITNESSED BY: David Stanton, RS PERC RATE: <2'-00"/inch (C layer) B Foamy sa d/8 SOIL SURVEY(1993): Carver coarse sand 30" 41.5 /k y / GEOLOGIC MAP(1986): Barnstable plain deposits a 4 N F 51.95t 4.00'OOM W �X 10.5 O'TOOLE CTopndation Invert 44.20t 2 DRY WELLS 42 S Use gas baffle Invert 40.43 H-20 C layer 2.5y 6/4 Existing med. coarse sand 28 S�0 4 PROPOSED DRIVEWAY (SHADED) ------ _ H-20 Proposed 41.0=Top Conc. ^�o o?( 1 5.0 _ -�� 40.7=Top Peastone pR N S=11 /ft vent PR Existing __ LOT 3Invert 44.64 .. 2 � I 5 1000 Gal. 137" no water 32.6 G P.Ro G 34.5 10 N Existing I Septic Tank ---------- T24" 111140±S.F. 24..: 4 4 CAUTION: EXISTING GAS LINE CLOSE L__________� 0 PROPOSED LEACHING "„� X o Invert 40.60 Invert 40.2 38.2 - 0) :. 45 METAL COVER TO GRADE 5.6 34�3 �: N IN DRIVE 6 Stone or compact Proposed Proposed Bottom F> PROVIDE SCREENED VENT p F. 1 I 4' 11' Bottom TH1=32.6 _ PROPOSED WATER SERVICE •'S'� ;-:,-- DESIGN DATA �� / •{ \F` ` TH 1 i••\• 10 41'9 BENCH MARK--TOP OF WOODEN �y. _ 4 1\ 9 STAKE = 44.53 ASSIGNED �� : ?¢? 9 Aw-� (3T OF SE CORN. HO.. 38'-s' OFF NE CORN. Ho.) BEDROOMS: 3 i �.. a: :"" +j49 ST r. 13 ,00•• E GARBAGE GRINDER: No LEACH AREA _8- \s �t' ,,- - a \ N gq 00 REQUIRED CAPACITY: 330 GPD 0 0= \ 6 ` USE 2 DRY WELLS WITH 4' OF STONE SEPTIC TANK: 1500 GAL. STKd4 \ ' F 48• �::: + 11 .E 42 91 ALL AROUND FOR A 25' LONG BY to se 2 i �.: 4�';: _ BOTTOM LEACHING AREA: 325 SF �.`.r�-` 25' X 13' 13 WIDE BY 2 DEEP LEACH AREA. \ .94 6. C.:: 14�8 ly�:::.:..� 8 � ESE [( )] \ 6 SIDE LEACHING AREA: 152 SF 4 9. t'b %�40 ' 2 13'+ 25' X 2' DEEP DESIGN _ j, g.9 a \ EX, 42 9g F N -74'0000 / x LAND BETWEEN NEWETOWN ROAD OT 3 LINE [(325 SF +ACITY 152 SF) X .74 GPD/SF]352 GPD Pq EO OR�vEw F F 41,3 j / FOR STRAIGHTWAY. 49�e 4 '46 42,11 41.29 43.99 4 0 218 40 0; S N/F M I ETLA N/F BIANCHI SITE PLAN FOR THIS PLAN IS A VALID COPY ONLY IF IT BEARS JOSIAS DASILVA AN ORIGINAL RED STAMP AND SIGNATURE. LEGEND TH 1 TEST HOLE LOCATION, NUMBER ���tN of Mgssa illjH of Mq ssq LOT 39 249 STRAIGHTWAY, H YAN N I S, MA W- EXISTING WATER LINE MARKINGS o`' c N OVEM BER 15, 2004 SCALE. 1 =20 > �s R D so » �w- PROPOSED WATER SERVICE J M q E- OVERHEAD ELECTRIC WIRES (IF SHOWN) GAS LINE MARKINGS # 60 #3i779 x$: EXISTING & PROPOSED ELEVATIONS ('X' MARKS POINT) Sc�sTERN gti�Ess\o� EXISTING CONTOUR gNITAP0\ 'R\1E RONALD J. CADILLAC, PLS, RS _$- PROPOSED CONTOUR I� ( n PROFESSIONAL LAND SURVEYOR & REGISTERED SANITARIAN UTILITY POLE (IF SHOWN) P.O. BOX 258 ® EXISTING DRAINAGE CATCH BASIN WEST YARMOUTH, MA 02673 x -- FENCE (IF SHOWN, NOT ALL SHOWN) 0 TREE (IF SHOWN, NOT ALL SHOWN) HEALTH AGENT APPROVAL DATE O (508) 775-9700 PAGE 1 OF 1 C 2004 BY R.J. CADILLAC PROVIDE PRECAST CONCRETE o C -- T.O.F. 2 EL.= 40.5'± EXTENSION RISER WITH CONCRETE INISH GRADE OVER D-BOX= 33.3'± 4n SCHEDULE 40 PVC MIN. SLOPE 1 /o FINISHED GRADE OVER BIODIFFUSERS= 33.0' - 34.0' C E N E RAL I n!V OT E S COVER TO WITHIN 6"OF F.G. OVER SLOPE @ 2%MIN. INSPECTION PORT WITH INLET AND OUTLET COVERS. REMOVABLE WATER-TIGHT COVER OVER ACCESS BOX TO WITHIN 1. UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION FINISH GRADE RISER TO WITHIN 6"OF FINISHED GRADE METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL FND. EL.= �' ' FINISHED GRADE OVER TANK EL. = 36.0'± 5"DIA. OUTLET(S) 3"OF F.G. (ONE PER ROW) CODE AND ANY APPLICABLE LOCAL RULES. } 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. PROPOSED 4" 36„ M / = 31.00' PVC SEWER PIPE N. 3• 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL -EXISTING 4" r, "MAX. 36"MAX.AX. TOP OF SAS B.O. SEWER PIPE �_ -� � SYSTEM UNLESS OTHERWISE NOTED. I 3"DROP MAX " PROVIDE WATERTIGHT 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN 6" 3" 3 9 2" DROP MIN = MIN L=41' JOINTS (TYP.) ELEVATION =31.00' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A �( 10° 4" PVC IN FROM 1. 8' 07�� 13" 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF SLAB EL. _� 14" �*32 6 + SEPTIC TANK 4"PVC OUT TO 0.59' (TYP.) 7.1P) THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. 33.0't --------- LEACHING FACILITY i + j 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. in n CONTRACTOR CONTRACTOR SHALL ' 12 ' 30.51' 29.92' (laid flat) 2.875'(34.5")--I 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. SHALL VERIFY SIZE 48" VERIFY CONDITION OF OUTLET TEE 31 .47 MIN. 31 .30 (TYP.) 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK AND CONDITION OF EXISTING TEES 22"ZABEL FILTER 6"CRUSHED STONE (TYP.) 5'MIN. FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS EXISTING SEPTIC AND REPLACE AS MODEL#A1801-4x22 OVER MECHANICALLY REQ'D 14.375' NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH TANK NECESSARY (GAS BAFFLE ON BOT.) COMPACTED BASE VARIES (SEE PLAN) AND DESIGN ENGINEER. 5 OUTLET DISTRIBUTION BOX 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM OF 30.87'ESTABLISHED -- _. - TO BE INSTALLED ON A LEVEL STABLE GROUND WATER ELEV.= < 20.58' BIODIFFUSERS (END VIEW) ON A NAIL SET IN UTILITY POLE#424/20B AS SHOWN ON PLAN. BASE. FIRST TWO FEET OF OUTLET TION 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION EXISTING 1,000 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. 19 - BIODIFFUSERS (PROFILE) THROUGH DIG-SAFE LEAST 72 HOURS PRIOR TO COMMENCING WORK C SITE AT CONTRACTOR TO VERIFY EXISTING ELEVATION PRIOR � TANK SECTION VIEW (BY ADVANCED DRAINAGE SYSTEMS, INC.) 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES ;SEPTIC TANK PROFILE. DISTRIBUTION BOX DETAIL AIL 19 - RC36 (#3613BD) BIODIFFUSERS TO THE DESIGN ENGINEER. NOT TO SCALE 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT. TO ANY WORK & NOTIFY ENt-' FER IF DIFFERENT. NOT TO SCALE NOT TO SCALE ---__---- _ _ ___.. _ __ _ _ 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING TEST PIT DATA REGULATIONS. OWNERIAPPLICANT IS TO OBTAIN SUCH DETERMINATION FROM S PERC NO. On File with BOH WING-TIES SCALE: 1"=20' APPROPRIATE AUTHORITY. • ° INSPECTOR: David W. Stanton, R.S. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS DESCRIPTION HCA HC-2 EVALUATOR: Ron Cadillac LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE 4) THEY SHALL WITHSTAND H-20 LOADING. BIODIFFUSER CORNER(1) 46.0' 24.5' I C.S.E.APPROVAL DATE: Unknown(3 � • • 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. BIODIFFUSER CORNER 2 35.7' 13.0' ' • • DATE: October 14, 2004 C 1 O $ TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE BIODIFFUSER CORNER(3) 27.8' 20.8' t ' _ MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. 1 a ELEV TOP- 32.00 REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, BIODIFFUSER CORNER(4) 42.2' 30.5' "� (2 � �, ELEV WATER= <20.58' FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). #249 LOCUS 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN w EXISTING C-2 PERC RATE _ <2 min./inch SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. c9 3-BEDROOM 16. PROPOSED PROJECT IS LOCATED WITHIN: a " " DWELLING • DEPTH OF PERC= 24 -42 Cl) TOF 1 = 36.5'± ' •• • TEXTURAL CLASS: 1 ASSESSOR'S MAP 268 PARCEL 279 x TOF 2 = 40.5'± I . °o SLAB = 33.0'± • In ; . • • : j OWNER OF RECORD: JOSIAS DASILVA&MARISE GENEROSA a + * •g ADDRESS: 249 STRAIGHTWAY� • •�•, • • • `• , . ' • • _ �* 0" 32.00'Fill HYANNIS MA ,. ZONE 2 • . 10 I E Loamy Sand 10Yr 5/2 30.67' FEMA FLOOD ZONE C • �« • 16 COMMUNITY PANEL# 250001 0008 D MAP 268 0 ; �,w ,� . `ts ' g Loamy Sand • + 10Yr 5/8 17. DEED REFERENCE: DEED BOOK 21729, PAGE 41 PARCEL 277 • It 24" 30.00' 18. PLAN REFERENCE: PLAN BOOK 331, PAGE 58 • • 30" _ 29.50' Perc _::� •* • "• . . 42" - 28.50' 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY # • FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY * 11 C Med. -Coarse Sand ( FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. MAP 268 ' •• 11 I 2.5Y 6/4 PARCEL 298 �-001 "E X�X's"' �, 1p 0' PROPOSED INSPECTION PORT WITH LOCUS PLAN N1 x-X' An% A. ACCESS BOX TO GRADE (TYP OF 5) PROPOSED TOTAL 19 ARC 36 SCALE: 1"= 1000' t2 `� p (#3613BD) BIODIFFUSERS IN A 137" 20.58 No Mottling, Standing or Weeping Observed FIELD CONFIGURATION I ` s 6- #249 DESIGN DATA LEGEND � / � X iN-GROUN� EXISTING Poop -� \ NUMBER OF BEDROOMS(DESIGN) 3 3-BEDROOM "Q s PROPOSED DISTRIBUTION BOX MAP 268 _ 50xO EXISTING SPOT GRADE DWELLING 1 PARCEL 278 c . DESIGN FLOW 110 GAUDAY/BEDROOM - - 50 - -- EXISTING CONTOUR TOF 1 = 36.5'± ,�.. �� N SLEEVE SEWER LINE 10' EACH , �� r m m TOTAL DESIGN FLOW 330 GAUDAY DECK TOF 2 =40.5'± % ,�� ry'` \a'o SIDE OF WATER LINE CROSSING ° SLAB - 33.0± � / `� °�` �' O _ � PROPOSED CONTOUR °� 3 o m Z DESIGN FLOW X 200 % 660 GAUDAY 1 $ a EXISTING LEACHING PIT TO BE N�` 0' o O t" G PUMPED, FILLED WITH CLEAN o y T USE EXISTING 1,000 GALLON SEPTIC TANK i1/H/W EXISTING OVERHEAD UTILITIES / .� � � � � � 4b o�. ;, 82 0 COARSE SAND & ABANDONED co :.A � �4°Opp = WPC W W EXISTING WATER LINE M po PPv�ppR X- INSTALL 19 - ARC 36 (#3613BD) BIODIFFUSERS SAS EXISTING GAS LINE VIP, 424/20A , p TEST PIT LOCATION EXISTING 1,000 GALLON SEPTIC TANK TO 4opp`O1 f_ "'1 SYSTEM CAPACITY BE UTILIZED AS PART OF THIS DESIGN `� N� 15' rn (TOTAL L.F. OF BIOS)(4.8 SF/LF)(0.74 GPD/SQ.FT.)=GPD EXISTING 1,000 GALLON SEPTIC TANK (95.0')(4.8 SF/LF)(0.74 GAUSQ.FT.)= 337.4 GAL. LEACHING/DAY GAS �� PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE MAP 268 / 00 MAP 268 PARCEL 279 r M PARCEL 280 TOTALS: O PROPOSED DISTRIBUTION BOX 11,106 S.F.± U.P. 42�/2013 TOTAL NUMBER OF BIODIFFUSERS: 19 TOTAL NUMBER OF COUPLINGS: 0 PROPOSED ARC 36 (#3613BD)BIODIFFUSER N Benchmark TOTAL LEACHING AREA: 337.4 Nail in U.P. TOTAL LEACHING CAPACITY: 456.0 / Elev. =30.87' Approx. M.S.L. REV. DATE BY APP'D. DESCRIPTION MAP 268 NOTE: PROPOSED SEPTIC SYSTEM UPGRADE PARCEL 297TH OFF EFFECTIVE LEACHING AREA OF 4.80 SFlLF OBTAINED FROM THE DEPARTMENT OF ENVIRONMENTAL PROTECTION APPROVAL LETTER JOHN L. �� PREPARED FOR: "MODIFIED CERTIFICATION FOR GENERAL USE" ISSUED TO ADVANCED cHUR ILL DRAINAGE SYSTEMS, INC. ON OCTOBER 3, 2003 (LAST MODIFIED JUNE L CAPEWIDE ENTERPRISES 41 30, 2009). TRANSMITTAL NUMBER=W000052. LOCATED AT NOTES: 249 STRAIGHTWAY HYANNIS, MA 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF EACH SEPTIC SYSTEM COMPONENT. SCALE: 1 INCH = 20 FT. DATE: FEBRUARY 2,2010 0 10 20 40 80 FEET 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION ------ PREPARED BY: OF THE PROPOSED LEACHING FACILITY TO ENSURE CONSISTENCY RESERVED FOR BOARD OF HEALTH USE WITH TEST PIT DATA SHOWN ON THIS PLAN. REPORT TO ENGINEER JC ENGINEERING, INC. 2854 CRANBERRY HIGHWAY AND LOCAL BOARD OF HEALTH IF SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. EAST WAREHAM, MA 02538 SITE PLAN 508.273.0377 3.) ENTIRE PROPERTY IS LOCATED WITHIN A DEP APPROVED ZONE 2. �-Drawn B -- B SCALE: 1"=20' y: MCP � Desgned y:MCP Checked By:JLC JOB No.1753