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Home My WebLink About0438 STRAWBERRY HILL ROAD - Health 438 Strawberry Hill ' �oad Hyannis . P fl 248 066004 0 ° , a o a , ° o ' Q to OS � nti r f r ak Q _ m rC -CiOp . I� » _ Gl Lu ID 04 rn o „ - m � o u D x W m to tg z m p (A,,l N e 0 04 10 NV •1 0 Sill 3. 1M!!TT �D13 �� TOWN OF BARNSTABLE SCV^^�d•� LOCATION !A 3c8 S1aCV%LVV,-r SEWAGE# VILLAGES`J57A!T- ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY Cjc%t[ay% LEACHING FACILITY:(type) 500 GAIL C�At: :� (size) k 3%.6 K 2— NO.OF BE�DROOMS �. OWNER%r�Z F PERMIT DATE: COMPLIANCE DATE: M Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility C4Ttt5(AJ!W C, Feet Private Water Supply Well and Leaching Facility(If any wells exist one 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�t , CJ1 s N CD x L c A. No.w I3W t®o Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Applitation for Misposal *pstem Construction permit ,Application for a Permit to Construct( ) Repair(1Y11*U1pgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. `J3 V Sf rct k3hN try J2,,) Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 113 Type of Building: Dwelling No.of Bedrooms 3 Lot Size 2 .i Z`3 sq.8. Garbage Grinder( ) Other Type of Building YW VS r No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) `j 30 gpd Design flow provided 3 4/$ gpd Plan Date (:�,C_"i' -3 — I u t-23 Number of sheets A Revision Date Title Size of Septic Tank e Y 1Sf i.v i�u�d c.�1 Type of S.A.S. 5OCp yj 1&,,j C_kc;,nn'Def_5 �T Description of Soil Nature of Repairs or Alterations(Answer when applicable) A)@ c,J S A ,S Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. S' ed� Ci( 12—, Date /0 Application Approved by Date ZOL#�Zgw-i Application Disapprove y Date for the following reasons Permit No.0(_j' qW Date Issued --------------------------------------------------------------------------------------------------------------------------------------- 00 No.Z-013_ qoo Fee 1100 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ftpYitation for Disposal *pstem Construction permit Application for a Permit to Construct( )� Repair(Vf"U0,pgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. H 3$ Sf-(.Ljbe/f`j j ) O terZoe,��dress,and Tel.No. Assessor's Map/Parcel G G a Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 'C>co,VSIG 5 A i31vw 1 Nc S�'ylX�-7/ y s r 1- 4 S Type of Building: Dwelling No.of Bedrooms Lot Size 9-2—12 3 sq.ft. Garbage Grinder( ) Other Type of Building hd VSr No.of Persons Showers( ) Cafeteria( ) Other Fixtures Desigd Flow(min.required) -�3 0 ? gpd Design flow provided a! ' gpd r Plan Date Cr-'r 1, 0)1-5 J Number of sheets Revision Date Title d Size of Septic Tank to 1( ;s' V!! 1 c)00e r, Type of S.A.S. 5-OC> 1 loa f VIC--% PP(S P Description of Soil Nature of Repairs or Alterations(Answer when applicable) 1 N c,-t G 1 NP tom.) 5, A -S Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. ed Date Application Approved by Date`4��'�Zo+7:) Application Disapprov y Date for the following reasons u Permit No.00(3_ 1 Date Issued Id til ZV --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance r THIS IS TO CCE�RTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded( ) Abandoned( )by A 12.)(GW N 1 NC_ at 1-/'3 S S)-ra w to-P f ry V1% t` has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. a,O 13 0" dated 101,1113 Installer 5- �S\G 5 �j�riw•/ T Itr C Designer 5taQ r'N �G c S #bedrooms tij Approved design flo 170 gpd The issuance of this permit shall t be co strued as a guarantee that the system w' fund' n as de 'gned..9 Date 44-"-rl" !'7 ) (3 Inspector t4i ----- -------- ------------=------------------------- N. Zo 1�2 �� Fee �g cc) THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposalpst Construction Permit Permission is hereby granted to Construct( ) Repair( ✓) Upgrade( ) Abandon( ) System located at 4 3 t3 H i K Q J 10 and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Proovvide`d s ction must be completed within three years of the date of this pe Date �� , -ao 13 Approved by Town of Barnstable Regulatory Services Richard V. Scali, InteriYn Director BMWSTABIZ 9 MASS. S Public Health Division Algatae'�° Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: I6 13 Sewage Permit# Assessor's Map''areel (� Designer:"' -►`-- F64- s Pe- Installer: Address: 2_7S f & Address: '?,Q. o Uo-7 On*(d4ae)20_L_ was issueda permit to install a (installer) septic system at 6^f ► L-A- -rza based on a.design drawn by (address) dated 1 �3 17-6 13 (designer) i/ 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 r distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i..e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed izl compharnce with the terms of the IAA approval letters (if applicable) r* � - sta eer s Signature) als °l ��i QSA a'v V 7 (Designer's Signature) (Affix Designer's tamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. " £ -13.doc QASepticTesigner Certification Form Rev 8=14 Town of Barnstable P# Department of Health,Safety,and Environmental Services �W Public Health Division Date /z/ 367 Mai`Street,Hyannis MA 112601 RARNSTABM • E "L<j Wing ATEDNIp�A Date Scheduled- Time Fee Pd. Soil Suitability Assessment for Sew Dis os �' It �� " i 171W Performed By: w;E' t' Witnessed By: / LOCATION & GENERAL IIVFORIYIATION - J Location Address Owner's Name PPi+ Address 5A-+••t�'"_ Assessor's Map/Parcel: gn;e,4,1pcq Engineer's Name $-f1t-P i-tdLA-J NEW CONSTRUCTION REPAIR Telephone# v 3& l3Z Land Use Slopes(%) u Surface StonesM^ _ Distances from: Open Water Body ft Possible Wet Area �� - ft Drinking Water Well-4— ft ,� _ Drainage Way ft Property Line I ft. , Other - ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximi to holes) ? ' a� Pk • I j E e ; . h w •7 Parent material(geologic) �4- Depth to Bedrock , ...y, Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face Estimated Seasonal Higa Groundwater DETERMt1ATION FOR SASQNY HGi w `!'E]E 't"ALX. . . Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: in. `Depth to weepingfrom side of obs.hole: ' in. . Groundwater Adjustment ft. Index Well#___...:_._ Reading Date:.—..—_ Index Well level. ___ Adi.factor Adj.Groundwater Level_. PER�OLA:TION TEST nat� g Time ► Observation _. Hole# f Time at 9" � �i}� Depth of Pere. w Time at 6" . Start Pre-soak Time @ Time(9"-C End Pre-soak Rate Min./Inch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(YN) Original: Public Health Division Observation Hole Data To Be Completed on Back j Copy: Applicant. ..... DEEP OB ERVATIQN HCL LOG Hole I Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Bi ulderes. Consistencv.° Gravel) AEEP OBSERVATION HOLE LOG Hole# > 1 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,B I ulderes. nsi t ncv.° Gravel) ......... ..... .._.. .. _ . DEEP OBSERVATI XROLE L. .. Hoae.# . . ... Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. i i tenc %Gravel ... .. ............ ....- .. ... _ ................... . . ...... o #._... HOL. . UEP _ ERNHOBS G _............... _.. ._. Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes Consistency,°°Gravel) Flood Insurance Rate MaR Abm, e 500 ,.,r flocd hm,mdarJ No Y c Within 500 year boundary No_ Yes Within 100 year flood boundary Now Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Y41 If not,what is the depth of naturally occurring pervious material? Certification I certify that on "�� `� (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 trainin p rtise and experience described in 3.10 CMR 15.017. Signature __ ____ Date �3 S% 24- -7 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION 1iP ;_7- RECEIVED LOB � _. = S U Z 9 2004 TOWN OF BARNSTABLE TITLE 5 HEALTH DEPT. OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: _438 Strawberry Hill Road Hyannis, MA 02601 Owner's Name: Jere Monka Owner's Address: Date of Inspection: September 18, 2004 Name of Inspector: (Please-Print) James M. Ford Company Name: James M. Ford Mailing Address:, P.-O. Box 49 Osterville,MA 02655-0049 Telephone Number: (508)862-9400 * CERTIFICATION STATEMENT ! _= I certify that I have personally inspected the sewage disposal system at this address and that the.jnformatioia3reported below is true,accurate and complete as of the time of the inspection. The inspection was performed baseeNn my, training and experience in the proper function and maintenance of on site sewage disposal system. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). Thestem: "y ✓ Passes Conditionally.Passes , m Neft Further Evaluation by the Local Approving A hority F ilsl Inspector's Signature: Date: September 22, 2004 The system inspector shall su it a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page I Page 2 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 438 Strawberry Hill Road Hyannis, MA Owner: Je re Monga Date of Inspection: September 18, 2004 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: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain:. The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 438 Strawberry Hill Road Hyannis. MA Owner: Jefe MonQa Date of Inspection: September 18, 2004 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. th System will fail unless y e 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 and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 438 Strawberry Hill Road Hyannis, MA Owner: Jefe Monga Date of Inspection: September 18, 2004 D. System Failure Criteria applicable to all systems: You must indicate either"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 '/z day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.l No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area- IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 438 Strawberry Hill Road Hyannis, MA Owner: Je ie Monga Date of Inspection: September 18, 2004 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection? ✓ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ Was the site inspected for signs of break out? ✓ _ Were all system components,excluding the SAS, located on site? ✓ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? ✓ _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No ✓ Existing information. For example,a plan at the Board of Health. ✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)]. 5 Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 438 Strawberry Hill Road Hyannis, MA Owner: Jeffie Monza Date of Inspection: September 18, 2004 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 0 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): n/a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Unknown COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): and Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records , Source of information: Unavailable Was system pumped as part of the inspection(yes or no): 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) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Approximately 1983-per owner Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 438 Strawberry Hill Road Hyannis, MA Owner: Je ie Monga Date of Inspection: September 18, 2004 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC _other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): i SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 10" Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1000 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: I" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions determined: Measuring stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Cement tees were present. The liquid level was even with the outlet invert. There did not appear to be any signs of leakage GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 438 Strawberry Hill Road Hyannis, MA Owner: Je ie Monza Date of Inspection: September 18, 2004 TIGHT or HOLDING TANK: None (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: Rallons Design Flow: Gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even 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.): The D-box was level. No solids were present. PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 438 Strawberry Hill Road Hyannis, MA Owner: Jefe Monya Date of Inspection: September 18, 2004 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 1 -6'x 6' with 2'stone(per as built card) leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: Innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): The leach pit was dry. The scum line was approximately 3'up from the bottom. There did not appear to be any signs of failure. CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: None (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.): 9 r , Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 438 Strawberry Hill Road Hyannis, MA Owner: Je re Monza Date of Inspection: September 18, 2004 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet.. Locate where public water supply enters the building. a a 3 � as 3 yi a� y y y, 3ci 10 Page 11 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 438 Strawberry Hill Road Hyannis, MA Owner: Jefe Monza Date of Inspection: September 18, 2004 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 25 +/- feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: Topographic and water contours maps Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic maps and water contours maps the maps were showing approximately 25'+/-to zround water at this site. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report. 11 r TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE ASSESSOR'S MAP&LOT INSTALLER'S N &PHO NO. SEPTIC TANK CAPACITY V LEACHING FACILITY: (type) G X6 NO.OF BEDROOMS BUILDER OR OWNER PERIv11 T DATE: COMPLIANCE DATE: Separ`dtion Distance Between the: Maximum Adjusted Groundwater Table and 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---I —, " ( I, �, s J r " G/? TOWN OF BARNSTABLE L6CATION ` J -�'��W��/ II SEWAGE # VILLAGE 1WA016 ASSESSOR'S MAP & LOT ®JUO* INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY I OW LEACHING FACILITY: (type) CXC it (size) 0 NO.OF BEDROOMS 3 �� BUILDER OR-OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 leac •ng facility) / Feet Furnished by nQ,o[l, n •� . �D/C Ask a III INVERT ELEVATIONS : DESIGN CR I TER / A : GENERAL NOTES INVERT OUT SEPTIC TANK: 99.25 DESIGN FLOW: 1• THIS PLAN /S FOR THE DESIGN AND CONSTRU INVERT /N DIST. BOX: 98.57 3 BEDROOMS AT 110 G.P.D. PER OF THE SEWAGE DISPOSAL SYSTEM ONLY. INVERT OUT DIST. BOX: 98•4 BEDROOM EQUALS 330 G.P.D. INVERT IN LEACH CHAMBER: 98. 1 2. VERTICAL DATUM IS ASSUMED. FOR BENCH MA BO T TOM OF LEACH CHAMBER: 96. 1 NO GARBAGE GR/NDER SET. SEE S/TE PLAN. ADJUSTED GROUND WATER: N/A SEPTIC TANK REQUIRED: OBSERVED GROUND WATER: N/A 330 G.P.D. X 200x - 660 GAL. J. ALL CONSTRUCTION METHODS AND MATERIALS 90 / MAINTENANCE OF THE SEPTIC SYSTEM SHALL BOTTOM OF TEST HOLE *I : SEPTIC TANK PROVIDED: l000 GAL. EXISTING CONFORM TO MASS. D.E.P. TITLE 5 AND LOC BOARD OF HEALTH REGULATIONS. SOIL ABSORPTION SYSTEM REQUIRED: DESIGN PERC RATE l 5 MIN/INCH SOIL TEXTURAL, CLASS l 4 :ALL;SEPT/C .SYSTEM CQM,PONENTS .L,OCA, T , UN AREAS SUBJECT TO VEHICULAR TRAFFIC OR G EFFLUENT LOADING RATE - 0.74 GPD/SF THAN 3 ' IN DEPTH SHALL BE CAPABLE OF WI ' 330 GPD / 0.74 GPD/SF - 446 S.F. REQUIRED STANDING H-20 WHEEL LOADS. PROVIDED: 2-500 GAL LEACHING CHAMBERS W/4' STONE AROUND. A-471 S.F. L SEWER PIPE SHALL BE SCHEDULE 40 PVC APPROVED EQUAL. 0 ! � 471 S.F. x 0.74 - 348 G.P.D. ly (� °� VP � �h �oa 6. SEPTIC TANK AND 0-BOX. SHALL BE REINFOR �n f PRECAST CONCRETE OR APPROVED POLYETHYL S~f a NPR` r ''o� �pN�' ��✓`��K 'Ik BOTH SHALL BE WATERTIGHT, D-BOX SHALL TESTED FOR LEVEL WHEN THERE IS MORE TH �''"•' c1�. I U1n). Ir/�n. GIB. t . OUTLET` . 7. BEFORE CONSTRUCTION CALL -DIG-SAFE'. 1-888-DIG-SAFE AND THE LOCAL WATER DEP FOR LOCATION OF UNDERGROUND UTILITIES. S 87°09 '18'E ' 8. SEPTIC SYSTEM INSTALLER SHALL NOTIFY T - - - - - - - - - - - - - - - - - DESIGN ENGINEER TWO DAYS PRIOR TO CON ' ��• SHED OF THE SYSTEM TO ALLOW FOR SCHEDULING +lo j- I CONSTRUCTION INSPECTIONS. i +lot. i ' 9. EXISTING LEACH PIT TO BE PUMPED DRY A � _ • - _ - _ _ - - _+,ot.5 BACKFILLED. TRAP DOOR � 4 OVER INLET , lot. I �.: . F . DECK + EXISTING L EACH PIT v, q Exlsr(Nc _ Ltlac' DRELLING 'rEXISTING _ \ h ♦ -rnlnlN' SEPTIC TANK '"D-BOSI I N ev g V/,#Yz fewc e y ' ON. CORNER SH_ = EL-101.88 '� '.'.'..' .....:...: .. .2 .'.'.' d OP Al' .............. ..4 : . ;25 ,�. O t� T ,S E tf 4 a1•'r ,� N _ Lip. 4A'rGAl1,V G F`•, �j T E^ DUND +160.6 •: I VEII'AY i - ,� ILge ��n1 - QE7T IV _+0 0' Apvev mgmm�a CB/SEAL FND S E P T 1 C S YS TM DES [ GN �E I � 38 STRAWBERRY H. I. LL % -- ROA'D'. MAP 66',:. P.,4RC UAA t: P14. H YA N N I S ) MA i !� ' BARNS TABLE r-T iAe . PREPARED FOR : L ECEND CONCRETE BOUND D O N A L D PARE , WATER L I NE HYDRANT 1 _ 2 0 O C T O B E R 3 , 2 0 1 3 ! GAS LINE SCALE : OVER NEAD. WIRES - - �: ,„ H A LIGHT POST S � . UNDERGROUND ELECTRIC LINE E N G I N E E R I N G I N , 923 Ro u t.,e 6 UNDERGROUND TELEPHONE LINE UNDERGROUND CABLEV I S ION LINE. Y a r mo u t h p o r t MA . 0267 ( 508 ) 362-8 1 3 SPOT ELEVATION /1\ ( 508 ) 367— 1 69 _ EX!S T I NG CONTOUR �, JOB PROPOSED CONTOUR ACCESS COVERS MUST BE WITHIN 9" MINIMUM. INVERT ELEVATIONS : DESIGN CR I TER I A : GENERAL NO TES : 6" OF FINISH GRADE 3' MAXIMUM COVER FIRST 2' TO INVERT OUT SEPTIC TANK: 99•25 DESIGN FLOW: BE LEVEL MIN 2" OF PEASTONE INVERT IN DIST. BOX: 98.57 3 BEDROOMS AT 1/0 G.P.D. PER I. THIS PLAN IS FOR THE DESIGN AND CONSTRUCTION 101.0 OR F 1 L TER FABRIC INVERT OUT DIST. BOX. 96.4 BEDROOM EQUALS 330 G.P.D. OF THE SEWAGE DISPOSAL SYSTEM ONLY. 4' D1AM PIPE 99 1 INVERT IN LEACH CHAMBER: 96. l 3/4' - l 1/2" D I A. NO GARBAGE GR/NDER 2. VERTICAL DATUM l S ASSUMED. FOR BENCH MARKS o - 99.25 98.4 2' °e DOUBLE WASHED STONE BOTTOM OF LEACH CHAMBER: 96. 1 GAS °v 96. / ADJUSTED GROUND WATER: N/A SET. SEE SITE PLAN. BAFFLE 98•S7 .0 98• l SEPTIC TANK REQUIRED: 3 OUTLET 2-500 GAL LEACHING CHAMBERS OBSERVED GROUND WATER: N/A 330 G.P.D. X 200% - 660 GAL. 3. ALL CONSTRUCT/ON METHODS AND MATERIALS AND EXISTING D-BOX W/4• STONE AROUND. 12.8'rr x 25'1 x 2'd BOTTOM OF TEST HOLE 90. 1 SEPTIC TANK PROVIDED: 1000 GAL. EXISTING MAINTENANCE OF THE SEPTIC SYSTEM SHALL 1000 GAL CONFORM TO MASS. D.E.P. TITLE 5 AND LOCAL SEPTIC TANK 6" CRUSHED STONE OR SOIL ABSORPTION SYSTEM REQUI RED: BOARD OF HEALTH REGULAT 1 ONS. COMPACTED BASE DESIGN PERC RATE C 5 MIN/INCH PROFILE • NOT TO SCALE SOIL TEXTURAL CLASS - 1 4. ALL SEPTIC SYSTEM COMPONENTS LOCATED UNDER EFFLUENT LOADING RATE - 0.74 GPD/SF AREAS SUBJECT TO VEHICULAR TRAFFIC OR GREATER 330 GPO / 0.74 GPD/SF - 446 S.F. REQUIRED THAN 3' IN DEPTH SHALL BE CAPABLE OF WITH- STANDING H-20 WHEEL LOADS. SOIL TEST PIT DA TA 9 PROVIDED: 2-500 GAL LEACHING CHAMBERS W14' STONE AROUND. A-471 S.F. 5. ALL SEWER PIPE SHALL BE SCHEDULE 40 PVC OR I NO I CA TES _N7 I NO I CA TES APPROVED EQUAL. PERCOLATION -- OBSERVED 471 S.F. x 0.74 - 346 G.P.D. TEST GROUNDWATER 6. SEPTIC TANK AND D-BOX SHALL BE REINFORCED TP l Ps/4/37 TP #2 PRECAST CONCRETE OR APPROVED POL YETHYL ENE. BOTH SHALL BE WATERTIGHT. D-BOX SHALL BE WATER HORIZON TEXTURE COLOR " HORIZON TEXTURE COLOR 0" 100. 1 0 /00. I TESTED FOR LEVEL WHEN THERE IS MORE THAN ONE Q LOAMY IOYR A LOAMY IOYR OUTLET. SAND 212 SAND 2/2 6* - - - - - - - - - - - - - - 99.6 8' - - - - - - - 99.4 7. BEFORE CONSTRUCTION CALL 'DIG-SAFE" B LOAMY IOYR B LOAMY IOYR /-888-0/G-SAFE AND THE LOCAL WATER DEPT. SAND 5/8 SAND 5/8 S 87°09'18"E FOR LOCATION OF UNDERGROUND UTILITIES. 24- - - - - - - - - - - - - - - - - - - - - 98. 1 22--- - - - - - - - - - - - - - - - - - - - - - 98.3 ° _ �/46 a� - -- - _ C/ MED-COARSE IOYR C / MED-COARSE IOYR ` ---_- -- 8. SEPTIC SYSTEM INSTALLER SHALL NOTIFY THE SAND AND 6/4 SAND AND 6/4 ` ` ` " ` - - ' - ' ' - - - - - sHEO t GRAVEL GRAVEL DESIGN ENGINEER TWO DAYS PRIOR TO CONSTRUCTION OF THE SYSTEM TO ALLOW FOR SCHEDUL ING OF THE - ' - - - CONSTRUCTION INSPECTIONS. ,0,.4 42" ' 9. EXISTING LEACH PIT TO BE PUMPED DRY AND / /J + BACKF 1 L LED. hh. L V T 7 TRAP DOOR Cb OVER INLET r hh N 22, 123f S. F. ; I20"' NO WATER g0. I 120' NO WATER 90. 1 �� DECK -'I= EXISTING DATE: SEPTEMBER 24, 2013 LEACH PIT TEST BY: STEPHEN HAAS _ _ _, -EXIST - _ ror.s , , y WITNESSED BY: DONNA MIORANOI DWELL ING '�fXISTING ' ' 1 1 L ILAC' ry PERC RATE: C 2 MIN/INCH W sEPrr2co rANK ' . -p Bok h �; wb BM. CORNER BH S 87°09'l8'E G \ / :..25 106.73' +100.6 2-500 GALLON LEACHING CHAMBERS PAYED DR/ \� �� W/4' STONE AROUND +,do.6 p - ^ er e p , TPs2 Tpsl Do- �. 265.41 ' 1 I 09 CB/SEAL FND e SEPT ! C SYSTEM CAES l ON RDUtE 2s 438 STRAWBERRY H / L L ROAD . MAP 66 , PARCEL_ 4 BARNS T�'-�► BLE . CHYANN / S ) MA . .ys LEGEND PREPARED FOR : A �FFr ■ CB WATER L l NE L_.i'CONCRETE BOUND -W O NA L1 P l �A E7 PI { WATER US O HYDRANT g G GAS LINE SCALE : l - 20 ' OCTOBER 3 '20 i 3 OHW- OVER HEAD WIRES I�F LIGHT POST STEPHEN A . HAAS --E- UNDERGROUND ELECTRIC L l NE ENGINEERING , I N C -T- UNDERGROUND TELEPHONE LINE CTV- UNDERGROUND CABLEV I S ION LINE / ` %= 923 ER co u t o 6 A +40.4 SPOT ELEVATION Ya rmou t hP co r t . MA . 026-75 ....,40__ EXISTING CONTOUR ( 508 ) 362-8 1 32 • 0 /0 20 40 40 PROPOSED CONTOUR 7� / ( 5 O 8 ) 3 6 7- 1 6 9 1 LOCUS MAP JOB NO: 13-082