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HomeMy WebLinkAbout0536 STRAWBERRY HILL ROAD - Health 536 STRAWBERRY HILL RD.,HYANNIS A= 249 032 , i I I I f �s BARNSTA LE LAND COURT REGISTRY DEED RESTRICTION Whereas, Sarah P. Pearl,Trustee of the Sarah P. Pearl Living Trust,under declaration of trust dated September 15,2016, a Certificate of Trust for which is filed with the Barnstable County Registry District of the Land Court as Document No. 1,305,403, of 73 LaFrance Avenue, Hyannis, Massachusetts 02601 ("Owner"), is the owner of the land shown on Land Court Plan No. 39723-A, located at 536 Strawberry Hill Road,Barnstable (Centerville),Barnstable County, Massachusetts,record title to which is evidenced by Certificate of Title No. 210927 (hereinafter, the"Lot"); and Whereas, Owner has agreed with the Town of Barnstable Board of Health to a restriction as to the number of bedrooms which can be included in any home on the Lot as a pre-condition to obtaining a disposal works construction permit in compliance with 310 CMR 15.000, State Environmental Code,Title V,Minimum Requirements for the Subsurface Disposal of Sanitary Sewage; and Whereas,the Town of Barnstable Board of Health, as a pre-condition to granting a disposal works construction permit for a septic system in compliance with 310 CMR 15.200, State Environmental Code, Title V,Minimum Requirements for the Subsurface Disposal of Sanitary Sewage, is requiring that the agreement for the restriction on the number of bedrooms in any house constructed or maintained on the Lot be put on record with the Barnstable County Registry of Deeds and/or the Barnstable Registry District of the Land Court, as applicable,by recording this document. Now,therefore, Owner does hereby place and impose the following restriction upon the Lot in accordance with their agreement with the Town of Barnstable Board of Health,which said restriction shall run with the land and be binding upon all successors in title: The dwelling constructed or maintained upon the Lot shall contain no more than two (2) bedrooms unless and until it is connected to the municipal sewer or the Board of Health of the Town of Barnstable permits otherwise. Property Address: 536 Strawberry Hill Road, Centerville, Massachusetts For title, see Certificate of Title No. 210927. jy�Executed as a sealed instrument this day of �) 1 , 2018. Sarah P. Pearl Living Trust By: Sarah P. Pearl, Trustee COMMONWEALTH OF MASSACHUSETTS Barnstable, ss. On this day of , 2018,before me,the undersigned notary public,personally appeared Sarah � Phhearl, ( iho proved to me through satisfactory evidence of identification,which was KA ltc� -bL— , or ❑ who is known by me and to me known,to be the person whose name is signed on the preceding or attached document, and acknowledged to me that she signed it voluntarily for its stated purpose and as her free act and deed, as Trustee of the Sarah P. Pearl Living Trust. Notary u ic My ColfAnission Expires: ,,,,`,,IIIIIII lllll 1pl��� o rPP�Y C Sid•�'••, ? oMMis§ioj,. VOL 23 •S: .011, 2 TRUSTEE'S CERTIFICATE I, Sarah P.Pearl, of 73 LaFrance Avenue,Hyannis,Massachusetts, under oath, do depose and say as follows: 1. That I am the sole trustee of the Sarah P. Pearl Living Trust,under declaration of trust dated September 15, 2016, a Certificate of Trust for which is filed with the Barnstable County j Registry District of the Land Court as Document No. 1,305,403. 2. That the Trust has not been revoked or amended and is still in full force and effect. 3. That I am duly authorized by the terms of the Trust and have been duly authorized and directed by all of the beneficiaries of the Trust,to sign, seal, acknowledge and deliver the attached or foregoing Deed Restriction concerning the land shown on Land Court Plan No. 39723-A, located at 536 Strawberry Hill Road, Barnstable(Centerville),Barnstable County, Massachusetts,record title to which is evidenced by Certificate of Title No. 210927. 4. That I am not the sole beneficiary of the Trust; and that no beneficiary of the Trust is a minor, a corporation or a limited liability company selling all or substantially all its Massachusetts assets,or a personal representative of an estate subject to estate tax liens, or is now deceased or under any legal disability or operating under any constraint or undue influence. bscr bed and sworn to under the pains and penalties of perjury this day of 2018. i Sarah P. Pearl COMMONWEALTH OF MASSACHUSETTS Barnstable, ss. On this day of , 2018,before me,the undersigned notary public,personally appeared Sarah P. Pearl, who proved to me through satisfactory evidence of identification, which was �-k Ir-a-Z)L- , or ❑ who is known by me and to me known,to be the person whose name is signed on the preceding or attached document, and who i i 3 i swore or affirmed to me that the contents of the document are truthful and accurate to the best of her knowledge and belief. �PaY pop, •• A OG441.*ML213,y,F,;p '•.: e Not Public * : = My cot expires: r••�gs'S kWEA4'�5.o�'• ,. i BAR NSTABLE COUNTY RE ISTRY OF DEEDS A TRUE COPY,ATTEST JOHN F.MEADE,REGISTER 4 BARNSTABLE REGISTRY OF DEEDS John F. Meade, Register Za 9 No. W Fee C / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: �./ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplitation for MispoBal *pstrm Construction permit Application for a Permit to Construct( ) Repair -11;Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.5_346 5 lE�l f 14 UL Rp Owner's Name Address,and Tel.No. Assessor's Map/Parcel Ouu �YAfJals ` . L10Wf�W_k_= E (4 /6jx)( Installer's Name,Address,and Tel.No. Lt77 -S-Z 77 Designer's Name,Address,and Tel.No. 541ji-A73�-0�3-2� CAPCWJ"n tT 607� e4J�� .T L GIs l Al�.. jL?C� -=aJ C, ty - 2 54 CNAOJ8090W 14�Y EK 4J,44,1 AA Type of Building: Dwelling No.of Bedrooms Lot Size 4;'E 0 S 7 fi sq.ft. Garbage Grinder( ) Other Type of Building ZET(P E�YTIA-L_ No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �.®�� gpd Design flow provided ;L 304 7 gpd Plan Date Number of sheets Revision Date Title "ICL; P4 4.T� Size of Septic Tank t,000 "dJ Type of S.A.S. �a� N-.10 5 0c�64t.L-�OiU Description of Soil Pk cb PAL a '5 (V.30" 6C29 Pt.,CIJ Nature of Repairs or Alterations(Answer when applicable) USE 6W_4 7-[j o C: 1,4000 i) J 6P l[t Tr(tiU� A.�aE� N_ad D.,.�X' �3��� �-,�® ��►� �l�t'�J �:� llc)C<. ��z�f Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accord once 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 o Heal Signed ' Date - 19-c t Application Approved by Date / Application Disapproved by Date for the following reasons r Permit No. / — 106 Date Issued �, .�`._ ,_ .y. .. ...y a,,�•-,•'�;'��, -:{�..�..lh..� ti,., r^ `� .T.+A,.r..�.1,L;-.tY'Ti.r' :F,�>�-Y y,w.,yR� .:4i.--'ti irt_.-i: -w`:: r-r-. . y.tTM=is a r .�No. 46 ' Fee J/ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ' Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Application for disposal 6pstem Construrtion permit Application for a Permit to Construct( ) Repair�( Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.-5:)(o 5-r44W tq k(6L M Owner's Name,Address,and Tel.No. Assessor's Map/Parcel oZ`49` 3 A NYAuNI$ 73 L4re>�� A4/E HY 1 Installer's Name,Address,and Tel.No. S j2—4E7/ —2 2*77 Designer's Name,Address,and Tel.No. 64r•A73—053,7 7 CApsWJfnE &Jt0 4J!;ftS -Tc_ Ekca/r)tsa,24u(� =0G IS CF I sT K s4 Gttrl�NB �Y E' "AAAf Type of Building: Dwelling No.of Bedrooms Lot Size 4 i O$ t sq.ft. Garbage Grinder( ) Other Type of Building kG.5(D Q J-ClA-t„ No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) :13LO gpd Design flow provided vt 30.*7 gpd Plan Date Number of sheets ! Revision Date Title 531Q 5142rE'[ P292 QW OI.LL PZ& Size of Septic Tank ( UQp 63C4."O Type of S.A.S. e:Z) (-4-)�o 5a0 ALL-.0b! i s Description of Soil W Qb Q12.!3 Q Q°�� f,�L4�L � ' 'P444 Nature of Repairs or Alterations(Answer when applicable) USE (--Y1STI&,o jp6on G�Xj 56Yr7Y(­ -d j::' -71) 060 N o D - 80jk, - � x)Cz < k,m 4w&gfs w 1-n c6ic� �- P Date last inspected: "` 1 .Agre$inent: _ 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 Heal . Si ed {i�'`.K � .,/"� Date 4-t Application Approved by Date 9 hQ ?w Application Disapproved by / Date 1 for the following reasons v tl Permit No. 7,a/n 06 "-• Date Issued 0 `( 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 Cog w t 1,G &)Timid jsgS Q at. 53(a S O�wy kf4t-k'0- - Hy- - has been constructed-in accordance with the provisions of Title 5 and the for Disposal Syst m Construction Permit No. , )e dated q/I J Installer � [y�l � 49-U78ZP4J5E5 Zf30 Designer E:11icP[I�F,'](.tx)� C #bedrooms ; • Approved design flow and The issuance of this permit shall not be construed as a guarantee that the system will functionas designed. ' Date i`l "� / "' i' Inspector tl , .! -----------------{�- -- -------- -------I-------- -------------- -- --------------V------------------------------------------ No. ICJ ^ /0-- Fee �. THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS ' ]Disposal *pstem Construction permit Permission is hereby granted to Construct( ) Repair(Y) Upgrade( ) Abandon( ) System located at 5r( &QA;D tf' )U(S and as described in the above Application for Disposal System Construction Permit. The applicant recognize his'/herdddu to comply with Title 5 and the following local provisions or special conditions. Provided:Constni ctiioon must be completed within three years of the date of this permi Date (mod Approved by 1 - l/ V4/Yti/'LUItf l�:'LU °otizraotsr 15859 P. 001/001 Town. of Barnstable Regulatory Services Richard V. Scali,Interim Director � IiARNF/i'A�LR ' HAS. Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: 1164 Sewage Permit# aQ 1` — 10(o Assessor's Map\Parcel 2-99 132 Designer: TC, EnF3ir)e_erin5 . Ync.. Installer: Gaee.wk6_ IrnFtr fc(se.5 Address: 2b5y C4-4-0o2.rr i� wwY Address: 1 -5-'5 cowene.Cccol Siree't East u)orelnAr , Y1A a2Zi56 moSlAitc, �A 02(e.q On Lt — j9'aO l 8 Ca,eewide. r'r 44weccses was issued a permit to install a (date) (installer) septic system at suo sklaw'ye(ex Hi(( 400 based on a design drawn by (address) � C. etisnuxio e, I 'Toc , dated bent ri, 2,0 (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the 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. 1 certify that the system referenced above was constructed ' e with,the terms of the I1A approval letters (if applicable) .idHN L � u CHURCHII.t.dR. CI (1 s atler Sign tore) pip 1epy i ( lgner's Signature) (Affix DrDlel a amp Here) PL SE RETURN TO ARNSTABLE PUBLIC HEALT N. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BVILT CARD ARE RECEIVFD BY THE_BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. 0:1SepticTusigner Certification Form Rev 8-14-13.doc r Town of Barnstable P# S 2� '. Department of Regulatory Services 4r Public Health Division Date MASS. 200 Main Street,Hyannis MA 02601 Date Scheduled l .4 7 (� /� ' Time q8 ` Fee Pd.— / 0 Soil Suitability Assessment for S ge Disposal Performed By: ��� C k.1- /l l , CS Witnessed By: 19V LOCATION&.GENERAL INFORMATION Location Address i 1 Owner a Name SAGA 4 PCAI2L �..� 53lp. s-TAAW 14«L kOAb Ny Address 73 (.AMr4NKIF-64VC (�}�i4A1it1(S 'ji C3GQ�'m9� Assessor's Map/Parcel ` Engineer's Name.5 C El'i ock zr]V ' NEW CONSTRUCTION REPAIR _� Telephone# fig-�('Z'j —Q'' -7 �oo_a73-0 Land Use eS� Slopes Surface Stones N A Distances from: Open Water Body 7 ft Possible Wet-Area 215C) ft Drinking Water Well )J ft Drainage Way, ft Property Line 2 1 D__ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) Ise-e XkC1C6.j I lull ' • II i Parent material(geologic)U ct I d V r�jw o� Depth to Bedrock > I�� 136E Depth to Groundwater. Standing Water in Hole:_ �4 IJ�T S Weeping from Pit Fnca Estimated Seasonal High Groundwater �E ATIQN FOR SEASONAL-HIGH WATER TABLE Method Used: �—c 2—C� t�fQ Ib n ? Depth Observed standing in obs.hole: ✓� In, Depth to soil mottles: Depth to weeping from side of obs.hole: > i-_per In, Groundwater Adjualment Index Well-# Reading Date: Index Well level „ Adj,-factor„,,_.,,,_ Adj.C)roundwmer Leval„p PERCOLATION TEST DA184-5-1 T1=e!0=-' a Observation Hole# ( Time at 9" Depth of Pero `t Time at 6" Start Pro-soak Time® 10, M Oa Time(911•611) _ End Pre-soak I O'070% Rate Min./Inch . Site Suitability Assessment: Site Passed�� Site Failed: Additional Testing Needed(YIN) Original: Public Health Division .F Observation Hole Data To Be Completed on Back------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTfC1PBRCFORM.DOC f DEEP-OBSERVATION HOLE LOG Hole# f Depth from Soli Horizon Soil Texture Sdil Color Soil. Other Surface(in.) (USDA) (Munsell) Mottling (Stnucture,Stones;Boulders. o�sistency.96't3tavel) 0- 10 L�� ' lance JoYr• 3f/ -- /o -So S16 1.S1' Gl4 — 0 Grewe). DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.)'' 's (USDA) ,1•I (Munsell), Mottling t (Structure,Stones,Boulders. •s.ste n DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders., DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color 5011 Other Surface(in.) (USDA) (Munsell) Mottling (Structure,SSottes;Boulders, Consistency.,%-Qmyel) Flood Insurance Rate Man: Above 500 year flood boundary No— Yes Within 500 year boundary No Z' Yes Within 100 year flood boundary No. ', Yes Death of Naturally Occurring Pervious Materlal Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring per sous material? Certification 1 i 997 I certify that on 4 I _(date)I have passed the soil evaluator examination approved by the Department of Environmental Protectl n and that the above analysis was performed by me consistent with . the required tra in ,ex ertise do erience described in�10 CMR 15.017. g Si nature Data;_ /�� Q:\S,EMC BRCPORM.DOC _ COMMONWEALTH OF MA.SSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617) 292-5500 WILLIAM F.WELD TRUDY COXE Governor Secretary ARGEO PAUL CELLUCCI DAVID B. STRUHS Lt. Governor Co*^**++ssioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A , CERTIFICATION Property Address: 5' io \-4,,k CC7- E, �, Address of Owner: �( �4C fo(g5 'Ed �1( Date of Inspection: I(�L `cj (If different) Name of Inspector: M t �`1�L I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CNIR 15.000) CJatbruir N Company Name: T �' L 7 0211 4�, Mailing Address: .(—; x �,��,4�h�T c L M 4, Telephone Number: � •—v�11 t �,ZC� CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accu`ate and complete as of the time of inspection. The inspection was performed based on my training and experience .the proper function and main enance of on-site sewage disposal systems. The system: (a�0 �♦ Passes p C _ Conditionally Passes � 1J9� rr Needs Further Evaluation By the Local Approving Authority N Fi�zz il Inspector's Signature: c y1t' Date: l 0 cl j f3 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days E ti this inspection. Ifthe system is a shared system or has a design flow of 10.000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SLTNZ ARY: Check A, B, C, or D: A) SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: i 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. Indicate yes, no. or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Cenificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04125/97) PaRe 1 of 10 1 ; SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) . Property Address: Owner: Date of Inspection: BI SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is d e to broken or obstructed pipes) or due to a broken. settled or uneven distribution box. The system will pass inspection if( ith approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is-removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or o tructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed CJ FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health n order to determine if the system is failing to protect the public health. safety and the environment. h, 1) r.SYSTEM NVILL:PASS UT"LESS BOARD OF HEALTH DETER, iLtiES THAT THE SYSTEM IS tiOT FLICTIO\Z\G IN A. ... ,v A1A\\ � VIi�CH WILL PROTECT THE PUBLIC HEALTIiA:ti'D SAFETY A.ti-D THE E\tiIRO\1IE\T: �cj / itn1 _ Vt Cesspool or privy is Xithin 50 feet of a surface watef Cesspool or privy is"yithin 50 feet of a bordering V¢getated wetland or a salt marsh. 2\ SYSTEM tNTLL FAIL UTLESS THE BOARD F �4 O TH (AI ND PtBLIC WATER SUPPLIER, IF APPROPRL�TE) ',DETER IIN-ES THAT�THE SYSTEM IS FUNCTIO, NG IN A N1AN'NER THAT PROTECTS THE PUBLIC HEALTH A.\-D SAFETY`AND'T�NVIRON`IEN7: The system has a septic tank and soil.ab rption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and s I absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and oil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a wel water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine stance (approximation not valid). 3) OTHER (revised 04/25/97) P2ge 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: DI SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined/wibe MR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine whnecessary to correct the failure. Yes No Backup of sewage into facility or system component due to an overloaded or clogged Spool. Discharge or ponding of effluent to the surface of the ground or surface waters due an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloade or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is le s than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged r obstructed pipe(s). Number of times pumped — Any portion of the Soil Absorption System. cesspool or privy is below a high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface w• ter supply,or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a publi well. 5 Any portion of a cesspool or privy is within 50 feet of a priv a water supply well. Any portion of a cesspool or privy is less than 100 feet b greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been apf'alyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammoniac nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: The following criteria apply to large systems in addition o the criteria above: The system serves a facility with a design flow of 10 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment beca/one. more of the following conditions exist: Yes No the system is within 400 feet of arinking water supply the system is within 200 feet of p tributary to a surface drinking water supply # the system is located in a niti- ten sensitive area (Interim Wellhead Protection Area -IWPA) or a mapped Zone U of a public water supply well) The owner or operator of any such system wall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. lease consult the local regional office of the Department for further information. (revised O4/25/97) Page 3 of 10 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 11, Owner: Date of Inspection: , Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No Pumping information was provided by the owner, occupant, or Board of Health. }( _ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates -C during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _ As built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. _ All system components. excluding the Soil Absorption System, have been located on the site. _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, naterial of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub- Surface Disposal System. d _ Existing information. Ex. Plan at B.O.H. _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) [15.302(3)(b)) (revised 04/25/97) Page 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 53 b �►fLYtw �-� N , I i Owner: Date of Inspection: 1.I JL n)9 l f� FLOW CONDITIONS RESIDENTIAL: Design flow: 330 ii.p.d./bedroom for S.A.S. Number of bedrooms:0-6 Number of current residents:_ Garbage grinder (yes or no):t Laundry connected to system (yes or no) Seasonal use (yes or no): fJ Water meter readings, if available (last two (2) year usage (gpd): Sump Pump (yes or no): ` Last date of occupancy: �n't�.5 qV1U�_ CONEAERCIAL/INDUSTRIAL: Type of establishment: Design flow: gallons/day Grease trap present. (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PV1b1PL�G RECORDS and source of information: System pumped as part of inspection: (yes or no)_ If yes, volume pumped: Gallons Reason for pumping: TYPE OF SYSTEM _ Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source,of information: Sewage odors detected when arriving at the site: (yes or no) (revised 04125197) P2ge 5 of 10 J5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: �j 6 �1t Ott l Owner: Date of Inspection: BUILDING SEWER: (Locate on site plan) Depth below grade: Material of construction: _cast iron _40 PVC _other (explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) t SEPTIC TANK.Vp (locate on site plan) i Depth below grade: LZ`( Material of construction: concrete _metal _Fiberglass _Polyethylene _other(expiain) If tank is metal. list age _ Is age confirmed by Certificate of Compliance I (Yes/No) + i Dimensions: Sludge depth: Distance from top of sludti::e to bottom of outlet tee or baffle: -50 31 Scum thickness: Distance from top of scum to top of outlet tee or baffle: tZ"� 1� Distance from bottom of scum to bottom of outlet tee or baffle: 1 i How dimensions were determined: Comments: (recommendation for pumping. condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage. etc.) t2o IIX.0 J t—, euy,111D C'S t� ,- 1 ' 1 t v:c� "c l ,,;'t e,.,,T ~ :� ^1 (L ! ( Iv ; GREASE TRAP: Nr� (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee.or baffle: Date of last pumping: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity. evidence of leakage, etc.) (revised 04/25197) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C 141 SYSTEM INFORMATION (continued) Property Address: S3 5 �t�-Y l Owner: Date of Inspection: TIGHT OR HOLDING TANK: PQ (Tank must be pumped prior to, or at time, of inspection) (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene —other(explain) Dimensions: Capacity: gallons Desien flow: gallons/day Alarm level: Alarm in workine order _ Yes. _ No Date of previous pumping: Comments: (condition of inlet tee. condition of alarm and floc[ switches. etc.) ►ISTRIBUTION BOX: (locate on site plan) . Depth of liquid level above outlet invert: Comments: (note if level and distributi n is aqua evidence of solids carryover, evidence of leakage into or out of box, etc.) T Gi'J r-,l t S 5 C e�•Y�I' .1•i v/e+2 r'C'��, PUMP CHAMBER: (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order(Yes or No) Comments: ' (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 04115/97) P2ge 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: '53G Owner: Date of Inspection: SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible: excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number: I �,>\(, leaching chambers, number:_ leaching galleries, number: leaching trenches. number,length: leaching fields. number, dimensions: overflow cesspool. number: Alternative system: Name of Technology: Comments: (note condition of soil. signs of hydraulicfailure, level of ponding, condition of vegetation, etc.) • � c Nd J N^ 6 '�- 4.�1 \ G G CM 1.�.�•, �'2. ��P.,C — CESSPOOLS:.A (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding. condition of vegetation, etc.) PRIVY: _ (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding. condition of vegetation, etc.) (revised 04/25197) P2ge 8 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: s�j(Q ek'l Owner: Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) �33�1 4,cW� U1i y (revised O4/25/97) P2gc 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: �j j(� �J � ` `'�Vo. Owner: Date of Inspection: Depth to Groundwater ? Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record } Observation of Site (Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators. installers Use USGS Data Describe in your own words how you established the High Groundwater Elevation. Must be completed) (revised 04/25/97) Page 10 of 10 TOWN OF BARNSTABLE } OC., 1°ION & 51MAI&QU4 ad,- SEWAGE # VILLAGE ' Ua hh13ASSESSOR'S MAP & LOT na INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY C�o� LEACHING FACILITY: (type) _A r (size) NO.OF BEDROOMS BUILDER OR OWNER 1'ERT TDATE:-1i119-J0 COMPLIANCE DATE: Separation Distance Between the: t Maximum Adjusted Groundwater Table 1 0 Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of•Wedand and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Az. Feet Furnished by w 9� W N V �/� TOWN OF BARNSTABLE �j LCXJ iT ON ✓'r' �T�i'Gti z`basic j Ll i SEWAGE # D VILLAGI V)14,wl I--e ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. [ SEPTIC TANK CAPACITY J6c0 LEACHING FACILITY:(type) (size) 6xl NO. OF BEDROOMS PRIVATE-WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No t, 0 W. N G F � _:.. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appluatinu, for Disposal Works TonuUur#inn famit Application is hereby made for a Permit to Construct ( ) or Repair ( �an Individual Sewage Disposal System at: ---...... - ..... .... -- ----------------------- ------....--------- Location-Address or Lot No. Ir�o.r__ .ukslP.�rtcY ....... . " ---------------------------------------------•--........... Owner Address a � �Q .....s . .!(.............. ----------��.c�:L SG� �. fo_.. ---------------- Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms---- ........................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—Type T e of Building .............. No. of ersons......................_.__.. Showers — Cafeteria a YP g -------------- P ( ) ( ) Q' Other fixtures .................................. w DesignFlow........ .. gallons per person per day. Total daily flow..... �1.._.....0......_..._gallons. `�-- - --------------- ----- -g P P P Y• Y - W -Septic Tank t Liquid capacity-kM.gallons Length____9� 1. Width........... Diameter________________ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area...................sq. ft. % f Seepage Pit No........I------------ Diameter.....1.0....._... Depth below inlet-._.-�........... Total leaching area..................sq. tt. Z Other Distribution box ( ) Dosing tank ( ) PercolationY --•• . Date........................................ a Test Pit No. I salts m nutes p r nch Depth of Test Pit...................... Depth to ground water-___•-__--.-_•__---__--. rX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--__.____---.__.-..____- a -----------------------•---••--•--•-.-•....---•--•---•------------•--.......•-----------.....------------•---•-••--•----•-•...........-------•------•----- 0 Description of Soil........................0....................................................0------------------------------------------------------------------------------------------ -------------------------------------------------x w -------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when a plicable_. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed_--------- ----------_ ---------------- -----------------------------........... Date Application Approved BY - `^-,. — ------------................................................. --- Dace Application Disapproved for the ollo-wing reasons- ------------------------------------------------------------------------------------------------------------- ------------------- ------------ --..............................-------- -----------------.....................------ - - ------------- I.r Dace PermitNo. .... --------------------------_- Issued ................................................................... Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE AVVIiraftou for lliipuoal Works Toustrydivit famif Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Systemsat,_'S(o , H%\t ! Gz "T� _% c A t � ..... .- - .. ............................................................... Location-Address or Lot No. ...............s_RG_ :...a.9 /� _ ISC\ " A .. !_«� .-.....C.f�f,�n. .._..•.-..........-.....-------- ....... ........__._._Y_... ._..._........-... ..........r..d.. «. Owner Address W + � Installer Address dType of Building Size Lot............................Sq. feet Dwelling—.No. of Bedrooms................................ .....Expansion Attic ( ) Garbage Grinder ( ) Other—T �e,of�- .uildin No. of persons............................ Show�rs — Cafeteria Othefixtures ------- ,z.. ----•------- •--•-•-- ............................. k IoUU X - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons, Length................ Width b;...__..... Diameter---------------- Depth................ x Disposal Trench—!No..................... Wid1hP................. Total Length......--._.-..------ Total leaching area--------------------sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area.......:..........sq. ft. s Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit----:............... Depth to ground water.............._-•-___--. •-------•----------------------------------•----•-••--......----.---------------•-------•-------------------------------------------------------------- •••--- 0 Description of Soil......................................................................................................................................................................... � - t= «rev f C3 U'U � ° . ...-----•---••-•------------- ................................ ---•--•-----------••-•-----------------------------------•----•--------------------------••--- x p irs U Nature of Repairs or Alte ations—Answer when a�licable_______________________________________________________________________________________________ --------•---------------------•--....-----------•-----------------------------------.....----•-..........---...-----------------------•------......---------------...........-•-••----•-................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Co e—The undersigFrjed further agrees not to place the system`in operation until a Certificate of Complian�e.hab`e n sf s ed'by,�tl ap�d'6f�health. Signed....._..................................................................................................... ---..................................... Irate Application Approved BY .............. -------- Date Application Disapproved for the following reasons- --------------------------------------------------------- --------------------------------------------------------------------------- ................................................... -----------------------------------------------.................................................----------- ---------------------------------------------------------------------------------------- --------------------------------------- Date PermitNo. !G- S 5�............................ Issued --................................................................. Date r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ,, (fer#ifirate of (fumplianre v hat`t`�ie In�dl�vid al Sewage Disposal System constructed.( ) or Repaired THIS ISO���RF�I�I` Y ( ) E by ... .�- --------------I-nstalle-�r -t.V .�(_r...-__--------_-- -----------------------------------...............------------- at -, --=.mr �-. has been installed In accordance with the e�provisio�o THE 5 of-The State )nvironmental'��ode ass c3�escrrbe�i l the application for Disposal Works Construction Permit No. ....o............V.. 5-f../dated ..::Z!............................... ..... THE ISSUANCE OF,THIS CERTIFICATE SHALL NOT BE CONSTRUED-AS A GUARANTEE THAT THE SYSTEM WILL OUNRCTIO14 SATISFACTORY. / 6_ 16 - 9 DATE------ --.......... -------------...................................................... Inspector ----................ ............... ............................. -------_--- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No......................... .......... Disposal ' -04Tfi tgtr it prrmit Permissionis hereby granted- - .....: { to Construct (�`)'`or�R�e�arr ( �and Individ�ia `Sewage`Disposal System --' ri"r ... Streeter `�l V '�.1/X✓tr y! �"+�, ...C .... as shown on the application for Disposal Works Construction Permit No ................... Dated.......................................... .� •...................•----•-•--•- -•Boa rd rd---of----------...-....-.-----.----•----•-••----------.« DATE.........! /f% .. .....Q.� � Health - /........................•-------••...... FORM 3880E HOBBS 6 WARREN,INC.,PUBLISHERS TOWN OF BARNSTABLE LOCATION 5 3(o 5-rRA to Pea Qy V ILL P1D SEWAGE# oZ0 L 8 - 10(p VILLAGE H%+ANP 1 S ASSESSOR'S MAP&PARCEL ;L4 9 3 a. INSTALLER'S NAME&PHONE NO.CAPLr W tQ C E&rrap. mscr 41 Z—22Z, SEPTIC TANK CAPACITY 1 0 00 (T*U,0tJ I LEACHING FACILITY:(type� o0 GAS r_(4A!� (size) 12.9 To ro.l�3C (1 io l� NO.OF BEDROOMS OWNER 5AMff PG;42L 1L1 V10C-, TR0S t PERMIT DATE: Li-l ct-20,B COMPLIANCE DATE: L1 L,2 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility N Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) "/A, Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) A)JA Feet FURNISHED BYcn 7' to j Q, cQ o 0 en 00 rr ;- N c, tt It W c1 T.O.F. EL.= 54.6'± FINISH GRADE OVER D-BOX= 54.2'± FINISH GRADE OVER CHAMBERS= 53.$' - 54.4' PROP. VENT WITH CHARCOAL FILTER TO ABOVE GRADE C7 F r\"I F P A I N(-)TF q PROVIDE EXTENSION RISER H-20 RISER WITH WATERTIGHT SLOPE @ 2% MIN. OVER SYSTEM 3/4"TO 1-1/2" DOUBLE WASHED WITH COVER OVER INLET& FRAME AND COVER TO GRADE H-20 CONC. RISER WITH WATERTIGHT STONE TO CROWN OF PIPE 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION OUTLET TO WITHIN 6"OF F.G. CAST IRON FRAME AND COVER TO INSPECTION PORT WITH ACCESS METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL FINISH GRADE , STONE OR GEOTEXTILE FILTER FABRIC F.G. OVER TANK EL. = 54.24 GRADE OVER ALL PIPED CHAMBERS BOX TO F.G. (SEE NOTE 21) OF DOUBLE WASHED CODE AND ANY APPLICABLE LOCAL RULES. _ } -- -- -- -4"SCHEDULE 40 PVC 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. MIN SLOPE 1% TOP OF SAS= 52.00� PROPOSED 4" 9" MIN. � 5" DIA. OUTLET(S) 9"MIN.EXISTING 4" SCH. 40 PVC 36" MAX. 51 .00' 36" MAX. 3. 4" SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL SEWER PIPE SEWER PIPE BREAKOUT EL= 51 .5O, SYSTEM UNLESS OTHERWISE NOTED. 3 DROP MAX L 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN 6 3 2" DROP MIN 3 9 L-_28 f PROVIDE WATERTIGHT ELEVATION =51.50' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A MIN.SLOPE Q 1 h o 0 13" 4" PVCSOM23 JOINTS (TYP.) C. 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S. AND THE TOP OF 14" k52.Q'± SEPTIC 4" PVC OUT TO 0 0 0 0 0 0 0 0 00 0 0 0 o THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. CONTRACTOR TO PROVIDE LEACHING FACILITY o0005. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. SPECIFIED DROP BETWEEN oo oaINLET AND OUTLET CONTRACTOR CONTRACTOR SHALL OUTLET TEE 51 .37' 51 .20' G 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. SHALL VERIFY SIZE 48" VERIFY CONDITION OF\ \ 20o° oo o00 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BA K AND CONDITION OF EXISTING TEES CGAS BAFFLE 6" CRUSHED STONE o0000 oo FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS EXISTING SEPTIC AND REPLACE ASOVER MECHANICALLY o� 00 o NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH TANK NECESSARY COMPACTED BASE 1.0' L 8.5' (np) AND DESIGN ENGINEER. 5 1.0' OUTLET DISTRIBUTION BOX VARIES 4.83' VARIES 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM. BENCHMARK ELEVATION OF 55.00, TO BE INSTALLED ON A LEVEL STABLE 19.0' SEE PLAN (TYP.) SEE PLAN ESTABLISHED ON A NAIL SET IN U.P. #285/30 AS SHOWN ON PLAN. BASE. FIRST TWO FEET OF OUTLET , GROUND WATER ELEV= < 43.00' Z 6.1'- 12.83' 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION PIPES TO BE LAID LEVEL. 49.00 SEE PLAN 5' MIN. THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT EXISTING 1 ,000 GALLON CONCRETE SEPTIC TANK CROSS SECTION VIEW 2 - 500 GALLON CHAMBERS CHAMBER END VIEW 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES *CONTRACTOR TO VERIFY EXISTING f� -- A. K!1,/ C TYPICAL CHAMBER PROFILE A ,. s ,_. ,._p /� , TO THE DESIGN ENGINEER. ELEVATION PRIOR TO ANY WORK & SE PTI PRO I L ' H-20 D I o I BUTT ON BOX DETAIL H-20 CHf f� DETAILS LS 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT. NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE NOT TO SCALE NOT TO SCALE --- ------- 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING NOTES: "'� }- S �/�fT jrj/f . 1 TF ST PIT n.ATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM PERC NO. 15629 APPROPRIATE AUTHORITY. r o ,� 1. MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF • • • 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS LOCATED S86 11 38 E EACH SEPTIC SYSTEM COMPONENT. '� : �'"'`�� -' t 1. INSPECTOR: Donald Desmarais, RS / 6.42' • ik - �` 1. -'j UNDER MORE THAN 3 FEET OF COVER OR LOCATED UNDER PAVEMENT, DRIVES, OR EVALUATOR: John L. Churchill Jr., CSE . �� '/� ° /�•'�f TRAVELED WAYS IN WHICH CASE THEY SHALL WITHSTAND H-20 LOADING. 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF • • r„;.off t� \ �'t o ��, tM X C.S.E. APPROVAL DATE: Nov. 1997 THE PROPOSED LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST -'• ;� / r 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. PIT DATA SHOWN ON THIS PLAN. REPORT TO ENGINEER AND LOCAL {{ r, / ( �„ DATE: April 5, 2018 BOARD OF HEALTH IF SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE �� / , •'' �� TEST PIT#: 1 MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. "* " Y _ 5 ` •;\' -' M V P= REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, •� ��1 N 3.) ENTIRE PROPERTY IS LOCATED WITHIN THE WELLHEAD PROTECTION ' tt !I s • ELE TO 54.00 FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). i Q N in OVERLAY DISTRICT&THE ESTUARINE ZONE WATERSHEDS. C1� N y� �� • • ,• ,. ELEV WATER= <43.00' 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN ro i MAP 249 ` \� ��h ���F�� SHED "� 4.) CONTRACTOR SHALL VERIFY THAT THE KITCHEN AND LAUNDRY PIPES ►� '. PERC RATE - <2 min./inch SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. ARE TIED INTO THE EXISTING SEPTIC TANK. `" �" ZC N E 2 - LOT 167 � 8" CHERRY CO 5 �, ! - h h < 16. PROPOSED PROJECT IS LOCATED WITHIN: r, DO,a d a f �. . _- • I ;` DEPTH OF PERC= 36��_ �� r ' ASSESSOR'S MAP 249 LOT 32 TEXTURAL CLASS: 1 MAP 249 •• ��!• .+ • • • •� LOCUS - _ OWNER OF RECORD: SARAH P. PEARL TRUSTEE J �� I GAS ;o� x LOT 138 (� �� i , • • � ` ••' SARAH P. PEARL LIVING TRUST G� GAS METER I /t 00,0 •f• ! • 0 0 54.00 i 14" LOCUST cas X " •( Loamy Sand ADDRESS: 73 LAFRANCE AVENUE / Xs . • • • f, • . •• , A HYANNIS, MA 02601 4 E• L_ •��• +. 1 10Yr 3/2 _.�_-_- • oy GP BH I • "� ' • tNIL I� \ • . \ 10,. 53.17 FEMA FLOOD ZONE X r C X B Loamy Sand COMMUNITY PANEL# 25001 C0564J \ G SPRUCE 0� �• • �� i 10Yr 5/6 17. i 17" OAK t ... �* ,`� DEED REFERENCE: LAND COURT CERTIFICATE: #210927 • • \ GP`' SAPLING #536 x t ��.'' t • 5 <�� �,�`• ' 30" 51.50' 18 PLAN REFERENCE: LAND COURT PLAN: #39723 S (TYP) EXISTING +, i !•'• •'• ' ;{�� . ���f, • .�' �•• •' • • 36" 51.00' /0 2-BEDROOM `- '- 17" PINE / 1 �' ' ' ,,�� ./'� 'rye �• •, . .' ,�� Perc 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. MAP 249 DWELLING � I', ' ( �� \ LOT 32 �� :' 54" 49.50' 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY 6,057± S.F. !t • • �• < `� FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY -LSA- Xr -,�` ,W • I4 FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. WV 16 Fine-Med. r} ,o 21. A 4" PERFORATED SCH. 40 PVC PIPE SHALL BE PLACED IN A VERTICAL POSITION TO A ,► \\ \ � Z,�4--� w��w- �FU1-L BASE MENT x ' _ r 1,�`��1 l ..�- ' r , C4 1 ,. .. C ne-Med. Sand 2.5Y 6/4 DEPTH OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3" OF FINISH GRADE. A x WATER � � "'� �.- � 20% Gravel REMOVABLE THREADED CAP SHALL BE PLACED ON THE TOP TO ALLOW FOR INSPECTIONS. METER PIT CRAWL~ X 0 1 22. OWNER/APPLICANT/CONTRACTOR SHALL BE RESPONSIBLE TO OBTAIN ANY AND ALL \ -7 11 LOCUS P LAN REQUIRED PERMITS AND APPROVALS FOR THIS PROJECT. in �O oy� 1 MAP 249 SCALE: 1"= 1000' 23. IN ACCORDANCE WITH 310 CMR 15.401 -15.405, THE FOLLOWING LOCAL UPGRADE O� \ BUSH (TYP) I LOT 33 132 43.00 APPROVAL IS REQUESTED FROM 310 CMR 16.211: 0 X x No Mottling, Standing or Weeping Observed (1.) A 10.0'WAIVER (20.0' - 10.0') FOR THE SETBACK FROM THE SAS TO THE HOUSE. - KITCHEN PIP 1 DESIGN DATA TEST PIT DATA I �-( I' 11 J ��\ = (SEE NOTE ^ x O ��2 `yam Q TOF = >< PERC NO. 15629 54.6'± LAUNDRY PII NUMBER OF BEDROOMS 2 I INSPECTOR: Donald Desmarais, IRS 50xO' EXISTING SPOT GRADE x \ -LSA- (SEE NOTE 4 x DESIGN FLOW 110 GAUDAY/BEDROOM EVALUATOR: John L. Churchill Jr., CSE 5n - - EXISTING CONTOUR \ EXISTING 1,000 GALLON SEPTIC - O x oti TOTAL DESIGN FLOW 220 GAUDAY C.S.E. APPROVAL DATE: Nov. 1997 _;i_0 PROPOSED CONTOUR TANK TO BE UTILIZED IN DESIGN -- - � 17„ � _X X-X DESIGN FLOW x 200 % = 440 GAUDAY DATE: April 5, 2018 50 \ PROPOSED SPOT GRADE X EXISTING DISTRIBUTION `MAPLE X X- _ I TEST PIT#: 2 SWING-TIES SCALE: 1"=10' USE EXISTING 1,000 GALLON SEPTIC TANK GAS - EXISTING GAS LINE BOX TO BE REMOVED--' Hw ELEV TOP= 54.00 U.P. #285/30 CONC. ..4 �.: :. x 0� PAD '' 1 DESCRIPTION HCA HC-2 ELEV WATER= <43.00' 0/H/W EXISTING OVERHEAD UTILITIES Benchmark ` COVERED CORNER OF STONE 1 11.2' 20.0' = Nail in U.P. #285/30 1,p, ENTRANCE � O INSTALL 2 - 500 GAL. CHAMBERS w/ AGGREGATE PERC RATE -----W W - EXISTING WATER LINE MAILBOX Elev. =55.00' O X 54.4' CORNER OF STONE (2) 14.3' 21.9' DEPTH OF PERC- Approx. M.S.L. SIDEWALL CAPACITY TEST PIT LOCATION GRAVEL X CORNER OF STONE (3) 29.1 32.2 (PERIMETER) (2' HIGH) (0.74 GPD/S.F.) = GAUDAY TEXTURAL CLASS: 1 DRIVEWAY EXISTING LEACHING PIT (approximate \ © x CORNER OF STONE (4) 29.3 30.0' (57.7) (2 ) ( 0.74 GPD/S.F.) = 85.4 GAUDAY I{y EXISTING 1,000 GALLON SEPTIC TANK location) TO BE PUMPED AND FILLED X 53.8' p X CORNER OF STONE(5) 18.2' 17.0' WITH CLEAN SAND &ABANDONED o X 54.3' x BOTTOM CAPACITY 0" 54.00' PROPOSED 4" SOLID SCHEDULE 40 PVC PIPE CORNER OF STONE (6) 12.6 11.0' (AREA) (0.74 GPD/S.F.) = GAUDAY A Loamy 10Yr 3/2 d ❑ PROPOSED H-20 DISTRIBUTION BOX SAPLING (TYP) \ l 2® x (196.3') (0.74 GPD/S.F.) = 145.3 GAUDAY 10" 53.17' 1\ #536 I Loam Sand PROPOSED 500 GALLON H-20 LEACHING CHAMBER x B y X 53 7' 5 X 4.2' EXISTING TOTALS: 10Yr 5/6 \ xi 2-BEDROOM TOTAL NUMBER OF CHAMBERS 2 30" 51.50' PROPOSED X DWELLING REV. DATE BY APP'D. DESCRIPTION TOTAL LEACHING AREA 311.8 SQ.FT. INSPECTION PORT x TOTAL LEACHING CAPACITY 230.7 GAL./DAY PROPOSED SEPTIC SYSTEM UPGRADE HC-2 H of PROPOSED H-20 \\ s cr M d 1 _ ts PREPARED FOR: DISTRIBUTION N o HC 1 'o _ �o JOHNL N a o (6) U CHURC LLJR. CAPEWIDE ENTERPRISES o x u�o N oo Fine-Med. Sand NO. 1807 1 PROPOSED 2-500 GALLON \ X �� (1) 12$ o C 2°5Y 6/4 �PF TE�� Q LOCATED AT \ � 20/o Gravel H-20 LEACHING CHAMBERS x w s> G 536 STRAWBERRY HILL ROAD X � � ® HYANNIS, MA 02632 PROPOSED 4" PVC \ \ X (a. i � ��' _ VENT PIPE; EXACT I 10.0, SCALE: 1 INCH = 10 FT. DATE: APRIL 17, 2018 LOCATION PER OWNER \� \ / " 132" 1 43.00' 0 5 10 20 ao FEET \ 6' M No Mottling, Standing or Weeping Observed 3 1 x ® PREPARED BY: RESERVED FOR BOARD OF HEALTH USE JC ENGINEERING, INC. 2854 CRANBERRY HIGHWAY 100 , (4) EAST WAREHAM, MA 02538 o�, � MAP 249 (3) SITE PLAN 'o =� LOT 137 _ 508.273.0377 SCALE: 1"= 10' X Drawn By: SA Designed By:SJI Checked By: JLC T JOB No.4113