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HomeMy WebLinkAbout0092 SUDBURY LANE - Health L udbury Lane s P71 206 4 I I 1 TOWN OF BARNSTABLE LOCATION ��. ) ,, u� SEWAGE# Q VILLAGE VA sl AS SSOWS MAP&PARCEL c� INSTALLER'S NAME&PHONE NO.R, .6,:gt ►�r �.k�a�=ram SEPTIC TANK CAPACITY QUO® Coat(. ®gyp��"�. 1.�...r►vh "" LEACHING FACILITY.(type) (size) Q�5' A, NO.OF BEDROOMS OWNER ��►J�. �.�►L I PERMIT DATE: O COMPLIANCE DATE: -2, =,. Separation Distance Between the: C Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility ' S 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� t—h-C-A L�1^��(t, M- t�LW � Q r a Cj 4 "! !s O ® _ 7 cq p. { 1 l No. Fee HE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes o ! PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 21pplitation for Disposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No.�d Owner's Name,A dress,and�el.No.-?7�' Assessor's Map/Parcel a 1 aC3 Installer's N e,Address,and Tel.No..Sz���e4`a 6 Designer's Name,Address,and Tel.No. ,row 360 Type of Building: Dwelling No.of Bedrooms Lot Size n j O Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3 Q`_'� gpd Design flow provided 3 CY Q gpd Plan Date ( r;` a ® Number of sheets Revision Date Title Size of Septic Tank 4© n Type of S.A.S.Cc _,,c k-� C(^4•,u��1-.� Description of Soil ' Nature of Repairs or Alterations(Answer when applicable) 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. ign Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued �_ - ------------ --- - --- - - No. . Fee <_ HE COMMONWEALTH OF MASSACHUSETTS Entered in uteri Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS oftplitation for -Misposal bpstem Construction Permit Application for a Permit to Construct( ) Repair`(VUpgrade( ) Abandon( ) ❑Complete System ndividual Components x. Location Address or Lot No. \oD 5 �, i ,c�-�� Owner's Name,Address,and Tel.No.-�7 y a 3 2-pe34C� }.�,�.,„�, �.•, 5 5�..,,5-ate �,`�,.n 1� Assessor's Map/Parcel ti a 0 7 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size O Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided > gpd Plan Date ( ( n Number of sheets Revision Date Title Size of Septic Tank O� (��-,� t-=�� Type of S.A.S.(en. G"Ale' Description of Soil ��_,� --- �� o 1 Nature iof Repairs or Alterations(Answer when applicable) _ - 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. ig d ,/� Date f /[/4 Application Approved by Date Application Disapproved vWV7 ilDate for the following reasons t Permit No. ' Date Issued 417/ \ ------------------------------------------ Ol CZ 1 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 ---'�' at has been construetin acc, de with the provisions of Title 5 and the for Disposal System Construction Permit No •dated 311 /5 y i Installer !G v1 G Designeri�? "k- #bedrooms Approved design fl w y gpd The issuance of thi permit shall not be construed as a guarantee that the system w 11 i n as desi ed. Date d Inspector-�l 10 2 . J V __ -_:/________________________ _ _ -___-______ __-__________________._____________.___--------__________--____-__-________._ J '^ r No _ -- ` Fee THE COMMONWEALTH OF MASSACHUSETTS . PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction Permit Permission is hereby granted to Construct( ) }Repair(� Upgrade( ) Abandon( ) System located at �� 48��,r.�f L--,a\A-e_ 1 A-, A�; 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. _ Provided:Constructiont b compl �ed within three years of the date of this permit. Date Approved by _, l v �% It / Town of Barnstable Regulatory Services Richard V. Scali, Interim Director BAPIa `�g Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 �t Installer & Designer Certification Form Date: .3 (zl -bo Sewage Permit#Q'WC9-nt3 Assessor's Map\Parcel D (L,,70 7 Designer: EO'#4,S Installer• Address: 0 �0?� ��� Address: OzS3- On 3 '�� `k�,�-, Q�� - � � G�as issued a permit to install a (date) (installer) i D 6VYL. LNqYA-NaISseptic system atbased on a design drawn by (add ss) e&/ dated Z� (desi er) A e_r c�A U ry%'s �M v I certify that the Peptic 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. I certify that the system referenced above was constructed in compliance with the terms of the IAA approval letters(if applicable) OF" ' IA (Installer's Signature) t Pilo. I IQ esigner's Signature) (Affix ere) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH D ON. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc cc TOWN OF BARNSTABLE J LOCATION v e0K I SEWAGE # /zdV;5'�-0gl VI .LAGS ESSOR'S MAP & LOT INSTALLER'S NAME&PHONE N � � SEPTIC TANK CAPACITY ZCy Od \ (� ?,EACENG FACILITY: (type) q(o 1)C/a t tx f 140.OF BEDROOMS BUILDER OR OWNS � 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 leaching facility) Feet Furnished by °� '�� . �' � .� �. C..) �9 �.� � r ,. � .. \ '�� ^� © � ^� '�y 1 � _ , �� /�' � o O ,�. � �� � - r. �i f - a I ,, ,; a ,, `� y _ � � I _.. ;�' No. aQ� S Fee a Q THE COMMONWEALTH OF MASSACHIlSETTS Entered in computer: Yes 4 PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2ppfication for Miopooar impotent Conotruction Permit Application for a Permit to Construct( . )RepairrXUpgrade( )Abandon( ) ❑Complete System Inndividual Components Location Address or Lot No. �` -E Owner's Name,Address and Tel.No. Assessor's Map/Parcel S-A"C Installer's Name,Address,and Tel.No. C. 4�S. Designer's NAme,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size 13 Coo sq.ft. Garbage Grinder,(¢_ Other Type of Building I)C-X1Q No.of Persons Showers( �afeten"a —721 Other Fixtures 07 Design Flow �?JJd gallons per day. Calculated daily flow _( - 8 gallons. Plan Date_—r eZC7 6f5- Number of sheets I I Revision Date �— Title Ei� 0 Size of Septic Tank Type o .A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) t 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 be lth. Signe Date —���� Application Approved by Date �� 0 Application Disapproved for the following reasons Permit No. 0R6os "�l Date Issued \ No. S — Q L/ f a r Fee y'", V r-3}tE'COMMONWEALTH OF MAS�SACAIS'ETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS ZippYication for Migpooal bpftem Construction Permit Application for a Permit to Construct( . )RepaiXr Upgrade( )Abandon( ) ❑Complete System ``ndividual Components Location Address or Lot No. 1.1, S J �U� Owner's Name,Address and Tel.No. 4 Assessor's Map/Parcel fl S '1M f o S e Installer's Name,Address,and Tel No. I� Designer's Name,Address and Tel.No. S. IC 53 Type of Building: Dwelling No.of Bedrooms Lot Size 1:5 0 sq.ft. Garbage Grinder(- Other 'Type of Building f 6ry No. of Persons �Showers( �afeteria( JKY. Other Fixtures ( a oa k-1 LIQ AA Design Flow 3_12v) gallons per day. Calculated daily flow gallons. gallons. Plan'Date c7 05 Number of sheets Revision Date► a I I —f 0 Title Size of Septic Tank 4 Type o .A.S. `5- -�� c'ty4J:Z t�5 Description of Soil �U /stage ia�X 3�/ Nature of Repairs or Alterations(Answer when applicable) 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_by-thi&Bo -d of_H alth. `4 Sign d , Date Application Approved by Date Application Disapproved for the following reasons Permit No. a�C�S 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 -1 A-, ,- at v S has been constructed in /accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.30 o _o%I dated � ��O 0 S-- . Installer ^ ,�Q.*- �, Designer l..fl The issuance of this permit shall not be onstrued as a guarantee that the s�:wil ction as designed. Date I �Q`� Inspector C No. �� 5 --CJ y ( —--------------------------Fee,/Dd THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Migpoat *pftem Congtrurtion Permit Permission is hereby granted to Construct( )Repair( )�pgrade(,-�Abandon( ) System located at _ g2Gr�Y1 S c 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 th CateofisDate: O Appr Town of Barnstable CF THE Tp� Regulatory Services 1 Thomas F. Geiler, Director * BARNSTABLE, b 9 � 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: to � Designer: : ��� . Installer: �\Vozr-vrs Address: � dX G�4 Address: 5 Tom* On G� ,�� 1. ' � iC was issued a permit to install a (date) (installer) septic system.at aD,9,961&J based on a design drawn by (ad4ft s) Fn- k) - Sws dated 1, o S (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. 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. Sti'oF ids sq; nstaller's ignature) o'�� CAR, EN cyGN Q SHAY N No. 1181 esigner's Signature) (Affix De e ere) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVIS N. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form „ TOWN OF BARNSTABLE LOCATION 77 Su SEWAGE # iF&V;5004 l VILLAGE ESSOR'S MAP &LOT - INSTALLER'S INSTALLER'S NAME&PHONE N l SEPTIC.TANK CAPACITY t LEACHING FACILITY: (type) �Y (size) NO.OF BEDROOMS BUILDER OR OWNED�` -71-pe—/ ) - 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 Feet on site,or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist . within 300 feet of leaching facility) Feet Furnished.by o �r 30, o�rT 40C CO`INIONV_E.4LTH OF MASSACHt'SETTS 1Z 12 1 EXECUTIVE OFFICE OF ENVIRONMENTAL AFFA c� DEPARTME 'NT OF ENVIROYMEITAL PROT ION �, _ ... I�`� ONE �•1NTER STREET. BOSTON. NtA 02105 61?-:S_•S:OG JUL. .. 1998 V1'ILL1 AM F D �— Govemc . _WEL_ T� • ARGEO P.4L1 CELLI CCI D B 57RL•1-_ Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissions RAA Q _p"1�'� I PART A CERTIFICATION Property Address; -17, sQA`)�LNA �-�' ► miVi� Address of Owner: Date.,of Inspection: fQ(5\q,t -� .. :Of different) Name of Inspector: L a o f� 11 E�ccem am a DEP ap roved system inspector pursuant to Section 13.340 of Title S (310 CMR 13.000) Company Name:& o y►4-r'e IC-11 A-,-0-,1 h K►t F.A Mailing Address: R O Acnx e_32!�i H/f5'Np2�L /••r' I9}0 26"4_9' , Telephone Number: rSe2�2 4L419- /4 7 c7 CERTIFICATIO% STATE.ME\T - I cent. that I have personall% inspected the sewage disposal system at this address and tha: the information reported below is true. accurate and complete as o:the time of inspectoo•-.. The mspec::on was performed baser on my training and experience in the proper function and maintenance o;on-we sex-age disposa� systems. The system: X Passes �C Concit.-onaii� Passes 'sees; Furthe- Eyaluano t. th Local Approving Authorm _ Fa.rs Inspector's Signature. Date: T;ie Svs:e^r lns�—co• sha" submit a coPe of this inspecton reoor, to the Approving Authority within them, (30) days of completing this inspecton. If the system is a shared system o• hat a desgn flow of 10,000 god or greater, the inspector and the system owner shall submit the repo- to the appropriate regional office of the Depanment of Enyironmenta: Protection. The orig:na! should be sent to the system owne- and copies !--a to the buye,, if applicable, and the approving authority. INSPECTION* SUMMARY: Check A, B, C, Or D: A) SYSTEM PA55ES: 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: Bj 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 NDi. Describe basis of determination in all instances. If'not determined', explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenry (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 exfilttation, 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. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) . Property Addeos: . _ . . - _ ,... . . Owner: ✓ T r; l ;':• j; -.Y• . •i.Jv Date of Inspection: BJ SYSTEM CONDITIONALLY PASSES tcontmnjihd- Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pmpeisl or due to a broken. settled or uneven distribution box. The system will pass inspection if(with approval of the- Board of Heaithi. Describe observations: broken pipe(s)are replaced 1 obstruction Is removed '.]VA .. distribution.box is levelled or mpiaced The system required pumping more than four times a year due to broken or obstructed p'mpe(sl._The system will pass inspection 0 Iwith approval of the Board of Health): broken pipew are replaced •, obstruction is removed - -=`• `•�'�! _ . .. • ' CJ FURTHER EVALUATiO% IS REQUIRED BY THE BOARD OF HEALTH: _••�.�.- Conditions exist which require funhe•evaluation by the Board of tiealth In order to determine if the system is failing to protect public health.sate_'*and the environment. 1) SYSTEMM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or prn% is within 50 feet of a surface water, — Cesspool or prm%-,• is within 50 feet of a bordering vegetated wetland or a salt marsh- 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER, IF APPROPRIATEI DETERMINES Th THE SYSTEM 15 FUNCTIO%ING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE EW. RONME%Y: •,•,_ The system has a septic tank and soil absorption system(S o and the SAS is within 100 feet to a surface water supply tributary to a sutiace water supply. The systern has a septic tank and soil absorption system and the SAS is within a Zone i of a public water supaty well. The systern has a septic tank and soil absorption system and the SAS Is within So feet of a private water supply well. �. The ssitern has a septic tank and soil absorption system and the SAS is less than 100 feet but So feet or more from a private water supply well, uniess a well water analysis.for conform baeteria and volatile organic compounds indicates the well is free from pollution from that facility and the preMitce of ammonia rtltragen and nitrate nitrogen is equal tc less than S ppm. method used to determine distance (approximation not valid). 9) _ OTHER • .. .. .. '•1. _ ... �K:ter'_ - •�� '_... .'7•._ . trevteed D�!IS/!'1 page 2 of ILO SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: D) SYSTEM FAILS: You must indicate either "Yes" or "No' as to each of the following: I have determined that the system violates one or more of the following failure trite a as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contact to determine what will be necessary to correct the failure. i Yes No Backup of sewage into facility or system component due to an over) ded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surce waters due to an overloaded or clogged SAS or cesspool. J Static liquid levei in the distribution boa above outlet invert duNto an overloaded or clogged SAS or cesspool. r Liquid depth in cesspool is less than 6" below invert or avail le volume is less than 112 day flov.. Required pumping more than 4 times in the last year NOT;due to clogged or obstructed pipe(s). Number of times pumped _. An; oor, o- of the Soil Absorption Svstem, cesspool or/privy privy is below the high groundwater elevation Anv portion of a 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 prey is within a Zon I of a public well. Any portion of a cesspool or privy is within 50 t of a private water supply well. Am• portion of a cesspool or privy is less tha 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the wel has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compou s, ammonia nitrogen and nitrate nitrogen. E) LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the f lowing: The following criteria apply to large systems in dition to the criteria above: The Svstem serves a facilir\ with a design flow of 10,000 gpd or greater (Large System) and the system is a.significant threat to public health and safety and the environment cause one or more of the following conditions exist_ Yes No the system is within 400 feet of 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 nitr en sensitive area (Interim Wellhead Protection Area -IWP,4) or a mapped Zone 11 of a public water suppiv well) The owner or operator of any such system shal bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00, Ile a consult the local regional office of the Department for further information. (revised 04/25/97) Page 3 of 10 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address; 11%Vj Owner: :; Date of spection: 66�% Check if the following have been done: You must indicate either"Yes"or"Was to each of the following: Y No Pumping information was provided by the owner,occupant, or Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow-rates during that period. large volumes of water have not been introduced into the system recently or as pan of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. The facdiN or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. The site Aas inspected for signs of breakout. ` All system components, excluding the Sod Absorption System, have been located on the site. • The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material o=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 irom owner were provided with information on the proper maintenance of 5u11urface Disposal System. Existing information, Ex. Plan at B.O.N. Determined in the field (tf any of the failure criteria related to Pan C is at issue,approximation of distance is unacceptablet [15.302(31(b)) (swilad WWII?) page 4 of to r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR..t PART C . SYSTEM INFORMATION Properh Address: Owner: Date of Inspection����C bb�� tJ FLOW CONDITIONS RESIDENTIAL: ��\\'` Design floe. V o.d./bedroom for S.A.S Number of becrooms n Number o`current residents Garbage g•, der (yes or no, Laundry co-•^ected to system (yes or no' Seasonal use (yes or no�._L=) "later meter readings. if available (last rwo i2: year usage tgpd(: _ Sump Pump (ves or nor_t1 Las, date o-'occupanc� DIIA.4AIN COMMERC14L9NDUSTRIAL: Type of establishmen: Design fim% _gahonsrda� Crease trap present tees or no Indus,nal 1%aste Holding i ank present. -ves or no_ Non-san;ta,% v.aste d,scnargec to the T,t,e 5 sysem ;ves or no_ eater meter readings if a%ailabie Las:pa,e o, c, OTHER: .De:cnbe Last care of cccucanc. GENERAL INFORMATION PUMPING RE ORDS and s urce ot. informatior. 66 L- -� System pumpec as par, of inspection: (yes or no._h,,)Cj If ves, volume pumped Gallons Reason for pumping TY E OF SYSTEM Septic tank/distribution box%sod absorption system Single cesspool Overflow cesspool Prn� Shared system (yes or no; (if yes, attach previous inspection records, if any) I/A Technologv etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: b h Sewage odors detected when arriving at the site. (yes or not (ravl�ad 04/25/9-7; Page S of 10 I_ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART,C SYSTEM INFORMATION (continued! Propert. Address: `�Z S'A 6; Owner: 1'.-T k-AI, (� Date of Inspection: BUILDING SEWER: (Locate on site Olan) Depth below grade. Material of construction. _cast iron 40 PVC,_-other texplain! Distance from private water supply well or suction li-t . Diameter Comments: (condition of joints, venting, evidence of leakage, etc.! SEPTIC TANK: Uocate on site pl h Depth below grade- Material of construction-Aconcre:e ,_meta _ftWglast _Polyethylene „_othertexpiatn If tank is mezal. Its- age_ is age conitrmec o% Ce^.itca:e o: Compttance flresAo Dimensions Sludge depth 144 Distance irom top o:s?uoee to bottom of outie:tee o•ba,�:;e, �t Scum thickness 1" Distance from top o:scum to top of outle:tee or batite I I t Distance iron bottom a-scum,to bo:o-t of oune: tee c,b-me How dimensions were determined Comments trecommendation for pumping_condition of tniet and outlet tees or baffles. depth of liquid level to relation to outlet invert,structural integrity, evidence of leakage,etc u ioo .a y` T jai i t o?mpl GREASE TRAP: Q (locate on site plan- Depth below grade:_ Material of construction: _concrete ,, metal ,,,_Fiberglass _Polyethylene „_;Pthedexplainl 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 batf►e: Date of last pumping: - Comments: -—- "Irecommendatron for pumping. condition of i•,let and outlet tees or baffles. depth of liquid level in refauo""udet-roves;structural integrity,evidence of leakage. etc.. _ __ ,_ . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Propert% Address: ON ner: &v-�. Date of Inspection: TIGHT OR HOLDING TANK: 'Tank must be pumped prior to. or at time, of inspection: (locate on site plan, Depth below grade Material of construction _concrete _metal _Fiberglass _Polyethylene _other(explain) Dimensions. Capac uy gal ion s Design flog galions,da. Alarm level A;arm in �%orking order _ Yes: _ no Date of previous pumping Comments (condition of role! tee. condition o- ala�rr and floa, switches. etc.) DISTRIBUTION BOX: iioca;e on site p:an Dept:: of iiouid lee`. aoo:e out;e: nee^ T- Comments tnote (eve! and des! lb_•or �s4Qual pvidIence oT solids car over, e- nce leakage i to or o of ox, etc.( \-7Z PUMP CHAMBER' (locate on site plan Pumps in working order: (Yes or No'. Alarms in working order (Les or No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 04/25/97) Raga 7 of 10 I ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Properh Addrrees+s� Owner: �P 1zv,. Date of Inspection: SOIL ABSORPTION SYSTEM (SAS): `� (locate on biteplan. ii possible, exce' uin not required. but may be approximated by non-intrusive methods, If not determined to be present, explain. Type: . leaching pits, number. leaching chambers, number leaching galleries, number.,,,_ leaching trenches, numbe►,leng(h leaching fields, nurnbe,. d,^aensions oveiilow cesspool, numbe• Alternative system ►vame of Technolog% Comments inore condition of so,i, s!grs of hydraulic failure, level of pondin . condiu ofyege on, + o •• AA A CESSPOOLS: llocate on site plan Number and con;igura--wt• _ Depth-top of hawd to inlet Inver. Depth of solids laye- Depth of scum layer Dimensions of cesspool Materials of constructior Indication of groundwate• inflow tcesspoo, must oe parnpe., as par, of inspection, Comments. (note condition of soil, signs of hydraulic failure, level of pondmg, condition of vegetation,etc.) PRIVY:A.! (locate on site plan) Materials of construction:, Dimensions Depth of 1 p solids: Comments Inote condition of sod, signs of hydraulic failure, level of pond,ng, condition of vegetation, etc., (rovased 0�/25/97) Pates • of 20 St_1BSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued; Propertm Address: Ot 5L) � Owner: to V � Date of I\mspection: GG 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) 1 � �Z e I • L ' y >a 3 t 5�A LAI (revyaed 04 '25!S7 Page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Propert% cldres•- J Zo Owner: CU%L9— Date o1 Inspection: p(8 f% 4 zd Depth to Groundw•ate• Feet Please indicate all the methods used to determine Mtgh Groundwater Elevation: Obtained irorn Design Plans on record Observation. o-;Site tAbunrng property, observation hole, basement sump etc.) Determine it irom local conditions Cne_. ►.ith Iota; Baarc o• neanr Chec� F;%in Maus Check pimpmF retorts Chec►. lots' ex. wo-s sequallvs t_se �5`� ^a� +. Dewite �c_ es:ac;-5"ec t + _¢" Crouncwatic Eie.atian tMttSt be- C7^p e!:C Vt 5 y C5 o Hazardous Materials Inventory Sheet Checklist Date . Physical Street Address-Check database to ensure it exists ,,,.Working Phone Number Actual Amounts -( ie. gas being used to fuel machines, thinner to clean brushes all count as hazardous materials-no blanks) Storage Information -location of storage, how long is storage for? If none;note that. Al Disposal Information =where and who? If none, note that. Applicant Signature - understand what is listed and noted Staff Initial -any questions, know who to ask Vehicle Washing/Rinsing? -glve a vehicle washing policy and explain it . Attach the Business Certificate with your sign off and comments *'The inventory form should explain what the business consists of and the'procedures they are doing. Notes need to be left to explain what you discussed with them. YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates COST $30.00 for 4 years. A Business Certificate ONLY (WHICH YOU MUST DO BY M.G.L. - it does not give you permission to operate). You must first obtain the necessarEGISTERS y signatures uM6 in the Town at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1'' FL, 367 iYlairi St. Hyannis, y g res on this form the Business Certificate that is required by law. MA 0260-1(Town Hall) and get `N "Fig Fill in please: DATE: 4:1 � ' APPLICANTS YOUR NAME: r n BUSINESS YOUR HOME ADDRESS: � T Zr TELEPHONE # Home Telephone Number: r" IV NAME OF NEW BUSINESS IS THIS A HOME OCCUPATION?s P.��(. ..t'_�1 $ r'r`� n'PE OF BUSINESS Have you been even a YES p ,t g pproval from the building division? YES NO� u /ADDRESS OF BUSINESS j � MAP/PARCEL NUMBER When starting a new business there are several things you must do in order to be in compliance with the rules and re tions of!Ae Tin of Barnstable. This form is intended to assist you in obtaining the information you may need. You Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses requiredMUST GO TO 20� ain St. (corer of town. to legally opera��our bu Ness this I. BUILDING COMMISSIONER'S OFFICE 00 This individual has-been informed of any permit requirements that pertain to this type of business, Authorized Signature** e ► COMMENTS: uJ r sV 2. BOARD OF HEALTH This individual hNbeoern informe f he ermit r uieement hat pertain to this type of business. ized Sig ure** COMMENTS: _ � 3. CONSU MER AFF AIRS S (LIC ENSING NSI N G AUTHOR ITY)TYTh.s individual has been inform ed ed f o the lic ensing en sin re g quirements that pertain to this type of business. Authorized Signature** COMMENTS: Date: OF l 2�f ZB� TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON- ITE INVENTORY NAME OF BUSINESS: ak BUSINESS LOCATION: INVENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: S� l r CONTACT PERSON: EMERGENCY CONTACT TE EPH NE NUMBER_ �`� _ MSDS ON SITE? TYPE OF BUSINESS: INFORMATION/RECOMMEND NS: Fire District: Waste Transportation: Al Last shipment of hazardous.waste: Name of Hauler: Destination: Waste Product: Licensed?. Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum Antifreeze (for gasoline or coolant systems) Misc. Corrosive NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Misc. Combustible Car wash detergents Leather dyes Car waxes and polishes ' Fertilizers Asphalt & roofing tar PCB's �. Paints, varnishes, stains, dyes ^ Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) NEW USED Any other products with "poison" labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc, Flammables hydrochloric acid, other acids) Floor&furniture strippers Other products not listed which you feel Metal polishes ImayItoxi, or hazardous (please list): Laundry soil & stain removers (including bleach) Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS - TOWN OF/BARNSTABLE LOCATION 52- �L0 b�� (.-N� SEWAGE # VILILAGE thi n*ak� ASSESSOR'S MAP&LOT - ` P06 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 000 L ' CHING FACILITY: (type) P IT— (size) l_ 0VC)ci 19' N .OF BEDROOMS 2 3 BUILDER OR OWNE ZE-POoff COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility t- 2-b 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) N Feet Furnished by � .. �, �� �� � `' w I'' �- � �. i � � , s � � � � 3 � � � � s � � �� N � � � � f _ �- �� ,�., :.' r VZ LOCATION SEWAGE PERMIT NO. �HILLAGE (Q) %/ —dzA e 1NSTA ER'S NA i ADDRESS 7 G�0 S U I l D E R c OR OWNER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED �� �� A 1 \J/�\ ,� i \ ��7 :: �v � � � � _ � Cs � Fizx 5.c............... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ...........Town...................OF......Barnstable --- - -----------------•------••----•-................_.. . Applirafiun for Disposal Works Tonstxnrtiun Prrmit Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal System at: ••- Lot a. �'. Hyannis, ............... Lo ation-Addres�. or Lot No. Capricorn Realty Trust 76-5_,FalmQAt „ Q _____„___,-,__•__, ••-_. ..- ••----•-•••••---•-......_.... W Steve Lebel Owner Address Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms------3...................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building Rancli............. No. of persons............................ Showers (2 ) — Cafeteria ( ) Other fixtures ----•--••-----.----•-_--•_-. - ------------------------------•---•------------------••---•-••.........._..-----------------••--- W Design Flow...55...................................gallons per person�per day. Total daily flow......................0_...............gallons. 9 Septic Tank—Liquid capacity 10 QOgallons Length8..L_....... Width4.'1 Q"... Diameter................ Depth... _'.8"... W Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. x Seepage Pit No...1............... Diameter......... .'__.._.. Depth below inlet.....6............ Total leaching area..2.6.6.......sq. ft. Z Other Distribution box ( ) Dosin tank ( ) '—' Percolation Test Results Performed b ...................l dre ge__Engine e ring.._....•:._. Date...1.1•-2•�-81.............. y ,aa Test Pit No. 1<..2. ___minutes per inch Depth of Test Pit...1.2...__._.._.. Depth to ground water_riQ]18...S11COunte (i, Test Pit No. 2..N�......minutes per inch Depth of Test Pit---NIA........ Depth to ground water ........ e R+ •• ---•• .• .............................. --•-..................-•......................................................... ODescription of Soil................0' ..-...2' loam..&...tQP?S.QU....•-----•-•--••••--••-•--••--••------•-----••---•--•••••-•--•---•=-•---•--------•••- x 2 ' - 10 ' medlum yellow.._sand--•--•----•--•----•..........................................•-••----•-••- 10 - 12med. white an ---------------------•--•----------•-------•- ------ --- •---- ---. --- af..-ravel/no....ws ter...a.t 12 U Nature of Repairs or Alterations—Answer when applicable............................................................................................... -•--------••-------------------------------•--•--•-•----------------------------------•--••-•-•----•---...----•••••-•---•--•---•-•-••••••-•--•---••--•-••-•-•-•---••-•••-••--•••-•--..............---•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITl,s�. 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is sped by the , k and of health to Application Approved By... =-�-------------------- ----- . • . .. .. y` Date Application Disapproved a following reasons------------------------------------------------------------•----------------------------------•------.......... .......................................................-•---•---••---•-...----••-•---..............--•---••--•-•--•--•-••---••---•-----•-•-•••••-------------•--•----- ............................... Date PermitNo......................................................... Issued_........................................................ Date Fz�.3....►.`'�..................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......T.Qvrm...................O F......BarnstAble.......-----•--------•.............................. Apphration for Bispvii al Works Tontrurtion Vamit Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal System at: ......Lat.1...q.3...... ...... ........ �.. ......;,�_. - . kIy nnis.�...MA.............................................................. Location•Address or Lot No. ......rapsi=rn...Rea]..V Tr-ust--------------•---•----._.--- ..... b5--•Falmouth...Roa.d t...Hyaxanis------------------- Owner Address Le ?sl- ----------------------------------------------------------------------------------•--------------- Installer Address dType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms....-_3...................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type e of Building No. of persons............................ Showers — Cafeteria a YP g �2��1G�------------• P (2 ) ( ) a Other fixtures -----••----•--•-••••-•-•-----•- . w Design Flow....55...................................gallons per person per day. Total daily flow__._................330...............gallons. W Septic Tank-Liquid capacity. DDOgallons LengthB.!.6".--- Widthl !.1-0.'-'.. Diameter................ Depth._5-18!!... x, Disposal Trench—No..................... Width.................... Total Length_......_.....__.__.. Total leaching area....................sq. ft. Seepage Pit No.... ..._..... Diameter.._......(_!_.._.. Depth below inlet.....6....._..... Total leaching area_..��j..___._sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by....Eldre-dge...Engi Bering............ Date...U-•2-5•-81.............. a Test Pit No. 1.<.2...0..minutes per inch Depth of Test Pit...12--......... Depth to ground water.none...encoUnte — (i Test Pit No. 2...IVA.....minutes per inch Depth of Test Pit---N/A........ Depth to ground water----N/A----------- e --------••------•------------------•-----------....................-•---....---..........--•--......:.......--..-------.------------------------•.----------- O ' ' Description of Soil----------------Q �---`...�---�---1Q�.IYI_.8k._tII�2S0i.1----------------_...._............---•--•----•-------------•------------------------- x ......-..lfl.....medum...YellQ!^'-gjand ... w 1� v=1.2.'..med..--white...sax.d,/-braces---af...grayel/no...water....at 12 ' UNature of Repairs or Alterations—Answer when applicable................................................................................................ ..-------•------------------•--......----------------•----•------------------------•--••----•----...---••••....-•••-•--_...••-•---------•---------•--•-----••--•-•••-....•----•--•-•---....._....----•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIE 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. /... nPj .i te Application Approved By..' ��<=='-/--f"" �--G--/ .. .. --.... Date Application Disapproved the following reasons:.............................................-•-•-••-•••-••-•-•-•-------•-•••....--•........................... ....----•------------••-•--•---------••-......-•---•-•---•••••••-•-•---•••••----•-•-•.............•------••-•-------•---•••-••----••--------•-----......--••----•-•-••----------.........-----•--------- Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......Town.............OF....Barnsta.ble................................................ kT rfif irta�r of Tontplianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (X ) or Repaired ( ) Steve Lebel by..................# �;.. ..... ..__..;�..•..•.........._...�.... --------- �^o } Installer n... Lot �Ch JV f H TITl g� 1.... ...•.�4esscribeWin .. at-•-•••......•------•----. --• -- . . has been installed in accordance with the provisions of T � ,jao The State Sa.nitary�C 2 theapplication for Disposal Works Construction Permit No...._._.................................. da.ted.._. ...... ._..........._........_..... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town Barnstable .. // ...........................................OF..................................................................................... .7 NOV...��1.... FEE........................ �i��o��t1 ork� �on,��rion Trani# Permission is hereby granted Steve Leblik ••....... •..................... ..............••----•--------•- to Construct ( or Repair {(� ) an Individual Sewage Disposal System at No LO t1- .._M?G �"l. .... Hnnis,...MA as shown on the application for Disposal Works Construction Permit Street No.� .......... Dated.."..Z:4. .............. ................... = .-------------------------------------------...---------............._ Board of Health .� DATE------------------•--------..................................................... FORM 1255 HOBBS & WARREN. INC., PUBLISHERS r j yti �o r 43 + i i'y \ � �L�,cz'+��` 1 �rF,�...�D EA�AraE' _-..•--"...._ LA Icxza GHQ. �As..!K C o co 8 f.w, ' O 6 .bts—rc�F3.�nnti. Boat r." id L@AC H. Pi r^y 1 + ,2o�o5t�D 20 V C so1L.TEST 1 t]� FwD EL= icxz 1 N 7. D 7 c 3 of F.9•gss \ LBEFA1�e�fI1.717-�. or 2c>' F S. \L3 P No.10951�d _ a tO, v, (_' S . El> . v ^F.SIGN A LEGENDSNOF�, , CERTIFIED PLOT PLAN EXISTING SPOT ELEVATION OxO �y EXISTING CONTOUR --- 0 --- ,r ��, Z-0 'V3 5-61015U�F% 1."Z- FINISHED SPOT ELEVATION 919is H �1y�/vA✓iS FINISHED CONTOUR 0 2W74 c IN APPROVED =. BOARD OF HEALTH DIsrsli SUR s ��di��� ���.r�, ���• DATE AGENT SCALE: 1 '' 30 ' DATE = D3-o3 82 LDREDGE ENGINEERING CO. 'NOCLIENT F/7r"INCo I CERTIFY THAT THE PROPOSED EGISTERE ofREGISTE-RED JOB NO. B1z05 BUILDING SHOWN ON THIS PLAN CIVIL LAND _ ��� CONFORMS TO THE ZONING LAWS ENGINEER SURVEYOR DR.BY OF BARNSTA E , S�. 712 MAIN STREET CH. BY: , 82 r- } `-- H YA N N I S, MASS. SHEET! OF z DATE R G. LAND SURVEYOR � C14 m4fZC � Z F•--D--H n, `f •` A ,: iC oyF'�. C ►- 3 � � M � m toy. yOTy y C � • ��,•I• p � rn D co h, tqo . A np +toti _•` 2: 1 n Z i A rn Aj m 3 y �° 2 y • �a C '� <�. DDT yb � �CkX �t � O ' coo LP c m a b �'I j W o4 O ln► f/1 p 0 0 C 2 N co ry ` 0 _ 0 U1 m m kPQo MDR fA tA 0 1 � - : -_ • _� • • : � c0 � y = op � CA � y ► , vo o ';'n . . � � y3n. �o Gl -h � � t/' � � Hr � opo � � laobo , ot ;n°ee °�. '•,_ •. , � � � yyba 3i rn • LEGEND HYANNIS m 4 PROPOSED CONTOUR 3 / ® PROPOSED SPOT GRADE EXISTING CONTOUR 26 11 + 96.52 EXISTING SPOT GRADE W— EXISTING WATER SERVICE ep A TEST PIT ��ti /50 SCALE: 1"=20' N i r , r �r /27 OOP 92 SUDBU 50. RY LN. r � / LOCUS MAP Z i LOCUS INFORMATION 51 .5 PLAN REF: LCP 72770 r TITLE REF: C151079 r PARCEL ID: MAP 271 PAR. 206 51 .5 LOT 43 PROPERTY IS IN ZONE 11, IS IN ESTUARIES PROT. r-" 2 FLOOD ZONE: PROPERTY NOT IN FLOOD ZONE ' -W - _- AREA = 0.30 ocres r � o w_:--- Lo W SEPTIC SYSTEM M o Lo W ,, REPAIR PLAN +V rr U) LOCATED AT: 92 SUDBURY LANE rn� ;r �• HYANNIS, MA v J gin\`. t° PREPARED FOR TP-2 ` 51 .8 SU SAN QU EALY/ 51 .2 --� '25kTP-1 READY ROOTER EXC. MARCH 16, 2020 i --� 51 .5 0 hOF SEWER r - ---;r N o� DARREN M. yam, MANHOLE M Ln Ven t 50 SNI TA O b/D 51 .7 l TBM = EL. 5 1 .7 ;v 13ULKHEAD FOUND. MEYER & SONS, INC. OOG L SEPTIC 1TCANK:" P.O. BOX 981 EAST SANDWICH, MA. 02537 PH: (508)360-3311 FAX: (774)413-9468 r meyerandsonstitle5®gmail.com SHEET 1 OF 2 J 1894 ELEV. TOP NOTE: PLACE MAGNETIC MARKING TAPE OVER ALL COVERS FOUNDATION: BRING ALL COVERS TO WITHIN 3" OF FINISH GRADE (Existing) FINISHED GRADE (51.80) = 52.50�••�F.G.EL• 51.5 F.G.EL• 51.20 F.G. EL- 51.60 � VENT MAINTAIN 2% MIN SLOPE OVER LEACHING AREA 2" OF 3/8' DOUBLE WASHED F.G.EL• 49.37 STONE OR FILTER FABRIC 3/4" - 1-1/2' •' ' ? DOUBLE WASHED STONE 4 " w 1 4" SCH 40 PVC ! 10" 14U 6 ® S= 1% (MIN. ®a®aa�a®aaa 0 !' TEE'S ARE TO BE INV. 47.65 ) ®a®®®®®E 4" SCH 40 PVC 2 EFF. DEPTH aaaaaaaaaaa INV. 48.10 1NV. 47.45 4' 2 X 8.5' 4' GAS PROPOSED DB-3 EFFECTIVE LENGTH = 25' EXISTING OUTLET BAFFLE DISTRIBUTION BOX INV. 48.35 A (H20) INV. ELEV.= 47.30 EXIST. 1,000 GALLON SEPTIC TANK OF GAS BAFFLE TO BE INSTALLED ON ����� ss9� BREAKOUT OUTLET TEE AS MANUFACTURED BY DARREN M. yGn ELEV.= 48.30 NOTES: TUF-TITE, ZABEL, OR EQUAL TOP CONC. ELEV.= 48.30 N 1) CONTRACTOR SHALL VERIFY ALL EXISTING N 1140 INV. ELEV.= 47.30 as PIPE INVERTS PRIOR TO CONSTRUCTION aaa 2) D-BOX SHALL BE SET LEVEL AND TRUE TO aaaaaaa GRADE ON A MECHANICALLY COMPACTED SIX N ®®aaa®a INCH CRUSHED STONE BASE. AS SPECIFIED IN �TAR�p� l Lo BOTTOM EL.= 45.30 3.75' 5 FT. 3.75' 310 CMR 15.221(2) 3) REPLACE EXISTING 1,000 GALLON SEPTIC TANK WITH 1500 GALLON SEPTIC TANK IF FAILED. SEPARATION 5.08 FT. EFFECTIVE WIDTH = 12.5 DAMAGED OR UNDERSIZED. SEPTIC SYSTEM PROFILE 4) INSTALL INLET & OUTLET TEES W/ BOTTOM OF TESTHOLE EL: 40.22 _ SOIL ABSORPTION SYSTEM (SECTION) GAS BAFFLE AS REQUIRED (500 GALLON H-20 LEACH CHAMBER) SOIL LOGS P#: TPT-20-37 GENERAL NOTES: DESIGN CRITERIA GIN ZONE II AND ESTUARIES PROT.** DATE: MARCH 9, 2020 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL NUMBER OF BEDROOMS: 3 BEDROOM DESIGN SOIL EVALUATOR: DARREN MEYER. R.S., CSE 1614 BOARD OF HEALTH AND THE DESIGN ENGINEER. SOIL TEXTURAL CLASS: CLASS I (0.74 GPD/S F) # 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS WITNESS: DAVE STANTON, BARNSTABLE HEALTH DEPT. OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE DESIGN PERCOLATION RATE: <2 MIN/IN LOCAL RULES AND REGULATIONS' EXCEPT AS REQUESTED BELOW' DAILY FLOW: 110 G.P.D. X 3 BR = 330 G.P.D. - 310 CMR 15.405 (1) (B): Elev. TP-1 D pth Elev. TP-2 Depth 1) A OM Fr. VARIANCE FRW 310ONMIs.s IM TO ALLOW LOOM GARBAGE GRINDER: NO (not designed for garbage grinder) 51.80 A 0' 51.80 A 0' TO BE 3.50 Fr OW BELOMI GR4IX VS FM" 3 Fr' (M/v¢Nr ) SEPTIC TANK: 330 gpd x 200% = 660 gpd, USE EXISTING 1,000 GAL SEPTIC TANK LOAMY SAND LOAMY SAND 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE Bu4MLLED PRIOR IOYR 4/1 10YR 4/1 TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE LEACHING AREA REQUIRED: (330)/0.74 = 445.94 S.F. 51.30 s' S1.13 8° DESIGN ENGINEER. CONDITIONS USE TWO (2) 500 GALLON PRECAST LEACH CHAMBERS W/ 4' 4. ANY CONDTIIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING IOYRLOAMY SAND 5/8 B LOAMY SAND aGNEER SWORE THOSE CONNsr�" SHALL n°NN CONTINUES.�D TO THE Dom" STONE ON ENDS & 3.75' STONE ON SIDES: 25' L x 12.5' W x 2'D 1oYR s/a 10YR 5/6 48.39 C 41" 48.47 C 40" s. ALL ELEVATIONS BASED ON ASSUMED DATUM. 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF BOTTOM AREA: 25 x 12.5= 312.5 SF PERC TEST THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 0 EL � MEDIUM MEDIUM HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. SIDE AREA: (25 + 12.5) X 2 X 2 = 150 SF AND SAND 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE TOTAL SQUARE FEET PROVIDED = 462 vs. 445.94 REQ'D 2.5Y 6/4 2.5Y 6/4 S.ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. DESIGN FLOW PROVIDED: 0.74(462 S.F.) = 342.25 G.P.D. vs. 330 G.P.D. req'd 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE THE LOCATION OF ALL UNDERGROUND UTILITIES. PRIOR TO BEGINNING .� 40.22 1 139" 40.22 139° CONSTRUCTION. 10. E)OSTING LEACHING TO LE PUMPED, CRUSHED AND FILED PER TITLE 5. PROPOSED SEPTIC SYSTEM UPGRADE PLAN PERC 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION NO M M7 OBSERVED 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY 9 2 S U D B U RY LANE, H YAN N I S, MA No GRouNDWATER OBSERVED AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY Prepared for: Quealy/Ready Rooter Exc. 13. NO PRIVATE WELLS WITHIN 150' OF PROPOSED LEACHING. 1. Darren M. Meyer. R.S.. CSE, hereby certify that I am � approved by MADEP pursuard to 310 CMR 15A17 Design and Site Plan by: SCALE DRAWN GATE to conduct =0 evohwUOrm and that the above anayefe has been performed by me eons dwd with the 14. NO WETLANDS WITHIN 100' OF PROPOSED LEACHING. MEYER&SONS,INC. raqutremmde of 310 CMR 15.017. 1 further Gerdy that I have passed the Soo EvoL Esmrr N October. 1999. 15. ALL PIPING TO BE 4' SCH 40 • 1/8'/FT (UNLESS SPECIFIED) N.T.S. DMM 03/16/20 AD Box REV DATE EASTSANDw/CN,MAa2M7 CHECKED SHEET N0. 508-362-29M DMM 2 Of 2 S thedule 40P VC)w Charcoul (Jdor .. ,51:'f TI01� _1 _,A �I I" 1C `T'i" / Ttltrr PROFILE VIEW IF ADDITION TO LEACIIING SYSTEM DISTRIBUTION FBOX SHAD HEt •H"ilk - ALI "t Akt 4 ';( Hf I1Ui i 4i1 (`.V�. 12' CONCRETE COVER ^� kr Jril - -- F xisting f oundution I house to 5eptic- tank SET LEVEL FOR AT LEAST 2 FT. C1� I D-Box cover must De I Septic took covers must be i 3" of 1 8" - 1 'Y Washed Peostone- TOP OF' FOUNDATION ELF'v 100.00 (Assumed) within 6 in. of finished grade / within 6 in. of finished grade --- --Grade over Septc Tank - 9900 l-Gods over D-Bar - 99.00 i ode over SAS - 99.00 /4" to 1 1/2 Wu ^,rOshed StoneL ` ' I 3 - 5' OUTLET a �:'- 2 KNOCKOUTS " t' I ---- i \ 4" PVC (CAPPED) MISPECTION PORT To BE - -- ` 5.5- - 12' INLET S - INSTALLED AND ((1 BE NI1HpJ 6. Of GRADE t` , �nET 0.02 3 HOLE H-10 } Top Load - E1ev. =95.80 : --- s• o BOX 3' Maximum Cover - 92 SHOWYLa O 10• EXIST. - 5=0.01 a ter Tap OF System- Elev. -95.25 I 2" /N► Crea EXIST. PIPE r 1,000 GAL _--- _ 5- O.of' per foot •- 15'5"� 4' - SCH. 40 T '�.�s• n N IS' 10" Effective Depth FROM Exlsr. FouNllATION / a, SEPTIC TANK n _ J// N Ch H-1D n o 2 s u�lt5 e 6.25' = 30' PLAN SECTION CROSS-SECTION 4 _ o CONCRETE Flu FOUNDATION- 0' °. a (6 rn + 0.83' (10 inches) 3 __._ W �, Kn 31.25'- 6 in 3/4"-1 1/2- Ku 1 A n 37,25' - - 3 HOLE H-10 DISTRIBUTION BOX SYSTEM PROFILE - compacted stone -ii Effective Length NOT TO SCALESW R Not to Stole eIX4 P.,d1A Av S�a•r r•;07t:a N A,TEO 4' a' If SOIL ABSORPTION SYSTEM_ (SAS) _- - 6 in.of 3/4"-1 1/2' 0g� D INFILTATROR HIGH CAPACITY (H-20 LOADING)/ GEORGE ❑'EIRIEN GENERAL NOTES ----- compacted stone EFFectwe Width OR EQUIVALENT Not to State NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE I o ( ) 1. Contractor is responsible for Digsafe notification ---------��� a Bottom of Test Hale 1 El 13200 CD0 No Groundwater Observed 132' NOTE: OVERALL'HEIGHT OF INFILTRATOR IS 18" /EFFECTIVE HEIGHT IS 10' and protection of all underground utilities and pipes. ---- - ------- ----- - ---------- ---- - 2. The septic tank and distri ution box shall be set level on 6 of 3/4"-1 1/2" stone. 3. Backfiil should be clean sand or gravel with no stones over 3" in size. 4. This system is subject to inspection during installation PERCOLATION TEST 5. by Carmen E. Shay - Environmental Services, Inc. The contractor shall install this system in accordance - with Title V of the Massachusetts state code, the approved plan and Local Regulations, 6. If, during installation the contractor encounters any Date of Percolation Test: JANUARY 17, 2005' soil conditions or site conditions that are different Test Performed By. CARMEN E. SHAY, R.S- -- C.S.E. from those shown on the soil log or in our design Results Witnessed By: WAIVER - (per Barnstable B.O.H.) installation must halt & immediate notification be Excavator: Shay Environmental Services, Inc. made to Carmen E. Shay - Environmental Services, Inc. Percolation Rate: Less Than 2 min./inch ------- --- ----- - - ----- --- ----- ---- -- _ ---- ------- -- - 7. No vehicle or heavy machinery shall drive over the 104.07 1 septic system unless noted as H--20 septic components. 8. install Tuf-rite gas baffles or equals on all outlet tee ends. 9. All Distribution lines shall be 4" diameter Schedule 40 NSF PVC pipes. Test Hole No. 1 10. All solid piping, tees & fittings shall be 4" diameter 3 DEPTH saLs ELEV. TEST HOLE `�1 Schedule 40 NSF PVC pipes with water tight joints. � _ 0 _ y ELEV.= 99.00 11. Municipal Water is Connected to ALL OF The Residence and Abutting 99.00' SHE - Properties Within 150 Feet. Sandy Loom -- --- 37.25'` 10' NOTE: ! 10 YR 3/1 o`=a" A sa.25 ` '� "- - THE PROPERTY LINES ARE APPROXIMATE AND ?( �- �r•• - COMPILED FROM THE PLAN BY BAXTER & NYE, INC. fQ e e <; ' ENTITLED "PLAN OF LAND IN HYANNIS, MA Sandy Loom \ + s.� t w.j �.,, 4" PVC DATED NOVEMBER 10, 1976, PLAN �36508-D -- - (_ I a >,: ,o vR 5/6 // Foiled 5, VEN Leach Pit AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN _ y PROJECT BENCH MARK IT SHOULD BE USED FOR NO PURPOSE OTHER THAN Sand TOP OF FOUNDATION -� -- D-Box Med-Coarse THE SEPTIC SYSTEM INSTALLATION. � --- - ELEV. - 100.00 (Assumed) 2-s T 7/s az_- 132 C, 88.00 EXISTING LEACH PITTO BE PUMPED OUT AND EXIST. 1000 al.i O 3 O \ 9 REMOVED TO FACILITATE NEW SEPTIC SYSTEM INSTALLATION j 0 Septic Tank NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE \, DECK O FROM THE EXISTING SEPTIC SYSTEM TO BE DISPOSED - --- - LOT #42 R LOT #44 OF AS PER BOARD OF HEALTH SPECIFICATIONS. - rrrrz ii NO WETLANDS ARE PRESENT WITHIN 200' OF THE PROPERTY EXISTING i ASSESSORS MAP 271 PARCEL 206 GARAGE 3 BEDROOM i I L E G E N 1 HOUSE I I Perc #1 t Perc Rate= <2 min./inch #92 i t Groundwater Not Observed 1DENOTES ADJUSTED H2O Elev. = No Adjustment Required SPOT GRADED PROPOSED 104- 1 I t i x 104.46 DENOTES EXISTING LOT #43 SPOT GRADE 9rp i s I 13,000 Square Feet +7%- PL PROPERTY LINE 3: Q 1 o a ; ,' - 996P PROPOSED CONTOUR �. - - - - - -97 EXISTING CONTOUR t 100.00' 1---- --- - - ------- I 1 DEEP TEST HOLE & 2-16• DIAM ACCESS MANHOLES 96 -- -- -_ ____�_______ _ _ I I --9s PERCOLATION TEST LOCATION 6 FOOT STOCKADE FENCE INLET - ._._ 1 \ '• -..- + T AS~ �.TD LJT Y LA..N_, P LOT PLAN -) J �• THE ACCESS COVERS FOR THE SEPTIC TANK, (40 FOOT RIGHT OF WAY) _ DISTRIBUTION BOX AND LEACHING COMPONENT OF PROPOSED SEPTIC SYSTEM UPGRADE SET DEEPER THAN H INCHES BELOW FINISHED GRADE SHALL BE RAISED TO MTHIN 6. OF FINISHED GRADE. PREPARED FOR STEEL REINFORCED PRECAST CONCRETE PLAN VIEW I S U SAN M . Q U EALY INSTALL TUF-I1TE GAS BAFFLES OR EQUALS ` 3-24• REMOVA911 COVERS Al I _ - _4. #92 SUDBURY LANE ... ; -1 S-_min.clearance --_ } 13• min. _ �13, -INLET•r HYANNIS , M A INLET T 2" mr, inlet to outlet e.rr>ti -� ~� d� - '--1 -- OUTLET }- 10• mn �- L'pwd level u•�I -_.-- - ---- -- ----- -.'"___ __-'_- s. ,. •: ,l.__j t-- 5. _,. . Design Calculations �-\H M 3 33a �� s9c PREPARED BY: Ea a..�. T Liquid depth Number of Bedrooms--2- Equivalent to 249-Gol./Day (330 Gal./Day Min. per Title V) A ME /� Garbage Grinder: No J RN EX � e a SW Y s Leaching Capacity Proposed: 330 Gal./Day Minimum (Min. Per Title V) o HA Cn _ _ _ _ _ Septic Tank ay = Septic an _ - 2 x 330 Got./Day 660 USE EXIST. 1,000 GAL. Stic Tank. "ENVIRONMENTAL- SERVICES, •• • , , G 0.� INC., _ 4' -10" SOIL ABSORPTION AREA: Using percolation rate of <2 min./inch 0 40 50 6 0" Bottom Area: 0.74 al s ft. x 370 s ft. - 273.8 gallons d �� P.O. BOX 627 CROSS SECTION END-SECTION g / q• q - g crSTE� Sidewall Area: 0.74 ol. s ft. 78 s gallons -ft. = 58 g q x Providing: = 331..80 gallons - I S�hITAR1PN AST FA�_MOU H, MA 2 I ITEL/FAX : 508-539-7966 TYPICAL 1000 GALLON SEPTIC TANK SCALE: 1 "=20 --- ------ --- -- I NOT TO SCALE Use: (5) INFILTRATOR HIGH CAPACITY H-20 UNITS, HAVING A 0.83' (10 INCHES) EFFECTIVE DEPTH, SCALE: 1 "- 20' DRAWN BY: CES DATE: JANUARY 20, 2005 TO BE USED WITH 4.0' OF WASHED STONE ON THE SIDES, AND 3.5' OF WASHED STONE -- ON THE ENDS. NO STONE UNDER. I PROJECT#SD686 FILENAME: SD686PP.DWG SHEET 1 OF 1