HomeMy WebLinkAbout0049 SUOMI ROAD - Health 49 Suomi Road ~!
a..
Hvannis P
- A = 268 094/
a d
0
O
1
� J
o
u u B a o
v o c
n A
e e °
� e �
° °
( TOWN-OFi BARNSTABLE
LOCATION�� Og&147� SEWAGE# Z Z
VILLAGE AMIW ASSESSOR'S MAP&PARCEL 4 J 9
INSTALLER'S NAME&PHONE NO. UdNe. �+�djf CQ y,��jov�
SEPTIC TANK CAPACITY 1440
LEACHING FACILITY:(type) �l T�lC�mr y (size) �ySX 3 2
NO.OF BEDROOMS :
OWNER
PERMIT DATE: _,L 4,Zo Z( COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) A Z Feet
FURNISHED BY ZUI# GvclS
t
W a
i � •
O
1 �•
1.
No. �> Fee
THE COMMONWEALTH`AF MASSACHUSETTS Entered in computer: Yes-6� '
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
RppliCAtion for Vopo8AY*pstem Construction Permit
Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System ndividual Components
Location Address or Lot No. 4 q $u p m't Owner's Name,Address,and Tel.No.
:Assessor's Map/Parcel 0qjD Q n S v£ C-rc� fG (er
Installer's Name,Address,
and Tel. o Designer's Name,
Address,and Tel.No.
pc�MC— ��o s� � S'� •fit S�r-V,
Type of Building:
Dwelling No.of Bedrooms Lot Size -3 3`5 3 0 sq.ft. Garbage Grinder
Other Type of Building ReS j ig+ a _No.of Persons Showers( ) Cafeteria'( )
Other Fixtures r
Design Flow(min.required) .3.3® gpd Design flow provided gpd
Plan Date �j `2q 7 d Z% Number of sheets a Revision Date Z.-ZZ—Zo Z-f
Title Size of Septic Tank ^ekc.$T cA j 1.000 Type of S.A.S. 5T4AJdtff yp
(m4?,L
Description of Soils
Nature of Repairs or Alterations(Answer when applicable) L2 c 2W /C
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 Bo• Heal
igned Date 7-1 —Z
r
Application Approved by Date
Application Disapproved by Date
for the following reasons
c.:
Permit No. Date Issued
,P
No. /r � �+�,� � � Fee----�1 6
THE COMIVIONW,EiC�1�TF MASSACHUSETTS Entered in computer: Ye
PUBLIC HEALTH DIVISION - T IWWOF BARNSTABLE, MASSACHUSETTS
Yicatton for Mi o aY-O stem Construction Permit
Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System *ndividual Components
Location Address or Lot No. 41 S U 0 m 1 P,,(. Owner's Name,Address,and Tel.No.
�
Assessor's Map/Parcel 2 6 Q "1 @ g s u a mM J2� o (e`
Installer's Name Address and Tel R�vio. Designer's Name,Address and Tel.No.
15ONe IQ I&H-r Gxcav4+�o r\ S•aep4t� SerV, g'' o� '
BOX 4 S a PJ&Ui MA 7 - / - I� /5 ✓x c�uX Lt(n d �( ;
TypeofBudtlmg t„ ,
r Dwelling No.of,Bedrooms ' Lot Size �3 3,5.3 D sq.ft. Garbage Grinder( )
Other Type of Building IRE i `n No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) ,33 lj gpd Design flow provided .a-0 gpd
Plan - Date 6 't,?- 7 7 / Number of sheets r1 Revision Date 7- Z Z e oZl
Title
Size of Septic Tank -Pkl ST r ny 1000 Type of S.A.S.
Description of Soil <'C4 0 (A i
1
Nature of Repairs or Alterations(Answer when applicable) f 4, (P �k r f e G/ t_e 401 yU
4C
1
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-0 Heal
Signed Date 2 O
Application Approved by J Date
Application Disapproved by Date
for the following reasons
Permit No. Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(X) Upgraded( )
Abandoned( )by DONE AlI�NTEXCAVATION .S'ERVIGE,S /n C_ ,
at '4 Q So o AA 1 Q a N � A V N 1 S has been constructed
ain,�accordance
with the provisions of Title 5 and the for Disposal System Construction Permit Now,-`a) c:�5 6 dated 7�Cy'�'1 a, '
Installer B 2 OT E LW S Designer IT E Y E& E -5 0 A.JS
r
#bedrooms 3 Approved design flow 33 a gpd
The issuance of this permit shall not be construed as a guarantee that the system will functio-as,designed.
Date �.•� `� Inspector
--------------------------------------------------- -----------------------------
0
N . i���`. / '�__� V Fee ( J
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION- BARNSTABLE, MASSACHUSETTS
MIsposal &pstem Construction Permit j
Permission is hereby granted to Construct( ) R air(<) Upgrade( ) Abandon( )
System located at q Q 5 U 4 M/ H-v Q n !1 1 S
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:Construction must be completed 'ithin three years of the date of this p�rm t.r
Date .f etc 4 Approved by..
J
Lei
McKenzie, Marybeth
To: meyerandsonstitle5@gmail.com'
Subject: 49 Suomi Rd. Hyannis Septic application
Hi Darren,
I called your cell the other day and left a message. Figured you were busy so I 'm emailing the items that need to be
addressed on the plan;they are the following:
The property can only be approved for a 3 bedroom not a 4 bedroom. I went over this with the real estate person the
other day too.
Please label the existing SAS.
Please label the 100 ' line from the wetlands.The line is not labeled and the distance is not noted.
A new application requesting 3 bedrooms rather than four.will need to be submitted too.
Thanks and if you have any questions please feel free to contact me.
Marybeth McKenzie R. S.
Health Inspector
Town of Barnstable
(508)862-4644
. 1
Town of Barnstable
Regulatory Services
Richard V. Scali, Interim Director
MAM Public Health Division
t639. ��
+ Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-8624644 Fax: 508-790-6304
Installer &Designer Certification Form
Date: vl Sewage Permit# Assessor's Map\Parcel S
tA k_
4
Designer:
S �i Installer: �yie—RRVv��X�aUc�1o� &J-Wh C--
,RYWCO t�2G
Address: Address: o- Box (0 6 q
Spr,dvw1 tm ,42.4wiA, /Qfi GaSZ-3
671,E
On '11d i/j aba � g1 �l�iw'o a� was issued a permit to install a
(date) (installer)
septic system at Som 1 - 41444 )S based on a design drawn by
(address)h&YY4A MfM4—/—/CSdated r�1 IA
desi
' Y 'N
TW
�I certify that the tic system re erenced 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
WU
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)
t J .��.OF
nstall r' Signatur
o�
�94Ia
4esigner's SignZ41
(Affix ere)
PLEASE � TABLE PUBLIC HEALTH D 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:\Septic\Designer Certification Form Rev 8-14-13.doc
Town of Barnstable
Regulitory Services
Richard V. Scali, Interim Director
"' Public Health Division
o39- s`� Thomas McKean, Director
200 Main Street,Hyannis,MA 02601
Office: 508-8624644 Fax: 508-790-6304
Homeowner Certification Form for Alternative Systems
Property Address: , S ub VI/1k H-Y&1,IIJ Iss MA
Assessor's Map\Parcel:
Property yOwners Name: D eo n l S
In accordance with Massachusetts DEP alternative system approval letters, the following certification
information is required by the Owner of record. The Owner of record must place an 'Y' in the
applicable box next to each line certifying the information.
y
Yes
N\A
lJ ❑ I have been provided a copy of the Title 5 UA technology Approval letters.
.(15 page Standard Conditions letter and the specific technology letter)
Ly' , ❑ I have been provided with the Owner's Manual
❑ �I have been provided with the Operation and Maintenance Manual
❑ VFor Systems installed under a Remedial Use Approval, I agree to fulfill my
responsibilities to provide a Deed Notice as required by 310 CMR 15.287(10)
,��nd the Approval
[IE� For Systems installed under a Remedial Use Approval, I agree to fulfill my responsibilities to
P
provide written notification of the Approval to any new Owner, as required by
,.,/ 310 CMR 15.287(5)
Lit' ❑ If the design does not provide for the use of garbage grinders,the restriction is understood
� and accepted (&la i D E5 i UN F p fio R, Gr12s P6 R)
❑ Whether or not covered by a warranty, I understand the requirement to repair, replace, modify
or take any other action as required by the Department or the LAA, if the Department or the
LAA determines the System to be failing to protect public health and safety and the
environment, d as eefii�ned in 310 CMR 15.303
641' `f'7) g agree to comply with all terms and conditions above.
ers ed na e
Property Owners Signature Date
Note: This form must be submitted along with the septic system disposal works permit
application for all IAA systems including new construction repairs\upgrades. with and
without aggregate (stone) and with conventional design criteria or credited design
criteria.
Q:\Septic\IA homeowner certification.doc
Fee$5 0.0
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: t/
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
2pplication for Migogar 6pgtern Congtructton Permit
Application for a Permit to Construct( . )Repair(x)�Upgrade( )Abandon( ) ❑Complete System EitIndividual Components
Location Address or Lot No. Owner's Name,Address and Tel.No. -
49 Suomi Rd. , Hyannis Mike Foley
Assessor'sMap/Parcel 26 _ MY Same
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Wm. E. Robinson Septic Service
P.O. Box 1089
Centerville MA 02632
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building ResidentialNo.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Sod;
Nature of Repairs or Alterations(Answer when applicable) we will replace broken 1 000 gal _
septic tank with a new 1500 gal, septic tank.
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 this Boaz f He
Signed Date
Application Approved by Date
Application Disapproved for td following reasons
Permit No.7 BO - Date Issued
.,1
�.f $50 0
M��� G Alfn i/ Fee
• it Entered in com uteri t/,
THE COIV 4WEALTH OF MAS(SACHUSETTS p Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
2pptication for �Digozal &pgtem Construction Permit
Application for a Permit to Construct( . )Repair(Xx)Upgrade( )Abandon( ) ❑Complete System [RIndividual Components
Location Address or Lot No. Owner's Name,Address and Tel.No.
' 49 Suomi 1W. , Hyannis Mike Foley
Assessor's Map/Parcel n j ov. Same
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Wm. E. Robinson Septic Service
P.O. Box 1089
Centerville MA 02632
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building ResidentialNo.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily,flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S. _.
Description of Soil;
Nature of Repairs or Alterations(Answer when applicable) we will replace broken .1000 aal g'
septic tank with a new 1500 gal. septic tank. ,
bate 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-
gate of Compliance has been issued by this Boar f He
Signed L Date
Application Approved by Date
Application Disapproved for following reasons
l
Permit No.�2 f10-2- ?V r Date Issued J
Foley THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of-Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( ) Repaired fix )Upgraded( )
Abandoned( )by Wm. E. Robinson Septic Service
at 49 Suomi Rd. , Hyannis, MA 02601 has been construct d hyaccordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. d 0 d dated
Installer Wm. 8. Robinson Sr. Designer
The issuance of �s ermit shall not be construed as a guarantee that the syst m ill unction as d si -ned.
Date j`� Inspector
. ,
No. Fee$5 0.0
Foley THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
Mo poot *pgtem Construction Permit
Permission is hereby ranted to Construct Repair x Upgrade Abandon
. Yg � ) P ( � Pg ( )
System located at 49 Sul$mi Rd., Hyanihis, MA 02601
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided: Construction must be completed within three.years of the date of permit.
Date: Approved by �//
i
TOWN OF BAR,DNST'ABLE
LOCATION n 7' St/b w1 1/ i�t,� SEWAGE#Q
VILLAGE a- A- I/3 ASSESSOR'S MAP & LOT �6
INSTALLER'S NAME&PHONE NO.t b 1^56 n
SEPTIC TANK CAPACITY
LEACHINGJFACILITY: (type) */, G/�l µ L� (size)
NO.OF.BEDROOMS
BUILDER OR OWNER 27,11 ZI U
PERMITDATE: ly~BZ' COMPLIANCE DATE: IFY��
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) 1 et
K
Furnished by
f
a
'S,
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS .
DEPARTMENT OF ENVIRONMENTAL PROTECTION . x
d
TITLE 5 '
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS !''
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORMf`I, E
PART A '
CERTIFICATION
Property Address: 49 SUOMI RD HYANNIS,MA 02601
Owner's Name: MR BAILEY #�
Owner's Address: 49 SUOMI RD HYANNIS,MA 02601
Date of Inspection: 12/14/01
Name of Inspector: (please print) ,1 JOHN GRACI s: q
Company Name: SEPTIC INSPECTIONS
Mailing Address: P.O:.BOX 2119 TEATICKET,MA.02536 �AN 1 0100 � j
Na r .
-564-6813 FAX 508-564-7270 j0\,N
Telephone Number: 508 F�NpEP� '''1" •:
P� .
CERTIFICATION STATEMENT
[certify that I have personally inspected the sewage disposal system at this address and that the information reported below is
, .:
true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and
experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system •rr �.�.
inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: x.,..
1y
X Passes
Conditionally P ses {'
Ott.ylr.
_ Needs Furth valuation by the Local Approving Authority
_ Failsr 1
Inspector's Signature: Date: 12/14/01 '� ;
The system inspector shall submit copy of this inspection report to the Approving Authority(Board of Health or DEP)within 0�
30 days of completing this inspect' n. If the system is a shared system or has a design flow of 10,000 gpd or greater,the
inspector and the system owner shall'submit the report to the appropriate regional office of the DEP. The original should be .
I owner and copies sent to the buyer,if applicable,and the approving authority. 4 ,
sent to the system p , ;
Notes and Comments
SYSTEM PASSES TITLE V INSPECTION. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE 5 x'
SYSTEM'S USEFUL LIFE. L
as �"
i ****This report only describes conditions at the time of inspection and under the conditions of use at that time.1116
will perform in the future under the same or different conditions of use.
inspection does not address how the system
Til. C 1—, —6on 1-twill r,/i�,i')nnn
Page 2 of I I
OFFICIAL INSPECTION FORM—NOT FOR,�VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM y :
PART A
CERTIFICATION (continued) '
Property Address: 49 SUOM1 RD HYANNIS,MA 02601 �
Owner: MR BAILEY ± r
Date of Inspection: 12/14/01
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes: '
X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310t.;a
CMR 15.304 exist.Any failure criteria not evaluated are indicated below.
Comments:
. . .
SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE sF
SYSTEM'S USEFUL LIFE.
• r
B. System Conditionally Passes:
_ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,
upon completion of the replacement or,repair,as approved by the Board of Health,will pass `
Answer yes,no or not determined(Y,N,ND) in the for the following statements. If not determined please explain. �=n
n/a The septic tank is metal and over 20 ears old* or the septic tank whether metal or not) is structurally unsound,exhibits
y
substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced : .
with a complying septic tank as approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating
that the tank is less than 20 years old is available. '
> �f
ND explain: n/a `�
n/a Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed
pipe(s)or due to a broken,settled oruneven distribution box. System will pass inspection if(with approval of Board of
Health):
_ broken pipe(s)are replaced ; .F
obstruction is removed =
_ distribution box is leveled or replaced
ND explain: n/a
n/a The system required pumping more Y
than 4 times a year due to broken or obstructed pipe(s). The system will pass .
inspection if(with approval of the Board of Health):
_broken pipes)are replaced ro
_obstruction is removed w � F
ND explain: n/a
. hAw°lh.
. i
Page 3 of 11 t
OFFICIAL INSPECTION FORM -NOT FOR�VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM4;tIYk
PART A '
CERTIFICATION(continued)
Property Address: 49 SUOMI RD,HYANNIS,MA 02601 ;
Owner: MR BAILEY
Date of Inspection: 12/14/01
C. Further Evaluation is Required by the Board of Health:
Conditions exist which require'further evaluation by the Board of Health in order to determine if the system is failing to
I protect public health,safety or the•environment. g
1. System will pass unless Board'of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is,
,. :.,. 4N
not functioning in a manner which will protect public health,safely and the environment: ..J4- ..'.
1,34
_ Cesspool or privy is within 50 feet of a surface water 1` x°
_ Cesspool or privy is within 50 feet of.a bordering vegetated wetland or a salt marsh
fik�•'��CK3�5
7• I �
2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the
system is functioning in a manner that protects the ublic health,safety and environment:
_ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water
supply or tributary to a surface water supply.
_ The system has a septic tank and SAS and the SAS is within a Zone,l of a public water supply. ,•
41 igy
_ The system has a septic tank*and SAS and the SAS is within 50.feet of a private water supply well.
' ram j
_ The system has a septic tari and SAS and the SAS is less than 100 feet but 50 feet or more from a private water ._
supply well**. Method used to determine distance n/a
` + performed at a DEP.certified laboratory, for coliform bacteria ands.. `
**This system passes if the well water analysis,p rY�
tes that the well is free from pollution from that facility and the presence of ammonia
volatile organic compounds indica
. 3,
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy,; 'ta
of the analysis must be attached to this form.
3. Other: 2
n/a '.
r x ;
C 't,
, rp
Nj-
Page 4 of 1 I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE"SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 49 SUOMI RD HYANNIS,MA 02601
Owner: MR BAILEY
Date of Inspection: 12/14/01
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all-inspections:
Yes No
X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged
SAS or cesspool
X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool
X Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2 day flow
_ X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times
pumped nLa.
X Any portion of the SAS,cesspool or privy is below high ground water elevation.
X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. :, •..
X Any portion of a cesspool or privy is within a Zone 1 of a public well.
X Any portion of a cesspool or privy is within 50 feet of a private water supply well.
X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with
no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP
certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free
from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be
attached to this form.l
(Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310
CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E. Large Systems:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd.
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes no
X the system is within 400 feet of a surface drinking water supply
X the system is within 2dd feet of a tributary to a surface drinking water supply
X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped
Zone II of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered
"yos" in Section D above the large system has failed,The owner or operator of any large system considered a significant threat
under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system oWttoY ,
should contact the appropriate regional office of the Department.
d
Page 5 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 49 SUOMI RD HYANNIS,MA 02601
Owner: MR BAILEY
Date of Inspection: 12/14/01
Check if the following have been done.You must indicate"yes"or"no"as to each of the following:
Yes No
X _ Pumping information was provided by the owner,occupant,or Board of Health
X Were any of the system components pumped out in the previous two weeks?
X _ Has the system received normal flows in the previous two week period?
X Have large volumes of water been introduced to the system recently or as part of this inspection?
X Were as built plans of the system obtained and examined?(If they were not available note as N/A)
X _ Was the facility or dwelling inspected for signs of sewage back up?
X _ Was the site inspected for signs of break out?
X _ Were all system components,excluding the SAS, located on site?
X _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the
battles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum?
X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance
of subsurface sewage disposal'systbms
The size and location of the Soil Absorption System(SAS)on the site has been determined based on:
Yes no
X _ Existing information. For example,a plan at the Board of Health.
X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is
unacceptable)[310 CMR 15.302(3)(b)]
5 � "
Page 6 of I 1
t e f Y�'•�•e�5
1 OFFICIAL INSPECTION FORM—NOT FORWOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM * ,
PART C �{ `
SYSTEM INFORMATION
Property Address: 49 SUOMI RD HYANNIS,MA 02601
I �.
Owner: MR BAILEY 1
i Date of Inspection: 12/14/01 '..�-, Via,
FLOW CONDITIONS
f RESIDENTIAL
�IRip
Number of bedrooms(design): 3 Number of bedrooms(actual): 3 # dst
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):330
' Number of current residents: 4 M
II Does residence have a garbage grinder(yes or no): NO • ,,t:- - "I�,�9
1I Is laundry on a separate sewage system(yes or no): NO [if yes separate.inspection required] � •:;� M�
Laundry system inspected(yes or no): NO '( .
I Seasonal use:(yes or no): NO
Water meter readings, if available(last 2 years usage(gpd)): n/air
Sump pump(yes or no): NO
Last date of occupancy: n/a
COMMERCIAL/INDUSTRIAL ,'
Type of establishment: n/a
Design flow based on 310 CMR•15.203. : n/a gpd
Basis of design flow(seats/persons/sgft,etc.): n/a �
{ Grease trap present(yes or no): NO "�
Industrial waste holding tank present(yes or no): NO # `F t t!
Non-sanitary waste discharged to the Title 5 system(yes or no): NO
Water meter readings, if available: n/a
Last date of occupancy/use: n/a
OTHER(describe): n/a
t
GENERAL INFORMATION
Pumping Records
# Source of information: n/a
Wass stem pumped as part of the inspection es or no NO
If yes,volume pumped: n/agallons--How was quantity pumped determined? n/a
Reason for pumping: n/a '
1 TYPE OF SYSTEM
X Septic tank,distribution box,soil absorption system
_Single cesspool
i54
_Overflow cesspool
Privy
_Shared system(yes or no)(if yes,attach previous inspection records,if any) .
Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from a=
system owner)
_Tight tank Attach a copy df4i,thetDEP approval
Other(describe): n/a
Approximate age of all components,date installed(if known)and source`.of information: `
1988
Were sewage odors detected when arriving at the site(yes or no): NO '
i
I� j'
Page 7 of 11 _
r
OFFICIAL INSPECTION FORM—NOT FORYOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C '
SYSTEM INFORMATION(continued) y :
f � -
t Property Address: 49 SUOMI RD HYANNIS MA 02601
Owner: MR BAILEY ; '
, °
Date of Inspection: 12/14/01 n: . i,
BUILDING SEWER(locate on site plan) ;sk,
Depth below grade: 14"
+ Materials of construction:_cast iron X40 PVC other(explain): n/ar;? . ';'
Distance from private water supply well or suction line: n/a
Comments(on condition of joints,venting,evidence of leakage,etc.):
TOWN WATER , t
SEPTIC TANK: X(locate on site plan) �.
Depth below grade: 8"
Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a
If tank is metal list age: n/a Is age confirmed b a Certificate of Compliance es or no): NO attach a co of certi locate
Dimensions: 1000G L 8' 6" H 5' 7" W 4' 101."
Sludge depth: 2"
Distance from top of sludge to bottom of outlet tee or baffle:32"
Scum thickness: 1"
Distance from top of scum to top of outlet tee or baffle: 6"
Distance from bottom of scum to bottom of outlet tee or baffle: 17" ; tip
How were dimensions determined: MEASURED ,w
Comments on pumping recommendations inlet and outlet tee or baffle'condition,structural integrity, li uid levels as related r .. f t
( P P g q .t.
to outlet invert,evidence of leakage,etc.):
SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.
RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG_ THE SYSTEM'S USEFUL LIFE.
GREASE TRAP:_(locate on site plan) ' ' n
Depth below grade: n/a '
Material of construction: concrete,.metal_fiberglass_polyethylene_other(explain): n/a
Dimensions: n/a a
Scum thickness: n/a i !�
Distance from to of scum to to of outlet tee or baffle: n/a ", Ha' :
P P
Distance from bottom of scum to bottom of outlet tee or baffle: n/a ,
Date of last pumping: n/a
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related
, '�; :
to outlet invert,evidence of leakage,etc.):
n/a a +.
Page 8 of
OFFICIAL INSPECTION FORM—NOT FORNOLUNTARY ASSESSMENTS
�'
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM + :
PART C
' SYSTEM INFORMATION(continued)
Property Address: 49 SUOMI RD HYANNIS,MA 02601
Owner: MR BAILEY `yykk;. a,
Date of Inspection: 12/14/01 _
TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) ;,
Depth below grade: n/ate
Material of construction:_concrete_metal_fiberglass polyethylene_other(explain): n/a � x,
Dimensions: n/a
Capacity: n/a gallons " .'
Design Flow: n/a gallons/day
Alarm present(yes or no): N/A 4t '
Alarm level: N/A Alarm in working order(yes or no): NO
Date of last pumping: n/a . 'Ha`
Comments(condition of alarm and float switches,etc.):
n/a ; ,ym.
DISTRIBUTION BOX:X(if present,must be.opened)(locate on site plan)
Depth of liquid level above outlet,invert: LEVEL WITH BOTTOM OF PIPE
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into r :
or out of box,etc.):
r r.r r • K '� x 8C
D-BOX IS STRUCTURALLY SOUND. a f;
�k.
PUMP CHAMBER: _(locate on site plan)
Pumps in working order es or no NO
t
Alarms in working order(yes or no):NO � .+•s�rA
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): y '
n/a
.4, f �
i{; ,L,
`.h ,
j pi, � +
Page 9 of 11
• to . �
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS 3 . "
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM '
PART C .
SYSTEM INFORMATION(continued) s " `
Property Address: 49 SUOMI RD HYANNIS,MA 02601
Owner: MR BAILEY
Date of Inspection: 12/14/01
SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) - • .+ .
If SAS not located explain why: ' ';
n/a .. skiType
#.'. .
i 1000 GAL 6'X 6' leaching pits, number: t 1
n/a �4 leaching chambers, number: y nla
n/a leaching galleries, number:,; n/a ,''' ''
j n/a leaching trenches, number,'length: n/a
n/a leaching fields, number: ' ' n/a •"` .
' n/a overflow cesspool, number: - n/a '
+ n/a t l;,innovative/alternative system
T e/name of technolo i. * M '
YP 9Y n/a 1)
Comments note condition of soil si ns,of hydraulic failure, level of ponding,damp soil condition of vegetation,etc. : '
LEACH PIT IS STRUCTURALLY SOUND AND FUNCTIONING`PROPERLY. PIT HAS T OF LEACHING LEFT; ,,
IN IT AND BOTTOM IS AT 9'. . .`'
CESSPOOLS: (cesspool must be pumped as part of inspection)(locatefon site plan)
i Number and configuration: n/a
Depth—top of liquid to inlet invert: n/a j
Depth of solids layer: n/a '
Depth of scum layer: n/a
Dimensions of cesspool: n/a
Materials of construction: n/a
Indication of groundwater inflow(yes or no): NO
Comments note condition of soil signs of hydraulic failure level of ppnding,condition of vegetation,etc. : '".
n/a
PRIVY: (locate on site plan) t ~
Materials of construction: n/a V A
Dimensions: n/a
Depth of solids: n/a
Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
n/a
,r
r �1
0
f
Page 10 of 11
41,
OFFICIAL INSPECTION FORM—NOT FOR'VOLUNTARY ASSESSMENTS `
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM '
PART C f d t
SYSTEM INFORMATION(continued)
Property Address: 49 SUOMI RD HYANNIS,MA 02601
Owner: MR BAILEY
Date of Inspection: 12/14/01
SKETCH OF SEWAGE DISPOSAL SYSTEM ?
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. E
' + �'• Y a
Locate all wells within 100 feet. Locate where public water supply enters the building.
7;:.� �:•Fri,
A•
t 1C'
r
1Ai7^.
50�
�c
t
Page I 1 of I I
l•�tti"
OFFICIAL INSPECTION FORM—NOT FOR-VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C :'5r .
SYSTEM INFORMATION(continued) ` yt'
Property Address: 49 SUOMI RD HYANNIS,MA 02601
Owner: MR BAILEY
Date of Inspection: 12/14/01 'R'• F-,
SITE EXAM
7fw'
Slopeh;,�,,
Surface water ,
Check cellar '
_Shallow wells
` Estimated depth to ground water 12 feet ?x 1
Please indicate check all methods used to determine the high round water elevation: `'
(check) g g
NO Obtained from system design plans on record- 1f checked,date of design plan reviewed: n/a fi x
YES Observed site(abutting property/observation hole within 150 feet of SAS)
i NO Checked with local Board of Health-explain: n/a = :
f NO Checked with local excavators,•installers-(attach documentation)
1 NO Accessed USGS database-explain: n/a
You must describe how you established the high ground water elevation:
' HAND AUGER- 12 FT. NO WATER ENCOUNTERED AT 12 FT. ') i
.0 hS�J
r �w
1 ar
y �4e• kF
6''3
_ k rf.p
4k A.
�l
MOM
N�■N fl NME
�■�� �
on
mod m
ism
�NIlkiI�LJ��mmm
�■I AiOuun�ui .tl
No
ON
mom
Nis mmm
IN ME
0 MEMO
�� ■n�■ins �
mammas
MEN
WEEMS
Noma
MA
I Fj A Wl F Ulal 11
Is t
RA 0
No
I�
SEEN
ME 0
I ir
MEN 0=001 ME
ME 00 ME
n■ll
N
�e
.w Ww
:Nay 1 6
' 1
1
i
i
i
9
u
o '
4 a
m 1 �
J
W
9Y m 7 n = r
F W
Q
O � V
>w•rIw E
oalor.sv ""'° NV-id 2100E ONO735
MILL�.M..O
I
1
W
J
u
� pp
�D Z
a
k
W
yy=Z
[ Y
_ �a Q-
YC tY
J '
U_
a ,
2 9
o
a Y I
u
$-� u
e n
Elf
I
c�
CONT.RIDGE VENT
' 1
7X 10 RAFTERS
0 16'O.G
II ARCHITECTURAL GRADE
—�I SHINGLES
7X 0 CEILING 110
JOISTS a 16'D.0 I '
Irl" PLYWWOD ROOF
--� SHEATHING
4"
40'
36" ICE 4 WATER SHIELD o
EXISTING m 6
STRUCTURE ge
BEYOND a a
I x 6 SIDING x d E g
0 0 0
2 X Co FRAMED
CONSTRUCTION
7x 10 FLOOR `�3)•7 X 10
JOISTS s Ib'O.0
3'STEEL SUPPORT GRADE LEVEL
.. COLU"IN ..
a•CONC. I -
SLA9 4"' -
- N
i F—7a•� I - N-. •«.
�L -1 �- ----- ----- - -- -- - -- -- - ----- - ----- ---� L
L J— -- - - --�-�� c
I I IF 4
I` -- - -- ---------- - ---26 ,------- ----- --- -----k E
Li
Dn"ly•u",Mn
I r
t
. i
v
3 2X 8
FDRY,-
ALL
VENTED EAVES
TYPICAL
INTERIOR POLY
-_ARRIER O
.••.•.c.o. 112"WALL 5WEATHING -
9
I .
3W7 .GDECK .. ...
li• 9�" 2X 10 J01575
J
• �+.r.a.w.0 _ _ to
.
� I!!"DR•'WALL '' -+..- • �
W
J
W Q
I F Q
2 X 10 PEADER5 7
POCKET INSULATED F
—INTERIOR POLY w..m.�•e�...
5
1 . .
�.t TOWN OFBARNSTABLE
LOCATION 7 7 ,ft.,b M l f\c� SEWAGE#Q
VILLAGE ��/��•- A— / 3 ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO.-9 iHS6
SEPTIC TANK CAPACITY /cSG y
LEACHING FACILITY: (ty ) �y' G/ 1� (size) '
NO.OF BEDROOMS
BUILDER OR OWNER
PERMIT DATE: B� COMPLIANCE DATE: X
Separation Distance Between the: A -
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
F
within 300 feet of leaching facility) } ` eet
Furnished by ilk, '
Y
5 '
.. �;
_' F
` � - 1
..
x
� �
.. �.
._
. j
:�
��
.«
��
`� � �
o
�.
�.
.d.�
:.,
� ��
TOWN O BARNSTABLE
k�v7k
LOCATION SEWAGE # e,0 `
VILLAGE AAS ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PH 4E NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) /) size)
NO. OF BEDROOMS
BUILDER OR OWNER
PERMTr DATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to t e�o�ng F cility 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 l_ �lG
,
.y
y
i
H
p(��y THE COMMONWEALTH OF MASSACHUSETTS
BOARD O HEALTH
OF......................................... G•G
ApplirFation for Dhivaii al Works (fouBtrurtiun Vernfit
Application is hereby made for a Permit to Constructs or Repair ( ) an Individual Sewage Disposal
System at:
Lots 7Y3, 74 & 75 Sauna Road, Barnstable, MA
................ ........-...............................:...................................... ------..._...----------------......._.....--•-----...------••---.........-------------•----------.
Barnstable Holdi�n° `�`b;`'IYf�. 100 West Main St&LO,NIyannis, MA
.........---•-•-----......................................•---•---.......----------._............ .............--------•----------=...........-•----....----....................................----
Owner
W Robert Our Co. Great Western Ro ;eHarwich, MA
......................•-••--•-----......---.......-•-----•--.........---.....----------------...-- ---••------------.........------................--.......------......------......-----...........
Installer Address 33,570
Q Type of Building Size Lot........... ...............Sq. feet
U Dwelling—No. of Bedrooms....... _ .Expansion Attic (rn®) Garbage Grinder
I.-,
(�dl
Other—T e of Building No. of persons............................ Showers — Cafeteria
a Other fixtures ------------------------------------- - -
W Design Flow............22p..................gallons per person per day. Tota daily flow..[_5 .33.C�...=-Y-9 gallons��
WSeptic Tank—Liquid'capacity_/_aOdgallons LengthSr___..lo_._ Width..l.710._ Diameter................ Depth5_..-_$_.
x
Disposal Trench—No. .................... Width............ Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No........./.---------- Diameter-----/`t�-.....__ Depth below inlet... _........... Total leaching area.?.y.....s�t y
Z Other Distribution box (X) Dosing tank ( )
Percolation Test Results Performed by..................................................-....................... Date.......................................
Test Pit No. �___x2_..minutes er inch Depth of Test Pit..... - -- Depth to ground water_..._ .................
.
----- P P -- - � P
fz, Test Pit No.y...<...�._minutes per inch Depth of Test Pit..... .r..`1�...... Depth to ground water_--_.IF ........
t� ----•--------------•-•--•---•-••---•--------------...-----_-----...............-- •--.....----•-------•----.......---------------•--.............._.
O
Description of Soil.--;5'&_1....C?----1.:4 ........ •'•----
U ---•--------•••. ..... --------•.........-----------=---------------•---......._-`. i.----------- --.:-•---•-----•--------
V 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 TITLE 5 of the State Sanitary Code—The un ersigned further agrees not to place the system in
operation until a Certificate of Compliance has been i'ssued e ealth.
Signed..................... •----• ---• ------•--• ............. Date
-••-----•-•-
Date
Application Approved By.........
4 .,.. .. -1-•-----•---•---•------------- ••-----•----- -' `+fit`=�
_
Date
Application Disapproved for the following reasons:------••---------------------------------••---------•--•-••---•---•-•-•-----•------•--••------------------------
....-------•••--------•-•----•-----------------------------------------------•-----........-•--•-....__.._..-----------•-------•---•---.---...-•--•••----••----•-----..._....---...----......_----------
Date
PermitNo......... .":. .............................. Issued.........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEA.LTH'•'' ' �•��AT �,�.��a.`DS
311 ���,'_Lf;:"'M :i-�'
(artt/+!sr...........OF........... 'r !�.'..'........°:.!.�`.. t.'.i.a�a_�i a7 I:d '33 o r;ICT
Trrtif iratr of To rhnnrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by......... D. . -------------•--.....-•-------------------•--------......-----.........------------.....--•----••-•------=------------•-------•--.........•
_ Installer
at............4 c•° ...:73.. —
.�-Y 36 -----S--��'`--- -------------------!! P --------------------------------------...----•-•-----------------.
has been installed in accordance -with the provisions of TIT-✓ 4>�of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No--------2?- 2_1--------------- dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE......................... --.--------_-------•---- Inspector......................
---Ne..............................................
G, ..
TWE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH ,
....................................I.,....O F...........................................
Appliration for Dispooal Works Totuitrnnrtion Vlernnit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
Sys em a
ots�3, 74 tk 75 Sauna. Road, Barnstable, MA
................__....----.........-•----•--••--••---.....................-- ......----••--• ••-•-- •------ ............:.......................................
Barnstable 1~Ioldiii tx*0 100 West Main StfeR,%yannis, MA
......................-.......................................................................... ..•-------------.....---------.....---........•-•--.............--•••-••-•--•-•.............•••---
W Robert Our Co. Owner Great Western Rodlf;enareaich, MA
Installer Address
33,570
Type of Building,,r ' Size Lot.................... .....Sq. feet
Dwelling of Bedrooms........ .........-.................----.Expansion Attic (ro) Garbage Grinder (tee)
`4 Other—Type of Builditl
a yp g ____________________________ No. of persons...................-........ Showers ( ) — Cafeteria ( )
Other fixtures .
WDesign Flow...........3.1.p...................gallons per person per dly. Total dailyp flo v.�: .X-33 ___.=.` � .gallons.
WSeptic Tank—Liquid'capacity./OG�gallons Length.-._lg..... Width_:/0 i Diameter................ Depth:4F-•.:..g...
x Disposal Trench—No. .................... Width`..-- ..--...... Total Length......_-.-- Total leaching area....................sq. ft.
Seepage Pit No---------1......... Diameter.....!.Y.--..... Depth below inlet................ Total leaching area4��-_.?_�.....sq it.,F
Z Other Distribution box oo Dosing tank ( )
~' Percolation Test Results Performed bY..................................................;....................... Date........................................
a Test Pit No.�... ...; ..minutes per inch Depth of Test Pit....:/............. Depth to ground water-----y..,.............
44 Test Pit NOY...<... ?,.-minutes per inch Depth of Test Pit..... Depth to ground water...... ..�.-.._--.
P4 ..-•---•----------------------------------------•••.... ..........
.................
0 ' ' ..
_5 -� .,.� ,Description of Soil__ ® =.:i.....................•-•---............---------
U -------------------------
41
x -�' -
V 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 'ITFLE; 5 of the State Sanitary Code— The u ersigned further agrees not to place the system in
operation until a Certificate of Compliance has been s ,y..e d ealth.
Signed... .•---•-G-............................
'z.. . U^
Date
Application Approved BY --------------------------------------------- ...........X•=...lr�---- -`----•------
Date
Application Disapproved for the following reasons:................. --•--•-------------------------------•------------------------•-----------•••-.......--.---•-
.............•--••--•_.-••-••---•...--•-••••----•-•--•••--••-•••----•-----•------•-------•-•-••••-------•••---•-•-------------•-----------•-----•---•-•--------•••------••••--•------•••••-----...------
Permit No........ S- /............................... Issued_...........................................Date Date----••.
Date
-- - THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
........../(sc.vw-:............OF...........
Jc',
.....................................................................................
(1-y"rrtif irFate of Tampliaurr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by......... .��.. ............:��.i�--...........----•-•----•-••-•-------.....------------....-•-----••------------...-•--••-•------...........-----•---••------••--•--..........
- Installer
at...............................73 7-Y 7S .. .------.....- �
I V_ - •------------•----•----•------•-----------*...............
has been installed in accordance with the provisions of TITLE '> of The State Sanitary Code as described in the
s application for Disposal Works Construction Permit No.------�9..`..... ............... dated-......---...----....---.--...--....--...--.....
THE ISSUANCE OF THIS CERTIFICATE SMALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE..............•••--.......----------------•-••-------------.....-••--•-•---_.... Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD nOF HEALTH
�9t4iiA.................OF......... 1.'�rr::v cv: . .......................................
No......!! FEE... —-
.... ............
Diapooal Works Tondrudion rrunit
Permission is hereby granted............r l------•-- ----•-----------•-----------------•---•-•-....--•----••------••-•----•--..............
to Construct ( _;or Repair ( ) an Individual Sewage Dis osal System
fat No..... Lv 7?i 4- 7• /-j•••1-�--• a"'"°•`-"- 1�-c_'-
Street r
as shown on the application for Disposal Works Construction Permit N ._cal:. _!._ Dated_5� .. f.....................
L� Board of Health
DAT - - (......................................................
�L
FORM I2!5,5 HOBBS & WARREN. INC.. PUBLISHERS ,, `1
LEVY, ELDREDGE & WAGNER ASSOCIATES, INC. r,
ENGINEERS-LANDSCAPE ARCHITECTS-PLANNERS
LAND SURVEYORS
889 WEST MAIN STREET
CENTERVILLE,MASSACHUSETTS 02632
(617)775-2244
August 31 , 1989
Town of Barnstable
Board of Health
Main Street
Hyannis, MA 02601
Re: As-Built Septic System
Lots 48, 49 & 73 , 74, 75
Dear Sirs:
Please be advised that the above referenced septic system has
been installed in-.accordance with the attached plan.
Very truly yours,
LEVY, ELDREDGE WAGNER ASSOCIATES INC.
Pa 1 A. Le y, P.E.
PAL/mlw
. 1373cn
88 WAVERLY STREET FRAMINGHAM.MASSACHUSETTS 01701
r L.
LOT 50
ELEV. • TOP OF LOT 46
129.88' ANK - 58.7
0 0
i.
0
44.0 7.6' 24.0' (9
i
T.O.F.-59.00 ELEV. •TOP OF
25.2 DIFFUSER 56.3
m '
D LOT 45
LOT 49
z
70
O 110.
LOT 48
i
N
J
t0
U�
,60 00 x
50 02.
1 8 31/89 INITIAL ISSUE PAL
NO. DATE DESCRIPTION BY
AS—BUILT SEPTIC SYSTEM —LOT 48,49
SHADY LANE
pf
BARNSTABLE, MASSACHUSETTS
DACEY HOMES INC.
I CERTIFY THAT THE SEPTIC SYSTEM =% SCALE 1" = 30' JOB N0. #1373
Paul A. w SHOWN ON THIS PLAN IS LOCATED LEVY �' 0 30 60
ON THE GR INDIC ED No. 10617 V)
Tom;'/ IBVY, kZRBDGB & RAGNSN ASSOCIAM INC.
ATE RE IST RED LAND SURVEYOR 5r� °� LAO 'amm
889 WEST MAID STKIMT CENTERV= MA 02632 i
I
7 1 '
LEVY, ELDREDGE & WAGNER ASSOCIATES, INC.
ENGINEERS-LANDSCAPE ARCHITECTS-PLANNERS
LAND SURVEYORS
889 WEST MAIN STREET
CENTERVILLE.MASSACHUSETTS 02632
(617)775-2244
August 31 , 1989
Town of Barnstable
Board of Health
Main Street
Hyannis, MA 02601
Re: As-Built Septic .S_y-st.em
Lots 48, 49 & ,73 , :74,,__,,,
Dear Sirs:
Please be advised that the above referenced septic system has
been installed in .accordance with the attached plan.
Very truly yours,
LEVY, ELDREDGE WAGNER ASSOCIATES INC. .
Pa 1 A. Le y, P.E.
PAL/mlw
1373cn
88 WAVERLY STREET FRAMINGHAM.MASSACHUSETTS 01701
:1 LOT:72 �Op.
LOT 73 /
/ �%
/
/
p /
ti T.O.E.= LOT 74
65.18
h Nrn
�� ^h ELEV. O TOP OF O�
TANK = 629
7'
/ � e� o
o
/
51 /
r, ELEV. OTOP OF
fig`r: PIT = 59.9/ /
All
! # O
�-
"� : LOT 75 00.
r
.1
0
0
0
198.42'
1 8 31 89 INITIAL ISSUE PAL
N0. DATE DESCRIPTION BY
AS-BUILT SEPTIC SYSTEM- LOT 73,74,75
-o SHADY LANE
_ w
BARNSTABLE, MASSACHUSETTS
or M4:r a rat
DACEY-HOMES INC.
PAUL A. 1 " = 30` JO
I CERTIFY THAT THE SEPTIC SYSTEM B N0. �1373
LEVY ' SCALE 1
SHOWN ON THIS PLAN IS LOCATED No. I0617 I o 30 so
ON THE GR I DI AT
VAfE
LEVY, FUREDGB do 1fAGNKR AWCUM 1NC.
R GI EKED :LAND :SURVEYO °m umn amnm game immmx
t• 889 WOT MAIN STREEfi CENTERVnl.S MA 02632
LEGEND HYANNIS
PROPOSED CONTOUR
V _ ® PROPOSED SPOT GRADE m
O/f
UTILITY 98 EXISTING CONTOUF}. can
'/� — -- Y
POLE /� + 96.52 EXISTING SPOT GRADE W. MAI
r;�.. N N SHEET � 1
,p W— EXISTING WATER, SERVICE
O TEST PIT
S(/OM/
> . RD
26
G O '
I QP 4
LOCUS
28 LOTS 73—75 49 SUOMI RD.
AREA = 33530 sf+— 4 '• "� LOCUS MAP
LAND COURT PLAN 11328-B \@�
30
` 0 \ \ ASSR MAP268 PCL 94
_ LOCUS INFORMATION
PLAN REF: LCP 11328—B
\ TITLE REF: LCC 186271
PARCEL ID: MAP 268 PAR. 094
321 �' { PROPERTY.IS WITHIN ZONE II
z4 \ FLOOD ZONE: "X"
33 `� G COMMUNITY PANEL 25001CO568J DATED:07/16/14
BENCH*MARK SEPTIC SYSTEM
i GARAGE SLAB
rop F<<iNG `' ; 22 25.16 REPAIR PLAN
' Ek ' 0" C I // BARNSTABLE GIS DATU
EXIST. 1,000G LOCATED AT:
SEPTIC TANK TP® 1�I '�i 11 ,,�� 49 S U 0 M I ROAD
PAVED DRIVEWAY H YAN N I S, MA
PREPARED FOR
R �� •F
e DENNIS & GAIL OLEY
33 ! I ! / 20
JUNE 29, 2021 REV: JULY 22, 2021
\
EXISTING 1.0000,% LEACH PIT / I (/ ,'
I 1` I i i � P�•�� OF
I ,
`DTP-1 E R�V
1 30 28 26 I �
3ITAR\a�
,ea"az' zz zo
WETLANDS FLAGGED BY:
BRAD HALL MEYER & SONS, INC:
�? P L A N P.O. BOX 981
SCALE: 1 in 30 ft
EAST SANDWICH, MA. 02537
= t
0 30 60 PH: (508)360-3311
FAX: (774)413-9468
0 1 20 0 30 60 meyerandsonstitle5@gmail.com
SHEET 1 OF 2 J 2076
NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GENERAL NOTES:
TOP OF FND SEPTIC TANK GRADE SHALL NOT BE < EL:28.49 FOR A DISTANCE
INSTALL RISERS & COVERS OVER INLET & 15' AROUND THE PERIMETER OF THE S.A.S. 1. ALL EL.=32.50t OUTLET TO FINISH GRADE PROPOSED D-BOX PROPOSED'S.A.S. D OGHEALTTH ANDPTHE DESGNLAN MUST BENGINER. � THE LOCAL
INSTALL RISER & LOCKING
INSTALL METAL RINGS AND LOCKItNC C6VERS COVER TO FINISH GRADE INSTALL A RISER OVER ONE CHAMBER (MIIN) 2. Au:'woRK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS
TITLE V. AND ANY APPLICABLE
F.G. EL.=30.50t AND SET TO 3" OF F.G. OLO�RU�AND�REGU�ENVIRONMENTAL
AS REQUESTED BELOW:
F.G. EL.=30.45t F.G. EL: 31.Ot F.G. EL: 31.49(MAX.) - 310 CMR 15.405 (1) (B):
I 1)A 1 Fr. VARIANCE FROM 310CMR15.211 TO ALLOW LEACHING
9" MIN COVER/ TO BE 19 Fr (MAX) FROM DWELLING VS REWD 20 Fr.
36" MAX COVER L = 25' L = 13'(MAX INSTALL TWO INSPECTION PORTS (MIN.) 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR
O S=IX (MIN.) EL=29.95 O S=1X (MIN.) O S-ix (MIN.) TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE
4"SCH40 PVC 47SCH40 PVC 4'SCH40 PVC DESIGN ENGINEER.
4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING
1" 14 6 / 11.3" TO ENGINEEFROM R BEFOREWCONSSTTRUCTIEON ON CONTINUES.REPORTED TO THE DESIGN
ffunflum
\INV.=28.90 M'UWID INVERT 5. ALL ELEVATIONS BASED ON ASSUMED DATUM.
LEva INV.=28.65 INV.=28.10
PROPOSED I 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR,THE FAILURE OF
GAS BAFFLE 5 ROWS OF 8 UNITS AT 4'/UNIT - 32'/ROW THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF
D-BOX INV.=28.23 HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION.
� INV.--28.40 DDL-;a 'SO-IL ABSORPTION SYSTEM (PROFILE)
7. DWELLING IS SERVICED BY TOWN WATER.
EXIST, 1.000 GALLON SEPTIC TANK S.ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED
RESTORE VEGETATIVE COVER TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR.
EXIST. SEWER OUTLET 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE
BACKFILL WITH CLEAN PERC SAND LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO STARTING WORK.
TO TOP OF CHAMBERS 10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND FILLED PER TITLE 5.
NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING : ',:' ;,;'=' COVER UNITS W1 FILTER 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION
PIPE INVERTS PRIOR TO CONSTRUCTION. ^'�"• • ,':•. • ":�'.•-%,'-'V FABRIC PRIOR TO BACKFILL 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY
2) SEPTIC TANK AND D-BOX SHALL BREAKOUT=TOP ELEV.=28.49 AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY
BE SET TRUE TO GRADE ON A MECHANICALLY INV. ELEV.= 28.10 13. NO KNOWN ABUTTING PRIVATE WELLS WITHIN 150 FT. OF PROPOSED LEACHING
COMPACTED SIX INCH CRUSHED STONE BASE AS BOTTOM ELEV.= 27.16 EXISTING SUITABLE 14. ALL PIPING TO BE 4" SCH 40 ® 1/8'/FT (UNLESS SPEC. )
SPECIFIED IN 310 CMR 15.221(2). MATERIAL 15. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW
2.83'
3) INSTALL PVC INLET/OUTLET TEES IN SEPTIC TANK AS REQUIRED. 5' MIN. ABOVE BOTTOM OF FOR THE USE OF A GARBAGE GRINDER.
4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE T.P. EXCAVATION OR G.W. EFFECTIVE WIDTH = 5 x 2.83' = 14.15' 16. NO WETLANDS WITHIN 100 FT. OF PROPOSED LEACHING
AS MANUFACTURED BY TUF-TTTE, ZABEL OR EQUAL (5.11' PROVIDED) USE 5 ROWS OF 8-HIGH CAPACITY 17. NO PROPOSED INCREASE IN FLOW.
ADJUSTED GROUNDWATER: EL. 22.05= INFILTRATOR (H20) UNITS
SEPTIC SYSTEM PROFILE
SOIL LOGS TPT: 21-164
N.T.S.
DATE: JUNE 8, 2021
or Mass SOIL EVALUATOR: DARREN MEYER, CSE 1614
WITNESS: DAVID STANTON, BARNSTABLE HEALTH
DAR E
1 o M R Elev. TP-1 Depth Tier. TP-2 Dew
" O 23.60 A 0" 33.42 A 0"
G/� LOB SAD L0� SAND
DESIGN CRITERIA **NO PROPOSED INCREASE IN FLOW** NITAROa� 23.10 B 6" 32.92 B 3/2 6'
LOAMY SAND LOAMY SAND
NUMBER OF BEDROOMS: 3 BEDROOM DWELLING 1OYR 5/8 10YR 5/8
DESIGN FLOW: RESIDENTIAL: 3 BEDROOMS ® 110 GPD/BR = 330 GPD !/
DESIGN PERCOLATION RATE: <2 MIN/IN SOIL TEXTURAL CLASS: CLASS 1 (0.74 GPD/SF) 21.60 C 24" 31.42 C 24"
GARBAGE GRINDER: NO (not designed for garbage grinder) MEDIUM MEDIUM PERC TEST
DISTRIBUTION BOX: USE DB-5 (H20) SAND SAND GEL 30.08
1
2.5Y 6/6 - 2.5Y 6/6
SEPTIC TANK: 330 gpd x 200% = 660 gpd USE EXIST. 1,000G SEPTIC TANK ! 18.10 66" 23.42 J 120"
PERC RATE <2 MIN/IN. S'C1' HORIZON)
LEACHING AREA REQUIRED: (330)/.74 = 445.94 S.F. GROUNDWATER BOSERVED AT 63 IN TH-1 (ELEV. 18.35)
PRIMARY S.A.S. PROPOSED SITE AND SEPTIC UPGRADE PLAN
i USE 5 ROWS OF 8 - INFILTRAOR QUICK 4 HI-CAP UNITS-NO STONE GROUNDWATER ADJUSTMENT
BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.73 SF/LF OF CHAMBER) WELL: . ZONE; c 49 SUOMI ROAD, HYANNIS, MA
85
(CHAMBER) 40 UNITS x 4 LF x 4.73 SF/LF = 756.80 SF LEVEL ADJUSTMENT: 3.7'
Prepared for: Dennis & Gail Fole
ADJUSTED GROUNDWATER EL 22.05 System Design and Topography Plan by: SCALE DRAWN DATE
TOTAL AREA = 756.80 SF MEYER&SONS,INC.
DESIGN FLOW PROVIDED: 0.74GPD/SF(454SF) = 560 GPD > 330 GPD req'd ' 1, Darren M. Meyer, R•S•. CSE. hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 POSOX981
N.T.S. DMM 106/29/21
to conduct soil evaluations and that the above analysis has been performed by me consistent with the EAST SANDMCH,MA02537 REV DATE CHECKED SHEET NO.
MEETS MADEP 400 SQ FT REQUIREMENT: 14.15 X 32 = 452.80 requirements of 310 CMR 15.017. I further certify that I have passed the Soil Eval. Exam in October, 1999. 50&3622922 07/22/21 DMM 2 Of 2
I
f
----- SOIL TEST
�j , DATE OF SOIL TEST
+�+' t•MD, 10• MIN. PRECAST CONCRETE RISER WITNESSED BY _ D�►S►Jrti.)t'
all
—� SEE NOTES 2 do 3 A ,
L�� � 4" SCH. ao PVC PIPE .i. PERCOLATION RATE 'z MIN.,ANCH
MIN. PITCH 1/8- PER FT.
J
" BACKFILL WITH r
CLEAN SAND ��'`-�-���1�� '��L� 3 DPr.,;�IJ� I IofJ }�01,� � OBSERVATIONH�OL�,E 1 OBSERVATION ..H.�O,LrE 2
D, O `�---- I ® �� t5 w, s GJ "o L�{l+ = 5�,D ELEV.- ELEV,-_25 9
(^ Xrr'-r) E6 o 0 00
' - —o.on -o.00 -o.00
1-OP4 _ s�Lr - J�Sx'IL_
PITCH ' - -- - ��' Wit✓ 'altNi7 �it11�( �LCok(?SYE �At�G
1/4- PER FT.
#E
FLOW LINE \\ 2" LAYER OF �+
1/8- - 1/2' (C-;t , 411,(D
WASHED STONE
— QngD vJRI'W_ —q,4d WftT>✓K.. -12.ov �� v�p'ttR_� _ �,ob w/ATW_.
V-0' ' AP'PL-ILATOf-1 f�PPIILA�t^N 1J0, "�b3�j
5 _ LEVEL Y N0, P- 1�392 C3'23 87) ��t:.� t� vJA'FaC _ Ll�c�l�l- LI�� Nc. b39f (3-2-.5-4a-7)
4•-0' .0 y�� DESIGN CALCULATIONS :
LIQUID > 1/4- - 1 1/2-
LEVEL F WASHED STONE NUMBER OF BEDROOMS
DISTRIBUTION +� '� wUw GARBAGE DISPOSAL UNIT
BOX q/ ;�A�j
W TOTAL ESTIMATED FLOW
(_ILL" GAL/BR./DAY X _2`_ BR.) 1' GAL. AY
` REQUIRED SEPTIC TANK CAPACITY tix ' ` GAL.
�\ , ACTUAL SIZE OF SEPTIC TANK 14200 GAL.
LEACHING AREA REQUIREMENTS
I000 GALLON SEPTIC TANK L I q' I SIDEWALL AREA 9.4--2- GAL./S.F.
BOTTOM AREA GAL./S.F.
SEWAGE DISPOSAL SYSTEM PROFILE �, LEACHING APACITY BOTTOM + SIDEWALL) GAL
xI'7)�x/,c%j y x 2s
V LEA/'CMG CAPACI� ) 1 A-GAL
NOT TO SCALE `� 680TTOM OF TEST HOLE) sAMv
� -- — --- ��A DS v ST�p WArTvp-- I,k;-Y9L
BREAKOUT CALCULATION: D LEACHING PIT NOTES:
1. ALL WORKMANSHIP AND MATE IALS SHALL CONFORM TO D.E.Q.E.
pl�T' �z✓��U +d x.l` `� TITLE 5 AND THE TOWN OF RULES AND
ELT D t ST a (p t /2 D,L \ \ REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE.
2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO
WITHIN 12" OF FINISHED GRADE.
1 I \ 3. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE
SHALL BE MORTARED IN PLACE.
4. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE
1 OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR
" WITHIN 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING
SHALL BE USED UNDER OR WITHIN 10 FT. OF DRIVES OR
1 r o \S PARKING.
5. HORIZONTAL AND VERTICAL CONTROL, SEE LEVY, ELDREDGE
- & WAGNER FIELD NOTEBOOK # ,;-4{;
Ro
N
M LEGEND:
EXISTING SPOT ELEVATION OOXO
EXISTING CONTOUR- --00-
---
FINAL SPOT ELEVATION
\ FINAL CONTOUR
SOIL TEST LOCATION
TOWN WATER W W
f SEPTIC TANK (�
— Nib �jiJ mm-� U � \� DISTRIBUTION BOX ❑
PRIMARY LEACHING PIT 0
RESERVE LEACHING PIT i
h
LoT 75 % \
INITIAL ISSUEuj
L
-- NO. DATE DESCRIPTION 8Y
T''rL?r'!E�A 1 c0-r I'!At' Jt►iD APTIL esiisl�
Q \
h0G -7 S SA�NR �br4p
Ll
/ \ SCALE: 1 =%0 7JOB NO. I°e)73
PAUL
tUAX 5*4`s IMI
1� APPROVED: BOARD OF HEALTH
r
�7 f cast K r rA-r4
L�7, FI:DREDGE k WAGNER MSowpA S'W.'•'
DATE -------- AGENT �)'� MIRM LJI=AR Al�iTltCfS PLANW UND SURVMILR
LOCATION MAP �0 669 WFST MAIN STREET CENTERVI—, MA. 02632