Loading...
HomeMy WebLinkAbout0045 TEVYAW ROAD - Health 45 'evyaw tRgad9 P.yanni A=269-017 t i k ° l I ip e { e o TOWN OF 1B�ARNSTABLE LOCATION E-,fYA A/ tt SEWAGE# VILLAGE kgAt-,jmi S ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. CAPS AoL;t� 12 8c.UL- co—- SEPTIC TANK CAPACITY I jJ LEACHING FACILITY:(type) j4AM60gX (size) . (-113 t� -�Us NO.OF BEDROOMS J P m Pic rc"C 9-1(pQ, OWNER BQkNSeaC-- PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility' 4A Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) IV Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) N Feet. FURNISHED BY dAQ eojcOis/&&�'Ckq P, 0 Q L k T �YAI,� A G-JL 4-3= yf=5 No. 0( 1 A I Fee PT a OD THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: - Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Applitation for Disposal *pstrm Constru>rtion 3dermit Application for a Permit to Construct( ) Repair(Xl Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 45 " FSV) (4 f P-00 Owner's Name,Address,and Tel No. fLl A,Awme t3cjpm§� Assessor's Map/Parcel &WI S d1fkTTAAJQ0(�A 'Z'd Installer's Name,Address,and Tel.No. 502-*71 1 Designer's Name,Address,and Tel.No. 50is-IX73_031-1 ( ABC-cv'I 36ET 6 6,5kcx-, 7G C:6Jetb,Jea. vc-T&� Z;T r «ZSJ q E{Cv 9 .f ei Type of Building: Dwelling No.of Bedrooms Lot Size 6 -sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures �l Design Flow(min.required) gpd Design flow provided gpd Plan Date f 0 _a3~;10 ICI Number of sheets Revision Date Title TE R� Size of Septic Tank (I ow &X Type of S.A.S. Description of Soil ,(f() Yun f �(f�Aj Nature of Repairs or Alterations(Answer when applicable) L/SG !V'UsTiija 1Popp Gpoi-FA) Semc_ 1'w1C 60 - 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 ljoalth. Si Date 10-31-AOL9 Application Approved by Date GO j3/1 Z,11 Application Disapproved by Date for the following reasons Permit No. 2,0 lei - G Date Issued 0 f 3i/ 7-0 l No. �' 1 a Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Application for Disposal *pstem Construction Permit Application for a Permit to Construct( ) Repair X Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. q5 -MV�(OW Ao4?> Owner's Name,Address,and Tel.No. IncAA.c�vNG. 43q 5�'t / Assessor's Map/Parcel k4AWS P b Feu A Installer's Name,Address,and Tel.No. 50g.,4-rl,g"a 11 Designer's Name,Address,and Tel.No. S02 - -5 CAQ1=w'106�aeu 6 6o Zo Se L�UC�eNc' 611J� icy, iqm C Lrr Type of Building: Dwelling No.of Bedrooms Lot Size 7--sq.ft. Garbage Grinder( 1 Other Type of Building Q,eC[�&-JTA Ake No.of Persons Showers( )' Cafeteria( ) Other Fixtures Design Flow(min.required) dt,x > gpd Design flow provided (�]. gpd Plan Date 10 -ay ;10 IQ /_ ' n`N,unmbbeer of sheets � Revision Date Title VYA(A) —Ro Ab H ."(5, �+ Size of Septic Tank l 000 iLg Type of S.A.S. t�e� �'�(j� _44_Z C' -,( <6 4lL(�-J Description of Soil (tom��, „ � 1 `f �•�,c is pi*&) Nature of Repairs or Alterations(Answer when applicable) USt� , °r� r Fyc ► -gr nli[ 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 I, Compliance has been issued by this Board of He lth. " Si Date Application Approved by Date jn J; "Application Disapproved by Date for the following reasons Permit No. Zo t9 - 1-11 Date Issued 10/ !31��01� --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certifirate of Eompiiance THIS IS TO CERTIFY,that the n-site Sewage Disposal system Constructed( ) Repaired(x) Upgraded( ) Abandoned( )by a DEW at 45 TLL�/Y �� �� I has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.�&1 - 41(a dated 16 131 -Zo 1, Installer dA&/A)ti)g lA 6d5m A6(je Co Designer ;IC-,el-) (,()C� ZK�C. #bedrooms Approved design flow gpd The issuance of this perm its all not be construed as a guarantee that the system will �ti Tdesign . Date Inspector 7 1 00 -------------------------------------------------------------------------------------------------------------------------------,------^--�---------- No. _ (, Fee �/)) THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair(� Upgrade( ) Abandon( ) System located at L � VYAQJ p6AP) 14�C' 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 within three years of the date of this pe it. - Date /(�/ �I�n/�j Approved b Dec, 5. 2019 :6,34PM No. 3608 P. 1 Town of Balrnstable `"E"° ,� Regulatory Services s Richard V.Scali,Interim Director • e►masraace, MAM $ Public Health Division pr.n,v, 1k eo . Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax; 503-790-6304 Installer&Designer Certification Form Date: l 2-5^l Sewage Permit# 20 lei - H i�o Assessor's Map\Parcel Designer: TG Evfcmep-cirlj , 'Tr,c,, Installer: GaQe_w�Ac, l:nF�rFcts�� Address: 2b.5'1 Granberr% Address: I5_5 Comtylerciol SI-ree;F t E,,,t warehU,r, , N(� oz5��5 1�ash�e�l �!N Ua�`� q On (U --3(— 2ol q Capevu(�f L�1�r�;fscs was issued a permit to install a (date) -t � (installer) 1 u septic system at y5 Te V a w 0 0 p based on a design drawn by (address) �S C 6:05i;nwto dated do#ub r a5 20 19 (designer) V I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of'the distribution box and/or septic tank. Strip out (if required) was inspected and the' oih were found satisfactory. 7 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 &Vocal Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. Y certify that the system referenced above was constructed ' e with the terms of the I1A approval letters (if applicable) H Of ASS s� JOHN L GNP { U CHURCHILLJIi. YlaSign ure) NOI18D1 4 Signature) (Affix Des' er amp Here) RN TO ARNSTABLE PUBLIC HEAL DI SION, 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,1Sepric0esigner Certification Form Rev 8-14.13.doe Commonwealth of Massachusetts o1 W- D/�,- Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form ' Not for Voluntary Assessments 45 TEVYAW RD Property Address MARIANNE BURNSIDE t Owner Owner's Name e information is HYANNIS required for every MA 02601 9-29-2019 page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form..Inspection forms may not be altered In any way.Please see completeness checklist at the end of the form. Important:when A. Inspector Information u filling out forms on the computer, ' use only the tab Douglas Brown key to move your Name of Inspector cursor-do not Cape Cod Septic,Services Inc.- use the return Company Name key. 350 Main St. Company Address - West Yarmouth MA 02673 City/Town State Zip Code 508-775-2825 S14297 Telephone Number License Number B. Certification I certify that: I am a DEP approved system Inspector In full compliance with Section 16.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal.systems.After conducting this inspection I have determined that the system: r 1. ❑ Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ® Fails Ins ors Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note:This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform In the future under the same or different conditions of use. t5insp.doc•rev.7/28/2018 Title 5 Official inspection Form:Subsurface Sewage Disposal System Page 1 of 1s r Commonwealth of Massachusetts Title 5 .0fficial Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments •'" 45 TEVYAW RD Property Address MARIANNE BURNSIDE. Owner Owner's Name information is required for every HYANNIS MA 02601 9-29-2019 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3,or 5 and all of 4 and 6.- 1) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc rev.7/26/2018 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts —,1 Title 5 Official Inspection Form M a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 45 TEVYAW RD Property Address MARIANNE BURNSIDE Owner Owner's Name information is required for every HYANNIS MA 02601 9-29-2019 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND,(Explain below): ❑. obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to.protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not.functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 Commonwealth of Massachusetts Title 5'Official Inspection Form e Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 45 TEVYAW RD Property Address MARIANNE BURNSIDE Owner Owner's Name information is HYANNIS MA 02601 9-29-2019 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner.that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑. The system has a septic tank and SAS'and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and.SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply,well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 45 TEVYAW RD Property Address MARIANNE BURNSIDE Owner Owner's Name Information is required for every HYANNIS MA 02601 9-29-2019 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to.All Systems: (cont.) Yes No ® Static liquid level in the distribution box above outlet invert due to an overloaded El or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/Z day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ Z Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ® ❑ 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. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems,.you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead.Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage,Disposal System Form-Not for Voluntary Assessments 45 TEVYAW RD V Property Address MARIANNE BURNSIDE Owner Owner's Name information is required for every HYANNIS MA 02601 9-29-2019 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15,304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for all inspections: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal.flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® E] Were as built plans of the system obtained and examined? (If they were not available.note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions,depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection- Form Subsurface Sewage Disposal System Form-Not,for Voluntary Assessments 45 TEVYAW RD Property Address MARIANNE BURNSIDE Owner Owner's Name Information is required for every HYANNIS MA 02601 9-29-2019 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 2 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms). 220 Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection El Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage 2017 328 GPD g ( y 9 (gpd))' 2018 365 GPD Detail: Sump pump? ❑ Yes ® No Last date of occupancy: CURRENT Date t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments z ter.'V 45 TEVYAW RD Property Address MARIANNE BURNSIDE Owner Owner's Name information is required for every HYANNIS MA 02601 9-29-2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commerciallindustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Canons per day(gpd) Basis of design flow(seats/pers.ons/sq.ft., etc.):. Grease trap present?. ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No 'If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts Title 5 ,Officia:lInspection Form ei Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 45 TEVYAW RD Property Address MARIANNE BURNSIDE Owner Owner's Name information is required for every HYANNIS MA 02601 9-29-2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 1989 PER PERMIT ON FILE AT BOH. Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): 18e Depth below grade: feet Material of construction: ❑ cast iron. ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: +10 feet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 45 TEVYAW RD Property Address MARIANNE BURNSIDE Owner Owner's Name information is required for every HYANNIS MA 02601. 9-29-2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 811 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene 0 other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 GALLON Sludge depth: Distance from top,of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): LIQUID LEVEL IS OVER THE INVERT OF THE OUTLET TEE. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts Title 5 Official- Inspection Form Subsurface Sewage Disposal System Form -Not for Vol untary'Assessments 45 TEVYAW RD Property Address MARIANNE BURNSIDE Owner . Owner's Name information is required for every HYANNIS MA 02601 9-29-2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations,.inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: . gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 n Commonwealth of Massachusetts, Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 45 TEVYAW RD Property Address MARIANNE BURNSIDE Owner Owner's Name information is required for every HYANNIS MA 02601 9-29-2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert FULL Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 45 TEVYAW RD Property Address MARIANNE BURNSIDE Owner Owner's Name information is required for every HYANNIS MA 02601 9-29-2019 page. Citylrown State Zip Code _Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 4 FLOW DIFFUSERS ❑ leaching galleries number: El leaching trenches number, length: ❑ Teaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection.. Forrn ^ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 45 TEVYAW RD Property Address MARIANNE BURNSIDE Owner Owner's Name information is required for every HYANNIS MA 02601 9-29-2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): SAS IS FULL 12. Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth.—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form =Not for Voluntary Assessments 45 TEVYAW RD Property.Address MARIANNE BURNSIDE Owner Owner's Name information is required for every HYANNIS MA 02601 9-29-2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): . Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t51nsp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of-Massachusetts Title 5 0fficial Inspection Form j Subsurface Sewage Disposal System Form-.Not for Voluntary Assessments to% 45 TEVYAW RD Property Address MARIANNE BURNSIDE Owner Owner's Name information is required for every HYANNIS MA 02601 9-29-2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 45 TEVYAW RD Property Address MARIANNE BURNSIDE Owner Owner's Name information is required for every HYANNIS MA 02601 9-29-2019 page, City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: +20 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site(abutting property/observation hole within.1,50 feet of SAS) ❑ Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: FORM SEPTIC INSPECTION ON ABBUTTING PROPERTY. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 Commonwealth of Massachusetts - - Title 5 Dfficial Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .% 45 TEVYAW RD Property Address MARIANNE BURNSIDE Owner Owner's Name information is required for every HYANNIS MA 02601 9-29-2019 page. Cityrrown State Zip Code. Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank-Pumping contract attached .For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.cloc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 Page 11 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 48 Lincoln Road Hyannis, MA Owner: Dan Grim Date of Inspection: December 1, 2003 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 25 +/- feet Please indicate (check) all methods used to determine the high ground water elevation: Obtained from system design plans on record- If checked, date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain:topographic and water contours maps Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using the Barnstable topographic map and water contours map the maps were showing 25'+/ to ground water at this site This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written.or implied, relating to the system, the inspection and/or this report. 11 I v.r n yr Dtuu'4a 1 t%DLC LOCATION SEWAGE # ` VELLAGE J-L ASSESSOR'S MAP & LOT-(k g •w INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY _9 4 r- LEACHING FACILITY:.(type) (size) II&W. t� ..,,Q.1 NO.,,BEDROOMS 3. . BUILDER OR OWNER PE*rrDATE: --�, -��COMPLIANCE DATE: Sepafation Distance Between the: MaitiTnum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Privatt 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 F9 7719 : b 17 l i z �TME _ l Town of Barnstable PT# TP-19-177 Department of Inspectional Services mRN3rA=, 9 MASS, Public Health Division i679• �0 jOlEp Mpt N 200 Main Street,Hyannis MA 02601 Office: 508-862-4644 Date Scheduled 10/17/19 Time 11:00 AM Soil Suitability Assessment for Sewage Disposal Performed By: Michael Pimentel, EIT; CSE Witnessed By: David W. Stanton, RS LOCATION & GENERAL INFORMATION Location Address: 45 Tev aw Road Owner's Name: Marianne E. Burnside Hyannis, MA Owner's Address: P.O. Box 24746, Chattanooga, TN Assessor's Map/Parcel: 269/17 Certified Soil Evaluators Name: Michael Pimentel, EIT Certified Soil Evaluators Email: mpimentel@jcengineeringinc.corr New Construction or Repair: Repair Certified Soil Evaluators Telephone# (508) 273-0377 Land Use Single Family Dwelling Slopes(%) 1-2% Surface Stones None Distances from: Open Water Body >1 00 ft Possible Wet Area >100 ft Drinking Water Well N/A ft Drainage Way >10 ft Property Line >10 ft Other ft Parent material(geologic) Outwash >Depth to Bedrock 132n Depth to Groundwater: Standing Water in Hole: >1 32" Weeping from Pit Face >132" Estimated Seasonal High Groundwater >132" i DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used:' Direct Observation Depth Observed standing in obs.hole: >132" in. Depth to soil mottles: >132" in. Depth to weeping from side of obs.hole: >132" in. Groundwater Adjustment N/A ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level PERCOLATION TEST Date 10/17/19 Time 11:00 AM Observation 1 Hole# - Time at 9" Depth of Pere 24"-42" - Time at 6" Start Pre-soak Time @ 11:00 AM Time(9"-6") End Pre-soak 11:09 AM I Rate Min./Inch <2 min/In II Site Suitability Assessment: Site Passed X Site Failed: Additional Testing Needed(Y/N) N Deep Observation Hole Log Hole#: 1 & 2 Depth from Surface Soil Horizon Soil Texture Soil Color Soil Mottling Other (in) (USDA) (Munsell) (Structure,Stones,Boulders, Consistency,%Gravel 0 - 8" A Fill 8" - 24" g Loamy Sand 10Yr 5/8 24" - 132" C Medium Sand 2.5Y 6/6 10-20%Gravel Deep Observation Hole Log Hole#: Depth from Surface Soil Horizon Soil Texture Soil Color Soil Mottling Other (in) (USDA) (Munsell) (Structure,Stones,Boulders, Consistency,%Gravel Deep Observation.Hole Log Hole#: Depth from Surface Soil Horizon Soil Texture Soil Color Soil Mottling Other (in) (USDA) (Munsell) (Structure,Stones,Boulders, Consistency,%Gravel Deep Observation Hole,Log Hole #: Depth from Surface Soil Horizon Soil Texture Soil Color Soil Mottling Other (in) (USDA) (Munsell) (Structure,Stones,Boulders, Consistency,%Gravel Flood Insurance Rate Map: Above 500 year flood boundary No Yes X Within 500 year boundary No X Yes Within 100 year flood boundary No X Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Yes If not, what is the depth of naturally occurring pervious material? N/A Certification I certify that on 10-27-99 (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature Date 10-25-19 SKETCH: (Or you can attach a separate sheet) (Street name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands in proximity to holes) SEE ATTACHED PROPOSED SEPTIC SYSTEM UPGRADE PLAN DATED OCTOBER 25, 2019 TOWN OF BARNSTABLE 67 C LW!k ON SEWAGE # VILLAGE- cd ASSESSOR'S MAP & LOT_2_6? d l7 INSTALLER'S NAME&PHONE NO. �o a,1ie SEPTIC TANK CAPACITY LEACHING FACELrFY: (type) 4�� NO. OF BEDROOMS BUILDER OR OWNER ' II� PERMITDATE. COMPLIANCE DATE ' -7.JZ Separa�on Distance Between'the: MaximumYAdjusted 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 ezisf within 300 feet of leaching.facility) Feet Furnished by � � �� � �� ��., �. N � .� . yb ,�o r ., 9 ., c �' 0 s^ vti No. 1 Fee J THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for Migoml *p5tem Construction j3ermit Application for a Permit to Construct( )Repair(grade( ' )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel _ �'�� t ,•-���J� c � �gstalle 's Name,Address,and Tel.No. �,_ Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank sit �7r Lj_'t,Q D Type of S.A.S. At R=ca PCI Description of Soil Nature of Repairs or Alterations(Answer when applicable) 4( 1V �;r V,e-vo as O ir5i,, 13— 12 C [f y r 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 nvironmental gpde and not to place the system in operation until a Certifi- cate of Compliance has been i B Signed Date 13 Application Approved by Date 3 ro'lc�•�Y Application Disapproved for thMIlowinq reasons Permit No. Date Issued Fe e ee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: er: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIPplication for Diqo!5al *p.5tem Congtruction Permit Application for a Permit to Construct Repair(grade Abandon [I Complete System El Individual Components Location Address or Lot No. 1+5-T 5N,,y a, owner's Name,Address and Tel.No. Assessor's Map/Parcel a(drl -61? -- L tape s Name Address and Tel No. Designer's Name,Address and Tel.No. F r2 0 O-e V'( ; C-<0r\t0t/W6Re_ �V4,�e V- Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers Cafeteria( Other Fixtures Design Flow gallons per day. Calculated daily flow 7k C1 gallons. Plan Date Number of sheets Revision bate Title- Size of Septic Tank 1;1�i 15,� L ---Type of S.A.S. tA Description of Soil %Me_� 15)_4.y\0 V 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 nvironmental e and not to place the system in a Certifi- IF * V em n operation until cate of Compliance has been 'sstt ' B 11rn Signed- A\ --7 Date C Application Approved by gew— Date Application Disapproved for theYollowin reasons Permit No. 718- -Z& eF- Date Issued --—————————— - - ---————————————— THE COMMONWEALTH OF MASSACHUSETTS f .1) - I I C� ARNSTABLE, MASSACHUSETTS...,\,' ' 1� \ 1 71 Certificate 4(cbirnpliance THIS IS TO CERTIFY, that the O-n'-site Sewage Disposal System Constructed Repaired Upgraded(Y.") Abandoned( by IZ/')el j�,l C V 1�2,0-V�l Vf!S at V V1 04d , H4/-\ v\rN45 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer -Designer The issuance of this permit shall not be construed as a guarantee that the syst will function as designed. Date Inspector LJ ---------------------------------------- No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS miqoal *p5te5 An.5truction permit Permission is hereby granted to Construct )Repair( )Upgrade`( )Abandon( System located at Tr vrg"Ivi and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date: -Approvedby V 1019/97 NOTICE: This Form Is To Be Used For.the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) hereby certify that the application for disposal works construction permit signed by me dated 3—a � _,concerning the property located at � v y f V1 12d • H-y ar o v/)1 S meets all of the following criteria: V. There are no wetlands located within 100 feet of the proposed leaching facility There are no private wells within 150 feet of the proposed septic system There is no increase in flow and/or change in use proposed There are no variances requested or needed. /if the proposed leaching facility will be located within 250 feet of any wetlands,the bottom of the proposed leachingfacility will n2l be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation. Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.I.S.map) _._ B)Observed Groundwater Table Elevation(according to Health Division well map) Q DATE: SIGNED:-�:� LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system.Also If the licensed installer posesses a certlned plot plan, this plan should be submitted]. q:health folder:cert G Q ' w - T TOWN OF BARNSTABLE LOCATION L SEWAGE # VILL'►GE —� ASSESSOR'S MAP & LOT-A g • 7 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type)T;"2 (size) Stu. t�. ��.,�•.� NO,OF.BEDROOMS BUILDER OR OWNER PE.RMITDATE: ^ Q COMPLIANCE DATE: Separation Distance Between the: M4zhr unl 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 witlnn 300 feet of leaching facility) Feet Furnished by 470 --aF z v 771 )k 17ly / Il ,/ TOWN OF BARNSTABLE LOCATION 7"�VY,1,Y)6_ SEWAGE # VILLAGE 4e±k-L/v--S ASSESSOR'S MAP & LOT/?,of 0!7 INSTALLER'S NAME & PHONE NO. U"lyauPAI SEPTIC TANK CAPACITY //OCR 956^1 LEACHING FACILITY:(type)l0 D d �� (size) NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER u6u� BUILDER OR OWNER kctft-Zb J "VW45,I i /c v9�Y . DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIA�!PE GRANTED: Yes No uruishel 6y 16(lf0a Aer- 9r- 8j��891 ;-. `i M FINISH GRADE OVER D-BOX= 48.5'± PROVIDE H-20 CONCRETE RISER w/SECURE PROP. VENT WITH CHARCOAL FILTER TO ABOVE GRADE T.O.F. EL.= 50.1'± CAST IRON FRAME &COVER TO GRADE FINISH GRADE OVER CHAMBERS= 48.4 - 48.7 GENERAL NOTES PROVIDE EXTENSION RISER H-20 RISER WITH WATERTIGHT (TYP FOR ALL CHAMBERS w/PIPED INLETS) SLOPE @ 2% MIN. OVER SYSTEM 3/4"TO 1-1/2" DOUBLE WASHED 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION WITH COVER OVER INLET& FRAME AND COVER TO GRADE 4" SCHEDULE 40 PVC INSPECTION PORT WITH ACCESS STONE TO CROWN OF PIPE METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL OUTLET TO WITHIN 6"OF F.G. MIN SLOPE 1 /° BOX TO F.G. (SEE NOTE 21) 2 OF 1/8 TO 1/2 DOUBLE WASHED CODE AND ANY APPLICABLE LOCAL RULES. FINISH GRADE ° �� �� �� @ FND. EL.= 48.9�± F.G. OVER TANK EL. = 48.9'± 5" DIA. OUTLET(S) _- STONE OR GEOTEXTILE FILTER FABRIC 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE 20"MIN.ACCESS } COVER(TYP.OF 3) I ' _ , PLACE RISERS ON ALL I DESIGN ENGINEER. PROPOSED 4" 9" MIN. „ TOP OF SAS = 46.40 CHAMBERS WITH I 3. 4 SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL ,-EXISTING 4" 36" MAX. , 6"MIN. SEWER PIPE PVC SEWER PIPE 45.40 36 MAX. BREAKOUT EL- 45.90� INLET PIPES TO � SYSTEM UNLESS OTHERWISE NOTED. _Z r - FINISHED GRADE 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN t6' 3" 3" DROP MAX „ L=92'± ELEVATION =45.90' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A 2" DROP MIN 3 9 MIN.SLOPE@1% PROVIDE WATERTIGHT� 4" PVC IN FROM J,� JOINTS (TYP.) o o ��� o THE LINER S NOT 40 MIL LESS THAN THE BREAKOUT ELEVATION. ANE LINER IS PLACE AT LEAST FIVE ET FROM S.A.S. AND THE TOP OF 14" � SEPTIC TANK 4" PVC OUT TO 0 � 0 0 � � � � � � 0 � 0 O O o 4�' j ± © LEACHING FACILITY 4 occ:)Cep� 0 0 00 0 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. °° 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. CONTRACTOR TO PROVIDE CONTRACTOR SHALL CONTRACTOR SHALL 2 0 SPECIFIED DROP BETWEEN VERIFY SIZE AND 48" VERIFY CONDITION OF OUTLET TEE 45.70 MIN. 45.53 0 0 0 0 °° oD0 0 0 0 oD0 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK 00 FILLING INLET AND OUTLET CONDITION OF EXISTING TEES GAS BAFFLE 6" CRUSHED STONE o 0 0 o 0 0R INSPECTION. SYSTEM IS 0 0 0 0o NOT TO BE BACKFILLEDEN SYSTEM WIITHOUT FIRST OBTAINING APPROVEARLY COMPLETE AND READY AL FROM BOARD OF HEALTH EXISTING SEPTIC AND REPLACE AS j OVER MECHANICALLY o TANK NECESSARY COMPACTED BASE AND DESIGN ENGINEER. 4.0' 8 5' (TYP) I 4.0 4.011 4.0' 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM. BENCHMARK ELEVATION OF 50.00, 3 OUTLET DISTRIBUTION BOX 4.83' LL- TO BE INSTALLED ON A LEVEL STABLE 25.0' (TYP.) ESTABLISHED ON NAIL SET IN OAK TREE AS SHOWN ON PLAN. BASE. FIRST TWO FEET OF OUTLET GROUND WATER ELEV.= < 37.50' 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION EXISTING 1 ,000 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. 1,63.40 12.83' THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT 2 - 500 GALLON H-20 CHAMBERS 5' MIN. CHAMBER END VIEW 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES CROSS SECTION VIEW TYPICAL CHAMBER PROFILE TO THE DESIGN ENGINEER. *CONTRACTOR TO VERIFY EXISTING ELEVATION PRIOR SEPTIC TANK PROFILE H-20 DISTRIBUTION BOX DETAIL CHAMBER DETAILS 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONCRETE STRUCTURES SHALL BE MADE TO ANY WORK& NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE NOT TO SCALE NOT TO SCALE WATERTIGHT. 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING MAP 269 • ` • ` TEST PIT DATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM LOT 18 ,� � ' PERC NO. TPT-19-177 APPROPRIATE AUTHORITY. x » 3 , INSPECTOR: David W. Stanton, IRS 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS LOCATED 11.58'± - 7573.07 x • "'t I • �/" EVALUATOR: Michael Pimentel, EIT, CSE UNDER MORE THAN 3 FEET OF COVER OR LOCATED UNDER PAVEMENT, DRIVES, OR J `'� TRAVELED WAYS IN WHICH CASE THEY SHALL WITHSTAND H-20 LOADING. 7j x . • •,�� C.S.E. APPROVAL DATE: Oct. 27, 1999 • • ' I ' I t PROPOSED 4" PVC . ' . ' • DATE: October 17, 2019 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. EXISTING SAS COMPRISING TREELINE 15„ PROPOSED H-20 I VENT PIPE, EXACT • : • +• TEST PIT#: 1 FOUR INFILTRATORS w/ STONE 48x6' oo LOCATION PER OWNER . b • © 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE DISTRIBUTION BOX -, _ • • , (APPROXIMATE LOCATION) I . ELEV TOP= 48.50 MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. X t . • ' ! REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, ELEV WATER= < 37.50 FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). TP 2 (3) (4) i _ • ' • • PERC RATE _ <2 min./inch >< 11 • • • 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN 8 GARAGE 48x5 16.9' X • H • • " • SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. DEPTH OF PERC= 24"-42" i t PROPOSED TWO (2) • + • ZONE 2 j 16. PROPOSED PROJECT IS LOCATED WITHIN: 12" BIT. _ t 500-GALLON H-20 LEACHING °' ' • : TEXTURAL CLASS: 1 ASSESSOR'S MAP 269 PARCEL 17 PATCH ,� I CHAMBERS w/AGGREGATE a + I . 0 14 48x5' P i t � * + • ` � B - OWNER OF RECORD: MARIANNE E. BURNSIDE 48x5' r, x t ao ++ . p" 48.50' ADDRESS- P.O. BOX 24746 Benchmark / 8x5 a _ `� _, , „� ,. . • . LOCUS Q CHATTANOOGA, TN 37422 Fill Nail Set In Oak - 48x5' . • 811 47.83 FEMA FLOOD ZONE X Elevation=50.00' ,. \ • , eelt lk, Approx. M.S.L. r 48)H f,rr -PROPOSED X INSPECTION PORT � •• � • •• �� B Loamy Sand COMMUNITY PANEL# 25001C0564J STONE r' 17" :< ZONE 2 C 10Yr 5/8 17. DEED REFERENCE: BOOK 23446, PAGE 183 PATCH I U.P.#3H •� GUYv1iIKE < t • �+ 18. PLAN REFERENCE: PLAN BOOK 94, PAGE 9 ' �`w, • < I r + 24 46.50 • /j •.; • Perc 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. x�, a ' t I • �• + * D 042 45.00 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY I \ g GRAVEL I FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY CONC.' 48x7' DRIVEWAY 1-4 �` C •• ' • FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. PAD 10" • • : • « owe CONC. X ' . . • •• . • • • " 21. A 4" PERFORATED SCH. 40 PVC PIPE SHALL BE PLACED IN A VERTICAL POSITION TO A PAD _ I ^� / + ;+ ; + Medium Sand DEPTH OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3"OF FINISH GRADE. A MAP 269 49- x BIT. �� 15" - - - C 20%gravel REMOVABLE THREADED CAP SHALL BE PLACED ON THE TOP TO ALLOW FOR INSPECTIONS. LOT 11 I N X PATCH 10-20%gravel I w 22. CONTRACTOR SHALL BE RESPONSIBLE TO OBTAIN ANY AND ALL REQUIRED PERMITS AND �t 24 i 1z CONC. / m Ir \ LOCUS PLAN APPROVALS FOR THIS PROJECT. Ix PAD l�49 SCALE: 1"= 1000' t �, 132" 1 37.50' 777777 HC-2 HC-1 ' t No Mottling, Standingor Weeping Observed �{ x _ _ 9, 101 k TOF=50.1'± W DESIGN DATA TEST PIT DATA LEGEND I X DECK ::E M PERC NO. TPT-19-177 12 / 1 co ( Ip 50xO EXISTING SPOT GRADE I x I i,w t m NUMBER OF BEDROOMS (EXISTING) 2 INSPECTOR: David W. Stanton, RS J I t c > I NUMBER OF BEDROOMS (DESIGN) 3 (PER PERMIT#98-168) EVALUATOR: Michael Pimentel, EIT, CSE - - - 50 - - - EXISTING CONTOUR EXISTING 1,000 GALLON SEPTIC TANK I x I i I W C C.S.E. APPROVAL DATE: I < Oct. 27, 1999 �ri� PROPOSED CONTOUR TO BE UTILIZED IN THIS DESIGN � m r � DESIGN FLOW 110 GAUDAY/BEDROOM � f '� #45 �9, I G o', TOTAL DESIGN FLOW 330 GAUDAY DATE: October 17, 2019 LSA EXISTING LANDSCAPED AREA EXISTING t m D TEST PIT#: 2 EXISTING DISTRIBUTION BOX X I 2-BEDROOM I -n O 0 DESIGN FLOW x 200 % = 660 GAUDAY TO BE ABANDONED DWELLING I I o ELEV TOP= 46.50' ❑/H/W✓ EXISTING OVERHEAD UTILITIES (APPROXIMATE LOCATION) �- X D USE EXISTING 1,000 GALLON SEPTIC TANK x / / I I ELEV WATER= < 37.50' -W-W-- EXISTING WATER LINE lK Iz INSTALL 2 - 500 GAL. CHAMBERS W/ AGGREGATE PERC RATE = GAS EXISTING GAS LINE DEPTH OF PERC= SIDEWALL CAPACITY TEST PIT LOCATION CID I } (LENGTH + WIDTH) (2 SIDES) (2' HIGH) (0.74 GPD/S.F.) = GAUDAY TEXTURAL CLASS: 1 t 25" I ) I (25.0' + 12.83') (2 ) (2' ) (0.74 GPD/S.F.) =112.0 GAUDAY _- _ O O EXISTING 1,000 GALLON SEPTIC TANK x I / „ k x BOTTOM CAPACITY 0 48 50 1 PROPOSED 4" SOLID SCHEDULE 40 PVC PIPE (LENGTH x WIDTH) (0.74 GPD/S.F.) = GAUDAY Fill (25.0' x 12.83') (0.74 GPD/S.F.) = 237.4 GAUDAY 8' 47.83 Q PROPOSED H-20 DISTRIBUTION BOX 3 y / I t B Loamy Sand O PROPOSED 500 GALLON H-20 LEACHING CHAMBER x 36" x �P I I 10Yr 5/8 x X ' TOTALS: FENCE , / w MAP 269 I TOTAL NUMBER OF CHAMBERS 2 (TYP 24" 46.50' -X-X- ) ve LOT 17 / TOTAL LEACHING AREA 472.2 SQ.FT. REV. DATE BY APP'D. DESCRIPTION X- 10,629± S.F. / i TOTAL LEACHING CAPACITY 349.4 GAL./DAY PROPOSED SEPTIC SYSTEM UPGRADE X_X X X I PREPARED FOR: 995,� tIf i CAPEWIDE ENTERPRISES � I NOTES: Medium Sand 2.5Y 6/6 3 48 C LOCATED AT EDG Q I 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF 10-20% gravel �F r.RAVELED wA ' L3 / EACH SEPTIC SYSTEM COMPONENT. 45 TEVYAW ROAD _' 'Y HYD. i HYANNIS, MA 02601 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF THE �- B _ PROPOSED LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST PIT SCALE: 1 INCH = 10 FT. DATE: OCTOBER 25, 2019 - -- DATA SHOWN ON THIS PLAN. REPORT TO ENGINEER AND LOCAL BOARD OF 132" 37.50' __ OF 0 5 10 20 40 FEET SWING-TIES (30'WIDE ORD ROAD HEALTH IF SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. j" 'ems I ►'R/1/ATE WAY No Mottling, Standing or Weeping ObservedNEW DESCRIPTION HC-1 HC-2 �, JOHN L �' 3.) ENTIRE PROPERTY IS LOCATED WITHIN THE WELLHEAD PROTECTION �, PREPARED BY: CHURCHILL LD OVERLAY DISTRICT AND DEP ZONE II. RESERVED FOR BOARD OF HEALTH USE CIVIL '^ JC ENGINEERING, INC. CORNER OF STONE (1) 22.9' 42.6' I N0. 41807 2854 CRANBERRY HIGHWAY 4.) SWING TIES SHOWN ON THIS PLAN ARE PROVIDED ONLY AS A COURTESY CORNER OF STONE (2) 26.0' 32.5' FOR THE INSTALLER. INSTALLER SHALL VERIFY SWING TIE MEASUREMENTS EAST WAREHAM, MA 02538 CORNER OF STONE (3) 49.5' 53.2' SITE PLAN IN THE FIELD PRIOR TO INSTALLING THE SYSTEM. CONTRACTOR SHALL 508.273.0377 NOTIFY ENGINEER IF MEASUREMENTS APPEAR TO BE INCORRECT. �- CORNER OF STONE (4) 47.9' 59.9' SCALE: 1"= 10' Drawn By: AT6 Designed By:MCP Checked By:JLC JOB No.4855