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0054 TEVYAW ROAD - Health
54 Tevyaw Road P __ -- Hyannis P 10 019 i i i _ ,,^^'T.O/WN/OF BARNSTABLE LOCATION �n yv I� SEWAGE# ) C9 VILLAGE ASSESSOR'S MAP&LOT 'j69' -019 INSTALLER'S NAME&PHONE NO. CAe� Cat SEPTIC TANK CAPACITY EX u'I P5 10tcW LEACHING FACILITY:(type) df�'" �l( Y -'9c-�)S (size) a n-1 'X 1 ®i NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: '7Ia7D)W COMPLIANCE DATE: Separation Distance Between the: /f Maximum Adjusted Groundwater Table and Bottom of Leaching Facility '��/ Cg'13z !Feet Private Water Supply well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet f; .Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by' � n 34 t TOWN OF BARNSTABLE LOCATION 7 7g V 44 G✓ if 3 SEWAGE# VILLAGE f"1 ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) ®/T (size) /Oeo aC,QL NO.OFBEDROOMS BL�"!DER OR PERMUDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 3— y- �1"J A a 0 a u o .� �+ � � o `.., -� II No. )-C? Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS implication for Misposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair(PKUpgrade( ) Abandon( ) 1.5complete System gedividual Components Location Address or Lot No.,;V 7—evy-cc--, Owner's Name,Address,and Tel.No..$--s'— 2 7 V— 05'r`r/ t-�si¢mrsr.9 ,j�a�te SIzQ//>�ar..vzd Assessor's Map/Parcel 26 Installer's Name,Address,and Tel.No.Loa'— Designer's Name,Address,and Tel.No. 2 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(min.required) 2 O gpd Design flow provided j 32 gpd Plan Date ti5�/z/ZO Number of sheets Z— Revision Date Title Size of Septic Tank /p06F Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) e—<rr /ono l Try L Z Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Application Approved by ONADate Application Disapproved by Date for the following reasons Permit No. �'' a Date Issued as dL' Y: �`-.-,-v���:,..Y- 3^z:. .r :t;.,,r'�,• a0. -+";;.:nw.*•. =!.,t'�,.�^4 ,.fir;�.;,�+°'^i.=�.-v-��r! .. -" - !i. c� No.. ,�yyy— d )` Fee F: THE COMMONWEA TH.OF MASSACHUSETTS Entered in computer: t� Yes PUBLIC HEALTH DIVISION- TOWN OF BARNSTABLE, MASSACHUSETTS application for Disposal *pstetu Construction Permit Application for a Permit to Construct( ) Repair(lf Upgrade( ) Abandon( ) Complete System L Individual Components Location Address or Lot No.j a/�"evy�cri Owner's Name,Address,and Tel.No.s--�- >'!- YG Assessor's Map/Parcel e j•p, Installer's Name,Address,and Tel.No.Sdd'- �'z'�"Z�'T�� Designer's Name,Address,and Tel.No. s o�4d»'6-3�� �m.r/ .���//Siiy �•G No["r� Se+.v/i�. .S"w rw*L �r7fi/d7 rrP�"d�i.p (.�I PGf •""3So �+et .�'r 5T. w Ys>,a�rs G �x ls.r'sf' Crerss�" cam 'urz-_S'+�c/Gd/.G Type of Building: Dwelling No.of Bedrooms , Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Othei Fixtures Design Flow(min.required) 2 O gpd Design flow provided `. %f A ' ' gpd Plan Date C5�/ x O Number of sheets G'-- Revision Date Title Size of Septic Tank /008 Typeyof S.A.St Description of Soil �,y�,/ �, _.tom�/ 30 YY + f Nature of Repairs or Alterations(Answer when applicable) �s V r•X/'s/-'i �n nr3 / TG 29 �X �^ Date last inspected: '` • Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in - . accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until.a Certificate of Compliance has been issued by this Board-of Health. Signed Date Application Approved by Date 7��d Application Disapproved by V Date for the following reasons ;;- "Permit No. Z°'' Date Issued 7 p 7 b, - THE COMMONWEALTH OF MASSACHUSETTS ' BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the Orr-site Sewage Disposal system Constructed( ) Repaired(4-1-1 Upgraded { Abandoned( )by 1401/ at has been constructed in accordance / with the provisions of Title 5.and the for Disposal System Construction Permit No.*30;0 dated /2 J/ ,Z•+ Installer Designer #bedrooms ; -- Approved design flow �,2�3 J gpd The issuance of this perm' shall not a construed as a guarantee that the system will f m to n efl slgned. Date �t Inspector No. dU '� E+ - - _Fee • __�_ THE COMMONWEALTH OF MASSACHUSETTS r PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Disposal *_ pste!A Construction Permit Permission is hereby granted to Construct( .) Repair( ) Upgrade( ) Abandon( ) System located at t�f i' 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 njust bo completed within three years of the date of this permit. Date -7 Approved by vlN J Town of Barnstable ©FtHE r Regulatory Services ;Richard V.,Scali, Interim Director BARNSTABLE. �o0 4 Public Health Division. °T\nM,>r° Thomas McKean,Director 200 Maid Street,Hyannis,MA 02601• Dfiicc: 501',-862-4644 Fax: 508.740-63(14- Installer & Designer Certification Farm Date: 7 } Z. S ZO Sewage Permit# 20,9d _2^'P Assessor's'Map\Pareel C-4-C c- M c C X+CZA ' _ �-e Ca A _5e Designr: er— Lj 11r Installer� :address: j Z. Wf Crts�.s--,L Address: 0 a Dn _ ����� C°`e Skfwas issued a permit to install a (date) (installer) � , C Septic systern at 59 Ts,v`�G t� r-� t���q based on it design drawn.by (address) n L;_Cr"rr ted ? / (designer) I certify that the septic system referenced above was installed substantially according to the deslgii, 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. t i l certify that the septic systetll referenced above was installed with t7fajor changes (i.e. . greater than L O' lateral relocation of the SAS or any vertical relocation of any component } of the septic system) but in accordance with State &Local,Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required) was inspected and the soils evere found satisfactory. I certify that the system referenced above ,eras constructed in with the tot-trts of the [',,A approval letters (if applicable) tH + 5My rNkL (histaller's Signature) 35109 Nb• 0 t (Designer's Signature) (Affix Designe ere) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIIICATF OF COMPLIANCE WILL NOT BE' ISSUED UNTIL I30'.TIT THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC 11:1;ALTI� DIti'IS1ON. THANK VOU'. (�:;Scpu ,jcai�ner Certification Foriti Rev 8-14-13.doe Engineers note:This certification is limited for an as-built inspection of system components as installed prior to backfiil.The engineer did not supervise construction of the system.The installer assumes responsibility for all materials,workmanship,bsckfilling t to specified grades vAth proper compaction and,etting risers.'co`ers as.shown on the design plan. Q_ _ J -)ARCEL 1 _. Comm, of Massachusetts Executive Office of Environmental Affairs Department of Environmental Protection ONE WINTER STREET,BOSTON MA 02108(617)292-5500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 5� PART A � C?'I�J° l.� CERTIFICATION Property Address: 54 Tevyaw Rd Name of Owner: Eric Cruz C 1 20 04 Hyannis,MA 02601 Address of Owner: SAME S E P Date of Inspection:05/17/04 BLE Name of Inspector:Michael J.DiMand TOVVH 0 OF DEPTH I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: MJD Inspections Mailing Address: 15 Hane Road,Mashpee MA Telephone Number: (508)685-9259 CERTIFICATION STATEAENT I 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 inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.The system: X Passes Conditionally Passes Needs Further Ev luation by the Local Authority Fails Inspectors Signat Date: The system Inspector shall submit a cop this ins n report to the Approving Authority(Board of Health or DEP)within thirty (30)days of completing this inspection.If the system is a shared system or has a design floe of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. F NOTES AND COMMENTS: 9/2/98 REVISION Page 1 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 54 Tevyaw Rd.,Hyannis MA 02601 Owner: Eric Cruz Date of Inspection: 05/17/04 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: X I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. COMMENTS: B. SYSTEM CONDITIONALLY PASSES: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion ofthe replacement or repair,as approved by the Board of Health,will pass. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances.If"not determined",explain why not. The septictank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years priorto the date of the inspection;or The septictank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank Failure is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as Approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) Or due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s).The system will pass Inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed Page 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 54 Tevyaw Rd.,Hyannis MA 02601 Owner: Eric Cruz Date of Inspection: 05/17/04 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 ifthe system is failingto protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310CMR 15.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering wetland or salt marsh. 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 PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and SAS and the SAS is within 100 feet of a surface water supply ortributary to a surface water supply. The system has a septic tank and SAS and the SAS is within Zone 1 of a public water supply well. 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,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm.Method used to determine distance (approximation not valid). 3) OTHER Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 54 Tevyaw Rd.,Hyannis MA 02601 Owner: Eric Cruz Date of Inspection: 05/17/04 D) SYSTEM FAILS You must indicate either"Yes"or"No"to each of the following: I Hve determinedthat one or more ofthe following failure conditions exist as describbed in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No X Backup of sewage into facility or system component due to an overloaded or cloOgged SAS or cesspool. _X Discharge or ponding of effluent to the surface ofthe 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 is less than 1/2 day floew. X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number oftimes pumped X Any portion ofthe SAS,cesspool or privy is below the high groundwater elevation. X Any portion of a 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 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.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: 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: The system serves a facility with a design floe of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the folloeing conditions exist.P 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 R of a public water supply well. The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2).Please consult the local regional office of the Department for further information. Page 4 of 11 t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 54 Tevyaw Rd.,Hyannis MA 02601 Owner: Eric Cruz Date of Inspection: 05/17/04 Check if the following have been done:You must indicate either"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 _ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates duringthat period.Large volumes of water have not been introduced into the system recently or as part of this inspection. X _ As built plans have been obtained and examined.Note if they are not available with N/A. X _ The facility or dwelling was inspected for signs of sewage back-up. X _ The system does not receive non-sanitary or industrial waste flow. X _ The site was inspected for signs of breakout. X _ All system components,exciudingthe SAS,have been located on the site. X _ The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for conditions of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum. The size and location of the SAS on the site has been determined based on: X _ Existing information.For example, Plan at B.OH. X _ Determined in the field(if any of the failure criteria related to Pail C is at issue,approximation of distance is X _ The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property d p rty Address: 54 Tevyaw Rd.,Hyannis MA 02601 Owner: Eric Cruz Date of Inspection: 05/17/04 FLOW CONDITIONS RESIDENTIAL: Design flow: 110 gp.d./bedroom Number of bedrooms(design):3_4 Number of bedrooms(actual):2 Total DESIGN flow 440 g.n.d. Number of current residents: 2 Garbage grinder(yes or no): no Laundry(separate system) (yes or no)-.no; If yes,separate inspection required Laundry system inspected(yes or no):_ Seasonal use(yes or no):no Last date of occupancy: 04 COMMERCIAIANDUSTRIAL: Type of establishment: Design flow: gn.d.(Based on 15.203) Basis of design flow Grease trap present:(yes or no) Non-sanitary waste discharged to the Title 5 system:(yes or no)_ Water meter readings,if available: Last date of occupancy: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped quarterly since 97,accordingto owner. System pumped as part of inspection:(yes or no) no If yes,volume pumped: gallons Reason for pumping: TYPE OF SYSTEM X Scptictank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) I/A Technology etc.Attach copy of up to date operation and maintenance contrail Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components,date installed(if known)and source of information: House built in the 1930's.Current system upgraded with leaching nit in 1996,accordingto Bamstablr BOH records.Age of holding tank unknown. Sewage odors detected when arriving at the site:(yes or no) no Page 6 of 11 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 54 Tevyaw Rd.,Hyannis MA 02601 Owner: Eric Cruz Date of Inspection: 05/17/04 BUILDING SEWER: (Locate on site plan) Depth below grade:_ Material of construction:_cast iron_40 PVC_other(explain) Distance from water supply well or suction line Diameter Comments:(condition of joints,venting,evidence of leakage,etc.) SEPTIC TANK: x (2 on site,ref.Unit 1 and Unit 2) (locate on site plan) Depth below grade: 12" Material of construction: x concrete—metal_Fiberglass_Polyethylene_other(explain) If tank is metal,list age_Is age confirmed by Certificate of Compliance_(Yes/No) Dimensions: T wide x I I'long x 6'deep Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle: 36" Scrum thickness: 0" Distance from top of scrum to bottom of outlet tee or baffle: n/a How dimensions were determined: Open inspection of interior Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage,etc.)_Upon open inspection of the interior,liquid level is at bottom of outlet invert and no solids are present.No recommendations. GREASE TRAP: (locate on site plan) Depth below grade:_ Material of construction:_concrete,metal_Fiberglass A Polyethylene_other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle:_ Distance from bottom of scum to bottom of outlet tee or baffle:_ Date of last pumping:_ Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage,etc.) Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 54 Tevyaw Rd.,Hyannis MA 02601 Owner: Eric Cruz Date of Inspection: 05/17/04 TIGHT OR HOLDING TANK: (Tank must be pumped prior to,or at time of,inspection.) (locate on site plan) Depth below grade: Material of construction:_concrete_metal_Fiberglass_Polyethylene_other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm present Alarm level: Alarm in working order:Yes_No_ Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX: X (locate on site plan) Depth of liquid level above outlet invert: 0 Comments: (not if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) D-box level and sound.No evidence of solids carryover or leakage into or out of box is present. PUMP CHAMBER:_ (locate on site plan) Pumps in working order:(Yes or No) Alarms in working order:(Yes or No) Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) Page 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 54 Tevyaw Rd.,Hyannis MA 02601 Owner: Eric Cruz Date of Inspection: 05/17/04 SOIL ABSORPTION SYSTEM(SAS): x (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: Type: leaching pits,number: 1 leaching chambers,number:— leaching galleries,number: leachingtrenc hes,number,dimensions: overflow cesspool,numnber:_ Alternative system: Name ofTechnology: Comments: (note condition of soil,sighs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) All conditions good,no recommendations. CESSPOOLS:(locate on site plan_) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: Inflow(cesspool must be pumped as part of inspection) Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) PRIVY:_ (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 54 Tevyaw Rd.,Hyannis MA 02601 Owner: Eric Cruz Date of Inspection: 05/17/04 SKETCH OF SEWAGE DISPOSAL SYSTEM: Includetiesto at least two permanent reference landmarks or benchmarks Locate all wells within 100'(Locate where public water supply comes into house) AC=27 BC=13' AD=41' BD=22' AE=57' BE=34' D C O O A Rear of house,54 Tevyaw. B Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 54 Tevyaw Rd.,Hyannis MA 02601 Owner: Eric Cruz Date of Inspection: 05/17/04 NRCS Report name Soil Type Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check cellar Shallow wells Estimated Depth to Groundwater 35 Fed Please indicate all methods used to determine High Groundwater Elevation: _Obtained from Design Plans on record x Observed Site(Abutting property,observation hole,basement sump etc.) x Determined from local conditions x Checked with local Board of Health t _Checked FEMA Maps _Checked pumping records x Checked local excavators,installers Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) Well on-site. Page 11 of 11 i , j; Barnstable Assessing Search Results Page 1 of 2 yy� z } CM,. . .. .-., a ram' g ss»> g s �ffi� s,v� yi..;, p/ y ., ,mod•' y z Home: Departments:Assessors Division: Property Assessment Search Results Owner: CRUZ, ERIC Property Bketch Legend Map/Parcel/Parcel Extension 269 /019/ Mailing Address CRUZ, ERIC ' 54 TEVYAW RD3; HYANNIS, MA. 02601 3 F"f 2005 Assessed Values: AS " Appraised Value Assessed Value Building Value: $76,900 $76,900 Extra Features: $0 $0 Outbuildings: $0 $0 Land Value: $95,600 $95,600 Interactive Property Map Ma re uires Plug in: I XC�S.V, Totals:$ 172,500 $ 172,500 1 have visited the maps before Show Me The Map =� � a April 2001 photos available Sales History: Owner: Sale Date Book/Page: Sale Price: SELFE, LISA A 5/15/1996 10222/ 136 $78,000 KOC, MARGARET B& 7/15/1992 8100/ 189 $ 1 KOC, MARGARET B& 10/15/1987 6001/005 $ 104,000 AVERY,CLAIRE 3023/ 119 $0 CRUZ, ERIC 12/23/1998 11939/295 $92,000 Tax Information: Tax information is currently not available for this parcel Land and Building Information Land Building Lot Size(Acres) 0.22 Year Built 1930 http://www.town.barnstable.ma.us/tob02/Depts/AdministrativeS ervices/Finance/Assessing/... 11/8/2004 Barnstable Assessing Search Results Page 2 of 2 Appraised Value $95,600 Living Area 907 Assessed Value $95,600 Replacement Cost$ 102,541 Depreciation 25 Building Value 76,900 Construction Details Style Cape Cod Interior Floors CarpetHardwood Model Residential Interior Walls Plastered Grade Average Minus Heat Fuel Oil Stories 1 Story F A Heat Type Hot Air Exterior Walls Wood Shingle AC Type None Roof Structure Gable/Hip Bedrooms 3 Bedrooms Roof Cover Asph/F GIs/Cmp Bathrooms 1 Bathroom Total Rooms 7 Rooms Extra Building Features Code Description Units/SQ ft Appraised Value Assessed Value Property Sketch Legend BAS First Floor, Living Area FST Utility Area (Finished Interior) UAT Attic Area(Unfinished) BMT Basement Area (Unfinished) FTS Third Story Living Area(Finished) UHS Half Story(Unfinished) CAN Canopy FUS Second Story Living Area (Finished) UST Utility Area (Unfinished) FAT Attic Area (Finished) GAR Garage UTQ Three Quarters Story(Unfinished) FCP Carport GRN Greenhouse UUA Unfinished Utility Attic FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story(Unfinished) FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck FOP Open or Screened in Porch TQS Three Quarters Story(Finished) http://www.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/... 11/8/2004 Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of IVa. Olt Environmental Protection William F.Weld Gaernor �Q j to SetrN Trudy EOFA CoxeI �1 � a M. David B. Struhs °� •�,996, Commissioner �Y�QeCot SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM e MAP#a6L7 PART A PAR# CERTIFICATION '9 Property Address: Z-J-1 70vy,9,,) AoR9 4y •n Hrnis Address of Owner: Date of Inspection: 3--A/-94 / (If different) Name of Inspector:34h,," 1j, Se•A e-3 Company Name, Address and Telephone Number: A & B Canco 350 Main Street West Yarmouth, MA 02673 (508) 775-2800' s: CERTIFICATION STATEMENT I 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: x. `Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: Q Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection:. if the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Depanmen! of Environmental Protection. The original should be sent to the system ov;ner and copwe x:,; lu uu bu)e:, if app;icablr ant the aprro',ing au;hori•y. INSPECTION SUMMARY: Check A, B, C, or D. A) SYSTEM PASSES: . ✓ I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. 61 SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, asses inspection.p pect on. ' r Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not) The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 8/15/9.5) 1 One Winter Street • Boston, Massachusetts 02108 • FAX(617)556-1049 • Telephone (617)292-5500 . A _ " Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 72—,v o v /ed, �19nn,-s Owner: Syble CA y Date of Inspection: Bj SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing•to'protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ The wstem has a septic tank an(J suii absutptiun byMem and is within 103 fCci to a surface water suppl') or tributary to a surface water supply. _ The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. _ The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free frpm pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm• DJ SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an 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 of cesspool. (revised 8/15/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: SY 7—wyei,,3 /?-0. 419110/s Owner: S'ydle Date of Inspection: 3,y_ D] SYSTEM FAILS (continued): Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for .:•, coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E]LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The design flow of system is 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: _ 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 8/15/95) 3 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: ,Sy %eUc",j /bf, �On,17;-S Owner: Syble C"t)ry Date of Inspection: 3_,y_961 / i Check if the following have been done: Pumping information was requested of th owner occupant, and Board of Health. ✓ None of the"system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. �As built plans have been obtained and examined. Note if they are not available with N/A. ✓ The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow /The site was inspected for signs of breakout. ✓All system components, pIcluding the Soil Absorption System, have been located on the site. LThe septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. The facility o++nc�: idnd uccupar-;o, if d;fierer,; Irk)-'. .+•ere pro+•ided ++ith information on the proper maintenance of Sub- Surface Disposal System. (revised 8/15/95) 4 1 i a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: L5W 7Zv flcJ . A�finrt is Owner: LS h/e ��Y Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow:oW6 allons Number of bedrooms:c2 Number of current residents: Garbage grinder(yes or no):_A(g r Laundry connected to system (yes or no): NJQ Seasonal use (yes or no): AW Water meter readings, if available: god GuAJL `eef pee Q0fy2Ter2 Last date of occupancy: COMMERCIAUINDUSTRIAL• Type of establishment: Design flow: — allons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of inspection: (yes or no)PO If yes, volume pumnee gallons Reason for pumping. TYPE OF SYSTEM Septic,tank/distribution box/soil absorption system Single cesspool Overflow cesspool. Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Other(explain) APPROXIMATE AGE of all components, date installed (if known) and source of information: /9,?3 Orin 4- 83—/0/(0 Sewage odors detected when arriving at the site: (yes or no) AJ(� (revised 8/15/95) 5 a J• SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Jewcj fyrJ A 0 1-5 Owner: coy b le G,-/,Y Date of Inspection: SEPTIC TANK:✓ (locate on site plan) Depth below grade:/a" Material of construction: _concrete _metal _FRP —other(explain) Dimensions: Ao00 6n//ct1 P/BCRsi Sludge depth: /off " Distance from top of sludge to bottom of outlet tee or baffle: Q" Scum thickness: 0" Distance from top of scum to top of outlet tee or baffler Distance from bottom of scum to bottom of outlet tee or baffle: / . Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) '%A if k 47- 'A6-rK _ iwG Leff L inI/ef fee - aRFFLe our/e-f" GREASE TRAP:_ (locate on site plan) Depth below, grade: Material of construction: _concrete _metal _FRP —other(explain) Dimensions: Scum thickness: Distance from top of scum to too of outlet tee or baffle: E)istan.ce from bottom n' < orr - hnttnm Of outlet tee or baffle- Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, et(.) i j (revised 8/15/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 72vq tj AW Owner: dylbie. C9ry Date of Inspection: S_ TIGHT OR HOLDING TANK:_ (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP —other(explain) i Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if I gel and disiribu;ic- e�:. ', e%idence e<<nhd> ca: \r) er, evidence of leakage into or out of box, etc.) i 1;,-r ,c c/ Aal /euel. PUMP CHAMBER: (locate on site plan) Pumps in working order.(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 8/15/95) 7 i e SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: SY TP��iy.dal � �/tnn�-S Owner: sy bl e ae11 Date of Inspection: 3 _ J4_ q(P SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: t Type: leaching pits, number: leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) !dod 6,4//a&r oe�cA5 /ir C&Vett GCS /r Ofe/er✓ GQAQC TliPrP /_S 3' tj g /.) ��r CESSPOOLS: _ (locate on site plan) Number and configuration: . Depth-top of liquid to`inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, sign: of hydraulic failure, level of.ponding, condition of vegetation, etc.) PRIVY:_ (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 8/15/95) 8 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION (FORM PART C SYSTEM INFORMATION (continued) Property Address: -7-e—V I k) 4 f nn 41 Owner: day b/e G' rc Y Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' O o I ROAD DEPTH TO GPO,UNDWATER O � Depth t roundwater:Z/a'L_feet method of determination or approximation: �71,4oZ £ dyc+ L5 ov P .fliv s v (revisedr8/15/95) 9 i W �j W W W � H G WI Ilk VIP W ' W t 3c V a ; = a a me at ca 7 W � ` � da W W 1 �i 13� � �� � -� �� ` � � �; ® -, - � .� �� . P � P � � , ����� 1 �, �1 �, ��` \� . , ,�Y � i ,. '- -- - - // r / f THE COMMONWEALTH OF MASSACHUSETTS j _ BOARD F HEAL jH _T ......OF......� .. l�l. . Appliration for Dispuiittl Works Tantitrurtiun Urrutit Application is hereby made for a Permit to Construct ( ) or Repair ( A4 an Individual Sewage Disposal System at .......6.Y...TCV_Y U) ................• ....... ............--------------- -----------------••----...........-----.. Location-Address or Lot No.:... u ........................................ ........: . I .. ........................................ °_n. ..••--. ........................................•- a Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers { ) — Cafeteria ( ) a Other fixtures ------------------------------ - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid capacity............gallons Length................ Width................. Diameter................ Depth................ Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ---•----•-• -------- --y-- -j ,�.._)...�.....j .----............................................................ ODescription of Soil.....---••••---........'—t. �!•�]1.---t---- -rx.!�L..�1-•-------------- --•----•---•-•----------------------------------------•--•--------. U ---------------------------------------------------------------------------------------------•-----........------------------------------------..------------------------................•----••-------• x ----••••...........................••---••-••-••••---------------•••--••••••----••••------------••••---••-----••••. • . . .......................... ••... Nature of Repairs or Alterations—A wer when a livable......__J_.1.ii -------- -- - ---- 1- 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 undersigned further agre s not to place the system in operation until a Certificate of Compliance has be issued�bb the oar f health. ) ,y i ned 1�'1.. .------_ 3 G e ApplicationApproved y_. .. ..,.lr...---•---------•-•....:...............•--•••••............................. l/._.. . ......--- Date Application Disapprove f r the following reasons-------------•--•-•--------------•-•---------•----------•------•----- .......................................... ......................................................................................................................................................................................................... Date PermitNo......................................................... Issued......................................................... Date I-- - -- - --- -- ------ - -- - -- -- - - - --- - THE COMMONWEALTH OF MASSACHUSETTS BOARD ,QF HEALTH Allpliration for Diipo,ittl Vorkg Tonstrartion rumit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at• ..-. . .........................................................•- r t y^ Location Address ` p �^or Lot No. ......t 't.+ 1 ' '... /' .^?l.✓� .._..._ .. ........ .. ......... �='°-�tysY ..................•--••--•-•--......................-- s 10yy� !r d ess ..� Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. 'of persons............................ Showers ( ) — Cafeteria ( ) P., Other fixtures ................••-•....._........---••••. WDesign Flow..........................................:---gallons per person per day. Total daily flow...........................................:gallons. WSeptic Tank—Liquid*capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date----------- aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 4, Test Pit No. 2................minutes per cinch Depth of Test Pit.................... Depth to ground water........................ ............ ��!. .. f�:,..�D.., .. x. ..-------••-•-----------------------•---•---•----------------•-•-------------•---.--•-- O Descrip tion of Soil----•---•-•-•---•-.._.._ ...- ,rJ . .. ------•---------------------•----- x U •--••-•-•••--•----•-------•...---------•---••------••-•-•------•------------------•----•--------•••---•-••--••...-•---•......--•-•---•-•••-•-••-•-......------•-----•---•-•-•--•-------•--•-------•-•-• ------------ U Nature of Repairs or Alterations—An wer when applicable._..i..._ -------------•----------.---•------...----- ------------.---.... .................................................................... 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 undersigned further agrees not to place the system in operation until a Certificate of Compliance has bew issued by theboarf health. � rr���`�r..tea✓ % � ) � �~ �'+/3y Igned. _���`.ce�. er................ ... .. f _ ...... C __.._ ® e Application Approved --- -- ��' 1 ........ Date Application Disapprove f the following reasons:-------••------•--.....-••-••---------------•---------•-- ... .....................................................------.........--•-•-----...-•-•-------........................ .................................................................................. Date PermitNo........................................................ Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTHf f ............. ........OF....... . .�� p ds .�% ............................ Trrtifiratr of Tuntplianrr TINS IyS,Tp CERTIFY,,Thatthe Inylfiv>dual Scuage Disposal System constructed ( ) or Repaired . y.. 4 ....................... at- z!_t.;d.t,!L�!..._ -..1 . '�.� �1 --------- * ' has been installed in accordance with tie provisions of TITLE, 5 of T State Sanitary Code de ib in the application for Disposal Works Construction Permit No.. 3' 1b� ._..___._ dated_.��_ ._ 7... PP I r�--.. ----- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE AS A GUARANTEE THAT THE SYSTEM DWI NCTION SATISFACTORY. DATE....�.1 .d . --------------------------••-.------------•------•-•--- Inspector THE COMMONWEALTH OF MASSACHUSETTS BOARS F HEALT �_J *,,&��................................ NO.. ..................... EE-.. .:. .. ..... t o ff xk ionfWw Ant Permission is hereby, granted... r , to Con str t ( or I� air ( "'�AI dividu 1 ev7 P System at No.. - = / -• , 7 - � /-S..eet tr as shown on the ap ica on.for Disposal Works Construction. Permit - .......... Dated...............:.......................... f Board of Health DATE-• ', . --•---•-••--•---•...............•--.............•--••...... / FORM 1255 A. M. SULKIN, INC., BOSTON LEGEND N -- 67 - - 1 EXISTING CONTOUR 01) a x 100.98 ' EXISTING SPOT GRADE a t PB 193 9- P OVERHEAD WIRES 5 c BENCHMARK G EXISTING GAS SERVICE o EXISTING SEPTIC TANK COR./BOTT. STEP TOP OF TANK, EL.=98.82 EXISTING WATER SERVICE N INV.(OUT)=97.49t(t/ER/FY) EL.=1OO.90 TEST PIT West � a Main st LOCUS BENCHMARK o � EXISTING S,A,S, o moo` °9hr wy 100.49 TO BE PUMPED, FILLED WITH SAND AND ABANDONED LOCUS MAP NOT TO SCALE N 04°48'20" W x 99.97' 100.20 x 99.86 GENERAL NOTES: 100.28 0.08 TP 1 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL 100.47 x BOARD OF HEALTH AND THE DESIGN ENGINEER. to + 9 9.71 P 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS 100,31 TP2 OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE I� O �\I LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: -310 CMR 15.405(b)- LOCAL UPGRADE APPROVAL FIREPIT .17 BM __,h5 1) A 3' variance, S.A.S. to crawl space, for a 17' setback. 100.90 ,1 X 9.g,�� 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR 100,36 7'''-�• 1 TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE 1;0100.28 + BH DECK GA N: :1 DESIGN ENGINEER. O _ 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING O 100.37 0 x :� 1.:'. 1 FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN C1 L D� 1EX/ST/NG 1 �� ENGINEER BEFORE CONSTRUCTION CONTINUES. Ci `W HOUSE(#54) _< ".;1 5. ALL ELEVATIONS BASED ON AN ASSIGNED DATUM. T.O.F.=101.7f 100.07 1 0 ;1 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF o 1 THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF �o 100,09 HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. m 99.87 100.21 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. x �' + 99.94 �10-►{F10 8. THERE ARE NO WELLS WITHIN 100' OF THE PROPOSED S.A.S. 3 100,20 I OF 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS ��`d MASs9 AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE DIRECTED BY THE APPROVING AUTHORITIES. 100.26 99.93 ':',:.�j,'..;.'. o PETER T. �, 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO .VERIFY O 100,15 100.02� :., .• 99.95 McENTEE THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING x CIVIL "' CONSTRUCTION. \1 No. 35109 1 1. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS x El�� Q IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND 100.06 FG/ST REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE 100.2 G� ',.`,:' I �� INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. ® 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND 63\ 74.24 O' NOT CONSIDERED TO BE A PROPERTY LINE SURVEY. 25.77' 100,18 14. THE ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED SEPTIC S 01°37 50 E PK SET 99.96" edge of Pavement 100.01 SYSTEM COMPONENTS NOT SHOWN ON THE PLAN 100,00 PARCEL ID: 269-019 TEV VA k R6AD PROPOSED SEPTIC SYSTEM UPGRADE PLAN 54 TEVYAW ROAD, HYAN N I S, MA �,. Prepared for: Cape Cod Septic Services, 350 Main St., W. Yarmouth, MA 02673 U,P, �' OWNER OF RECORD Engineering by: SCALE DRAWN JOB. N0. I SHELHAMER, LAINIE Engineering Works, Inc. 1"=20' P.T.M. 168-20 P, 54 TEVYAW ROAD HYANNIS, MA 02601 12 West Crossfield Rood, Forestdole, MA 02644 DATE CHECKED SHEET N0. (508) 477-5313 5/12/20 P.T.M. 1 of 2 4� NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH jGRADE SHALL NOT BE < EL. 97.0 +T_ FOR A I DISTANCE OF 15' AROUND THE PROPOSED SEPTIC TANK PROPOSED D-BOX PERIMETER OF THE S.A.S. PROVIDE RISER & COVER OVER INLET & OUTLET INSTALL RISER & COVER PROPOSED S.A.S. MANHOLES AND SET WITHIN 6" OF FINISH GRADE SET TO 6" OF GRADE INSTALL RISER & COVER OVER ONE CHAMBER AND T.O.F=101.7t SET TO 3" OF F.G. TO SERVE AS INSPECTION PORT F.G. EL.=100.3t F.G. EL.=100.2t F.G. EL.=100.0E F.G. EL.=100.0t MAINTAIN 2% SLOPE OVER S.A.S. L = 38' L = 16'(MAX.) a DECK �6•$ 11 �7 ' ® S=1% (MIN.) p S=1% (MIN.) BH ,/ _ /x 1 4"SCH40 PVC 4'SCH40 PVC 2" LAYER OF 1/8" TO 1/2" 0� p 1 6" ^ DOUBLE WASHED STONE 10"1 as $ as (OR APPROVED FILTER FABRIC) �� ��� � 1 14" s" 2' EFF. aaaaaaa /EXISTING m 1 c(0 EXISTING 48" LIQUID DEPTH aaaaaaa —3/4" TO 1-1/2" DOUBLE HOUSE(#54) �3��1 1 LEVEL ADD GAS PROPOSED 2.6' 4.8' 2,g' WASHED STONE T.O.F.=101.7t v7 1 BAFFLE INV.=96.87 D BOX INV.=96.70 p, 1 INV.=97.49t EFFECTIVE WIDTH = 10' (VERIFY) 3 OUTLETS INV.=96.50 �1 �8• 1 EXISTING SEPTIC TANK H-10 2-500 GALLON LEACHING CHAMBERS WITH STONE g 5 AROUND AND BETWEEN CHAMBERS AS SHOWN INSTALL PIPE U H-10 RATED BETWEEN CHAMBERS TOP CONC. ELEV.= 97.3t BREAKOUT ELEV.= 97.00 NOTES: INV. ELEV.= 96.50 aaaa a Baa aaaaa aaaaa aaa 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPES & aaaa aaaaa aaaa INVERTS EXITING HOUSE, PRIOR TO INSTALLATION. BOTTOM ELEV.= 94.50 4' ENDS 8.5' 4' 2) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE 4' OF NATURALLY OCCURRING EFFECTIVE LENGTH = 29.0' S.A.S. LAYOUT ON A MECHANICALLY COMPACTED SIX INCH CRUSHED PERVIOUS MATERIAL STONE BASE, AS SPECIFIED 310 CMR 15.221(2). 5' ABOVE GROUNDWATER 3) INSTALL INLET & OUTLET TEES AS REQUIRED. LEACHING SYSTEM SECTION 4) A GAS BAFFLE SHALL BE INSTALLED ON OUTLET TEE NO GROUNDWATER, EL.=88.8 — 3/4" TO 1-1/2" DOUBLE AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. WASHED STONE 3" LAYER OF 1/8" TO 1/2" SEPTIC SYSTEM PROFILE DOUBLE WASHED STONE tEMEO EO®®®EO EO®® 33" (OR APPROVED FILTER FABRIC) N > ®®®®®®®® SOIL LOG 102" DESIGN CRITERIA DATE: APRIL 16, 2020 (REF#TPT-20-69) 4" KNOCKOUT NUMBER OF BEDROOMS: 2 BEDROOMS SOIL EVALUATOR: PETER MpENTEE SE-1542 WITNESS: DAVID STANTONS R.S. HEALTH AGENT 20" DIA. COVER SOIL TEXTURAL CLASS: CLASS I (LOADING RATE=0.74 GPD/SF) ELEV. TP- I DEPTH ELEv. TP-2 DEPTH DESIGN PERCOLATION RATE: <2 MIN/IN p„ 1 p„ 4" KNOCKOUT / 4" KNOCKOUT 58" 99.8 A 99:8 A DAILY FLOW: 220 GPD LOAMY SAND i LOAMY SAND DESIGN FLOW: 330 GPD 10YR 4/2 1 10YR 4/2 99•0 loll99,1 8" 4" KNOCKOUT GARBAGE GRINDER: NO-not allowed with design B B LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF LOAMY 10YR SAN5/8D LOAMY 5/8D 500 GALLON CAPACITY, H-10 LOADING .74 GPD/SF 97.1 C 32 97.3 C 301, CHAMBERS EXISTING SEPTIC TANK: 1000 GALLON CAPACITY PROPOSED D-BOX: 1 INLET, 3 OUTLET (MIN.), H-10 RATED PERC USE 2-500 GALLON LEACHING CHAMBERS IN SERIES WITH 36"/54" MED. SAND PROPOSED SEPTIC SYSTEM UPGRADE PLAN SAND STONE AROUND AND BETWEEN CHAMBERS (10.0' x 29.0') 2E5DY 6/6 2.SY 6/6 54 TEVYAW ROAD, HYANNIS, MA SIDEWALL AREA: 2(10.0' + 29.0') X 2 = 156.0 SF Prepared for: Cape Cod Septic Services, 350 Main St., W. Yarmouth, MA 02673 BOTTOM AREA: 10.0' x 29.0' = 290.0 SF TOTAL AREA:.....................................................I........446.0 SF 88.8 132" 88.8 132'I. Engineering by: SCALE DRAWN JOB. NO. Engineering Works, Inc. N.T.S. P.T.M. 168-20 PERC RATE <2 MIN/IN: "C" HORIZON 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. DESIGN FLOW PROVIDED: 0.74 GPD/SF(446.0 SF) = 330.0 GPD NO GROUNDWATER ENCOUNTERED (508) 477-5313 5/12/20 P.T.M. 2 Of 2 iv F+ , a 24'-0" 2,�„ I I I D a I o I L xI I - o 1-011 ry I 3 I r _ I 0 I R / I o I ' 3 I � I I I I I I I � I - - - - - - - =r - - - - - 9'-10" 1 I � I Try" 1'-5" 7v ��Xxxj\ a i -TI I I N sr' - - - - - - - - --- w - - - - - - s- 7QI p w - - 2S N644S46 - - - 4'-611 -� 4'-6" ' ~ 19'-0" A r DACE . „/o�./o�. S WA I N E R -54 TEVYAW LANE PROPOSED F1.O0R SCALE } PLAN HYA.N N ISr MA �_ ,_ „ v4 -� ° : 508-77T-049T 24'-0" 1,7 a OD70 o 7 <7 3 < F-� i F I D i <,> I o °D I I I o ,_ I z _ i I _ ' I I i El ' AAAANX4I I 3 { 7'-5If I \ � 101�2" I � I y - - - - - - - - - - - - - - I ry D I I I II Z II 19'-0" Z � MAIN FLOOR PLAN T/ov o/ 4 5 WA I N E fZ ..� 54 TEVYAW CANE AS-BUILT " SCALE HYANNIS, MA 1/411 Off 508_ �� 77 0491