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HomeMy WebLinkAbout0096 THIRD AVENUE (HYANNIS) - Health xo 96 Third Avenue Hyannis A = 246 091 Yi R F f f � N 4 9 3 _ TOWN OF.BARNSTABLE LOCATION 94 &P AV C SEWAGE#201L ' Z1 L VILLAGE Spor4 ASSESSOR'S MAP&PARCEL Zy& 191 INSTALLER'S NAME&PHONE NO. II EXCo�Va��l on y OL S3 SEPTIC TANK CAPACITY 6ZZ j000 qv� LEACHING FACILITY: (type) SOO!qc,J (size) ►3 A 32 X 7- NO.OF BEDROOMS y OWNER Mnrncs }Jatr/di,/�5 PERMIT DATE: G I Z 3116 COMPLIANCE DATE: �,•Z$- �G Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY pip � Cp ?> � bC� � f�A � � s L � � V1 V1 � W N N i 1 0 � � ; u ` �o 0 � � � 9 CJ � (� "� � O ,. C r _. 9 3 `. . M F No. � l ; Y Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes apphLation for Mispo8al 6potem Construction permit Y. Application for a Permit to Construct( ) Repair V Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.q t -Fh �� C 1` Owner's Name,Address,and Tel.No. L Assessor's Map/Parcel �Z/6.-6 ka,os -I 6 I Ve IS V'ti Installer's Name,Address,and Tel.No. 5� - Designer's Name,Address,and Tel.No. 6ib �cavafi��l� �y T�a6� OvSS WA Masi Type of Building: i Dwelling No.of Bedrooms `F Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( Other Fixtures Design Flow(min.required) y D gpd Design flow provided gpd Plan Date (0 13 12 01(p Number of sheets Revision Date Title Size of Septic Tank N V a 5 Type of S.A.S.3 50060 100 pwast MA Y11 Description of Soil see arc Nature of Repairs or Alterations(Answer when applicable) o IWO I Date last inspected: 4 1 2.01 U T 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 of Ith. 1 j igne Date Application Approved by Date Application Disapproved by Date for the following reasons Permit NO. J(� ���4 Date Issued No. (L v'/ Fee (� a THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Ides t` Zipplication for MispoBal.*pstem Construction Permit Application for a Permit to Construct( ) Repair N) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components s Location Address or Lot No.q /e ` Owner's Name,(Address,and Tel.No. -Assessor's Map/Parcel �` �(� --d �j' HQ �v I�I(�S I I( V� �l y �S ►�' Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel No. 1 bib fxAvaClon ly 10)( 1, 11. at'sS Da ,d M& bob - �'>3 � 1"1 Type of Building: I` Dwelling No.of Bedrooms `t Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria Other Fixtures Design Flow(min.required) y gpd Design flow provided gpd Plan Date �O 112�'(y Number of sheets Revision Date Title 3 ' Size of Septic Tank '� �) �S (lj Type of S.A.S.3 500 Q0 I I O n Qt( 4 W d rn b(6 ' Description of Soil se e Y� 16U 6 S'1 O V Nature of Repairs or Alterations(Answer when applicable) r Date last inspected: M A � 2 01 kO 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 B ar of ealth. igne , Date tO Application Approved by Date CO, (o Application Disapproved by Date for the following reasons Permit No. ,('p Date Issued Q --------------------------------------- -------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-siteSewage Disposal system Constructed( ) Repaired(✓) Upgraded( ) ;.,Abandoned(77 'l )by at .v) YJ `d V has been constructed in accordance with the provisions of TTitle 5 and he for Disposal System Construction Permit No dated In 6-:3 Z Installer `r C Designer M IA�6 n #bedrooms Approved design flow 990 gpd The issuance of this permit shall not be construed as a guarantee that the system will `nc oifas design d. Date �p -7 1 Inspector �, 2 --------------------------------------------------------------------------------------------------------------------------------------- No.rL2:9 6 '� Fee 7 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Misposal *pstem Construction permit Permission is hereby granted to Construct( ) Repair(V) Upgrade 1( ) Abandon( ) System located at "l li I t 1 i rd A , H\7�n n l� oU y Y 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 irlrt t. y Date �� ,,� /1� Approved b � i b ' 'own of Barnstable WE lti Regulatory Services Richard V. Scali,Interim Director * sa[txsraer.e, MASS. Public Health Division n " Thomas McKean,Director 200 Main Street,_Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Q Installer&Designer Certification Form Date: (O (�V �p Sewage Permit# (�' Assessor's Map\Parcel Z (o Designer: �'� j Installer: � Address: 40 Address: On 2 ' ,was issued a permit to install a (da ) (installer) I septic system at �w� �, � ,�I�� ��based on a design drawn by (address) V"I,A���L`J dated (z, 16 zEt(o (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed m co nuance with the terms of the IAA approval letters (if applicable) 04. UAVID (Installer's Sign e � MASON \ 1 No.1066 ` 's'iNITARt (Designer's.Signature) (Affix Desi ::�v�., mp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc Commonwealth of Massachusetts 100244526 ~� Asbestos Notification Form ANF-001 Asbestos Project# Project Revision Project Cancellation sw A. Asbestos Abatement Description V 1.Facility Location: ►-` BONFIGUO 96 THIRD AVENUE ". Name of Facility Street Address r.r Instructions 1.All HYANNIS MA 026,01 0000000000 sections of this form City/Town State Zip Code Telephone must be completed in X X order to comply with MassDEP notification Facility Contact Person Name Facility Contact Person Title requirements of 310 Worksite Location: ATTIC/BASEMENT CMR 7.15 and Department of Labor Building Name,Wing,Floor,Room,etc. Standards(DLS) 2. Is the facility occupied? r Yes ❑No notification requirements of 453 CMR6.12 3. Is this a fee exempt notification (city,town, district, municipal housing authority, state facility, or owner-occupied residential property of four units or less)? ICI Yes r No MassDEP Use only 4.Blanket Permit Project Approval,if applicable: Date Received Approval ID# 5.Non-Traditional Asbestos Abatement Work Practice Approval, 2.Submit Original if applicable: Approval ID# Form To: Commonwealth of 6.Asbestos Contractor: Massachusetts NEW ENGLAND SURFACE MAINTENANCE LLP 850 WASHINGTON ST P.O.Box 4062 Boston,MA 02211 Name Address WEYMOUTH MA 02189 7813372117 City/Town State Zip Code Telephone A0000196 Contract Type: FYJ"Written r—i Verbal DLS License# 7, JOHN P.VALLIQUETTE AS060773 Name of Contractor's On-Site Supervisor/Foreman DLS Certification# $, RICHARD K.BOWEN AM061044 Name of Project Monitor DLS Certification# 9, FLI ENVIRONMENTAL INC AA000144 Name of Asbestos Analytical Lab DLS Certification# 10. 7/11/2016 7/13/2016 Project Start Date(MM/DD/YYYY) End Date(MM/DD/YYYY) 8-4 N/A Work Hours-Monday Through Friday Work Hours-Saturday&Sunday 11.What type of project is this? r" Demolition Fy-j Renovation r Repair � Other-Please Specify: Revised: 11/13/2013 Page I of 4 Commonwealth of Massachusetts 100244526 L71Asbestos Notification Form ANF-001 Asbestos Project# Project Revision Project Cancellation A.Asbestos Abatement Description: (coat.) 12.Abatement procedures(check all that apply): Glove Bag Encapsulation Enclosure Disposal Only [ Cleanup v_; Full Containment Other-Please Specify: 13.Job is being conducted: Indoors Outdoors 14.Total amount of each type of asbestos.Containing materials(ACM)to be removed,enclosed,or encapsulated: 55 800 Linear Feet(Lin.Ft.) Square Feet(Sq.Ft.) Boiler,Breaching,Duct, Transite Pipe Tank Surface Coatings Lin.Ft. Sq.Ft. Lin.Ft. Pipe Insulation 55 Transite Shingles Lin.Ft. Sq.Ft Lin.Ft. Sq.Ft Spray-On Fireproofing Transite Panels Lin.Ft. Sq.Ft. Lin.Ft. Sq.Ft. Cloths,Woven Fabrics Other-Please Specify: Lin.Ft. Sq.Ft. Insulating Cement VERMICULITE 800 Lin.Ft. Sq.Ft Lin.Ft. Sq.Ft. 15.Describe the decontamination system(s)to be used: AS REQUIRED 16.Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)(g): AS REQUIRED 17.For Emergency Asbestos Operations,the MassDEP and DLS officials who evaluated the emergency: Name of MassDEP Official Title of MassDEP Official Date of Authorization(MM/DD/YYYY) Waiver# Name of DLS Official Title of DLS Official Date of Authorization(MM/DD/YYYY) Waiver# 18.Do prevailing wage rates as per M.G.L.c. 149,§26,27 or 27A—F apply to this ❑ y� No project? Revised: 11/13/2013 Page 2 of 4 Commonwealth of Massachusetts /00244526 Asbestos.Notification Form ANF-001 Asbestos Project# Project Revision Project Cancellation B. Facility Description 1.Current or prior use of facility: RESIDENCE 2.Is the facility owner-occupied residential with 4 units or less? r Yes ❑ No 3.SAME SAME Facility Owner Name Address SAME MA 00000 0000000000 City/Town State Zip Code Telephone 4.X X Name of Facility Owner's On-Site Manager Address X MA 00000 0000000000 City/Town State Zip Code Telephone 5.X X Name of General Contractor Address X MA 00000 0000000000 Note:Temporary storage of Asbestos City/Town `State Zip Code Telephone containing waste X material is only allowed at the place Contractor's Worker's Compensation Insurer of business of a DLS X 1/1/2017 licensed Asbestos Policy# Expiration Date(MM/DD/YYYY) contractor or a transfer station that is 6.What is the size of this facility? 1200 2 permitted by MassDEP and operated in Square Feet #of Floors compliance with Solid Waste Regulations C. Asbestos Transportation & Disposal 310 CMR 19.000 1.Transporter of asbestos-containing waste material from site of generation: Directly to Landfill or Fyj To Temporary Storage Location/Transfer Station NEW ENGLAND SURFACE MAINTENANCE,LLP 850 WASHINGTON STREET Name of Transporter Address WEYMOUTH MA 02189 7813372117 City/Town State Zip Code Telephone 2.If a temporary storage location/transfer station is used,list name of transporter of asbestos containing waste material from temporary storage location/transfer station to final disposal site: REDTECHNOLOGIES 10 NORTHWOOD DRIVE Name of Transporter Address BLOOMFIELD CT 06002 8602182428 City/Town State Zip Code Telephone Note:Contractor must sign this form for DLS Revised: 11/13/2013 Page 3 of 4 ,. ...'�I,. -.�.. I e �1 � � � � cI� �k �G,Y , --�, ��k� Q��. . _ t� Commonwealth of Massachusetts 100244526 Asbestos Notification Form ANF-001 Asbestos Project# F- Project Revision Project Cancellation nuw wauun Nw Nuaca C.Asbestos Transportation&Disposal: (cont.) 1 3.Name and address of temporary storage location/transfer station for the asbestos containing waste material: RED TECHNOLOGIES 203 PICKERING STREET Temporary Storage Location Name Address PORTLAND CT 06480 8603421022 City/Town State . Zip Code Telephone 4.Name and location of final disposal site(asbestos landfill): MINERVA ENTERPRISES MINERVA Final Disposal Site Name Final Disposal Site Owner Name 9000 MINERVA ROAD Address WAYNESBURG OH 44688 3308663435 Cityrrown State Zip Code Telephone A Certification "I certify that I have personally examined the foregoing and am JIM DOYLE JIM DOYLE familiar with the information Nam Authorized Signature contained in this document and PARTNER 6/6/2016 all attachments and that, based on my inquiry of those Position/Title Date(MM/DD/YYYY) individuals immediately 7813372117 NESM,LLP responsible for obtaining the Telephone Representing information, I believe that the 850 WASHINGTON STREET WEYMOUTH information is true,accurate,and Address City/Town complete. I am aware that there MA 02189 are significant penalties for submitting false information, State Zip Code including possible fines and imprisonment.The undersigned hereby states that I have read the Commonwealth of Massachusetts regulations governing asbestos abatement (453 CMR 6.00 promulgated by the Department of Labor Standards and 310 CMR 7.15 promulgated by the Department of Environmental Protection), and that I am aware that this permit application or notification shall not be deemed valid unless payment of the applicable fee is made." Revised: 11/13/2013 Page 4 of 4 �cT / Barnstable Town of Barnstable Regulatory Services DepartmentA&An C " �ST"M g rY p V P 9 O D 1639. � ' Public Health Division o 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO June 6, 2016 CERTIFIED MAIL# 7015 1730 0001 4990 496-5 ; James Hawkens 96 Third Avenue Hyannis Port,MA 02647 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 The septic system located at 96 Third Avenue,Hyannis Port, MA was inspected on May 4, 2016, by Brett Hickey,registered sanitarian and health agent for the Town of Barnstable Health Department: The inspection of the septic system showed that the system "fails" under the guidelines of 1995 TITLE 5 (310 CMR15.00) due to the following:. • Leaching facility with standing liquid level at or above the invert pipe (per Town Code#360.-20h) You are ordered to replace the septic system within Two (2)years of the date you receive of this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF T BOARD OF HEALTH Thomas cKean, R.S., C Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Ev1U6 Third Ave HyPort May 2016.doc IME T Town of Barnstable BARNWABLC gyp,b 9. �,�� Regulatory Services Department ea� Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 5/11/16 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x" marked.in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any "conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑ Leaching pit or cesspool with high liquid level, <12" below inlet(per Town Code §360-9.1) Leaching facility withstanding liquid level at or above the invert pipe (per Town Code §360-20 h) , OTHER Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc f Commonwealth of Massachusetts, W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° .0 96 Third Ave Property Address r M+ James Hawkins Owner Owner's Name / C} information is H annis ort V Ma 02647 5-4-16 required for every y p �_. page. City/Town State Zip Code Date of Inspection C?1t 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. General Information (� filling out forms (J 90 on the computer, use only the tab 1. Inspector: key to move your cursor-do not Brett Hickey use the return Name of Inspector key. B&B Excavation rQ Company Name 374 Route 130 Company Address m Sandwich Ma 02563 City/Town State Zip Code (508)477-0653 S113747 Telephone Number License Number B. Certification certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 5-4-16 Inspector's 06 > V1 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 is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report_to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****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. l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 O vs l�� Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 96 Third Ave Property Address James Hawkins Owner Owner's Name information is required for every Hy P annis ort Ma 02647 5-4-16 page. CityFrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) 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: B) System Conditionally Passes: 10 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): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts d Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 96 Third Ave Property Address James Hawkins Owner Owner's Name information is required for every Hy p annis ort Ma 02647 5-4-16 . page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ 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): 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 public health, safety or the environment. 1. 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: ❑ 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 I Commonwealth of Massachusetts v2 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 96 Third Ave Property Address James Hawkins Owner Owner's Name information is required for every Hy p annis ort Ma 02647 5-4-16 page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) 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, 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. 3. Other: D) 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 ❑ ® 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 'h day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 96 Third Ave Property Address James Hawkins Owner Owner's Name information is required for every Hy p annis ort Ma 02647 5-4-16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® 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 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. [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 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. 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 If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 96 Third Ave Property Address James Hawkins Owner Owner's Name information is p required for every �ann H is ort Ma 02647 5-4-16 page. Cityfrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: 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? ® ❑ 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)] D. System Information . Residential Flow Conditions:. Number of bedrooms (design): 4 Number of bedrooms (Actual) 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 96 Third Ave Property Address James Hawkins Owner Owner's Name information is P required for every �H annis ort Ma 02647 5-4-16 page. Cityfrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 4 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d See below 9 ( Y 9 (9P ))� Detail: 2014-91,500gallons 2015-102,000galIons Sump pump? ❑ Yes ® No Last date of occupancy: current,Date Commercial/Industrial Flow Conditions: Type of Establishment: NA Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Cortimonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 96 Third Ave Property Address James Hawkins Owner Owner's Name information is H annis ort Ma 02647 5-4-16 required for every Y p page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Owner-last pumped 2012 Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1000 gallons How was quantity pumped determined? Tank size Reason for pumping: Owner request 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): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 96 Third Ave Property Address James Hawkins Owner Owner's Name information is required for every HY p annis ort Ma 02647 5-4-16 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 2005 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1'6" feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: >20'feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: $ feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ 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: 1000gallon Sludge depth: $ t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 96 Third Ave Property Address James Hawkins Owner Owner's Name information is required for every Hy p annis ort Ma 02647 5-4-16 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 28 Scum thickness 6 Distance from top of scum to top of outlet tee or baffle 6 Distance from bottom of scum to bottom of outlet tee or baffle 11" How were dimensions determined? measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank was in working order at time of inspection and pumped after inspection was complete. Grease Trap(locate on site plan): Depth below grade: NA 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° 96 Third Ave M Property Address James Hawkins Owner Owner's Name information is H annis ort Ma 02647 5-4-16 required for every Y p page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: NA Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 96 Third Ave Property Address James Hawkins Owner Owner's Name information is required for every Hy p annis ort Ma 02647 5-4-16 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 11 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.): D-box was in working order at time of inspection. 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.): NA * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: , t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 96 Third Ave Property Address James Hawkins Owner Owner's Name information is H annis ort Ma 02647 5-4-16 required for every —y p page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: (3) 500gallon ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching was in hydraulic failure at time of inspection. Water level was over inlet invert. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan).- Number and configuration NA 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 i _ Corhmonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 96 Third Ave Property Address James Hawkins Owner Owner's Name information is H annis ort Ma 02647 5-4-16 required for every Y p page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: NA Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments %M 96 Third Ave Property Address James Hawkins Owner Owner's Name information is required for every Hy p annis ort Ma 02647 5-4-16 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 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 COTTAGE A1-72' 1»26` ANT 97.23' A3-31' 83-2W t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 96 Third Ave Property Address James Hawkins Owner Owner's Name information is required for every Hy P annis ort Ma 02647 5-4-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 6.4' t 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: 3-30-05 Date ❑ Observed site (abutting property/observation hole within 150 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: Plan on file with BOH. I Before filing this Inspection Report, please see Report Completeness Checklist on next page. l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 96 Third Ave Property Address James Hawkins Owner Owner's Name information is required for every HY p annis ort Ma 02647 5-4-16 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file _ 4 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Town of Barnstable P# Department of Regulatory Services c BARMABL& Public Health Division Date ` - 61g,p�� 200 Main Street,Hyannis MA 02601 IM't \1 Date Scheduled Time_ +A M- Fee Pd. ;'C Soil Suitability AsseCspsymrnt for Sew e Disposal Performed By: (�! : Y Witnessed By: A V f LOCATION&GENERAL INFORMATION r Location onn Add'reesss y n \ Owner's Name ��/�� 1 I4�c. > - (..�► 16 1 iI W AVE, �'`1I Y/w)�+`/�!1�Y� Address F W�- F^f 1 '�)o Assessor's Map/Parcel: ZL.��/Q � Engineer's Njjam��e(�(3��, ���j NEW CONSTRUCTION REPAIR Telephone#✓� "r/•� _n j Land Use. Slopes(%) Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) V F a W v Parent material(geologic) Depth to Bedrock Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level PERCOLATION-TEST Date Time Observation Hole# �j ¢ Time at 9 -/� " G Depth of Perc Time at 6" �` 1 Start Pre-soak Time @ _ Time(9"-V) End Pre-soak 1 Rate MmAnch �676t I SiteSuitability Assessment: Site Passed Site Failed: Additional Testing Needed(YIN) POriginal: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100'of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:\S EPTIC\PERCFORM.DOC r DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other -+ Surface(in.) (USDA) (Munsell Mottling (Structure,Stones,Boulders. Consistency,° Gravel �I 1 WO I DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other . Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) Flood Insurance Rate Mao: / Y Above 500 year flood boundary No/Yees YesWithin 500 year boundary NosWithin 100 year flood boundary No! Death of Naturally Occurring Pervious Material Does at least four feet of naturally occurring p o enal exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is thjdepth lly occurring pepe i�rial?CertificationI certify that on (date)I have passed the soil evaluator examination approved by the Department of El Pro ction and t the above analysis was pe ormed by me consistent with the required traise d ex nce es *bed in 310 CMR 15.017. Signature Date Q:)SEPTICCH'ERCFORM.DOC � --s� Q �� � � � � �' � -� � �� N c a --� - -�.— � � . �_ �i . �. � � �. -�. , . �. r� ....si _�: '� �1 C k r - .r y. Commonwealth of Massachusetts _ W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments M 96 Third Ave Property Address James &Gloria Hawkins - Owner Owner's Name information is p required for every y West H annis orf MA 02672 10/15/12 page. - City/Town -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. General Information filling out forms on the computer, use only the tab 7 key to move your 1. Inspector: Ik cursor-do not r"" Fes` Ricky ' ck Wright. use the return key. Name of Inspector B & B Excavation,lnc. Company Name 14 Teaberry Lane p , . :.�. Company Address _ 63 Forestdale MA 1 02644 City/Town State Zip Code 508-477-0653 S14595 Telephone Number License.Number B. Certification _. 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 the inspection. The inspection was performed based.on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a:DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15000). The system: ® Passes ❑ Conditionally Passes ❑ Fails Needs Further Evaluation by the Local Approving Authority i 10/15/12 Inspector's 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 is a shared system or has a design.flow of 10,000 gpd or greater,the inspector and the.system owner shall submit the.. report to the appropriate regional office of the DEP. The original should be sent to the system owner .... and copies sent to.the buyer,.if applicable, and the approving authority.. ***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. - - Vol t5ins•11/10 Title 5 0 al pection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 96 Third Ave Property Address James &Gloria Hawkins Owner Owner's Name information is required for every West HY P annis ort MA 02672 10/15/12 - page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 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: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. 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 FIND (Explain below): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 96 Third Ave Property Address James &Gloria Hawkins Owner Owner's Name information is required for every West Hy p annis ort MA 02672 10/15/12 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ 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): 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 public health, safety or the environment. 1. 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: ❑ 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 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GSM 96 Third Ave Property Address James&Gloria Hawkins Owner Owner's Name information is required for every West Hy p annis ort MA 02672 10/15/12 page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) 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, 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. 3. Other: D) 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 ❑ ® 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 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 96 Third Ave Property Address James &Gloria Hawkins Owner Owner's Name information is required for every West Hy p annis ort MA 02672 10/15/12 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® 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 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. [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 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. 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 If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts , .. Title 5 Official Inspection. Form o Subsurface Sewage Disposal System Form.-Not for Voluntary Assessments M •'" 96 Third Ave Property Address _. _ _.... ..._ _-. _.. _. .. James &Gloria Hawkins Owner Owner's Name .. information is West H annis ort MA 02672 10/15/12 required for every y p page: City/Town:: - State Zip Code Date ofTnspection - C. Checklist Check if the following have been done..You must:indicate":yes" or"no".as to each.of the following: Yes No NiEl Pumping information was provided by the owner, occupant, or Board of Health ❑ N Were.any of the system components pumped out in the previous two weeks? .. IZ ':.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 El ® this inspection? ® Were:as built.plans of the ystem obtained and:exam ined?(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)], D. System.Information ... Residential-Flow Conditions: ... .. Number of bedrooms(design): 4 Number;of bedrooms (actual)-. 4 DESIGN flow based.on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): . 440 t5ins•11/10; Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 96 Third Ave Property Address James & Gloria Hawkins Owner Owner's Name information is required for every West Hy p annis ort MA 02672 10/15/12 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d n/a 9 ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): I Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 96 Third Ave Property Address James &Gloria Hawkins Owner Owner's Name information is required for every West Hy p annis ort MA 02672 10/15/12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1000 gallons How was quantity pumped determined? site glass Reason for pumping: customer request 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): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 96 Third Ave Property Address James&Gloria Hawkins Owner Owner's Name information is required for every West Hy p annis ort MA 02672 10/15/12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 2005 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 6 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: >20 feet Comments(on condition of joints, venting, evidence of leakage, etc.): At time of inspection building sewer appeared to be in working order. No sign of leakage or blockage. Septic Tank(locate on site plan): 2' Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ 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 gal Sludge depth: no sludge , t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 96 Third Ave Property Address James &Gloria Hawkins Owner Owner's Name information is required for every West Hy p annis ort MA 02672 10/15/12 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle no sludge Scum thickness no scum Distance from top of scum to top of outlet tee or baffle no scum Distance from bottom of scum to bottom of outlet tee or baffle no scum How were dimensions determined? scour stick Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At time of inspection septic tank appears to be structurally sound. No sign of back-up. 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 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 96 Third Ave Property Address James &Gloria Hawkins Owner Owner's Name information is required for every West Hy p annis ort MA 02672 10/15/12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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 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 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 I • Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 96 Third Ave Property Address James &Gloria Hawkins Owner Owner's Name information is required for every West Hy p annis ort MA 02672 10/15/12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 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.): At time of inspection d-box appears to be in good condition. 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.): Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 96 Third Ave Property Address James &Gloria Hawkins Owner Owner's Name information is required for every West Hy p annis ort MA 02672 10/15/12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 3 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At time of inspection leaching appears to be in working order. Water level 8" below invert at time of inspection 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 t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 J Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ° 96 Third Ave M Property Address James &Gloria Hawkins Owner Owner's Name information is required for every West Hy p annis ort MA 02672 10/15/12 ' page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 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.): 15ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 I I i Commonwealth .of Massachusetts Title 5-Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments i 96 Third Ave Property Address James &:Gloria Hawkins Owner Owner's Name information is West Hyannisport MA 02672 10/15/12 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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 Cc -��� Ri= Ia' A I A = �5' 2 Pj2= a3' i c , - A3= -3 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 96 Third Ave Property Address James &Gloria Hawkins Owner Owner's Name information is required for every West Hy p annis ort MA 02672 10/15/12 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water >6.4' per soil evaluation 3/3/05.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 150 feet of SAS) ® Checked with local Board of Health -explain: perc test/soil evaluation 2005 ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 96 Third Ave Property Address James &Gloria Hawkins i Owner Owner's Name information is p required for every y West H annis ort MA 02672 10/15/12 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 /O ist A�f1p/(/i 1 , ry - 101 77 3TAx-�- - -f 1 . a ,� - r a �; o ,� r a ��` ' .�F ; t 4 , r � 1 r Stanton, David From: Stanton, David Sent: Wednesday, May 25, 2016 8:47 AM To: 'David' Subject: RE: 96 Third Ave Hi Dave, The plans as is cannot be used (may be referenced if there is any relevant info towards the new design. ) It needs a witnessed perc test (was unwitnessed in 2005) and also would need a two compartment tank or two tanks in series (if no kitchen in the cottage, would need floor plans of it to exempt it from the 2nd kitchen triggering the 2 compartment or 2 tanks) They may apply to the Board for a variance from the 2 compartment or two tanks in series requirements and see what the Board says if they would like. Thanks, Dave -----Original Message----- From: David (mailto:dbmason44@msn.com] Sent: Thursday, May 19, 2016 8: 19 AM To: Stanton, David Subject: 96 Third Ave Dave, The referenced system is failed. There is a plan on file dated 3/30/2005 by Carmen Shay. How shall this proceed? Dave Sent from my iPhone I 1 Office: 508-862-4644 Barnstable FAX: 508-790-6304 Town of Barnstable o WmedcaCdY Board of Health I ' F 200 Main Street, Hyannis MA 02601 2007 Coo,) r � (-&f C/' 4" f, rTv �f I �^ vd August 10,2010 Revised March 9,2016 Public and Environmental Health Program Policies, Procedures, and Guidelines Enforcement of 310 CMR 15.223, Septic'Tanks/ Properly Sized Septic Tank and Two Compartment Tank Enforcement No. 2010-007 Septic Tank Size When/if an applicant requests a local or State Code variance involving a setback distance to wetlands, high groundwater, or any other environmental type of variance to the Board of Health to be reviewed at a public meeting of the Board (not a variance request involving a setback distance to a foundation or property line), the Board of Health will require full compliance with Section 310 CMR 15.223 of the State Environmental Code, Title V. Specifically, when an environmental variance of any type is requested, a properly sized septic tank will be required by the Board. Two Compartment Tank or Two Tanks in Series When a design involves facilities other than a single family dwelling unit or whenever the calculated design flow is 1,000 gallons per day or greater, a two compartment septic tank or two tanks in series will be required. This requirement shall be enforced during the construction, repair and/or upgrade of a septic system, regardless of whether the \ repair or upgrade is proposed for the leaching facility only. (See back of page for clarification and examples regarding the requirement for two compartment tanks at Avs- dwelling units.) ` However,this policy does not apply to minor component repairs such as replacement of a distribution box,tee, piping, or component lid. Wayne Miller, M.D. Paul Canniff, DMD Junichi Sawayanagi Q:\POLICIES\Dual Compartment Tank Enforcement.doc f r Two Compartment Tan r Two anks in Series at Dwelling Units Two Tests (1)"Self Sufficiency AND(2) Work is Needed or Proposed To Be Done To the Septic System Double-compartment tank in all on or installation of two tanks inOand ' e only required when there is a need or proposal to construct,upgrade, repair e septic system oabsorption system(for additional bedrooms above the existing s is c acity for example) here there is self-sufficiency is each of the two living units(e.g. in-law apartment). The addition o kitchen,by itself,does not_—,po r"J trigger an upgrade. However, if an additional kitchen is proposed along with additional bedrooms above + the existing septic system capacity,then a double compartment tank shall be introduced(see example list` below). �1 Here are some examples for Test#1 only (remember there are two tests involved here) f7_97,ate Pool House-NO(double compartment tank is not required) 2)Sep ate Pool House with private room(s)that may be considered as possible"bedroom(s)" -NO 3) Se a Pool House with private room,bathroom and kitchen-YES(double compartment to is required) 4)Btdmover m over a Garage-NO 5)B a garage with a bathroom-NO 6) Bedr m over detached garage with bathroom and kitchen-YES 7) Bedr/o over attached garage with bathroom and kitchen-YES 8)Addt n for an apartment with a bathroom,kitchen and i s n bedroom,regardless of whether there is an increase in flow over 11 or not(i.e bedroom relocation)-YES A double compartment tank is required for the proposed construction of an in-law apartment which may be attached or detached from the main house and for other similar se rate structures. If there is self- sufficiency,then a double compartment tank would be required. If the structure is a detached bedroom with self-contained living quarters,the applicant will be require to install a double compartment tank. However, if there is a connection in the house o t new living area,this would not necessarily be considered as a separate dwelling. If what is pro d requires someone to travel to the main house for amenities(such as traveling to the main kitchen in the house), it would not require a double compartment tank. ou�mpartment tank installation is only required when there is"self-s , 'ency" in each of the two dwelling units AND if there is a wish or need to construct,upgrade,and/ r repair he septic system and/or the SAS itself. w Q:\POLICIES\Dual Compartment Tank Enforcement.doc TOWN OF BARNSTABLE LOCATION C ye,19 Ai--Q SEWAGE # VILLAGE—t-taw��S iDDOj--� ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY filDO g LEACHING FACILITY: ) (size) 0o't�/.���oZ �(NO. OF BEDROOMS-7 3 �� w ►S �UELDER OR OWNER t[=i y"S PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility . Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility). Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 1 s�,�t�. 662• WLL 6b 03,3 Alt , No.C�'�-y J I)_5 Fee O THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: _ Kes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 91ppIfcation for Zfgpont *pgtem Congtruction Permit Application for a Permit to Construct( . j RepairXUpgrade( )Abandon( ) El Complete System >idividual Components Location Address or Lot No. �� '�� A%J 1 }2 Owner's Name,Address and Tel.No. 3t�nn ES N�)WiP,- AS Assessor's Map/ParcelS.RM E ca Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. h�plgra�aC S C S,4c. 6 4",2 E�1 v1 earl M�t�1T�g` ��iC S Type of Building: Dwelling No.of Bedrooms Lot Size��_sq.ft. Garbage Grinder( 41A_ Other Type of Building f No.of Persons Q Showers( t/jCafeteria Other Fixtures LVAV A 1-'C'kjE� . aT Ri%JLj!DQ_Y Design Flow 4 4 gallons per day. Calculated daily flow D gallons. Plan Date © Number of sheets Revision Date Title � Ak C: S U Size of Septic Tank Type of S. .S. 'SOS _9Q can C_1r)cknCN Description of Soil k 13 ' X 32' X2.' 1� c►� Nature of Repairs or Alterations(Answer when applicable) ( NCO oav\ Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with.the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been is ued b this Bo ,d f Healt tgned Date 3— 31_ S Application Approve Date 3 3 Application Disapproved for the following reasons Permit No. 5 k5 Date Issued G No. S—l)_5 Fee / ;'?00� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ~PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS s 01ppfication for 33igoal *pgtem Construction Permit Application for a Permit to Construct( . )Repairr upgrade( )Abandon( ) ❑Complete System individual Components Location Address or Lot No.Gj(Q 740,V_A Owner's Name,Address and Tel.No. N v— nQ\s cr+ '3RnnE5 N�wr��tJs Assessor's Map/Parcel S�M E CQ Ala Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. I�O�pCa� S C.. En1UJZ0NMEn1TQ%- SACS Type of Building: Dwelling No.of Bedrooms Lot Size _sq. ft. Garbage Grinder Other e'�'�^-�••• •• Typ of Building, _ No.of Persons Showers( p-j Cafeteria E Other Fixtures ��A�1 ca�-no 4 rr�t�►,1 Ctti��T9 �'.T Q V Design Flow .4. 4n gallons per day. Calculated daily flow��t��-' gallons. Plan Date ` n cr Number of sheets 1 Revision Date Title Size of Septic Tank Type of S. .S. - 5 � Description.of Soil `��� P3 i X 31' XZ' 1'77t"C-A ±s�An Nature of Repairs or Alterations(Answer when applicable) �e Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-si ft f'e sewage disposal system in accordance with.the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued •y this Board f Health. ' ig" n�ec Date_-5- ' Application Approv dby___ Date 3 Application Disapproved for the following reasons Permit No. Date Issued THE COMMONWEALTR OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO C TIFY, that the On-site Sewage Disposal System Constructed ( )Repaired ( )Upgraded ZV) Abandoned( )by // at i has been constructed in accordance with the proNsions o Title 5 and the for Disposal System Const ction Permit o.. P>�'i �/,S dated 3�3Installer � Designer The issuance of thispermit shall not be construed as a guarantee that thlle syste , P Ikunction as designed. Date G� ,J� Inspecto7., _...— —.—.---._,_-- ------ ------- No. ��C./ I I Fee 1 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Mizpogai *pgtem Con5truction Permit Permission is hereby granted to Construct( )Repair( )Upgrade(�J)Abandon( ) System located at 07 V /I // I ct 11f1VUr)U__f_ 4: and as described in the above Application for Disposal System�onstruct` n Permit. The a plicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditiCteof ns. r• Provided: Construction m st be completed within three years of the dthis i Date: �� Approve a TOWN OF BARNSTABLE LOCATION G Z< 49-4L— SEWAGE # ;20r0.j VILLAGE S AG 6_.1 /ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO,'� SEPTIC TANK CAPACITYx!'ST %/11G� Cs�ff LEACHING FACILITY: (type) - (size) saZ[ �.�� c NO. OF BEDROOMS a Ck k.iftb %r BUMDER OR OWNER ,�V_A 6"S PERMIT,DATE: _3I"� COMPLIANCE DATE: Separation Distanc6 Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by i n2 6.2. 0 r G 31 ` v t Town of Barnstable OFtHE �G Regulatory Services Thomas F. Geiler, Director * BARNMBLE. 9� KAS& Public Health Division 1639. s Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: 4/11/05 Designer: _Shay Environmental Services, Inc. Installer: Robert Septic Services. Address: P.O. Box 627 East Falmouth Address: 5 Trenton Street MA 02536 Yarmouth, MA On 4/01/05 Robert Septic Service was issued a permit to install a (date) (installer) septic system at 96 THIRD AVENUE, HYANNISPORT, MA based on a design drawn by (address) Shay Environmental Services, Inc. dated 04/01/05 (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. _ 0"OF 4f4SS 9 staller s ignature) CARMEN cy� o E. �,. SHAY No. 1181 � a STE11 R� S (Designer's Signature) (Affix p Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......... ........o .:A. %;,5N)t. ------------------------------- Appl ration for Disposal Works Tonstrnrtiun jhrmi# Application is hereby made for a Permit to Construct ( ) or Repair (-�an Individual Sewage Disposal System at: ,' jj ............`. _--__. --' ---- -� ............................. ____________"..._lam ..............................._.._...... Lp�cation- ,ddress� or Lot No. .._....... r1. .�s...:; .=, °' c•----•-'---'.............. ..'-•••-'-•' - v - ......----___...............__.............._. •• Owner T Address l�j ��y �q a � ..:---•-'•=•"-.' = r i..................•______ _f.�=__'- � ?L-�SL_ 1 .................................................._.. M Installer Add s Type of Building l Size Lot............................Sq. feet Dwelling—No. of Bedrooms...... .................................Expansion Attic ( ) Garbage Grinder ( ) a Other—T e of Building No. of persons____________________________ Showers Cafeteria QOther fii- ures •-------••-----------------------•--•----•---•------..._....-----•---•----------••••---------•--- W Design Flow...... . ___________________________gallons per person day. Total daily flow...... .....................gallons. WSeptic Tank-I-Liquid capacity� :'_gallons Length_______:_ Width... ........ Diameter________________ Depth................ x Disposal Trench—No_ ____________________ Width.................... Total Length___...._.__....._._. Total leaching area....................sq. ft. Seepage Pit No.....1.............. Diameter.____......... Depth below inlet....Wit.......... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) b.4 Percolation Test Results Performed by.......................................................................... Date........................................ Test 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........................ ----------------------------------------•--......----------..._.....-----------... --------- ----------------------------------- 0 Description of Soil.............................................•-•---•----•----.._..-----...-----•-----------------•----------------------•--------------------•••-----....._'-'-"_-_... W tJ ----------- --------- •-------- .... ---------- --------------- -•-------- ----------------•-----------------•---•----•---•--•---------••-•-•---------•••--------------------- ••---------- W ................•-••-••••••-----------•••-••-••...••••••-••---•-•••-•--•--••••--•-------•-••--•-•••-----••---- --- U Nature of Repairs or Alterations—Answer when applicable____— 6!�=- - � IJ%� 7:._ �f �`............. ............OV�=--i � ��c: ....... ....... ` - `�' -------------------------------------------------------------------------- . Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITI M 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued fby the board of heAlth. y Signed...................../ . _- ------' ......... F Date Application Approved BY ---------- ..... Date Application Disapproved for the following reasons______________________________________________._.._..._•------•••--•-•-•-••----------------- _........_._ ...........................----------------L-�------'------•---/.._.....----------------......---------.._.._.__...._....--------------------------------------...------------.._.- -•----'---"' Date Permit No......../..��._ ..1_G•q................... Issued---•....................'-•----..................------ Date No._ 7�..- THE COMMONWEALTH OF'MASSACHUSETTS ,BOioeRD OF HEALTH , Apphiatiun for Uhipostt1 Works Tonstrurtion "pprntit Application is hereby made for a Permit to Construct ( ) or Repair ( vf_`an Individual Sewage Disposal System at: " 6,, ,P� .....»---.G4 _..__. ...'!......... :��------------------------------•-- ---••-. ...---•---•----; ---.............................. ».».._»._.. A L cation-A`dd�ress or Lot No. .........r'-�'�._40A ............................ ............�r t '...........................' .....................»..... Owner Address at-�Llv�(..........> r S'G1�....................... ......•-•-• �`��-�------------------------------------------ Type � i................ _ ....... �,i, --• Installer .: Address' of Building Size Lot................ ........Sq. feet ►., Dwelling.-No. of Bedrooms...... .................................Expansion Attic ( ) , Garbage Grinder ( ) pal Other—Type of Building ............................ No. of persons............................ Showers ( ) Cafeteria ( ) Q' Other fixtures . = .. d --------------------------•-•- ......................... WW Design Flow..... �.........................gallons per person per day. Total daily flow......3_.!!� .............gallons. WSeptic Tank C Liquid*capacity I. _gallons Length... ....:--:- Width...' ...... Diameter................ Depth........... x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No...._�______________ Diameter..... i -_..... Depth below inlet....:.--....... Total leaching area...................sq. ft. Z Other Distribution box ( ) Dosing tank.( ) `" Percolation Test Results Performed by _.. ...............................=--------------------------- .Date................ -------, ' Test Pit-No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water:__:..............._... . ••• ••-----•...............•-.........-••---........ JQ _ Description of Soil............................................. ---•-------------------•------••-•••.................................................................................... W ---------•---- ..................................................................................................... .....-------••--••••••• !.....--•••-•••-••••-•-•-•••••......••••••-•••--......•----•-•••-••-•--•••. ....._ . U - Nature of Repairs or Alterations—Answer when applicable. X 46, <r►.iIl.�.�.z -r Mgr.' .. t.!.....:,%... ........... ---•- --._..... .... ._.. ...... '.Agreement r - The undersigned,agrees to.,install the aforedescribed Individual Sewage Disposal System in accordance with ! the provisions Of TITIE . 5 of the State Sanitary,Code '—'The undersigned further agrees:not to place the system in _ _. -operation untiba'Certificate of Compliance has been issued by the board`of health jQ Al . ;:: . •w -Signed......... .......... .....-7 - - " X �a� -`_�_ -�" . ...........• ••.......... f. ate .Application-Approved BY--•....._ - .� .v _R . y :v e- ......... --••..................................:. :• Date `Application Disapproved for they f ollowing reasons:.............. . ......_..� ' --...-•-• •---•--------•----- ./.-��.--1�_'_••-/ ! -----•---- ---- -----.._................._.......-............................... Date --^ Permit No...... . ----------•-•---•- ....................................................... . Issued .... _.... •.- .Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH —T`p wvv OF '�, 12��s � .......................................... .•..... Trrtif iratr of Tomphanre THIS IS TO CERTIFY, That the dividual,Sewage Disposal System constructed ( ) or Repaired.(,.).✓ - Installer at..•------•-•---•-�f0---•......��•--r........... ......... M- ` ., --------------------•------........................--------:............--•- r has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No........� ....... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY.' .,��� ::Z � DATE............. Inspector..... ,....=ram.,. .......-�;..� ....... ....................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH FEE. ..... Disposal Works Tonstrnttion V.rrntit Permission is hereby granted...........`�' .('' = ?� _ .............•-•-•........................................».... to Construct ( ) or Repair ( L)_an lndiidual Sewage Disposal Systemat No................................. ?' ,r_....... p'' ......, Street '.. as shown on the application for Disposal Works Construction Permit No... ._ . . . Dated.......................................... •----..--••-•............. �:::.��._.. -----------.---.-..............-•----. j Board of Health DATE---------------------------------------------........-....-------------- e , 9/16/03 Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems. Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM 1 hereby certify that the engineered plan signed by me dated concerning the property located at meets all of the following criteria: • This failed system is connected to'a residential dwelling orily. There.are.no.commercial or business uses.associated with the dwelling. • The soil is classified as.CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or.may conduct deep test holes and percolation tests.at the site without a health agent present. e There is no increase in flow and/or change in use proposed 0 There are no variances requested or needed. • The bottom of the proposed leaching facility will-be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the. Frimptor method when applicable] Please complete the following: A) Top of Ground Surface Elevation(using GIS information) 2 B) G.W.Elevation +adjustment for high G.W. 't u� _ DIFFERENCE BETWEEN A and B A(Ct 4 SIGNED : DATE: _, . NOTICE Based upon the above information-,a repair permit will be issued for bedrooms maximum.. No additional bedrooms are authorized in the future without engineered septic system plans. I qAsephc\perceXemp.doc �t Permit Number: Date: Completed by: HIGH GROUNDWATER LEVEL COMPUTATION �t T1r, �d Ate - --- Site Location: 1 � fl �y�� Lot No. Owner: �'S .�� "ir�r�;, Address: Contractor: e: -\ r r Tn1U U Address: 7 ,0 Notes: STEP 1 Measure depth to water table tonearest 1/10 ft. ..................................................:........................... .Date O month/day/year STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: t O Appropriate index well.......................................:............. OWater-level range zone ...................................... STEP 3 Using monthly report "Current Water Resources Conditions" -4 determine current depth to water level for index well ........................... mon h/year STEP 4 Using Table of Water level Adjustments for index well (STEP 2A), current depth to water level for index well (STEP 3), and water•level zone (STEP 2B) determine water-level adjustment .............................. STEP 5 Estimate depth to high water by subtracting the water• level adjustment (STEP 4) from measured depth to water level.at site (STEP 1) ........ .................... h Figure 13.--Reproducible computation form, • 15 ' TOWN OF BARNSTABLE LOCATION ` A E SEWAGE # � Q� VILLAGE _ �y�,p _z, d�4� ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. Cv10 '!SEPTIC TANK TANK CAPACITY BLEACHING FACILITY:(type) (size) `fiat./h NO. OF BEDROOMS PRIVATE WELL O IC W ER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: ri VARIANCE GRANTED: Yes No a s f 1 U - �3W'vU N1W:LV i --y - ALL OUTLET PIPES FROM THE CIat9`'11e3tK�RO fHAMBER cover must be SECTION A -A DISTRIBUTION sox SHALL BE 12• _ •NOTE Al_L PIPES ARE_ TO BE 4" SCHEDULE 40 P.V C SE!LEVEL FOR AT LEAST 2 FT CONCRETE COVER t0' min. from-- "/in 6• °' Grade PRUFILF. VIEW OF LEACHING SYSTEM �I house to septic tank --- -- - Existing Foundation D-BOX cover must be - tic tank covers must be •n f r KNOCKOUTS RFT s. Septic w/t 6' o Grade within 6 in. of finished grade ---Grade over Septic lonk 96 75 Grode over D--Bo. 9&50 ---fir°de over SAS - F1EV- f18.50 ' - NTanroc -- — a/�•r r r ' rrw cr..e.a srw. --e• N r/a-- r/s• r..A.a rra+.. T5.5' — I -__� •, OUTLET j r ,I• e1l,Ei .'Pew S 0 _ HOLE H-10 \\\\ \ — 02 3 E I 5-0.10 DIST BOX 3' Monmwn Cover Top of SAS-Elev.=94.63 15.5 '— -� X26' -- ul 1,000 GAL OR GREATER = --- 5- 0010" ver toot + r I n o ci 0 0 0 4" - SCH. 40 Te tXS' w o 25' -- ll n L� n o 0 0 o PLAN SECTION CROSS-SECTION SEPTIC TANK ,� �} u, fA 20• --2' ENeclive Depth 0 LD /-\ O O O ��_O 1' rn H-10 od e.rr N o 0 3 Units 2 8.5' = 25.5' FLU FOUNQA v ° „ � I � I3.25�-2s.s'-- I3.2 3 HOLE _H-10 DISTRIBUTION BOX u u II 4 — .--5 f 4 L� - SYSTEM PROFILE b in of 3/4"-1 1/2• m IV 0 �- l _ NOT TO SCALE :`" compacted stone o o _0 —'-13'- II Effective Length " i Not t0 Scale - C ' ®f:e(FrM VtNh:.3m�arr®2o}a N.t-1 F. Effective Width _------ I v SOIL ABSORPTION SYSTEM (SAS) GENERAL NOTES - c v GENERAL j 500 C H AO LEACHING UNITS / WIGGINS PRECAST 1. Contractor is responsible for Di safe notification j 6 in.of 3/4'-1 1/2" m -- - P g -- - - -- - compacted stone Not to Scale and protection of all underground utilities and pipes. NOTE: ALL COMPONENTS MUST HAVE RISERS TO VNTHIN 6" BELOW GRADE Bottom of Test-Hole-1 Elev.-86.50 2. The septic tank and distribution box shall be set -- -- -- - level on 6" of 3 4"-1 1 2" stone. ♦Obs. Groundwater - Test Hole 1 El NONE OBSERVED / 3. Bockfill should be clean sand or gravel with no -- ------- ---- -- -- stones over 3 to size. 4. This system is subject to inspection during installation by Carmen E. Shay - Environmental Services, Inc. 5. The contractor shall instoll this system in accordance PERCOLATION TEST with Title V of the Massachusetts state code, the approved plan and Local Regulations. j6. If, during installation the contractor encounters any Date of Percolation Test: MARCH 29, 2005 soil conditions or site conditions that are different Test Performed By: CARMEN E. SHAY, R.S. from those shown on the soil log or in our design P-suns Witnessed By. WAIVER (per BARNSTABLE B.O.H.) installation must halt & immediate notification design Excavated By SHAY ENVIRONMENTAL SERVICES, INC. I made to Carmen E. Shay - Environmental Services, Inc. be Percolation Rate: Less Than <2 MPI ® 30" I .NiF' l'/,II'FOIZI) .41.LF,N HETTL'.�' Y ' 7. No vehicle or heavy machinery shall drive over the PROJECT BENCH MARK septic system unless noted as H-20 septic components. TOP OF FOUNDATION 8. Install Tuf-Tite gas baffles or equals on all outlet tee ends. Test Hole ELEV. = 100.00 (Assumed) 9. All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipes. No. 1 ' _ I I -- --- --- - �{.- � - — 10. All solid piping, tees & fittings shall be 4" diameter Failed DEPTH SOILS ELEV. 0 98 50 i i II __ Cesspool 12 0.00 j Schedule 40 NSF PVC pipes with water tight joints. =1 EXIST. 11. Municipal Water is Connected to ALL OF The Residence and Abutting Sandy Loom i i I 1 BIR - Properties Within 150 Feet. 10 YR 3/2 +� i COTTAGE ---- 1 MOTE:. - THE PROPERTY LINES ARE APPROXIMATE AND Sand I --L- -- _ ( / COMPILED FROM THE PLAN BY BEARSE & KELLOG, YARMOUTHPORT, MA I 4" PVC EXIST. SHED / ENTITLED PLOT PLAN OFLAND OF RALPH & VIOLA GREENE-HYANNIS, MA 10 YR 5/6 I i Cleanout 'i1 OSTERVILLE, MA" DATED JULY 8, 1947, PLAN BOOK 80, PAGE 11 9'- 30" Be 96 OO�I 1 I to Grade EXIST. 1000 of. :i; AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN 9 IT SHOULD BE USED FOR NO PURPOSE OTHER THAN Medium I 1 I Septic Tank _ - Sand THE SEPTIC SYSTEM INSTALLATION " 10 YR 7/4 O O 1� 30 - 14a C, 86 50 f L EXISTING LEACH PIT TO BE PUMPED OUT AND CD � i 1 O FILLED IN PLACE OR REMOVED TO FACILITATE INSTALLATION OF NEW SAS. I i j � 1 o 0� I t I Failed I = EXISTING o Q NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE f- i I Leach Pit i 3 BEDROOM o -4 FROM THE EXISTING LEACHPIT TO BE DISPOSED -- E0 1 i I I o HOUSE -4OF AS PER BOARD OF HEALTH SPECIFICATIONS. I I L• --- i 1 ' NO WETLANDS ARE PRESENT WITHIN g0n' OF THE PROPERTY �I ' I L • ;' �" / 1t --- 77TTr \ ASSESSORS MAP 246, PARCEL 091 - — 2646'--- _ LEGEND Perc #1 i 1 32' L • ,9 Depth to Perc: 36" to 54"Perc Rate= 2 MPI , � DENOTES PROPOSED ' i i, Groundwater Not Observed I i r • TEST HOLE #1 \���- i o 1C4X1 No Observed ESHWT i 1 ELEV = 98.50 i '-f- - SPOT GRADE ADJUSTED H2O Elev. = None DENOTES EXISTING ' t 2.5'_-2\13=—1 I LOTS A&B x 104.46 f i ---_- I I r- SPOT GRADE 1 L ---98 - - - ---------------------- + ------�-------r� '2,000 Square Feet +` ++ 120.00' PL PROPERTY LINE \ nr L ----- 96P PROPOSED CONTOUR T� l ��- - ------ .�-- ------ ---- _ . . -- - --- -- --97 -- - -- ----- -- - -- -- - — - -- -- — —97 EXISTING CONTOUR '------------ -2-18• DIAM. ACCESS MANHOLES --- - ---- - ------- ----- --- ,L f A VF N tl A, DEEP TEST- B O LE(40 FOOT RIGHT OF WAY) PERCOLATION TESTcLOCATION 6 FOOT STOCKADE FENCE INLET Oil E T LOT P N I-_JTHEACCESS COVERS fOR THE SEPTIC TANK. LA DISTRIBUTION BOX AND LEACHING COMPONFNT .�•^..7 - 9:T T= SET DEEPER THAN 6 INCHES BELOW FINISHED '-. - '- ,.z .-• -. •. GRADE SHALL BE RNSED TO WITHIN 6. OF (, _ STEEL'REINFORCED PRECAST CONCRETE FINISHED GRADE. O F PROPOSED SEPTICSYSTEM UPGRADE PLAN VIEW VIEW INSTALL TUF-TITE GAS BAFFLES OR EQUALS PREPARED FOR 3-24• REMOVABLE COVERS �\ __--_---- _---- ------ — MR . J A M E S H A W h I N S I NOTE. CONTRACTOR TO NOTIFY DIGSAFF AND � ' ` CONTRACTOR TO VERIFY LOCATION OF ALL UTILITIES AT 3'min:clearance . ; I 1tr jj ` WT•T' • PRIOR TO EXCAVAI1uN 9 6 THIRD AV E N U E INLET a min.T 12" min. Inlet to outlet e.min _. d level ' I OUTLET -- ,. � � 14•5 r 5 -, ---- -- - -- H YA N N I S P 0 R T, MA _ 4-0 min. _.-- v e.°err 1-4ild depth } o I Design Calculations ��H q PREPARED BY: f j - _ Number of Bedrooms: 4 Bedroom EXISTING Garbage Grinder. No P R N CA T E. SHAY 6'-0" -- - 4' -1O- _ Leaching Capacity Required: 440 Gal./Day (MIN. PER TITLE V) CROSS SECTION END-SECTION Septic Tank - 2 x 440 Gal./Day = 880 USE EXIST. 1,000 GAL. Septic Tank. O 20 40 5 S co NVIRONMENTAL SERVICES, INC. SOIL ABSORPTION AREA Using percolation rate of <2 min./inch Bottom Area: 0.74 gal/sq. ft. x 416 sq. ft. = 307.84 gallo,)s —-- - - -- -- NO 10P.O. BOX 627 TYPICAL 1000 GALLON SEPTIC TANK Sidewall Area: 0.74 gal./sq. ft. x 180 sq. ft. = 133.2 gallons /STEM EAST FALMOUTH, MA 02536 NOT TO SCALE ' EJ Providing. = 441.04 gallons 41YITAR\PN Use: (3) PRECAST 500-C H-W UNITS, HAVING A 2' EFFECTIVE DEPTH, SCALE: 1 "=20' TEL/FAX 508-548-0796 TO BE USED WITH 4' OF WASHED STONE ON THE SIDES AND SCALE: 1 "=20' DRAWN BY: CES DATE: MARCH 30, 2005 3.25' OF WASHED STONE ON THE ENDS. ` PROJECT#SD712 FILENAME: SD712PP.DWG SHEET 1 OF 1 2.� ASSESSORS MAP: TEST HOLE LOGS PARCEL: , ► ►l l� _ _�__ _ ___-_._.__. __ _ I) The installation shall comply ►vtlh Title V and Town of oard ol. GP FLOOD ZONE: tit'` SOIL EVALUATOR: L lealth Regulations. �� 1 I -- WITNESS : r- 2) The installer shall verify the location of utilities, sewer inverts and septic REFERENCE: 1 -7Z # DATE: ---73y t' O _ --- � f _ _J��J components prior to installation and setting base elevations. P PERCOLATION RATE: Off`"_—(.,y4k^ __.._ _ C► H q z- 1 ' 1 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8" per foot. The first two feet ont of the d-box to the leaching shall be level. TH- 1 TH-2 4) This plan is not to be utilized for property line determination nor any other ; purpose other than the proposed system installation, \ Pixy ) I � t 10 �t 5) All septic components must meet Title V specifications. I 6) Parking shall not be constructed over 1110 septic components. wy', S'/4`(„�— LAB 7) The property is bounded by property corners and property lines. lt) , � L 8) The property owner shall review design considerations to approve o LOCATION MAP y l g --- �'� � design g pp f total gn flow and number of bedrooms to be considered for design. Receipt of payment for the plan and installation based on the plan shall be deemed approval of the design flow by the owner.. CI 9) The existing leaching or cesspools shall be pumped and filled with material � P p per Title V abandonment procedures. Those within the proposed SAS shall be removed along with contaminated soil and replaced with clean sand per 0 � �b,lJ `'l'l �,1,Q ( '' bCj Title V specs. t"1`ti ' 10)System components to be 10 feet from water line. Sewer !fines crossing the water line shall be sleeved with 4 inch SCf 140 PVC with ends grouted if - --` applicable. The proposed SAS is being installed below the water service line. The line is to be sleeved as aforementioned and maintained in place. SEPTIC SYSTEM DESIGN 11) If a garbage grinder exists it is to be removed and is the responsibility or the 1. owner to ensure such. ' FLOW ESTIMATE 12)The installer is to take caution in excavation around the gas line if such ' N/F CLIFFORD AL! N BETTES I exists. PROJECT BENCH MARK 4 BEDROOMS AT 110 GAL/DAY/BEDROOM GAL/DAY 13)'Fiie installer shall verifythe location quantity and elevation of the sewer ' TOP OF FOUNDATION , q Y ' lines exitinn the dwelling "rior to the installation. t t` °p I ELEV. = 100.00 (Assumed) g p 14 `i'his Ian is representative only that a s stem can fit on a property meeting SEPTIC TANK ) p p y y Foiled 120.00' Title V requirements. _ cesspool ' / GAL/DAY x 2 DAYS GAL EXIST. ' , �••• 1 1 -BR 4+_,, �� _ --99 USE 1UJj GALLON SEPTI TANWFj(iy'(�1 �1� COTTAGE ,� S�I L At:3SORPTI ON SYSTEM _ __ -------------- �'S DD 4" PVC ti EXIST. SHED _ f 3 �� . ,t L �• , Cleanoul _ i t to Grade - v nn / u� - Q•i ' , EXIST, 1000 ga(. • 1 1 i� Septic Tank ,� ---"__- -` � � � 0r,L1'1S ; r o , ' " S I DE AREA: 0� o o O o BOTTOM AREA: , '� n1 = �� j MAS01`1 �; m t ' I ed = XISTING p ,� ' p No.1066 L och Pit j BDROON .., 1� O i ; I�—s - .-, ,� ��I a HOUSB SN' _ SEPTIC SYSTEM SECTION tI 1 2B.16 1 t 6' &I An t i .., (4p) i • TEST HOLE N 1 t ► ELEV 98.50 t '1' �"► �t�Y. �tfri/� _.. LOTS A&B --- ------98 aFI'1.� A�tt(t �, ---� • ---------- -------' 12.000 Square feet +/- I I 0� v Ck r 1 12 0.00' ---— - -- b -i-- GAL .Qj A11' -I"l -- - --- ------- SEPTIC, TANK `� -� . I , ---_ -- -- V1�W�5_ 70 (4-- FOOT RIGH1 C7 WAY) - �) SITE AND SEWAGE - PLAN LOCATION : PREPARED FOR bL �10 P , O. M 0 S ALE: W DAV I D B . MASON R5 DATE: 1 0� z DBC ENVIRONMENTAL DESIGNS 0 DATE HEALTH AGENT EAST SANDWICH . MA W ( 508 ) 833- 2177 Z