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HomeMy WebLinkAbout0017 VANDERMINT LANE - Health Fl 7 Vandermint Lane Hyannis A- 250—052 e I i TOWN OF BARNSTABLE n LOCATION 11 SlfaAer(Aillh' SEWAGE # VILLAGE Stairm s ASSESSOR'S MAP &LOT--` — Z re, INSTALLER'S NAME&PHONE NO. V—M l pn�r Cur S SEPTIC TANK CAPACITY LEACHING FACILITY: (type) Lit' 9► ¢ (size) a WI 5 NO.OF BEDROOMS__ BUILDER OR OWNER Anne- 4Jw k}�a r PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist !within 300 feet of leaching facility) Feet Furnished by i i Ali a$' Q 3 N Q3 as' y inSPe�,�. TOWN OF BARNSTABLE LOCATION SEWAGE # � L+ VILLAGE 0 t^� S ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) r✓Jo S (size) NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) ' Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet1 of leaching facility) Feet Furnished by& � (n3 f :(f!et,4 10 /2*h V ,' � _" -- � ,I 1 N N _ 1a,, �� W .� � � --� CN J, �-;' cE �: � - No. Fee ✓ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,, MASSACHUSETTS 01ppli.Eation for Mi0pogaf Op$tem Construction Permit Application for a Permit to Construct( . )Repair )Upgrade( )Abandon( ) ❑Complete System El Individual Components Location Address or Lot Non? ancie-im,44- Owner's Name,Adaresp and Tel.No. ' I Assessor's Map/Parcel 1 —�-Q�'� rn Jy 0 :, f Inggiler's Name,Address,and Tel.No. � Desi ner's Name,Address ano Tel.No. r' � � ��� `-'Z37rn cY,2e i I( SSo� 2'n G 3t3 i4v!tu c2d- U : OQnn i.S 1s73 majn s 13nervs-�er Otm Type of Building: ` Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date i Number of sheets Revision Date Title Size of Septic Tank 15-00 Type of S.A.S. 0 Description of Soil ®om u 4 mecuit-M SQ.n Ce Nature of Repairs or Alterations(Answer when applicable) E 1C_ 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 Environm tal Code an n tt to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Heal Signed � Date 3 �` �� Application Approved by P�1��/ D/lv��t�_ Date jQ11, 14 Application Disapproved for the following reason oF Permit No. i ��.5 y Date Issued b +'b 100 No. f Fee Entered in computer: THE COMMONWEALTH OF MASSACHUSETTS Z Yes 1 PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZppYication"for �Digpogal *potent Congtruction Permit Application for a Permit to Construct( )Repair K)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot Nol? V Q yl e rm;O' h a o.� Owner's Name,Addres and Tel.No. I 170+ �aA S Alme Motffier 9s Assessor's Map/Parcel �� 14SO, 05 (,[ S4er, m q o a & 3 1_3 . Ins�t)aller's Name,Address,and Tel,No. Designer's Name, j ,Address and Tel.No. r1 60�-lra rFo oC. Z""Vy) al,ke i 11 a 313 H to u u rrl _ c 126 - t� . 0e n n 1 S t Z-73 8��9� s E3nP t.vs+ec Type of Building: w, Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date/ate Number of sheets Revision Date Title _ Size of Septic Tank I,500 Type of S.A.S. oe-,61 nA ire nchN -� Description of Soil [0:0 ed i u fn .50 n_Ij t Nature of Repairs or Alterations(Answer when applicable) Q Ic r Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Boaz ealth. Signed Date Application Approved by 1��' Date ?J 1 y Application Disapproved for the following reason Permit No. I �r 1 ---.� Date Issued THE COMMONWEALTH OF MASSACHUSETTS ' BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired k Upgraded( ) Abandone ( )by 0 : C: ) _. e— at I �I C102 r 'ti A has been constructed in accordance ` with the provisions of Title 5 and the for Disposal System Construction Permit No. UI�_ �� dated it Installer km �n chDr5 ::rhC,- Designer The issuance of thi�}permit shall not be construed as a guarantee that the system w'11/ftanction`a desi ned. Date Lf 19 fit Inspector- - �i _ (—�q-- No. �� —Qr.J� ------------------------Fee l l 1 V c THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Migpogal 6pgtem Congtruction Permit Permission is hereby granted to Construct( )Repair( „Upgrade( )Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. Date: c7-"� Approved by J Town of Barnstable PyoFs '�y Regulatory Services Richard V. Scali,Interim Director + BABNSPABL% �$ b 4 g Public Health Division a�EDM A Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: 4/27/15 Sewage Permit# 2015-052 Assessor's MaplParcel 250/52 Designer: J.M. O'Reilly&Associates, Inc. Installer: PKM Contractors Address: P.O. Box 1773 Address: . P.O. Box 775 Brewster, MA 02631 East Dennis, MA 02641 On 3/25/15 PKM Contractors was issued a permit to install a (date) (installer) septic system at 17 Vandermint Lane based on a design drawn by (address) J.M. O'Reilly&Associates, Inc dated 12/2/2014 (designer) I certify that the septic system referenced above was installed substantially according to he 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. F,P��H OF Mgss ELI certify that the system referenced above was cons co comph 'th the terms of the 11A approval letters(if applicable) JOHN O'IEILLY rni �(� c� CIVtL U) oII�x. NO.36200 (Instal er's Signature)— etONAL �- ( e ' er's igna re (Affix Designer's Stamp Here) PLEASE RETURN V0 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. QASeptic\Designer Certification Form Rev 8-14-13.doc Town of Barnstable FBarnstable Regulatory Services Department i M"s[� s 8 639 Public Health Division A 200 Main Street, Hyannis,MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL # 7012 1010 0000 2851 3863 October 6, 2014 Anne Walther 95 Holly Avenue Brewster MA 02631 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 17 Vandermint Lane,Hyannis, MA was last inspected on . 9/12/2014, by Sean Mcelroy,,a certified septic inspector for the Sate of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • Backup of sewage into facility-or system component due to overloaded or clogged SAS or cesspool. • Liquid depth in cesspool'is less than 6" below invert or available volume is less than V2 day flow. You are ordered to repair or replace.the septic system within sixty (6) days from the date you receive this notification. Failure to repair/replace the septic system with the deadline period will result in future i enforcement action. PER ORDER OF THE BOARD OF HEALTH cKean, R.S., CHO. Agent of the Board of Health lrp ! Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\17 Vandennint Ln HY Oct 01214.doc i v JE http;f jissgl2JintranetiprDpdataJPanelDetaiLaspx?ID=18200 Live Search p ' ®Application Center(2) ®http--mmtown,barnstable... Application Center ®Suggested Sites Web Slice Gallery Favorites ®Parcel Detail i $ tiSTAIfIE 1 t ._ ' MASS. 1 Parcel Info k 1 Parcel — Developer i ID 250.052 I Lot LOT 4 3., Pn' g Location 117 VANDERMINT LANE I 208 Frontage Sec Sec RoadI I Frontage 9 L . Fire Village HYANNIS - --_I HYANNIS District Town sewer exists at this Road Index 11759 address IND ; Asbuilt Septic Scan: Interactive ' - i°I 250052_1 Map - - , EY I v Owner Info Owner IWALTHER,ANNE I Co-Owner Streets 195 HOLLY AVENUE I Street2 I city BREWSTER I State Zip 02631 Country T Land Info Acres 0.34 Use Single Fam MDL-01 Zoning RC-1 Nghbd 0105 Local Intranet 100/0 Start iJI Parcel Detail Wind 9;58 AM �� �1 ��J ��� 1 0 C' "'& S Commonwealth of Massachusetts �'. Title 5 Official Inspection Form �o 0 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments '? � � �G r�a�.QV'v✓1 f ✓� T G--/lam Property Address Ory ner ON ner's Name Information is14' required for every ✓1 r S V /� .�--- page. City/Town State Zip Code Date of{ spectlo 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. fmpooutf rrris A. General Information filling out forms W� on the computer, 1N, use only the tab 1. Inspector: key to move your ' cursor-do not use the return key. Name of Inspector X/r/l /7 J Company Name Company Address cr f�'1 City/7own l,^ n� State Zip Cade Telephone Nwy6er V / j 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..Thejospection was performed based on my training and experience in the proper function and maintenance of on situ - sewage disposal systems. i am a DEP approved system inspector pursuant to Section 15.1-40 of mZ Title 5 (310 CMR 15.000). The system: w•°= `l t ❑ Passes ❑ Conditionally Passes Fails CD ❑ Needs Further Evaluation by the Local Approving Authority -- cr, y i=y3 rYJ CD Inspec is Signature I Date The ystem inspector.shall submit a copy of this inspection report to the Approving Authority (Board of H alth or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 god or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DER 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. 15fns•3113 _ - Title 5 Official Ins l�ecti.Form ace SewageOlspcsalSystem•Page1of17 s Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r l V,�:; C) ✓/YI i rit G—N r Property Address Ow ner Qv ner's Name Rcj Information isSrequired for every 'A00/ page. City/Town State Zip Code Date of IrApectiorY B. Certification (cont.) Inspection Summary: Check A,B,C,D or E ! always complete all of Section D P rY 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 CM 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 Healt h. *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): t5ina .3I13 Title 50fficial Ins pecton Form Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address / / l,�✓ G1 � e✓ Ovv ner ON ner's Name Information is �� required for every // page. My/fown State Zip Code Date of specti n 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): t ❑ 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 mannerwhich 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 Or*.3,113 Title 50"cial Inspection F am Subsurface Sewage Disposal System-Page 3 of t'7 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Oar ner ON ner's Name information is required for every -- page. C;77own State Zip Code Date of 4nspedtion B. Certification (cont.) 2. System will fait 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 ogged SAS or cesspool ❑ harge 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 E3 ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow 15ins-3a13 TIUs 5 01 rwial iris pection F orm Subsui ace Sewage Disposal System•Pega 4 of 17 Commonwealth of Massachusetts ~f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments z " J Property Address Cw ner ON ner's Name Fl information is S rJ c�6 0 1 required for every page. 5 flown State Zip Code Date of nspec n B. Certifica ion (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: ❑ iny 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 orprivy is within a Zone 1 of a public well. ❑ L�' 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, r failure criteria are triggered. A co of the analysis vided that no other p ro 9g Y 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 bij.6. 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. t5 m-3113 TiVe 5 010clei lns pec tlon F orm su psurf ace sewage Disposal system•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form t Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address Ow ner Cw ner's Name (y information Is A4 �a 6 0 required for every �r✓1�! page. City/Town State Zip Code Date of I spectio C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ l� P m in information was provided b the owner, occupant, or Board of Health P 9 P Y P e ❑ 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? ❑ W e 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? ❑ ere all system components, excluding the SAS, located on site? ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank ins e'd for the condition of the baffles or tees, material of construction, mensions, 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? T e 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): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x #of bedrooms): t5ins 3113 Title 5 Official Inspection F orm SubsLrf we Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Gi v� B v Property Address Ow ner ON ner s Name information is required for every page. City/Town State Zip Code Date of Inspection D. System Infor ' Description: Number of current residents: Does residence have a garbage grinder? ❑ Yes Er No Is laundry on a separate sewage system? (Include laundry system inspection 0 Yes No information in this report.) Laundry system inspected? ❑ Yes No Seasonal use? ❑ Yes Ul-K10 Water meter readings, if available (last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes No (mot- yew f Last date of occupancy: gate 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.): 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: t5itls-3/13 Me 5 olOcial inspection F crm Subsuiace Sewage DI sposl System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form J- Not for Voluntary Assessments Property Address ON ner Owner's Name / information is required for every �-►✓I S ��6�% La' page. City lTown State Zip Code Date of 16specti6n 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: gallons How was quantity pumped determined? Reason for pumping: Type of System: ❑ Septic tank, distribution box, soil absorption system ❑ ,---ogle 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): 151ns•3113 Title 5Offlcial Ins pecUcnForm Subsurface Sewage Disposo System-Page 8of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewa ug ge Disposal System Form - Not for Voluntary Assessments Property Address Ow ner 5 ner's Name information is required for every ✓t•✓1 f /�!/�" yr p[., page. City/Town State Zip Code Date of I spection D. System Information (cont.) Approximate age of all components, date installed (if kno a d so rce of information: Were sewage odors detected when arriving at the site? ❑ Yes Q No Building Sewer(locate on site plan): Depth below grade: feet Material of constructi;�40 El cast iron PVC ❑ other(explain): / Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: feet Material of constructions ❑ concrete . ❑ metal ❑ fiberglass ❑ polyethylene yethyl ene ❑ 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: Sludge depth: t5ins-3/13 Title 50 facial lnspecticn Form Subsurface Sewage Disposal System.page 9of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal S/ystteem Form -Not for Voluntary Assessments r,ode Property Address �� I Ow ner CW ner's Name information is 14 required for every trl G;44 ff � page. cttyfrown State Zip Code Date of nspection D. System Information (cont.) cont. Septic Tank p (cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease Trap (locate on site plan): Dept h bel ow g ra de: feet Material of construction: ED 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 f Date of last pumping; Date t5ins-3/13 TlUe5olAclel Inspectlon F orm Suosulace Sewage0lsposel System-Page 10 of 17 Commonwealth of Massachusetts k.i Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments d / �oi vt �$./✓`�i vti Property Address ner oN ner's Name Information Information Is �a 6 O f required for every ..._.. page. City rrown State Zip Code Date of Inspectio D. System Information (cons) 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): Dept h bel ow g ra de: 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: pate Comments (condition of alarm and float switches, etc.): i 'Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No Ons,3113 TiOe5MCA ins pec Oon Form Subsulace Sewage Disposal System-Pagel 1 or 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form • Not for Voluntary Assessments Property Address ON ner Cw ner's Name Information is f (o required for every � page. CRyrTown State Zip Code Date of spectiofi D. System Information (conQ Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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,): Pump Chamber (locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soll Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: 15ins•3113 Title 5 Official Iropectimform SubsLeace Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address Ow ner Owner's Name information is required for every page. Cityrrown .State Zip Code Date of in pectin D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): �Q�/-- 1 rp �✓ pSS o0 o Cl 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 7Yes Materials of constructionIndication of groundwater inflow �t&ns,3/13 Title$01ficid InspectonForm Suel System•Page 13 of W Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments V7 V / 7 /f �rH � L y �� Py Property Address /�fJ Cw ner Cw ner's Name /��� Information is /� /� J required for every fi 0✓l page. City/town State Zip Code Date of I pection D. Systeni'l nformation (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): V I� O(�✓ H � 74 ef 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.): tws-w3 TIOe50l8cial Ins pec bon Form Subsvface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal S�ysttee Form -Not for Voluntary Assessments r- l V '„ ✓1 ✓/�1 ✓� / � Property Address Cw ner Cw ner's Name information is � V1 V1 t f o d Go/ required for every --- �! page. City rrown State Zip Code Date of Inspection D. System nformation (cont.) Sketch Of Sewa a Disposal System: Provide a view of the sewage disposal system, including ties to at least twspefmanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where lic water supply enters the building, Check one of the boxes below: hand-sketch in the area below ❑ drawing attached separately �C 1/4 t V-�e o tor" C'e 5 SP�a Al -31 t5in.s•3113 Title 5Of6dal Ins pection F orm Subsulace Sewage Disposal system•Pape 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,Z 2 ci H �.Q��vr ✓� T' /t/ Property Address / Ow ner ON ner's Name information is required for every Z& Ot V101 I // page. City/Town State Zip Code Date of lnsp6etion D. System Information (cost.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 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: pate ❑ 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: 6�,9, 4 11qG �a t�,✓t a rLr 1 02 0/f� -- l 0 U � VL Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5lns•3113 Tiue5Offlcial Ins pecuonForm Subsurtace Sewage Disposal System Page 16of 17 ssachusetts Commonwealth of Ma Title t e 5 Official Inspection Form ayo Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address ON ner Cw ner's Name information is4 required for every / page. Cityf row n State Zip Code Date of specti n E. Report Completeness Checklist Inspection Summary; A, B, C, D, or E checked Ell-inspection Summary D (System Failure Criteria Applicable to All Systems) completed 01-ISYst Information—Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file 9 p Y p9 p t5rts•3113 T119500clal InspoebonForm Subsurface SewogeDisposd System-Page 17 of 17 Town of Barnstable P Department of Regulatory.Services t Public Health Division DateAll i sap.a 200 Njain street,Hyannis MA 02601 Date Scheduled Ili/: Time 41 1 Fee Pd. & 0 Soil Suitability Assessment for Pafamed By. Witnessed By: / LOCATION&GENERAL INFORMATION Location Address1 i- Owner's Name R,,N- WJ oL l�h B� n VGY?G2fmtrlit t�Ylt; Address CtS 1A0tk I A,)e- N-yG�r�r�ts QX'euws�e, mA OaOi Assessor's Map/Parcel: aso& .Engineer's Name V,6 �P�YX.emiesi Q NEWCONSTR�UCTION REPAIR ' Telephone# ( Law Use 1"W�JQAJ CQ Slopes(%)(` SorfaceStones_�+/Yt� DDistances ftoio open wets Boar i ft Posthle wet Atea7l!W, ft Dtinlvng water wev�lQU f2 Drainage way >I(jo` fl Propr ky Linn �!C), 8' other It SKETCH:(Street Dame diamsims o lot,exact locations of test hohre At pert tests,locate wetlands in proximity to holes) U��er .3' �Ve- 1 `-- ZE Parent mat etiai(8.k4ft)0l AW Q 1 I ev\ Depth to Bedrock V l — �.) Depth to Gmw dwater:Standing water in Hole: I weeping from Pk Pace PJA ^ . estimated seasonal High Grease neater �` DETERMINATION FOR SEASONAL HIGH WATER TABLE v � Method Used: r� C-r Depth Observed standing in obs.hole: in. Depth to enil tnetties: is F%l/l(�fiW Depth to weeping ftom side of ore.hole: in. Grotmdwaw A*stment R Index Well# Reading Date: Index Well level -A4-,&ctor Adj.Groundwater level_ PERCOLATION TEST Date Time / Observation Hole# - - Time at 9" ' Depth ol'Perc (0 0 .- Time at 6" - Start Pro-soak Time Q - V t Time(V-6") - End Pro-soak Rate MinAlnch Z fb►.�/� i n�, ®•`�OV - - Site Suitability Assessnsont: Site Passed_ Site Failed: Additional Testing Needed(Y/N) Original:Public Health Division Observation Hole Data To Be Completed on Back ***If percolation teat is to be conducted within 100'of wetland,you mast first notify the Barnstable Conservation Division at least one(1)week prior to beginning. r DEEP OBSERVATION HOLE LOG Hole# I Depth from Soil Horizon .Soil Texture Soil Color Soil Other - Surface(in.) - (USDA) - (Mansell) Mottling (Structure,Stones,Boulders. - - r 0� f ,4" AA S4" (L5lC. Ue t SGAd I LA 5--toY. ®tee DEEP OBSERVATION HOLE LOG Hole# Depth.from Soil Horizon - Soil Texture Soil Color -- Soil Other , Surface(in.) (USDA). (Munsell) Mottling (Structure,Stones,Boulders. ConsistencL%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil.Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. Consistency.%Graver) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon' Soil Texture Soil Color. Soil Other ' Surface(in.) (USDA) (Muusell) Mottling (Structure,Stones,Boulders. - --< - Consistency,% .ravel) ' Flood Jusu'once Rate Man: Above 500 year flood hamdary No_ Yes Within 500 year boundary No f V Yes` Within 100 year flood boundary No K Yea_ Delm of Naturally Oecurrim Pervious Material Does at least four feet of naturally occurring material exist M aQ mess observed throughout the area proposed for the soil absorption system? es If not,what is the depth of naturally occurring pervious material? Cerdocatioa I certify that on (date)I have pealed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,expertise and experience described in 310 CMR.15.01r7. Si :9 Date Y Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 17 Vandermint Lane, Hyannis _ M -250 P-52 Property Address c/o Attorney Michael Hayes Owner Owner's Name information is required for every 23 East Main_Street, West Yarmouth MA_ 02673. October 20, 2010 — _ page. CitylTown 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 filling out forms A. General Information _ on the computer, 693 use only the tab 1. Inspector: key to move your cursor-d.o.not Troy-Williams _ use the return key. Name of Inspector Troy Williams Septic Inspections Company Name I 19 Hummel Drive Company Address . South Dennis MA_._ 02660 City/Town State Zip Code- (508)385-1300 _ _ S1682 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 ❑ Fai s ❑ Needs Further Evaluation by the Local Approving Authority co � P0 October 20, 2010 Inspector's Signature Date N Ca The system inspector shall submit a copy of this inspection report to the Approving Aut[Rity(VFiard 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. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 I ,J Commonwealth of Massachusetts Title 5 Official inspection Fora Subsurface Sewage Disposal System Forme- Not for Voluntary Assessments r 17 Vande_rmint Lane, Hyannis Property Address --- ---— ------ M -250 P -"52 Michael Hayes Owner Owner's Name information is required for every 23 East Main Street, West Yarmouth MA 02673 page. City1rown - October20, 2010 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: I This inspection is not a guarantee or warranty on the future working conditions of cesspools, pipes or the structural integrity of cesspools. Cesspools or pipes may need repairs prior to the expiration of this report. Upgrade to Title V would be recommended. 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 - Health: of * 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): N/A ' lr; t5ins•o9/o8 r' Title 5 Official inspection Form:Subsurface sawage Disposal system;Page 2 of 17,;;' �t�}}i• Commonwealth of Massachusetts Title 5 Official Inspection Form A o Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 17 Vandermint Lane, Hyannis M -250 R-52 Property Address -- Michael Hayes Owner Owner's Name information is required for every 23 East Main Street, West Yarmouth MA 02673 October 20, 2010 page. City/rown — 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): N/A ❑ 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): N/A _ 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 a ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh Fir t5ins•09/08 i Tale 5 Official Inspection Form Subsurface Sewage Disposal System;Page 3 of 17 r ar ii,1';.o w Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1,7 Vandermint Lane, Hyannis IVI-250 P-52 Property Address Michael Hayes Owner Owners Name — information is required for every 23 East Main Street, West Yarmouth MA 02673 October 20, 2010 Cit Y page. crown _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. I ❑ 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 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: N/A 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 ❑ ® Dis'h"arge or ponding bf effluent to the surface Of ft1e.ground or surfacewiiaters 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 0 ® Liquid depth in cesspool is less than 6" below invert or available volume Is less than '/z day flow t5ins•09/08 +' Tdfe 5 Official'inspection form:Subsurface Sewage DisQosal System Page 4 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal,System Form- Not for Voluntary Assessments w 17 Vandermint'Lane�annis M-250 P-52 Property Address Michael Hayes Owner Owner's Name information is required for every 23 East Main Street, West Yarmouth MA 02673 October 20, 2010 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. i ❑ ® 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 g d to 15,600 gp d. _ P 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. t51ns•08/08 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System Pa 9 ge 5 of 7 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1.7 Vander._mint Lane, Hyannis. M -250. P.-52 _ Property Address Michael Hayes Owner Owner's Name information is required for every 2_3 East Main Street, West Yarmouth MA 02673 October 20, 2010 page. Cityrrown 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? i ❑ ® Have large volumes of water been introduced to the system reeently or as paid 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? Ji ® ❑ 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): 3 -- Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 gpd t5ins•09/08 T1tle 5 Official Inspection Form Subsurtace Sewage Disposal system Page a Of, J i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 17 Vandermint Lane, Wannis M-250 P--52 Property Address — —-- ----- - Michael Hayes Owner Owner's Name — information is required for every 23 East Main Street, West Yarmouth MA 02673 October 20, 2010 page. CitylTown State Zip Code Date of Inspection B. System Information Description: N/A Number of current residents: 0 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 years usage (gpd)): 09= 12,000 gals. Detail: 08= 17,000 gals. Sump pump? --- --- ❑ Yes ® No Last date of occupancy: occasional use Date Commercial/Industrial Flow Conditions: Type.of Establishment: N/A Design flow(based on 310 CMR 15.203): N/A Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): N/A Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No 'F _ t Water meter readings, if available: N/A �' �,: p t5ins•09/08 TNe 5 O[ficial Inspection Form:Subsurrace SewaB a Dls sal S fir Zlqd a'�a .e Po ystem t Pa9e T,o ;7, , Commonwealth of Massachusetts -- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 17 Vandermint Lane, Hyannis _ M -250 R-52 Property Address Michael Hayes Owner Owner's Name information is required for every 23 East Main Street, West Yarmouth MA 02673 October 20, 2010 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: N/A Date Other(describe below): N/A I General Information Pumping Records: Source of information: NoRumping info available. Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: N/A _ gallons How was quantity pumped determined? N/A Reason for pumping: NIA------ __ Type of System: Septic tank, distribution box, soil absorption system ❑ Single cesspool ® Overflow cesspool 0 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 I, inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): to t5ins•09/08 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 17 Vandermint Lane, Hyannis M -250 t?-52 Property Address Michael Hayes Owner Owner's Name information is required for every 23 East Main Street, West Yarmouth MA 02673 October 20, 2010 _ 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: Ori inal to building built approx. 40 years ago. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1811+ r feet Material of construction: ® cast iron ® 40 PVC ® other(explain): orangeburg Distance from private water supply well or suction line. N/A feet ' Comments(on condition of joints, venting, evidence of leakage, etc.).- Lines were found clear at the time of inspection. Sch 40 from home to main cesspool. 1 Septic Tank (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass El polyethylene El other(explain) N/A If tank is metal, list age: N/A years Is age,confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: N/A t Sludge depth: N/A K' t`�, - 15ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 9 of 17 wy, f rr Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 17 Vandermint Lane, W annis _ M -250 F--52 Property Address Michael Hayes Owner Owner's Name information is 23 East Main_Street West Yarmouth MA _ required for every _ � 02673 October 20, 2010 _ page. City/Town State Zip Code Date of Inspection ©. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle N/A_ Scum thickness N/A Distance from top of scum to top of outlet tee or baffle" N/A Distance from bottom of scum to bottom of outlet tee or baffle N/A I How were dimensions determined? N/A Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): N/A Grease Trap(locate on site plan): Depth below grade: N/A feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: N/A Scum thickness N/A Distance from top of scum to top of outlet tee or baffle N/A Distance from bottom of scum to bottom of outlet tee or baffle N/A � Date of last pump N/A ing: Date e t5ins•09/08 Title 5 Official Inspection forma Subsurface sewage Disposal system",Pape too 7 � �� 4 �tWFh� re s r a� " tiG r u it , T Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 17 Vandermint Lane, Hyannis M -250 R-52 Property Address Michael Ha es Owner Y------------ — -- Owner's Name information is required for every 23 East Main Street, West Yarmouth MA 02673 October 20, 2010 page. City/Town State Zip Code Date of Inspection ®. 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.): N/A l Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: N/A Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: N/A Capacity: N/A gallons Design Flow: N/A — gallons per day Alarm present: ❑°Yes ❑ No Alarm level: N/A-- --- - --- Alarm in working order: ❑ Yes ❑ No Date of last pumping: N/A Date Comments (condition of alarm and float switches, etc.): N/A "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No (Sins 09l08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System s Page 11 of 17 S� 1 • .. t .0+ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form.- Not for Voluntary Assessments w 17 Vandermint Lane, Hyannis M -250 R-"52 Property Address Michael Hayes _ Owner Owner's Name — information is 23 East Main Street, West Yarmouth MA 02673 October 20, 2010 _ required for every _ — page. CitylTown 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 N/A 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.): N/A 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.): N/A Soil Absorption System(SAS) (locate on site plan, excavation not required).- If SAS not located, explain why: N/A i t5ins•09/08 - Title 5 Official Inspection form:Subsurface Sewage Disposal System-Page 12 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 17 Vandermint Lane, Hyannis M -250 P-52 Property Address Michael Hayes Hayes _ Owner Owner's Name information is required for every 23 East Main Street, West Yarmouth MA 02673 October 20, 2010 _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers- number: — ❑ leaching galleries number: ❑ leaching trenches ' number, length: ❑ leaching fields number, dimensions: ® overflow cesspool number: 1 -5'X 5' ❑ 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.): Cesspool was found dry on inspection with a visible stain line approx. 2' below inlet line. No evidence of hydraulic failure or problems in the past were found present at the time of inspection. Verizon telephone line'goes over edge of cover. Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration main cesspool • Depth—top of liquid to inlet invert 5' dry 3" Depth,of solids layer Depth of scum layer none _ Dimensions of cesspool -5' X 5� Materials of construction cesspool block Indication of groundwater inflow ❑ Yes ® No ,3'ik t5ins•09108 Tina 5 Official inspection Form:Subsurface Sewage Dlapoaal System Papa 13'0(17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r 17 Vandermint Lane_Hyannis__ M -250 P.-52 Property Address Michael Hayes Owner Y--------------- ---- ------ Owner's Name information is 23 East Main Street, West Yarmouth MA 02673 _ required for every .-- _ _ October 20, 2010 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.): No evidence of hydraulic failure was found at the time of inspection. Tees were present on inlet and outlet lines. Walls were stained up to outlet invert and found clean above. r Privy (locate on site plan): Materials of construction: N/A -------- Dimensions N/A -- -- Depth of solids _N/A Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/A f t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System,.Page 4 of 7 1 1 14((i 4 7 aid. 6Cs Commonwealth of Massachusetts Title 5 Official Inspection Form e Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 17 Vandermint Lane, Hyannis M -250 P-52 Property Address -- Michael Hayes Owner Owner's Name --- -- —information is 23 East Main Street, West Yarmouth MA 02673 October 20 2010 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 0 wd--v C,. , T ' l � pFr✓w- l 2 311 3btsrt r t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 17 Vande_rmint Lane, Hyannis M-2250 P -*52 Property Address_.__—__....� Michael Hayes _ Owner Owner's Name information is required for every 23 East Main Street, West Yarmouth _ MA 02673 October 20, 2010 _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ❑ Check cellar ❑ Shallow wells l Estimated depth to high ground water: 20.0'+ 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: ❑ Checked with local excavators, installers (attach documentation) ® Accessed USGS database-explain: AIW 230 Zone D 22.2' _2.3 adustment You must describe how you established the high ground water elevation: .Hand auger hole 4' below bottom of deepest cesspool with no water found at 12.5'. Groundwater adjustment in area at the time of inspection was 2.3'. USGS groudwater map for Barnstable shows groundwater to be approx. 38.4' below grade. Bottom of deepest cesspool at 8.5'was found dry and not to be located in the high groundwater elevation. Before filing this Inspection Report, please see Report Completeness Checklist on next page. r t5ins•09I08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 i Commonwealth of Massachusetts. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 17 Vandermint Lane, Hyannis M -250 P -52 Property Address Michael Hayes Owner Owner's Name informationis required for every 23 East Main Street, West Yarmouth _ MA 02673 _ October 20, 2010 _ page. City[Town 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 I t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 No. 1200? —(09, 7 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIppYication for �Digogar *pgtem Con5trUCtiott permit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No./7 ��'/✓� G�l��/✓� �ti. Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 'lope of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank .jt/�..� Type of S.A.S. e eLro,i'w r Description of Soil Nature of Repairs or Alterations(Answer when applicable) --r r c---'.J'T_;!:�D Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boar f Health. Sig ed Date Application Approved by Date J� 1 Application Disapproved by: Date for the following reasons Permit No. 77 —0<1. / Date Issued ------------------- 4 '3 --- .-r� - .�r.•."^w.r^.'"v��J.-. °-".F:S:'^ ;..a+.v-'2i"ta+a"�5,.4�'°'` .. cw�d: "�Yr-+'`.a-,'t..Jc.,. ..�.;v� .r•tK.. �:r... ' No. �LJ�-' "r0 / Fee O THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01ppricatiou for Migogal *pgtem Congtruction Permit Application fora Permit to Construct O Repair Upgrade O Abandon O ❑ Complete System ❑Individual Components Location Address or Lot No. � C"'. Owner's Name,Address,and Telr o. Assessor's Map/Parcel'.7'l"a Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of B Dwell ingng. No.of Bedrooms �.' {' Lot Size ,- L e sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(miii:'required) gpd Design flow.provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank h/�. Type of S.A.S. G 41JVOtV& y a Description of Soil ` Nature of Repairs Alteration (Answer when applicable) A, ) - i ~Date last inspected: Agreement: tt The'undersigned, rees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the-Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Bo of ealth. Si ed Date ✓ 3l 9 Application Approved by '' Date - Application"Disapproved by: Date t F for the following reasons Permit No. 9--CO-7 / Date Issued --- - --------------=-----------_----\—~---- THE COMMONWEALTH OF MASSACHUSETTS �\'��—• �. ARNSTABLE, MASSACHUSETTS ,..+ Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired Upgraded ( ) Abandoned( )by QXT 44"e90 ey� at'--'7 P y has been constructed in accordance l with the provisions of Title 5 and the for Disposal System Construction Permit No.Ooo 7 -7 dated Installer Designer #bedrooms Approved design flow gpd ^ ' • The issuance of this permit shall nox be construed as a guarantee that the system/will fun do �s desig`;4ned. Date _ -V i Inspector -- — ———— ----------�""' -------------- No. ,400 _ t Fee f D THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS,,. =igpogal *pgtem Co gtructton Permit Permission is hereby granted to Construct ( ) Repair ( Upgrade ( ) Abandon ( ) System located at I i ) 7 , 4-- and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date this rme t. 2 1 Date J)/ ' I , Approved by --- ' N 'Yan n15 S 1 TEST L OL E NOTES I: OGS: M GENERAL�I�AL NO A f TEST HALE I EL 4 9.8_ A. NEITHER DRIVEWAYS,NOR PARKING AREAS ARE ALLOWED OVER 5 PTIC Y5TEM ' OTHER SYS TEM OE IGN CALCULATIONS :DEPTH FROM S IL 5OiL SOIL SOIL UNLESS H- O COMPONENTS ARE USED 2 C M < SURFACE HORIZON TEX1lIRE IN COLOR MOTTLING (INCHES) U50 )A MUNSEt1 ,: SEWA E DESIGN . G U S GN FLOW < , THE DESIGNER WILL NOT E RESPONSIBLE. TH Y ENt f B.) H DE5 G ER L O BFOR E 5 ST AS DESIGNED UN 3 BE - DROOM DWELLING I I GP_ O GPD 330 D I AM O G A LOAMY AN I - 4 NONE- LESS CONSTRUCTED AS SHOWN; ANY CHANGES SHALL'BE APPROVED IN WRITING. S D OYR 3 0 . O N 1 6.35 B LOAMY SAND FOYR 5 8 ONE „r : V LEACHING CAPACITY REQUIRED. : a t " nd e ! r C. CONTRACTORSHALL BE RESPONSIBLE FOR VER EYING THE CATION F ) LOCATION O ALL „_ ,, ,. � mi NONE I E 3 f 4 - b E fUM AN 1 O PERC 60 - 5 % V 3 BEDROOMS (MAX.)5 4 C M D SANE) OYR 8 G O GRAVEL.. � - ( AX) @ O GPD 33f? GPD.REQUIRED Ln, Z I UNDER OUND AND OVERHEAD UTILITIES PRO TO COMMENCEMENT OF GR ARWORK. SEPTIC TAN CAPACITY ,/. F DATE OF TESTING I I/24l 4 T K C AC TY REQUIRED , t „ „ DAILY LOW- 330 P v F D 200� - ,� ,•''� G 660 GAL:REQUIRED . i @ rt 2 N NCH IN T1 T . .PERCOLATION RATE. LESS THAN M ! G LAYER;" � ,. CC�NST G ON NO ES RU . ANDE I I E N S PE J.M. R LLY ASSOCIATESINC.,. WITNESSED BY KE TH E. F R M E � , SEPTIC TANK CAPACITY PROVIDED. �. DONNA MIORANDI AGENT, BARNSTBALE HEALTH DEPARTMENT i 500 GALLON SEPTIC TANK(MIN. ALLOWED) \r cq s : NO v WATER ENCOUNTERED T l. A L CONSTRUCTION SHALL CONFORM TO THE STATE ENVIRONMENTAL CODE LEACHING I PROVIDED:H NG CAPAC TY USE QADING RATE OF 0.74 GPD SF FOR SIZING OF SOIL ABSORPTION SYSTEM: .� o L OCUS AL / � REQUIREMENTS F THE LOCAL k TITLE 5 AND THE. : U REME O OC L BOARD OF HEALTH. _ , REO T r, ONE I X( }65 3 X 2 'LEACHING TRENCH CAN LEACH. 4 Vt= G5X3 + G5X22:-1 -3X22 X0.74GP F 2. SEPT C TANK S GREASE TRAPS DOSING CHAMBERS AND DISTRIBUTION Certtficahon. [ D S 345.58 GPD ` r 45 GP >3 D 330 GPD.iZE UI ED! Q R 28 e , �d out BOX(ES) A L VEL' TABLE A' i t P R SHALL BE SET ON A E S BASE WHICH HAS BEEN MECHANICALLY , �s NOTE: A GA RBAGE DISPOSAL F S SNOT PERMITTED WITH 1 CQMPACTED O ON G INCH CRUSHED TONE. TT THIS DESIGN.. R A NC S BASE; w. . I certify that on-10f24 OS I (Keith E.Fernandes passed the examination _ fY / (K )P NSTALL m ' h Environmental Protection d t h v approved t o De Department f E ean tha the above_ b o f AY P , 3. SEPTIC TANK S SHALL MEET STM STANDARD C I f 27 93.AND SHALL HAVE.:. OONE 1 - 1- : 500 GALLON SEPTICTANK consistent with the required a i e f ) Q) analysis was rfonned b m con, d tr m n 'expertise ss e_ Y 9 g> P AT LEAST TNREE'20 DIAMETER MANHOLES. THE MINIMUM D Y Pe ET M DEPTH FROM THE.BOT N _ ' ONE I 3 OUTLET DISTRIBUTION BOX' H 2 6?. ,. C ) ( O Rated). N TT R 15.017. , O O SCALE and experience described in 10 CM , �: TOM OF THESEPTIC TANK TO THE FLOW LINESHALL P e ds 3 W. BE 48. ONE 1 -rG5.X 3 X 2.LEACHtNG TRENCH . . O � THREE '3 _ 24 CONCRETE COVERS BUILT �� E CO RS BU LT UP TO WITHIN O TH N G OF GRADE SEE FLOW PROS ICE 4. SCHEDULE 0 PVC INLET AND OUT TEES H ( ) CV_ 4 L LET E S SHALL EXTEND A MINIMUM OF 6 ONE 1 -SWEET AI VE NT ENT(SEE FLOW PROF CV t ) RO LE ABOVE E W LINE THE IINSTALLED BO THE FLO L N Of SEPTIC TAN AND SH BE _K A ALL ON THE f..__._..,_ : � cv PLAN B_ 00 222 E K PAG E 3 ON I INSPECTION I :N S CT O PORT WITH SCREW CA BUILT � G O P L UP TO WITHIN 3 OF GRADE T I NA1� DATE CENTERL NE OF THE TAN DIRECTLY UNDE HE K R T CLEANOUT MANHOLE. ,_: _-w--� ,•J f / � :DEED BOO 2 o K 24 GO PAGE 320 1 I 5. RASE COVERS OF THE SEPTIC TANK AND DISTRIBUTION BO WITH P� x RECAST o ASSESSORS MAP 25 0 PARCEL 52 , CONCRETE WATER TIGHT RISERS OVER INLETAND OUTLET TEES WITHIN i . T 5 TO T N 6-OF FINISH GRADE,'O AS APP OVED B THE LO AL RA R R Y C BOARD OF HEALTH AGENT. c� Gj PIPINGSHALL CONSIST OF 4"SCHEDULE V O40 PVC OR EQUIVALENT. PIPE SHALL E E L G ND BE LAID ON A MINIMUM CONTINUOUS GRADE OF NOT SS THAN '- -LE I°k. 7j DISTRIBUTION LINES PO SOIL ABSORPTION SYSTEM (AS REQUIRED}SHALL BE 48.9 -- EXISTING CONTOUR OU R 4 DIAMETER SCHEDULE 40 PVC tD AT 0.0 5 `IN 4 9 LA Q FTlFT L E SHALL BE GAPPED 32 PROPOSED CO. , ' NTOUR g A ND T E OR A5 NOTED. X i 2.34 : EXlT1 N. S G SPOT.GRADE S. OUTLET PIPES FROM DISTRIBUTION BOX SHALL REMAIN LEVEL FOR AT LEAST : `24x5 PROPOSED SPOT GRADE B ORE PITCHING TO SOIL ABSORPTION 5YSTEM. WATER TEST 49.3 _ 0 W WATER SERVICE LINE- T BOX TO ASSURE EVEN DISTRIBUTION. ` _ . MEASURE BELOW 49 2 4 E UNDERGR OUND. ELECTRIC SER VICE DISTRIBUTION OX SHALL HAVE A MINIMUM SUMP OF6, w i F OVERHEAD _ THE OUTLET INVERT. d / UTILITY SERVICE Q' p e ' V „ A DETAIL. _ 3 f UG S S N a U DERGROUND UTILITY SE VICE 10. BASE AGG GATE F R THE LEACHING FACILITY SHALL � R ) RE D LL CONSIST OF 3/4 TO r Y a J 49 ` e„ fi G- 1'-1 2 DOUBLE WASHED NE EE`.OF IRON, F •1 E WAS E STONE FR RO PINES AND DUST AND SHALL BE t GAS SERVICE LINE , 9 1 INSTALLED ELOVJ THE CROWN OF HE DISTRIBUTION:IN SCALE i 20_. O >P _ LL B H RO N TLINE O THE BOTTOM Of THE /�T x 49.Z TEST {1 S e E OLE BORING N '. O NG LOCATION x / R I SOIL ABSORPTION SYSTEM. BASE AGGREGATE SHALLE V DB- ' 497 O B . COVERED WITH A 2 LA OF I O L€WASHED STONE 49,5 ST SEPTIC TANK LAYER /8 T I/2 DOUBLE D S O E FREE IRON .FINES AND DUST. r : ✓ DB i. VENT SOIL ABSORPTION SYSTEMWHEN DISTRIBUTION LINES EXCEED 50FEET DISTRIBUTION BOX _ x' 9.5.. SAS,. I L WHENEITHER'�N a > :�- SO ABSORPTION HE LOCATED WHOLE OR N PART UNDER DRIVEWAYS PARKING AREAS, q� SYSTEM- 1 • : „.., TURNING AREAS OR OTHERIMPERVIOUS MATERIAL O WHEN P R RESSUfZE DOSED. Reserve . ' RESERVED FO T R FU URE ", x so. OI I M E V ,..; .- 2. S L ABSORPTION 5YSTE SHALL B COVERED WITH A MINIMUM OF 9 OF G '� UTILITY'P S ,. 5 OLE x o I �r�q� ' GLEAN MEDIUM SAND(E-XCLUDING TOPSOIL). ,w.. • A® C TCf1 BASIN SCH:40 PERFORATED S CB FND , x , t ) 50,1 I FINISH IM tvl F 4 9.8 3 SH GRADE SHALL A MAX U CY 3G OVER THE TOP OF ALL SYSTEM PVC PIPE LAID � ,. L7 x 50.4_ FIRE HYDRANT YD T e LOT 4 RA COMPONENTS, INCLUDING THE SEPTIC TANK DISTRIBUTION SOX DOSING CHAMBER 0:005 F1lFT 3 49.9 k A 15,09I SF+ � ELLAND O L ABSORPTON SYSTEM. SEPTICTANKS SHAG HAVE A MINIMUM COVER OF SLOPE r so,s,< OF 911, ® DRAINAGE MA NI10LE: F ,, :_ L I : : ■14. O A OF INSTALLAT ON D .THE SO L ABSO IONS STEM UN t o.9}FRO TttE D TE RPT Y T L . L CONCRt`TE BOUND"FOUNU , t 51 _ , RECEIPT F CERTIFICATE OF COMPLIANCE,THE PERIMETER Of SOIL ABSO RE PTO A CERT A R P.P O , __�_ ,_ . � _ TOP� I � OF BANK , 50,7 3 N P 49,9 / 5Y ALL BE S AKED A D FLAGGED TO EVENT THE USE OF SUCH , TION . STEM SHALL T RINSPECTION 'h _ , � �; x , PROPOSED PORT 51.1 x 50.4 x L MIT OF WO , ' , t WORK A MIGHT DAMAGE T ,AREA FOR ALL ACTIVITIES THAT C, DA THE SYSTEM. - ,. e : t. _.. FENCE P OSED VENT O N H HA U1 INSPECTION PR 1 5_ THE BOARD OF HEALTH SMALL REQUIREOF ALL CONSTRUCTION N T s :, t c - E NOT t h SE E 7 x_ p ( ) 9.8 F HEALTH I f EDGE F.BY AN AGENT OF THE BOARD O HE LT OR THE DESIGNER IF THIS SYSTEM RE : O CLEARING _ f , 0) �0 0 ,� 8 x 5 A VA LANCE AND MAY REQUIRE SUCH PERSON TO CERTIFY WRITING C� QUIRESR ) WR �,, -o e , a J a r THAT ALL WORK` HAS BEEN COMPLETED IN ACCORDANCE WITH,T,HE TERMS S OF THE .PERMIT AND APPROVED PLANS. 48 HOURS ADVANCE NOTICE!S REQUESTED- x , ,, a aa t o <na �e a _ 0.0 a F tv x 513 O C c � 50.3 x 50.2 - ,a � / S b ( 1N T V a G. EXISTING CESSPOOL�OVERFLOW TO REMOVE[). ANY CONTAMINATED SOIL WITHIN 5 OF THE PROPOSED 501L ABSORPTION SYSTEM SHALL BE REMOVED'AN D x REPLACED WITHCLEAN SAND: AREA TO BE COMPACTED TO MINIMIZE SETTLING: 3 x � , :• 51.2 01 _ 4,: I LOCATION T APPROVED H �7. PROPOSED VENT LOCAT O TO RO ED BY HOMEOWNER. G 5 0 v , 50.0 ,. 5 I, / F 9 r ,. � E FND BENCHMARK: 8. CONNECTION Of EXISTING SEWER TO NEW SYSTEM: INSTALLER SHALL SECURE �.. . , , � , y 50:6, S O r-a .. ,, 4 Ct F N TO T THE CONNECTION O THE EW SEWER TO OLD EWE AN EXI TIN 1 0 of Concrete HE SEWER @ 5 G JOINT. �,. _: 'O , .., �. � c ete Bound x t<7 _ SO 9_ Assum� � ed dat m 1F ' N Y PIPE I ENCOUNTERED I I � u ORA GEBURG/CLA E ST SHALL BE REPLACED WITH SCH.40 PVC. , ,. ( ) OAK . ,\ z C 5 � 1 t 1. 9. INSTALLER TO CONFIRM LOCATION OF ALL UNDERGROUND C R RGROUND AND OVERHEAD ._ 50.3 t T IJTIE5 PRIOR TO START OF'CONSTRUCTION. �.U OR . , , T 4 a F LOOK PL AN Cess ools � - ,. , (See Note#I 6 ti . � so y NOT TO SCALE x x7 49.7 S a. ' INSPECTION NOTE: _ PLAN , o F \ 50.1 PR{OR.TO FINAL INSPECTION BY THE ENGINEER SYSTEM / TP `� SCALE I 20 a , F P x F LOW IDOF LE r F V NEED TO B_COMPLETE INCLUDING BUILDUP FOR COVERS. S� Bedroom Bedroom O � x Lrv+n Room / 9 to �` 3 NOT TO SCALE / c � O F G- 49,5 „ COVER. � ; 3 „ c 4 DIAMETER CONCRETE V r 2 ET COVERS 4 SCHEDULE 40 PVC ACCESS/INSPECTION � Ga a e F x 49.9 : � g RAISED ,O WITHIN I O INSTALLED T WI T 6 QF FINISH PORT T O WITHIN 3 OF GRADE \ 49.5 4 PVC VEP1T � Bed r 00 m/ Kitchen tch n TOP OF FOUNDATION ,� PIECE OF# ,,, ;, x 49:6 Bath e AN 18 C 5 REBAR SHALL BE ATTACHF_D GRADE(OR AS NOTED) �CAP BY ,�WEETAIR PROPOSED VENT : \ Bath: EL 52.I_, F INSPECTION PORT ALLOW F- FUTURE SEE NOTE#5 r TO TO OR U URE SEEN NOTE I G .. ... ( O # 7) (SEE NOTE#17 MI ) LOCATION 3G N - c ... Pro osed _ 1• EL 50.0_ +_ N�, C TE PROPERTY _ r PR RTY 15 , •-'- p Pra used EL 49.9 P o osed EL 50.0__ LOCATED IN THE ZONE 2 OF A PUBLIC WATER SUPPLY ` y - ch v Area o r f Utdit,es ,• � . �t X 36 Pro sed u, _ o v p 4 PVC VENT m Anne Walther 48.7_ „ ,, - : (9 Min-3G Max) 47.0_ 95 boll Avenue, ve ue Brewster Ma 0263 I Y � > FILTER FABRIC47; S: , �u 8 47.55 \ !O _ r , , (PE TO BE n n � 4. „�. ,. 'SEWAGE DISPOSAL SYSTEn I4. 47.30 f f ,^' /, r 46�38 3/4 - I-1/2 .STONE I� D�S GN ! x war ` PERFORATED r [_ o +, 3 4G:94 4G.73 WITHW T H s 24 _� RENC : ,� 17 Vandermin , 46.70 IT,. � t Lane t1 `annls Ma r ; �Z_ ,� _ �.r�sl � c 2 DROP _��F�NA AF a GAS B FLE ` s \raL PIPE WITHIN TRENCH , M. OREILLY ASSOCIATES INC. 44.38 , 44.38 PERFORATED PIPE LAD AT A t Professional Engineering neering & Land Surveying�gServices SLOPE OF 0.005 FTIFT C.6 - Lone est m Ca R / 1 I „S DE VIE I I _ t W3 500 GALLON f � UB-s LEACHING _ ; �.. .. 1573 Maui Street Route 6A TRENCH ,_ ,_ + P.O. Box 1773 EL 37.. _& BOTF M F I I O O TEST PIT# ,2 40 SEPTIC TAN + Q 60 65 x 3 x 2 : - 508 898 880 D BOX : , ( ) 1 Office Brewster, MA 02831 508 896 8802 Fax t DATE:E H-20 SCALE BY. CHEC K: JOB NUMBER -. SCALE I -2065 ` MTF/ I2/2/I4 As Noted JFM k JMO_ 7022 G.\ obs\Walther7022 dwg\70225D S.DW6 KEF