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0028 VANDERMINT LANE - Health
28 Vandermint Lane - -� Hyannis P 250 058' i� 6 Y f r " TOWN OF BARNSTABLE r 1�4?CAT10N A,9WA4✓T rAT /—N SEWAGE#:Z®-0 7 .—,Z VILLAGE y�) A✓/Jy! ASSESSOR'S MAP&PARCEL INSTALLER'S NAME, &PHONE'NO. 'A a e./�/ elf."w f r a �,h P SEPTIC_ TANK CAPACITY LEACHING FACILITY:(type) ! !3>t:��Yi FFy1 t�l(Size)` J x 3 b NO. OF BEDROOMS OWNER PERMIT DATE O COMPLIANCE DATE: Separation Distance Between the: t.. 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 ,> W o W m w Lo No. .LLl®q Fee ®C� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2pplication for �Bigont *pgtem Con0tructiou Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. 2 8 VA NpC&yA 1 aZ Lo*04E Owner's Name,Address,and Tel.No. A,VA'A Assessor's Map/Parcel Insta er's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. } " ...� �, .sif.uC 1 i OA r�v-tzf-A M 6_ 362-- Z 9 ZZ Type of Building: y Dwelling No.of Bedrooms Lot Size /J 000 sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 SO gpd Design flow provided o gpd Plan Date Zoo O Number of sheets 2— Revision Date 'Z—T Title ��tt Size of Septic Tank ��'(►x� `OCO Type of S.A.S. Q Description of Soil .y Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenanc afore dew ed on-site sewage disposal system in ` accordance with the provisions of Title 5 of the Env'. I C not place t em in operation until a Certificate of fl Compliance has been issued by'f i He S' Date Application Approved by 12 . 4 , Date Application Disapproved by: Date for the following reasons le Permit No. 200cl_ 2_7[0 Date Issued ��J%ffeq No. G.GII�gtO i `�' 7 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Application for )Di5po5al �&pgtem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components • Location Address or Lot No. Owner's Name,Address and Tel.No. �ll'NA to�S i 1-1� ���I i N�; Assessor's Map/Parcel .0,0 InstMoA Addr s,and Te N De i ner' N e Address an Tal. o, ` .� U '7�7'S - i3�Z t o goy C,j g l >±AS� 4-.d-j'w M� b I Type of Building: ,r Dwelling No.of Bedrooms Lot Size 000 sq. ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.require 3 gpd Design flow provided 3� ' gpd Plan Date 1� I Z 01:� Number of sheets Revision Date Z?l Title Size of Septic Tank �C�SZ�t.Y.i U� �eAl..Type of S.A.S. lot ON+ Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance-, f the afore described on-site sewage disposal system in accordance with the provisions of Titl, 5 of the Enviro.meal odad notato place he-'y�m in operation until a Certificate of Compliance has been issue.by'th�s- �H a•tl ,/SSignedlll_l Date Application Approv d by d 12 • A Date 28 Application Disapproved by: Date 'for the following reasons �} f Permit No. ? Qo61— Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTI Y,that the On-site Sewage Disposal System Constructed ( ) Repaired ( P) Upgraded ( ) Abandoned( )by l'G�A at g \/A 4-4 0f 2- I,.A N E A444 N►5 has been constructed in accordance / with the provisions of Title 5 and the for Disposal System Construction Permit No. G� � 2 7(P dated 45/� A I Installer 1`nc A Designer 0/%��iE"� "V #bedrooms Approved design flow AS 33 • gpd The issuance of tthhiis�}er n' all not be construed as a guarantee that the system wi 1 ful not om t�djes_igne 6p Date vim°" Inspector °'� a p No. � � �Q Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS Digo al �&pgtem Congtruction Permit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) System located at E t5 yAt4 �'- M 1 'Qs\c 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 mmust be completed within three years of the date of this pa• it. Date ' °' 1p Approved by r ` 1S No. 2 cc Fee /DO THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: / Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUS TTS pplication for Xigpotal *p!6tem Couttruction Ver tt Application for a Permit to Construct( ) Repair e�upgrade( ) Abandon( ) ❑.Complete System ndividual Components Location Address ooAot No. , i41V AN!5 Owner's Name;'Address,and Tel.No. IL VA r Assessor's Map/Parcel o2S O (f Installer's Nam Address,and Tel.No. Designer's Name,Address and T .No. 6'a- o 3 Type of Building: Dwelling No.of Bedrooms � Lot Size / sq. ft. Garbage Grinder (A-6 Other Type of Building No.of Persons ' w a e ate( ) Other Fixtures \ �1 Design Flow(min required) r 3 gpd Design flo provid(Revision gpd Plan Date O Number of sheets Date Title i Size of Septic Tank L Je 5 ! O d Ty e of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: �. The undersigned agrees to ensure the cons uction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the, nvironmental Code and to ce the system in operation until a Certificate of Compliance has been issued by this,§Da4of ealth. �Z Sign Date 4 Application Approved` :, Date Application Disapproved by: Date for the following reasons C Permit No. Zee 2 Date Issued 2� 6� THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (Upgraded ( ) Abandoned( )by at N T �/� has b__eeen constructed in accordance with the p visions of Title 5 and the for Disposal System Construction Permit No.2C)�!I'Z 7& dated An i Installer A -G'49( Designer #bedrooms Approved design w ''\� g' d The issuance of this permit shall not be construed as a guarantee that the system will func' as designed. Date Inspector a No. 7t0 a i Fee /00 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUS TTS Yes Application foriqoaY 61ptem Coutructior der it _ Application for a Permit to Construct( ) Repair(,I-<pgrade( ) Abandon( ) ❑ Complete System ndividual Components Location Address or/Lot No. /1/ Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Installer's Nam% Address,and Tel.No. Designer's Name,Address and T .No. so tF- 7) i 3 6 S`o F 3 6-1-- 2 cj -2 a-- Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder (__6 Other Type Building No.of Persons Showers )''Cafeteria-( ) Other Fixtures / Design Flow(min.required) 3 l] gpd Design flo r vid�'d y�� i / gpd Plan Date �2 b d Number of sheets Revision Date Title r Size of Septic Tank E)e 15 l is O 4P Ty e of S.A.S. Description of Soil -1 Nature of Repairs or Alterations(Answer when applicable)Z l Date last inspected: Agreement: .The undersigned agrees to ensure the cons uction and Stenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the nvironmbntal Code and not-to place.the'system in operation until a Certificate of Compliance has been issued by this,,Board-oof Health f ,,.Signed. r��/J t- Date K� IZ,6,1�� 9 Application Approved by •-� , Date Z� Application Disapproved by: Date for the following reasons Permit No. Zo�i 2 Date Ised Z`G Chi _c 4 t �rFrs-:nr.art.+�+`—w®...d.�,:�R.+�.j,�+..+*'.-�tr'�r THE COMMONWEALTH OF MASSA&IUSETTS BARNSTABLE, MASSACHUSE TS Certificate of �Comptiance THIS IS O CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Re aired ( P<Upgraded Abandoned_(= . by at // ��A ry E fL i y% has _been constructe in accordance , with the pr6visions of Title 5 and the for Disposal System Construction Permit No.�-u l'2 dated �} Ze,lo"I Installe, A—C Designer. ep/g2o e #bedrooms L "~- - Approved design flow g J d The issuance of this perm t shall not be construed as a guarantee that the system will functiort as designed S Id" Date r, Inspector rr�� "�p+r�+ v��qc-.—�•ts�o.�:a�'�r'�is�OWfi.t•w.P+f�W-.ww., �...i«.�_� No. 2 T� Fee �d " THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS =i5pont �&p5tem Cow6truction Permit Permission is hereby granted to,Co/nstruct ( ) Repair (✓) Upgrade ( ) Abandon ( ) System located at !/ /a rX <I -mot % ��% /✓ /t/ r A 7 t and as described in the above Application fbr 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 perm't' Date /D Approved by ` - if, 12 .S kr" Town of Barnstable �p1HE Regulatory Services Thomas F. Geiler, Director BAMUrABLE. � Public Health Division .i639 �0 '639 `Thomas McKean, Director — 200 Main Street,Hyannis,MA 02601 Office: 508-362-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: Sewage Permit# 2 ®Cr') '7i6Assessor's Map\Parcel Designer: I otyl /"I Installer: C© Address: � z 1 Address: &oA _/Y090%/,I, 0Pj On a2-- d'� � was Issued a permit to Install a • , (date (installer) septic system at U v �v � l ��C" based on a design drawn by (address) dated— I 4 l/ {designer) . J( 1 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 • of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designe follow. _ o ARR ME n-taller?#S g re) ` N. 40 RfGISTE�� � I I N I TA%\I'� (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNS ABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF CONIPLIANCE 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 3-26. 4:'doc APPLICANT: D A4. e ADDRESS: 'L� VA-rl✓0ey-M )►J L►,S r ` DESIGN FLOW: gpd REVIEWED BY: DATE: N/A OK NO Legal boundaries denoted [310 CMR 15.220(4)(a)] - Street, Lot, tax parcel number and lot number noted on plan [3.10 CMR 15.220(4)(u)] Locus Provided 310 CMR 15.2204(t)] X Plan proper scale? (I"=40' for plot plans; 1"=20' or fewer for components) [310 CMR 15.220(4)] Easements shown [310 CMR 15.220(4)(b)] _ X System located totally on lot served [310 CMR 15.405(l)(a) for upgrades]- if not, a variance is required 310`CMR 15.412(4)] X Location of impervious surfaces (driveways,parking areas etc.) 310 CMR I5.220(4)(d)] X Location all buildings existing and proposed 310 CMR 15.220(4)(c)] Location and dimensions of system components and reserve areas [310 CMR 15.220(4)(e)] x System Calculations [310 CMR 15.220(4)(f)] daily flow X septic tank capacity (required andprovided) soil absorption system (required and-provided) X whether system designed for garbage grinder North arrow [310 CMR 15.220(4)( )] Existing and ro osed contours [310 CMR 15.220(4)( )] Location and log of deep observation holes (existing grade el. on each test) [310 CMR 15.220(4)(h) X Names of soil evaluator and BOH representative [310 CMR 15.220(4)(h) and (i)] K Location and date of percolation tests (performed at-proper elevation?) [310 CMR 15.220(4)(i)] X Percolation test results match loading rate? [310 CMR 15.242] X , Certification statement by Soil Evaluator [310 CMR 15.220(4)0)1 Observed and Adjusted groundwater(method for adjustment given or indicated) [310 CMR 15.103(3) and 310 CMR X 15.220(4)(n)] Location of every water supply,public and private, [310 CMR- 15.220(4)(k)] X Address 28 E /N7_ G�1� i✓),S , Sheet l of 7 within 400 feet of the proposed system location in the case of surface water supplies and rayel packed public water supply �( within 250 feet of the proposed system location in the case within 150 feet of the proposed system location in the case of private water supply wells X Location of all surface waters and wetlands located up to 100 ft. beyond setbacks listed in 310 CMR 15.211 and any catch basins located within 50 ft. [310 CMR 15.220 4)(1)] x Water lines`and dther=subsurface utilities located [310 CMR 15.220(4)(m) (if water line cross see 310 CMR 15.211( ) 1 ) x Profile of system showing invert elevations of all system components and the bottom of the SAS 310 CMR I5.220(4)(o)] X Stamp of designer 310 CMR 15.220 1 and 310 CMR 15.220(2)] X Stamp of Registered Land Surveyor(required if construction activities within 5 ft. of lot line) [310 CMR 15.220(3)] X Test Holes adequate (two in each of the primary and reserve unless trenches as permitted in 310 CMR 15.102(2)or as approved for an upgrade under LUA at 310 CMR 15.405(1)(k)] x Test hole adequate to demonstrate four feet of suitable material? 310 CMR 15.103(4)) X Test Holes adequate to confirm adequate groundwater separation? [310 CMR 15.103(3)] X Benchmark within 50-75'of system 310 CMR 15.220(4)( )] x Materials specifications noted? [various sections of 310 CMR 15.000] x System components not> 36" deep(unless Local Upgrade jApproval or LUA requested)1310 CMR 15.405(1(b) X Address GERM NT N , NOIWA(Is M,A Sheet 2 of 7 Size OK? -[310 CMR 15.223(1)] ~ Inlet tee located ten inches below flow line 310 CMR 15.227(6)] Outlet tee 14" or 14" +5"per foot for increase ft depth [310 CMR 15.227(6)] Outlet tee with gas baffle or approved filter [310 CMR 15.227(4)] Note regarding installation on stable compacted base [310 CMR 15.228(l)] x Separation between inlet and outlet tees (no less than liquid depth) 310 CMR 15.227(2) . X Inlet/Outlet elevations at least 12' above high groundwater. (except as described 310 CMR 15.227(5)) or permitted for upgrades under LUA [310 CMR 15.405(1)(k)] X Minimum cover 9" (Tanks buried more than 9" must have risers on all openings and on the d-box) [310 CMR 15.2228(1)and 310 CMR 15.232(3)(f)] Three access covers (inlet and outlet must be 20" or greater) - middle access at least 8" (b 7/07) [310 CMR 15.228(2)] X Access to within 6 "'Ill grade one port for sysle [000gpd, two fors stems>1000 gpd 310 CMR 15.228(2) k All at-grade covers secured to unauthorized access? [310 CMR 15.228(2)] > 10 ft from building foundation [310 CMR 15.211(1)) �C Buoyancy calculation Required/Done 310 CMR 15.221(8)] H-20 Where appropriate? 310 CMR 15.226(3)1 Setbacks from resources [310 CMR 15.211 Required when other than single-family dwelling or flow>1000 d [310 CMR 15.223(1)(b)] x First compartment 200%daily flow; Second compartment 100% daily flow 310 CMR 15.224(2) and (3)] "U"pipe through or over baffle, outlet of each compartment with as baffle or approved filter[310 CMR 15.224(4)] 7 I Address �� Y ��(Z�/l l�'r ��• , �(1(Q�I J�jS Sheet 3 of 7 Located at least ten feet from any water line? [310 CMR 15.222(2)] )( Disposal piping at least 18"below water line (when water and sewer cross, see 310 CMR 15.211(1) 1]) - Cleanouts required/provided ? 310 CMR 15.222(8)] Thrust blocks specified in force mains? 310 CMR 15.221(6)(c)] Slope of sewer line not less than 0.01 (1/8"/ft) 0.02 preferable [310 CMR 15.222(6)] X Proper pitch on all runs?(.005 within gravity-distributed trenches and beds) f310 CMR 15.25](9) and 310 CMR 15.252(2)(c)] X Siphonproblem/ leachfield below pump chamber) X Endca s or vent manifoldspecified? X Size and orientation of discharge holes specified? (not smaller than 3/8" not larger than 5/8") [310 CMR 15.251(8)and 310 X CMR 15.252(2)(h)] Materials specified (310 CMR 15.251(5) specifies various pipe types allowed) 10 Stable compacted base [310 CMR 15.221(2) and 310 CMR 15.232(2)(a)] X Splash plate or baffle tee required on inlet/provided? (when pressure sewer to d-box or steep pitch of gravity sewer) [310 CMR 15.323(3)(a)] Riser if deeper than 9" 310 CMR 15.232(3)( Inside minimum dimension 12" 310 CMR 15.232(2)(b)] Minimum sum 6" [310 CMR15.232(3)(e)] Watertight cover if<2000gpd); waterproof manhole if>2000gpd [310 CMR 15.232(3)(d)] �( Capacity(emergency.storage above working=design flow)? [310 CMR 231(2 } x Pro er setbacks [310 CMR 15.211 (same as se tic tanks)] Watertight 20-in minium access manhole at least 20"MUST BE TO GRADE [310 CMR 15.231(5)] _F Service components accessible (not too deep,with piping, disconnects accessible) Alarm floats - alarm on circuit separate from Pumps specified? Exceeds two units must have two pumps operating in lead-lag mode. [310.CMR 15.231(6) and (8)] Stable Compacted Base [310 CMR 15.221(2)] Buoyancy calculations needed ?Provided? [310 CMR 15.221(8)] Address AN09M I NT LN. ►A .� Sheet 4 of 7 r Calculations correct? 4 feet of naturally occurring material demonstrated?[310 CMR 15.240(1)] X Required separation togroundwater? 310 CMR 15.212).] Aggregate specified as double washed [310 CMR 15.247(2)] System Venting required/provided? (system under driveway or >36"deep) [310 CMR 15.241]> X Inspection ports specified and within 3"final grade? [310 CMR 15.240(13) X Breakout requirements met?(No violation of breakout elevation within 15 ft of SAS unless barrier)[310 CMR 15.211(1)[4] and Guidance Document] =r Chambers and Gal. in trench'configuration supplied with inlet every 20 ft. 310 CMR 15.253 6 Each struclure with one inspection manhole(if>2000 gpd must be tograde) 310 CMR 15.253(2)] x Aggregate I'minimum-4'maximum. 310 CMR 15.253 1)(b)] 2'sidewall credit maximum [310 CMR 15.253(l)(a)] In bed configuration, inlet every 40 s . ft. [310 CMR 15.253(6)] Width'2'minimum 3'maximum [310 CMR 15.251(1)(b)] 100 feet-maximum length 310 CMR 15.251 1) a Minimum separation 2x effective depth or width whichever eater(3x if reserve between trenches) [310 CMR-251 1)(d)] Situated along contours [310 CMR 15.251(2)] Breakout OK? [310 CMR 15.211(l)[4] and Guidance Document] minimum 2 distribution lines [310 CMR 15.252(2)(a)] Maximum separation between lines 6' 310 CM RI5.252(2)(d Maximum separation between lines and outside of bed 4' [310 CMR 15.252(2)(e)] Aggregate depth below discharge pipes 6"minimum, 12" maximum. [310 CMR 15.252(2)( )] Separation between beds 10' minimum. [310 CMR 15.252(2)(f)] Bottom area used in calculations only 310 CMR 15.252(2)(i)] W r t t Sheet 5 of 7 Address J _� _ Pressure Dosed System ? Provided pump and piping calculations as re uired' 310 CMR 1 5.220(4)(r)] Pressure dosing required on all systems>2000gpd or alternative systems undef'mnedial approval [310 CMR 15.254(2) and UA Remedial Use Approvals] If used in gravelless system - make sure jet is directed as not to scour soil interface [Guidance Document] )C Inspections once per year(systems<2000 gpd) or quarterly (>2000 dgood to note on plan 310 CMR 15.254(2)(d)] Construction in fill - Did the plan specify that the fill shall meet the specification of 310 CMR 15.255(3)? X Impervious barrier and/or retaining wall ? [Guidance Document] Impervious barrier installation must be supervised by designer [310 CMR 15.255(2)(b)] ' Retaining wall must be designed by Registered Pr-ofessional Engineer[310 CMR 15.255(2)(a)] Side slope not exceed 3:1 ? 310 CMR 15.255(2) Breakout requirements met? [310 CMR 15.252(2) and Guidance Document] At least 5 ft. from impervious barrier to edge of SAS (10 ft. recommended) [310 CMR 15.255 (2)(e)] S. Check DEP Approval letters for credits and design conditions X If used with pressure dosing do not allow pressure discharge to scour soil interface x Was DEP Approval Letter provided and/or have you reviewed the letter for conditions? X ' Is the technology being properly applied and does it meet all DEP Approval Conditions? Is there a note on the plan regarding the requirement for perpetual maintenance agreement? Any alarms involved on separate circuits Did the applicant submit an operation and maintenance manual? Hasa plicant submitted a copy of a maintenance Are the variances listed on the plan ? [310 CMR 15.220 (4)( )] RLS Stamp necessary on plan if a component is within five feet of property line [310 CMR 15.412(4)] ,y New construction or increased flow proposed - [Refer to 310 CMR 15.414] Address G� 1 �W-f �N � Yl L U � Sheet 6 of 7 I Is the system in a Designated Nitrogen Sensitive Area(Zone II for a public supply well)? [310 CMR 15.214, 310 CMR 15.215 and 310 CMR-15.216 - also refer to Policy regarding upgrades of such existing systems] Is the system proposed on the same lot as served by private well ? X [310 CMR 15.214(2)] Are the nitrogen loads proposed in compliance? [310 CMR 15.216(1)] Pumping to septic tank? [ 310 CMR 15.229 Shared System [310 CMR 15.290 Address �4 Grvt Sheet 7 of 7 Town of Barnstable P# o Y' Department of Regulatory Services BAMUMBEA : Public Health Division Date v � MAIM t6J9. ,6$ 200 Main Street,Hyannis MA 02601 prFO Date Scheduled ��� -� !� ��/� , Time--N-'�— Fee Pd.—ILO Soil Suitability Assessment for Sewage isposal Performed By: Qj! �AMA�� Witnessed By: U, LOCATION & GENERAL INFORMATION FA ion Address Owners�vame � I )LAddressssessor's Map/Parcel: Q—(1S'8' En Inee�lapeA..� �r NEW CONSTRUCTION REPAIR y J Telephone# p _ Z L Land Use ��P,►� A / Slopes(%) Surface Stones Distances from: Open Water Bodye--'** fOB.0 ft PossibleWetArea ft Drinking Water Well L/-'ft Drainage Way_ >- l d U 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) 1 + sf I ! 0,1 y. DI III 1 rrn I- j rn o fTl I I to m I ---WATER LINE I �'' x 1 �1 I �p Z m (,o e8I --- 1-- tZ I . 1 r- 1 -t. ) 1 Z Z la o I �� i of ---I---;---------J -------- \\ -� - 1 PgVED DRIVEWAY' GARAGE \ (SLAB) j I 1 1 1 1 r------------ 1 I Fol�i 9 D I 9 4- Abe - I 120.00 /t Parent material(geologic) je,e2jq,S(� Depth to Bedrock Nl Depth to Groundwater Standing Water in Hole: Weeping from Pit Race . Estimated Seasonal High Groundwater 44 �T DETERNUNATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles. Depth to weeping from side of obs.hole: 1n, Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor— Adj.droundwater Level , v Observation PERCOLATION TEST bate x'ttne. Hole# I Time at 9" Depth of Perc Time at 6" Start Pre-soak Time @ Time(9"-6") ' - End Pre-soak ��� 1 y .. L M►N) Rate Min./Inch 2 !vV►A�_�. Site Suitability Assessment: Site Passed ^ Site Failed: Additional Testing Needed(Y/N) Originals Public Health Division. Observation Hole Data To Be Completed on Back----------- ***Ifpercolation 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:\SEPTIC\PERCFORM.DOC DEL,P.OBSERVATION HOLE LOG Hole# l Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones;Boulders. Consistency,%Grvel ''-46 B S o IoYR-�5/8 DEEP OBSERVATION HOLE LOG Hole# 7-- Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. Consistency,% ra el DEEP OBSERVATION HOLE LOG Hole# fI Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. Consistency, o Gravel) DEEP OBSERVATION HOLE LOG Hole# N f1' Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. Consistency, Flood Insurance Rate-Map: Above 500 year flood boundary No_ Yes x _ Within 500 year boundary No X. Yes Within 100 year flood boundary No Yes Depth of Naturally Occurrina Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? YES If not,what is the depth of naturally occurring pervious material? Certification I certify that on (date)I have passed the soil evaluator examination approved.by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the requir nin expertise and experience described in 310 CMR 15.017. Signature DatDg t . Q:IS•BPTICTERCFORM.DOC ( _ TOWN OF BARNSTABLE { LOCATION,O1b URw-1W-UV SEWAGE# VILLAG ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY $Ocr LEACHING FACILITY: (type) Pt \ (size) 1 6r NO.OF BEDROOMS BUILDER OR-Q Rop PER MMATE: 1 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and I Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) 61-3 LI%- Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) I Feet Furnished by 2�)� e-V--Q V,;k �! 3 z A' A3 r COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION < iAP .r`j t TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 28 Vandermint Lane i Hyannis Owner's Name: Brendan O'Keefe t y Owner's Address: Date of Inspection: 8/25/2004 Name of Inspector: (please print) Patrick T. Sullivan -F, cfi Company Name: Ready Rooter Mailing Address: P.O. Box 371 Sandwich,MA 02563 rn Telephone Number: (508)888-6055 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of 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: zpasses Conditionally Passes Needs Further Evaluation by the Local Authority Fails Inspector's Signature: e Date: v 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. Notes and Comments ****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. Page 2 of 11 OFFICIAL INSPECTION FORM—NOT'FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 28 Vandermint Lane Hyannis Owner: Brendan O'Keefe Date of Inspection: 8/25/2004 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D C. System Passes: 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.An fa ilure criteria not evaluated are indica ted ated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section eed to be replaced or repaired.The system,upon completion of the replacement or repair,as approved b� e Board of Health,will pass. Answer yes,no or not determined (Y,N,ND)in the for the following s6tements. If"not determined"please explain. F. 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%/s imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved p�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. ND explain: 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 unever'`distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: /± i; The system required pumping moreIthan 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 obstruction is removed ND explain: ' { Page 3 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 28 Vandermint Lane Hyannis Owner: Brendan O'Keefe Date of Inspection: 8/25/2004 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board ealth 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 determin in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which w' protect public health,safety and the environment: _Cesspool or privy is within 50 feet of urface water Cesspool or privy is within 50 feet a bordering.vegetated wetland or a salt marsh 2. System will fail unless the Board'of Health(and Public Water Supplier,if any determines that the system is functioning in a manner that protects the public health,safety and envia`onment: _The system has a septic tank and soil absorption system(SAS)and the AS 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 ne 1 of a public water supply. The system has a septic tank and SAS and the SAS is withjr(50 feet of a private water supply well. _The system has a septic tank and SAS and the SAS is)ess 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,pete med at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates tha well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitro 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. r' 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 28 Vandermint Lane Hyannis Owner: Brendan O'Keefe Date of Inspection: 8/25/2004 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 _ _Z 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 and overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6"below invert or available volume is less than %day flow _,Z Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped _,ZAny 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 I of a public well. Any portion of a cesspool or privy is 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] w�;?(Yes/No)The system fails. I have determined that one or more of the above 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 dwlin flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no % the system is within 400 feet of a surface drinking.-,hater supply f _ the system is within 200 feet of a tributary too surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped k Zone II of a public water supply wellV' 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. ,i f,. i Page 5 of 11 OFFICIAL INSPECTION FORM.-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 28 Vandermint Lane Hyannis Owner: Brendan O'Keefe Date of Inspection: 8/25/2004 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No -iZ'-- 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? " -Z_ 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 than 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: Yes No _\Z-_ Existing information.For example,a plan at the Board of Health. _\.Z_ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 28 Vandermint Lane Hyannis Owner: Brendan O'Keefe Date of Inspection: 8/25/2004 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Number of current residents: "Z?— Does residence have a garbage grinder(yes or no): 'sc�s Is laundry on a separate sewage system_(yes or no):/_-,�[if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use: (yes or no): � �,"� a�,o����:,� 00':=�3 Water meter readings, if available(last 2 years usage(gpd)): _ -7 C P � Sump Pump(yes or no):,l-' ` Last date of occupancy: e—,, COMMERCIALANDUSTRIA L Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 sy em(yes or no): Water meter readings, if available: Last date of occupancy/use- OTHER(describe): GENERAL INFORMATION Pumping Records Source of information:� .,e o-: f 3-,� �,,J�� n �� 13 Was system pumped as part of the Inspection(yes or no): If yes,volume pumped: Ions--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM A,,-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) _Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(-iif known)and source of info tion: l Were sewage odors detected when arriving at the site(yes or no): A Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 28 Vandermint Lane Hyannis Owner: Brendan O'Keefe Date of Inspection: 8/25/2004 BUILDING SEWER(locate on site plan) Depth below grade: " Materials of construction:_cast iron 0 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: locate on site plan) Depth below grade: L l U Material of construction: v oncrete ' metal_fiberglass_polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: k g NK L( Sludge depth: 211 Distance from the 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: r•- Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): ' �lC�vr �A�,�J"" �v�►S�`eC,=\'�p,�� �••3'��S e �..f'�h cam. GREASE TRAP:_(locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fibergl _polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or ffle: Distance from bottom of scum to bottom of ou et tee or baffle: Date of last pumping: Comments(on pumping recommendation , inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of 1 kage, etc.): Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 28 Vandermint Lane . Hyannis Owner: Brendan O'Keefe Date of Inspection: 8/25/2004 TIGHT or HOLDING TANK: (tank must be pumped at time mspection)(locate on site plan) Depth below grade: Material of construction:_concrete_metal—fiber g s_polyethylene_other(explain): Dimensions: Capacity: gallons Design Flow: gallons/da Alarm present(yes or no): Alarm level: Alarm in work' g order(yes or no): Date of last pumping: Comments(condition of alarm d float switches,etc.): DISTRIBUTION BOX:—z7if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: CQ.r Comments(not 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 or no): / Alarms in working order(yes or no): Comments(note condition of pump chamber,co ition of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 28 Vandermint Lane Hyannis Owner: Brendan O'Keefe Date of Inspection: 8/25/2004 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: leaching chambers,number: 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.): yc Jo� ' CESSPOOLS: (cesspool mustZpar, )(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 Comments(note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation,etc.): PRIVY: (locate on site plan) Materials of construction: 77' - Z Dimensions: Depth of solids: Comments(note condition of soil,signs of hydrauli failure, level of ponding,condition of vegetation,etc.): Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 28 Vandermint Lane Hyannis Owner: Brendan O'Keefe Date of Inspection: 8/25/2004 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch 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. i O O O Page I 1 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 28 Vander-mint Lane Hyannis Owner: Brendan O'Keefe Date of Inspection: 8/25/2004- SITE EXAM Slope Surface water Check cellazt/ Shallow wells Estimated depth to ground water> feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record—If checked,date of design plan reviewed: Observed site(abutting property/observation We within 150 feet of SAS) _�/Checked with the local Board of Health-explain:���� �_ Checked with local excavators, installers-(attach documentation) 1 Accessed USGS database-explain: _ You must describe how you established the high ground water elevation: r w COmmornweatth of MOSSOChUSettS John Grad EXeci,ltNe Office of ErMrOrV wntOi Affairs D.E.P. Title V Septic Inspector department of P.O. Box 2119 Environmental Protection Te 08)t,MA 02536 (508)�5.64-6813 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ORT O ,Vn,o'/ }a CERTIFICATION v 2 1„16 Property AddresVandermint Lane, Hyannis Address of owner: Date of Inspection:111'1919s (If different) 4 Name of Inspector:John Grad Flynn �a •t Company Name,Address and Telephone Number: C�d CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: X Passes _ Conditionally Passes _ Needs Fu her aluation By the Local Approving Authority Fails Inspector's Signature: Date: 11119196 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. 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 Department of Environmental Protection. . The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. INSPECTION SUMMARY: Check A, B,C,or D: A] SYSTEM PASSES: X I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: _One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair,passes inspection. Indicate yes,no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If "not determined", explain why not.) _ The septic tank is metal,cracked,structurally unsound,shows substantial infiltration or exfiltrabon,or tank failure is imminent.The system will pass inspection if the existing septic.tank is replaced with a conforming septic tank as approved by the Board of Health. I (revised 11115195) One Winter Street 9 Boston,Massachusetts 02108 • FAX(617)556-1049 9 Telephone(617)292-5500 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 10 Vandermint Lane,Hyannis Owner: Flynn Date of Inspection:11119196 Sewage backup or breakout or high static water level observed in the distribution box is due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the.public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER, IF APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone 1 of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. _ The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply.well,unless a well water analysis for coliform bacteria volatile organic compounds indicates that the well is free from pollution for that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm. 3) OTHER D] SYSTEM FAILS: _ I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage in facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged cesspool. SAS is in hydraulic failure. (revised 11115195) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 10 Vandermint Lane,Hyannis Owner: Flynn Date of Inspection:11119/96 D] SYSTEM FAILS(c.ontlnued) Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Numbers of times pumped . Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria:' The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area (IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 11/15195) ' 3 r - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 10 Vandermtnt Lane,Hyannis Owner: Flynn Date of Inspection:11/19196 Check if the following have been done: X Pumping information was requested of the owner,occupant, and Board of Health. X None of the system components have been pumped for at least two weeks and the and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. n1aAs built plans have been obtained and examined. Note if they are not available with NIA. X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout. X All system components,excluding the Soil Absorption System,have been located on the site. X The septic tank manholes were uncovered,opened,and the Interior of the septic tank was inspected for condition of ba ffles or tees material of construction,dimensions,depth of liquid,depth of sludge,depth of scum. X The size and location of the Soil Absorption System on the site.has been determined based on existing information or approximated by non-intrusive methods. X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11115195) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 10 Vandermint Lane,Hyannis Owner: Flynn Date of Inspection:11M919ti FLOW CONDITIONS RESIDENTIAL: Design flow: 330 gallons Number of bedrooms: 3 Number of current residents: 2 Garbage grinder(yes or no): No Laundry connected to system(yes or no): Yes Seasonal use(yes or no): No Water meter readings,if available: rda Last date of occupancy: n1a COMMERCIAL/INDUSTRIAL: Type of establishment: n1a Design flow:0 gallons/day Grease trap present:(yes or no) No Industrial Waste Holding Tank present: (yes or no) No Non-sanitary waste discharged to the Title 5 system: (yes or no) No Water meter readings,if available: n1a Last date of occupancy: rda OTHER: (Describe) n1a Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System was last pumped In 1995 System pumped.as part of inspection:(yes or no)No If yes,volume pumped: 0 gallons Reason for pumping: n1a TYPE OF SYSTEM x Septic tank/distribution box/soil absorptions system Single cesspool Overflow cesspool Privy. Shared system(yes or no) ( if yes,attach previous inspection records,if any) Other(explain) APPROXIMATE AGE of all components,date installed(if known)and source information: 1992 by A&B Canco Sewage odors detected when arriving at the site:(yes or no) No (revised 11115195) 5 ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 10 Vandermint Lane,Hyannis Owner: Flynn Date of Inspection:11/19196 SEPTIC TANK: X (locate on site plan) Depth below grade: V Material of construction:X concreate_metal_FRP_other(explain) Dimensions: L 8'6'H 5'7"W 4'10" Sludge depth:Z" Distance from top of sludge to bottom of outlet tee or baffle: 25' Scum thickness:0 Distance from top of scum to top of outlet tee or baffle:6" Distance form bottom of scum to bottom of outlet tee or baffle: 0 Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) Septic tank and all components are structurally sound.Recommend pumping system every one to two years for maintenance. GREASE TRAP: (locate on site plan) Depth below grade: rda Material of construction: _concrete_metal_FRP_other(explain) Dimensions: Na Scum thickness:rda Distance from top of scum to top of outlet tee or baffle:rda Distance from bottom of scum to bottom of outlet tee or baffle: n1a Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) nla (revised 11115195) 6 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 10 Vandermint Lane,Hyannis Owner: Flynn Date of Inspection:11119/96 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: nla Material of construction:_concrete_metal_FRP_other(explain) Dimen sions: n1a Capacity: nra gallons Design flow: nla gallons/day Alarm level: n1a Comments: (condition of inlet tee, condition of alarm and float switches, etc.) rda DISTRIBUTION BOX: X (locate on site plan) Depth of liquid level above outlet invert: Liquid level with bottom of pipe. Comments: (note if level and distribution is equal,evidence of solids carryover, evidence of leakage into or out of box etc.) D-box is structurally sound PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no) Comments: (note condition of pump chamber,condition of pumps and appurtenances, etc.) Na (revised 11115/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 10 Vandermint Lane,Hyannis Owner: Flynn Date of Inspection:11/19196 SOIL ABSORPTION SYSTEM (SAS):x (locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present, explain: n1a � Type: leaching pits,number: 1,000 gallon leach pH leaching chambers,number:n1a leaching galleries,number: n1a leaching trenches,number,length: nla leaching fields, number,dimensions:n1a overflow cesspool,number:n1a Comments:(note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc) The leach pit is structurally sound and functioning properly.It had T of water In it at the time of the inspection. CESSPOOLS:_ (locate on site plan) Number and configuration: nla Depth-top of liquid to inlet invert: n1a Depth of solids layer: n1a Depth of scum layer: n1a Dimensions of cesspool: n1a Materials of construction: n1a Indication of groundwater: n1a inflow(cesspool must be pumped as part of inspection) nla Comments:(note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation, etc.) n1a PRIVY:_ (locate on site plan) Materials of construction: n1a Dimensions: nla Depth of solids: rda Comments:(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.) PrivyComments (revised 11115195) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 10 Vandennint Lane,Hyannis Owner: Flynn Date of Inspection:11119196 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' g � DEPTH TO GROUNDWATER Depth to groundwater:12 feet method of determination or approximation: USGS Maps and Charts (revised 11115195) 9 TOWN OF BARNSTABLE V LOCATION' #VRnn l SEWAGE# l " VILLAGE 'X ASSESSOR'S MAP 6z LOT 3-,�7-df iq/() INSTALLER'S NAME & PHONE NO. A & B CANCO 775-6264 SEPTIC TANK CAPACITY O00 C 4 LEACHING FACILITY:(type) leActy (size) yau (1,4 NO. OF BEDROOMS A ,PRIVATE WELL O UBLI�WAT�ER BUILDER OR OWNER -J'A-Pve-5 CIS/A)A) DATE PERMIT ISSUED: 4(s . 45 � DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No C �I D� p b, W e 4 F�s.. .. ............ _ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH a. TOWN OF BARNSTABLE Appliration for DWposal Works Tomitrnrtiun jJamit Application is hereby made for a Permit to Construct ( . ) or Repair (V*ran Individual Sewage Disposal System at: ..... .............. .......... - Location•-Address or Lot No. ...................t . . Owner Address Installer AddrCss Type of Building Size Lot____________________________Sq. feet U Dwelling—No. of Bedrooms_______ .................................Expansion Attic ( ) Garbage Grinder ( ) U PL4 Other—T e of Building No. of persons____________________________ Showers — Cafeteria Pa Other fixtures -------------------------------- - - W Design Flow............................................gallons per person per-day. Total daily`flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter________________ Depth................ Disposal Trench—No_____________________ Width.................... Total Length..................... Total leaching area____________________sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by........................................................................... Date......................................... Test Pit No. I................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________________-_______ a -•••-------•--------•--•-•••--------•-._....•-••-•-•-------•----------------------•---•----•--------•---------•--•----•--•----------------•----....------•-- 0 Description of Soil......................................................................................................................................................................... U ------------------=------•--••••--------------•------•------=•--------------------••---••---•---------------•-••---•-------•----------•-----•-••-••--................................................. --------------------------------------------------------------------------------------------....... V Nature of Repairs or Alerati s—answer when appli ble° ---LOo-o -(�-----------�'cw`-�---- -�--= b .......1'p-jQ............ ------ -3 ....U``�a'------------°*...-'----------------------------------------•-•--•--••----•----._..............__. Agreement: The undersigned agrees to install the aforedescribed.Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Env ental Code—The undersigned further agrees not to place the system in operation until a Certificate of Co plianc been su by the board of health. Signed . ----- ------- - ----------- - -------------......................;--------- Dace 4 Application Approved By - -------------- �--" ---//------ IYate Application Disapproved for the following reasons- ................----------------------------------------------------------------------- -------------------------------------------- .. - Dare Permit No. '" L�f Issued --------------------------------------- Date .......... THE COMMONWEALTH OF MASSACHUSETTS BOARD -OF HEALTH TOWN OF BARNSTABLE - Appliration for Disposal Warks Tonstrnrtinn rruti#- Application is hereby made for a Permit to Construct ( ) or Repair (W) an Individual Sewage Disposal System at: D6-2 Nl n ►.N T .L-ti: b A 00 `• .. ---------------------------------------- Location .. -Address ( i or Lot No. N -............'----------------------------------------•----....................................... Owner Address a l ." !3 C A►�cc� ''.r-- ..s� .�.. 9..9_ l Y b 2.�a�T--- ---------- ;; .-L................ - - M Installer f Address Type of Building L d yp g �� ,�-- Size Lot............................Sq. feet V Dwelling No—of-Bedrooms..•.--.�^................................Ex ansion Attic a g �_ �' � �p � (. ) Garbage Grinder ( ) aOther—Type of�Building ............................ No. off persons......................�-'' Showers ( ) — Cafeteria ( ) dOther Ifixtures .•-••••......-----•-----•-- •-•--.-•------•---•••••-------------•---••••••-••---•-••----------------.....-----•-----------•------ W Design Flow................ .......................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid c ipacity............kallons LLength................ Width................ Diameter................ Depth_•__•__•••_•--_. x Disposal Trench—No.............k._��,,Width....................Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No_____________________ Diameter.___.__..-__.__..... Depth below inlet.................... Total leaching area..................sq. ft. Z Other'Distribution o Dosing tank ( y) a 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........................ a ................ ................................................................. 0 Description of-Soil.....................: ...........................................•----•--=--•---------------------•---------•---•-•-------------------------•-••......---------••- V .....--•----••••-•--•-•----••••--•-----•------•------•-----•-•-•----•------•-••••-•--------------•--•--•----•--•-•------•----•-•---------•--•-•---------•....•----•••-------•-------••---••-•------•--••. V Nature of Repairs or Al erations—Answer when applicable ___P_.__n_..._!_______________ ____ u^^......._-_ ....................--...__.._. 0O® `2----- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal'System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance as been issued by the board of health. ....6.7S Signed .. Date Application Approved BY `J ��'t�^,r."",t�----------------- ---.......... --------------- ......G JDare Application Disapproved for the following reasons- ---------------- --------------------------------------------- ........................... ------------ _ - -------------------------------------- - ---- ------------ ----------------------------------------------------- -- -------------------- /Permit No. -----��~ ��� -------------------------- Issued --------------------- Date ..--.. .Dare..................................--- THE COMMONWEALTH OF MASSACHUSETTS l BOARD OF HEALTH TOWN OF BARNSTABLE C ertifirate of Compliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ✓) by........... °t - C,-.t-je p ------------- _---_---- ---..... --------------......----------------------------......----------............... .................. Installer at -....../D V A. �£Q`{v. �`'r 't...... -----------------------1-`�.... 1J�. ..----................................................................................. has been installed in accordance with the provisions of TITLE 5 of The State Environmental 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 WILLVUNCTION SATISFACTORY. DATE - .`_':.-- ....... Ins e for .-:---.. � ------=---------•------------------------- -...------------------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No....,...1:�:.tl FEE..3A!.." Disposal Works Tontr ion "prrntit Permission is hereby granted......A.`}......0 fl C .................................•.._ __ _ to Construct ( ) or Repair (1'- an Individual Sewage Disposal System ' at No.......1.0........V.A.W 9 2 n_!...?.`...........1-:..?... ... .4.1J Street ci� as shown on the application for Disposal Works Construction Permit No.JI ._ Dated.......................................... , ....................................--••--•....•...................................................•» q -•-•..........................................• Board of Health DATE........�--`��-.;l. FORM 36508 HOBBS&WARREN,INC.,PUBLISHERS _ TOWN OF BARNSTABLE Lt`i>;ATION fJ`�O V�W� �� C—N SEWAGE # VIT.,AGE JJ TJ l 5 ASSESSOR'S MAP& LOT 11,STALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY eCYJ o l LEACHING FACILITY: (type) !a 1 (size) t C Y NO. OF BEDROOMS ,, ll BUILDER OR OWNER i DATE: �1, 1�l �_COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and I 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 C�C�� i r CkAU� W -,t N l 6\,. ; LEGEND PROPOSED CONTOUR ~ y r � 67 SITE \ -' \� \' PROPOSED SPOT GRADE. o rr c 00 ft \ r \ EXISTING CONTOUR m 3 12p 66 + 96.52 EXISTING SPOT GRADE \\ \\ W— EXISTING WATER SERVICE o \; ® TEST PIT \\ \\ -A G \ \o LOCUS MAP 'N.T.S. 10 \ \ GENERAL NOTES: O O O L� \ t. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL \\ 0) �} \\ \ BENCH MARK BOARD OF HEALTH AND THE DESIGN ENGINEER. \ ` 0 �\ \ 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS �\ \ AEA = 15000 sf\\ �Z \ \ CORNER OF STEP OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE \ \ R \ t9O Z \ \ ELEVATION = 68.37 LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: OO\\ \\ i ,, � Z 2 \\ \ BARNSTABLE GIS DATUM - 3to CMR t5.405 (t) (e): \ w P�E�2 \ \\\ d 1) 4.1'111 Fr. VARIANCEFr BELOW GRADE RVSMREQ'D 3 FT- (H20/VENT15.221(7) TO �PRO PROVIDED) LOW LEACHINGTO BE G \ \ \ \ 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR � \ \\ \\\ \ \ TOSINSPECTION NSPE TI NEER D APPROVAL BY THE BOARD OF HEALTH AND THE � \ \ O \ '/'' \ \ 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING �Z \ \ \ Existing Leaching FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN A \ 68�� \ (Note lO \ ENGINEER BEFORE CONSTRUCTION CONTINUES. PGE \ \ \ 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. GP,? 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF HEEALTH CONTRACTOR RCPROPER INSPE OWNERCTIONS DURING NOTIFY THE ONSTRUCTIION.AL BOARD OF I 1 \��\\ w P� � I \ 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. I 8.ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. 9."IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. �!' 10. EXISTING LEACHING TO BE PUMPED AND REMOVED. FILL WITH CLEAN --'— MEDIUM SAND PER TITLE V. \`/ \ 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION \ 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY TH-1 AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY 13. NO PRIVATE WELLS WITHIN 100 FT. OF PROPOSED LEACHING 67 14. ALL PIPING TO BE 4" SCH 40 ® 1/8"/FT (UNLESS SPEC. OTHERWISE) 15. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW M" Part, �?p' FOR THE USE OF A GARBAGE GRINDER 16. NO WETLANDS WITHIN 100 FT. OF PROPOSED LEACHING \ `! 17. PROPERTY IS IN ZONE II OR NITROGEN SENSITIVE AREA. Of Mgss (\ \ \ \ DA M. YER No. 1140 PROPOSED SEPTIC SYSTEM UPGRADE PLAN cis�E ° 28 VANDERMI:NT LANE, HYANNIS, MA NITAR\�'� MAP.•250 Prepared for: Arch Construction SURVEY REFERENCE: LOT.• 058 Engineering by: Surveying by- SCALE DRAWN DATE: DEED BOOK, 19197 DARRENM.MEYER,R.S- Roo—Tech Bgvhwnmenw 1"=20' DMM 08/26/09 PLAN OF LAND BY CHARLES N. SAVERY, RLS DEED PAGE. 261 EST&4ND /CH,MA�7 (508) 364-0894 REV. DATE: CHECKED SHEET NO. DATED:. MARCH 8, 1968 50e-362-2M 08/27/09 DMM 1 of 2 ------------- NOTE: TO PREVENT BREAKOUT, THE PROPOSED NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS FINISH GRADE SHALL NOT BE < EL:63.89 FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A:S. SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. T.O.F. EL.=69.49 INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER. INSTALL A 4" DIAMETER INSPECTION PORT OVER OF Mqs OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE ONE CHAMBER (MIN.) AND SET TO 3" OF F.G. F.G. EL.=68.5f ti F.G. EL.=67.5f F.G. EL: 68.0t F.G. EL: 68.0(MAX.) VENT I RR R xx9wxA1%=go N o. 1140 L = 1O'"t 9" MIN COVER/ L = 60' 7INV.=63.80' O'MAX)) INSTALL TWO INSPECTION PORTS (MIN.) / S=1Te (MIN.) 36" MAX COVER ® Smt% (MIN.) x((MIN.) NITAR��`� 4"SCH40 PVC 4"SCH40 PVC 40 PVC n • /0 " D� •" u" s" 11.3" TO d �/ INV.= 64.85 48'LIQUID INVERT o LEWL } INV.=64.60 GAS BAFFLE J PROPOSED D BO 3 ROWS OF 5 UNITS AT 6.25'/UNIT + 0.75' WEDGE = 32.0'/ROW • X INV.=64.0 DB-3(H-10) INV.= 63.50 SOIL ABSORPTION SYSTEM (PROFILE) EXISTING 1,900 GALLON SEPTIC TANK RESTORE VEGETATIVE COVER , EXISTING SEWER OUTLET BACKFILL NTH CLEAN PERC SAND 75" NOTES: 1) CONTRACTOR SHALL VERIFY TO TOP OF CHAMBERS ALL EXISTING ,. : .; PIPE INVERTS PRIOR TO CONSTRUCTION 2) D-BOX SHALL BE SET LEVEL AND TRUE TO BREAKOUT=TOP ELEV.=63.89 GRADE ON A MECHANICALL COMPACTED SIX INV. ELEV.= 63.50 INCH CRUSHED STONE BASE, AS SPECIFIED IN BOTTOM ELEV.= 62.56 EXISTING SUITABLE 310 CMR 15.221(2) 2.83' MATERIAL 3) REPLACE EXISTING 1,000 GALLON SEPTIC 5' MIN. ABOVE BOTTOM OF IN&;2 w UP I Wm TANK WITH 1500 GALLON SEPTIC TANK T.P. EXCAVATION OR G.W. EFFECTIVE WIDTH = 3 x 2.83' = 8.49' r 76" IF FAILED, DAMAGED, OR LESS THAN 1,000G IN CAPACITY. (6.06' PROVIDED) USE 3 ROWS OF 5-HIGH CAPACITY 4) INSTALL INLET & OUTLET TEES, AS REQUIRED BOTTOM OF TESTHOLE EL.=56.50 __ ADS BIODIFFUSER UNITS-NO STONE PROFILE W/ CONTOURED WEDGE SEPTIC SYSTEM PROFILE TYPICAL SECTION 16" N.T.S. Kta 11.2 DESIGN CRITERIA SOIL LOG P#: 12679 NUMBER OF BEDROOMS: 2 BR EXIST./3 BR DESIGN (NO INCREASE IN FLOW ALLOWED) DATE: AUGUST 26, 2009 �- 34"--� SOIL TEXTURAL CLASS: CLASS I SOIL EVALUATOR: DARREN M. MEYER, R.S., CSE. SECTION END CAP DESIGN PERCOLATION RATE: <2 MIN/IN WITNESS: DAVE STANTON, BARNS B.O.H. DAILY FLOW: 330 G.P.D. Elev. TP-1 Depth Elev. TP-2 Depth 16"" HIGH CAPACITY (H-20) BIODIFFUSER UNIT DESIGN FLOW: 330 G.P.D. 68.0 1 Flu 0" 68.0 p"FILL MODEL 16" HICAP GARBAGE GRINDER: NO (NOT DESIGNED FOR GARBAGE GRINDER) 67.0 A 12" 67.0 A 12" ,� LOAMY salvo LOAMY SAND LENGTH 76�� NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT PROPOSED SEPTIC TANK: USE EXISTING 1,000 GALLON CAPACITY 10YR 4/1 10YR 4/1 EFFECTIVE LENGTH 75 TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY LEACHING AREA REQUIRED: (330) = 445.94 S.F. 66.67 B 16" 66.67 B 16" SIDE WALL HEIGHT 11.2" DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. 74 LOAMY SAND LOAMY SAND OVERALL HEIGHT 16" 10YR 5/8 10YR 5/8 DISTRIBUTION BOX: 3 OUTLETS (MINIMUM) 64.67 C1 40" 64.67 C1 40" OVERALL WIDTH 34' 4640 7RUEMAN BL VD PRIMARY S.A.S. MEDIUM SAND CAPACITY 13.6 CF HILLIARD, OHIO 43026 USE 3 ROWS OF 5 - 16" ADS BIODIFFUSER H-20 UNITS-NO STONE :50 (101.7 GAL) ADVANCED ORNNAOE sYs1EMs, INC.PERC®s3 AND EXTENDED 0 75' W/ CONTOURED WEDGES MEDIUM SAND 2.5Y 6/6 BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.70 SF/LF OF BIODUFUSER) 2.5Y6/6 PROPOSED SEPTIC SYSTEM/SITE PLAN (BIODIFFUSERS) 15 UNITS x 6.25 LF x 4.70 SF/LF = 440.63 SF 56.50 138" 56.50 138" 28 VANDERMINT LANE, HYANNIS, MA (CONTOURED WEDGE) 3 ROWS x 0.75' x 4.70 SF/LF = 10.58 SF PERC RATE <2 MIN/IN. ("C" HORIZON) Pre TOTAL AREA = 451.21 SF Prepared for: Arch Construction DESIGN FLOW PROVIDED: 0.74GPD SF 451.21 SF = 333.89 GPD > 330 GPD re 'd NO GROUNDWATER OBSERVED are / ( ) q Engineering by: Surveying by: SCALE DRAWN DATE: DARRENM.MEYER,R.S. Eco-Tech Ehvinonmexild NTS D.M.M. 08/26/09 • I. Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 P08OX081 (508) 364-0894 CHECKED to conduct sail evaluations and that the above analysis has been performed by me consistent with the E4STSiAIVDWlCM ��47 BAW DATE: SHEET NO. requirements of 310 CMR 15.017. I further certify that I hove passed the Soil Eval. Exam in October, 1999. Ep@. 2-26V 08/27/09 D.M.M. 2 Of 2 i