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HomeMy WebLinkAbout0078 WAGON LANE - Health EWagon Lane nis P 270,207 ' I . � o u. I f II 4� o if 1� 0 1 e I1111 I� 4)i i �i e e {I �I 1' { d e � 8 C a TOWN OF rr BARNSTABLE LOCATION �( C�.p�py�,, 4. �2. SEWAGE# :nty VILLAGE �A\(,4,iN v-,S ID ASSESSOR'S MAP.&PARCEL 9 7 '0O-7 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type)' c (�� (size) 3 Z`L X T. NO.OF BEDROOMS OWNER �cSZw-ora� fir, rs.Ar.A. PERMIT DATE:-��I L` 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 orf` " 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 .I (O D� �) r� L� t\ � n D ' C (Cli 0 Aj J n _ U 00 00 � TOWN OF BARNSTABLE LOCATION'e-I �S U3A GOQ LplKN�;- SEWAAGE#_^).611 `" Q VILLAGE hN�3`s, ASSESSOR'S RP&LOT d- INSTALLER'S NAME&PHONE NO. l._,t'i SEPTIC TANK CAPACITY J� Xk&6u j 16bnG'i�tl LEACHING FACILITY.(type) L C- (size) NO.OF BEDROOMS 2� BUILDER OR OWNER PERMIT DATE: �� -2 D2( COMPLIANCE DATE: y 2.dL Separation Distance Between the: s Maximum Adjusted Groundwater Table and Bottom of Leaching Facility //1��� 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 J F � � � � � � � �' � �. � � ,�, A ,� �1 �7 SLRtit � c S :A S S 1 ° .,�. t , 3 �� �® t J j No. �0 24 Fee V THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: / PUBLIC HEALTH DJVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes AppliLAtion for -Disposal *pBtrm Const urtion i3Prmit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System �dividual Components Location Address or Lot No.Td' 0�er' N�m�Addres . G ,and Tel.No. e ��6— u. Civ Assessor's Maz�ap l0 � a 2 '7 Instta�ller's Name,Addres Van j_Tel.4. Designer's Name,Address,and Tel.No. v=6Z_ Y777—3 /3 ./u6 ffetl1 CC,d 5`e^i, f�rvf�� E b<cr<� w orrcf Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �, � gpd Design flow provided VS8 gpd Plan Date ���/' Number of sheets 2 Revision Date Title Size of Septic Tank Z 00 d Type of S.A.S. Description of Soil �_ � �21,61 s21g;;Z y� I Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Application Approved by Date V Z Application Disapproved by Date for the following reasons Permit No. ! Date Issued Z fi+1N k c;{"a's` r{�,�.i;S,y }'R�'y, Jam' 4'•L1y,yyn'T.kn �'!'.F�.. �o.-,w, �,,1K� n{.r,,p+.-�r 7-., .rF`•^r`8",tipi'-..r7F4,�`r� Yd�*n"!...J..w,�;iS'`.c M k��e.^*.a+;C'-+..y.,�.� ;K" .-»t!4�««+ T'.:e No. 1 -4` 1 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered m'computer: Yes PUBLIC HEATFI,.DJVISION TOWN OF BARNSTABLE, MASSACHUSETTS 4plitation for,30ts osal,6psteln Construction Permit ,..�. 1~ ' Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System &Kndividual Components ¢' Location Address or Lot No.Z '46009 a L-V. Owner's N'me,Address,and Tel. ''��(� " f,�,ya+rr�=•'y ,�•r/u�ojzl� �-reivcdq � Assessor's Mapardel _?n Ins filer's Name,Address,and Tel:No. _5 d,e-� 7?'# 'Q'a '- Designer's Name,Address,and Tel.No. 3ZW- 36a "'" ty . ,ap;'s6'[j /2 Gw.sf cro yJFi•-/c,� cti a G �c57r- .�'" 4+ Type of Building•" Dwelling h,No.of Bedrooms q. g ( )Lot Size ft. Garbage s Grinder Other Type of Building No.of Persons Showers( ) Cafeteria Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date ��/qs� Number of sheets 2 Revision Date Title c T Size of Septic Tank f aC7 d Type of S.A.S. /"1!�o,-_/—.a• tion of Soil r Description p � ,f Nature of Repairs or Alterations(Answer when applicable) '�.,,,„ i7/3vt 4�,�/ %'— CC-G �!®..,/�.-•s �«, 'f� sr°'c�C� • Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not"to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date irl�._94 e� Application Approved by Date Application Disapproved by 4mate for the following reasons r Permit No.' � � �� Date Issued !/ ! _.- -- --• -- - - --- ----- -,_..,.._._,_._.,_ -_--•--•-• - --- , ----•----•- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of CoMpliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(�� Upgraded( ) Abandoned( )by fs�. at 7 (i/p�.�� /_t> /�yrArys s. has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. , L r 13 dated qL4,111 Installer �_, oe ' Designer #bedrooms , ~, Approved,dees'i`g�n,fld'w � �4 gpd The issuance of this pe it shall not be construed as a guarantee that the systemj-,"Yil° 1 fIion as designef�Date N/� -V V'. Inspector ,.AA ,_J()G �. ., -r_ r - ..._. _ . . No. Fee�•� !-tY0 t r THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS -isposal *Vstem Construction Permit Permission is hereby granted to Construct( ) Repair(6-K. Upgrade( ) Abandon System located at `7-245' i- ' and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with A Title 5 and the following local provisions or special conditions. 2 `Provided:Construction must be completed within three years of the date of this permit. Date Ml ly_j s Approved by Town of B.ArkistaW - eRegulatory Services Rich ard,V-Scali,liliterim-Director t. BAANSTA8M >` - - "r Q P'tePlic Health Division f Thoffias IMcKean, Director Y' 200 Main Street;Ilyanws,NIA'02601. �. Office: 508-862-4644 Cj hax: .SUS-790-6304 Installer.& Designer Certification Form Date: J Sewage Permitt#r Assessor's lIap\Parcel���7 C) `2ct 7 Designer: t"�c :u�¢fir; c�trr Li s It i Iiastaller: � , „re rut cl. Address: J2 Wj C Address: '&V3 McLC'A _ , M r7z473 U11 Qd&eJ�Se1IAc;,, was issued a permit.to install,a (date) (installer) septic system at "7 C � o c -C 1,,44,j based on a design drawn by (ad ress) E t1 3 L4s_ /yr dated ..�1 `f 4/6 (designer) certify that the sr ptic, system referenced above was installed.substantially according to the design,.which inay includei minor approved cliange.s such as Lateral relocation: of the distribution box andlor 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.( .e. greater than 10' lateral relocation of the SAS or any vertical relocation of any.cornponent of the septic system) but in.accordance with State & LocaI Regulations. Plan revision or certified as-built by designer to.fol'low. Strip ou,t.(if required) �vas inspected and the soils, were found`satisfactory. I certify that the system re:terenc�ed above was constructed in . with the"tet7iis of the I\A approval letters(if applicable) (Installer's Signature), Ct351p9 q�p.. 0 (Designer's Signature) (Affix x Desigt e s ere) PLEASF•RETLIRN TO BAI2NS'1ABLE PUBLICHEALTIT D.IVIS_ION. CERTIFICATE OF COMPLIANCE WILL NOT BE :ISSUED.UNTI.L. BOTH THIS FORM, AND.AS I$UILT CARD ARE RECEIVED BY THE BARNSTAB E PUBLIC H.I ALTH D VISIO,M THANK YOU. (j .Septi es finer Certifwation Fortis Rev 8-14-13.doc Engineers note:This certification is limited to an as-built inspection of system components as:installed prior to f ackti6L The engineer did not supervise construction of thesystem.The installer assumes responsibility for alf malerials,workmanship;,backtilling to specified grades Lath proper compaction and setting riserskovers as Shown on the design plan: No. ,�-V l" ' M� � � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ye PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Application for disposal 6pstr tt Construction jhrmit Application for a Permit to Construct( ) Repair(Upgrade(Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 'I 1T cA-)A,-j Owner's Name,Address,and Tel.No.TO ?6°9 t Assessor's Map/Parcel (3'( Q ,io Installer's Name,Address,and Tel.No.5Z37 Designer's Name,Ad ress,and Tel.No. ���.,5,�.•n�, TI pe of Building: r. Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building J No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 J ® gpd Design flow provided gpd Plan Date YY-1 vt�F tAA�j a�l C)ol�( Number of sheets Revision Date Title Size of Septic Tank O—N G',197'N3 Type of S.A.S. c- Description of Soil Nature of Repairs or Alterations(Answer when applicable) lte Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date / Application Approved by t/ Date Application Disapproved by Date for the following reasons Permit No. T1 Date Issued 4 , No. �'y� G w pO V t ( ; y g ".,:.sY Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ye PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftplication for Disposal *pstem Construction Permit Application for a Permit to Construct( ) Repair(Upgrade(Abandon El Complete System ❑Individual Components Location Address or Lot No. ~(`3 '� `�' �' Owner's Name,Address,and Tel.No.Sa`87"-.0 b'6.9 3 t�i Assessor's Map/Parcel a 7 (j'� Ir-t��„� &\\4, O' 6© � ��vl,p Installer's Name,Address,and Tel.No.5Z3 'E"?F 6e�-jZ` Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building 'y,-S No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3 gpd Design flow provided 6 ( glad Plan Date Mb�U� a (� `�p<<� Number of sheets Revision Date eW Title Size of Septic Tank er :f524� Type of S.A.S. �3 Description of Soil Nature'of Repairs or Alterations(Answer when applicable) � � l 1 t S AZ_S Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. ab (d _0 Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded(/'f Abandoned.(- )by �.oc.SZ�I ��?�J- �.�r CA e.2A at � 5� C.��c,a.-1, L,d,�,� has been co"d*n ce with the provisions of Tit el 5 aand the for Disposal System Construction Permit Nated Installer��C 4�- s , r.1- C'W c Designer .-C./ f n in c �. #bedrooms Approved d Si:. flow ;7 A gpd The issuance of this permit shAll of �e construed as a guarantee that the system i fu coon as/designed/ f Date Inspector /,��/yl✓��`r f ! i`?VIP,! -✓1 ? P No. Feet 60 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS } Misposaf 6pstem Construction 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 recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided::f Constructionrust.be completed within three years of the date of this permit. � Date V Approved by Town of BarnstableJ3 Department of Regtdatory Services nntwsrnar� t Public Health.Division Date M AB,4 "'a39 200 Main Street,Hyannis MA 02601 rFD PM`t Date Scheduled— Time-� Fee�cl. cJC s Stoll � Suitability Assessment for Se a eIs ®s _Performed By:_ .cad-S"e w `M,G`�Z?J-' Witnessed By: V,/ .��i �,. l G' / � LOCATION & GENE'RAI,T_NT OI�1VIrt� 'ION Location Address' ��� �t`�„R� Owner's Name Address 'F Assessor's Map/Parcel: a Engineer's Name �� e�'�Y f SQChS �^ NEW CONSTRUCTION REPAIR Teleplione# Land Use - �.j�F / j Slo cs ql 0— �^ P7e Surface Stones „& rn Distances from: Open Water Body �-ZB(D ft Possible Wet Area ,Zee ft Drinking Wafer Well Drainage Way wd ft Property Line ----ft Other ft SICETCH:(Street name,dimensions of lot,exact locations of test holes&I'ere fasts,!Dealt wetlands(n proxinuty to ho]cs) SEE PP-0 P0 S� � J t s�w 1�-6rE ItOZ4-yJ 3 B"J .C:S 10 k 6 Parent material(geologic)I t u U E/y v A511 Depth to Bedrock '• I 41 Depth to Groundwater. Standing Water in Hole: Weeping ffotn Pit FlIce A A Estimated Seasonal High Groundwater 11/A DEA TN!,WAa1'VATION FOR SEAS4..ON.(' L I1[AGH WY ATER J7,,,('`js,B.ILA.N':1 - _- _ Method Used: _ Depth Observed standing in obs.hole: In, Depth to soil mottles: Jt,, Dcpth to weeping from side of obs.hole: _ _ in. Oroundwuter AdJushrlent ft. htdcx Well I# Reading Date: Adj.tatter— AcIj.(IVU11 wuterlevl AEHCOL rIO gESTDitto—_ -- Dittos__,,,�,_ Titao N Observation Hole# Time at 9" Depth of Pere T►n'ie at 6" lStart Pre-soak Time @ o Time(9"-6") End Pre-soak 1017 Rile Min./Inch V Site Suitability Assessment: Site Passel] ✓`` Site Failed: Additional Testing Needed(YIN) Original: Pubic Health Division Observtition Hole Data To Be Completed on Back---------- ***1f Percolation test is to be conducted within 100' of wetland, you must first:notify tile. Barnstable C ouservation Division at least one (1) week prior.to lied fining. QMEPTIC ERCPORM.DOC DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Sdil Color Soil . Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency,Y6 Caravel) 5`- - °' 13 126" DEEP OBSERVATION HOLI;LOG Hole# �G Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsisten '% ravel �3t' Lt DEED'OBSERVATION HOLE LOG Hole# Depth from Soil H n Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consi to cy,90 OraVal) DEEP OBSERVATION HOLE LOG hole it Depth from Soil Horizon Soil Texture Soil Color 5011 Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders, Consistency, 6 a x Flood Insurance Date Map: Above 500 year flood boundary No— Yes Within 500 year boundary No Vt Yes Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? 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 required4raining,expq tise and experience described in 10 CNM 15.017. Signature G Date 3 �� Q:1.5 EPTIC�PL�RCPORM.DOC � . 11 `i 1 i v to'et i qg� ��� i 1 1 6t i f C0c Gy Y /p J It TOWN OF BARNSTABLE V LOCATION r �A�A' ��' SEWAGE # VILLAGE y ASSESSOR'S MAP & LOT Ago�Z'a 7 /.u5PeC, P;STAL9MR'S NAME&PHONE NO. g -�)Zd yC© SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) = 7 NO.OF BEDROOMS / BUILDER OR OWNER PERMITDATE: CONWL E DATE: �ro2 C Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility. Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by V o � � 1 � `o 241— _ I i i 1 L VAT ION SEWAGE PERMIT NO. F VILLAGE 61 I IeN.ST A ER'S Of ME A ADDRESS S UIL� . ` OR OWKEP DATE PERMIT ISSUED DATE COMPLIANCE ISSUED T a v _ � �1 V� �, d e �" � I ` I `� i P` 5,... .. � .� � � f ............... THE COMMONWEALTH OF MASSACHUSETTS BOAR F HE TH � -.-------OF.......: .: Appftr� iou for Diiposat Workii Towitrurtion 1hrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: �c- ................__. Q. :...�.�.. ..... .y...-_................... --.---.---_---.- --:----:�.--- -----.�--y:.---.--..--------------- Location-Address or Lot No. O er 22 " ddress a ............. ....iJ -- ...... ------------��•------.-`--------------- �G r n ller Address Type uilding Size Lot............................Sq. feet V Dwelling—No. of Bedrooms.......Is ................•.............___....Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building No. of ersons..............................Showers — Cafeteria a Other fixtures -------------------------------- . . . - W Design Flow........../1b........................gallons per person per day. Total daily flow..__,3.-��...._......_............gallons. WSeptic Tank—Liquid"capacity-.../!gallons Length__1-j---IV/... Width...� _____ Diameter________________ Depth LSD'-_._-. x Disposal Trench—No--------------------- Width.................... Total Length......._..r........ 'Total leaching area....................sq. ft. Seepage Pit No...___ �- -- Diameter.._.74---------- Depth below inlet.............._. Total leaching area....a ...sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date............................•--------- aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Description of Soil------.... ` L.....•.....l3: `2'1.......1.. "� `3C� �, ` D ......l u g o>t. W •--•••------------------•----....---•-----•-•-••--•----------•------•-----------------•--------•••--------•--•••--...------------•••--•-••••--•-•-••---•-•-•---••-••-------•-•------•---•-------......-- UNature of Repairs or Alterations—Answer when applicable.....................___...................................._.____.............................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TLl'i , 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. - ---•-- -----• --•--- �- ..... -- --------------------- --------- ---- -•-..2�.._ A plication Approved By--.---- . ••. -•----------••---•-- -----•------•---------••----------•--•--•------•----- --.----• -•- ...•.... p Date Application Disapproved for e f owing reasons---------------••--------------------•---------•-.._.._..----------------------------....._..----•••............. ---•-------------•••.....----•••----•----•-----••---•---••-----•--•••---•-----•-•-------•--------......••--•-•---•-•--------•-••----------------•-•---•---•••---••••--••----••-•---------------......... Date PermitNo......................................................... Issued....................................................... Date NO.l. :. FEB.... ............. THE COMMONWEALTH OF MASSACHUSETTS BOA R �ETH ....`.. :.......OF... . ....... ... . . ApplirFatiun for Bispoii al Worko Tomitrnrtiun Permit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ................__.. ... ' • •----- .... `•--•--•.............. ........••----- ......------.. .........•--• °••------•.......•••••. Location-Address e W Ow er :!VAS ', ...... .. ...... ..Bu ... Address UType o ilding Size Lot...........................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) a� Other—T e of Building No. of persons............................ Showers YP g ---------------------------- P ( )--- Cafeteria ( ) Otherfixtures .-------•--------------------------•-•-•----------- -•-•••--------•------•••----•••• . �1 Desi n Flow..._._ 11.6................. .....,gallons per person day. Total dajl flow..... sF� W g pp P P �' fa Y' ` ----•-• Ions. WSeptic Tank—Liquid capacity.....�"R�111ons Length ...... Width...' . ....... Diameter................ Depth................ x Disposal Trench—: o..................... Width.................... Total Length._.....-f........ Total leaching area...... o--sq. ft. Seepage Pit No....... .! ). Diameter.-_....2......... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution bok ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fx, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ " r �?ODtnof Soil---•---- F - � A ev- C_A •---•- ........................................................ 6t� �,1� ,i�.. UW -------------------------------------- .......................................... ............................... Nature of Repairs or Alterations—Answer when applicable................................................................................................ .................................................------•--•---•--•-----------------.....----------•---•----•----.......------------•--•------------------------------------------------••--•--•-------• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been iss ed by the board of health. fing ------------------- ate 7 Application Approved BY ........................................................ ! Date.............. - Application Disapproved for th�olsons________________ ........................-................................................................................................................................................................................ Date PermitNo.......................................•••......••....... Issued•....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Tatifiratr of Tort liFaurr THISJS�V .�6ZC 'TIFY, That the Individual Sewa -pis osal System constructed or Repaired by....•......,p'%'!l`.. tfP ° , P �' ( ( � '------------------------------------------------------------------ --------------- ---------------- ns I er at. r� - ----r--- • -- ... fG------------- -----•-- ..... has been installed in accordance with the'pr visions of TITl1 .�v State Sanitary Coe °fle c> eyi'in the application for Disposal Works Const�rncti Permit No......................................... dated_....__ _.................._... k THE ISSUAi OF THIS C� Perm' SHALL NOT BE CONSTRUE® S A GUARANTEE THAT THE SYSTEM WIL CTION SATISFACTORY. DATE....lT 1-f.....d..�.................................................. Inspector..... ...-----------------.......-----------------•----•--•---.........--- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........................................:.0 F.................._..............._... ........ No.... . ••--•-•-•-- FEE........................ Muvoua1 . r1rofilanotnulion firrmit Permission to Construct ( > hepebypair granted :''.� ' �,� ' an Indiva.SST Disposal Sys"t at No. - .. .�- - � �---------------- . Street /r as shown on the application for Disposal Works Construction Permit No��,._:_.._._._._ Dated__. "f.............:............ .............................: "_�'`,:"-------------------....-------•------•-•---••-----•---- FBoard of Health DATE :.. --•----•-----------------------•--•----•............... �/ FORM .1255 HOBBS & WARREN. INC., PUBLISHERS i 51►JGLr— FAM1L-Y - ;3 BEOR00M DA1L�( FL oW a Ito x 3 � 33o G.Rp !"B•4 �'� 9�• 5EPTkC TANK = 33oxi5o% .495G.P. u5E l000 GAL. 1I � I �1 wT �B , �. 4 0%6Po5AL PIT BOTTOM AREA, 50 S.FF X I o -TOTA1-.. DF-51GI4 -- 425 -TC>TAL DA►LIY PER.Got_A.TtoN RATE : 1"Ii j 2MIN oP--Lf= ��c oiFARD dCHAF _M�� cy W. A. 8AX7ER ' �.•A � Jp�E S N No.21048 10 h�.SRO A / To F1,10 =100.0 svB,�C✓L► r:. , GAL. L '•' P14 T• ��N . ��r•i� 97 G Ova IY P. q T N / i LEAGu G.2.9✓EL pIT ANY. INV. WIT1a WASNGD i cdues,�- j CER.TIFtGP P1_o-T PLAN P Z0 I L� LocA7 ►otN 4y�-4xl'Lll I, N o" 5 C,ALE PLAN REFS2.ENGE CERTIFY THAT TwF-- tSi 1n1G-PND.5KO1WN NEREC�11 GOtAFL%(5 YJITNTHE SIP6-- 6-17" 70 j AND SGTgo.GK R.6Q0%P-EMEN`r!�, 0p -TµE -TOWN OF:� $ARNISTa 6LE- AN'D IS Nd-►— GK 2�37 j�6. z y 1_ocp.TE \NIT14lw T E G►-Oop P A►N DAT 5: BAxTEcZ.e N`(E INS• I REG I S���6U'►-Au D 5 u E`�EYoeS -T Ia 15 P L&IsJ 115 NET 4 n 5 r ra a b A N CJ 3T G 9-1/l t_LC— /HAS s• IuSTP-L-IMENT 'Sv2vEY � 'TtNE OFF5ET5 5uout,D i c�2A No-Z' 1>E uSED'T O t7E'TF-F-POW G 1_.or }- INE�j APPLICA►-aT �6•aT -/�,4SGL�/ti 3Z�Oz C� RECEIVED � 1. I S G 3 SE? % 6 Z003 COMMONWEALTH OF MASSACHUSETTS TDWH E LBH DEPT BLE Z w EXECUTIVE OFFICE OF ENVIRONMENTAL FAIRS m d DEPARTMENT OF ENVIRONMENTAL PROTECTION o, ,e /\ 350 MAIN STREET WEST YARMOUTH,MA CUM0 508-775-2800 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION MAP 270 PAR 207 Property Address: 78 WAGON LANE HYANNIS,MA 0261 Owner's Name: LABOMBARD,WAYNE Owner's Address: 78 WAGON LANE HYANNIS,MA 02601 Date of Inspection SEPTEM BER 12,2003 Name of Inspector: (please print) JAMES D. SEARS Company Name: A& B Canco Mailing Address: 350 Main Street West Yarmouth,MA 02673 Telephone Number: 508-775-2800 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the infonnation 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 Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent tot he 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. Title 5 Inspection Form 6/15/2000 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 78 WAGON LANE HYANNIS, MA 02601 Owner: LABOMBARD,WAYNE Date of Inspection: SEPTEMBER 12,2003 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ./ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: N/A 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. Answer yes,no or not determined(Y,N,ND)in the 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 extiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. 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 uneven 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: 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 obstruction is removed ND explain: Title 5 Inspection Form 6/l 5/2000 2 Page 3 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 78 WAGON LANE HYANNIS,MA 02601 Owner: LABOMBARD,WAYNE Date of Inspection: SEPTEMBER 12,2003 C. Further Evaluation is Required by the Board of Health: N/A Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety,or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or 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 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 I of 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 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. 3. Other: Title 5 Inspection Form 6/15/2000 3 Page 4 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 78 WAGON LANE HYANNIS,MA 02601 Owner: LABOMBARD,WAYNE Date of Inspection: SEPTEM BER 12,2003 D. System Failure Criteria applicable to all systems: N/A You must indicate"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in pit is less than 6"below invert or available volume is less than'/z day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation N/A Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply N/A Any portion of a cesspool or privy is within a Zone I of a public well N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well N/A 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 or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.) NO (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CM 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: N/A To be considered a large system the system must service a facility with a design 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 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 I I 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 is 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. Title 5 Inspection Form 6/15/2000 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 78 WAGON LANE HYANNIS,MA 02601 Owner: LABOMBARD,WAYNE Date of Inspection: SEPTEM BER 12,2003 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 nornial flows in the previous two week period? ✓ Have large volumes of water been introduced to the systern recently or as part of this inspection? ✓ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ Was the site inspected for signs of break out? ✓ Were all system components,excluding the SAS,located on site? ✓ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum ✓ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)has been determined based on: Yes No ✓ 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 CM 15.302(3)(b)] Title 5 Inspection Form 6/15/2000 5 r Page 6 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 78 WAGON LANE HYANNIS,MA 02601 Owner: LABOMBARD,WAYNE Date of Inspection: SEPTEMBER 12,2003 FLOW CONDITIONS RESIDENTIAL Number of Bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 1 10 gpd x#of bedrooms: 330 Number of current residents: I Does residence have a garbage grinder(yes or no): YES Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): YES Seasonal use(yes or no): NO Water meter readings,if available(last 2 years usage(gpd)): 2002 37,500/2003 45,000 Sump pump(yes or no) NO Last date of occupancy: PRESENT COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CM 15.203): Basis of design flow(seats/persons/sgtt,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: 1999 AND 2001 Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: gallons—How was quantity pumped detennined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank Attach copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: 1983 PERMIT 83-730.NEW DISTRIBUTION BOX SEPTEMBER 2003 Were sewage odors detected when arriving at the site(yes or no): NO Title 5 Inspection Form 6/15/2000 6 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 78 WAGON LANE HYANNIS,MA 02601 Owner: LABOMBARD,WAYNE Date of Inspection: SEPTEM BER 12,2003 BUILDING SEWER(locate on site plan): ✓ Depth below grade: 6" ' / Materials of construction: Cast iron (/ 40 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 onsite plan): ✓ Depth below grade: 8" Material of construction: J concrete metal fiberglass polyethylene other(explain) If tank is metal list age: Is age continued by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1,000 GALLON PRE CAST Sludge depth: 2" Distance from top of sludge to the bottom of outlet tee or baffle: 28" Scum thickness: I" Distance from top of scum to top of outlet tee or baffle: 12" Distance from bottom of scum to bottom of outlet tee or baffle: 17" How were dimensions determined: ASBUILT AND TAPE Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): MAIN TANK AT WORKING LEVEL. INLET BAFFLE.OUTLET BAFFLE.TANK AND COVERS 8"BELOW GRADE.NO SIGN OF OVERLOADING OR LEAKAGE. GREASE TRAP(located on site plan) N/A Depth below grade: Material of construction: concrete metal fiberglass _ polyethylene other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): • Title 5 Inspection Form 6/15/2000 7 Page 8 of 1 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 78 WAGON LANE HYANNIS,MA 02601 Owner: LABOMBARD,WAYNE Date of Inspection: SEPTEM BER 12,2003 TIGHT or HOLDING TANK: N/A (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass polyethylene other(explain) Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no) Alarm level: Alarm in working order(yes or no): Date of last pumping Comments(condition of alann and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 0 Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.,): DISTRIBUTION BOX IS NEW IN SEPTEMBER 2003. DISTRIBUTION BOX IS 16"xl6",20"BELOW GRADE. ONE LINE IN,ONE LINE OUT.NO SIGN OF OVERLOADING OR SOLID CARRYOVER IN OLD BOX. PUMP CHAMBER: N/A (locate on site plan) Pumps in working order(yes or no): Alarns in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Title 5 Inspection Form 6/l 5/2000 8 e Page 9 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 78 WAGON LANE HYANNIS,MA 02601 Owner: LABOMBARD,WAYNE Date of Inspection: SEPTEMBER 12,2003 SOIL ABSORPTION SYSTEM (SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 1 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.) LEACHING IS ONE 1,000 GALLON PRE CAST PIT. PIT AND COVER ARE 3' BELOW GRADE.NO SIGN OF OVERLOADING OF SOLID CARRYOVER.30"WATER IN PIT.NO HIGH STAIN LINE,WALLS CLEAN. CESSPOOLS: N/A (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation etc.): PRIVY: N/A (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.) I Title 5 Inspection Form 6/15/2000 9 Pa�e9 of'II OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 78 WAGON LANE HYANNIS, MA 02601 _ Owner: LABOMBARD.WAYNE Date of Inspection: SEPTEM BER 12,2003 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 buildine. • i ``11 i �A e 1 \ 31, o IX )CO Title 5 Inspection Form 6/15/2000 10 Page I I of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 78 WAGON LANE HYANNIS, MA 02601 Owner: LABOMBARD,WAN'NE Date of Inspection: SEPTEMBER 12.2003 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to groundwater 22 feet Please indicate(check)all methods used to determine the hillh ground water elevation: Obtained from system design plans on record-If checked.date of design plan reviewed: Observation site(abutting propertyiobservation hole within 150 feet of SAS) Checked with local Board of Hcalth-explain: Checked with local excavator::. installers-(attach documentation ✓ Accessed USGS database-explain: You must describe how you established the high ground water elevation: USGS WELL DATA 22,ZONE D 2.ADJUSTED 20 Ilk II r s i r Title 5 Inspection Form 6/15/2000 1 1 No. P`—_ �')-7 Fee— THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZippYication for Mi5pool *pgtem Construction Permit Application for a Permit to Construct( )Repair( epgrade( )Abandon( ) ❑Complete System L6'ittdividual Components Location Address or Lot No. Owner's Name,Address and Tel.No. �✓A C,o Al 4/t/ i—4 6 a M/3,4>e D Lv,4 Assessor's Map/ParcelN r ?,r7O^ 2b g, W 4 4 G V -N /1 r Installer's Name,Address,and Tel.No._5 D 1- '7)t -01 F a o Designer's Name,Address and Tel.No. �d Cd vGo Type of Building: No t Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan,Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) C Z 4&a X Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss by this Board of Health. Si ned Date Application Approved by Date R O 3 Application Disapproved for the following reasons Permit No. Date Issued 1� No. �"•'� 3 _ L/( )"7 Fee �� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0(ppYication for Oi5po5ar *pgtem Construction Permit Application for a Permit to Construct( )Repair( e Upgrade( )Abandon( ) ❑Complete System 'Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 7 !4 O N L M �1 /�f Q G m 6,4 a 1D Lt/.�I�J��t✓� Assessor's 1VIap/Parcel N ,Z r(o 20 n 9' W A 4 O A.- A.M, hi f, I Installer's Name,Address,and Tel.No._f G 8• '71) ,r - A r 4 o Designer's Name,Address and Tel.No. J 57 Type of Building: Na 5 t Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other ' ,'-Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. A Description of Soil w 4 Nature of Repairs or Alterations(Answer when applicable) 'Z Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue.4 by this Board of Health. Si ned 'z Date /_2 ¢ Application Approved by Date I O 3 Application Disapproved for[he following reasons} l„ z _ 3. 1 ,fi 4 4g � a< 6V. Permit No. a00 3—4/y-7 "" Date Issued — , --- ---------- ----------=----- c. # THE COMMONWEALTH OF MASSACHUSETTS # BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( 'Upgraded( ) Abandoned( )by h+r o : To m,4 dr I at ? 7 `-y 4 Ao k !.A, 4 Y ev, has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. Zc -Ny�dated 9 /Z-p.3 Installer . .prat, .� a_ Designer The issua?cre of thisipermit shall not be construed as a guarantee that the system W.. tes' - Date Z' U Inspector ,$5 No. � -------------------------Fee -•�t"� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS 'Wi5po5af *pgtem Construction Permit Permission is hereby granted to Construct( )Repair( 4 Upgrade( )Abandon System located at SI L4j 4/_G N 4. ,-, A/ ' 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 pe t., r Date: 1 k 3 Approved b _ r� Y _ Town of Brrnstable °pTHE 1pN, Regulatory Services ti Richard V. Scali, Interim Director 1 BA ^BLE Public Health Division 9 MASS. g �pTE1 39- a`� Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Homeowner Certification Form for Alternative Systems Property Address: V)P�GD t l L Aw&—: ,H Assessor's Map\Parcel: 9,20 a.o7 Property Owners Name: In accordance with Massachusetts DEP alternative system approval letters, the following certification information is required by the Owner of record. The Owner of record must place an "x" in the applicable box next to each line certifying the information. Yes N\A ❑ I have been provided a copy of the Title 5 I/A technology Approval letters. (15 page Standard Conditions letter and the specific technology letter) 0'/' ❑ I have been provided with the Owner's Manual ❑ '7`'�I I have been provided with the Operation and Maintenance Manual ❑ AC For Systems installed under a Remedial Use Approval, I agree to fulfill my responsibilities to provide a Deed Notice as required by 310 CMR 15.287(10) and the Approval ❑ For Systems installed under a Remedial Use Approval, I agree to fulfill my responsibilities to provide written notification of the Approval to any new Owner, as required by 310 CMR 15.287(5) 0— ❑ If the design does not provide for the use of garbage grinders, the restriction is understood and accepted ❑ Whether or not covered by a warranty, I understand the requirement to repair, replace, modify or take any other action as required by the Department or the LAA, if the Department or the LAA determines the System to be failing to protect public health and safety and the environment, as defined in 310 CMR 15.303 I , o Y �,�, agree to comply with all terms and conditions above. Property Ow ers printed name NA Property Owners Signature Date Note: This form must be submitted along with the septic system disposal works permit application for all I\A si stems including new construction, repairs\upgrades, with and without aggregate (stone) and with conventional design criteria or credited design criteria. Q:\Septic\IA homeowner certification.doc i Town of Bar nstable Regulatory Services o� Richard V. Scali,Interim Director * BA STABLE, + 9� MAM ��g Public Health Division ArED�,ta Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: AS "i Sewage Permit# Assessor's Map\Parcel 210 10-7- Designer: J✓dc . Installer: Address: r �, � Address: On was issued a permit to install a '(date) (ins taller) septic system at LN 40 1AVe, f "W'f based on a design drawn by / (address) P-1(P� G �� • dated �- 6 (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of ally component of the septic system) but in accordance with State &Local Regulations. Plan revision or certified as-built by designer to follow. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed-in compliance with the terms of the IAA approval letters (if applicable) OF (Installer's Signature) 114, ;' 'FfC/STEM esigner's Signature) QNITAO PLEASE RETURN TO BALSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc I� - HYANNIS LEGEND �� r -�-�-� PROPOSED CONTOUR ° 28 79 8-1 PROPOSED SPOT GRADE WAGON LANE —— 98 —— EXISTING CONTOUR + 96.52 EXISTING SPOT GRADE W— EXISTING WATER SERVICE I I 100.0 LOCUS Z . I I I 78 WAGON LN. N ® TEST PIT - +--j -- ---- `j 9 -7---A-1------- I--------- W � I I lLij > ° > I WEST Mp�N 0 i II Q LOCUS.-M.AP W LOCUS INFORMATION PLAN REF: 287/029 TITLE RF: PARCELSS D: MAP52702PAR. 207 EXIST. 3 B R 99 FLOOD ZONE: "C" O D WE L L'1 N G (full) /,' O COMMUNITY PANEL: 250001-0005-G DATED:08/19/85 TBM=TOF=EL. 100.0 SEPTIC SYSTEM _--_--_ REPAIR PLAN ag. 99.3 �' LOCATED AT: CK (on tubes) %/ 78 WAGON LANE EXIST. o 0HYANNIS, M A GENERAL NOTES: SEPTIC TANK + 1 PREPARED FOR 0 E. HERRARA/ I. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE(LOCAL coREADY ROOTER BOARD OF HEALTH AND THE DESIGN ENGINEER. o i 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS MARCH 29, 2014 OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE r LOCAL RULES AND REGULATIONS. - 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR FO - OF TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE _ O'� TH_ TH-1 13 3 ����� Mgss9� DESIGN ENGINEER. EXIST��' o, DA E ti 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING r nR ' FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN _ L.P. rid I �t- ENGINEER BEFORE CONSTRUCTION CONTINUES. /' ram` ° No. 1140 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. I 32.00' 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF ��`��� ��`k%���/_ 6/$TER�� THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF X SA NITA R�a� HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. ap 7. DWELLING IS SERVICED BY MUNICIPAL WATER SUPPLY. 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED 98. TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE ;, 100.0 LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO STARTING WORK. , �" 10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND FILLED PER TITLE 5. MEYER CX SONS, INC. 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION P.O.- B 0 X 9 81 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY I AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY 13. NO KNOWN PRIVATE WELLS WITHIN 150 FT. OF PROPOSED LEACHING EAST SANDWICH, M A. 02537 14. ALL PIPING TO BE 4" SCH 40 ® 1/8"/FT (UNLESS SPEC. ) I (5 0 8)3 6 2—2 9 2 2 15. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A GARBAGE GRINDER. 16. NO WETLANDS WITHIN 150 FT. OF PROPOSED LEACHING ' r SCALE 1"=20' SHEET 1 OF 2 J#1573 " NOTE-.4,"TO PREVENT BREAKOUT, THE PROPOSED J NOTE:, MAGNETIC TAPE TO BE PLACED OVER ALL COVERS FINISH GRADE SHALL NOT BE < EL 96-49 FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. TOF: EL.=100.0t SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL A 4" DIAMETER INSPECTION PORT OVER 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=99.0t. F.G. EL.=99.0f F.G. EL: 98.70t F'G. EL 98.49(MAX.) �� �� OF MAss9 c 7- ' bo DAR{, M. 9� 9" MIN COVER/ - �1 MFvY' l 36" MAX COVER L = 35. L = IO'(MAX) INSTALL TWO INSPECTION PORTS (MIN.) C i"� NO. 1140 N6 ® 5=1% (MIN.) EL = 98.25 ® S=11% (MIN.) 0 S=1% (MIN.) 4"SCH40 PVC 4"SCH40 PVC 4"SCH40 PVC • 'QfGlST ER�� 10• 1a• 6• 11.3" To SANITAR�a� \INV.=97.20 4e"ugU/D INV.= 96.95 iINV.= 9NVE0 T I [EVE[ PROPOSED GAS BAFFLE D-BOX INV.=96.00 3 ROWS OF 5 UNITS AT 6.25'/UNIT + 0.75' WEDGE = 32.0'/ROW l2 111 INV.=96.2DB- SOIL ABSORPTION SYSTEM (PROFILE) EXISTING 1,000 GALLON SEPTIC TANK EXISTING SEWER OUTLET RESTORE VEGETATIVE COVER ' LL WITH CLEAN PERC ,SAND 75" TO TO TO TOP OF CHAMBERS - NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING 1 BREAKOUT=TOP ELEV.=95:49 PIPE INVERTS PRIOR TO CONSTRUCTION 2) D-BOX SHALL BE SET LEVEL AND TRUE TO INV. ELEV.= 95.10 GRADE ON A MECHANICALLY COMPACTED SIX BOTTOM ELEV.= 94.16 EXISTING SUITABLE INCH CRUSHED STONE BASE, AS SPECIFIED IN 2.83' MATERIAL 310 CMR 15.221(2) 5' MIN. ABOVE BOTTOM OF '-r 76" 3) REPLACE EXISTING 1,000 GALLON SEPTIC TANK T.P. EXCAVATION OR G.W. EFFECTIVE YIIDTH = 3 x 2.83' = 8.49' WITH 1500 GALLON SEPTIC TANK IF FAILED, (5.56' PROVIDED.)--- i DAMAGED, OR UNDERSIZED. BOTTOM OF TESTHOLE EL/s=88.60 '\ USE 3 ROWS OF-5-HIGH CAPACITY PROFILE= ADS J 62QBD BIODIFFUSER (H20) UNITS-NO STONE 4) INSTALL INLET & OUTLET TEES W/ W/ CONTOURED WEDGE GAS BAFFLE AS REQUIRED �--_--- • SEPTIC SYSTEM PROFILE TYPICAL SECTION 16" N.T.S. "rs 11.2" SOIL LOG P#: 14313 k,10 A DESIGN CRITERIA DATE: MARCH 27, 2014 I�--34" � NUMBER OF BEDROOMS: 3 BEDROOM DESIGN SOIL EVALUATOR: DARREN M. MEYER, R.S., CSE #1614 SECTION END CAP SOIL TEXTURAL CLASS: CLASS I DESIGN PERCOLATION RATE: <2 MIN/IN WITNESS: DONNA MIORANDI, BARNSTABLE HEALTH DAILY FLOW: 110 G.P.D/BR. DESIGN FLOW: 330 G.P.D. Elev. TP-, 1 Depth ` Elev. TP-2 Depth 16" HIGH CAPACITY 1620BD (H-20) BIODIFFUSER UNIT 60 ff GARBAGE GRINDER: NO (NOT DESIGNED FOR GARBAGE GRINDER) 98. A LOAMY SAND 0' 98.70 F A LOAMY SAND 0" MODEL 16" HICAP SEPTIC TANK: 330 gpd x 200% = 660 gpd RE-USE EXISTING 1,000 GALLON SEPTIC TANK 98.18 • tOYR 3/2 5" 98.20 10YR 3/2 6" LENGTH 76" B LOAMY SAND B LOAMY SAND � NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT LOAMY SAND 10YR SAND EFFECTIVE LENGTH 75 TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY ,,"95.10 AOYR42" ' 95.12 43" DIFFER SLIGHTLY FROM ACTUAL PRODUCT,APPEARANCE. LEACHING AREA REQUIRED: (330)/0.74 = 445.94 S.F. C C SIDE WALL HEIGHT 11.3' DISTRIBUTION BOX: 3 OUTLETS (MINIMUM) MEDIUM MEDIUM OVERALL HEIGHT 16" OVERALL WIDTH 34 ,4640 TRUEMAN BLVD " PRIMARY S.A.S. SAND SAND 13.6 CF . HILLIARD, OHIO 4JO26 USE 3 ROWS OF 5 - 16" ADS 16208D BIODIFFUSER H-20 UNITS-NO STONE 2.5Y 6/4 2.5Y 6/4 CAPACITY PERC ® (101.7 GAL) ADVANCED DRAINAGE SYSTEMS, INC. AND EXTENDED OW CONTOURED WEDGES EL 93.60 BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.73 SF/LF OF BIODIFFUSER) PROPOSED SEPTIC SYSTEM/SITE PLAN (BIODIFFUSERS) 15 UNITS x 6.25 LF x 4.73 SF/LF = 443.43 SF 88.60 120" 88.70 120" 78 WAGON LANE, HYAN N IS, MA (CONTOURED WEDGE) 3 ROWS x 0.75' x 4.73 SF/LF = 10.64 SF TOTAL AREA = 454.07 SF PERC RATE <2 MIN/IN. SOILS IN ("C2" HORIZON) Prepared for: Herrara/Ready Rooter DESIGN FLOW PROVIDED: 0.74GPD�%,.SF(454.07SF) = 336.01 GPD > 330 GPD req'd NO GROUNDWATER OBSERVED System Design and Site Plan by: SCALE DRAWN DATE: t Meyer&Sons,Inc. NTS D.M.M. 03/29/14 1, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017' PO BOX 961 to conduct soil evaluations and that the above analysis has been performed by me consistent with the EASTSANDW/CH,MA02537 CHECKED SHEET NO. requirements of 310 CMR 15.017. 1 further certify that I have passed the Soil Evol. Exam in October, 1999. 508-362-2922 D.M.M. 2 Of 2 1 4 -- 98 -- EXISTING CONTOUR x 100.98 EXISTING SPOT GRADE W PROPOSED WATER SVC. f * � G EXISTING GAS SERVICE 4 _014Ja=94.5 OVERHEAD WIRES t .^}' 'Radio Station TEST PIT BENCHMARK LEGEND 78 Wagon Ln,!t a !��_,.-•� " Hyannis,MA 02601 LOCUS MAP WAGON LANE 99.80 99.83 EDGE 99.94 OF 100.04 PAVEMENT 100.04 99.98 100,38'` 10 0.7 ❑ 24'45'20" 100.00' x 101. 100.89 WW.__... 100,8 100.87 100, 4 x 101,64 GAVEL.'.: c� `.-DRIVEWAY::._' 101.24' 101.74 101. WALK + W + 101.34 + 101.2 1 1.31 EXISTING HOUSE(#78) T.O.F.=102.5t SLAB CELLAR V) 101.2 + 101.53 rn 101.35 + BM BH Cn W SONOTUBE Cn W DECK FOUNDATION + 1.2401 to 100.50 �4 o x rn o � 101.32 �c X1,45 o PROPOSED S.A.S. 7 LC-6 PRECAST CHAMBERS �*r-�T � SURROUNDED W/4' STONE(SIDES) AND 2' STONE(ENDS) 101.14 O O O O O O i 0 A 99.8 EXISTING SEPTIC TANK .;': ..:.:. -.. : MANIFOLDED VENT (TO REMAIN) 100.90 :::.:._:1_aa': . '.6 L_f__ +_A 12' TOP OF TANK, EL.=100.521 INV.(OUT)=99.19f SHED x x 100.25 + 99.78 rX 100.71 �' -�TP-1 + 51 i I-<99,980X TP-2 9 .39 LOT 7B >� EXISTING S.A.S� J EXISTING S.A.S. 13,500 ±SF / 0 TO BE ABANDONED / 99.39 3 ROWS OF BIODIFFUSORS / x x 99.02 / 0 S 24 20r' W 100.00' rrjoP PLAN REVISION 4/6/21 Mg1) D-BOX INVERTS T. l's 2) ADD INLET TEE TO D-BOX PARCEL ID: 270-207 CIVILcEN N PROPOSED SEPTIC SYSTEM UPGRADE PLAN No. 35109 78 WAGON LANE, HYANNIS, MA FSSI +� Prepared for: Cape Cod Septic Services, 350 Main St, W. Yarmouth, MA 62673 OWNER OF RECORD HERRERA, EDWARD Engineering by: SCALE DRAWN JOB. N0. -4�- 1, SANCHEZ, AUDREY L Engineering Works, Inc. 1"=20' P.T.M. 144-21 78 WAGON LANE 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. HYANNIS, MA 02601 (508) 477-5313 3/19/21 P.T.M. 1 Of 2 eJ� / NOTE: TO PREVENT BREAKOUT, FINAL GRADE SEPTIC TANK SHALL NOT BE AT, OR BELOW, EL.=96.0 INSTALL RISERS & COVERS OVER INLET & FOR A DISTANCE OF 15' FROM THE EDGE OF THE PROPOSED S.A.S. OUTLET AND SET TO 6" OF FINISH GRADE PROPOSED D-BOX PROPOSED S.A.S. INSTALL RISER & COVER INSTALL RISER & COVER OVER ONE CHAMBER (MIN.) SET TO 6" OF GRADE AND SET TO WITHIN 3" OF FINISH GRADE TO SERVE T.O.F=102.5t AS AN INSPECTION MANHOLE. F.G. EL.=101.5t F.G. EL.=99.8t to 101.3t F.G. EL.=101.3t F.G. EL.=101.3t CHARCOAL VENT 2" LAYI�R OF 1/8" L = 9' L = 38' TO 1/2 DOUBLE ® s=1% (MIN.) ® S=1% (MIN.) WASHED STONE 4'SCH40 PVC 4"SCH40 PVC (OR APPROVED FILTER FABRIC) 6" 3'•• 10"I E3 Q EM 6 n la" 1 I I 2 EXISTING 48" LIQUID LEVEL ADD INV.=98.17 PROPOSED 4' 3' 4' GAS BAFFLE _ INV.=98.00 3/4"-1 1/2" INV.=99.19 �� EFFECTIVE WIDTH = 11' DOUBLE WASHED (VERIFY) 3 OUTLETS INV.=95.50 STONE EXISTING SEPTIC TANK H-20 USE 7 LC-6 LEACHING CHAMBERS IN SERIES WITH INSTALL INLET TEE 4' OF STONE ON SIDES AND 2' OF STONE ON ENDS H-20 RATED NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE TOP CONC. ELEV.=96.33 --- --- INVERTS, PRIOR TO INSTALLATION. INV. ELEV.=95.50 E3 E3 E3 EM®E3 -BREAKOUT ELEV.=96.0 2) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE ®E3 E3®EM E3 E3 i ON A MECHANICALLY COMPACTED STABLE BASE OR BOTTOM ELEV.=94.50 SIX INCH AGGREGATE BASE, AS SPECIFIED IN 310 1 1 2' 1 7 x 6' = 42' 2' CMR 15.221(2). 4' OF NATURALLY OCCURRING 3) INSTALL INLET & OUTLET TEES AS REQUIRED. PERVIOUS MATERIAL EFFECTIVE LENGTH = 46' 4) A GAS BAFFLE SHALL BE INSTALLED ON OUTLET TEE 5' (MIN.) ABOVE G.W. AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. EST. HIGH G.W., EL=89.3 - LEACHING SYSTEM SECTION SEPTIC SYSTEM PROFILE SOIL LOG GENERAL NOTES: DATE: MARCH 27, 2014 (Ref. P#14,313) SOIL EVALUATOR: DARREN MEYER RS(CSE#1542) 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL WITNESS: DONNA MIORANDI R.S. HEALTH AGENT BOARD OF HEALTH AND THE DESIGN ENGINEER. ELEV. TP-1 DEPTH ELEV. TP-2 DEPTH 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE 99.3 A O 99.4 A O LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: LOAMY SAND LOAMY SAND -310 CMR 15.405(1)(b): LOCAL UPGRADE APPROVAL 10YR 3/2 10YR 3/2 1) A 3' variance to the 3' maximum cover requirement, for up 98.9 B 5" 98.9 B 6" to 6' of max. cover. S.A.S. shall be H-20 and vented. LOAMY SAND LOAMY SAND 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR 10YR 6/6 10YR 6/6 TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE 95.8 42" 95.8 43" DESIGN ENGINEER. C C -4. ANY`CONDITIONS-ENCOUNTERED DURINCCONSTRUCTION DIFFERING FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN ENGINEER BEFORE CONSTRUCTION CONTINUES. 5. ALL ELEVATIONS BASED ON AN ASSUMED DATUM. MED. SAND MED. SAND 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 2.5Y 6/4 2.5Y 6/4 THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 8. THERE ARE NO WELLS WITHIN 100' OF THE PROPOSED S.A.S. 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS 89.3 120" 89.4 120" AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE /IN. "C" HORIZON NO GROUNDWATER, PERK RATE: <2 MIN. DIRECTED BY THE APPROVING AUTHORITIES. 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS r----4,---- ---------- IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND KNOCKOUT REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). I 20'DIX COVER I I 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE _ INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. 4"KNOCKOUT 4• KNOCKOUT I I L --------- 4'KNOCKOUT ---- I 72" PLAN VIEW DESIGN CRITERIA NUMBER OF BEDROOMS: 3 ® ® ® 0 ® ® ® 22„ ® 0 SOIL TEXTURAL CLASS: CLASS I (LOADING RATE=0.74 GPD/SF) INVERT i ® ® ® ® ® ® ® 12" 1 I t I DESIGN PERCOLATION RATE: <2 MIN/IN DAILY FLOW: 330 GPD 72" 1 36' - DESIGN FLOW: 330 GPD SIDE VIEW END VIEW GARBAGE GRINDER: NO-not allowed with design WIGGIN LC-6, H-20 LOADING LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF LEACHING CHAMBER .74 GPD/SF EXISTING SEPTIC TANK: 1000 GALLON CAPACITY PROPOSED DISTRIBUTION BOX: 1 INLET, 3 OUTLETS PROPOSED SEPTIC SYSTEM UPGRADE PLAN USE 7 LC-6 LEACHING CHAMBERS IN SERIES WITH 78 WAGON LANE, HYANNIS, MA 4' OF STONE ON SIDES AND 2' OF STONE ON ENDS SIDEWALL AREA: (11.0' + 46.0') x 2 x 1' = 114.0 SF Prepared for: Cape Cod Septic Services, 350 Main St, W. Yarmouth, MA 02673 BOTTOM AREA: 11.0' x 46.0' = 506.0 SF Engineering by: SCALE DRAWN JOB. NO. Engineering Works, Inc. N.T.S. P.T.M. 144-21 TOTAL AREA:........................................................... 620.0 SF 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. DESIGN FLOW PROVIDED: 0.74 GPD/SF(620.0 SF) = 458.8 GPD (508) 477-5313 3/19/21 P.TrM. 2 Of 2