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0124 WAYLAND ROAD - Health
2124 WaylandRoacl � k 1777) Hyannis P 'A = 271' '203 i I TOWN OF BARNSTABLE LOCATION 129 VJ AJ L A J D e.D. SEWAGE#?OLI — O'T O VILLAGE A-0 p k 15 ASSESSOR'S MAP&PARCEL 2Z 703 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY k000 Ra`\. LEACHING FACILITY:(type)500 ge<. C R A-yA3eeS (size) I2.$3 -7C ZS NO.OF BEDROOMS 3 OWNER <W— M EM4 .a L 'AJ L PERMIT DATE: q COMPLIANCE DATE: 31 to FZJ Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility- N Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet 131dge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY OU L-CO. 5 A viv Li 1 44.8 Z3 �- 38.11 28.E 9 ZI.S O A S 11 o-Z. $ ,too No ✓� � Fee AV THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION , TOWN OF BARNSTABLE, MASSACHUSETTS Yes 21ppfication for Disposal *pstem Construction Permit � Application for a Permit to Construct( ) Repair( ) Upgrade(-A Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. lay �c, Cs C Owner's Name,Address,and Tel.No. Assessor's Map/Parcel aZ l go3 0^115 ©Y) L Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. ob4-4 OvIZ TA rAq14e4.r) A%-y Crc dlwlw Type of Building: Dwelling No.of Bedrooms Lot Size �I 67 sq.ft. Garbage Grinder( ) Other Type of Building Re6a d4,1 Ilk ] No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) -3 30 gpd Design flow provided )LI9 gpd Plan Date ,?)" 5 a®d Number of sheets ` Revision Date Title Size of Septic Tank 000 Rdn Type of S.A.S. �^ "��pcl���a�a� Pre c cxs5 Description of Soil C11vw%�— Ft AQ Scrt,d JCS S� .0/Y Nature of Repairs or Alterations(Answer when applicable) aAanotto cdd �Svo cm., n 1000 6C.11®n wb, n SQL R&n 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. 2 Signe Date Application Approved by Date 319J Application Disapproved by Date for the following reasons Permit No. Date Issued ------------------------------------------------------- - No 076 6 Fee f dV " THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION-,TOWN OF BARNSTABLE,.MASSACHUSETTS co - 21ppritation fot ispbar 6pstent Construction 3permit r� Application for a Permit to Construct( ) Repair( ) Upgrade Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.;( 'ow y4 ew Rood Owner's Name,Address,and Tel.No. Assessor's Map/Parcel � p'tD , ,y G`✓�/il �/1 i fs 3 ( /G�fW��Oi Installer's Name,Address,and Tel.No. u 1� Designer's Name,Address,and Tel.No. r Ro1xC4 OVIZ In IL Vn9l4t& ► �`y Cr�nc��rry+ Type of Building: t `.Dwelling No.of Bedrooms - Lot Size J A#� sq.ft. Garbage Grinder( ) Other Type of Building 11.0 4 1 Gz � No.of Persons Showers( ) Cafeteria( ) Other Fixtures F Design Flow(min.required) A 30 gpd Design flow provided ', L49 gpd Plan Date �" 5- aca i Number of sheets Revision Date ,Title "S Size of Septic Tank 3 ooc (,C,Jkd n Type ofS.A.S. Teel"I,V*'4` Description of Soil M(rIVIY-b 'F►�14 SI.ke' kO { 64ak SAAC ! Nature of Repairs or Alterations(Answer when applicable) OAA A t'to ('' - 0 0411On C h en A'S TLC ' r riP► t 1000 6r_11 o n 15-,O 0 Le- e d+.Ic JQ P R A 6 ,. 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 3"�-���� Application Approved by Date Application Disapproved by Date for the following reasons 1� PermitNo. Date Issued - - - - - - - -- } t THE COMMONWEALTH OF MASSACHUSETTS - -_ - BARNSTABLE;IVIASSACHUSETTS - Certificate of Compliance THIS IS TO.CrEERTIIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded(�) Abandoned( )by i'iij00@+""�' OWL V%C.R at 1XI y 1�tl , YCAnhts has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No,> /-(3?0 dated Installer 91Qbdl, 4- Xly_- Designer —T(- nA1nu1 %,14 #bedrooms Approved design flow _ gpd The issuance of this permit shall not be construed as a guarantee that the system wiT ctioj�as d esgned. Inspect( 1/Date` AD No. � ° r ^' I Fee r�c) THE COMMONWEALTH OF MASSACHUSETTS DA-PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal bpstrm Construction permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) System located at 0%4 JA)avr k AA kph J , F1 V 4.A A 1 S B � and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date f t .� Approved by�, y. Town of Barnstable Regulatory Services Richard V. Scali,Interim Director AIAM s wtvsrne�. _ p�� Public Health Division 16 Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: 3-18-21 Sewage Permit# oZ a a4 —D7 Assessor's Map\Parcel 271/203 Designer: -SC Eggt ltecin Installer: Robert B. Our-Co.,Inc.(RBO) Address: 28 S'4 Croev\oury �ta�way Address: 363 Whites Path Ea54 62.53$ South Yarmouth,MA On RBO was issued a permit to install a. (date) (installer) septic system at 124 Wayland Road based on a design drawn by (address) �C �e-� 'TV)-Cc dated 3-5-21 (designer) X 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. 1 certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or -- —`" 7 '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 i lance with the term- s of the RA approval letters(if applicable) • 1H OF AN /17 0 a� JOHN L CHILL At H {I taller's nature) CM! .4t i ZqV. ner's Signature (Affix De t p Here) PLRETURN TO ARNSTABLE PUBLIC HEALTH DM SION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM I AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\SepticUDesigner Certification Form Rev 8-14-13.doc { TOWN OF BARNSTABLE ✓ LOCATION SEWAGE#. '2.000- i z$ %"ILLAGE ASSESSOR'S MAPS&PARCEL a7/ -a y3 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY Z p ud t LEACHING FACILITY:(type) (/Z) � /Q yj ( 6 l�ltel(size) NO.OF BEDROOMS 3 ('� O'vV'NER a./P_%0 S a 00Jr0 a P e r o t rc_. PERMIT DATE: 5- t COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility r✓o 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). I feet FURNISHED BY � '� ��V-VQa S Gj L CL_ a N e � c7o t�w � Q w No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: UBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Ye Zipplicatiou for 30i!5po.5al *p5tem Cougtruction Permit Application for a Permit to Construct( ) Repair QQ Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components 4' Location Address or Lot No. W 444- va A J Owner's Name,Address,and Tel.No. PQ��Z A_4 Assessor's Map/Parcel -2-7 20 ✓a-wv� N Installer's Name,Address,and Tel.No.C/kipCi,/i&L P� �) Designer's Name,Address and Tel.No. l L CG-v�r�..� �1� �0��2 3��9"11 l .z✓�C.�ly, r+w+ m�a uzs3Fs Type of Building: Dwelling No.of Bedrooms Lot Size 12, 1-G-1 sq. ft. Garbage Grinder ( ) Other Type of Building 11� _ No.of Persons Showers( ) Cafeteria( ) Other Fixtures r�T� / Design Flow(min.required) J gpd Design flow provided Ito 3 gpd Plan Date 5--13 `,L0 a Number of sheets Revision Date Title 12 Lc) ✓+-LJ Size of Septic Tank 16'0 d e-<, Type of S.A.S. (Z $ r o,-d tS) 1 CL Description of Soil SaL C)�� L Z Nature of Repairs or Alterations(Answer when applicable) C�K(S vs:IN In/ �� 11-e u T3— %3®x 1 b tG� J���->7 ��4MC��j t1� �C71� �(o ��'• C. �•�>^)ar.V-7�RJSo�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 Boa of Health. Signek, m Date ' Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. dW Date Issued :11 No. . ( ,K�. ( - � . Fee ' �EAM THE COMMONWEALTH OF MASSACHUSETTS - Entered ii compne1: UBLIC DIVISION - TOWN OF BA •�_Yes r BARNSTABLE, MASSACHUSETTS e v hiation for Mi!gpo al 6p!gtem Construction Permit Application-for a Permit to Construct( ) Repairr(>4 Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components } Location Address or Lot f o„ ( '� W 44--1 t,.1--A J (4 0-3 Owner's Name,Address,and Tel.No. P2�C c i/1,,✓a ' t• Assessor's Map/Parcel ^� t Z p (� /a V� v► Installer's Name,Address,and Tel.No.C"ye ';OL TUt�/i�t� Designer's Name,Address and Tel.No. ,C. ��(L—t,—,, 7l`3 Sa�- 2 3'c,3 71 'Z9f *� �� (in wy 1.,,r�•a, m r� t>z s 3� Type of Building: f- Dwelling No.of Bedrooms 1? Lot Size 12, G'l sq.ft. Garbage Grinder ( ) Other Type of Building5))% { , No.of Persons Showers( ) Cafeteria( ) R` Other Fixtures Design Flow(min.required) gpd Design flow provided :?g(. 3 d gP Plan Date 5 '13 -'Lao Number of sheets Revision Date Title 2`{ W ✓4Mj Size of Septic Tank, A Type of S.A.S. (Z Description of Soil rat D h, r— a 6 KT Nature of Repairs or Alterations(Answer when applicable) Gxk 5 4--, ;y-, �U (1 Q.�,t 1�— �'�O y 1 6 CZ) 5i pig-¢ fie» CR.,A CL t /2 To i<1( 3(® t.,4 c Date last inspected: Agreement: t 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 Boa of Health. Signe o An Date J Application Approved by !� ,� � I � _-,..,.J. Date Application Disapproved by: v / r I Date for the following reasons fi Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS sr BARNSTABLE, MASSACHUSETTS 4 Certificate of_Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (>4-) Upgraded ( ) Abandoned( )by— 4A J; (La CK V-4 L(,<_ at I Z-`{ t J ( ✓Nh V1 has bee constructed in.3ccordance with the provisions of Title 5 and the for Disposal System Construction Permit No. "'/ dated Installer C,4,,,,,,J;J_n t'1\4-(/A(i') < Designer c J #bedrooms 3 Approved design flow' gpd The issuance of this perm t shall not be construed as a guarantee that the system will unction as desig � Date (a Inspector No. Fee ✓ ; , (,/y THE COMMONWEALTIH`OF MASSACHUSETTS ' PUBLIC HEALTH DIVISION — BARNSTABLE, MASSACHUSETTS ligpofsar *p.tem Con!9truction Permit Permission is hereby granted to Construct ( ) Repair (X,) Upgrade ( ) Abandon ( ) System located at t/.>,. 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 mus fb6 com/'leted within three years of the date of this ermrt ,r%t Date / lF �� Approved by �7 `_~ t1 TRANS. NO.: CITY/TOWN: Hyannis APPLICANT: Capewide Entelprises ADDRESS: 124 Wayland Road, Hyannis, MA DESIGN FLOW: 330 gpd REVIEWED BY: DATE: N/A OK NO GENERAL Legal boundaries denoted [310 CMR 15.220(4)(a)] X Street, Lot, tax parcel number and lot number noted on plan [310 CMR 15.220(4)(u)] VX Locus Provided [310 CMR 15.2204(t)] X Plan proper scale? (1"=40' for plot plans, 1"=20' or fewer for components) [310 CMR 15.220(4)] X Easements shown [310 CMR 15.220(4)(b)] X System located totally on lot served [310 CMR 15.405(1)(a) for upgrades]- if not, a variance is required [310 CMR 15.412(4)] A Location of impervious surfaces (driveways,parking areas etc.) [310 CMR 15.220(4)(d)] v X Location all buildings existing and proposed 310 CMR 15.220(4)(c)] A Location and dimensions of system components and reserve areas. [310 CMR 15.220(4)(e)] System Calculations [310 CMR 15.220(4)(0] LIX daily flow septic tank capacity(required and provided) X soil absorption system (required and provided) whether system designed for garbage grinder X North arrow [310 CMR 15.220(4)(g)] Existing and proposed contours [310 CMR 15.220(4)(g)] 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)] X Location and date of percolation tests (performed at proper elevation?) [310 CMR 15.220(4)(1)] X Percolation test results match loading rate? [310 CMR 15.242] X Certification statement by Soil Evaluator [310 CMR 15.220(4)0)] X Observed and Adjusted groundwater (method for adjustment given or indicated) [310 CMR 15.103(3) and 310 CMR 15.220(4)(n)] X Address l Z Ll � L Z�t2 [ Sheet 1 of 7 a G t c N/A OK NO Location of every water supply, public and private, [310 CMR 15.220(4)(k)] X L/ within 400 feet of the proposed system location in the case of surface water supplies and gravel packed public water supply X within 250 feet of the proposed system location in the case X 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 other subsurface utilities located [310 CMR 15.220(4)(m)] (if water line cross see 310 CMR 15.211(1)[1]) Profile of system showing invert elevations of all system components and the bottom of the SAS [310 CMR15.220(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)] 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)] Benchmark within 50-75' of system [310 CMR 15.220(4)(g)] VX Materials specifications noted? [various sections of 310 CMR 15.000] X System components not> 36" deep (unless Local Upgrade A royal or LUA requested) [310 CMR 15.405(1(b)] X Address 4 Sheet 2 of 7 N/A ON NO a Size OK? [310 CMR 15.223(1)] Inlet tee located ten inches below flow line [310 CMR 15.227(6)] X Outlet tee 14" or 14" + 5" per foot for increase ft depth [310 CMR 15.227(6)] X Outlet tee with gas baffle or approved filter [310 CMR. 15.227(4)] X Note regarding installation on stable compacted base [310 CMR 15.228(1)] 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)(01 X Three access covers (inlet and outlet must be 20" or greater) - middle access at least 8" (by 7/07) [310 CMR 15.228(2)] X Access to within 6 " of grade - one port for systems<1 000gpd, two for systems >1000 gpd [310 CMR 15.228(2)] X All at-grade covers secured to unauthorized access? [310 CMR 15.228(2)] X > 10 ft from building foundation [310 CMR. 15.211(1)] X Buoyancy calculation Required/Done [310 CMR 15.221(8)] X H-20 Where appropriate? [310 CMR 15.226(3)] X Setbacks from resources [310 CMR 15.211] X Multi-Compartment Tanks ,.. 4k fir_x Required when other than single-family dwelling or flow>1000 gpd [310 CMR 15.223(1)(b)] X First compartment 200% daily flow; Second compartment 100% daily flow [310 CMR 15.224(2) and (3)] X "U" pipe through or over baffle, outlet of each compartment with gas baffle or approved filter [310 CMR 15.224(4)] X Address I / � � Sheet 3 of 7 N/A OK NO BUILDING SEWER AND OTHEgj?IPING.11 , Located at least ten feet from any water line? [310 CMR 15.222(2)] X Disposal piping at least 18" below water line (when water and sewer cross, see 310 CMR 15.211(1)[1]) X Cleanouts required/provided ? [310 CMR 15.222(8)] X Thrust blocks specified in force mains? 310 CMR 15.221(6)(c)] X 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) [310 CMR 15.251(9) and 310 CMR 15.252(2)(c)] X Siphon problem/ leachfield below pump chamber) X Endcaps or vent manifold specified? 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 CMR 15.252(2)(h)] X Materials specified (310 CMR 15.251(5) specifies various pipe types allowed) X DISTRIBUTIONBOX > . , .., u w ,, : 77, u; 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)] X Riser if deeper than 9" [310 CMR 15.232(3)(0] X Inside minimum dimension 12" [310 CMR 15.232(2)(b)] X Minimum sump 6" [310 CMR15.232(3)(e)] X Watertight cover if<2000gpd); waterproof manhole if>2000gpd [310 CMR 15.232(3)(d)] X PUMP CHAMBERS, Capacity(emergency storage above working=design flow)? [310 CMR 231(2)] X Proper setbacks [310 CMR 15.211 (same as septic tanks)] X Watertight 20-in minium access manhole at least 20" MUST BE TO GRADE [310 CMR 15.231(5)] X Service components accessible (not too deep with piping, disconnects accessible) X Alarm floats - alarm on circuit separate from pumps specified? X f Exceeds two units must have two pumps operating in lead-lag mode. [310 CMR 15.231(6) and (8)] X Stable Compacted Base [310 CMR 15.221(2)] X Buoyancy calculations needed ? Provided? [310 CMR 15.221(8)] X Address l 2 6�✓f � J _ Sheet 4 of 7 N/A OK NO SO'IyL:`ABSORRPTION:SYSTElYIS (SAS) 4fWFER Ii Calculations correct? X 4 feet of naturally occurring material demonstrated? [310 CMR 15.240(1)] X Required separation to groundwater? [310 CMR 15.212)] X Aggregate specified as double washed [310 CMR 15.247(2)] X 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] X GALLERIES,PITS,CHAlVIBERS 3;10.C1VIR 15.253 A- Chambers and Gal. in trench configuration supplied with inlet every 20 ft. [310 CMR 15.253(6)] X Each structure with one inspection manhole (if>2000 gpd must be to grade) [310 CMR 15.253(2)] X Aggregate I minimum- 4'maximum. [310 CMR 15.253(1)(b)] X 2' sidewall credit maximum [310 CMR 15.253(1)(a)] X In bed configuration, inlet every 40 s . ft. [310 CMR 15.253(6)] X TRENCHES 3fO ( MR#"15 251 Width 2'minimum 3'maximum [310 CMR 15.251(1)(b)] X 100 feet -maximum length [310 CMR 15.251 1)(a)] X Minimum separation 2x effective depth or width whichever greater(3x if reserve between trenches) [310 CMR 251(1)(d)] X Situated along contours [310 CMR 15.251(2)] X Breakout OK? [310 CMR 15.211(1)[4] and Guidance Document] X BED SAS,,(Maximuim�size of bed,Gr,,field 5000 gpd) minimum 2 distribution lines [310 CMR 15.252(2)(a)] X Maximum separation between lines 6' [310 CM RI5.252(2)(d)] X Maximum separation between lines and outside of bed 4' [310 CMR 15.252(2)(e)] X Aggregate depth below discharge pipes 6" minimum, 12" maximum. [310 CMR 15.252(2)(g)] X Separation between beds 10' minimum. [310 CMR 15.252(2)(0] X Bottom area used in calculations only [310 CMR 15.252(2)(i)] X Address Z � Sheet 5 of 7 N/A OK NO DID THE ELAN-INVOLVE '�� � K �k''` Pressure Dosed System ? Provided pump and piping calculations as required [310 CMR 15.220(4)(r)] X Pressure dosing required on all systems >20009pd or alternative systems under remedial approval [310 CMR 15.254(2) and I/A Remedial Use Approvals] X If used in gravelless system - make sure jet is directed as not to scour soil interface [Guidance Document] X Inspections once per year(systems<2000 gpd) or quarterly (>2000 d) good 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] X Impervious barrier installation must be supervised by designer [310 CMR 15.255(2)(b)] X Retaining wall must be designed by Registered Professional Engineer [310 CMR 15.255(2)(a)] X Side slope not exceed 3:1 ? [310 CMR 15.255(2)] X Breakout requirements met? [310 CMR 15.252(2) and Guidance Document] X At least 5 ft. from impervious barrier to edge of SAS (10 ft. recommended) [310 CMR 15.255 (2)(e)] X Grayelless System[I/ 4pProval Le,tier)w I x 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 Alternative'Septce,'System�[I/A Approval LetfersJ 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? X Is there a note on the plan regarding the requirement for perpetual maintenance agreement? X Any alarms involved on separate circuits X Did the applicant submit an operation and maintenance manual? X Has applicant submitted a copy of a maintenance X �Varaanees e the variances listed on the plan ? [310 CMR 15.220 (4)(q)] X RLS Stamp necessary on plan if a component is within five feet of property line [310 CMR 15.412(4)] X New construction or increased flow proposed - [Refer to 310 CMR 15.4141 X Address �� / �� (�/�/� Sheet 6 of 7 N/A OK NO 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] X Is the system proposed on the same lot as served by private well ? [310 CMR 15.214(2)] X Are the nitrogen loads proposed in compliance? [310 CMR 15.216(1)] X Miscellaneous41 Pumping to septic tank ? [ 310 CMR 15.229] X Shared System [310 CMR 15.290] X Address t Z y (A)AVLAMO Sheet 7 of 7 �1 Own or ,sarnstabie Regulatory Services Thomas 1,. Geller, Director e1 9. �, ' Public Health Division Thornas McKean, Director 200 Main Street,Hyannis, MA 02601 Office; 508462.4644 Fax; 50-NO.6304 Installer & Aniener Cer ' c t on Form Date: Tuo g- 5 -2ua Q ' Designer: SC.� C-n ?Vlee.ctn Tn C. --,-�--.. 5 ` Installer: Address: zL `f ,t{(v%WJ0VAddress: C�s� uJa�e.h<..m N(� 6J?.53 � _ �.Q��-�ln,��-L. ✓t�l-v � On 4 S�1 K- 20 0 ��'L 'i was issued a permit to install a tal (datc7 (insler) septic system at 12-t wnylond ._ R,0ad based on, a design drawn by (address} ��. � �l�e✓Ciil , "a �G. dated .�GY. t3 zoo 9 (designer) ^' - -- — _ Z certify that the septic. system referenced above was installed substantially according v,, the design, which may include minor approved changes such as lateral relocation of th,. distribution box and/or septic tank. 1 certify that the septic system referenced above was installed with major changes (i.t. greater than 10' lateral relocation of the SAS or any vertical relocation of any compontsnt of the septic system) but in accordance with State & Local Regulations. Plan revisioa. or certified as-built t)y designer to follow. Kt1 hR 1,1.�e„ I �4. JOHNJ L Ni! -7—A! (Designer's Si ej Afii esig»ar's tamp Here) �- -- 'LEASE RET11 R. TOft! ST LE B H)E V ON. CERTIFICATE OF CO C L ISS T B BUEL RE B E S N. 4 Healtf/SepticA:)esignerCertification Fiomii T 1A 'A JCCC% CJ7 CMC nA l T L77 AI T k1 --7_--_--t` 06/05/2009 13:02 FAX 5084283928 CAPEWIDE 2 001/001 TOwn of lfarnstabie Regulatory Services DA i Thomas F. Geiler,Director 1 MAW Public Health Division ►ef4 Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office; 509-R62.464A Fax; 50-")G•63G6 Instzi er& si a Cer ' c t o r Dater T000- ra, ava ' Designer: e.cm • To C. Installer: CCU .-Lu Address: ZA•-..Y eccv'�W .VI e'c+ / Address: P o (3ox I c.� On S-I u- Zoos At elw`.10 was issued a to Permit install (date) (installer) P s all a septic system at Iz4 WAy(ond Qoocl based on a design drawn by (address) 3'C �r1�tt1��Ci(1 y , "T�nc:•�. dated _NQy 13. 2009 (designer) _,IZ I certify that the septic system referenced above was installed substantially accordinE; t<a the design, which may include minor approved changes such as lateral relocation of th., distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.t. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan reovisiot: or certified as-built by designer to follow. ljOHN L , tal I erTs-3 i aturej^" c;ti«. �,:►;�'► tvI; - (Designer's Si e) -- (AfR esigner's amp Here) PLEASE RETU TO BARNSTARLIF. PFIIRT.iHE V ON. CE Fl 'AT'E F CO I mix A II' ARE REE;EIVED AY Q Health/Septic/Designer Certification Fotn, I0 'd L920 £LZ 80S 9NIN33NIDN33r wa Zb: to 600Z-S0-Nnr �Si Town of Barnstable P# I Department of Regulatory Services WN"ABM; .—Public,_Public.Health Division Date 6 �' 039. 16� 200 Main.Street,Hyannis MA 02601 . Date Scheduled ��. Time Fee Pd. U/ Soil Suitability Assessment for Sewage Disposal Performed By: Witnessed By: t. �. LOCATION & GENERAL INFO.I ATIOIv Location Address i` ,( A/ . Owner's Name w/A Mdt►� S Address o Assessor's Map/Parcel: TC .Engineer's Name [/� NEW CONSTRUCTION REPAIR Telephone#, Sd3- Z7.3 ev 3 7 Land Use S/W GL C�A sty ��r Slopes(%.) —Z _ Surface Stones" Distances from: Open Water Body � ft Possible Wet Area _ ft Drinking Water Well ft Drainage Way ft Property Line 7 ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) S . cc 77 .� - P LA'4 OAS 5 3iavvq / Parent material(geologic) u-r(VAS/4 Depth to Bedrock 7 0o Depth to Groundwater: Standing Water in Hole: 7 ]3 _ Weeping from Pit Fac- 3 _ Estimated Seasonal High Groundwater 7 )"3o. DE . RMINATION FOR SEASONAL HIGH WAT.W,.TAKE. Method Used: 7 UgfGe'�<17�Df� Depth Observed standing in obs.hole: ?13 0_ in. Depth to soil mottles; a 13 t7 in, Depth to weeping from side of obs.hole: 7130 in. Groundwater Adjustment �' ft• Index Well# Reading Date: Index Well level Adj.factor , Adj.Groundwater Level I�E'RCOI,AT1GN.TE 1�ntQ ."1?'og7rlup DIY . Observation Hole# Time at,9" r _ Depth of Pere 28-Y1 Z$'yb Time at 6" Start Pre-soak Time C W/O 10.1 S Time(9"-6') End Pre-soak l o:2 y ID., 2 Li Rate Min./Inch L 2° "''�lJ 2Y/w;L/� Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) /" Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at l9ast one(1) week prior to beginning. Q:\SEPTIC\PERCFORM.DOC DEEP OBSERVATION ROLE LOG Hole Depth from Soil Horizon Sal Texture Soil Color Surface(in.) Soil Other (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel 0 -3 31 $ �28 L S v5�� �Z-ice -2 S n /o ye-yg - AEEP-OBSERVATION HOLE:LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Surface(in.) Soil Other (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Grave] a 1 G k 51f-, �2-130 =2 C SAI-0 `6yn58 DEEP OBSERVATION ROLE.LOG Hote4 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel DEEE OBSERVATION HOLE LOG Hole Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure;Stones,Boulders. Consistenc Gravel) Flood Insurance Rate Map: Above 500 year flood boundary No Yes Within 500 year boundary No 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? ES If not,what is the depth of naturally occurring pervious material? Certification I certify that on 0'2�" (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 required training,expertise and experience described in 310 CMR 15.017. Signature Date Q:\SEPTIC\PERCFORM.DOC I A- Town of Barnstable Barnstable ' Regulatory Services Department A&AanMn p SAMSTAq 1639.�� Public Health Division 6 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 70081830000205008642 4/23/2009 Alexsandro Perreira 124 Wayland Road Hyannis, MA 02601 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 The septic system located at 124 Wayland Road, Hyannis MA was last inspected on April 13, 2008,by Robert Paolini, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Backup of sewage into facility or system component due to an overloaded or clogged SAS. • Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS. You are ordered to repair or replace the septic system within Sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 124 Wayland Rd. Property Address Alexsandro Perreira Owner Owner's Name information is required for Hyannis Ma. 02601 4/13/2009 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. ImpO1rtant: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your Robert Paolini cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC. Company Name P.O.Box 763 Company Address Centerville Ma. 02632 r10° City/Town - State Zip Code (508)428-4028 S14454 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 4/13/2009 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the.approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. LI'L4 6 t5ins•09/08 Title 5 Official Inspection Form:Subsurfage Disposal System-Page 1 of 17 t Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 124 Wayland Rd. Property Address Alexsandro Perreira Owner Owner's Name information is required for Hyannis Ma. 02601 4/13/2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 124 Wayland Rd. . Property Address Alexsandro Perreira Owner Owner's Name information is required for Hyannis Ma. 02601 4/13/2009 every page, Cityrrown State Zip Code Date of Inspection B. Certification (cont.). B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 124 Wayland Rd. Property Address Alexsandro Perreira Owner Owner's Name information is required for Hyannis Ma. 02601 4/13/2009 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 c , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4�M ,°•�'°° 124 Wayland Rd. Property Address Alexsandro Perreira Owner Owner's Name information is required for Hyannis Ma. 02601 4/13/2009 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 1 0,000g pd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CM 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 9 t Commonwealth of Massachusetts 4 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 124 Wayland Rd. Property Address Alexsandro Perreira Owner Owner's Name information is y required for Hyannis Ma. 02601 4/13/2009 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of.Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 N �4 ! Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 124 Wayland Rd. Property Address Alexsandro Perreira Owner Owner's Name information is required for Hyannis Ma. 02601 4/13/2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: The septic system consists of a 1000 gallon septic tank,distribution box and one leaching pit. Number of current residents: unknown Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2007:186,000 g ( y g (gp ))' 2008:168,000 Detail: 2007:510gpd. 2008:460gpd. Sump pump? ❑ Yes ® No Last date of occupancy: unknown Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 124 Wayland Rd. Property Address Alexsandro Perreira Owner Owner's Name information is required for Hyannis Ma. 02601 4/13/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for um in : P p 9 Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 124 Wayland Rd. Property Address Alexsandro Perreira Owner Owner's Name information is required for Hyannis Ma. 02601 4/13/2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1982 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 16"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 20'+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented through the house vents. Septic Tank(locate on site plan): Depth below grade: 14"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallon Sludge depth: 7" t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 ` Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4M 124 Wayland Rd. Property Address Alexsandro Perreira Owner Owner's Name information is required for Hyannis Ma. 02601 4/13/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 24" 811 Scum thickness Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 6" How were dimensions determined? measured Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): . Pump septic tank every two tears.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears to be structurally sound. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 124 Wayland Rd. Property Address Alexsandro Perreira Owner Owner's Name information is required for Hyannis Ma. 02601 4/13/2009 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments'(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 124 Wayland Rd. Property Address Alexsandro Perreira Owner Owner's Name information is required for Hyannis Ma. 02601 4/13/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert yes stain.line above invert. Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Box is level.Box has one outlet lateral.Evidence of solids carryover.Evidence of leakage out of top of box. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located; explain why: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M , 124 Wayland Rd. Property Address Alexsandro Perreira Owner Owner's Name information is required for Hyannis Ma. 02601 4/13/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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.): Sandy dry soil.Leaching pit shows signs of hydraulic failure.Pit was empty at time of inspection but stain line shows system has been full at some point.Heavy scum also observed on top of invert pipe in pit. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 124 Wayland Rd. Property Address Alexsandro Perreira Owner Owner's Name information is required for Hyannis Ma. 02601 4/13/2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 t, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �1M , 124 Wayland Rd. Property Address Alexsandro Perreira Owner Owner's Name information is required for Hyannis Ma. 02601 4/13/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: Bottom of leaching 34.6' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: As-Built Card ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: USED:USGS Observation Well Data.USED:Technical Bulletin 92-000-01 plate#2 annual ranges of groundwater elevations. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 f 5 • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 124 Wayland Rd. Property Address Alexsandro Perreira Owner Owner's Name information is Hyannis Ma. 02601 4/13/2009 required for y every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Map Page 1 of 2 Town of Barnstable Geographic Information System Parcel Viewer Custom Map Abutters I Map Size Zoom Out ®In AK 7.-, ' t r,fiir r. >i ! ri. r ! ! i' r: a 1 r rA: 35 6 1� r. _. 2D Feed` ....... Set Scale 1" = 20 I Aerial Photos I MAP DISCLAIMER rnrnrrinhf)nnF_9nnA Tnurn of Romcfohlu hAA All rinhfe roeunn httn•/hxnxrxv tntxm linrnetahla ma A/1 a iINnnn COMMONWEALTH OF MASSACHUSETTS �,^— EXECUTIVE OFFICE OF ENVIRONMENTAL AFFA DEPARTMENT OF ENVIRONMENTAL PROTF-01 4AR 22 PM {: 24 D'IVISlON TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 124 Wayland Road P �� Hyannis MA 02601 Owner's Name: Robert Smith •r,i"tCLI Owner's Address: t CC Date of Inspection: March 14 2005 Name of Inspector: (Please Print) James M. Ford Company Name: James M.Ford Mailing Address: P.O.Box 49 Osterville,MA 02655-0049 Telephone Number: (508)862-9400 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: ✓ Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: March 20, 2005 The system inspector shall sub 't 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. Title 5 Inspection Form 6/15/2000 page 1 i Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 124 Wayland Road Hyannis MA Owner: Robert Smith Date of Inspection: March 14, 2005 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: 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 exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. 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: 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 124 Wayland Road Hyannis MA Owner: Robert Smith Date of Inspection: March 14 2005 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 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 a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for 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: r 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 124 Wayland Road Hyannis MA Owner: Robert Smith Date of Inspection: March 14 2005 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _ ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _ ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than'/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. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _ ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. _ ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for 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.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design now 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 II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 124 Wayland Road Hyannis MA Owner: Robert Smith Date of Inspection: March 14 2005 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection? — Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ,/ Was the site inspected for signs of break out? ,/ — Were all system components,excluding the SAS,located on site? / — Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? ✓ _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: 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 CMR 15.302(3)(b)]. 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 124 Wayland Road Hyannis MA Owner: Robert Smith Date of Inspection: March 14 2005 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 0 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): n/a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings,if available(last 2 years usage(gpd)): 20044 87,000 gals 2003-87.750 gals. Sump Pump(yes or no): No Last date of occupancy: Unknown COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): spd Basis of design flow(seats/persons/sqft,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 infonnation: Unavailable Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: _gallons--'How was quantity pumped determined? 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 a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Installed in 7119182-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OF FICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 124 Wayland Road Hyannis MA Owner: Robert Smith Date of Inspection: March 14 2005' BUILDING SEWER(locate on site plan) Depth below grade: 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 on site plan) Depth below grade: 20" Material of construction: ✓ concrete _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: 1000 gal Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 6" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions determined: Measuring stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Tees were present The liquid level was even with the outlet invert There did not appear to be any signs of leakage. Recommend um in . GREASE TRAP: None (locate on site plan) 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.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 124 Wayland Road _Hyannis MA Owner: Robert Smith Date of Inspection: March 14, 2005 TIGHT or HOLDING TANK: None (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 alarm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even 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.): The D-box was level. PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 •a Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 124 Wayland Road Hyannis MA Owner: Robert Sin ith Date of Inspection: March 14, 2005 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 1 -6'x 6'(1000 gal.) 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.): The pit was dry. The scum line was approximately 2'up front the bottom There did not appear to be any signs offailure. The bottom to grade was 8'. CESSPOOLS: None (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: None (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.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 124 Wayland Road Hyannis MA Owner: Robert Smith Date of Inspection: March 14, 2005 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketcE the sewage disposal system me udmg tiesTo aT"least two permanent f&mce-landmmarksw- benchmarks. Locate all wells within 140 feet. Locate where public water supply entei s the building. A c,� 4 3 a � i y� a3 Y a sq ag 3 -),Lj 3� y -Wo yy 10 Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 124 Wayland Road Hyannis MA Owner: Robert Smith Date of Inspection: March 14 2005 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 25 +/- 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 hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours maps Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic and water contours maw the maps were showing approximately 25'+/-to_ground water at this site. I This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system:will function properly in the future. There have been no warranties or guarantees,either expressed, written or implied,relating to the system,the inspection and/or this report. I1 ID n b fit ov T -ar, f 1 TOWN OF BA.RNSTABLE LOCA VON I ay_ �� /M� RC' SEWAGE # V 1I E �� 1 ASSESSOR'S MAP& LOT a1 ao3 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY nn�N LEACHING FACILITY: (type) V�' �X 4 (size) NO.OF BEDROOMS 3 BUILDER OR OWNER SM1"� PERMITDATE: - COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of lea hing facili� Feet .Furnished by I/1 SQet�io•, � FOrc� I 1 , I ' 3 a � 80� r ys' a3 Y a 39 a? 3 3y 3� y y� yy Y [I- MTISEWAGE PERMIT NO• LLAG-E F3 kU LER'S . NAME i ADDRESS G U L D E N. OR OWNER to DA-rE- FER 1T tSSVED 5 DAT E COMPLIANCE ISSUED ri9rgL i i �No .............qq.- Z 6 3 Fps s................ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .......Town..............F.....BarnstAbl.Q.................................................... Allp irFatiun for Bhipvii al 19orks Towitrurtiun rrmff Application is hereby made for a Permit to Construct ( X) or Repair ( ) an Individual Sewage Disposal System at: Lot # L� v � ....... . rw Location-Address or Lot No. Capricorn. Realty... ...... y ... ------------------- Owner Address .....Steve Lebel.............................................................. •....._..-••••••--•-•••••-.......-•-••...-•--••--••••-•-••...._..--••-.._.._........-•-------- Installer Address Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms____.3....................................Expansion Attic ( ) Garbage Grinder ( ) pa,, Other-Type of Building ranch.............. No. of persons............................ Showers (2 ) — Cafeteria ( ) a Other fixtures ____________________________ _ W Design Flow.................. �5_.....................gallons per person per day. Total daily flow................. 311...................gallons. WSeptic Tank—Liquid capacityl_0_QQ_gallons Length.$___fi_..___ Width_.4.__1.0--- Diameter________________ Depth__52__$ _.. x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No.........1.......... Diameter........6_'....... Depth below inlet.... '________.__ Total leaching area__26.6.......sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '-' Percolation Test Results Performed by---Eldre-dgz---Engine-o.r ng..--..•------ Date... Test Pit No. 1.<2.._0___minutes per inch Depth of Test Pit-----22'....... Depth to ground waternQ.lO__.enCOunte — Li, Test Pit No. 2..N/A.__._minutes per inch Depth of Test PitN/A.__________ Depth to ground water.n1A.............. e 04 ----•...... ---------------- -.................. •............. .•-•----•... --••-------- -.......... --------------- ---------------------- ------------- •----------- 0 Description of Soil---------Q-1-------2-T---•-•-•-..O.gm..&..taps0_J 1---------------------------------------------------------------------------•------------- x 2 ' - 10 - medium yellow---Sand-_-------•--------------•----•----•---------------------------•--•-•--------- U ---------------- ____________________--- f__.__.__..._____i__________.._....._.____._ , W ---------------------------------- 10-•---__-12••.-:--•me-d._-_white__sand-_traces--.pf-•-grave�,�r�Q---wax-_a ---12 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 liTf:12 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 b and of hea Si ed. = -j' .J-_yl ----- ApplicationApproved By.... •---- •- --- ............................................................... .....s°'.. �-....._ Date Application Disapproved for a fo owing reasons:.............................................___._.__...__...._______=__________---•-•---•---••._.......--•---- .....................................................................................................•.................................................................................................. Date PermitNo.............................-........................... Issued.------------------Date----------------------------------- — N ,......... .....`............._ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWn-------------OF.....Barnstable..--------•------•---.............................-- 1 I Appfirttttou for 3 hyagal Workii Tomitrurtturt rrmit Application is hereby made fore Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at: yLo t ! L_.vi l .....Hy_amnia,...N.1 ............................................................ Location-Address or Lot No. Ca ricorn Real�..Tru .......... ..-----.._.....--•---......--- .-------$.t.............................. ....7..5---almauth..Road.,...Hyanni Hyannis.................... Owner Address a Steve Lehe -� -------------------------------- -•••-------•------- Installer Address Q Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms_....3....................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building 1' 1 CLh.............. No. of persons............................ Showers (2 ) — Cafeteria ( ) 0.' Other fixtures .........•--•-•--•-----•••-..... . W Design Flow................55......................gallons per person per day. Total daily flow__-_..-......_..33.0....................gallons. WSeptic Tank—Liquid capacitylOO. ..gallons Length.8.`.6.'-`.... Width.4.110". Diameter________________ Depth_5 1.8".-.__. x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No........I.......... Diameter.......b'_._..... Depth below inlet---6............. Total leaching area.266--------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '-' Percolation Test Results Performed by..E1d.redge..•Enginee_ri 2g............. Date.11-25.-$�•___..........._. aTest Pit No. 1<.2x.Q....minutes per inch Depth of Test Pit....12._:------- Depth to ground waternQr?.Q .ene0unteN- 04 Test Pit No. 2..NIA,.._._minutes per inch Depth of Test PitN/A............ Depth to ground water N/A.............. e --------------------------------------------•-••-----....................----.-.-----------••------------------------------------------------------- C) Description of Soil..........Q .... . t...-----.loam...&..tapsail........................................................................................ 2'.......................................... .............................................................................. ....................------ ---------- �0_-----`--.i2.-------med..-.white.--Sand/t .Cef.--nf 5te1/na. .ter fit-12' U 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 T=p 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 hea�. 'zS � " /? f ---•............. .A Date Application Approved By. �!/S.`.�`..........-•-----•••--•......•--•-•---•----•--•----..------ ---- t ' 1------- -� �� Date eApplication Disapproved forh fp owing reasons-----------------------•-------------------------------......------------------.........--- ----....----•- ....-•-------------------------------------------•-----------•--------.......-----------------------•----.--....-----------------•-•-------------------------------------------------------••----•--..... Date PermitNo......................................................... Issued-....................................................... Date l THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................TOWn...........OF.........P�rnsta.1J .er........................................... Tntifiratr of Tompliatta THIS TO C IF , That the Individual Sewage Disposal System constructed ) or Repaired ( ) teveeTbe �'------ --- - - ----- ---- --- ------ ��----------------------.........------------------.........-----•--•---•••••. A t Installer )[� �gq 1JtJ ,j _ irYy�.'m.�6.r'11 ].s lYltl has been installed in accord with the provisions of TIE-! L.,j154 T e State Sanitary Code as deserribed in the application for Disposal VV r Construction Permit No... - .._-'... ... --- dated----, ,' fi x -------------• THE ISSUANCE OF THIS CERTIFICATE SHALL OT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATIS ACTO�RY. DATE....................................•-- Inspector ��W�G `�'`/ %'" THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH a OVm Barns table ` T J ..........:................OF....._.... ._...............................................-.-................ No.............. .... FEE ..................... Steve Lebel Permissionis hereby granted.............................................................................................................................................. to ConstrIt ) or Repair ( ) an-Individual Sewage Disposal System LL ' �` i ��" = --•--•-----•----------------•------....----•-----------••...._._....._... at No..... ............ _ •--• Hyannis-..�!�A- �; `........ Street 7,�- as shown on the application for Disposal Works Construction Permit N�o--��."��_�. Dated ..._. ���:............... ------------------- ............ ....-••••-• ------- Board of Health DATE....................................... FORM 1255 HOBBS & WARREN. INC., PUBLISHERS lo,c F". 2ca ' F s. 12, qo 1 o' .5 s: �3 . \ �z�.ao ,s 7 s °sue '/ Z "ZE7--, of � I GN do sum • 3 34i 90.o d- • 1 �6 zo- ' � es% PQoAosco 3 f3,e q 0 N a Al o /0 0 v 4.1-4, r 7-^,vlc 7EST 4 Pi 14 F-O L-oT- 46 ,moo �°� 'p 2-, C-P 7 S F I.ol + / EX PANsiON Np � cp 1 2- 1-9 7 o Q W A'_E'e S CJ/sr"fo iV l'.j -LEGEND U19TINS SPOT ELEVATION 0.0 ��,v oFM4SIP CERTIFIED PLOT PLAN EXISTING CONTOUR __— O — 02 ALBERT sG FINISHED' SPOT ELEVATION A. yr 4 5 wA y«+� FullBHLD CONTOUR -- 0 N IN APPROVEDI BOARD OF HEALTH o9o� GI T�P�\`'� FSS/0NAL�a DATE AGENT SCALE 3 n DATE$�tW REDS E"'NEEM'" C* CLIENT ��'"c"Ea I CERTIFY THAT THE PROPOSED 1STE E REdISTEAED OS N0. g.= BUILDING SHOWN ON THIS PLAN CIVfL LAND CONFORMS TO THE ZONING LAWS �•BY' �' A OF BARNS ASS. T 12. M Af 11' STREET... CH. BYe--�- MYANN I S,, MASS. SHEET—LOF 2 DATE 0. LAND SURVEYOR 20.FT. .M/N.. � n /1lOTE /F E/TNER TNE-SEPT/G .TAI/.,4 OR P/T Alt ? MORE /2"BELOIV ' /D fT'M/k �' :1,4AOE� f� 24'O/AMETEK CONCRETE :COVE/P S�JALL BE BROCIGNT TO 6RAz7, TRA CONCRC �TE 4 PVC P/PC yE,gVY CAST /RO/Y CDVzrT SN.4LL Q M/N. PITCH E USEO P411r,CO �9.oER F7 /F//V DR/✓E yVA Y- 2 • MiN. CO/VC.R IL-7— a' I � _ GAOE CUVER CLEAN S�4ND BACKF/LL __ UQU/O LL'YEL • i t a 4 4'•CAST� 2"LAYER /RON P/PEk. v o o o o G1F /�g -3/B" P/TcN G.�I L , e • . . . . • • . e • 'Ptt rT SEPT/C%4 TA/ 'X B o�b • • • . ♦ o o i WASHED S7T7NE ;Q o Y • • 1 8 • r � . • � •rr "• r •EFFECT/VC * , 314 a r v , • 01=PT: • • ♦ i o o e WAS.YEO STONE 100,5 x .2 S, . r • • • • • • . p r•o PRECAST SEEPAGE l/VI��C°1R" C . 017 CR EQu/Y.T �x e a �L 84-, /NYERT AT QlJ%LD/NG 89`..o FT. 6 FT D/AM. n /NLET SEPTIC'_Ti4NK r 88. 8 FT ;r.[T'C�rL-l�CtT�( S¢�j 6�O /C� F7- D/.�M- C�SEE rA8VI-TA r: GC/TLET SEPTIC NK9':Lo FT. �'• - t INLET D/STR/8!/TDN BOX SS �-'FT GROUND W,ITER 7,4BLE SECT/O/V OF- NLET DEA. CN eVT/O/Y BOX 8 8:�L FT wG /?/T : 86 ,0 F.T. SElt/AGE. O!S'P4�SA 1 SYSTEM - LEACH//1/G 0IT TABULATION DESIGN CR/,TER/�l 3cALE �� " _ /_ o� D/M/:/✓S/ON A D/Af.�NS/aN $ � FT. N[/MBER OF 9EDROOMS D/MANS/ON C 4 FT. G 4R9AGE D/SPO.SAL UNIT NOFsE SOIL LOG. ToT.4L EST/MArEG.,FLGAoSI -510 GAL. .DAY S014. TEST #/ S.O/L 7EST#2 DSO/L TEST NUMBER.QF L,EACmNG PITS ELFY. DATE OF S"O/L .Tl�ST 05 l8 S`�L LE>4CH/NG,PER P/T l 8$ RESULTS iY/TNESSED 8Y I �t�foP-13 .� 9oTTOM LFr�G'N/NG PER P/T �8 $q. ,rT. p -2 �M _ -roQ�fL ' COXAT/O/V AA7- A / M//V♦//IVCN TOTAL LEACH/NG AREA_ Z�CA SQ.' FT. AwtCOLA7/0.1/ RA 7-E/�2` �� /y/N /NGH RESERVEGEi4CN/NG'`;4iQEA UoL SQ. FT. - i7 N OF O F M �H. M�ssgOti ,, 2'-1�, S�N)) - L-�r g"6 ��yam--• AtBERT NWmA71RAcE � � � � � °.• Cam' `r� . �'�j'r=-'� /���/�f/ S No 10951 O .o El-D RED GEENCrl AIZERINCr CO,/NG. �FSS/ONA� a.78.6 .. 7/Z MAIN ST , HYfI•c/NiS.:Iv1.gSS, ND GRO[JiVr7: YY,4TER E/VCOUIV7s-eEO C-U R GROUND YvATER AT ELEf/ - OB NO• cY!ZaS SHEET Z OF a- C �9TE T.O.F. EL.= 53.0'+- FINISH GRADE OVER D-BOX= 51 .0'± FINISH GRADE OVER CHAMBERS= 502 - 51 .0' GENERAL NOTES PROVIDE EXTENSION RISER SLOPE @ 2% MIN. OVER SYSTEM 314"TO NE T DOUBLE WASHED REMOVABLE WATER-TIGHT COVER OVER STONE TO CROWN OF PIPE 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION WITH COVER OVER INLET& RISER TO WITHIN 6"OF FINISHED GRADE 4" SCHEDULE 40 PVC INSPECTION PORT WITH ACCESS FINISH GRADE OUTLET TO WITHIN 6"OF F.G. 0 2"OF 1/8"TO 1/2" DOUBLE WASHED METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL @ FND. EL.= 51 .0'± F.G. OVER TANK EL. = 51 .7'± 5" DIA. OUTLET(S) MIN SLOPE 1 /o BOX TO F.G. (SEE NOTE 21) STONE OR GEOTEXTILE FILTER FABRIC CODE AND ANY APPLICABLE LOCAL RULES. - - - 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE TOP OF SAS=48.63' PLACE RISERS ON ALL DESIGN ENGINEER. ' �T EXISTING 4' PROPOSED 4" 9" MIN- 9"MIN. CHAMBERS w/PIPED 3. 4" SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL SEWER PIPE SCH. I 47.80' 36"MAX. BREAKOUT EL= 48.30' INLETS TO WITHIN 6" SYSTEM UNLESS OTHERWISE NOTED. SEWER PIPE I 40 PVC 36" MAX. OF FINISHED GRADE""' --- `' 6" 3" 3" DROP MAX t 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN 2" DROP MIN 3 g L=3T#MIN PROVIDE WATERTIGHT ELEVATION =48.30' FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE SAS. UNLESS A_SLOPE @ i% o 7T13" P f't 4" PVC IN FROM i/ JOINTS (TYP.) Q o�ow� 0 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S. AND THE TOP OF 4" PVC OUT TO 0 0 0 0 0 0 0 THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. i -114 _ � U ± SEPTIC TANK o 0 0 CONTRACTOR TO PROVIDE r --- LEACHING FACILITY 0 ZI(D = � 00 0 5, SLOPE ALL SOLID PIPE AT 1.0%MINIMUM. SPECIFIED DROP BETWEEN CDC) INLET AND OUTLET CONTRACTOR CONTRACTOR SHALL 12' 6' , oo °° CD 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. �� OUTLET TEE 48.17 MIN. 48.00 2 o 0 0 Q SHALL VERIFY SIZE 48 VERIFY CONDITION OF o0 00 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK AND CONDITION OF EXISTING TEES GAS BAFFLE 6" CRUSHED STONE 00 o o o FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS EXISTING SEPTIC AND REPLACE AS OVER MECHANICALLY o0 0 0 o NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH TANK NECESSARY COMPACTED .BASE 4.011 _ 4.0' �^ I I AND DESIGN ENGINEER. -� - 5 OUTLET DISTRIBUTION BOX (NP,) 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM. BENCHMARK ELEVATION OF 51.00' _ - TO BE INSTALLED ON A LEVEL STABLE 25.0' ESTABLISHED ON A NAIL SET IN TREE AS SHOWN ON PLAN. BASE. FIRST TWO FEET OF OUTLET 45.80, GROUND WATER ELEV.= < 38.87' PIPES TO BE LAID LEVEL. 12 83' 9- CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION EXISTING 1 ,000 GALLON CONCRETE SEPTIC TANK 2 - 500 GALLON CHAMBERS 5' MIN. CHAMBER END VIEW THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT CROSS SECTION VIEW p p 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES 'CONTRACTORTO VERIFY EXiSTINC' SEPTIC TANK PROFILE DISTRI U-I)ON BOX DETAIL TYPICAL CHAMBER PROFILE CHAMBER DETAILS TO THE DESIGN ENGINEER. ELEVATION PRIOR TO ANY WORK k NOT TO SCALE �✓ NOT TO SCALE 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT. NOTIFY , seIGINEER IF DIFFERENT NOT TO SCALE _ �. - _ _._ -- ;_ - - _f 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING - - • +� +r �tF ST ��T DATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM NOTES: `` •• , • . ; /� .111 ?r♦ 1 APPROPRIATE AUTHORITY. PERC NO. 12559 i •; /�� / " ��1 �" INSPECTOR: David W. Stanton, R.S. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS LOCATED 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF j + ♦ " UNDER MORE THAN 3 FEET OF COVER OR LOCATED UNDER PAVEMENT, DRIVES, OR EACH SEPTIC SYSTEM COMPONENT. r LAN ��• ♦ • # // . ♦ � EVALUATOR: Michael Pimentel, E.I.T.VViq Y ? l •• + C �It .n• • %p TRAVELED WAYS IN WHICH CASE THEY SHALL WITHSTAND H-20 LOADING. (4p-W/ /�� C.S.E. APPROVAL DATE: Oct. 1999 DF Ap ••• • .'; • « ' ;� 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF THE ` LAYOUT) . • �,� • ` r1`. 4 ^+ DATE: May 12, 2009 PROPOSED LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST PIT s + . '♦ '� �j M //t/ J ♦ i . ` 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE DATA SHOWN ON THIS PLAN. REPORT TO ENGINEER AND LOCAL BOARD OF / / • . • TEST PIT#: MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. f° HEALTH IF SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. + . . ,'1; f *{` ". ♦ ` ELEV TOP= 50.20' REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, <t j �` , • . �` • • ♦ , « FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). 3.) PROPERTY IS LOCATED WITHIN A DEP APPROVED ZONE 2. ^ ♦ • . . • • ELEV WATER = < 39.37' • .�_,• LOCU • • 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN y "EpG_`Qfi pq� • b ' • '• •� « . * . 4� PERC RATE _ <2 min./inch SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. e E�ANT { yi (� • '• ; ^0 � f� ' � DEPTH OF PERC = 28"-46" 16. PROPOSED PROJECT IS LOCATED WITHIN: 5 58,1211IN ` " --.� i tl. A .r «f «r', i '• , TEXTURAL CLASS: 1 ASSESSOR'S MAP 271 LOT 203 i S4 -..► OWNER OF RECORD: I K R Y N.97 - . « �;, KENNETH O NE L & IMBE L O E L �e OUP 1516/9 ,�% / «•otI �� 31 - 0" 50.20' ADDRESS: 124 WAYLAND ROAD 3„ Fill 49.95' HYANNIS, MA 02601 's . ` ` ; ♦• r, •'�•• Loamy Sand A 10YR 3/1 FEMA FLOOD ZONE X 81T DR/V / � � �r • table • ' � r !'+ , ';a. �•• 8" 49.54' COMMUNITY PANEL# 25001C0566J MAP 271 h 5ch -- ,^g B Loamy Sand 17. DEED REFERENCE: L.C.C. 188681 ; t. : /� �, 10YR 5/8 LOT 203 47.87 18 PLAN REFERENCE- L.C. PLAN No. 36508-D -,, ,-•� 12,667 S.F. ± . • . • • r . . ♦"j• -_, /' C-1 I 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. co LAD IL �i♦ ♦ rN'l !�l Perc Medium-Fine 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY to co « . { t Sand FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY \ ) z a , « 4140 . 2.5Y 7/1 FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. MAP 271 \ ;� ` •i P I �' I P HA PLACED IN A VERTICAL POSITION TO A a LOT 202 trt.. 21. A 4" PERFORATED SCH. 40 PVC PIPE SHALL BE C D Ch Kl , « 8 70 72" 44-20' DEPTH OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3" OF FINISH GRADE. A I J� Coarse Sand REMOVABLE THREADED CAP SHALL BE PLACED ON THE TOP TO ALLOW FOR INSPECTIONS. \ 5A C-2 10YR 518 /���y h� " .��')"\t \ 22. OWNER/APPLICANT if CONTRACTOR SHALL BE RESPONSIBLE TO OBTAIN ANY AND ALL !� a k� LOCUS PLAN REQUIRED PERMITS AND APPROVALS FOR THIS PROJECT. icy ^cy � \\ SCALE: 1"= 1000' Y 130 39.37' Q GARAGE ' No Mottling, Standing or Weeping Observed INSPEC. DESIGN DATA TEST PIT DATA LEGEND #124 PERC NO. 12559 4) HC-1 EXISTING 3-BEDROOM NUMBER OF BEDROOMS 3 INSPECTOR: David W. Stanton, R.S. 50x0' EXISTING SPOT GRADE DWELLING DESIGN FLOW 110 GAUDAY/BEDROOM EVALUATOR: Michael Pimentel, E.I.T. - 50 � EXISTING CONTOUR r �� ,gip. TOTAL DESIGN FLOW 330 GAUDAY C.S.E. APPROVAL DATE. Oct. 1999 PROPOSED CONTOUR MAP 271 � DATE: May 12,2009 50 PROPOSED SPOT GRADE TOF=53.0'± DESIGN FLOW x 200 % = 660 GAUDAY r o LOT 204 TEST PIT#: 2 PROPOSED TWO (2) (3) _- �s Zoo DECK ! o USE EXISTING 1,000 GALLON SEPTIC TANK ELEV TOP- 49.70' GAS EXISTING GAS LINE 500-GALLON LEACHING 0 0 / - CHAMBERS w/STONE \ -- PROPOSED 2 ELEV WATER = < 38.87' -- p/H/W EXISTING OVERHEAD UTILITIES \ � - DISTRIBUTION \ BOX BH INSTALL 2 - 500 GAL. CHAMBERS W/ STONE PERC RATE _ �/ W' EXISTING WATER LINE \ HC-2 f DEPTH OF PERC = SIDEWALL CAPACITY TEST PIT LOCATION \ I TEXTURAL CLASS. 1 1 1) (LENGTH + WIDTH) (2 SIDES) (2 HIGH) (0.74 GPD/S.F.) = GAL/DAY TP 2 er) (25.0' + 12.83') ( 2 ) ( 2' ) ( 0.74 GPD/S.F.) =112.0 GAUDAY O O EXISTING 1,000 GALLON SEPTIC TANK 10 TP 1 ' 2) --EXISTING 1000 GALLON SEPTIC;' j BOTTOM CAPACITY 011 Fill 49.70' PROPOSED 4" SOLID SCHEDULE 40 PVC PIPE 49.7 TANK TO BE UTILIZED AS PAR-,' ! (LENGTH x WIDTH) (0.74 GPD/S.F.) = GAUDAY 3" 49.45' OF THIS DESIGN I PROPOSED DISTRIBUTION BOX 50.2 ------------ ------- (25.0'x 12.83') (0.74 GPD/S.F.) = 237.4 GAUDAY A Loamy Sand /1/ 10 YR 0 3 0 PROPOSED 500 GALLON LEACHING CHAMBER APPROXIMATE LOCATION I OF EXISTING LEACHING PIT TOTALS: B Loamy Sand Lr' (ABANDONED) TOTAL NUMBER OF CHAMBERS 2 28 10YR 518 47.37' REV. DATE BY APP'D. DESCRIPTION 4 TOTAL LEACHING AREA 7 SQ.FT. TOTAL LEACHING CAPACITY 349.4 GAL./DAY PROPOSED SEPTIC SYSTEM UPGRADE MAP 270 C-1 Medium-Fine PREPARED FOR: Sand �\ 2 5Y 7/1 ROBERT B. OUR CO., INC. LOT 101-028 -EX DI�TRIBUT{ON BOX EXIST TOTAL 12 ARC 36HC BIODIFFL), (6 BIODIFFUSERS EACH TRENCH, �21.8 \ SHED 72" 43.70' CONTRACTOR TO REMOVE At. �' LOCATED AT BIOD{FFUSERS & SPOILS LOCATED .. 1�J� Coarse Sand ( ) C-2 10YR 518 124 WAYLAND ROAD WITHIN 5 FEET OF NEW SAS TO BE HYANNIS, MA REMOVED& REPLACED w/CLEAN Benchmark COARSE SAND PER 310 CMR 15.255(3) Nail Set in Tree SCALE: 1 INCH = 10 FT. DATE: MARCH 5, 2021 SWING-TIES Elev. = 51.00' ; 130" 38.87' 0 5 10 20 40 FEET Approx. M.S.L. I No Mottling, Standing or Weeping Observed DESCRIPTION HC-1 HC-2 MAP 270 �� °F s, i PREPARED BY: MEOW JOHN L. J' CORNER OF STONE (1) 23.1' 56.7' LOT 101-027 RESERVED FOR BOARD OF HEALTH USE CHURCHILL JR. JC ENGINEERING, INC. CIvIL CORNER OF STONE (2) 31.0' 68.7' U NO. 4 807 ,� 2854 CRANBERRY HIGHWAY + EAST WAREHAM MA 02538 CORNER OF STONE (3) 23.4' 80.4' S ITE PLAN ` _ 508.273.0377 CORNER OF STONE (4) 11.0' 70.5' SCALE: 1"= 10' Drawn By: MCP Designed By:MCP Checked By: JLC JOB No.1612 PROVIDE PRECAST CONCRETE GENERAL NOTES T.O.F. EL.=-53.0'+- EXTENSION RISER WITH CONCRETE INISH GRADE OVER D-BOX= 50.7'± 4"SCHEDULE 40 PVC MIN. SLOPE 1 % COVER TO WITHIN 6"OF F.G. OVER FINISHED GRADE OVER DIFFUSERS= 495 - 50.71 INLET AND OUTLET COVERS. REMOVABLE WATER-TIGHT COVER OVER INSPECTION PORT WITH ACCESS BOX TO SLOPE @ 2%MIN. 1. UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION FINISH GRADE RISER TO WITHIN 6"OF FINISHED GRADE WITHIN 3-OF F.G. (ONE PER TRENCH) METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL @ FND. EL.= 51 .0'± FINISHED GRADE OVER TANK EL. 51 .7'+ 5-DIA. OUTLET(S) CODE AND ANY APPLICABLE LOCAL RULES. - - ------- 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. PROPOSED 4" 9"MIN. EXISTING 4" 36"MAX. 9" MIN. 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL P1 I PVC SEWER PIPE SEWER PIPE J==Z� / - I 36"MAX. TOP OF SAS B.O. 47.73' SYSTEM UNLESS OTHERWISE NOTED. 3" DROP MAX F PROVIDE WATERTIGHT 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN 6" 3" 3" 9" , 2" DROP MIN MIN.SLOPEtA1W_ I JOINTS (TYP.) ELEVATION =47.73' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A low 4" C IN FROM 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF 14" \-*49.0'± SEPTIC TANK I LEACHING PVC OUT TO 1.33' THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. T 16"TYP LEACHING FACILITY (TYP.) n 0.90, n10.75Yj"TYP 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. 1 42" T6 CONTRACTOR CONTRACTOR SHALL 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. I OUTLET TEE 48.00 MIN. 4 7.83' SHALL VERIFY SIZE 48" VERIFY CONDITION OF 47.30 \-46.40 (LAID FLAT) -2.875'(34.5-) 5.75' 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK AND CONDITION OF EXISTING TEES 22"ZABEL FILTER 6"CRUSHED STONE (TYP.) EXISTING SEPTIC AND REPLACE AS MODEL#Al 801-4x22 OVER MECHANICALLY 5.0' FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS TANK NECESSARY COMPACTED BASE (TYP.) 5'MIN. 11.50 NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH AND DESIGN ENGINEER. 5 OUTLET DISTRIBUTION BOX 30.0' (TYP FOR BOTH TRENCHES) 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM OF 51.00' ESTABLISHED TO BE INSTALLED ON A LEVEL STABLE ON A NAIL SET IN A TREE AS SHOWN ON PLAN. BASE. FIRST TWO FEET OF OUTLET GROUND WATER ELEV.= < 38.87' 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION EXISTING 1 ,000 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT CROSS SECTION VIEW BIODIFFUSER (PROFILE) BIODIFFUSER (END VIEW) 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES *CONTRACTOR TO VERIFY EXISTING ELEVATION PRIOR SEPTIC TANK PROFILE DISTRIBUTION BOX DETAIL 12 m ARC 36HC (#3616BD) BIODIFFUSERS TO THE DESIGN ENGINEER. TO ANY WORK & NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE NOT TO SCALE NOT TO SCALE 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT. 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING TEST PIT DATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM 41 t3 i APPROPRIATE AUTHORITY. tl ;z PERC NO. 12559 too INSPECTOR: David W.Stanton, R.S. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS VVA CAiVo 0 4 • • a a EVALUATOR: Michael Pimentel, E.I.T. LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE a THEY SHALL WITHSTAND H-20 LOADING. (40, VVIO C.S.E.APPROVAL DATE Oct. 1999 0A 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. 16 May 12, 2009 DATE: LA 0 TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE 3?,8 l �- YOIJ7-) a MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. ELEV TOP 50.20' REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, 1,)0 00 a all ELEV WATER <33.37' FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). a L 0%CAJ I •34 • 0 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN 00 PERC RATE <2 min./inch C) L0 • SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. (D 28 a co 0 a 0 DEPTH OF PERC 28"-46" Z , :4 : a 16. PROPOSED PROJECT IS LOCATED WITHIN: 0 0 TEXTURAL CLASS: 1 ASSESSOR'S MAP 271 PARCEL 203 54.97, a OWNER OF RECORD: ALEXSANDRO H. PEREIRA P 1516/9 . ADDRESS: 124 WAYLAND ROAD a 0 50.20 HYANNIS, MA 02601 Fill ZV 49.95' % Loamy Sand 'D ble Og A 3" 1 OYR 3/1 FEMA FLOOD ZONE C , 49.54' COMMUNITY PANEL# 250001 0005 C MAP 272 B Loamy I OYR 5/8 Sand 17. DEED REFERENCE: L.C.C. 176232 LOT 77 28" 47.87' 18. PLAN REFERENCE: L.C. PLAN No. 36508 D 12,667 S.F. C-1 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. Perc Medium-Fine 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY Sand SWING-TIES 46" 46.37' FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY 4 46 2.5Y 7/1 MAP 271 FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. DESCRIPTION HC-1 HC-2 LOT 202 BIODIFFUSER CORNER(1) 42.5' 88.5' 72" 44.20' Coarse Sand BIODIFFUSER CORNER(2) 33.2' 85.0' 0 C-2 1 OYR 5/8 It LOCUS PLAN BIODIFFUSERCORNER(3) 25.8' 56.4' SCALE: 1"= 1000' BIODIFFUSER CORNER(4) 37.0' 61.6' 130" 39.37' No Mottling, Standing or Weeping Observed #124 DESIGN DATA TEST PIT DATA LEGEND EXISTING PERC NO. 12559 HCA 3-BEDROOM INSPECTOR: David W. Stanton, R.S. 50x0 EXISTING SPOT GRADE NUMBER OF BEDROOMS (DESIGN) 3 DWELLING EVALUATOR: Michael Pimentel, E.I.T. - - - 50 EXISTING CONTOUR TOF = 53,0' ± DESIGN FLOW 110 GAUDAY/BEDROOM TOTAL DESIGN FLOW 330 GAUDAY C.S.E.APPROVAL DATE: Oct. 199950 PROPOSED CONTOUR MAP 271 DATE: May 12, 2009 LOT 204 DESIGN FLOW X 200 % = 660 GAUDAY TEST PIT#: 2 EXISTING OVERHEAD UTILITIES ELEV TOP 49.70' USE EXISTING 1,000 GALLON SEPTIC TANK GAS GAS- GAS EXISTING GAS LINE -W-W-W-W- EXISTING WATER LINE ELEV WATER= <38.87' 70, (2) TEST PIT LOCATION PERC RATE <2 min./inch BH HC-2 INSTALL 12 - ARC 36HC (#3616BD) BIODIFFUSERS DEPTH OF PERC= 28"-46" EXISTING 1,000 GALLON SEPTIC TANK 0 (3) SYSTEM CAPACITY TEXTURAL CLASS: 1 PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE TP 2 0 117Q 49.7 PROPOSED DISTRIBUTION BOX TP 1 (TOTAL L.F.OF BIODIFFUSERS)(7.8 SF/LF)(0.74 GPD/SQ.FT.) GPD E3 50.2 EXISTING 1000 GALLON SEPTIC (60.0')(7.8 SF/LF)(0.74 GAUSQ.FT.)= 346.3 GAL. LEACHING DAY on 49.70' TANK TO BE UTILIZED AS PART Fill PROPOSED ARC 36HC(#3616BD) BIODIFFUSER 3-0 49.45' OF THIS DESIGN TOTALS: A Loamy Sand 1 OYR 3/1 APPROXIMATE LOCATION OF 8. 49.04' TOTAL NUMBER OF COUPLINGS: 0 \-(4) LP EXISTING LEACHING PIT TO BE TOTAL NUMBER OF BIODIFFUSERS: 12 Loamy Sand cly PUMPED AND FILLED WITH CLEAN, B I OYR 5/8 COARSE SAND TOTAL LEACHING AREA: 468.0 SQ.FT. V_ 28" 47.37' RE DATE DESCRIPTION SO TOTAL LEACHING CAPACITY: 346.3 GALJDAY C-1 PROPOSED SEPTIC SYSTEM UPGRADE MAP 270 7LQ Perc Medium-Fine Sand PREPARED FOR: LOT 101-028 PROP0.SED DISTRIBUTION BOX 46" 45.87' s7so NOTE: 2.5Y 7/1 CAPEWIDE ENTERPRISES 12 EFFECTIVE LEACHING AREA OF 7.80 SF/LF OBTAINED FROM THE PROPOSED TOTAL 12 ARC 36HC BIODIFFUSERS 72" 43.70' (6 BIODIFFUSERS EACH TRENCH) HE DEPARTMENT OF ENVIRONMENTAL PROTECTION APPROVAL LETTER LOCATED AT 121-87, l MODIFIED CERTIFICATION FOR GENERAL USE ISSUED TO Coarse Sand NOTE: ADVANCED DRAINAGE SYSTEMS, INC. ON OCTOBER 3, 2003(LAST C-2 1 OYR 5/8 124 WAYLAND ROAD MODIFIED JULY 23, 2008). TRANSMITTAL NUMBER=W000052. PROPOSED INSPECTION PORT WITH ACCESS Benchmark HYANNIS, MA 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE BOX TO GRADE (TYP OF 2) TOP EDGE OF EACH SEPTIC SYSTEM COMPONENT. Nail Set in Tree 38.87 SCALE: 1 INCH 10 FT. DATE: MAY 13,2009 Elev. =51.00' 130" ' Approx. M.S.L. 0 5 10 20 40 FEET 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE MAP 270 No Mottling, Standing or Weeping Observed OF ktA6,r LOCATION OF THE PROPOSED LEACHING FACILITY TO ENSURE LOT 101-027 PREPARED BY. RESERVED FOR BOARD OF HEALTH USE 6U L Z g-,�_��L CONSISTENCY WITH TEST PIT DATA SHOWN ON THIS PLAN. JC ENGINEERING INC. REPORT TO ENGINEER AND LOCAL BOARD OF HEALTH IF SOILS y JR.41 2854 CRANBERRY HIGHWAY ARE NOT CONSISTENT WITH TEST PIT DATA. EAST WAREHAM, MA 02538 SITE PLAN 508.273.0377 3. PROPERTY IS LOCATED WITHIN A DEP APPROVED ZONE 2. SCALE: 1"= 10' Drawn By: JLC Designed By:JLC Checked By:JLC JOB No.1612--------- -----_ I i