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HomeMy WebLinkAbout0032 WEST HYANNISPORT CIRCLE - Health 32 West Hyannisport Cir Hyannis A = 267 133 o e E i TOWN OF BARNSTABLE LOCATION 1TIPWik-l5 06AA— CRc� SEWAGE # �bC3 -69 VILLAGE ASSESSOR'S MAP& LOT 2L 3 INSTALLER'S NAME&PHONE NO. -7"75-Z7-7 6 SEPTIC TANK CAPACITY GG LEACHING FACILITY: (type) I 'Da age (S (size) 13 NO. OF BEDROOMS BUILDER OR OWNER 1"�R U i 7 (��►1'Zh(r2 PERMITDATE: 3 /T 3 I10;. COMPLIANCE DATE:_ 19/0,z), Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by L � O .r: a r COMMONWEALTH OF MASSACHUSETTS ExECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 32 W. Hyannisport Circle o`�d °� c33 W. Hyannisport Owner's Name: Florence Barber Owner's Address: Date of Inspection:,1, — y/ --a Name of Inspector:(please print) William _ • Rob' nson Sr. v / Company Name: William E. Robinson Septic Service MailingAddress: P O Box 1089 Centerville, MA Telephone Number: t5081 775-8776 CERTIFICATION STATEMENT I certify that 1 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 pursuant7P"asscs tion 15.340 of Title 5(310 CNIR 15.000). The system: Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: �j L �J}� Dute: AU The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Heatth 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. Ci Notes and Comments h ****This report only describes conditions at the time of inspection and under the conditions use at hat s" IAJ 1-1 lime.This inspection does not address how the system will perform in the future under the s ie or d ffereu co conditions of use. Co r— Title 5 Inspection Form 6/15/2000 page I ( 1 Page 2 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 32 W. Hyannisport Circle W. Hyannisport Owner: Florence Barber Date of inspection: Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System,Passes: � - �1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: lOne or more system components as described in the"Conditional Pass"section need to be replaced or expla' d.The system,upon completion of the replacement or repair,P p tr,as approved by the Board of Health,will pass. r yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please . 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 existingtank 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 cxplhin: bservation of sewage backup or break out or high static water level in the distribution box due to broken or obstruct pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with approvallof Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND exp ain: e system required pumping more than 4 tines a year due to broken or obstructed pipc(s).The system will pass in pection if(with approval of the Bo'ard of Health): broken pipes)are replaced h obstruction is timoved ND expl�in: f j Page 3 of]I OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 32 W. Hyannisport Circle W. yannispor Owner: Florence Bar er Date of Inspection: -j,r - -/* ---E ,` C. Further Evaluation is Required by the Board of Healtb: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is fail' g to protect public health,safety or the environment. 1. ystem will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the s stem 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. Sy tern 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 s face 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 front 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 colifonrt 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 arc triggered. A copy of the analysis must be attached to this form. 3. Other: 3 ]'age 4 of OFFICIAL INSPECTION FOI01—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 32 W. Hyannisport Circle W. Hyannisport Owner: Florence Barber Date of inspection: /L -1 —y D. yslem Failure Criteria applicable to all systems: You ust indicate'lies"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 _1 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 G"below invert or available volume is less than ',day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipc(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 walcr supply. Anylportion of a cesspool or privy is within a Zone I 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 grea(er than 50 feet from a private uatrr supply well with no acceptable water quality analysis. (This system passes if(lie well water analysis, performed at a DEI certified laboratory,for coliform bacteria and volatile organic compounds indicates that(lie H•cll is free from pollution from that facility and (lie presence of ammonia nitrogen and nitrate nitrogen is equal to or less than S ppm, provided that no other failure criteria arci'triggered.A copy of(he analysis trust be attached to (his form.) (Yes M )The system fails.1 have determined that one or more of the above failure criteria p t exist as dekcribed in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of I1calth to determine what will be necessar y to correct the failure. E. Large�ystems: To be con idered a large system (he system must serve a faci!ity with a design floor of 10,000 gpd to 15,000 gpd• % You m �t indicate either"yes"or"no"to each of the following: (Thc llowing criteria apply to large systems in addition to the criteria above) yes no Ole system is within 400 feet of a stuface dr4"g water supply the system is within 200 feet of a tributary to a surface drinking water sypp1r. + l II the system is located in a nitrogen sensitive area(Interim Wellhead Protection Arca—1 WPA)or a mapped }Zone 11 of a public water supply well If you ha'a answered"yes"to any question in Section E the system is axuidered a significant ducat,or answered "yes" in$cction D above the large system has fai The e ow-ncr ar opmtor oC wry large system considered a significant ducat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMK 15.304.The system owner should contact the appropriate regional office of the Department. V 4 f ' Page S of 1 i OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 32 W. Hyannisport Circle W. Hyannisport Owner: Florence Barber Date of Inspection: ,S r Check if the following have been done.You trust 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 7 ✓ 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 7 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? e/ _ Was the site inspected for signs of break out? �— Were all system components,excluding the SAS,located on site 7 _ 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 7 _✓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: 32 W. Hyannisport Circle W. Hyannisport Owner: Florence Barbedr Date or inspection:1 C) FLOW CONDITIONS RESIDENTIAL. Number of bedrooms(design): Number of bedrooms(actual): i DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x a of bedrooms):� O Number of current residents: v Does residence have a garbage gr1nder(yes or no): Is laundry on a separate sewage system(yes or no): yes separate inspection required) Laundry system inspected(yes or no): /L, o Seasonal use:(yes or no): -6- 0 Water meter readings,if available(last 2 years usage(gpd)): 0 4/0 5 — 1 1 0 , 2 5 0 I Sump pump(yes or no):_,6- v 0 3 0 4 — 141 , 000 Last date of occupancy: COMMERC UINDUSTRIAL Type oCesta Iishment: Design flo (based on 310 CMR 15.203): irpd Basis of d ign flow(seats/persons/sgft,etc.): Grease tr present(yes or no):— Industria waste holding tank present(yes or no):— Non-s tary waste discharged to the Title 5 system(yes or no):_ Water eter readings,if available: Last d e of occupancy/use: OTH R(describe): GENERAL INFORAIATION Pumping Records Source of information: _('� 1-- i l UWas system pumped as part of the inspection(yes or no): _ If yes,volume pumped:_gallons-- How was quantity pumped determined? Reason for pumping: TYPP/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 in ormation: ,) Were sewage odors detected when arriving at the site(yes or no): l2, 6 f Pja c ] of I I OFFICIAL INSPECTION 1`0101 —NO'T FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION F0101 PART C SYSTEM INFORMATION (continued) Property Address: 32 W. Hyannisport Circle W. yannisport Owner: Florence Bar Ser Dote of Inspection:/e' BUILDING SLNVE (locate on silt plan) Dcpdi below grad ; Materials of con lruction:_cast iron _40 PVC_olhcr(cxplau,): Distance (ion, rivale seater supply well or suction line: _ Comments( ,condition of juints,venting,evidence of Icakagc,ctc.): SEPTIC TANK:— locate on site plan) Depth below grade. � fhtatcrial of construction: ✓t`o„crctc metal fiberglass i,ul)cthylcne _othcr(explain) If tank is metal list age:— Is age confinned-by a Certificate of Cun,plianee oyes or nu): _(attach a cuPy of ccnificatc) , Dimensions: -4' �� rx 1 0 Sludge depth: 3—,/ Distance from top of sludge to bunol,l of oullcl ice or ba(llc: � Scum thickness; Distance from top of scum to tulr of oullcl tee or ballle: Distance Gorn bottom of stun,to bosom o utlet tee or bafll[ flow were dimensions determined: A— Comments(on pumping recommendations,inlet and outict�r baftic condiji(;l,, struc�l ill te6rit)•, liquid lC\'cls as related to outict invert,evidence of leakage,etc.): GREASE TRAP: (locate on site plan) Depth below gra c:_ ivlatcrial of con ctiou:_cuncrcic _n,clal_(ihcrglass__put)ctl,}Icnc otl,cr (caplain): Dimensions: Scum Ihic css: Distance ona top of scull, to lop of oullcl tee or baffle: _ Distance Gotn bottom of stun,to bollum of outict ice or bafllc: Date of ast pumping: Conuricnts(on pumping rcconuncndaliuns, inlcl and oullct ice or baftic cundii :i,'suuctmal inlcgrity, liquid Icscls as iOalcd to oullcl invctt,cs-idcncc of Icakagc,cic.). r 7 'age 8 of I I t OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSL;SSMIENTS SUBSURFACE' SENVAGL DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 32 W. Hyannisport Circle W. Hyannisport Owner: F1 c)r n . - Barber Date or lospectlon:1C> TIGHT or IIOL ING TANK:_(tank must be pumped at time of inspection)(locate on site )Ian) depth below gr e: Material of con ruction:__concrete_metal_fiberglass�ulyethylene _other(explaut): Uimcnsions: Capacity: allons Dcsign Flow: gallons/day Alarm presc (yes or no): Alarm level: Alann in working order(ycs or nu): ` Date of last lumping: Conuncnis condition of alarm and (loaf switches,ctc.): DISTRIBUTION BOX: spresenl Host be opcncd)(locate on site plan) Dcpth of liquid level above oullcl invert: C' 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, cic.): J 'K PUMP CIWIUL locale t( oil site plan) Pumps in work• g order(ycs or no):_ Alarms in wo ing order( •cs or no): __ Culimicnis utc condition of pump chamber, cun(1iliun of pumps and appurtenances, ctc.): 1 , Page 9 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 32 W. Hyannisport Circle W. Hyannisport Owner: Florence Barber Date of Inspection:_9U SOIL ABSORPTION SYSTEM(SAS): 'locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: ✓leaching chambers,number: leaching galleries,number:_ leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool, number: innovative/altemative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil, condition of vegetation, etc.): _ CESSPOOLS: (ces pool must be pumped as part of inspect ion)(locate on site plan) Number and configur ton: Depth—top of liqui to inlet invert: Depth of solids lay r. Depth of scum la er. Dimensions of sspool: Materials of c struction: Indication of oundwater inflow(yes or no): Comments ote condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: Tatconplan) Materials of co struction: _ Dimensions: Depth ofsol•ds: Comments note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): 9 Page 10 of 11 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 32 W. Hyannisport Circle W. Hyannisport Owner: Florence Barber Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet. Locate where public water supply enters the building. `� ` Y h` � f n J d 1 r 10 Page I 1 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 32 W. Hyannisport Circle yannispor Owner. Florence Bar er Date of Inspection: ZJ2 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water % 3 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: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: /J I1 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZppYication for 30iopood bpotem Conotruction 3permit Application for a Permit to Construct( . )Repair( X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 32 West. Hyannisport' Circle David Barber As s sM p.— / yannis Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service Daniel Johnson P O Box 1089, Centerville 1 804 Main St. , Osterville Type of Building: Dwelling No.of Bedrooms 1ax; at- , Lot Size sq.ft. Garbage Grinder( ) Other Type of BuildingRe s; d e t; ,: No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 330 gallons per day. Calculated daily flow gallons. Plan Date --a—n 2 Number of sheets 1 Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil med—r-nsrse aanA Nature of Repairs or Alterations(Answer when applicable) replace cesspools with 1 , 500 c}a l tank, (plastic) and 3 leaching drywells ( 30 'W X 10 'W X 2 ' H) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Bo of Health. ? Signed Date J -7:,,�"6.-2, Application Approved by Date' Application Disapproved for the following reasons Permit No. Date Issued �' At Fee i THE COMMONWEALTH OF MASSACHUSETTS Entered,in computer: ✓'� Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppliattion for Otopool *pgtem Couotrurttou VerrfYit Application for a Permit to Construct.(--,")Repair( Xj Upgrade( )Abandon( ) 0 Complete System O,Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 32 West Hyannisport Circle David 'Barber �I Ass ss 'sM p/Parcel yaTlnis °" �.- Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service Daniel Johnson P O Box 1089, Centerville 1 804 Main St Osterville Type of Building: Dwelling No.of Bedrooms I axi Rt. Lot Size sq.ft. Garbage Grinder( ) Other Type of BuildingRQF%4 dp nt:441No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 330 gallons per day. Calculated daily flow gallons. Plan Date 3_4-02 Number of sheets 1 Revision Date Title Size of Septic Tank ) Type of S.A.S. Description of Soil med-coarRP Rand i Nature of Repairs or Alterations(Answer when applicIb`l&) replace c cs R R non l R with 1 500 g a l tank, (plastic) and 3 leaching drywells ( 30 ' WX1010'W X 2'H) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Bo�pd of Health. Signed Date Application Approved by Date ". °' Application Disapproved for the following reasons Permit No. Qalw Date Issued THE COMMONWEALTH OF MASSACHUSETTS Barber BARNSTABLE, MASSACHUSETTS C,ertiftcate of Comphance - THIS IS TO CERTIFY,that the On-site,Sewage Disposal System Constructed( )Repaired ( X)Upgraded( ) Abandoned( )by Wm. E. Robinson Septic Service at 32 West Hyannisport Circle Aj annis has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permi OO� *"f dated V r— ice..-,0 Installer Wm. E. Robinson Sr. Designer Plan 7^11"s The issuance f is permit shall not be construed as a guarantee that the syst will f diction as d si;ne Date I U Inspector (1n .1 .�r i No. ili i 41 " Fee $5 0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Barber liopoar *potem Comarurtton Verna Permission is hereby granted to Construct( )Repair( Upgrade( )Abandon( ) System located at 32 West Hyannisport Circle, Hyannis "'A and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of thh rmit. Date: dw 4T Approved r g TOWN OF BARNSTABLE C_, LOCATION :32 )AJ6!5J A-1 CA-f- CAC SEWAGE # 26C3 VILLAGE ASSESSOR'S MAP& LOT 2� INSTALLPR'S NAME& PHONE NO. S612Q 77S—97-7 SEPTIC TANK CAPACITY GG LEACHING FACILITY: (type) e2. D#ty o)re 01 s (size) NO.OF BEDROOMS -3 r ` BUILDER OR OWNER 17 Al2� 2 jj PERMITDATE:hio,-�_COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by b, S� -- 0 5/25/01 ` NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. PERCOLATION TEST AND SOIL EVALUATION EXEMPTION - FORM 4 I, D/ 9. J <f N S o N ,hereby certify that the engineered plan signed by me dated 3 v a , concerning the property located.at 3a- w H�4,Y IJPDXT- C//24f, N meets all of the - following criteria: This failed system is connected to a residential dwellingonl There e Y Th r are no commercial or business uses associated with the dwelling. It • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or may conduct preliminary tests at the site without a health agent present. k • There is no increase in flow and/or change in use proposed t There are no variances requested or needed. • The bottom of the proposed leaching facility will not be located less than fourteen (14) feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable]' Please complete the following: r i A) Top of Ground Surface)Elevation (using GIS information) 3A 1 B) G.W. Elevation /o. +adjustment for high G.W. t DIFFERENCE BETWEENNA and B F SIGNED : DATE: /A/-0.)- NOTICE Based upon the above information, a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder.percexmp 1 CLAN Or 56PRL SYS71�/11 EGA TEST PIT DATA L� l Performed By: Daniel B. Johnson 98r8 Date: February .27, 2002 /,sOa 6ALL.oN SEPr�t T`aNk T)Q-1 (EL. = 98,4) , 9� r i 0" - 10" 4/A 10YR3/2 Loamy sane , 10" - 241 Bw, 10YR5/8 Loamy sand 24" -132" Cl, 2. 5Y8/2 Med.-coarse sand l51.0 Nk Mrt�r 16.4 7,e seer,(. rY+ No Observed ESHWT 7 103.4 Ti�Et;S il.• No Observed Groundwater j�o Cwcr` tS. ►�1► �`° tS PZIMLATION TEST DATA { I et Cate: February 27, 2002 E � .0 �►rvo `.*41L POCrt"t ;. 7S�o ry"1�rlrNty Sdi .C1a s: Cla (0.74 / F) t p.rr0 4IrWt. CFSS Pa OL; Perc Ra te:: 2 MPl (7 P-1) .b. 20 1/+1 d"0.1'CN0 j ? - a 9s EC,-�8,9 Depth of Perc test: 2411 - 42" 99 ._ 3 Zt +acr+iNG SCNNDUXX Or ZLMTTONS 4, 4, /� pry w�ci3 1 i 7 0640 Foundation 4 y to raw x� d Inv-. out +Baia r .✓` `` 3oLY- { rg) 7 » rid ` Inv. 1n Septic Tangy; i5na 6AtLON Inv. Out Septic Tank 9 7 . 00 rC T�►fd7C '', Inv. 1n #'79,I�c,�'.9.lalffi�iracl o ���a I, SEPr . €�1=i �c�sric) y -. F3E'�tCA�+ARX rllfrry r iu7 .4�j t� Inv. Out C9, tibcati.ori box 96. }1 ^n ao k3vME EL, o Int. DT Leaching Dry Wollm 60 ` LL q"�cN'10 P of tc,"C O-ErrF c , ct , am `' ' Noo � f1 7/1 k iW'' 07 . 4 a #> 4°5cFI4OP. I P+gTt p O� p y CrA ) S IZIiC# D EGK �qr 99tq 98+� Ntrr�w fpfr,o ac1 tti.rl Contour acar .� atl dimpmel�ams In Inchon a►ttow 0% of varla tlon on the tong th and Pr on tho width Proposed C>rontour. � _J- A-L-, Lit- ! i TANK LIQUID VOLUME 15211 U GAL (WO ) I ; Teat Pit SEPTIC` TANK0 Finished Floor Elevation FFr' � sea ROUTE xOt, ST-CLET Et�1/IIat�Pl. i cwlra c, , ISO US TEL.s t-A40-:163�-fit 4? E� s G N sE f ISLAS� Basement Floor Elevat ion BFE I �-460--�s�-�s�� X145500 a1, b FiF= Water Line W----- a g FE= 97,77t PL,Ar•T�'DRAIN IJMtTEE REVe7/o� aaAwlNc : cAY2a24a•-us Gas Line G DISTRIBUTION BOX N-10 CAALCVLATTCIN$ i REMOVABLE COVER 4"5CN 40DUTLET LATERALS DISTRIBUTION BOX TO MEET SHALL BE SET LEVEL FOR A 3 Bedrooms (Existing) REQUIREMENTS OF 310 CMA MINIMUM OF THE FIRST TWO 110 GFDIBedroom X 3 Bedrooms15.232(WATERTIGHTNESS. FEET AND CONNECTED TO 330 GPD A CONSTRUCTION� ETCL 7, EACH DISTRIBUTION LINE Percolation Rate - < 2 MPI (TP-1) ; t WITH SOLID SCH 40 PVC PIPE Bail Class: Class 1 7 4"SCH40 (0. 4 G/SE') NO, OFOUTLETS: 3 PI20BOSED IrEACSIN(; AREA: 0 f�'(M!N( � MECHANICALLY CRUSHED 00 0 0�" STONE(i-3/4"DW) STABLE LEVEL BASE LeArea: achingDry Wells: 3 at 30'L X 10-'W X 21H 41 160 SF X 0. 74 G/S. - 118 . 4 GPD 43 Bottom Area : 300 SF X 0.74 G/S F Total Leaching Capacity: 340. 4 GP13 LE ACHINGDA'fWELLS 5{3QGALLONS c>. "END"CROSS SECTION MODEL SHOREY MECAST CONCRETE FINAI 11RArjr 10 Or %TABII GPI D zt_ls- FINISHED CaAADE (SLOPE-:02) o 0 DR 3y4VAK ---- - - ----- ___ 7� d R9 SYOMEY I o ..m:w �..w... R `° TT1 IEW III O4O E �t c 12, IMIN) cN o4 NAUS ° ! PAW emu �lry,o «« oReus+i ocvS AV 000 �" Lt:AI ilMtail �I�'WI.I.I.S o GvE_S T' fd NN�Sf'Q27 C,tIZCL� IP1i'I �'trr'w '1"II w.. I ,.. /4"•1l 'DOUBLE <A 2 , :• 3rMrrOns 1 pR�PRffR�++✓oae nv 2 e WASH T A STONE I '��' o .' •` • 5. POND RD , f�E' 101.(� p 3 Z y 0 4`� �� C)Vf.iif4l L I.CACtIINtI AF1I"A 3/4" 1 1/2'DOUBLE 3 CRA+Gvrttd I w� ��R IfU+C1�Ob0 AV ( R.. 5:1 cw Ma '1" ." 1 � o F iLE or SEPTi c 5 y STe`r� t+tAC..� e 5 ONp: 04 pQ giv rp,v ! Xy L X 10 W X: Ii WASHED STONE SLr1� x �4S jl{bwrJ Rp P ,� )VA 1 . . Jy�y � ra F t P • c? �te► yak° �q ,►F non r A ,� I Sr LEACHING DRY WELLS I NYANNIS PORT r 'xt "°o. TO COMPLY W°1TH THE /0° t. 99><S 9 CPOL • CLV8 y «,y des �; Ciu S riN lr 6rtL 4 0 6 Le h M'i Rsrory �` Br REQUIREMENTS OF . �V L 310 CMR 15252 _- ...._._. HYANN15 - � �� N0Q Nrt� � UA PORT ¢ MILL RD MAACNANT ;A V �� 4AKL" AV MASSACNNU ITT$ ,rAV ti)GCNIrt � NOTES IVAI GxAYTo Av � �,, 1 . All construction methods sh all all conform to the Title V (310 { C`MR 15) and the Hamilton Board of Health Regulations . 9 S t 97,oo 4'tc 90 JroIr� >, 9 , 2 . There are no known private or F public wells within 1t�0 5 ► + -,:, "i►1EhZr1 feet/400 feet, respectively, f F y, from the proposed leaning area . 3 . Existing cesspools to be pumped and removed ...� F p ed prior to D,sT-�2l6.,Tlt]N i 9 I p _ 9� �r'E' y1.�t q.bo installing the new septic tank.. 4 . No changes are to be- made in the field without the approval _ ' n 1Sod GAunN' 3 I,,E�►cNin[(r Of the Board of Fler�it"r ,end r_1�;e design engineer. Se-pric j:M1K I>AY WELL5 au ' [Pl.asrrc�j 3o'�.�ro'>Kx�N a . Proposed leaching � r R is not., de: iclned for use with 9� garbage disposal . f , i 5. Contractor to notify Dir7 Safe 72 hour: prior to 7� Z construction . (800) 344•-7233 . a 0 9 7 . Property line information taken from Plan Book 173, Page o 141 . S#�Tatric: Plan not to be used as a property line survey. Z W : rr IL . s SUBSURFACE SEWAGE DISPOSAL SY$ �$ p 32 W. Hyarinisport Circle, Hyannis -moDA oTTO 7P- CG.= . SCALE: a M 1 ) a: (} .§:wYt 7 ." As ShownAPPROVED BY DRAWN BY o p 065, <'r'r* O w�` i E"�o""If 7 , DATE: 3/4/02 Daeii.�l B ac►ha,t<an t71, . 5', r.f_ O< aid DAvid 15asber (500) 773-6524 o F 1 32 W. 8yannir�port Circles, ltTanr�lr, l 1 rrp C t?ZC DiSIM, XVC, (5500) 420-•1004 DRAWING NUMBER u ©ro afra otAo 0+ 0 0+40 ' 0+4'0 t qlo 1 �� by: 004 tta,ic Street, #tiara tri, dst.rxwill;a, 'Mbb► 020ffi