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HomeMy WebLinkAbout0261 BISHOPS TERRACE - Health 261 BISHOPS TERRACE, HYANNIS A = i 4 , P. Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 261 Bishops Terrace Property Address Diane Gurney Owner Owner's Name information is required for every Hyannis MA 02601 11-21-14 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. Important:When A. General Information filingng outout forms �{ �/ �f `�pgruiirrNrr on the computer, use only the tab 1. Inspector: � key to move your o�':• ' may cursor-do not James D.Sears =g= JAM ES N use the return = c key. Name of Inspector CapewideEnterprises, LLC *� �'• O,� F�r Q-a Q Company Name 153 Commercial Street Company Address - Mashpee MA 02649 Cityrrown State Zip Code 508-477-8877 S 1623 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 11-21-14 actors 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. tSins•3/13 I This 5 Official tlapodian s ace Sewage Disposal Sys •P 1 of 17 1 I VV GV 1•t VJ.`+Ip p ^ L Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 261 Bishops Terrace Property Address Diane Gurney Owner Owners Name information is required for every _Hyannis MA 02601 11-21-14 page. CItyrrown 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: El I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 16.304 exist.Any failure criteria not evaluated are indicated below. Comments: The system is a 1000 Gal Tank D Box and two rows of five each Biodiffusors. 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•3113 Tine 5 Official Inspection Form:Subswlace Sewage Disposal System•Papa 2 or 17 f ` rvvv LV IY V:J.Y/I.1 p•3 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 261 Bishops Terrace Property Address Diane Gumey Owner Owners Name information is required for every Hyannis MA 02601 11-21-14 page. City/Tom State Zip Code Date of Inspection B. Cer tification (cont.) ❑ Pump Chamber pumpsialarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ ND ND (Explain belo w):❑ The system required pumping more than 4 times a year du to broken e Y b ken 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. I. 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.3113 Title 5 Official impaction Form:Subsurface Sewage DiWQ8el System•page 3 of V I IVVV L1J IY VU.-tIp 0.4 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form -Not for r Voluntary Assessments 261 Bishops Terrace Property Address Diane Gurney Owner Owner's Name information is required for every Hyannis MA 02601 11-21-14 page. cdyfrown state Zip Code Date of Inspection B. Certification (cunt.) 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. Q The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered_A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No El ® 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 is less than 6" below invert or available volume is less than '/day flow /- C/;C#11v&'• Mina•W3 Title 5 OlAaial Inspectlort Fonn:Subsurrare Sewage Disposal System•Page 4 or 17 p.5 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 261 Bishops Terrace Property Address Diane Gurney Owner Owners Name irtformation is required for every Hyannis MA 02601 11-21-14 page, City/Town State Zip Code Date of Inspection B. Certification (cons) 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 S ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 16,000 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 11 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 16.304.The system owner should contact the appropriate regional office of the Department. (Sins-3113 Title 5 Mdal himectlon Form;subswace sawaga Disposal System•Paps s of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °< 261 Bishops Terrace Property Address Diane Gumey Owner Owners Name information is required for every Hyannis MA 02601 11-21-14 page. City/Town State Tip 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 NIA) ® ❑ 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 15ins•3M3 T1119 5 Olficiel inspection Form:Subsurface Sewage Disposal System•Page 6 or 17 IYVV GJ 1'+VV.°}0i.1 n Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 261 Bishops Terrace Property Address Diane GurneyOwner Owner's Name information is required for every Hyannis MA 02601 11-21-14 page. Citylrown state Zip Code Date of Inspection D. System Information Description: The system is a 1000 Gal-Tank D Box and two rows of five each Biodiffusors Number of current residents: Does residence have a garbage grinder? E] Yes ED No Is laundry on a separate sewage system?(Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): 2013-35,250Gals 2014-33,750 Gal's Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Present Date Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(g)d) Basis of design flow(seatslpersons/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: t5hs•3113 Title 5 Of6dal Inspeaun Form:Subsurlaoe Sewapa Disposal System-Pego 7 of 17 1.VV LJ IY VJ,YJf.J ' p.8 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �Wtv 261 Bishops Terrace Property Address Diane Gurney Owner Owners Name information is required for every Hyannis MA 02601 11-21-14 page. cltyrrown 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: 8-22-14 Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume pumped: _ gallons How was quantity pumped determined? Reason for pumping: Type of System: 0 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) ❑ InnovativelAltemative 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•3/13 Tide 5 Official RupecbDn Form;Subsurface Sewage Disposal System•Page 8 or 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal Systern Form-Not for Voluntary Assessments 261 Bishops Terrace Property Address .Owner Diane Gurney irlformation is ee"Name required for every Hyannis MA 02601 11-21-14 page. Cfty/Town state Zip Code Date of Inspection D. system Information (cunt.) Approximate age of all components, date installed (if known)and source of information: Tank NA-D Box and leaching 2009 Permit#09-273 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 20" feet Material of construction: ®cast iron ®40 PVC ❑other(explain): I Distance from private water supply well or suction litre: feet Comments(on condition of joints,venting,evidence of leakage, etc.): Pipeing is cast iron House to tank Pipeing is 4" PVC SCH 40 Septic Tank(locate on site plan): Depth below.grade: 10" 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 Gal Precast H 10 Sludge depth: oil i5ins•3J73 Title 5 Official inspection Form:Subsrtfaoe Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 261 Bishops Terrace Property Address Diane Gurney Owner Owners Name information is Hyannis required for every y MA 02601 41-21-14 page. Citylrown Stale Zip Code Date of Inspection D. System Information (cont.) Septic Tank(coat) Distance from top of sludge to bottom of outlet tee or baffle 30" Scum thickness 0" Distance from top of scum to top of outlet tee or baffle 81. Distance from bottom of scum to bottom of outlet tee or baffle 18" How were dimensions determined? Asbuilt-Tape-Plan Sludge Judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tank at working level.Tank and covers at 10" below grade. Inlet baffle, outlet tee. No sign of leakage or over.loading. 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•3113 Title 5 OlGdat Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 I p.11 Commonwealth of Massachusetts Title S Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 261 Bishops Terrace Property Address Owner Diane Gurney information is Owner's Name information required for every Hyan nis MA 02601 11-21-14 page. CitylTown 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 9 ❑ 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 Is le-vu Tile 5 offic al Inspection Form:Subsurface Sewage Disposal Syslem-Page 71 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 261 Bishops Terrace Property Address Diane Gumey Owner Owner's Name information is required for every HYannis MA 02601 page. QWrown 11-21-14 State Zip Code Date of Inspection D. System Information(cunt.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 16"x16"-32"below grade wloover at 16". Box is clean and solid w/two lines out. No sign of over loading or solid can over. Pump Chamber(locate on site plan): Pumps in working order; ❑ Yes ❑ No` Alarms in working order: ❑ Yes ❑ No` Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): •If pumps or alarms are not in working order, system is a conditional pass. Soil Absor ption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Mis•W13 Title 5 Official Inspection Fomc Sibneacs Sewage Disposal System•Pepe 12 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 261 Bishops Terrace Property Address Diane Gurney Owner owners Name information is required for every Hyannis MA 02601 11-21-14 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 2 ❑ leaching fields number, dimensions: ❑ overflow cesspool number. ❑ innovative/altemative system Typetname of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.): Leaching is two trenches of five each biodiffusors. Ck D Box and camera out, both trenches.Clean wAivet bottom. No sign of holding water. 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 151ns4 3/13 - Tide 5 Official Inspedion Form;Subsurfsoe Sewage Disposal Systern•page 13 of 17 } Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 261 Bishops Terrace Property Address Diane GurneyCarer information is Owner's Name required for every Hyannis MA 02601 11-21-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 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-3113 Title 5 Official Inspection Fam:subsurface sewage Disposal pos System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection. Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 261 Bishops Terrace Property Address Diane Gurney Owner owner's Name information s required for every Hyannis MA 02601 11-21-14 page. Cityrrown state Zip Code Date of Inspection D. System Information (cons) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately P- Z-2 3 f 0-i = /7 g:: 24 I I D Eek Ohs•3M3 TWO 5 Olficid Ins pedion Form Srrduafaw Sewage Disposal System•Page 15 0117 p.16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 261 Bishops Terrace Property Address Owner Diane Gurney information Owner's Name is required for every Hyannis MA 02601 11-21-14 page. Cityrrown State Zip Code Date of insp cUon D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Np Estimated depth toFig—h ground water: 1U'+ 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: 7-10-07 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ 'Accessed USGS database-explain: You must describe how you established the high ground water elevation: T.H. on Design plan 7-10-07, No G.W. at 10'+. Bottom of leaching at 4'below grade. Bottom of leaching at 6'above T.H. Depth Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15rne-3113 Tale 5.Ofidal tsapedbn Forth:Sutmarace sewage Disposal System-Page 16 01 17 . Commonwealth of Massachusetts lugTitle 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 261 Bishops Terrace Property Address _ Diane Gumey Owner Owner's Name information is required for every HYennis MA 02601 page. Cityrrown 11-21-14 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 t5lru•303 Title 5 otsaw Inspection Forth:Subsurface Sewage Disposal System•Pape 17 of 17 TOWN OF BARNSTABLE LOCATION o[q 3 Z//,,Lv4 �S fW GGE'# 09- 273 VILLAGE ¢vr CA'A'A S 9 `&(P'AARCEL INSTALLERS AME&PHONE NO. SEPTIC TANK CAPACITY ✓`000 /* /U i-je rA n" LEACHING FACILITY.(type) /�fi�Q2 /3lD (size) 611 3 X3?- NO.OF BEDROOMS OWNER "'*bxann-c Gwrfl eLf PERMIT DATE: Z®®l CO LIANCE DATE: '1 k- Zop�, Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility V'e 61 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 i 300 feet of leaching facility) Feet FURNISHED BY C',6VW-4 W I No. D73 r Fee -- - THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Y�� PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS es fpplitation for Nsp08al *pstem Construction permit Application for a Permit to Construct( ) Repair(Q Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.°Z(0 j �i 51no��s TiEf✓Ace Owner's Name,Address,and Tel.No. i�►e �>cne.� Assessor's Map/Parcel Installer's Name,Address,and Tel.No.°(,ape ai&2 &),v -fn>es Designer's Name,Address,and Tel.No. Cam,her.f.1,<e ,Md1 Type of Building: Dwelling No.of Bedrooms Lot Size 2(t&-7c(!- sq.ft. Garbage Grinder( ) Other Type of Building S i��Ca✓v,,,k-T No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.re uired) gpd Design flow provided . 6 gpd Plan Date 1 Q1 -"tz".9 Number of sheets f Revision Date Title -2-�,l i'- <-- Size of Septic Tank Ooo Type of S.A.S. c�iCf3.c�p Z� 'C�e wnc�.c-j Description of Soil c° 3fs Nature of Repairs or Alterations(Answer when applicable) 616-�,1 14", p4V&,,, 'u I 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. Sign Date Application Approved K Date Application Disapproved by Date for the following reasons Permit No. Date Issued yyx..:,,.*,.-r.-.,_..yin-;,d;;�.ti,».n,�v,�+-w ..'^�^•.�.^4..AY:r�—„-,T.�.-..�,,,..--,...w.j.,,:,,,...:E '•i:•»t. r .... +�,. - - .. "''� � ..ter n...�ni ��}�y.sub,.F 'Rk+.+SiT'�'�..+•..:...i':•-*v e✓`t -.�.:«* r..�«,CkR.`-• No. r9V0 I — D7_3 Fee THE COMMONWEALTKOF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWNOF BARNSTABLE, MASSACHUSETTS Yes r ftPfitation for Joisposaf 6pstem Construction permit Application for a Permit to Construct,(,, ) Repair(>� Upgrade( ) Abandon( ) ❑Complete System . ❑Individual Components Location Address or Lot No.Z(01 [ i 51n o,P's .. t d J At e Owner's Name,Address,and Tel.No. I1y'1�n 5 V Z/ �✓u�✓�� � Assessor's Map/Parcel 7 Installer's Name,Address,and Tel.No.CApezt&-,P tr^�j f .;c Designer's Name,Address,and Tel.No. 17��+ `80."?a.3 Ce_. •-iI.»le rYlel i Type of Building: Dwelling No.of Bedrooms Lot Size Z(,&-7`C sq.ft. Garbage Grinder( ) Other Type of Building $;n,�I e C-,cwt, -y No.of Persons Showers( ) Cafeteria( ) _ Other Fixtures Design Flow(min.required) _7 gpd Design flow provided (, gpd Plan Date U 10 Z c a cj Number of sheets 1 Revision Date t Title 2.c,t 3,����s Size of Septic Tank U,'Aa, (t7c_,o Cr Type of S.A.S. Description of'Soil at Nature of Repairs or Alterations(Answer when applicable) Cx:­, c,4l )IMA. J-6 /U { Date last inspected: �00,; v 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===-� t Date Application Approved b " Date Application Disapproved by m Date for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO C/E+RTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(/Q Upgraded( ) Abandoned( )by at re �L�,ia-V in -t has been constructed in accordance. � �7•�� Q with the provisions of Title 5 and the for Disposal System Construction Permit No. �J✓ O'.11ated C� Installed'a.001A I Si g ��ee(�7�,,pi (_( c Designer x S=t #bedrooms 2y Approved design flow 3 13iJ end The issuance of this pe ii shall hot b onstrued as a guarantee that the systemwill�functi n'as designed. Date ( � 169 Inspector -- - -- - --- -------------. No. ��..��y�}} P73 =------=Fee-----==-==--- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS 30isposal *pstem Construction Jermit Permission is hereby granted to Construct( ) Repair(X) ``Upgrade( ) Abandon( ) System located at G 1 ?t,11t'u��� TP-�l,j f}ce li.�Vyy, t 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 be om leted within three years of the date of this permit.( _�Date C� rust t() Approve 'by �— TOWN OF BARNSTABLE LOCATION /o?(�j 1 1 to P.s 4 SEWAGE#_ 9- 2 7 3 VILLAGE ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. 2o. rQF cilc n' SEPTIC TANK CAPACITY /0 00 /* /U LEACHING FACILITY.(type) (/0) P/ra,/y 1310 f r (size) NO. OF BEDROOMS OWNER f,1 PERMIT DATE:3" Z� 2 p10q CO PLIANCE DATE: ' !(-.Zpp Separation Distance Between the: II Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility dL•L l� 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 FURNISHEDBY Z�rTi �y (,,,,( C I i z I �?1 j 3 '22, o 133 3 bco.f AS i Town of$arnstable Regulatory Services Thomas F.Geiler,Director BAPOWABM * Public Health Division 163 Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: li t% Sewage Permit# ?001�2�3 Assessor's Map/Parcel Installer&Designer Certification Form Designer: $ c hly�7 0!o,'� Installer: Cgye Wi ye �► �p�►s><s Address: I�T �S'�21 Address: Q�O-d off, \�03 On "Z�P2o op�.,i�p� lsh"Cer�KiSt� was issued a permit to install a (date) (installer) septic system at `Z b� �jA cG based on a design drawn by (address) C "—,K 1WeALv4 dated ��iblDc( designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10'.lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Loca ations. Plan revision or certified as-built by designer to follow. Stripout(if r L� pected and the soils were found satisfactory. STEPHEN V MATSON - CML ( ller's Signatu 4 �ssIONAL ECG` ( esigner's Signature) (Affix Desi r s Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. q:\office fomis\designercertification form.doc Town of]Barnstable P# 2 6 Sri Department of Regulatory Services tt„MST"L , : Public Health Division Date a� . _.�p >� 1639• �� 200 Main Street,Hyannis MA 02601 lFD MAC A If Date Scheduled ol Time 0 49.E Fee Pd. 0" Soil Suit�ility Assessment fir Sewage Disposal Performed By:.C5w1_C as � �y Witnessed By: {11 y� k����` LOCATION & GENERAL INFORMATION Z(al 3isl,otO� Location Address Owner's Name �.S TerrR � � `'"1�+1 r►i) Address Assessor's Map/Parcel: 2 y w Engineer's Name NEW CONSTRUCTION (/ "% �� � REPAIR Telephone# 5-3& q o^tT Land Use4S.�p , ��W� Slo es 30 P ( ) (51"�� Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) Parent material(geologic) CLA 0L� f Depth to Bedrock Depth to Groundwater. Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater eeixi q . / v(��� DETERIVIINATION FOR SEASONAL HIGH WATER TABLE 4y Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: (n Depth to weeping from side of obs.hole: in. Groundwater Adjust , ment in Index Well# Reading Date: Index Well level�...�. Adj,factor- Adj.Groundwater Level PERCOLATION TEST bate Time v� Observation Hole# Time at 9" Depth of Pere 61! _ Time at 6" Start Pre-soak Time @ to La a Time(9"•6") T End Pre-soak 01 _ Rate Min./Inch 2 0 Site Suitability Assessment: Site Passed_ Site Failed: Additional Testing Needed(YIN) 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 least one (1) week prior to beginning. Q:\SEPTIC\PERCFORM.DOC` DEEP-OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. on istenc, % vel o y A s 6 rA lo"s1-'e, ►t ' a ' 6 DI,Q._ i fo�nV DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling" g (Structure,Stones,Boulders. Consistency,%Gravel u "• o j 44tJ—3 Z O r v..� o Y� �6 .t' r' 13 'i►� DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gray 1 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%OravI • t Flood Insurance Rate Map: Above 500 year flood bouneary No— Yes Within 500 year boundary No A Yes �. t ' "Within 100 year flood boundary No l Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturaly occurring pervious aterial exist in all areas observed throughout the area proposed for the soil absorption system? V.5 If not,what is the depth of naturally occurring pervious material? Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of En 'ronmental Protection and that the above analysis was performed by me consistent with . the required t in g,experdse and xperience described in 310 CMR 15.017 Signature � Date 1 a Q:1S.EPTIC\PERCFORM.DOC L i COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS s DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON. MA 02108 617-292-5500 •V 9 WILLIAM F.WELD Shar pen IDY COXE Governor ✓i Secretary ARGEO PAUL CELLUCCI VID;B TRUHS. Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION F M�� /ke4y Commissioner PART A l S CERTIFICATION �9,99 Property Address: 261 Bishops Terrace , Hyannis Address of Owner: Date of Inspection: f �-3 d g / MA (If different) . .s, Name of Inspector: Wm E Robinson Sr I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: Wm E Robinson Septic Servi _p Mailing Address: PO Box 1089 , C _ntprvi 1 1 p r MA 02632 Telephone Number; 5 0 8 ; 7 7 5—R 7 7 F CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: � Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: W Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, Or D: AI SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 31.0 CMR 15.303. Any failure criteria not evaluated are indicated below. C MENTS: B) SY TEM 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. Indi ate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (r wised 04/25/97) Page 1 of 10 J y DEP on the Worid Wide Web: http:/twww.magnet.state.ma.us/dep ej Printed on Recycled Paper I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 261 Bishops Terrace , Hyannis , MA Owner: Sharon Capen Date of Inspection: j—.7— 4-7 7 B) SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed ti pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with apprcval of the Board of Health): broken pipe(s) are replaced obstruction is removed C] F RTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1 SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is witir in 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic lank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply wel , unless a well water analysis 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. Method used to determine distance (approximation not valid). 3) OTHER (revised 04/25/97) Page 2 of 30 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 26-1 Bishops Terrace , Hyannis , MA Owner: Sharon Capen Date of Inspection: /X j--q DJ SYS EM FAllS: You mu t indicate ei;t,er "Yes" or"No" as to each of the following: have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis r this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct t e failure. Yes N Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. _ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged 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 112 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 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 greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: You must ndicate either "Yes" or "No" as to each of the following: he following criteria apply to large systems in addition to the criteria above: Tie system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to p jbIic health and safety and the environment because one or more of the following conditions exist: Yes o the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply _ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area- IWPA) or a mapped Zone II of a public water supply well) The ow er or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program require ents of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04/25/97) Page 3 of 10 • �3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 261 Bishops Terrace , Hyannis_ , Ma Owner: Sharon Ca-pen Date of Inspection: Check if the following have been done: Yoe must indicate either "Yes" or"No" as to each of the following: Yes No Pumping information was provided by the owner, occupant, or Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or / as part of this inspection. V _ As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or industrial waste flow. _ The site was inspected fo- signs of breakout. _ All system components, excluding the Soil Absorption System, have been located on the site. _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. / The size and location of the Soil Absorption System on the site has been determined based on: The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of / Sub-Surface Disposal System. Existing information. Ex. Plan at B.O.H. _ Determined in the field (i=any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) [15.302(3)(b)) (revised 04/25/97) page 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 261 Bishops Terrace , .Hyannis , .MA Owner: Sharon Capen Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow: 3-70 g.p.d./bedroom for S.A.S. Number of bedrooms: 3 Number of current residents: Garbage grinder (yes or no): A,0 Laundry connected to system (yes or no� . Seasonal use (yes or no)aL d 1998 50 , 000 gal. Water meter readings, if available (last two (2) year usage (gpd): Sump Pump (yes or no):.*L 4) 2-0, 000 gat. Last date of occupancy: CO ERCIAL/INDUSTRIAL: Type J establishment: Design flow: gallons/day Grease trap present: (yes or no)_ Industr al Waste Holding Tank present: (yes or no)_ Non-sa itary waste discharged to the Title S system: (yes or no)_ Water Teter readings, if available. Last ate of occupancy: OT R: (Describe) Last ate of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of inspection: (yes or no) � If yes, volume pumped: gallons Reason for pumping: TYPE_O STEM �/IN tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: _�_�_�� Sewage odors detected when arriving at the site: (yes or no),eLc) (revised 04/25/97) Page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 261 Bishops Terrace , Hyannis , MA Owner: Sharon Cal en Date of Inspection: BUI ING SEWER: (Local on site plan) Depth low grade: Materia of construction: _cast iron _40 PVC_other (explain) Distan a from private water supply well or suction line Diam er Com ents: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK:_v (locate on site plan) jl Depth below grade: Material of construction: oncrete _metal _Fiberglass _Polyethylene —other(explain) If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No) Dimensions: Sludge depth: 3 Distance from top of sludge to bottom of outlet tee or baffler Scum thickness:_ , Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee r baffle:LL How dimensions were determined: �.4 PC Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of li uid I I n relation to outlet i vert, structural integrity, evidence o„f I kage, etc.) •i �. l� '�G r a Cif cnB GREA E TRAP: (locate on site plan) Depth elow grade: Materia of construction: _concrete _metal _Fiberglass _Polyethylene —other(explain) Dimen ions: Scum t ickness: Distan a from top of scum to top of outlet tee or baffle: Distan a from bottom of scum to bottom of outlet tee or baffle: Date f last pumping: Com nts: (recom endation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet.invert, structural integri , evidence of leakage, etc.) (revised 04/25/97) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) -Property Address: 261 Bishops Terrace , 'Hyannis , AMA Owner: Sharon Capen Date of Inspection: /-,Z?-Qcj TIG TOR HOLDING TANK: (Tank must be pumped prior to, or at time, of inspection) (Iota on site plan) Depth below grade: Materi I of construction: _concrete_metal _Fiberglass _Polyethylene —other(explain) Dime sions: Capa ity: gallons Desi n flow: gallons/day Alar level: Alarm in working order_Yes; _ No Dat of previous pumping: Co ments (co ition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:_L (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, ev dence of solids carryover, evidence of leakage into or out of box, etc.) ti/ 15 PUMP HAMBER:_ (locate n site plan) Pumps i working order: (Yes or No) Alarms i working order (Yes or No) Comme ts: (note c ndition of pump chamber, condition of pumps and appurtenances, etc.) (revised 04/25/97) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: z61 Bishops Terrace , Hyannis , MA Owner: Sharon C•apen Date of Inspection: �f SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: / leaching pits, number:✓ leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydrau failure, level of pondinWondition of v getatio , etc.) C> �2 l0 x t~' a rs l2G' 9 P/ CESS OLS: _ (locate n site plan) Number nd configuration: Depth-to of liquid to inlet invert: Depth of olids layer: Depth of um layer: Dimensio s of cesspool: Materials cf construction: Indication f groundwater: inflow (cesspool must be pumped as part of inspection) Comment (note can ition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY:_ (locate on site plan) Materials of co struction: Dimensions: Depth of solid Comments: (note conditio f soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 04/25/97) Page 8 of 10 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 261 Bishops Terrace , Hyannis„ MA Owner: Sharon Ca-pen Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) a. 33 '' 3L (revised 04/25/97) Page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 261. Bishops Terrace ,, Hyannis , MA Owner: Sharon Capen Date of Inspection: Depth to Groundwater (Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of Site (Abutting property, abservation hole, basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers Use USGS Data Describe in your own words how you established the High Groundwater Elevation. (Must be completed) ti 5 ys ✓�� G 6 9 S (revised 04/25/97) Page 10 of 10 ; jy'' % . � x ��• � _•., :�a ''r. '''` + ' SEFM SYSTEM CONSTRUCT ES:ION NOT NOTES �� ' l 1) THE MREAILf OF IiMS PUN 6 10 OE51GN A SEP11C SISIEY RtPNR AT LOCUS THIS PLAN 6 NOT d .e"-'f" , Syr';;•-^-.,.n. "� '•, '!,.+ a. , ... f .� _� �► . -� S .�:> r.' ' ,•_ �• �, ~��- ' � 1. All SYSTEM COMPONENTS SHALL BE NSTAL.Lm N ACr:ORQAIYCF WITH iTRE V OF 10 BE CONS9RHJED AS A PROPERTY UIE OR EXISIMGG CONDiTDMS SURVEY. f`=f ` '�' / " '• 4 t+ ' t s, i�► \ 1tNS PLAN, ANY LOCAL R<KES /21RE+GULA1y0WS AppL1CABLE/OC AS AMENDED THROUGH THE DATE OF 2) LOW ARD1 IS OOIFRiSFD OF r ZONE RC WQH GP OVERLAY s r'Goos+4rRyr :;�5 x s i �;, .•°t ASOR"S MMP 251 - 4 "�'�► 2 ANY CFYINGE TO INNS PLAN MUST MPROVED N WRUNG BY THE PARCEL 184 �<-,IM•ad .; o' rya '�l .s i`-, ♦ 1 `'\� ELEVATION NJFORMA110N MUST NOT BE CFNNCED WITHOUT WRIiTEN PRIOR APPROVAL BY THE EN(NNM THE PROPERTY UW MITORMMTION 6 AS SHOWN PER THE DEED RECOfM AT THE OWSTAEM.E 30 OF DEEDS R �NPt k' .� :. - � � • ■ 3. WHEN EXCAVATION FOR SITS 6 COMPLETE, PRIOR TO NSTALLA11ON, NOTIFY DESIGN CO j*� �� ;�J � lN1Y EGISTRS' IN PIMA BOOK 350 PAGE 5e�, DATED JAMMRY 1981. .P - ENGNM FOR NSPECTiON. ' LsetM ,�� ; r y'f� �' �r` `-_` � .�� ••;�` �c%c�+ot`�,+� -' ,*` ' �! � � 4. WHEN CONSTRUCTION 6 COMPLETED, PRIOR TOBACIGFR.LK NOTIFY THE BOARD NINE L GAWEY REALN TRUST ON�NER: DiANE L GIIRHEY, TRUSTEE �: s t .• t�"t ` % \ CL Am oml NiF ( of HEALTH AGENT AND DEIGN ENGINEER FOR NVSPECTION. 261 BUM TEWACE .' `�'�a:�'v: t •'i, `� `{► �� •,, + ""�� i' a J GE7?gLp� 4. ALL SANITARY DISP06A1- SYSTEM PIPING TO BE 4 SCHED 40 PVC. UNLESS �E N1rAHNS ` � �..,,,, ,�, .j •;j ap .4. r .ti�. S _""�E F'EE E OTH INWISE Nm HEREFL 4 PR=0Ei10Y41>r( �: �'� `"• :..�. � �4� -r° � � �- �`� 4` „�;''�� EXGVAiE LINSURABI.E NATETtNI AS NOIEO, TO THE '� HORIZON' , FOR A HORLZ Fp�y AT BUXHEAD <.. 3' �.. • S 2Ow � 5• LOP OF lON ! E dSTMK OF 5- SURROUNONG THE LFACHANG HELD, AND REPLACE WITH am Flly, : 70,g4' SAND PER 310 CMMZ 15.255 TO THE TOP ELEVATION OF THE SAS. t* -x i ��•,\ '41 5) EXLSW CINDOION NFORVM 6 FROM AN ON THE GROUND SURVEY, PERFORMED BY INSULATE ALL PIPES AGANST FREEZING AS REQUIRED WHEN LESS iFMANI 3' OF , ��''�f;�i.• ` P � ��•' �.,"'" 1• *.� S t r. ..ti - T `'�.` g.g BOXIER-M'E ENq�EER/ilG ON AUGtbT 4. 20019 AND FROM pS NFORW110N OBTAAB°D FROM THE COWL W Dow ON AATIONiON SIOMN 6 DETE)WO 10 BEEM41O�1.'UR1 MM0IN COACT N�iI I E�DESIX THE LOCUS MAP NOT TO SCALE/ i ' ___`� ? 1 / 7. THE SEPTIC SYSTEM DESKIV QQM INCLUDE GARBAGE GRINDER 06POSAlS. CONTRACTOR SHALL CONTACT THE ENGMM ILA MIELY FOR MR AHD POSSRE REDESIGN. ;` �,• a WM THE CONTW= SHALL CONTACT oiG SAFE (AT 1-888-DIG-SAFE) AND 6) COMNWJNMTY AM NNOM 250001 OW C OF THE FLOOD NSUOAN,'E RATE OP DEFIES THIS UTILITY COMPANIES TO LOCATE ALL DOSING UTIL= AT LEAST 72 HOURS BEFORE AREA AS ZONE G ARFA OF MNML. RDODW16 • \ / THE START OF CONS7RUCiM THE CONTRACTOR SHALL OETERIIPE THE EXACT • ` ' \ L.OGA710K BOTH HORIZONTALLY AND VERTICALt.Y. OF ALL DOSINNG UTIJTIES BEFORE 7) THE START OF ANY WORK. THE LOCATiON OF OWING UNDERGROUND UMITES ARE SHOWN N AN APPROXLAWTE WAY ONLY. MAY NOT BE LAMED TO DIM SHOWN -SITE 6 NOT WITHIN AN A.C.EC. (AREA OF CRITICAL EIMRONMt1ENTAL CONCERN). G I \ HEREON AND HAVE NOT BEEN INDEPENDENTLY VERIFIED BY THE OWNER OR ITS�/ REPRESEINrA1NE THE CONTRACTOR AGREES 10 BE FULLY RESPONSKE FOR ANY •SIZE 6 NIr W M AN AREA OF E'STMMiM WHIXT OF RARE MDLFE PER " 624' -�}. G PAVEp �NEIMAY �� // AND ALL DAMAGES WHICH MIGHT BE OCCIl41M BY THE FAEURE TO NFESP WP OCiOBER 1, 2008 'M MMiED HIALItrAls OF RATE WM.DLFE• / tit N LOCATE THE UTILITIES EXACTLY. IF ELEVATION IIPORWTON DIFFERS FROM PLAN FOR USE M W THE MA WETLANDS PRO7EC ION ACT REGULATIONS (310 CMR 101- -� NFORYATION!, THE CONTRACTOR SHALL NOTIFI' THE ENGINEER AfA MTELY FOR ■SITE DOES NOT CWTAN A CER'IM••ED VERNAL POOL PER *I ESP WP OMM 1. 2W6 �• G g POSSIBLE REDENK AT UTILITY CROSOM VERIFY N FIELD THE LOCATION / G f 68.3 fA NVINIS OF SMIK M TELEPHONE & OATAICOMM AND RELOCATE F IFEO VOW POOLS., CONFLICTING WiTH PROPOSED MN VM PER M ENGP*M DIRECT10N. THE •SIZE LS NOT WRHWI A PROBITY FLAIIIDIT PER NiHESP WP OCIOMR 1. ZOOS '1'RIOIH,IIY 69.1 CONTRACTOR SHALL PRESERVE ALL UNDERGROUND UTN1TiES AS REQUIRED. WJMD TS OF RARE SPECIES•FOR SPECS UNDER THE MAS'SACHUSEITS ENDANGERED 050 / 9. THE PROPOSED UTMITY CONNECTIONS SHOWN HEREON ARE SCHEMATIC. FNAL SUB ACT. REGULATIONS (321 CWIO0 j LAYOUT SIAL BE AS DETERMNED BY THE APPROPRIATE UTMm COMPANY. ' i • SITE 6 NOr VIM A ZONE I (M►ELLHfAD ZONE OF COWRDUTION) 8) / 70.4 BENCHMARK: TOP OF FOUNDATION AT BULKHEAD . EXiSING SEPTIC SYSTEM #fUIIMMTION OBTAMED FROM THE IOMV OF BARNSTAIHLE 7d.6 ELEV. - 70.64 AS-BUM.T CMD �3•-969, ELATED II/M/A RECEIVED ON MARCH 11, 20M ri - L7OW ELECTRIC LW SF WM SIM ON THIS PIMN IS FROM A IMP PROAn BY NSTAR BMW ON 8/7/09. MDiCATMrG TINT LOCUS 6 FED OVERHEAD OFF POLE N EXISTING 1.000 GALLON SEPTIC TANK 1183/1& HOWEVER THETIE MAY BESOME SERVICES AROUND OR OFF THIS POLE THAT REMAIN. PUMP DRY To ALLOW FOR _ - COULD B FED HADETiGMiOUND. c / /261 INSTALLATION OF NEW SEWER PI 80l. LOt�B DATE 1!/6/Ot) 80L LO08 DATE A/6/0o • DOSING INTER LIE SHOWN ON iM PLAN IIAS FED LOGIIED BY BOXIER WE 1-STORY CONNECTION TO DOSTiNG LEACH T TO 0101 E19M& SU ODD ON AUGUST 4. 2DO9 FROM DIGSAFE WRIWGS D E DECKDECKTTAANKKOOUTLET WITH PREVIOUS MORTAR. TICC DAV1D STANTON, RS . EXLSW GAS SERVICE SHOW ON THIS PUW VS FED LOCKED BY MR NYE 9.3 ENGNMW A SURW= ON AUGUST 4. 2009 FROM DWSAFE MARIWGS J % T p �2-36 MA SUL N PE a / TEST PIT 1 TEST PIT 2 / APPROXIMATE LOCATION OF SEPTIC TANK a LEACHING PIT LOT 58 • G.S.E. = 70.0 G.S.E. = 70.0 SHOWER DOSTiNG INV. ELEV.-67-ftk' ' 70.2 O 219679 SQ. FT. FILL; 10YR 5/6 ; SANDY LOAM FILL; 10YR 5/6 ; SANDY LOAM LEACHM AREA REQIIROAENTS / CONTRACTOR TO VERIFY IN O 0.50 ACRES w NITROGEN LOADING LIMITATION: NA / FIELD PRIOR TO CONSTRUCTION. SEE GENERAL NOTE /5 0/A; 10YR 3/1; 10YR 6/1 0/A; 10YR 3/1; 10YR 6/1 RESIDENTIAL- 3 BEDROOMS DOSfiVG LEACH PIT To BE PUMPED DRY SANDY LOAM SANDY LOAM x 110 GPD/EIEDROOM ® W / ABANDONED AND FILLED WITH SAND As -� W . WATER SERVICE �" ° � - TOTAL DESIGN FLOW = 330 GPO h ` NECESSARY 2 ELEV 69.8 2 IM 69.8 e g GARBAGE.GRINDER (NOT INCLUDED) _ N/A N/F B ; 1OYR 5/6 6 10YR 5/6 24 LF. �• 4w PVC J 6g• x 68.3 BRUCE W. & CHERYLN A. SANDY LOAM SANDY LOAM' PERC RATE _ CL�ISS 1 r ; OHW-' __ OHw OH o / o 4.cE�c t wI�E�LErt m LIAR = 0.74 GPD/S.FIIN f INCH pHW_-_ .- OHW ` y 38 (ELEV 66.8) 38 (ELEV 66.8) i 10YR 6 3 MIN. LEACHING AREA OF S.&S. REQUIRED: C; 1OYR 613 C; 330 GPD/ 0.74 GPD/S.F. = 446 S.F. MIN. HW-'- OHW OH V�F (, ? MED. SAND W/ GRAVELMED. SAND W/ GRAVEL PROPOSED SYSTEM: 120- (ELEv 60.0) 120- (ELEV 60.0) LEACHING CHAMBERS CONFIGURATION 5 CHAMBERS PER TRENCH: ` No WATER OBSERVED TO 120 ' ' / NO WAS SAS: 2 TRENCHES O 31.6T L x 2.8 W x 0.942 D VE ARFA PERC O 56- (ELEV 65.33) EFFECTIVE AREA: 1.67 2 83' + (2 x 0.942)) x 63.3 = 498 SF 1 DBOx - _ :- TP #1 � � x 6s.a "--- ,,,•,._ I RATE= 2 MIN/IN TO 120; ELEV 60.0 � ' I , ' sr� - CLASS I SOIL I ING AM _ 498 SF / 16� ORE I CERTIFY THAT ON 7 10 07. i HAVE PASSED THE SOIL EVAUu11nR EXAMINATION �SYSTEtiI DESIGN CAPACITYTAL EFFECTW i - 498 SF x 0.74 GPD/SF = 368.5 GPD I Y 4 LF N C PVC aLl / / I O s=a5X I `"--.•,. _.... \ � APPROVED BY THE DEPARTMENT OF ENVIRONMENTAL PROTECTION AND THAT THE SEPTIC TANK SIZING: EXISTING SEPTIC TANK TO BE USED REMOVE AND REPLACE EXISTING 2 CO) `-.__ _` ABOVE ANALYSIS WAS PERFORMED BY ME CONSISTENT WiTH THE REQUIRED CHAIN LINK FENCE To INSTALL - AREA _i' TRAINING, EX AND EXPERIENCE DESCRIBED IN 310 CMR 15.017 1 PROPOSED SEP71C SYSTEM I ... `--- j S� J �-� e10pH f ed SIGNATURE RATE 1 1 E 15 LF - 4• PVC 18 OR EQU� SITE LOCATION: 59.7 o S-4.OX MI Bishops Terrace 31.r...� Hyannis, MA PREPARED FOR 167-4,r _ CAPEWIDE ENTERPRISES P. & uIv C AREA : P.O. BOX 763 CENrERVILLE MA o2 2 o Box 2.8 , , 63 5 « BIOWTUSER 18009D (OR 50"28-4M LEACHING TRLE MIN. DIST. UNE RESERVE AM � REPAIR PLAN FOR MIN ON-SITE SEWAGE DISPOSAL SYSTEM 5 N BIODIFFt1SfR 18008D (OR TYPICAL SYSTEM PROFILE LEACHING BAMR NYE ENGINEERING & SURVEYING NOT. To - ( � •.. `, 2.8' NOTES: I l r- 31.67 1. ALL MATERIALS SHALL. MEET H-20 LOADING REQUIREMENTS IF PLACED Registered Professional Engineers and Land Surveyors PLAN VIEW78 North Street-3rd Floor,Hyannis,Massachusetts 02601 WITHIN 10 FT OF A ROADWAY OR DRNEWAY. NOT To SCALE Phone- (508) 771-7502 Fax - (508) 771-7622 - jH OF TOP OF FOUNDATION SET FRAMES & COVERS TO WITHINiyqNIN �� ELEV • 71-M r OF FINISH GRADE. RISERS & 10 0 10 20 g EM. GRADE - 70.2 COVERS SCOW. BE WATERTIGHT' � cr GN SCALE IN FEET SON y CIVIL FISHED GRADE OVER EXI5ING 77MM( = MA RNISHED GRADE 1-=10' No.ae3r15 'Q OF Fn� R - 36"MAX.-9"MIN. `(IMPACTED �1Lip S°�sre N��`�� rai 4•SCH 40 PVC 3•WL COVERS SCOW. BE WATERTIGHT OOAPACTm FILL INSTALL ONE INSPECTION PORT N w \ \ X 'TOP OF CHAMBER OVAL E ASSUMED EXIST. L- u� ASSUME 2% a MIN. 24 IF-4!'SCH 40 PVC 4S-4X FNS�O CRAOf �VE1e a OW • 09.0 � WITH 2 LAYER DOUBLE WASHED ,,z PIPE INVERT Q.� /�..S STONE 1/8 TO 1/2 OR OVERIFY 1 �TO VERIFY IN FIELD r LAVER DOUBLE W4SHED E GEOTEXTiLE FABRIC PER 310 ,d EFFECTIVE N IN FIELD PRIOR TO 15 LF«4 SCH 10 PYC �6-4AEr' PEft 81001FFUSER 1800BD (OR CONSTRUCTION - SEE GAS BNFFIEPRIOR TO CONSTRUCTION - SEE GENERAL NOTE #& ODOM LD" AINIc a10 cA1R CHAMBERS CM CLEAN SAND ••'�; DEPTH GENERAL NOTE /5. ♦ Y' IMe mw r (TO BE 4'sa14o Pa: ti u S'CRUSHED 4•SCH �o PC aHweEx My N- e6.ee PER 310 CMR ��% �� �, DATE: 08/(6�09 STONE aASE Nv IN- e7 2• *•/=f` 15.255 ,y:N ;�� . ,.•,�� .. , . ..r.i • - :.' . �� .r• ,t• ;,:i .J SUHtP • W 1- QQ.2� r r pyl. i en .z. SP NOT T 0 SCALE Cal E>08TN0 t000 QAUM SEFM TANG PLASTIC LUCHM 'CHAMBER SEPTIC TANK m BE INSIMM t CLEANED ANNIWLY - 660 CRUHIB� UNSUITABLE SOIIS. IF ENCOUWERED BELOW 4' MIN NO. BY DATE REMARKS STONE DPAWING NUMBER RE IXWED 70 n+THE PEASTONE E'1c HoRaa�Hr AS I�� No ORMUNDWAIM rn ELEV Soo wN : MTM HH ter DISIFIMIION BOX _ SET: CONSTRUCTION NOTE 05 ADS-BIODIFFUSER 1600BD (OR EQUAL) M BE TNsrA110 ON A LINE SME BrISE LAY-UP LENGTH 760 'PER UNIT 0:\2009\2009-010\CAL\PLOT\2009-035SEP.dwg 2 OUnEiS REnUfIED JOB J2009-010 N O N i