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0090 DUNN'S POND ROAD - Health
90 Dunn's Pond Road Hyannis A= M TOWN B TABLE y$ "I ,CATON Una C. ( SEWAGE # VfLLArE m A Oo? ASSESSOR'S MAP & LOT N &PHONE NO. 6d� 6 - 2 -/7715 SEPTIC TANK CAPACITY 1000 r,A-I. LEACHING FACILITY: (type) _1 n i /T�Cc (size) NO. OF BEDROOMS BblffiBER-OR OWNER ,Ie- 0V,1S ca - v 701/0., PERMITDATE: DATE: -,,414 JOOP Separation Distance Between the: i �� V /nfP®C4 v 9. 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 �1 _ t � . . p { f �1 N r ,�. � r�'.�� ,� 1 � - fi Tov.>n of Btrntable r# �tl :Services vicesIpO*t RatOry Public Health Division n>►te a s A t 200 Matn; trees,Hyannis MA 02601 Date Scheduled w . _ Time Feel'd • or Suitability Assessment for.►sewage Performed By: `r LOCATION:& GENERAL INFORMATION l.oealion Address ��en n Owner's Name fvl-ar-"A ��w�5 - 1 R!,'S " - Address 5 jC} Assesse-Smap/parcel.•.- O 1 (6 Engineer's Name ��}- �'LQ` n \ I NBW CONSTRUCTION RBPAIIt . Tel hone# J / ` Land Uses t� ✓mac I Slopes(96) : ` Surface Stones /v/A_ Distances-from:: Open WAter Body 7�� ft Possible Wet Area:: J ft . Drinking Water Wyll7121 Drainage Way-7y ft Property,Line. Other -tf SKETCH'(Street.name,dimensions of lot,exact•locations of test holes,, pare tests,locate wetlands h pmxinuty-to holes) r 11� fi r C z o I J n1'S .b"'� 6vo 20, W. Parentmaterial(geologic) Depth to Bedrock Depth to Groundwater. Standing.Water in Hole: �` ' Weeping from Pit Pace Estimated Seasonal High Groundwater f DETERMINATION FOR SEASONAL MG WAYTER' Method.Used: - s-�-,-'"_— :E^let.r _ - Depth:to weeping,from.side of obs.holy IR. Groundwater Ad wttnent t> Index.Well# Reading Date: Index Welllevel,.w, Adj,fhetOr A d �i vai PERCOLATfo T Tn LAYtj�� Obsetwation Hole#.. Time at 9" ,. . ; Depth of Pere Tune ttf 6" Start Pre-soak Time® (.6Z 2' lf1 i Timo(VnV) .._ End Rate Min/Inch ?� Site.Suio lity Assessment: Site Passed 1 SitppP led: AdditionaLTgsting Needed(Y/N°).:: original;.Pnbtic Haalth:Division ObserYation.Hole Data TO Be Completed OII Bask --- »- ***If percolation test is to be conducted within 10014 wetland,you:must fi7i t pli e Barnstable Conservation Division at least one (1) week prior to beginning. nnnrrir/knRb/�Rr1bM nry, DEEF.OW ERVATION HOLE LOG Hole# 1 Depth from Soil Horizon Soil Toxture Sdil Color Soil'• Other Sufface(,n) (USQ1) (Mrsell); Mottling ($dueture,Stone;llouldcrs. IlJY1z `� REEF OB ERVA-`ION HOLE.LOG Hole Ik(tft from Soil Horizon• .• Soil Texture. Soil Color Soil; Otht r SurPaee(in)..: (USDA) (Mansell) Mottiitig (Structure,'StonQs,l3oulders; .. .. r, .:.. ... 77777 _ ..-.... ^r .. n DEEP 485ERVATION HOLE LOG Hole# h 9bflflliorfzoa Soli Texture: Soil Color So11 p " r SutfaCa(io) (USDA :.0 i (Mansell)„ Mottling (Strucwre,Stoma,8ouldws. EF�f}ESERVATION HULE LOG Hols# . Depth from:: Soli fiorfzoa Soil Texwre Sol II Color Soft . Other 5urfaca(i (USDA �) ) (Munn Mottling (Structuro,Stoles,Bbuidars.;. Flood Insurance R,�R an: . . Abowe� ." floodbouti ' Wat3iia5Qiv ygarbourtcaYY J. Witfifri�t��y�f`tlodd l�oundary�No.� Yes. Duo° � trrltaAzPervious Ma#erlal Dies of least°dour ftidt of naturally occurring pervious Iniiterial exist tri all areas observed'thrpughaut the area'proposeii coot the soil absorption.system? 5 P y g pervious matorial? Ifrl64 what is the de th of 11.a 11 ;.o-currin ��rti>gcatton _ I certify that on tq 0. (date)I have Pas soil evaluator examination a P pproved by the Ddjutmt;nt of Enwronmental Protection:and thatahe°above anah is was y performed by me consistent with the red,ttainin$,expertise and experience described in 10 CMR 15,017 l Stgnakura.� 1�— - Date" Q.1SB1?�'ICtP�#�-�Ek�iiM�1SOC : - 1 TOWN OF BARNSTABL,E ATION !!�Q u 1L 12' 4,1 -2 1,,4 - SEWAGE # r VfLLAGr 14 V 4 41-41 e S ASSESSOR'S MAP &LOT � — INSTALLER'S NAME&PHONE NO. ELL/ S' 12 (1 SEPTIC TANK CAPACITY I D o V LEACHING FACILITY: (type) L� r( ) "_� �S C�C_> � clnia�•1�'� sine NO.OF BEDROOMS ° BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: ` Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 r Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 1 1 3 t e LU II . -,► � `VA . � 11 No. . t I Fee / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 0[ppliCAtion for Tigpogal *p5tem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Component Location Address or Lot No. �'Dvv fos fdnd Owner's Name,Address,and Tel.No. 1T9 v o jr>S4- Assessor's Map/Parcel 7)G!!„�� g Installer's Name,Address,and Tel.No. S� V-' 3 v l Designer'FV,js Name,Addrest and Tel.`o. S 7 7 S 3 1 Type of Building: Dwelling No.of Bedrooms .3 Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.re uired) 3 3 O_,CPD gpd Design flow provided G• 7`1 [S 9 0 gpd Plan Date O CP Number of sheets Revision Date Title Size of Septic Tank love- Type of S.A.S. 3 — S G-i 1 kn Description of Soil Opp sa v I LcrP E Nature of Repairs or Alterations(Answer when applicable) S Q Sep QLj t t°S�f n Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this oar of Health. Signed Date Application Approved by Date 'Application Disapproved by: Date *,for the following reasons Permit No. Qq o 0 ( Date Issued 2 '� �� t � pr J No. 51-60 -- I '�� F ee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: }`PUBLIC;HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2"pYication for �Dlgonl �§p!5tem Cowaruction Permit Application for a'Peniiit to Construct O Repair O Upgrade O Abandon O ❑Complete System ❑Individual Components Location Address or Lot No. oij do S Cc /I(i1 H717 1 v6wner's Name,Address,and Tel.No. ry s ! 1 Assessor'sMap/Parcel G Installer's Name,Address,and Tel.No. 3 G d Designer's Name,Address/and Tel.No. r1 Y ��r k-Cc lcf rr Type of Building: v �� Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons \\ Showers( ) Cafeteria( ) " Other Fixtures l � 3 G /�/� d De n flow provided ' 7 LI 5 S`''CO J~ y'W G' d Design Flow(min.required) , gp g p gp ,Plan Date ' O C� Number of sheets Revision Date Title Size of Septic Tank I y a o Type of S.A.S. 3 ` S c a r Description of Soil A P So / L c� Nature of Repairs or Alterations(Answer when applicable) i t ` Date last inspected: Agreement: - The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health, Signed Date Application Approved by �tn.�-% 1 / Date a "� Application Disapproved by: ` Date for the following reasons x__..._. Permit No. -d-y ` d; (_ Date Issued --,._--THE COMMONWEALTH OF MASSACHUSETTS --BARNSTABLE, MASSACHUSETTS Certificate of Compliance a THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( _Upgraded ( ) Abandoned( )by {= i I t� Anc i 4. I r^o r SL at 0 O'cn h rt S p a te c'/ R to(/1 I`� n I'S has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. a 0 0 p b dated - Z c7'4 Installer �:f `� �rC r k pi S l o,) 3� Designer #bedrooms Approved design flow 1 l gpd v The issuance of this permit h � nn'o)t fe�ccoo,'strued as a guarantee that the system 6411 fdriction as.deessigneV Date (J r( /(J Inspector �liC No. o�G© O -7 Fee f VV THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS ;Di!5 oat i§ .5tem Con5tructiort Permit _ Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) System located at gJ O bMr) I' S Odle 2co-fif , W, q n S ►r'1 and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. „ Provided: Construction must be completed within three years of the date of this permit. Date 2 ` 1 'U h Approved by Town of Barnstable Regulatory Services ,l Q, Thomas F.Geiler,Director Public Health Division NAM . Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 Date: 3 16 16f Sewage Permit# 2-00 8 'o? l Assessor's Map/Parcel Z70"O Installer&Designer Certification Form fe+e rT. M a5n+" ft—�-. Designer: !',�e.e r:n e. W ew k s Installer: 4511:5df �` s Address: (2 Vy . CrQ S S-F� Cl J2 il Address: G'6• l�x I rats t-CIAJ4 I"1 A Gla ply 1u eol cw Aae'g-, 'On ?4 �`� 0� ���rs /31OS7 . was issued a permit to install a (date) (insta ller) l septic system at 90 ��,�n f etd �c� based on a design drawn by (address) `� c 1"I G�`t+e-e P. dated 2 / 0 D (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 re f any component . of the septic system)but in accordance with State&Local 40 revision or certified as-built by designer to follow. Stripout(if requ' d the soils were found satisfactory. a y� o PETER T. :z McENTEE CIVIL ZU m No. 35109 (Installer's Signature) A90FFS esigner's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WH L NOT BE ISSUED UNTIL BOTH THIS FORM AND AS �Jx BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. q:\office fonnsWesignercertification form.doc n x, � � s R, C(\ ,�' TOWN OF BARNSTABLE OCATION�d /� J(KJ ®� SEWAGE VILLAGE ASSESSOR'S MAP & LOT070--0/�p INSTALLER'S NAME & PHONE NO / 7Zl�Q➢"3`7` Y)� �'�� SEPTIC TANK CAPACITY LEACHING FACILITYAtype)� i/� / (size) NO. OF BEDROOMS PRIVATE WELL O PUBLIC WATE BUiLDE OR OWNED DATE PERMIT ISSUED: /a-g- Y DATE COMPLIANCE ISSUED: s �` VARIANCE GRANTED: Yes Now\� O i f Y� h^ D oc:= 1 s U83 s 890 02-28-2008 1 =33 BARNSTABLE LAND COURT REGISTRY DEED RESTRICTION WHEREAS, H+ 1C;�otES �vST�rv' ��uct s of (owners name) �4 !�uS'riu C- f!a<•-cE S P o.v o� MA (address) is the owner of TO 6 v,u u s Po,vot X aC 3eAA u. 's located (address) at NIA (hereinafter referred to as and being shown on a plan entitled "Subdivision of Land in MA, Property of . et at, duly recorded in Barnstable County Registry Of Deeds in Plan Book , Page Or on Land Court Plan.Number 9 S /o6 /y_ WHEREAS, i�r�Rrc 14oc-cep as the owner of said lot has (owners name) agreed with the Town of Barnstable Board of Health to a restriction as to the number of bedrooms which can be included in any home built on said lot as a pre-condition to obtaining a'disposal works construction permit in compliance - with 310 CMR 15.000 State Environmental Code,Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage; WHEREAS, the Town of Barnstable Board of Health, as a pre-condition to granting a disposal works construction permit for a septic system in compiance with 310 CMR 15.200, State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage, and authorizing the issuance of a building permit for the construction-of a-single family home on this property, is requiring'that the agreement for fte restriction on the number of bedrooms in any hodse constructed on the lot be put on record with the Barnstable County Registry of Deeds by recording this document, deedr 1 ~ NOW, THEREFORE, &4R.l< Melats Uotrio wel r4oes hereby place the (owners name) following restriction on his above-referenced land in accordance with his agreement with the Town of Barnstable Board of Health, which restriction shall run with the land and be binding upon all successors in title: 1. . .a A,0j,w s Pd A d 2J may have constructed (address) upon the lot a house containing no more than Tycr,, (3) bedrooms. k,a.nK5HVzft S Oasrl&.' -VdZAZEs agrees that this shall be permanent deed (owners name) KA ail iT+N restriction affecting located on MA, and being shown on the plan recorded in Plan Book , Paged Or on Land Court Plan a For title of see the following deed: Book , Page . Or Land Court Certificate of Title Number . ! 7.X5? i Executed as a sealed instrument X7 day of o ' Owner's signa e wner's signat e Owner's signature COMMONWEALTH OF MASSACHUSETTS a ss . 2006 Then p rso ,4Ily a e red the above-name n e � -Ma �- known to me to be the person who executed the foregoing instrument and acknowle ged the same to be free ct and deed, before me, s Notary Public g�'.•M�• �To�•, My commission expires: •�pNWE '••. l} 6BARNISTABLE COUNTY Cor �Ekee Meng a,�OfO J I Rl� O DEEDS deedr 'l'® '._,'� 5€�i r� `� A TRUE COPY,ATTEST u .,, ARNSTASLE REGISTRY OF DEEDS rV� TOWn of Barnstable Health Inspector THE tp� Office Hours NP� do Regulatory Services 8:30—9:30 Thomas F. Geiler,Director 1:00—2:00 SAMSTABLE, MASS. Public Health Division Q'] 01 t639.9. ��� plEn MA{ Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-63 AMNESTY PROGRAM APPLICANT - SEPTIC QUESTIONNAIRE 1. General Information: Size of Property: D,Sd Address: 9d 3VIVAf T,Dw) �b, IlYh /AIIT Map ,,?26 .Parcel 67/67 Name: /l// /L LM Phone #: 7�O-�7. 2a. How many bedrooms exist at your property now? 2b. Are you planning to add any bedrooms? U If yes, how many? 2c. How many bedrooms total are proposed at this property (including the amnesty unit)? 2d. Please include a copy of the floor plans for the entire property - showing the existing rooms in the home plus the proposed amnesty apartment and/or addition. Please label . each room clearly on the plans. 3. Is the dwelling connected to public sewer? YES or NO If the dwelling is connected to putahc sewer skipquestions through,# below; 4. Location of dwelling is (: INSIDE or OUTSIDE a Zone of Contribution to public supply wells? YV 2 5. Is the dwelling connected to an ONSITE WELL or to PUBLIC WATER? - 6. Is a disposal works construction permit on file? YES t<or NO 6a. If yes, how many bedrooms were approved according to this permit? Bedrooms. 7. Were any building permits obtained for construction of additional bedrooms? YES of NO CT, iTT 8. Is there an engineered septic system plan on file at the Health Division? �l'ES or NO 9. Has the septic system been inspected by a DEP certified inspector within the last two years? YES or NO -----------------------[ V-- -------------------------------------------- _ - C� - - -------------------------------------- /s FOR OFFICE USE ONLY The Public Health Division/has no objection to bedrooms at this property. Special Conditions: Signed: . ate: O;1health/wpfiles/amnestyapp Q(S— �� �w�"�S�a �o "v'r '�ilJ.,, 0 '3 1ad' C rDYkZ 1 ` \v z I F COMMONWEALTH OF MASSACHUSETTS z EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS r d DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 90 Dunn's Pond Road Hyannis MA 02601 Owner's Name: Karen Lovasco-Sutton f' Owner's Address: 200 Glen Charlie Road Wareham MA 02538 Date of Inspection: August 12,2005 Job#05-234 Name of Inspector: PATRICK M. O'CONNELL t €a Company Name: SEPTIC INSPECTION SERVICES CO. Mailing Address: 189 CAMMETT ROAD r_ a MARSTONS MILLS MA 02648 Telephone Number: 508-428-1779 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,.accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system` %ojHtOF'Mq X Passes Conditionally Passes O;' ••'• G Needs Further Evaluation by the Local App ving Authority = TN IC :�; Fai o, E 't fr- Inspector's Signature: Date: 8/12/05 INSPEG�``��� The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments: Observed no standing water in infiltrators,tank is not in need of pumping at this time. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page I + Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 90 Dunn's Pond Road,Hyannis Owner: Karen Lovasco-Sutton Date of Inspection: August 12,2005 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _XX_ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes,no or not determined (Y,N,ND) in the for the followingstatements. If"n " explain. of 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 existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: T;tlo r, r.,—,.t;,,,, r_ �n�i�nnn 2 Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 90 Dunn's Pond Road, Hyannis Owner: Karen Lovasco-Sutton Date of Inspection: August 12,2005 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. I. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(l)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. — The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: T41. C Incnarfinn Fnrm 4/1�/7M(1 3 Page 4 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 90 Dunn's Pond Road, Hyannis Owner: Karen Lovasco-Sutton Date of Inspection: August 12,2005 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No — _X_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _X— Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool —X— Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool —X— Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2 day flow —X— Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped —X— Any portion of the SAS, cesspool or privy is below high ground water elevation. —X— Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. —X— Any portion of a cesspool or privy is within a Zone 1 of a public well. — —X— Any portion of a cesspool or privy is within 50 feet of a private water supply well. — —X— 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. IThis system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this forma _No_(Yes/No)The system fails. 1 have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no — _ the system is within 400 feet of a surface drinking water supply — _ the system is within 200 feet of a tributary to a surface drinking water supply — _ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area— IWPA)or a mapped Zone 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 15.304.The system owner should contact the appropriate regional office of the Department. T41A c r„�„A r:,„ R.rr„411;110nn 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 90 Dunn's Pond Road, Hyannis Owner: Karen Lovasco-Sutton Date of Inspection: August 12,2005 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No _X_ — Pumping information was provided by the owner,occupant, or Board of Health _X_ Were any of the system components pumped out in the previous two weeks '? _X_ _ Has the system received normal flows in the previous two week period ? _X_ Have large volumes of water been introduced to the system recently or as part of this inspection ? _X_ _ Were as built plans of the system obtained and examined?(if they were not available note as N/A) _X_ _ Was the facility or dwelling inspected for signs of sewage back up? _X_ _ Was the site inspected for signs of break out? _X_ — Were all system components, excluding the SAS, located on site? _X_ — 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? _X_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 _X_ — Existing information. For example, a plan at the Board of Health. _X_ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] Page 6 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 90 Dunn's Pond Road, Hyannis Owner: Karen Lovasco-Sutton Date of Inspection: August 12,2005 RESIDENTIAL FLOW CONDITIONS Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15,203 (for example: 1 10 gpd x#of bedrooms): 330 Number of current residents: I Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system (yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use: (yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Two years total: 106,650 gal. = 146 gpd. Sump pump(yes or no): No Last date of occupancy: Currently Occupied COMMERCIALANDUSTRIA L Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sqft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records: Tank pumped three months prior to inspection. Source of information: Owner Was system pumped as part of the inspection (yes or no): No If yes, volume pumped: gallons-- How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _X_Septic tank,distribution box, soil absorption system _Single cesspool _Overflow cesspool Privy _Shared system(yes or no)(if yes, attach previous inspection records, if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) —Tight tank _Attach a copy of the DEP approval —Other(describe): Approximate age of all components, date installed(if known)and source of information: Compliance date: 12/27/93 Were sewage odors detected when arriving at the site(yes or no): No Talo C rncnartinn perm Aii Ciinnn 6 Page 7 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 90 Dunn's Pond Road,Hyannis Owner: Karen Lovasco-Sutton Date of Inspection: August 12,2005 BUILDING SEWER: XX (locate on site plan) Depth below grade: 1' Materials of construction:_cast iron _X_40 PVC_other(explain): Distance from private water supply well or suction line: - Comments(on condition of joints, venting, evidence of leakage,etc.): SEPTIC TANK: XX (locate on site plan) Depth below grade: 6" Material of construction:_X_concrete—metal fiberglass_polyethylene —other(explain) — If tank is metal list age:— Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: 8.5' long x 5.2'wide— 1000 gal. Sludge depth: 0" Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: trace Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: STICK WITH HINGE FLAP. Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Tees intact and clear liquid level at b ears. ottom of outlet invert Recommend Dumping tank every three GREASE TRAP: No (locate on site plan) Depth below grade:— Material of construction:—concrete_metal fiberglass_polyethylene other (explain): — — Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): TaIA C (ncnnrtinn Anrm �ii�i�nnn 7 Page 8 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 90 Dunn's Pond Road, Hyannis Owner: Karen Lovasco-Sutton Date of Inspection: August 12,2005 TIGHT or HOLDING TANK: No (tank must be pumped at time of inspection) (locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches, etc.): DISTRIBUTION BOX: XX (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.): No solids or_hizh stains liquid level at bottom of single outlet invert PUMP CHAMBER: No (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): T:+IA G Tncnurt:nn Rnrm 411 Vnnnn 8 Page 9 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 90 Dunn's Pond Road, Hyannis Owner: Karen Lovasco-Sutton Date of Inspection: August 12,2005 SOIL ABSORPTION SYSTEM(SAS): XX (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits, number: —X_leaching chambers, number: Three infiltrators. leaching galleries, number: leaching trenches, number, length: leaching fields, number, dimensions: overflow cesspool, number: innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil, condition of vegetation, etc.): Observed no standing water(ponding) in infiltrators CESSPOOLS: No (cesspool must be pumped as part of inspection) (locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.): PRIVY: No (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.): T41. G Tncnartinn Rnrm ail�i�nnn 9 Page 10 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 90 Dunn's Pond Road, Hyannis Owner: Karen Lovasco-Sutton Date of Inspection: August 12,2005 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. Dunn's Pond Road Water service Driveway #90 27 26 44 55 41 Three infiltrato 42 Titlo C inenop6nn Rnrm 4/1 10 Page 11 of 1 1, OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 90 Dunn's Pond Road, Hyannis Owner: Karen Lovasco-Sutton Date of Inspection: August 12,2005 SITE EXAM Slope None Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water: More than 20 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) _X_Accessed USGS database-explain: USGS topo map and town GIS You must describe how you established the high ground water elevation: Town groundwater contour map shows water at el.25 and topo map shows property at or above el.50. Titles Q incnartinn Fnrm till ci�nnn I 1 ON S E W A G /URM,91T N0. _.v i7LL A" E IVY I N S T A LLER'S. NAME & ADDRESS 100, B UILDE R OR OWNER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED y �. �' - -` ��� �.�, P � J� � s V,� f �. �� ` �� s .. a �J� .. 107 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1. ............O F..��...C.X.4rn...'....................................................... Appliration for Diapwi al Works Tnnitrnr#inn ranfit Application is hereby made for a Permit to Construct ( ) or Repair ( an n rvidual Sewage Disposal Syst t --------------------------------------------------- lgmmtion Address or Lot No. .. _ .... ......................... ........................................... _...----....................._................ �f -.... .._•�. � 1 "r//stallie�r -------------•----•-••----•---•-Address , Address dType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.. .............................Expansion Attic ( ) Garbage Grinder ( ) Other—Type e of Building .............. No. of ersons._.......................... Showers — Cafeteria a YP g -------------- P ( ) ( ) Q, Other fixtures -------------------------•_..• - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid'capacity__.._._.._..gallons Length................ Width................ Diameter________-___--- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-----_-------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-----------_............ fi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ •---•----•----------------------------------------------------------------------•-------. -.. ...... •-•------ •--------- •-------------------------------- 0 Description of Soil...............................................................................................................................--...................................... x V Natuye Qf Re airs or Alterations swer when applicable.. _� '_l6®j ..- .__.j................... ................•--•---------•----------------------•--------------------- •--•-............................... Bement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLL, 5 of the State Sanitar Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance h b iss by the bo rd of lth. s 7 Sige --`-,f---•---------- -------- "�-•--�rlh'-____."�.�.......---- •�-----��---••�•••- Date ApplicationApproved By---------- - A....._...••-••-•................•---•-----•----------•------•------------... ----------` �`�= ...... Date Application Disapproved forte following reasons:........................................................................................... a................. -••-----------------••--•---•--•------------••-------••--•-•---------•---...----•---------........---•----•••••--...--•-•..........----•-..................----••......-•-••---.... ......-•--•- Date Permit No......................................................... Issued......1- 9'•_. f.•..................... Date FEB..,......................... THE COMMONWEALTH OF MASSACHUSETTS BOAR ,OF HEALTH ................................................................ Appliratiou for Mipatial Workii Tonotrurtion Vamit Application is hereby made for a Permit to Construct or Repair an�Individual Sewage Disposal Syst ...... ...... -------------------------------------....----..... --- -------------------........ Address or Lot No. .................. ... Address - ----------- -------7............ ......................................... ..........."--------------------------------- ------- ......................... 0 nstal?e/n,tailer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms...................................._14Expansion Attic Garbage Grinder Other—Type of Building ........ ..-------11N.o,, of persons____________________________ Showers Cafeteria Other fixtures ........s-I ................................7 ------------ wr,;;..�......................................... ay.-- o al'dail flow...... ....gallons. Design Flow_............................... ..gall'bns.per person per'd T-AR y ,�Width............... Diameter------------------Depth-... Liquid capacity gallons ... ..... C4 Septic Tank me r ............ Disposal Trench—No...............JL'_ Width-':.-_,�.........z�.... Tbfg Leifgth�................... Total lea'c�hing_area....................`.,-sq. ft. Mg. Seepage Pit No_____________________ Diatnetef',!l-,. . ����,"*;��",�,-�j6ep.tl-i,,below.inlei.�l.�.�.-�:.............Total l9bhin'g'1area.................Sq. ft. Z Other Distribution box Dosing tank Percolation Test Results Performed -------- ...... Date-...... 7....... V,............................ ---------- Test Pit No. I----------------minutes per inch Depth,,ofag -------- ---- Depth to ground water-�t-----------............ Test Pit. ' --- Test Pit No. 2.................minutes per inchbepth"ofjesi Pit.................. 2Depth to ground water ............. ......... ...... ...............0........... . ...... ..............................0.............................................. 0 Description of Soil.................................................. ............... .......................................................0................................... ..........0........................................0........0...............................0........... ........:'T..................0................ ...................... .. U -- ------------------- ............................................................................................................ ------ ................ te-V p U Nat, e 46f airs or Alt Mrad ns saver when applicable-------I- * . ... .. ...... 46 , - -, , --------------V, -------------------- 110k dec000powwo S .11 ... ......... .0 ..... ........ ...................... ............................................. ...................................................... greement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanita rx,Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance S n is d by the Ar/d . .......... ......Sig ..... ........... ... ....... ......------- Date Application Approved By....... /f� - 7r' ........ -------------0......... Date Application Disapproved for the following reasons:................................................................. ........................................... ----------- ------------------------ . .. ............ .............................................................. ........ -------............ ---- ---- -Dt PermitNo........................................................ Issued..................................Y, Di Date 1�k THE COMMONWEALTH OF"M'A_SSACHUSETTS BOARD .. .........�OF$� ... ... ................ Tntifiratr of Tampliana �R I That e Individual Sewage Disposal System constructed e RepaiF)ed by-- �_o . .... ...... ... ... ................................................................................................................. ------- sat.. ...F.4.0........I.....U. .......t.._ ............ ... ............................................................................................. .......... has been installed in accor nce with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit �'o........../'?-/.................I..... dated------------------------........................ THE ISSUANCE OF THIS CERTIFICATE SqALL NOT BE CONSTRUED AS A GUAR TEE THAT THE SYSTEM W�IL FUNCTION SATISFACTORY. Zoe-- Sped,&...DATE........... ..... .................................................... in _THE.,COMMONWEALTH OF MASSACHl!s-ETTS _ 0 ISOAR OF`-HEALTH. 9 to Off t ............. ................................................................ No...... .......... FEE............. ........... Permission is hereby grant 4,d1;!r!_!A_ .... . ....................... ................................ ............................................................. to Cons Xj;ict_( or Repair ( Ind u ge Dispo System a27�......... V. . . . ......7...... .. ..... ........................................................................... /. A..0 1, as shown on the application for Disposal Works Construction Permit No... ...... ........... Dated.l!-.....�,.�.. ------ 0............. ............... ................................................... . ............. A 7 Board/Health DATE-----------------------------...............................................:2-, FORM 1255 HOBBS & WARREN, INC., PUBLISHERS �ptt APP j THE COMMONWEALTH OF MASSACHUSET garnSt8t;I@anent BOARD OF HEALT — - — e1t¢<13 TOWN OF BARNSTABLE Sigma ,m. om' Appliratiuu for Di ipaiiu1 World, Tonstrurtinn Urrutit Application is hereby made for a Permit to Construct ( ) or Repair (r>4 an Individual Sewage Disposal System at: ------------ ...----...90_........ ...._ ....- ._......---- �%� ortt'on•:\ddress /f, or.Lot ...:. > �v �fVJ ..... --- ................. O�rncr -..� ddress W 13..77JC.0� ...-_._�l�J$��-------�Zo �/�l t....................................................JV1. �11 1�5,�----.... .. Installer Address Type of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms..........u37---------------------_--Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a, Other fixtures ------------------------------ W Design Flow..............._3 --------.-------gallons per person per day. Total daily flow............ 0..._....__........... gallons. 04 Septic Tank—Liquid capacity_/&.4---gallons Length................ Width---------------- Diameter..........:..... Depth................ Disposal Trench—No. ......../........ Width....... ........ Total Length...!xTotal leaching area....................sq. ft. 3 Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ' Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f%4 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ a ------------------------------------------- •.... •--..... ..----- •........... --•............. ..... ___...... .--......... ---------------- •...... .... ..----------- ODescription of Soil----------------------=------------------------------------------------•---------------....---------------------------------------------•--------------.......--------- x W --------------------------------------------------------------------------------- •--------------------------------.......--------....------------------•-------------- ._...... U Nature of Repairs o Alterations—Answer when applicable._--.774:2��4 4.�.. - ... .... .......7 i�aL� Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance �y sen i ue by oard of health. Signed --------- ----------------- --- --- - ---- � .... Dare Application Approved By ----------------��___10........... ............................... ...�'at.r... r1.. .. ---------................... Date Application Disapproved for the following reasons: . . ... ........................................ .. .....-- ........................................ ...................... .......................................................... ........................................................... Dace Permit No. n..........�..7.�... ............. Issued . . ........... Date r+`.""_`K'y.'-ve�v.l�ti-E.b...s'wtw,«,Fi�,t•�'..w;f.r '.:sti'.. it .` f r 'r��� 3'� ,•R..�j�•-�,... y;,+e.-?�.^\,��V+�SJ"�^��Rsr>v�. Q THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTHAk_--_\ I\-) 3 TOWN OF BARNSTABLE Apphratiun for Diripuua1 Works Tonutrnrtiun Frrmit Application is hereby made for a Permit to Construct ( ) or Repair (y[) an Individual Sewage Disposal System at: o........---.... ,.� zs.--- ...... ...------��....----- -- ........................................................... Location-Address �— or Lot No. C/177 -......--- ---- ---- --------------------- ^^ ..... W L �J�" Owner /U1�� � �G /N .G ddress .<-'=.s.1.� l i •........................ Installer Address UType of Building Size Lot............................Sq. feet . I Dwelling— No. of Bedrooms.........._�.........................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ------------------------------- - - W Design Flow................:5.5....................gallons per person per day. Total daily flow.......... 0....................gallons. WSeptic Tank—Liquid capacity.Z/au)---gallons Length................ Width-__-_-._ ---_-_ Diameter................ Depth............... x Disposal Trench--No -------- ........ Width......7......_.. Total Length-_cn Z z.x: Total leaching area....................sq. ft. 3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Lil Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ----•--••................••-•--•.......••-•------•-•••••---•---.....••----------............_....---......................................................... 0 Description of Soil........................................................................................................................................................................ x W x ................................... ---------------------•---------...__....._...------••---•••---••---------------•-•---------------••.....--------•---•----•--••-----•-•--•-- U Nature of Repairs or Alterations—Answer when applicable.__--.- ......Ze2Qn!_5 --,-��N�� Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i ue by the-board of health. Signed ......... .!J''..- �_-----.. ..�-- .............. .... ApplicationApproved By ................ ... ......................... ... ...................................................................... ...f<�..�..1� 1....3.. Dale Application Disapproved for the following reasons: ...... ..... . ............................. . .................................................................. .............I.................................................................................................................................................................--------------------------------- .......................I................ Dare Permit No. _73----- .. -�............................ Issued .....................-.-.............................- .............. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE 01ertifirate of Compliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by ..- .... /1'-zt e�...��. ...........G �. s�ru�c -row. _...... .......... -- ....._ ........ - .. � .................................................................. Q i6 Ins�allcr ,-� at ....................................._...... - - ......../.�............✓�.v s...... YU"1 - =���..............................lrlJ.. .............................. has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ..f -3_`--66 79_ _.. dated _........................................_. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. - q DATE......__....... ... -- .. _ ��.... �:....1._ .................... Inspector ..... - .....................:..................... THE COMMONWEALTH OF MASSACHUSETTS �� /`1 BOARD OF HEALTH V TOWN OF BARNSTABLE FEE._' ............ 11topouttl Vvrki3 Tonotrurtiun "rrmit Permission is hereby granted-------------------��' lJ�L-7-0 Le�T7 r n.e1S. .l�J��l�?�/ to Construct ( ) or Repair O_an Individual Sewage Disposal System at No. ��f� � •uenj�.1_ ......i%?�.vJ� -------'`_ -.._.._c�/?v l C t�q d............................ Street r} � as shown on the application for Disposal Works Construction Permit No/`3n6.7.9. Dated--_-__/;-.--.J?_-_��._.... .......................... ........................ oard------------------------------------------•-••-------7 p � of Health DATE.---•------•-.f v> = -------7 )------------------------•---• FORM 36508 HOBBS&WARREN.INC.,PUBLISHERS } LEGEND N Q NZ ��1 EXISTING CONTOUR �p 61 x 100.98 EXISTING SPOT GRADE Route 28 L� SIN EXISTING WATER SERVICE G EXISTING GAS SERVICE S`,j et,eff `S --OHW-- EXISTING OVERHEAD WIRES z { Z j A TEST PIT ? S 35°17'50" W BENCHMARK 0.Li v o �\x 9&50 STOCKADE FENCE 100,OQ' 99.50 x/ ' SOufh o HIGH PROPOSED S.A.S. M°n SCHOOL 3-500 GALLONS CHAMBERS SURROUNDED WITH STONE a TP. 1 ._ TP—2 ' 7 / 4 p LOCUS 99,25 LOCUS MAP O :..99.40 — L- .._ . EXISTING S.A.S. NOT TO SCALE TO BE ABANDONED BENCHMARK 24'---< WHITE PAINT MARK ON �. .,/ � GENERAL NOTES: TOP OF CONC. SONOTUBE 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED) BY THE LOCAL EL.=100.00 (Assumed) x 99.35 T5 EXISTING SEPTIC TANK TOP OF TANK, EL.=98,68 BOARD OF HEALTH AND THE DESIGN ENGINES-R, INV.(OUT)=97.35t 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS SHED 99.37 x ._. „ x 99.35 OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE LOCAL RULES AND REGULATIONS. [_Ir DECK I 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE GATE � 99.37 x DESIGN ENGINEER. STAIRWAY UP -� - 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING o a'- f / / ; %�� CHAIN LINK FENCE p FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN N ti ENGINEER BEFORE CONSTRUCTION CONTINUES. ' EXISTING ,' CV 1 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. [ It LO 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF ; HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. x 100.42 �% 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. j// 8. THERE ARE NO PRIVATE WELLS WITHIN 150' OF THE PROPOSED S.A.S. ,' 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE 13 PAVED ' , '/ ' DIRECTED BY THE APPROVING AUTHORITIES. DRIVE x 0 42 x 1c0.63 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE \\ PN 270-016 f THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING �+ CONSTRUCTION. , 12,916±S.F. 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS IN WITH HCLEAN AREA SANDEAS SPECIFIED AND ON AIN 31LL IOEC RF 55(3)THE ,A,S. AND REPLACE I ©Q� LAMP �� OF Mqs�, 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE C'AINSPECTED BY HEALTH DEPARTMENT PRIOR TO BACKF LL. 9 E ED E \ G 3 '100.00 o PETER T. PROPOSED SEPTIC SYSTEM UPGRADE PLAN _ _ McENTEE S N 35.17' 0." E� t clvlL 90 DUNK G ' POND ROAD, HYANNIS, MA { y No. 35109 9 EDGE OF PAVEMENT , 1f CISZE� �2 Prepared for: Mark Holmes, 90 Dunn's Pond Road, Hyannis, MA 02601 9s �O i S E Engineering by: SCALE DRAWN JOB. NO. DUNN'S POND ROAD �� 1„=20' P.T.M. 115-08 Enmeer�n Engineering Works v�D 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. (508) 477-5313 2/19/08 P.T.M. 1 of 2 t T.O.F F.G. EL: 99.5NOTE: TO PREVENT BREAKOUT, THE PROPOSED (MAX.( ) FINISH GRADE SHALL NOT BE < EL:96.50 Ph (EXISTING) I F.G. EL:- 99,4t PERIMETER TOFCTHEFS S.AROUND THE EXISTING F.G. EL: 99.4t(EXISTING) j MAINTAIN 2% MIN SLOPE OVER S.A.S. 4' SCH 40 PVC PERFORATED PIPE WITH SCREW CAP SET TO WITHIN 3" OF FINISH INSTALL RISERS OVER INLET & OUTLET INSTALL RISER OVER D—BOX TO 3-500 GALLON LEACHING CHAMBER GRADE TO SERVE AS INSPECTION PORT. TO WITHIN 6" OF FINISH GRADE WITHIN 6" OF FINISH GRADE IN SERIES WITH STONE ALL SIDES OR INSTALL RISER OVER ONE CHAMBER AS SHOWN ON PLAN AND SET COVER TO * L-8 '. L=23'(MAX.) 6" OF FINISH GRADE FOR INSPECTION 4" SCH 40 PVC 4" SCH 40 PVC e 10, " - --2" LAYER OF 1/8" TO 1/2" A ;113S . ® S= 1% MIN. s ®® � DOUBLE WASHED STONE ( ) ® S= 1% (MIN.) B �aa®Be® (OR APPROVED FILTER FABRIC) 48" upUio } 2' EFF. DEPTH eiaa®BBB�.evEL INV=96.97INV.=96.803/4"-1 1/2" EXISTING ADD D-BOX i 4' 5.2' 4 DOUBLE WASHED BAFFLEVINV.=97.35± `4 EFFECTIVE WIDTH = 13.2' STONE EXISTING SEP11C TANK EXISTING r • ; INV.=96:00 M, TOP OF CHAMBER ELEV.=96.8 --BREAKOUT ELEV.=96.5 NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING INV. ELEV.=96.00 ®Ba®a PIPE INVERTS PRIOR TO CONSTRUCTION. BBC®BaBBa®® 2) D-BOX SHALL BE SET LEVEL AND TRUE TO BOTTOM ELEV.=94.00 GRADE ON A MECHANICALLY COMPACTED SIX _ 3, 3 x 8.5'=25.5' INCH CRUSHED STONE BASE, AS SPECIFIED IN 5' MIN.. ABOVE BOTTOM OF �' EFFECTIVE LENGTH = 31.5' 310 CMR 15.221(2). T.P. EXCAVATION OR G.W. 3) INSTALL INLET & OUTLET TEES AS REQUIRED. LEACHING SYSTEM SECTION 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE. I NO G.W. ENCOUNTERED BOTTOM OF TP EL: 89.0 SEPTIC SYSTEM PROFILE N.T.S. t (3) S" DIA.OUTLETS is" J72. DESIGN CRITERIA ;'`/;X/ i i % NUMBER OF BEDROOMS: 3 BEDROOMS 15.5" 12" / ' / SOIL LOG SOIL TYPE: CLASS I s• ..,EXISTI DESIGN PERCOLATION RATE: 2 MIN./IN. " HOUSE(#90)';� ,/ DATE:FEBRUARY 14, 2008 (REF#12,104) DAILY FLOW: 330 G.P.D. H-10 LOADING 2' j i ' ,i j' r / /', SOIL EVALUATOR: PETER MCENTEE PE DESIGN FLOW: 330 G.P.D WITNESS:. DONNA MIORANDI IRS O—BOX ' BACK OF HOUSE'j,; m.. HEALTH AGENT GARBAGE GRINDER: NO STAIRWAY UP 47,E," I' LEACHING AREA REQUIRED: (330) = 445.9 S.F. ELEV. TP'— 1 a DEPTH ELEV. TP-2 DEPTH 74 11 12 2.5 •DECK _ 99 0 A 0 9g 1 A '- 0 EXISTING SEPTIC TANK: 1000 GALLON CAPACITY (RECORD) ®00® 0 0 E3 E3 E SANDY LOAM SANDY LOAM r- ®®ED®®®®EM®®E@ —J— cb 10YR 4/2!' 10YR 4/2 33" N $9 5 6., 89 g 6„ USE 3-500 GALLON LEACHING CHAMBERS IN SERIES 4, ®®�®®®®®®®® 33. a)®o0t;�®®®®�I®®® �3 B SANDY LOAM B N. SANDY LOAM SIDEWALL AREA: 2(13.2' + 31.5') X 2 = 178.8 S.F. 4S 6' 10YR 5/6t, 36" 96.3 34 10YR 5/6 102" 96.0 BOTTOM AREA: 13.2' x 31.5' = 415.8 S.F. �v\ C 44" C TOTAL AREA: 594.6 S.F. N C�)' PERC = ' 4" Kwocxour DESIGN FLOW PROVIDED: 0.74(594.6) 44Q.0 G.P.D. (ADD L CAPACITY) _ / (vim // M—C SAND 56" M—C SAND 4" KNOCKOUT s 4" KNOCKOUT 62" ,/C) / 2.5Y 6/4 k PROPOSED SEPTIC SYSTEM UPGRADE PLAN Q % 6/4 / �CQ 104� GRAVEL 10% GRAVEL 4" KNOCKOUT Q / I 90 DUNN S POND ROAD, HYANNIS, MA Prepared for: Mark Holmes, 90 Dunn's Pond Road, Hyannis, MA 02601 `.'p. 89.0 120" 89.1 1 120" Engineering by: SCALE DRAWN JOB. NO. P.T.M. PERC RATE <2 MIN/IN. ("C" HORIZON) - NTS 115-08 500 GALLON CAPACITY, H=10 LOADING E�gineer�ng�vYks CHAMBERS S.A.S. LAYOUT NO GROUNDWATER ENCOUNTERED 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET' N0. (508) 477-5313 2/19/08 P.T.M. 2 of 2 i 1, it