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HomeMy WebLinkAbout100-108 FIRST AVENUE (HYANNIS) - Health 1 io-108 first Avenue, yannis A 4 6 Il�g ;1 f, ,I, �: �i7d1 D P s OF BARNSTABLE LOCATION /6L > SEWAGE#�C�l!� 3 VILLAGE /�i,/�yi_s�y 7 ASSESSOR'S MAP&PARCELG-2.. jZQ INSTALLER'S NAME&PHONE NO.AQc�i mar, �—y i3 SEPTIC TANK CAPACITY LEACHING FACILITY:(type 7 62 Al P aJ (size):. U,7 NO.OF BEDROOMS OWNER . .;PERMIT DATE: COMPLIANCE DATE: 1/2 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY \L 5> 0 G w J h `k1 I, v V ® � �OL g a LEA QN sl A U ,.< .�,rw•sh.e`�" rod �t 6"7 - r�� LOCATION 'g� SEWAGE PERMIT NO. 11 too Av£. hYllo2T VVLLAG E I N S T A LLER S NAME A ADDRESS I' d U1LDE R OR OWNER . DATE PERMIT ISSUED DATE COMPLIANCE ISSUED - , 33 � - -- -- - . � �� ��J �/ � � a_._.�J� � ! -� � �a� fF; �� !� w �. ����!� `��� � 3s � ��- . . , .� y �. No. d-D '7Vqq Fee �-- THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes BLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppCication for Ti9pogal 6p.5tem Construction Verna d� Appli a ' n fo a Permit Colt tract ) Repair pgr ( ) Abandon( ) ❑ Complete System ❑Individual Components catio d ress or hot No. Own 's Na e, ddress,and Tel,No. ssessor ap/Parcel -7 f , r� 3 w 1/ 7—" Installer's Name, ddress,and Tel.No. Designer's Name,Address and Tel..;No. �/ 4-1 Y- 3 6o� S Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder (0000� Other Type of Building is S No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required l'f � gpd Design flow provided �� gpd Plan Date l ® Number of sheets Revision Date Title Size of Septic Tank -,EX 1 sr 7' /O y d Type of S.A.S.3Z &2 a a&ZF Description of Soil Nature of Repairs or Alterations(Answer when applicabl Date last inspected: Agreement: The undersigned agrees to ensure the,construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boa lth. Signe Date a �6 Application Approved Date Application Disapproved by: Date for the following reasons Permit No. �� ✓y�Y��s_� ------ Date Issued —— --—————————— 4 ¢@� ° 't <� s Fee N THE COMMONWEALTH OF Ente OF M red in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS L',47 prtcation for �Digoal *pztem ctCongtruction Permit j Appli of:n for a Permit o Con tructt(J) Repair pgra O``.`Abandon( `) w.0 Complete System Individual Components �dc /0 G) 1 I*bocatio d reamsss or Lot No. 4 _ Owner's Na, e, ddress,and Tel,No. ssessor ap/Parcel .7 /v d a Installer's Name,Address,and Tel.No. Designer's Name,Address and Tell..No. t�C/ `'j' 4/ Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder (;�� Other Type of Building f S No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required ytO gpd Design flow provided �y gpd Plan Date f /i p Number of sheets Revision Date Title Size of Septic Tank T !© P d Type of S.A.S.32 - Description of Soil- Nature of Repairs or Alterations(Answer when applicable Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board_of-Health. - Sig d " � _ , --� Date Application Approved by F "Date Application Disapproved by: Date for the following reasons Permit No. ®� (/ Date Issued p( THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS rf-0Al )we J .Nkl Certificate of Compliances THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( k-,Kpgraded ( ) Abandoned( )by at U I—, S ? G!t ) -...-—ffa"b been constructed in accordance with the pros' tons of Title 5 and the for Disposal System Construction Permit No. dated Installer /7 D?G Designer .4!2�1 42 P5 j #bedrooms L` Approved design fl w y 0 gpd The issuance of this perms shall not be construed as a guarantee that the system wi 1 fu con as de igned. I q Date "1 �' J Inspector � t � —_ — =` ---- — ----�— — --- —----r r— --------------- No. — —— _ -- _—__ _ V /n Fee THE COMMONWEALTH OF MASSACHUSETTS ` PUBLIC HEALTH DIVISION — BARNSTABLE, MASSACHUSETTS Migogal *pgtem Congtruction Permit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Aba do ) System located at / d � !/ � % /6 °Z / I and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. Date "! / '- 0 Approved by I La r i Commonwealth of Massachusetts = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1 1.88Tirst Ave Z�✓T - 1 �rj� ��I �yp, � — Property Address Janet Loveridge Owner Owner's Name information is required for (�WeV _1 MA 02672 July 27, 2010 every page. CitylI own 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: A. General Information When filling out forms on the 147 computer,use 1. Inspector: I only the tab key to move your Patrick M. O'Connell cursor-do not Name of Inspector use the return key. Septic Inspection Services Co. _ Company Name VQ 189 Cammett Road Company Address Marstons Mills MA 02648 man City(rown State Zip Code 508.428.1779 SI 12855 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 - �F1 Needs Further Evaluation by t L. cal Approving Authority . ti July 27, 2010 Job# 10-190 -Z In ctor's igr Date77 O ' The system inspector shall submit a copy of this inspection report to the Approving Authoritmoaq j of Health or DEP)within 30 days of completing this inspection. If the system is a shared sy em oI. has a design flow of 10,000 gpd or greater, the inspector and the system owner shall sub rr is e = report to the appropriate regional office of the DEP. The original should be sent to the sysi�m ovitr and copies sent to the buyer, if applicable, and the approving authority. a l-.► C «.** 4b 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. t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 108 First Ave _ Property Address Janet Loveridge Owner Owner's Name information is required for West H annis ort MA 02672 July 27, 2010 _ every page. City/town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Tank is not in need of pumping at this time, leaching system shows no signs of saturation or surcharge. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is ,. structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•09(08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 t f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 108 First Ave Property Address Janet Loveridge Owner Owner's Name information is West H annis ort MA 02672 Jul 27 2010 required for y P Y every page. City/town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box dues to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 15ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 r ''-,�O� � 'Y 1. tk. 4, f. �� y 1 a! j. �Y �'%„ Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 108 First Ave Property Address Janet Loveridge _ Owner Owner's Name information is west H annis ort MA 02672 Jul 27, 2010 required for y p y every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to.a surface water supply. ❑, The system.has•a septic tank and SAS and.the SAS is within,a?one l of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: '*This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: 0 D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than_day flow t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 - III f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 108 First Ave Property Address Janet Loveridge Owner Owner's Name information is required for y p West H annis ort MA 02672 July 27, 2010 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. Any portion.of cesspool or privy is wit hin 100 feet of a surface v.later supply of tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,. provided that no other failure criteria are triggered.A copy of the analys4s 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 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply El El Area system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 108 First Ave _ Property Address Janet Loveridge Owner Owner's Name information is West H annis ort MA 02672 Jul required for Y p Y 27, 2010 every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ Q'I Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part.;of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 — t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 108 First Ave Property Address Janet Loveridge Owner Owner's Name information is West H annis ort MA 02672 Jul required for y p Y 27, 2010 every page. City/town State Zip Code Date of Inspection D. System Information Description: Number of current residents: Unknown— Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required) ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Currently Occupied. Commerciatlind'ustrial Flow Conditions: Type of Establishment: — Design flow(based on 310 CMR 15.203): — Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): — Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: — t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 108 First Ave Property Address Janet Loveridge Owner Owner's Name information is West H aMIS O required for Y P rt MA 02672 July 27, 2010 every page. Cityrrown 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: Tank pumped last summer. 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: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): l5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of'17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 108 First Ave Property Address Janet Loveridge Owner Owners Name information is West H annis o required for Y P rt MA 02672 July 27, 2010 every page. City/town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Compliance date: 5/12/97 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 1' Depth below grade: feet Material of construction: ❑cast iron ®40 PVC ❑ other(explain): . — Distance from private water supply well or suction line: feet — Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 1 g1- 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: 1500 gal. Sludge depth: 2" _ 15ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 108 First Ave Property Address Janet Loveridge Owner Owner's Name information is west H annis ort MA 02672 Jul required for Y P Y 27, 2010 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 30" Scum thickness 1 Distance from top of scum to t 6��ap of outlet tee or baffle — Distance from bottom of scum to bottom of outlet tee or baffle 13" — How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Liquid level was found at bottom of outlet invert, tees were intact and clear. Tank is not in nedd of pumping at this time. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: — Scum thickness Distance from top of scum to top of outlet tee or baffle — Distance from bottom of scum to bottom of outlet tee or baffle — Date of last pumping: Date t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 0617 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 108 First Ave Property Address Janet Loveridge Owner Owner's Name information is West H annis ort MA 02672 Jul required for y p y 27, 2010 every page. City[Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: — Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: — gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 108 First Ave Property Address Janet Loveridge Owner Owner's Name information is West H annis required for y pod MA 02672 July 27, 2010 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, ahy evidence of leakage into or out of box, etc.): No solids or high stains present, liquid level at bottom of single outlet pipe. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and,appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: 15ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 108 First Ave Property Address Janet Loveridge Owner Owner's Name information is Jul West H annis crt MA 02672 required for y P y 27, 2010 every page. Cityrrown State Zip Code Date of.Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 3 Cultec chambers. ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding,.damp soil, condition of vegetation, etc.): Leaching system shows no signs of surcharge into d-box, stone and soils surrounding SAS were probed with no evidence of saturation found. 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 l5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 or 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 108 First Ave Property Address Janet Loveridge Owner Owner's Name information is West H annis required for Y port MA 02672 July 27, 2010 every page. Cltyfrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of'17 Commonwealth of Massachusetts Title 5 Official Inspection Form , o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 108 First Ave Property Address Janet Loveridge _ Owner Owner's Name information is West Hyannisport MA 02672 July 27, 2010 required for every page. City/Town. State Zip Code Date of Inspection D. System Information (cont.) Y 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 Right Side 1 Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 108 First Ave Property Address Janet Loveridge Owner Owner's Name information is west H annis ort MA 02672 Jul required for Y P Y 27, 2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must d0scribe how you established the high ground water elevation: Location of property and SAS are considerably higher than.surface water at end of road. Before filing this Inspection Report, please see Report Completeness Checklist on next page. l5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 108 First Ave Property Address Janet Loveridge Owner Owner's Name information is Y 27t t Hes annis or MA 02672 Jul required for W Y p , 2010 every page. Citylrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Town of Barnstable P# Department of Regulatory Services HARNSTASM • Public Health Division �D MASS. Date 059.IN 200 Main Street,Hyannis MA 02601 Date Scheduled 6-7h 0 / — Time Fee Pd. l �� Soil Suitability Assessment for S wage Dis os Performed By: '; a6 Witnessed By: LOCATION& GENERAL INFORMATION Locatio Address i J Owner's Name`jw,v fipe V f2 I C!Ad N %j [O Z T Address a�3 G�v� N// ✓�D Assessor's Map/Parcel: 6 a Engineer's Name NEW CONSTRUCTION REPAIR Telephone# Land Use 'E� 1�� o Slopes(90) 4. Surface Stones /-)One Distances from: Open Water Body U ft Possible Wet Area 0 GI fit Drinking Water Well ft Drainage Way fit Property Line fit Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) le M s� tn M m c-2 „ rial(geologic)Parent mate �1St1 o 2 Depth to Bedrock Depth to Groundwater. Standing Water in Hole: ' Weeping from Pit Face Estimated Seasonal High Groundwater 1( {3���1,� Method Used: DETERMINATION FOR SEASONAL HIGH WATER TABLE Depth Observed standing in obs.hole: Depth to weeping from side of obs.hole: in. Depth to soil mottles: In. Oroundwater Adjustment in. Index Well# Reading Date: Index Well level - ft. .� m�.. Adl,factor— Adj.GrOUtIdwater Lavel PERCOLATION TEST bate Time FRa \ - --�-- Time at 9" t�— _ Time at 6" t h '.('��Q p O Time @ b� Time(9"-6") f`7`fl h La M P t Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one (1) week prior to beginning. Q:\SEPTICIPERCFORM,DOC `t DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Soil Color Soil. Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) hs DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consi ten %Gravel) 0 - SCl cSQ 2 3 �► fir, G-3 Z'Lj LIS 3� ao . i'-+'lq t6-°?Z DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel DEEP OBSERVATION HOLE LOG Hole# j3 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones.Boulders. Consistency. I FLA Insurance Rate Map: Above 500 year flood boundary No— Yes Within 500 year boundary No Yes, 4 ' / Within 100 year flood boundary No ..✓ Yes . Depth of 1°laWrally Occurring Pervious Material Does at least four fect of naturally occurring pervious material exist in all areas observed throughout the area proposed.for the soil absorption system? __y If not,what is the depth of naturally occurring pervious material?,,._.4j!NL CertificatioS.i I certify that on (date)I have passed the soil evaluator examination approved by the Department of Env'.onmenta Protection and that the above analysis was performed by me consistent with . the required trai ng ex r e erience described in 310 CMR 15.017. Signature_ Date Q:\S.EPTiCU'ERCFORM.DOC Town of Barnstable P�OFTHE Tp�� Regulatory Services o„ Thomas F. Geiler, Director BARNSTABLE, Public Health Division 9Q MASS. OA 1639• IN Thomas McKean, Director TED MAC 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: q'c��" \0 Sewage Permit# Assessor's Map/Parcel Installer & Designer Certification Form Designer: C < Installer: P CL(—" Address: Cir Address: IAC�S�N- On ' \ �2�. Ccr)ST. was issued a permit to install a (date) (installer) septic system at abased on a design drawn by (addres ) Cq,me r3 �w dated (designer) /X I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. 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 & Local Regulations. Plan revision or certified as-built by designer to follow. Stripout (if required) was inspected and the soils were found satisfactory. nstaller's Signat e, , ( signer's gria ure) (Affix DelgnaC� Ship :``ere) 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 forms\designercertification fonn.doc _ t `JR (/ Commonwealth of Massachusetts RECEIVE® Executive Office of Environmental Affairs MAY '1 9 1997 Department of HEaLTF QEPT. t Environmental Protection TOWN OF BARNSTABLE Wllllam F.Weld Trudy Coxe Governor fin, Arpw Paul Celluccl David S.Struhs LL Governor c1ommbsfoner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A - CERTIFICATION Prope tyAddrese: 1 00-1 08 1st Ave, W Hyannisport, Middressofown,, Janet Loveridge Date of Inspection: S -)a—9 ,,, (If different) Name of Inspector. W.E. Robinson SR Company Name,Address and Telephone Number. ( 5 0 8) 7 7 5-8 7 7 6 W.E. Robinson Septic Service / P.O. Box 1089 Centerville MA CERTIFICATION STATEMENT I 9�rtify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate aad 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 G Date: s 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: A] 'SYSTEM PASSES: V I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. to 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, 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. (revised 11/03/95) 1 One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500 i,Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) property Address: 1 00-1 08 1st Ave, W Hyannisport Owner. Janet Loveridge Date of Inspection 131 SYSTEM CONDITIONALLY PASSES(continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pips(s) or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): 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 approval of the Board of Health): broken pipe(s)are replaced obstruction is removed 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 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 within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and 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 is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well,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. 3) OTHER (revised 11/03/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1 00-1 08 1st Ave, W Hyannisport Owner. Janet Loveridge Date of Inspection: D) YSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 16.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the 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 1/2 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 ooliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E1 GE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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 owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program req mente of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.. (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECIMIST P,vpertyAddress: 1 00-1 08 1st Ave, W Hyannisport Owner. Janet Loveridge Date of Inspeotlon: f;t�� f Check if the following have been done: / f _camping information was requested of the owner,occupant,and Board of Health. / one 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. As built plans have been obtained and examined. Note if they are not available with N/A. ;�u facility or dwelling was inspected for signs of sewage back-up. he system does not receive non-sanitary or industrial waste flow _he site was inspected for signs of breakout. V 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. L_Tths size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. 4 ` e facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub. Surface Disposal System. (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION property Address: 1 00-1 08 1st Ave, W Hyannisport Owner. Janet Loveridge Date of Inspection: / FLOW CONDITIONS RESMENTIA U Design flow: 9 /b Number of bedroo ^`1 Number of aurent Garbage grinder(yes or no):" _ Laundry connected to system(yes or no):.p/—d5 Seasonal use(yes or no):t1=U Water meter readings,if available: Last date of occupancy:_,f COMMERCIAL/INDUSTRIAL:- Type of establishment: Design slow:_ gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non4mmitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING'RECORDS and source of information: ~ C 1�8k J�C egg S t�-g7 l�en l��=401 System pumped as part of inspection: (yes or no)R C If yes,'volume pumped: gallons Reason for pumping: TYPE O PSYSTEM 't/ Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yea or no) (if yes,attach previous inspection records,if any) Other.(explain) APPROXIMATE AGE of all components,date installed(if known)and source of information: _�t."—c.cJ Sewage odors detected when arriving at the site: (yes or no)�v (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1 00-1 08 1st Ave, W Hyannisport Owner. Janet Loveridge Date of Inspection: S^l •`� SEPTIC TANK 1/ (locate on site plan) 1 Depth below grade: Material of construction:_concrete_metal FRP her(e:plainn) l�U 8 _ Dimensions: Sludge depth: h Distance from top of sludge to bottom of outlet tee or baffle:t]3 Scum thickness:_ %k Distance from top of scum to top of outlet tee or baffler Distance from bottom of scum to bottom of outlet tee or baffle:_/L• Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) tit�u i 1 6-U 'e: i I )p n- 1:L 1 7 GR E TRAP:_ (locate n site plan) Depth bel w grade: Material of co _concrete_metal_FRP—other(explain) Dimensional- scum Distance m top of scum to top of outlet tee or baffle: Distance m bottom of scum to bottom of outlet tee or baffle: Comments (reeomme daticn for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence f leakage,etc.) VV— (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1 00-1 08 1st Ave, W Hyannisport Owner. J net Qveridge Date of Inspection: - 6 r� `/ TI HT OR HOLDING TANK- 0 ca site plan) Depth grade: Ma of construction: concrete_metal_FRP_other(explain) no: Capaci ¢allons Design w: gallons/day Alarm 111: Comments: (condi ' n of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX: !/ (locate on site plan) Depth of liquid level above outlet invert:_ Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) L PUM CHAMBER:_ (locate n site plan) Pumps working order-(yes or no) Commen (note co t'on of pump chamber,condition of pumps and appurtenances,etc. (revised 11/03/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) propertyAddrem 1 00-1 08 1st Ave, W Hyannisport Owner. Ja-net Loveridge Date of Inspection: --t02 2l SOIL ABSORPTION SYSTEM(SA9)e Iz (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:4 leaching galleries,number: leaching trenches, number,length: leaching fields, number,dimensions: overflow cesspool,number: 2� Comments:(note condition of so',s gns of hydraulic failure, level of ponding,condition of vegetation etcJ 'Tc' "s- 'Pe-c K'ZQ I 0, _Q CESSPOOLS: (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(cesspool mart be pumped as part of inspection) 47ts:(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) P _ (l te on site plea) Matte of construction: Dimensions: Depth of solids: Comm�nta:(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) (revised 11/03/95) g SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1 00-1 08 1st Ave, W Hyannisport Owner. Janet Loverdige Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' �vb h� 1 0 1 c DEPTH TO GROUNDWATER Depth to groundwater: t S - feet method of determination or approximation: YJ��1 (revised 11/03/95) 9 • TOWN OF BARNSTABLE ¢� LOCATION 1 .4") s SEWAGE # 9 4 VILLAGE � d �`'� � ASSESSOR'S MAP & LOT INSTALLER'S NAME& HONE NO. s F SEPTIC TANK CAPACITY LEACHING FACILITY: (type) ;L-® � ) NO.OF BEDROOMS �- BUILDER OR OWNER �,} 6i�PERMITDATE: `'f -- t COMPLIANCE DATE: . j f 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) oL o Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) AL 6 Feet Furnished by A /1 i b)� ' 4 0 .0 0 No Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for 30igpo5ai *p5tem Construction Permit Application i y­m�d e for a Permit to Construct( )or Repair( x)an On-site Sewage Disposal System at: /Location Address or Lot No. Owner's Name,Address and Tel.No. i 100 1st Ave W.Hyannisport Phillip Duddy, Trustee ssessor's Map/Parcel IV� .N d 6 1dIre1 S'O 17 T No.t i c Service Designer's Name,Address and Tel.No. P.O. Box 1089 Centerville MA 775-8776 Type of Building: Dwelling No.of Bedrooms 3' Garbage Grinder( n6 Other Type of Building ° No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Description of Soft sand Nature of Repairs or Alterations(Answer when applicable) install a 1 , 500 al HD p last i c septic tank, d-box and 4 u 330 stonepacked infiltators. Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this azdof Health. Signed Date 9e Application Approved by Date` Application Disapproved for the following reasons Permit No. ,. — Y�� Date Issued Fee 4 0.0 0 No. r s ' l THE,COMMONWEALTH OF MASSACHUSETTS ' PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS ZInfication for Mgooal *potent Congtructfon Permit a.. 0 ., Application is hereby made for a Permit to Construct( )or Repair( x)an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. _ 100 1st Ave - W.Hyannisport Phillip .Duddy,, Trustee Assessor's Map/Parcel s N e,,pddress,and Te No. Designer's Name,Address and Tel.No. . . �`o SOn Septic Service P.O. Box 1089- Ce Type of Building: Dwelling No.of Bedrooms 3 ) Garbage Grinder( n6 Other Type of Building No.of Persons Showers(. ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Description of Soil sand i• Nature of Repairs or Alterations(Answer when applicable) install a 1 ,500 gal HD 121astic septic tank, d-box and 4 # 330 stonevacked infiltators- Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in,.operation until a'Certifi, �j cate of Compliance has been issued by this B and Health. - ; Signed ':� Date'" Application Approved by 4✓ vt Date 5 Application Disapproved'for the following reasons >. i ' l Permit No. Date Issued ————————-——————————————— ——— •—-— ——-— Duddy/Trustee THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( )or repaired/replaced(x )on by Installer W.E. Robinson Septic at 100 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 9 dated 19` Date tr _ ! ._ �l ? Inspector r--1 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYS- TEM WILL FUNCTION SATISFACTORY. No. G �.��I _- _ _ _ -------.— Fee 40.00 Duddy/Trustee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Miopogal *p5tem Con.5truction Permit Permission is hereby granted to W. E. Robinson Septic "Service to con4 rucHt ya)e port On-site Sewage System located at No.# 0 0 1st Ave H h sweet and as described in the above Application for Disposal System Construction Permit. 9 6 Z;f2f f/ No. Date r' The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. All construction must be completed within three years of the date below. Date: 9-// _ y!n Approved by (/'�/l�`ir Board of Health ' CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) I, lJ ��a� >�. s o 5 , hereby certify that the application for disposal works construction permit signed by me dated �j`-��- , concerning the property located at j U o I s v , i, ?.e i meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • The observed groundwater table is 14 feet or greater below the bottom of the leaching facility • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. nor SIGNED : l� DATE: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. I r t . r I i� ca y. t G° t � r w 4 r TOWN OF BARNS`I'ABLE LOCATION 1 r� s SEWAGE # VILLAGE CS l ASSESSOR'S MAP& LOT . . INSTALLER'S NAME& HONE NO. d1'S 6 SEPTIC TANK CAPACITY LEACHNG FACILITY: (type) ze) l am ^ NO::Q.F BEDROOMS � ' BIJIL. . R OR OWNER ' t Sf t DE PERMUDATE: �7``f` " �COMPLIANCE DATE: ) Separation Distance Between the: Mianium Adjusted Groundwater Table and Bottom of Leaching Facility 1 S� Feet Private Water Supply Well and Leaching Facility (If any wells exist on site:or within 200 feet of leaching facility) o Feet Edgeof:Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) /f% A Feet Furnished by � Qc L t s Commonweafth of Massachusetts Executive Office of Environmental Affairs S Department of Environmental Protection W1Nine F.weld V' GoVemw 8 Argee Paid Celluocl u.oorsnror SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A - 1 0 0 1st Ave CERTIFICATION W. Hyannisport Property Address: Address of Owner. Phillip Duddy Trustee Date ofI on:nspeoti 8-29-96 (If different) Name of Inspector. W.E. Robinson SR Company Name,Address and Telephone Number. ( 5 0 8) 7 7 5_—8 7 7 6 W.E. Robinson Septic Service P.O. Box 1089 Centerville MA 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-aite sewage disposal systems. The system: P/asses _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails p Inspector's Signature: 4/ v; 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: A] PASSES: I have not found any information which indicates that the system violates any of the failure criteria u defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B) SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection- Indicate 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, cracked,structurally unsound, shows substantial infiltration or ezfiltmtion,.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. (revised 11/03/95) 1 One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-55W Printed on Recycled Paper , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 100 1st Ave W. Hyannisport owner. Phillip Duddy Trustee Date of Inspection: 8-2 9—9 6 B] CONDITIONALLY PASSES(continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed 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): 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(a). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed C) ER EVALUATION I8 REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require iluther 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 within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. Z) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and 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 is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for ooliform 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. S) (revised 11/03/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) 100 1st Ave W. Hyannisport Addmw Phillip Duddy Trustee Date of InVOCUM 8-29-96 D) SYSTEM FAIIB: I bava daiarmined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination w identified below. The Board of Health should be contacted to determine what will be necessary to oorract the 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 overloadsd 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 1/2 day flow. _ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of tunes 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 ao 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. E1 LARG SYSTEM FAILS: following criteria apply to large systems in addition to the criteria above: system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public and safety and the environment because one or more of the following conditions exist: 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 U of a public water supply well) The or operator of any such system shall bring the system and facility into NU compliance with the groundwater treatment program is of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.. (revised 11/03/95) 3 t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST 100 1st Ave W. Hyannisport Pieputy Phillip Duddy Trustee Owner. 8-29-96 - Date of InVeottow Check if the following have been done: Pumping information was requested of the owner,occupant,and 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. _12As built plans have been obtained and examined. Note if they are not available with N/A facility or dwelling was inspected for signs of sewage back-up. ,ZThe system does not receive non-sanitary or industrial waste flow site was inspected for signs of breakout. All system components,excluding the Soil Absorption System, have been located on the site. e 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 site and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11/03/95) 4 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION PmwrtyAddress: 100 1st Ave W. Hyannisport Owner. Phillip Duddy Trustee Date of Inspeoftm 8—2 9—9 6 FLOW CONDITIONS RESIDENTIAIt , Design mw IIons� Number of bedrooms: Number of eur:ent residents:� Garbage grinder(Yes or no):�i Lama"Connected to"swm.(yes or no):V Seawmd an(Yes or no):_ N A Water meter"whop,if available: Last date of oocupsaey:,� NDUSTIUAU Type of lishment: Design ��day Grease tra present:(yes or no)— Industrial rite Holding Tank present: (yes or no)_ Non waste discharged to the Title 5 system: (yes or no),_ r Water readings,if available: Lest date occupanry: OTHER: ) Lest date of oocupaM: r GENERAL INFORMATION i PUMPING RECORDS and source of information: System pumped as part of inspection: (yes or no)A. 0 If yes,volume pumped:---?allons Reason for pumping: TYPES r"M 'BM Septic tankMistribution box/soll absorption system Sin&Cesspool Overnow,Cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) Other(explain) APPROXIMATE AGE of all components,date installed(if known)and source of information: ,L Sewage odors detected when arriving at the site: (yes or no)1� (revised 11/03/95) 6 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Pmpwty Address: 100 1st Ave W. Hyannisport Own; Phillip Duddy Trustee Date of Inspeotioo: 8-2 9-9 6 SEPTIC TANG:./ 0oeab an alb plan) Depth blow grader Material of construction: r/comete_metal_FRP—other(explain) L r Dimensions: ludge SDistance from to bottom of outlet tee or baffler Scum thickness: 0 ti—d y t Distance from top of scum to top of outlet tee or battle: r I N Distance from bottom of scum to bottom of outlet tee or baffle: / Comments: (recommendation for pumping,condition of inlet and outlet tees or battles,depth of liquid level in relation to outlet invert,structural inbgt*, evidence of leakage,etc.) � e 2? LtJ 04 -- (i TRAP: (locate on ' plan) Depth bl grade: Material of _concrete_metal_FRP—other(explain) Dimensions: Scum Dklaaos L scum to top of cutlet tee or baffie: Distance of scum to bottom of outlet tee or bane: Commen ( lion for pumping,condition of inlet and outlet tees or battles,depth of liquid level in relation to outlet invert,dbwhusl bt*P*, evidence k"age etc.) (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Addrew 100 1st Ave W. Hyannisport Owner. Phillip Duddy Trustee '. Date ofInsPeOU008-29-96 TI OR HOLDING TANK_ (boats site plan) Depth grade _metal_M_other("plm) Material constt+tetion:_concrete_me Dimensions: GpecitT ors Design aallondday Alarm lava: Comments (condition inlet tee,condition of alarm and float switches,etc.) V DISTRIBUTION BOX:_ (locate on site plan) Depth of liquid level above outlet invert:_ Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) s t SR._ lan) g order.(yss or no) f pump chamber,condition of pumps and appurtenances,etc.) (revised 11/03/") 7 J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(omtinued) Peoperty Address 100 1st Ave W. Hyannisport oar. Phillip Duddy Trustee Date of Lu peeUm 8—2 9—9 6 SOIL ABSORPTION SYSTEM (SASr v (bat•as site plan,if possible;excavation not required,but may be approximated by non-nos ive methods) If not determined to be present,axplsin: Type: leaching pits,number leaching chambers,number:_ leaching galleries,number leaching trsnches,number,length: f Joachim g fields,number,dimensions: overflow cesspool,number: (note condition of soil,signs,of hydraukc failure,level of ding,conditio i of vegetation,etc.) A t , F. 1hiftw :_ plan) configuration: liquid to inlet invert: s Dyer: layer: f ceapool: construction: groundwater: iaw(cesspool must be pumped as part of inspection) Comme (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) (locata an site plan) of Conduction: Dimensions: Depth of lids: Commsnb (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) (revised 11/03/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(eontinued) Peoperty Addraas: 100 1st Ave W. Hyannisport Phillip illip Duddy Trustee Date of inveowow 8-2 9-9 6 S-IT OF SEWAGE DISPOSAL SYSTEM: twin&ties to at least two permanent references landmarks or benchmarks locate all wells within 100' L v� f ' � Li DBPTTIH TO GROUNDWATER Depth to petmdwater: method of determination or approximation: U (revised 11/03/95) 9 j' TOWN OF BARNSTABLE q LOCATION k(D(D �jrSk � SEWAGE # I ®� VI LLAGE ^S ASSESSOR'S MAP & LOT2l7P` r INSTALLER'S NAME & PHONE NO. SCOW rc WI 1-( 7 2S'S�f SEPTIC TANK CAPACITY IOUO (5c-\,L. LEACHING FACILITY:(type) �p( � (size) (9X6 a NO. OF BEDROOMS 3 PRIVATE WELL ORCU:BLD YATER� BUILDER OR OWNER Vl,(,� S0 ��� Jb� ct DATE PERMIT ISSUED: wOcl� DATE COMPLIANCE ISSUED: n VARIANCE GRANTED: Yes No s o� � w 9LJ No.51Y...�,1r.2 Fas....s??.®........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Allpfiration for Uiti-Vniitti Wor1w Tonitrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair (V/) an Individual Sewage Disposal System at: - C71-.A..V- -----------:'------------------------------------------------ ------------- e cation-:\ddress or Lot No. ................................................. ----•-..... n, - . Installer Address Type of Building '2 Size Lot............................Sq. feet Dwelling— No. of Bedrooms---------• -------------------- -----------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures __________________________________ W Design Flow............................................gallons per person per day. Total daily flow---------------------------------_..........gallons. WSeptic Tank—Liquid capacity._1&6-galIons 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 ( ) PIA Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. l________________minutes per inch Depth of Test Pit---------------_::a Depth to ground water___._-.-.-___________--- GX, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Pr ' : - ...._ .. ------------------•---...........-•---•----- Description of Soil. --------------------------------------------•-- 4 �. U ---••-•••••--•---•--...-------••-----•------------•---••-•-....-----•-•--•---------•-•-•--•••••-••--------•-•--------------••-----•---••.... ... �; ------------ U Nab??.. e�� - -io -—Ans er when applicable. � �Nature of Repairs or Alterations � � ��'� Y c 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 Compli e has been 'ssue(j, o`ard of health. ' Sinned ..... �- 710TA y ............................................................ ............ . ................... . Dace Application Approved By ----------- . ------------------------------------------------------------------------- ...... Date Application Disapproved for the following reasons: ..... . .................................. ..................................... . .................... ......... ........ .... . .................... ................................................. ............. ---------------------------------------- �Permit No. ----- -- '....... ..�.--�m.. Issued ................................................... ....�e - I- ... Dace CD f . No...,... - 1 , FEB r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ; App iration for Di-nVaiiMl Workii Toustrurtinn Prrutit Application is hereby made for a Permit to Construct ( ) or Repair (L/ an Individual Sewage Disposal System at: Dk L cation e\ddress for Lot No. ............... ..... ............................................... C �nz:t c�. ............................................... Ow er 1� dress .n5 � Q . 2....��n� _?...N �c __.MCA Installer Address UType of Building Size Lot............................Sq. feet r—t Dwelling— No. of Bedrooms........................•__..._._-..-_.._-Expansion Attic ( ) Garbage Grinder ( ) a Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Other fixtures . W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons. WSeptic Tank—Liquid capacity.j%%_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 ( ) Percolation Test Results Performed by.......................................................................... Date........................................ W Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ----------------------------------•-----------------------•-------------------......------......••.......................................................... x Description of Soil.------ -.�_�_�� �-------------•---------------------------•--- ----------------------------------------------- U •--•--••-•------•-----------------------•-----------•-----------------------------------------------------------------------------------------------..--•-----------------------•••------- W -}----------------------------------------------------------------------- --- U Nature of Repairs or�Alterations—Ans ver when applicable.-...�-1.(� �. _--C�s5s L_)( _s-.. ...�r►..l _o.. 1_C,cSv---••(jr 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 Compli nee has been 'sued he oard of health. f Signed ..... / .. ... Date Application Approved By .............. e�w-� t .-- - ----------------------------------------------------------------------- ..... _:.�.:x;•-- .Ci. `/ �► Date Application Disapproved for the following reasons: ................... ...........................-- ................ ----- -- ............... --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ........................................ Date PermitNo. ..... ....�-L -- --0 �----------------_ Issued ..............................................---------------------- Date ------------------------------------------------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE 01,e rtiftrate of Compltttnre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( �) by ........;��.C.0 M ---��V� l -Installer L at ............. . ........ �.c S ..&..`' .: �1 ------------------------------------------------------------------------------------------------- has been installed in accordance with the provisionslit TITL5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. .. .._yy...-....�. ... ... 1---------- dated ------------------------------_----------_- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE rCONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTIONSATISFACTORY. DATE.........��---- -- -------- -.r.---................................ Inspector -:------ �--- -_-`-T----------------------------------- �. ----------------------- ---------------------------------------- ------------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH tr TOWN OF BARNSTABLE Bispan1 Workii Tom#rutinn "rrutit Permission is hereby granted S---v� C- —------------------------------------------------------------------------------------------------- to Construct ( ) or Repair (�an Individual S - rage Disposal System atNo...........L2: ...... •-•1. Z??-r' -•--- ---•- ;. ---- . -- ---------------------------------------------------------------------••--••-- reet QQ as shown on the application for Disposal Works Construction Permit No.?.-*- h1.� Dated-..-. ........ ----......--••-••---•-....-•--•-------...... - ----------------------------•----------•----- —� J U3o�ard of Health DATE------------------ - /%---------------------------_.... FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS H �j Commonwealth of Massachusetts 's S Executive Office of Environmental Affairs :p3 N Department off F U � Ali r Environmental Protection _ 44 F.VIM &-I"Paul Ceiluool '11.swift u ctorna oonrnrroner R1� Oil MAPH& SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FO k PART A - PARr✓Ct,N0; 1 0 0 1st Ave CERTIFICATION ���- `��.�_Ar.,d 7 Property Address: W. Hyannisport Addrerofowner. Phillip Duddy Trustee Date of Inspoodow 8—2 9—9 6 (If different) r� Name of Inspector. W.E. Robinson SR Company Name,Address and Telephone Number. ( 5 0 8 ) 7 7 5-8 7 7 6 � � W.E. Robinson Septic Service / P.O. Box 1089 Centerville MA 7°'� '�� 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: Passee tionally Passes . Further Evaluation By the Local Approving Authority Inspector's Signature: 4,Aj s 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: A SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 16.303. Any hilure criteria not evaluated are indicated below. B SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,pares Inspection- to yes,no,or not determined(Y, N, or ND). Describe basis of determination in all instances. If"not determined",explain wby not) The septic tank is metal, cracked,structurally unsound, shows substantial infiltration or rfiltration,or tank failure is imminent. The system will par inspection if the existing septic tank is replaced with a yonfbrming septic tank as approved by the Board of Health. . (revised 11/0 M) 1 One VAnter Street a Boston,Massachusetts 02108 a FAX(617)SWI049 a Telephone(617)292-5500 Pnmed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(oontinued) Pmpm"Addmw 100 1st Ave W. Hyannisport Ownee: Phillip Duddy Trustee Date of hwpeatlm 8—2 9—9 6 B) CONDITIONALLY PASSES(continued) Sewage backup or breakout or high static water level observed in the distn'bartion boa is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution bar. The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced 7 obstruction is removed distribution boa is levelled or replaced The system required pumping more than four tines 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 CI THER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions mist which require hirther 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: Ceapool or privy is within 50 feet of a surface water Ceapool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 9) BTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) D INES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tribW&7 to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is des from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 6 ppm. 3) _ (revised 11/03/95) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 100 1st Ave W. Hyannisport owner. Phillip Duddy Trustee Date of Inspectiow 8—2 9—9 6 D] FAILS: , I> e determined that the system violates one or more of the following failure criteria as defined in 310 CMR 16.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded of 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 1/2 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. LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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) The ov hsb or operator of any such system shall bring the system and facility into hill compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for fhrrther information.. (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CH16CKUST 100 1st Ave W. Hyannisport Peopes&yAddrsm Phillip Duddy Trustee Ows 8-29-96 Dab of iaspeadm Check N the lbliowing have been done: �p information was requested of the owner,occupant,and Board of Health. u* ne 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. built plans have been obtained and examined. Note if they are not available with N/A. facility or dwelling was inspected for signs of sewage back-up. system does not receive non-sanitary or industrial waste flow 1The site was inspected for signs of breakout. 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 bagles or tees material of construction,dimensions,depth of liquid,depth of sludge,depth of scum. 4Z size and location of the Soil Absorption System on the site has been determined based on existing information or a tad by non-intrusive methods. The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11/03/95) 4 L SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 100 1st Ave W. Hyannisport Owner. Phillip Duddy Trustee Date of Inspection: 8—2 9—9 6 FLORi CONDITIONS RM KRTIAL:. Design flowc.33 g_Sallons Number of bedrooms: Number of current residents: Garbage grinder(_yes or no): A Laundry connected to system or no):Y Seasonal use(yes or na):�S N/A Water meter readings,,if available: Last date of occupancy: COMMERCIAL/INDUSTRIAL: Type of establishment: Desk,flow: zaallons/day 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: Lest date of occupancy: OTHER:(Describe) Lest date of occupancy: GENERAL INFORMATION PUMPING RECORDS and of information: System pumped ds part of inspection: (yes or no)��5 If yes,volume pumped: /(16--d gallons Reason for pumping: TYPE OF SYSTEM Septic tanWdistnbution box/soil absorption system in&oenpooI = Ov me cesspool Privy Shared system(yes or no) (if yes,attach Previous impaction records,if any) Other(explain) APPROXIMATE AGE of all components,date installed(if known)and source of information: Coen S Sewage odors detected when arriving at the site: (yes or no)/j> O (revised 11/03/95) 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) PropertyAdarem 100 1 st Ave W. HyAnnisport Owner. Phillip Duddy Trustee Date of Inspection: 8—2 9—9 6 SEPTIC T jb te p ) w grade: _ Of constriction: concrete_metal_FRP—other(explain) h:om top of sludge to bottom outlet tee or ba1Be:n om top of scum to top of outlet t\baffle:om bottom of scum to bottom of : ( tion for pumping,condition of es or baffles,depth of liquid level in relation to outlet invert,structural integrity, evide of leakage,etc.) YV G E TRAP:_ on site plan) Depth low grade: Mato ' of construction:_concrete_metal_FRP_other(ezplain) ttiickaea: fiom top of scum to top of outlet tee or bathe: from bottom of scum to bottom of outlet tee or baffle: Co ts. ( tion for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,struchual integrity, eviden of leakage,etc.) (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) �3,Addeesec 100 1st Ave W. Hyannisport Owner: Phillip Duddy Trustee Date of Inspection: 8-2 9-9 6 ;GHT OR HOLDING TANK_ on site plan) Depth ice: intUs: construction:_ooncrete_metal_FRP other(e:plam) ' one flow: ons/day : of 7inlet tee,condition of and float switches,etc.) DIS UTION BOX_ (locate sits plan) Depth of d level above outlet invert: Cowmen (note if I and distribution is equal,evidence of solids carryover,evidence f leakage into or out of box,etc.) PUMP C ER:_ (boats on place) Pumps in order-(yes or no) . Cowmen (note condi' of pump chamber,condition of pumps and appurtenances,etc.) (revised 11/03/95) 7 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) Pmppe1,t,Address: 100 1st Ave W. Hyannisport Owner. Phillip Duddy Trustee Date of Inspection: 8—2 9—9 6 son.ABSORPTION SYSTEM(SAS): Weeks an site plan,if poodble;eucavati not required,but may be appra m ated by non-intrusive methods) If not determined to be present,e q ain: Type: leaching pica,number. leaching chambers,number._ leaching galleries,number: lesching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: Comments:(note condition of soil aigos Yh ulic failure, level of ponding,condition o�ve do ) 1 �'` �J C) S A , CESSPOOLS:_ (locate on site Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer. /'y —f Depth of scum layer: 4 '' Dimensions of cesspool:_-b T r Materials of construction: n ICS Indication of groundwater: inflow 1 must be pumped",part © Comments:(note condition of soil,signs of hydra c failure, level of ponding,condition of vegetation,etc.) Ca (bcata on site plan) of construction: Dimensions: of solids: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) (revised 11/03/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) PropertyAddeeas: 100 1st Ave W. Hyannisport Owner Phillip Duddy Trustee Date of Inspection: 8-2 9-9 6 I SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent referen landmarks or benchmarks locate all wells within 100' r ILL �5 DEPTH TO GROUNDWATER Depth to groundwaterji:�—feet �6 method of determination or approximation: v I (revised 11/03/95) 9 TOWN OF BARNSTABLE LOCATION EW5-r lye_ ssW- ArE#:i-2rl Sp VILLAGE VQ1 �bnmr, ASSESSOR'S MAP&PARCEL WSTA!bbE 'S NAME&PHONE NO. n�OAAJ- rtr1 SEPTIC TANK CAPACITY LEACHING FACILITY:(type)`-n,�i!t�,F�+ (size) NO.OF BEDROOMS OWNER LpUV_10 PERMIT DATE: DATF` v, 10 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY Right Side i .J\f4J4f4f4F4f4i4f4f4f\f4f4f ., .. F4f4J4f4f4J4f4F4f4J4f4J4F\F4F ' \ k \ \ \ \ \ 4J4J4f J f f J f f \ 4F J F f �f4f4f f4J J4 \ \ f f f f F F f f f f J f f f 27 • \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ f f f F F f F f f f F f F f f f f f F F •F 4f4J\f4J\f4f4f\f4J\f1/\/ f4f4f4/4f4% F4f4J4J\f\f4f4f4f4J\f\f4F\f\f\f . f f%f%f f f J f F f%f80 J F J f J F J f J J f f f f i 2-18" DIAM. ACCESS MANHOLES + f� r• "•+.a..:,iL:t'iSrX'..l''"'.i..J. *NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. ESTABLISHED VEGETATIVE COVER 10' min, from t Existing Foundation house to septic tank / _.._. r ti k TOP OF FOUNDATION S. is tank covers must be D-Box *over must be / , ELEV. 100,00 !n wkhin S In. of finished grads OU T wit in 6 In, of finished groda }• - Grade o S Tank- 98.50 Crode over D-Box -O&SO rods over SAS-98.00 to 9e.60 over tic eP , N, s ,r„:.:r .,, ,.,•:. ,',, .,. i,..k .^r' '4, 1r BACKFiLL WITH CLEAN SAND • r a 't r t i, . ,� «, ,� 1, .+, ,, ^,r, +r,r:: . .,� THE ACCESS COVERS FOR THE SEPTIC TANK, ,,.: ,:a ,:,. x r , ,�•��^ s,r"r,,,�'", ^ ,5 t,i, ' . t r � ,�. (NATIVE OR PERC SAND) �` e+ t:-•^'!;+``t ' i ,t',r ' ,R}, „ y t + r I; S DISTRIBUTION BOX AND LEACHING COMPONENT t „ rn".a „Y .r t, Sr nY, .6r ..,, e ,,ny ^'., , a r' -.rz•+' •'e'. ,p..,nt•s. ,r"',". TRIG %In 6 a d ' „r w;,, ;.,r+h, t, h' ,« . r 'r"., "'M SET DEEPER THAN a INCHES BELOW FI ISHED n f: � : + , p„,,1,•, ; .-. „ . n„ ❑ ,. n : .:, 5.n.r,,,•. ,t :!, n,. „' re.rV „� t� •.,, ;j i1• +�. ��' :p; ::,,•.•r: •.:',;r, I RAISED WI IN tti OF S ,+ O. - ELEVATION - 9 .7 +,., r ,, t n k.t, GRADE SHAH BE TO TH s, � O2 a HOLE H 1O 4 TOP OF UNIT ELEV T 5 5 ,r, + . ' • ., ,a ,:;:•r�, ,,;"r;'r'' r'`,•' ,., „t.„�,, „ r« r ,,,'�,,, ,�' GGRADE, , a .t ..� 1 T. 0 „ ,� S Box m r ' ': � r ,� r 5 s, r ;", ,1,. ,,,r.r+', .,, ', ,� i..",.rht: ,, : r• ', STEEL REINFORCED PRECAST CONCRETE FINISHED ADE k�w w v 5 O.Ot or Grote Maximum Cow " 5 7 T r 4 VC(CAPPED)INSPECTION PORT TO BE EXIS . P 1 � � Yr.t :q r "h tip,^Y„ y,.5, M i'M• +, ; ,.'r.,.,H,•: � " ,r �,' ,� •' , � ,�,^, . �,, .. ,,: r,, , �; ' .;5,7i;w�' 'S;h' '"^ "�'' '4, . „+ INSTALL TUF TITS OAS BAFFLES OR EOU S sp rn 1400 GAL, " INSTALLED AND TO BE WITHIN a OF GRADE INV, ELEVATION 95.50 „,t.•t - '`t ' �csrss�.r..s s a ,,. ,++�. :.+ , 5 ^^ ^'.. . ., _PLAN. VIEW FROM EXIST. FOUNDATIONj' SEPTIC TANK (�Qp 25 p�pp P foot :; }t1 \ '.� "; y. trt�•h+ ,.,. 5 °f �{, ` GA IA Q 1s' - • • • ^hnw .;, e,. l , y:6 °i r,..,Gt. x`., ,^ c II H^10 cV s y e •. q' r;' /^3-24"REMOV OLE COVERS CONCRETE Fuu -- u } II rn . • • . • • • BOTTOM ELEVATION - 94.75 • ' +'' y 6 In.of 3/4"-1 1/2" iI z•oa' 4 GENERAL NOTES ' m; clearance " 13" INLET"T w compacted atone , ' S MIN ABOVE BOTTOM OF $ . 6"4» B min� 2 min. Inlet to outlet e.mm .i 1, Contractor Is responsible for Digsafe ratification, Verification of Utilities & y II 4 ROWS OF a UNITS AT 4/UNIT+2 END CAPS + 32.00' TEST PIT OR GROUND WATER p YSTEM PROFILE ? > $'�'IF. IiIATII 12."XO' EXISTING SUITABLE MATERIAL ,* o"mm. Lgl"uTd'rew�"ry «d and protection of all underground utilities and pipes. Bottom of Test Hole 1 Elav: 87,00 6' -�' ' -" L_ `' LI ;'s' -�" 2. The septic"tank o l distri LLtion box shall be set Not to Scale a m.af 3/4"-1 1/x ;' �^ level on 6 of 3�4 -1 1/2 stone. E 4'-0' min, compacted stone GROUNDWATER NOT OBSERVED ae.son. " i• uquld depth 3. Backfill should"be clean sand or gravel with no NOTE: ALL COMPONENTS MUST HAVE RISERS TO-WITHIN 6" BELOW GRADE _ BOTTOM OF TP-1.: 87.00 $OIL .ABSQRPTIQN SYSTEM CSECTIQN) + � " stones over 3 in size, INFTLTATRQR QUICK 4 (H--10 LOADING)/ GEORGE O'BRIEN ; ";, �, 4. This system is subject to inspection during installation • «r.,,y'. .r.. " , ,�:.,;z, .«, ,, ,,.. , „ • ' ^ ''f y Carmen E. Shay - Environmental Services, Inc. (OR EQUIVALENT) 5. The contractor shall inatail this system in accordance NOTE OVERALL HEIGHT OF INFILTRATOR IS 12" CRQSS SECTION END-ECTIQN with Title V of the Massachusetts state code, the approved plan 4 and Local Regulations. 6. If, during installation the contractor encounters any TYPICA O00 GA L N SEPTIC TANK soil conditions or site conditions that are different NOT TO SCALE from those shown on the soil log or in our design Installation must halt & immediate notification be made to Carmen E. Shay - Environmental Services, inc. 7, No vehicle or heavy machinery shall drive over the PERCOLATION TEST septic system unless noted as H-20 septic components. Date of Percolation Test: 8/27/10 8. install Tuf-rite gas baffles or equals on all outlet tee ends. Test Performed By. CARMEN E. SHAY, R.S., C.S.E. 9. All Distribution Lines shall be 4" diameter Sch. 40 NSF PVC pipes. Results Witnessed By: DONALD DESMARAIS - BARNSTABLE BOH 10. All solid piping, tees & fittings shall be 4" diameter EXCAVATOR: Shay Environmental:Services, Inc, Schedule 40 NSF PVC pipes with woter tight joints, Percolation Rate; <2 MPI 3$" 11. MUNICIPAL WATER IS CONNECTED TO THE SITE and Surrounding Test Hole Test Hole Properties. No. 1 No. 2 DEPTH SOILS ELEV. DEPTH SOILS ELEV, 0 98.50 0 98,50 NOTE: Lcamx QmY THE PROPERTY LINES ARE APPROXIMATE AND 10 YR 3/z 10 YR 3/Z COMPILED FROM THE PLAN BY PAUL VAN AUKEN, RLS ENTITLED "PLAN OF LAND 1N HYANNIS PORT, MA OF AP 98 0 4"-6" A► 8. HOWARD J. BLACKMER - LOTS 11, 13, 15 DATED APRIL 3 1950 PLAN BOOK 92 PAGE 123 LOAMY SANDY AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN 10 YR 0/e io YR a/e IT SHOULD BE USED FOR NO PURPOSE OTHER THAN Bw 95.50 6"-36" eve 95,50 THE SEPTIC SYSTEM INSTALLATION, Mod, Sand Med. Sand w/cobbles w/cobbles NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE 25 Y 7/4 2,5 Y 7/4 FROM THE EXISTING LEACH PIT TO BE DISPOSED 38"- 138 C, $7.00 36"- 120 C, 88.50 OF AS PER BOARD OF HEALTH SPECIFICATIONS. IYYANNISPORT COUNTRY CLUB EXISTING LEACH PIT TO BE PUMPED DRY & REMOVED 00 ASSESSORS MAP -- 267 PARCEL. 140 �\\ --S\\ 10D 5'1' 30"E Perc 1 ZONING - RESIDENTIAL Depth#to Perc: 40" to 58" 120.00, �1 EXIST, Perc Rates <2 MPI SAS Groundwater Not Observed NO WETLANDS ARE.PRESENT WITHIN 200' OF THE PROPERTY a' No Observed ESHWT ADJUSTED H2O Elev. None EXISTING 3 BEDROOM #100 Q f O ALL OUTLET PIPES FROM THE a_ I I DISTRIBUTION BOX SHALL BE 1 " HOUSE a. 1500 al, SET LEVEL FOR AT-LEAST 2 FT, I g C� CONCRETE COVER 'i I Septic Tank r, 0� 6 - 6" OU T r' '; r., r , a .t h,. 2 LEGEND ' KNOCKOUTS , • ., © 1 4?, PROJECT BENCH MARK ---- --1s,5" i' l PATIO - 1 outET 8X0 1 TOP OF FOUNDATION � 12 IN-LET DENOTES PROPOSED TEST HOLE #1 ELEV. -= 100.00 (Assumed) 6" � ., SPOT GRADE Q1 1 ELEV.- 98,5024.y' i it '' °', "•''" a'' 2 X 104.46 DENOTES EXISTING W CO i COY FISH I 15.5" SPOT GRADE �. ► 1 1 1,75" , a *. POND EXISTING 0 i PLAN--SECTION GROSS S TON 4 9EDROOiIat i 2,7' TEST HOLE #2 PL PROPERTY LINE ELEV. 98.510 HOUSE 6_ HOLE DISTRIBUTION BOX ----- H 10 --C�;�' PROPOSED CONTOUR FAILED NOT TO SCALE A i #10e i` i LEACH PIT 97_., _ -^: ..:.. --97 EXISTING CONTOUR Design Qgi,G.u1gtigns �----------- --- a 3 11 I 3 I i Number of Bedrooms: 4 Equivalent to 440 Gal./Day DEEP TEST HOLE & (i I ASPHALT i C) 11.00' �1 Garbage Grinder: No PERCOLATION TEST LOCATION I i DRIVEWAY I DECK Leaching Capacity Proposed: 440 Gal./Doy Minimum 100 1^ f Septic Tank ; - 2 x 440 Gal./Day -880 USE EXIST. 1,000 GAL, TANK ". FENCE Sep c an SOIL ABSORPTION AREA: Using percolation rate of <2 min./inch - - PRIVATE DRINKING WATER WELL 9 / 9 q. 447.08 gallons t I i i I .---^ n- . - -,.�.T..-•8- ox 1 Sidewall Area: NOT USED / I r Bottom Area: 0,74 al s ft. x 604.18 s ft� i r I ,l 15HALT I Providing, 47.08 gallons REVISIONS J � I i r r ,rr I I I 120.00 I /DRIVEWAY i se 4 WS F Q D G AMBER LINITS WITH NO t3SLf? - SlIK4 SIALV�RJ2�1 N0. DATE: DEFINITION ,. �-• I ST N FQHAVING_THE_DIM NGION 12Z x 30,D' N >DD 51' 30"IP �.Si:�......_13 AN,-�A�.., . � ^, `� ,�. t • : #1 9/22/10 SAS 0 #100 Bottom Area; (General Use Approval for 4.72 SF/LF of INFITRATOR �.- ----...--.,..� �.�...,--% `.,_.....' `..------�. ..L' Cb *....---------------�.------_---------------.----„-------..------..----. 8 UM + R =�,. c1j g UNITS 2 END CAPS per OW 32.0 �T #2 9/23/10 Re-Scale SAS 1t 4 ROWS x 32.0 x 4.72 SF/LF . 604.16 r> DESIGN FLOW PROVIDED: 0.74(604.16 S.F.) - 447.08 GOD JF'.T.R S 7"" A T��..E'1V'T,_71iE (40 FOOT RIGHT OF WAY) PREPAREDFOR : PROPOSED SUBSURFACE SEWAGE DISPOSAL SYSTEM OF JANET M . LOVERIDGE1 oo o FIRST AVENUE 243 TOWER HILL ROAD HYANNISPORT, MA OSTERVILLE-, MA 0265NQFA1gSs � � PREPARED BY: Y. CARHEY E. SHA Y I t• T�, a Rye _,� ^r . 0 20 40 50 1 E'NVIRONM.ENTAL SERVICES, INC. 0. ' t + + �ISTtiQ 111 THORNBERRY CIRCLE S�NITAR\P SCALE: 1" ZO' MASHPEE, MA 02649 VARIANCE REQUESTED: TEL/FAX 508-539-7966 1. REQUEST A VARIANCE TO REDUCE DISTANCE FROM SAS TO A SLAB FOUNDATION . SCALE., 1"=20' DRAWN BY: CES DATE: SEPT. 14, 2010 SLAB FROM 20 FEET TO '1 S•4If3' _ _ PROJECT#SD-1189 ILENAME: SD1189PP,DWG SHEET 1 OF 1