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HomeMy WebLinkAbout0025 OAKVIEW TERRACE - Health 25 Oakview Terrace Hyannis A= 269-244 l TOWN OF BARNSTABLE LOCATION 1C 7/ (QiSEWAGE VILLAGE ASSESSORS MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type &C(Itj (size) T Z rjt�r NO.OF BEDROOMS OWNER Q� PERMIT DATE: COMPLIANCE DATE:/ L(p Separation;Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply We 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 Ja&e W' �1 l (�l 7K) lu 6` s . r No. tTW Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION — TOWN OV BARNSTABLE, MASSACHUSETTS ftplitation for IDis os Y 6pstem Construction 3permit Application for e t Construct( ) Repair Upgrade(V/ A bandon( ) ❑Complete System ❑Individual Comments Location d ess of No. �✓�� f Owner's Name,Address,and Tel.No. 5"'CT a� � e Wrn: Assessor's Map/Parcel %. Zk-q1 ^a, CA Installer's Name,Address,and Tel.No Designer's Name,Address,and Tel.No. /ilk �Z� c2 .�,: I�b ® (119 chow(- zV Wq� Type of Build' g: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3:3 c) gpd Design flow provided 3 gpd Plan Date Number of sheets Revision Date Title t Size of Septic Tank ' , 000 Type of S.A.S. Le qck �y Vy�k�OGI'� Description of Soil E�— Nature of Repairs or Alterations(Answer when applicable) e_ ,ctL6, a A t, { ►, n1 Date last inspected: Agreement: The undersigned agrees to ej5the he construction an ce of the afore described on-site sewage disposal system in accordance with the provisions of Titl tal Code and not to place the system in operation until a Certificate of Compliance has been issued by this B It . /X Signed Date Application Approved by Date f ,� Application Disapproved by Date for the following reasons Permit No. 11"io 1h^ l Date Issued 44 { y No. & (Y �C� J t Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN (IF4-13—XfMSTABLE, MASSACHUSETTS application for Mispo Y * stem Construction Permit r Application for e t o Construct( ) Repair Upgrade(Abandon( ) .j❑Complete System El Individual Components Location-Addre`ssp of No. ?-V ^ S Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Z.� o y �1 v.^�� ., to Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. o w(-- Lr5' 1M,cS,- get(s- ✓1`` �� "` fb SoQ 1 —4Loo Type of Build' g: Dwelling No.of Bedrooms 3 Lot Size 1 779 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 n gpd Design flow provided gpd i Plan Date Number of sheets Revision Date Title Size of Septic Tank QOp Type of S.A.S. �� 4C�; r Description of Soil S ' Nature of Repairs or Alterations(Answer when applicable) .ct tt, ol.A 6, V• , CIL"Ct�► e r C Date last inspected: Agreement: The undersigned agrees to ensure the construction and cer[an e f he afore described on-site sewage disposal system in accordance with the provisions of Title 5 of thFir. ntal Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boar Signed Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. (a , — Date Issued -----------------------`,----------------------------------------------------------------- ------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( Upgraded(, Abandoned( )by _�®ny t�,;bt C e�o 4.`y C t S A GDI Q CD at `` Cf �Cr _ has been constructed in accordance (l / J with the proviSi s f f T'f e _ai3d-t rAi posa� 15ystem Construction Permit Np '✓4 1 dated ] �! 7//f� t ! Installer Designer Gt Z L L�L C #bedrooms Approved design flow A U gpd The issuance of is perm—it shall not be construed as a guarantee that the system wil fiCtii�a's designed. !� Date Inspector ` (, y i ---- -------------------------- -------------------------------------------------- -------------------------------- No. Fee/( { ) Q THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal *pstem Construction hermit Permission is hereby granted to Construct( ) Repair Upgrade( ) Abandon( ) System located at (� 1 V 0 `T. :S (-(2 and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions., Provided:Construction must be comp eted w�f thiJin three years of the date of this permit. Date )� /�b Approved by Town of Barnstable Regulatory Services Richard V.Scali,Interim Director � MAMABIE, Public Health Division 1639. ► ° Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508- Installer&Desianer Certification Form Date: � Sewage Permit# ra Z Assessor's Map\Parcel�� �-� Designer: - V o 1 g L�o�!•1•{eC�n� Installer: �o� , —t'.t^ 'o(f�(�o� Address: ill 61- z(' Address: g t`„r- On . 6 ` was issued a permit to install a (date) (installer) septic system at (r V Ze cf-ei4k V�fC4%7 based on a design drawn by (address) ,c6 "He dated (designer) /6//6 I certify that the septic system referenced above was installed substantially according the design,which may include minor approved changes such as lateral relocation of tl distribution box and/or septic tank. Strip out (if required) was inspected and the soi were found satisfactory. I certify that the septic system referenced above was installed with major changes (i. greater than 10' lateral relocation of the SAS or any vertical relocation of any compone of the septic system)but in accordance with State&Local Regulations. Plan revision certified as-built by designer to follow. Strip out(if required)was inspected and the soi were found satisfactory. I certify that the system referenced above was constructed in compliance with the tern of the I\A approval letters(if applicable) r/,r a « 401 t� *rr""*C=q `(in ally er Signature) 3� 7= Q 25_W (best Signature) (Affix Design s tamp(W) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICAT OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND A BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISIOI THANK YOU. Q:\SepticMesigner Certification Form Rev 8-14-13.doc Town of Barnstable P# oFVE l b Department of Regulatory Services MRNarANA : Public Health Division Date �alg�vl 6.9 MASS • � tali �� 200 Main Street,Hyannis MA 02601 Alfl>MA'1� � • Date Scheduled �� Time 0 f1 Fee Pd._ uy Sail Suitability Assessment for Sew ge isposal `� f _ 1 �. Performed•By:_ �TiIJ' ��L(�/�6�N Witnessed By: L�v- ; S LOCATION&.GENERAL INFORMATION Location Address 15 ®Avo t cw TL'�reA� Owner's Name 3co.rT 1._© 6 a 141 a A n 1 S / Address �.-M. o2lsO 1. Assessor's Map/Parcel: ` 77(oO� Z L' 'Engineer's Name �60 -r C.&A A/n) . NEW CONSTRUCTION EPAIR Telephone#Lo5 z(ot4— 3 1 33 Land Use'-- eJ Slopes(96) C7 Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way , ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&petiests,locate wetlands in proximity to holes) N� 2 1"` r 'j0 I V,c4 Z.S' OAKV1 Ycv �r�.� C�t/1`t�na,T Parent material(geologic) Depth to Bedrock Depth to Groundwater. Standing Water in Hole: Ad o4 .ZD`- Weeping from Pit Face ,V IA Estimated Seasonal High Groundwater A 11A DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: In. Depth to soil mottled: 1n. Depth to weeping from side of obs.hole: _- In, Groundwater Adjustment ft. Index Well-k Reading Date: Index Well level Adj,factor Adj.Groundwater Level m - Observation /� Hole# _0 Time at 9" r Depth of Perc Time at 6" 4` X Start Pre-soak Time @ `a,:.p 0 Time(9"4") End Pre-soak Rate Min./Inch 2 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:\SEPTICVERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil• Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency.96'araven � _ 6A t06M t f -I-W ' 2= 3 Zo DEEP OBSERVATION HOLE LOG Hole# - Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Cgnsistency,% 1 to 2 3 I ro`- 2 Co ^P to VIL dto i, DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, DEEP OBSERVATION HOLE LOG. Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Cnnsigency. t f Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes . Within 500 year boundary No=' Yes Within 100 year flood boundary No.' Yes • Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervi us n3iterial exist in al l areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pe ious malarial? .._,_ Certification I certify that on 2AWT' (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training, eras nd experience described in�10 CMR 15.017. Signature Date l°13+ 1140 Q:4S.EPT 1C`\PERCFORM.DOC LOCAT ON SEWAGE PERMIT NOoajw� &�o , •,1/ VI ( IAGE 2 INST LLER' NAME 4 AD RESS 6-2 o00-- )��r 0 U I L D E R OR OWNER DATE PER IT ISSUED- 't �2, �� DATE COMPLIANCE ISSUED � � ����� CUt 61 [Ioo5e: �Z :��tK 2� 3� aZ j0 3? Ole No 8 0;2-?(�.... - a Fx$ ... ........ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH N...._..._.OF....._OR.?_N�S1�C� ApplirFation for Uiiipa i al Workfi C ontitrurtirlat 11antit Application is hereby made for a Permit to Construct ( ✓S or Repair ( ) an Individual Sewage Disposal System at: .....................l-w� ..7r;.n.fir------------------- ------------------------..............----�... ----------......----------.......--------- Location-Address or Lot No. ...CAPA.lc r�� E y........7 A�l........... -•--.....•-------------•••---..........-----...-•--------.....------------....-----------......--- ]� wner Address W .n ... ------- --•-----------•---•-------•- ----- Installer Address U Type of.Building Size Lot... 'Sq. feet Dwelling—No. of Bedrooms.............. .........................Expansion Attic ( ) Garbage Grinder �ND) Other—T e of Building No. of persons.......................... Showers a YP g ------,•-----------•------------•--------. --- -- ( )__— Cafeteria (-•--)• � Otherfixtures -------------------------------- -------------------------------- --------------------------- W Design Flow____________________ .................gallons per person ear dal. Total dai;y fllow___._.._ �__:__........__..._...ga;lonj WSeptic Tank—Liquid capacity/0NOgallons Length__ ..__._ Width-__—t/_ �Diameter___.6_ -__ Depth__.�_._E. x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-----------f........ Diameter........G._' i----- Depth Depth below nlet----G.f.......... Total leaching area---2_P-0-.sq. ft. Z Other Distribution box ('I Dosing tank ( ) _ ~' Percolation Test Results Performed by.......... �. _......��1�'!:�-.... Date.....�_...�"l.�.gv.._.. a Test Pit No. 1............. per inch Depth of Test Pit______._/2 r Depth to ground water.._ ..__. rX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water lv. Description of Soil--•••-•C�- �`'-- - ..-i-..0 Y�v L+!3_ga;: W -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable_______________________--------__--______:----•..______........................................ -----------------------------------------------------------•---------------------------------------•----•---•--------------------------------------------------------------------------------.......---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'T`: p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance ha eefn issu Jd by the boar o ie""' g ;�`� L'F -G�------- Si red-- - -•---------- .......... Date Application Approved By � �^ � �% } -•----------------------------------- - L` iJ Application Disapproved for the following reasons__________________________________________ .................................................Date•-••--------.. Date Permit No......................................................... Issued--f` �--�1f4 ................... Date Nop 270.... Fps ................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........-.oF.......� . t .......... Appliration for Bhipoii al Workii Towitrnrtinn rrmit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: C --.... .............................................�•---- ...................... ......•----------------..�-f.... -----........------.....--- Location-Address or Lot No. —CA AA/C &W r k T7., ................ caner. e Address W -.,e --- � Installer Address VType of Building Size Lot_— ......Sq. feet + �-, Dwelling—No. of Bedrooms.............. ...............1._.._...Expansion Attic ( ) Garbage Grinder ke) a Other--Type of Building ............................ No. lo f persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ........................................... ------------ .....------. w Design Flow.................... .. _gallons per person per day. Total daily flow....... - ft ...gallons, _ Width...__._ �_.. Diameter__ W Septic Tank—Liquid capac>tyQ _gallons Length__ __. ..__ _ 6-...-. ,epth_, __.. . x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-----------$-------- Diameter........V �_.... Depth below inlet---- -......... Total leaching area...? 6..sq. ft. Z Other Distribution box Dosing tank ( ) a _ Percolation Test Results Performed by---------- ._f... ..........__ Date..... �_.. a Test Pit No. 1__---"'�"":_-_minutes per inch Depth of Test Pit.......�` "_�. Depth to ground water... �4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-&6t?1K!&7 1 -• r -•------------- -•----------------------------------------•--.----- O Description of Soil-- .....Q - �`"' t �_:S `' n...`4........................................... w UNature of Repairs or Alterations—Answer when applicable.--------------------------:-_--.--.--_____--•----.--_-___-.-_-_--___-________--.------------.-. ...----•--------------------------------------------------•---------------------------•-------•-•-•----•-----------------..................................................-.......................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of i I p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance ha been issued by he boar o iealth. Signed_ -4......._.. .... I . a t e e------------D .....-------•-- Da 00 Application Approved By.-.,ad I "ded............. Date Application Disapproved for the following reasons:----------- .................. ----•-------------------.....------------------...----------------•---•--------- r ------------------------------•---............................................... .............................................-............... Date PermitNo......................................................... Issued..:.................................................... Date L 4 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............................................ Trrtafirtttr of ToutpliFanrr THIS 0 CE FY at the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by-•--_--' ----------------------- •-----•. -----•------...........---------------------- ..........._...... ...._......--------•.-- Installer at......44- ------.T/........... ..------------I-e-1_4JC4-------------00Z%1VAe-if--------•-----------------------------_------------ has.been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No:W L!_-_Z."y40................. dated.....-_..-._.__---_-_-_--_-.---.----_-_-_-•---- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WALL FUNCTIO SAT-OACTORY. DATE... . = Inspector --•------ ----- .. 7, _ .............................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............ '..... 'J........OF. .......g.."�". l t�`�T�� .... ................ 4 'Dispoli al k ion Trani 'Permissi n s hereby granted•--- --- ------ -- ----• -----'-------- •---•------------------------------.. .............................. to Construct) r Repair ( ) an Individual Sewage Disposal System at No. 411 P"._ ........... / .! .&?s' ...................................... Street as shown on the application for Disposal.Works Construction rmi� ................. Dated_._._.----.-'_--_---'_--...:_.::---.__A � DATE....... .......................................... Board o alth '. FORK 1255 HOBBS & WARREN, INC., PUBLISHERS 8 � e ro COMMONWE ALTH OF MASSACHUSETTS I rfCEVEO EXECUTIVE OFFICE of ENMoNMENTAL AFF MA':Y 199 � 7 7 DEPARTMENT OF ENVIRONMENTAL PROTECTION '01*0F ONE WINTER STREET, BOSTON MA 02108 (617)292-5500 WILLIA>aI F.WELD ` Governor ecretarg ARGEO PAUL CELLUCCI DAVID B. STRUHS Lt.Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 41.t�Gcdf✓ei-Illtl � �c�cc�t �cct�r-Address of Owner: Date of Inspection: 1���'Y�— / (If different) Name of Inspector: ���y►ot.,\�� ��µ S K Company Name, Address and Telephone Number.' �-�v`�✓S r ��`� �3� fkT1-Kt-S' %C--SR �� �w�\-�^� L JS CERTIFICATION STATENEIIT' �� 5�-s.�11- �y�,a, �..t�ti C _4. 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 ir, the proper function and maintenance of on-site sewage disposal systems. The system: Passes Conditionally Passes Deeds Further Evaluation By the Lodi Approving Authority _ Fails Inspector's Signature: �-L �2LDate: S` b7 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(301 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: have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CtstR 15.303. Any failure criteria not evaluated are indicated below. BI 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 T 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. trev:scd 11/03/95) 2. JO SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A u i CERTIFICATION (continued) Property Address:25 C ,,J� � .� `` Owner: a, Date of Inspection:l� OS/o�/yam t6]'#STEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution b is due to broken or obstructed pipe(s) or due to a broken, settled or.uneven distribution box. The system will p- 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 broke 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 Cj FURTHER EVALUATION 15 REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of ealth 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 DETERNAI ES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFF,T1'AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of a surface, a:er Cesspool or privy is within 50 feet of a bord rring vegetated wetland or a salt marsh. Z) SYSTEMWILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNE THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT. _ The system has a septic tank and it 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 nd soil absorption system and is within 50 feet of a private water supply well. tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water The system has a septic � _ supply 1 well, unless a wellAvater analysis for coliform bacteria and volatile organic compounds indicates.that the wed is free from pollution frornAat 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 i r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: '`s u�' Y` . cc• Vd Owner. Date of Inspection: D] SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as fined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to d termine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded r clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface aters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available olume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT du to clogged or obstructed pipe(s). Number of times pumped _. Any portion of the Soil Absorption System, cesspool or pri is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone II/Zfa public well. i Any portion of a cesspool or privy is within 50 fee;/of a private water supply well. Any portion of a cesspool or privy is less than 1p0 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 compound ,ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: The following criteria apply to large systems in ddition to the criteria above: The system serves a facility with a design flo 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 o asurface drinking water supply the system is within 200 fee of a tributary to a surface drinking water supply the system is located in •nitrogen sensitive area (Interim Wellhead Protection Area (IWPA) or a mapped Zone 11 of a public water supply we The owner or operator of any such syst shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6. 0. 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 CHECKLIST Property Address: �' 6lt�QL� D Owner: ' V� �5_ Date of Inspection: Check if the following have been done: 4.1 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. 00 As built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout. All system components, excluding the Soil Absorption System, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or liquid,tees material of construction, dimensions, depth of quid depth of sludge, depth of scum. The size 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 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address./'.5 Q - Owner: � ,.,p v ccc� Date of Inspection: l FLOW CONDITIONS RESIDENTIAL: Design flow: 330 gallons Number of bedrooms: ol> Number of current residents: Garbage grinder (yes or no): N Laundry connected to system (yes or no):�S Seasonal use (yes or no): wiry Water meter readings, if available: tZ�o_� Last date of occupancy:Tni5ys ?0jK— COMMERCIAUINDUSTRIAL• Type of establishment: Design flow: gallons/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: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: 6 s . t S x- v n — Sys em pumped as part of ins ection: (ye or no)jt�L �'—� '"�'-"-• If yes, volume pumped: gallons 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) Other (explain) APPROXIMATE AGE of all components, date installed (if known) and source of information: Sewage odors detected when arriving at the site: (yes or no)_,&,)() (revised 11/03/95) 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:Z_ �vr�c c, f Owner: #C-.,K 4v Date of Inspection: SEPTIC TANK: t (locate on site plan) I� U Depth below grade: Material of construction: •concrete _metal _FRP —other(explain) Dimensions: jorrA MI Sludge depth:_ Distance from top of sludge to bottom of outlet tee or baffle: 3211 Scum thickness: lot _ Distance from top of scum to top of outlet tee or baffle:b�1 Distance from bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, stru�jural integrity, evidence of leakage, etc.) I�k�C��11rY1NT P+� � �S ��7�t �� °► - Rtf�Q ,`^" v' j&kQ — GREASE TRAP:_ (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP —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: 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.) (revised !1/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 2$ Owner: f�U14 y Date of In{pCection: Co " TIGHT OR HOLDING TANK:_ (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP —other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: LYA (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.) PUMP CHAMBER:_ (locate on site plan) Pumps in working order:(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 11/03/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: Lj Date of Inspection SOIL ABSORPTION SYSTEM (SAS): t f,� (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: Dig+x b t+, leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: f oil signs of hydraulic failure level of on din , con lion f vegetation,etcJ Comments: (note condition o s g y P r �. th MIS e> I 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 must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVIR'A (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.) (revised 11/03/95; 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:2S � Owner: CJ �N- ( - �f C�o�vLA" �OZ Date of Inspection: /Lt°o��5�� Co—Y�cz!— I/ V, o 7- SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' I 0 , g Q 3 � y 36t1 l �b�� NIL- , rb2 DEPTH TO GROUNDWATER t Depth to groundwater: 10 feet method of determination or approximation: 10,4 (revised ?_iO3:'S 9 TOWN OF BARNSTABLE LGCATION SEWAGE VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 00Q$TXL i j LEACHING FACILITY: (type) (size) \CC-DoN a r^A NO. OF BEDROOMS BUILDER OR OWNER ATE: acl COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and'Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) ' Feet .Furnished by r • 2. heL 33�„ M- m, Im 4 o p.\A— 461 $ t r n. .. ' - 1 .. � �"alkr?'c,, e -��i��t '.�`��''L x� a j:'�aF •.�. �, ' y n_r', .. F _ +.^s,Y :'(•w e'f"+.'.- . s. - ',. .. .+, •�S.r.-7r�g _'�r+y,i•f , f3,,,,�r3Y' t'i=#sC-`� �.,ar;, pa.�' 7,f s. �'„�..s. .r?. ,•y�,{ +.v-`� _ - t s,a 4 `��' ,x , Y - . .;. ' �. .. `- `' a ,� ai _ ,A� J•+•. f Y...r a�Fa Ar -f (.,,4j' �'r.-, 3' ,. 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T.. ./J:.J^a_1•-l�r\). ,1 f3 /"n, y..� c r y :'+K�� !� l�J ,'� `�;� �f fC��• 01�1�;Tf I�:��7�0'C��,1D' � /'+`�� �t' * f t+ F �Y .} -�,/ F' '� - Cb•R'�C "PY,r` 4 ',`r ,:r! J.pL�i 1• s �: t; .9r' rra to �-„r l�vv; �n 117� *• r OF T • y ♦ -a l r-9 C �i'Gi,%/V ��<. ,�,�` a `.: �,� :fig; irs d .�r •�. a rs�`:rt`- �//{��- +• ':N n DST L/E (LTizN AC:5E�_41 T� I�A;TE �CJ itJ �/ �, s�. *�� ��� � � i:: r ��• •'• Li'PP�CJ i/,4 L�'J `•a�- t,, r'� _ INSPECTION NOTE: PRIORTO FINAL INSPECTION BYTHE EINEEA,SYSTEM Town of BamstaWe Hyannis,AAA NG NEEDSTO BE COMPLETE iNaMOING BUILDUP FOR COVERS. N�y` / Parcet 002 V I40O E (483)t c 7S nrr Map 269 (491) 4 (47.7) c: o _ w Parcel222002 SeeNote#19 SAS (,D Comer Brick as O 2 (480) 48 �enj0 " Edsting 1.000 Locu Tank �lTp m �c i Q TM' w (49.z6) 33rp• m 1}Assessor's Map 269 Parcel 244 (4") S7 -�. �� a e' Map. 2.j Book 16620 Page 313 Parcel 30 3.)Plan Book 340 Page 244 Lot 31 (499) 43 This property is in the State Approved 1?edr (4" Zone II Water District I Lot 31 5)Property is in the Wellhead Protection District "ouse#2 5 1 7,778± Cry. Ft. 5.)This properly is not in a Flood Zone o -"i .�) LEGEND (47.6) (49.6) _ P (4&0) EXISTING SPOT GRADE OW GG W 24z5 PROPOSED SPOT GRADE Map 269 OHW G � l(Itclien Bath 24 — PROPOSED CONTOUR Parcel 245 �► Bath Bed 1 �-- OVERHEAD UTILITY LINES w WATER LINE (47.5) MW 269 G GAS SERVICE LINE G �,.�� ,�•� Parcel 242 Living Bed 3 Bed 2 EDGE OF CLEARING Paved Spa Room FENCE D1W �-''� 17`r - TEST HOLE LOCATION VARIANCES REQUESTED IimHoor oe DISTRIBUTION BOX / Local Upgrade Approvals:310 CMR 15.403 5A5 SOIL ABSORPTION SYSTEM 269 Variances.310 CMR 15.221(7)General Construction Prepared far: Parcel 243Map Requirements for AN,SyAern Components: Stott and Hannelore Lobas 1a sal Absorptlonsysbenr>36°BelowFmsh Grime 25 Oakview Terrace Hyannis,MA 48°Held 12°Variance Requested /J (Not t°Exceed'�°' Proposed Sewage Disp osal posal System 25 Oakview Terrace Hyannis,MA I CEIRTIFYTHAT I AM CURRENTLY APPROVED BYTHE DEPARTMENT OF g e ENVIRONMENTAL PROTECTION PURSUAMTTO 310 CMR 15.017TO CONDUCT 4 SOIL EVALUATIONS ANDTHATTHE ABOVE ANALYSIS HAS BEEN PERFORMED Prepared by: BY MECONSISIEMW[THTHEREQUIRIDTIiAININC,,EXPERTISE,AND DIPeiIENCE :Ir DESCRIBED IN 310 CMR 15A17.1 FURTHER CERTIFYTHATTHE RESULTS OF MY All Cape Septic LLC SOH.EVALUATION,AS INDICATED ON THE ATTACHED SOIL EVALUATION FORM, 61$ Route 28 OARE ACCURATE AND IN ACCORDANCE 310 15.100 THROUGH 15.107. a West Yarmouth, 7 26 MA 0 3 bTer 0 20 40 60 ��c Igiay aCQ SCOTT MCGANN,CERTIFIED SOIL EVALUATOR SCALE 1 =20 �508) 771-4200 Email:allcapeseptiC@gmail.Com Date:07/12/16 sheet 1 of 2 By:MA Check SM Project No.AC-6S Aof J 14-'Zp COVERS RAISED WITM Proposed Vent CONSTRUCTION NOTES FINISH GRADE(OR ASNOTED) r 1.)ALL WORK SHALL CONFORM TOTHE STATE ENVIRONMENTAL CO?E,'I1TLE S t310 d1AR 15.000x E1a492t H-48.St STANDARD REQUIREMENTS FOR THE SITING,CONSTRUCTION,INSPECTION,UPGRADE AND EXPANSION OF OWSTTE SEWAGETRFATMENT AND DISPOSAL SYSTEMS AND FORTHETRANSPORT AND DISPOSAL OF SEPTAGE,ANDTHE LOCAL BOARD OF HEALTH REGULATIONS - E _ Z)ANY SEPTIC SYSTEM COMPONENT STALLED Rai A LOCATION W HERETHERE IS POTELtT11AL FOR 46 0 a43 GEOTp(Ttl E H16RlC VEHICLES OR HEAVY EQUiPMENTTO PASS OVER TTSHALL BE DESIGNEDTO Wf i WIAND AN H-20 LOADING, IF UNDER AN IMPERVIOUS SURFACE,SYSTEM SHALL BE VENTEDTO THE ATMOSPHERE. (IN PLACE OF 114'-12"PEASFOIdE) 3.)TO MINIMIZE UNEVEN SETTLING,SEPTIC TANKS AND 04=SHALL BE INSTALLED ON ASTABLE MECHANICALLY-COMPACTED BASE ON S0(INCHES OF CRUSHED STONE 45 45A 443 44.13 3/4"to 447 - ` i-in,STONE' 4.)COVERS OVER THE INLET AND OUTLET TEES OFTHE SEPTICTANK,THE DISTRIBUTION BOX,AND : ry 44A v THE SOIL ABSORPTION SYSTEM SHALL BE RAISFDTO WtTHIN6 OF FINAL GRADE.LEACHING DB-3 � (Double FIELDS,TRENCHES,AND OTHER SOILAB�SOOPTIONSYSTEMSWfTHOUTACCESS FKbESSHALL � fA5 H-20Rated TIfRl3rM1(3)• PRECAST CONCRETE7F HAVE AT LEASTONE(i)INSPECTION PORTCOi SISIING OF 4`PVC PIPE D-BOX Y LEAS CHAMBERS(a'X B'X l DEEP) ' VER71CALLYTOTHE BOTTOM OFTHE SOIL ABSORPTION SYSTEM WrTH A CAP 71ED WITH MAGNETIC t WITH 4'STONE ON THE SIDES W DAND ENDS MARKWGTAPE,ACCESSiBLETOWRMN3'OFFINALGRADE LTip "� �. EXISTING I,OOOGALLON - �V 4w 4 ^'1�'—"� 5.0' 5J PIPING SHALL CONSIST OF 4"SCHEDULE 40 PVC OR EQuWL.ENT.PiPE SHALL BE LAID ON A (TO REMAIN) La�yes LEACH CHAMBERS MINIMUM CONTINUOUS GRADE OF NOT LESSTHAN2 %FROM THE BUILDING TOTHESEPTICTANl4 (ENDVIEW) ANDNOTLESSTHANi %OTHERWISE. SEPTICTANK FLOW PROFILE ° D °"'T "°'� 6.)DiSTMW71ON LINES FORTHE SOIL ABSORPTION SYSTEM SHALL BE V DIAMETER SCHEDULE 40 32 0' NOT TO SCALE PVC(OR EQULVAUM LAID AT MM FT/Fr UNLESS OTHHiiiA%NOTED.DIES SHALL BE CAPPED -� 11 , AT END OR AS OMTHEQ `—'�`—_ $�___fw_f SYSTEM DESIGN CALCULATIONS 7.)LINES FROM THE DISTRIBUTION BOxTO BE LEVEL FORTHE FIRST-TWO(2}FEET�O� i�1.... _� ¢ j ' PITCHING TO THE RIB ABSORPTION SYSTEM.DISTiRtBUiION BOX SHALL BE WA7BiTFSTEDT0 � 1 :r SEWAGE DESKa�I FLOW RK2UIR11?:3 BEDROOM DW ll fNG 0 i 10 GPD/BEDROOM=330 GPl) ASSURE EVEN DISTRIBUTION. �r '�. Y REWAGE 8.)GROUT70 BE USED AT ALL DINTS WHERE PIPES ENTER OR LEAVE ALL CONCRETE STRUCTURES `` ' QUIRED IN a ORDER TO PROVIDE A WATERTIGHT SEAL. ;� ,; � - - SEWAGE DESIGN FLOW PROVIDED:THREE t31 CONCRETE LEACH CHAMBERS 4'X 8'X i'-6"DES 9.)HEAVY EQUIPMENT SHALL NOT BE ALLOWEDTO OPERATE OVERTHE LIMITS OFTHE SEWAGE WITH 4 STONE ON THE ENDS AND 4'STONE ON THE SIDES DISPOSAL FIELD DURINGTHE COURSE OF CONSTRUCTION OFTHESYSTEM ` `� s �- 51 Vt=((32.0 x IZO)+2(32.0+1ZO)x.74=349 GPD PROVIDED 10.)IN ACCORDANCE W TH 310 CMR 15.221,ALL SYSTEM COMPONENTS SHALL BE MARKED WITH 349 GPD PROVIDED>330 GPD REQUIRED MAGNETIC MARKING TAPE SEPTKTANK CAPACITY REQUIRED 330 CAD X 20(1R6=660 GPD RE('�UBiED i i J THERE ARE NO KNOWN WELLS WITHIN 100'OFTHE PROPOSED SOIL ABS iION SYSTEM SEPTICiANK CAPACITY PROVIDED.1.000 GALLON PROVIDED(EXISTING) 12.)FROMTHE DATE OFTHE INSTALLATION OF THE SOIL ABSORPTION SYSTEM UNTIL RECEIPT OF D-Booc A GARBAGE DISPOSAL IS NOT PERMITTED WITH THiS DESIGN FLOW THE CERTIFICATE OF COMPLIANCE,THE PERIMETER SHALL BE STAKED AND FLAGGED TO PREVENT USE OF THE AREA THAT MAY CAUSE DAMAGE TOTHE SYSTEM. Test Hole#1(EL=48.Ot) TEST HOLE LOGS 13)THE DESIGNER WILL NOT BE RESPONSIBLE FORTHE SYSTEM AS DMGNED UKES5 CONSTRUCTED AS SHOWN ON PLAN. ANY CHANGES SHALL BE APPROVED IN WRITING BYTHE Depth Elev. Layer Soil Class Soil Color .Comments DESIGNER. , 14,)THE BOARD OF HEALTH REQUIRES INSPECTION OF ALL CONSTRUCTION BY AN AGENT OF THE 011A" 47.2 A Loam I OYR 3/1 BOARD OF HEALTH AND THE DESIGNER THE DESIGNER SHALL CERTIFY IN WRITING THATTHE _ SEWAGE DISPOSAL SYSTEM WAS INSTALLED IN ACCORDANCE WITH THE TERMS OF THE PERMIT 9"-28 45.7 B Loamy Sand 1 OYR 5/6 auk 5 ANDTHE APPROVED PLANS.48 HOURS ADVANCE NOTICE IS REQUESTED. 28"-120" 38.0 C Medium Sand 25Y 6/3 Stones/Gravel 1SJ LOCATION OF UTILITIES IS APPROXIMATE AND CONTRACTOR SHALL BE RESPONSIBLE FOR a DETERMINING THE LOCATION OF ALL UNDERGROUND AND OVERHEAD UTILITIES PRIORTO COMMENCEMENT OF ANY WORK.THIS INCLUDES,BUT IS NOT LIMITED TO,REQUESTS TO DIGSAFE, Test Hole#2(EL=48.0t) ANY PRIVATE UTILITY COMPANIES,AND THE LOCAL WATER DEPARTMENT. 16.)CONTRACTOR SHALL VERIFYTHAT ALL WASTEUNES ARE CONNECTED BY WATER TESTING Depth Elev. Layer Soil Class Soil Color Comments WITHIN THE DWELLING PRIORTO INSTALLATION OF ANY SEPTIC COMPONENTS. Proposed Sewage Disposal System 17.)CONTRACTOR SHALL VERIFY EXISTING INVERT ELEVATIONS PRIOR TO INSTALLATION OF ANY 00-9" 47.2 A Loam 10YR 3/1 SEPTIC SYSTEM COMPONENTS. 10"-28" 45.7 B Loamy Sand 1OYR 5/6 23 Oakview Temce Hyannis, MA 18JTEST HOLES COMPLETED PER STATE ENVIRONMENTAL CODE,TITLE S.SOILS CAN BE Prepared by: VARIABLE ANDTEST HOLE DATA IS NO GUARANTEE OF SOIL CONDITIONS IN OTHER AREAS. IF 2W-120" 38.0 C Medium re Sand 2.5Y 6/3 Stones/Gravel Prepared for: P SOILS DIFFER FROM THOSE SHOWN IN THE SOILS LAGS,DESIGN ENGINEER IS TO INSPECTTHE Scott&Hannelore Lobas All Cape Septic LLC SOILS PRIOR TO PROCEEDING WITH INSTALLATION OF ANY SEPTIC COMPONENTS. 618 Route 28 � DATE OF TESTING: 7/11/16 2S Oakview Terrace 19.)EXISTING SEPTIC COMPONENTS TO BE LOCATED,PUMPED DRY,FILLED WiTH CLEAN SAND AND SOIL EVALUATOR SCOTT MCGAPIN West Yarmouth,MA 02673 Hyannis,MA ABANDONED IN PLACE OR REMOVED AS REQUIRED AREA TO BE COMPACTED TO MINIMIZE SETTLING. BOARD OF HEALTH AGENT DAVESTANTON (sOs)771-4200 PERCOLATION RATE: LESS THAN 2 MINIINCH IN"C"LAYER AT 66" ailcapeseptic@gmal.com NO GROUNDWATER ENCOUNTERED Date.07/12/i6 Sheet 2 of 2 By:MA Check SM Project No.AC.e5.Sht2. Qi=tf. -i 1 1 b Add 1410