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Home My WebLink About86, 88 QUAKER ROAD - Health 86 & 88 Quaker Road, Hyannis A= 310 - 299 - OOA&B d i i I r TOWN OF BARNSTABLE LOCATION ��W `e- SEWAGE # VnIAGE ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: 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) sJ's�y 7 Feet Furnished by It'J' a 0 G 1' w 00 LA TOWN OF BARNSTABLE LOCATION r�V,;kr C"Z. SEWAGE# VILLAGE � T«.� S ASSESSOR'S MAP&PARCEL fo ,7 INSTALLER'S NAME&PHONE NO. 0065 SEPTIC TANK CAPACITY '` G, ' � CC➢s� :� -r^"Cl�� LEACHING FACILITY:(type) (p0 L G-&Q C\,,t,C t size) f® )C r 6a ,)c I-r+ NO.OF BEDROOMS ",-k OWNER PERMIT DATE:_ r L 4 11`{' COMPLIANCE DATE: MAUL 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 e Z k?1 C.J\ t �aa � 33 r3as LA 31 15 of C3a Jarlz ® . `� t: No. 114V Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS N; Zipplitation for Mispo9AY 6pstem ConstrUttion Verruit Application for a Permit to Construct( ) Repair( %,<Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. v�V—kr Owner's Name,Address,and Tel.No. Assessor's Map/Parcel \S — a C6 �Zk t\&C,.r� Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder()q Other Type of Building 0sp \,?—y XAP\j�Vo.of Persons Showers( ) Cafeteria( ) Other Fixtures 1 , Design Flow(min.required) y gpd Design flow provided t��S cj gpd Plan Date- 1U Number of sheets Revision Date Title y Size of Septic Tank 5✓b� ( �� 1 Type of S.A.S. Description of Soil M e 6xmd . - Nature of Repairs or Alterations(Answer when applicable) !Q Q n`c C_'_ e x(S"\/�C, �iP'� L („j c. C,t 0 (. G VX.JA6xQ k 0 is 7C 'z` Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in r accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date T Application Approved by Date Application Disapproved by Date for the following reasons Permit No. 0 _ 0 Date Issued No. r90 I L d3C1 g � - f Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: i Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS H ftprication for Disposal *pstem Construction Permit Application for a Permit to Construct( ) Repair(V�Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No..g(p- �1 v GuN N Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Ny�M s _ a G�j �I\ C\&C-r3 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. ScvE� rw-�C, �n a�, ob �► S -� �, So 36 a kt3 Type of Building: ~\ Dwelling No.of Bedrooms Lot Size t sq.,ft. Garbage Grinder(N6 Other Type of Building y�p �_)C Nko V�Vo.of Persons Showers( ) Cafeteria( ) Other Fixtures tr- Design Flow(min.required) �(� gpd Design flow provided ( < < gpd Plan Date a 1 Number of sheets Revision Date Title Size of Septic Tank ��(� ;� ( 4M�(Jc.f��^t�� Type of S.A.S. Description of Soil Gad Nature of Repairs or Alterations(Answer when applicable)Q p,n�c C u e X SAC\!�C, tP '� L (,J c. 2LC.UM, c,r�C �`� t 0 to C,\n, C Vcv^6tr� 10 t% X t Q-e4_0 Date last inspected: Agreement: i The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. OIL! _ 0 � Date Issued a - LI- l,-I >, THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of (Lompliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(V/ Upgraded( ) Abandoned( )by f e!, � at — �� C.��(,,r LC,,,,>�� h s Mee in accordance with the provisions of..Title 5 and the for Disposal System Construction Permit No. -10 I l- Cl I dated :P C j ' I LI Installer S CO�\ V h � Designer S 1 #bedrooms L Approved der' flow gpd The issuance of this pe 't sh.11 t b co trued a guarantee that the system �I�Z �,sign, Date !� Inspector ' UI! ----- - -� --�- Fee-- ---------------------------------- ------------------------------------------------ �- -- No.� O' L _ �, THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair Upgrade( ) Abandon( ) System located at 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 completed within three years of the date of this permit.1__ /_ (2 S Date c;2— j L[ — I Approved by ;. Town`of Barnstable FTME A Regulatory Services Richard V. Scali, Interim Director 9 MAMBARNWABLF4 Public Health Division QED MAT Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer &Designer Certification Form Date: a �S L� Sewage Permit# a -t-('3c1 Assessor's MapTarcel 3 fU �qS Designer: S/�'r'��' ' A- 1+0-4-5 PC- Installer: ScC�I_lC 1�7ct_f_\:C_ Address: 723 R-Oxf-rt 4DA Address: On t�t_A (1\-A ScrJ�-'��^'��- _was issued a permit to install a (date) (installer) septic system at Sr based on a design drawn by (address) S7i=pH `' 4. r�"AS, Pd dated a (designer) I certify that the septic system referenced above was installed substantially according to. the design, which may include minor approved changes such as lateral relocation of the x distribution box and/or septic tank. Strip out (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. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in,cQUTliance with the terms of the RA approval letters (if applicable) f (Installer�Sip�atwe)�� & llRl i.. (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABIL BOTH THIS FORM AND AS- PUBLIC HETH DIVISION.BUILT OF COMPLIANCE WILL NOT BE ISSUED UNT BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. QASeptic\Designer Certification Form Rev 8-14-13.doc 02/14/2014 10:51 5087605716 SHOREY MFG PAGE 01/03 On* 351 White's Path PRECAST-CONCRETE PRODUCTS Te(. 508-760-1070 So, Yarmouth, MA 02664 Fax 508-760-571 s facsffiiae tr ansrn��tal To: l Fes'- rJ (J 0 l Attn: 5CO�- qa4t � gate: ` f c4! f From: V.6ft (Pages: Re: C-.-f ❑!Urgent 0 For Review ❑Pfene Comment ❑Please Reply ❑please R®cyr* E blooms: t I I i . . . . . . . . . . . . . . . + 1 i 02/14/2014 10:51 5087605716 SHOREY NAG PAGE 02/03 ACME PRECAST C 0 . INC . PLANT ADDRESS; 590 THOMAS B. LANDERS ROAD, WEST FALIMOUTH, MA. 02536 MAILING ADDRESS; P.O. BOX 2034, TEATICKET , MA.. 02536 PHONE (508) 548-9607 FAX(508) 548-1664 TOLL FREE 1-800-560-9949 [9 C9 19 o0o D rc 3' H-20 PRECAST 125 GALLON LEACHING CHAMBER ITEM## LC1252 02/14/2014 10:51 5087605716 SHOREV MFG PAGE 03/03 . ACME PRECAST CO . , INCE PLANT ADDRESS; 590 THOMAS B. LANDERS ROAD, WEST FALMOUTH, MA. 02536 MAILING ADDRESS; P.O. BOX 2034, TEATICKET , MA. 02536 PHONE (508) 548.9607 FAX(508) 548-1664 TOLL FREE 1-800-560-9949 H-20 PRECAST 125 GALLON LEACHING CHAMBER 10" Inspection cover 3' D I D 1/2A steel lifting hooks (1) - 5" KNOCKOUT WITH I' SUMP PER SIDE 4" 4" t r �� LEl B E3 E3 fi ® 1 Trench Knockout 2,� 5, 11 l 3° 3" 6, 6-1„ 3' ITE M# LC 1252 S P E C I F I CAT IONS PRODUCT WT. 1,025 LBS. Concrete Minimum Strength: 5,000 F .S.I. at 28 days GALLEY CHAMBER SHAL BE INSTALLED LEVEL AND TRUE Steel Reinforcement: ASTM -A-615-68, Grade 60 TO GRADE ON A LEVEL ANC STABLE BASE THAT HAS Design Loading: standard units - AASHO- H-20 BEEN MECHANICALY COMPACTED AND ON TOWHICH SIX INCHES OF CRUSHED STONS HAS BEEN PLACE[). 41 Town ofBarnstable A # � - Department of Regiilatory Services Public Health Division Agate 16y9 1�� 200 Main Street,Hyannis MA 02601 e Date Scheduled \� .. j i , t , Time' If, Fee 1'd. �0'11 Suitability Assessment fior S s d � Performed By: Witnessed By: L LOCATION& GENER&L INFORMATION ION ! / Location A4ttirs?SW �/ ,f N !7` Owner's Name Q Address Assessor's Map/Parcel: Engineer's Name NEW CONSTRUCTION REPAIR V Telephone# p � 3 Land Use- Slo es 96 P ( ) Surface Stones .V DisGunces from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way . ft Property Line /C+'S'' ft Other ft SIV"rCHl (Street name,dimensions of lot,exact to of test holcs&Pere tests,locate wetlands[i proximity to(roles). "a�+ r t ' • IN ;:..3• ` kA Parent material(geologic) UvJ�i�l1-g rt I)eptlttpf3edrockT7UL'--' � ` Depth to Groundwater: Standing Water hi Hole: Weeping from Pit Ppce tw Estimated Seasonal High Groundwater' ` a H DETERMINATION FOR SEASONAL-RIQT R TWA TER ri:'.ADL Method Used: Depth Observed standing in ob4.hole: In `Depth to soli mottles: Depth to weeping from side of obs.bole: Iq OftiundW4teY AdJUstMent Index Well# Reading Date; '. index Well level __.• Adj,fhotor Atu.Gruut)dWoter Level PElRCOLAXION.`]l'EtST . Date I'ilita_ Observation / Hole ti / [Itna at 9" Depth of Pere Tln'te at G" r Start Pre-soak'Iiine @ Time(9„•.b ) End Pre-soak" Rate Min./Inch ' Site Suitability Assessment: Site Passed ✓ Site Failed: Additioirai Testing Needed(Y/N). Original: Public Flealth Division Observation Hole Data To Be Completed on Back----------- ""If Percolation test is to be Conducted within 100' of wetland,you must first notify tile. Barnstable Conservation]),!vision at least one (1) Week prior to beginning. QASflPFiC_'�i'rARCPOR.M.DOC z • z DEJ EP.OBSEJ R'VATION HOLE,LOG -Hole# / Depth from"": Soil'Horizon ,.� ' Soil Texture Soil Color Soil Other Surface(in,): • (USDA) ,. ` (Munsell) Mottling (51nuc[ure,Stones;Boulders. onsi itency T2 Oravel) Ls h ",t 4 c , m DI♦EROBSER VA.T'ION HO ' LE I,®G. t. Hole# Z Depth from' Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) f Mottling. (Structure,Stones,Boulders. Q onsistencv.%travel) r / LS f Uri' DEEE'OBSERVATION MOLE LOG ° ° ` Hole#k Depth from y LL Soil Horizon Soil Texture Soil Color Soil Other Surface(in-)• (USDA) (Munsell) Mottling (Stricture,Stones,Boulders. • Can Istcnc Oraycl) C x' DEi rip OBSERVATION HOLE-LOG Hole#� Depth from Soil Horizon Soil Texture `Soil Color Soll Other Surface(tn),.' (USDA) (Mansell) Mottling (Structure,Stones,Boulders, — Consistency.R6 Qtaypl) �.. _:. )T lood-.nSu arice hate Map: , . r, Above 500 year flood boundary No Yes'. With-In 500 year boundary No `� Yes ,"VithinJ00 year floodboundary No— Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the, area proposed for the soil absorption systems � S If not,what is th`e depth of naturally occurring pervious matarlal7 W____^__ r - ' CeYtlCation jrcertify that on ! (date)I lihve,passed the soil evaluator examination approved by the 4 ' Department of Environmental Protection and that the above analysis was performed by me consistent with the required tra' expertise and experience described in" l0 CIvIlt 15.017 t=, Signature r t• r k Date L"17 '>`� Q:\4"lC\PL-RCPORM,DOC TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date 1-,7-0 ►` Time: In Out Owner Tenant Q� Address ��il.-1 O\ � Address & OLk A T,\-) Compliance Remarks or Regulation# Yes NO Recommendations 2. Kitchen Facilities 3. Bathroom Facilities -a G"I 4. Water Supply 5. Hot Water Facilities 6. Heating Facilities 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities �� 5K/4- 'r0 10. Curtailment of Service 11. Space and Use .✓ 12. Exits 13. Installation and Maintenance of Structural / Elements ✓ 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal 17.Temporary Housing NA 18. Driveway Width ✓ 19. Number of Tenants Observed 2- PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms 2 Number of Vehicles Allowed (max) Number of Persons Allowed (max) Person(s) Interviewed :]� 1 Inspector If Public Building such as Store or Hotel/Motel specify here 4000 COMMONWEALTH OF MASACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAI AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET BOSTON MA 02108(617)292-3500 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 86&88 QUAKER RD. HYANNIS, MA 02601 M310 P299 LOOA& B Name of Owner JEFF LYONS;INDIGO MANAGEMENT Address of Owner: BOX 611 HYANNISPORT MA.02647 Date of Inspection: 7/7/00 Name of Inspector: JOHN GRACI I am a DEP approved system inspector pursuant to Secdon 15.340 of Tide 5(310 CMR 15.000) Company Name: SEPTIC INSPECTIONS Mailing Address: P.O.BOX 2119 TEATICKET,MA.02636 Telephone Number: 608-664-6813 FAX 608-664-7270 CERTIFICATION STATEMENT i, 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: X Passes _ Conditionally Passes _ Needs Further Evaluati the Local Approving Authority Fails Inspector's Signature: Date:7/11/00 The System Inspector shall sub a copy of this Inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this Inspection.If the ystem 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. NOTES AND COMMENTS "The Inspection is based on criteria defined In Title V code 310 CMR 15.303.My findings are of how the system is performing at the time of inspection.My Inspection does not Imply any warranty or guarantee of the longevity of the septic system and any of Its component's useful life." THE SYSTEM PASSES TITLE V INPECTION.RECOMMEND PUMPING THE SYSTEM EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. revised 9/2/96 Page 1 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 86& 88 QUAKER RD. HYANNIS, MA 02601 M310 P299 LOOA& B Name of Owner . JEFF LYONS;INDIGO MANAGEMENT Date of Inspection: 7/7/00 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: X I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. S. 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. Indicate yes,no,or not determined(Y,N,o(ND).Describe basis of determination in all instances.If"not determined",explain why not. nLa The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank, whether or not rridtal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. nLa 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 Wa 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 revised 9/2198 Page 2 of 11 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 86 & 88 QUAKER RD. HYANNIS, MA 02601 M310 P299 LOOA& B Name of Owner JEFF LYONS;INDIGO MANAGEMENT Date of Inspection: 7/7/00 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 IN ACCORDANCE WITH 310 CMR 16.303(1)(b)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 surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER.IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well, _ The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply 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,Method used to determine distance nLa (approximation not valid). 3) OTHER " n/a tt 3 4 revised 9/2/98 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 86& 88 QUAKER RD. HYANNIS, MA 02601 M310 P299 LOOA& B Name of Owner JEFF LYONS;INDIGO MANAGEMENT Date of Inspection: 717/00 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.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. Yes No X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow, X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped Q. _ X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well, _ X Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.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. E. LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: The following criteria apply to large systems in addition to the criteria above: 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: Yes No X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X 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 upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 86 $ 88 QUAKER RD. HYANNIS, MA 02601 M310 P299 LOOA$ B Name of Owner: JEFF LYONS;INDIGO MANAGEMENT Date of Inspection: 717/00 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health. X - 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. X _ As built plans have been obtained and examined.Note if they are not available with N/A. X _ The facility or dwelling was inspected for signs of sewage back-up. X - The system does not receive non-sanitary or industrial waste flow. X - The site was inspected for signs of breakout. X _ All system components,excluding the Soil Absorption System,have been located on the site. X - The septic tank manholes were uncovered;opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been determined based on: X - Existing information,For example,Plan at B4O,H, X _ Determined in the field(if any,of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)1 5.302(3)(b)j X _ The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. ;.! t, ' e revised 9/2/98 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM �`I I PART C SYSTEM INFORMATION Property Address: 86& 88 QUAKER RD. HYANNIS, MA 02601 M310 P299 LOOA& B Name of Owner JEFF LYONS;INDIGO MANAGEMENT Date of Inspection: 717/00 FLOW CONDITIONS RESIDENTIAL: Design flow: 110 g.p.d./bedroom Number of bedrooms(design): 4 Number of bedrooms(actual): Total DESIGN Flow: 440 gpd Number of current residents:3 Garbage grinder(yes or no):NO Laundry(separate system)(yes or no): NO If yes,separate inspection required Laundry system inspected(yes or no): NO Seasonal use(yes or no): NO Water meter readings,if avail able last two ear's usa e: n/a 9 , ( Y 9,) gpd Sump Pump(yes or no): NO Last date of occupancy: n/a COMMERCIAL/INDUSTRIAL Type of establishment: n/a Design flow: n/a gpd(Based on 15.203) Basis of design flow:n/a Grease trap present:(yes or no): NO Industrial Waste Holding Tank present:(yes or no): NO Non-sanitary waste discharged to the Title 5 system:(yes or no):NO Water meter readings.if available: n/a Last date of occupancy:n/a K al� OTHER: (Describe) n/a GENERAL INFORMATION PUMPING RECORDS and source of information: n/a System pumped as part of inspection:(yes or no):NO If yes,volume pumped n/a gallons Reason for pumping:n/a TYPE OF SYSTEM X Septic tank/distribution boxisoil absorption system _ Single cesspool _ Overflow cesspool _ Privy _ Shared system(yes or no)(if yes.attach previous inspection records,if any) _ I/A Technology etc.Attach copy of up Iodate operation and maintenance contract _ Tight Tank Copy of DEP Approval Other:nla APPROXIMATE AGE of all components,date?installed(if known)and source of information: 1997 §@Wdg@odor§ Whin§11iving At the%its:M§N no) NO revised 9/2/98 Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 86 & 88 QUAKER RD. HYANNIS, MA 02601 M310 P299 LOOA& B Name of Owner JEFF LYONS;INDIGO MANAGEMENT i Date of Inspection: 7/7100 BUILDING SEWER:X (Locate on site plan) Depth below grade: 42" Material of construction: _ cast iron X 40 Pvc _ other(explain) Distance from private water supply well or suction line: n/a Diameter: 4" Comments: (condition of joints,venting,evidence of leakage,etc.) THERE IS TOWN WATER SEPTIC TANK: X (locate on site plan) Depth below grade: 36" Material of construction: X concrete_ metal_ Fiberglass_ Polyethylene_ other explain: n/a If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): NO Age: n/a Dimensions: 150OG L 10'6"H 5'6"W 5'8--- Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle: 31" Scum thickness: 4" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: n/a How dimensions were determined: MEASURED 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.) THE SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. GREASE TRAP: _ !' (locate on site plan) Depth below grade: n/a Material of construction: _concrete_ metal_ Fiberglass _ Polyethylene_other Explain: n/a Dimensions:n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle n/a Date of last pumping: n/a 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.) n/a NE''t\ revised 9/2198 '.J Page 7 of 11 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 86& 88 QUAKER RD. HYANNIS, MA 02601 M310 P299 LOOA& B Name of Owner JEFF LYONS;INDIGO MANAGEMENT Date of Inspection: 7/7/00 ;, TIGHT OR HOLDING TANK: _ (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: n/a Material of construction: _concrete_ metal_Fiberglass _Polyethylene _other Explain: n/a Dimensions: n/a Capacity: n/a gallons Design flow: n/a gallons/day Alarm present: NO Alarm level:N/A Alarm in working order:NO Date of previous pumping: n/a Comments: (condition of inlet tee,condition of alarm and float switches,etc.) n/a DISTRIBUTION BOX:X (locate on site plan) Tqi, Depth of liquid level above outlet invert: n/a Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) n/a PUMP CHAMBER: _ (locate on site plan) Pumps in working order:(Yes or No): NO Alarms in working order(Yes or No): NO Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) n/a revised 9/2198 Page 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 86 & 88 QUAKER RD. HYANNIS, MA 02601 M310 P299 LOOA& B Name of Owner JEFF LYONS;INDIGO MANAGEMENT Date of Inspection: 7/7/00 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: n/a Type: leaching pits,number:(2)1000 GAL 6'X 6' leaching chambers,number: (n/a)n/a leaching galleries,number: (n/a)n/a leaching trenches,number,length: (n/a)n/a leaching fields,number,dimensioris: (n/a)n/a overflow cesspool,number: (n/a)n/a Alternative system: n/a Name of Technology: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE LEACH PITS APPEARS TO BE FUNCTIONING PROPERLY.SYSTEM SHOWS NO SIGNS OF FAILURE. CESSPOOLS: _ (locate on site plan) Number and configuration: n/a Depth-top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer. n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater: n/a inflow(cesspool must be pumped as part of inspection)NO Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: Wa Depth of solids: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a revised 9/2/98 Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) I Property Address: 86 & 88 QUAKER RD. HYANNIS, MA 02601 M310 P299 LOOA& B Name of Owner JEFF LYONS;INDIGO MANAGEMENT Date of Inspection: 7/7/00 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) II I � 63 •E:t I q IAA 3� qy (3c L° LIP- revised 9/2/98 Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 0 Property Address: 86 & 88 QUAKER RD. HYANNIS, MA 02601 M310 P299 LOOA& B Name of Owner JEFF LYONS;INDIGO MANAGEMENT Date of Inspection: 717/00 NRCS Report name: n/a Soil Type: n/a Typical depth to groundwater: n/a USGS Date website visited: n/a Observation Wells checked: NO Groundwater depth: Shallow_ Moderate_ Deep_ SITE EXAM _ Slope _ Surface water _ Check Cellar Shallow wells Estimated Depth to Groundwater 12 Feet+ Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site(Abutting property,observation hole,basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps _ Checked pumping records Checked local excavators,installers X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS-12+FEET revised 9/2/98 Page 11 of 11 c o COMMONWEALTH OF MASSACHUSETTS ExECUTIVE OFFICE OF ENVII3,ONMENTAL AFFAIRS DEPARTMENT OF ENViRoNmENTAL PROTECTION ONE WINTER STREET,BOSTON MA 02108 (617)292-5500 WaJIAM F.WELD TBUDY COXE Governor _...,i Secretary .ARGEO FAUL CELLUCCI i DAVID$.gTB.LTHS . f Lt.Governor ! Commissioner I f ) � I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A / CERTIFICATION Property Address. -tA1t&-A.,_i/e,- 1W , Ky" — -Z - Address of Owner: Date of Inspection:' S/y�-- (If different) Name of Inspector: �11cy,o t—% e�e,c. � Company Name, Address and Telephone Number. RT 1�i.1T\C t.�Y'►i3,pf-_�r-► ya�t�„ CERTIFICATION STATEMENT-TjL%� �Ct�_ ty�,p, ...s�,� 'f_-�-1 .4--Ag 1 certify that I have personally inspected the sewage disposal system at this address and that the information re is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and ex p e r r nction and maintenance of on-site sewage disposal systems. The system: Y. Passes Conditionally Passes RECEI Needs Further Evaluation By the Local Approving Authority 2 5 1997 _ Fails l CC J U N OF Inspector's Signature �� Date: TOWN HEALTH DEPTkBLE ,a•�,� T' The System Inspector shall submit a copy of this inspection report to the Approving Authority within thi )(00) days of Como Ping this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector an sue'y�t ownef sha11 submit the report to the appropriate regional office of the Department of Environmental Protection. i 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, 8,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 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 replace Iment 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 noL The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltrdtion, 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. trevised 11/03/95) v y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:VC .�c.��VQ- /f . f�Y Owner: /Z�S Vt-- Date of nl spedion: .B] SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high stati water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or un ven distribution box: The system will pass inspection if(with approval of the Board of Health): broken pipets) are re laced obstruction is remov d distribution box is I elled or replaced _ The system required pumping more t n four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Boa of Health): broken pipets) are r placed obstruction is remo ed C} FURTHER EVALUATION 15 REQUIRED BY THE BO RD OF HEALTH: Conditionvex'st which require further evaluati n 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 H LTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILLIPROTECT THE PUBLIC HEA H AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 fee of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD F HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERIMINES THAT THE SYSTEM 15 FUNCTIONING IN A NER THAT PROTECfs THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank an 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 a soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank a soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank a d.soil absorption system and is less than 100 feet but 50 feet or more from a private water T supply well, unless a well wat r analysis for coliform bacteria and volatile organic compounds indicates that the we!l is free from pollution from that ciliry 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 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:$�� Owner: at y,`'�` Date of Inspection: D] SYSTEM FAILS: I have determined that the system violates one or more of the fo owing failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health hould be contacted to determine what will be ne the failure. cessary to correct Backup of sewage into facility or system component ue to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of th ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above out t invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below inv or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last y ar NOT due to clogged or obstructed pipe(s). Number of times pumped_. i Any portion of the Soil Absorption System, cessp I or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 et of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Z e I of a public well. I Any portion of a cesspool or privy is within 50 et of a private water supply well. Any portion of a cesspool or privy is less than 00 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well h s been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] 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 10,0 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because ne or more of the following conditions exist: the system is within 400 feet of a surface dri ing 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 ea (Interim Wellhead Protection Area (IWPA) or a mapped I,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 requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.' (revised !1/03/95) 3 y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:-7'�r ,,-, OE ;4-Zy� Kw� Owner: 3_ LA--,,/LiS L,+ L Date of Inspection: 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. 4�As built plans have been obtained and examined. Note if they are not available with N/A. NThe facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. 1�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 tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on 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 Property Address: ledt Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow: gallons Number of bedrooms:.�3 Number of current residents:-6 5 Garbage grinder (yes or no):_I!J!�, Laundry connected to system (yes or no): eS Seasonal use (yes or no): t•Nc Water meter readings, if available:_ %Aq..-,j3A vsw�r Last date of occupancy: �ac�y„Z-' COMMERCIAUI NDUSTRIAL: 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 RECORDSand source of information: &&4 System pumped as part of inspection: (yes or no)_.�p 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) NO (revised 11/03/95) 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Addressr�(' Owner: �"'- C.f✓�/�r��f - ��rai-_ Date of Inspection: `7 4- SEPTIC TANK: %-ke (locate on site plan) Depth below grade:Z, *pTdLriL1�. Material of construction: _2jconcrete _metal _FRP_other(explain) Dimensions: MO a gp1 Sludge depth: Co" Distance from top of sludge to bottom of outlet tee or baffle: `6° Scum thickness: (o rt Distance from top of scum to top of outlet tee or baffle: 10�' Distance from bottom of scum to bottom of outlet tee or baffle: %6'% 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.) Z4*V�- hUcA!1s 'S 1iNTIAtT '.3 . 3"u ��v Q -A GREASE TRAP:_L-b (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 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:',?r6 C�� 7" u Owner: _a- L�yLt� 11 Date of Inspection: TIGHT OR 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:kNj (locate on site plan) Depth of liquid level above outlet invert: 4Jo�l�►+� Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) ��X —ZoX ��R-�b�i�ttow� `stiv�ld $va�.vL�: oF—Sc�\�� C . cye.XC tJc��v�O�sLSZ� a� PUMP CHAMBER: LX> (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: 71-- Date of Inspection: �1 SOIL ABSORPTION SYS77``EEM (SAS/) U C5 (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:2• ("Y y p•� leaching chambers, number:_1 leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of v�eg'eta�n,etc.) CESSPOOLS: Q-X> (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.) PRIVY: �3a (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:? /- Owner: �� L.C�IZ c&,�� cQ� Date of n�spection: O S jZ SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' ' Z t .0 K2 Y,�- L1`{' R3- Sao t�3- toO` INS 9- DEPTH TO GROUNDWATER Depth to groundwater: feet method of determination or approximation: c (revised 11/03/95) 9 Page 1 of 1 TOWN OF BARNSTABLE LOCATION �� Q w ` — gA SEWAGE# VILLAGE ��, ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMPTDATE: 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) y J,�� Fit 7 Furnished by )h. ae 9 Z 1 k 0- 62 u A3-9t h4., 1,11 8q- �v6rt 6w FtS.540 n5- G4 http://issgl2/intranet/propdata/prebuilt.aspx?mappar=310299&seq=1 11/22/2013 t TOWN OF BARNSTABLE 9 LOCATION ke-y SEWAGE # '2-�j?- VILLAGE ASSESSOR'S MAP 6z LOT INSTALLER'S NAME 6z PHONE NO. t ��v Cv 4PI SEPTIC TANK'CAPACITY LEACHING FACILITY:(type)� 6A_ L (size) NO. OF BEDROOMS-PRIVATE WELL OR PUBLIC WATER BUILDER OR 0WNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: G o VARIANCE GRANTED: Yes Nod D ♦� /' � � •..,;J � � �� - � �— ; I �� -- ._.._ a n �n � �. �� ` � �� ' e � ... �. $ ' THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Town.................oF.....-.Barnstable --------------------------------------------------- ApplirFatiun for Disposal Works Tonutrar tiun rrmit Application is hereby made for a Permit to Construct ( ) or Repair (X ), an Individual Sewage Disposal System at: 88 Quaker Road Hyannis 88 Quaker Road ................-........_...................................................................... --....------.....---------------....------------------..........-•----------------------.......... Location-Address or Lot No. .....s�4Ylx)...�Ir .t......... -•-----•---------------- P .0 Box W Chatham - --•.....- -•---....5_7.�... ... - - W Arthur Sears & °ons Inc 313 Hokum Rocrd. Dennis, Mass ,-� .............•.......------........-•-•--------------------........------•---•-.....------------.. .......---•----------••••-----•-•----•---•---.............--•--•.........................------... Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures -------------------------------•---•---------- W Design Flow............................................gallons per person per day. Total daily flow--------_...................................gallons. W Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth......:......... x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by........................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit------------- ....... Depth to ground water------------------------ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 04 --•-•----••------•--...-•----------•••-••-------•-••••---•••••••-•••---------------•........................................................................ 0 Description of Soil........................................................................................................................................................................ x w x Installation of 1500 al . U Nature of Repairs or Alterations—Answer when applicable.............................................•............_._.......-_........_tank., .....C2.)----6QQ-_LP...W1.2-p--•OX...at. -�•e-'------•---...-•-••-•-----••--•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iII= 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Date Application Approved By----------- l-,��"``-� `'��- ``. •..........................•------ ........... Date Application Disapproved for the following reasons--------------------------------------------------------------------------------•----------------------......---- •---•---...---•----•.......•------•-•--•-------------•••-•--•-------------....._......--•----••••--•----.-••-••••----•-•--•---•--------•-----------•--•-•-----•----•••------•••------------------....... Date Permit No.---_----_ $..- `�t .. Issued....................................................... Date No...........�6....... FRs...... ....'.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town. oF........Barnstable Appliratinn for Uiipnial Workii Tonstrnr#inn Errant Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal System at: 88 Quaker Road Hyannis 88 Quaker Road ................-................................................................................ ----•-•----------------.......-•-•--......------....-------------••-------•-•....------......--•-- Location-Address or Lot No. .....JohnWright............................................................. P .O . Aox529..--- ... Chatham.......-----.....--- . . W Arthur~ Sears & Yis Inc 313 Hokum Ro6lf"Rd . Dennis, Mass ,-a -----------•------------------•--.....---...----•--•---•-•--..........-----.......••-•--....------ .........----------..................................... •----....__...........-- Installer Address Pq UType of Building Size Lot............................Sq. feet .., Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) a4 Other—T e of Building No. of persons............................ Showers —Type g --------•------------------- P ( ) — Cafeteria ( ) dOther fixtures ...............•--------•----•-----------------------......---------•--------------•---------._....----------------- ---------•- W Design Flow............................................gallons per person per day. Total daily flow........................................:...gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth....... x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.................... P4 --------•----•-------------------•-----------------•----•----------------------•---••---•----..........---....--•------ 0 Description of Soil........................................................................................................................................................................ x U --------•-----------------------------------------------------------------------------•-•-••-------------•---------------------•------•--------------...------------------...----------••-----------... w ------------•------ ........................................................................................------------------------------�--••--------•--f------------------••-------------•--------- g U Nature of Repairs or Alterations—Answer when applicable.........Installation o 1500al . t.....................................................................................ank., ---2 °f stone . . ----••--•----------------•----------------•-•---•---------•------------•-------------------•-•-••--•-------.........---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITHE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed-`�- ``.,� -----------------------------•-----•------------ t J l• ....... Date Application Approved By............. �--i"��'s-^'=-� ............. ........... -Date Application Disapproved for the following reasons----------------•---------------------------------------•------•---------------....-------------•----------.-- ................j--••----••-----•---••----------•--•--------•------------------•---------...-------••--------•---...--•----•------------------••---------------•-------------•--------•---•---.....---- Date PermitNo......---. - ................................ Issued------------------------------------------------------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH i, .. r'Via.-..t.a..........OF......... . Qom:.:.....(..................................... UTrrfiftratr of Tnntpliattrr l THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (�) by.. -"{ �''-----.....1 ............................................................................................................................... �+ Installer -A-------- - - -----r.. -•--------••----------------......_..--•---------.......-•----------•-••-•------------------ has been installed in accordance with the provisions o'ITIE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No..� ......1.. -/_&.............. dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........................ ...LQ..-L JS�-•-----••---....----- Inspector................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No.. ............ .........0 F........./� Gt:_:ta: h.(' ! .................................. FEE--- �l�..... �t��r�a��tl �-�nrk� �nn��rinn Fermi# Permission is hereby granted-------- 1r, :_ _ t..,:= _.__. s- ..._......--•----•------------------------------------------•---•-•-•--....... to Construct or Repair an Individual Sewage Disposal System V Street r as shown on the application for Disposal Works Construction Permit No `/!_:/,t,_ Dated.......................................... \.DATE................. _. �y .. ._..... �VVJ Board of Health --------�--...Li._ FORM 1255 HOBBS & WARREN. INC., PUBLISHERS �W G ACCESS COVERS MUST BE wl THIN MINIMUM. I N VER T ELEVATIONS : DESIGN CR l TER l A : GENERAL NOTES : 6' OF FINISH GRADE 3' MAX/MUM COVER 102.53 FIRST 2' TO INVERT AT BUILDING: 97.5 DESIGN FLOW: BE LEVEL MIN 2' OF PEASTONE INVERT /N SEPTIC TANK: 96.75 4 BEDROOMS AT 1/0 G.P.D. PER I. THIS PLAN IS FOR THE DESIGN AND CONSTRUCTION OR F l L TER FABR l C I NVER T OUT SEPTIC TANK: 96.5 BEDROOM EQUALS 440 G.P.D. OF THE SEWAGE D l SPOSAL SYSTEM ONLY. 4- DI AM PIPE INVERT IN DI ST. BOX: 96.27 DO " - l l/2" O I A. NO GARBAGE GRINDER 2. VER T I CAL DATUM IS ASSUMED. FOR BENCH MARKS 0 0 {bB � DOUBLE WASHED STONE ` INVERT OUT DI ST. BOX: 96. / SET. SEE SITE PLAN. 97.3 - � 6 96. l 12" �� 96.75 s su-Fla�$.'v 96.D �' 95.0 INVERT IN LEACH CHAMBER: 96.0 10006 500 0 SEPTIC TANK REQU I RED: 2 COMPARTMENT 3 OUTLET 6 LC-6 LEACHING CHAMBERS BOTTOM OF LEACH CHAMBER: 95.0 440 G.P.D. X 200% - 880 GAL. 1st COMP 3. ALL CONSTRUCTION METHODS AND MATERIALS AND �0 W/3.5' STONE AROUND. 10'w x 50'1 x l2'd ADJUSTED GROUND WATER: N/A MAINTENANCE OF THE SEPTIC SYSTEM SHALL D-80X 440 G.P.D. X IOOx - 440 GAL. 2nd COMP ' 1500 GAL OBSERVED GROUND WATER: N/A SEPTIC TANK PROVIDED: 1500 GAL, 2 COMP CONFORM TO MASS. D.E.P. TITLE 5 AND LOCAL 2 COMPARTMENT 6" CRUSHED STONE OR 'BOTTOM OF TEST HOLE #2: 87.9 BOARD OF HEALTH REGULATIONS. SEPTIC TANK COMPACTED BASE SOIL ABSORPTION SYSTEM REQUIRED: PROF l L E : NOT TO SCALE DESIGN PERC RATE C 5 MIN/INCH 4. ALL SEPTIC SYSTEM COMPONENTS LOCATED UNDER 1 SOIL TEXTURAL CLASS - I AREAS SUBJECT TO VEHICULAR TRAFFIC OR GREATER j V EFFLUENT L OAD l NG RATE - 0.74 GPO/SF THAN 3 IN DEPTH SHALL BE CAPABLE OF WITH- 440 GPD / 0.74 GPD/SF - 595 S.F. REQUIRED STANDING H-20 WHEEL LOADS. i PROVIDED: 6 LC-6 LEACHING CHAMBERS 5. ALL SEWER PIPE SHALL BE SCHEDULE 40 PVC OR W/3.5' STONE AROUND. A-620 S.F. APPROVED EQUAL. 620 S.F. x 0.74 - 459 G.P.D. j 6. SEPTIC TANK AND D-BOX SHALL BE REINFORCED PRECAST CONCRETE OR APPROVED POLYETHYLENE. SOIL TEST PIT DA TA & BOTH SHALL BE WATERTIGHT. D-BOX SHALL BE WATER l NO 1 CA TES �_ l NO I CA TES TESTED FOR LEVEL WHEN THERE IS MORE THAN ONE PERCOLATION --- OBSERVED OUTLET. TEST GROUNDWATER UP�\ 7. BEFORE CONSTRUCTION CALL 'DIG-SAFE', CATCH sasrN \` TP #1 P#14237 TP #2 1-888-DIG-SAFE AND THE LOCAL WATER DEPT. 0.\\ HORIZON TEXTURE COL OR HORIZON TEXTURE COLOR 98.9 FOR LOCATION OF UNDERGROUND UTILITIES. \� LOAMY IOYR LOAMY IOYR 8. SEPTIC SYSTEM INSTALLER SHALL NOTIFY THE \ SAND 2/2 'Q SAND 2/2 DES 1 GN ENGINEER TWO DAYS PRIOR TO CONSTRUCTION \� S 88e45'00"E 5" - - - - - - - -- - - - - - - - - - - - 98.5 9" - - - - - - - - - - - - - - - - - - - - 98.2 141.78' OF THE SYSTEM TO ALLOW FOR SCHEDULING OF THE a\ p I B SAND 5/8 L OAMY IOYR D LOAMY SAND 5/8 IOYR CONSTRUCTION INSPECTIONS. ' 30- - - - - - - - - - - - - - - - - - - 96.4 26" - - - - - - - - - - - - - - - - - - - - 96.7 +ioo.s �� MEDIUM IOYR MEDIUM IOYR 9. EXISTING LEACH PITS TO BE PUMPED DRY AND - _TELEPHONE EASEMEf�T _ l SAND AND 6/6 l SAND ANO 6/6 BACKFILLED. 8M. CORNER STEP\ \ GRAVEL ORA VEL \ \ /0. ALL UNSUITABLE MATERIAL (A & 8 HORIZONS) / L\02.4 \ +99.4 /\ ENCOUNTERED BELOW THE INVERT OF THE LEACHING lsoQ cALtoa j TELEPHONE EASEMENT_ 60" FACI L I TY TO BE REMOVED FOR A DISTANCE OF 5' ry 2 COMPARTMENT _ AROUND AND REPLACED WITH SAND IN ACCORDANCE SEPtIC TANK _.._. :Wl.TE1_T1IlF OAKExl Z V \ ¢ TANK LNG - -. I20" 88.9 132" 87.9 \ LOT J 7A I BED .• �\ ,',' � � o NO WATER NO WATER d \ 13. 486- S.F. �'OOM _,.•.• :.�-.• � �, /0) OAK , _ - O h DATE: JANUARY 6• 2014., 100_Ffi r TEST BY: STEPHEN HAAS -- L L EACH � e i \ 4i �••• KA14 / h I 0) WITNESSED BY: DONNA MJ�O`RAND/ " 101,o ••• .. D-BOX PERC RATE: .. ,2 MI.N/I NC!! 'OR/ LEACH � .. � ,Y6' f• PIT OAK 100.7 i 6 LC-6 LEACHING CHAMBERS / W/3.5 STONE AROUND oot- N OAK 49 �1 l TP#2 40•� 141 04. OAK\ '/ S �EP T I C S Y',S TEM DES I ON 85 - 88 QUAKER ROAD MAP 3 / O . PARCEL 299 /L/ BARNS TABLE CHYANNI s ) MA PREPARED FOR : • LEGEND ■ CB CONCRETE BOUND R I CHARD E� L V V ROUTE 28 -W WATER L I NE! GO HYDRANT SCALE* : I 20 ' FE,BR UAR Y l 2 . 2014 W -G GAS LINE mFgs QQ F OHW- OVER HEAD WIRES S T E P H E N ' A . H A A S -0 LIGHT POST UNDERGROUND ELECTRIC LINE ENGINEERING , INC -T- UNDERGROUND TELEPHONE L I NE 9 2 3 Route 6 A -CTV- UNDERGROUND CABLEVISION LINE � ��., 'l�� \ Yo rmo u t h p o r t MA . 02675 +40.4 SPOT ELEVATION ( 508 � 362-8 1 32 _•._.••.40-•••-__ yjEXISTING CONTOUR LOCUS MAP 0 10 20 40 40 PROPOSED CONTOUR JOB NO: 13- l15