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HomeMy WebLinkAbout0092 WINDSHORE DRIVE - Health 92 WINDSHORE DRIVE, HYANNIS A= 271 156 i 1 II TOWN OF BARNSTABLE I LOCATION �,2 //I �02(i P/2— SEWAGE# VILLAGE (40 n d/S ASSESSOR'S MAP&/_PARCEL INSTALLER'S NAME&PHONE NO. )PaG�� fbe SEPTIC TANK CAPACITY /D D LEACHING FACILITY.(type) NO.OF BEDROOMS OWNER PERMIT DATE: k2 r & COMPLIANCE DATE: 3/ / 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 OQ � � I'� �� COp �1J W N .� � � � ��� {. 10Pq64 t, FgKa) r?--�7­93� 4011 No. M's I be Sc a_ Fee too THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 0�15PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes -N ZippYication for MisposaY 6pstettt Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. c?A (,vi„�w� mz� pp Owner's Nye,Address,�gld�'T�.No. Assessor's Map/Parcel Installer's Name,Address,And Tel.No. Designer's Name,Address,and Tel.No. 10n f t shX4L w qD Ynttm s-T 64- Sv vV C- r_p13 zd,,— i z 9 Spa Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building f AouSP No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3_0 gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank 000 Type of S.A.S. Alt Qd tcUC Description of Soil Nature of Repairs or Alterations(Answer when applicable) A4ZO %D Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. " Qne,d Date Application Approved by 0 Date Application Disapproved by Date for the following reasons Permit No. ' Date Issued �� (AZIA14L 4 No. :. H ✓ll� `--'C.r U ' t Fee I(7t THE COMMONWEALTH OF,MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION = TOWN OF BARNSTABLE, MASSACHUSETTS Yes t Y • � application for BtsposaY.6pstettt construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑lr'rdividual Components Location Address or Lot No. c�� (v f„�/ 1 t7Q Owner's Name,Address,an L Tel.No. Assessor's Map/Parcel 11 Installer's Name,Address,lZd Tel.No. Designer's Name,Address,and Tel.No. 04 F5hZ& q4h ytrrtm, f"N 64- s'vKVZy IVV� Type of Building: r Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building 000SP No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd ' Plan Date Number of sheets Revision Date Title Size of Septic Tank ►f}p0 i Type of S.A.S. ' �q QukLK 4i S ,U-E(h/14JA_s Description of Soil 1- 1 • t Nature of Repairs or Alterations(Answer when applicable) ����2 0� p 40 gp(,,L- Y f Date last inspected: ' Agreement: I 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. 2;ned Date t Application.Approved by ! Date IV Application Disapproved by Date for the following reasons i Permit No. "'" 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_P,6&-C � S�, at �� ��,©/I p r7 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit Now/ da ed ' Installer_ �p 40&_,d Designer #bedrooms — / Approved d ' riff 33.z gpd h The issuance of t is pe it shall not be construed as a guarantee that the system 11 tion as desi d. Date 3 Inspector r f 141 T- _ ----------------- ------------------------. ------------ - No. f/, Fee-1_r �� THE COMMONWEALTH OF MASSACHUSETTS T PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Bisposal *pstem Construction Vermit Permission is hereby granted to Construct( ) Repair( v� -Upgra e( ) )0 Abandon( ) System located at � C b i � ) 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 b comple&d within three years of the date of this permit. Date Approved by i f Town of Barnstable '"E r° ,; Regulatory Services �. Thomas F. Geiler,Director BARNSFABM ' MASS. Public Health Division 163.q. Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: Nt� Designer: `4 5 4 Install Address: �� T , 1�— Address: C'Lt Z�G3 On 3-Z ' `� was issued a permit to install a (date) installer) septic system at ��11�ds�yY, AP71 W based on a design drawn by . (address) l � 1�l- . �` a�e� dated - 2"1 (designer) Z-St> tw!v 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 ti distribution box and/or septic tank. 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. pA of MgSsgcy E �o DAVID �N D. (Install s Signature) o FLAHERTY, JR. N No. 1211 STEk S'4NiTAR1P� (Designer's Sign tune) / (Affix Designer's tam( Here) PLEASE RETURN TO BARNSTABLE PUBLIC HALT$ DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Desiper Certification Form Town of Barnstable P# 3 a f Department of Regulatory Services ` Public H> ealth Division Hate o � MAM 1639. �� 20U Main Street,Hyannis MA 02601 plFO S a { Date Scheduled Time /!j n1 Fee Pd. f d/> _ soil'suitability Assessment for Sewage Disposal Performed By: �i� Witnessed By: 01MJJ.ILU OCA ION& GENERAL INFORMAT N Location Address Owner's Name L 07 O/ Address ,��1/�.✓G� Assessor's Map/Parcel: 2'71 1,5-6 Engineer's Name 1 7 Z� VAL l �� Oi't'!,� / NEW CONSTRUCTION REPAIR fel.-f Enef. r�'��-3G/V Gp s2?- ?Gw - Land Use l / . �� �� �Slopes(R6) Surface Stones Way N�,fi►�L av,L Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well r } �► j� Drainage Way g Property Line l ft Other__�; GZ�%�Z SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) lV i i Parent material(geologic) ✓�� ; Depth to Bedrock = Depth to Groundwater. Standing Wa r in Hole: �v'` C Weeping from Pit Fnce ' .Estimated Seasonal High Groundwater z ' /Z � DETE] NATION FOR SEASONAL HIGH WATER TABLE Method Used: � th Observed standing in hole: In. De to.Soll mottles: in, Depth ing from side of obs. In, GroundAdjustment ft. Index Well# Rea ' ate: In a Well level .� a AdJ,factor\_Adj.Groundwater Ix pl R � PERCOLATION TEST Date] '° '! 'rime Observation �J Hole# 1 Ar �'p/�-e Time at 91, _ Depth of Pere Time at 6" Start Pre-soak Time ' ! Time(9"-6") End Pre-soak .0-e > Rate Min.Anch n t Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 1001 of wetland,you must first notify the. Barnstable Conservation Division at least one(1) week prior to beginning. Q:\SEPTICIPERCFORM.DOC . DEEP.OBSERVATION HOLE LOG Hole#De pth from Soil Horizon Soil Texture Soil Color Soil Surface(in.) (USDA) (Munsell Other Mottling (Stnucture,Stones,Boulders. orrg_i_stenc%96 vel)_ �►,� Oa�7 ZZ" :: C-E � �D R �,L � la v r�✓ c Z C� ( 2.5 Y 4 DEEP OBSERVATION HOLE LOG Hole#Depth from Soil Horizon Soil Texture SoirColor Soil J' Surface(in.) er (USDA) (Mupsell) Mottling (Structure,Stories,Boulders. onsis en % ra 1 Yam" pr h n ea'Cc� DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other (in.) (USDA) (Mupsell) Mottling (Structure,Stones,Boulders. 1t DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. consistency, Flood Insurance Rate Man: 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 peryipos material exist in all areas observed throughout the area proposed.for the soil absorption system? f If not,what is the depth of naturally occurring p rvious m4erial? Certification Q I certifythat on //S� (date)I have assed the soil evaluator examination approved b the ) P PP Y Department of Environmental Protection and that the above analysis was.performed by me consistent with . the required trainin , per' e n e hence described in 310 CIVJIt 15.017. Signature D�t�-� Date g --� Q:ISEPTl0PERCPORM.DOC 1. 0`CATION 92- SEWAGE PERMIT NO. POE VILLAGE r�eiA wtiP-s IN.STA LLER'S NAME & ADDRESS BUILDER OR OWNER DA T E PERMIT ISSUED DATE COMPLIANCE. . ISSUED 7f- S ' cr �� THE COMMONWEALTH OF MASSACHUSETTS BOAR® O�FL HEALTH 4719 .40...........OF........... Appliration for Disposal Works Tonotrurtion rautit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at .. ✓ ,. ......49�•--•............... ........ /, ,�ta .f' - ......... �r ation-Adams or Lot No. G Owner ............................................Address Installer Address Type of Building Size Lot.. ......Sq. feet ,., Dwelling—No. of Bedrooms......3................................Expansion Attic ( ) Garbage Grinder Wa> 'rL,_l Other—T e of Building ............................. No. of persons............................ Showers — Cafeteria Other fixtures .1- 4me------------------------------- W Design Flow................ ...�r. ......._._....___gallons per person per day. Total daily flow.............. _-------.._----_gallons. WSeptic Tank�iquid capacity-/gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No.................... Width_...._ ._._.,.._._. Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.1 _ DiameteLVewe-Y 1pth belo}�' inle ...... ........... Total leaching area._�f� ;7.sq. ft. Z Other Distribution box ( ) Dosing to ( dG " 7 ' 1'4 Percolation Test Results Performed by......... .........4:� _/!a-e....... Date.....:.I/_-.;?-77 ,� Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ rZq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground.water........................ a' ........... -•------ ................... . r�, r Description of oil.. V �a.-.. ..`3�_. lt� .e-r'l K t9f--------- 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 TI'i M' 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. Sign. . - � Date Application Approved By........ j-- ..... ....................... ...../_Z-... -,9—.-77.--- Date Application Disapproved for the following reasons:-----••--------------------------•----------------•--•------•-------------------•--------------------- -------------------------------------------•--------•--------- Date PermitNo......................................................... Issued_.........................................................Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH dA.............OF........ ✓ ., .._. ..................................... J%pplirtttion for Dispuiitt1 Works Tonstrurtiun famit Application is hereby made for a Permit to Construct ( ) or Repair ( )fan• Individual Sewage Disposal sy • .� � 1 ................................................. t�n A or Lot No. C . .r ,Z Owner Address .....---•- ff`d_-` -....... : r+�4,..................................... Installer Address U Type of.Building ; , f Size Lot.��®�........Sq. feet Dwelling=No of Bedrooms - -------_ ----_-.. Expansion Attic,( ) Garbage Grinder a0ther'Other, Type 4T,,Buildiiig ... No. of persns .. Showers ( ) — Cafeteria fixtures ±-------••-----•••--••----•-•--. --•----•--- ••• •--- ------------------------•--------•---•------..........-••••---••--•- W Design Flow.......... .. ...........gallons per person.per day. Total daily flow............ '' _---_--.-_--_gallons. WSeptic TankeLiquid capacity- W.gallons Length................. Width................ Diameter.............. Depth................ x Disposal Trench No ......... idth _�� Total'Length.................... Total leaching area....................sq. ft. Seepage Pit Naf _ . Diame ...€ ' epth below inlet................... Total leaching areak�_�.--sq. ft. Z Other Distribution box ( ) " ` Dosing tank ( f�. / //-��►^' ' Percolation Test Results Performed by..___.__._. .�,_ Date_s? ^' `77_.......... ,.� Test Pit N6.`'l................minutes per inch Depth of Test Pit.......... ___- Depth to ground water........................ fi Test Pit No. 2................minutes per inch 'Depth of Test Pit..... ............. Depth to ground a ; ! water.--______._-_---_____. w� r O I_Description of Soil - t-> �" 6 .._......._. x Nature'of Repairs or Alterations—Answer when applicable__________________ Agreement: x : The tmdersigned agrees to install the aforedescribed Individual Sewage Disposal.System in accordance with the provisions of TITLE . 5 of the State Sanitary Code—The undersigned further',agrees not to place the system in operatidn until a Certificate of Compliance has been issued by the board of health. Date, . Application Approved BY % C:�- �G ' 1 � �.L.. Date � +� Application Disapproved for the following reasons---------------------------••------•---------------------------............................................... w x' F.4 . ... .• ........................:.................................................... _.._._.._..__.. _..}� ..........................'.. __... ..T ........... Permit No............................... -•--•-•-•-..............-......---. Issued..------ ....................--(�-'-------------- Date THE COMMONWEALTH OF--MASSACHUSETTS M BOARD OF HEALTH (Entif"tratr of Toutp ittnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( ) by -- ............................................� � t < < ••.. ..---•............................................................•--•-•-•-•--...-- ats . ' ''dl l� ! t -- --- -----------------------•----....----.•.......-•--------... _ 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......................................... ............... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY DATE..... Inspector_:.. ----------------- --•---•---------------•-.----- y... THE COMMONWEALTH OF MASSACHUSETTS �.r BOARD OF HEALTH ... �'* ............._OF... , '/'° ............................................... �, d..+ 19iipttsttl nr w (gnngtrnrtivit lamit Permission s hereby granted.................. .... :.: ........ ram. ............................ .........•-•-••••......----•- to Co tac or Re air ( ) an, �.ivldual SewageA p s S tem Street as shown on the application for Disposal Works Construction Per 't No... Dated....__.C_2.,!!.....'7 .._........ ........•• ............................................. - � Board; ealth FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS Uv C�Aresn�E vrzl�tv�sL _ L'adl Lam( >`L.,oW n 110 +c 3 + 33b G.P•D, ... Is 1 -t c -I-�►c 33ov IS % • 4-95 6.P.0. t• • use t 000 6A,L . ; SPOSA�- PST usE IC> Gam.. :.: I�jo SF >,c 2.S + 37S G.P.D. .. � •�' /0�� ToT'QL. 1:>G6I6W • 25 G.P.D. %AO NII�r tl• I ' a r_ I [ 4 t bT•A L Tjlsl L�� FL nW *' t .'; � �k f ,r r r., • :. I PVfZ1C-DL&TI0f'.1 QATE `11IQ th111:1'OQ LEyS ... 0. e� 1 ! i. � tiyY, /11� + 1f1 p,.74i `E � ; } �i i � �•j . • " �� i 4 � � 1 { it S,.r. + ' ? I tt s� i j �tN OF r;q -4 WVI ILLIAM GN, ` I' o� ALA J 40 H .41r.t f,p No..19334 fi �V�yp sux� i ' -J(J(1s. �•�'l? I `` t + F •.i �«"��• '.:__ //� /�� � ;�T .. /•.N1 ''CST` ' '\' / �/ I•'P/�t. 4rAVA �. IW. . 6A.1..-Box sepnc ` WV TANK ! ! S •. t 1 SA,vDy , Hwyy ' GAI.• r r t PIT Ja. .1.� ' '. i_ i. it 1 �. ., .i ,•/ .F. Y [ .' t'. � .` i.` k/ITa.i I 1. a. � i � _r � _'. ! �• i`_�...:6 � t , I`8 WASHED i SAwA C - ZTIF1ED pLC>-r PL./SIJ { LOCAT1af.J I-1 (A1.� NIS; -/ u s��,� cn� - t Jt5 uuTE�. a 12.21 ` - _. t TWA b' -I- '7. 1 Ct�t2-rl1=if T1-(A-r- 1TI-1G {� IZ.OP VkAJELLSuowu i .^� .. t %4V--2GC51-1 Gc�PLk(G W I'1.1-1 rwc-- -jIDE..uwG-- p 'z( a , I 'AWD �A UI�EMrLl OF THC.' SE'r L t tG L�4 TS -ro w u or=- C3 p,R.1J 5`m• L Ic► . L C . "3 ,;ATE 12��� . - . ..�' _ `_- e,�i x-rc►�.j-�.T u�� I�G: ; •.� ' Ic2cGIS rclz�v 1- wo ! 5oevayotZ,S TI- I'S 17LAW, le, Oc),r BA-sev ' v"' A&J.( � OSTEfLV1l_t.C� o; I�fASS• A.PrpLi �CE r:.. r.i.��.�...�r.r...... tA:�'1.41t .. a_... ��es ! r./.. x�� a a♦ - _ 11t7 4t•nt X:;); va-rAl mat L� FLOW %10 4 3 • 33o Cm.P-D. ;.,.y,4 _.3,-�.€•� -Ses—nc TA�aC = 330,. ISO % • 4q�6.PD. i f USE- 100X-`) 6AL. POSAL PIT - test= loco Gam-. Q //S',2 61I -',Me"/ALL AVE-A _ ISo s.P. ISo SF �c 2.5 * 3'15, 4s.P.[7. So 6-p-v. i�o. ?��, �I►J d• ' I ' i , l.` s' TarAL -DF-Sl6w • 425 Tt�ToL �alL.�( FLDW * 33D cS�PD. o,t a r � l a Mip `� r,, v�rzcoa.eY►o�1 tze-r� ; '�„aU 2ht1 W' oa Lx-- °' j � ski • /`��tH OF At I 1,� WILLIAM ALA,V ? .t / ! 1 L r y N Y E- rn ! �, Jot No..19334 F � fir• ' ,. 4,C �i I4 ' / � •• ,i � 4 i r C� '► IWI'PMs' - .1,.. I ' f . `...r �: W� t �t I Poe luv• { �wlllc fa •1J,;r. IW IGGb /Z I .� ANK SANDy IOoo iuyy t_ GAl-. 9(i.Z FiT � + �_ F { r i,i j.. •� C �_ :?.. -/r s r .! ! e 8 I WASHED r ; ,. ON t t I , ..� f.o___.. . [ 11t , 1- f I SAwA , I i { CEIZTiPiELU pLtb`t' -1 L. t r. L ocATi o" N`��A►� N I S I�aS� : ' '- I .2,2� ' V WA { , ,C GGtZT11=� TI-(AT' .T14r-- iP �jP, VUUEZLS&A0'%u1J j � ; PLAa.I TZ����LE�^ �� ,�%4ZRt;!nw Cc�PLYS W ITN T1-C--- 51D�..L1►-ate SE'rl;n�K X'c4�CQE/vcrl.�Ts o� TNt:. 'ro w IJ o1�- �Q.R.1.� 5`TA. L tc r � I BQXTCtZ ft �t2EGlS�[Ltz�D 1-AL/G. ` 5U2v�Yd..s. C?C .Ai.-j IS �10T, OSTE2�%1l_lG �IJSt-a2tJM Et:IZ' ;u Ti4c-.: 01=p-,5 , ,'SI40tja.a I •� at~ uc __.:.ra eMl i s7 ajA - rnny nr euW�r"�. Y ti4rr5-+� - 11:)t+l JMT rJ 1-6C•7I Of i '�` f. - ;s.itr"�r'rf'r°"A.''.,y,,.,!'�1 p""'c'.,.rurv�'RiP"yeF��a"�;y'^",rb�g?"'q"�'Fn`3y*y;P!rT,t", A�M' "'DMv,*'iR•��AzfLt�9._n "F:Q alv,'AIC<r rR,�. r="L�`y' ,. TIGER HOME -INSPECTION INC.° �r PrfhE THE EYE OF THE TIGER d 969 WASHI,NGTON STREET 7 ' BRAINTREE, MA 02184 ' 617-849-0088 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM TITLE 5 INSPECTION FORM Address of property 9'Z W_-,oi�7SNoti_4E: )SA_. t�Y,�-,�n,�� _ MA Owner' s name �SE�i �ax�11L Date of inspection �� 9 r PART A CHECKLIST Check if the following have been done: ✓ Pumping`- information ws$ aquestedo ft wner, occupant, and Board ofae Health. V"' None of the system components have .been pumped for at least two weeks and the system has been receiving normal Ztkow rates during that period. Large volumes of water have njot bee. intr�duc��ed into the system recently or as part of this inspection. _ �r �S, As built plans have been obtained and examined.p ..�`_I'��o��' if Zthey are not available with N/A. rc�� The facility .or dwelling was inspected for signs of sewage back-up. The site was inspected for signs of breakout. 1�ff All system components, excluding the SA P- 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 'SAS 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 SSDS. `''+r'°`'`^- r�Srrtt"'t""tp,fi,G;,.+`,.y;.�'��! '�'rt`„'+;pr"A�'p�Lrc�+ri+*r '�'�'"�"-�?''*'p"ps'P,fyq�iT '"'�r:. '�{d'e��fiYP#+`t+V!'`�i'�het7�.''�r: a, .- "�:�' ,, , '�,tr��-"•- z?i:3. µ,rya"• evw.,r: 'G" - r T.PGaER HOME INSPECTION INC.° { HIRE THE EYE OF THE TIGER. e; ' -- -- 969 WASHINGTON STREET } BRAINTREE, MA -02184 - 617-849-0088 - 8 SUBSURFACE SEWAGE DISPOSAL^ SYSTEM INSPECTION FORM _ PART B SYSTEM INFORMATION / Sf FLOW CONDITIONS If residential 3 number of- bedrooms o ers of .`,current, residents. i - j garbage",gr'ind`er; y-es; or no laundry- connected .•to system, ,es r no e55 seasonal use'` e -r no If nonresidential, • calculated flow: water meter-readings, if• available: r4-ce ,' 9•{ US�C ` r 3� _S Last date. of occupancy V 4 "Z '. GENERAL INFO; LION.'' . Pumping records and source of information: , >S } as System pumped as part of inspection, yes o no if yes, volume pumped Reason for pumping: -', Type of system w Type tank/distribution box/soil absorption system r ' 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. Source,, of information: 1 /JO Sewage odors detected when arriving at the site, yes o no �,�7"».i'u'""��n;�;�t?r�(�.+t+ �7�!"ref'*�/�f'* �2Ms+l� i�'�Tf�+7�bn�iv2�r�f`�iai'�'��•`-�' �►. +�T�`� fs +�°i" `�Vs'Si�'��^ �+s�'1��dr�:�t i =TIGER HOME INSPECTION INC.© " HIRE THE EYE OF THE TIGER 969 WASHINGTON STREET BRAINTREE, MA 02184 9 - ' 617-849-0088 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B P f SYSTEM INFORMATION continued SEPTIC TANK: ✓ E' (locate on site plan) depth' below grade: 1� material of construction: -1zconcrete metal FRP other(explain) dimensions: y x'A x 8 LZL'sludge depth: fit,, distance from top of sludge tc bottom of outlet tee or baffle I' scum thickness zV" distance from top of scum to top of outlet tee or baffle 3" distance from bottom of scum to bottom of outlet tee or baffle f 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, recommendations for repairs, etc. ) K �� �, l�� /U�•r fZ�ct.r�-.��.��.- ���.,L-r N.9io �_a.rsi ,�t�r�`^ �-rrr.��xu� `r�'z.��,c�t9 DISTRIBUTION BOX: ';. , ,,,,_ .,locate on site plan) _ " depth of liquid level. above outlet invert "'+� sue• �__ Comments: (note if level and distribution is equal, ev;idence .of solids carryover, evidence of leakage into,yor. ,out, of box,, recommendation for;.repairs, etc.-) PUMP CHAMBER: (locate on site pumps in working order, yes or no 4 Comments: (note condition of pump chamber, condition of pumps and appurtenances, recommendations. for maintenance or repairs,etc. ) � rMrll#, ^4�r!k�+�r +racr3di'��c+x���+e�'# �+ ' �i'�r'+�"tY✓�t�"+�seA�'^r�°ti'44i !4'��•lra�a+}� `�'.�',6d#i�„ ,•,,��'5,6�{y,�s�.,;,s`._„�.��'1 TIGER HOME INSPECTION INC.( HIRE THE EYE OF THE TIGER 969 WASHINGTON STREET 10 BRAINTREE, MA 02184 ' - 617-849-0088 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART 8 F M SYSTEM INFORMATION continued SOIL ABSORPTION SYSTEM (SAS) : V / 3 (locate on site plan, if possible; excavation not required, but may be x ;approxim4ted by non-intrusive methods) If, not> determined to be present, explain: leading- pits and number leaching chambers and number leaching galleries and number /9 leaching trenches, number, length 013 leaching fields, number, dimensions o overflow cesspool, number 42 Comments: (note .condition of soil, signs of. hydraul>ic .'failure, level of ponding, condition of vegetation,� recom,mendations;for maintenance or repairs,etc. ) CESSPOOLS (locate on site plan) . number and configuration , depth-top of liquid to inlet invert j 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) f # Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs,etc: ) p` PRIVY: (locate on site plan) r materials of construction : dimensions ` depth of solids Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs,etc. ) . r^1i?��+ `-'wr."P�;"�+it '�f� '�4it'K``,�a.'�.'�,�� r' ", 'A:'� �i�'�, .�, �n�'�'a T'•*-.,,, ,.,�•-4�w.,�c, �sXsro[ - ram., O�t TIGER HOME INSPECTION INC.° HIRE THE EYE OF THE TIGER 969 WASHINGTON STREET 11 BRAINTREE, MA 02184 - * 617-849-0088 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART .8 SYSTEM INFORMATION continued x SKETCH OF MEWAGE DISPOSAL SYSTEM: include ties to at least two- permanent .' wo permanent references landmarks or benchmarks locate all wells within 100' Gm o z11© O fi 4 � f 3ey ya YET DEPTH TO GROUNDWATER lo+ depth to groundwater method of determination or approximation: t AJO St /Yi1t 1��T QR 71 J M r� ^S.J M s.1T & E&-,. s jf2.aa&I Tn �tde9lL l kt�"Ev�•�+��bka.�R-��+'!'�"+3�ra�t 'rt���4��`v"',�+�`�i�-�'4`������"�f`tF"�+°'`'`; `���+'i��•M,�i�s°"',p'+�11 bfr'�3�%''� ° `�'` ��ti*�` =' 1,eTIGER HOME INSPECTION INC.° HIRE THE EYE OFTHETIGER 969 WASHINGTON, STREET. BRAINTREE, MA- 021184 -'` 12 " 617-849=0088 SUBSURFACE .SEWAGE DISPOSAL BY TEM INSPECTION. FORM ` PART C FAILDRE.. CRITERIA < Indicate yes, no, or not determined (Y, N, or ND) . Describe basis of F` tidetermination in all instances. If "not determined", explain why not) Backup of sewage into facility? Discharge or ponding of effluent to"the surface of the ground or surface waters? , M1U SSSfnJ rY l_''' _/Q Static liquid level. in the distribution box above outlet invert? r _/ ) Liquid depth in cesspool <610 below invert or available volume< .1/2 day R>„r , flow? A.)C.c $ Required pumping 4 times or more inthe last year? , number of times purr ed .-"::, I. (fie 0us�.3enSc�.m4izl µ ' me _ Septic tank is metal', cracked. . structural'ly =unsound. substantial infiltration? .substantial exfiltratian? tank failure imminent? Is any portion of the SAS, cesspool. or privy: 1 below the high .groundwater elevation? r 1 within 50 feet of a surface water? �H;cS�cAtc.�c d�t��sVfs€�j ,within 100 feet of a surface water supply or tributary to a surface y; _'wit,er s.uPPY' ' ; y i k , within a zone I of a public well? -Per, LSCt�r�svri-�' - . within 50 feet of a bordering vegetated wetland or, salt marsh (cesspools and privies only; , not the SAS) ? ITT P�c�CR�-� R; /J within 50 feet of a private water supply .well? „ ht-n._ c9wx�t^ 1> ` 4 Aj . 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 analysi�: f for coliform bacteria, volatile organic compounds, ammonia nitrogen . and nitrate nitrogen. xe H r""pro' t 1 s TE� ER HOME INSPECTION INC. r i HIRE THE EYE OF.THE TIGER ;9.69 WASHINGTON\STREET 4 a' `BRAINTREE, MA- 02184 617-849-0088 r s'r°f oo ,f. ' f 33 t i ri 13 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORD , PART D-` y CERTIFICATION . r Name of Inspector Company Name", ompany. .Address RftC M d2.d g, . ,yy Certification Statement I ,certify that I have personally inspected the sewage disposal system ;at `Kr this address and_' that the information reported" is: true, accurate and complete,•a's of the time`.of :inspection.. The inspection:::was, performed and ' any, recommendations regarding upgrade, mantenance`and repair''are }' consistent with my training and experience 'in. the proper..'.function and manitenance of on-site sewage_ disposal systems. Che�kone I have not found any information,which indicates that the- system fails to adequately protect public;`health or .the environment as defined in 310 CMR 15. 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. I have- determined that the system fails to protect public health and 1th6 envi,�onment 44s 8efimed ini 310.-'CMR 15 °3�0 j Th6" i�asis for this determiriati�on� is �pr.ovided in the FAIL CR TERIA'`s'ection':of this form. Inspector's Signature / �Date ' y 1 1`� tq Original to system owner Copies to: Buyer (.if applicable) ' Approving authority TM 41 �s li x r t: F 4 t S�. .x. eri t. � l C.11 ; E i ;4 s LOCUS DATA , CURRENT OWNER MARTHA COLLINS � / i LOT . 24 PLAN REFERENCE LCP 37666—A, 2 / / — DEED REFERENCE CTF. 16643734' ZONING DISTRICT RB LOT 25 ��526• a OVERLAY DISTRICT ZONE II - WP FLOOD ZONE "C" 250001 / Q / o \ BENCHMARK: \ CORNER OF CONCRETE BULKHEAD ' ASSESSORS MAP 271 / / 28' ' \ ELEVATION 53.00 21.8 PARCEL 156. LOT AREA 11,082f S.F. / O / ED¢#2 52 o / / w BED#3 V o �eS / CH47N c? SITE & SEWAGE BED#1 BATH _ REPAIR PLAN � �/ `O / z /' BATH 33' a 51.6 WINDSHORE DRI VE- l oNw y\/� LIVING 159 o IN / / � '� KITCHEN DECK HYANNIS, BARNSTABLE ! /-� � 52.0 D.T.H. #1 DATE: 3-12-11 / / I DRIVEWAY / / c� APPLICANT: GARAGE �,> 50.8 Ms. MARTHA COLLINS / 106.38. 7' 92 WINDSHORE DRIVE o HYANNIS, MA 02601 LOT 26 "'3 2.. NOTE: W EXISTING 1000 GALLON SEPTIC SHEET 1 OF 2 TANK TO REMAIN. EXISTING D-BOX AND LEACH PIT TO BE 2v ( 9FMAS REMOVED ROUTE 28 PREPARED BY: MASS, EAS SURVEY, INC. b-TIO �, Ji, 141 R T.. 6 A 28 Eo �� 0 20 30 40 A'��'.y LOCUS N P. O. BOX 1729 s ,o SANDWICH , MA 02563 t x GRAPHIC SCALE: PH. (508) 888-3619 � 1 INCH = 20 FEET LOCUSMAP CELL )508) 527-3600 �� � NOT TO SCALE: SYSTEM DESIGN RAISE COVERS TO WITHIN 6" OF FINISH GRADE OBSESILL ELEV, 53.69 FINISH GRADE PORT T GR DESIGN FLOW PORT TO GRADE 3 BEDROOMS AT 11� OPB/D �3A. GPD o� GRADE ELEV, 51.7 ELEV, 51,4 FINISH GRADE ELEV. 51.4 REQUIRED SEPTIC TANK ,Y O ELEV. 51.3 G OUND ELE TI 51,7 2.3 OF C T2.7' OF COVER ___3Q3c_2__ _ ____ 660 GAL, „ 18'®S-0.15 i, TOP EL V 49.00 SEPTIC TANK REQUIRED IM.9-_GAL, SCH .40. 4" PVC SCH 40 5'®S= 0.01 EXISTING S.T. TO REMAIN - 1,9QQ__GAL. 's INV.= 51.02 I49.33 10 TEE 14"TEE INV. TIE ENDS SIZE OF LEACHING FACILITY REQUIRED 49.16 6" w DESIGN PERC RATE __<�____MIN./INCH GAS BAFFLE H-20 D83 „ " LONG TERM APPL. RATE-0.74_GPD/S.F. f 4'-1" LIQUID LEVEL D-BOX SET '.'QUIK-4" STANDARD PLUS LEVEL INV.=48.89 INV.=48.67 o L SIZE OF LEACHING SYSTEM PROVIDED: "T" REQ. a. IN 48.72 •.f: 32.0' I cv o 48.00 330 _ 0.74 SF/GPD = -446 S.F. MIN. REQ. § USE (24) QUIK 4 STANDARD PLUS vi vi USING 24 STONELESS UNITS DATUM : EXISTING 1,000 GAL TANK TO REMAIN CHAMBERS TOTALING 96 LINEAR FEET I ELEV, 38.8 ATOR - 24 QUIK "4" STANDARD PLUS 48"x34"x12" STONELESS BED FORMATION NO GROUNDWATER TPIT#1 \VERTICAL DATUM: BARN.. GIS - MSLt THREE ROW OF EIGHT PANELS ) 4.73 S LF X (4' x 24) = 453.74 S.F CONSTRUCTION NOTES: ( 'BENCH MARK USED: CORNER OF CONCRETE 2 OBSERVATION PORT .74 x 0.74 G/SF = 336 GPD BULKHEAD ELEVATION 53.00 1. CONTRACTORS / INSTALLERS SHALL VERIFY GRADES AND / SCREW CAP TO GRADE ELEVATIONS AND SITE CONDITIONS PRIOR TO COMMENCING 336 GPD PROV > 330 GPD REQ. = 6 GPD RES. WORK ON THE SITE. SAND FILL IANCE SITE & SEWAGE 2 WITH NO D DEEDEID OR ZONING NATION HAS BREGU REGULATIONS. OWNER /EEN MADE AS TO LAPPLICANT NO (GARBAGE DISPOSAL GRINDER ALLOWED) IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. REPAIR PLAN 3. VEHICULAR TRAFFIC, PARKING OF VEHICLES AND PLACING o ^� MATERIALS OVER THE SEPTIC TANK IS PROHIBITED. C`�. GENERAL NOTES: �t-2.83'- --2.83'---{--2.83'� WINDSHORE DRl VF 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. D.T.H. #1 D.T.H. #2 TITLE V AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS 8.5' DATE: 3-10-11 DATE: 3-10-11 N FOR SUBSURFACE DISPOSAL OF SEWERAGE. END VIEW GROUND ELEV. 50.8 GROUND ELEV. 51.1 • HYANNIS, BARNSTABLE 2. AT LEAST ONE ACCESS POINT OVER TANK TEES SHALL BE ACCESSIBLE ITBROU'G O FINISH GRADE,1� OF FINISH SH GRADE.REMAINING ' I CERTIFY DEPARTMENT T I AM ENVIRONMENTAL APPROVED 13Y TCONDUCT NO GROUNDWATER��13,�12 NO GROUNDWATER DATE: 3-12-11 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE SOIL EVALUATIONS AND THAT THE RESULTS OF MY SOIL A A CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE EVALUATION ARE ACCURATE AND IN ACCORDANCE WITH 310 LOAMY SAND LOAMY SAND APPLICANT: UNDER OR WITHIN 10' OF DRIVES OR PARKING AREAS THEY CMR 15.100 H OUGH 15.1 7-- 10YR 4/3 8,�. 10YR 4/3 4„ Ms. M AR TH A COLLINS 4. THE E CMUST WIAVATION CON RACTORH-20NG.SHALL VERIFY THE LOCATION -- -` AT --- B B EV OF ALL UTILITIES PRIOR TO ANY EXCAVATION. ED D A STONE, CERTIFIED SOIL ALUOR LOAMY SAND LOAMY SAND 92 WI N D S H 0 R E DRIVE 5. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE + 7.5YR 5/6 7.5YR 5/6 OR WITHIN 6" OF GRADE SHALL BE MORTARED IN PLACE. ELEV =49.0 22 ELEV = 49.1 24 HYANNIS, MA 02601 6. FINISH GRADE SHALL HAVE A MINIMUM OF 0.02 FEET PER GROUNDWATER ADJUSTMENT C-1 C-1 FOOT OVER THE S.A.S. AND DISTRIBUTION BOX. COARSE SAND COARSE SAND NO OBSERVED GROUNDWATER 7. SEPTIC TANK SANITARY TEE'S SHALL BE CONSTRUCTED OF 1OYR 7/6 $0 10YR 7 6 SCHEDULE 40 PVC AND SHALL EXTEND A MINIMUM OF 6" ABOVE DEPTH TO BOTTOM OF HOLE 12 10% GRAVEL 48 10% GRAVEL THE FLOW LINE AND SHALL BE ON THE CENTERLINE AND 90" 96" LOCATED DIRECTLY UNDER THE CLEAN OUT MANHOLES. I, C-2 C-2 SHEET 2 'OF 2 8. THE INLET PIPE INVERT ELEVATION SHALL BE NO LESS THAN MED./COR. SAND MED./COR. SAND 2 INCHES NOR MORE THAN 3 INCHES ABOVE THE INVERT �IHOFMAs ELEVATION OF THE OUTLET PIPE. yam sy 2.5Y 7/4 2.5Y 7/4 PREPARED BY: 9. THE SEPTIC TANK SHALL HAVE A MINIMUM COVER OF 9 INCHES �o� D ID G�c� NO G. WATER 144" NO G. WATER 144" 10. THE OUTLET SANITARY TEE SHALL BE EQUIPPED WITH A GAS o ELEV =38.8 ELEV =39.1 E A S SURVEY, I N C. BAFFLE, 4 INCHES IN DIAMETER AND CONSTRUCTED OF 4" PVC " TY J 141 R T. 6 A 11. ALL PIPES SHALL BE SCHEDULE 40 PVC SEWER PIPE AND 4 N : 211 INDICATES DEEP B.O.H. SHALL BE SLOPED 1/4 INCH PER FOOT MIN. EXCEPT FOR THE .0 �a DTH #1 TEST HOLE DAVE STANTON GISTE� • FIRST TWO FEET OUT OF THE DISTRIBUTION BOX WHICH SHALL ! SOIL EVALUATOR P . O. BOX 1729 BE LEVEL sq I TAR P� �48„ PERCATES TEST RACED. STONE OPERATOR. 12 TOHEASES OR SURVEYEINCI�ORTB.O.HPTIC DESIGN AND DESIGN ENGIRE NEERS NEERSTIREVIEWN J 7i ( � P-1 4 RODNEY FISHER SANDWICH , M A 02563 AND APPROVAL, NO MOTTLING SOIL TYPE: 1_ PH. (508) 888-3619 13. MAGNETIC TAPE OVER ALL COMPONENTS. NO WEEPING PERC RATE: <2 MIN. PER INCH CELL (508) 527-3600 75" INDICATES ADJ. GROUNDWATER LOADING RATE: _0_74 GAL/SF/MIN 4 .� 4 .. .. - � ` .. { .i � - � W di `, _ _ r � 4 � / � � \ � i * .._ - - mac:': _ i � � , � t i r� ... i .. ! �' :` � W _ ' .. �' �' _ _ r .-F .- � i ". '. �. } . _ � � � � \ 1 � � � �5 III N ` ' c s n 1 .. ' -_ � • - �• ��