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HomeMy WebLinkAbout0113 WINDSHORE DRIVE - Health 113 WINDSHORE DRIVE, HYANNIS A= 271 138 � 1 I 0 I i I I i TOWN OF BAMSTABLE b:JCATION /3 Gt/6nG{�5�o /0Y',G �i^l11/' SEWAGE # 2d0Q—/OQ VILLAGE !� iS ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. do5Q4 de da^,a SEPTIC TANK CAPACITY /000 LEACHING FACILITY: (type) 2 SU0 C )V/�ry W/��/(size) NO. OF BEDROOMS Z BUILDER OR OWNER D,.ivlgg PERMITDATE:, COMPLIANCE DATE: 7-41 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 leachin facility) Feet Furnished by a S — e • ,bk Ntz TOWN OF BARNSTABLE LUCAI ION //3 GJ—ricU KA UILA-- k11L SEWAGE # VILLAGE ASSESSOR'S MAP & LOT.A71 -13f INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (Zze NO. OF BEDROOMS 3 BUILDER OR OWNER ��►� PERMITDATE: *%%IVCOMPLIANCE DATE: Separation Distance Between Ae: 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 TOWN OF BARNSTABLE LOCATION /l.3 "Cl6JIa'ea- SEWAGE 4 VILLAG ASSESSOR'S MAP & LOT a?Z�"�1F—.401 D*Tqi9bi!ER'$NAME&PHONE N0T4V LLdJ#*1er: =Z&ze-d !LP" SEPTIC TANK CAPACITY LEACHING FACILITY: (type) �size) NO.OF BEDROOMS --_ BAR OWNER PERMITDATE: .t % "COMPLIANCE DATE: Separation Distance Between e ° 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 TOWN OF BARNSTABLE LOC-ATION S /�,-Ore- �� . SEWAGE # VILLAGE '^.w , ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITYAtype) (size) NO. OF BEDROOMS ? PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER j-, �• 1 L. DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No vim. 4� . .. �� �� �� � 1` vim. ?( � _. (` � w' .j±; �� a ! No. Fee / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftpliCatlon for Noposal 6pstem ConstrULtlon Permit Application for a Permit to Construct(41" 'Repair QJ Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.%/3 or,i/l_= Owner's ame,Address,and Tel.No. Assessor's Map/Parcel �yW f4ls QAV%d 3�.Yrr';rsky j/ ��� Installer's Name,A40Tess,and Tel.No.S A? I/ZO �/7 32 Designer's Name,Address,and Tel.No, WAY 1 Pax lye % 15. •YA4,OZo Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 0j 3 gpd Design flow provided Y�— gpd Plan . Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature ofRepairs or Alterations(Answer when applicable) Z'sft sTGil/ /.ldf T 4 `f: Slbll.� %AND/fi// 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. I Sued �, Date N Application Approved by Date `0 Application Disapproved by Date for the following reasons Permit No. i9_00 ( r 6� Date Issued `� No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: � J PUBLIC HEALTH DIVISION -TOWN OF.13ARNSTABLE, MASSACHUSETTS Yes' ir Nplitation for Misposal *pstem Construttion Permit Application for a Permit to Construct(4,f-- Repair(6,Upgrade Abandon( ) Elconplete System ❑Individual Components Location Address or Lot Noj/3 4(11,0 /5 Do illi Owner's Name,Address,and Tel'No. Assessor's Map/Parcel 1,71113E I Installer's Name,Address,and Tel.No. 506 41:&2 Designer's Name,Address,and Tel.No. AOAS pix de y 961. 'C' Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( )-Cafeteria( Other Fixtures Design Flow(min.required) 0 gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 0/10/ r 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. Sid--- c Date 0/ Application Approved by Date Application Disapproved by Date for the following reasons Permit No. 9 09cl 16� Date Issued >r-- - -- -------------------------------------------------- -------------------------I------------------------------------- --------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE;-MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed(e--) Repaired e--) Upgraded Abandoned by ls,4"v0-5 at I I/*/::, //1 lv/S has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No 00° JO� dated Installer Z),160O."'a-5 Designer a.4 rp-%Z!!7 40tv #bedrooms Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the system will function as designedf Date -71 0� Inspector (4 ;J,,, Q -- --------- No. eaoaf — /61 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION.4 BARNSTABLE,MASSACHUSETTS Bisposal Opstem Construction Permit Permission is hereby granted to Construct(.1_4 Repair Upgrade Abandon System located at w5 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. Date —01 Approved by � r ' � sr Town of Barnstable "E' Regulatory Services Thomas F. Geiler, Director BAB.vsrABLL MAse. Public Health Division .� 1a3� ve'pT 639 Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 503-362-4644 Fax: 503-790-6304 Installer & Designer Certification Form Date: IZ Sewage Permit# �I� Assessor's Map\Parcel Designer: KIM Installer: ,5'e� 9e_ J6i ;n-0-, Address: _ ��Z :Address: tl 9M YJ,G/,7_95e On Y)e lel)wk� was issued a permit to install a (date) (Installer) septic system at 1/J7 WIIV6J510& 012W?° based on a design drawn by (address) ✓✓e, Itf e ex-- dated 0S D( 0 V (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. 1 certify that the septic system referenced above was installed with mayor changes (i.e. greater than 10' lateral relocation of the SAS or anv 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. ., OF Mgss9� DA , M ti (Installer's Signature) No: 1140 isTE � (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q: Health/Septic/Designer Certification Form 3-2641doc i P# SSA '.Gown of Bk-nstable. � Department of Regulatory Services ' set$. • Public Aealth Division Date r KAM e$ 200 Main Street.Hyannis MA 02601 ' FFD rlt►'1 M` I • Date Scheduled / r /� r !Time;— Yee Pd. oil Suitability Assessment for Sewage Disposal r C t'�t�r V\ i"��q C�tl Witnessed By: 'v Performed By: „ LOCATION & GENERAL INTORMATION - Location Address*.� -�J W I!�(�Sl FOtQG �(ZWE ; Ownces Name aYS-��cs�•Y pF1�t }}�lgT1►�1 S ►V►A Nyr�N i l s Address D� Assessor's Map/P4rcel: l l 3� Engineer's Name�p12 ! NEW CONMIZU#ION REPAIR I Tel e phone# �v o Land Use t-�i„���'"� Slopes(%) s Surface Stones Distances from: Open Water Body ft Possible Wet Area 7 2 ft Drinking Water.Well �ft I ft Drainage Way "- ft. Property line _2- Q —ft Other SKETCH:0treet name,dimcnsiods'of lot,exact locations of 1*holes&perc tests,locate wetlands in proximity to holes) It Ov,IE • � 4 N 3 N ro i co p O I O 11 ` `° �`� w 8 1 it n v�kV4S4 ( ''Depth to Bedrock N � I Parent material(geologic) /1J I Weeping from Pit Face -- -- Depth to Groundwater. Standing Water in Hole: QQ Estimated Seasonal Y jigh Groundwater �n I DtTR N TION FOR SEASONAL 11IGrH WATER TATOLEEM Method Used: io. Depth to Sall mottles: In. Depth Qbcervcd standing obs.hole: I in. ©roundwater AdJuetment • Depth tolwceping from side of obs.hole: A�,{actor,�,.� A��duntiwnter LeVel..,.,e Index Welt# . Reading Datc Index Well level,�.e.-..... • I PERCOLATION TEST Date 'xi!�e--- _ Observation I Time at 9" Time at 6" Depth of Pere - I Time(9"-6'7 -------~- Start Pre-soak Time.@ • 11__— End Pre-soak I . Rate MinJinch Site Suitability Asse¢sment Additional Testing Needed(YIN) Site Passed X Site Failed: — o Be Completed on Back Original:.Public Health Division Observatioq Hole Data T ---- ***If ereola ion test is to be conducted within 100' of wetland,,you must first notify the P _. ,.�. nivif:ian at least one(1)wectic prior to beginning* I DEEP OBSERVATION HOLE LOG Hole# Soil Other Depth from Soil Horizon Soil Texture Soil Color Moulin Structure,Stones,Boulders. .Surface(in.) (USDA) (Mansell) g ( onsistenc S'b ravel A LOAM all 35"_ 2r. L I�1cd Sa>1r� a .5y 6� z DEEP OBSERVATION HOLE LOG Hole#_ _ Depth from :Soil Horizon Soil Texture Soil Color Soil Other Surface-(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, Gravel If �t► ► S1 io �3/v ILIA (O if 34''-120� c e 0 SQnd �► 5Y �l DEEP OBSERVATION HOLE LOG Hole# •N Depth from' Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsistenc %Gravel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. on ist ncy,%Qmvel) Flood Insurance Rate May: Above 500 year flood boundary No_ Yes __ Within 500 year boundary No :X Yes,,.R Within 100 year flood boundary No X Yes Death of Naturally Occurrine 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 system? If not,what is the depth of naturally occurring pervious material? Certification I certify that on d (date)I have passed the soil evaluator examination approved by the Department of Enviro mental Protection and that the above analysis was performed by me consistent with the required1faime.expertise and experience described in 110 CNR 15.017. Signature / DatC46�01 Dq J 0:\.SEPTIMERCFORM.DOC Town of Barnstable CF ZME�� o Regulatory Services Thomas F. Geiler,Director w MUMSPABLE, 9 MASS. 16;9. A Public Health Division ArEO MA'S Thomas McKean,Director 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 June 4,.2007 Mr David Bystritsky 113 Wind Shore Drive Hyannis,MA 02601 ORDER TO COMPLY WITH STATE ENVIROMENTAL CODE, TITLE 5 The septic system located at 113 Wind Shore Drive,Hyannis, MA was last inspected on May 9tb,2007,by Troy M. Williams, a certified septic inspector for the State.of Massachusetts. The inspection of the septic system showed that the system"Failed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00).due to the following: System is in hydraulic failure Y Y You have 60 days from the date of the system failure to bring the system into compliance. If there are any questions about this reminder,please feel free to contact the Barnstable Health Department. BARNSTABLE HEALTH D PARTMENT Thomas A. McKean,R.S., C.H.O. Agent of the Board of Health I AV— TROY WILLIAMS _ SEPTIC INSPECTIONS Certified by MA Department of Environmental Protection (508) 3b5-1300 19 Hummel Drive South Dennis, MA 02660 _1C� COMMONWEALTH OF MASSACHUSEI"I'S EXECUTIVE, OFFICE Of ENVIRONMENTAL AFFAIRS QS V DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPEC"I'ION FORM. - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SVSTEM FORM FART A e _ 1313 CERTIFICATION L- 7 Proper(% Address: 113 Wind Shore Drive Hyannis,MA 0,A ner's Namc: David Bystritsky ry , Owner's Address: 113 Wind Shore Drive I Hyannis,MA 02601 I Date of Inspection: May 9,2007 t -tee <. Narne of Inspector: Troy M.Williams . O tp --- Company Name: Troy Williams Septic Inspections Mailing Address; 19 Hummel Drive South Dennis,MA 02660 Telephone Number: (508)385-1300 Cn m . CERTIFICATION STATEMENT 1 certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the.time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am'a DEP approved s)stem inspector pursuant to Section 15.340 of Title 5(310 CMR I5.000). The systeni Passes Conditionall\- ['asses Needs Further Evaluation b) the Local Approving Authority Fails inspector's Signature: ,) Date: S'/5 fo ? The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of I lealth or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable, and the approving authority: Notes and Comments All system meets the minimum requirements set forth by the Massachusetts Department of Environmental Protection,certification is not to be construed as a guarantee of future working condition of.system,piping or components. This Inspection represents the conditions of the system on the Date of Inspection noted above. This report only describes conditions at the time of inspection and under the conditions of use at that time. 7 his inspection does not address how the system will perform in the future under the same or different conditions of use: Title 5.Inspection Form 6/15/2000 pace I of I.I Pagc2ofll Uril'ICrAI.. INSII')'i;CTION DORM — NO`1j' VOR VOLUNTARY ASSE SSMEN'rs SUBSURFAC!! SF,'YACI!, PISVOSAI, SYSTEM INSPECTION FORM P4 Yz'>i' A �M1IY[i� IC. '!ON (coutinried) I'roperly Address: 113 Wind Shore Drive Hyannis,MA Owner: David Bystritsky 1)ite of Inspection: .May 9,2007 Iuspectiou Summary: Check A,11,C1)or I'/ AI:WA YS coir►pletc all of Secliciu 1) A. Systen►Passes: - I have not found any inf,611nation whicli indicates lha .ny of the lailute criteria described in 310 CM12 15.303 or ill H)CM12 15.304 exist.:Any failure crile,ia , evaluated are indiealed below. Cormueuts; IL System Coudttfoually Passes: One or more system components as described in the"Condilional Pass"section need to be replaced or repaired.-The system, upon completion of the replacement or repall-, as approved by the hoard of lealill, will pass. Answer yes, no or not determined(Y,N,N1)) in the 7ur Ilse fallowing statements. It"not determined"please explain., -- The septic tank is inclal and over 20 years old* or the septic tank(wl,ei r metal or not) is structurally unsound, exhibits suhstaoiial infillratioll or exlillratiou or lank failure is inu . neut. System will pass inspection if the existing tank is replaced willi a complying septic fink as approvecl_by 11 . oarcl of I lealilt. *A inelal set)tic tank will pass inspectio,i it'it is structurally sound; nc cakinb and if a Certificate of Compliance indicating Ilia( (Ile tank Is less Illall 20.y.cais old Is available NO explain: Observation o(sewage backup or bieak put . .ugh static water level it) (lie distribution box doe to broken or obstructed pipe(s)or title it)a btokmi, settled or t _ ven distribution box. System will pass inspection if(with Approval of I3o4rd of Ileallb): -- brokci pipe(s)are replaced of ruction is fenloved isrribution box is leveled or replaced NO explain: 3 The syslenl it ired pumping ino e, Illu a year due to broken or obsirucled pipc(s),The system will pass inspecliou if illi approval.of the Board of Ileallh):. broker pipe(s)are repaked obstrucuoii is removed Nil oxhlairt. ' Pagt 3 of l l OFFICIAL INSI C'1'1()N IiO12M NOT FOR VOLUNTARY ASSESSMEN`rS SUBSIJJW CI- SE, Vy4C)l 1)ISl'()SAM, S 1lST NI XNSr'rc't'YQN 1�0I21Vt P4 RT A CIL I2TIFIC.A`ION (continued) I'l uperly Adr1!ess: 113 Wind Shore Drive Hyannis,MA owncl David Bystritsky Mile of lnspection: May 9,2007 C. Vorther l!"valuatioo is I2erluiretl by the I)mIl-rl of lleallh: Conditions exist whirl;require further evalualion by the hoard of I(ealth in order to delern-;ine if the system is failing to protect public I;eallh, safely or the enviroumetit. I. Syslcru Will pass unless hoard of health det4li►il►es in accord:uncc with 310 CM12 .5.303(l)(b) ll►at ll►c system is not functioning in a numiler which will'proleci public IlcallII,safety a d (lie e►►Yironntenl: Cesspool or privy is within 50 keel of a sill liked water Cesspool or privy is within 50 feet of 4 bordering vegetated well and or' salt marsh 2. System will fail unless the 1lo'ki-rl of 11ca111► (aml Pill,lic W. tel-Supplier,if mly) delerrtiines that life system is I'll►►cliuutfig iu it manner shut protects Oke public I alit►,safely and ell vi roil filet)l: The syslenn has a septic tank and soil ahsorplioo ystem(SAS) anal the SAS is within 100 feet of a surface water supply or(r ibutary to it surface waiter upply.. The systerrI has a septic lank and SAS n; {Iit SAS is wilhip a Lone I of al public wales:supply. The systeiu hies a septic lack and S and the SAS is within 50 feel of a private waler supply well. `l'Le syslcm Las a septic lank a c_SAS w1d tLe SAS is less ll;an 100 feel bur So feet or more fiom a Private water supply well**: Mt . ad used to delermine distanee **Phis sysleiii passes if Ilse ell water analysis, her lbrruerl at it DIET certified laboratory, for coliform bacteria and Volatile orb; is conipouuds iodicales That the well is lice iiom pollulial fiorn 11iitl facility and lilt presence oran11110 a nitrogen and hilrate nitroi;en is equal to or less than S ppm, provided tl;al no other failure ru ileria are ggtred. A copy of lilt antilysls riu;sl he aftacLed to this form. , 3. 011►ci I 3 Page'I of,I 1 nl�I�tC1A1.. 1NS1TC'j'►0N DORM — NO'M' 1?(W VOLUNTARY ASSENSMEN'f'S SUOSURFACE SEWAGE PISPOSAI, S'YS'1TUVi INSPECTION FORM PA f:T A C1�)I2'I�II'ICA'Y'ION(continued) 113 Wind Shore Drive properly Address: Hyannis,MA David Bystritsky Owner: May 9,2007 f)a1C of inspection: 1). System Failure Criteria applicable 10 all syslen►s; You must iitclicalc"yes"or"po"to tacit of file fallowing 161- all inspections: Yes No ✓ Backup of sewage into Iacility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of elllucnt to the surface of the ground fir surface waters clue to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above oritl.tt invert due to an overloaded or clogged SAS or cesspool ✓ _ Liquid depth in i el is less titan 6"below invei t or available volume is less than %day flow Required pun►ping iruxe than 11 times in (lit last.year NOT due to clogged or obsinicled pipe(s). Number of lilies pumped _ _✓ Any portion of the SAS,cesspool or privy is below high ground wales elevation. Any portion of cesspool of privy is within 100 Icet of it surface water supply or tributary 10 a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 obit public wall. ✓ Any portion of a cesspool or privy is within SO Ic0 of a private water supply well. 4,/ Any portion of a cesspool ol.privy is less lhcttt 100 Ieel I,ul greater than 50 feel from a private water supply well with no acceptable water quality analysis. IThis syslent pusses if llie well water analysis, pel-f01-med at a l)l:l' cel-lificil habits►lo!y, for coliforn►hacleria antil volatile ol•ganie compounds indicates heat the well is 1'17ce Iron►pollution trot►► (l►at facility and Ih►e presence()fall)monia nitrogen and nifl-aft nilrogen is equal to(tt-less thin► 5 ppn►, provided 111:►1 lit) oll►er failure criteria are Iriggered. A col►y of the analysis lilltsl lie allached to this form.) Yr`S (Yes/No)'I'he system fails. I have deltrmil►eil Ihal one or more of file above failure criteria exist as described in 310 CMR 15.303, lhtrcfi►re the syslent Jails, 'i'bc system owner should contact the Board of Ileallh to dclermine what will be necessary 10 correct file failure. h�. }<.:uge Systoles' 1'o be collsidereil a lrlrgc sysieil► bite systtrll must serve :1 facility will! a esign flow of 10,060 gpd to 15,000 gpcl. You must indicate eilber"Yes"of"no"to each of(he.following: (The fi)llowit►g criteria aPply in large systems in addition to the crit is above) Yes no tilt system is wilhing00 feel ofa surface drinkit water supply _ _ the systcnl is wilhin 200 tool of a Iributary . a surface di inking water supply ll►e syslent is located in a nilroget►se hive art!(lnlerim Wellhead 1'rolecfion Area—IWpA)or a mapped 'Lone II of a public wafer supply l If yoel lave answered"yes" to any Clue .1041 in Seclic►n 1 the system is considered a sigili(cant threat, or answerer! "Yes"in Sectiot!P allove fi►e large steili alas failed.`idle owner ol.operatclr of any large systelr!cc1lsf tiered a sigi)ilican4 Illreal l!ncler Secliop r.,i`lailecl.lµlcler.Seclioll P sl1.►all opgrOO Ole systetT!I!1 flCeP4r� t1Le will►3}0 CMl2 i5.3. The s Ste ; owne sit e contact the a ol► 1 to e ylnlll of Ice , f 11le t altnle 1`{ Y l►4, r , � , i'lf 1a 16 I . f 4 PP _lt . q Page 5 of 11 0141CIAL INSPECTION J1 ORM - Nn'1' FORVnI CJN'1'�112 Y ASSI:SSMI iV`Y'S SUBSU!ZI�ACE SrVVAGE DISI OW, SYS'I'I-LfYI INSI'IC,CT ION FORM Pik Wr y3 O1I.,c;KIAS>a Properly Atltlress: 113 Wind Shore Drive Hyannis,MA Owner: David Bystritsky t)ate of lnspectitul; May 9,2007 Check if Ilse following have been donne. Yonl rnllst indicate "yes"or"no"as In each of the following: Yes No Punnping information was provided by Ibe owner,occupant, or Board of health -- ✓ Were any of the system components punq>ed oft in the previous two weeks '? Ilas tine system Ieceived Normal flows in tine previous two week period __ _ ✓ Have large volunles of Water been ill(lodoced to life system recently of as part of this inspection'? Werc as built plans of the syslem obtained and examined'? (if they were not it note as N/A) _ Was the facility or dwelling inspected fur signs of sewage back tip'? —� _-- Was the site inspected for signs of break ixlt Wcre all sysleill c0loponcnts, excluding the SAS, located on silt '? Wcre the septic tank manholes uncovered, opened, and the interior of the lank inspected for the condition df tbt babies or tens, material of conSU uctiou, dimensians, depth of liquid, depth of sludge and depth of scum _✓ _ Was tilt; facility owner(and occupants if different from owner)provided Willi information on the proper out iIItellallce of sllbsrllface sewage disposal syslellis ? `!'Ile size and Iocatiou of the Soil Allsol plian System(SAS) on the site has been determined based on: Yes no lixtsling information. ror example,a plan al the 13oar0 of l leallll. pelerwined ill the field Orally of the failure criteria febled to Part C is at issue approxin-talion of distance is unacceptable)f 310 CM 15.302(3)(b)) , t t 5 F. !'age 6 of 0I1IICIIAI.. 1NS1'1?C`I'I()N 1�012M — N(a`' FC)C2 V0j,UN`Jl'Al2Y ASSI!SSMLN'I'S SOBSUR ACE SI",WACC I ISPOSAI. $Y$`I'j'41 INSPEW'I'CON )[FORM PA R'f C SYS"I'I'M INFORMATION Properly Address: 113 Wind Shore Drive Hyannis,MA Owner: David Bystritsky Dale ol•Inspeeli(I)): May 9,2007 rl.Ovy C0 NI)I'I'IONs ItL.SI IWN'I'I A I. Nurrtber of bedrooms(design): 3 Numher o f bedrooms(aclual): 3 [)!:SIGN flow based on 310 CM12 15.203 (for exnrnplt; !10 gp�l x #of bedrooms): 33 r) Ni nil)er of current Iesidenls: o? I)oes.residence have a garbage grinder(yes or no):�m o is lamully on a separale sewage system(yes or no): A/-A2 cif yes separrile inspection requiredf laundry systein inspected (yes or no): &14 Seasonal use: (yes or no): r/p Water meter readings, if available(Dist 2 years usage(gpd)): 0(0 _-21�oV O �i/�,�S U J Sump pun)p(yes or nm: A/n Last dale of occupancy: CONIMI?I2CIAI,/INI)US'1721AI. Type of cstahlisbmenl: _ ___ _ Design flow(based o0 310 CIvIR 15.203): gl)il Basis of design flow(seats/persons/scgfi,efc.): Grease trap present(ycs or no): -- Industrial waste holding lank present(yes or no): Non-sanilary waste disebarged to tbe.`l'itle 5 sy In(yes or no): Water meter readings, if available: (late of occupaney/htse: -- - - O'1'IILIt (describe): G.ENEIZAL INVORIvIA'I'llON 1'umpiug liecords Source Of. ltlfOltnallOtl: Was system pumped as part of the inspection(yes 01.no): MR Yes,yes,volume pumped: gallons -- Ilow was(luaulity humped determined'[ Reason ft)r puny)ing: - 'I'YI,!'', Septic lank, distribution box, soil ahsorptioirsystenl ngle cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes, attach previous inspection records, if any) Innovative/Alle►nalive lecln)oloby. Allach it copy of flit curreof operation and mair)tenance.contract(to be. oblaine(I from system owner) 4 _'fight tank _Altach a Copy of!lit I)l P approval _Other(describe): )roximale age►1f1111 components, dale installer!(if known)allcj source ofinforn)atinn: Were sewage odors detected when arriving at file site(yes or no): No 6 ,:. Page 7 of'I I 014,11C1AL INSPECTION F01 M — NOT MOOR V01,ONTAR'Y ASSESSMfl:NTS SUBSURFACE SC'WAGU. R1SPOSAJ, SYS'!'I?M INSPII!CI'ION POTtly1 PA OT C SYS'1'!I M 1N1_1OWVjA'j'jON (continued) Properly Address: 113 Wind Shore Drive Hyannis,MA Owner; David Bystritsky Dale of Illspectioll: May 9,2007 13UIL1)INCy SEWER(locale on site plan) Deplb below tirade:— 1���� _ Mateuals of a)nstluclion:_cast itou ��{0 I've Oilier(exBlainj: i #!1_t_�(� s /�✓� ate water supply well or suction line: 1)islance burn pi ov Coll'llllellts(till c4ndllioll offolllis, velilinb, evidence gfleakage, etc.): SEPTIC"PANIC: (locale oil site plan) / Depth below glade: Mock ial of consliocliou: t/concrete_—metal_libcrghiss— polyelbylene _elllel'(eXt.1I8111)__ __ If lank is melill list age: — Is age confirmed by a Ceitilicilte of Compl ilk lice(yes(I►no):_ (attach a copy of cerlilicule) Distance from top of sludge lolxlllonl of nutlet tee nr battle: Scuill lllickness:_I'' _ ----- Distauce fi-on)lop of scion to lop of gullet tee or ba(le: b Distance fYonl botimil nl scull)le) bnll"I'l of outlet The of ballle: Ilow were;diluensions defelmined:_ ��y -- ------------- --- Commeuls(on pllrnpirlg iea)Iluuendalii�ns, inlel and outlet tee of billlle condition, structurill inlegiily, liquid levels as ielaieil to outlel iilvelI evulcuce of,leakage, etc.)-. / �q0 44=9�,e-. Q �i. e C L. —�` Gu—LL /../�..- �Lln J �--�-tea--k /h._�_ t✓_'�.s �^�--.-_ ca ll ww�F-.✓�✓,.t G o�t � �o V-� i Ly/.�• ^(locale on site plan) Deptl►below grade: Material of construction:__concrete _melul fiberglass_po elbylclie_olber (explain): DllllellStonS: Scunl thickness: Distance loom Inp of scum to top of outlet tee or baffle: Distance froni boltnm of scum to boluxn of nutlet to. or baffle: Date of last Bumping: _ Cgnuiiei�ls(on purilpilig recommendations, it I Anil ciutlel lee Ar halite condition, stniclura) integrity, liquid levels as related to outlet invert,evi once.of lea )e,etc.): 7 Page 8 of 011 ICIAI. INSITCTION F01IM - NQ'l' V,01I 'VOI UN'I'ARY ASSESSMI-LNTS SUBSUR AC1! SWA6V DISI'QS4V SYS'1 V,M INSPECTION r,OR 1 sysrr rn INI�or?MA'110N(cowinned) Properly Add►-ess; 113 Wind Shore Drive Hyannis,MA Owner: David Bystritsky Dire of Inspection: May 9,2007 7'l '1111'or 1l0r"plN(1'TANK; (milk ilulsl be pumped at titrle of inspecli ,l)(loa►le on site plan) Depth below grade: Malenal of collsinictloll: collclete metal fiberglass )n1ye1hylene other(explain): Dimensions: ---- -- -- Capacity: —_ gallons Design Flow: --gallons/day Alarm preseul(yes or no): Alm-in level:_ Alarin ill working order es or no): Date of last primping: -- Comments(condition of alarm and float vi(clles, ere.): 0lSTl2l1l11'l'lON 11OX: (If present must be opeiled)(locille till site plan) Depth of liquid level above oullel invert: wl�� Corrunents(nolc if bax is level and disil ihution to outlets equal, any evidence of stilids carrytiver, ally evidence of leakage into or out ofbox, etc.): l'UNJI CIIAMIIER:__(locaie an site pJilli) Pumps in wuiking order(yes or nti): Alarms in working order(yes or no): comments(pole condition of pmnp cllarnber, condilioo of imps will appurtenances, etc.): I 8 . page 9 of OP-FICIAL INSPFCI'ION FORM - NOT FOR VO!XN`C'AjIY ASSrSSMJWI'S S111>Sl)ItI+ACID Sr1WAG �. I)I4I'OS41, SYSIgNI 1NS1'rCTION 1+n12M 1'A S yS`I'I?lyl IN1',0121y1A`I InN (continued) Properly Address: 111 Wind Shore Drive Hyannis,MA Owner: David Bystritsky pate of inspection: May 9,2007 SO11,AUSORPTION SYSTEM (SAS): �✓ (luc:tfe up sltc rtla►t, cxc;►yatl�n pot t ecluired) If SAS not located explain why; T"bodling pits, puiuber:_f - L 'k leaching chambeis, number: { leaching gallciies, nuniber: -- ---leaching Benches, nun►bei, length: leaching fields, number, dimensions: --------- --overflow cesspool, number: -- inc►ovntive/,►llernative systcrp 1'ype/name of technology;----_----- Coinn►ents(note con$lion of soil,signs of hydraulic 6dh"c, level of punching, damp soil, condition of yr gelation, Cl?SS�'OOI.S; (cesspool rouZ., rt of ir►spection)(k Dili on she plan) Nunlhei ouch configuratio ►: - — - Deplh--lop of liquid to inlel iovcrlDepth of solids layer: — - D� plh of scum layer:!)imensiops of cesspool:_Moteiials ol'c�ipslOcctii;now(ColpMenls(pgte condilion pf soil;slitilure, Ic vet pfpoudipg, condition ol'vegetalipp, etc.): PlOVY: (locate on site plan) Materials of construction: _ � ------- l)uptl►pf solids:--- --- COn1111enIS(nl1lL' ConlIlllOn n f SnII, SlgnS pf hyclia► c failure, level of ponding, condition of vebelatiop,etc.): t 9 j. Page 10 of I OFPICIA1, INSV(' C'1'ION 1?0121V1 — NOT VOR VOf,UN`I'AR'V ASSI?SSIVIENTS SUBSURFACE SEWAGE PISPOSAI, S'YS'TI m 1Nsp C'rjON PORM 1'A k I C ,S'YS'I'I?M INI+OI2.IVlt1'I'10N (continued) 113 Wind Shore Drive Properly Atltlress: Hyannis,MA David Bystritsky Olvuei: May 9,2007 i)ale of luspeclion: SILL'#CII ()JAI SEWAGE I)ISI'OSAI.,SYS'I I�CM I'rovicle a sketch of llie sewage disposal sysle111 including ties to at least two permanent reference landmarks or benchmarks. Locale all well wilhiu 100 feet. Y..ocate where public wales supply enters the building. I 3 I l p Zo 1O i Page I I of I OITICIAL INSPECTION DORM — NOT POR Vc!-JJNTA12Y ASSESSMENTS SUBSURFAC►? SEVyAGI� 1)�SI'ps�l, S�S'I'I.M INS.I'IWTION DORM I'AItj' C SYSTEM iNVORIVIATION (conlinued) Properly Address: 113 Wind Shore Drive Hyannis,MA Ow1er.: David Bystritsky Dalc.of lnspeclion: May 9,2007 SITE, I'XAIVI Slope sullace water / Check cellar ✓ Shallow wells Estimated dep(h to ground water�Oflcel Ad tisled.high groulid wale(clevaljon — feel Please indicale(check) all nncthods used to deter olive (hc high ground wales elevation: _Obtained lion)system desigir plans oil record - Il'checked, date ofdesign plan reviewed: ✓ Observed site(abu(ting propeily/ol servaliou hole wilhitr 150 feel of SAS) -- Checked with local lloard ol'l lealth-explain: _ Checked Willi local excavalors, installers- (allacli documenlalion) Accessed 11SGS database-explain: --------- -- ----- --.- You must describ e how you established [lie high groynd water elevation: — — ------SJ.S.-�-S--�j fQ.�:_,d�t�.o..�.-= .,...�� s 5.1►{t�,.�.�..1 ��±��_S.�L�t. �_ _.---- ,.--�a1�5---�-�=�--`�g_�-- � .���m_E�,P.._ i�-,._.�,,.,. -_�1_:_3_�_3_�L�.��,.,wok-•>.--- Thls report has been prepared pod llle system Inspecleo as of 111e dale of jnspecllort. This report is not a warrar?ly o{g6 ..Ooe Thal the syslerrl wlh (unction.(Troper�y In llle(inure. There have bead no warrpnties or guarantees, either exp{essecJ, wriltoq or Irppllpq relplir g to the systelp, the jr�spectlon'anq/or Illis rePprn. l II r w 7 SUBSURFACE SEWAGE DISPOSAL SYSTEX INSPECTION roRH Address of property I,k, C,4 S � o v Or ` �- N•, s Owner's name / Date of Inspection Pao ( F—&,-% ^ d kq PART A Z� CHECKLIST Check if the following have been done: Pumping information was requested of the owner, Occup ant,pant, and Board of .�L None of the system components have been pumped for atwo and the system has been receiving normal flow ratesduringtthat weeks Period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and exami available with N/A. ned. Note if they are not V/ The facility or dwelling was inspected f / or signs of sewage back-up. 4� The site was inspected for signs of breakout. A11 system components, excluding the SAS, have been located ated on the The septic tank manholes were uncovered, opened an d tthe septic tank was inspected for condition of baffleshorinter tees, of material of construction, dimensions, depth of liquid, / sludge, depth of scum. depth of '✓ The size and location of the SAS on the site has been determined on existing information or approximated by non-intrusivemhods..based The facility owner (and occupants, if different from ow provided with information on the proper maintenance- Of'-SSDS,�ere - SUBSURFACE SEWAGE DISPOSAL SYSTEH 'INSPECTION FORM PART B SYSTEM INFORMATION / FLAW CONDITIONS If residential 3 number of bedrooms — number of current residents garbage grinder, yes or no* s laundry connected to system, yes or no c � seasonal use, yes or no If nonresidential, calculated flow: Water meter readings, if available- r'"a``"' /-7"5 yL� f� 'f` S ` � -'?b/ aov Last date of occupancy 77 GENERAL INFORMATION Pumping records and source of inform tion: �/ c�cJa, 'r /C. �- -� JV0 System pumped as part of inspection, yes or no if yes, volume pumped 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. Source of information: h� V N ✓ /Y Sewage odors detected when arriving at the site , yes or no I 9 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SEPTIC TANK: (locate on site plan) depth below grade: — material of construction: concrete metal FRP other(explain) dimensions: iX /� 6 /oo o ck ii sludge depth 1 / distance from top of sludge to bottom of outlet tee or baffle N°NE 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, ev ' ce o leak/Iage, recommendations for repairs, etc. ) J ✓� J' � Cis i..� +- �✓ ti S r�,t IA ��J i r�i�'c t 4 DISTRIBUTION BOX: —Z (locatef on site plan) depth of liquid level above outlet invert Comments: (note if level and distribution is equal, evidence of solids carryover, ev/�dence of le-aka ge into or out of box, recommendations for repairs, etc.) 'tJ 0 v h U � � c� ...v� � o v`C'� d✓Y�C.cv. o �.r� c.<.. � PUMP CHAMBER: (locate on site plan) pumps in working order, yes or no Comments : (note condition of pump chamber, condition of pumps and appurtenances, recommendations for maintenance or repairs , etc. ) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SOIL ABSORPTION SYSTEM (SAS) :� (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 and number leaching chambers and number "`L a` 4 ) -� 5""M• z leaching galleries and number leaching trenches, number, length leaching fields, number, dimensions overflow cesspool, number Comments: (note condition of soil, signs of hydraulic failure, level of condition of vegetation, on tation re P din g commendations for maintenanc or r .repairs,etc. ) 6 d V c r I cc.�� �•f' W i L(.� S o�J / c ✓�,,• 1►'t 6A � �� v N-+ .�,,•sJ� CESSPOOLS (locate on site plan) : �" $ ' ' bl�. number and configuration depth-top .'of liquid to inlet invert depth p h of so lids lids 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 pondin condition of vegetation, recommendations for maintenance or repairs,etc. ) PRIVY ; (locate on site plan) materials of construction dimensions depth of solids Comments : i (note condition of soil , signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs,etc. ) 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE E=SPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 1001 �o a i�(gap • � r - a . . • Safi� �-� �` DEPTH TO GROUNDWATER - depth to groundwater method of determination or approximation: i 'SUBSURFACE SEWAGE DISPOSAL SYSTEK INSPECTION FORH PART C / FAILURE CRITERIA t Indicate yes, no, or not determined (Y, N, or ND) . Describe basis of determination 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? -A Static liquid level in the distribution box above outlet inve rt. Liquid depth in cesspool <6" below .inv flow? ert or available volu2Ae< 1/2 dal .� Required pumping 4 times or more in the last year? number of times pumped - Septic tank is metal? cracked? structurally unsound? substantial infiltration? substantial exfiltration? tank failure imminent? Is any portion of the SAS, cesspool or privy: below. the high groundwater elevation? within 50 feet of a surface water? -1—V within 100 feet of a surface water supply or tributary to water supply? rY a surface w within a Zone' I of a public well? / `/ within 50 feet of a bordering vegetated wetland orsa (cesspools and privies only, not the SAS) ? It marsh /V within 50 feet of a private water supply well? less than 100 feet but greater than 50 feet from a private water. supply well with no acceptable water quality analysis? If the-veil has been analyzed to be acceptable, attach copy of well water analy. for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. r 13 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART D CERTIFICATION Name of Inspector Company Name -�- �i + s SQ Company Address Ll e) Q l d Oct 5 5 a k-- Se),) Y_L, ox U+ s ,riG_ ,� Certification Statement I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true, accurate and complete as of the time of inspection. The inspection was performed and any recommendations regarding upgrade, maintenance and repair are consistent with my training and experience in the proper function and manitenance of on-site sewage disposal systems. one: VI have not found any information which indicates that the to system fails ad Y adequately protect public health or the environment as defined 310 in CMR 15.303 . Any failure criteria not eval uated are as stated in the FAI LURE CRITERIA section of this form. I have determined that the system fails to protect public health and the environment as defined in 310 CMR 15.303.. The basis for this determination is provided in the FAILURE CRITERIA section of this form. Inspector' s Signature-- Date Original to system owner Copses to: Buyer (if applicable) Approving authority LOCATION SEWAGE PERMIT NO. VILLAGE INSTALLER'S NAME & ADDRESS -ti BUILDER OR OWNER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED _ �, a "^`+_......� —V i � '`� e� ,, ,� . � � ��� � w '� �� s� �' `, �. '�� . ` �� �` �� � � �,. , '�. . ,, _- Y. r Dt=_ S16�l1 T>ATA ; ;� r uo GAtzaA�� �RI*.rotEtz � `t L-�4 S:'L.0 a s tic) +c 3 t 33b 4.PD i ';. ...� { ' (� ;. i !:EF'T'1G TL 1tC = 330,E Ir7D % • .A-9r7 u Ste- l 00C:!, C=A L. i f i �T"727/Vl ,LL>ZE1�r �,p ST I :. i lwR'B Mfg Sb S.P D. �_ �i!" �, I EXn .if r 1 TOTAL ESIGW s 42shI t ToTA t_ mat t_�-( 1=Low = 33D 6.PD i I Q r l t•.� i j" All OBiSCIXI� I ! t ._._.VF,.QGOt..pTlot.l tZATE : `��IU �.�4tlt,�• OR � ', � -- � J. OF M4VT � 4 ' (• , � � ASH OF Mq ,k I . . � i .` � ` t + .k�� � � { ` € p� WILLUM AL 1 _ rig C. �„ _.. �„� - -- N'Y E.,,. ( A No. 14334 •'t' '' - �nl t 1+�,Q- . j +. ' . • � . i i .R .`i.;i # ,.J. Ul I.. '!' 1 t•� ' f- .r r I l .a, ,. _ TOP F�NO'�100.0 t 14 Wy � 4r�PfsI GAL. v8 f t 'box ql,•b Sepncf �? INV. T-AWC 1000 LsAG N FIT ! r W i r►-t # WASWED t, STONfc 190! } ( �1"QTIF.IEtD PL-a-r IN!.7 t C: L oCA�TI 0" 14 Y& N N 15 _� NU Vc-NTF 4 Jo �aat.� �C3t�tV:'. As KloTCT) . C 12, 21.11 +T"A T T N tr P1ZUP' C)NI�CLt:, 5 t--Iovr►J Pt a,t�1 TZ I=F" E►.1 c_C r WC-2 Mt_�(I=ni-I CcaPS W I'Ct-A TW;F-- 51DE-L.II-a& L�GT Aun SEYFv�tK L'�qu►QEtit�uT-S o>=' T►� ITO VJ u ct= T3�-►.�5T'A��trC, I.r , G, 31, G G!o 1S ----- BlS.XTC12- c'. t-•IY'C tuG- r cZCGts rc_�zcD 1�Na SU���.�fo�- TI-415 PLLA►-I (� WOT t ,n,�,ry va 1 A•.J v y'TEevtL_Ll- o . kCAsy, IW,r.rC?:JJtnC_tJ'r �,UF_•/t��{ ;�-�Tra�: c�l=�,�C'�, 1�1awLD n.Nl ►mot <_n.���-r C/�.PE V`/I p�= DGVI , I•,�`::r i::a;. v�>ec-� rc., >>I_•rcc_tit►►'�� ►._c��-' 1_II��•� - � — ..r-.......-w«r-r+•-•.Irr..p., -r...-.r-.,.............._........... ._.......�._..�...-.......__.._.....�....� .��_...�....�.._...._� •.--...+.►`.r�.w w•�w_.-..wr.w. w,.. No........ Fz�$� �f' ....._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..6b -#V.-.........OF.............. Appliratiun for Bispvo al Works Tonstratrtiun Prrutit Application is hereby made for a Permit to Construct (r4or Repair ( ) an Individual Sewage Disposal System / --.... —.. ...- . ....._. .: ............................. .................. .................................................. ���a Location- dress orpLot No. - Ow I Address .......................... .......•-•------------.--............------....--------...----•---••--........................••.. Installer Address UType of Building „ Size Lot....30t -----Sq. feet Dwelling—No. of Bedrooms........................................Expansion Attic ( ) Garbage Grinder (/Z) a Other—Type of Building ............................ No. of persons................_........... Showers ( ) — Cafeteria ( ) Other fixtures .----- ` W DesignFlow___________________ S._ ....._.__ gallons per person per day. Total daily flow_._...._ // - -• ,�r g P P P Y• Y �94------------------------gallons. WSeptic Tank-t Liquid capacity/('_' -gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width ....... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.IOW -. DiameteA epth beloNy inlet.... _.___ .. Total leaching area....�IA;7---sq. ft. Z Other Distribution box ( ) Dosing tank 0, l4— d'—7 7 '-' Percolation Test ResulZ Performed by-----------__ � ...____ Date.__.6d.�__--C.-2.7..._.... minutes per inch Depth of Test it.................... Depth to ground water........................ Test Pit No. 1_._ -___ G%4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ...... . - -------------------- ............................... 0 Description of Soil............f).... ..... ....... ..... ..... . s ..........r _ �a •'V.. at ""`...=-..................... x W U Nature of Repairs or Alterations—Answer when applicable.......................:....................................................................... .--•----------------•-----------------------------------•-----------------------•--•---•--•---••--•------.....•••--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TI'i U 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 Da " Application Approved BY /!G� -• •---•------------------ ....._.�_ ` Date Application Disapproved for the following reasons:...............................................--•--------------•-------------•--------------------------•----- ..•---•-........--••••--•-------•------------•-•-----•--------•--•--...-••--•----....•-------•-----••----•-•----------------••--•-•-------•-----•-•---•------.......................................... Date i O Permit No......................................................... Issued.-----.�..�--------��--------... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH ~~pp--~----- ~~ --p--~ - ---- ---------- Permit— | Application is hereby made for u Permit to Construct u'"\ or Ilcnuir ( ) an Individual Sewage Disposal ' ' 7 Address . ' Installer Size { Sq. � '^ Dwelling—- 'c6 Attic ( ) Grinder 4��) / rih°___ ~6f Building .- -___--' No. of persons............................ Showers ( ) -- Cafeteria ( ) Other -_ Design Flow ..... --gallons per person per day. Total daily flow....... ..................gallons. Total leachi �� `�cunr �«x��unovuuv� � / ��r"' uvuu� 10 ` ~" ��ru�ut��o Test ��s� - Performed ��-- ' A ����)utc.I�L��-'r-�����-.--- Test Pit No. l' ..rzoutc�perinch Depth of Test Pit.................... Dcpthtv ground water........................ � � Test Pit No. 2 .minutes per inch Depth of Test Pit. Depth mground water � � ---------------------- 0D /� 5o� ��.'~ �~ ��- ��-� ������� - _________-------------_------_-----------------..-----_--'-'_--_----^c--'-----_---.------_--'----'---- � '--_-_------'-_-----.. ��^���--_^--_----.--_-._--`--_-'-_'__--_'_-'-_-----_'_____ � ~� Nature of orAlorudn�o--Answer when applicable------__-_-'_.-.---_---------_--'-'- � ---'-----' Agreement: The undersigned agrees to install the afore6esoibed Individual Sewage Disposal System in accordance with the provisions of T I TIE 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 � "g ......... te | Application Approved By..................................... _-----_'^�?...................................... ............... .-.-'---- � o"� for the rxoxomx:-.--...__.__'-----_--_-'�-._----_--'-'-'-_--____- ' lication ' v~ --- Permit Date ' \ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed 0011-for Repaired has been instilled in accordance with the provisions of :F,, 5 of The State Sanitary Code as described in the application for Disposal Works.Construction Permit NoR:V_.?-7 .............._ dated-/. ------------_ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION,,ASATISFAdTORY. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH N74............... FEE... .............. Street as shown on the application for Disposal'Works Construction Permit No............. Datedl , ` -_VA`.....C -------------'-----'_ FORM 1255 HOBBS ik WARREN. INC.. PUBLISHERS ' ^- . . i SURVEY REFERENCE: LEGEND A PLAN OF LAND BY STANLEY R. SWEETSER, PLS DATED: JUNE 11, '1973 B E N &H MARK PROPOSED CONTOUR r 55 PAINT SPOT ON ® PROPOSED SPOT GRADE �.. BULKHEAD CORNER EXISTING CONTOUR % \ ELEVATION 56. 22 --sjsjayiand.Rd.. / + 96.52 EXISTING SPOT GRADE zzl/ BARNSTAB,LE GIS DATUM '' `, S r °'' �• 55\ // \ tf W— EXISTING WATER SERVICE TEST PIT r t ,tad r \ 'n 554 4�Y. \ y� it LOT 7 \ ; ,V y LOCUS MAP N.T.S. \\ AREA = 12618 sf GENERAL NOTES: `\ Existing Leaching P� \� �� I. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL 1 /� J �N BOARD OF HEALTH AND THE DESIGN ENGINEER. \ (See Note 10) / �� i �. F 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS O OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE LOCAL RULES AND REGULATIONS. \ �O� \ O� 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR \ TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE \ \ �O / DESIGN ENGINEER. TH-2 \ \\ �\ 9L 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN (1 �a /4 ENGINEER BEFORE CONSTRUCTION CONTINUES. 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. \• J \\ O \ �,.� 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF !� THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF \ �Z\V S� T �//. \ �.� HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. \ 0T� v \ \ 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. O I r \ 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED \ I \ O � TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. � 20 ft �:� 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE \ a THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING _ i ? CONSTRUCTION. 10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND FILLED. 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION ------ 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY \, _---' AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY �\ TH-1 �g8 f� 13. NO PRIVATE WELLS WITHIN 150' OF PROPOSED LEACHING. - 14. NO WETLANDS WITHIN 150' OF PROPOSED LEACHING. 15. ALL PIPING' TO BE 4" SCH 40 0 1/8-/FT (UNLESS SPECIFIED) 53' -53 16. PROPERTY IS LOCATED IN A ZONE II/NITROGEN SENSITIVE AREA. 4 { OF DAIREN M. y PROPOSED SEPTIC SYSTEM UPGRADE PLAN M -�No. 1140 113 WINDSHORE DRIVE, HYANNIS, MA "' ,,gyp Prepared for: Joey DeBorros MAP: 271 Engineering by: Surveying by: SCALE DRAWN JOB. NO. NITAR\a� LOT-138 DARRENM.MEYER R.S. Bco—Tech Boviroamente! 1"=20' DMM PD BOX 9 1 LCP:C137887 EgSTSWDW/CH,MA02537 (508) 364-0894 DATE CHECKED SHEET NO. \ WV.-W-2M 05/01/09 DMM 1 of 2 i .. ELEV. TOP BRING ALL COVERS TO ;WITHIN 6 " OF GRADE FOUNDATION NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS (Existing) i ` FINISH GRADE=54.0 56.0 �F.G.EL: 54.0 F.G.EL: 54.0 F.G. EL: 54{.0 -7-\ x 1, MAINTAIN 2% MIN SLOPE OVER LEACHING AREA 71 RISER TO W/IN 3" OF GRADE 772" OF 3/8" DOUBLE WASHED 3/4" - 1-1/2" DOUBLE " wp • . 1 f: STONE OR FILTER FABRIC WASHED STONE 7 4" SCH 40 PVC LLil e ' e MIN. • 0 ®aa® TEE'S ARE TO BE 14 ® 71NV.51 .3 1�' ( , ®a®®®®® INV.51 .5 ) 4" SCH 40 PVC - 2 EFF. DEPTHINV.52.26 T jjtE0:3E133Ea®®ease �g GA PROPOSED DB-3 4 2 X 8.5 4 EXISTING OUTLET BAFFLE H='10 DISTRIBUTION BOX EFFECTIVE LENGTH = 25 . S INV. ELEV.= 50.58 INV. 52.51 EXISTING 1000 GALLON SEPTIC TANK ` GAS BAFFLE TO BE INSTALLED ON BREAKOUT OUTLET TEE AS MANUFACTURED BY ELEV.= 51 .08 TUF-TITE, ZABEL, OR EQUAL TOP CONC. ELEV.= 51 .08 . INV. ELEV.= 50.58W QII� asaa aaaaa®aaa NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING BOTTOM EL.= 48.58 , PIPE INVERTS PRIOR TO CONSTRUCTION 5 FT. 3.75 2) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE ON A MECHANICALL COMPACTED SIX SEPARATION 6.08 FT. EFFECTIVE WIDTH = 12.5' INCH CRUSHED STONE BASE, AS SPECIFIED IN SEPTIC SYSTEM P R 0 FI L E 310 CMR 1s.TING 1 SOIL ABSORPTION SYSTEM SECTION 3) REPLACE EXISTING 1,00o GALLON SEPTIC BOTTOM OF TESTHOLE EL: 42.5 ( ) TANK WITH 1500 GALLON SEPTIC TANK (500 GALLON LEACH CHAMBER (H-10) LOADING) IF FAILED, DAMAGED, OR UNDERSIZED. 4) INSTALL INLET & OUTLET TEES AS REQUIRED SOIL LOGS P#: 12552 DESIGN CRITERIA DATE: MAY 1, 2009 NUMBER OF BEDROOMS: 2 BEDROOM EXIST./3 BEDROOM DESIGN (PROP IS IN ZONE II) SOIL EVALUATOR: DARREN MEYER, R.S., CSE SOIL TEXTURAL CLASS: CLASS 1 (0.74 GPD/SF) WITNESS: DAVID STANTON, BARNSTABLE B.O.H. DESIGN PERCOLATION RATE: <2 MIN/IN Elev. TH-1 Depth Elev. TH-2 Depth DAILY FLOW: 110 G.P.D. X 3 BR = DESIGN FLOW: 330 G.P.D. 53.5 0" 53.8 0" GARBAGE GRINDER: NO (not designed for garbage grinder) A LOAMY SAD A LOA R 3SA D SEPTIC TANK: 330 gpd x 2.0 = 660 gpd USE EXIST. 1,000 GALLON SEPTIC TANK 53.17 B 4" 53.3 B 6" Of3s LOAMY SAND LOAMY SAND LEACHING AREA REQUIRED: (330) = 445.94 S.F. 9�yG 10YR 5/8 10YR 5/8 .74 DA E N 4 50.58 C1 35" 50.97 34" USE TWO (2) 500 GALLON PRECAST LEACH CHAMBERS W/ 4' STONE V No. 1140 C1 ON SIDES & 3.75' STONE ON $IDES: 25' L x 12.5'-aW x 2'D BOTTOM AREA: 25 x 12.5= 312.5 SF PERC ®49.0 '" SIDE AREA: (25 + 12.5) X 2 X 2 = 150 SF `�NITAA�p� MEDIUM MEDIUM TOTAL SQUARE FEET PROVIDED = 462 vs. 445.94 REO'D �• O f SAND SAND DESIGN FLOW PROVIDED: 0.74(462 S.F.) = 342.25 G.P.D. vs. 330 G.P.D. req'd 2.5Y6/6 2.5Y6/6 PROPOSED SEPTIC SYSTEM UPGRADE PLAN 113 WINDSHORE DRIVE, HYANNIS, MA 42.5 132" 7 ', 43.8 120" PERC RATE <2 MIN/IN. ("C" HORIZON); PERC RATE <2 MIN/IN. ("C" HORIZON) Prepared for: Joey DeBarros NO GROUNDWATER OBSERVED NO GROUNDWATER OBSERVED Engineering by: Surveying by: SCALE DRAWN DARRENM.MEYEI�R.S. Eco-Tech Bnvironmentel N.T.S. DMM • I, Darren M. Meyer, R.S.. CSE, hereby certify that I are currently approved-by MADEP pursuant to 310 CMR 15.017 P10 BOX 981 (508) 364-0894 DATE CHECKED SHEET N0. to conduct soil evaluations and that the above analysis has been performed by me consistent with the EASTSAND11i MA 02837 requirements of 310 CMR 15.017. 1 further certify that"I have passed the Soil Eval. Exam in October, 1999. 508-882L2922 05/01/09 DMM 2 Of 2