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HomeMy WebLinkAbout0006 BRISTOL AVENUE - Health 6 Bristol Avenue Hyannis P v A = 309 020 - -- - - - ----_- _ -- -- - 0 i i i r. pp TOWN OF BARNSTABLE L�OCATION (-O uri sh AVC SEWAGE # ''11.-LAGS_Ny/a/►�l Is ASSESSOR'S MAP & LOT 30C1 Oa 0 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /.SW t: LEACHING FACILITY: (type) Cy4"+�k4(size) NO.OF BEDROOMS BUILDER OR OWNER �OGf'1 PERMITDATE: COMPLIANCE DATE: 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°leachipg facility) Feet 4 Furnished by Tit j,0to 101) f O 4 SACok c � of 3 Ca 30 TOWN OF BARNSTABLE LOCATION f3r�s�al Avg- SEWAGE # Vi I-iAGE /?/lU"GS ASSESSOR'S MAP & LOT 02,0 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /S00 '904 . LEACHING FACILITY: (type) - 5"00 a&L G'`i. rs(size) NO.OF BEDROOMS `3 BUILDER OR OWNER Morin( PERMTTDATE: 5—1 97 COMPLIANCE DATE: " S-` 2 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility ON 914.E 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 .Ti9GQVEJ' /�Gi2/JY ` 0417 - - r � (�nor�a dcuJ e Q19SOdoav Tor rm 76 d Op9 f o�a,� y 44P.- �6 ,^ TOWN OF BARNSTABLE LOCATION SEWAGE# ..VILLAGE��/�`^' ASSESSOR'S MAP&PARCEL3p9' INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITYGEX i/'i��..� dC LEACHING FACILITY: (type);r0Z NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: /L® 6vif%t2 Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility /42 'Feet Private Water Supply Well and Leaching Facility(If any wells exist on / i site or within 200 feet of leaching facility) J Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY 4 Q ee�/,,z i o0 11 — No. V' _ 1 Fee THE COMMONWJF MASSACHUSETTS Entered in computer: ` Yes PUBLIC HEALTH DIVISION -TBARNSTABLE, MASSACHUSETTS applitation for Bispo8al 6pstem ConstCuttion i9ermit Application for a Permit to Construct( ) Repair(Pxvpgrade(�) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. ,�O/J'j04/ Owner's Name,Address,and Tel.No. Assessor's Map/Parcel �o , -- 0 j Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building Or�� No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) _T' O gpd Design flow provided ��� gpd Plan Date Number of sheets 7 Revision Date Title Size of Septic Tank �X/✓'T��°'' o Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board 9MTealth. Si a Date Application Approved by Date 4 Application Disapproved by Date for the following reasons Permit No. 35 3— Date Issued —,_ _ ---�_----__ _ T 1 AlNo. C Fee /y Q / THE COMMONW1W47,UF OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - T BARNSTABLE, MASSACHUSETTS Yes ZIpplication for Misposal 6pstem Construction j3erinit � Application for a Permit to Construct( ) Repair 4T s,� ade �) Abandon( ) ❑Complete System Individual Components Location Address or Lot No.4E&'O',67Q/f'Tp, 41/4C Owner's Name,Address,and Tel.No. Assessor's Map/Parcel .,30 9 — OoT p �y Co,fT Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. \7�10W ! Gi4 Type of Building: Dwelling No.of Bedrooms -� Lot Size sq.ft. Garbage Grinder Other Type of Building OP 4`/P, No.of Persons Showers( ) Cafeteria( ) Other Fixtures I Design Flow(min.required) 3O gpd Design flow provided -:3i'JO"40 gpd Plan Date .100'/ Number of sheets / Revision Date I Title Size of Septic Tank 46-7 -"0aTQ o Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board alth. Si Date — �" ,2_ Application Approved by Date Application Disapproved by Date for the following reasons Permit No. �,c)Z!a !2 �� Date Issued S_ - - - - - -- -- --------- - -------------- ------- ---- -------------- = 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 lf//" z 4ngg:2gE l//C 'Pe'o—'770-C at T-,Z r,Aas been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No'�(�dated t A Installer J/yam Le��O��/r Designer t 4W4P� B./��i5f✓'��" �� #bedrooms 3 Approved design flow 7 0-'® gpd The issuance of this permits all n be construed as a guarantee that the system w. functi igned. Date Inspector _ No. d-1J ��� Fee /d Q THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal .6pstem Construction 3permit Permission is hereby granted to Construct( ) Repair( 4�r' Upgrade( ) Abandon( ) System located at dr 49%9!A:r7"O l 4 -Vol 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 mus be co pleted within three years of the date of this pe it. Date 'n Approved by Town of Barnstable Regulatory Services Thomas F. Geiler,Director a g"`�f3fA8`� Pubtic Health Division .e,a Thomas McKean,Director eo,nar°' 200 Main Street, Hyannis,MA 02601 Office- 508-862-4644 Fax: 508-790-6304 Date: '� J Sewage Permit# c — Assessor's Map/Parcel Z Installer&Designer Certification Form Designer: �� U` Installer:-1U..� Address: E�A ST 54"'4 tDW KA Address: W l,j On 1 (Ndt 7,01?— ]lig L WF was issued apermit to install a (installer) septic system at 10WJ4E;;L 14\c 1 LJC4"15based on a design drawn by (address) -1� . u "C CL3 dated It 5 Z1D (designer) I certify that the septic system referenced above was installed substantial) according to the design, which may include mmor approved changes such as lateral relocation o the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. X 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 F- 'Anions. Plan revision or certified as-built by designer to follow. Stripout(if re- --cted and the soils were found satisfactory. OF o a�� DAV1D (installer's Signature MA � SOrV rr }I 0 0 9 No.1066 Q �;3 SST 'gnature PLEASE RETURN TO BA)RtNSTABLE PUBL,_ QF COMPLIANCE 'VVII I_, NOT BE ISSUED t JU16 F( AND—AS- TgUII.T CARD ARE RECEIVED BY TIIE BARNSTABLE PUBLIC HEALTH DIVISION. TYL9 NK YOU. gAoffice formMmiperceitification fonn.doc Town of Barnstable P# c� -6 Department of Regulatory Services i 4-9 Public Health Di ' » vision Date � /� 200 Main Street,Hyannis MA 02601 f0 AAId _� t Date Scheduled I'A � Time_J& Fee Pd. Soil Suitability Assessment for a e Disposal Performed Br. Witnessed By: LOCATION& GENERAL INFORMATION Location Address ���/f'To 4,e"e. Owner's Name !_ 47 J%7i Address Assessor's Mapft=l: O�— O Engineer's Nam 'l//e, NEW CONSTRUCTION REPAIR Telephone# Land Use Slopes(46) Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands 1n proximity to holes) Ca CR C C7 Parent material(geologic) Depth to Bedrock Depth to Groundwater. Standing Water in Hole: Weeping from Pit Race -0 � Estimated Seasonal High Oroundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: ln, Depth to weeping from side of obs.hole: in. Groundwater Adjustment tt, Index Well# Reading Date: Index Well levcl Adj.factor T Adj.groundwater Level,,,e Observation PERCOLATION TEST bate�.._ Thu M_ J Hole# ���11,�'`^ VW nme at 9" Depth of Perr ��I ---- Time at 6" start Pre-soak Time® Time(9"-611) �- End Pre-soak Rate MinJlnch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) I Original: Public Health Division Observation Hole Data To Be Completed on Back------ ***If percolation test is to be conducted within 100'of wetland,you must first notify the. Barnstable Conseirvation Division at least one(1)week prior to beginning. Q:%SEPTICIPERCFORM.DOC DEEP-OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. n i tenc ravel DEEP OBSERVATION HOLE LOG , Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other! Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, Oravell DEEP OBSERVATION HOLE LOG Hole# _ Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones:Boulders. Consistency, l A' 1 Flood Insurance Rate Map: / Above 500 year flood boundary No_ Yes✓ Within 500 year boundary No_ Yes Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pe .ous mtiterial 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 y1 (date)I have passed the soil evaluator examination approved by the Department of Envir mental Protection and that the above analysis was performed by me consistent with . the required training,expe se an—cdk,,expenence described in 310 CMR 15.017. 7 Signatur Date /d Z- 71 Q:\SBPTIC\PERCPORM.DOC . COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION RE D FEB 0 9 2005 TOWN Ik:L; .. ..;-'ABLE TITLE 5 HEALTH 0EPT. OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION 3 0 tv Property Address: 6 Bristol Avenue RCf=1 4Z�y Hyannis,MA 02601 Owner's Name: Keisser Rocha Owner's Address: Date of Inspection: January 10, 2005 Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford Mailing Address: P.O.Box 49 Osterville,MA 02655-0049 Telephone Number: . (508) 862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ Passes Conditionally Passes Needs F er Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: January 12, 2005 The system inspector shall sublk copy of this inspection report to the Approving Authority(Board of Health 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 ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page I • Page 2 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 6 Bristol Avenue Hyannis, AM Owner: Keisser Rocha Date of Inspection: January 10, 2005 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or.due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: i 2 i Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 6 Bristol Avenue Hyannis, MA Owner: Keisser Rocha Date of Inspection: January 10, 2005 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria 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,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 • Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 6 Bristol Avenue Hyannis,AM Owner: Keisser Rocha Date of Inspection: January 10, 2005 D. System Failure Criteria applicable to all systems: You must indicate either`yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than'/z day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_ ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for 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,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. 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) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply 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 If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 6 Bristol Avenue Hyannis, MA Owner: Keisser Rocha Date of Inspection: January 10, 2005 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection? ✓ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ _ Was the site inspected for signs of break out? Were all system components,excluding the SAS,located on site? ✓ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? ✓ _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No ✓ Existing information. For example,a plan at the Board of Health. ✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)]. 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 6 Bristol Avenue Hyannis,MA Owner: Keisser Rocha Date of Inspection: January 10, 2005 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 0 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): n/a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings,if available(last 2 years usage(gpd)): Sump Pump(yes or no): No Last date of occupancy: Unknown COMMERCIAL/114DUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): god Basis of design flow(seats/persons/sqft,etc.): 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: 2004-213,750 2003- 167,250 gals. Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Never pumped-per owner Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: _gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Installed on 915197 per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 6 Bristol Avenue Hyannis,MA Owner: Keisser Rocha Date of Inspection: January 10, 2005 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC _other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 16" Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1500 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 5" 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: 10" How were dimensions determined: Measuring stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Tees were present. The liquid level was even with the outlet invert There did not appear to be any signs of leakage GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,.evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 6 Bristol Avenue Hyannis, MA Owner: Keisser Rocha Date of Inspection: January 10, 2005 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): The D-box was level and clean. No solids were present. PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): � I 8 Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 6 Bristol Avenue Hyannis,MA Owner: Keisser Rocha Date of Inspection: January 10, 2005 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: ✓ leaching chambers,number: 2-500 y_al. chambers leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: Innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): The leach chambers were dry and clean. There did not appear to be any signs offailure CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: None (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.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE.DISPOSAL SYSTEM INSPECTIONFORM PART C SYSTEM INFORMATION(continued) Property Address: 6 Bristol Avenue Hyannis,MA Owner: Keisser Rocha Date of Inspection: January 10, 2005 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. A o a SAC k. C. ao D3- 3q 10 Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C. SYSTEM INFORMATION(continued) Property Address: 6 Bristol Avenue Hyannis, W Owner: Keisser Rocha Date of Inspection: January 10, 2005 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 20+/- feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours maps Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic and water contours maps, the maps were showing approximately 20'+/-to ground water at this site. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied,relating to the system, the inspection and/or this report. 11 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE VMMR STREET,BOSTON MA 02108 (617)292-6500 TRUDY CORE Secretary ARGEO PAUL CELLUCCi DAVID B.STFiLTHS Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECTIow FORM Cotnsnise:aner PART A / _ CERTIFICATION Alvat PropsrtyAdldrass: G 6-1Sl0/ cive Nanta of OsmanData of bt,p.etia j � adid/res.or owns.: — r pi-�a G r►h�S �1��, 0d�Gv; Name of Mupector.(P -Peintt 0 /o/Gtrb� Ya/Se— I I sin a OEP approved syetsm impa�to�•�to Section 15.340 of Title 61310 CMA 15.0001 Cortrp.ny Name: by — T � C Ma&q Address: , c4 " 4c., C7't 6 4 — TeMoKmta Number: CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience In the proper function and maintenance of on-site sewage disposal systems. The system: posses Conditionally Passes Needs Further Evaluation By the Local Approving Authority _ Fails hmpeetor's Signature: 0 ,t' Date: 0 CJ The System Inspector shall submit a copy of thie Inspection report to the Approving Authority(Board of Health or DEP)vhtNn thirty(30)•days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department otr nvironmentall Protection. The original should be sent to-" system owner and copies sent to the buyer, If applicable,and the approving authority. NOTES AND COMMENTS RECEIVED MAR 0 8 2000 TOWN OF BARNSTABLE HEALTH DEPT. revised 9/2/98 Peke I of 11 `�Pnnied on Recycled Pam, 4 SUBSURFACE SEWAGE DISPOSAL SYSTEbM INSPECTION FORM PART A TION(aarttlratsdl Owner Dew of ktspe�f n O lwspnnolt>➢ wmARY: CtMdt A, 8, Q, Ol O i SY PASSES: 1 have not found any Information which indicates that any of the feRure oor4dons described in.310 CMR 14.342"at. Any failure whorls not evaluated are indicated below. j COMMENTS: a. SYSTEM CONDITIONALLY PASBU: One or more system components as described In the'Conditional pass'section need to be replaced or repaired. The system,upon co►nplation of the replaceffmt w ropolr,as approved by the Board of Health,wM pass. ;ndicate yes: no, or not determined;Y,N,or NDI• Describe basis of detemlinetlon In IN instance$. If "not determined', explain why not, _ The septic tank Is motel.unless the owner or operator hoe provided the system Inspector with a copy of a Commas"of Complianee(ottachod)Indicating that the tank was Installed wWM twenty(201 Veers prig►to the date of dte btspeetlortl or the septic tank, whether or not motel,Is cracked,structurally unsound,shows substantial frditrat en or exfktrstion,or tank failure is Imminent. The eyetem well pass Inspection if the existing septic tsnk is replaced with a oamplying septlo tank as approved by the Illoard of Heslth. Sewage backup or breakout or high static water level observed In the dloWbutlon box is due to broken or obstructed piws) or cue to a broken,settled or uneven distribut(on box. The system will pass inspectlon If(with approval of the Board of Health), broken pipets)are replaced obstruction Is removed distrilkutlon boa Is levelled or replaced The system reerybed pumplfty I Wit titan tourttmee•yeenluete ttroMan er efretroated plps(sI. ThrsYetern wNtptiar^ inspection if iwith opproW of rho Board of HeoiM1: - broken pips(s)are repleced obstruction is removed :sad 9/4/7C Page 2or11 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A C7TIFICATION(continued) Property Address- � a� �Gc✓�vr rs �a Owner: I/v19�' Date of hapection: 3- 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 IIII ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTE IS NOT FUNCTIONING IN A MANNER WHICH.]MLL.PRQTECT THE PUBLIC HEALT)LAND SAFETY AND THE ENVIBONMENTT- 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 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 o 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 t 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 (approximation not valid). 31 OTHER revised 9/2/98 Page 3of11 A SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: �l S Q!/� G.�l✓1 f Owner: j'� �r(� Date of Inspection: n D. SYSTEM FAILS: You must indicate either "Yes" or "No" to each of the following: 1 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 Backup of sewage imo fecili"r-wwtern component due tto an overloaded orclegged SAS,or-cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or / cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. U� Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. L Any portion of a cesspool or privy is-within a Zone I of a public well. I _ Any portion of a cesspool or privy is within 50 feet of a private water supply well. -V 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 the system is within 400 feet of a surface drinking water supply the system-is-within 200 feet of-o-tibwtery-tea eurfaoo.drinicing-watw-oupply 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 15.304(2). Please consult the local regional office of the Department for further inforgiation. revised 9/2/98 Page 4or11 I � SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Owner: i^-tQ vt l kj P Date of Inspection: 3- 00 Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Y s No Pumping information was provided by the owner,occupant, or Board of Health. None of the system compoa onU.b&ws men pumpadwor-atJaast two weeks an&the aystem hasbaaoaacaiaiogaaatal mow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. J _ As built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or industrial waste flow. J _ The site was inspected for signs of breakout. V _ All system components, excluding the Soil Absorption System, have been located on the site. _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimerisions,depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System orrthe site has been determined based on: � ! ✓/ _ Existing information. For example, Plan at B.O.H. v _ Determined in the field(if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) / 115.302(3)(b)) The facility owner (and.ocrsrpants.if differeat from-arwner).,Ware,prnyided.adth iafnrmatioann.theprnpar,mainfanap000f SubSurface Disposal Systems. revised 9/2/98 Page 5ofII SUBSURFACE$EWAGE DISPOSAL SYSTEM INSPECTION FORM PART C 1� SYSTEM INFORMATION Property Address: ���i f/�' are, f T Gi N l�f /iI.Cl Owner: r t Date of bupection: Flow CONDITIONS RESIDENTIAL: Design flow:�g.p.d./bedr m. Number of bedrooms(�: Number of bedrooms(actual): Total DESIGN flow Number of current residents: Garbage grinder(yes or no):_zEry7 Laundry(separate system) (yes or no)-A-10 If yes, separate inspection required _ Laundry system inspected (ves oto Seasonal use(yes or nol: - Water meter readings,if available(last two year's usage(gpd): Sump Pump(yes or no): /U Last date of occupancy:-9v COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: gpd ( Based on 15.203) Basis of design flow Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings,if available: - Last date of occupancy: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of informatio System pumped as part of inspection: ( r no)_ If yes, volume pumped: gallons Reason for pumping: qPZEF SYSTEM . Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or not (if yes, attach previous inspection records,if any) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components,date installed/if known)-and source efwNeernation: 2 Sewage odors detected when-arriving at the site: (yes or no)�/V revised 9/2/98 Page 6of11 • l 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Icofftinued) Property Address: `rj L✓ 1f ve, G K /4 Owner: r �rf Date of hrspection: BUILDING SEWER �O (Locate on site plan) Depth below grade: Material of construction: cast iron 4140 PVC_other(explain) Distance fro p;7vate water supply well or suction line Diameter A / Comments: (condition of joints, venting, evidence of leakage,-etc.) SEPTIC TANK:_ (locate on site plan) Vconcrete Depth below g►ade:Material of construction: _metal_Fiberglass _Polyethylene_otherlexplain) If tank is metal,list age_ Js.age confirmed by Certificate of Compliance_(Yes/No) f Dimensions: ! 0 x C, Sludge depth: Distance from top f sl dge to bottom of outlet tee orbaffle:_jC� _. Scum thickness: Distance from top of scum to top of outlet tee or baffle: _/ Distance from bottom of scum to bottom/of outl tee or ba le: ' -! How dimensions were determined: L;(e ^a - Q Comments: (recommendation for pumping, condition of inlet and outlet tees or-ba les, depth of liquid level in relation to outlet invert, truct eF+ntegrity, evidence of leakage, etc.) %� �e p� r. /l•�b >ria v7 �,k r i�ft" GREASE TRAP: (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_Fiberglass _Polyethylene_otherlexplain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: 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 9/2/98 Page 7of11 I r • J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Add► Owner: ` : (� ��r s�l GA� Date of bnpeetkm: 2 TIGHT OR HOLDING TANK: (Tank must be pumped prior to, or at time of, inspection) (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_Fiberglass_Polyethylene_other(explain) Dimensions: r— Capacity: gallons Design flow: gallons/day Alarm present Alarm level: Alarm in working order: Yes_ No Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches,etc.) DISTRIBUTION BOX:. (locate on site plan) Depth of liquid level above outlet invert Comments: (note if le ve nd dispibution is equal, evidence of s lids carryover, eviden a of leak¢ge it o or/out of box, etc.) GU� � C2Gt� r s7V0 Z— Pa7 PUMP CHAMBER:_ (locate on site plan) Pumps in working order:(Yes or No) Alarms in working order(Yes or No) Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) revised 9/2/98 Page 8of11 ci SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C / SYSTEM INFORMATION(continued) Property Address: Owner: Mort ii Date of Inspectkm- 9_ � o i SOIL ABSORPTION SYSTEM(SAS):_ (locate on site plan, if possible:excavation not required,location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits, number:_ leaching chambers,number: J leaching galleries,number:_ leaching trenches,number,length: leaching fields, number,dimensions: overflow cesspool,number:_ Alternative system: Name of Technology: Comments: (note condition of soil, signs o ydre c failure,!�Vel of ponding, d p spy condition of vegetation, etc.) "�a r7Iva - CESSPOOLS:_ (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as part of inspection) 0 Comments: (note condition of soil, signs of hydraulic failure,level of pending,condition of-vegetation, etc.) _.- PRIVY:_ (locate on site plan) Materjals of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation;etc.) ! h revised 9/2/98 Page 9orn SUBSURFACE SEWAGE DISPOSAL SYSTEM NSPECTION FORM PART C SYSTEM INFORMATION(contimsed) Property Address: , ��t Gj�'LO Gif')✓1Gl' Owner: y "1 �^( ✓� Deft of Inspectkm: 3_ ��r� � 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) ll / revised 9/2/98 Page worn M SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECTION FORM PART C SYSTEM UINFORMATION jco nthwed) Property Address: l0 r STN Gr ve, /1 �1 VI q ij Owner: 0/ (o Date of Inspection- - -9-0 0 NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate1Z Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater&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 hacked local excavators, installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) 7 to revised 9/2/98 P2ge11of11 17,RTz-;e//a G ^erA A4w o JZfc TO? OF fGL'r1404i'loN f.- �L aNp rD N CON Cic i i cc COVc�S /.;`N D ,2E/SL ACEry lvi�,/ CL�7¢N��7•r+o m , i. •'� 4CAS IRON 1 .,,... . '30 ,'� OR SCHEDULEIM AO rl 4"SCHEDULE 40P.V.C. (ONLY) LEACHING TRENCH I/'IREO• � „ oV.C. PIPE fLI;J. 9 AtIN . PIPE-IN IN. I/8"- Ih" WASHED STONE 36 MAX. P1TCN 1/S Pr4.i t. �.�.. .....�••�. �� - Z. ,�' D ! 3 COX 1 8•r °'. Iti`!E?T L--, pi ,;O�:�.�%C7 �C?`'Q.CI; 4' EL.. C:? SEPTIC TA1tiK IKV-�� DIST. 1t31r=-� ;q�:r�'o�t��:t ;'ti' �i;o'L6;• _ 24' INV=RT EL.?r/r�s'S BOX EL '�S v,�,djo;o,;o r'�I%,•�-t��p ko- /.moo.. ... caL.. rL 9 . z INVERT Precest 500Gcl.Leach tNv � ; 6'�CRUSiiEO STONE EL26,3 . (Z) REO. Chamber WASHED STONE oV�R H- rb •.r a, r P,Ot'1 l F C) IVo�IL NJ1/Coci �zC OD !,: :•. GROUND WATER TABLE SOIL LOG SEWAGE DISPOSAL SYSTEM —TYPICAL CaoSS SECTION a�; ¢/997 TIME //;av /.�-r�. NO SCALE LEACH I NG TRENCH . TEST H.OL= I T:ST )-'.OLE 2 3//o/y7 J*Al,CQrgye.. 24,,z!- �L_=v. .Z .vo.. . . �_Ev. .. . . ... ... DESIGN XFA _ vA=1, � L-�9� �15.1i) OF �rDROOt:S w OR °ya 3l+E 79 i� % I i OTAL E3:;.`.!;,—_0 :Lri�Y .. . `?p. ... :.;LLJ.i S/.J:Y � _'.._ :�., \ - ` - iF1- - t e 607ivt.1 L=CC t::G AREA -� t��._ $v.:i.I in=J:C:i�G,73 r� L7-L�!Cl•�, 24" w SiDE LEACHING AREA ../5'/32 . .:_ A C MLA S�rdD GARBAGE DISPOSAL .N�e..(50% A?-rA INCASAS`F) �PD• 3 c 1 . TOTAL LEACHING AREA .472..�7: sc.:i. L s L w PERCOLATION ?.ATE .�r .?4-1 rJ�!%r F_RANCH LEACHING AREA PER P°«RCOLAT,ION SO.i i/CP.r17. ,yeNr rn/cnu vf��Dl � -- -- - - . . .. GiRCLIND 'tb:i E.R k?.�. A?PROVc? BOA?0 OF HEALTH Np...;�%+i_R cNCOUJYi:.RED DATE ...__.. ..... ..._.... �s.� 1PI(ITI�ESS1=© BY : 6 Q,e is -'.'�T S>R t ?_�jy�� `'`f r c� °��' 'OF 4 pET�iz ET . .. ENGINEER . . _ . . _ . . . . . . . . . y o. 28100 4 �! 'ss�o£lrS:ta�°g�' PETITIONER ' �,0.EVAlCt+�<` No. 97 .2 Lf ® �^ O O Fee 1"e THE COMMONWEALTH OF MASSACHUSET.TS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Tipplication for MizpooY *pMem COn$truction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) QZomplete System O Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 77S— $B. Assessor's Map/Parcel 3 o 9 — D 30 !DEAK.s 9-s ze, .. y "s aZ6a/ Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel. o. "97tzF I�tr/il/E/^ -a: Type of Building: Dwelling No.of Bedrooms _ Lot Size ✓ 3 sq.ft.r^ TGarbage Grinder( ) Other Type of Building No. of Persons howers(.55Q Cafeteria( ) Other Fixtures 2)/5//?./, l� ., srS Wlewet Design Flow i6c% 330 gallons per day. Calculated daily flow 3 7 gallons. Plan Date Alf a-4 A�, /9 Q g Number of sheets Revision Date Title L/ Ar,Spa V-y I+ Size of Septic Tank /S60 jef-f. Type of S.A.S. Description of Soil S-;E 7 Z-,,g Q-S Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and ni&kU@*aacc_of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue y this Board of ealt4. ` Signed Date 5� / Application Approved by Date 4L14 ' Application Disapproved for the following reasons Permit No. 9 2 — 2 y 3 Date Issued S Aro "1 No. / 2 v 3 o / a O y„-.. a t Fee �W THE OMMONWEALTH F MASSACHUSETF 'Entered in computer: w Yes PUBLIC HEALTH-DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS Application for �D'igaar 6p.5tem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) 191r!o*`mplete System O Individual Components Location Address or Lot No. ,6 Owner's Name,Address and Tel.No. fc ��r-ssa Assessor's Map/Parcel /Ve 30? - 0ao Sao DF x_srs H 's -Oz6o/ Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel. o. I a - ;:JT pe of Building: -Dwelling No.of Bedrooms 3 Lot Size o, o_Q sq.Lt. t .Garbage Grinder( ) Other Type of Building No.of Persons ? ST�Tt� WD�howers(49) Cafeteria( ) i Other Fixtures 7/�4%/. k& Design Flow 330 gallons per day. Calculated daily flow .3 gallons. Plan Date ZIZA- lis . /9 9 e Number of sheets Z Revision Date Title `� k%f Spa l 4v>c Size of Septic Tank /suo grf Type of S.A.S. Description of Soil S177- /a GS Nature of Repairs or Alterations(Ans..Wer when applicable) i Date last inspected: Agreement: The undersigned agrees to ensure the construction and rnaiawaaPxxof the afore described on-site sewage disposal-system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issuleqvthis Board of YealA. Signed Date _ / Application Approved by L Date 5---,!�4 � �• Application'Disapproved for the following reasons Permit No:., Q 7 2 S/3 Date Issued { ——— ——————————-———————————————————————— j THE COMMONWEALTH OF MASSACHUSETTS j BARNSTABLE, MASSACHUSETTS I Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed (k-)Repaired ( )Upgraded Abandoned( )by. i Kh!�,Y-1 V1 at L 1- r has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer -The issuance of this permit all not be construqd-aas7 a guarantee that the system w-il•1_fu-n-ccttion as designed. Date Inspector -J --------------------------------------- No. 9 7" .1 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS 1=igo$al '*p!5tem Construction Permit Permission is hereby granted to Construct.()Repair )Upgrade( )Abj ndon( ) System located at_ �a �>ri r A/eNe R'�A In r and as described in the above Application for Disposal System Construction Permit. The applicant recognizes 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: ' Approved by 611,f.1�4 12( �It.1 -(fro �M 10�� TOWN OF BARNSTABLE LOCATION �/"!S�-a/ ��/E' SEWAGE # VILLADE �yA/1//1//S ASSESSOR'S MAP& LOT 30'—02Q INSTALLER'S NA &PHONE NO. �,g U es l�I o %!Y 7 ME SEPTIC TANK CAPACITY /SOO GAL LEACHING FACILITY: (type) a2- SDO (ram Clz*m s(size) NO.OF`'BEDROOMS "3 BUII;DER OR OWNER --�FIGa VAS /�o ri 11 PERMIT DATE: 5' 9 I COMPLIANCE DATE: Separation Distance Between the: . Maximum Adjusted Groundwater Table and Bottom of Leaching Facility ON F/AE Feet Private.Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of' etland and Leaching Facility(If any wetlands exist within.300 feet of leaching facility) Feet Furnished by .:)� _ dE�' M02/IX . . - �+ Q epic J C°�` Jpl . I �' �p BB.` a`'♦ R . �0pgs� s,'jc9 � Aft � wom A-as" y PROPOSED J s BR .:.: L _ HOUSE arr E (far Boa") � � .' � � 1 row .• j A .S 66 44 50' W ° TOP of STANDARD NO TES FOUNDATION EL 100,8_ 0 _ U 10 99 EXISTING GROUND SURFACE EL EXISTING GROUND F SURVEYING ❑R ZONING O D SURFACE EL R ❑F 'A SEPTIC SYSTEM INTENDED ❑R 1) THIS PLAN IS FOR THE INSTALLATION ❑R REPAIR , AND IS NO T 6 MIN PURPOSES. TD30CMR15,000 THE STATE ENVIRONMENTAL CODE, 2) ALL INSTALLATI❑N PROCEDURES ND MATERIA SHALL CONFORM 1 - N �armou-�� OUTLET PIPE LEVEL 2,8 VENT REQUIRED TITLE 5 AND THE TOWN OF SUBSURFACE DISP❑SAL REGULATIONS.------------------ TOP EL _ LIQUID LEVEL FIRST TWO FEET 3) NO DETERMINATI❑N HAS BEEN .MADE AS TO COMPLIAN CE OF AVAILABLE .PR❑PERTY INF❑RMATI❑N WITH REC❑RDED DEEDS 98,1 MIN 2• LAYER DOUBLE VASFED ' - D-BOX 1/H'— L2' STONE • INVERT EL G REGULATIONS, 14❑R ZONING JEFDE '97,50- 0 O O O O O O 0 O ' O d OPE TY. CTIVES , HIS PR❑ R4) T❑W N WATER SERVICE T95.75 SIEWALL• + Gas Baffle at Outlet � � 0 � 0 ' � ; 9 .75 _ INVERT EL SYSTEM, 7 T WELLS ❑N THIS PROPERTY ❑R WITHIN 100 ❑F THE PROPOSED SOIL ABSORPTION 5> THERE ARE N❑` KNOWN PRIVATE . . . . . . INVERT EL . . . . . . V E INVERT L , , F BROUGHT T❑ WITHIN 12 ❑F FINISHED GRADE WITH ONE COVER ❑ THE 6) ALL COVERS ❑F SYSTEM COMPONENTS SHALL BE BR❑ t 96,55 4 z 8 FhondltJrusora 93.3 + 96.38 3/4 1 1/2 DOUBLE SEPTIC TANK ` BROUGHT WITHIN..6 •❑F GRADE.. . . INVERT EL ical (T.�P ) WASHED STONE 6 STONE BASE INVERT EL + , E. GATED DIRECTLY BOTTOM EL 5.8 _ TS SHALL REMAIN ACCESSIBLE FOR INSPECTI❑N. NO STRUCTURES SHALL B L❑ I 7) ALL 'SYSTEM COMPONENTS H 1 ends/4 sides 1500 GAL Septic ?knk ACCESS LOCATIONS, WHICH WOULD INTERFERE. WITH THE PERFORMANCE ACCESS INSPECTION . P BOTTOM EL UPON ❑R ABOVE THE COMPONENT A loel 15 _ ± 11 - ± PUMPING OR REPAIR. 31 � EL 89.0 U AREA SHALL BE LOCATED ABOVE A SOIL `ABSORPTION CIO MIN) ESTIMATED HIGH GROUND WATER 8) NO DRIVEWAY, `PARKING OR TURNING AREA, DR OTHER' IMPERVIOUS E _ (using USGS Method) j r SYSTEM EXCEPT WHEN VENTING HAS BEEN PR❑VIDED. 32 ` ❑N 6 STONE BASE 9) SEPTIC TANKS, GREASE TRAPS, D❑SING CHAMBERS AND DISTRIBUTI❑N BOXES SHALL 'BE -PLACED A STABILITY AND PREVENT SETTLING, T❑ ENSURE ESIG D _N P, TA V ❑R A MINIMUM ❑F THE FIRST TWO FEET ❑F THEIR LENGTH. , 10) OUTLET DISTRIBUTi❑N LINES -SHALL REMAIN 'LEVEL M _ 1 ends/,4 sides 11) ALL SYSTEM COMPONENTS SHALL BE CAPABLE OF WITHSTANDING H 10 LOADING UNLESS ;THEY ARE UNDER DR WITHIN 10 3 NUMBER OF BEDROOMS ____ ___BR O PARKING ❑R TURNING AREAS IN WHICH CASE H 20 COMPONENTS SHALL BE USED, ❑F . DRIVEWAYS R ARKI I , NO GARBAGE. GRINDER --------- r I , SHALL HAVE AN INNER DIAMETER OF 4 AND SHALL BE CAST-IRON ❑R SCHEDULE 40 PVC, 12) ALL BUILDING SEWER LINESHA L A I330 DESIGN FLOW ---------GPO • I - NPROVIDED. 13) THE DEPTH OF THE TOP OF ALL SYSTEM COMPONENTS SHALL NOT EXCEED 36 UNLESS VENTING HAS BEEN _ (110 GAL/'BR/DAY x NUMBER OF BR) U U ❑ S PROPOSED CONTOURS,14) IN THE AREAS OF EXCAVATION, EXISTING GRADES SHALL BE REESTABLISHED UNLESS NOTED A 1 5OO SEPTIC TANK --1------GAL (MINIMUM''= y 15) iF -SOILS ARE ENCOUNTERED DURING THE EXCAVATIDIN OF THE S❑IL ABSORPTION SYSTEM .THAT DIFFER. NOTABLY FROM DESIGN FLOW x 200 ) LEACHING 'A E HOLE LOG CONTACT THE ENGINEER BEFORE PROCEEDING, H AREA THE DEEP OBSERVATION ❑ \ SIDEWALL ---8 8�--SF UNDERGROUND UTILITIES, \ c2 s EV 0,96 34 16) CONTRACTOR TO VERIFY LOCATION ❑F ALL NDERGR❑ iD ALES x _FT x ______Fn 96 12 (2 ENDWALLS x _9,---FT x -----FT) 408 SF \ BOTTOM; --------- 12 34 �------FT x ------FT) 0,74 GP /SF \ LONG TERM ACCEPTANCE RATE (LTAR) --------- D \ 367 GPD LEACHING;AREA DESIGN CAPACITY __ _ .(SIDEWALL AREA BOTTOM AREA) x LTAR to \ • 101 \ Ch DEEP OBSERVATION HOLE LOG DEEP OBSERVATION HOLE LOG Pro 1 500 Gal. Pro Lea chin Fa czli t p O b°• Y Teat Role 1 Test Hole 2 ?'eat HoIQ Test Hole • Septic Tank EL = 98.9 f EL 99.5 f EL = 98.E f f Four 4 x 8 Flo wdiffusors- a � .P \ \ \ � J ( J F J DEL 98.7 J w 1 ,Slone on Ends and E _ Lot 19 \ 4 Stone on Sides 0 _ \ , • 5 .,. ,.. 40 96.St ILL SAND 7 93 t I ' F ND 2 .b F SAND 88 9b.7t FILL SAND 4 9� t o AA D b .2 .FILL SAND /i' 6 _ 0 - ,r .- f f mrRs_ G \ \ SD 9.1.7 FILL ASPHALT 8� 92.b Ct LOAMY f foYR6 6 ..... SAND 42 96.,2E FILL ASPHALT 7x 92.7 ct LOAMY /B SAND /B 1 ;; f OYRB � f 8 6 t�'1' 9,26 Ct SANDY LOAM 1 t38 88.0 CZ YSD SAND YS f08 89.7 Cf SILTY S 86Yg f Pro Box 100 _ \ / /� AND � �sz 8r� ca Lo,urY SAND xarn� P F-. \ rr coBe.Lss 1 o 144 88.91 CR SANDY LOAM foYB6 4 . O \ JIfFD SAND W \ � o TH ,2 \ \ T 4 2 f \ 1 _ • Io \ zf 99 \ \ 1 2 n. ob. Noce nte: gar fs. >ae� ou. BobDate rAr r� fees on. aw. n.� r�r� fae� Deep Deep �P � Deep OLs SoL'Datr JftT It 1Da9` Soil Evaluator. B1CITAIM LRAJMD Boa Iva uaton.. BiCBABD LSABWAD Soil iwlaator. RICKAlID LZ&J WlD Soli Z*Nhmtm- RICBIRD fiARWLD t \ Thnoosed ✓6RR!'Di7xxI111C Tunsesed ✓GREY DUxx1NC 111taaaasA ✓ Shored •l � Pero Bate: NI Pau Rab: NI Pao Rate: x1 Pere iRate: . < B JQJI//111/• e 1 Soil Deeorl CARP3R - Bodl CARYE7Q De+o 8afl n; CAR/dR 8otl Survey ti \ �7 Ptio'n• Survey ripttoax 8mTr7 Description: 7 Deaorlpttoa CABPBR C S s 101 \ M.bri.t OUlIA89 Matarlat oDrnA a waaat orrrrAstl MabrLk WWASH 3 \ � � b Titer. f0.�t b hater. fo.e t Depth to Dateir. lUe 1/dR ll�so�wv?hai O Depth Standias Depth 9taadio� Dep t>wndiat Depth b Standing Water 'f0.4 t to Tatar. .: NA _-. Da b T Tatar. 1vA to la NA n' '` \ tar to Bfatae NA TH 1 P Depth �1�L PL NDaiL Depth RiePlaL Depth TieploB \ Da to Cohn•. NA to Calve. xd De to Dolor IfA ' : . . . � 0 \ � ��( r �► ( r l►� tee( �. b Coloe xA I I Esc Seasonal Clk fo.o t Est eaaeon•t cn foe t iM seasonal clr. . R �+ � � x/ Est s...en.l Nl� � fo.1 t P R •� 5 QQ vacs oh..r..tien T.lr Af>I tao uScs oh..r.etion T.lc U1'tsv oeoa o>,..�.atton T.i>; x� l>lIBS Observation T.m AN sso 5 2 i _, \ 1 \ Data of Let Measurement: APR tt. tsay Deb of Let Measurements APB rM /pey Dab of Let Me..m�.ment XA Date of Last Measurement: APR 097 Di ►� I cammsaats: cemmanta: Comments: cam4mezatec - �� \ � ' 0 \ . . . THJ3 OF , T r ' R — 19. 48 r � r , \ r L = 31. 10 N \ r w �5-� \ Prop. Wa t�r Line r , - �'. r PROZECT LOCATION � \ r 99 � 100 r V 100 c, L o c-• ASSESSORS MAP LOT '� . . to t TB1lI = 100. 00 r APPLICANT.• r \ i r .: `�J Prop. Set NaNazl in Tree \ "� Bayberry Bulldln Company .v y � P ny As halt - r.Ydy 300 Bearses Wa EXCA VATION NOTE. ,� J �. E kb Hyannis, M4 CD Id" Exca Ya to 5 around leaehing o '� 66 5 o / 9A o of C1 A fa czh ty' down ` to _top / 9 \ PREPARED BY. TH4logs) , - \ la er see TH,�1 and # A & M Land Services Cape-Tech Environmental ima to EL=94.f. , q �� 33 Old Me1n Street P.O. Box 1541 i a t approximatetj k� South Yarmouth, MA 02664 &wws�ter, MA 02631 \ (508) 398-2121 Fax 394-9642 508 896-4999 OL �- i t P 4 \ ' , >R� - SCALE 1 10 DATE: May 16, 1997 .REV. LOCUS MAP TBM = 99. 38 6 Bristol A ve. Hyannis, MA D WC. NO. T1045 SHEET 1 OF 1 - Cor. Cone Slab. ASSESSORS MAP : �—�—_- --_. NU'I'1?';: PARCEL: -AZ� TEST HOLE LOGS C� FLOOD ZONE: �I�I ��' (� � SO I L EVALUA7 RJR :3 AVI �/ 1) The installation shall comply wily Title V and 'Town ol• 2a P1 l So vd of lj W I TNESS : 2t I Irnllli ItcE'iilttliuns, REFERENCE: ��'y/67�� d�.Z="�_�� C' /7j�� ,� ----�---• - --- ------ -- ----- ---- DATE. 0�l�r, 2) The installer shall verify the location of utilities, sewer inverts and septic �,- / PERCOLATION RATE: . 1 I components prior to installation and setting base elevations. LV�� - --- j -- - 1 3 All Trams.it septic piping to be 4 inch Sch 40 PVC at 1 " 7 `'/� A ' y;Q� ) I✓ y p p p g /8 per luot. the first _. 7..___-- _- / '�'•�✓I � two feet out of the d-box to the leaching shall be level. I I _ � TH-2 4) This plan is not to be utilized for property line determination nor any other purpose other than the proposed system installation. ►� (1 5) All septic components must meet Title V specifications. A 6) Parking shall not be constructed over II10 septic components. --- - ---------- V, /� 7) The property is bounded by property corners and property lines. LOCATION MAP�, 1j j 0b design flow and number of bedroom 8) The property owner shall review design considerations to approve of total — n C+✓�G�.,/�UG7�.� �,/ �/� ���' �/r� � � � g s to be considered for design. Receipt - - �ttn� bo �lw)1 , L of payment for the plan and installation based on the plan shall be deemed �142l�/6 (�' .��'��$L,/�j� htq.�l �j►{�1�� approval of the design flow by the owner. C'p / ld �� Ib �.�� 9) The existing leaching or cesspools shall be pumped and filled with material "-"- I 1 per Title V abandonment procedures. Those within the proposed SAS shall ��7 r ► �' be removed along with contaminated soil and replaced with clean sand per 1 d0 Vet 2� 1 40 404APj Title V specs. 10)System components to be 10 feet from water line. Sewer lines crossing the I -- water line shall be sleeved with 4 inch SCI140 PVC with ends grouted if applicable. The proposed SAS is being installed below the water service SEPTIC SYSTEM ' DESIGN j line. The line is to be sleeved as aforementioned and maintained in place. 11) If a garbage grinder exists it is to be removed and is the responsibility of the owner to ensure such. FLOW ESTIMATE ! 12)'1'he installer is to take caution in excavation around the gas line if such 1 exists. ✓"`\ BEDROOMS AT lD GAL/DAY/BEDROOIA - GAL/DAY 13)The installer shall verify the location, quantity and elevation of the sewer ��T17( ! l(,Q�,.I t� Or _-- lines exiting the dwelling prior to the installation. _ - _-_ i - - SEPTIC TANK 14)This plan is representative only that a system can fit on a property meeting 112 , 17 _----,. "Title V requirements. GAL/DAY x 2 DAYS - gt::� GAL 11►.ICf --� USE (. DO GALLON SEPT I C TANK ��✓TI�IL?l _ S01L MORO, ION SYSTEM N n I 4 -- if`I llrl S 1 DE AREA: ; 7i - _ rsT r tJ i ---� _ _M _ '�J� BOTTOM AREA: x 0i 7,j5 q l Z { SEPTIC SYSTEM SECTION ix I+n V� j �Up 0� fl lv l I I I�KKIri�I ► VDJ) L _._ _... b q u �' ✓( 0-I /-� 911 9`1 _ '� — V (p� EL-DKX0 GAL %,G- fIZp ► i� a , " - �T g►, SEPTIC TANK -` t,� 16 ' SITE AND SEWAGE PLAN LOCA r ION : 61oL AX)E 1 PREPARED FOR : 11M Lfz,,�3060'f= -- 7 a -i i S ALE I , ZO z DAV I D B . MASON� `� DATE: DBC ENV I RONMEIJTAL DES I GIJS w LAST SANDWICH . MA DATE HEALTH AGENT ( 508 ) 833- 2177