Loading...
HomeMy WebLinkAbout0018 BRISTOL AVENUE - Health i _.18.Bristol-Avenue,Hyannis - — ---- -- - A= 0 0 ° ° . o "'` TOWN OF BARNSTABLE LO: A'i1fiN Ql s SEWAGE # VI;,a;�E ASSESSOR'S MAP &LOT O Z0�''0/ INSTALLER'S NAME&PHONE NO. ' SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by I O �• C,c ti 5 y• r� � i �l TOWN OF BARNSTABLE LOCATION �/J � ���- SEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. i)d arc a a ✓ `'� / t� SEPTIC TANK CAPACITY LEACHING FACILITY:(type)- //'3710C 2 (size) NO.OF BEDROOMS Z OWNER 0a"J/"� PERMIT DATE:, - -/I COMPLIANCE DATE: a Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY U Jz r . e No. FEE CO MONWFALTH Or MASSAC14USETIS Board of Health, &C114-�MA. r APPLICATION FOR. DISPOSAL\SYSH [ CONSTRUCTION PERMIT r Application for a Permit to Construct( ) Repair( Upgrade( Abandon( - ❑Complete System ❑Individual Components i Location •f-u/ ve Owner's Name ., ✓-q Map/Parcel# Address Lot# Telephone# Installer's Name � ,�i1 c� �� Ao r �`„i Designer's Name — i Address �s C lx�' �+ � L i t.� �1- Address I Z G✓C S h" �'�l�'S'����r'� f� ,/�/�J f'c : ��' Telephone# f ��f/ Telephone# Type of Building g S Lot Size sq.ft. Dwelling-No. of Bedrooms Z Garbage grinder( ) Other-Type of Building No.of persons Showers ( ),Cafeteria( ) Other Fixtures Design Flow (min.required) z,20 gpd Calculated design flow Design flow provided v gpd Plan: Date ®""I Number of sheets 2 Revision Date Title Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation DESCRIPTION OF REPAIRS OR ALT',,)ZF ATIONS r The undersigned agrees to mi stall the abov .described' divi�-Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to not toplace the 5wrn ii opera on until a Certificate of Compliance has beenissued by the Board of Health. Signed '' -� Date Inspections No.i-al / O�5 FEE COMMONWEALTH OF MASSAC14USETTS Board of Health, 12 '0 L(J MA. I APPLICATION FOR DISf),OSALt"SYSTEM,CONSTRUCTION PERMIiT Application for a Permit to Construct( ) Repair( )VUp€.rXde`("') l bandonO - ❑Complete System ❑Individual Components Location / a/"r-f f.d Owner's Name ve r24.,.� 0 Map/Parcel# 3a �' — O�/ Address / , 1 Lot# ' Telephone# Installer's Name ��QK ,H D'/^ f t r K Designer's Name 'ram L Address 3�-�CW4{a Grp' L p f't.�f�`' Address I -Z era s�'Ci '� ,/r , Telephone# �`(/ Telephone# Type of Building gee S Lot Size sq.ft. Dwelling-No.of Bedrooms 2 ! Garbage grinder ( ) Other-Type of Building No.of persons Showers ( ),Cafeteria( ) Other Fixtures Design Flow (min.required) 1 ?O gpd Calculated design flow /�-3 Design flow provided J gpd Plan: Date /—,/,g �' 'A Number of sheets 2 Revision Date Title Description of Soil(s) , Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS Ae-,A� 1,yl, L/ dab G, a-//a" cC .S' The undersigned'agrees to install.the above describe ndividual gewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to not oap ache s te�p �trtificate of Compliance has been issued by the Board of Health. Signed Date r � Inspections .-.,�r oa spa o.���--•y�ak:�.x �.. ,.c ..�....x.oa a .. . .._.. -., ... ..... . . - _ , . .. _.. ,. t..... ,c._. - ,r. No. - 0a5 FEE COMMONWFALT14 ®F MASSACHUSETTS Board of Health, 1� ,-,.4 l ��D ,MA. CERTIFICATE OF COMPLIANCE Description of Work: ❑Individual Component(s) Cl Complete System The uundersigned hereby certif that the Sewage Disposal System; Constructed ( ),Repaired ( ,Upgraded O,Abandoned ( ) by: jW ON C-. 1, �. at / /.�� Af -✓� has been installed in accordance with the provisins of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No.9WO1- G�-5, dated /h s/o . Approved Design Flow (gpd) Installer p " I. a-�P� �--L oA Designer: /l eW-t' 1*k-a n )4 < < Inspector:t .w ,.___i��__� Date: The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No. --)o/ d J _ FEE /D C) COMMONWEALTH OF MASSACHUSETTS Board of Health, 0 4,qL) b MA. DISPOSAL SYSTEM[ CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair( ) Upgrade( A)/`Abandon( ) an individual sewage disposal system at 4 _as described in the application for Disposal System Construction Permit No.,OC/T -L,4)-dated / t4 h ► Provided: Construction shall be completed within three years of the date of-tliis, ermi , local conditions must be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Chadesloun,MA Date ��/7`�� Board of Health 1 - TOWN OF BARNSTABLE ^M LOCATION r/J' I /�vt SEWAGE# l-ei VILLAGE YGrr n: .S ASSESSOR'S MAPS&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /J LEACHING FACILITY:(type)/o /�37��Z� (size) NO.OF BEDROOMS 2- OWNER Qa/"&4- / I_ � COMPLIANCE DATE: PERMIT DATE: Separation Distance Between the: Feet Maximum Adjusted'Groundwater Table to the Bottom of Leaching Facility Private Water Supply Well and Leaching Facility(If any wells exist on Feet site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist within Feet 300 feet of leaching facility) /��f FURNISHED BY �z�a e� '�/,/9fi o`.e LA ✓�^ 4- z Z C - 3` 2S- d' C - 3 /6�S r Town of Barnstable of 1xE rpm ti Regulatory Services Richard V. Scali, Interim Director BARNS'rABLE, 9'0 1639. `0� Public Health Division ArEO"'t'�p Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 503-790-6304 Installer& Designer Ce►tificatian Forth Date: ��J i 9 Sewage Permit# °?SAssessor's Ma \Parcel �✓CS�•--o N c k ex+e-e ( - p Designer: 1]�jc ;.,41er`i1x t�lct�l�s lVl� Installer: Address: )Z Vj, Cr ts- -P'lc/ /Zd Address: Iz,;-•�, �cc��, �1� 0 Z icy � t � A Oil �'©''I d '^t���Y w as issued a permit to install a. (date) (installer) septic system at �U 17+�"5 t / v`Q 1 (i %A0 t j based on a design drawn by (address) �n ;n eer'rr . lyc:✓Lcs 1�� dated (designer) V- 1 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 boa and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory, i I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the Septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in with the terms of the RA approv 0 lieable) F � PETERT. r� McENZEE stalleCs Signature) C1V1L No.35109 O (Designer's Signature) 1D g ) (Affix Designe ere) PLEASE RETURN TO BARNS r'ABLf PUBLIC HEALTH DIVISION. C.ERTIFICATk OF COMPLIANCE �VILI NOT BE ISSUED l'!i`ITIL BOTfI THIS FO12iVI AND AS- BUILT CARD Altl; RECEIVED BY "1HE B.4KNSABLE PUBLIC I:IEALTII DIVISION. THAI\K YOU. Q:'.5e}ai;••,Uasigner Certification Form Rev 8-14-13.doe Engineers note:This certification is limited to an as-built inspection of system components as installed prior to backfitl.The engineer did not supervise construction of the system.The installer assumes responsibirty for all materials,workmanship,backtiliing to specified grades with proper compaction and setting dserslcovers as shown on the design plan. Town of Barnstable P# ST7 Department of Regulatory Services G • t� Public Health Division Date I '200 Main Street,Hyannis MA 02601. rE'D MA'I t' Date Scheduled Time Fee Pd. ` Soil ,�Suitability Assessment for Se e Disposal Performed BY:IFIVP-r 1 G�rL}CrC S — 15Vrz Witnessed By: LOCATION& GENERAL INFORMATION Location Address Owner's Name • too// � 5�� �v-� r'� tv;e n S Address 9 17G- Q 1 k-Q Assessor'sMap/Parcel /�; 0 2 1 3�� —O C Engineer's Nam nee k r D WW d e \mil L NEW CONSTRUCTION REPAIR X0Telephone# ' 477—s 3 i3 Land Use S `G� eyl Slopes(go) 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(toles&perc tests,locate wetlands in proximity to holes) 1 � 2� - ....._- ._ ...... ___...__........ (�,►2 t�s-ro 4S Parent material(geologic) Depth to Bedrock Depth to Groundwater. Standing Water in Hole: T�— ' >>y Weeping from Pit PACe Estimated Seasonal High Groundwater f DETERMINATION TOR OR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: In, Depth to soil mottles: L in. Depth to weeping from side of'obs.hole: in, t3roundwater Adjustment ft. Index Well# Reading Date: Index Well level , Adl,factor .,Q r Adj.Groundwnter Lavel PERCOLATION TEST Dole- 'rime Observation ^�'��� l b> Hole# � "Cime at 7" ,36 Depth of Perc �Z Time at 6" ,� 10 Start Pre-soak Time O G Time(9"-6") 2 4 (3 End Pre-soak !_57i d 67 Rate Min./Inch. Z9 / Site Suitability Assessment: Site Passed v Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observdtion Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTIC\PERCrORM.DOC DEEP.OBSERVATION HOLE LOG Hole# II' Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (M'nnsell) Mottling '(Structure,Stones.Boulders.. n i ten ravel S-Zy S-.JI ?114 2y -4 o �, Id �.,t 2�S l o S" 5 1 A 14, DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.% rave 10--34 a SG.� to�� f"?� 3U —12� C tM ECK S-A -,5 Y Lr i L t' DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. Grave I DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) Wunsell) Mottling (Structure,Stones;Boulders. Consi It en Flood Insurance.Rate Map: Above500 year flood boundary No— Yes __ Within 500 year boundary No— Yes Within 100 year flood boundary No---C- Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious l exist in all areas observed throughout the area proposed for the soil absorption system?. U If not,what is the depth of naturally occurring pervious material? Certification j I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required ini ,expertise and experience described in 10 CMR 15.017. ( [y ` t Signature Date , QN5.13PTIG\PERCFORM.DOC Commonwealth of Massachusetts DEC :3 199e Executive of Environmental Affairs DEP A- Department of Environmental Protection C SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: f , `3 e- H-q lu N 1S r HP, Address of Owner: C-7" (if different) 3� c�,,��,u.,, 6,e. Date of Inspection: Name of Inspector: Michael D eD ecko Company Name, Address and Telephone number: Atlantic Environmental P.o Box 2384 - Mashpee Ma 02649. Tel: (508)4771420 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 Passes ---- Conditionally.Passes ---- Needs further evaluation by the local Approving Authority ---- Fails Inspector ' s Signature: Date: L The system Inspector shall submit a copy of this inspection report to the Approving Authority within.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 or the Department of Environmental Protection. The original should be sent to the system owner and copy sent to the buyer,if applicable and the approving authority. i ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: \$ Owners : V�cvJs Date of Inspection : INSPECTION SUMMARY: Check A,B, C, or D AX) SYSTEM PASSES: -\ I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CM 15.303. Any failure criteria not evaluated are indicated below B) SYSTEM CONDITIONALLY PASSES: ---- One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair,passes inspection. Indicate yes, no, or not determinate (Y,N, or ND). Describe basis of determination in all instances. If"not determinated", explain why not. --- The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration,or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. ---- Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box. The system will pass inspection if (with approval of the Board of Health). ---- broken pipe(s) are replaced ----- obstruction is removed ---- distribution box is levelled or replaced -- The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): ----- broken pipe(s)are replaced ----- obstruction is removed I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address : I Owner: VmNS Date of Inspection: It(20 k5 C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: -- Conditions exist which require further evaluation by the Board of Health in order to de- termine if the system is failing to protect the public health , safety and the environ- ment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: ---- Cesspool or privy is within 50 feet of a surface of water ---- Cesspool or privy is within 50 feet of a bordering vegetated wetland or a small marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNC- TIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT. ---- The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. ---- The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. ---- The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well --- The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analy- sis 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 notrogen is equal to or less than 5 ppm. D)SYSTEM FAILS: -- I have determined that the system violates one or more of the following failure criteria as defined in 310 CM 15.303. The basis for this determination is identfied below. The Board of Health should be contacted to determine what will be necessary to cor- rect the failure. --- Backup of sewage into facility or system component due to an overloaded or or clogged SAS or cesspool. 3 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: I4 &%Qo I Owner: V IQJ& Date of Inspection : 1(�Zo�5 D) SYSTEM FAILS (continued) -- 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 over- loaded 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. j -- Any portion of cesspool or privy is within 100 feet of a surface water supply ortributary to a surface water supply. ---Any portion of a cesspool or privy is within a Zone I 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 ana- lysis. 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. i h. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: lb Be,sTo Owner: V�cNs Date of Inspection : t t `2Z E) LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above The design flow of system is 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 : I --- 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 11 of a public water supply well. The owner or operator of any such system shall bring the system and facility into full compli- ance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please,consult the local regional office of the Department for further information. i - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: It SwsTo C Owner: q%CNS Date of Inspection: Check if the following have been done : -x Pumping information was requested of the owner,occupant and Board of Health. --x None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during the period. Large volumes of water have not been introduced into the system recently or as part of this inspection. --x As built plans have been obtained and examined. Note if they are not available with N/A. --x The facility or dwelling was inspected for signs of sewage back-up. --x The system does not receive non-sanitary or industrial waste flow. --x The site was inspected for signs of breakout. --x All system components,excluding the Soil Absorption System, have been located on the site. •--x The septic tank manholes were uncovered, opened and the interior of the sep- tic,tank was inspected for conditions of baffles or tees,material of construc- tion, dimensions,depth of liquid, depth of sludge, depth of scum. -x The size and location of the Soil Absorption System on the site has been deter- mined based on existing information or approximated by non-intrusive methods ---x The facility owners and occupants if different from owner were provided with information -on the proper maintenance of Subsurface Disposal System. I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: IS St.sT-t. Owner: II%cNs Date of Inspection: tt`za RESIDENTIAL: Design flow : 3O gallons Number of bedrooms : O 3 Number of current residents: O Garbage grinder(yes or no) : p.o Laundry connected to system (yes or no): e s Seasonal use (yes or no) : NO Water meter readings, if available:N�q Last date of occupancy : cam,moye j 15 C. COMMERCIALANDUSTRIAL : Type of establishment: Design flow: gallons/day Grease trap present: (yes or no) Industrial waste holding tank present (yes or no) : Non-sanitary waste discharged to the Title 5 system (yes or no) : Water meter readings, if available: Last date of occupancy : Other: (Describe) ............................................................................................................ Last date of occupancy: GENERAL INFORMATION PUMPING 9WORDS a s urce of information: S!1l�I I System pumped as part of insp ction (yes or no) :...... if yes, volume pomped : .................... gallons Reasonfor pumping :............................................................................................................ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1S.!B9h 7Q I Owner. Vtcv_,S Date of inspection: t t \zX_A9.L 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).... ..�. . .es��.. ..�c - ..Ca 1ST- tt... AURO IMATE AGE of all components,date installed (if known)and source of information . . .-... ... .......................................................................................... .................................................... ................................ Sewage odors detected when arriving at the site : (yes or no)....!uQ... SEPTIC TANK : .....t. (locate on site plan) Depth below grade: .......... Material of construction: ....... concrete ......... metal ........ FRP ........ other (explain) ................................................................................................................................................ Dimensions: .................. Sludge depth':............ .. Distance from top of sludge to bottom of outlet tee or baffle:.............................. Scum thickness:..................... Distance from top of scum to top of outlet tee or baffle: ....................................... Distance from bottom of scum to bottom of outlet tee or baffle:......................... Comments: (recommendation for pumping , condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage,etc.)...................... ................................................................................................................................................ ................................................................................................................................................ i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: k Owner: VtcN Date of inspection: IL GREASE TRAP : ....... (locate on site plan) Depth below grade: ............... Material of construction: ........concrete.........metal........FRP........other(explain).... .......................................................................................................................................... Dimensions:............................... Scum thickness:........................ Distance from top of scum to top of outlet tee or baffle:....................................... Distance from bottom scum to bottom of outlet tee or baffle:............................... Comments: (Recommendation for pumping condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.)........................ ................................................................................................................................................ ............................................................................................................................................... TIGHT OR HOLDING TANKS:.... (locate on site plan) Depth below grade:............... Material of construction:........concrete........metal.........FRP..........other (explain).......... ................................................................................................................................................ Dimensions:............................ Capacity:....................gallons Design flow:...............gallons/day Alarm level:............................. Comments: (condition of inlet tee, condition of alarm and float switches, etc.) 9 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PAR T C SYSTEM INFORMATION (continued) Property Address: (1- o l Owner: \/,.DNS Date of inspection: ,t (zo Iyy DISTRIBUTION BOX:.& (locate on site plan) _.. Depth of liquid level above outlet invert:................... Comment: (note if level and distribution equal evidence of solids carryover, evidence of leakage into orout of box,etc.).................................................................................................................. ................................................................................................................................................ ................................................................................................................................................ PUMP CHAMBER:.) �... (locate on the site) Pumps in working order: (yes or no)............... Comments: (note condition of pump chamber,condition of pumps and appurtenances, etc.).................... ................................................................................................................................................ ................................................................................................................................................ 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, rr ......................................................................... leaching pits, number: ..4.1�6.... .. leaching chambers, number:........ leaching galleries, number:........... leaching trenches,number ,length:..................... leaching fields, number, dimensions:................... overflow cesspool, number:.......... Comments: (note condition of soil : ns of raulic failure, level of ponding, condition of v getation, etc. .... } .. . ..< i... .1� 5. .. ... . ... . .... ................... �o I i SUBSURFACE SELVAGE DISPOSAL SYSTEM INSPECTION FORM PAR T C SYSTEM INFORMATION (continued) Property address: r8 r �sT6 Owner: Uevis Date of inspection: l ZO`5� CESSPOOLS:...41!�5.. (locate on site plan) _ i Number and configuration: ..... � Depth-top of liquid to inlet invert: .....a�.lo�............ Depth of solids layer: ......7,2'(.................................... dr Depth of scum layer: .....d....................................... Dimensions of cesspool: ...(aK y.......... Materials of construction: . Indicator of ground water: ....N.0........ inflow (cesspool rust be pumped as part of inspection) /.VO..(J. .(�..!`?fo................................................................... ................................................................................................. Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc .4a 11 PRIVY: ...4e-site (locate on ) Material of construction: ................................... Dimensions: ...................... Depth of solids: ................ Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.). . ................................................................................................................................................ SUBSURFACE SELVAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Bwaz'a Owner: v 4c,+JS Date of inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate at wells within 100' I I DEPTH TO GROUNDWATER: Depth to groundwater: Q.d...feet Method of determin lion or approximative: l? 1.Wlay ...S' nS).iii , .................................................................................. . ...................................................................................................................................... . .................................................................................................................................... ASSESSCP.=S MAP N0. 76� PARCEL Li) CAT10N SEWAGE PERMIT NO. VILLAGE IN-SI LLER'S 11E i ADDRESS S U I L D E R OR OWNER ` ��n.vr� ��, � 'mac r•�"-� - DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED L r j IQ 9(l!(L$1 I J THE COMMONWEALTH OF MASSACHUSETTS ^ 0 C� BOARD OF HEALTH �✓ .7.C7...W.\f.........OF..... � g.�l. .l(��bl ........................!^C•�`(`� Appliratiun for 11iupusttl Works Tonutrurtiun trrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ................_-t_7'.....................................................................f34... a �-v-e ti-�y .� ........................................... Y Lot No. 7� Loc ion-Addr or ................_.._ 1NC!!. ......... � :... e--......... .................. a _ ..- ----------------------------------------------------- ` t7m n Address a -`.......`c...._.Q`c ...... ............ .........� �„ ...`T ...__.} �► Installer .n Address Type YPe of Building Size Lot............................Sq. feet �-. Dwelling—No. of Bedrooms--_.-�..............................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons Showers ( ) — Cafeteria ( ) QOther fixtur ------ -----------•-----------•-----------••-•-------------------------------- Desi Flow.._....... ................... allons er erson er day. Total dail flow___...._ _W g P P P Y Y ?.........................gallons. WSeptic Tank—Liquid'capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No...../............. Diameter..... `1...... Depth below inlet....... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ 14 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a' •--------•-------------------••-• .....•--•---•-•------•••-----•-----•-•----•-•-----•--...-•••••----...••----....•----......... ......_ 0 Description of Soil..................................... W - V .............................................................. ----......------....---.....------•-•---•---•-•--•--•••-----•--•••-----•-----••---------•-----•••-----------.....----••-------•----_•----- W -----------------•---•------------------------------------------••. •----------•--------...--••-------------------------------- V Nature of Repairs or Alterations—Answer when applicable.__ e__-___---_-_fit._ '--p-•---- ,•- ,?i - --•-, �� Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accofdance with the provisions of iITLI: 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Complianc- W of health Signed.Application Approved BY---.. .. Q� -••-------------- �Q 3Z? Date Application Disapproved for the following reasons:......................-•---......-•--•-.....----•-•--...-•............................... -_-••-••-•••_ .................................•---•--...----...---..._^.........��...-----••-----•------••----......_...-•-•----•--••--------•-•-•-- --..........D -- Date PermitNo. .......�l Issued...................................................... Date 4�� Now�--- `� Fas, THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH a ..:...: ... f��..� (........OF..... :u .. �.�.�...d°V . . ........................ r- G Appliration for 33isposal Works Tanstrudion Frrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: 41 ................__s..?�.........r�` � ` a.................................................... ........................ Location Address or Lot No............................................. ^ ................. ___...::a......... .......... W Owner 1 Address -......... � Installer ..........................7..............:`............ Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms........ _____________________________Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building Pao Other—Type g ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures , _ _ - - ---------•--•----•-•----••---- W Design Flow...........F ._._� ___________________gallons per person per day. Total daily flow......... .. .. . ..__....___.....__.gallons. WSeptic Tank—Liquid capacity_._...__-_._gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area...................sq. ft. 3 Seepage Pit No......I............ Diameter..-.. ...... Depth below inlet.......S-� ...... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed bY........................................................................... Date................................. Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ frr Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a -----------------------------------•-----------------------------•...............-•-•---......... ..................--------•••------'-'-............. O Description of Soil........................................................................................................................................................................ x V ..............................................-----•••'--------._...--------------------•--°----------°-°--------------°•---------------•----------...-------------------...•---•---'-----•-------•-••. °•-----•----------------------------------------•-------------------------............__...•----••••-••------ ••••• J U Nature of Repairs or Alterations Answer when applicable ;1 2 4 ............ 1-�---• � �u .. i _.:... >__ Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in. operation until a Certificate of Compliance,has been issued by the boa-dof health "T Signed. . Application Approved BY -// !...-•-----•••----_..... v3U � . -- - - Date Application Disapproved for the following reasons---------------•-------------•---•--------------------•------•----...-----------•-------..-._..._......--------- ........__--•-•--......--•-•-----......-•-•••---...-•--•---••-----•-•-•---•-•--•-•----------------'•-----..•-'------••--'-•----•--------••-•••-----•--•----•---•-••----•----•---•-•-----••...__...___.___ Date PermitNo._._ � ....-----. ......._............ Issued..................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF....... ........:......................... ..Y.:-...:-.................................. Trrtif irate of Tautphattir THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by................... ti .... •- y.. -•-••••••---- ..._._......---........'--•----•--•--•----•---_..__.....__.........................__.___...... -� Installer ate ................ 1%? s9 --_ ............................................ has been installed in accordance with the provisions of TITLE 5 of 'h�State Sanitary C e , S ..;;�}},,���� in the application for Disposal Works Construction Permit No.__ �: � �--••-- dated.....l— ..... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUA ANTES THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.................... .. ............:..................................'----"-- Inspector...............----•-----------------------•-••---•--•-----......................-- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 3i .. . .4.: No......................... J FEE _..•••-•-•-........... Uio:puoaLlurk,, Tonstrirtion Permit Permission is hereby granted...........`:j.. ........y`:.c '.................. •-----------------------•---•••----••-•-•--•-•-•••--•-•-•--•--......--•----••''-•--- to i usual Sewage Disposal System at Nonstruct �!or Repair ( } an ndl -----__ --------------------------------------------------------- ---------------------------------- Street ------- - as shown on the application for Disposal Works Construction Permit NoS-. D�It d.. - . d �'._.___._.... �. J� V Board of health ,----- DATE-------- I " LEGEND N EXISTING CONTOUR x 36,98 EXISTING SPOT GRADE M°ry°�iee —H/ EXISTING WATER SERVICE M°�Y°�' xLA Ge — St �5 gh're y _ �.Ham- EXISTING OVERHEAD WIRES H°m C e t9 TEST PIT " /BM-2 BENCHMARK o B� ol Pve S LOCUS BULKHEAD CORNER EL.=34.88 32.68 st 1 only ? X G g Q x 32,5)1 „ IN ,,—TP-1� 0 LOCUS MAP NOT TO SCALE 5 �o- TP-2 FENCE SINE /�3� �,�-�3 3-4- GENERAL NOTES:. 4.44 32,06 LOT 18, 34.88 x O 34,75 2 ' 1 BOARDALL HANGES OF HEALTTH TO TAND THE DESIGN MUST BENGIINE APPROVED BY THE LOCAL / 33.77 9y940 S`F. � .• ,:;':� �! 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS x � � 34,56 1 O 0\. OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: <N O• O: -310 CMR 15.405(1)(b): x 34,71 ���� 'O ';•:� 1) A 10' variance, S.A.S. to cellar wall, fora 10' setback. `� EXISTING CESSPOOLS 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR / EX/STING -' x�O TO BE TO BE REMOVED TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE "-I=-35rG'5-^ HOUSE(#18) ���N� DESIGN ENGINEER. 35.35 35.1 1 T 0.%=35.95E ��34. 0 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING ` 34. FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN Q ':; x 2 35 ENGINEER BEFORE CONSTRUCTION CONTINUES. EX 5E,3.3.2$ vu,• 1/ 5. ALL ELEVATIONS BASED ON AN ASSUMED DATUM. GARAGE "NV•� \\ vyo� 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF POR THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF \34 X9 O / 1`Z HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 0 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. p0 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. s. O : :35.91; 36:13.; �p O. 5,37 O. \ CBdh 9. ALL AREAS CLEARED FOR CONSTRUCTION. SHALL BE RESTORED AS �+ - x Z �0 � 3 ® AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE �z DIRECTED BY THE APPROVING AUTHORITIES. 3 -PAVED 35, 1 ATCH BASIN T•.: .:: 35.03 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY 5,74 '..+, DR/VEWA) . 35.83 Q� 7 THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING _ �1�' E PROPOSED CONSTRUCTION. \ ltAf� SEPTIC TANK 1 1. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS 35,$9 �'�'. :. 66/ IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND N PLK 35.20 REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). 36 • SIpE�N J (Ile SLEEVE SEWER ,02 e 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE EXISTING CESSPOOL PO 10' EACH SIDE OF WATER INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. TO BE PUMPED, FILLED of SERVICE CROSSING WITH SAND & ABANDONED 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND edge �J NOT CONSIDERED TO BE A PROPERTY LINE SURVEY. 36,33INEER IS 35.88 14 SYSTEM GCOMPO ENTSSTNOT SOHOWNLONOHE PLANNDOCUMENTED SEPTIC OF M4Ss �"� 0� PARCEL ID: 309-019 o PETER T. 36.623 MA�L.=36.00 GNETIC NAIL SET 1 McENTEE PROPOSED SEPTIC SYSTEM UPGRADE PLAN � � Y � v CIVIL 36.76 MAG. NAIL 18 BRISTOL AVENUE, HYANNIS, MA No. 35109 STE 36.00 Prepared for: DiBuono Sewer & Drain, 35 Content Lane, Cotuit, MA 02635 • RfGIR� �`` OWNER OF RECORD Engineering by: SCALE DRAWN JOB. NO. VIENS, GARY R Engineering Works, Inc. 1"=20' P.T.M. 106-19 v rl\ 18 BRISTOL AVENUE 12 West Cfossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET No. HYANNIS, MA 02601 (508) 477-5313 1/10/19 P.T.M. 1 Of 2 t NOTE: TO PREVENT BREAKOUT, FINAL GRADE SHALL NOT BE AT, OR BELOW, EL.=31.8 FOR A DISTANCE OF 15' FROM THE EDGE SEPTIC TANK PROPOSED D-BOX OF THE PROPOSED S.A.S. INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & WATERTIGHT PROPOSED S.A.S. OUTLET AND SET TO 6" OF FINISH GRADE COVER SET TO 6" OF GRADE INSTALL RISER & COVER OVER ONE CHAMBER (MIN.) AND SET TO WITHIN 3" OF FINISH GRADE TO SERVE T.O.F.=35.95t AS AN INSPECTION MANHOLE. F.G. EL.=35.0t F.G. EL.=35.0t F.G. EL.=34.8t F.G. EL.=34.9t ~71 20•8'�y -- u m 53' .� EXISTING � HOUSE(#18) o/vi�- = 37 L = 30' L O S=1% (MIN.) = 23'(MAX.) GARAGE T.O.F.=35.95E p S=1% (MIN.) @ S=1% (MIN.) 4"SCH40 PVC 4'SCH40 PVC 4"SCH40 PVC B" __ " lo•I E3 O® -2" O 1/2`RDOUBL OF EB �w 14' s• 12" WASHED STONE V) M INV.=32.25 43' LIQUID OR APPROVED FILTER FABRIC) �iS` a LEVEL GAs01 ADD J INV.=31.70 PROPOSED INV.=31.53 3.5' 3' 3.5; 3/4"-1 1/2" 10'i �� INV.=32.00 D-BOX ENV.=31.30 EFFECTIVE WIDTH = 10 DOUBLE WASHED ?� f ONE PROPOSED SEPTIC TANK USE 5 LC-6 LEACHING CHAMBERS IN SERIES IO, WITH 3.5' OF DOUBLE WASHED STONE-ALL AROUND L-- SEWER CONNECTION 1, INV.=33.28 SEWER CONNECTION 2, INV.=33.78 H-20 RATED TOP CONC. ELEV.=32.13 NOTES: -- -BREAKOUT INV. ELEV.=31.30 E3 E3 E3 O E3 E3 E3 ELEV.=31.80 S.A.S. LAYOUT 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE INVERTS, PRIOR TO INSTALLATION. BOTTOM ELEV.=30.30 2) SEPTIC TANK & D-BOX SHALL BE SET LEVEL AND 3.5' 5 x 6' = 30' 3.5' TRUE TO GRADE ON A MECHANICALLY COMPACTED 4' OF NATURALLY OCCURRING SIX INCH CRUSHED STONE BASE, AS SPECIFIED IN PERVIOUS MATERIAL EFFECTIVE LENGTH = 37' _ ------- ------ 310 CMR 15.221(2). 5' (MIN.) ABOVE G.W. I 4• KN I 3) INSTALL INLET & OUTLET TEES AS REQUIRED. LEACHING SYSTEM SECTION I 20• Da. COVER 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE ADJUSTED G.W., EL=24.5 AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. - SEPTIC SYSTEM PROFILE 14•KNOCKOUT 4• KNOCKOUTI M I I L------ 4• KNOCKOUT SOIL LOG 72" -� DESIGN CRITERIA DATE: JANUARY 9, 2019 (REF. P#15,878) PLAN VIEW SOIL EVALUATOR: PETER McENTEE SE#1542 NUMBER OF BEDROOMS: 2 BEDROOMS WITNESS: DONALD DESMARAIS IRS HEALTH AGENT SOIL TEXTURAL CLASS: CLASS f ELEv. TP- 1 DEPTH ELEV. TP-2 DEPTH ® ® ® O DESIGN PERCOLATION RATE: <2 MIN IN 33.5 A LOAMY SAND o 34.0 A LOAMY SAND O IN12RT I ® ® Ea ® ® ® Ea 2" I ® ® ® DAILY FLOW: 220 G.P.D. / 1OYR 4/2 1OYR 4/2 32.8 B 8" 33.2 B 10" " DESIGN FLOW: 330 G.P.D. LOAMY SAND LOAMY SAND 72 r 36 GARBAGE GRINDER: NO-not allowed with design 10YR 5/4 10YR 5/4 SIDE VIEW END VIEW 31.5 C C 24" 31.5 30" LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF + PERC WIGGIN LC-6, OR EQUAL, H-20 LOADING .74 GPD/SF 22"/40" LEACHING CHAMBER PROPOSED SEPTIC TANK: 1500 GALLON CAPACITY MED. SAND MED. SAND PROPOSED D-BOX: 1 INLET, 3 OUTLETS, H-10 RATED 2.5Y 6/4 2.5Y 6/4 USE 5 LC-6 LEACHING CHAMBERS IN SERIES WITH PROPOSED SEPTIC SYSTEM UPGRADE PLAN 3.5' OF DOUBLE WASHED STONE-ALL AROUND 24 5 HIGH G.W 108" 24.5 HIGH G.W. 1 14" 18 BRISTOL AVENUE, HYANNIS, MA REDOX - REDOX - SIDEWALL AREA: (10.0' + 37.0') x 2 x 1' = 94.0 SF 24.0 STDG. G.W. V 114" 24.0 STDG. G.W. _ 120" Prepared for: DiBuono Sewer & Drain, 35 Content Lane, Cotuit, MA 02635 BOTTOM AREA: 10.0' x 37.0' = 370.0 SF 23.5 1 120" 23.5 126" Engineering by: SCALE DRAWN JOB. NO.TOTAL AREA:........................................................... 464.0 SF PERC RATE: <2 MIN./IN. Engineering Works, Inc. N.T.S. P.T.M. 106-19 STANDING GROUNDWATER, EL.=24.0 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. DESIGN FLOW PROVIDED: 0.74 GPD/SF(464.0 SF) = 343.4 GPD ADJ. HIGH G.W.(REDOX), EL.=24.5 (508) 477-5313 1/10/19 P.T.M. 2 Of 2