HomeMy WebLinkAbout0055 BRISTOL AVENUE - Health j 55 Bristol Avenue
Hyannis 'P
A _ '309 012
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YOU WISH TO OPEN A BUSINESS?
For Your Information: Business certificates (cost$40_00 p.r 4 _ears). A business certificate ONLY REGISTERS YOUR NAME in town [which you
must do by M.G.L.-it does not give you permission to�600Tate.—You must first obtain the necessary signatures on this form at 200 Main St., Hyannis.
Take the completed form to the Town Clerk's Office, 1st FI., 367 Main St., Hyannis, MA 02601. (Town Hall) and get the Business Certificate that is
required by law. Q
3::,'r:^:=::r +'.:T ,t,•, i DATE: Jo (, �b Fill in please:
ido ,•/ Oil ��t';'��, APPLICANT'S YOUR NAME/S: W I
""i, "`'`` �' '`tri:4 BUSINESS YOUR HOME ADDRESS: "C�� w w+
if�,i KjL .. �� '.
LT _,`py '`•} ; ��J.1. =;f TELEPHONE # Home Telephone Number o rJ
" r d
NAME OF CORPORATION:
NAME OF-NEW BUSINESS rV L V ptI W OWYPE OF BUSINESS C
IS THIS A HOME OCCUPATION? . YES NO
ADDRESS OF BUSINESS. . v N N I �} t�2 4AAP/PARCEL NUMBER Y ���� (Assessing)
When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of Yarmouth
Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your s in this town.
1. BUILDING COM ISSIO ER'S OFFICE
This individu I h b n-info . f a y p rmit requirements th t pertain to this type of business.
MUST COMPLY WITH HOME OCCUPATION
Aut or' d i re** RULES AND REGULATIONS. FAILURE TO
MMEN COMPLY MAY RESULT
A -- ) �/ - - V r",E4 I
d 1
Ou
2. BOAR o EALTH MUST COMPLY WITH ALL This individual has been infor e th p r it re uirements that pertain to this type of business. HAZARDOUS MATERIALS REGULATIONS
Authorized Si nature
COMMENTS:
3. CONSUMER AFFAIRS [LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature**
COMMENTS:
mi
l �6
TOWN OF BARNSTABLE Dater!/ 3
TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY
NAME OF BUSINESS'.�xJ� (10k) I v � S60ZVI CC
BUSINESS LOCATION: INVENTORY
MAILINGADDRESS: SS 21 �lw�iJi AVM �IVA?vrv /S MA 0?GO. TOTAL AMOUNT-
TELEPHONE NUMBER: Sore 364 86o3
CONTACT PERSON: K,L Y ►DA S it I/A
EMERGENCY CONTACT TELEPHONE NUMBER: So e 36 9 e6 03 MSDS ON SITE?
TYPE OF BUSINESS: Gl F, N I A)
INFORMATION/RECOMMENDATIONS: Fire District:
Waste Transportation: Last shipment of hazardous waste:
Name of Hauler: Destination:
Waste Product: Licensed? Yes No
NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use,
storage and disposal of 111 gallons or more a month requires a license from the Public Health Division.
LIST OF TOXIC AND HAZARDOUS MATERIALS
The board of health and the Public Health Division have determined that the following products exhibit toxic or
hazardous characteristics and must be registered regardless of volume.
Observed / Maximum Observed / Maximum
Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive
❑ NEW ❑ USED Cesspool cleaners
Automatic transmission fluid Disinfectants
Engine and radiator flushes Road salts (Halite)
Hydraulic fluid (including brake fluid) Refrigerants
Motor Oils Pesticides
❑ NEW ❑ USED (insecticides, herbicides, rodenticides)
Gasoline, Jet fuel,Aviation gas
Photochemicals (Fixers)
Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED
Miscellaneous petroleum products: grease, Photochemicals (Developer)
lubricants, gear oil ❑ NEW ❑ USED
Degreasers for engines and metal Printing ink
Degreasers for driveways &garages Wood preservatives (creosote)
Caulk/Grout Swimming pool chlorine
Battery acid (electrolyte)/Batteries Lye or caustic soda
Rustproofers Miscellaneous Combustible
Car wash detergents Leather dyes
Car waxes and polishes Fertilizers
Asphalt& roofing tar PCB's
Paints, varnishes, stains, dyes Other chlorinated hydrocarbons,
Lacquer thinners (including carbon tetrachloride)
I3 NEW ❑ USED Any other products with "poison"labels
(including chloroform, formaldehyde,
Paint&varnish removers, deglossers hydrochloric acid, other acids)
Miscellaneous. Flammables Other products not listed which you feel
Floor&furniture strippers may be toxic or hazardous (please list):
Metal polishes
Laundry soil &stain removers
c� (including bleach
Spot removers&cleaning fluids
(dry cleaners)
Other cleaning solvents
Bug and tar removers
Windshield wash 4ica
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS ApSignature Staff's Initials
No. ( V1 ' Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in comps t'et! .�
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
ftplitation for lnieip Sal *pStrm Construction VErm t
Application for a Permit to Construct( ) Repair(grade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 6'5 Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel Z `1—�—� rn
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
Gce oG b��� FPS500J6Y 60 S f2-1c
Type of Buil g: ` ?
Dwelling No.of Bedrooms y Lot Size sq.ft. Garbage Grinder( )
Other Type of Building t4oube No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) ?3 0 gpd Design flow provided 3 3 t,:� gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank 1 S0a Type of S.A.S. QUIL y ST4 12AA .I1
Description of Soil
Attu]
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 of Health. ,
Signed Date
Application Approved by a. Date
Application Disapproved by Date
for the following reasons
PermitNoQ 16 A Date Issued
•�+.r�.�s - - _ 'ter-- -
r -
Fee�/
Entered in compu'P L/
THE COMMONWEALTH dF MASSACHUSETTS t Yes
PUBLIC HEALTH DNIS1dN -TOWN OF BARNSTAB.L�E MASSACHUSETTS
ftpYitation for Misposal 6pstem Construction 3permit
Application for a Permit to Construct( ) Repair(�Jpgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. tj 5 &Z1 S�of #tp Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel ✓l rk l� lixcv h I V o t
No. Designer's Name,A dress,and Tel.No.
Installer's Name,Address,and Tel.
`0� �6 u�e� _ � S ►2 e�/ fD-rlfType of Buil g: r
Dwelling No.of Bedrooms \� Lot Size sq.ft. . Garbage Grinder( )
Other Type of Building f{DLr(W No.of Persons Showers( ) Cafeteria( )
Other Fixtures '
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank I Type of S.A.S. D%ji t4 ST�t►�nP�,e �r .7y
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)�qc1,12A(� j G..� /�c�Q-ZQ( ,
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 , L
Compliance has been issued by this Board of Health.
SignedL-14e, Date
` Application Approved by C Date
i Application Disapproved by Date
(' for the following reasons
Permit No I(( 2 e 7 Date Issued
---------------------------------------------------------------------------------------------------------------------------------------
TH E COMMONWEALTH OF MASSACHUSETTS
I' I BARNSTABLE,MASSACHUSETTS -
Certificate of Compliance
Dis+osalsstem Constructed aired Uaded THIS IS TO CERTIFY,that the On-site SewageRe
P Y ( ) P ( PSr' (I )
Abandoned( )by iv Vl
at , INV Al C--> has been constructed in accordance
with the provision s of Title 5 d the f r Disposal System Construction Permit No. Wdated
Installer �o ti Designer S' S ( A
#bedrooms Approved design flow z(A gpd
The issuance of this permit Pap not bt construed as a guarantee that the system will n tion as designed.
4,
Date lol l 3 Inspector �jt/� ,f I w /// ,.•
---------------------------------------------------------------------------------------------------------------------------------------
No.�Q� — I A Fee. l 0.0 �. • - -
-- -THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS
misposal &pstem OnstrUctlon 'Permit
Permission is hereby granted to Construct( /) Repair( � Upgrade( ) Abandon( )
System located at� �->L�(_ 44 w
y.
i
„ and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date of this permit. /n ^
Date Approved by r V^l(/K
+
i
Town of Barnstable
Regulatory Services
` Thomas F. Geiler,Director
s6;q• �e
Public Health Division
o Wit.. Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer & Designer Certification Form
�m�- 2r�t3— (��
Date: t VA P 309
Designer: IEFA,S 8tVdE`f tXP— Installer: �g-ts tom.
Address: 47,09*c 1-2r-) Address: 440 M4oS &•
W4R.&JI6a'M9
On -r$'l 3 �sk e_,_ was issued a permit to install a
(date) (installer)
I ' -
septic system at 55�1{SAC. ?mritS based on a design drawn by
.(address)
� �Q QtZ dated
(designer)
I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank.
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-bull Cby designer to follow.
OF k4S
1 a DAVID
S9cg,�
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st - er's f ature) o b.
FLAHr:R'f`1 ,J1i. N I
No. 1211
STE9-
S.
(Designer's Signa (Affix R' tamp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC aALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTV THIS FORM AND AS-
BUILT•CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
Q: Health/Septic/Designer Certification Form
r -
TOWN OF BARNSTABLE �y
LOCATION fJ lrToL �i' SEWAGE# 2,0 1_1 ��d
-VILLAGE ASSESSO 'S MAP&PARCEL 3
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) 13✓/ - Lj��p _ (size)
NO.OF BEDROOMS 3
OWNER
PERMIT DATE: 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 leaching facility) Feet
FURNISHED BY
97
r
TOWN OF BARNSTABLE
LOCATION S6 `�S�OI Ale- SEWAGE —T 5recAiot^
VILLAGE ASSESSOR'S MAP & LOT C- —
bfiWS NAME&PHONE N0. �r"(A t~
IJC.,onr��� l2 IT)
SEPTIC TANK CAPACITY I500 qcf
LEACHING FACILITY: (type) r3 (size)
'-NO.OF BEDROOMS 3
BUILDER ORv`r� r�211y U��
PERMITDATE: CGMeLENNC-E DATE: 3 I1b y_5__
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (1f 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
f�
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�a . .,
2�
i ..
TOWN OF BARNSTABLE
LOCATION 2tcs,G_L- 4VUr_ SEWAGE #
VULLAGE XU ASSESSOR'S MAP & LOT-709 — 6/,7-
INSTALLER'S NAME & PHONE NO. /s G�'C., a�.c3� Cx;j,_%s
,SEPTIC TANK CAPACITY 4520
LEACHING FACILITY:(type) /�cr�i�i7L�,'Z3� (size)
NO. OF BEDROOMS PRIVATE WELL OgjfijiLIC ATE
BUILDER OR NEE
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED: ►-`
VARIANCE GRANTED: Yes -No /
lea
10� '
qq 33 W
TOWN OF BARNSTABLE
LOCATION 5- 3 G
VILLAGE_ SEWAGE#
�S ASSESSO 'S MAP&PARCEL
INSTALLER'S NAME&PHONE NO. _ �!Z
SEPTIC 6-TAM{CAPACITY
LEACHING FACILITY: �"�,
(h'Pe) VY DU/ (size)
No.OF BEDROOMS
OWNER
PERMIT DATE: j
COMPLIANCE DATE: j
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility
Private Water l-upply Well and Leaching FacilityFeet
site or within 200 feet of leaching facility) (If any wells exist on
Edge of Wetland and Leaching Facility(If any wetlands exist within Feet
300 feet of leaching facility)
FURNISHED BY Feet
i
z
TOWN OF BARNSTABLE
LOCATION iSlO Ave SEWAGE e Pam+^
VII;LAGE t~YAiS ASSESSOR'S MAP & LOT3 OIZ-
FaWAA,WS NAME&PHONE NO��CIUC A,,J1
SEPTIC TANK CAPACITY 15UD
LEACHING FACILITY: (type) (size)
NO.OF BEDROOMS 3
BUILDER OR 0,999,
PERMIT DATE: C1"EUMIC-E DATE: I b v
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
3
-s
TOWN OF BARNSTABLE
LOCATIO �¢vr
SEWAGE # 9C7.,)�
VILILAGE
ASSESSOR'S lAP & LOT-709 - 61.Z
INSTALLER'S NAME a PHONE NO. �
u w (3�;,`s - 00,
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type)
(size)
NO. OF BEDROOMS � pyATE WELL O
BUILDER OR �E� IC ATE
D AJ0Vjf�s'
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes
No
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10
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Town of Barnstable P# 31�9 lD
Department of Regulatory Services l
Public Health Division Date 2/ 3
200 Main Street,Hyannis MA 02601
Date Scheduled �/ (/ / Time ` / Fee Pd.
Soil Suitability Assessment for Sewage Disposal
Performed By: Witnessed By.
LOCATION& GENERAL INFORMA ON
Location Address Owner's Name
wI,_7�p9 Address
Assessor's Map/Parcel: Engineer's Name w�Cy��6tt�
NEW CONSTRUCTION REPAIR Telepho
3GaJ
3/99 /47�/�C. .eeS.v u v✓.¢ ,'
Land Use Slopes(%j Surface Stones
Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well —ft
Drainage Way AJ/A:_ft Property Line Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes)
1#wv1 &P l".3t,,_�l
0
try
�55
Ito
1 1Z
1
Q5_
Parent material(geologic) C���r —_ l v L� Depth to Bedrock (
t -
Depth to Groundwater. Standing Water in Hole:_ l Weeping from Pit Face /VfA
Estimated Seasonal High Groundwater L(�
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used:
Depth Observed standing in obs.hole: 4W/ in, Depth to soil mottles: - , In.
De";eeing from side of obs.hole: /I«Aiif in. Groundwater A�stment Z ft.
Index Well ding Dte: Index Well level Ad,factor Af�-�'"�--� � _-�--_- Atll•(Jroundwaterl.evel,,,��8 �
PERCOLATION TEST Date
Observation
Hole# Time at 4" c
C w
Depth of Perc Time at 6"
j O
Start Pre-soak rime @ ` Ci 'lime(9"•6") _L? t -177
End Pre-soak -
Lt'1..PQ
Rate MinJlnch tf)
Site Suitability Assessment Site Passed Site Failed:_Additional Testing NeededM)
011 s'S7
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 Consel}vation Division at least one(1)week prior to beginning.
Q:\SEPTICVERCFORM.DOC
DEEP.OBSERVATION HOLE LOG Hole# 5
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling
(Stnucture,Stones;Boulders.
or�sistency.96 Oravell
r Co a
DEEP OBSERVATION HOLE LOG Hole#_ � D
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
onsi tency.96 •
�=l"51�� � ��' GL 2�/.� • /D m Give • .
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) :(USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency.
7
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones:Boulders.
on ' to
Flood Insurance Rate May:
Above 500 year flood boundary No_ Yes4 .
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 pervip material exist in all areas observed throughout the
area proposed for the soil absorption system? tt11 CR
If not,what is the depth of naturally occurring per4ous material?
Certification .
I certify that on ✓' - 9 f(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 traini pe se d rt 'bed in 310 CMR 15.017.
"r Date
• Signature � -�[ 13 -
Q WEPTIOPERCFORM.DOC
down cape engineering, inc. SIEVE SOILS ANALYSIS 55 BRISTOL AVE.'HYANNIS, MA
DATE OF REPORT:2/27/13
JOB : GRAIN SIZE ANALYSIS-SIEVE TEST
SITE: 55 BRISTOL AVE. HYANNIS, MA
LOCATION: EAS TEST HOLE C2
SIEVE ANALYSIS Weight Sample(Grams): 232.3
SIZE WEIGHT RETAINED % RETAINED % PASSED
11/2"
-------------.............(sum)..........................----------------------......................................
1" 0.0i 0.0%' 100.0%
-------------......................................................
3/4" 0.01 0.0% 100.0%
.................................................... -----0.0; 0.0%€ 100.0%
-------------,.....................................................>---------------------}------------------
3/8" 0.0 0.0% 100.0%
-------------:......................................................----------------------------------------
#4 0.01 0.0% 100.0%
--------------I......................................................y_-_____----_--_-____4.......................
.6.........
#10 25.3 10.9% 89.1
-------------.......................................................---------------------,.....................................
#20 63.0 27.1% 72.9%
-------------...........................................6........,-------------27.1 --�........................2.........
#40 117.3 50.5% 49.5%
•--------------.....................................................:---------------------......................................
#50--------j........................................136.9 58.9% 41.1%
#80 ; 173.7i 74.8/0; 25.2/0
#100 194.9 83.9/o' 16.1 /o
--------------i.......................................................--------------------- -----------------
#200 219.1 94.3% 5.7%
-------------......................................................----------------------------------------
PAN: 230.71 100.0%E 0.0%
SAMPLE: 232.3
NOTE:TEST ON PASSING#4 ONLY, 7.3% RETAINED ON#4<45%O.K.
RESULTS:
SOIL CLASSIFIED AS AASHTO A-1-b ( GRAVEL&SAND)(UNCOMPACTED)
PERCENTAGE OF MATERIAL PASSING#4 SIEVE :
#4 100% (TEST ONLY MATERIAL PASSING#4) OK
#5010%-100% OK
#100 0%-20% OK
#200 0%-5% CLOSE
SAMPLE IS CLOSE TO MEETING TITLE 5 FILL SPECIFICATION
>94%SAND
RESULTS: PERMEABLE MATERIAL-CLASS I <5 MINJIN. MATERIAL f "OF L�
NONCOMPACTED �Y �`�H of M'Ssq�
SOIL DESCRIPTION: SAND ''C, �ANICIL_A.
( N-A
3 CIVIL.
ONA
P .
�` i e
COMMONWEALTH OF MASSACHUSETTS
Z EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
d
R' F
DEPARTMENT OF ENVIRONMENTAL PROTECTION
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TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 55 Bristol Avenue
Hyannis MA 02601 ¢
Owner's Name: Ruth M.Arsenault ^�
Owner's Address: Same ,' o
Date of Inspection: March 18,2005 Job#05-53 2 --:0 CD
N
ko
Name of Inspector: PATRICK M.O'CONNELL o >
Company Name: SEPTIC INSPECTION SERVICES CO. �• '
Mailing Address: 189 CAMMETT ROAD
MARSTONS MILLS MA 02648
Telephone Number: 508-428-1779 PQ p
m
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 Dtttt�
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: OF
_X_ Passes �l' '•:9�+ '%
Conditionally Passes a �::' PATRI ••y�,'
Needs Further Evaluation by the Local Approving Authority
Fails LL
Inspector's Signature: Date: 3/18/05 �''•,,��T�F RTIE��G�Q �
4 8INSPti``����
The system inspector shall submit a 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: System in good condition,tank not in need of pumping at this time.System was not
designed for use with garbage grinder, recommend not using or removing grinder.
****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 1
Page 2 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 55 Bristol Avenue,Hyannis
Owner: Ruth M.Arsenault
Date of Inspection: March 18,2005
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
_XX_ 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:
Title i inv—tinn P^r Ail;mnnn 2
Page 3 of 11
OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 55 Bristol Avenue, Hyannis
Owner: Ruth M.Arsenault
Date of Inspection: March 18,2005
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:
T:tla 9 fnenartinn Rnrm Aii cnnnn 3
Page 4 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 55 Bristol Avenue,Hyannis
Owner: Ruth M.Arsenault
Date of Inspection: March 18,2005
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections:
Yes No
—X_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
_X— Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
—X_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
_X_ Liquid depth in cesspool is less than 6"below invert or available volume is less than %z day flow
_X_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped
_X Any portion of the SAS,cesspool or privy is below high ground water elevation.
_X_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
X Any portion of a cesspool or privy is within a Zone 1 of a public well.
_X_ Any portion of a cesspool or privy is within 50 feet of a private water supply well.
_X_ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis. [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 Systems:
To be considered a large system the system must serve
g Y y 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—1 WPA)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.
Tit1P�Z Tnc—fi'nn 4
Page 5 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 55 Bristol Avenue,Hyannis
Owner: Ruth M.Arsenault
Date of Inspection: March 18,2005
Check if the following have been done. You must indicate"yes"or"no"as to each of the following:
Yes No
_X_ _ Pumping information was provided by the owner,occupant,or Board of Health
_ _X_ Were any of the system components pumped out in the previous two weeks?
_X_ _ Has the system received normal flows in the previous two week period?
_X_ Have large volumes of water been introduced to the system recently or as part of this inspection?
_X_ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A)
_X_ _ Was the facility or dwelling inspected for signs of sewage back up?
_X_ _ Was the site inspected for signs of break out?
_X_ _ Were all system components,excluding the SAS, located on site?
_X _ 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?
X_ _ 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
_X_ _ Existing information. For example,a plan at the Board of Health.
X_ _ 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)]
Titlo G incnnntinn Rnr </i«innn 5
Page 6 of I 1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 55 Bristol Avenue,Hyannis
Owner: Ruth M.Arsenault
Date of Inspection: March 18,2005
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 3 Number of bedrooms(actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 1 10 gpd x#of bedrooms):330
Number of current residents: l
Does residence have a garbage grinder(yes or no): Yes
Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required)
Laundry system inspected(yes or no):
Seasonal use:(yes or no): No
Water meter readings, if available(last 2 years usage(gpd)): two years total consumption: 75,750 gal.=103 gpd.
Sump pump(yes or no): No
Last date of occupancy: Currently Occupied
COMMERCIAL/INDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sgft,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:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records: Tank pumped every three years.
Source of information: 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:
Compliance date: 4/10/95
Were sewage odors detected when arriving at the site(yes or no): No
T41. C fncnvn*inn Fnr Oil ci,)nnn 6
Page 7 of I I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 55 Bristol Avenue,Hyannis
Owner: Ruth M.Arsenault
Date of Inspection: March 18,2005
BUILDING SEWER: XX (locate on site plan)
Depth below grade: 16"
Materials of construction:_X—cast iron _40 PVC_other(explain):
Distance from private water supply well or suction line: 20'
Comments(on condition of joints, venting,evidence of leakage,etc.):
SEPTIC TANK: XX (locate on site plan)
Depth below grade: 18"
Material of construction:_X_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: 10.5'long x 5.8'wide—1500 gal.
Sludge depth: 2"
Distance from top of sludge to bottom of outlet tee or baffle: 32"
Scum thickness: 2"
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: 12"
How were dimensions determined: STICK WITH HINGE FLAP.
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 intact and clear,liquid level at bottom of outlet pipe No high stains or evidence of leaks
-GREASE TRAP: No (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.):
Titles A/I;i,)nnn 7
i
Page 8 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 55 Bristol Avenue,Hyannis
Owner: Ruth M.Arsenault
Date of Inspection: March 18,2005
TIGHT or HOLDING TANK: No (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: XX (if present must be opened) (locate on site plan)
Depth of liquid level above outlet invert: 0"
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.):
Liquid level at bottom of both outlets No solids or high stains present
PUMP CHAMBER: No (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.):
Titio C inennrtinn 97nrm 4/1 ci)nnn 8
Page 9 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
t
Property Address: 55 Bristol Avenue,Hyannis
Owner: Ruth M.Arsenault
Date of Inspection: March 18,2005
SOIL ABSORPTION SYSTEM (SAS): XX (locate on site plan,excavation not required)
If SAS not located explain why:
Type
leaching pits,number:
_X_leaching chambers, number: Eight Infiltrators
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.): No damn soils,excessive vegetation or evidence of breakout
CESSPOOLS: No (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: No (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.):
Titia i fnenantinn 17nrm Ai.l ci,)nnn 9
Page 10 of 1 I
i
I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 55 Bristol Avenue, Hyannis
I .
Owner: Ruth M.Arsenault
Date of Inspection: March 18,2005
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.
Bristol Avenue
Driveway
Water service
#55
32
30
29
39
TiNa q Tnonc.ntinn Rnrm 4n V')nnn 10
Page I I of I I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 55 Bristol Avenue,Hyannis
Owner: Ruth M.Arsenault
Date of Inspection: March 18,2005
SITE EXAM
Slope None
Surface water None
Check cellar Dry
Shallow wells None
Estimated depth to ground water: More than 15 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:
_X_Observed site(abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health-explain:
Checked with local excavators, installers-(attach documentation)
_X_Accessed USGS database-explain: USGS topo map and town GIS
You must describe how you established the high ground water elevation:
Town groundwater contour map shows water below el 25 and topo map shows property above el.40
Also low area to rear of property is 8-10' lower than bottom of SAS.
I
Titles G Inen—tinn Rnrm Ail ci)nnn I 1
C7 q� a
NO.:_/.4d..: Fis....3 ..............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Ap.pliration for Di-ripaiial Vorks Tonotrnr#inn trrmit
Application is hereby made for a Permit to Construct ( ) or Repair ('cP4 an Individual Sewage Disposal
System at:
..........45 ..�� -.5 �-.......� -.................. 7i>+-,.rz !.Y'
.._
kZ Location- \dd rss or Lot No.
..DLc .....k .a�................................................ C0t r.J�,a-, �� `1J�uvF._,,...N► 1
y _
a (1✓�'1 G WTI C.iUr _TN C�1`—l(/N /�.D J W.�4.(4ZO/ Add s '
...... A' ------------------------•------ ...---•-- ------------ • rM.�--✓ .........
� Installer Address
Q Type of Building Size Lot............................Sq. feet
Dwelling— No. of Bedrooms... Attic ( ) Garbage Grinder
aOther—Type of Building _____________________-___- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
04 Other fixtures ................................. .
W Design Flow..................5-5 -..._-___.-gallons per person per day. Total daily flow.......... 3 o.........__.._._..__gallons.
WSeptic Tank—Liquid capacity/-<_)9...gallons lrength................ Width---------------- Diameter................ Depth................
x Disposal Trench—No. ---------1...__.... Width..... ........... Total Length... .... Total leaching area....................sq. ft.
Seepage Pit No...................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box (,4)- Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
a Test Pit No. I----------------minutes per inch Depth of Test Pit.................... Depth to ground water.........................
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
.............................................................................................................................................................
0 Description of Soil........................................................................................................................................................................
V ....................----..........................---•-------•----•••••••-•--•••--........----------...._........................----•----------•••-•.....•••••.......--•----•-•----•---.................
W ...............•------------.............---------..........---------------------------•._._..............._....--------............•---------------...._.__.........--- .........................
UNature of Repairs or Alterations—Answer when livable.. .. .... -___ _�_...5 --------------------- ....
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code —The undersigned further agrees not to place the
system in operation until a Certificate of Compliance s ben issued y t board of health.
Signed .................. ..... ........ ........... ....... .............'..X. ....................
Dace
Application Approved By ..............` �-��'.�'... ................ ..... ..... .7.:,... .�.........................................................
Application Disapproved for the following reasons: ...................................................................................................................1..................
................................................................................................................................................................................................................ ........................................
Permit No. ....../c, ...........��................. Issued .............................................. ......D�.e......
Dare
Fx$.............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
pplirttfualt for Dispnsttl lVark.6 Cfunstrnr#tun "amit
Application is hereby made for a Permit to Construct ( ) or Repair (t�4 an Individual Sewage Disposal
System at:
�--.s%-..L...-----�........................ ..`':7 i.!•cr.........-----•---------...--------------------------------------
cfc:�_ Location- \d.d_rc.Ass�$ [.— ltor Lot No.— �-- C..L
. �� ..v
. . ..... ...
Addccss
a �G/�1_{i_c.oTi ..-••----IoC(.cNs�.(l_U_c�t'_'_/ri�.1--- �C�J---- naa ..;..... i 1 is
OQ
UType of Building Size Lot............................Sq. feet
.-, Dwelling—No. of Bedrooms--------------�------------------------Expansion Attic ( ) Garbage Grinder (--7
a- Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
dOther fixtures --------------------------------------------------------------------------------------- -------------------------------------------------------------
W Design Flow..................� .............gallons per person per day. Total daily flow---------- _3 0....................gallons.
W Septic Tank—Liquid'capacity./ w..gallons Length________________ Width................
Diameter................ Depth................
x - Disposal Trench— No. ........f......... Width-----;?-.......... Total Length.._ _____... Total leaching area....................sq. ft.
3 Seepage Pit No------------- ------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box (�. Dosing tank ( )
Percolation Test Results Performed by...........................•-•-•-•-•••-•-----------••---•-••...._...--•••• Date........................................
Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water.........................
L., Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
9 ---••---•......................•--•----.................---..._.._.......-------------•--•-••-•--............................................................
0 Description of Soil........................................................................................................................................................................
w
Z. -••---••--••-------------------------------••--•------......--------••--•...._...-•-•--••-•-•••• •-•---•--•----•-----•--•....--••-•-------••---•-••----------•••••••-
U Nature of Repairs or Alterations—Answer when .plicable.J .�� ..... 4 ....f:�Z 0_....:.5V ........................Q ...
..........015!..-. rs-� -. /!h/r-(_�_[/ •4- TiRS 1�>1-r i74.U ... 5.?U�` ,,.
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has bQecn issued y t board of health.
Signed ........... /...... ........ ............ .......... . ......................
� eJ../... �-
t_
Application Approved B �.
PP PP y ................. •-�r-r- ................... ....................................................::::...... -...r..4...�.�.....Dace�
Application Disapproved for the following reasons: .........................................................................................................................................
............................................................................................... ....................................... ........................................
Permit No. �..5...........���:�.................. Issued ...............................[e......
Dace
-------------------------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
(111-Prtifirate of Complian e
THIS IS TO CERTIFY, j:hat t�h e Inds ividual Sewage Disposal System constructed ( ) or Repaired ( )
by .............................................. ................... ....�...r1..1:ti... ........................GUN......5�.�.�. ...........................................................
Installer
at .............................................. .. .. .. /t-t.S'r�t,......../a1/.�-............/�-l'tl�-�.J�1 1 1................................
.................................... !"
has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as describre�d in
the application for Disposal Works Construction Permit No. ..c��:.-..�.Q ............ dared ........ —�.?�. ..X�.S...:
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................. <................: .... ............. Inspecuane..... r.. .........�......
..... .....
f
------------------------------ --------------------------- --- ----------I
THE COMMONWEALTH OF MASSACHUSETTS
BOARD, OF HEALTH
TOWN OF BARNSTABLE -
No. ��i•-•.7�1� FEE.._.3d--�--...
Disposal Works Tunutrudian "rrmit
Permission is hereby granted I= C /w.G/G1--------------------
to Construct ( ) or Repair (!>4 an Individual 5,em/Le Disposal System
at No.... - � ..._.. 1 J--b-
Street Ccyy
as shown on the application for Disposal Works Construction Permit No\/.1�_'-.--a--- Dated......2 .....c,�
DATE-------------------
�S ........................•••--... `/ Board of Health
�.�:-7---=--•------
.
FORM 36508 HOBBS&WARREN.INC.,PUBLISHERS
LOCUS DATA
CURRENT OWNER M. ALAMINO
PLAN REFERENCE LCP 14034—A
DEED REFERENCE CTF. 177039 Pv
Z
ZONING DISTRICT RB 0 /
\S un
OVERLAY DISTRICT NOT A ZONE II—AP ate'
36 rs.
FLOOD ZONE "C" 250001 / / N 664 II � y \ O� C BENCHMARK CORNER CONCRETE
SLAB ELEV 34.36
ASSESSORS MAP 309
PARCEL 12 / � 1 � �
LOT 5
LOT AREA 9,000t S.F.
\ �� \ 7� PROPOSED
SITE & SEWAGE \ #55 OBSERVATION
REPAIR PLAN \ \ 3 EXISTINGBEDROOM PORT
\ DWELLING _---
#55 \\ 1 LIMITS OF
pp T \ O .545� EXCAVATION
o/?IS/ O� AVENUE \ �p Pg E�'' SCREENEDI g' 22.5'x42.0'
N PORCH :'C'•
c'r. \7.c CONC , p;. '' "ss�� 20.3'
H YA N N I S, B A R N S TA B LE \\ PAD �'� PROPOSED S.A.S.
�, .:.. 8.5' x 32.0'
DATE: 4-19-13
° :;:: :.: .0• (24 UNITS)
1-0
REV: 5-7-13
o LOT 6
��• 9,000 S.F.
APPLICANT: TH#1
�Y 0=Q'
MARCELINO ALAMINO LOT 7
55 BRISTOL AVENUE �QH°F/4lgSs9 i N 66
�yG , JOB No. 13-0108
H YA N N I S, MA 02601 �� EDWARD SHEA.
STONE
SHEET 1 OF 2 ���F�FG• 28980
ROUTE 28
PREPARED BY: REMOVE ALL LEACHING
IN
E A S SURVEY, INC. �� EXISTING z5 / / COMPLLIIANCE WITH TITLE 5'
1,500 GALLON 6�
141 R T. 6 A -- - SEPTIC TANK y� N
PROPOSED
P. O. BOX 1729 D BOX OUTLET
0 20 30 40 P ��s
SANDWICH , MA 02563 LOCUS
PH. (508) 888-3619 1 INCHHIC 20 FEET
CELL )508) 527-3600 No TO SCALE:
I
RAISE COVERS TO WITHIN 6" OF FINISH GRADE SYSTEM DESIGN
ON
FINISH GRADE PORTRVA TOnGRADE
DESIGN FLOW
GRADE ELEV. 34.9 ELEV. 34.1 FINISH GRADE 310CMR 15.255(C) BEDROOMS AT 1 00 GPB/D MQ- GPD
3\ ELEV. 34.0 ELEV. 33.9
/� `� GROUND ELEVATIO 34.0 5' AROUND TO C-1
TOP _ ��� ��///�� / �� �� .� /��/ � HORIZON
r 2.7' OF COVER r2.8e' OF COVER REQUIRED SEPTIC TANK
f; PVC 2'®S=0.01 4'OS= 0.01 ( TOP ELEV 31.17' ___33_0__x_2___ _ _ ___6_6_0_
4" PVC SCH 40 SEPTIC TANK REQUIRED = 1,%0AL GAL.
SCH 40 EXISTING INV.= M3"MAX
INV.= 31.44 31.20 10"TEE 14"TEE INV.= co EXISTING S.T. TO REMAIN
of IMS 31.00 6" ri SIZE OF LEACHING FACILITY REQUIRED
GAS BAFFLE H-20 D63
ya SET "QUIK-4" LOW PROFILE INFILTRATORS LEVEL DESIGN PERC RATE <2 --MIN./INCH
D 4'-1" LIQUID LEVEL D=BOX USE (BE QUIK 4 LOW PROFILE FEET4"x8") 0 LONG TERM APPL. RATE-0•74_GPD/S.F.
INV.=30.98 \�INV.--=30.77
CHAMBERS TOTALING 96 LINEAR FEET
F J �l INV.=30.81 I a 30.5' SIZE OF LEACHING SYSTEM PROVIDED:
12 32.0' o 0
q o 42.0' STRIPOUT -1 ui 4 330 _ 0.74 SF/GPD = 446 S.F. MIN. REQ.
�G/sTeR� EXISTING 1,500 GAL TANK TO REMAIN ELEV. 25.5
S'q P 32.0'THREE
STO W OF BED FORMATION ADJ. GROUNDWATER TPIT#1 USING 24 STONELESS UNITS
NITA / ( THREE ROW OF EIGHT PANELS )
DATUM : /3 STRIPOUT 18.5' x 42.0 INFILTRATOR - 24 QUIK "4" LOW PROFILE
4.73 SF / LF X (4' x 24) = 453.74 S.F
VERTICAL DATUM: BARN. GIS - MSL± CONSTRUCTION NOTES: 453.74 x 0.74 G =
1 OBSERVATION PORT SF 336 GPD/
BENCH MARK USED: CORNER OF CONCRETE 1. CONTRACTORS / INSTALLERS SHALL VERIFY GRADES AND / SCREW CAP TO GRADE 336 GPD PROV > 330 GPD REQ. = 6 GPD RES.
PAD. ELEVATION 34.36 ELEVATIONS AND SITE CONDITIONS PRIOR TO COMMENCING NO (GARBAGE DISPOSAL / GRINDER ALLOWED)
WORK ON THE SITE. SAND FILL P-13886
2• NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE
SITE 8c SEWAGE
WITH DEEDED OR ZONING REGULATIONS. OWNER / APPLICANT D.T.H. #1 ib D.T.H. #2
REPAIR PLAN IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. N o DATE: 3-13-13 DATE: 3-13-13
3. VEHICULAR TRAFFIC, PARKING OF VEHICLES AND PLACING GROUND ELEV. 34.5 GROUND ELEV. 34.0
C MATERIALS OVER THE SEPTIC TANK IS PROHIBITED.
• J ADJ. G. WATER 108" ADJ. G. WATER 108"
2 83 2 83' 2.83'
BRIS GENERAL NOTES:
TOL A lIENUE
1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P.
TITLE V AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS 8.5'
N FOR SUBSURFACE DISPOSAL OF SEWERAGE. END VIEW FILL FILL
H YA N N I S, B A R N S TA B LE 2. AT LEAST ONE ACCESS POINT OVER TANK TEES SHALL BE "
ACCESSIBLE WITHIN 6" OF FINISH GRADE, WITH ANY REMAINING
ACCESS PORTS BROUGHT TO WITHIN 12" OF FINISH GRADE. EL. = 25.5 108 108"
DATE: 4-19-13 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE
CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE EL. = 23.5 132" EL. = 23.2 130"
REV: 5-7-13 UNDER OR WITHIN 10' OF DRIVES OR PARKING AREAS THEY I CERTIFY THAT I AM CURRENTLY APPROVED BY THE A A
MUST WITHSTAND H-20 LOADING. DEPARTMENT OF ENVIRONMENTAL PROTECTION TO CONDUCT SANDY LOAM SANDY LOAM
APPLICANT: 4. THE EXCAVATION CONTRACTOR SHALL VERIFY THE LOCATION SOIL EVALUATIONS AND THAT THE RESULTS OF MY SOIL 10YR 3/2 10YR 3/2
EVALUATION ARE ACCURATE AND IN ACCORDANCE WITH 310
OF ALL UTILITIES PRIOR TO ANY EXCAVATION. ,
CMR 15.100 ROU H 15107. 138' 136"
M A R C E LI N 0 A L A M I N 0 5. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE EL. = 23.0 EL. = 22.7
OR WITHIN 6" OF GRADE SHALL BE MORTARED IN PLACE. '_ ___-_1�________ C-1 C-1
55 B R I S TO L AVENUE 6. FINISH GRADE SHALL HAVE A MINIMUM OF 0.02 FEET PER EDWARD A STONE CERTIFIED SOIL EVALUATOR COARSE SAND COARSE SAND
A. ,
FOOT OVER THE S.A.S. AND DISTRIBUTION BOX. 10YR 5/4 WET 10YR 5/4 WET
H YAN N I S, MA 02601 7. SEPTIC TANK SANITARY TEE'S SHALL BE CONSTRUCTED OF 1 10% GRAVEL• 10% GRAVEL
SCHEDULE 40 PVC AND SHALL EXTEND A MINIMUM OF 6" ABOVE GROUNDWATER ADJUSTMENT 156" 158"
THE FLOW LINE AND SHALL BE ON THE CENTERLINE AND EL. = 21.5 EL. = 20.8
LOCATED DIRECTLY UNDER THE CLEAN OUT MANHOLES.
SHEET 2 OF 2 DATE OF WELL: FEB/MAR/2012 OBS/AVERAGE/22.0 C_2 C-2
8. THE INLET PIPE INVERT ELEVATION SHALL BE NO LESS THAN INDEX WELL: AIW-230 MEDIUM SAND MEDIUM SAND
2 INCHES NOR MORE THAN 3 INCHES ABOVE THE INVERT WELL ZONE: D 2.5Y 6/4 WET 2.5Y 6/4 WET
PREPARED BY: ELEVATION OF THE OUTLET PIPE. I DEPTH OF WATER: 132" SOIL ANALYSIS
9. THE SEPTIC TANK SHALL HAVE A MINIMUM COVER OF 9 INCHES WELL ADJUSTMENT: 24" DOWN CAPE ENG. 186" 186"
10. THE OUTLET SANITARY TEE SHALL BE EQUIPPED WITH A GAS 1 DEPTH OF ADJ.: 108" CLASS 1 <5 MPI ELEV =19.0 ELEV =18.5
E A S SURVEY, INC. BAFFLE, 4 INCHES IN DIAMETER AND CONSTRUCTED OF 4" PVC
141 R T. 6 A H.
11 SHALL PIPES
SLOPED 11/4SCHEDULE
NCH PER FOOT MIN.EXCEPT PIPE
FORAND
THE ' DTH #1 INDICATES
HOLEDEEP
B.O.
O DON DESMARAIS
FIRST
LEVEL O FEET OUT OF THE DISTRIBUTION BOX WHICH SHALL SOIL EVALUATOR
P. O. B 0 X 1729
INDICATES ED. STONE
12. CHANGES OR REVISIONS TO SEPTIC DESIGN REQUIRE NOTIFICATION SAMPLE LOC. BACKHOE OPERATOR.
SANDWICH , MA 02563
TO EAS SURVEY INC. FOR B.O.H. AND DESIGN ENGINEERS REVIEW NO WEEPING / MOTTLING RODNEY FISHER
AND APPROVAL. SOIL TYPE:
PH. (508) 888-3619 13. MAGNETIC TAPE OVER ALL COMPONENTS. INDICATES ADJ. GROUNDWATER PERC RATE: ! 5 MIN. PER INCH
CELL (508) 527-3600 INDICATES OBS. GROUNDWATER LOADING RATE: 0_74 GAL/SF/MIN