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HomeMy WebLinkAbout0058 BRISTOL AVENUE - Health 5�8`BnS 'Ave '+ Hyannis, Ak 291-146 „ t, TOWN OF BARNSTABLE LOCATION �j �2f (��, SEWAGE# 2OIO VILLAGE -ASSESSOR'S MAP L&/PARCEL �91 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) 32 &id,� `+Ig (size) NO.OF BEDROOMS. y OWNER VR corn co e LL& PERMIT DATE: p o COMPLIANCE DATE: D a 0 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 -�04 _ �� ay 3® �u (go f . No. l5 Fee THE COMMONWEALTH OF MASSAC.HUSFTTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS : Yes 01ppYication for Ahgpozar *p5tem Con!gtructiou Perron Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. —`'v a-4e Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 1129 0— I CCf. ie1a�� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: cS ?Gl� Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) y/�{ O gpd Design flow provided VedZ) gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank SQ Type of S.A.S. i32 (fit✓(CK e4 9'j"_. i•cd c� lfx�rrE � Description of Soil Nature of Repairs or Alterations(Answer when applicable) P.�.gr V 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 de and not to place the system in operation until a Certificate of -Compliance has been issued by this Board of igned Date Application Approve Date c� J Application Disapproved by: Date for the following reasons Permit No. lJ Date Issued i r -M -"mil. .,�,�. "%`+•"r-.. .'?"' ��..' .. •fi" . Apr-'•r"" No. D /� Fee ,10 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALl"H"DIVISION - TOWN 'OF BARNSTABLE, MASSACHUSETTS . Yes 711 r 01'pplicatiou for Digogaf 6p5tem cowaruction permit Application for a Permit to Construct( ) Repair( ) Upgrade( )` Abandon( ) 0 Complete System ❑Individual Components , Location Address or Lot No.` ✓!- ���S?L �`e Owner's/Name,Address,and Tel.No. Assessor's Map/Parcel (— � � �` �� �✓ 4 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. � 1/h yAlfe�y Type of Building: •'� } S��1114 , G6 x, Dwelling No.of Bedrooms Lot Size f sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) ! /D gpd Design flow provided ��a gpd Plan Date Number of sheets Revision Date q Title Size of Septic Tank Type of S.A.S. 32 Qv e(< <-1 Description of Soil Nature of Repairs or Alterations(Answer when applicable) I 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 de and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Heap. I. igned ZQ�C Date Application Approve ' Date Application Disapproved by: Date for the following reasons Permit No. Date Issued ZQ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE -MASSACHUSETTS Certificate of Compliance _ ;iL is THIS IS TO CERTIFY,thatthe On-site Sewage Disposal System Constructed ( ) Repaired Graded ( ) Abandoned( )by yltioc�y �c 5 k e4c— at_ S8 19 KtS f�L. &LA& has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. o7-016 —9/ S dated /0)/3 d Installer ne JS� Designer 00-C• S y I/��I( - #bedrooms -1 Approved design flo gpd The issuance of his p it shall not be construed as a guarantee that the system wil fu ct1n as de gned. Date 2 d Inspector p' w --- j—/---------.------..—.--�--.--- ----_-----------� ' No. i`i�� 7 / Fee Q •. THE COMMONWEALTH OF MASSACHUSETTS- PUBLIC HEALTH DIVISION — BARNSTABLE, MASSACHUSETTS =i!5poat *p5tem Construction permit Permission is hereby granted to Construct ( ) b Repair ( Upgrade ( ) Abandon ( ) System located at IvL, aAe,, t4j=kt� s ' and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty . { t to comply with Title 5 and the following local provisions or special conditt* . Provided: Construction must b completed within three years of the date of this permit. Date �Q/`� /Q Approved by Town of Barnstable Regulatory Services Thomas F. Geiler,Director BAJtNffAJUA Public Health Division .`� Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 r Office: 508-862-4644 Fax: 508-790-6304 Date: 1 D '29- /0 Sewage Permit#AP Assessor's Map/Parcel . 2-� � r .I44 Installer&Designer Certification Form Designer: rS c�) lJt' Installer: IS eV Address:. t;2 G 3n� Qae& Address: 444) PA&"W Lr On d �'•�- 1 D (yC� '1t, was issued a permit to install a (date) (installer) septic system at S0 (24Lk,s—based on a design drawn by (address Vt O�: 1AC(2:7N dated t 0 — (designer) V I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. 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 certi as-built by designer to follow. Stripout(if required) was inspected and the soils were satisfactory. DAVID ���, Y A(In i re) o D. u FLAHERTY, JR. No. 1211 17 _PP A YA ERGO (Designers Sig ture) (Affix ere) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoffice fonns\designercerti6cation fonn.doc oF�� Town of Barnstable P# 13 z Department of Regulatory Services t,ARNerAilill Public Health Division Date v MAS& E130. �� 200 Main Street,Hyannis MA 02601 Date Scheduled r Tithe Fee Pd. (U U Soil Suitability-Assessment for Sewage Disposal Performed By:_ �Z Witnessed By: LOCATION& GENERAL INFORMATION , Location Address `�p� Owner's Name V 2CJytico`e V v- Ryd 5 M'�' V1 �y U Address C Assessor's Map/Parcel 2� ` Q�N � � Engineer's Name 1-- -` WX ZZ NEW CONSTRUCTION REPAIR tC 11- Telephone# ��_ Land Use 7B2),lt-,4-1 all Slopes(30) ( a �' J/� Surface Stones Distances from: Open Water Body_A ----ft Possible Wet.Area ft Drinking Water Wei] ft Drainage Way 01, ftProperty Line - ��ft/�eavr J' �c �kho `Rod-�a Ott '� . SKETCH:(Street name,dimensions of Im exact locations of test holes&perc tests,locate wetlands(n proximity to holes) 2c.�t- 40 z°1 t -1301 �v 9 —vti� ti 20 1- 1 v •'L►G1c 3uq —n�o Parent material(geologi GGG !l111 4th to Bedrock Depth to Groundwater. Standing Water in Hole: Weeping from Pit Anee Estimated Seasonal High Groundwater DETE TION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed Stan tng m obs.hole: In. Depth to soil mottics:Depth to weeping from side of obs.hole: n Reading Index Well# � �In, Groundwater Adjustment, ft ng Date: Index Well level factor Ac({,Groundwater Level PERCOLATION TEST ngtp- Observation Hole# / Time at 9" Depth of Pere4A� Time at 6" Start Pre-soak Time End Pre-soak 7• �V .I RateMin./Inch G^ Z G� 7�1 �t'Y Site Suitability Assessment: Site Passed Site Failed:. . Additional Testing Needed(YM) Original: Public Health Division Observation Hole Data To Be Completed on Back----L ***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:\SEPTICIPERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistencv.%G el 28 - 3'L- YQSA. 0 r►gtciln S444 10 24/i DEEP OBSERVATION HOLE LOG Hole# Z j Depth from Soil Horizon Soil Texture Soil Color Soil—, Other Surface(in.) N. (USDA) (Munsell)' Mottling (Structure,Stones,Boulders. Consistency.%Gravel) b— 2G- 3 d o Luca_` C`a.n vn-a/:r 34 _` . Lta S 7.SIa. 54 t4 a N; S o R t vz v • r � a �l, z��� n co va►�8 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) ,(Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel 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. I FLA Insurance Rate Man: , Above 500 year flood boundary No— Yes Within 500 year boundary No= Yes Within 100 year flood boundary No— Yes Depth of Natitrally Occurring Pervious Material Does at least four feet of naturally occurring pervio s material exist in all areas observed throughout the area proposed for tiie soil absorption system? 11 If not,what-is the depth of naturally occurring per ions material?— Certificatio�.i I certify that on 6-- (date)I have passed the soil evaluator examination approved by the Department of En ronmental Protection and that the above analysis was performed by me consistent with . the required trainin erti and experie a described in 310 CMR 15.017. Signature_ Date 9 17 AD Q:\S,EMCW'ERCFORM.DOC MAY.24.2002 9:44AM BARNSTABLE COM/ECO.DEVELOPMENT NO.818 P.2i7 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTAR f AINMMM SUBSURFACE SEWAGE DISPOSAL SYSTE M FORM PART A JUN 14 2002 CERTIFICATION TOWN OF BARNSTABLE Property Address: HEALTH DEPT. Owner's Name: Owner's Address: _�. MAP Date of Inspection p{ f^ PARCEL 4(o""'"" Name of[nspector 1 ase rant 9 #� LOT 1 Company Name: Y Mailing Address: ' Telephone Number: CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to ection 15.340 of Title 5(310 CMR 15.000), The system: ✓ Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date:�txlkt 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 ofrice of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time:This inspection does not address how the system will perform in the future under the some or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 MAY.24.2002 10:17AM BARNSTABLE COM/ECO.DEVELOPMENT NO.819 P.1/5 OFFICIAL.INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: 20I Inspection Summary: Check A,B,C,D or E/ALL—AYS complete all of Section D A. System Passes: I have not found any information which indicates that any of the failure criteria described In 310 CMR V-5'50L3 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: 2 i MAY.24.2002 9:45AM BARNSTABLE COM/ECO.DEVELOPMENT NO.818 P.3i7 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY.ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1� Owner: Date of Inso'ectioniaJQ140 11,97 2MI 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 I3.303(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 SO feet of a surface water Cesspool or privy is within SO 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 pubic health,safety and environment: _•The system has a septic k and soil absorp ' system(SAS)and the SAS is within 100 feet of a surface water supply or tribut to a surface w r supply. The system has a septic tank SAS d the SAS!s within a Zone 1 of a public water supply: The system has a septic tank and S and the SAS is within SO feet of a private water supply well. The system has a septic tank wA SAS the SAS is less than 100 feet but 50 feet or more tom a private water supply well*s.Metfii d used to de ine distance "This system passes If the wpl�l water analysis, erfo at a DEP certified laboratory,for eolifotm P ry, bacteria and volatile organic compottrtds indicates that thew 1 is&ee from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than S ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other; 3 MAY.24.2002 10'17AM BARNSTABLE COM/ECO.DEVELOPMENT •NO.819 P.2i5 Page 4 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Owner: Date of Inspection: D. System Failure Criteria applicable to all systems: You AM indicate"yes"or"no"to each of the following for sll inspections: Yes No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or pending of effluent to the surface of the ground or surface waters due to an overloaded or Clogged SAS or cesspool Q Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6"below invert or available volume is less than'A day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pip a).Number of times pumped _ Any portion of the SAS,cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within,a Zone 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well, Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet Flom a private water supply well with no acceptable water quality analysis.(This system passes it the well water analysis, performed at a DEP certified laboratory,for coliform bacteria end 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 S ppm,provided that no other failure criteria are triggered.A copy of the analysts must be attached to this form., (Yes/No)The system JIU1.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: L Large Systems: To be considered a large system the system musts rve a facility with a design flow of]0,000 gpd to lS,000 gpd. You must Indicate either'�res"or"no' each of a following (The following criteria apply to large syst s. addition to the criteria above) yes no the system is within 400 abet o surlbc linking water supply the system is within 200 fe of a tributary to a t�ace drit"S water supply _ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Aica—IWPA)or a mapped Zone Ili 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 "wes"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 1 S.304.The system owner should contact the appropriate regional office of the Department. i 4 MAY.24.2002 9:45AM BARNSTABLE COM/ECO.DEVELOPMENT NO.818 P,4i7—' Page 5 of 11 OFFICIAL INSPECTION FORM--NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Owner:SC Date of Inspectiop: Check if the following have been done.You must indicate` es"or"no"as to each of the following: Yes No Pumping information was provided by the owner,occupant,o:Board of Health Y, Were any of the system components pumped out in the previous two weeks? Has the system received normal flows in the previous two week period? Alb Have Iarge volumes of water been introduced to the system recently or as pan of this inspection? Were as built plans of the system obtained and examined?(If they were not available note as NIA) Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break.out? Were all system components,excluding the SAS,located on site? Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition Kfe baffles or toes,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner)provided with information on the proper )�4aitienance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no „ Existing•information.For example,a plan at the Board of Health. — Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)(310 CMR 15.302(3)(b)] I • 5 MAY.24.2002 10:18AM BARNSTABLE COM/ECO.DEVELOPMENT NO.819 P.3i5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 'q Owner:- f Date of Inspection: 17 j_ FLOW CONDITIONS RESIDENTIAL. Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 1 S.203(for example: 110 gpd x#of bedrooms): Number of current residents: Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system(yes or no):&V [if yes separate inspection required) Laundry system inspected s or no): Seasonal use:(yes or no): Water meter readings,if avaable(last 2 years usage(gpd)): Sump pump(yes or.no): �J Last dare of occupancy: COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): d 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 Source of information: := tu. Was system pumped as pan of th ns ection(Yes or n ): -�— If yes,volume pumped: gailons-How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM Septic tank,distribution box,soil absorption system - g1e cesspool veMow 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,data installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no): 6 MAY.24.2002 9:45AM BARNSTABLE COM/ECO.DEVELOPMENT NO.818 P.5i7 Page 7 of l I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:iA/' ,�(�� . Owner: Date of Inspection: 6k la L4 S (D BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: cast iron 40 PVC_Jdeotlu7(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): (QrRQ -.39094 2 SEPTIC TANK: (locate on site plan) Depth below Bade: Material of construction:_ crete_ I fiberglass polyethylene —other(explain) If tank is metal list age:, Is age o ed by a Certificate of Compliance(yes or rip):_(attach a copy of certificate) Dimensions: Sludge depth: Distance fiom top of sludgZop om of ou tee or baffle: " Scum thickness: Distance from top of scutttf outlet tee orb e: Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): GREASE TRAP:�( to on site pl Depth below grade;; Material of construct*:_cc to—metal fiberglass__polyethylene other (explain): . ; Dimensions: Scum thickness: Distance from top of scumt'o top of outlet or battle: Distance fl•om bottom of scum to bottom of o t tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and let tee or baffle condition,structural integrity,,liquid levels as related to outlet invert,evidence of leakage,etc.): MAY.s4.20 0211 10:18AM BARNSTABLE COM/ECO.DEVELOPMENT NO.819 P.4i5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: t4 i e �nag-- Owner: Date of Inspection: / TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below Bade: Material of construction: concrate metal fiberglass polyethylene other(explain): Dimensions: Capacity: sallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working o er(Y or no). Duo of last pumping: Comments(condition of alarm and float s4witches,etc.): DISTRIBUTION BO,X: (if present must be ' ened)(locate on site plan) Depth of liquid level above outl invert: Comments(note if box is level in ' tribut to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PUMP CHAMBER: (1 ate 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.): S MAY.24.2002 9:46AM BARNSTABLE COM/ECO.DEVELOPMENT 1V0.818- —P.6i7 Page 9 of 11 OFFICIAL INSPECTION FORM--NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner• Date of Inspection: SOIL ABSORPTION SYSTEM(SAS) (loeate on site plan,,excavation not required) If SAS not located explain why: Type leaching pits,number:_ leaching chambers,number. leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: ovefflow cesspool,number: innovative/alternmive system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): CESSPOOLS:t(cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: ti'9 .Jov- Fkc,a,i Depth—top of liquid to inlet invert: at Depth of solids layer 444 Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow es or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 1 V d • PRIVY: (locate on site plan) a Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil, gns of bydrauluc ilure,level of ponding,condition of vegetation,etc.): I • I 9 MAY.24.2002 10:18AM BARNSTABLE COM/ECO.DEVELOPMENT NO.819 P.5i5 Page 10 of 11 OFFICIAL.INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SURSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM FART C SYSTEM INFORMATION(continued) Property Address; Owger: Date of Inspectfoo; 24=1 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. MCA- 0 10 i MAY.24.2002 9:46AM BARNSTABLE COM/ECO.DEVELOPMENT N0.816 -P.7i7 — .. Page l I of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 11n p7a Owner: T 675 Date of Inspection: (o f SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet ~ Please indicate(check)all methods used to determine the high ground water elevation: —Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Soard of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USCrS database-explain: You must describe how you established the high ground water elevation: . I 11 HYANNIS 28 Roves PARCEL ID: 309/025 cc s'4:-- z LOCUS CB i N N SR,gTOL PARCEL ID: o ANVE 291/139 3 o MP PUMP & REMOVE � E O LEACHPIT PER TITLE V o , 5.6 LOCUS MAP \ 6 CHI c3: PARCEL ID: SQa,,t o; 309/016 LOCUS INFORMATION PARCEL ID: \ \ 291/140 \\ CB \ s 6 a= 6 PLAN REF: LC 14034A SH.2 \ TBM: TITLE REF: CTF#164711 COR BLHD "0 ` ���� �6 3 2.9 \ PZONEL IDRB MAP 291 PAR. 146 NOT IN STATE ZONE II \ 0 FLOOD ZONE: "C" \ 1 \ 36.20 \ 7- \ \ _ COMMUNITY PANEL- 250001-0005—C DATED:08/19/85 QQ \ `�` \ BLHD — __ __ ►; o SEPTIC SYSTEM #58 REPAIR PLAN 4—BEDROOM=—\\ PARCEL ID: LOCATED AT: DWELLING 291/14'6 #58 BRISTOL AVENUE \ \ --��- \ \" — T.O.F. = AREA=9,000 S.F. HYANNIS, M A. �'� ELEV.=37.0' PREPARED FOR �.. \ (3\1, - e LAWRENCE E. 25'1 VADEBONCOEUR PARCEL ID: \ \ \ \ SCALE: 1"=20' 291/145 \ I i \ O A \ \ \ W / OCTOBER 4, 2010 ��tN or Mgss9 cy � J'o \\ `ZN OF Mq sq o`'� EDWARD �s \ \ \ A . �, \\ \ �� L) STON Cn 66 V FLAH J . ' �o o. A89 0 L s \ y� �\� ASTER CB 36 / S�NITAR\p' V• E. A. S. UPOLE VARIANCE REQUESTED: SURVEY, INC. GRAPHIC SCALE 141 ROUTE 6A TO INSTALL A SEWAGE ABSORPTION SYSTEM SALT POND BUILDING 20 0 10 20 40 so 17' FROM THE FOUNDATION ASKING FOR P.O. BOX 1729 A 3.0' VARIANCE. SANDWICH, MA. 02563 ( IN FEET ) BUS:(508)888-3619 CELL:(508)527-3600 1 inch = 20 ft. SHEET 1 OF 2 J 1279 TOP OF FOUNDATION EL=37.0 4" SCHEDULE 40 P.V.C. OBSERVATION PORTS 10' MINIMUM MIN. PITCH 1/8" PER FOOT W/ WCAPS TO GRADE TO GRADE EL=36.5 EL= 36.3 EL .,,,,,,,,,,,,, = 36.1 EL= 36.0 : . 6 35.9 .......`:;:; , .. ., EL- MAX.' .. .... •�s4 `:... ................ ...... 9" MIN. . .... ... .... COVER *EL= CONC. TOP OF LINER = 33.0 " " " a,p CLEAN SAND FILL RISER & Q�, PER 310 CMR 15.255 2 9' 400 LEVEL �• INVERT BETWEEN AND TO A MIN. OF 6" A COVER p�v EL= 32.67 OVER UNITS �•�' 10' ® S=.04 S= .06 FOR J '� EL= 33.0 O FLOW LIN 1s.o' s=.o1 3 3 INVERT LA 11 LA INVERT 110" INVERT INVERT 12" (EXIST.) EL=34.6 MIN. EL= 33.0 6" SUMP EL=32.83 8"L EL= 32.0 4' 6' BASE OF MECHANICALLY COMPACTED SAND PROP. D85 LINER=-► 32.0' DISTRIBUTION 6" BASE OF MECHANICALLY 32-QUICK 4 STANDARD INFILTRATORS COMPACTED SAND BOX PROPOSED BOTTOM ROM 2s.o (34"W X 48"L X 12"H) EACH Z SOIL ABSORBTION SYSTEM (S.A.S.) VARIANCE REQUESTED: 1 ,500 GALLON TANK PROFILE OF (BED FORMATION) 11 .33' X 32' °°� TO INSTALL A SEWAGE ABSORPTION SYSTEM SEWAGE DISPOSAL SYSTEM ui 17' FROM THE FOUNDATION ASKING FOR (NOT TO SCALE) (5' STRIPOUT ALL AROUND 21 .33' X 42') A 3.0' VARIANCE. BOTTOM OF TH #1 ELEV.= 23.6 GENERAL NOTES I CERTIFY THAT I AM CURRENTLY APPROVED BY THE DEPARTMENT OF (NO GROUND WATER) ENVIRONMENTAL PROTECTION PURSUANT TO 310 CMR 15.017 TO CONDUCT 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. SOIL EVALUATIONS AND THAT THE ABOVE ANALYSIS HAS BEEN PERFORMED TITLE 5 AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS BY ME CONSISTENT WITH THE REQUIRED TRAINING, EXPERTISE, AND EXPERIENCE FOR SUBSURFACE DISPOSAL OF SEWERAGE. DESCRIBED IN 310 CMR 15.017. 1 FURTHER CERTIFY THAT THE RESULTS OF MY DESIGN DATA 2. AT LEAST ONE ACCESS PORT OVER TANK TEES SHALL BE ACCESSIBLE WITHIN 6' OF FINISH GRADE, WITH ANY REMAINING SOIL EVALUATION, AS INDICATED ON THE ATTACHED SOIL EVALUATION FORM, ACCESS PORTS BROUGHT TO WITHIN 6" OF FINISH GRADE. ARE ACCURATE AND IN ACCORDANCE WITH 310 CMR 15.100 THROUGH 15.107. 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE NUMBER OF BEDROOMS........._4 CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE GARBAGE DISPOSAL................. UNDER OR WITHIN 10' OF DRIVES OR PARKING AREAS THEN THEY MUST WITHSTAND H-20 LOADING. EDWARD A. STONE, CERTIFIED SOIL EVALUATOR TOTAL ESTIMATED FLOW ' ► 4. THE EXCAVATION CONTRACTOR SHALL VERIFY THE LOCATION (110 GAL./BR./DAY X 4 BR.) OF ALL UTILITIES PRIOR TO ANY EXCAVATION. D 440GPD X 200% = 880 GAL 5. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE TEST PIT RESULTS: 1 13056 INSTALL: USE NEW 1500 GAL. TANK OR WITHIN 6" OF GRADE SHALL BE MORTARED IN PLACE. 6. FINISH GRADE SHALL HAVE A MINIMUM OF 2% GRADE SOIL TEST DATE: SEPT. 17, 2010 32 QUICK4 STANDARD INFILTRATORS (34"W X 48"L X 12"H) OVER THE S.A.S. AND DISTRIBUTION BOX. AND BACKFILL WITH CLEAN SAND FILL PER 310 CMR 15.255 7. SEPTIC TANK SANITARY TEES SHALL BE CONSTRUCTED OF B.O.H. AGENT: DON DESMARAIS, R.S.SCHEDULE 40 PVC AND SHALL EXTEND A MINIMUM OF 6" ABOVE / 40MIL. LINER & (42' X 21.33') STRIPOUT ALL AROUND THE FLOW LINE AND SHALL BE ON THE CENTERLINE AND SOIL EVALUATOR: EDWARD A. STONE W LOCATED DIRECTLY UNDER THE CLEANOUT MANHOLES. BACKHOE: RODNEY FISHER SOIL CLASSIFICATION................ �____ 8. THE INLET PIPE INVERT ELEVATION SHALL BE NO LESS THAN DESIGN PERCOLATION RATE..... <2 KilbL/N. 2 INCHES NOR MORE THAN 3 INCHES ABOVE THE INVERT EFFLUENT LOADING RATE.........___74 9. ELEV TION O THESOUTLEHAVEEA MINIMUM COVER OF 9 INCHES. TH#1 EL.=35.6 PERC RATE<2MIN./IN. ©78 BOTTOM REQUIRED LEACHING CAPACITY.....440 GAL/DAY 10. THE OUTLET SANITARY TEE SHALL BE EQUIPPED WITH A GAS ELEV. DEPTH IN. HORIZON TEXTURE COLOR MOTTLING OTHER LEACHING CAPACITY PROVIDED.....447 CA _DAY BAFFLE, 4 INCHES IN DIAMETER AND CONTRUCTED OF 4" PVC. 33.3 0"-28" "X" FILL ----- --- ----- (4) ROWS OF (8)INFILTRATORS X 4.72 S.F./L.F. 11. ALL PIPES SHALL BE SCHEDULE 40 PVC SEWER PIPE AND FIRST TWO FEET OUT OF THE DISTRIBUTION BOX SHALL 32.9 28"-32" OEA LOAMY SAND 1oYR5/1 --- ----- 128 L.F. X 4.72 S.F./L.F.= 604 S.F. BE LEVEL. 30.3 32"-64" B LOAMY SAND 7.5YR5/6 --- ------ 604 S.F. X .74 GPD./S.F.= 447 GPD 12. CHANGES OR REVISIONS TO SEPTIC DESIGN REQUIRE NOTIFICATION TO EAS SURVEY, INC. FOR B.O.H. AND DESIGN 23.6 64"-144" C MEDIUM SAND 10YR6/6 --- 10%GRAVE ENGINEERS REVIEW AND APPROVAL. 447 GPD PROVIDED - 440 GPD REQUIRED = 7 GPD RESERVE NO GROUNDWATER/NO MOTTLES CONSTRUCTION NOTES: TH 2 EL.= 35.8 OF `j"OF dL9ss ELEV. DEPTH IN. HORI ON TEXTURE COLOR MOTTLING OTHER o'r �DAV�Ass9�c EDWARD9cy�� SEPTIC SYSTEM DETAIL PAGE 1. CONTRACTORS / INSTALLERS SHALL VERIFY GRADES AND ) A. -` #58 BRISTOL AVENUE ELEVATIONS AND SITE CONDITIONS PRIOR TO COMMENCING 33.6 0"-26" "X" FILL ----- --- ----- STO WORK ON THE SITE. 32.9 26"-34" OEA LOAMY SAND 10YR4/3 --- ----- F�LA o No. 8 HYANNIS, MA. 2. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE 12 p WITH DEEDED OR ZONING REGULATIONS. OWNER / APPLICANT 30.3 34"-66" B LOAMY SAND 7.5YR5/6 --- ------ o �� `cG s E IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. " /sTF-51 s OCTOBER 4, 2010 • 3. ALL SYSTEM COMPONENTS SHALL BE MARKED WITH MAGNETIC MARKING 23.8 66 -144' C MEDIUM SAND 10YR6/6 --- 10%GRAVE sgN1T 0' ^ N TAPE OR A COMPARABLE MEANS. NO GROUNDWATER/NO MOTTLES J. SHEET 2 OF 2 J# 1279