Loading...
HomeMy WebLinkAbout0052 CHERRY STREET - Health 52'Cherry-Street Hyannis. P A = _309 121 ' k I i o TOWN OF BARNSTABLE LOCATION SQ ChcrrM 54 SEWAGE# 2olL4 - 030 VILLAGE ASSESSOR'S MAP.&PARCEL 309 - 121 INSTALLER'S NAME&PHONE NO. n4,3 Excoyc-1 i on 14`77- 06S3 SEPTIC TANK CAPACITY ISOO LEACHING FACILITY:(type) T00 qa l c1aA5 (size) 13 x 2 S x Z NO.OF BEDROOMS 3 OWNER So4,r� C'at-cu PERMIT DATE: COMPLIANCE DATE: Z-I I-14 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 ori`< site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leachin acility) Feet FURNISHED BY � .� b � W WaNfAD LIN 00 0 r , O Tel 0 fl d A D TOWN OF BARNSTABLE LOCATION �-Z C IA /a S SEWAGE # ft. Vit LADE P Vr 7, ASS S.O.RMAP & LO INSTALLER'S AME&PHONE NO. l SEPTIC TANK CAPACITY / LEACHING FACILITY: (type) (size) NO.OF BEDROOMS �2 BUILDER OR OWNER PERMITDATE: OMPL r IANCE ATE: rPIJU 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 �l within 300 feet of leaching facility) Feet Furnished by No. I L 3 0 FeAlz THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION-TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01ppYitation for Misposai 6pstem (Construction Permit Application for a Permit to Construct( ) Repair(/Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 52.0`1e22 7— Owner's Name,,Address,and Tel.No. Assessor'sMap/Parcel �l �o 9 �,`� /Z� `' h n �-`',P_e .509 -77'5 -,3� 7q Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 8-r9,exca V0_f16n 502-'(77-4653 Town � �i�� .50�362-ysy I Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures 2 II Design Flow(min.required) J3 gpd Design flow provided gpd Plan Date 1 (o Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 Boar Health. 1 �gned Date k4 2 � Application Approved by Date Zp Application DisapprovedP;05 Date for the following reasons kol Permit No. &10 — 0,30 Date Issued No. 11' 3 0 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS es ftpritatiou for Disposal bpstem Construction Vermit Application for a Permit to Construct( ) Repair(*) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 52-(f hee�e 5T- Owner's Name,Address,and Tel.No. Assessor's Map/Parcel . 4o ..3o 9 C1(LCe �zl `� r I n `-a 2e y -50� • 7 76 -�j�'' 7 y Installer's Name,,Address,and Tel.No. Designer's Name,Address,and Tel.No. �i �x«�V�f IGj1 5G� �i77 Gb53 -Dvvvn Caj�v E-IV6-- 56)k 36,,2 '16gl Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building 4{S 1Gp No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 U gpd Design flow provided gpd Plan Date I J 1 (a 1 1 U Number of sheets ! Revision Date 'Title ± , Size of Septic Tank Type of S.A.S. , Description of Soil Nature of Repairs or Alterations(Answer when applicable) i Date last inspected: ; t Agreement: i 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. 'gned � �=-�"S� Date ► ��' I y Application Approved by Date ao�t Application Disapproved Date for the following reasons i Permit No. &l L-j --f0 3C) Date Issued .--------------------------------------------_-------------- -- - - - -- - - - - - - ------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(y) Upgraded( ) Abandoned( )b/y- I�7 l� X 6 (I` D f I/� at 1)Z ( _� 1 Err \1 ��P�'� has been constructed in accordance / with the provisions of Title 5 and the for Disposal System Construction Permit No L -IJ3t7 dated Installer K(J1� I �T� L1 6\/ Designer W #bedrooms _� Approved designim.ow cp ) gpd The issuance of this permit sh not b cons rued as a guarantee that the system wi I nct on as de i ed� Date Inspector ��� IV /J'� Y No Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction J)Ermit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) -System located at 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:Constr ction must be completed within three years of the date of this permit Date Z/h 7i01 Approved by t 1 I i GI L li >Zvi�;� . es t �.,, . hl omas F. GeRer,_ -i_ec or x �a,�JS'SASF�) xr s. All, I Ta-IIlp, HenLLh Db/lksion Thorn as McKean,Director I-O0 Main S t,Hpzimmns,B/U 026071 Office: 508-962-4644 Fax: 503-790-6304 ¶nst 1�cu Designer cCe�ti- catioin Form Date- 2- Z Sews-e 1perrmWit 2D[ —QJD Assessor's G i mpTarce, c3a 6 a Designer: �Owv\_ Gv_ ✓lah Installer: Address- �� /"la h �` Adldl�ess e � a,✓�M 0, e e On 1 was issued a permit to install a ( ate) (installer) septic system at C n e-Y' jt_- 4 4MA based on a design drawn by (a dress) P� p ,101� ' ` Q dated slgner) I certify that the septic system referenced above was installed substantially according to the design, which may include=Or approved changes such as lateral relocation of jibe 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-built by designer to follow. H OF MqS DANIELA. ' o OJA� (Ins is Signature) " CIVIL C No.46502 � o -L111 .,, o��SONALE,\a� (Designer's Signature) (A Designer's tamp Here) PLEASE R.ETIMN TO BARNSTABLE FUTLIC EEAL EI DIVISLION. CERIL.TIOATE OF C0ie :ajAr a L NOT .0 V I IT-'fl'U BOaH TICS FOR AAD AS-BUILT OAR AR F,EC EI-VEi D BY=BAW61ABLE PUBLIC YES'L TH DIVISION. 'A'HANK Y OAT. 0:gearth/Septic/Designer Cerffiicatiou Form 3-26-04_doc 13 - J/d � Town of Barnstable P# Departiment of Regulatory.Services t�nnrtaTnar� Public Health Division DateMAM +e�p 200 Main Street,Hy nuis MA 02601 s Date Scheduled ime Fee)<'d. 6 ,p T ® 00 r 0 , ►o 'uitability ,Assessment for Se e .lei pis Performed-By: Nr)l e ( Von�'Q(ye S Witnessed By: A LOCATION&GENERAL INFORMATION Location Address �1 S&' Owner's Name C Address 7 �3Assessor's Map/Parcel: o9/12_� Engineer's Name t„j Q NEW CONSTRUCTION REPAIR Telephone# O,P 3 b,� Land Use: L a w Surface es SloP 96 St ( ) J to oucs Distance's from: Open Water Body Q Possible Wet-Aren /�r✓G ft Drinking Wa[er Well �(v� ft Drainage Way �r ft Property Une i( o ft Other ft SI�TCJH[:(Street name,dimensions of lot,exact locations of test holes&Pere tests,locate wetlands-in proximity to holes) C,U All) (..1 Ie rii Parent material(geologic)G�QC t�( o�i T�aS / Depth to Dedrgelt OC) Depth to Groundwater. Standing Water in Holc: / A._ - Weeping fl•om Pit,Fnee Estimated Seasonal High Groundwater )VIIA DETERAIINATION FOR SEASONAL HIGH WATER-TABLE Method Used: IV 6 W E Depth Observed standing in obs.hole: Iu, Deptlt to 5911 moult s: Itt. Depth to weeping from side of obs.hole: In, ©roundwater Adjuslment fir. Index Wcll# Reading Date: Index Well loyal^M Act].&ctor- Adj.Groundwater Leval PERCOLATION TEST lDute l/1�/NTIma L`00 Observation Hole# Time at 9" rr Depth of Pere 3, Time at G" Start Pre-soak Time® Time(9"-6") End Pre-soak Rate Min./luch Site Suitability Assessment: Site Passed Sitq Failed: Additional Testing Needed(Y/N) A Original: Public health Division Observation Hole Data To Be Completed on Back------- ***If percolation test its io be conducted within 100' of wetland,you must first notify the. Barnstable Consevvation Division at least one(1)week prior to begiDmiug. Q:\S EPTICPERCFO RM.D O C DEEP-OBSERVATION HOLE LOG Hole Depth from Soil horizon Soil Texture Sdil Color Soil. Other Surface(in.) (USDA.) (Munsell) Mottling (Structure, Stones;Boulders, 0_ 3 A L i to ;y�6 ,ravel, sy- zd C DEEP OBSERVATION HOLE LOG Hole# � Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA.) (Munsell) Mottling (Structure,Stones,Bouldem —Cojisistrngy.%Grave ------------ 14-S C r �1 S 15- jo GrUP/ S�f-l2d C, DEEP OBSERVATION HOLE LOG Hole#. Depth from Soil Horizon Soil Texture Sol]Color Soil Other• Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Co i tc c Orayon DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency: Flood Insurance Rate Map- Above 500 year flood boundary No_ Yea "Within 500 year boundary No el, Yes ' Within 100 year flood boundary Nol Its Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas obstrved throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? ._ Certification I certify that on (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 training,expertise and experience described in�10 CMR 15.017. Signature � _l--vG �-� Datb 1116M QA3.EPT1aP-ERCF0RM.D0C No. ��/ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes „l� PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 0(pprtcation for Migoml *pgtetn Conwtruction Vermit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel � - 7,9 FAA191Sd Installer's Name,Address,and Tel.40. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size q.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) �? XY16 US��� aZ Date last inspected: Agreement: The undersigned agrees to ens a construction ntenan the afore described on-site sewage disposal system in accordance with the provisi ns o itl 5 o E to ode and not to place the system in operation until a Certifi- cate of Compliance has been' sue y is o alt Signed Date/2 //9/0 Application Approved by Date IV Application Disapproved for the following reason Permit No. 6 6 Date Issued { + No: RE Fee Entered in computer: THE COMMONWEALTH OF MASSACHUSETTS Yrt/ PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS' i Zippfication for Mizpogar *potem (fongtruction Permit Application for a Permit to Construct( , )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components S' Location Address or Lot No. s Owner's Name,Address and Tel.No. ,cp Assessor's Map/Parcel ,Fc (!�Ik�� FAA1# '9 Installer's Name,Address,and Tel.k o. Designer's Name,Address and Tel.No. o /t GviSfXX /ZD 's ;aw/s Type of Building: 2 Dwelling No.of Bedrooms J Lot Size q.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil ', v• Nature of Repairs or Alterations(Answer when applicable) lout 416&S, -�"�� uG/ir. <cz) Date last inspected: Agreement: The undersigned agrees to ens a construction ntenan the afore described on-site sewage disposal system in accordance with the provisi ns o itl 5 of th E o to ode and not to place the system in operation until a Certifi- cate of Compliance has been'ssue y&s B/o alt Signed Date 1 Application Approved by w Date Application Disapproved for the following reason6l_____� _V" Permit No. Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS itertificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired (X Upgraded( ) Abandoned( )by at as nstructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ted Installer Designer The issuance of this permit shall not be construed as a guarantee that the syst��e{{•�will unction s designed. Date 'rZ I 0 Inspector ---------------------------- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS 30igpooar 6potem Conotruction Permit Permission is hereby g ted t Re air ) .pgrade nd n System located and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Constpct' n mu (be completed within three years of the date of ts"�p rmMA Date: Approved by COMMONWEALTH OF MASSACHUSETTS 8 9 EXECUTIVE OFFICE OF ENVIRONMENTAL AFF e� d 'r Cf DEPARTMENT OF ENVIRONMENTAL PROT I� iVE ,r ONE WINTER STREET. BOSTON, MA 02108 617-292-5500 Ci 7 r 199 � kvttv � TOWN 1 y�HO9NSTAB , N fPT �f WILLIAM F.WELD A OXE Govemor 1 ecretary ARGEO PAUL CELLUCCI E B.STRUHS Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Cornmissioner PART A CERTIFICATION Property Address: 'Sep C l�rQ� `5` �`�0. t.� Address of Owner: nn Date of Inspection:--Gi" c`D (If different) rt0`COY cX Name of InspectorZ211, �/ am a DEP approved yytem inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: `c Mailing Address: Telephone Number: 1-j 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 Loca Approving Authority _ Fails _ Inspector's Signature: Date: The System Inspector shall su mit 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 of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, .C, or D: A] �SYSTT PASSES: `� I have not found any information which indicates cates that the system violates any of the failure criteria as defined in 314) M 1 .C R 5 303. 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. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not. _ The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty(20) years prior to the date of the inspection; or the septic tank, whether or not metal, is 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. (revised 04/25/97) Page 1 of 10 DEP on the World W de Weo. h ap/Mreti.magnet.state.ma.usldep , ej Printed on RecyGed Paper �Kw'1F R+P>+M'v#.w+�:ta.wn^MIAI;'twW!-«s'.,—�'^wN+•kTM Y'.W`^AIM'hiFM"f�Y^n,4AMH*�»e`AP,W�nY� A.i(RYN�"WM�b'+ivlm. 4+.-AMM.aWiWMbI•+n a«rrs.mwwwnaymnrt-rN� { «x�wa'+e U...-... A e,i °. t$ xr `i r•1 7 s,#•.. "t tt d F rtt* ""4�i` Jq�symfl; y '. # w SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION�FORM w PART A CERTIFICATION (continued) { Property Addres,s;,67c1 C IN e r f rLo r-1 „ Owner: e_o.r41 e5 y £`} �"M ,4 x 'g Date of Inspection:1_� .ct7 n a� SA B)SYSTEM CONDITIONALLY PASSES(continued) Sewage backup or breakout or high static water level observed in the d stribution�box is due to broken oeobstructed 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). Describe observations: broken pipe(s)are replaced }' r' obstruction is removed distribution box is levelled or replaced � r _ The system required pumping more than.four times a year due,to, broken or obstructed.pipets). The system will pass inspection if(with approval of the.Board of Health): `b' ; Pam• broken pipets.)are replaced e <s( �,, «� ��,A ` obstruction is removed .s a . } Q FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:., • . :r;... � _.. .:. .Act ��Y .Fc "ry ,.i j .. �+ -;4 ..,.. Conditions exist which require further evaluation by the Board of Health in order-to determine rif the system is failing to protect the public health, safety and the environment. •Z. {i• +YY 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING.I_N A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND 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 APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE_.'.. ENVIRONMENT: er it tin system SA and the 5 is within 1. feet a surface'wa water I or _ The system has a septic tank and so absorption sy e (SAS) _ AS t, 00 ee to su a .. t .supply tributary to a surface water supply. The system has'a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. ' The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well.' _ The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or,more from.a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that 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. Method used to determine distance (approximation not valid). }n 3) OTHER II - (revised 04/25/97) Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Cori e5 D41p of Inspection: -7-an-c17 D] SYSTEM FAILS: You ust indicate ei;=.er "Yes" or"No" as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 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. Any portion of a 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 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 analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: You must indicate either "Yes—or "No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000.gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area-IWPA) or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance 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. (revised 04/25/97) Page 3 of 10 e SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 5� C.h er r''/ S t r 7`1 Owner: COm* Date of Inspection: -7- -CZ-ci Check if the following have been done: You must indicate either "Yes" or"No" as to each of the following: Yes No Pumping information was provided by the owner, occupant, or Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or / as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. Y _ The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary,or industrial waste flow..: The site was inspected for signs of breakout. All system components, excluding the Soil Absorption System, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of / Sub-Surface Disposal System. V Existing information. Ex. Plan at B.O.H. . _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) [15.302(3)(b)j I (revised 04/25/97) Page 4 of 10 o SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:a 5p1-G�r-sY Y�� ST N� wwts Owner:Co rZ, 5 Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow:_ _g, d./bedroom for'S.A.S. Number of bedrooms: Number of current residents:4 Garbage grinder(yes or no): A Laundry connected to syste (yes or no):y Seasonal use(yes or r ;7 Water meter readings, if available (last two (2)year usage (gpd): /�I Sump Pump(yes or no): N Last date of occupancy: -� COMMERCIAL/INDUSTRIAL: 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 c PUMPING RECORDS and source of informatio System pumped as part of inspection: (yes or no)_ T If yes, volume pumped: Gallons Reason for pumping: TYPE OF SYSTEM eptic tank/distribution box/soil absorption system Single cesspools ✓Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: 36 rf S Sewage odors detected when arriving at the site: (yes or no)!Y (revised 04/25/97) Page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: G�Xevey 5r Owner: Lpv-J'Q'es Date of Inspection: -7-a a,c�-7 BUILDING SEWER: (Locate on site plan) it Depth below grade: /' Material of construction: cast iron _40 PVC other (explaikovar`� V-o Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK:L� (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene —other(explain) If tank is metal, list age_ Is age confirmed by Certificate of Compliance _(Yes/No) 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: How dimensions were determined: 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. GREASE TRAP: (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: (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.) (r*viaed 04/25/97) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C i( SYSTEM INFORMATION (continued) Property Address: Owner:Co Date of Inspection: -7-aci--V-7 TIGHT OR HOLDING TANK: (Tank must be pumped prior to, or at time, of inspection) (locate on site plan) . Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) Dimensions: Capacity'-gallons Design flow: gallons/day Alarm level: Alarm in working order_Yes; _ No Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:Lq (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) PUMP CHAMBER: ! 1 (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order (Yes or No) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 04/25/97) Page 7 of 10 o- , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ` SYSTEM INFORMATION (continued) G Property Address: 5�- eYY•l ST- ►—f�( Owner:C p rC.p fc Qdte,of Inspection: $OIL ABSORPTION SYSTEM (SAS):_ (locate on site.plan, if possible; excavation not required, but may be approximated by non-intrusive methods) F . If not determined to be present, explain: Type: leaching pits, number:_ leaching chambers, number._ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Alternative.system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) CESSPOOLS: a— (locate on site plan) (� Number and configuration: ('"ll f vv_""'(S � fr Depth-top of Iiquid to inlet invert:_ PIT- ov>✓ lip* 0,r a• a t Depth of solids layer: Qt' i►— P tT Depth of scum layer: o'4 _r 3u Dimensions of cesspool: 6)cT_ — G),F Materials of construction: �b fir„IL Indication of groundwater: lua--Q— inflow (cesspool must be pumped as part of inspection) uUri-S OvwVjZJ h+o r,`:(euJ Comments: (note condition of soil, signs of hydraulic failure, leve)) of ponding, condition of vegetation, etc.) Ate, I L-ff��$Gant o w Co�•e Azo Sl�c4 S OIG /4K-Y y C.c'�J PRIVY: (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.) (revised 04/25/97) Page 8 of 10 ,N t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:5 C-�- cue, V. sT- N Y Owner: Cpvr,0rs Date of Inspection: -7 5-7 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) 5 �^^l J � � I 6"YY-1 k (revised 04/25/97) Page 9 of 10 r . i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C + SYSTEM INFORMATION (continued) Property Addres : S-c)= G 1�yvy SC' V- -f Owner: CO70�S Date of Inspection: 7-Zk±9 No WI-r— Depth to Groundwater feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of Site(Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers /' V Use USGS Data Describe in your own words how you established the High Groundwater Elevation. Must be completed) fly I I (ravisod 04/25/97) Paga 10 of 10 T ALL SYSTEM COMPONENTS SHALL. BE SYSTEM PROFILE NOTES SYSTEM V MARKED WITH MAGNETIC TAPE OR (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. PROVIDE MIN. 20" DIAM. WATERTIGHT 1. DATUM IS APPROX.' NGVD ACCESS COVERS TO WITHIN 6" OF FIN. GRADE 2" PEASTONE OR GEOTEXTILE CONCRETE COVERS TO WITHIN 3" GRADE TOP FOUND. EL. 42.9' FILTER FABRIC OVER STONE 42.6' 2% SLOPE REQUIRED OVER SYSTEM 2. MUNICIPAL WATER IS EXISTING MINIMUM .75 OF COVER OVER PRECASTCb o PRECAST H-lo WATERTEST D'BOX FOR LEVELNESS BLOCKS OR 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. °C [ocu PRECAST H-1 PRECAST RISERSRISER a 2'm 4"OSCH40 PVC MORTAR ALL INVERT IN 38.67' PIPES LEVEL 1ST 2' 4. COMPONENTS 4' 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO errs St ~ ENDS (TYP•) SIDES 39.50 H- 10 39.66'** 10" 1500 GAL H-10JE �. P°�° _ o o a o a Hya. Eo et 39.44' TEE SEPTIC TANK °°o°o°o 39.19 �a®® ®®®®®® aa® o ° o° 5. PIPE JOINTS TO BE MADE WATERTIGHT. E�em. Sch. tr St. St. ° ° ° ° ° ° O >°°°°°°°° °°O°°°°° 00 0 0 0 0° °°°°°°°o ®�®®®®��®�® ®0®®®®0��0� '°°°°°°° teven� °r GAS BAFFLE.."' ° ° ° ° ° o 0 0 0 0 0 0 °0°no^°^°_ N ;oOOOO°O° o o°o 0 r °° ° ° ®®�®®��®®�® °°° 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH 38.95' 38.78' °°°°° °°° °°° 36.67' 4' LIQ. LEVEL (ACME OR EQUAL) °°°o Mitchells MASS. ENVIRONMENTAL CODE TITLE V. 1E . . ,... . :. ... . .. -.• 6" MIN. SUMP � t o°°o°°oo°o°°oo°o°°o°°oo°o°o°o°o°°o°°o°°o°o°o°o°°oo°oo°o°°o°0 12" MIN. INT. DIM. South S�a oo�o�oo�o°o„o,g,o°0000000�o�g„g°g°o„o°00000. 3/4"-1-1/2" DOUBLE WASHED STONE 4' MIN. H-10 500 GAL. LEACHING CHAMBERS B� ACME PRECAST OR EQUAL ALL AROUND PRECAST STRUCTURES (2) UNITS REQUIRED 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO c _6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 25.00' X 12.83' BE USED FOR LOT LINE STAKING OR ANY OTHER PURPOSE. m Main *PLUMBING TO BE RE-ROUTED TO EXIT AT AREA SHOWN. COMPACTION. (15.221 [2]) ^ $t O MIN. PROPOSED EXIT ELEVATION SHOWN 16t' „ ( 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4 PVC. ?% SLOPE) ( 2 5G SLOPE) ( 1 � SLOPE) MIN. 11 SEPTIC TANK 12' D' BOX 13' LEACHING 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED FOUNDATION- 32.5' BOTTOM TH-1 NO GROUNDWATER FOUND WITHOUT INSPECTION BY BOARD OF HEALTH AND PERMISSION LOCUS MA FACILITY OBTAINED FROM BOARD OF HEALTH. * NOT TO SCALE THE INSTALLER SHALL VERIFY THE G-W EXPECTED AT EL. 20't PER MAP LOCATIONS OF ALL UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING ASSESSORS MAP 309 PARCEL 121 PRIOR TO INSTALLING ANY PORTION OF DIGSAFE (1-888-344-7233) AND VERIFYING THE LOCATION SEPTIC SYSTEM OF ALL UNDERGROUND & OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF WORK. I LEGEND 11. EXISTING LEACHING FACILITY SHALL BE PUMPED AND REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. 100.0 PROPOSED SPOT ELEVATION 12. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE REMOVED 5' BENEATH AND AROUND THE PROPOSED +100.00 EXISTING SPOT ELEVATION LEACHING FACILITY. SYSTEM DESIGN. 100 PROPOSED CONTOUR 41 NOTE: TOP OF SAS IS BELOW GARBAGE DISPOSER IS NOT ALLOWED 1 QQ EXISTING CONTOUR CRAWLSPACE FLOOR ELEVATION 2.30 EXISTING 3 BEDROOM DWELLING 32.60 DESIGN FLOW: 3 BEDROOMS @ 110 GPD = 330 GPD F USE A 330 GPD DESIGN FLOW ii 0 x 42.41 < 014 .43 SEPTIC TANK: 330 GPD 2 = 660 S P ( ) 42.53 TH2 .87 TH1 USE A 1500 GAL. SEPTIC TANK -60 4 O60 4 8 001 . TEST HOLE LOGS 5" 42.81 LEACHING: Ap 0 TREE �. 93 SIDES: 2 (25 + 12.83) 2 (.74) = 112 GPD DANIEL E. GONSALVES, SE #13587 42 69 2 1 3' LOT AREA BOTTOM 25 x 12.83 (.74) = 237 GPD ENGINEER: \ CRAWL. 12,778tSF WITNESS: DONNA MIORANDI, RS x 42.62 / TOTAL: 472 S.F. 349 GPD GAR. SLAB DATE: 1/16/14 .45 � CP USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) 42. 5 FULL BASE. PERC. RATE _ < 2 MIN/INCH WITH 4' STONE ALL AROUND BENCH MARK - ON TAG 2.60 CLASS I SOILS P# 14261 BOLT #244 ELEV. = 44.7 PPVER DRw� 6242 67 EXISTING DWELLING MA 4 o TOP OF FNDN. APPROVED DATE, BOARD OF HEALTH ELEV. ELEV. x 42.60 EL. 42.9' oil 42.5' oil 42.5' � 6 .70 APPROX. AREA OF EXISTING CESSPOOLS A A TITLE 5 ' SITE PLAN 4� w .47 LS LS `�Go 8 � o OF 10YR 4/2 10YR 4/2 41> s. 2.48 ``' o �� 31, 3" A, <<,�� 1 42.3 B B 1.60 42 CP 52 CHERRY STREET LS LS .46 42 x 42.31 HYANN�S 14" 10YR 5/6 41 .3' 14" 10YR 5/6 41 .3' Spy wg4K 90 42 42.08 Cy .17 �o ° PREPARED FOR C1 C1 F MS MS RRy .6 41.70 PERC VW/ GRAVEL, W/ GRAVEL sT�, 90 B&B EXCAVATION/CAREY 10YR 7/4 10YR 7/4 FF 54" 38.0' 54" 38.0' r I 1 DATE: JANUARY 16, 2014 \ 40.60 off 508-362-4541 C2 C2 '` fax 508-362-9 80 M/CS M/CS �"o / of �� qss� downcape.com 10YR 7/4 10YR 7/4 c E7ANlGLA. cti� �� DANIEL �� OuALA N down cope engineering, inc. 120" 32.5' 120" 32.5' A'L CIVIL 2 9 c�JALA civil engineers 0•40 8® Ion surveyors ; NO GROUNDWATER ENCOUNTERED Scale: 1"= 20' 4ti� sso/NAL ��� 939 Main Street ( Rte 6A) s SURve YARMOUTHPORT MA 02675 0 10 20 30 40 50 FEET DCE #13-310 DATE DANIEL A. OJALA, P.E., P.L.S. 13-310 B&B_CAREY.DWG