HomeMy WebLinkAbout0143 CHESTNUT STREET - Health 143 Chestnut,Street ,
Hyannis P
-:7 309 141
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TOWN OFBARNNSSTABLE `�
LOCATION / ,3 ChCSrN v/ Sr1f66 SEWAGE#dU f� �d XV
VILLAGE ASSESSOR'S MAP&PARCEL -30.7 A//
INSTALLER'S NAME&PHONE NO. X�6'Cofp Co -7-7 S-'
SEPTIC TANK CAPACITY
,1 LEACHING FACILITY:(type(Z[ s I(o0b GID (size)
- NO OF BEDROOMS
a:
Il
':..'OWNER i f
j PERMIT DATE: COMPLIANCE DATE:
w�. Separation Distance Between the:
q FMaximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
`r nT:Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) Feet
Ed e of Wetland and Leaching Facility If an wetlands exist within
g g tY( Y ".
` 300 feet of leaching facility) Feet _
rs
rP FURNISHEDBY
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No. Fee
THE COMMONWEALTH OF MASSACHUSE,TTS Enteredmcomputer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
01pplirdtion for Mis tpo5aY *p5tem Construction Permit
Application for a Permit to Construct( ) Repair(dj UpgradeV<Abandon( ) Complete System ❑Individual Components
Location Address or Lot No. `yam C/9.rIW4� J` s Owner's Name,Address,and Tel.No. Aol,
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No�u/ Designer's ame,Address and Tel.No.
�/3 �'�rrCO 3,jo �ta.� T%• a.,r.Gov ./�-t e'yE�
Type of Building:
Dwelling No.of Bedrooms Lot Size / .?v50 sq.ft. Garbage Grinder ( )
Other Type of Building f'st /e No.of Persons .�lw�_Z, Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min,required) may y£'0 gpd Design flow provided l/D t- SY = 4'11-l4 gpd
Plan Date _Zf®�/i Number of sheets_ Revision Date
Title
Size of Septic Tank Type of S.A.S. /6' �_,QOf lB� f'csJ e i
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Sig a Date -1C1_ l/
Application Approved by Date
Application Disapproved by: Date
I
for the following reasons
Permit No. '� Date Issued
,_ „/�
No. Fee
v * Entered in computer:
THE COMMONWEALTH OF MASSACHUSE�T S-
UBLIC HEALTH,DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
2pplid'U'Ro I �Or T qo!5' aY *pztem C omarUction Verna
Application for a Permit to Construct O Repair(A<Upgrade Abandon O Complete System ❑Individual Components
Location Address or Lot No. I�V-y CA'r7lv4 f -r Owner's Name,Address,and Tel.No. A-1, �!
Assessor's Map/parcel 7e>
Installer's Name,Address,and Tel.No/G,,/ Designer's ame,Address and Tel.No.
�yri3 �'v.cc 3So Via.,;, r7 r-yer
Sod'-
Type of Building:
Dwelling No.of Bedrooms Lot Size /Z, sq.ft. Garbage Grinder ( )
Other Type of Building _f'„ram/e No.of Persons q yl,,g,,,,, Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required)/ja Y/ `��� gpd Design flow provided //D F, y = yyO gpd
Plan Date Number of sheets 1Z Revision Date-
Title
ti
Size of Septic Tank _4S'o ® L o-V /d Type of S.A.S. /6'
Description of Soil 1"M/,'�•-' S'o�•44 a
Nature of Repairs or Alterations(Answer when applicable) ,�ys,c®// / --i s-om me./' si
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.
Sign e � _ n Date
Application Approved by t 114 -..- r1 Date
Application Disapproved by: Date
for-the following reasons
,v e
Permit No. N 1 � Date Issued
-----------1---- - ———————————— - - -----------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
CCertitirate of CC011PItanre
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired Upgraded ( )
Abandoned( )by
at h b enn nstruct�d i 7ordance
with the provisions of Title 5 and the for Disposal System Construction Permit No dated
Installer Designer tr
#bedrooms Approved desig$n flow //o,l�S/ = y`/a gpd
( �� �
The issuance of this permit shall not b�e�construed as a�guarantee that the system willl.functib ig ed.
Date / Inspector
———
No. J / j Fee-- ✓ �.p..
V
:THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS t,
wtgag0Y 6p.5tem CCow trurtton PerTYYit
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 recognizes his/her duty
to comply with Title 5 and the following local provisions or special conditions.
Provided: Cons ction must be completed within three years of the date of this permit.
J Approved b !
Date / pp Y
Town of Barnstable ' '
Regulatory Services ,
Thomas F. Geiler, Director A(UG 2 0 2011 1
unxxsrne[,E. + �i
9 MA9& Public Health Division
Thomas McKean, Director *------- ------
200 Main Street,Hyannis,MA 02601
Office: 503-362-4644 Fax: 503-790-6304
Installer & Designer Certification Form
Date:t I� I ( Sewage Permit# `c�0�1_ aln Assessor's vlaplParcel (� L/f
Designer: DojaA Installer:
Address: PO toy, S?) �C4-t r,Address: ,d t:.E� ,
MA l�lrrYt_
o'2-<37?_
On b)a0 \\ /��f q C 1 A) y was issued a permit to install a
(date) (installer)
septic system at Cott ESIJU�' �T • based on a design drawn by
(address)
la�A dated 1 I2_0 j l
(designer}
1 certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation ofythe
distribution box andlor 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 anv 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.
OF Mgs`f9
o DARR
1
(Installer's Signature) \ 1140
S01 TAR�1'�
(Designer's SignaturerN
(Affix Designer's Stamp Here)
PLEASE RETURN TO BE 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.
Q: Health/Septic/Designer Certification Form 3-M-(}41doe
r
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
' PART C
# SYSTEM INFORMATION (continued)
I
E Property Address :
Owner: SZ.x �4
Date of inspection:
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks locate at
wells within 100'
O �
DEPTH TO GROUNDWATER:
i
Depth to groundwater: ...�O..feet
Method of deter ination ar approximatirre:
........................................................................................................................
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((?? CHESTNUT STREET % c
5- 10,
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°q - - - - °.'°soySIDEWALK
-VBDf�S�> g0 0 a - Oo N� aO
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ov po qR 9 3o Co 1 - - \ �Q
y 5 Fq., /7 r �O. ter/ po ;1'i ..�• N, N ... ;o
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+ ►+� _ _' }.i� Q }.� C� �F GARA ASPHALT Aco
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---------DRIVEWAY I I � �. G G a • `,-C' _
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38.25'---I 47'� l
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WOODED ;D
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y
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color - Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
onsistene %Gravel
SY
DEEP OBSERVATION HOLE LOG Hole# 1-
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistent %Gravel)
b, Dvl / r / A
11 �. ar
3 3 1,11A44AA
DEEP OBSERVATION HOLE LOG Hole# N��-
Depth from' Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Cons istcncv.%Gravel
DEEP OBSERVATION HOLE LOG_ Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency. ra I
t
Flood Insurance'Rate Maw
Above 500 year flood boundary No Yes
Within 500 year boundary No 7, Yes
Within 100 year flood boundary No Yes
Depth of NaturalIy Occurring Pervious Material
Does at least four feet of naturally occurring pervious material exist.in all areas observed throughout the
area proposed for the soil absorption system? - i P•
If not,what is the depth of naturally occurring pervious material?
Certification
I certify that on Cis` (date)I have passed the soil evaluator examination approved by the
Department of Environinental Protection and that the above analysis was performed by me consistent with
the requiref .rai ing,expertise.and experience described in 3:10 CMR 15.017.
Signature I � A� Date
Q:\SEPTIC\PERCFORM.DOC
r
No. w" �� GL/ Fee -50
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
ZippYication for Mie;pogar *pttem Construction Permit
pplica6on for a Permit to Construct( air( )Upgrade( )Abandon( ) O Complete System LJ'Irtdividual Components
e•tab`
Location Address or Lot No. y C Owner's Name,Address and Tel.No.
�
Assessor's Map/Parcel 301 Iq �-
Installer's Name,Address,and Tel.No. 4 Designers Name,Address and Tel.No. `e y'I.
5
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.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) Q"( es.��L_ :,.',�T�. )a r. d �
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 E Vi onmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issu t 'S o f alth.
Signed / 9 1 Date
Application Approved by icc Date 70 d
Application Disapproved for the following reasons
Permit No. 2-CQ3�- ZZ�7 . Date Issued S 2dO
2 •;jn
No. 3 .22/ - Fee
' THE COMMONWEALTH OF MASSACHUSETTS
Entered'in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,, MASSACHUSETTS
ZippYication for Miopooar *pgtem Construction Permit
Application for a Permit to Construct( air( )Upgrade( )Abandon( ) ❑Complete System 2<T vidual Components
Location Address or Lot No. {y C ^r2.S t'ty j Owner's Name,Address and Tel.No. V�Q Q 14-\
t 1 y v� •�.�:S. 9 3 p 4 Q_
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. .� -� Q C) Designer s Name Address and Tel.No. 'Lid(o- 98 4S
350 S'C'�ee l'
LT If It �u
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ff. 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 evisior Date _)
Title
Size of Septic Tank Type of S.{A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) CL-2
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 Certifi-
cate of Compliance has been issu b t 's, o of Health.
Signed IL Date
s ,. xs �rwxr..,
- —= Application Approved b - Date L
PP PP y
Application Disapproved for the following reasons r
a,.
Permit No. 2 co-3- 22,7 Date Issued 3 2G O
�ra{ THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
(Certificate of (Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired (x)Upgraded( )
Abandoned( )by (4 Q C cx.r.c C�
at has been constructs, in atcordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. 2W 3`2 2 7 dated 6 2 010 3
Installer Designer r
The issuance of this permit shall not be construed as a guarantee that the system wi. u on a igned
Date- 3-20 b 3 Inspector s,
------------------------------------_---
No. Fee S�y
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
Mi.5poar *p5temAton5truction Permit
Permission is herebyranted to Construct Repair( U/rade Abandon
g ( ) `'') Pg ( ) ( )
System located at 1 L4 C\tee_sr S
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions. .
Provided:Construction must be completed within tbr'ee years of the date.of this
Date: Approved by
I \.
v
12
Commonwealth of Massachusetts
Executive of Environmental Affairs
D-E P $y i
OCT 1 5 19 '0
Department of "
Environmental Protection F +
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Property Address: y3 ST: ►n»5, M o2ba J
Address of Owner. S i �.ma� STD
(if different)
Date of Inspection: c���;��`c�
Name of Inspector: Michael DeDecko
Company Name, Address and Telephone number: Atlantic Environmental
P.o Box 2384 - Mashpee Ma 02649. Tel: (508)4771420
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and
that the information reported below is true, accurate and complete as of the time of
inspection . The inspection was performed based on my training and experience in the
proper function and maintenance of on site sewage disposal systems. The system
- Passes
---- Conditionally Passes
---- Needs further evaluation by the local Approving Authority
---- Fails
Inspector 's Signatur :t4 t Date: t 2 S(a
The system Inspector shall submit a copy of this inspection report to the Approving
Authority within thirty (30) days of completing this inspection. If the system
is a shared system or has a,design flow of 10,000 gpd or greater,the inspector and the
system owner shall submit the report to the appropriate regional office or the Department
of Environmental Protection.
The original should be sent to the system owner and copy sent to the buyer, if applicable
and the approving authority.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 1 y3
Owners: STckl
Date of Inspectio g ►zl 9
INSPECTION SUMMARY:
Check A, B,C, or D
A) SYSTEM PASSES:
AI have not found any information which indicates that the system
em violates any of the
failurey
criteria as defined in 310 CM 15.303. Any failure criteria not evaluated are
indicated below
B)SYSTEM CONDITIONALLY PASSES:
--- One or more system components need to be replaced or repaired. The system, upon
completion of the replacement or repair,passes.inspection.
Indicate yes, no, or not determinate (Y,N, or ND). Describe basis of determination in all
instances. If "not determinated',explain why not.
---- The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or
exfiltration,or tank failure is imminent. The system will pass inspection if the existing
septic tank is replaced with a conforming septic tank as approved by the Board of
H ealth.
•--• . Sewage backup or breakout or high static water level observed in the distribution
box is due to broken or obstructed pipe(s)or due to a broken,settled or uneven
distribution box. The system will pass inspection if(with approval of the Board of
Health).
-•--• broken pipe(s)are replaced
----- obstruction is removed
---• distribution box is levelled or replaced
--•- The system required pumping more than four times a year due to broken or obstructed
pipe(s). The system will pass inspection if(with approval of the Board of Health):
----- broken pipe(s)are replaced
-•-•• obstruction is removed
9
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address : y3 �res3T S�
Owner :
Date of Inspection : q` zl b
C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
-- Conditions exist which require further evaluation by the Board of Health in order to de-
termine if the system is failing to protect the public health, safety and the environ-
ment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE
SYSTEM IS NOT FUNCTIONING INAMANNER WHICH WILL PROTECT THE
PUBLIC HEALTH AND SAFETYAND THE ENVIRONMENT:
---- Cesspool or privy is within 50 feet of a surface of water
---•Z,esspool or privy is wiii iih-M feet of a bordering vegetated wetland or a small
marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER
SUPPLIER, IFAPPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNC-
TIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY
AND THE ENVIRONMENT.
---• The system has a septic tank and soil absorption system and is within 100 feet to a
surface water supply or tributary to a surface water supply.
---- The system has a septic tank and soil absorption system and is within a Zone I
of a public water supply well.
•--- The system has a septic tank and soil absorption system and is within 50 feet
of a private water supply well.
--•- The system has a septic tank and soil absorption system and is less than 100
feet but 50 feet or more from a private water supply well,unless a well water analy-
sis for coliform bacteria and volatile organic compounds indicates that the well is
free from pollution from that facility and the presence of ammonia nitrogen and
nitrate notrogen is equal to or less than 5 ppm.
D)SYSTEM FAILS:
-• I have determined that the system violates one or more of the following failure criteria
as defined in 310 CM 15.303. The basis for this determination is identlied below.
The Board of Health should be contacted to determine what will be necessary to cor-
rect the failure.
--- Backup of sewage into facility or system component due to an overloaded or
or clogged SAS or cesspool.
1
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: j Z �� %T-
Owner: ��'vd
Date of Inspection.
D)SYSTEM FAILS (continued)
-- Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool.
--- Static liquid level in the distribution box above outlet invert due to an over-
loaded or clogged SAS or cesspool
-•- Liquid depth in cesspool is less than 6" below invert or available volume is
less than712 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 cesspool or privy is within 100 feet of a surface water supply
ortributary to a surface water supply.
•--Any portion of a cesspool or privy is within a Zone I of a public well.
--- Any portion of a cesspool or privy is within 50 feet of a private water supply
well
--- Any portion of a cesspool or privy is less than 100 feet but greater than 50
feet from a private water supply well with no acceptable water quality ana-
lysis. If the well has been analyzed to be acceptable, attach copy of well
water analysis for coliform bacteria,volatile organic compounds, ammonia
nitrogen and nitrate nitrogen.
i
1
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:
Owner: %d1�
Date of Inspection . 911"2`R b
E) LARGE SYSTEM FAILS:
The following criteria apply to large systems in addition to the criteria above :
The design flow of system is 10,000 gpd or greater Large System and the system
is a significant threat to public health and safety and the environment because
one or more of the following conditions exist :
--- the system is within 400 feet of a surface drinking water supply
-- the system is within 200 feet of a tributary to a surface drinking water supply
--- the system is located in a nitrogen sensitive area(Interim Wellhead Protection
Area -IWPA)or a mapped Zone 11 of a public water supply well.
The owner or operator of any such system shall bring the system and facility into full compli-
ance with the groundwater treatment program requirements of 314 CM 5.00 and 6.00.
Please, consult the local regional office of the Department for further information.
f
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: A y 3Owner:
Date of Inspec io�
°It�z'4 b
Check if the following have been done :
-x Pumping information was requested of the owner, occupant and Board of
Health.
; none-or-ine system components have been pumped for at least two weeks
and the system has been receiving normal flow rates during the period. Large
volumes of water have not been introduced into the system recently or as part
of this inspection.
--x As built plans have been obtained and examined. Note if they are not available
with N/A.
--x The facility or dwelling was inspected for signs of sewage back-up.
-x The system does not receive non-sanitary or industrial waste flow.
--x The site was inspected for signs of breakout.
--x All system components,excluding the Soil Absorption System, have been
located on the site.
--x The septic tank manholes were uncovered, opened and the interior of the sep-
tic tank was inspected for conditions of baffles or tees,material of construc-
tion, dimensions,depth of liquid,depth of sludge, depth of scum.
---x The size and location of the Sod Absorption System on the site has been deter-
mined based on existing information or approximated by non-intrusive methods
_-x The facility owners and occupants if different from owner were provided with
information on the proper maintenance of Subsurface Disposal System.
I �
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: )Lt3 CA,..a-,Vj oT-
0 caner.
Date of Inspection: 1 Z l
RESIDENTIAL:
Design flow: ?:>a>O gallons
Number of bedrooms : p l:?,>
Number of current residents: o2
Garbage grinder (yes or no) : Uo
Laundry connected to system(yes or no):tAtS
Seasonal use (yes or no) : Q
Water meter readings, if available:
Last date of occupancy :
COMMERCIALANDUSTRIAL :
Type of establishment:
Design flow : gallons/day
Grease trap present: [yes or no)
Industrial waste holding tank present(yes or no) :
Non-sanitary waste discharged to the Title 5 system (yes or no) :
Water meter readings, if available:
Last date of occupancy :
Other: (Describe) ............................................................................................................
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS pnd source Of inf rmation
b pr�.. .t\ ... tlYl !l�?. ..
Syste pumped as part of inspection(yes or no):......
ifyes,volume pomped : .................... gallons
Reasonfor pumping:............................................................................................................
N
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: t`k-5
Owner:
Date of inspection: U
�t`rz��1b
TYPE OF SYSTEM
--- Septic tank/distribution box/soil absorption system
--- Single cesspool
-- Overflow cesspool
--- Privy
--- Shared system (yes or no)(if yes, attach previous in action re ords, if any)
-X Other (explain).... jr,n ,a,,.. ...4...V� 1P.......... ............
APPROXIMATE ACHE of all components, date installed (if known)and source of information
K....�.11.�(�-....i...4` '.5.................:..........................................................................
..................................................................................................................
................................
Sewage odors detected when arriving at the site : (yes or no)...1��.
SEPTIC TANK : ....( ��...
(locate on site plan)
Depth below grade: ..........
Material of construction: ....... concrete ......... metal........ FRP........ other (explain)
................................................................................................................................................
Dimensions: .............:....
Sludge depth:...............
Distance from top of sludge to bottom of outlet tee or baffle:..............................
Scum thickness :.....................
Distance from top of scum to top of outlet tee or baffle: .................................
Distance from bottom of scum to bottom of outlet tee or baffle:.........................
Comments :
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid
level in relation to outlet invert,structural integrity,evidence of leakage,etc.)......................
.......................................................................................................
i_ �
e
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PAR T C
SYSTEM INFORMATION (continued)
Property Address: 1`\3 C.14-5-7tNo'�-
Owner: �;rQ 1,\q�
Date of inspection:
GREASE TRAP: ....... ...
(locate on site plan)
Depth below grade: ...............
Material of construction: ........concrete.........metal........FRP........other(explain)....
...........................................................................................................
Dimensions:...............................
Scum thickness:........................
Distance from top of scum to top of outlet tee or baffle:........................
is „e from-bottom -outfet,tee or baffle:...............................
Comments:
(Recommendation for pumping condition of inlet and outlet tees or baffles, depth of liquid
level in relation to outlet invert,structural integrity,evidence of leakage, etc.)........................
.........................................................................................................................................
............................................................................................................................
TIGHT OR HOLDING TANKS:.....
(locate on site plan)
Depth below grade:...............
Material of construction:........concrete........metal.........FRP..........other (explain)..........
................................................................................................................................................
Dimensions:............................
Capacity:....................gallons
Design flow:...............gallons/day
Alarm level:.............................
Comments:
(condition of inlet tee, condition of alarm and float switches,etc.)
................................................................................................................................................
................................................................................................................................................
a
{
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 1�Vt C6sTr jQT Qj ,
0 wner. 1
Date of inspection: \ z'g b
DISTRIBUTION BOX:...Q.0
(locate on site plan)
Depth of liquid level above outlet invert:...................
Comment:
(note if level and distribution equal evidence of solids carryover, evidence of leakage into
orout of box,etc.)............................................................................................................
................................................................................................................................................
................................................................................................................................................
DL4.4P CHAMBER:...
(locate on the site)
Pumps in working order: (yes or no)...............
Comments:
(note condition of pump chamber,.condition of pumps and appurtenances, etc.)....................
................................................................................................................................................
................................................................................................................................................
SOIL ABSORPTION SYSTEM (SAS):.... 'C ......
(locate on site plan, if possible; excavatii nok requied,but may be approximated b non-
intrusive methods)
. y pR y
if not determined to be present, explain:
...............................................................................:.................................................................
........................................................................................................................................
Type
leaching pits,number: ..................
leaching chambers,number:........
leaching galleries,number:...........
leaching trenches,number ,length:.....................
leaching fields, number,dime n ions:...................
overflow cesspool,number:..A. JvX ,
Comments:
(note n ' i n of ail s' ns of by ra 'c failure,level of pond' ,co dition of v��,g9etation,
et .)... ' .. .....5 ... .:f' ... 1�t . .... Q. �.
n
4k1G�
,f
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property address:
T 3 Gam. i ►�� sr;
Owner.
Date of inspection:
1�12��b
CESSPOOLS:...4.1 �....
(locate on site plan)
Number and configuration: ... ...........
`�
Depth-top of liquid to inlet invert: la....................
Depth of solids layer: ...:..!.` ....................................
Depth of scum layer: .....al......................................
Dimensions of cesspool: ..4.iL'I.........
Materials of construction: ...C',cryx.� �
Indicator of.ground water: ....NP........
inflow (cesspool must be pumped as part of inspection)
1J.0...................................................................................
.................................................................................................
Comments:
(note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation,
etc.)
VT
PRIVY : .....�.
(locate on the site)
Material of construction: ...................................
Dimensions: ......................
Depth of solids: ..,.............
Comments:
(note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation,
etc.).
................................................................................................................................................
. ................................................................................................................................................
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address : I Lkl,>
Owner:
Date of inspection:
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks locate at
wells within 100'
O �
DEPTH TO GROUNDWATER:
Depth to groundwater: '.10.feet
Method of deter ination or approximative:
..SuAd ............................................................................................
................................................................................................................................................
e �
CATCH- ' HYANNIS
BASIN*-
r
I 0�37-40 2
2a. .
{' Q R-20 O
N 9�-sFs �N� ARE
vo
yoo 0
o LOCUS oZ
W i
U
i
LOCUS MAP
PARCEL ID: __-- - �� `Jdo. 0
309/141 LOCUS INFORMATION
AREA=14,260t S.F. _- #143 - `�'o: �'
TCF: PLAN REF: 18327-A
- - O TITLE REF: CTF# 142633
- ELEV.=39.54 PARCEL ID: MAP 309 PAR. 141
�O FLOOD ZONE: "C"
PARCEL ID: = _ - q ------ COMMUNITY PANEL: 250001-0005-C DATED:08/19/85
309/142 EX15t. CC55FOOl
(see note 10) __ _ _ _ a�.��- ��� SEPTIC SYSTEM
-_ _ \ `` REPAIR PLAN
r'I-Q. -— _ ► �� LOCATED AT:
MAPLE GP�PG�1 = � `` 143 CHESTNUT STREET
GENERAL NOTES. 'o, TBM: H YAN N I S, MA.
1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL COR BLHD 72=38. __ _
_
BOARD OF HEALTH AND THE DESIGN ENGINEER. ELEV. ,--�, \ — — t°'` ---------- PREPARED FOR
2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS
OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE �;' % /� "' 23 All' R I C H A R D H . 8c H E L E N C.
LOCAL RULES AND REGULATIONS. / (0& °
3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR 30"MAPLE �1� 6` ,'� ``, HILL
TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE i' JULY 20, 2011
DESIGN ENGINEER. _ —� \ CATCH
4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING TH-1 \ BASIN
FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 24"MAPLE +
ENGINEER BEFORE CONSTRUCTION CONTINUES.5. ALL ELEVATIONS BASED ON ASSUMED DATUM. �� �37.1 O OF
Mq�S9
6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF. t>' DA REN
THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF TH-2
HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. \ EYER
7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. + " No. 1140
8 DISTURBEDALL AREAS DURING CONSTRUCTION TO A CONDITTIONAGREEDUPON BETWEEN SHALL B OWNERANDCONTRACCTOR. 3�'�2 �fG/STE M
9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY E�
LOCATION ALL UNDERGROUND_' UTILITIES, PRIOR TO BEGINNING PROP. 1 5000 W°°� �p2°4 SANITAR�P�
10. EXISTING PITS TO BE PUMPED, CRUSHED,AND`FILLED.
all-.-48-HOUR-NOTICE-FOR=-ENGINEER'CERTIFICATION
—� —� SEPTIC TANK
12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY
AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY '��•��
13. NO PRIVATE WELLS WITHIN 150 FT. OF PROPOSED LEACHING N ' PARCEL ID: MEYER & SONS, INC.
14. ALL PIPE TO BE 4" SCH 40 ® 1/8°/FT (UNLESS SPEC. OTHERWISE) 309/1 45 P O BOX 9 81
15. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW
FOR THE USE OF A GARBAGE GRINDER
16. NO WETLANDS WITHIN 100 FT. OF PROPOSED LEACHING PARCEL ID: EAST SANDWICH, MA. 02537
309/144
(508)362- 2922
1
SHEET 1 OF 2 J#1351
NOTE: 'TO PREVENT BREAKOUT, THE PROPOSED DESIGN CRITERIA
NOTE: MAGNETIC TAPE TO BE RLACED OVER ALL COVERS FINISH GRADE SHALL NOT BE < EL:35.14' "
FOR A DISTANCE OF 15' AROUND THE NUMBER OF BEDROOMS: 4 BR DESIGN (PROP. NOT IN ZONE II)
PERIMETER OF THE S.A.S.
SEPTIC TANK PROPOSED D-BOX SOIL TEXTURAL CLASS: CLASS I DESIGN PERCOLATION RATE: <2 MIN IN
PROPOSED S.A.S. 1 /
T.O.F. EL.=39.54 INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL A 4" DIAMETER INSPECTION PORT OVER DAILY FLOW: 110 G.P.D. x 4 BR DESIGN FLOW: 440 G.P.D.
F.G. EL.=38 OUTLET
AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE ONE CHAMBER (MIN.) AND SET TO 3" OF F.G. GARBAGE GRINDER: NO (NOT DESIGNED FOR GARBAGE GRINDER
�F.G. EL.=38.25t F.G. EL: 37.80t F.G. EL: 38.0(MAX.) )
AM,/ PROPOSED SEPTIC TANK: 440 X 200% = 880 GPD (USE PROP. 1,50OG TANK)
;3J LEACHING AREA REQUIRED: (440)/0.74 = 594.59 S.F.
9" MIN COVER/ DISTRIBUTION BOX: DB-3 (3 OUTLETS (MINIMUM))
L = 30't 36" MAX COVER `' L = 25' L = 10'(MAX) INSTALL TWO INSPECTION PORTS MIN.) PRIMARY S.A.S.
® S=1% (MIN.) EL. = 69.0 ® S=1% (MIN.) 0 S=1% (MIN.)
4"scH4o PVC 4"scH4o PVC a"scHaO PVC USE 2 TRENCHES 6- 16008D ADS BIODIFFUSER H-20 UNITS-NO STONE
10" 1a 6 tt 2" TO AND EXTENDED WITH 0.75' W/ CONTOURED WEDGE
INV.=36.44 M.LIQUID INVERT TRENCHES: (GENERAL USE APPROVAL FOR 7.88 SF/LF OF BIODIFFUSERS
LEVEL INV.= 36.19 PROPOSED (BIODIFFUSERS) 12 UNITS x 6.25 LF x 7.88 SF/LF 591.0 SF
GAS BAFFLE INV.=35.55 2 TRENCHES OF 6 UNITS AT 6.25'/UNIT + .75' WEDGE = 38.25'/RO
D-BOX (WEDGES) 2 UNITS x 0.75 LF x 7.88 SF/LF = 11.82 SF
-AMINV.=35.7 IDS INV.= 34.75 SOIL.ABSORPTION SYSTEM (PROFILE,) TOTAL AREA = 602.82 SF
PROPOSED 1,500 GALLON SEPTIC TANK DESIGN FLOW PROVIDED: 0.74GPD/SF(602.82SF) = 446.08 GPD>440 GPD req'd
///���RESTORE VEGETATIVE COVER - -
EXISTING SEWER OUT / BACKFiLL WITH CLEAN PERC SAND
EL. 37.04 f TO TOP OF CHAMBERS 75„
NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING
PIPE INVERTS PRIOR TO CONSTRUCTION
EXISTING SUITABLE :.' '•: .
2) TANK AND D-BOX SHALL BE SET LEVEL AND BREAKOUT=TOP ELEV.=35.14 MATERIAL
TRUE_ TO GRADE ON A MECHANICALLY COMPACTED INV. ELEV.= 34.75
SIX INCH CRUSHED STONE BASE, AS SPECIFIED BOTTOM ELEV.= 33.81
IN 310 CMR 15.221(2) 2.83' 6.00'
3 INSTALL INLET & OUTLET TEES W 2.83'
) / 5' MIN. ABOVE BOTTOM OF
GAS BAFFLE AS REQUIRED T.P. EXCAVATION OR G.W. �� 76"
(7.47' PROVIDED) USE 2 ROWS OF 6 16008D ADS H2O LOAD PROFILE
BOTTOM OF TEST HOLE EL.=26.3 - BIODIFFUSER UNITS-NO STONE W/ WEDGE -Q--
SEPTIC SYSTEM PROFILE TYPICAL SECTION -
N.T.S. N.T.S. 16„
11.2
SOIL LOG P#: 13353
DATE: JULY 20, 2011 �---34"
SOIL EVALUATOR: DARREN M. MEYER, R.S., CSE #1614 SECTION END CAP
WITNESS: DONALD DESMARAIS, BARNSTABLE BOH
\N OF Mgs�9�y E1ev. TP-1 Depth Elev. TP-2 Depth 16" ADS 16008D (H-20) BIODIFFUSER UNIT
o� R N M. ✓+ 37.50 A 0" 37.60 A 0"
l
LOAMY SAND LOAMY SAND
. YER 10YR 3/2 1OYR 3/2 36.67 10'! 36.77 10" MODEL 16" 160OBD
0. 11-40 B B LENGTH - 76" NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT
EFFECTIVE LENGTH 75"
LOAMY SAND LOAMY SAND TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY
$i 10YR 5/6 IOYR 5/6 SIDE WALL HEIGHT 11.2" DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE.
E�
NITAR�a� 34.75 C 33" 34.85 C 33" OVERALL HEIGHT 16"
I OVERALL WIDTH 34" 4640 TRUEMAN BLVD
M ZDIS M 6AAND - Y MEDIUM SAND HILLIARD, OHIO 43026
2.5Y 6/4 CAPACITY 13.6 CF =me
b-73 (101.7 GAL) ADVANCEO DRAINAGE SYSTEMS. INC,
VA
PERC ® 33.17 PROPOSED SEPTIC SYSTEM SITE PLAN
26.34 134" 26.44 134" 143 CHESTNUT STREET, HYANNIS, MA
PERC RATE <2 MIN/IN. ("Cl" HORIZON) Prepared for: Hill
NO GROUNDWATER OBSERVED
Engineering by: Surveying by: SCALE DRAWN
Meyer&Sons,Inc. AfacDouga/I Survey NTS D.M.M.
• I, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 p080X981 (508) 419-1086
to conduct soil evaluations and that the above analysis has been performed by me consistent with the EASTSANDW/CH,MA02537 DATE: CHECKED SHEET NO.
requirements of 310 CMR 15.017. 1 further certify that I have passed the Soil Evol. Exam in October, 1999. 508-362-2922 07/20/1 1 D.M.M. 2 Of 2