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HomeMy WebLinkAbout0046 DELTA STREET - Health ...; 46 Delta Street Hyannis . P A = 292 222 Zu `TOWN OF BARNSTABLE LOCATION SEWAGE# VILLAGE �}\�J S ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. �254 d0 a� SEPTIC TANK CAPACITY P'y` 5k sca \b i. $Q Gil. 10C LEACHING FACILITY-(type)3 a1(; S"0(3 e, (size) f o?•S X,33e NO.OF BEDROOMS C 14\`"-1 t.F;3 OWNER CC.©rU Vic,\ PERMIT DATE: I C7 COMPLIANCE DATE:5 15 2 b Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) N Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY _ t A % 533= a� A kl N tr, b csS can No. —/( Fee ®C� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -;TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIpplitation for -Mispo80.Y 6pstem Construction 3pPrmit Application for a Permit to Construct( ) Repair(,4 Upgrade( ) Abandon( ) ❑Complete System ,Vndividual Components Location Address or Lot No. 4(o`D--k�a 6k b Nrmts Owner's Name,Address,and Tel.No. Assessor's Map/Parcel C-1901) Installer's Name' �Address,and Tel.No. 6e a 00�Cl g Desi ne 's Name,Address and Tel.No. ' `1� 5Gakk M �rc,raVt'C.FJ �S.I fC 0 JCG ZZ fsGa Pz�f3K� OJ Type of Building: Dwelling No.of Bedrooms Lot Size 36 066 sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) _ gpd Design flow provided 44(/,� , I gpd Plan Date L-A I t-1 i11 QI Number of sheets Revision Date Title_L{C 4 Size of Septic Tank I$'d 0 14�0 Type of S.A.S. j J o2 j3 ���1 t,py, c`r.Yr. J� Description of Soil y t H 26 Nature of Repairs or Alterations(Answer when applicable) & A,—0 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. Ine Date Application Approved by Date / Application Disapproved by Date for the following reasons Permit No. ��-' o Date Issued :��.T9rk•K.:'�,A'..d%iJ'T. ,yT' a.•_• --' �r..t d t,*ea.i+�'.'-.Lt^'.Mw"wWLd'.�'� W'tr�' _..._-w�`rt1�'' ,f"� YY'k. ., ;rt-.:.�s. �.ir"r"``'.,.-L•-y,_. f.'.'1 i.L.:..%..rM'.:..• -Rn�r .�",j �rA� �!m art,,a. �`���„+T: '�l�t <4P'."r''i e . ,.�'r .'1."' . No:Pao Fee le 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: /1 4a Yes PUBLIC HEALTH DIVISION , TOWN OF F3MNSTABLE, MASSACHUSETTS Rpplitation for Bisposd *pstem Construction,Permit Application for a Permit to Construct( ) Repair(4 Upgrade(. ) Abandon:(.) ❑Complete System Z�individual Components Location Address or Lot No. 1(0 Qp-qG L ,�M,� ."`Owner's Name,Address,and Tel.No. Assessor's Map/Parcel t `j .. a'di 4EJ Installer's Name,Address,andd Tel.No. z 4 /�(p 9 Designer's Name,Address,and Tel.No. Cj C O M 'F G.�\/L n V L 1 U(J" I �^ n CC4G� G S� E+Co .2yd� <Z� .S: L Type of Building: r Dwelling No.of Bedrooms Lot Size 30 666 sq.ft. Garbage Grinder(AhO a: Other . Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures t= Design Flow(min.required) LI/ gpd Design flow provided [/[, 3 gpd Tr� Plan Date lfi 11") Number of sheets 1 Revision Date -w. Title 24C. 4,7 Size of Septic Tank Type of S.A,S. .J f) . .C`AO r sv Description of Soil Mptr) �, t.�4 " �'M- q- Q • ��,�„- 1"r1 r n. jL Nature of Repairs or Alterations(Answer when applicable) R nT G to a,KjjkA, ,n 1 f r 1,� n l A , :C) G,C. k a 0 C �; r.,nn 6-c r v Q 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. _ S.gne - - •;`'' _ .. - Date Application Approved by 1 Date J� Application Disapproved by Date for the following reasons Permit No. - /�c� p Date Issued THE'COMMONWEALTH OF MASSACHUSETTS ,BARNSTABLE,MASSACHUSETTS, , Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(� Upgraded( ) Abandoned( )by 7sc n M at , ( �.1. t has been constructed in accordance ^�w tYi the provisions of Title 5 antd the for Dis,osal System Construction Permit No,'� - 3 dated ,'>�// Installer Designer�4�1F.. 1,r,06t r-A 01.1J #bedrooms . i Approved design flow--U 1. 1 1 f-, t,7 gpd The issuance of this permit shall of be co/Trued as a guarantee that the syste 1 f ctio as deli .ned. Date t / yes Inspector 1 No.. � Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Bisposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair(✓) Upgrade( ) Abandon( ) System located at Lt(_ Qdkr� and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with . Title 5 and the following local provisions or special conditions. Provided;Construction mmu-s't 6e co !l-e�ted w.i,thin three years of the date of this permit rr Date �_ 9 /� r ..L 9 Approved by Town of Barnstable "E'Q�ti° Inspectional Services Public Health Division MWISTABIZ b' Thomas McKean, Director ; Ar�o �a 39. 200 Main Street,Hyannis,MA 02601 r Office: 508-8624644 Fax: 508-796-6304 t a+ Installer& Designer Certification Form Date: �6 �+ -0 Sewage Permit# O-zessor's MaplParcel'l- Designer: D4V 1 d p• 6004 �4ow'r, �S Installer: SC ,t 1 M Address: tS5 Ceo ?_Yder I,d, 5©0 h Address: onS'A ! DIO was issued a permit to install a (date) (installer) septic system at 4-6 Det ki S-f based on a design drawn by (address) Gq alwwr t�-s dated Apy:t t71 2,67Z(Q. (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic stem referenced above was installed with major changes (i.e. p greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in c Ii ce with the to rms of the IAA approval letters (if applicable) �p�.kA OF Mg p DAVID cY�s o D. COUGHANOWR N (Installer's Signature) No. 1093 9�G1ST0k �• SgN17AR\ (Designer's Signature) (Affix Designer tamp Here) 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. WoMdeptAHEALTMSEWER connceASEPTIODesigner Certification Form Rev&14-13.DOC 61 Town of Barnstable Health Inspector Office Hours ' .� Regulatory Services 8:30-9:30 Thomas F.Geiler,Director 1:00—2:00 * snaxszABM Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 AMNESTY PROGRAM APPLICANT— SEPTIC QUESTIONNAIRE 1. General Information: Size of Property: Address: l J�' Map 2 -/ L Parcell 2-�— Name: (�-�' LA /�-�� Phone #: 7 2a. How many bedrooms exist at your property now? 2b..,Are you planning to add any bedrooms? If yes, how many? 2c. How many bedrooms total are proposed at this property(including the amnesty unit)? 2d. Please include a copy of the floor plans for the entire property-showing the existing rooms in the home plus the proposed amnesty apartment and/or addition. Please label each room clearly on the plans. 3. Is the dwelling connected to public sewer? YES or O If the dwelling is connected to public sewer,skip questions#4 through#9 below. 4. Location of dwelling is IDE or OUTSIDE a Zone of Contribution to public supply wells? 5`GIs the Aelling connected to an ONSITE WELL or to P BLIC AVER? ;wJ 6--Is a disposal works construction permit on file? YES or NO 6a If yes,ho many bedrooms were approved according to this permit? Bedrooms. all •, T—Were any;b_uilding permits obtained for construction of additional bedrooms? YES or NO 8. Js there an engineered septic system plan on file at the Health Division? YES or NO c.l 9. Has the septic system been inspected by a DEP certified inspector within the last two years? YES or NO ------------------------------------------------------------------------------------------------------------------- FOR OFFICE USE ONLY The Public Health Division has no objection to �i bedrooms at this property. A Special Conditions: he oorw'4 "de„ s7j,01( 110 t kzlyta", Signed: Date: Q;1health/wpfi les/amnestyapp i kdroorilAt I f L 1 Vi 1'1G► MOM f I0tv DIN �iVe�(/� ft�pdill Z� COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION RECEIVED OCT 8 2002 TOWN OF BARNSTABLE TITLE 5 HEALTH DEPT. OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 46 Delta Street Hyannis, MA 02601 Owner's Name: Juan Diaz Owner's Address: Same Date of Inspection: September 19, 2002 Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford Mailing Address: P.D. Box 49 Map:292 Osterville,MA 02655-0049 Parcel:222 Telephone Number: (508) 862-9400 Lot: 1 &2A 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 Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ Passes Cond' tonally Passes N s urther Evaluation by the Local Approving Authority Fai I Inspector's Signature: Date: September 22, 2002 The system inspector shall sub ' a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page I Page 2 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 46 Delta Street Hyannis, MA Owner: Juan Diaz Date of Inspection: September 19, 2002 Inspection Summary: Check A,B,C,D or E/ALWAYS 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 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass'inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 46 Delta Street Hyannis, AM Owner: Juan Diaz Date of Inspection: September 19, 2002 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 46 Delta Street Hyannis, AM Owner: Juan Diaz Date of Inspection: September 19, 2002 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to 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 ''/z 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 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 from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this forml No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd- You must indicate either`yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area- IWPA)or a mapped Zone II of a public water supply well If you have answered`yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 46 Delta Street Hyannis, MA Owner: Juan Diaz Date of Inspection: September 19, 2002 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant,or Board of Health ✓ 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? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection? ✓ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ 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 of the baffles or tees,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 maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No ✓ 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)]. 5 Page 6 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 46 Delta Street Hyannis, MA Owner: Juan Diaz Date of Inspection: September 19, 2002 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 2 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): 2002-93,000 gals.; 2001 - 158,250 gals. Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCULANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sqft,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: Never pumped-per owner Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: The owner was going to pump the system after the inspection for maintenance. TYPE OF SYSTEM ✓ Septic tank,distribution box,soil absorption system. Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Jan. 21187-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 46 Delta Street Hyannis, MA Owner: Juan Diaz Date of Inspection: September 19, 2002 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron 40 PVC _other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: Approx. 3' Material of construction: ✓ concrete _metal _fiberglass _polyethylene_ _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1 S00 gal. Sludge depth: S" Distance from top of sludge to bottom of outlet tee or baffle: 26" Scum thickness: 15" Distance from top of scum to top of outlet tee or baffle: 9" Distance from bottom of scum to bottom of outlet tee or baffle: 2" How were dimensions determined: Measuring stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tees were present. The liquid level was even with the outlet invert. Recommend pumping and installing risers on the covers. GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 46 Delta Street Hyannis, MA Owner: Juan Diaz Date of Inspection: September 19, 2002 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete _metal fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): The D-box was level. There were no signs ofsolids. Recommend installing risers. The distribution was equal. PUMP CHAMBER: None (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.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 46 Delta Street Hyannis, MA Owner: Juan Diaz Date of Inspection: September 19, 2002 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 2-6'x 6'- 1000 Qal. leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: Innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): One pit(#4)had approximately 1'of water on the bottom. The scum line was at the same level. There were no sigm of failure. The bottom to grade was approximately 11. The cover was approximately 20"below grade. The other pit(0)was located but not dum up. CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: None (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.): 9 U Page 10 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 46 Delta Street Hyannis, MA Owner: Juan Diaz Date of Inspection: September 19, 2002 Map:292 Parcel:222 SKETCH OF SEWAGE DISPOSAL SYSTEM Lot: 1 &2A 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. 3 O O a � � 3 3 �s ay Y yG 39 s a� aY 10 d Page 1 I of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 46 Delta Street Hyannis, AM Owner: Juan Diaz Date of Inspection: September 19, 2002 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 25' +/- 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 Board of Health-explain: topographic and water contours maps Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: The bottom of the leach pit to grade was approximately 11. Using the Barnstable topographic map and the Cape Cod Commission water contours map, the maps were showing approximately 25'+/-to ground water at this site. This report has been prepared and the system inspected and passed as of the dale of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report. 11 -- - TOWN OF BARNSTABLE LOCATION .2o7-* TA 577 SEWAGE # VILLAGE 'tee-aye P��s7.ASSESSOR'S MAP & LOT INSTALLER''S NAME & PHONE NO. IZ11 c R ,/ (-onis. 7 7/- /, SEPTIC TANK CAPACITY /, -o O LEACHING FACILITY:(type)/.Pr size) /, DOD r�/9 r NO. OF BEDROOMS PRIVATE WELL OR UBLIC WATER BUILDER OR QWNER y ��PO�I/ DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No h O O - Q s. s9'6 Q 0 NOY. Fmc.f�(D........ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH . Town...............OF..............Barns-table................................................. , ppliration for Bhipoiial Works Tonstrudion Frrutit Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal System at: Lot 1 - 46 -Delta Street - Hyannis ................---------•--------- ------•-------.....------------......_......-------------- ....................................................-----......................................... Sharon Diaz Location-Address or Lot No. --- ......................-.......................................................................... -------------••-.._...._...----------------------.._..---....------------..._...............--.... Owner ress W Kevin Hickey PO Box 236 - Cen edd ille, MA -------------------------------------------•----•-------..•..------------....--•------------------ -•---•------•..............---------•-----................--•----------•--•-...........---•---•--• Installer Address Type of Building Size Lot......10,0.00_......Sq. feet U Dwelling—No. of Bedrooms---.-•.--•---4---•-----_-_--•--.----.--Expansion Attic ( ) Garbage Grinder ( ) '_4 Other—T e of Building No. of persons............................ Showers — Cafeteria A4 Other fixtures -----------------------------•• - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid capacity------------gallons Length................ Width................ Diameter................ Depth................ xDisposal Trench—No. -----•--.--..--_--- Width-------------------- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '-� Percolation Test Results Performed bY.........................................-................................ Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.--................. Depth to ground water........--........-----. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ •------------------------------------------------------•---........-------------•--••---------_.............................................................. 0 Description of Soil......................................... x V --------------------------------------------------------•-----•------------------------------------.......-•------•-------•----------------------------•-------------------...._._....-••--••-••-•.---- W ••-•-•------------------•-------•-••--•-•---•••---•----------------••••--•-----••--•••----------•---•••••-•-•••---••-•---•--•-••---•---•-------------•-•--•--••----••---•-••---•--••......---•----.--.-- VNature of Repairs or Alterations—Answer when applicable.....1y500.--ga11on_-_Septic-`dank--------------------------------- 2------1.:000..gallon..-pits.with. '-3/4--'-12.Stone.............................................................------------------------------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of i T�' _�: p 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance ha en issu he b and of health. '" Signed..... -- Dat ` Application Approved B .. ................................................................- C.r Date Application Disapproved for the following reasons:.............................................--------------.......................... ---------------------------------•--------•---••----•...........-----••--•--•---•••-----•--•-------------•-•-••....-•--••----------••--•--••-••-•--•••-•-••••-•-••-•--•-•-•••------------•---•--••--•- Date '-•-------------------- Issued........................................................ Permit No..... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH O F.............. - Town................ Barnstable--------------------------------------------------- Appliration for Bhip a al Works Tnnstrurtiun Prrutit Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal System at: ................ot 1 - 4 � elta Stet - Hyannis , _............................................................ •--------------------.....----------------------....................--•------••- Location-Address or Lot No. Sharon Diaz ......................-.......................................................................... ------------...................................................................................... Kevin Hieke Owner Address w Y...-----•••-••••---••-----•-----•--•-•----•---•---••----.... ...... O Box 236 - Centerville, MA Instalier Address UType of Building Size Lot------}a.,000..+-..Sq. feet �-, Dwelling—No. of Bedrooms......__..--4-------------------------•--•Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ..................... w Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—NTo. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water_.--_-_-_-_____-..._-_.. (14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ••--•-••--•-•---------------•---•-•--••----•-••••-•••--•......-•-•----------•••--•----------•---•-------•------•............--•--.........•----•--•---.....-- 0 Description of Soil........................................................................................................................................................................ W U ••-•-••••----••-•------•--•••-•••--._...-•-•---------••--•--••----•-•-••-•--•••---••-----•-------••-••-------•----••••-•••-•----••--••••......--•••--•....••........................................... W -------------------------------------------------- ------------------------------------------------------------------------------------------------.................................................... U Nature of Repairs or Alterations—Answer when applicable----- y5- 00--ga- -lflrt_-septle-Tank---------------------------------- 2 " 1,OQQ..gallon --with 2 3�4 - 1 ..Stone-----------------------------------------------------------------------------------------•--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TTTx.. p 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. --------------------- ApplicationDate - A roved B � . -•--------------•--••-••......-•---•------• ----•--•••• ... _••- PP Y > �C lG�' rJit Application Disapproved for the following reasons-----------------------------------------------------------------------------•-------------------------.......--- •••••......--••••---•-•••...-------•--•-...•-•-••••--••••---••-•••••••-••-----•-•----......-•------------••-----------------•••---•-----•------••--•----•-•------------•••-•--•-•--•--------••----•----- �J Date PermitNo. <Z .••--�--- I-'----------------------- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........ToWn.......................OF....................Barnstable......----------....................... TOrr#if iratr of Tompliatirr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (X) bY--------Kevin--Hi_C ----------- ---------Installer-------------------------------------------------------------------------------•--------------- at.......�t 1 ' -4b._Del.xa__Sty__k1�1; c]t] . a---MA------------------------------------------------------------------------------------------------•.....------------ has been installed in accordance with the provisions of TILT E 5 of The State Sanitary Co as described in the application for Disposal Works Construction Permit No...�.�..-.__L_(__._..... dated__..._!_.. ..._��-................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A G ARANTEE AT YHE SYSTEM WILL FUNCTI N S FACTORY.TIS 1 DATE.-------•..................••-•-•� -T• •--•-- ...--------.. Inspector........--- �1.. .._.. THE COMMONWEALTH OF MASSACHUSETTS t BOARD OF HEALTH ............. own...............OF.----•-...Barnstable.-----.................•--•••........ --- .... FED:.v............... Rapos al Works WT.1ntr ion rranit Permission is hereby granted--_------Kerrin-.Hickey...................................................................................................... to Construct ( ) or Repair (X) an Individual Sewage Disposal System at No............ 1 - 46--bk:l ta-Stxeet....Hyanni.s,.....MA----02601......................................................................... _ Street c as shown on the application for Disposal Works Construction Permit N __- Dated..... .____. . ........................... =......"Vo d t Health , DATE----'-••- ' = It r �//� //( - ----------- FORM 1255vµ�BBS& WARREN. INC.. PUBLISHERS a TOWN OF BARNSTABLE LOCATION �e. '�,' SEWAGE # VILC,AGE Am IS ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY J /� LEACHING FACILr Y: (type) LG x(o P,T (size) /U" NO.OF BEDROOMS BUILDER OR OWNER JIJ�n 1 A2- PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leachin facility) ) Feet Furnished by r/1 S/� c B� A. Coe- - i 3 � B , O O a � 3 a !y!o 3 �s ay Y y� 39 } PSEPTIC ��� EXISTING LEACH PIT U II��L� V SS TO BE PUMPED AND PONENTS ' ' Ij WATER LINE � FILLED OR REMOVED THIS IS A �n�= 1_j, GAS LINE -=��G COLOG3f'°`l'Falinout GARB PLAN ,f4, UTILITY .' G R s ` Q1.11,l o � ' DRAIN® USE COLOR PLAN ONLY'•- POLE EXISTING OT FOR INSTALLATION +Tc.q ®b LEACH PIT/• 1 OWED FULL DETAIL IS BEST Pam., e�EP°a'm G�� a pliciaR�ad o ,.,VON B ,.. e .m A CESSPOOL � VIEWED IN 1l�,B�; Q•. c� o• „��p��6.O DISTRIBUTION BOX❑® FULL COLOR ¢ @�Q .� y3� Y �Dr �au� e e TEST PIT ® pp t' r���c p� jH�Yy�ANNIS.{pMAs lU ® lb l� d1911 A 1" 48 47 4 6 --I _ 208.00 ft �49 IT G �I n IATU N "U D 44 EL AT t I -- — — — —— --- — SHEDro F'vi49.38 4 9 OF FOUND P� PAVED DRIVEWAY VV�1.�I f _ J r P® oo � o � E VENT � € t WE PIPE T a k o 42 I o 4K 6 I PROP SED SOIL N „ o ;CJ -IjN _ — ., , ABSORPTION / t y Cn m, -rEE DETAI �\ O MINIMAL 48 / ON BA \� �� Q GRADING 2q ;G �`V" W. F���. ��� PROPOSED 24 in :£ \ OAK Vv h I I LOT I AREA = 20000 sf+— / I PLAN BOOK 241 PAGE 137 O � ASSR .MAP 292 PCL 222 4 I46 208.00 ft 44 47 42 VARIANCES REQUESTED a n n ���N OF*ss9 �P��N OFMASs9 MAY BE GRANTED IMMEDIATELY BY HEALTH AGENT OR HEALTH INSPECTOR. /LJ/// � /^`// � � D y� PLAN U\VV/ o DAVID �tio o DAVID `� SEWAGE DISPOSAL COUGHANOWR N COUGHANOWR `� Q� SYSTEM PLAN 310 CMR 15.221(7) - COMPONENT D. �, 0 F DEPTH TO FINISH GRADE. 36 in SCALE: 1 in = 20 ft MAX REQUIRED - VARIANCE TO No. 1093 No. 461' [ . e -TO SERVE EXISTING DWELLING 60 in OF COVER REQUESTED. o� 20 40 I _ a ELISA & CAORU FGIST SO�PFROVE� H A I B A R A 310 CMR 15.211(1) - SOIL ABSORPTION o l0 20 sq r` �U Yo •• OWNER(SI OF RECORD SYSTEM TO CELLAR WALL. 20 ft MIN PRINT ON 11 x 17 in �� PESQOO 46 DELTA STREET REQUIRED VARIANCE TO 16 ft PAPER. FOR PROPER SCALE HYANNIS. MA THIS PLAN IS INTENDED SOLELY FOR INSTALLATION OF THE SEPTIC SYSTEM 155 Geo Ryder Rd S PROPERTY ADDRESS SEPARATION REQUESTED. DEPICTED ON IT FOR ANY OTHER CHANGES,TO THE PROPERTY INCLUDING PLACEMENT OF ADDITIONS. SHEDS. FENCES OR SWIMMING POOLS. OWNER Chatham, MA 02633 SHOULD CONSULT WITH A MASSACHUSETTS REGISTERED LAND SURVEYOR. DOVIdcouOHotm011.com DATE.- APRIL 17, 2020 508 364-0894 PG. v2 JOB., ETE-4447 BoE SOIL EVALUATOR: DAVID D. COUGHANOWR. ASE 0461 DESIGN FLOW: 4 BEDROOMS X 110 GPD - 440 GPD DIMENSIONS & DETAIL S U S rEOVII CONSTRUCTION DETAIL WITNESSED BY: DAVID STANTON. HEALTH DEPT. SEPTIC TANK: 440 GPD X 2 DAYS = 880 GALLONS USE EXISTING TANK IF STRUCTURALLY SOUND. USE SHOREY PRECAST 500 GALLON LEACHING DRYWELL TEST PIT NO GROUNDWATER ENCOUNTERED USE EXISTING 1500 GALLON SEPTIC TANK IF IN PUMP & INSPECT TANK REPLACE WITH A NEW PERC AT 50 in - 2 MIN/INCH IN C FOILS SOUND STRUCTURAL CONDITION. IF NOT, INSTALL AT TIME OF REPAIR 1500 GALLON TANK 6RYwE`L* 33.5 ft ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR Svi. OTHER NEW 1500 GALLON SEPTIC TANK. IF CRACKED, ROTTED UNIT INCHES HORIZON TEXTURE (MUNSELL) MOTTLES co 47.85 DISTRIBUTION BOX: INSTALL UNIT DEPICTED I in OR OTHERWISE cx�Y 0-6 Ap SANDY LOAM 10 YR 2/2 NONE FRIABLE TAPER COMPROMISED. c) 46.02 6-22 Bw LOAMY SAND 10 YR 4/4 NONE FRIABLE SOIL A8SORBTION SYSTEM: ', w cy) 22-132 C MEDIUM SAND 10 YR 5/6 NONE LOOSE THE LONG TERM ACCEPTANCE RATE FOR A CLASS ONE Lo °off In 36.85 SOIL WITH A PERCOLATION RATE BELOW 5 MINUTES F PER INCH = 0.74 GALLONS PER DAY PER SQUARE FOOT. c '� N M-- - I 5 ft— NO GROUNDWATER ENCOUNTERED THE 33.5 ft x 12.5 ft x 2 ft LEACHING GALLERY x i A� o 4 ccyi� TEST PIT 2 MIN/INCH IN C SOILS DEPICTED BELOW CAN LEACH: 8 in STONE ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER 4 ft 8.5 ft 8.5 ft 8.5 ft 4 ft INCHES HORIZON TEXTURE (MUNSELL) MOTTLES BOTTOM AREA = (33.5 x 12.5) =418.75 sq. ft. - 46.95 0-10 Ap LOAMY SAND 10 YR 3/2 NONE FRIABLE SIDEWALL AREA = [2x(33.5+12.5)] x2 = 184 sq. ft. _` NOT 4428 10-32 Bw LOAMY SAND 10 YR 5/6 NONE FRIABLE TOTAL AREA = 602.75 sq. ft. \ TO 500 GALLON DRYWELL 34.95 32g144 C�MEDIUM SAND` to YR 5/4 NONE LOOSE I, INSTOALL A 33.5Tft x 12.5 ft xo2 ft GALLEAYO3 gal/day AS CONFIGURED I0 ft-6 /n GO SCALE.. DIMENSIONS & DETAIL® INSTALL ONE INSPECTION THREE I BELOW. FLOW CAPACITY = 446.03 gol/day WHICH EXCEEDS INCHES OF FINAL GRADE THE 440 gol/day REQUIRED FOR A FOUR BEDROOM DESIGN. INLET OUTLET & INDICATE LOCATION COVER COVER ON AS-BUILT D�RS TIDY�o V V OUV v(D /� INSTALLER TO OBTAIN DISPOSAL WORKS UDB-3 H2O FLOW LINE SE SHOREY 3 IN DROP _ Q��, 36 PERMIT BEFORE STARTING WORK. N -ALL COMPONENTS INSTALLED SHALL MEET DIMENSIONS PIPES EXITING D-BOX TO RUN LEVEL FROM - - �n THE MINIMUM REQUIREMENTS OF AND. DETAIL .FOR 2 ,FEET BEFORE PITCHING DOWN BUILDING 10 in 14 TO 4 �ry®0 USE 3. MASSACHUSETTS TITLE 5 SEPTIC '^ D-BOX RATED O CODE (310 CMR 15). a . 48 in ,.:r $'\0 UNITS (" §? -INSTALLER TO VERIFY LOCATIONS OF ALL =s LIOUID GAS UNDERGROUND UTILITIES BEFORE l2 1n LEVEL BAFFLE T EXCAVATING FOR SYSTEM. c I MIN -ECO-TECH RAPID RESPONSE RECOMMENDS mil, x. -► I --► CROSS SECTION VIEW rr,� THE INSTALLATION OF LOW FLOW � FROM = = "' INSTALL AN APPROVED GEOTEXTILE FIXTURES & APPLIANCES, AND PERIODIC N TANK v� TO 6 in STONE BASE FABRIC OVER STONE PUMPING OF THE SEPTIC TANK. ' SAS a ^ SEPARATION BETWEEN INLET & OUTLET TANK NOT DESIGNED TO �,4oµ . 40 EECSEPVEHICULAR LOAD NG. DO OT IPARKTOR b�inSTo�NE BASE TEES NO-LESS THAN LIQUID DEPTH " e DRIVE VEHICLES OVER SEPTIC TANK. ,(� CROSS SECTION VIEW 9/4 In T^3 � 24 in CROSS SECTION VIEW in 1-1/2 1n GRAVEL'e DEPTH I V E®. 1-1/2 in GRAVEL' 46 in 58 in 46 in 150 in BE DOUBLE WASHED AND FREE OF IRONS. DUST AND P IN FINES LACE I TOP OF FOUNDATION RAISE COVERS TO WITHIN O ALL PIPE TO 4 in BE SCH. 40 PVC VENT EL 49.38 +— 6 in OF FINAL GRADE AND TO PITCH AT 1/8 in/ft MIN PIPE 47.70 DD-BID 5, , USE H-20 USE H-2C MAX RATED EXUST0NG 43.0011 if UNITS EXISTING -1e�10O GALLOUV o0 0 0 PRECAST 0 ooa o0 Fn ��p�0� ��°, �7 42.70 0�0000�a° DRYWELL 42.10 0000 ooa000 aQOD000Do EXISTING REFER TO DETAIL BOX STONE SOOOV A°- C83SSC r PT N +, 42.27 BASE 42.00 6 in STONE BASE IF NEW SYSTEM —REFER TO EXISTING 35 ft 5 .12 f t DETAIL BOX 40.00 NO GROUNDWATER BELOW MOTTLING OBSERVED _ -34.95 SEWAGE DISPOSAL SYSTEM PLAN 146 DELTA STREET HYANNIS, MAIJAPRIL 17. 2020 1ETE-4447 PG 2/2