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HomeMy WebLinkAbout0056 DELTA STREET - Health 56 Delta'Street � Hyannis P A = 292 087 i COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTA T�r�T�'^o�� - RECEIVED OIG 2 8 2003 TOWN OF BARNSTABLE ° ,i HEALTH DEPT. { TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 56 Delta Street Hyannis, MA 02601 Owner's Name: Estate of Patricia Johnson MAP Owner's Address: c%Dan Johnson, Executor PARCEL, Date of Inspection: August 11, 2003 (LOT Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford Mailing Address: P.O. Box 49 Osterville,MA 02655-0049 Telephone Number: (508) 862-9400 CERTIFICATION STATEMENT 1 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 Conditionally Passes Need Further Evaluation by the Local Approving Authority Fail Inspector's Signature: Date: August 12, 2003 The system inspector shall subm' 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 1 f Page 2 of l l OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 56 Delta Street Hyannis, MA Owner: Estate of Patricia Johnson Date of Inspection: August 11, 2003 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: 56 Delta Street Hyannis, MA Owner: Estate of Patricia Johnson Date of Inspection: August 11, 2003 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(I)(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: 56 Delta Street Hyannis, MA Owner: Estate of Patricia Johnson Date of Inspection: August 11, 2003 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 form.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large 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 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 56 Delta Street Hyannis, MA Owner: Estate of Patricia Johnson Date of Inspection: August 11, 2003 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? Y 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 CM 15.302(3)(b)]. 5 Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 56 Delta Street Hyannis, MA Owner: Estate of Patricia Johnson Date of Inspection: August 11, 2003 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 0 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)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Unknown COMMERCIAL/INDUSTRUL 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: 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: Oct. 3197-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 S Page 7 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 56 Delta Street Hyannis, MA Owner: Estate of Patricia Johnson Date of Inspection: August 11, 2003 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: 12" 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: 1500 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 4" Distance from top of scum to top of outlet tee or baffle: 8" Distance from bottom of scum to bottom of outlet tee or baffle: 12" 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. There did not appear to be any signs of leakage. 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.): I 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: 56 Delta Street Hyannis, MA Owner: Estate of Patricia Johnson Date of Inspection: August 11, 2003 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. No solids were present. The D-box was under an asphalt driveway and was inaccessible. A video camera was used to conduct the inspection. 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.): I i 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: 56 Delta Street Hyannis, MA Owner: Estate of Patricia Johnson Date of Inspection: August 11, 2003 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits, number: ✓ leaching chambers, number: 2-500 gal. chambers(per as built card) 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.): The chambers were dry. There did not appear to be any signs offailure. The chambers were under an asphalt driveway and were inaccessible. A video camera was used to conduct the inspection. 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 A Page 10 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 56 Delta Street Hyannis, MA Owner: Estate of Patricia Johnson Date of Inspection: August 11, 2003 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply'enters the building. • /9 �ro�T t3 I I Q � 0 t �(111t4+A�f I 3 y 3y.6 G�6 .o Page 11 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 56 Delta Street Hyannis, MA Owner: Estate of Patricia Johnson Date of Inspection: August 11, 2003 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 15 +/- feet Please indicate (check) all methods used to determine the high ground water elevation: Obtained from system design plans on record- If checked, date of design plan reviewed: 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: Using the Barnstable topographic map and the Cape Cod Commission water contours map the maps were showing approximately 15'+/-to ground water at this site. This report has been prepared and the system inspected and passed as of the date 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 L/ COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617) 292-6500 TRUDY COX Setaeta: ARGEO PAUL CELLUCCI DAVIFi;'Fi Gwerncr D B. S? SUBSURFACE SEWAGE DISPOSAL SYSTEM NSPECTION FORM Cot:ttaiss:oa( 0�1 1 PART A j 3e �2��Gt S� arrh3 itf4 CERTIFICATION Property Address: Nerve of Owner Jacau e.5 0�1 Date of krspection.11014'� Address of Owner:3OO�rsPS�/�,, /f,�un.��5 �� 0„)10/ Nama of Inspector:fPleasa Prin" �I N/' OXe' •ll' I em a DEP approved system impactor put meet to Section 16.340 of Title 51310 CMR 15.0001 Company Name: EA'k'-ro — 7'L e 14 MdkV Address: PC OX ' Rc ✓'7 �r� �a�C�,� Telephone Nurttber: CERTIFICATION STATEMEAIT 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 end experience in the proper function and maintenance of on-site sews disposal systems. The system: _�/Pesses Conditionally Passes Needs Further Evaluation By the Local Approving Authority _ Fails \� Inspector's Signature: �/ U+ ' Date: —�6 The System Inspector shall submit a copy of this inspection report to the Approving Authority leoard of Health or DEP?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 c1*Envir6nmsntel Protectlon. The original should be sent tovw system owner and copies sent to the buyer, If applicable,and the approving authority. NOTES AND COMMENTS r lChp 1 V�ley ore 11Q00 a sz revised 9/2/98 Page Ior11 00 Primed on Recycled PAP*, Y SUBSURFACE SEWAGE DISPOSAL SYSTEM SIISPECTiDN FORM PART A I,ERTfACAT10N laentiratodl .De/4 s� i Ctn n oat Prop".Addrete: Owner: k1,?0 t"I k 1 Date of trope rem:J 00 —�Is— INt3PECTiox SUMMARY: Cheek A, B, C, of O: e..7SY PASSES: , I have not found arty information which Indicates that any of the failure conditions deewtbed in 310 CMR 16,303 exist. Any fa(Iws witeris not evaluated Are indicated below. COMMENTS: B. SYSTEM CONDITIONALLY PASSES: One or more system components es described In the"Conditional Pass'seatlon need to be replaced a repaired. The system,upon completion of the replacement or repair,as Approved by the Board of Health,wM pus. Indizote yes. no, or not determined(Y,N,or NDI. Describe basis of determinetlen in 0 Instances. B "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 Ceftmeste of Compliance(attached)Indlostlng that the tank was Instaned within twenty(20)vows prW to the dots of the ktspeetlon;or the ssptlo tank, whether or not motel,Is crooked,structurally unsound,shows substantial Infiltration or sxfitrstion• or tank failure is Imminem. The system will pus Inspection If the existing saptie tank is replaced with a complying ssptlo tank to approved by the Board of Health, Sewage backup or breakout or high static water level observed In the distribution box Is due to broken or obstructed pips(s) or due to a broken, settled or uneven distribution box. The system win pass inspection If(with approval of the Board of Health)'; broken pipo(si etc replaced obstruction is removed distribution bait Is levelled or roosted _.. The syrtsm required pumptrig jiml then fourMmee•year•aifs to broUw+of ebetructed pipelsl, The>►tgn no OM inspection If lwfth spproyM of tin Sowd of Health): broken pipe(s1 era replaced obstruction to removed .:9%_sed 9/2/98 Psge2or11 J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) PropertyAddress- Owner: Pr 0 ✓ V _ Date of Inspection:3`/ 4 _ O( 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 the public health, safety and the environment. 11 SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTE IS NOT FUNCTIONING IN A MANNER WHICH3MLL.PRO ECT THE PUBLIC HEALTHAND SAFETY AND THE ENVIBONMENT: Cesspool or privy is within 50 feet of 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 I' FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE 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 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 0 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 vafid). 3) OTHER revised 9/2/98 Page 3of11 w rf SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: owner: Date of Inspection: 3 00 D. SYSTEM FAILS: lam'V You must indicate either "Yes" or "No" to each of the following: l� I have determined that one or more of the following failure conditions exist as described 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/ V Backup of sewage into fecili",-, stern compon"t due�to an overloaded orcleggad SAS., 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 112 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). aNumber of times pumped_. v/ 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. E. LARGE SYSTEM FAILS: 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: 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 feetof-e-t4butery-toaevofaoodxinfcwywater•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 upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further inforgiation. revised 9/2/98 Page 4or11 l SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: �� Ael S� ��CI6Irr,1 "'OP& ©v, �© I Owner: ,�- yl o r i V-? Date of Inspection: Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Y No J — Pumping information was provided by the owner,occupant, or Board of Health. _ -None of the system eompooents.ba`�-an puaMwxhtoratJeast two weeke and the system hasbeeoaoceitigwrafal 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 NIA. — 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: / Existing information. For example, 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) 115.302(3)(b)) — The facility owner(and-ocrypants.if different frozn�wnet),were prayided.with infnrmatiodpn thn___nrn_W.EaH1nt,.- -..f Subsurface Disposal Systems. revised 9/2/98 Page 5of11 r( SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C �� oe �� '� SYSTEMNVFORMATION 7�t G&16,1(S 41cl 6kWl Property Address: Owner: T m Q h(ki Date of Inspection: ��??n _'� _ V v FLOW CONDI770NS RESIDENTIAL: Design flow: 10 g.p.d./bed om. Number of bedrooms(design):- Number of bedrooms(actual):_ Total DESIGN flow 33 0 ����JJJJ Number of current residents:L Garbage grinder(yes or no): N Laundry(separate system) (yes or no):NC If yes, separate inspection required Laundry system inspected (yes or6? Seasonal use lyes or no):/VJ Water meter readings,if available(last two year's usage(gpd): (►/ Sump Pump(yes or'no):-ALO !� Last date of occupancy: 3-4 COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: qpd ( Based on 15.203) Basis of design flow 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) Lest date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: j �O�No W!Y67 System pumped as part of inspection: (yes or no /VV If yes, volume pumped: gallons Reason for pumping: TYPE 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) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date instaNediif lrnown)•end course ofwMem►ation: -•---.- .- Sewage odors detected when arriving at the site: (yes or no) revised 9/2/98 Page 6ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C J SYSTEM INFORMATION(ewrtinued) Property Address: s 1 Oe4 6 0 / Owner: QV`I✓� Date of Inspection: 3 - 4- 00 BUILDING SEINER: (Locate on site plan) Depth below grade: Material of construction:_cast iron 40 PVC_other(explain) Distance frorrt private water supply well or suction line Diameter—L-IL7 Comments: (condition of joints, venting, ' evi rtce of faak a�� �noag y,-etc.) SEPTIC TANK:_ c' (locate on site plan) Depth below grade: Material of construction:_concrete_metal_Fiberglass _Polyethylene_other(explain) If tank is metal, list age_ Js.age confirmed by Certificate of Compliance_(Yes/No) Dimensions: / Sludge depth: Distance from top of sl dge to bottom of outlet tee or baffle: _ Scum thickness: / �r Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom pf outlet>;qe or baffler How dimensions were determined: c! Comments: 7 (recommendation for pumping, condition of inlet and outlet tees orAaffles, depth of liquid level in rel tion to outlet invert, syucturel-integrity, evidence of leakage, etc.) �/! ]_LPG �p(�'� Fl0� c 0 st l�l��/*I C i 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.) revised 9/2/98 Page 7of11 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: 7- I^'►ort�� Date of Inspection: —00 J 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: y ' Capacity: gallons Design flow: gallons/day Alarm present 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:_ (locate on site plan) Depth of liquid level above outlet invert: �r I Comments: (note if level grlddistribution is epual, a ilence of solids cam` ver, evidence of I ag to or out of box, etc.) I/ ! -1/ le /Y Jjc+'1S ✓� Olie✓r AT f• PUMP CHAMBER:_ (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 9j2/98 Page 8of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ✓Ql SYSTEM INFORMATION(continued) Property Address: Owner: T Date of Inspection- .- /6- 00 SOIL ABSORPTION SYSTEM(SAS) (locate on site plan, if possible;excavation not required,location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits,number:_ leeching chambers,number: �C SO0 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 b ulic ilure, le of ponding, damp soil, condition of vegetation, etc.) y , d Q vt C'/K r� G t _<0 t , O r CESSPOOLS:_ (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 (cesspool must be pumped as part of inspection) 0 Comments: (note condition of soil, signs of hydraulic failure,level of pending,condition ef.vegetation, etc.) PRIVY:_ (locate on site plan] Materjals of construction: Dimensions: Depth of solids: Comments: (note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation;etc.) revised 9/2/98 Page 9ofII r - $ SUBSURFACE SEWAGE DISPOSAL SYSTEM MSPECTION FORM PART C SYSTEM INFORMATION 1eerr6rtred) Property Address: G 6441,, Owner: Date of Inspection: / 0/0 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) 14 Foo, 1 0 ! d, AL revised 9/2/98 Page 10of11 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: w O ner• �0 r Date of Inspection: J-/ 6- o NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater L Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site(Abutting property, observation hole, basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records 1Checked local excavators, installers V/1"Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) Pgc �vl� 1�rc,,de- , � GiC,J' lea vCS U j 13 � revised 9/2/98 Page 11of11 cam \ TOWN �O.�F..BA.RNSTABLE .LQCATION •J 6 UAA �r SEWAGE # 91 y�3 VILLAGE I-/yA v1 tS ASSESSOR'S MAP & LOT aqa'.0 87 WSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) oZ ' sW 641 (size) C Ars+ Gil NO.OF BEDROOMS 3 BUILDER OR OWNER �3`T�c- 04 Ar J01"-Jgf% PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) _ ! Feet Furnished by ��SptGT1On .� • rot G 1 - r G A 6) Q gi O O f d � '7—Lj�3 No. Fee ✓ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0(ppYication for Migooar *paem Con.5truction permit Application for a Permit to Construct(x)Repair( )Upgrade( )Abandon( ) VCompleteSystem ❑Individual Components Location Address or Lot No.,5ry 11tea,S-fi-ee-t,AlyaVN/S Owner's Name,Address and Tel.No. �1� 7✓Iori K 3a o 6Cllr3e8 Assessor's Map/Parcel ,2 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. w n2o r w 3 o a rsts way W-el vi" g 44' Type of Building: Dwelling No.of Bedrooms -3 Lot Size sq. ft. Garbage Grinder( ) Other Type of Buildings ram; q No.of Persons VAIK• Showers(;I—) Cafeteria( ) Other Fixtures l Design Flow 1 36 gallons per day. Calculated daily flow gallons. Plan Date (0 30 1?1 Number of sheets Revision Date Title Size of Septic Tank 45-00 / Type of S.A.S. Description of Soil ivG(cr �O9r-t _ �d�/�G1 %✓� C Zr M—C ..S,4A b Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to a the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions le 5 of the Environmental Code and not to place the system in operation until a Certif1- cate of Compliance has been issued Board of H e lth. qnK Signed Date >ll 7 Application Approved by Rate Application Disapproved for the following reasons Permit No. Date Issued `J No. Fee �dU -4 U 0 �,THE-COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLEs MASSACHUSETTS t riraetait foi XDig ogaf6 stem Congtruction permit " APP4 4tipn��r a.Pe t t&Qstruct(XO Repair( )Upgrade( )Abandon( ) �Somplete System El Individual Components 5to �U$%lel lc hH/S Owner's Name,Address and Tel.No.Location Address or Lot No. Owne @�.J _ ' �. '� YJ f JClC�Ues 77�0/iK ,3a0 666 lclal./ Assessor's Map/Pazcel J k lillr//.S , 7ylA �.. aZloo/ Installer's Name,Address,and Tel.No. ¢y -Designer's Name,Address and Tel.No. 1 Jb(JV( S lU,. IYTO(�`c 3G0 �PG/ses �J GG •5 Type of Building: Dwelling No.of Bedrooms Lot"Sizes sq. ft. Garbage Grinder( ) Other Type of Building S�a in i(�a No. of Persons • - Showers(,A-) Cafeteria( ) Other Fixtures f£ Design Flow 3 b gallons per day. Calculated daily flow .'.-�3 a gallons. Plan ;Date 0 `� Number of sheets 17 Revision Date i Title Size,of Septic Tank SOD i p // Type of S.A.S. Description of Soil /►�aa'�9 �9/"1 = �dHit�c y �� �'I—C -S�� Nature of Rep airsaor Alterations(Answer when applicable) ,.Date last inspected: i Airiement: w EThe undersigned agrees.to ns a the construction arfd maintenance of the afore described'on-site sewage disposal system ____„ in accordance with the provisions' T le 5 of the Environmental Code and not to place the system in operation until a Certifi- cate Y " of Compliance has been issued s Board of Health. Signed. , Date Application Approved by Date _—!A Application Disapproved for the following reasons � h 4 � a� h Permit No. =.JiDate Iss .: / / y7 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed ( ) Repaired( ) Upgraded C ) Abandoned( )by 'Q at 5 -�-fj e/ (� has been constructed in accordance -, with the provisions of Title 5 and the fd Disposal System Construction Permit No. 7 / `*dated / Iq 17 Installer J_'q A). 7V ar l K Designer The issuance of this permit shall not be c nstrued as a guarantee that the sys em wil unction as designed. Date -.Inspector ..- ,fi l , —�`,`!��---- --f � ----------------- No. Fee �0D � '7 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALT DIVISION - BARNSTABLEs MASSACHUSETTS zigpggal A pgtem Construction Vermit Permission is hereby granted to Construct'( ) Repair( )Upgrade( )Abandon / System located at 3L elt a S-1if(e , ;�(y(,y=n i g } 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 ..ust be completed within three years of the date of this permit. Date: i ���l Approved by ��(J _" 1 � � � � � c ��� � , n � r � � � �. �, �� � � �,- � � � � � � � � �. v TOWN OF BARNSTABLE r� LOCATION SEWAGE it VILLAGE �Utannl� rr ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO._t�i' fog nl o r t h 7 75'8 lbz Z SEPTIC TANK CAPACITY 1500 .::LEACHING FACILITY: (type) C6%tobhp (size) _ U.SOo NO.OF BEDROOMS 3 BUILDER OR OWNER A yIp@r ry u t�dl°r ERMTT DATE: $'Z '°i1 COMPLIANCE DATE: ,paration Distance Between the: :;:Maximum Adjusted Groundwater Table and Bottom of Leaching Facility 9 4,2 Feet Private Water Supply Well and Leaching Facility (If any wells exist .,on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist Within 300 feet of leaching facility) Feet Furnished by E- 6 �, i m � '-1C1ED"AR CLOSET M Nk _ °�p I I I STUDY ROOM Mn3 II o ENTRY WAY 4 � I Cp�i I i 2'-10" '2 ,'rl ' _ =0 x 6�-8"co ! �, Orr ' AS 'I I - 9-1 O'r► DRYER n, w II Q i - 9 1 o BIKE ZONE I W Cn S N�t. i k i _ _._ .. 71/ 4 A rl t� _ FREEZE., � T-11 rn i 9r_1 r► IIANI T h' M 0 PLAY ROOM 00 T6ILET LI 4 M I 61 M _ 4'-0 x 6-8"BF MO:W 000 STALL j 3'-O" MECANICAL ROOM '� II i -- SUMP PUMP NOT wn DER I I - TOWN OF BARNSTABLE CF TH E TO OFFICE OF DABI►9TAHL s BOARD OF HEALTH ,, l °o 039• �� 367 MAIN STREET o MAY I' HYANNIS, MASS.02601 July 11, 1997 Jacques N. Morin 300 Bearses Way Hyannis, MA 02601 RE: 56 Delta Street, Hyannis Dear Mr. Morin: You are granted a variance from the Board of Health Interim Groundwater Protection Regulation limiting sewage flows to 330 gallons per acre in certain Zones of Contribution to public water supply wells. This variance will allow you to install an onsite sewage disposal system at 56 Delta Street, Hyannis, Ma., with the following conditions: (1) The septic system must be installed in strict accordance to the engineered plan. (2) The designing engineer must be onsite and supervise construction of the onsite sewage disposal system and must certify in writing to the Board of Health that his design has been strictly adhered to prior to the issuance of a Certificate of Compliance. (3) The dwelling cannot have more than three(3) bedrooms. Sewing rooms, dens, lofts, mudrooms, enclosed porches, finished cellars and similar type rooms are considered bedrooms according to the Department of Environmental Protection. (4) It shall be recorded on the deed that the onsite sewage disposal shall be pumped every three (3)years and written certification submitted to the Board by a licensed septage hauler. (5) The dwelling must be connected to public water. (6) The dwelling must connect to town sewer when the Board determines its availability. (7) This variance expires August 1, 1998. jacques r This variance is granted because it is one of the few remaining vacant lots in a developed r area. It is the opinion of the Board that the installation of another septic system-in the area will not significantly alter the poor quality of the groundwater in the area. Sincerely yours, Susan G. Ras , R.S. Chairman Board of Health Town of Barnstable SGR/bcs jacques PART XII: VARIANCE REQUEST PROCEDURE ADOPTED 11/1/83, REVISEDEFFECTIVE 1/1/94TOWN OF13AHNSTAE �fTHETO OFFICE OF t „"gUn BOARD OF HEALTH NAIL +639. 367 MAIN STREET HYANNIS,MASS.02601 yA1tiANCE REQUEST PROCEDURE The Board of Health, of the Town of Barnstable, Massachusetts, in accordance with, and under the authority granted by section 31, of chapter 111 of the General Laws of Massachusetts, adopted the following rules and regulations after a public meeting of the Board of Health on December 9, 1993. (1) All requests for variances from the Board of Health or State Regulations will be submitted fifteen (15) calendar days prior to the scheduled Board meeting. The variance hearing may be held at a later date if the Board has scheduled eight (8) hearings prior to submission of the request. (2) The variance request shall be made on a form prescribed by the Board of Health. (3) Plans clearly showing the details of the request must be attached. Plans for onsite sewage disposal systems must be prepared and certified by Professional Engineer or Registered sanitarian for all new construction and shall be submitted at least fifteen (15) daps prior to the scheduled Board Meeting. (4) Any applicant who submits revisions to plans, required under Paragraph 3 above, less than two (2) days prior to the scheduled Board meeting shall be required by the Health Department to postpone the variance hearing to a later date. (5) No request for variances from 310 CMR 15.00, Title 5, of the state Environmental code, Minimum Requirements for the subsurface Disposal of sanitary sewage, nor from any other Board of Health Regulation listed under section VIII: Onsite sewage Disposal Regulations, shall be heard for a new sewage disposal system, nor for an enlargement to an existing system which increases capacity to accomodate additional flows except after the applicant has notified all abutters by certified mail at his own expense at least ten (10) days before the Board of Health meeting at which the variance request will be on the agenda. (6) A non-refundable filing fee of $65.00 is required. No fee will be required for filing a variance request upgrading existing onsite sewage disposal systems unless the upgrading involves approval of a building permit. This regulation is to take effect on the date of publication of this notice. Brian R. Grady, R.S., irman XI44� Susan G. R s , R.S i seph C. snow, M.D. OARD OF HEALTH TOWN OF BARNSTABLE FRiECE-IT'D NO. J U N 6 1997 / DATE sMwereete HEALTE i,�.,''C, MAS& TOWN Or EARNSTAQLE S own of Barnsta REC. Board of Healt m REc�r 367 Main Street, Hyannis MA 01J U N 6 1997 TOWN OF 5:;.; Susan Ras , Office: 508-790-6265 G. R.S. FAX: 508-775-3344 a4 Brian R:4 y,R.S. RalphvA. urphy,M.D. VARIANCE REQUEST FORM All variance requests must be submitted at least fifteen(IS)days prior to the scheduled Board of Health meeting. NAME OF APPLICANT��GQ645:5 / r TEL.NO. 77S—��aa ADDRESS OF APPLICANT gdO Q 9V Mhti�ri� NAME OF OWNER OF PROPERTY SUBDIVISION NAME RAIL DATE APPROVED I-11VK ASSESSOR'S MAP AND PARCEL NUMBER A,4-1!" 92- LOCATION OF REQUEST �EL 7h e 73 A CRE SIZE OF LOT SQ.FT WETLANDS WITHIN 200 FT.YES NO VARIANCE FROM REGULATION (List Regulation) .33 b ,e�"4v� id� REASON FOR VARIANCE (May attach if more space is needed) Gdti��iy/N� .3 4 �Gd YID 5 PLAN - FOUR COPIES OF PLAN MUST BE SUBMITTED CLEARLY OUTLINING VARIANCE REQUEST. VARIANCE APPROVED Susan G. Rask, R.S., Chairman NOT APPROVED Brian R. Grady, R.S. REASON FOR DISAPPROVAL Ralph A. Murphy, M.D. TOWN OF BARN' As: . M,pM•M Pt 10" �s ttco�t go PY 9 K n04 .IB I 1 ^ 1 Y e .LO 4:. a 87— N O O gay W (D aoG v .I j Do z C v o •L9+c y� sz I'll 2 SaG U cps 11 .+Inc n .19- 120 3 Z 1 lu 32G •1 leg � sc 2 ,e � `. t w n y3 2 3 4, $ ° .6, 39 4 •tO PG 9E�� ,a�►.e' a 2.S84C 24K RIO e., o }1As o c tl BeAt. ?9 O % �L3 ' �✓"i . .Jill ,2aA o g�-2 •wc ie 0 I4 _i •26t �o' C a -3 c O 2e �sAa tine d/Y ® 'o.,a �a t1 is 6•/ J E6 40 2e4a ;� 364c 8G. >6 u V� 44 1 v 3 0 31L 4, o •23� Q. v; we R L. s P1gSq.S ao tt . a l4 :s 3 lee ... � 'ae 4l8 .. Rio. Szz � 16 >a o I .dAAC R/9 .24A4 / •z3ec 311 2a 4 .31j 1 b •R�-\0 i f0: 3 IS 14 24 3 � O 16 25K 4L� �e O at J ti i =\ W 11 n �o O" •ZZAC O ` .32e.L J `J -1 0 31 4. 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A ..Z90 A-aql-H � ioe 94 - CIRCIE t` •22 fHANGtS�r��r�'�� ♦ a'a r. e Sf .27nc t 07/09/97 10: 16 T 508 945 4999 P.02 Permit Number: Date Completed by: M HIGH GROUND-WATER LEVEL COMPUTATION Site Location: b;eJ40— Lot No. Owner: Q4—,rr • Address: 1 Contractor Address: D D !5 Notes: %6a STEP 1 Measure depth to•water table p tonearest 1/10 ft............................................................................... .Date Ahdts ' O �ylytar STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: OAppropriate index well................................................... W ©Water-level range zone..................................................... D STEP 3 Using monthly report"Current Water Resources Conditions" determine current depth to water level for index well........................... 84 o / ear STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A),current depth to water level for index well (STEP 3), and water-level zone(STEP 28) idetermine water-level adjustment .......................................................................................... STEP 5 Estimate depth to high water by subtracting the water- level adjustment(STEP 4) from measured depth to water p a. level at site(STEP 1)........................ ,g Tr Nure 1&—RWoduCF*cwputdm form. 15 07/09/97 10: 15 T 508 945 4999 P.01 CAPE-'TECH Environmental PO Box 1541 Brewster,MA 02631 Phone(508)896-4999,Fax(508)896-6433 FAX TO: Tom McKean COMPANY: Barnstable Health Department FAX NUMBER: (508)790-6304 PHONE NUMBER: FROM. R.Learned DATE: July 8, 1997 NUMBER OF PAGES(including cover sheet): 2 COMMENTS: High Groundwater Level Computation Sheet for Lot 2 Delta Street. Call me if you have further questions. (If there is a problem with this transmission,please contact us immediately.) ills t:lac:' der II!�IIN� , -i�dy _,;ille w �IIIIIIiIINUB yam: ulalln'nll14 ills ■ . > .. � i. r. �' •t. IIII::;'� � .. � I■/IIII,111111/1■ ���7%(yr Ing III \\1; ■ I■ IIIIgIIItN�� ��w_"•.., Ill ills It! �"�.~�: . �y�. '• F ra _ I A = BEDROOM ii �i r ,.,�.�. BEDROOMs BEDROOM MINES MINES mmum - - - - - - - - - - - - Z"OPEN TO r TOWN OF BARNSTABLE � LOC,ATION':� E l�to SEWAGE # 9-1- 15 3 VILLAGE tyv u A n n is ASSESSOR'S MAP & LOT f INSTALLER'S NAME&PHONE NO. Tat (north 7 7 '8%Z 2 SEPTIC TANK CAPACITY 15oo LEACHING FACILITY: (type) C 6%%Tn 6 tt$ (size) t K.TO o NO.OF BEDROOMS 3 BUILDER OR OWNER J A fiber r!4 J u.t Ides ERMIT DATE: $-Z' -'�'1 COMPLIANCE DATE: eP aration Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility 9 4 1 2 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 ofleaching facility) Feet Furnished by C-h-V Z t5, '� O � �' f• ` � � � � (1 � � ln1 � s �� �� �� . � � - ,l (�:. �e ., !1si ; Egg it :3 oil AY F Hill ... .. ...... . .... 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N[ITES q�•� ,5 EXISTING GROUND SURFACE EL EXISTING GROUND SURFACE EL ,�---- 1) THIS PLAN IS FOR THE INSTALLATION OR REPAIR OF A SEPTIC SYSTEM, AND IS NOT INTENDED FOR SURVEYING ❑R ZONING ~6' MIN PURPOSES. 2 2) ALL INSTALLATION PROCEDURES ND MATERIA4� SHALL CONFORM T❑ 310 CMR 15.000, THE STATE ENVIRONMENTAL CODE, + OUTLET PIPE LEVEL _ Nn_ VENT REQUIRED , TITLE 5, AND THE TOWN : +p4 _ SUBSURFACE DISPOSAL REGULATIONS. — .) (�- TOP EL FIRST TW❑ FEET KN 2' LAYER DnUI1LE VASHED 3) NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE OF AVAILABLE PROPERTY INFORMATION WITH RECORDED DEEDS ;.LL `'��--- LIQjTD LEVEL 1/B'- 1/2' YTDIE D-BnX - 11 1/2' ❑R ZONING REGULATIONS. ��' ' 4) TOWN WATER SERVICES THIS PROPERTY. . 14• Cl Q CI [� l� p p CI Cl Cl p Cl 5) THERE ARE NO KNOWN PRIVATE WELLS ON THIS PROPERTY OR WITHIN 100' ❑F THE PROPOSED SOIL ABSORPTION SYSTEM. INVERT EL ��r= G_ � _ I EFFECTIVE 6) ALL COVERS OF SYSTEM COMPONENTS SHALL BE BROUGHT TO WITHIN 12' OF FINISHED GRADE, WITH ONE COVER OF THE _ / G2r p Q p p p [� SIDEWALL `13• Q� Cress BaP�te at Outlet INVERT EL INVERT EL - SEPTIC TANK', BROUGHT WITHIN 6' OF GRADE. Q 7) ALL SYSTEM COMPONENTS SHALL REMAIN ACCESSIBLE FOR INSPECTION. NO STRUCTURES SHALL BE LOCATED DIRECTLY UPON OR ABOVE THE COMPONENT ACCESS LOCATIONS, WHICH WOULD INTERFERE WITH THE PERFORMANCE, ACCESS, INSPECTION 1 IN EL PUMPING ❑R REPAIR. y r OO± �� 4, Z 81 �' jN[LlOI'8 i— • i 3/4 1 1/2 DOUBLE 8) NO DRIVEWAY, PARKING OR TURNING AREA, OR OTHER IMPERVIOUS AREA SHALL BE LOCATED ABOVE A SOIL ABSORPTION INVERT EL �1� WASHED STONE SYSTEM,. EXCEPT WHEN VENTING .HAS BEEN PROVIDED. 6' STIIItTw' BASE: INVERT EL � / �„ BOTTOM EL � 5 I 9) SEPTIC TANKS, GREASE TRAPS, DOSING CHAMBERS AND DISTRIBUTION BOXES SHALL BE PLACED ON A 6' STONE BASE 1500 G3L S'evila Tank 3 •.F. /3 SIcIL BOTTOM EL TO ENSURE STABILITY AND PREVENT SETTLING. / r- b ' 1 1 10) OUTLET DISTRIBUTION LINES SHALL REMAIN LEVEL FOR A MINIMUM OF THE FIRST TWO FEET OF THEIR LENGTH. 1 Z '- ESTIMATED 1t[GN GROUND WATER 11) ALL SYSTEM COMPONENTS SHALL BE CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10' (using USGS ROUND i) ❑F" DRIVEWAYS OR PARKING OR TURNING AREAS, IN WHICH CASE H-20 COMPONENTS SHALL BE USED. �Z r C1D MIN) 12) ALL BUILDING SEWER LINES SHALL HAVE AN INNER DIAMETER OF 4' AND SHALL BE CAST-IRON OR SCHEDULE 40 PVC. ` 13) THE DEPTH OF THE TOP OF ALL SYSTEM COMPONENTS SHALL NOT EXCEED 36' UNLESS VENTING HAS BEEN PROVIDED, I� V 14) IN THE AREAS OF EXCAVATION, EXISTING GRADES SHALL BE REESTABLISHED UNLESS NOTED AS PROPOSED CONTOURS, NOTABLY FROM �/ 15) F ABSORPTION SYS TEM, THAT DIFFER I S❑I R SOR SOILS A AB E ENCOUNTER E SOIL ENCOUNTERED DURING F TH I G THE EXCAVATION 0encls/3 SIcle5 THE DEEP OBSERVATION HOLE LOG, CONTACT THE ENGINEER BEFORE PROCEEDING. 16) CONTRACTOR TO VERIFY LOCATION OF ALL UNDERGROUND UTILITIES. �I i Ip41 00, {/ i DEEP OBSERVATION HOLE LOG Test Hole #1 Test dole #2 (EL =qg f (EL _ soil �it I�p{,� }Ay g� .. ., a (m) (mil xaatson D E S I G N DATA" Herisan rpz�l �. ) A) (Munson) Ar i4 / o •r- -- I S� ! R 3 Qr g✓ ���� Y a_ r, NUMBER OF BEDROOMS . -------- BR Z � �3 �� Sane 'S � N❑ GARBAGE GRINDER ------ �2 t�' _—3 3 0_—GPO 8 Y Z•t�,.. „ r vycci,, fl <. {. DESIGN FLOW � \ (110 GAL/BR/DAY x NUMBER OF BR) f `� tt (a n Prop. Leaching Facility SET T 1500 c M C-,<Ae)e<1 Four 4 x 8 Flomf�ffusers SEPTIC TANK �� �L.(9, y '------GAL / w13' Stone All Around (MINIMUM DESIGN FLOW x 200%) 100.7 s LEACHING AREA yr SIDEWALL 88 SF 104,00. �' a <2 SIDEWALLS x �.96 FT x _34__FT) + (101.05) 1 C2 ENDWALLS x 6 FT x __12_FT) (97 4) / � BOTTOM 4 0 8__sF Deep oh. Sole n.c« 6/.sa�7 Deep Ube Hole Date: saaib� / 12 3 4 soil Evaluator 2Wd Duman Soil Evaluator. Tod Du"m 100.4 ` / C______FT x _--___FT) Witnessed � JERRr Al NG wlcaa..aa ,,77�� LONG TERM ACCEPTANCE RATE (LTAR) O,74-GPD/SF Paco Rate: 4;k rv+rH ,q ® (oG�► Per* Rate: :Tz rrw r Q 711 f ------ Soil Surrey Description CARVER Soil Sure Description- CARVER r c -7 94.2 ti y P ( c -7 J � 94.5) � LEACHING AREA DESIGN CAPACITY __��•LL__GPD Geologic Haterlat ovr'�rasR Geologic Material- ovnrase Depth to 9 N A Depth to St Wlug water. �/ (100.85) TH#1 (98.6 -r `.�t ) J (SIDEWALL AREA + BOTTOM AREA) x LIAR Depth to 1►se�p ni water. //,"A Depth to Weeping water. I oA$ TBM El 100.00 W Depth to Nottling(Color): N4 Depth to Nottling(Color): Nn/A,/ Top of Conc. Nall W S 1 J Est Seamonal M&b aw n/ Est Seasonal High G1F. q y • / Prop- ro J ro. :•' tlsc8 Ohservat3on wall /J� USGS Observation wail 4• ky.,. ,4��.► Z3e (D ;� Date or la.t Measurement �A Date of last Measurement i�14 45.00'D—B x � 97 4 � �` / I M a-y 2; l y� Commentr. Comments: 7 (100.001 TH#2 J (98.5) (94.2) Prop. 3 Bed . Prop / TOF Ira ter Line Inv. Out =�)5. b (98.55) (98.80) TBM = 10 . I _(9Z 1) Nail in 16" Oalrs / �ro�. LOT ,PROJECT LOCATION i Of Area = 31, 980� ,or (97.7) Cisi ASSESSORS MAP Z �' LOT 6 25.00 (94.2) 1 APPLICANT. Bayberry Building Company (96.75 -� (s2.z) •� Q S�J 300 Bearses Way 1 11 Hyannis, MA - PREPARED BY.• Etc A & M Land Services Cape-Tech EnTim=entat 33 Old Main Street P.O. Box 1541 South Yarmouth MA 026 4� -. • < � � 6 Brewster,. MA 02631 (508) 398-2121 Fax 394-9642 508 896-4999 .,w SCALE- 1" 20 DATE. June 30 1997 ,tN OF T 5 4 �V LOCUS MAP Lot ,2 Delta Street Hyannis, MA DWG. NO. T1065 SHEET 1 OF 1 I