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Home My WebLink About0053 ELDRIDGE AVENUE - Health 53 Eldridge Avenue Hyannis P A = 21 0660 0 6 b h TOWN OF BARNSTABLE LOCATION �. e-,d;6&r104-4--,4V EWAGE#.7 VI1,,LAGE /i��'��/�'sC� ASSESSOR'S MAP.&PARCELo� INSTALLER'S NAME&PHONE NO. 0J yam. Ae4S® jam SEPTIC TANK CAPACITY�"��,pj"i�ts ��® ® ��• LEACHING FACILITY:(type) (size) NO.OF BEDROOMS OWNER PERMIT DATE: C COMPLIANCE DATE:Jo 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 orr 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 0 N7 0 M � rl TOWN OF BARNSTABLE LOCATION C:G rt�S C A VC. SEWAGE # VU,L AGE 1 V AAII I S ASSESSOR'S MAP & LOTa01 (0 0 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY Wb k - n LEACHING FACILITY: (type) (size) !NO GA NO. OF BEDROOMS 3 , .fy BLUDER OR OWNER •y 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 leachingJacility) Feet Furnished by J/1SpE,G 1Cn �0�� A � r ay 20 a aS a � 3 6 3 a� a3 b ._- - LOCATION- ---J�3----- ; - _SEW- AC,E_PERMIT_ U0._ V ILL A.GE Od'z.1.' ItJSTQLLER 5 -MW—AE - ADDRESS_ _ 5UILDER 5 - Q-&".F---�, ADDRESS DN.-TE PERNAIT 155UED DATE COMPLI &DICE ISSUED : 3E �� G �-[ v�lJ'1�r�~J, ��r. , : V l No. � `� • Fee lc cz _ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftpYication for Misposai *pstrm Construction 3permit Application for a Permit to Construct( ) Repair Grade( ) Abandon( ) ❑Complete System ndividual Components Location Address or Lot No.S" _,4 ve Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 292 -- -1!015� Inss�taaller's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building ✓�C No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 70 gpd Design flow provided ` gpd Plan Date Number of sheets > Revision Date Title n Size of Septic Tank a�fWlType of S.A.S. ®�" � �`� "", ICJ Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board o Si,946 Date Application Approved by Date 8 /® Application Disapproved b Date for the following reasons Permit No. 04/(j 2 Date Issued VZO�?c�/�, r No. �`' �� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: x�. PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 21ppliLation for -Misposaf *pstrm Construction Permit Application or a Permit to Construct( Repair A Upg ade( ) Abandon( ) ❑Complete System RKndiidual Components Location Address or Lot No.S` d ��U� Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 2 9 2 1y Installer's Name,Address,and Tel.No. ' Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building 4;�4ep No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 0 gpd Design flow provided y9 gpd Plan Date ,P —i'O Number of sheets / Revision Date Title n Size of Septic Tank ,"Oo O 4 Type of S.A.S. C CGr,"ne C�� v�,► " Description of Soil , (`gg1gt Z,,2eC Nature of Repairs or Alterations(Answer when applicable) �'G�� /l✓ 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 oWent� 4 Si Date cY rI Application Approved by _ — Date /o TD/6 Application Disapproved b Dates for the following reasons Permit No. OQ16 — 2 Date Issued O --------------------------------------------------------------------------------------------------------------------------------------- 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 /Xf�! �'�DQO�l/�' ,f'G "i T/C �r liG at 1-3 g-L44Eol � �iE �_�/ has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit NoA16—0:76 dated 0/10 Zee//n Installer 1:z�-ow Z,c�`i�i,��'!// Designer ��/,�p �i"•�� #bedrooms Approved design flow and The issuance of this erm•t shall not be construed as a guarantee that the system wi functio 's designed. Date ( 0 Inspector ------------------/------------- -------------------------------------------- --------------------------------------------------- G�C) No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Mispo8al *pStem Construction lermit Permission is hereby granted to Construct( ) Repair(.ljJ� Upgrade( ) Abandon( ) System located atl/Ge" 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:Conac ion must be completed within three years of the date of this permit. Date //U��,,b Approved by From: 08/12/2016 10:24 #219 P.001/001 Town ®f Barnstable �aFnie r �o Regulatory Services Richard V.Scan,Interim Director ' HAPMAK4 9� MAM. Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Officer 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form j Date: r 1Z ((0 Sewage Permit##®/O M Assessor's Map\Pareev Designer: '�__ i �1 Installer: Address: %: VWC� Address: On.. �� (� --m_ was issued a permit to install a ( (installer) septic system at WL Ullgased on a design drawn by e. I4(a s) �� dated 1� Zc)l b (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes y pp d such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. 1 certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State& Local Regulations. Plan revision or certified as-built by designer to follow.. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in co n]iance with the terms of the IAA approval letters (if applicable) ,ole" aFA'gs� (Instal er's Sign e) MASON N0.1066 STE?, d esi a ignature) (Affix Desi mp Here) PLEASE RETURIN 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 DMSION. THANK.YOU. QASeptic\Designer Certification Form Rev 8-14-13.doc Town of Barnstable P#. 1 Departitnent of Regulatory Services ,� Ux Public health Division AM Date 1439•A 200l Main Street,Hyannis MA 02601 ' fEll MA't `" ' Date Scheduled Time . ( � Fee Pd. �� a Soil Suitability A.ssessmentfor Sewage I)isposal Performed By:. �._ \ -a. '' r ' • Witnessed By: V( �_S v f LOCATION& GENERAL INFORMATION Location Address � .�C� t/,� ��1,r Owner's Name Assessor's Map/Parcel Engineer's Name NEW CONSTRUCTION_ REPAIR 11� Telephone# 1 l Land Use Slopes(9'0) "Surface Stones .. Distances from: Open Water Body fl Possible Wet•Aiea' ft Drinking Water Well ft Drainage Way ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands 11n proximity to holes) A I 2 Parent material(geologic) Depth to Bedrock Depth to Groundwater. Standing Water in Hole: Weeping from Pit Fnce Estimated Seasonal High Oroundwater Method Used: DETERMINATION FOR SEASONAL-HIGH WATER TABLE Depth Observed standing in obs.hole: In, Depol to sell mettles: Depth to weeping from side of obs.hole: ltt Index wea#, IL Groundwater Adjustment ft. Reading Date: Index Well levol Adj,[actor Adj.Groundwater :Level _ Observation PERCOLATION TEST bate Time Hole LP Time at y" Depth of Pero Time at G' Start Pre-soak Time @ Time(9"6") _ ^ End Pre-soak Rate Min./Inch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Back—------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1) week prior to beginning. Q:IS EPTIC\PERCFORM.DOC DEEP-OBSERVATIONHole'BOLE LOG # , Depth from Soil Horizon Soil Texture Shcl Color Soil Other i Surface(in.) ('JSDA) (Munsell) Mottling (Structure,Stones,Boulders. or sii 'stency,%Gravel) -2 lo e i w, DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Otlrer Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.T2 ra DEEP OBSERVATION BOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%O DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color ` Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones',Boulders. r• Consistency, y Flood Insurance Rate Maps Above 500 year a ood boundary No Yes _ Wititin 500 year boundary No Within 100 year flood boundary No,/✓/ Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring per v o t rial exist in all areas observed throughout the area proposed for the soil abso-ptibn system? If not,what is the depth of it turally occurring pery ous matorial?� V Certification ��rr I certify that on "� (date)I have passed the soil evaluator examination approved by the Department of Enviro ental Protection and that the above analysis was perfor ed me consistent with . the required training, x or' a p ience described in 10 CMR 15.017. Signatur Date Q:\S@PTIC P-RCPORM.DOC Date: TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: )abA_co P006:7 t-)Cr Cpr-'S iku��ip� BUSINESS LOCATION: /"k A Q460 / MAILINGADDRESS: C &,-n,,s Mail To: Board of Health TELEPHONE NUMBER: ,�`co 8 - �3 8 16 �'y Town of Barnstable CONTACT PERSON: C U/� 11J O C�CY v I`R P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: Hyannis, MA 02601 TYPEOFBUSINESS:_ ROOF #, IJ& ✓-1 JD C,APP2:"j,7Py Does your firm store any of the toxic or hazardous materials listed below, either for sale or for you own use? YES NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Quantity Antifreeze(for gasoline or coolant systems) Drain cleaners NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Lo,us Gasoline, Jet Fuel Photochemicals (Fixers) Diesel fuel, kerosene, #2 heating oil NEW USED Other petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) Swimming pool chlorine Rustproofers Lye or caustic soda Car wash detergents Jewelry cleaners Car waxes and polishes Leather dyes Asphalt & roofing tar Fertilizers Paints, varnishes, stains, dyes PCB's - Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint & varnish removers, deglossers An h „ y other products with poison labels Paint brush cleaners (including chloroform, formaldehyde, Floor & furniture strippers hydrochloric acid, other acids) Metal polishes Laundry soil & stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION p ivIAP PARCEL. LOT TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 53 Eldridge Avenue Hyannis, MA 02601 Owner's Name: Bill Davis Owner's Address: Date of Inspection: March 25, 2004 Name of Inspector: (Please Print) James M. Ford 6 Company Name: James M. Ford �, :111i Mailing Address: P.O. Box 49 0 70 Osterville,MA 02655-0049 t , co Telephone Number: (508) 862-9400 -i `� CERTIFICATION STATEMENT z - I certify that I have personally inspected the sewage disposal system at this address and that tf e inform"ion r?jjorted'-. below is true,accurate and complete as of the time of the inspection. The inspection was per rmed baged onrmy training and experience in the proper function and maintenance of on site sewage disposal sy ems. I am a IRP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: March 28, 2004 The system inspector shall sub t 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 Page 2 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 53 Eldridge Avenue Hyannis, MA Owner: Bill Davis Date of Inspection: March 25, 2004 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: 53 Eldridge Avenue Hyannis, MA Owner: Bill Davis Date of Inspection: March 25, 2004 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 an determines that h y ( pp y) a t 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: 53 Eldridze Avenue Hyannis, MA Owner: Bill Davis Date of Inspection: March 25, 2004 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. 1 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- I WPA)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: 53 Eldridge Avenue Hyannis, AM Owner: Bill Davis Date of Inspection: March 25, 2004 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 r Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 53 Eldridge Avenue Hyannis, MA Owner: Bill Davis Date of Inspection: March 25, 2004 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: 1 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): n/a [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: Currently occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Pumped 2 weeks ago-per owner(for maintenance) 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: Installed 1218175-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 53 Eldridge Avenue Hyannis, MA Owner: Bill Davis Date of Inspection: March 25, 2004 BUELDING 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: 1000 gal. Sludge depth: 0" Distance from top of sludge to bottom of outlet tee or baffle: 31" Scum thickness: 0" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 14" 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.): Cement 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.): 7 i Page 8 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 53 Eldridge Avenue Hyannis, M4 Owner: Bill Davis Date of Inspection: March 25, 2004 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: aal lons 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: None (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 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.): 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 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 53 Eldridge Avenue _ Hyannis, MA Owner: Bill Davis Date of Inspection: March 25, 2004 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located gxplain why: Type ✓ leaching pits,number: I -6'x 6'(1000 gal.) 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.): The pit had 6"of water on the bottom. The scum line was at approximately 3. There did not appear to be any signs of failure. The cover was 2'6"below grade. 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 • Page 10 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 53 Eldridge Avenue Hyannis, MA Owner: Bill Davis Date of Inspection: March 25, 2004 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. A B ay ao o a Ca a LQ3 3 y 3( 306 0 Y 10 • V Page 11 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 53 Eldridge Avenue Hyannis, MA Owner: Bill Davis Date of Inspection: March 25, 2004 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: 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 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 andlor this report. 11 No. ................ Fizic.1/0................. THE COMMONWEALTH OF MASSACHUSETTS 0 BOARD iEA Z�H .....OF......... .!8"4'_- Lj4 0......... Appliration -for Uhipviial Workii Towitrurtion Puntit Application is hereby made for a Permit to Construct ((4 or Repair an Individual Sewage Disposal Sy-- --••---- stem at .. ....... ................ ........................................ . 0" Address or W 0 d .. .... ......... . . ..... .. .............................. ..... ... vI. ..... 9&,j�Adres ..... ... . . . ........... 0----------------------- 'aPtaller Address Type of Building Size Lot...A6,,.7j19W------Sq. feet U Dwelling—No. of Bedrooms-----3....................................Expansion Attic Garbage Grinder ( ) -1 PL4 Other—Type of Building ---------------------------- No. of persons-________________________-__ Showers Cafeteria ( ) Other fixture ..... Design Flow.....---------- �a V.............a..1.1.o..n...s...per. ...person ....... .......... ----------------------------------------------------- per day. Total daily flow___.._.___. _________________...__...,gallons.0' P -------gallons Length________________ Width-____--_-_-__.-......... 1) Depth_--_______-__-_ 9 Septic Tank/—Liquid capacit .iamety-------_---_- Disposal Trench—No_____________________.( Wid I------0 g1h a 1,,ng a.rea--------------------sq. f t. t Imeter/2� -- ---- W opo b� 0 a aching are- ------------_--sq. it. Seepage Pit No./--------------- Z Other Distribution box ( ) Dosin�tank 7f Percolation Test Results Performed by-------------------------------------------------------------------------- Date---------------------------------------- Test Pit No. I................minutesperinch Depth of Test Pit_-_-________________ Depth to ground water---_--__-____________. r=, Test Pit No. 2................minutesper inch Depth of Test Pit-__.. ------------- Depth to ground water__-_--_____--__.______-- --- --- ---------- 0 Description of S 'I ------ 1 - - -- 0 -------------- U ----------------------------112---- ------ ..........................................------------------------------------------------------------------------------ ------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable---------------------------------------------------------------------------------- ------- ----------------------------------------------------------------------------------------------------------------------------------------------------- ----------- ------Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI 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 t e)board of health. 'Qed... t: ---------- Date A .... Igr Application Approved By.............. .... .. .... ... A__ _______44 - -- Date Application Disapproved for the following reasons:-------------------------------------- ----------------------- ............................................ -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Date PermitNo......................................................... Issued........................................................ Date No.......................... FRiz /Jo............... THE COMMONWEALTH OF MASSACHUSETTS BOARD 0 HEAn-_,TH ....OF........... ----------- Appliration 411r. ER-4pagat Works Towitrurtion Prrutit Application.lis hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: ................................................................................................ ................................................................................................. Location-Address or Lot No. ...................................................................♦#----------------------------- -------------------------------------------------------------------------------------------------- Owner Address ................................................................................................. -----7............................................................................................ Installer Address U Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic Garbage Grinder -1 'Other—Type of Building ............................. No. of persons-______:-____..__......__:.. Showers Cafeteria P4 Other fixtures ... Design Flow.................. nla ......./ per day. Total daily flow...........6.j-----------------------_---gallons. a ons per person y P4 Septic Tank-1 Liquid capacity/ t1lons Length________________ Width_____--__----.- Di mete ---------I...... Depth-.--______._.._ Disposal Trench—No- ---------- ------ -"Alid ing area--------------------sq. f t. aching ---------------- Diameter_. ching area------------------sq. f t. Seepage Pit No.--/ t b Jo mete �4 Other Distribution box Dosing tank 7 1",ft Percolation Test Results Performed by------ Date---------------------------------------- Test Pit No. 1----------------nunutesperinch 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 So ----------- . ..... U -------------------------- ---------------------------------------------------------------------------------------------I................................. ------------------_----- ----------- --------------------- ----------------------------- ----------------------7....... ----------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable._-_______________________ _ ___________________________________.......................... ......................................................................................................:------------------------------------------------------------ -------------------------------- Agreement: The undersigned agrees to install the -aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI 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. d -- .....; 00e- -------- AlD..a.t7e Application Approved By------- �.... - .- ✓------- ------------------------- Date Application Disapproved for the following reasons----------------------------------------I /----------------------------------------------------------------------- ------------------------------------------------------------------------------------------------- ..................... ............------------------------------------------------------------ Date PermitNo........................................................ Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS, BOARD. OF.4HEALTH .....OF.-..._ . . .. .................................................. .... ......if %Vtdif iratr of "Tantphauri IS a CERTI t diyidual,Sewage Disposal System constructed or Repaired by.. Adhdmf 00-0 ----------------------------------------------------------------------------------------------- Installer V ---- .. ..... . .... ........................................................ ...... has been ..nst'. d,in accor da c with the provisions of Art* f he State Sanitary Code as described in the .. ... ............ application for Disposal WoesConstruction Permit No.. dated. -..../A------ ......... THE ISSUANCE OFi; HIS CERTIRCATE,SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL UNCTION SATISFACTORY. DATE....................... ............... Inspector---- ............................................. ...................................... .......................................... THE COMMONWEALTH OF MASSACHUSETTS :BOARD Of,4HEALTH 910A 1,11 .. , . 1 5 N ... ... I . . --------------------- ........................ FEE.& .........r trrntit Permission iy ljoif-by granted---- -- -- ----- -- -- ----- --------- -------- to Const or Falr n4* i I S Di sal Sys em 4, at No. AUC -41 ...... et _*------------ - - -- ------o- as shown on the application for Disposal Works Construction. r t No.. .._ . t d ----------------------------------------- ------- ----- . ..... oa ' l, f ealth DATE........ .................................................................. FORM 1255 HOBBS & WARREN. INC.. PUBLISHER!g 4 �S'" .-net �,y"�i.-.�. \ ��'6a-�^�,.,�,`�.. t� �,2 r �',`I' y th �.:r7� < ")rt .-� t ,��1U, 'el-+"y i �.�k� � --y �^ , tw. t4 s�,• �z� � a )� _ � ��a �. ro ��f xi ti -sti c.., '' t� i �°' r. r� � .✓ E , .::i ��S# �t��z� a 7 a _I aO s ry 72 '�_. ar t, h 1�'L f �. f �1 r: a � . �3 3''t x p �{,' V s .v I/O+ ;. t•r�'�"a1 e s � -, a 'P -s _ ,.r s± a p,�: 8 I Z Z, s' d 3 r � `�.I�.HFREBY 'CERTIFY THAT THE 7:P1 AN OF LAND_a STRUCTURE $T.RUCTURE, SHOWN S"t1EREON"WAS"§:LGEATEG � - �----�-�- �.� 9Y AN .ACTUAL FIELD ;SURVEY ON N =�f r:�f �NOV ZC�' 19TS�"�,ANO �"CON_ FORMS TO':,,THE = �„� I'�( �20NIN0 .BYLAW �OF T�iE TOWN�:OF 1 MAssacrtus�`rTs . . � `. ,.{ iN t x ,QA e,v sra 6 LE � � � � .5'EE NG Vi°1 e/ANCG�. . � E � '� ,BAievsrA c sa MASS S S a V BA 12 N STf� ' ' REGISTERED �A D ,SU EYOR ,� SCALE 1 ��.(� ,Nov ,W t yl DATE x ��' Mgss 4„. r— SO INC.°l f:APt~ COD SURVEY, CQNSULTANTS YOUNG � y ,, A DIVISION . OF BOSTON SURVEY �CON3ULTANTS,IN tIYANNIS, MASS a � r4 SUM ASSESSORS MAP :PARCEL: TEST HOLE LOGS - - -- � .. _ 1) The insta11,1iort dull eornp with Tille V alid 'I'mVII o hoard of FLOOD ZONE: �` , , ' ,� SO I L EVALUATOR :c: /'P I lealth Regulafions. WITNESS : DI OVI.C-,t REFERENCE: 2) The installer shall verify the location of utilities, sewer inverts and septic / ' PATE: l r PERCOLATION ATE:----" 3) All gravity septic components prior to installation and selling base elevations. 1 � � , .� / __- t a piping to be 4 inch Sch ,10 PVC at 1/8" per foot. The first e V. UV �� — two feet out of the d-box to the icraching shall be level. _T_Yr •� __,_ ___ ___ _._..,.. : r.___ r•m_ TH- 1 I -2 4) This plan is not to be utilized for property line determination nor any other ; purpose other than the proposed system installation. 5 All septic components must meet Tille V specifications. t 3 6) Parking shall not be constnicted over 1110 septic components. tt; 7) The property is bounded by property corners and property lines. �Q 8) The property owner shall review design considerations to approve of total LOCATION MAP ? `' design flow b o ;� � g wand number f bedrooms to be considered For design. Receipt • 1° of payment for the plan and installation based on the plan shall be deemed -- -- - - . i_ approval of redesign flow by the owner p t i 9) The existing leaching or cesspools shall be pumped and filled with material per Title V abandonment procedures. Those within the proposed SAS shall be removed along with contaminated soil and replaced with.clean sand per. l?o.� r� i tt ,`�;, Title V specs. NoT P.4VG0 o. I �'®-_!�! .�_ _ 0)System components to be 10 feet from waterline. Sewer• !fines crossing !be water n l sleeved with �I inch SCI 140 PVC with ends grouted 'r applicable. TheSAS is being installed below the water service 1 line. The line is to be sleeved as aforementioned and maintained in lace. SEPTIC SYSTEM DESIGN P ' 1 1) Ira garbage grinder exists it is to be removed and is the responsibility orthe ' owner to ensure such. \ FLOW ESTIMATE 12)The installer is to take caution in excavation around the gas line irsrich ex ists. (� BEDROOMS AT ✓/ GAL/DAY/BEDROOM A GAL/DAY 13)'I'ite installer sbnl) verify Ibe Incalion, gnnnlily and clwaliuu of thi sewer lines exitinn the dwellinl;'brior to the installation. SEPTIC WANK 14)Tbis plan is representative only that a system can fit on a property rneetin r Title V requirements. ^� GAL/DAY x 2 DAYS - GAL USE IC GALLON SEPTIC TANK m �. t�► o SOIL ABSORPTION SYSTEM Lb fl 107 SIDE AREA: � I ' - X , >( 77 114 �' DAVID ' BOTTOM AREA: - 5 ,f t ^� , 't a = „ MASON � / P .1 P�'"Al C� 39 a��® _ 3� W SEP P=- SYSTEM SECTION r r ��80 /y 03 V ! 47k -c N17 GAL �Tl?(� >U. ' 1.t�1�lk•1 q.. � l � SEPTIC TANK -785 4/ 4L SITE AND SEWAGE PLAN � i LOCATION : --- PREPARED FOR : I P H C� SC W LE : - C? a oy DAV I D B . MASON b DATE: Its DBC ENV I RONMENtfAL DESIGNS EAST SANDWICH . MA DATE HEALTH AGENT 50 S 8 3- z 3 2177 �rrrrr�.uerrrrrrnr■rwir.■■r■ — - a■,.