HomeMy WebLinkAbout0086 ELM STREET - Health 86 Elm Street '
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TOWN OF BA RNSTABLE
LOCATION El 7'` SEWAGE # 9-00 t 7
VILLAGE L W a'rl 't is ASSESSOR'S MAP & LOT f D. I
INSTALLER'S NAME&PHONE NO. :C. L•tar fj 1qn
SEPTIC TANK CAPACITY l SAC Ci 01 .
LEACHING FACILITY: (type) f/t't"� �'4t-OC C. (size)
NO. OF BEDROOMS ii
BUILDER OR OWNER -T y d t 'T r+V S
PERMIT DATE: COMPLIANCE DATE: I aL
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
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COMMONWEALTH OF MASSACHUSETTS
H W EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
d DEPARTMENT OF ENVIRONMENTAL PROTECTION
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PARCEL
TITLE 5 LOB -"1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 86 Elm Street
Hyannis MA 02601
Owner's Name: Judith Titus
Owner's Address: Same
RECEIVED
Date of Inspection: April 7,2004
Name of Inspector: PATRICK M. O'CONNELL APR 2 12004
Company Name: SEPTIC INSPECTION SERVICES CO. TOWN OF BARNSTABLE
Mailing Address: 189 CAMMETT ROAD
HEALTH DEPT.
MARSTONS MILLS MA 02648
Telephone Number: 508-428-1779
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is hue, 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 DE p�%%X%111oF III
P I/
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: `�� •ZH...,MR• qi��'��
X— Passes
- - � ATRI :G
Conditionally Passes •m r
Needs Further Evaluation by the Local Approving Authority , I:LL ;y
Fails 1Ae
•• !k�
Inspector's Signature: Date: _04/07/04_ IN
The �slflfti t111111�
The system inspector shall submit 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: Observed no standing water in infiltrators.
****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 l
i
Page 2 of I I
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 86 Elm Street,Hyannis
Owner: Judith Titus
Date of Inspection: April 7,2004
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
_XX_ 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:
Page 3 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 86 Elm Street,Hyannis
Owner: Judith Titus
Date of Inspection: April 7,2004
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(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:
Page 4 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 86 Elm Street,Hyannis
Owner: Judith Titus
Date of Inspection: April 7,2004
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections:
Yes No
_X_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
— _X_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
_X_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
_X_ Liquid depth in cesspool is less than 6"below invert or available volume is less than %2 day flow
_X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped
_X_ Any portion of the SAS,cesspool or privy is below high ground water elevation.
_X_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
_X_ Any portion of a cesspool or privy is within a Zone I of a public well,
_X_ Any portion of a cesspool or privy is within 50 feet of a private water supply well.
— _X_ 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 forma
_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 Systems:
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 11 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.
A
Page 5ofII
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 86 Elm Street,Hyannis
Owner: Judith Titus
Date of Inspection: April 7,2004
Check if the following have been done. You must indicate"yes"or"no"as to each of the following:
Yes No
_X_ _ Pumping information was provided by the owner, occupant,or Board of Health
_X_ Were any of the system components pumped out in the previous two weeks?
_X_ _ Has the system received normal flows in the previous two week period ?
_X_ Have large volumes of water been introduced to the system recently or as part of this inspection`?
_X_ _ Were as built plans of the system obtained and examined?(if they were not available note as N/A)
_X_ _ Was the facility or dwelling inspected for signs of sewage back up'?
_X_ _ Was the site inspected for signs of break out
_X_ _ Were all system components,excluding the SAS, located on site?
_X_ _ 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'?
_X — 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 .
_X_ — Existing information. For example, a plan at the Board of Health.
_X _ 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)]
I
Page 6 of I I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 86 Elm Street,Hyannis
Owner: Judith Titus
Date of Inspection: April 7,2004
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 4 Number of bedrooms(actual): 4
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440
Number of current residents:4
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):
Seasonal use: (yes or no): No
Water meter readings, if available(last 2 years usage(gpd)): Two years consumption: 170,250 gal.=233 gpd
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: None
Source of information: -
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
_X_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:
Compliance date: 12/14/01
Were sewage odors detected when arriving at the site(yes or no): No
Page 7 of I I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 86 Elm Street, Hyannis
Owner: Judith Titus
Date of Inspection: April 7,2004
BUILDING SEWER: X (locate on site plan)
Depth below grade: 16"
Materials of construction:—X—cast iron _40 PVC_other(explain):
Distance from private water supply well or suction line: 30'
Comments(on condition of joints, venting, evidence of leakage, etc.):
SEPTIC TANK: X (locate on site plan)
Depth below grade: V
Material of construction:—X—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: 10.5' long x 5.8'wide—1500 gal.
Sludge depth: 2"
Distance fi•om top of sludge to bottom of outlet tee or baffle: 30"
Scum thickness: 1"
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: 12"
How were dimensions determined: STICK WITH HINGE FLAP.
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 intact and clear,liquid level at bottom of outlet pipe
GREASE TRAP: No (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.):
Page 8 of I 1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 86 Elm Street,Hyannis
Owner: Judith Titus
Date of Inspection: April 7,2004
TIGHT or HOLDING TANK: No (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: X (if present must be opened) (Iocate on site plan)
Depth of liquid level above outlet invert: 0"
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.):
Box set level,no solids or high stains One outlet pipe
PUMP CHAMBER: No (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.):
n
Page 4 of'11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 86 Elm Street, Hyannis
Owner: Judith Titus
Date of Inspection: April 7,2004
SOIL ABSORPTION SYSTEM (SAS): X (locate on site plan,excavation not required)
If SAS not located explain why:
Type
leaching pits, number:
_X_leaching chambers,number: 5 Infiltrators.
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.): Checked interior of infiltrators with camera observed no standing water.
CESSPOOLS: No (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: No (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.):
Page 10 of 1 I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 86 Elm Street,Hyannis
Owner: Judith Titus
Date of Inspection: April 7,2004
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.
Elm Street
1n
Page 11 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 86 Elm Street, "yannis
Owner: Judith Titus
Date of Inspection: April 7,2004
SITE EXAM
Slope None
Surface water None
Check cellar Dry
Shallow wells None
Estimated depth to ground water: More than 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:
Checked with local excavators, installers-(attach documentation)
_X_Accessed USGS database-explain: USGS topo map and town CIS
You must describe how you established the high ground water elevation:
Town groundwater contour map shows water at el.20 and topo map shows property at or above el.
45. Bottom of SAS 4-5' below grade leaving more than 20' of separation to groundwater.
Health Complaints
10-Sep-01
Time: 10:00:00 AM Date: 9/6/01 Complaint Number: 3066
Referred To: LEE MCCONNELL Taken By: LEE MCCONNELL
Complaint Type: Title V SEWAGE
Article X Detail: UNSANITARY CONDITIONS
Business Name:
Number: 3066 Street: 86 Elm St.
Village: HYANNIS Assessors Map-Parcel: 310/189
Complaint Description: complaining about her overflowing
cesspool which had failed inspection at the time
of the closing of her house. She purchases the
house at 86 Elm St. on June 26, 2001 under the
agreement that$7500.00 was put in an escroll
account to upgrade the present septic system.
She has contacted the lawyer Richard Curley
who opened the account but has not recieved
any phone calls back.
Actions Taken/Results: I went out 09/06/2001 and 09/07/2001 to
investigate her complaint. On the second day I
observed her overflowing cesspool. I spoke to
her about the situation, and explained that she
was responsible for the failed septic system.
On 09/10/2001 1 sent a certified.notice,
REGULATION 310 CMR 15.02 (207)AND 105
CMR 410.300 regarding the health hazard. I
called Richard Curley twice but has also not
heard back from him.
Investigation Date: 9/7/01 Investigation Time: 11:00:00 AM
1
t
Health Complaints
10-Sep-01
2
The Town of Barnstable
0
: H9T ? Department of Health, Safety and Environmental Services
' 39� Public Health Division
367 Main Street,Hyannis,MA 02601
Office 508-790-6265 Thomas A.McKean
FAX 508-775-3344 Director of Public Health
September 10, 2001
Richard Curley
77 Robbins Lane.
Osterville, Ma 08655
Dear Richard Curley:
Please be advised the following notice has been sent to Judith Titus at 86 Elm St,
Hyannis, regarding her overflowing cesspool. According to Judith a septic inspection
was conducted at the closing; which did not meet the Title V requirements. This report
was never filed at this office. Please contact the Health Department immediately at 508-
time and consideration.
862-4740 to rectify this matter. Thank you for your m s
Sincerely,
6
Lee McConnell
Board of Health, Town of Barnstable
oFSHE Tp� Town of Barnstable
Regulatory Services
RAMi
ikss`fig Thomas F. Geiler,Director
�A 1b39
'Foy Public Health Division
.o_
Thomas McKean, Director
367 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Judith Titus
86 Elm Street
Hyannis, MA 02601
NOTICE TO ABATE VIOLATIONS OF 310 CMR: 15.00 THE STATE
ENVIRONMENTAL CODE TITLE V:..MINIMUM REQUIREMENTS FOR THE.
SUBSURFACE DISPOSAL..OF SANITARY SEWAGE AND 105 CMR 410 00
STATE SANITARY CODE If - MINIMUM STANDARDS OF FITNESS FOR
HUMAN HABITATION.
The property owned by you located at 86 Elm Street was inspected on September 7,
2001 by Lee A. McConnell Health Inspector for the Town of Barnstable, because of a
complaint. The following violation of 310 CMIZ15.00, the State Environmental Code,
Minimum Requirements for the Subsurface Disposal of Sanitary Sewage and 105.
CMR 410.00 State Sanitary Code 11 - Minimum Standards of Fitness for Human
Habitation was.observed:
REGULATION 310 CMR 15.02 (207) AND 105 CMR 410.300:
Overflowing sewage onto the ground. This violation is a serious public health hazard.
1). You are directed to hire a licensed septage hauler to pump the overflowing cesspool
within twenty-four(24) hours of receipt of this letter.
2) You are also directed to keep the on-site sewage disposal system pumped as many
times as necessary to keep from overflowing onto the ground.
3) 'You are further directed to contact and hire a professional engineer to design a septic
ZD
system which meets local and state regulation requirements within seven (7) days of
receipt.of this letter in order to repair this system or connect to town sewer.
You may request a hearing before the.Board of Health if written petition requesting same
is received within seven (7) days after the date the order is served.
Non-compliance could result in a fine of up. to $500.00. Each day's failure to comply
with an order shall constitute a separate violation.
PsDER THE BOARD OF HEALTH
. McKean
Director of Public Health
No. 4 FEE ST I
COMMONWEALTH Of MASSACHUSETTS
Board of Health, 1>Gt.�fivS'�Gv�D(K MA.
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair( ) Upgrad,�'<Abandon( ) - 4Complete System 0 Individual Components
Location ,(j /C 0-1S y`e�� YC1410 is Owner's Name -A T1,4vj
Map/Parcel# Address X C14-w f&r-e �
Lot# - Telephone#
Installer's Name . Designer's Name mil.
i
Address Address CeWA- G
Telephone# g�,, � Telephone# SZ4 --[l Zi7,?er Z
&
Type of Building ,t`6f� Lot Size•D //`1 L-ser'fC"
Dwelling-No.of Bedrooms Garbage grinder ( )
Other-Type of Building No.of persons Showers ( ),Cafeteria ( )
Other Fixtures /`
Design Flow(min.required) ( y 40 gpd Calculated design flow yd Design flow provided `7 -7 gpd
Plan: Date Number of sheets Revision Date
Title
Description of Soil(s) / i
Soil Evaluator Form No. Name of Soil Evaluator 8 ' ✓✓!dt Date of Evaluation 0— / Z "ZOW l"
DESCRIPTION OF REPAIRS ORALTERATIONS
The undersigned agr9q to inst above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees on ot place tern in operation until a Certificate of mplian a has been issued by the Board of Health.
Signed Date ' a r
Inspections
,r.
N � FEE
Board"o Health
f ,
APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair( Upgrad94,Abandon( ) -4Complete System ❑Individual Components
Location G F S f r e�-- H�s Owner's Name Ty 4 14 T�-�jf
Map/Parcel# Address A C k r- —e
Lot# "7 —7 Telephone#
Installer's Name ea, ,'- Designer's Name
Address Address
Telephone# Telephone# S'jj�—G� Z�� ,?, lJ Z
Type of Building 1f�(,- Lot Size 40
Dwelling-No.of Bedrooms "7 ii Garbage grinder ( )
Other-Type of Building l No.of persons Showers ( ),Cafeteria'R(;')+
Other Fixtures41/
f f
Design Flow (mini required) / y 40 gpd Calculated design flow yd Design flow provided 7 7 gpd
Plan: Date. Number of sheets Revision Date
4
Title
Description of Soil(s)' l
Soil Evaluator Form No. Name of Soil Evaluator R/o,"!h Date of Evaluation l/ — � 2 -240
DESCRIPTION OF REPAIRS OR ALTERATIONS
..............
The undersigned agr es to inst1, above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees to no to place ti system in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed Date ( i '' 0 `
i
Inspection
No. COMMONWEALTH Of MASSACHUS ETTS FEE SV
f
Board of Health, 13�-' �L lie MA.
CERTIFICATE OF COMPLIANCE
Description of Work: ❑Individual Component(s) Xcomplete System
,The undersigned hereby certify that the Sewage Disposal System; Constructed ( ),Repaired ( .),Upgraded ( ),Abandoned ( )
by:
at AZ,7 /*'-
has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application Nq��! dated 101'1"ZJI. Approved Desig Flow (gpd)
Installer i LA,
Designer: Inspector: Date: t2 d
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
No.1voo"Z- %w) FEE
Board of Health, �� h J e�K,4& , MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Lat
rmission is hereby granted to; Construct( ) Repair( ) Upgrade Abandon( ) an individual sewage disposal system
Z62 /dJ'! �J/Y� � "661 Gt.�?i1�a as described in the application for
sposal System Construction Permit No. OV'0 , dated12' -ovided: Construction shall be completed within three years of the date of t 's permit. All local conditions must be met.
.1255 Rev.5/96 A.M.Sulkin Co.Boston,MA DateZj', ' r Board of Healt
TOWN OF BARN STABLE
LOCATION._ ��Yvt ��� SEWAGE #
VILLAGE L`}W G,.rin l ASSESSOR'S MAP& LOT f D
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY t S t cv q I.
LEACHING FACILITY: (type) .rt-le l�T(?at'�'p�` (size)
NO. OF BEDROOMS
BUILDER OR OWNER V
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
Ll
o use, fl _C 3.s. q
0-C '®'o '
3 -D 37
snum
NOTICE-: This Form Is To Be Used For the Repair Of Failed
Septic Systems-Only..
PERCOLATION TEST AND-SOIL,EVALUATION EXEMPTION
FORM
6-� E•e Q 'rtnS&vr 0•S•, hereby certify.that the engineered plan,signed by me
- dated , concerning the property-located at
Y-4 -1 vn Sir__e meets all of the
following criteria: }
This failed system is connected-to a residential dwelling only. There are no
commercial or business uses associated with the dwelling.
The soil is classified as CLASS I and the percolation rate is less than or equal to 5
minutes pet-inch. The applicant may use historical data to conclude this fact-or_may
conduct preliminary tests at the site without a health agent.present.
• There is no increase in flow and/or.change in use proposed
• There are-no variances requested or needed. - -
The bottom of the proposed leaching facility will not--be located less than fourteen
-(-14) feet abovd the maximum adjusted groundwater table elevation._(Adjust the
..groundwater table using the Frimptor_method when applicablel
Please complete the follo)vwig:
A) Top of Ground Surface Elevation (using GIs information) 4P
B) G.W.-Elevation +adjustment for-high G.W. _0 _ 0I'M�
DIFFERENCE BETWEEN-A and-B
SIGNED DATE:
NOTICE
Based upon the above information, a repair permit will-be issued for :bedrooms
maximum. No additional bedrooms are authorized in the future without engineered
septic system plans. t �;
a%,-x% A-%JJIXIIII
Page i or 3
No. -Date: 10 VV
Commonwealth_of LM&SSa&USettS
f_?a-,,-*-*P,-tole- Massachusetts
- Soil-Su Sewage Disposal
-1,//�/
j��1-7 .. ..........
Performed-By: Date:
WitnessedBy: ..................................................................................................................................................................
y6 _7`1TvJ
Aftcu.MW
Tcw=I
New construction Repair
Office Review
Published Soil Survey Available: No M Yes ❑
Year Published -.... ....... -Publication-Scale ..... ........... Soil Map Unit
Drainage Class Soil Limitations . .. . ........... ... .. . ...........
Surficial Geologic Report Available: No 1_1 Yes 71
Year-Published Publication Scale
Geologic Material fMap Unit) ................. .......... ..................... ............................................ .. . . . ....................
Landform ................ .............................................................. .........._.......
Flood Insurance Rate Map:
-Above-500-year flood boundary No El Yes
Within-500 Year flood boundary No El Yes ❑
Within loo year flood boundary No 0Yes ❑
Wetland Area:
National Wetland Inventory Map (map unit) ............................................... ........................................................
Wetlands Conservancy Program Map(map unit) .................. ............................. ................................................
Current Water Resource Conditions(TJSGS):,Month
Range :Above Normal - E1 Normal El Belc w Normal El
Other References Reviewed-
DEP APPROVED-FORM--12107195
�a
l'agc2of3
Location Address or Lot No. �� Ni S �� / 7 kA.0
Con-site Review
Deep Hole Number
Oate .(fri.L•( -Time: )Z,'Ifd -Weather �ttr C(r'Gj
Location-(ident y on site-plan)
Land Use .-. -
-c ., . Slope i%) o _3 Surface Stones
Vegetation . .:..�fl'`ic��(u` (i
Landform
Position-on-landscape (sketch on the back) -
Distances from: Zvu
Open Water Body -feet -Drainage way ?«� feet
Possible Wet Area '7,00 feet Property Line Z feet
Drinking Water Well >i:0� feet Other
DEEP .OBSERVATION HOLE =0G!
Depth from Soil Horizon Soil Texture Soil Color Soil -Other
Surface(Inches) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, 3b
Gravell
If -y n Al
Parent Material(geologic) j�V'"�"-tn1
nepthtosedrock: >1 3 Z
Oeoth to Groundwater: Standing Water in the-Hole:, ✓ � Weeping from Pic Face:_ N�+4
Estimated Seasonal High Ground Water:
( 32 «
I)LP APPROVED FOPMI-12107/95
9 /
Page 3 of 3
-Location Andress or Lot No.
Detennination ,for Seasonal high Water Table
Method Used:
_E -.Depth observed_steriding -in observation hole................... .inches
El-Depth-weeping from-side of observation hole........... .... inches
Oepth-to soil mottles .'..f 3: -inches
Q Ground water adjustment ................... feet
Index Well Number ................. Reading Date .................. Index well level ,... .. . ..
Adjustment factor .................. Adjusted ground water level ....................................... ...........
Depth of Naturally Occurring Pervious Material
-Does at-least four feet of naturally -occurring pervious material exist -in all areas
observed throughout the area proposed for the soil absorption system? - e
If not, what is the depth of naturally occurring pervious material?
Certification
I .certify that on (date) 1 have passed the soil evaluator examination
approved by the Department of Environmental Protection and that the above analysis
was-performed by me consistent with the required training, expertise and experience
described in 310.CMR 15.017.
Signature XDate_ l�
DU APPROVEDTOXM--I219719S ,
A vay.a &A, - A i;,K%%.•VLH11VIr 'J'k;ST
location-Address or 'Lot No.
COMMONWE=A=LTH -OF MASSACHUSETTS
f3a.•r VL 5 ,(a Massachusetts
Percolation Test*
�l. /L / lZ . ZO
Date: . Time: �'''�
Observation Hole # r
-Depth--of P-er-c
Start Pre-soak
-End Pre-soak -
Time at 12"
Time at-9"
Time at 6"
Tii-me
Rate-Min:/Inch
Minimum of 1 percolation test must be performed in both the primary area AND
(ebei ve atca.
-Site -Passed Site Failed
Performed By:
Witnessed.By:
Comments: `'! �- L.
av� L. � . .: y.:.....:.:... . . ... ......:.::... . ... ..:.
DFp AMOVW FORM-12W195
S I E 0 N
ELM R REET Design Calculations ���
Number of Bedrooms: 4
cpprox , edge of pavement Garbage Grinder: No
------------------------------------ -- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Leaching Capacity Required: 440 Gal./Day
0 C.B Ind. Pfoposed Leaching Structure: 1-37Leaching Area Required: 440 Gcl./(0.74 Gc1./Sq,Ft.)=595 Sq.Ft.
ca . 1 X 11'W X 2.0'D Leaching Trench 0
� Leaching Area Provided: 599 Sq,Ft.
1 73 ± Proposed Leaching Capacity: 443 gpd > 440 gpd, req'd. LOCUS
> NO SCALE
LOTS 45 , 46 & 47
AREA = 17,300± SQ. FT.
CD
0 co
0 NO. 86 00 0 GENERAL NOTES
0 1. ADDRESS: 86 Elm Street
0 DWELL C.O.ING 0 U 2. ASSESSORS NUMBER: Map 310, parcel 189
CD FF EL- 100.7' 3- DEVELOPER'S LOT: LOTS 45, 46 & 47
full cellar 4. TOPOGRAPHIC INFORMATION WAS COMPLIED FORM AN
0 ON THE GROUND INSTRUMENT SURVEY.
98.25' 00 5. MUNICIPAL WATER IS PROVIDED TO SITE AND
98.58' SURROUNDING PROPERTIES.
6. REFERENCE PLAN: PLAN BOOK 87 PACE 95
7. NO WETLANDS ARE LOCATED WITHIN 100 FEET OF SAS.
Ln 8, NO POTABLE WELLS ARE LOCATED WITHIN 100 FEET OF SAS,
BA .
0
0 34
T,H. #1 37 0
5 HOLE
% 10" 16"
—D— BOX
ipout
p setic setback
15'- -str00ut CONSTRUCTION NOTES
install 4" dip-' Observation port
- 5 H-20 HI CAP INFILTRATORS
within 6 of grade. 0 1. Contractor is responsible for Digsafe notification
173 END—SECTION and protection of all underground utilities and pipes.
NOT TO SCALE 2. The septic tank and distribution box shall be set
level on 6" of 3/4"-11/2" stone,
6' stockade fence 3. Backfill should be clean sand or gravel with no
stones over 3" in size.
Map 3 0 PC 276 MCP 310 PCI 275 4. This system is subject to inspection during installation
by Glen E. Herrington, R.S.
SITEPLAN 5. The contractor shall install this system in accordance
1 — 3 71 X I I V X 2 . 0' D with Title V of the Massachusetts Environmental Code
SCALE: 1 "=20' leaching trench using and the Regulations of the Town of Barnstable.
BENCH MARK ON CORNER OF 6. Provide c Acme Precast 1500 gal. H-10 septic tank,
REAR STOOP ELEV.=100.00'(ASSUMED) 5 H - 20 Infiltrators wltl-i H-10 D-Box and 5 H-20 infiltrators or equal.
47. No vehicle or heavy machinery shall drive over the
' of stone on s*�des & 1 4" under. septic system unless noted as H-20 septic components.
8. Install cjos baffle or equal on septic tank outlet tee end.
3-20"DIAM.ACCESS MANHOLES 9. Remove unsuitable or impervious soil and replace with
soil according to 310 CMR. 15.255, as necessary.
10. All existing inverts and site conditions shall be verified by contractor.
........... 1 1. Existing cesspools to be pumped and removed.
PERC TEST & SOIL EVALUATION
------ .
r.
Date of Perc. Test & Soil Eval.: November 12, 2001
Test Performed By: GLEN E. HARRJNGTON, R,S., CSE
INLET
Excavator: Mike Leary 01 ITLE7
PERK TEST @ T.H. �1
Test Hole PERK DEPTH=45"-63"
No, 1 BEG. SOAK 0 2:30 PM STEEL REINFORCED PRECAST CONCRETE
END SOAK @ 2:38 PM
DEPTH SOILS ELEV. Unable to soak with 24 gals of water PLAN VIEW
0 98 99" USE PERK RATE < 2 MPI FOR DESIGN PURPOSES 3-20"REMOVABLE COVERS
nnn,y-nd
11" 10YR4/3 97,18',
E ' 3"min clearance 13-f
KET-I'
f. -ad INLET--EEe'=
15" --------- OUTLET ------- ---------
OYR5/2 96.85' Llq.id I—I
40" EY3,w,/, 94,77'
CAS BAFrLE _IaWd depth
GAS BAFFLE
C 1
sand
10YR6/6
132" _VA CROSS SECTION END—SECTION �,6 OF A.0 PROPOSED SEPTIC SYSTEM UPGRADE
NO GROUNDWATER ENCOUNTERED H-10 1500 GALLON SEPTIC TANK N PREPARED FOR
NOT TO SCALE LEGEND E 1 JUDITH M. TITUS
USE ACME PRECAST OR EQUAL RRI 70 AT
k, (?) EXISTING CESSPOOLS TO BE p 86 ELM STREET (HYANNIS)
i PUMPED & BACKIFILLED
*NOTE: ALL PIPES ARE TO BE 4" DIA. SCHEDULE 40 P.V.C. P
Z ROPOSED 1500 GAL GISI BARNSTABLE, MA
—10' min. from *NOTE: INSTALL GAS BAFFLE OR EQUAL ON SEPTIC TANK OUTLET TEE. Fo7- H-10 SEPTIC TANK IVIT
house to septic tank Septic tank covers must be Finished grade over sysLem=2% slope away
Existing House within 6� of finished grade 5 HOLE X 104.46 DENOTES EXISTING PREPARED BY:
Top of Fndn. Elev-100.7' EXISTIY�NADE DIST. BOX Existing Grade Fiev.=98'± SPOT GRADE
-----------95------------ EXISTING CONTOUR GLEN E. HARRINGTON, R.S,
12" rain.
0,02' 36" max. 9 LEDAROSE LANE
f u I I S=,ol 11 Level for 2' Min. 2"-1/8"-1/2" DEEP TEST HOLE
S__01 washed stone Top Peastone Elev.=96.2'
10'cellar MARSTONS MILLS, MA 02648
SEPTIC TANK
4' Invert FIP—q5.71'
__T I C1 rn ® PERCOLATION TEST
GAS BAFFLE M M C3 CD TEL: 508-428-3862
Line 1-Existing Inv.76ev- 97,08" > OR EQUALe cII 24"MIN.
2-Exisfing Inv. elev.� 96.91' Uc� Approx. location FAX: 508-428-3862
eac W-----------------\?v-----------
Yol'tern Q_
Trench EIevL- 9'3
6" OF 3/4"-11/2" STONE 5 c R existing water service
LEACH
37'TRENCH
6.6 SCALE: I "=20' DRAWN BY: GEH NOV. 20, 2001
SYSTEM PROFILE 6" OF 3/4"-'11/2" STONE vBottom of T.H. #1 Elev.=87,10'
Not to Scale FILE: TITUS.DWG SHEET 1 OF 1
I