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HomeMy WebLinkAbout0050 FIRST AVENUE (HYANNIS) - Health mmmoppp- irst Avenue - ijL nis .w.__ 67 — 027 — 1 � e a ,k an P r N A ,y TOWN OF BARNSTABLE LOCATI6NSO rS,�- 4VL VILLAGE ASSESSOR'S MAP&PARCEL 0 'S NAME&PHONE NO. SEPTIC TANK CAPACITY 50 I LEACHING FACILITY.(type) �7�y �5 (size) NO.OF BEDROOMS" OWNER cXX l PERMIT DATE: ATE: in�zP I� 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 we ds exist within 300 feet of leaching facility) Feet FURNISHED BY I 40 :34 f J f f f F f J F f J F % /%/%!%J - f Water Service f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r 50 First Ave 2(p�^� M Property Address Maureen Handel Owner Owner's Name information is West HanntS °rt U 'A no MA 02672 September 22, 2010 required for ypUS!"� every page. Cityrrown 7 State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your Patrick M. O'Connell cursor-do not Name of Inspector use the return key. Septic Inspection Services Co Company Name 189 Cammett Road Company Address Marstons Mills MA 02648 �nm Cityrrown State Zip Code 508.428.1779 SI 12855 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority September 22 2010 Job# 10-231 U1 ector's Signature Date 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. ****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. .7 -d f1V.LI��#`;eri t(i at�a.<.t t5ins•09108 t? :x.; f 4 f Titleg5 91LIC l Inspection Form:Subsurface Sewage Dis sal System 1 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 50 First Ave. Property Address Maureen Handel Owner Owner's Name information is West Hyannisport MA 02672 September 22, 2010 required for every page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 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: Tank is not in need of pumping at this time leaching galleys had 5-6" of effective leaching. 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. Check the box for"yes", "no" or"not determined" (Y, N, ND) 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. ❑ Y ❑ N ❑ ND (Explain below): t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 hN Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 50 First Ave. Property Address Maureen Handel Owner Owner's Name information is West Hyannisport MA 02672 September 22, 2010 required for State Zip Code Date of Inspection every page. City/Town B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ElND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): r e to broken or obstructedpipe(s). The ❑ The system required pumping more than 4 times a year du system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 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 t5ins•09/08 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 50 First Ave. Property Address Maureen Handel Owner Owner's Name information is required for West Hyannisport MA 02672 September 22, 2010 every page. City/rown State Zip Code Date of Inspection B. Certification (cont.) 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 indicates absent 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: D) System Failure Criteria Applicable to All Systems: You must indicate "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 El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than_day flow t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 50 First Ave. Property Address Maureen Handel Owner Owner's Name information is West H annis ort MA 02672 Se tember 22, 2010 required for y p p every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® 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 fecal coliform bacteria indicates absent 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 and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® 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. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. 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. 15ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 50 First Ave. Property Address Maureen Handel Owner Owner's Name information is required for West Hy p annis ort p MA 02672 September 22, 2010 every page. City/Town State Zip Code Date of Inspection C. Checklist 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: ® ❑ 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(5)] D. System Information J Residential Flow Conditions: Number of bedrooms (design): 5 Number of bedrooms (actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 15ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 50 First Ave. Property Address Maureen Handel Owner Owner's Name information is West Hyannisport MA 02672 September 22, 2010 required for State Zip Code Date of Inspection every page. Cityrrown D. System Information Description: 3 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Currently Last date of occupancy: Occupied Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: l5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 i Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 50 First Ave. Property Address Maureen Handel Owner Owner's Name information is West Hyannisport MA 02672 September 22, 2010 required for State Zip Code Date of Inspection every page. Cityrrown D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Tank pumped 6-8 months prior to inspection Was system pumped as part of the inspection? ❑ Yes ® 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) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 50 First Ave. Property Address Maureen Handel Owner Owner's Name information is West H annis ort MA 02672 Se tember 22, 2010 required for y p p every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Compliance date: 3/31/87 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 2' Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10.5' long x 5.8'wide- 1500 gal. 2" Sludge depth: t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 50 First Ave. Property Address Maureen Handel Owner Owner's Name information is West H is ort MA 02672 Se tember 22, 2010 ann required for y p p every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 31" Scum thickness Trace 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? Measured 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 intact and clear, liquid level was found at bototm of outlet invert. Tank is not in need of pumping at this time. Grease Trap (locate on site plan): Depth below grade: feet 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: Date 15ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 50 First Ave. Property Address Maureen Handel Owner Owner's Name information is West H annis ort MA 02672 September 22, 2010 required for y p p every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (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: f gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments N 50 First Ave. Property Address Maureen Handel Owner Owner's Name information is West H annis ort MA 02672 September 22, 2010 required for y p p every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate 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.): No solids or high stains present. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 50 First Ave. Property Address Maureen Handel Owner Owner's Name information is y p required for ort ann p West H is MA 02672 September 22, 2010 every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ® leaching galleries number: Eight 4x4 galleys ❑ 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.): Galleys had 5-6"of effective leaching at time of inspection. Cesspools (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 ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 50 First Ave. Property Address Maureen Handel Owner Owner's Name information is West H annis ort MA 02672 September 22, 2010 required for y p every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (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.): 15ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 50 First Ave. Property Address ---- -- — — .— -- -- — Maureen Handel Owner Owner's Name information is West H annis o _ required for Y p rt MA 02672 September 22, 2010 every page. CitylTown State Zip Code Date of Inspection .D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view 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. Check one of the boxes below: ❑ hand-sketch in the area below ❑ drawing attached separately •.,' 40 34 \ \ \ \ \ \ \ \ \ \ \ \ \ 3 5 2 \ \ \ \ \ \ \ \ \ \ \ \ \ \ r ! r ! \/\/\i\i\!♦!\!\!\/\!\!\!\r\/\ Water Service First A ve Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 50 First Ave. Property Address Maureen Handel Owner Owner's Name information is West H annis ort September 22, 2010 MA 02672 required for y P ,every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 20 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® 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) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Marsh area at end of road is considerably lower than property. Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 r Commonwealth of Massachusetts t Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 50 First Ave. Property Address Maureen Handel Owner Owner's Name information is ann West H is ort MA 02672 September 22, 2010 required for y p p every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file 15ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 d1� TOWN OF BARNSTABLE LOCATION SQ F e sl SEWAGE # ?6 - VILLAGE W ml ASSESSOR'S MAP &.LOT 2.6 7 - e 9-Z INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) w (size) NO. OF BEDROOMS PRIVATE WELL O PUBLIC WATE BUILDER OR OWNER DATE PERMIT ISSUED: DATE :COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �� " -s.E \ O p �J 1 \ o .N;\ O i N0J.'4.............. � ! Fps... ....�....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -•-----`?own...--..........OF...... ............................................ ApplirFa#ion for Uhyaaal Works Toustrurtiun Frrulit Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal System at: ................._............................................................................. .................. .................................................... Location-Address or Lot No. ..........Aku'1..-I-W--r✓rcg....f Al Ok�.......................... ..........s® Fi rsf.. 1111G..........-----•-----...............---.. Owner Address1 rW-a ------------y.! '-1.............................................. 5....... Installer Address d Type of Building _ Size Lot------ 0.0.....Sq. feet Dwelling—No. of Bedrooms._....._.!`!✓G.. ..................Expansion Attic (�) Garbage Grinder V4) Other—T e of Building No. of persons-__--__•-___---..___•______- Showers — Cafeteria Q' Other fixtures ------------------------------•. . ---------- Design Flow.................................SS..gallons per person per day. Total daily.flow..__......_......._.__SS7.p .._gallons. WSeptic Tanl�..—��hiqu d capacity-l�r-. .gallons Length_10.`-f.... Width._ZF!:."..:Diameter_________ ______ Depths'. .... x Disposal T-�ei3ehot No......!_,_._,_ ... Width..... .......... Total Length.._32. Total leaching area__5/Z._......sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (<) Dosing tank ( ) aPercolation Test Results Performed by..C�a�e__Cr�cQ.�s.�sv ._�e�rhs`1 ....... Date...4 P-_4 4...-Z4.......__.. Test Pit No. 1..... ...___.minutes per inch Depth of Test ..... Depth to ground water-----_ riq Test Pit No. 2................minutes per inch Depth of Test Pit--- ..... Depth to ground wate t _ Fir 7_0Qoo 1s ° /r r� !i /i c STEPHEN '3 Description of Soil......._l1'-�------T Rr-------------- �' �....Sv�a8z�r1.---�-'------/2-0 ..................... G x s� fJ TP Z D-- .TB>4. L .COOTS e° Z ALLYN �^ U c �c?[t1 L-<t€tts ._.S Y-=-�!!7u - = -^--------------------- M------ W Bs�.:. �"._SUB SO/L /Sl��` /1i+�Gaiu/LrE-�.�-Jit/i��� �?'®NHS...----- � {d�,6�� i, U Nature of Repairs or Alterations—Answer when applicable...___............................................................. ?- !. ---•------------•-------...--•---------------------------------------•--------•-------------.......----------•--------------------------•---------•••--•-----•---•••••-•--..._ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal Syste in ordi3t� ith � _yG the provisions of ITL;: 5 of the State Sanitary Code—The undersigned further agrees not to place the system ink operation until a Certificate of�Compliance has be n issu by the board of health. e ! ; Signed••-- . -••---<-............--- = ' = t- --------•--- ; ] to ApplicationApproved By................-............-- ----- ----- --- ---- ............................ Date Application Disapproved for the following ons:................................................. ..- ...................•---------•--•----......-------------•-•----- -----•......-----........----------•••--------•--------•••... -------------------------------------------------------------- jj Date PermitNo. .�.......4:.�.. - ----- Issued....................................................... Date T .............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........?ace...J'....... ......OF....... Ht?cVST14'f.3L ........................................ Appliration for Disposal Workii Toustrnrtiun antic/ Application is hereby made for a Permit to Construct ( ) or Repair ( x) an Individual Sewage Disposal System at: ................__......-...................................................................... ........................... --- .---•--•--•-----._...........--- Location-Address o Lot No. ••••--.--,�tJ�,j.. r!ilrry e-�„ anr/a� 30 �.�..t ��..:................. Owner Address,/ �� , Gs f ands dr!. -- � Type of Building U 3••- -••----..__ --------------------------- �- nstaller Address d yp g Size Lot__:...a.el=-----Sq. feet Dwelling No. of Bedrooms---•---.�ilE....................a g— Expansion Attic Garbage Grinder (�) p, Other—Type of Building ..............................No. of persons........... ........._._._. Showers ( ) — Cafeteria ( ) Other fixtures °!31 --------------------------------------------------------:._...----------- Desl n Flow................................. !;- .. allons er erson per day. Total daily flow.........................' !.V;9 0.......gallons. . W .g g P P P Y Y �� R� Septic Tan iquid capac>ty h._gallons Length/Q Via..... Width.-r►'�_0...._ Diameter`-�'_ _..__. Deptl�S�F?'..... W Disposal �o-No.------/............. Width•...$1-_:..... Total Length----3 1...... Total leaching area---S1Z,------sq. ft. x _ Seepage Pit No--------------------- Diameter.._......_..-....... Depth below inlet.................... Total leaching area..................sq. ft., z Other Distribution box (K) T`Dosing tank ( , ) aPercolation Test Results Performed by.. ea�e.Cry.Sut�ittsU�l.lrrt►i ....... Date... .......... Test Pit No. 1.....�.......minutes per inch Depth of"'Test­Pit---/Za........ Depth to ground wat f34 Test Pit No. 2..................minutes per inch Depth of Test Pit...t�107;;'t_.... Depth to ground w "... � ►x ------••••• .-•-• -•••..........-• .......................:.•-•--... Description of Soil---- .$....... Q� �_,Peo ls., 8 ' ,Sc i�ro� +�lQ..- /zo -•••--• x.••----A1 i v'.....- Vx ec�iv l...� 5?tl _ itQ��.Sit'�idiGL./, Ib!VE$S.. .e1 ,Q......O..`�. -� _._. .._. P-A W B"••ZQ�' Sv,�SOiG Zo'� '� e�Go...---- - o -- �ac�s rw UNature of Repairs or Alterations—Answer when applicable.................................................................. ----------------------------------------------------••-•--••............-- .... sSIONAa E Agreement The undersigned agrees to install the aforedescribed Individual Sewage,Disposal System ' accorda C wi i �i-�-8G the provisions of TITLE S of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is_ y the board of health. 1 Signed Date Application Approved BY-----. . l �•- Date Application Disapproved for the f ollowing r ons:-•-----•-• " - ....••--•---••...............•••••--•-••-•-••-•••--••••••--•---------------•---•-......-----••••---......----•-......--•••-•••-•••-•--•--•-----•------------------------------------------------------ Date Permit N�_� 1..�k.. ........................... Issued.................. .............Date -- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH c OF....... .......................................... (9rdif irab of Tomplianrr THIS IS TO CERTIFY,iThal the Individual Sewage Disposal System cpnstructed ) or Repaired ( ) by `jr7i{f>G ...... --- ........................................ .... ... . /...........................--------------- Installer v _has been Installed in accordance with the provisions of TIT�m t E j of T State Sanitary C e as described in the application for Disposal Works Construction Permit No.- dated...... . ..... . . . ............. THE ISSUANCE OF THIS;CERTIFICATE SHALNOT BE`CO STRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........................3.r::.3.t'=---3-7..:..................... Inspector......... L � �..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7 CIO Mops Workg %'Donotrnrtion rani# a Permission is hereby granted......... t Construct (-1.0- or Repair ( ) an Individual Sewage Disposal System atNo, r ------------------------------------------------- as shown on the application for Disposal Works Constr xc ion Permit N4... f_1... Dated....../ 0'2j ....... _r. -, DATE........ = -----......•••....... •-•-•....... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS ASSESSOR'S MAP NO. PARCEL OJ , ' L'0,C*AT ION. w SEWAGE PERMIT NO. VILLAGE x INSTA `L.1. R'S NAME A ADDRESS . `. " �. 1. CRAIG MRDEIROS 9t.5 k 78 LINDEN ST. V- R 00: OWN ER DATE PERMIT ISSUED DATE COMPLIANCE I S S U E D . W G1 \ f, SOIL TEST PIT DATA INDICATES INDICATES SEPTIC TANK DETAIL: ;5�D0 �< .. DISTRIBUTION BOX DETAIL. GALLEY ►DETAIL: Eve loNs. PERC. - - OBSERVED NOT TO SCALE NOT TO SCALE NOT TO SCALE /0 -3 TEST GROUNDWATER NOTES, I- SEPTIC TANK SHALL BE STEEL 4 INLET AND OUTLET TEES TO BE CAST IRON OR c NO. OF OUTLETS: 3_ `RAM a SEED - OR PAVEMENT TP TP T.P �- -TP REINFORCED CONCRETE SCHED. 40 PVC TEES TO BE CENTERED UNDER ; - NOTES- 9(0•_ v 2 SEPTIC TANK TO WITHSTAND H-10 LOADING MANHOLE COVER T-- _ _J � GIRD. EL. _ _ __ __ GRD. EL. _ _ GRD. EL.____ _ GIRD. EL. ___ 77 I DIST. eox TO WITHSTAND H-10 LOADING 2'MIN OF 1/B' UNLESS UNDER PAVEMENT, DRIVES OR r i UNLESS UNDER PAVEMENT DRIVES OR TO 1/2" � FILL !j GW. EL. GW EL. ______— GW_ EL. _ ._____ GW• EL. --- .- TRAVELED WAYS,WHEREIN H-20 LOADING I ' 1 TRAVELED WAYS WHEREIN H-20 LOADING STONE 1 PRECAST WASHED PVC INLET PIPE \ SHALL APPLY I SHALL APPLY. — �__, _ 3 ALL PIPE CONNECTIONS AND CONCRETE [ I I DIST I t K; T"'-"`--'�7 '` - --� y 8 a T ICJ/G CONSTRUCTION TO BE WATERTIGHT 2 BOX t 2 PROVIDE INLET TEE OR BAFFLE WHERE SLOPE OF SUB S�/L ��`� 5eifj INLET PIPE EXCEEDS O.OB FT/FT. OR IN PUMPED SYSTEM •T .z . w L._--- J >' fi ^r ' 0 0 o t� I� -, � o ❑ k � A( NOTL GENERAL NOTES • 12'•MiN 11 r'-�——— LEACHING COVER i___ 3 FIRST TWO FEET OF PIPE OUT OF DIST z , ACHING PIT TO F+ - -- -- - BOX TO BE LAID LEVEL. n _ WITHSTAND H-10 LOADING - • • * ; PLAN VIEW w ^ J PRECAST �� � r �0� PLAN IS FOR DESIGN AND 0 0 r� t� �a p ❑ I CONSTRUCTION OF THE SEWAGE �_ ,^ �; � �: UNLESS UNDER OR ' REMOVEABL.E � PAVEMENT,DRIVE 9Z rJNORYAL WATER LEVEL COVER w 3%4"TO I I/2" _ ❑ p TRAVELED WAY' WHEREIN DISPOSAL FACILITY ONLY. DOUBLE H-20 LOADING SHALL_ • v WASHED GALLEY APPLY 2 ALL CONSTRUCTION METHODS AND �y 1 I MATERIALS SHALL CONFORM TO MASS. C0�( v '� I PROVIDE STONE -- - INLET TEE 1 WATERTIGHT a (no fines > D.E O E TITLE 5 AND LOCAL BOARD pyjj i -- i a LL, ❑ o � CU-3 � c_-3 ::� a o OF HEALTH REGULATIONS ,r Nt.;� � -- — ------- _ - -+---- JOINTS(tYP, ,t I' �I I 1 -. ry/-SOIri�•� TANK 1`• �:R' Ali 4 -O_ MIN UUTLET "_ '' _, I-'l 9EE I I 1 �O ^ • V ` r /; 3 / I �' ALL PIPES LOCATED UNDER PAVEMENT ;YUnf / .al'c?i19 — PSEPTICT i 4' INLE �� 4' OUTLET - - t3 !� L� ca c� o n OR TRAVELED WAY SHALL BE LIQUID DEPTH TEE T NOTE 2 ) 57b/✓� I 1 ----. _ . �— .� L. 0 0 "► 4 SCHEDULE 40 OR EQUAL I,• I -- j I // , �J � r IfG, MIN - - - - - - -- �--- -- --- - -' - ---- ' ' ?.rop. BOTTOM ON LEVEL STABLE BASESTABLEr --- � n iJ, CROSS-SECTION —i✓ — ✓Gi/ BASE PLAN VIEW CROSS-SECTION VIEW CPUSS-SECTION I CONSTRUCTION NOTES: DATE DATE: DATE: DATE: INVERT ELEVATIONS• TEST BY: TEST BY: TEST BY: TEST BY. 4�•6. NEur : r r t%��Eu:�' N/F _ �, INVERT AT BUILDING _ �, ,� � f ��,�,,�,� .�,,�•�;,y6,y,;,�,�,,,f WITNESSED BY WITNESSED BY: WITNESSED BY WITNESSED BY. 2 THE HYANNISPORT CLUB INVERT AT SEPTIC TANK(in) �1�w G/a�f + 3 ►• yT •Q /✓ 6 g p 0• INVERT AT SEPTIC TANK out) PERC. RATE: PERC. RATE: PERC. RATE: PERC- RATE: �•B'FN� INVERT AT DIST. BOX(in) MIN./INCH MIN./INCH ___ _ MIN./INCH __ MIN./INCH --- -- INVERT AT DIST. BOX(out) 93.3'F3 \ 80.00 96 INVERT AT GALLEY az. 4 DATUM: /r .55 �.�f� __- BOT TOM OF GALLEY �Q• x a_ � � L � � ' - - _. _ �_ s " 1 U .S G S. MAXIMUM GROUND VERTICAL DATUM: 6 2 y -'� - WATER ELEVATION -� OBSERVED GROUNDWATER _ __1___ E L_ E V AT 10 N _ BENCH MARK USED: / STORY � � I � o xn �r W/F 1- _ - - - - t ✓ � __ _ � _1 GARAGE 4• �G• T 0.F. EL.= 96.9 I •3 EX/S TING X peep. L1.Bax� : /r CESSPOOL I DESIGN CRITERIA: ,Gx ca All- Z O ' /!,7//1I --e-- i DESIGN FLOW: 01 g W/LLIAM F. BRASS/L _ BEDROOMS AT //0 G.P.B./D 51�' G.P.D. - I _._.._:.:,��•--� to ------------- ----------- ---- _`_ - - The B S C Group N/F SUL KHEAD Q5 EDWIIV S. GOZONSKI O REQUIRED SEPTIC TANK: Q I I 7 z �Sp x_ iSo f� _ f3Z5" GAL. `i DECK k g o ` SEPTIC TANK PROVIDED: _ 41*00 GAL. v� 2. n I Cape Cod Survey Consultants Tt> f SIZE OF LEACHING FACILITY REQUIRED ._ I � ! DESIGN PERC. RATE: MIN./INCH / STY. W. F. I \ G , '!;;____ ! I DWELLING g6 - - 3 .S., r3/D {)2630 DECK -- - Are 721A- ✓ 0 a 5.�.��s/srs�X3.:f_ -__ Fri a l�'OTES � � NO. 50 �__-` ° _- _--- - PROJECT TITLE —--__.__--- SIZE OF LEACHING FACILITY PROVIDED: ? /) Pfr'OPERT Y t974 - - - 9�>< t � �. TOP OF FOUNDATION EL. _ � / /NL S SNOBS iV iiEREON 4YERE C0�19P1L L U F/,OAf ECOF'DED ! 7 N A PL AN , SEWAGE DISPOSAL CUNTY REGIS7,4Y OF IJTEDS I SYSTEM DESIGN /N PLAN BOOK P<l GE --- AND DOES Nc�T rUAL t/E Gvf . r7ng UPGRADE ryT �o 8'x,�z '- zsL s.� x � � zit:. �.,�L�; I �----- FOR . PROPOSED 21 THIS TOPOGRAF'H/C SURVEY WAS ,4fADE ON THE (5ROUA'D q)' 9� x o 9�x 5 RENOVATIONS I!�'AN'.S/T A,ti'D STADI,9 ,1fL-THOD - B.M. EL EV. = I00.00�(assumed l Tar'.ats s' �." B�,G G•�?.'. { it W ? TAG BOLT NO. 34 ON HYDRANT -- - -- - -- ---- AT 31 UA'DE/►GROUND L/T/�I TIES ql c RE C0,11PfI_En FRO,if A VA/CABLE O W 1 B F N� /iECORDED PLANS OF UTILITY COMPf�NI,�, % NCILc — LOCUS PLAN: 1"a= 2000�-* 50 FIRST AVE. RST - �w.._ is AFi'E APPh'0.1'/i11,�1 TE ONL); 6'EFORE G'FSIt�rV Al110 CCiiVSI'fr'UCT/Uh' IN ';ALL ��D/ii SAFE " 1-600-32`- 4894 CATCH BASIN b " sT BARNSTABLE ----------- _ _ _.__-- R/M 97.33 � a<a ? ,. ...._. . _._.. - _ ...__.._ r.g,�:•ac - _ o�y Q ( WEST HYANNISPORT ) i 9 1 0 3 'k MASS . PREPARE ,' a r' 1k NEIL a MAUREEN` HANDEL C. " zU 50 FIRST AVE. _b� FIRS T AVEO WEST HYANNISPORT, MASS . P/�UfE. SSIUN<aL LAIN SUFN/L_YOR - ( 40' WIDE — PUBLIC WAY �� 1� LOCUS DATE OCTOBER 24, 1986 /r _ -' .. J• •" COMP DESIGN RPM. ' v r �� � CHECK .i DRAWN R.L H. - PLAN VIEW Prb \ --- ur/L/rY FIELD R.LH. / �.v.B. SS/ONAI_ i".Nc�/,VLE C✓V!L L.JI POLE j • -__- -- SCALE: 1" = 10' _ \: s0O,q / ,% FILE NO 0 ---5 10- - 20 30 FEET DWG NO 1 198 SHEET JOB NO I 0[