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HomeMy WebLinkAbout0043 FOREST GLEN ROAD - Health 43 FOREST GLEN RD. (HYANNIS) A=290- r v6v ago Z-,O� d / —7 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS M DEPARTMENT OF ENVIRONMENTAL PROTECTION APR 19 2001 TITLE 5 TOWN OF BARNSTABLE OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY SSEMbft- SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: L 3 Fol-es l I Oa of Owner's Name:H .�,i & Qe O[NG. Owner's Address: Date of Inspection: a/ / Name of Inspector: (please print) RY' 0�(i/� Company Name: jiF—W i'10 — j EGH Mailing Address: o.x /01,4g "Gs ll,y, Telephone Number:(—; CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails a Inspector's Signature: ct� 4 Date: / D/ 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 ****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. Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 42 F res4 Oeti O/ Owner: Date of Inspection: (0 D Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: V 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.A�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: fOrPS4 Cleo Owner: fflovlalr Date of Inspection: C. Further Evaluation is Required by the Board of Health: _ ` Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: L �o�eS7 (l2 o iQci / Owner. L,./o, Date of Inspection: YL101 0 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _ � ackup of sewage into facility or system component due to overloaded or clogged SAS or cesspool P/ 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''/:day flow _✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number / of times pumped . V�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.] (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—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. Page 5 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 1ri Fa'e "� 26 /`C LbQAV1(4D� Owner: Wce Date of Inspection: /�% v/ Check if the following have been done.You must indicate"yes"or"no"as to each of the following: YeKNo roping information was provided by the owner,occupant,or Board of Health ere any of the system components pumped out in the previous two weeks _ the system received normal flows in the previous two week period Have large volumes of water been introduced to the m ste recently or as of this inspection g system Y part mspecti /�_ Were as built plans of the system obtained and examined?(If they were not available note as N/A) 1/ 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 P d, mspec of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum V/_ 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: Ye� 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 1�ximation of distance Ts unacceptable) [310 CMR 15.302(3)(b)] I Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION t Property Address: 13 f ores- Pe P7 R, lfz ��9ng loi Owner: (1✓ch� Date of Inspection: o FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CI�15.203(for example: 110 gpd x#of bedrooms): Number of current residents: Does residence have a garbage grinder(yes or no):1VO Is laundry on a separate sewage system(yes or no):*0 [if yes separate inspection required] Laundry system inspected(yes or no): NC Seasonal use: (yes or no):�s Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no): /00 Last date of occupancy: .7 Ja o/ COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): RDd 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: /� `'� ,C � c, (9 t voe�^ Was system pumped as part of the inspecti n(yes or no): If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: TYP"F 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)an4j source of information: /� — e0H Were sewage odors detected when arriving at the site(yes or no):/11/0 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM //INFORMATION(continued) Property Address: QrB (rie �r Owner: 0W6 #(' 9 Date of Inspection: BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction:_cast iron _40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:_(locate on site plan) Depth below grade: f 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: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: 531- Scum thickness: 72/r ' Distance from top of scum to top of outlet tee or baffle: f/ Distance from bottom of scum to botto q�outlet t�j or baffle• How were dimensions determined: �O(_ Z:j I Lice, Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as re#d to outlet invert,evid nce of leakage etc. : // t." , , v70 ";; V T �l�S 1l ►M 2� no 4n e '04 -c ) . 0 6-0- Ci GREASE TRAP:Al/oocate 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 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: -2 ro/'CS� A?1�11 kv Owner: (,✓ai r Date of Inspection: 04 U TIGHT or HOLDING TANK: A/ (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: �llons Design Flow: Zallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: (/ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert:_I OrOn-on/ 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.): gO z (s /ep/ IV,) s c'0 �, , v e,- S PUMP CHAMBER locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Fcre4 Oe yr k,1 < < Owner: It i Date of Inspection: Y h p SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number:_ 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.): I�w O P��e cr✓,� I��� ec rI Cl �v cam �0I �/O i avl ,Oc?e Gri-o b y �o w S G�eGvt Or C d ,�� �,�5ti -1s; r-1 /—tows, CESSPOOLS:jZ(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:k0ocate 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 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 42 Fores4 (s-feo N r 0.2 6©( Owner: Date of Inspection: Vtodot 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. Fro V1 0 C 3 EET � ..., Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Fora P �,Ieh Rd aAvl� al Owner: wa/' Date of Inspection: Lp u SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water N 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: erved site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Oli::a Checked with local excavators,installers-(attach entation) Accessed USGS database-explain: You must descri how ou establish the high ground water elevation: l be o lroe- 2. ✓i b g / rn v h G� yvvl 1✓c, / �{ ��V7 e lotil LOCATION . SEWAGE PERMIT NO. VILLAGE INST ER'S NAME&ADDRESS BUILIAR OR OWNER 61 DATE PERMIT ISSUED I 9- - �� DATE COMPLIANCE ISSUED 12 - 16 - i.5 le O - -h O r . v D THE COMMONWEALTH OF MASSACHUSETTS t BOAR® OF HEALTH ............................OF...:...................................................................................... . ApphrFation for DwposFai Workii Tnnitrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System t:.e. .... - , ............ -=f - /L._. .mac 4 . _. '�: r- .�:.-.a--'-••- Locatiory�ddre or Lot No. Zwner A�ress ......_,. ........���,�.:.._......5� �' -'.. ...... .. . ...._...... ..... .?®-? � • F / Installer Address d S Type of Building Size Lot..._.1��,A�>__ q. feet V Dwelling—No. of Bedrooms....... Expansion Attic (�) Garbage Grinder ( ) Pk Other—Type of Building _ °p?__� No. of persons....... Showers ( ) — Cafeteria ( ) a' Other s _._.._.__ d �-------------------------------------------------------------------------------------------------------------------------------------------- W Design Flow_______________________________�?�_______gallons per person per day. Total daily flow_.___._.���_____________-__.......gallons. 04 Septic Tank—Li kid capacity gallons Length_._._..__`-_.WWidth._..__.___ Diameter_____________---Depth....--:..... T0. ......5_______.. Width_.:.. 1._._.__.__ Total Length...... f_______ Total leaching area__ ___ `'_ sq. ft. Seepage Pit No...N-. .•.... Diameter_.__-_--:": Depth below inlet__:::___ Total leaching area______________....sq. ft. Z Other Distribution box (✓) Dosing tank ( ) '-' Percolation Test Results Performed ......1_�_Su-Y..........._ __ Date....... 5............ Test Pit No. 1.<2-.___minutes per inch Depth of Test Pit_____-©r........ Depth to ground water...... �_.__.... Test Pit No. 2_-�:_Z......minutes per inch Depth of Test Pit.......6_........... Depth to ground water_____?" ........ 1 tx _----------------------------------- 0 Description of Soil...-- -'e5-Z Loi2w �`s,18 z La✓1� 5��..... ---------... ---------------•••• .... xZ rb� .• Gr! " .----------------------•------------•--•-Z• �-- .fir '!` ..................•-----------•-------•---------------------------- W -•--•i------------------ -•------•----------•-•-•-•--••••-----•----•--•----------------•--•-•--------••----•-•--•---•--•-•-•••------•----•--•••-•••----••-•---•-•-•---•••-•---•---•-••-•-•--••••--•-•- UNature of Repairs or Alterations—Answer when applicable................................................................................................ Agreement: The ersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the jr'a rov'sio s of T " 5 of Vompliance State Sanitary Code-The undersigned further agrees not,to place the system in opntil fi o, has been issued by the board of health. Signed...........:................................... Date Aon proved BY -1�`�___�` �==�G__—_----------•------- -------•------- Date ADisapproved for the following reasons----------------------------------•-•=---•------•--------•--------------------•----------------••------••-••-•••..._ ---•-----------•-•------•••-•....................•-•-•---.....-••.._..._....•-••-•--•------------•-------•--------•--•••-•--•-------•••--•-•••••---..•Date----------._-. PermitNo............. .........................._.._. Issued-....................................................... Date No........................ FEfs.................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........ ................................OF........... .................................................... Appliratioujor BOVviial workgZamitrurtion Permit V. Application is hereby made- for a Permit to Construct al Sewage Disposal or Repair an .Individu System';t: . ......... .... ;Y -e ........ ....... ................................. ........ Locatio� Ndd 0 or Lot . ...........r. ... .... ...... .... .......... wner Aodress J .......... . ......... .............. Installer Address Type of Building, , Size Lot . ..... ................Sq. feet Dwelling—No. of Bedrooms.___..y............. ...........:....Expansion Attic (>o ) Garbage Grinder Other—Type of Building _q j2,1:: .. No. of persons____-__4................ Showers Cafeteria 0 Others ... ............................................................................... ........................................................... Design Flow............... .......... -.3.......gallons per person per day. Total daily flow_,.___- G.......................gallons. SCDtI'CTan cit g allons Length.........—­ Width...........=Diameter._......_...--.—Depth....:-7�...... ra il i uv cap a i Dq==c I— i 0. ...... Width..__.4............ Total.Length......Y9...... Total leaching area-_. L .......sq. ft. Seepage Pit No....P'1�...... Diameter.................. Depth below inlet..:77:7:: ....... Total leaching area.:7777=.......sq. it. Z Other Distribution box (v ) Dosing tank Percolation Test Results Performed ......14�i ?�: .........;1---­----------------- Date..___. ---- ------ Test Pit No. L.-4 2-__rninutes per inch Depth of Test Pit---- Depth to ground water..... .......... ------r-------- -------------- Test Pit'No. 2.!f�!.Z.-...._minutes per inch Depth of Test Pit------8.......--- Depth to ground water_.._ 'y........ ........ .... ................ ...... ........ ............ 7... ........*... 21 ---*--------- 0' Description of Soil...... .....................................................................................—-------- —Y-------------*--------- --------- - Se ................... I S. .,(A ... ..I.........f ........................................................5 ----------*------*------ ------- ............................................. ......................................................................................................................................................... U Nature of Repairs or Alterations—Answer when applicable.-....... --_-------------------- .................................... ------------- ..................................................................................................................... ................................................. ............................... Agreement: The unfersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provi4ods of T,171L 5 of-tiYe"'State Sanitary Code— The undersigned further agrees not to place the system.n- . 4X/1 rdr in in operation- N 1 Ce ificate ofiC/bmplia:nce has been issued by the board of health. _Ligaed....................................................................................... ............................ l<;--3 Applimti6proved By..........................................*........................................................ ..................... .............. Date Applic tion Disapproved for the following reasons:.......................................... ------------------------------------................................ .......................................................................................................................................................•------------- ---------------------------- Date PermitNo......................................................... Issued....................................................... Date ............ .. .... THE COMMONWEALTH OF MASSACMUSETTS BOARD OF HEALTH ..................................._OF..................................... ......................... Tntifiratr of Tomptiatta THIS IS TQZ,#NIFbj' at the Individual Sewage Disposal System constructed (>Z/) or Repaired by------------------------------------ ----------------------*---------------- ----------------*---------------------------------------------- V44 I s eL-r'-NT ------------ at..................... ........................................................................................................................................................ has been installed, .5 o4liF State Sanitary Code as dj�icyibgd in the. in accordance with the provisions of T1TL]Fi. application for Disposal Works Construction Permit No......................................... dated................. .............................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE... -2—1 ► ------------------------------------ Inspector................ --- ------- ................................... 4 ............. THECOMMONWEALTH OF MASSACHUSETTS Vprre I nw& BOARD OF. HEALTH C=>a 07V 7-;,::- ......................................OF...................................... ........... ... No......................... FEE... CL....... Bisvaso Work i Tonotrnrtion Permit Permission is hereby granted-----...---- ................................................................................................................................ Indiv�jual,�eg'V Dog�al Suk&m to Construct 1y0'9pair-,,(,( at No Street -7 q2 M_ as shown on the application for Disposal Works Construction Permit No............. ...... Dated.... ............................................ .... ------ ----------- ...................................... % 0 rd of Health DATE........... ................................... FORM 1255 A. M. SULKIN, INC.;BOSTON Z Cc,r 1a t cd by r, flI�GIi GRUONU WA!L,R I.I_V.I l_ C UPI PLJiATI01 n � } Site Locat ion c.S j a /z - r --- _ — v r•. D_ Lot No. 2/ Owner._ _ Address. - -- -- � ` Contractor: Address w s , Notes: _ — r s STEP 1 Measure depth to water table 6 $ to nearest l/10 ft. t . . 6 -------- ------- -—' -- date ` • <: STEP 2 Using Water-Level Range Zone �= and Index We) I,: Map )oca te' x ' t'' s4 site. and de-t a rmi ne: A) Appropriat:6 index well. . - - , B) Water-Teve1 range .zone - . , • ,.- ��� *'_ STEP 3 Using monthly::report"CuJr rent ` kx x: Water Reso;ur�es C,ond i t i ons" } `� 4 a ; determine current=depth to 7water level f.or :index y+el1 - , . �/�.�•. . � �x< f mo yr STE"P 4 Using Table of Water-,level Ad j us tment- s- r 5 i ndex we 1 1 x TSfi 2A _ t L. j� - //Curren d 'nth t0 V _ 7 r /3 " iV fit" k water level for index well (STEP 3),Yand water-level i. 7 vz; 3 r rx zone (STEP 26) determine A ;, water-leve`1 adjustment w c STEP 5 Estivate depth to high water; by subtracting the water- f ' j r (STE'R. 4). � level ad ustment .3 from measured depth.Jo water level at site .(.S'TEP; :1) - . . . . _ 1 ar 4 1: ro _ ,+,�,p U � .: ,-. „r. -..,ad• ,.t�. i..,. .n �r ,�.�^ r �z:;, �.v S., +., r ..R;d7...,..r �� .'� u r t. .? _ r3.5.. :;tn;r. .r�,t �:; lt'.� .. 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G.EIa.N 4"O/A- 1 .41 ;, SCHEDULE 40 ' _ Z 7 AV.C: P/PE . ?Aoo GAL. ea Ta 4 M//Y P/.TCN< Dis7; Q_ a C1 ca R� '�` O7SGHA PGE L/NE ` isa ;KEPT/C rA,NK !�c p� / Q•,PER FT. L.EACHf.G SEC7�OJ1/DF :GR0VNPrAVA'TER_T�f[9LE: •ELE�/ zo GPO po ( .E O/SP0.5AC .5`YSTEM _ `TABIlL,4T/p/� - �t D/MESION:. B 4 FT /14cr $O/[. TEST pATE.OFso/L TEST S �zfr��S SO/L .LQG t RESVLT3'!t�!'TiVESSEO ELEY`25S EL40- V.Z3;9 A Ai PEi?C'DLAT/GN,_RA f/Z /N, /IYGK CL LAYER OF S u . SA NO pO_Y- 11).4EkE /{(4;1W,9ER OF CEDROOMS �. . Z' -Y_.v{ Z Z/:. . r OYER Z~LA-YERe .t L7 0 O� 3g •� ,. _ 6ffR6.4qE 0/SP�SAG UN/T l✓ASNEOSTAWE.EST/hJATFO FL O i 1C g 4 GA L f1 Y. w S/DELEAGN/NC* AmEA' SQ FT. ' BOTTOM LEACHING- RZA ZO 4 .?�t�.FT.. E[, 171. SEC T/O N TD TA L EA _ 3 ;5 Q FT-SEC, WA ram."rt i.1 T S�_A --O _ RESERVE., 4REg4 SQ FT C:.L 7-Z.T -'Cl . NO-GROui1t0 WA-TER ENCOUN D , / V VERT El-EVA.T/ONs a GRO UNO. AVATER AT EL EY •° .ta tea, ���� �Z1 'Fo!, (ic �a• y ;2, (ZL�/t� �� Y � /NV,ERTA7 BU7LD/NG 27/a FZ // 1 / ALE :�3 c• hT /NCET SEP'T C TANK FT OUTLET S' PVC TAA'AI �!4� p.7' fit. P o. iU?til ,.J �.e, �. i?� ; t INLET D/STR/DuT/ON Qcuc . Z�,. LcL.OR��GE FNGI�/EERING CO., , f e < l „ ` -�• FT y 7l2 AIA,5T. YA�N S /'4 5 Tti�` �z OUTG'&7'P ZIR/BUT/OND4X , N M N I AS ,'.JNLETFLD R �..< z5:7 ,c'T. ELLENT-r !a2nrss: :PATg: j :J"_No. :i F:Fs_o 7 q$T � t sH+' 7! ' t S M e .�,,. i• i<V Zr f-; a 4Z. r + r r ,�`.G �ltxh. ♦ ,� �j ry -mil�,l iR k S7 7 f '. (J� y0§• t y } 3 ',l +_#j, � 3 1 51 E I �T if ,N mo uik`u�" 1v'>t p AV � a ti SEA ft F ; w , � , vi 3 � y;r vfn, �s > l�y,f f f r T�N1G �r \ r i a4f gg a Fhi �� 0 7, fyI / -SOIL, w T A ^ ,' 0 �r� ��k�p{f�eft �, S , F�y,', 'tl �J: x. z7 0/.,.'. (�,• �` .'�1 �:' � fd z,,,,. � d�� ��}�'1 J �'3' �:I��x l t;. 1 - / � _ I h..,t ` "y��`l, Ih r�,�V�V r,.`�, `Y �.: f<`' � `�� :.�f•- „' � .., '0, p4e ., g7�sja r � p U ��-afk �UG f!/1/0�1 t( tit t 3 J" r $'. F y�,t', ^ O p/ , t t i iY'AarnT� 2�s 4 ° a�/ ` �l• oQ rJ, s� a / � ,,K� '�. y LJ�;1tJ /'l7 gug? 1 R � " o� r l,�[ ,'.]bP•SAGC HNV`O ih�rG. r 5[� !": /�c%'s s S,c� fig, ^ry nc M v✓2� 4 � ,ROBE.RT r P .. F �o.. - o„� Nd7 �- A 12-T, 1 r 1 t S Y 51 M ]p�72 Tl TLC /2G'G.?*17 / 2 tJ 7 t' c r i a.J tit- � / ' f, gt� 'K B. l.DREDGE . r a� k Z �fo 19367 K �e t o, , ' Rtx "' �l L QF f ALBEF rls i o ,• MORSE in'µ �EXI#{TINA $POT ELEVATION OxO . r No. I U951�Q�2 J rLX1TiNA CONTOUR ---- 0 �- �'�G%��.� /} !b CERTIFIED PLOT P.LA•N, % 14ii9MED r 6POT ELEVATION �. �rsTE/% 1 P� ,� ,Ie �11 NEp�"CONTOUR � FS�10 k 14 I'>s. 4e location Of anyr existing underground sewerage, 3 as1<ber utilities` shown on this plan is approx IN mae only as d'stermined from re and/or, \ _ �►f�Qrulat�ao:;The con 'actor is responsib o for the, ' S �� � ctio int ,n.t of the `existi loa hefield ATE s G 7/�':� g �AREDGE`ENG/NEER/NG; WIN , .�'r /,✓ CLIENT.,...,., I CERTIFY THAT THE PROPOSED ill t REa1ST6RED �s�7 z 408 N0, BUILDING SHOWN ON THIS PLAN f. . ,G.I.MI1. LAND "' , t CONFORMS . TO- THE ZONING LAWS} x r ERpRtY� �.. OF BARNSTAB.LE MASS. 12 MAI N .STREET CM NYC ��f � �� t � �;'�° � i ► � MA9 S. sHEET.:L''OF Z ATE REG. LANs suRVEYOR L NN I S President: Member of: ROBERT BRUCE ELDREDGE,R.L.S. CAPE COD SOCIETY OF PROFESSIONAL ENGINEERS AND LAND SURVEYORS ELDREDGE ENGINEERING MASS.ASSOC.OF LAND SURVEYORS Associates: AND CIVIL ENGINEERS ALBERT A.MORSE,P.E.,R.L.S. COMPANY INC. AMERICAN CONGRESS ON PHILIP WEINBERG,P.E.,R.L.S. SURVEYING AND MAPPING AMERICAN SOC;ETY FOR -,?ECYCSEEZEQ • CRE[�LStE2ECl TESTING AND MATERIALS land Ifi'd 712 MAIN STREET U4VEL/0¢i P'•rr,r n9inEEza HYANNIS,MASS.02601 TEL.(617)775-2244 December 9, 1985 Board of Health Town Office 267 Main Street Hyannis, Ma. 02601 RE: Barnstable. Holding Co. , Lot 21 , Forest Glen Road, Hyannis, Ma. Job ##85072. Gentlemen: A final inspection was made on Dec. 5, 1985 and the results are . as follows : Design As-Built Top of Foundation Elev. 31 .0 (min. ) Elev. 31 .35 Inv. at Foundation Elev. 27.00 Elev. 27. 46 Inv. at Septic Tank Inlet Elev. 26 .60 Elev. 27.35 Inv. at Septic Tank Outlet Elev. 26.40 Elev. 27 .20 .Inv. at Leaching Pit, - (Dist. Box Outlet) Elev. 26.00 Elev. 26 .92 Inv. at Flow Diffusors Elev. 35.70 Elev. 36.60 The System appears to have been installed substanitally in con- formance to the minimum design standards specified in our sewerage plars dated June 7, 1985. Sincerely, ELDREDGE ENGINEERING .CO. , INC. Robert B. Eldredge, R. I. S. President cc - Barnstable Holding Co. RBE/lld