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HomeMy WebLinkAbout0036 FOURTH AVENUE (HYANNIS) - Health 36 Fourth Avenue Hyannis P 246111. _ 1 oil i i i P I i I' I' i i i W , I i I L TOWN OF BARNSTABLE LOCATION 3 ul to U/? T// A Ile- SEWAGE # VILLAGE U1fS1'1/XA"1 SApA r ASSESSOR'S MAP & LOT�� INSTALLER'S NAME&PHONE NO. J /I/I A C O M B e R 1' SEPTIC TANK CAPACITY S O O LEACHING FACILITY: (type) 3— p R ✓ w f L L S (size) NO.OF BEDROOMS y BUILDER OR OWNER 4 1' PERMUDATE: COMPLIANCE DATE: :fM ' Separation Distance Between the: t Feet Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility -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.. �. -, ,,,,� _ =3 �/ ,. O � ,� ^ � �3s `iq°� ,l` . _ � _ �_: � i � �� ti'�x.., . � +'dam � � `� - �4�/ �� .-. - �1 � f. � � �'. . � .� `\ •� �� � ., .. _ . No. v l Fee 1001 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABILE., MASSACHUSETTS ZippYication for 33igpogal bpgtem Construction permit Application for a Permit to Construct( . )Repair(� )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location A s o Lot No. Owner's Name,Address and Tel.No. S(P lag VX 15pa'4� ,n1�.• gtc c yte (i�eig Assessor's Map/Parcel '3Cn 1'1 Av.Q, :)qb -111 w lS o.-+ OU oa -21 Installer's Name,Address,and Tel.No. Soy' 7X"3'2,3% Designer's Nape,Address and Tel.No `So j'�,1t1'1p�parY�bCr a �Yl j C., D�LG►RR�*l t►�+� , $ox la�o a,�l Ct�n6nln� �{�g 11 c)-suata Type of Building: i , Dwelling No.of Bedrooms I Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 440 gallons per day. Calculated daily flow 4411i en gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 1600 Type of S.A.S. 500 Description of Soil Nature o Repairs or Alterations(Answer when applicable) bo Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been is b thi o f ealth. Signed O Date Application Approved by Date Application Disapproved for a following reasons Permit No. au 0 Date Issued a t U L q /'u — No. (J O • I Fee /v / xF �-COMMONWEALTH OF MASSACHUSETTSYes Entered in compute ` ,PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ZIppYication for bizpozal 6pelem Congtruction Permit Application for a Pen-nit to Construct( )Repair(� )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Locatio A s o Lot No. Ow er's Name,Address and Tel.No. WIV eve. w, Ata"I5po�'r Ott,. 'P-511mr f A (yretg Assessor's Map/Parcel U / 3� LI 1 V Installer's Name,Aqddress,and Tel.No. S9S Designer's Name,Address and Tel:No. 1 T.P•t1W_zr)ARr&W1a 5s5Y1 j c-, tL)L 1R-Abr Mq , y�ox corn ���( Ct�D 6w-N F tgltwo_v C�►4�ry��� ring. 0a4n � •t�rQ-L�, vtl�. �$ Type of Building: Dwelling No.of Bedrooms I Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 4 4 0 gallons per day. Calculated daily flow �f4U.�� gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 150 C) Type of S.A.S. 3 SOo L-eA C.h.)l1b0'S Description of Soil Nature o Repairs or Alterations( nswer when ap licable) 0 n 11 I CC � Q'I 6j a � ��J� A�Ion /5��.� � Date last inspected: Agreement: �• " The undersigned agrees to ensure the construction and maintenance ofthe afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue ythi , _ ealth. Signed L` IJ Date Application Approved by `.j R Date ` UY Application Disapproved forYie following reasons Permit No 260 �� Date Issued a 0 C y THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY that the Qn-site Sewage Disposal System Constructed( )Repaired ( )Upgraded( ) Abandoned( )by S'Y, P �«17I�J�J' aAZ•,A rjG)yyl at 36 G,_t+L -A i l UI 15Po n l4. has been constryS!ed i no dance with the provisions of Title 5 and the for Disposal System Construction Permit No. Ou q v- dated d' -, Installer Designer The issuance of is permit shal not be construed as a guarantee that the sys m w l-fjglction as d s gned. Date ' l 7 Inspector 1^ �• P . I I No. �d0q ---•-----------------------Fee Av— THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS )Di5poga1 *pgtem Con.5truction Permit Permission is hereby ranted to onstruct( )Repair(/1 )Upgrade( )A a don( ) System located at � 4 t/wU'1(SQonf and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Constructi n myst be completed within three years of the date of th• p it,. Date:_ L1 U Y Approved by ' ` r FUG-27-2004 01 : 15 PM JCENCINEEPING 508 273 0367 P. 02 Town of Barnstable Regulatory Services i > i Tbomes F.Gailer,Director ,y Public lSealth Division Thomas Mc Mali,Director 200 Main Street,Ryannie,MA 03601 Oifioe: 508-862-4444 Fax: 503-190.0304 Tn�oiler 16v D®asoaer C erti�eaN..,.Zsr.,rm Date: a f o� Dedper: IC Inc 'nee! r � �nc. Installer: Address: Address: f- Darr,4,,m ,JnA 6;s3 P M6 Q 4 3 a 02 vaq lo was issued apv=it to install a ( ins er) septic system at...3 frt)U A A)eove baaed on a design drawn by address �C n -fr)ft{in� he. dated P1r, 15, �ooy —Ws, er) I oertil�that the septic system referenced above wub installed substemtially azoording to the desl}e4 which may include minor approved changes auoh as lateral relocation of Me distribution box and/or septic w5k. 100rdy tbAt the septic system referenced above was installed with m 'or ehari~ges (i.e. groater than 10' lateral relocation of the SAS or any vertical relooatioa 0 any eorapc►nent of the Septic srtam)but in accordance with State& Local Regulations. Plata revision or certified as-built by de3si.per to follow, ,�1 `A oP 1., Ll u JR. S ��tttt'0 f.1Yit. No M11fsC'! eesg:Ier e '� x esagn x stamp ore T Oa ON. AM RE Q:Hee1d,/8eptta�Deslp�ar Ctre!$oatias Form TOWN OF BARNSTABLE LOCATION 3 /'o u rf/ ye SEWAGE ## VILLAGE Wf S l'/?X,4,a/&/ S08°�D ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. / I-V 4 C©Al e P 1- S'a.�/ SEPTIC TANK CAPACITY —/ Q . w LEACHING FACILITY: (type). 3 , V R -w e L L S (size) 3�� / /�"3' •X NO.OF BEDROOMS y BUILDER OR OWNER PERMiTDATE: .COMPLIANCE DATE: 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 I Edge of Wetland and Leaching Facility(If any wetlAds exist 4 within,300 feet of leaching facility) Feet i Furnished by Jo VIC it I ' z I \� t O . 0 0 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL P.ROTECTIO RECEIVED SEP 3 0 2002 -.TOWN OF BARNSTABLE. ,TITLE 5 HEALTH DEPT. OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Sy Z Property Address: 36 Fourth Ave. 24�D W H,Xannis ert � Owner's Name: Blanche Grei g PARCEL • Owner's Address: SamP I(1T ' Date of Inspection: Name of Inspector: (please print) William E_ .Robinson sr. Company Name: William E. Robinson Septic Service Mailing Address: P O Box 1089 _Centerville, MA - Telephone Number: ( 508) 775-8776 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 ttoSection 15340 of Title 5(310 CMR 15.000). The system: { !/Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails ell Inspector's Signature: Date: G 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 bas 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 approxing authority. Notes and Comments ""This report only describes conditions at the time or 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 or use. Title 5 Inspection Form 6/152000 page 1 Page 2 of 11 h CIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS 5. OFFI. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A v CERTIFICATION(continued) Property Address: 3 6 Owner. Date of inspection: Inspection Summary: Check A,B,C,D or E/ALWAYS complete all Section D ' A. Syst Passes: 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15:303-,or rn 31 i CMR 15.304�exist.Any failure criteria not evaluated are indicated below. B.. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or rep fired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Ans r yes,no or not determined(Y,N,ND)in the for the following statements.if"not determined"please expla' . - e septic tank is metal and over 2 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 indica6g that the tank is less than 20 years old is available. ND exp ain: bservation of sewage backup or break out or high static water level in the distribution box due to-broken or obstruct pipe(s)or due to a broken,'settled or uneven distribution box.System will pass inspection if(with approv of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND exp ain: e system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass ins,cction if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removcd Me ain: Page 3 of 11 OFFICIAL INSPECTION FORM-.NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM t PART A` CERTIFICATION(continued) Property Address: 36 Fourth Ave. W Hyannisport Owner: Greig Date of Inspection: —�--�5 C. Further Evaluation is Required by the Board of Health: Co itions exist which require further evaluation by the Board of Health in order to determine if the system is failing to rotect public health,safety or the environment. 1. Syste will pass unless Board of Health determines in`accordance with 310 CMR 15.303Q)(b).that the system is not functioning in a manner which will protect public health,safety and the environment: Ces ool or privy is within 50 feet of a surface water _ Cess ool or privy is within 50 feet of a'borderiiig vegetated wetland or a salt marsh 2. System wi 1 fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is funs:Toning in a manner that protects the public health,safety and environment: _ The s stem has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface w ter supply or tributary to a surface water supply. _ The ystem has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. Th system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The ystem has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more frond a private w ter supply well".Method used to determine distance "This Sys ern passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria an volatile organic compounds indicates that the well is free from pollution from that facility and the presenc�of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other . failure crite is are triggered.A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION.F..ORM. PART k CERTIFICATION(continued) Property Address: 36 Fcou rt W Hyannisport Owner: Greiq ry Date of Inspection:/^y^D� D. System Failure Criteria applicable to all systems:. You ust indicate"yes"or.,no"to each of the following for all inspections: Yes o _ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _ Discharge or ponding ofeflluent to the.surface of the Bound 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 in more than 4 times in the last year NOT due to clogged or.obstructed pipe(s).Number _ Required pumping y 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. _ Water Any portion of a cesspool or privy is less than 100 feet.but Beater than 50 feet ffrom ll water anal 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 ro tided that no other failure criteria the presence of ammonia nitrogen and nitrate nitrogen is equal to p or less than 5 m,p are triggered.A copy of the analysis must be attached.to this form.] mined that one or e of the ve failure criteria exist as (Yes/No)The 310 CMR 15.303,therefore the system fails.rThe system o described should contact the Board of Health to determine what will be necessary to correct the failure. E Large Systems: T be considered a large system the system must serve,a facility with a design flow of 10,000 gpd to I5,000 Y must indicate either"yes"or"no"to each of the following: ( e following criteria apply to large systems in addition to the criteria above) yes no water supply _ _ the system is within 400 feet of a surface drinking _ 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 11 of a public water supply well . » E the s is can a significant threat,or answered If yol have answered yes to any question in Section yam° lar e system considered a "yes"in Section D above the large system has failed..The owner or operator of any $ y significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 4 Page 5 of I 1 r OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS M SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR ' x PART B CHECKLIST Property Address: 36 Fourth Ave. W Hyannisport Owner: Greia Date of Inspection: Q 2— 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.? _L/_ _ Were all system components,excluding the SAS,located on site? /4,0 Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _ ✓Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no y Existing information.For example,a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)) 5 ' F Page 6 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART,C SYSTEM INFORMATION Property Address: 36 Fourth Ave. W Hyannisport Owner: Gre Date or Inspection: & —6 --C�-- FLOW CONDITIONS RESIDENTIAL. Number of bedrooms(design):. Number of bedrooms(actual): � DESIGN flow based on 310 CMR 15.203(for example: 11.0 gpd x H ofSedrooms): `dG Number of current residents:�_ { Does residence have a garbage grinder(yes or no) b Is laundry on a separate sewage system(yes or no)-AQ[if yes separate inspection required) Laundry system inspected(yes or no):?' Seasonal use:(yes or no): "'.S Water meter readings,if available(last 2 years usage(gpd))- `2 0 01 13,0 0 0 gal. Sump pump(yes or no): "t, a 2000 12,750 gal. Last date of occupancy: C �—'Cs* CIDF, MERCIAL/INDUSTRIAL Type f establishment: Desig now(based on 310 CMR 15.203): - gpd flow Basis f design (seats/persons/sqft,etc.): Greas trap present(yes or no):_ Indus ial waste holding tank present(yes or no): Non- itary waste discharged to the Title 5 system(yes or no)-_ Wate meter readings,if available: Last ate of occupancy/use: " OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as An of the inspection(yes or no):�3 If yes,volume pumped:6e U Kallons--How was quantity pumped determined? Reason for pumping: r- TYPE OF SYSTEM YUPic tank,distribution box,soil absorption system le cesspoolrflow cesspool Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Altemative technology.Attach a copy of the current operation and maintenance contact(to be obtained from system owner) _Tight tank Attach a copy of the DEP approval _Other(describe): Approximate age of 11 com on�date ins piled(if known)and source of informal*o g Were sewage od rs detected when arriving at the site(yes or no)/►_d 6 I _ 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: 36 Fourth Ave. yannispor Owner• Grei Date of Inspection: BUI ING SEWER(locate on site pl'an)- Depth low grade: Materia of construction:_cast iron _40 PVC_other(explain): Distant from private water supply well or suction line: Comme is(on condition of joints,venting,evidence of leakage,etc.): SEPTI. TANK:_(locate on site plan) Depth bel grade: Material o onstruction: ..concrete_metal_fiberglass_polyethylene _other(ex lain) if tank ism al list age:_ Is age confirmed-by med•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: Scum thickne Distance from op of scum to top of outlet tee or baffle: Distance from 3ottorn of scum to bottom of outlet tee or baffle: How were dim nsions determined: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels. as related to o tlet invert,evidence of leakage,etc.): GREASE T P:_(locate on site plan) Depth below gra-e:_ Material of cons ction:_concrete_metal_fiberglass__polyethylene—other (explain): Dimensions: Scum thickness: Distance from top f scum to top of outlet tee or baffle: Distance from bolt m of scum to bottom of outlet tee or baffle: Date of last pumpi g: Comments(on pui iping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS OFFICIAL INS, SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION PART C SYSTEM INFORMATION(continued)` Property Address: Owner: =�S Date of inspection: . TIGHT or OLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below ade: of eth lene ,.-other(explain): . ' Material of co struction: concrete metal fiberglass_p Y Y Dimensions: allons Capacity: allons/day Design Flow: Alarm present( es or no): es or no Alarm level: Alarm in workingorder(y ): Date of last pu ping: Comments(co dition of alarm and float switches,etc.): DISTRIBUTIO BOX: (if present must be opened)(locate on site plan) Depth of liquid lev above outlet invert: ual,any evidence of solids carryover,any evidence of Comments(note if ox is level and distribution to outlets eq leakage into or out c f box,etc.): PUMP CHAMB (locate on site plan) Pumps in working or (yes or no): Alarms in workin ord r(yes or no): condition of pumps and appurtenances,etc.): Comments(note condi ion of pump chamber, 8 i r Page 9 of l l OFFICIAL INSPECTION.FORM,-NOT,FOR VOLUNTARY...ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM P RTC SYSTEM INFORMATION(continued) Property Address: 36 Fourth Ave. W Hyannisport Owner Gre i Date of Inspection: / SOIL ABSORPTION SYSTEM (SAS): ✓ (locate on site plan,excavation not required).V f If SAS not located explain why: TYP/ y leaching pits,number: leaching chambers,number: leaching galleries,number: le 'hing trenches,number,length: hing fields,number,dimensions: overflow cesspool,number: innovative/altemative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,. etc.): IV, `aQ 60 � 0 8 .e 6 Jv p C' psi CESSPOOLS: /' (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: 0 Depth of solids layer: Depth of scum layer: t Dimensions of cesspool: a - Materials of construction:/A,/6 o f d I P✓� G® d Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan) Materials o construction: Dimension . Depth of s lids: Commen (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 t Page 10 of 1 l ' OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY.ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART..C: SYSTEM INFORMATION(continued) Property Address: 36 Fourth Ave. W Hyannispor _ _. ...... Owner: Grei Date of Inspection: 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. v � ly 10 r 'Page 11 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 36 Fourth Ave yannispor. Owner. reig Date.of inspection: / -2,6 ,;L— SITE EXAM Slope Surface water Check cellar Shallow wells h Estimated depth to ground water a-LO feet Please indicate(check)all methods used to determine the high ground water elevation: �tained 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) Accessed USGS database-explain: You must describijow you esta6lis ed the high ground water elevation: j i u rgs 1 11 TOP OF FOUNDATION = 28.41' FINISH GRADE OVER D-BOX= 25.8' FINISH GRADE OVER CHAMBERS = 24.8' - 26.0' GENERAL NOTES PROVIDE RISER TO WITHIN 6"OF REMOVABLE COVER TO SLOPE @ 2/o MIN. OVER SYSTEM 1• UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION METHODS 0 FINISHED GRADE OVER OUTLET COVER WITHIN 6"OF FINISH GRADE 4"SCHEDULE 40 PVC MIN SLOPE 1% 3/4"TO 1-1/2" DOUBLE WASHED STONE TO CROWN OF PIPE SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL CODE AND ANY FINISHED GRADE FINISH GRADE OVER 5" DIA. OUTLET(S) APPLICABLE LOCAL RULES. @ FOUNDATION - TANK EL.= 27.0' 2"OF 1/8"TO 1/2" DOUBLE WASHED STONE 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE } } EXISTING 4" 20" MIN. ACCESS COVER 12„ MIN. I DESIGN ENGINEER. C.I. PIPE (TYPICAL FOR 3) 36"MAX. 36"MAX. I TOP OF SAS = 23.08' PLACE RISERS ON ALL CHAMBERS 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL 9"MIN. TO 6"OF FINISHED GRADE PROPOSED 4" 22.25' 36" MAX. � SYSTEM UNLESS OTHERWISE NOTED. f BREAKOUT EL = 22.75 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN SCHEDULE 40 PVC PROVIDE WATERTIGHT ELEVATION =22.75' FOR A DISTANCE OF 15 FEET AROUND THE PERIMETER OF THE 2" DROP MIN. S.A.S., UNLESS A 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST 5 FEET FROM S.A.S. MIN.SLOPE�t% 6" 3" 3"DROP MAX. 3.. g�. JOINTS (TYP.) 10,E _ AND THE TOP OF THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. - 4" PVC IN FROM 2 � �9, o 0 0 0 SEPTIC TANK 4" PVC OUT TO O pro �� O 5• SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. 26 08' 14" 23.0' LEACHING FACILITY op __-_ T oo o 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK 23.25' 22.67' MIN 22.5' 2'12" oo o0 0 0o FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS 48 OUTLET TEE o0 00 0 NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF " 6"CRUSHED STONE o0 0 0 0o HEALTH AND DESIGN ENGINEER. 10.4' 22"ZABEL FILTER �J OVER MECHANICALLY 1 00 0 0 0 0 0 0 8. ELEVATIONS BASED ON ASSUMED DATUM OF 25.00 OBTAINED FROM A NAIL IN A UTILITY MODEL#A1801 HIP(GAS COMPACTED BASE � 3.5' POLE AS SHOWN ON PLAN. BAFFLE ON BOTTOM) 5 3.5 8.5' (TYP. FOR 1) 4.0' 4.0' OUTLET DISTRIBUTION BOX 32 5' 4.9' 9• CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION 6" CRUSHED STONE TO BE INSTALLED ON A LEVEL STABLE (TYP.) THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT OVER MECHANICALLY BASE. FIRST TWO FEET OF OUTLET GROUND WATER ELEV.- < 15.22' 12.9' 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY COMPACTED BASE PIPES TO BE LAID LEVEL. 20.25 DISCREPANCIES TO THE DESIGN ENGINEER. PROPOSED 1500 GALLON CONCRETE SEPTIC TANK CROSS SECTION VIEW - 500 GAL. CHAMBERS 5'MIN. 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONCRETE STRUCTURES SHALL BE MADE WATERTIGHT. LENGTH 10.5' WIDTH 5.66' DEPTH 5• DISTRIBUTION BOX DETAIL TYPICAL CHAMBER PROFILE CHAMBER DETAILS CHAMBER END VIEW 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING N SEPTIC TANK PROFILE NOT TO SCALE REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM NOT TO SCALE NOT TO SCALE --- ---------- APPROPRIATE AUTHORITY. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS '� • . • �% TEST PIT DATA LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE THEY SHALL -'�" • • - ! ~ WITHSTAND H-20 LOADING. i a . • . • • AGENT: Unwitnessed 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. `" •"•�'• ( • 37 EVALUATOR: Bradley M. Bertolo 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND • +• DATE: April 26, 2004 UNSUITABLE MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING •�, son `� i i • FACILITY. REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE MAP 246 ti • - TEST PIT#: 1 op E� � ,• . ,� FROM CLAY, FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR PARCEL 110 +� �{' V1 3D ELEV TOP= 27.22' 15.255(3). { • `� • ' ELEV WATER < 18.00'• : 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN•�1 1 • ,. • = SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. F / ) II• ' • • if ! _} '� * PERC RATE _ <2 Min/In 16. PROPOSED PROJECT IS LOCATED WITHIN: O EXISTING CESSPOOL °li •Ct �l • • 1 ASSESSORS MAP 246 PARCEL 111 Oyj - � o#) DEPTH OF PERC= 32"-50" Q TO BE PUMPED AND /�� II ( - •• + •' OWNER OF RECORD: Blanche Grei w EXISTING FENCE (TYP) FILLED WITH CLEAN SAND _ � r : ' * TEXTURAL CLASS: 1 ADDRESS: 36 Fourth Ave 100.00' - ♦ v. .. F- -- - - - i L. • • 0 27 22' West Hyannisport, MA. 02672 cn I - w - S87°24'45"V11 I "� • .,.` � , q Loamy Sand FEMA FLOOD ZONE C `� �t ( o } • . ` . „ 10 YR 3/2 o SAS GAS AS GAS MAP 246 I 'Lop3'� "1 6 26J2 AS SHOWN ON COMMUNITY PANEL# 250001 0008 D W CO ' ' / 17. PLAN REFERENCE: �'' EXIST CB � `ti N PARCEL 111 rn I PROPOSED WYE AND r B y RIM -22.75' \ 7,841 S.F. ± 'k'"ti , Loam Sand 1. PLAN ENTITLED"PLAN OF SEASIDE PARK AT HYANNISPORT, MASS.,AUGUST 1893, 1ti/ C9 / CLEAN-OUT TO GRADE ,w / 10 YR 5/6 SCALE 100 FEET TO AN INCH, FRED 0. SMITH, C.E.", PLAN BOOK 34 PAGE 23. EXIST INV -- CESS \ i� 32" 24.55' 2. PLAN ENTITLED"TOWN OF BARNSTABLE PLAN SHOWING THE LAYOUT OF MAPLE -26.41' : : \ AR `� �"'�`: • Perc =T> WAY, WEST HYANNISPORT AS MADE BY THE SELECTMENT, SCALE: 40 FEET TO AN INCH, 40; '': %S 50" �`` 23.05' FEBRUARY 20, 1953,AS RECORDED AT THE BARNSTABLE REGISTRY OF DEEDS. EXISTING / P - .° ' MAP 246 ' m 4-BEDROOM ° ' pp, `: - 3. PLAN ENTITLED"TOWN OF BARNSTABLE PLAIN SHOWING THE LAYOUT OF FOURTH • _ .- -. � •. Medium Sand W i I DWELLING / \ PARCEL 106 J.- _ 2.5Y 6/8 AVE, WEST HYANNISPORT AS MADE BY THE SELE:CTMENT, SCALE: 40 FEET TO AN INCH, \ 1 FEBRUARY 23. 1951, PLAN BOOK 98 PAGE 45- O D N N 1�J fN OAK TOF =28.41' EXIST INV / DECK �• Q o N - - FnR _ 4 ' I H 3 i .j MI w P ' `- 15% Gravel 4. PLAN ENTITLED "PI AAI !1F I QNlfl IAI Dnnw ..L-7 1 rHNNISPORT)MASS. FOR ao o I I MARTIN TRAYWICK,TR., SCALE 1:40, FEB 19, 1985, PLAN BOOK 420 PAGE 64. '. wo m Ci �I m \ FULL BASEMENT PORCH � - 2- I - - 18, DEED REFERENCE: HC 1 �, PROPOSED CLEAN-OUT No Groundwater, a IN OAK I TO GRADE Weeping or Mottling 1. BOOK 9154 PAGE 333 0to O rn I O CRAWL , LOCUS PLAN Observed 19, ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. O LLo " (4) 0. 20. PROPERTY LINE INFORMATION IS APPROXIMATE, ONLY. THIS PLAN IS TO BE USED ONLY LL, \ Z "_ FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY o SCALE: 1 - 1000 I ( C) 144" 15.22' FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. GARAGE DESIGN DATA LEGEND -IN PINE -�=-._•=� - _- Ili 10.3' < 'N-_ _ HC 2 011 // 50 - - - EXISTING CONTOUR PROPOSED 3-500 GALLON /� /% \ SHED ( \ 50 PROPOSED SPOT GRADES (1) G h / PINE /�j NUMBER OF BEDROOMS (ASSESSORS) 4 LEACHING CHAMBERS //�PINE `� \ O =. s -' '� ��! \ j�� //� I ��� ` NUMBER OF BEDROOMS (DESIGN) 4 Jv - A _\\` �- PROPOSED CONTOUR _ X�X� \ DESIGN FLOW 110 GAUDAY/BEDROOM E/T/C - EXISTING OVERHEAD UTILITIES DISTRIBUTION BOX 9-IN PINE (3) / ORSYTHIA THE TOTAL DESIGN FLOW 440 GAUDAY O - / / �\ I DESIGN FLOW X 200 % = 880 GAUDAY W EXISTING WATERLINE T 1 I USE PROPOSED 1500-GALLON SEPTIC TANK O (3 O 27x22 I \ (MIN. PER TITLE V) GAS EXISTING GASLINE ��' Ilgf/r �� \I �i12-fN PINE 7 IN PINE � �� DIRT �lilfJ (2) _�\�`��/j DRIVES TEST PIT LOCATION I INSTALL 3 - 500 GAL. CHAMBERS O O O PROPOSED 1500 GALLON SEPTIC TANK �1l PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE B.M. so s �/%�I\,- �� \\� /�- SIDEWALL CAPACITY 85.00' II \ Nail in U.P. , _ , ��` S87°24'45'W ❑ PROPOSED DISTRIBUTION BOX ASSUMED , << �' / JhI � (LENGTH +WIDTH) (2)(2' HIGH) (.74 GPD/S.F.) = GAUDAY 0 PROPOSED 500 GAL. LEACHING CHAMBER GUY WIRE 13-IN P -- - � - - - - _ - (32.5'+ 12.9') (2)(2') (.74 GPD/S.F.) = 134.4 GAL/DAY EDGE OF PAVEMENT UP 38 EDGE OF \ \ RHODODENDRONS \ PROPOSED 1500 BOTTOM CAPACITY \ GALLON SEPTIC TANK (LENGTH x WIDTH) (.74 GPD/S.F.) = GAUDAY REV. DATE BY APP'D. DESCRIPTION (32.5'x 12.9') (.74 GPD/S.F.) = 310.2 GAUDAY __---- i PROPOSED SEPTIC SYSTEM UPGRADE MAPLE STREET TOTALS: PREPARED FOR: BLANCHE GREIG (40 FOOT WIDE LAYOUT) TOTAL NUMBER OF CHAMBERS: 3 LOCATED AT DESCRIPTION HC 1 HC 2 (1953 PUBLIC L.O.) TOTAL LEACHING AREA: 600.85 SQ.FT. TOTAL LEACHING CAPACITY: 444.6 GAL./DAY LEACHING CORNER(1) 23.0' 36.8' 36 FOURTH AVE LEACHING CORNER(2) 38.1' 23.8' WEST HYANNISPORT, MA 02672RESERVED FOR BOARD OF HEALTH USE LEACHING CORNER(3) 32.0' 11.3' SCALE: 1 INCH = 10 FT. DATE: MAY 15, 2004 LEACHING CORNER(4) 10.2' 30.3' or I o 5 10 20 ao FEET r�1�H � I � cy 0 CHURCHILL CIVIL JC ENGINEERING, INC. VI No 41807 2854 CRANBERRY HIGHWAY EAST WAREHAM, MA 02538 SITE PLAN j 508.273.0377 SCALE: 1"= 10' `5 /s�� Drawn By: MCP Designed By:MCP Checked By:JLC JOB No.660