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HomeMy WebLinkAbout0074 HAMPSHIRE AVENUE - Health 74 Hampshire Avenue Hyannis F/R' J A = 291 136 k n ;i 1 i ' o i C No. ` J Fee THE COMMONWEALTH OF MASSACHU SETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Appfic ZI Itration for 33igpozar Opotem Con�trurtion Permit a on for a Permit to Construct( . )Repair)Upgrade( )Abandon( ) X omplete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. VAY4 pot Irv-F-0 151.:U£ Assessor's Map/Parcel ?—C-i I E Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 3 Lot Size t T10-4, sq.ft. Garbage Grinder(11/4 Other Type of Building 1J nr4 C No.of Persons Showers(-V5 Cafeteria Other Fixtures L[ ,r�_$z�ti ickkC\g,� �ar�ic Design Flow gallons per day. Calculated daily flow ~ gallons. Plan Date I 1 to-1 C Number of sheets Revision Date Title sgA 5e-o�+C SLt Size of Septic Tank__SCC (Lv0AC%0 `7O Type of S.A.S. X ?i-4 t �yJC�1 Description of Soil 6\cam Nature of Repairs or Alterations(Answer when applicable) AKT 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 provisi ns of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has be s ed by this Bo HealthVA S' ned —Date7� Application Approved Date ®� Application Disapproved for the following reasons Permit No. Date Issued t No. r Q / Fee 9 J THE COMMONWEALTH OF MASSACHUSETTS Entered in computer; PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZIpprication for 33i.5pool 6potem Con.5truction Permit _ Xcateifor a Pernut to Construct('�':)Repair)Upgrade( )Abandon( ) Complete System ❑Individual Components Location Address or Lot No. - }1 gtr,pS w,QE AV E Owner's Name,Address and Tel.No. f Assessor'sMap/Parcel Zcl1 + 13� �jaM� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size 11 O�. sq.ft. Garbage Grinder Other Type of Building N fi.�.�G No.of Persons "3 Showers(1, ) Cafeteria( ✓� Other Fixtures k-rN;X-, k k kc y-r, g P Y ` y � ,PIC> gallons.Design Flow �'�h gallons per day. Calculated daily flow Plan Date S 11, I n<- Number of sheets i Revision Date Title - 'mac r;c��.`a.\ 47::�An r C,,,C M t 1 Dr n-r\_0 Size of Septic Tank-1 con c,r,�\r v, ;7�t�.v ,�lvr o-Type of S.AN. (i), x 9 1 '?'Q rt�1C),i � "i , _ . J _ _ -OZDescription of Soiln � �sS Nature of Repairs or Alterations(Answer when applicable) a cllzr _11-7t \G 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 ssued by this Board of Health S'gned ), Date O Q Application ApproveXy __�.c Date r l Q Application Disapproved for the following reasons Permit No. Qt"' r �q .. Date Issued AA`5 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded X) Abandoned( )by Db ) vo'l at Lf QjanjoiS has been constructed in pccordance with the pr visions of Tidl5-and the for Disposal System Construction ermit No. ® `� l�dated ,� >✓` Installer >'.U�i �l.In Designers��n The issuance of this permit shall not be constmed as a guarantee that the system-will fun as designed. Date /�1 /rJ -'' Inspector)/ - No.�r=�—�f� Fee )r� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Mi5poaf *pgtem Cou!5tructiou Permit Permission is hereby granted to Construct( )Repair( )Upgrade(/Y)Abandon( ) System located at —7 //Yl,0 5 A i /O � _ fir,//I Vl r 5 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: Const /ction must be completed within three years of the date �of this rmi'. Date: 6 /) Approved by` \l TOWN OF BARNSTABLE 4 LOCATION I /y 14 ►D��, P SEWAGE VILLAG ASSESSOR'S MAP & LOT' — INSTALLER'S NAME&PHONE NO. SEPTIC TAIJ.K CAP-ACITY 0 LEACHING FACILITY: (type) 1A �C� Tf'�,�Om�size) �7 X 10( Zc 1 NO.OF BEDROOMS 3 \' BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE. Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 4 C /s f � r 131 . Ga. - 3, = i®a 9/16103 Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems.Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM I, •:a AY ,hereby certify that the engineered plan signed by me dated ,5 C_5 ,concerning the property located at meets all of the following criteria: • This failed system is connected to'a residential dwelling only. There.are no.commercial or business uses.associated with the.dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or.may conduct deep test holes and percolation test&at the site without a health agent present. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will-be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the. Frimptor method when applicable] Please complete the following: A) Top of Ground Surface Elevation(using GIS information) 40 ,0,eA B) G.W.Elevation J +adjustment for high G.W. .1 I . _ (� DIFFERENCE BETWEEN A and B ,a � SIGNED DATE: BSI %t °�. NOTICE Based upon the above information;a repair permit will be issued for bedrooms maximum.. No additional bedrooms are authorized in the future without engineered septic system plans. ' I gaSepdc\p=exemp.doc 'JN Permit Number: Date: Completed by: HIGH GROUNDWATER BEVEL COMPUTATION Site Location: �-1 IafatriP si�� { � �� 94ka�iril=j Lot No, Owner: -A\qA` ��•►�, Address: ,t Contractor: �:: NIC:r; : Address: Notes:— ` t; V ` 1� �C"1 y"g STEP 1 Measure depth to water table to nearest 1/10 ft. .................•.. .Date month/day/year STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: yo O Appropriate index well................................................. ... flt © Water-level range zone ........................... STEP 3 Using monthly report "Current Water Resources Conditions" determine current depth to a� water level for index well ,,,,,,,,,,,,,,,,,,,,,,,,,,, ..— � 42"2�A mo th/year STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A), current depth to water level for index well (STEP 3), and water•level zone (STEP 28) determine water-level adjustment ............ .......................... STEP 5 Estimate depth to high water by subtracting the water- level adjustment (STEP 4) from measured depth to water level at site (STEP 1) ......................................•.•............•......................................... -r Figure 13.--Reproducible computation form, 15 TOWN OF BARNSTABLE LOCATION `! q C7 A J'h h+rr --->A,� SEWAGE # VILLAGE�1� J N 1 S. ASSESSOR'S MAP & LOT' ( INSTALLER'S NAME&PHONE NO. � Rn�-,erV> SEPTIC TANK CAPACITY A`6Z k� Y�LEACHING FACILITY: (type) �� '����''���?'^ (size) �X 1 is 1, 0.OF BEDROOMS 3 BMDER OR OWNER J e �, PERMITDATE: COMPLIANCE DATE: 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 i of tA T z� � 1 t TOWN OF BARNSTABLE LOCATION SEWAGE# VILLAGE �SSESS 'S MAP&LOT NAME&PHONE N SEPTIC TANK CAPACITY I CHING FACILITY: (type) s � (size) .Y 6ea- O.OF BEDROOMS r2 BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: . f Maximum Adjusted Groundwater Table and 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) A //4 FePt Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leachin f ty) Feet Furnished b a I 7�1 0 G � / � � 6� C . 06 �� ���� see \ , � a' Town of Barnstable �FtME rgy�o Regulatory Services Thomas F. Geiler,Director * &MMSTnar.e, MASS. ��� Public Health Division �E039. Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: 5/18/05 Designer: Shay Environmental Services, Inc. Installer: Robert Septic Services. Address: P.O. Box 627 East Falmouth Address: 5 Trenton Street MA 02536 Yarmouth, MA On 5/6/05 Robert Septic Service was issued a permit to install a (date) (installer) septic system at#74 HAMPSHIRE AVENUE, HYANNIS, MA based on a design drawn by (address) Shay Environmental Services, Inc. dated 05/06/05 (designer) XX I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. H OF Mgssgcy CARMEN N aller's Si o E. SHAY fn No. 1181 STER� Sq N (Des r s Signature) (Affix Desi p Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form f °4INE•r � Town of Barnstable Regulatory Services r' * BARNSTABLE, * Thomas F. Geiler,Director 9�A MASS.9. .0�A Public Health Division TFD MA'S Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Alfred Blue March 1, 2005 28 Peach Tree Rd. Marston Mills,Ma. 02648 NON-COMPLIANCE WITH STATE ENVIRONMENTAL CODE TITLE V. The septic system owned by you located at 74 Hampshire Ave. Hyannis was inspected on, 6/14/2002 by Timothy E. Cash a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: Backup of sewage into facility or system component due to overloaded or.clogged SAS or cesspool. Our records show that the system has been in a failed state for more than two years. You are ;ordered to hire a professional engineer or registered sanitarian to prepare a plan of proposed replacement septic system component(s). This plan is to be submitted to the Town..of. Barnstable Public Health Division Office (Regulatory Services, 200 Main Street, Hyannis),within (90) days receipt of this letter. The plan will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title V. You are a lso o rdered t o u pgrade o r r eplace t he s eptic s ystem w ithin s ix months (180) days o f y our receipt of this letter. Any person aggrieved by any order issued by the local approval authority may appeal to any c ourt o f competent jurisdiction as provided for by the laws of the Commonwealth. You have. the option of requesting an adjudicatory hearing pursuant to 310 CMR 15.422 Failure to comply with this order will automatically result in a public hearing scheduled before the Board of Health. P F T E BOARD OF HEALTH Thomas A. McKean, R.S., Agent of the Board of Health CC: Board of Health 1/failed_septic_letters Barnstable Assessing Search Results Page 1 of 2 t s f > Home: Departments:Assessors Division: Property Assessment Search Results r; 74 AMPS AVENUE, Owner: BLUE,ALFRED Property Sketch Legend Map/Parcel/Parcel Extension 291 /136/ £WICK. Mailing Address 4-, 4 . BLUE,ALFRED 28 PEACH TREE RD MARSTONS MILLS, MA.02648 f F 20: 2005 Assessed Values: ;• Appraised Value Assessed Value Building Value: $ 120,500 $ 120,500 Extra Features: $2,400 $2,400 Outbuildings: $400 $400 Land Value: $ 137,700 $ 137,700 Interactive Property Map: ap requires Plug in: Totals:$261,000 $261,000 1 have visited the maps before � s Show Me The Map ,• April 2001 photos available Sales History: Owner: Sale Date Book/Page: Sale Price: WILLIAMS, ELLEN J 7/15/1996 C141500 $97,900 BUCKINGHAM, ELIZABETH M C81336 $ 1 CAPE COD&ISLANDS ASSOC 6/19/2002 CDD-N $46,182 BLUE,ALFRED 11/28/2003 C171415 $224,000 2005 REAL ESTATE Tax Information: Tax Rates: (per$1,000 of valuation) Land Bank Tax $47.37 Town Fire District Rates Other[ $6.05 Barnstable-Residential $2.12 Land B. Barnstable-Commercial $2.80 Hyannis FD Tax(Residential) $396.72 C.O.M.M.-All Classes $1.01 Cotuit FD-All Classes $1.28 Town Tax(Residential) $ 1,579.05 Hyannis-Residential $1.52 Hyannis-Commercial $2.39 W Barnstable-Residential $1.44 http://www.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/... 2/17/2005 IBarnstableAssessing Search Results Page 2 of 2 y W Barnstable-Commercial $2.10 Total: $2,023.14 Due to rounding differences these values may vary Land and Building Information Land Building Lot Size(Acres) 0.38 Year Built 1959 Appraised Value $ 137,700 Living Area 1541 Assessed Value $ 137,700 Replacement Cost$ 150,671 Depreciation 20 Building Value 120,500 Construction Details Style Ranch Interior Floors Carpet Model Residential Interior Walls Drywall Grade Average Heat Fuel Gas Stories 1 Story Heat Type Hot Water Exterior Walls AsbestShingle AC Type None Roof Structure Gable/Hip.. Bedrooms 3 Bedrooms Roof Cover Asph/F GIs/Cmp Bathrooms 1 1/2 Bathrms Total Rooms 5 Rooms Extra Building Features Code Description Units/SQ ft Appraised Value Assessed Value FPL1 Fireplace 1 $2,400 $2,400 SHED Shed 60 $400 $400 Property Sketch Legend BAS First Floor, Living Area FST Utility Area (Finished Interior) UAT Attic Area(Unfinished) BMT Basement Area(Unfinished) FTS Third Story Living Area(Finished) UHS Half Story(Unfinished) CAN Canopy FUS Second Story Living Area(Finished) UST Utility Area(Unfinished) FAT Attic Area(Finished) GAR Garage UTQ Three Quarters Story(Unfinished) FCP Carport GRN Greenhouse UUA Unfinished Utility Attic FEP Enclosed Porch -PTO Patio UUS Full Upper 2nd Story(Unfinished) FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck FOP Open or Screened in Porch TQS Three Quarters Story(Finished) http://www.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/... 2/17/2005 I 1i Septic Inspection Information DataEntty©ate 7/18/2002 SepEic Inspect No" 592 Ass ssorsMap 291 Pact 136 Lot Eiusmess� fNurnbe ..,�, 74 Address Ham shire Avenue y:�J�ltag H annis tnspector Timothy E. Cash p `�� 6/14/2002 M,Sjis#em Status lns ect�ate": � � F ommet Liquid depth in cesspool is less than 6 inches below the invert or avialable flow is less than one half days flow ��Per i �—� Rep�r Dater ;�N�o#ificatr�onDFa��te" ' En �lris�t l ,Repai, Deadline Date. COMMONWEALTH OF MASSACHUS .'I`TS ® ''tla��b�'®In EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION s _ 1 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY A SEA SUBSURFACE SEWAGE DISPOSAL SYSTEM F ORM PART A JUL 0 8 2002 CERTIFICATION TOWN OF BARNSTABLE HEALTH DEPT. Property Address: 2b.SAIee Aye Owner's Name: EIle t, An/A J Owner's Address: 41 N MAC-i"R I ye 7 v/ . Date of Inspection: Name of inspector: (please print) Company Name: .. Mailing Address: (7.. 0�6�5 : Telephone Numbe : (60g),36A--3,;?a1 PARCH 3 �D CERTIFICATION STATEMENT LOT 1. 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. 1 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 f Inspector's Signature: Date: t7 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 of}ginal should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority, . Notes and Comments ""This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page I Page 2 of 11 ` OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Owner: Date of Inspection: / Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic talk(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure's imminent.System will pass inspection ifthe, existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break-out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or-replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 ` Page 3 of I 1 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION-(continued) Property Address: Owner: e 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 front a private water supply well".Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: 3 i Page 4 of 11 OFFICIAL INSPECTION FORM-NOT-FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) t Property Address: ' ke . O / Owner: Date of Inspection: / O' 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 ✓ _ Liquid depth in cesspool is less than 6"below invert or available volume is less than''/2 day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped Any portion of the SAS,cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure.erheria are triggered.A copy of the analysis must be attached to this forma Yes (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 imsflrtrve 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. 4 r Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: ke 260 Owner: a'AAFE Date of Inspection: Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No Pumping information was provided by the owner,occupant,or Board of Health Were any of the system components pumped out in the previous two weeks Has the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or as part of this inspection? _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) _ Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out? Were all system components,excluding the SAS,located on site? _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth�of liquid,depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no _ _�Z 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 IPage6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:_ grn ,/y�� Ave lwaonls /1h,0 0/ Owner: Date of Inspection: J FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): .2- Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#.of bedrooms): Number of current residents: Z Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system(yes or no): 6& [if yes separate inspection required] Laundry system inspected(yes or no):&L Seasonal use:(yes or no):// Water meter readings, if available(last 2 years usage(gpd)): 4/=14S- ood:4,61 I3),100 CH Sump pump(yes or no): 11b Last date of occupancy: ,/ QcCc e4l COMMERCIALIINDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): i;pd 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:_Rwi 54AUP Tren4me&A hAnt Was system pumped as part of the inspection(yes or no): Wo If yes,volume pumped:_gallons--How.was quantity pumped determined? Reason for pumping: wop,IMP Wo d1001L Ocui ekA_S v . AIAS�jd TYPE OF SYSTEM _Septic tank,distribution box,soil absorption system ,2 Single cesspools _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known)and source of information: ZAIr 5 eA ly 6;s Were sewage odors detected when arriving at the site(yes or no)://a 6 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: A C Owner: Elletu Pbole 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: 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: 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: How were dimensions determined: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid Ievels as related to outlet invert,evidence of-leakage,etc.): GREASE TRAP:_(locate on site plan) Depth below grade: Material of construction:_concrete_metal_fiberglass_polyethylene—other. (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: . Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 1 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: O bJ Owner: E/AA,-Pa6le- Date of Inspection: (Q /3 off. 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: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,.any evidence of leakage into or out of box,etc.): PUMP CHAMBER: (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.): i 8 ` Page 9 of l l OFFICIAL INSPECTION FORM NOT FOR'•VOLUNTARY ASSESSMENTS `SUBSURFACE SEWAGE'DISPOSAL SYSTEM INSPECTION FORM PART.0 SYSTEM!INFORMATION(continued) Property Address: Owner: E116u Pode Date of Inspection: 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.oftechnology-­­­" Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and'configuration: — fn X rb C P Depth—top of liquid t inlet invert:CPU I C P Depth of solids layer.yd �r Ai ' Depth of scum layer. " rr :A, Dimensions of cess ool X6 " t. Materials of con � tL+° struction: n;� i Indication of groundwater inflow es or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,`condition of vegetation,etc.):..;! . . PIQ6, al 0cLk-r.T & cesso[JA a itl dw,11 •-ce 3/o �L dr'yAA,)' �/erU 4;eL 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.): Page 10 of I 1 OFFICIAL INSPECTION FORM•="NOTTOR-VOLUNTARYASSESSMENTS- SUBSURFACE SEWAGE-DISPOSAL SYSTEMINSPEEMON FORM 'PART C SYSTEM INFORMATION(continued) Property Address a Owner: 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.. _ .. i.:!r I'.} 'ii,'.i�,'.. '>.fi,�,''?I�',,l.,!S(b�ll't.j' •v .r."�`i.�t�;:Tl�':.C�i2r;`{ii I` ,3 wG •. 4�'rw• r ,.'i`- :3.i: '�:? `(='?�+• � ,��J 1�'!.�JCl i:'a`�`t��°l�lii t !tl,.jS?(t eV�ll����f rS.r,,�( :1 1• .. :11:[-. ....... ..... ..w..._... ._ .. _-- .. �!:✓ ..w:.J.�wrC.i..y^'�}t"�'`,+Y•F,+i.rW+ r+�M+_.4 _ ..�.._.... ......._1..... ..: e q,/.h..3(i r/i,..�. 'Ji?c;Fa�.�•:Q Ci,u� fi'e6.( ��i�lsf4f(7�1(3:Q�f�lf �;ia'3 iff J,. :>'�1:f.,,/ 1. _ i.+,1('_ 1 ,'10. .. f Page 11 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 41 42nar�51` E; Owner: IF Date of Inspection: / SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation h le within 50 feet of SAS _'Checked with local Board of Health-explain:AlbSIMe loeti # . Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: I1 *NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. VENT PIPE Least 24 inches toll) SECTION A -A f�HtihTt stNAS1Y > 10 min. from c ALL OUTLET PIPES FROM THE 4, Existing Foundation house to septic tank Schedule 4 PVC w/Charcoal Odor Filter t2, y DISTRIBUTION BOX SHALL BE : D-Box cover must be PROFILE VIEW OF ADDITION TO LEACHING SYSTEM sET LEVEL FOR AT LEAST 2 FT. CONCRETE COVER i r TOP OF FOUNDATION = ELEV. 100.00 (Assumed) Septic tank covers must be within 6 in..of finished grade within 6 in, of finished grade g - -�' ,"-�.• ..�..+• 2 Grade over Septic Tank 99.00 r-Grade over D-Box 98.00 Vode over SAS - 98.50 3" of 1/8". - i/2". Washed-Peaston KNOCKOUTS + .f I 4 � t"^5a / "r 3/4" to 1 1/2' Washed Crushed Stone ' $ 'mot 12' MET S + 0.02 3 HOLE H-10 4" PVC(CAPPED)INSPECTION PORT TO BE t` ' OUTLET , 78' NEW S=0.01 DIST. BOX 3' Maximum Cover Top OF System- Oev. +85.25 iNSTALL.ED AND TO BE WITHIN 6'OF GRADE 8'. } EXIST. PIPE `Y h 1,500 GAL. or Greater r' '` 2 d 74 Hmmpshtre Ave, FROM EXIST. FWNDATIr7N 25' - S= 0.07• per took 10" Effective Depth 15.5'--- 4".- SCH. 40 Te 1.75" rn vj SEPTIC TANK eP u 11 cn POLYETHYLENE . ,,.8a,,, a, o � 20' "---- PLAN SECTION CROSS-SECTION CONCRETE FULL FOUNDATIJ la H-10 tI 5 Units E 6,25' 30' 0.83' (10 inches) s - N O r` 3r 3 i tau 7 va SYSTEM PROFILE 6 In.of 3/4"-1 1/2'compacted stone 31,25' 3 HOLE H-10 DISTRIBUTION BOX u a) c > m m rn 37.25' NOT TO SCALE 5 4 4' Effective Not to Scale - c p - Effti Length e* 7ttarxrtt :aCa"�, y® aNA-TEo > c v JA - I ll _ v 3 SOIL ABSORPTION SYSTEM (SAS) GENERAL NOTES 6 in.of 3/4'-1 1/2' Q 11 4) compacted stone Q Ef fective Moth o INFILTATROR HIGH CAPACITY (H-20 LOADING)/ GEORGE ❑'BRIEN NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE 1 o -- 1. Contractor is responsible for Digsafe notification, Verification of Utilities o in (OR EQUIVALENT) Not to Scale and protection of all underground utilities and pipes. w Bottom of Test Hole 1 NONE6GO BS NOTE: OVERALL HEIGHT OF INFILTRATOR IS 18" EFFECTIVE HEIGHT IS 10" 2. The septic tank and distribution box shall be set Groundwater observed _ NONE oesETevED_ / level on 6" of 3/4"-1 1/2" stone. 3. Backfill should be clean sand or gravel with no stones over 3 in size. L 4. This system is subject to inspection during installation PERCOLATION TEST_ by Carmen E. Shay - Environmental Services, Inc. 5. The contractor shall install this system in accordance Date of Percolation Test: APRIL 259, 2005 with Title V of the Massachusetts state code, the approved plan Test Performed By. CARMEN E. SHAY, R.S., C.S.E. and Local Regulations.' Results Witnessed By. WAIVER(per Barnstable B.O.H.) 6. If, during installation the contractor encounters any EXCAVATOR: Shay Environmental Services, Inc. soil conditions or site conditions that are different Percolation Rate: Less Than 2 MPI ® 42" LOT #44 from those shown on the soil log or in our design - - -----i cD installation must halt & immediate notification be Test Hole 1 made to Carmen E. Shay - Environmental Services, Inc. No. 1 Wi 7. No vehicle or heavy machinery shall drive over the DEPTH SOILS ELEV. \ �\ septic system unless noted as H-20 septic components. o_ 98.00 \ LOT #43 8. install Tuf-Tite gas baffles or equals on all outlet tee ends. Sandy Loam �\ \\ 9. All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipes. 10 YR 3/2 LOT #30 \\ 45.00, 10. All solid piping, tees & fittings shall be 4" diameter \ tight with water es Schedule 40 NSF PVC I ti joints, 0"-12" A, 97.00 pipes 9 Sandy O \� 4" PVC �7 5, `-- - 11. Municipal Water is Connected to ALL OF The Residence and Abutting Loam o --, Vent Properties Within 150 Feet. 38' 37.25' to YIt 5/6 `\ \ THE PROPERTY LINES ARE APPROXIMATE AND Medium \\ ��\ D-Box ;` }�' r,t s`•.-_a;: '�?�h. } COMPILED FROM THE SURVEY PLAN GENERATED BY . . r BEARSE & KELLOG of BARNSTABLE, MA Sand SUBDIVISION-PLAN OF LAND, HYANNIS, MA" LC 14034-A SHEET 2 25 Y 7/4 DATED DATED FEBRUARY 26, 1954 42' 144 c, PROJECT BENCH MARK \\\ \\\� TEST HOLE #1 y f7' AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN iT SHOULD BE USED ,FOR NO PURPOSE OTHER THAN TOP OF FOUNDATION \\\ \���ELEV.= 98.00 THE SEPTIC SYSTEM INSTALLATION. ELEV. - 100.00 (Assumed) \ \ Failed 0 \ CESSPOOL EXISTING CESSPOOL TO BE PUMPED OUT AND FILLED IN PLACE NEW 1500 gal. �� 3 .5' �\ 1 O Polyethyl,�4 Tank NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE o) i O ---_- F----- _i FROM THE EXISTING CESSPOOL TO BE DISPOSED -- to EXIST. i 1 1 OF AS PER BOARD OF HEALTH SPECIFICATIONS. O I 1 _ Deck Perc 1 i i� \h am LOT #32 THERE ARE NO WETLANDS ARE PRESENT WITHIid 200 OF THE PROPERTY Depth#to Perc: 42" to 60„ // 10 I - Perc Rate= 2 MPI ,� 1 it I, `� ASSESSORS MAP 291 PARCEL 136 Groundwater Ngt Observed LEGEND No Observed ESHWT /�� ij ADJUSTED H2O Elev. None 4 l 3-24' DIAM. A ',. ccEssMANHOLEs EXISTING i 104X1 DENOTES PROPOSED 1���' 3 BEDROOM SPOT GRADE XIS N DENOTES ETkG xoUSE X 104.46 SPOT GRADE #7¢ I� LOT #29 I 111 PL INLET 1 / ti./ `.�.t OUT Er INLET - .PROPERTY LINE �� PHALT ' THE ACCESS COVERS FOR THE SEPTIC TANK. i 1RIVEWAY I -- 96P PROPOSED CONTOUR DISTRIBUTION BOX AND LEACHING COMPONENT ' / I 1 SHALL BE RAISED TO WITHIN 6" OF t -z n'-7 -Z FINISHED GRADE. i I ; _ - _ -'-97 EXISTING CONTOUR STEEL REINFORCED PRECAST CONCRETE INSTALL TUF-TiTE GAS BAFFLES OR EQUALS PLAN VIEW ON ALL OUTLET TEE ENDS DEEP TEST HOLE & 3-24' REMOVABLE /// � I I - I! -LOT #�31 � I � PERCOLATION TEST LOCATION I- _.:;: �4 . ., +• _ �_ 15,102 Square Feet 6 FOOT STOCKADE FENCE - _ 3 min. clearance _ B' min f ., I � �t3' 1Nt.ET Y � - ---'--`.. T � I MJIET. _1�-�T2_min. inlet to o tlet 8 mh 'j'r}- 9�. MILE - �T 1- ­ dq id T4 I--. � OUTLET - 10' I IIIUUUIII ' , . 6 -1 I '-5 -7 _ - I 5� g6_._ E S i '_ 4'1-0' min. J_: f1 , I I 1 PLAN Liquid depth 1 1 9.1 4 1 I P L� 0 I 1 J V - t � -: .• . - -- PL OF PROPOSED SEPTIC SYSTEM UPGRADE CROSS SECTION END-SECTION ---------------------------------------------------� - ------------------ PREPARED FOR _TYPICAL (H- 10 LOADING) 1500 GALLON SEPTIC TANK MR . ALFRED BLUE AT NOT To SCALE t 1D�P, I h �' V r1vu- #74 HAMPSHIRE AVENUE Substitute with 1500 gallon H-10 Polyethylene Tank-Geode O'Brien Co. (40 FOOT RIGHT OF WAY) HYAN N I S, MA I Design Calculationpzl OF .' S 9 PREPARED BY: Number of Bedrooms: 3 Equivalent to 330 Gal./Day (330 Gal./Day Min, per Title V) Garbage Grinder: No >�� 1 it Y E. A�ll.L-1� u/� Y Leaching Capacity Proposed: 330 Gal./Day Minimum (Min. Per Title V)Septic Tank : - 2 x 330 Gal./Day = 660 USE NEW 1,500 GAL. Septic Tank. H SOIL ABSORPTION AREA:. S ENVIRONMENTAL SERVICES, INC.Using percolation rate of <2 min./inch' Bottom Area: 0,74 gal/sq. ft. x 370 sq. ft. = 273.8 gallons 4 P.O. BOX 627 Sidewafi Area: 0.74 gal./sq. ft. x 78 sq. ft. _ 58 gallons 0 20 40 50 cfsT��`` EAST FALMOUTH MA 02536 Providing: _ 331.80 gallons SANITAPOl'� } Use: 5 INFILTRATOR-HIGH CAPACITY H- NI „v TEL/FAX 50$-539--7966 O C TY 20 UNITS, HAVING A 0.83 (10 INCHES) EFFECTIVE DEPTH, a- , SCALE: 1 "=20' DRAWN BY; CES DATE: MAY 6, 2005 TO BE USED WITH 4.0' OF WASHED STONE ON THE SIDES, AND 3.5' OF WASHED STONE , ON THE ENDS. NO STONE UNDER. SCALE: 1 =20 PROJECT#SD734 FILENAME: SD734PP.DWG SHEET 1 OF 1