HomeMy WebLinkAbout0037 ISALENE STREET - Health 37 ISALENE STREET,HYANNIS
A= 267 037
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TOWN OF BARNSTABLE
LOCATION 31 15ALC KPP �5TR SEWAGE# AC(q �-
V_I-LLAGE ASSESSOR'S MAP&PARCEL Wal-I 377
INSTALLER'S NAME&PHONE NO. Race r ccy-p-c®
SEPTIC TANK CAPACITY 15-0o GAC. oms _ ' _ _ _-
LEACHING FACILITY:(type) (3)500 e. C4AKWkS (size) 4--544APE
NO.OF BEDROOMS 3 ti��uJ °wn' Zvuo-N?9
OWNER T40 KA-S t R ENA4 Ir 1 AOS
PERMIT DATE: lam-i 9=4 0tq 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) K A, Feet
Edge of Wetland and Leaching Facility(if any wetlands exist within flfl�
300 feet of leaching facility) Feet
FURNISHED BY R6060—t A�. QC)Q� CD �
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291 # 3 7 %sc�IQ��
n � SFF
( -Ir 2 9
C -2= 22.5,
No. Q� Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
2ppliLation for Bisposal *pstrm Construction 3per it
Application for a Permit to Construct( ) Repair A Upgrade( ) Abandon( ) ❑Complete System ndividual Components
Location Address or Lot No. 3-1 �(�N� �-i Owner's Name,Address,and Tel.No.
Tl4otIAS � VC—MA FIA05
Assessor's Map/Parcel a!o I-�XANvCS Z I S :5-Y- HY40d J( '
Installer's Name,Address,and Tel.No. 50S-477- 77 Designer's Name,Address,and Tel.No. Sc&—A73—037 7
Type of Building: / I'e Jeff ,/y�� �Udo— Y7 y _J
Dwelling No.of Bedrooms Lot Size t0�8 sq.ft. Garbage Grinder( )
Other Type of Building 4qE5lZk6X.M -L No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) I;L An gpd .Design flow provided gpd
Plan Date ,/9L—(,3 —34011 Number of sheets L Revision Date
Title 37 r Lt,�� Sze - HY4,oj&)(5`
Size of Septic Tank ( TS 00 C,4UAp ?S Type of S.A.S.
p` r
Description of Soil A40D 'M Cwh959-
Nature of Repairs or Alterations(Answer when applicable) USES SE)USTrA_LC j Spy —7� Zen $ [C� •Jf�
10 Neo n -ao� TM 3) 75c.;,l7 cak-c.oxi lx .A ``L!'- S"Am_—p
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 Certificate of
Compliance has been issued by this Boar of He
Si Date
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. o- Date Issued / —t C!—
b A
ni—
kkkjjj
No — - Fee V 0 —
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION,-,TOWN OF BARNSTABLE, MASSACHUSETTS es
Rpplitatlon for Disposal i�pstrm Construction jorrinIt
Application for a Permit to Construct( ) Repair Al Upgrade.( ) Abandon( ) ❑Complete System ividual Components
Location Address or Lot No. 3-) Owner's Name,Address,and Tel.No.
c-�NE
' Y-Fvcw�s r QC-NA F I,AJ5
-�Assessor's Map/Parcel � 14Y a1 , t
Installer's Name Address,and Tel.No. 7 Designer's Name Address,and Tel.No. 50$-z7 3-40 3?
CAEpC-Wt06(Rt 2� a,p- �O :.� <rC •C Aj fF�.c,rE�CrsrC:-
le.4o�ge
& ( �/ /
Type of Building: 3 c/'�u J err I �"0- l �� PeGri,�de
j2/��� „
Dwelling No.of Bedrooms Lot Si e sq.ft. Garbr( )
Other Type of Building �G5�1�ezr T/-�,/� _ No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) :a gpd Design flow provided ;3 V4, t. gpd
Plan Date ��T `q- ` Number of sheets / - Revision Date
Title
E Size of Septic Tank j_._S p,n_ C- Type of S.A.S.
Description of Soil y _ ,, c`� Iw C 2. ?, '� ;/
i
Nature of Repairs or Alterations(Answer when applicable) U S WC-
Mac
r �
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 Certificate of
Compliance has been issued by this Board of Health.
Si Date
Application Approved by Date _ �Cf
Application Disapproved by Date
for the following reasons
Permit No. '7„ Ct if ll2 Date Issued T� _ C) /
---------------------------------------------------------------------------------------------------------------------------------------
a 1 THE COMMONWEALTH OF MASSACHUSETTS
3 dnn I Gw 0
BARN TAlBLE MASSACHUSETTS
'�UOtl- qW P_-j j(� Certificate of Col pliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( Y) Upgraded( )
Abandoned( )by 0 "Ci.N
at _Z 77 X54( e •rt* .0 has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. O L dated _ /�-M
--f
Installer,N,I nLr- � �,.i', 120, Designer _T4-
#bedrooms 2 Approved design flow god
The issuance of this pe it shall not be construed as a guarantee that the system will ctio designed
Date ") p Inspector S
No. or 1 _ Fee 00 _
- THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS
�is�osaY �pstetrt �Construction,.�errnit
Permission is hereby granted to Construct( ) Repair O Upgrade( ) Abandon( )
System located at
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Constructio must a completed within three years of the date of this permit.Date 161 Approvedby C4tiv
Town of Barnstable
•�fs"�l°'�yo Regulatory Services
` Richard V, Scali,Interim Director
+ 11AR�STA13M +
MASK, �� Public Health Division .
i639• ��
ArEo ,ta Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer& Designer Certification Form
Date: 1` 9- ZO Sewage Permit#dO a 9 -'4 F Assessor's Map\Parcel 0-7/ 37
Designer: SC 47,oc Installer: Ciee.w{de. E-vike.,ec-i Se s
Address: S51 C-rao\ozrcy t,i4,wo.y Address:
rc�5k Wore—iaivi C2 3 Nnsitta: e , !rt 6 Z (C 1/ '-j
Oil (Xa l9 a)L019 cct"'. %clt was issued a permit to install a
(date) (installer)
septic system at S Q Sc e- 5+ce based on a design drawn by
(address)
"Co C'. dated
(designer)
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. Strip out (if required) was inspected and the soils
were found satisfactory.
1 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. Strip out (if required) was inspected and the soils
were found satisfactory.
I certify that the system referenced above was construe nce with the tenns
-of the AA approval letters (if applicable)
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JOHN L ar
c CHUR !LL JR.
iVIL
nstalle ' Signa re) N .41
s
esigner's Si8q'i (Affix igne s St mp He,f
PL ASE RETU TO BARNSTABLE PUBLIC HEA H D VIS N. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOT IS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBUC HEALTH DIVISION.
THANK YOU.
QASepticTesigner Certification Form Rev 8-14-13.doe
TOWN OF BARNSTABLE -
LOCATION 31 e oAo SEWAGE # IWO•- H74
VILLAGE R�AY+NiS raarL4- ASSESSOR'S MAP & LOT 2-67-6 �7
INSTALLER'S NAME&PHONE NO. ?-ADbi QSo r0 56 J2 i C 17 S-7 7 7(o
u �
SEPTIC TANK CAPACITY I S 0 D f
LEACHING FACILITY: (type) X Ufty 0C- (size) 12 *Z *Y- ;1
NO.OF BEDROOMS
BUILDER OR OWNER Ida
PERMIT'DATE: St 1 t i aoo,0 COMPLIANCE DATE: RII I 260O
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
P
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Se
0
0
No. Fee $50ow
-
THE COMMONWEALTH OF MASSAC USETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
ZIpprtcatton for Mt.5poal *pgtem Cougtruction Permit
Application for a Permit to Construct( )Repair( X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Locati--Address or Lot No. Owner's Name,Address and Tel.No.
37 .Isalene St . , Hyannisport Linda Gruberski
Assessor'sMap/Parcel 69 Hadmen. Rd.. , Worcester
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Wm. E. Robinson Septic Service
P 0 Box 1089, Centerville
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil S and.
Nature of Repairs or Alterations(Answer when applicable) Title-5 septic system consisting
of a tank. n—hnx and 2 precast, c9nc126to Ghamaers with
stone a 1 1 ar jnd
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 issued by this Board of He lth.
Signe '9 Q Date
Application Approved by 'f. Date
Application Disapproved for the following reaso K10,
Permit No. Date Issued
"o No.
THE COMMONWEALTH OF MASSAC USETTS Entered in computer:
Yes
r, PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
ZippYication for Miopooal *p.5tem Co-ngtruction Permit
Application for a Permit to Construct( )Repair( X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
oca onrAddress or Lot No. Owner's Name,Address and Tel.No.
7sglene St . , Hyannisport Linda Gruberski
Assessor's Map/Parcel 69 Hadwen Rd. , Worcester
w
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Wm. E. Robinson Septic Service
P 0 Box 1089, Centervillei
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building -No. of Persons Showers( ) Cafeteria( )
Other Fixtures +
Design Flow gallons per day. Calculated daily flow gallons. '
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil Sand.
Nature of Repairs or Alterations(Answer when dpplicable) Title-5 septic S,yst em ,,c ons is t it
Of a tank, D-box and 2 =Pnast . n91_Cr@tn all2mbal2n Wits`
stone all around .
f
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 Cert1 1
cate of Compliance has%been issued by this Board of He lth.
g 4
Si gn D Date
Application Approved by' Date
Application Disapproved for the following reaso
6,
Permit No. '"` Date Issued
------- ----------------- ------
THE COMMONWEALTH OF MASSACHUSETTS
Grubersk-' BARNSTABLE, MASSACHUSETTS A
Certificate of Compliance
THIS IS`TTO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( X )Upgraded( )
Abandoned( )by Wm. E. Robinson Septic Service
at s e ha be n cm struct f n accordance
with the provisions of Titles and the for is
with I System Construction Permit N ated
Installer Wm. E. Robins on S Designer
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
Date Inspector r., r^��
�s 1
——— —————————————————————————————
No. C_iC/ 77# ! A -::: „t ,,...Q ' Fee11 (/t�
E C�M ONWEALTF,OF MASSACHUSE S '--��
PUBLIC HEALTH IV� - BARNSTABLEx`MASSACHUSETTS
Gruberski Migoar *pgtetn Conotruction Permit
Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( )
System located at 37 Isglene Rd. . Hyannisport
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:Constructio muf be completed within three years of the date o pe t.
�,AA
/'I J tt
Date: Approved by t _ 1
r1
• �I// �Q� ., i, 116/99
NOTICE: This Form Is To Be Used For the Repair Of Failed
Septic Systems Only.
CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL
WORKS CONSTRUCTION PERIV Tf(WrrHOUT DESIGNED PLANSI
I, W ill iain E. Robinson,S>ltereby certify that the application for disposal works
construction permit signed by the dated concerning the
property located at 37 Iscilene St . , Hyannisport meets all of the
following criteria:
• The failed system is connected to a residential dwelling only. There are no commercial or business
uses associated with the dwelling.
Th soil is classified as CLASS I and the percolation rate is less than or equal to:5 minutes per inch.
i
The a are no wetlands within 100 feet of the proposed septic system
The a are no private wells within 150 feet of the proposed septic system
The a is no increase in flow and/or change in use proposed
• Th a are no variances requested or needed.
e bottom of the proposed leaching facility will nc�t be located less than five feet above the
0mun adjusted groundwater table elevation: f Adjust the groundwater table using the Frimptor
ethod when applicable)
• If the S.A.S.will be located with 250 feet of any vegetated wetlands,the bottom of the proposed
leaching facility will not be located less than fourteen(1.1)feet above the maximum adjusted �
groundwater table elevation,
Please complete the following:
A) Top of Ground Surface Elevation(using GIS information) I+n
B) G.W.Elevation : +the MPJX. High G.W. Adjustment._ =
DIFFERENCE BETWEEN A and B
SIGNED : ZZDATE: �/ C
[Sketch proposed plan of system on backs.
y:heaM folder:een
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TOWN OF BARNSTABLE -
LOCATION 37 SSAIe,wE goAc) SEWAGE # 2WO- H-7 4
VILLAGE R�tA►4N, S row R.4" ASSESSOR'S MAP & LOT 7-15 3 7
INSTALLER'S NAME&PHONE NO. 9,obi1> sN $6Q i( -77 5-7 7 7(a
SEPTIC TANK CAPACITY 1 ;o 0
LEACHING FACILITY: (type) X U42y v�C i(S (size) i 2-x Z 'IL aS
NO.OF BEDROOMS
BUILDER OR OWNER 3
PERMITDATE: I►.` I �ooU COMPLIANCE DATE: 2�c4
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility (If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
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SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
ADDRESS: 37 Isalene Street
ASSESSORS' REFERENCE: Map 267, Parge 037
` dp
OWNER'S NAME: Lorette Orlando dd
DATE OF INSPECTION: June 19, 1995 n G�
PART A �9 'r
CHECKLIST d,
s ti
Check if the following have been done: P
X Pumping information was requested of the owner, occupant, and Board of-
Health.
X None of the system components have been pumped for at least two weeks
and the system has been receiving normal flow rates during that period.
Large volumes of water have not been introduced into the system recently
or as part of this inspection.
N/A As built plans have been obtained and examined. Note if they are not
available.with N/A.
X The facility or dwelling was inspected for signs of sewage back-up.
X The site was inspected for signs of breakout.
X All system components, excluding the SAS, have been located on the site.
X The septic tank manholes were uncovered, opened, and the interior of the
septic tank was inspected for condition of baffles or tees, material of
construction, dimensions, depth of liquid,depth of sludge, depth of scum.
X The size and location of the SAS on the site has been determined based
on existing information or approximated by non-intrusive methods.
X The facility owner (and occupants, if different from owner) were provided
with information on the proper maintenance of SSDS.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
SYSTEM INFORMATION
FLOW CONDITIONS
If Residential
3 Number of Bedrooms
1 Number of Current Residents
No Garbage Grinder, yes or no
Yes Laundry Connected to system, yes or no
.No Seasonal use, yes or no
If Nonresidential, calculated flow:
Water meter readings, if available: 7/92-9; 7/93-46; 7/94-73; 3/95-92.
Current Last date of occupancy
GENERAL INFORMATION
Pumping records and source of information:
No pumping for past 5 years. Source: Water Pollution Control
No System pumped as part of inspection, yes or no
if yes, volume pumped:
Reason for pumping:
Type of System
Septic tank/distribution box/soil absorption system
x Single Cesspool
x Overflow Cesspool
Privy
No Shared system (yes or no);
(If yes, attach previous inspection records, if any)
Other (explain):
Approximate age of all components. Date installed, if known. Source of
information: 35 years - 1960
No Sewage odors detected when arriving at the site, yes or no
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
SYSTEM INFORMATION (CONT.)
SEPTIC TANK: ; (Locate on site plan)
Depth Below Grade:
Material of Construction: Concrete; Metal; FRP; Other (explain)
Dimensions:
Sludge Depth
Distance form 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
Comments: (Recommendation for pumping, condition of inlet and outlet tees or baffles,
depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,
recommendations for repairs, etc.)
DISTRIBUTION BOX: (Locate on site plan)
Depth of liquid level above outlet invert
Comments: (Note if level and distribution is equal, evidence of solids carryover, evidence
of leakage into or out of box, recommendation for repairs, etc.)
PUMP CHAMBER: (Locate on site plan)
Pumps in working order, yes or no
Comments: (Note condition of pump chamber, condition of pumps and appurtenances,
recommendations for maintenance or repairs, etc.)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
SYSTEM INFORMATION (CONT.)
SOIL ABSORPTION SYSTEM (SAS): (Locate on site plan, if possible;
excavation not required, but may be approximated by non-intrusive methods.
If not determined to be present, explain:
TYPE
Leaching Pits and Number:
Leaching Chambers and Number:
Leaching Galleries and Number:
Leaching Trenches, No., & Length:
Leaching Fields, No., & Dimensions:
Overflow Cesspool, Number: 2
Comments: (Note condition of soil, signs of hydraulic failure, level of pondirig, condition
of vegetation, recommendations for maintenance or repairs, etc.)
Recommended lines to overflow cesspools be reseated to lower level and provide
proper pitch for flow. No evidence of hydraulic failure or ponding.
Vegetation is normal.
CESSPOOLS (Locate on site plan):
Number and Configuration: 1 - Circular:. (6x6)
Depth-top of Liquid to Inlet Invert: 2"
Depth of Solids Layer: 1211
Depth of Scum Layer: 1"
Dimensions of Cesspool: 6x6
Materials of Construction: Concrete Block
Indication of Groundwater Inflow
(Cesspool must be pumped as part of
inspection): No
Comments: (Note condition of soil, signs of hydraulic failure, level of ponding, condition
of vegetation, recommendations for maintenance or repairs, etc.)
No signs of ponding. Recommended system be pumped. Recommended inlet and..
outlet tees be installed, and pipes to overflow be reset to proper level.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
. PART B
SYSTEM INFORMATION (CONT.)
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, recommendations for maintenance or repairs, etc.)
SKETCH OF SEWAGE DISPOSAL SYSTEM:
Include ties to at least two permanent references landmarks or benchmark. Locate all
wells within 100 feet.
i
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DEPTH TO GROUNDWATER
11' 7" t Depth to groundwater
Method of determination or approximation:
Tes hole boring to 11'7" was completed. No ground water was observed.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
FAILURE CRITERIA
Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all
instances. If "Not Determined", explain why not).
N Backup of sewage into facility?
Test of toilet
N Discharge or ponding of effluent to the surface of the ground or surface waters?
Observation
N/A Static liquid level in the distribution box above outlet invert?
N Liquid depth in cesspool <6" below invert or available volume < 1/2 day flow?
Observation
N Required pumping 4 times or more in the last year? Number of times pumped?
No pumping for past two years per property owner.
N Septic tank is metal? cracked? structurally unsound? substantial infiltration?
substantial exfiltration? tank failure imminent?
Observation
N Is any portion of the SAS, cesspool or privy: below the high ground water elevation?
Test hole
N Within 50 feet of a surface water?
Observation
N Within 100' of a surface water supply or tributary to a surface water supply
Observation
N Within a Zone I of a public well?
Water Department
N Within 50' of a bordering vegetated wetland or salt marsh (cesspools & privies only,
not the SAS)? Observation
N Within 50' of a private water supply well?
No private wells in the area per property owner.
N Less than 100' but greater than 50' from a private water supply well with no
acceptable water quality analysis? If the well has been analyzed to be acceptable,
attach copy of well water analysis for coliform bacteria, volatile organic compounds,
ammonia nitrogen and nitrate nitrogen.
No private wells in the area per property owner.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART D
CERTIFICATION
NAME OF INSPECTOR: ROBERT W. SABEN, JR.
COMPANY NAME: BARNSTABLE COUNTY SYSTEMS INSPECTORS
COMPANY ADDRESS: 25 MID-TECH DRIVE, WEST YARMOUTH, MA 02673
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and
that the information reported is true, accurate and complete as of the time of inspection.
The inspection was preformed and any recommendations regarding upgrade;
maintenance and repair are consistent with my training and experience in the proper
function-and maintenance of on-site sewage disposal systems.
Check One
I have not found any information which indicates that the system fails to
adequately protect public health or the environment as defined in 310 CMR
15.303. Any failure criteria not evaluated are as stated in the FAILURE
CRITERIA section of this form.
In have determined that the system fails to protect public health and the
environment as defined in 310 CMR 15.303. The basis for this
determination is provided in the FAILURE CRITERIA section of this form.
INSPECTOR SIGNATURE:
DATE: June 23, 1995
Original to system owner
Copies to:
Buyer(if applicable)
Approving Authority
CMBION-WE.'ALTH OF MASSACHL;SETTS V
_ t EkECtiTI�� OFFICE OF E1'VIRO\:�iE\TAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE tt'LNTER STREET. BOS T ON NLA 0210e 1617. 292-550v
TRUDT COI-
Seav:ar%
ARGEO PALL CELL;iCCi DAVID B STR*-*HS
Governor EM _ Cotstmissioaer
SUBSURFACE SEWAGE DISPOSAL SYST OMPECTWN FORM
PART A
CERT11FICATION
P+opertyAdd►ess: 37 ISalene `S�. , Km ofDwne►T,ine3a',(�rl7rerSki
an�i s oft Address of Owner: n u b Wen Rd,T4� s t e r
Date of Inspection: r f 5^d $
Name of hupector:Imease Print)Wm. E. Robinson S r.
I am a DEP approved s erq inspector to Section ISJW of Title 5(310 CMR 15.000)
oo„panyName: Wm. E . Robinson Septic Service
MarlingAddress: PO Box 10891 Centerville,-MA
Telephone Number:
CERTIFICATION STATEMENT
1 certify that 1 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 inspection. The inspection was performed based on my training and-experience in the proper function and
maintenance of on-site sews disposal systems. The system:
Passes
Conditionally Passes
_ Needs Further Evaluation By the local Approving Authority
Fails Pie
Inspector's Signature: r Date:
The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty (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 Department of Environmental Protection. The original should be sent to the
system owner and copies sent to the buyer, if applicable. and the approving authority.
NOTES AND COMMENTS
ILL
QD E1tEivro
S E P 8 2000
HMTH DE"
reviSe6 Pape ior11
w •
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 1 v
PART A
CERTIFICATION(continued)
Nop"Address: 37 Isalene St. , Hyannisport
awner: Linda Gruberski
Dave of Irsspeetion:
g-/S-6 � m
INSPECTION SUMMARY: Check V B, C, o/ D.-
AL SYS PASSES:
1 have not found any information which indicates that'any of the failure conditions described in 310 CMR 15.303 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.
Indicate as,no, or not determined(Y. N,or NO). Describe basis of determination in all instances. If"not determined'.explain why not.
The septic tank is metal.unless the owner or operator has provided the system inspector with a copy of a Certificate of
Compliance (attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection: or
the septic tank,whether or not metal,is.racked,structurally unsound,shows substantial infiltration or exfiltration. or tank
failure is imminent. The system will pass inspection H the existing septic tank is replaced with a complying septic tank as
approved by the Board of Health.
_ Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)
or due to a broken, settled or uneven distribution box. The system will pass inspection if Iwith approval of the Board of
Health).
broken pipe(s)are replaced
obstruction is removed
distribution box is levelled or replaced
The system required pumping more than four times a year due to broken or obstructed pipelsl. The system will pass
inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
revised 5/2/98 Page 2of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 37 Isalene St . , Hyannisport
owner: Linda Gruberski °
Date of Inspection:
7^/Srs d v
C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
onditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the
blic health, safety and the environment.
1) S STEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303 111(b)THAT THE SYSTEM
IS OT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
2) SYS M WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS
FU CTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a
private water supply well, unless a well water analysis 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. Method used to determine distance (approximation not valid).
3) OTHER
reY-se- Page 3of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (cornimied)
Property Address: 37 Isalene St . , Hyannisport
Owner: Linda Gruberski
Date of Inspection:
D. SYSTEM FAILS:
You mus indicate either "Yes" or "No" to each of the following:
have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this
termination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure.
Yes N
Backup of sewage into facility or system component due to an overloaded orelogged 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 112 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation.
Any portion of a 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 I 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
E. GE SYSTEM FAILS:
You st indicate either "Yes' or "No' to each of the following:
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public
health and safety and the environment because one or more of the following conditions exist:
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)
The o ner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional
offic 6"he Department for further information.
revised PaRc3of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM.
PART B
CHECKLIST
Property Address: 37 Isalene St. , Hyannisport
Owner: Linda Gruberski
Date of Inspection:
Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following:
Yes, No
Pumping information was provided by the owner, occupant, or Board of Health.
i/ _ None of the system components have been pumped for st least two weeks and•the system has been receiving normal flow
rates during that period. Large volumes of water have not been introduced into the system recently or as part of this
/ inspection.
V _ As built plans have been obtained and examined. Note if they are not available with NIA.
_ The facility or dwelling was inspected for signs of sewage back-up.
_ The system does not receive non-sanitary or industrial waste flow.
Tne site was inspected for signs of breakout.
6� _ All system components, excluding the Soil Absorption System, have been located on the site.
1/ _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles
or tees, material of construction, dimensions,depth of liquid, depth of sludge, depth of scum.
/ The size and location of the Soil Absorption System on the site has been determined based on:
Existing information. For example, Plan at B.O.H.
_ Determined in the field(if any of the failure criteria related to Part C is at issue. approximation of distance is unacceptable)
115.302(3)(b)]
41/ The facility owner (and occupants,if different from owner) were provided with information on the propermaintenaar"f
SubSurface Disposal Systems.
rev-se6 96 Page 5of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
`rop"Address: 37 Isalene St . , Hyannisport
owner: Linda Gruberski
Date of Inspection:
FLOW CONDITIONS
RESIDENTIAL:
Design flow:Wa g.p.d./bedroom. +•�
Number of bedrooms(design): Number of bedrooms.(actual):,S
Total DESIGN flow (1s0
Number of current residents:-
Garbage grinder(yes or no):A-- o
Laundry Iseparate system) (yes or no)YLO: If yes, separate inspection required
Laundry system inspected (yes or no)
Seasonal use (yes or no):/`O
Water meter readings,if available (last two year's usage Igpd): 1999 25, 500 gal.
Sump Pump (yes or no): ILO 1998 49, 500 gal.
Last date of occupancy: /S-4�
CO ERCIALJINDUSTRIAL:
Type f establishment:
Desig flow: apd ( Based on 15.203)
Basis o design flow
Grease rap present: lyes or no)_
Industri 1 Waste Holding Tank present: (yes or no)_
Non•san tary waste discharged to the Title 5 system: (yes or no)_
Water ter readings, if available:
Last dat of occupancy:
OTHER. D scribe)
Last da of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and 9source�f information:
System pumped as part of inspection: (yes or no)fd (�
If yes, volume pumped:�gajlons
Reason for pumping: MO• a p2
TYPE 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)
I1A Technology etc. Attach copy of up to date operation and maintenance contract
Tight Tank Copy of DEP Approval
Other
APPROXIMATE AGE of all components, date installed(if known)and source of information: _/�/��tc.,f• iS' VS, S/,S O-L-�
66
Sewage odors detected when arriving at the site: (yes or no)4,L,l) �
—�
v G 7�L/
re sec 9/2,'9c
Page 6 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION Icor+timwd)
*roperty Address: 37 3salene St . , Hyannisport a
Owner: Linda Gruberski
Date of Inspection:
B DING SEWER:
:oca a on site pion)
Depth elow grade:_
Materi I of construction:_cast iron_40 PVC_ other(explain)
Dista ce from private water supply well or suction line
Dia ter
Co ents: (condition of joints, venting, evidence of leakage,-etc.)
SEPTIC TANK:_ _
(locate on site plan)
r '
Depth below grader
Material of construction: ✓concrete_metal_Fiberglass _Polyethylene_other(explain)
If tank is metal,list age_ Wage confirmed by Certificate of Compliance_ (Yes/No)
Dimensions:
Sludge depth:_
Distance from top of sludge to bottom of outlet tee or baffler
Scum thickness: d � I
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 dimensions were determined: N�
'omments:
(recommendation for pumping, condition of inlet andd outlet tees or baffles, depth pf liquid I vel in rela ion to outlet invert, structural integrity,
evidence of leakage, etc.) ��/ O G'U eS �b �'- /i►- s lec, tom'
GREA E TRAP:
(locate n site plan)
Depth be ow grade:_
Material f construction:_concrete_metal_Fiberglass _Polyethylene_other(explain)
Dimensio s
Scum thic ness:
Distance om top of scum to top of outlet tee or baffle:
Distance om bottom of scum to bottom of outlet tee or baffle:
Date of i t pumping:
Comme s:
(recom endation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity,
evide a of leakage, etc.)
revised G/2j 50 Page 7ofII
c
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION Icontinued)
'rop"Address: 37 isalene St . , Hyannisport
Owner: Linda Gruberski
Date of Inspection: 91 �_ J
TIG . OR HOLDING TANK: (Tank must be pumped prior to, or at time of, inspection)
(locate n site plan)
Depth be w grade:_
Material o construction:_concrete_metal_Fiberglass_Polyethylene_other(explain)
Dimension
Capacity: gallons
Design flo gallonsiday
Alarm pre ent
Alarm lev Alarm in working order: Yes_ No_
Date of p evious pumping:
Comme s:
(conditi n of inlet tee, condition of alarm and float switches,etc.)
DISTRIBUTION BOX:
(locate on site plan)
Depth of liquid level above outlet invert:
Comments:
Inote if level and distribution is equal, evidence 1 solidspar"-over, evidencegt leakage into or out of box, etc.) -
PUMP CH MEER:_
(locate on s to plan)
Pumps in w rking order: (Yes or No)
Alarms in w rking order(Yes or No)
Comments:
(note condi ion of pump chamber, condition of pumps and appurtenances,etc.)
reviseC 9/2 /98 Page 8of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
'rop"Address: 37 Isalene 'St . , Hyannisport
Olwr*,: Linda Gruberski
Date of Inspection: 51'. S O-c_�
SOIL ABSORPTION SYSTEM(SAS):_✓
(locate on site plan, if possible;excavation not required,location may be approximated by non-intrusive methods)
If not located, explain:
Type:
leaching pits: number:_
leaching chambers, number:_'
leaching galleries, number:_
leaching trenches, number, length:
leaching fields, number, dimensions:
overflow cesspool, number:_
Alternative system:
Name of Technology:
Comments:
Inote condition of soil, s�gz!s of hydraulic failure, I vel of ponding, damp soil, condition of vegetation, etc.)
ti L2(
CESSPOOLS:_
(locate on site plan)
Number and configuration:
Depth-top of liquid to inlet invert:
Depth of solids layer:
)epth of scum layer:
Dimensions of cesspool.
Materials of construction.
Indication of groundwater:
inflow (cesspool must be pumped as part of inspection)
(notecon
Comment
of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
PRIVY:_
loocate on ite plan)
Materials o construction:
Depth of s lids: Dimensions:
Comments
Inote con tion of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
c�� c
ti— L Pap 9 of t I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(cot rand)
''roperW Address:37 Isalene St. , Hyannis-port
Jwrw: Linda Gruberski
Date of Inspection: p-�S 0--v
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent reference landmarks or benchmarks
locate all wells within 100' (Locate where public water supply comes into house)
a
I✓bG.
1 t
q—
v a ,
\a
Ye-:=sec
Page 10 of 11
. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
ropertyAddress: 37 Isalene St . , Hyannisport
Owner: Linda Gruberski
Date of h apecr ion:
NRCS Report name
Soil Type_
Typical depth to groundwater
USGS Date website visited
Observation Wells checked Deep
Groundwater depth: Shallow Moderate .
SITE EXAM Slope
Surface water
Check Cellir
Shallow wells
Estimated Depth to Groundwater LyFeet
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
V Observed Site (Abutting property,observation hole, basement sump etc.)
Determined from local conditions
Checked with local Board of health
Checked FEMA Maps
Checked pumping records
Checked iocal excavators. installers
Used USGS Data
Describe how you established the High Groundwater Elevation. (Must be completed)
v d
1Ls l 14616 s�a��-�
revised 9/2/95 Page 11of11
f
�! TOWN OF BARNSTABLE
;LOCATION SEWAGE #
VILLAGE W �/,pd�is�icd''
ASSESSOR'S MAP & LOT YI �'67
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) F60,M (size) X6
NO.OF BEDROOMS Jr
BUIEMROROWNER, LoRitT73--- O?LRNDO
PERMIT DATE: COMPLIANCE DATE:
Separation Distance.Between the:
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) Alan, Feet
Edge of Wetland and Leaching Facility(If any.wetlands exist
within 300 feet of leaching fa�cility . �I - � / ��� Feet
Furnished by
�— 11s
' b
m
FINISH GRADE OVER D-BOX= 34.0' FINISH GRADE OVER CHAMBERS 33.7' - 34.3' r F N F R A I N CSTF S
T.O.F. EL.= 35.9 _T SLOPE @ 2% MIN. OVER SYSTEM
/ PROVIDE EXTENSION RISER REMOVABLE WATER-TIGHT COVER OVER 314"TO 1-112" DOUBLE WASHED 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION
WITH COVER OVER INLET & j RISER TO WITHIN 6"OF FINISHED GRADE 4 SCHEDULE 40 PVC INSPECTION PORT WITH ACCESS STONE TO CROWN OF PIPE I. METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL
FINISH GRADE OUTLET TO WITHIN 6"OF F.G. i MIN SLOPE 1% BOX TO F.G. (SEE NOTE 21) 2"OF 1/8"TO 1/2" DOUBLE WASHED CODE AND ANY APPLICABLE LOCAL RULES.
@ FND. EL.= 34.3'± F.G. OVER TANK EL. = 33.7't 5 D1A. OUTLET(S) STONE OR GEOTEXTILE FILTER FABRIC 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE
DESIGN ENGINEER.
N ALL
COVER'N.ACCESS(T(P.OF 3) g��MIN TOP OF SAS= 31 .83' PLACCHAM ERE RISERS GS WITH 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL
- EXIcTtNG 4„ � PROPOSED 4 36" MAX. 9 MIN. !"1LET P" `S Tv OF 9
C I
PVC SEWER PIPE 31 .00 36' MAX. BREAKOUT EL- 31 .50 P 6 �' ( SYSTEM UNLESS OTHERWISE NOTED.
SEWER PIPE FINISHED GRADE 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN
= ---� -�-- �- -� 3" DROP MAX " L=37'± ELEVATION = 31.50' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A
6 3 2 DROP MIN 3 PROVIDE WATERTIGHT o 0
--------.---- -_..._...._ , MIN.SLOPE@ t% o o e 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S. AND THE TOP OF
- - - 4" PVC IN FROM JOINTS (TYP.) <�ow� -
E 14" SEPTIC TANK 4" PVC OUT TO o O o o �� O o 0 5. SLOPE ALTHE L ISOLID PIPE ATH10% MINIMUM.
N THE OUT ELEVATION.
LEACHING FACILITY oo t--� C o > €---� o
oo U o o r 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL.
CONTRACTOR TO PROVIDE i CONTRACTOR SHALL CONTRACTOR SHALL 31 .40' MIN. 31 .23' 2 0 00 0 0 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK
SPECIFIED DROP BETWEEN VERIFY SIZE AND 48" VERIFY CONDITION OF OUTLET TEE o o ��0 0o FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS
INLET AND OUTLET CONDITION OF EXISTING TEES GAS BAFFLE 6"CRUSHED STONE L�� o 0 0EXISTING SEPTIC AND REPLACE AS OVER MECHANICALLY o NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH
I AND DESIGN ENGINEER.
TANK NECESSARY ` COMPACTED BASE 4 0' _ $ 5, (TYP) - � -4.0' 2 0' i 4 83' L2 U 8I 8- ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM. BENCHMARK ELEVATION OF 35.00'
5 OUTLET DISTRIBUTION BOX
TYP. ESTABLISHED ON THE CORNER OF THE BULKHEAD AS SHOWN ON PLAN.
TO BE INSTALLED ON A LEVEL STABLE F----- VARIES {SEE PLAN} ( )
BASE. FIRST TWO FEET OF OUTLET GROUND WATER ELEV.- < 22.70' 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION
EXISTING 1 ,500 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. 29 00 8.83 THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT
3 - 500 GALLON CHAMBER.-, 5' MIN. CHAMBER END VIEW 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES
` CROSS SECTION VIEW TYPICAL CHAMBER PROF11I F TO THE DESIGN ENGINEER.
°CON f _. ti FY EXISTING SEPTIC' TANK PROFILE # J I ST R I B 0 0 i� _ h UX D E FA I L CHAMBER DETAILS 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONCRETE STRUCTURES SHALL BE MADE
ELEVATION PRIOR TO ANY WORK&
NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE NOT TO SCALE NOT TO SCALE WATERTIGHT.
t'�` !'�+ !\ 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING
• ,,�._ .: TEST P• TA
SWING-TIES ` ' REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM
'' '. �� <f� = .''` PERC NO. TPT-19-225
_ APPROPRIATE AUTHORITY.
1
HC-1 HC-2 • ` ' •S '`� •' INSPECTOR: David W. Stanton. RS 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS LOCATED
DESCRIPTION
• ��� '� �� ` • ' EVALUATOR: Michael Pimentel, EIT, CSE UNDER MORE THAN 3 FEET OF COVER OR LOCATED UNDER PAVEMENT, DRIVES, OR
CHAMBER COVER (1) 45.8' 18.V j t/ `sl K °
pro `" ��� � 'I " •� '� Oct. 27, 1999 TRAVELED WAYS IN WHICH CASE THEY SHALL WITHSTAND H-20 LOADING.
€ • ,E C.S.E. APPROVAL DATE:
CHAMBER COVER (2) 47.4' 22.2' : % " >�� t • •• + all
• 00 • DATE:-
lei. December 13, 2019 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES.
. • • • .,� .. I•
• • /j , iI • • ••+ • "7t
CHAMBER COVER (3) 41.7 19.0' j.�� e_O N E I I TEST PIT#: 1
•. •. , ' • j„+. •. • .. 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE
MAP 267 ' . • • ` '#• • •''` • ' •�' I +I ' ' ELEV TOP= 33.70` MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY.
LOT 152 • !�� f r r • ' • °• . • REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY,
• •at :1r.�, t ; •, • ' •+• • • ELEV WATER= <22.70'il as FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3).
PROPOSED 3-500 GALLON • °t " _- '. • •\ + . .• .
H-10 LEACHING CHAMBERS 3 " •� i . it PERC RATE _ < 2 min./inch 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN
PROPOSED _ _�,. .. + •.
w/AGGREGATE _ • i •�, M • SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK.
INSPECTION PORT C� • " • • "
LOCUS , , • DEPTH OF PERC= 32 50
a r _ 1t ° • • '• •I •- __. =,;+� •� r 1+ 16. PROPOSED PROJECT IS LOCATED WITHIN:
• ("o, ' TEXTURAL CLASS: 1
I 99.73' r� .,,
°� *.•� •t •• i \\', ;r+ ASSESSOR'S MAP 267 PARCEL 37
aCl • • ' 37,�t •' -
•
33x' N87° 3T 05"W • #4 18 , • . + ri, ; OWNER OF RECORD: THOMAS & RENA FIANS
o A59/1-1 1 _ •• •„ • � �i; 0" 33.70' ADDRESS: 37 ISALENE STREET
tD (2 3) 5.A • ."' ;; • • • r� . Goff C+OufSE •, A Loamy Sand HYANNiS, MA 02601
19.3' 1 11 •" ' • •• •�' ►k'• \t €' � 10Yr 3/2 33.03'
TP1 • 14� }` ♦ ' • 1• i FEMA FLOOD ZONE X
` ';; .• . '`' +} '• !` -' _ k}, I COMMUNITY PANEL# 25001CO564J
%33x7 00i It ; �'t ' Loamy Sand 17. P 1
MAP 246 . �• c B 10Yr 5/6 DEED REFERENCE: BOOK 13204, AGE 0
10.0' It-i, •- . . • , a s .
LOT 82 I I II ; , ••
w �""°" ' I II II • •' • •;+r ( � `�J 32" 31.03' 18. PLAN REFERENCE: PLAN BOOK 139, PAGE 11
!. u� 0 10.5 J t r r• t
- cl; --PROP. D-BOXs •• • ' '
4 w t Ai '�� .� .i•• '� •! '�-, • � '\� � i'erc 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION.
cNv o '`''• , '"'j t •' • 50" 29.53' 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE, THIS PLAN IS TO BE USED ONLY
>- N - f V 1 ♦
t-, o (1 °' z !f�� + •• FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY
w z TP2 HC 2 HC- X ��fv� g `~"+�• " /'� �r , FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE.
1W -1 ell
z % l r •'' f 21. A 4" PERFORATED SCH. 40 PVC PIPE SHALL BE PLACED IN A VERTICAL POSITION TO A
w; \ 12.9 a .I. �
33x%7' w w _ , __, _ Med. to Coarse Sand DEPTH OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3"OF FINISH GRADE. A
15.9' 8 8, w w 1 O - t C 2.5Y 6/6 REMOVABLE THREADED CAP SHALL BE PLACED ON THE TOP TO ALLOW FOR INSPECTIONS.
.. ' 0 22. CONTRACTOR SHALL BE RESPONSIBLE TO OBTAIN ANY AND ALL REQUIRED PERMITS AND
M W LOCUS PLAN APPROVALS FOR THIS PROJECT.
\ TOF = 35.9'± ` 23, IN ACCORDANCE WITH 310 CMR 15.401 -15.405,THE FOLLOWING LOCAL UPGRADE
0 ' SCALE: 1" = 1000' � APPROVAL IS REQUESTED FROM 310 CMR 15.211:
EXISTING 1,500 GALLON SEPTIC TANK 33x - I i 132" 22.70' 1. A 8.4' WAIVER (20.0' - 11.6') FOR THE SETBACK FROM THE SAS TO THE EXISTING HOUSE
TO BE UTILIZED IN THIS DESIGN-- �' s ' FULL BASEMENT.
MAP 267 I No Mottling, Standing or Weeping Observed
#37 LOT 37 DESIGN DATA TEST PIT DATA LEGEND
EXISTING D-BOX (TO I (� w EXISTING 10,000± S.F. N
BE ABANDONED - PATIO 2-BEDROOM \ ' o N GI TPT 19-225
--�-< p o N �;v� PERC NO.
DWELLING )
I 3 AREA m o NUMBER OF BEDROOMS (EXISTING) 2 5 �E '` �, ;S . INSPECTOR: David W. Stanton, RS 50x0 EXISTING SPOT GRADE
x o ' I - 50 EXISTING CONTOUR
EXISTING SAS I I cx' z NUMBER OF BEDROOMS(DESIGN) 3 (MIN. PER TITLE 5) EVALUATOR: Michael Pimentei, EIT, CSE
(LOCATION PER '� 3 0 W Oct. 27, 1999
p 110 GAUDAY/BEDROOM C.S.E. APPROVAL DATE: E�^ PROPOSED CONTOUR
c� DESIGN FLOW ,,�
AS-BUILT CARD) -- -- x , Z_ Y W
r' v -� DATE: December 13, 2019
I o j TOTAL DESIGN FLOW 220 GAUDAY LSr EXISTING LANDSCAPED AREA
� x / W DESIGN FLOW x 200 % = 440 GAUDAY
TEST PIT#: 2
x [ C .BH
- - " '` =`d ------
1 EXISTING OVERHEAD UTILITIES
Z � ELEV TOP= 33.70' ,
W b USE EXISTING 1.500 GALLON SEPTIC TANK ELEV WATER - �22.70'
l a APPROX. LOCATION I W W EXISTING WATER LINE
I 0 / \ _ GAS GAS GAS GAS GA: -AS I ...J
x R INSTALL 3 - 500 GAL. CHAMBERS w/ AGGREGATE PERC RATE = GAS - EXISTING GAS LINE
MAP 246 x Benchmark
LOT 82-3 x ` / Top Of Bulkhead Cnr. HVA DEPTH OF PERC=
I SIDEWALL CAPACITY
Elevation = 35.00' TEST PIT LOCATION
x TEXTURAL CLASS. 1
XI
Approx. M.S.L. (PERIMETER) (2' HIGH) (0.74 GPD/S.F.) = GAUDAY
I :_.P -a'-X t I (84.66') ( 2' ) ( 0.74 GPD/S.F.) = 125.3 GAUDAY EXISTING 1,500 GALLON SEPTIC TANK
x
x \ a x 1 p" y 33.70' w q , su, PROPOSED 4" SOLID SCHEDULE 40 PVC PIPE
I BOTTOM CAPACITY Loam Sand
SHE 10„ I \x (FOOTPRINT AREA) (0.74 GPD/S.F.) = GAUDAY A 8„ 10Yr 3/2 33.03' � PROPOSED DISTRIBUTION BOX
I ( fI� (295.8 S.F.) (0.74 GPD/S.F.) = 218.9 GAUDAY
f`I i B Loamy Sand PROPOSED 500 GALLON LEACHING CHAMBER
x k,�` x 1 10Yr 5i6
I i TOTALS: _
/ TOTAL NUMBER OF CHAMBERS 3 32" 31.03' -
x - , REV. DATE BY APP'D. DESCRIPTION
TOTAL LEACHING AREA 465.1 SQ.FT.
TOTAL LEACHING CAPACITY 344.2 GAL./DAY
N87' 37,o5"w PROPOSED SEPTIC SYSTEM UPGRADE
PREPARED FOR:
1 CAPEWIDE ENTERPRISES
MAP 267 I
LOT 36 � C Med. t2 5Y 6!6 Coarse Sand
I LOCATED AT
NOTES. 37 ISALENE STREET
HYANNIS, MA 02601
1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF EACH SEPTIC SYSTEM
COMPONENT-
132" SCALE: 1 INCH = 10 FT. DATE: DECEMBER 13, 2019
22.70 0 5 10 20 40 FEET
2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF THE PROPOSED LEACHING
FACILITY TO ENSURE CONSISTENCY WITH TEST PIT DATA SHOWN ON THIS PLAN. REPORT TO No Mottling, Standing or Weeping Observed �k ;_.` _
ENGINEER AND LOCAL BOARD OF HEALTH IF SOILS ARE NOT CONSISTENT WITH TEST PIT DATA.
y` PREPARED BY:
RESERVED FOR BOARD OF HEALTH USE 1*
,IpNNt" = \ JC ENGINEERING, INC.
HL r` 4 CRANBERRY HIGHWAY
3.) ENTIRE PROPERTY l5 LOCATED WITHIN A DEP APPROVED ZONE II. C 41 285 C
4.) SWING TIES SHOWN ON THIS PLAN ARE PROVIDED ONLY AS A COURTESY FOR THE INSTALLER. EAST WAREHAM, MA 02538
R HALL VERIFY SWING TIE MEASUREMENTS IN THE FIELD PRIOR TO INSTALLING THE ' 508.273.0377
INSTALLS S SITE PLAN _-
SYSTEM. CONTRACTOR SHALL NOTIFY ENGINEER IF MEASUREMENTS APPEAR TO BE INCORRECT. i
SCALE: 1"= 10' ` l .211f Drawn B . MCP Designed B MCP Checked B JLC JOB No.4954
Z1Y 9 y Y