HomeMy WebLinkAbout0476 OAKLAND ROAD - Health 476 Oakland Road
Hyannis P
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TOWN OF BARNSTABLE
SEWAGE #
VILLAGE ,��c�n/I ASSESSOR'S MAP & LOT �a'���0
INSTALLER'S NAME&PHONE NO. /�>{ ,' /���� �o✓ y34-S9�L
SEPTIC TANK CAPACITY I s-ed 6-w c
LEACHING FACILITY: (type) /off (size) 1/ X 36.2.!''x is
NO. OF BEDROOMS
BUILDER O OWNE
PERMITDATE: 3 -oy COMPLIANCE DATE: 13
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
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pOF��BARNSTABLE _ �J
LOCArIOI l 76 t�F/` SEWAGE#
VI&AGE Y ASSESSOR'S MAP &LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACPTY
al��- �ot,� (size) �o` Le"ft Tftpd,
LEACHING FACII.ITY:.(type) si( )�
NO.OF BEDROOMS
BUILDER OR OWNER
PERMITDATE: 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) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facili ) Feet
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YOU WISH TO OPEN A BUSINESS?
For Your Information: Business Certificates COST $30.00 for 4 years. A Business Certificate ONLY REGISTERS YOUR NAME in the Town
(WHICH YOU MUST DO BY M.G.L. - it does not give you permission to operate). You must first obtain the necessary signatures on this form
at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, I" FI., 367 Main St., Hyannis, MA 02601(Town Hall) and get
the Business Certificate that is required by law.
DATE: 8
T Fill in please: ���o�
�� APPLICANT'S YOUR NAME: /�/7 ��� ��E%D
x BUSINESS YOUR H9ME ADDRESS: y7,0j
A
TELEPHONE # Home Telephone Number:
NAME OF NEW BUSINESS_ �'X7`� r � P/9/" / �--/iV TYPE OF BUSINESS
IS THIS A HOME OCCUPATION? YES: NO.
Have you been given approyal from the building.division? YES NO >a
ADDRESS OF BUSINESS -r7?�9 MAP/PARCEL NUMBER —
When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of
Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this
town.
1. BUILDING COMMIS#. d
OFFICE
This individual.hrmed of any permit requirements that pertain to this type of business.
Signature**COMMENTS:
2. BOARD OF HEALTH
This individual has been ' rmed of the p mi_ equirem t that pertain to this type of business.
_. ._;
uthorized Signature** USTYWITHALL
Z�4RD
COMMENTS: MATERIALS REGULATIONS
3. CONSUMER AFFAIRS (LICENSING AUTHORITY) .
This individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature**
COMMENTS:
Hazardous Materials Inventory Sheet Checklist
_Date
ysical Street Address-Check database to ensure it exists
Working Phone Number
Actual Amounts—(i.e.gas being used to fuel machines,thinner to
/ Clean brushes all count as hazardous materials).
V Storage Information—location of storage,how long is storage for?
t/ If none,note that.
(isposal Information—where and who? If none,note that.
Applicant Signature—understand what is listed and noted.
Staff Initial—any questions,know who to ask.
}Vehicle Washing/Rinsing?—provide a vehicle washing policy and t
explain it—note that it was given.
Attach the Business Certificate with your sign-off and comments.
"The Inventory form should explain what the business consists of and theprocedures
they are doing. Notes need to be left to explain what you discussed with them.
�- Date:
TOWN OF BARNSTABLE
TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY
NAME OF BUSINESS: C ACM C— P f IV TI'�1
BUSINESS LOCATION: 76 .-49�V /Q9 rNVENTORY
MAILING ADDRESS: 15)9MF TO AMOUNT:
TELEPHONE NUMBER: 771-t 467/077
CONTACT PERSON:
EMERGENCY CONTACT TELEPHONE NUMBER: 774�f�7 ®7� MSDS ON SITE?
TYPE OF BUSINESS: P191" �1 odt/
INFORMATION/RECOMMENDATIONS: Fire District:
Waste Transportation: Last shipment of hazardous.waste:
Name of Hauler: Destination:
" Waste Product: Licensed? Yes No
NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use,
storage and disposal of 111 gallons or more a month requires a license from the Public Health Division.
LIST OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health and the Public Health Division have determined that the following products exhibit toxic
or hazardous characteristics and must be registered regardless of volume.
Observed/Maximum Observed/Maximum
Antifreeze (for gasoline or coolant systems) _ Misc. Corrosive
NEW USED Cesspool cleaners
Automatic transmission fluid Disinfectants
Engine and radiator flushes Road Salts (Halite)
Hydraulic fluid (including brake fluid) Refrigerants
Motor Oils Pesticides
NEW USED (insecticides, herbicides, rodenticides)
Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers)
Diesel Fuel, kerosene, #2 heating oil NEW USED
Misc. petroleum products: grease, Photochemicals (Developer)
lubricants, gear oil NEW USED
Degreasers for engines and metal Printing ink
Degreasers for driveways &garages Wood preservatives (creosote)
Caulk/Grout Swimming pool chlorine.
Battery acid (electrolyte)/Batteries Lye or caustic soda
Rustproofers Misc. Combustible
Car wash detergents Leather dyes
Car waxes and polishes Fertilizers
Asphalt & roofing tar PCB's
Paints, varnishes, stains, dyes Other chlorinated hydrocarbons,
Lacquer thinners (inc. carbon tetrachloride)
NEW USED Any other products with "poison" labels
Paint &varnish removers, deglossers - (including chloroform, formaldehyde,
Misc. Flammables hydrochloric acid, other acids)
Floor &furniture strippers Other products not listed which you feel
Metal polishes may be toxic or hazardous (please list):
Laundry soil & stain removers ► " ZC,47-- 11/ • 7— //Ol/
(including bleach)
Spot removers &cleaning fluids
(dry cleaners)
Other cleaning solvents
Bug and tar removers
Windshield wash
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS
NoFee 13— �/�. VI/
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
ZippYication for Migooar bpgtem Construction 3permit
Application for a Permit to Construct( )Repair( )Upgrade(✓)Abandon( ) Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No.
Assessor's Map/Parcel "awl-
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
�r�bloi' Go�1�7` 4oh---A Bale ���eerd�
7 7/`Q34Y
Type of Building:
Dwelling No.of Bedrooms 17 Lot Size j� sq.ft. Garbage Grinder(_Ct�
Other Type of Building L'e No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow J119 gallons per day. Calculated daily flow 3e5) gallons.
Plan Date Number of sheets I Revision Date
Title 2!2 5 a
Size of Septic Tank 125-M Type of S.A.S. //� ` ;/9 4!!�41_07
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
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 thi VB ?xd f Health.
Signed/-A. a Date
Application Approved by Date
Application Disapproved for the following reasons
Permit No. Date Issued
x .. 13-3 Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yds 7/
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS
Application for Migpo5ar *p.5tem Construction Permit
Application for a Permit to Construct( )Repair( )Upgrade(✓)Abandon( ) LJ Complete System ❑Individual Components
Location Address or Lot No. `! / Owner's Name,Address and Tel.No.
„/ f� oQ�l� /r
Assessor's Map/Parcel r �
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
7 7/
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder.(-e-b
Other Type of Building _ Ce No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow _ gallons per day. Calculated daily flow �J >,�q gallons.
Plan Date /)7 Number of sheets Revision Date
Title �` z° f S AlC/`l d 2-1 !/74
{ Size of Septic Tank of S.A.S.
Description of Soil
f
Nature of Repairs or Alterations(Answer when applicable)
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 thi B." d of Health.
t
Signed/--Ay Date
Application Approved by '��';' Date
Application Disapproved for the following reasons L .
q
i91
Permit No. Y ` Date Issued
---------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERT , that t, a On-site Sewage Disposal System Constructed( )Repaired( )Upgraded
Abandoned( )by /d /r C ,x-.
at �� �Q k t/ /7/� ha ,� constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No 'ated
Installer Designer
The issuance of rthis permit shall not be construed as a guarantee that the system will fuT ction as delg��d.,q
Date Ll 1 �� u Inspector
. No.---�---��----------------------------
Fee
1-
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
Migogal 6peum Construction Permit
Permission is hereby granted to Construct )Repair air( )Upgrade Abandon( )
System located at N ;76
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:Construction" ust b om Jeted within three years of the date of thffA
j Date: Approved by
1 / /
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TOWN OF BARNSTABLE F C.
LOCATION Y7 e7, vd d �G) SEWAGE #
I
VILLAGE ,Gnn/S ASSESSOR'S MAP & LOT )1 a—A
INSTALLER'S NAME&PHONE NO. , /i,>� ,' /.�...r�sP,rro.•� r1�Y-89�L
SEPTIC TANK CAPACITY iS`so e4c
LEACHING FACILITY: (type) (size) 11 'X 36.25',A io
NO. OF BEDROOMS
BUILDER 0 OWNE .
PERMITDATE: a1-0,�' COMPLIANCE DATE: 3 d
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility S 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 /1".✓ Cao> G�iw,-ng
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.C�N Commonwealth of Massachusetts
Executive Office of Enviromuental Affairs
Dept. of Environmental Protection ,John Grad
One winter Street,Boston,Ma:02108 . D.E.P. Title V Septic Inspector
P.O. Box 2119
Teaticket,MA 02536
(508) 564-6813
WILLIAM F.WELD
Governor
ARGEO PAUL CELLUCCI
Lt.Governor �,
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
F:
Property Address: 4760aldand Rd.Hyannis Address of Owner: EP 9
Date of Inspection:9116/97 (If different) 2 1997
Name of Inspector:John Graci Chase TOWNOF �
I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) hfq!HD pSTggLE
Company Name,Address and Telephone Number:
L
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
X_ Passes This inspection is based on criteria defined in Title V
_ Conditionally Pe es code 310 CMR 15.303.My findings are of how the system is
_ Needs Fu er aluation B the Local Approving Authority performing y the time of the inspection.My inspection does
Y PP 9 tY not Imply arty warranty or guarantee of the longevity of the
Falls septic system and any of its components useful life.
Inspector's Signature: Dater 9/16197
The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this
inspections. 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.
INSPECTION SUMMARY:
Check A, B,C,or D:
A] SYSTEM PASSES:
X I have not found any information which indicates that the system violates any of the failure criteria
defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below.
COMMENTS:
B] SYSTEM CONDITIONALLY PASSES:
_One or more system components need to be replaced or repaired. The system, upon completion
of the replacement or repair, passes inspection.
Indicate yes, no,or not determined(Y, N,or ND). 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 cracked,structurally unsound,-shows substantial infiltration or exhlballon,of tank
failure is imminent.The system will pass inspection if the existing septic tank is replaced with a conforming septic tank
as approved by the Board of Health.
(revised 04/27/97)
One Winter Street • Boston,Massachusetts 02108 a FAX(617)556-1049 9 Telephone(617)292-5500
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 476 Oakland Rd.Hyannis
Owner: Chase
Date of Inspection:9/16/97
_ Sewaae backup or.breakout.or hiah.static water level observed.in.the distrihution box is due to a broken.
or obstructed pipe(s)or due to broken,settled or uneven distribution box.The system will pass inspection 'If
(with approval of the Board of Health). Describe observations:
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
—The system required pumping more than four 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
Cl 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 the public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS
NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND
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 APPROPRIATE)DETERMINES
THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
The system has a septic tank and soil absorption system and is within 100 feet to a
surface of water supply or tributary to a surface water supply.
The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply well.
The system has a septic tank and soil absorption system and 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 coi'Iform bacteria and volatile organic compounds indicates that
the well is free from pollution from that facility and the presense of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm. Method used to determine distance (approximation not valid)
3)Other
D] SYSTEM FAILS:
You must indicate either"Yes"or"No"as to each of the following:
_ 1 have determined that the system violates one or more of the following failure criteria as defined in
310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be
contacted to determine what will be necessary to correct the failure.
Yes No
Backup of sewage in facility or system component due to an 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
cesspool.
SAS is in hydraulic failure.
(revised 04127/97)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 476Oakland Rd.Hyannis
Owner: Chase
Date of Inspection:9/16/97
D] SYSTEM FAILS(continued)
Yes No
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 1/2 day flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Numbers 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 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. 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] LARGE SYSTEM FAILS:
You must indicate either"Yes"or"No"as to each of the following:
The following criteria apply to large systems in addition to the criteria:
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 owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(revised 04127/9/)
,IF
l
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECLIST
Property Address: 476 Oakland Rd.Hyannis
Owner: Chase
Date of Inspection:9/16/97
Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following:
i
_y_ — 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 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.
X 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 system does not receive non-sanitary or industrial waste flow.
_ — The site was inspected for signs of breakout.
X All system components,excluding the Soil Absorption System,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 Soil Absorption System on the site has been determined based on
The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of
Sub-Surface Disposal Systens.
x Existing information. Ex. Plan at B.O.H.
x Determined in the field(if any failure criteria related to Part C is at issue, approximation of distance is
unacceptable))15.302(3)(b))
(revised 04/27/97)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 476 Oakland Rd.Hyannis
Owner: Chase
Date of Inspection:9/16/97
FLOW CONDITIONS
RESIDENTIAL:
Design flow: o g•p•d./bedroom for S.A.S.
Number of bedrooms: 3
Number of current residents: 2
Garbage grinder(yes or no): No
Laundry connected to system(yes or no): Yes
Seasonal use(yes or no): No
Water meter readings, if available:(last two(2)year usage(gpd):
n/a
Sump Pump(yes or no): No
Last date of occupancy: t
COMMERCIAL/INDUSTRIAL:
Type of establishment: n/a
Design flow:0 gallons/day
Grease trap present:(yes or no) No
Industrial Waste Holding Tank present: (yes or no) No
Non-sanitary waste discharged to the Title 5 system: (yes or no) No
Water meter readings,if available: n/a
Last date of occupancy: n/a
OTHER:(Describe) n/a
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
System was last pumped three years ego by Macomber
System pumped as part of inspection: (yes or no)Yes
If yes,volume pumped: loon gallons
Reason for pumping: maintenance
TYPE OF SYSTEM
Septic tank/distribution box/soil absorptions system
X Single cesspool
X Overflow cesspool
Privy
Shared system(yes or no) ( if yes,attach previous inspection records,if any)
I/A Technology etc. Copy of up to date contract?
Other:
APPROXIMATE AGE of all components,date installed(if known)and source information:
26 years
Sewage odors detected when arriving at the site: (yes or no) No
(revised 04/27/97)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 476 Oakland Rd.Hyannis
Owner: chase
Date of Inspection:9/16/97
SEPTIC TANK:
(locate on site plan)
Depth below grade: We
Material of construction:X concreate metal FRP Polyethylene_other(explain)
If tank is metal, list age o . Is age confirmed by Certificate of Compliance No. (Yes/No)
Dimensions: n/a
Sludge depth:n/a
Distance from top of sludge to bottom of outlet tee or baffle: n/a
Scum thickness:n/a
Distance from top of scum to top of outlet tee or baffle:n/a
Distance form bottom of scum to bottom of outlet tee or baffle: n/a
How dimensions were determined: Measured
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,etc.)
n/a
GREASE TRAP:
(locate on site plan)
Depth below grade: n/a
Material of construction: _concrete_metal_FRP_Polyethylene_other(explain)
Dimensions: n/a
Scum thickness:n/a
Distance from top of scum to top of outlet tee or baffle:n/a
Distance from bottom of scum to bottom of outlet tee or baffle: n/a
Date of last pumpingn1a
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,etc.)
n/a
BUILDING SEWER:
(Locate on site plan)
Depth below grade: s'
Material of construction:_cast iron_40 PVC_other(explain)
Distance from private water supply well or suction lino—
Diameter: 4•
Gvamments:(conditions of joints,venting,evidence of leakage,etc.)
(revised 04/27/97)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 476Oakland Rd.Hyannis
Owner: Chase
Date of Inspection:9116/97
TIGHT OR HOLDING TANK:
(locate on site plan)
Depth below grade: We
Material of construction:_concrete_metal_FRP_Polyethylene_other(explain)
Dimensions: rda
Capacity: n/a gallons
Design flow: n/a gallons/day
Alarm level:_nra Alarm in working order?_Yes_No
Date of previous pumping:
Comments:
(condition of inlet tee, condition of alarm and float switches,etc.)
n/a
DISTRIBUTION BOX:
(Locate on site plan)
Depth of liquid level above outlet invert: nra
Comments:
(note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box etc.)
n/a
PUMP CHAMBER:
(locate on site plan)
Pumps in working order:(yes or no)No
Alarms in working order(yes or no)_Yes
Comments:
(note condition of pump chamber,condition of pumps and appurtenances, etc.)
n/a
(revised 04/27197)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C.
SYSTEM INFORMATION(continued)
Property Address: 476Oakland Rd.Hyannis
Owner: Chase
Date of Inspection:9/16/97
SOIL ABSORPTION SYSTEM (SAS):X
(locate on site plan,if possible;excavation not required, but may be approximated by non-intrusive methods)
If not determined to be present,explain:
n/a
Type:
leaching pits,number: We
leaching chambers,number:n/a
leaching galleries,number: n/a
leaching trenches,number,length: one 20'
leaching fields,number,dimensions:n/a
overflow cesspool,number:6'x6'block
Alternate system: n/a Name of Technology:_n/a
Comments:(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.)
The leach pit was empty at the time of the inspection shows signs of being 3/4 full.
CESSPOOLS:X
(locate on site plan)
Number and configuration: one
Depth-top of liquid to inlet invert: 6"
Depth of solids layer: 3"
Depth of scum layer: t"
Dimensions of cesspool: 1,000 gallons
Materials of construction: block
Indication of groundwater: none
inflow(cesspool must be pumped as part of inspection)
n/a
Comments:(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.)
Main cesspool and all components are structurally sound.Recommend pumping system every one year for maintenance.
PRIVY:_
(locate on site plan)
Materials of construction: We Dimensions: n/a
Depth of solids: n/a
Comments:(note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation, etc.)
n/a
(revised 04127/97)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
476 Oakland Rd.Hyannis
Chase
9/16/97
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references, landmarks or benchmarks
locate all wells within 100'(Locate where public water supply comes into house)
(3 ex�.
PC,t`�
�N6
IA�
0
!R
S
r
T
(revised 04/27/97) logs 9 of 10
r
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
476 Oaldand Rd.Hyannis
Chase
9/16/97
Depth of groundwater 12+
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from design plans on record.
Observation of Site(Abutting property, observation hole, basement sump etc.)
Determine it from local conditions
Check with local Board of Health
Check FEMA Maps
Check pumping records
Check local excavators, installers
x Use USGS Data
Describe in your own words how you established the High Groundwater Elevation.(MUST be completed)
USGS Maps and Charts
(revised 04/27197) Pays 10 of 10
TOP FNDN. AT EL, 61.8' SYSTEM PROFILE TEST HOLE LOGS
•, ACCESS COVER TO WITHIN 6' OF FIN. GRADE (NOT 7p SCALE)
ACCESS COVER (WATERTIGHT) TO
ENGINEER: RICK JUDO, RS -
MINIMUM .75' OF COVER OVER PRECAST /� WITHIN 6' OF FIN. GRADE 2% SLOPE REQUIRED OVER SYSTEM
60.-0' WITNESS!. DAVID STANTON
RUN PIPE LEVEL 2' DOUBLE WASHED PEAS7ON DATE: 3/15/02
• �_
FOR FIRST 2' PERC, RATE _ < 2 MIN/INCH I �'
PROPOSED1500 3' MAX. " LOCUS
GALLON SEPTIC 57.0' CLASS I SOILS P#
57.25 TANK (H- 10 > GAS 57.0
BAFFLE 56.68' �� 56.51IF! Ada I Ef
a
MIN � 56.5 - � Q
( 2 % SLOPE) �6' CRUSHED STONE OR MECHANICAL ELEV.
COMPACTION. <15.281 [23> $ 0 83� sta 55.6' 0_ 6Q•1
DEPTH OF FLOW = 4 ( SLOPE) ( 1_% SLOPE> are 26
I
TEE SIZES: 3/4' TO 1 1/2' DOUBLE WASHED STONE,""' FILL
INLET DEPTH = 1O"
OUTLET DEPTH = 14" 14" LOCATION MAP NTS
LEACHING 6.9' S E
FOUNDATION-- 21' SEPTIC TANK 26' D' BOX 3' ASSESSORS MAP 272 PARCEL 106
FAC
ILITY 10YR 4/1
*.-UNKNOWN INVERT OUT. PROVIDE MIN. 27 PITCH TO PROPOSED
16 �
SEPTIC TANK. Bw
FS
48.7'
10YR 4/6
40" 56.7'
63.4 -
_.. Cl
PERC
LCOS
x 6Z 2.5Y 5/4
116.50 61 84"
t
60. 60 i ni' C 2 Ix N
/ v! M/COS
. ._ 6" 7'
/ o _ _ ,
13 2 5Y 7/4 48
60.4 \ �' DIRT F 60.7 TH q NO WATER ENCOUNTERED
\y� PARKING NOT E S
9 ,
I_ /_ ` _ �9� 60.9 >>• o SEPTIC DESIGN: (GAkBAGE DISPOSER IS NOT ALLOWED > 1. DATUM IS APPROXIMATED FROM QUAD
330
DESIGN FLOW 3 BEDROOMS ( 110 GPO) - GPD 2. MUNICIPAL WATER IS- EXISTING
59•I USE A 330, GPD DESIGN FLOW 3. MINIMUM PIPE PITCH TO BE 1/8' PER FOOT.
'qLOT 17L
Q�
14,244t SQ. FT.
SEPTIC TANK: 330 GPD ( �) 4. DESIGN LOADING FOR "ALL PRECAST UNITS TO BE AASHO H- 10
` o ,, .% -
660 S. PIPE JOINTS TO BE MADE WATERTIGHT.
/ 1500 GALLON SEPTIC TANK
/ a USE A ---- 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS,
/ 1 6C 9 LEACHING; ENVIRONMENTAL CODE TITLE V.
/ o + I ° SIDES: 2(36.25 + 10,83) (.$3� �.74) = 57.8 7. THIS PLAN IS FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT
TO BE USED FOR ANY OTHER PURPOSE.
EXIST. DWELL. 61'0 , '` BOTTOM: 36.25 X 10.83 (.74) = 290 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4' PVC.
` TOTAL: 470 S.F. 347.8 GPD 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT
/ �07 ^ ' 7.8 USE 5 HIGH CAPACITY INFILTRATORS WITH 2.5' INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED
gR t FROM BOARD OF HEALTH.
/ Z
STONE AT ENDS AND 4' AT SIDES 10. PUMP & REMOVE (OR FILL W/CLEAN SAND) EXIST. CESSPOOLS
W i
/ l
a i602 i
I '+ 60.0 G��c ; ;' SHED LEGEND TITLE 5 SITE PLAN
100.0 PROPOSED SPOT ELEVATION OF
0
l
476 OAKLAND ROAD
100x0 EXISTING SPOT ELEVATION
IN THE TOWN OF:
/ /� 9 / 116•50 X -x--"��x 100 PROPOSED CONTOUR ( HYANNIS) B A R N S TA B L E
x ----x -x-----W&C-T 100 EXISTING CONTOUR PREPARED FOR: BORTOLOTTI
CONSTRUCTION/HERRERA
20 0 20 40 60
BENCH MARK - CENTER OF BOARD OF HEALTH �I
CATCH BASIN. EL. = 59.8' APPROVED DATE MA SCALE: 1" _ 7o' DATE: MARCH 20, 2002
off 508-362-4541
A fox 5" X2-9m
. I
`00 wn cape engineering, Inc, ��`" of MAJ. %tN of ,y
`I9
ARNE Cyc �o� ARNE H
CIVIL ENGINEERS � H. OJALq
LAND SURVEYORS 9Q No.J 6ALA 34 � IVIL 2
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02-058 939 main st, yarMouth, Ma 02675 AR JALA, DATE
-