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HomeMy WebLinkAbout0043 SAINT CATHERINE AVE - Health 43- Saint-Catherine Ave Hyannis A 291 062 9 0 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a u 6�� 43 St.Catherine Ave. Property Address Carol Caldeira a� ��� Owner Owner's Name information is required for Hyannis Ma. 02601 6/10/2008 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important: A. General Information When filling out forms on the. computer,use 1. Inspector: only the tab key to move your Robert Paolini cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC. Company Name P.O.Box 763 Company Address F Centerville Ma. 02632� City/Town State Zip Cod (508)428-4028 S14454 c_ - Telephone Number License Number ) ® -r �:T B. Certification ' uk 117-0 I certify that I have personally inspected the sewage disposal system at this addres and that)the r- information reported below is true, accurate and complete as of the time of the insp ction. ft% Inspection was performed based on my training and experience in the proper function and-mai tenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of _ Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 6/10/2008 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****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. 43 Sl.Catherine Ave.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 2 Commonwealth of Massachusetts W Title 5 official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 43 St.Catherine Ave. Property.Address Carol Caldeira Owner Owner's Name information is required for Hyannis Ma. 02601 6/10/2008 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 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 tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed 43 St.Catherine Ave.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 2 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 43 St.Catherine Ave. Property Address Carol Caldeira Owner Owner's Name information is required for Hyannis Ma. 02601 6/10/2008 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ 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: d 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. 43 St.Catherine Ave.-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 3 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 43 St.Catherine Ave. Property Address Carol Caldeira " Owner Owner's Name information is required for Hyannis Ma. 02601 6/10/2008 every page. City/Town State Zip Code Date of Inspection ti B. Certification (cont.) C) Further Evaluation is Required by the Board of Health(cont.): ElThe system has a septic tank and SAS and the SAS Is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: " This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent 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: 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 El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® 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. 43 St.Catherine Ave.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 4 Commonwealth of Massachusetts v Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 43 St.Catherine Ave. M Property Address Carol Caldeira . Owner Owner's Name information is required for Hyannis Ma. 02601 6/10/2008 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. El 0 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 fecal coliform bacteria indicates absent 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 and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® - The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. 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. 43 St.catherine Ave.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 5 I Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 43 St.Catherine Ave. M Property Address Carol Caldeira Owner Owner's Name information is required for Hyannis Ma. 02601 6/10/2008 every page. City/Town State Zip Code Date of Inspection C. Checklist 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? El ® 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) M. ❑ 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: ® ❑ 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(5)] 43 St.Catherine Ave.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 6 Commonwealth of Massachusetts W Title 5 official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 43 St.Catherine Ave. Property Address Carol Caldeira Owner Owner's Name information is required for Hyannis Ma. 02601 6/10/2008 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2007:58,000 g ( y g (gpd)): 2007:58,000 Sump pump? ❑ Yes ® No Last date of occupancy: 6/10/2008Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) i Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ -Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): 43 St.Catherine Ave.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 7 J Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 43 St.Catherine Ave. Property Address Carol Caldeira Owner Owner's Name information is required for H annis Ma. 02601 6/10/2008 y every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Capewide Enterprises,LLC. Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1000 gallons . How was quantity pumped determined? Measured Reason for pumping: Maintenance Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: New leaching installed in 2003 Were sewage odors detected when arriving at the site? ❑ Yes ® No 43 St.Catherine Ave.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 8 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 43 St.Catherine Ave. Property Address Carol Caldeira Owner Owner's Name information is Hyannis Ma. -02601 6/10/2008 required for y every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 15"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 20'+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented through the house vents. Septic Tank (locate on site plan): 1' Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene El other(explain) If tank is metal, list age: years Is age confirmed b a Certificate of Compliance? attach a co of certificate ❑ Yes ❑ No 9 Y ( PY ) ----------------------------------- ------------------------------------------------------------------------------------- Dimensions: 1000 gallon Sludge depth: 0 Distance from top of sludge to bottom of outlet tee or baffle na Scum thickness 0 Distance from top of scum to top of outlet tee or baffle na Distance from bottom of scum to bottom of outlet tee or baffle na How were dimensions determined? Tank pumped at inspection 43 St.Catherine Ave.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 9 f Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 43 St.Catherine Ave. Property Address Carol Caldeira Owner Owner's Name information is Hyannis Ma. 02601 6/10/2008 required for y every page. City/Town State Zip Code Date of Inspection D. System Information(cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump septic tank every 2 years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears to be structurally sound. t Grease Trap (locate on site plan): Depth below grade: feet 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: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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): 43 St.Catherine Ave.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 10 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 43 St.Catherine Ave. Property Address Carol Caldeira Owner Owner's Name information is required for Hyannis Ma. 02601 6/10/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert No 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.): Box is Ievel.Box has one outlet Iateral.No evidence of solids carryover.No evidence of leakage into or out of box. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑. No Alarms in working order:. ❑ Yes ❑ No 43 St.Catherine Ave.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 11 Commonwealth of Massachusetts W Title 5 official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 43 St.Catherine Ave. Property Address Carol Caldeira Owner Owner's Name information is required for Hyannis Ma. 02601 6/10/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 2-500gl. LC ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Sandy dry soil.No signs of hydraulic failure.Leaching chambers had 3" of water in them at time of inspection with no stain line above this point. 43 St.Catherine Ave.-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 12 I • Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 43 St.Catherine Ave. Property Address Carol Caldeira Owner Owner's Name information is required for Hyannis Ma. 02601 6/10/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 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.): 43 St.Catherine Ave.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 13 Map , Page 1 of 2 Town of Barnstable Geographic Information System 4 Parcel Viewer Custom Map Abutters Map Size Zoom Out I I ne In [}J}qVNIA ..,.--a. .,,...,...,. ------------- s i ` - -- _ _ , • r � f 4 i I rI a ! - I L •- q h J ........ t` 0 20 Feet S F L r ' x Set Scale 1" = 20 I Aerial Photos • f`nnvrinht 7M�"9nnA.Tn,•,n of P.—f.W. KAA All A hfc roecnn httn://www.town.bamstable.ma.us/arcims/appgeoapp/map.aspx?propertyID=291062&map... 6/10/2008 e Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 43 St.Catherine Ave. Property Address Carol Caldeira Owner Owner's Name information is required for Hyannis Ma. 02601 6/10/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: Z Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: Bottom of LC 30'feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date 003 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: / ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: USED:USGS Observation Well.Data.USED:Technical Bulletin 92-000-01 plate#2 annual ranges of ground water elevations. 43 St.Catherine Ave.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 i 0pZNE r Town of Barnstable Regulatory Services 0 BARNSTABLE, : Thomas F. Geiler, Director 9� 6� `fig' Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 REGARDING SEPTIC INSPECTIONS BY PRIVATE CONTRACTORS DISCLAIMER This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original or copy of the report; this Division does not warranty the functionality of the septic system in_ the future nor does this Division agree with any technical observations and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would be listed on the "Disposal Works Construction.Permit". If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection. Q:ISEPTIC\Disclaimer Private Septic Inspections.DOC TOWN OF BARNSTABLE ,.00ATION 4"'1 SEWAGE # ;1W3-t(.0 VII, SAGE A uowm S ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. Iati-1146J . gEC �0 7S� 7 7CT SEPTIC TANK CAPACITY L o oo LEACHING FACILITY: (type) Z l�?T r�SE R5 (size) 13 A Z. )c o2 S f L) NO.OFBEDROOMS_ BUILDER OR OWNER—CA IckI fin. PERMTTDATE: 4 Jr7 /U COMPLIANCE DATE: S 3 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) 1yE.3 Feet 'Edge of Wetland and Leaching Facility(If any wetlands exist within 300*feet of leaching facility) Feet Furnished by © o a , _ + p Fee �C1 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: i�✓� f Yes t PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE. MASSACHUSETTS ZippYication for 33i.Opo5al OpOtem Conotruction 3permit Application for a Permit to Construct( )Repair�/)Upgrade(_\)Abandon( ) ❑Complete System ❑Individual Components Location Address or L yNo. Owner's Name,Address and Tel.No. ssessor's Map/Parcel Installer's Name Address,and Tel.No. 7 Designer's N e,Address and Tel.No. W 6. �o�,�soN Sealri� S�v. C . A. S`s o �- P.o. Type of Building: Dwelling No.of Bedrooms�.� Lot Size sq.ft. Garbage Grinder(n)0 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 Nature of Repairs or Alterations(Answer when a licabble) ,o% D t o - 09low 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 issue y this B �deall,,. Signed Z Date Application Approved by L442 M� Date —0 Application Disapproved for the Yollowing reasons Permit No. 20 6 7 0 Date Issued 7 �,_ -.... .. -ts.... - ,v,,,.. —,.-.•,r...,_ .< - _, —. -�+'�x.d,;..�. ,, .. -.y.. ...rs�t.y. -ti .:*` ••. .... ..-.,.. ,-.c- T:. .. .+,.� '�;>`,� ,t. s'- j / QV �(pb i Fee-6 No.f 11 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Y es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS_ 0(ppfication for Migpogar *pgtem Construction Permit Application for a Permit to Construct( )Repair( Upgrade(.�)Abandon( ) ❑Complete System ❑Individual Components Location Address Lpt No. Owner's Name,Address and Tel.No. ssessor's Map/Parcel 'A v,t_N U 1 Installer's Name`Address,and Tel.No. 7 7 S Design is N e,Address and Tel.No. /�. Sao/,r Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage;Grinder(n)o 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 Nature of Repairs or Alterations(Answer when a licable) rl s i /x 5� Pry c h 22 P/ASS 9 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 issue y this Boar d ealti. z Signed r Date = Application Pproved byE Date -1 7-o T Application Disapproved for the Yollowing reasons r f Permit No. 2 b 6 3—I0 Date Issued 7 t - - ...-- - -- -- --- } THE COMMONWEALTH OF MASSACHUSETTS CA BARNSTABLE, MASSACHUSETTS Certificate of Compliance ! THIS IS TO CERTIFY, that the the On-site Sewage Disposal System Constructed_ ( )Repaired(Upgraded( ) Abandoned( )by kJ L- l�G6 in_ 5.e J i C .SQ, l C e� at A-13 S7 C f ✓'/n e- Any 1/ S has been constructed i accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 200 3-16 U dated l 1 t 7 03 Installer Designer The issuance o ts permit shall not be construed as a guarantee that the system will functio a d ' esigned. z Date v 3 Inspector No. 9 0 D � ��� Fee J t,00 CA l e l A THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Xmui5pooal *pgtem Congtruction Permit Permission is hereby granted to Constru y( )Repair( )Upgrade( )Abandon( ) System located at 4/-7 Sr C 1h e,"l n e- f/e e f 9hI? l�S 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:Consttuction must be completed within three years of the date of thi ermit Date: 41710� Approved by 'J ��s• TOWN OF BARNSTABLE H LOCATION ':� Lr9 6t��i -�(�,[ �- SEWAGE # @3-an VILLAGE RVAvi &i 5 ASSESSOR'S MAP &LOT Z1 INSTALLER'S NAME&PHONE NO. 1Z6 Ia taJ ®IJ Sc 91 C SEPTIC TANK CAPACITY 1 i a tlo LEACHING FACILrrY: (type) .Z D�l� RI (size) t 3 r-Z k Q S NO.OF BEDROOMS 3 BUILDER OR OWNER PERMUDATE: � In 10 3 COMPLIANCE DATE: S It.I d 3 " 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 j 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 ti ck ® kuscr L t Q fi i 1 W � I ci V � O t fA ~' W Vn W � N A � G � W N c — W out W L •� � W � W s o! 49 as g Z W ..� W A Q 1 W -a W`J tw V ... t t W W Q 1 Q d Q �,� .. ��r � - ��e^ NO............ Fzi3............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD g 0 HEA T .. _........... ...........OF..........j .4:59.�. . . ... .... .............................. Appliration for Disposal Works Tonstrurtion ramit Application is hereb made for a Permit to Construct or Repair an Individual Sewage Disposal System at ...... . ...... . .., 0 ................. L....t' n-Address ................ ....................13.... .........r Lot No........................................... ...........? ......ChA41ja.... L ..Put. --- ---------------------------- 1. Address • ................ .................................................................................................. ----------------------------------- Installe Address Type of Build* ize Lot....... ....Sq.. feet ..........................Expansion Attic (/ Dwelling No. of Bedrooms....... Garbage Grinder `(/rA Other—Type of Building ............................ No. of persons............................ Showers Cafeteria PL4 Other fixtures ............................ ................. ..... *------ --------- --------- ---- ------ --------- ----------- Design Flow j. ......_....._..._gallons per'person"per'-day."'Total"'da-ily,fl-ow,----.,.,-,.,.,.,.,.�Z'-2'.,.-41*.,..*.---.,.-;-..-.,.gall'ons'. W Liquid capacity............gallons gallons Length................ Width....__.......... Diameter................ Depth.............._. 9 Septic Tank I Disposal Trench—No. ................... Width_.__............_.. Total Length............ .... Total leaching area............ sq. f t. Diameter........ .... Depth below inlet....... ..... Total leaching area..g.L.- ..sq. ft. Seepage Pit N(.......... ......... z Other Distribution box Dosing tank Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water.___.._....._........__.. Test Pit No. 2................minutes per inch Depth of Test Pit_._............._... Depth to ground water____._......._.......... .. ...... . ....... ---------------------------- .................**­-------------*­----------------------"------- • ----­----­-- 0 Description00,of Soil...... 1k,,Qeq.,n..... ys;tll............ ..................�9....... ,2............. ................................ ........................................................................................................................................................................................................ U Nature of Repairs or Alterations—Answer when applicable................................................................................................ .............................................................................................................................................................................................. Agrediment: The undersigned agrees to install >the aforedescribed Individual Sewage Disposal System in accordance-with ' -the provisionsof L.ITLE 5 of the,State Sanitary Code—The undersigned further agrees not to place the system in' operation until a CertificAe of Compliance has been issued by the board of health. "'S ed ............ ......................................................... ................................- - -------- /01 D yal Application Approved By.... ................................ .......... Date Application Disapproved for the following reasons:...........................................1.................................................................. ........................................................................................................................................................................................................ Date Permit No......................................................... 1ssUed_-4_0_::�..!6.....7 .......................... Date Q . No..- -•-• _....... Fss............................. THE COMMONWEALTH OF MASSACHUSETTS . i Ye' BOARD Off HEA T ...... ,�.��rlirtt#i�art���u� �i,��rla��a� nrk,� C��n��rnr#iun rrmif Application is'hereb maderfor a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System UZI , ^• - /� Loca•on-Address /or Lot No. !I:Z _. _......... z.._... ..1 �?tP?. .Y ...... .t/r.. -' a Pa Address ... .................................. ...................••••••-•••- ••-•-•' -••-----•-••-••-•••••-•-•••....................... 14 �4.WstaW Address PQ V Type of Building,. Size Lot......IYl L2.----Sq. feet Y �/ �.. Dwelling No. of Bedrooms___ . _._•.._..--.•.-- ___._Expansion Attic ( 'g— --------- ) Garbage Grinder (/rh) Other—Type of Building ____________________________ No. of persons___:...._'................. Showers ( ) — Cafeteria ( ) Q' Other.fixtures ..-•••-••------------------- s. W Design F . ___ _______________________gallons per person per day. Total daily flow...._. ��%t__�_.__...__.___..__._gallons. I WSeptic Tank Liquid capacity___.____.._.gallons Length................ Width'............... Diameter................ Depth__ _ - x Disposal Trench No .......... Width_. _:___:. Total Length._____ Total leaching area }} sq. ft. Seepage Pit No ::_____ _.,.. Diameter........ ( ..__ Depth below inlet....... Total leaching 9Xea..r�__4 sq. ft. Z Other Distribution box (.w ) Dosing tank aPercolation Test Results Performed by_________________________________________________ 4_ _.___..._ Date........................ a Test.Pit No. 1................minutes per inch Depth of Test Pit............. _.____ Depth to ground water _.______ ___._._.__. G4 ;.,Test.Pit No. 2..............:.minutes per inch Depth of Test Pit..................... Depth to ground water......................... p� ..--•---•-------------------------••----...._._.....-• ____-•••----......._._. •----••• .............................................. 0 Description of Soil.....0•- / = '''�_ l , , = -sg-�-�-----•--•-- f r �" ....>Js v r __... __tlJL° �a<�2 t._ E zY1S�(.___.._.....••----.. .... ./ t 2 f_l��4"__... d.�'_ !. �. ---------•-----------------------------"------------------------------------------•--------•••-•----•-••--•--•--•-•- U Nature of Repairs or Alterations—Answer when applicable................................................................................................. _-•--••-----•••-••-•••-•----------------------------------•---•-----------•-•---••--------------•---•----------•--- Agreement: --' The tmdersigned„agrees to install,, the aforedescribed Individual Sewage Disposal System in accordance with the provisions of�I".'1�" 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Sied _-..._ .__.....•---•--•----•-------• ' Da • ' : = �r_ Application Approved By..__. ,,.r ,�,�I-------------- . Application / Date Application Disapproved for the following llowing reasons:-------•------••---•---...--•------------------------------------- =' ...•..............-- Date • - t. Permit No.................................................._...... Issued_................... =` =::... ------- Date THE COMMONWEALTH OF MASSACHUSETTS _. BOARD HEALT . .........> ....:.....OF...... Trrtifirate of TompfiFanrr THIS T R Y, at the Individual Sewage Disposal System constructed (94�_Or Repaired ( ) by F ef' .......................... ..---­----------------- ata Installer /} / k -•-- - has been installed in accordance wi�i the provisions of T ` of The State Sanitary Cod s described in they:- application for Disposal Works.Construction Permit No _.. '__.____ ___________ dated_... .-. THE ISSUANCE OF THIS;CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION::SATISFACTORY. A , Inspector DATE... ..................... .......... .. .......... . ............................... THE COMMONWEALTH. OF MASSACHUSETTS `BC?ARD OP, HEALTH No......................... FEE... r i bra �t1 0 st ton rrmi . 4 Per' is s on is.hereby granted......... ,.••. ... -- --- -- - ------------------•-•-• ---------••----------•- -••---..... .............. to C&;Z or ( I dividual e D> poy at lop Street as shown on the application for Disposal Works Construction Pep9t,No :-- ----- ated'__:`" jK == Boa d of Heal DATE..---> R ........................................... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS 777 R �E � .. xl9n .- � f°may _ :„> °•. i' s - - :-�y=� b^� a d _��lJ ?a r✓ O J. '�� �' 1 CXf'�!✓S/0A✓, ,+ "�' °' ` -� fi+:. .,�• F. / - h G - � 7_6 570. q . . )0 Q U L 36' 20 000 ,Ip .tr to g Lye ' o BUNIKIS i o p�Nu 22ib2 ti ( 90, - sTIONAI l H. LEGEND . EXI'STiNG SPOT ELEVATION 0,6 CERTIFIED PLOT PLAN EXISTING. CON TOUR - - -"p 0-T- /3 S_T, C-47;''E:RIA/E A.ve FINI_S+iED SPOT ELEVATION L� ` FINISHED CONTOUR -- p_ W_4 -_— i`�`Y� 1W r APPROVED ,BOARD OF HEALTH S , per. „ ' `,.9All�1 � A.3...� , Alss* r DATE AGENT SCALE /� _ ✓v DATE ;`.�G , 7� I: LD_ REDGE ENGINEERING CO. 1MC CLIENT M!'n.l' I CERTIFY THAT THE PROPOSED EGISTERE REGISTERED JOB NO. � !_2--� BUILDING SHOWN .ON- THIS PLAN CIVIL LAND. ENGINEER I DR.'BY fl; / • CONFORMS TO THE :ZONING LAWS __- ._S� SURVEYORS OF BARNST, BLE , ASS. 33 NO MAIN ST 712 MAIN. ST CH. BY: SO. YARMOUTH, MASS. HYANNIS MASS.' ID14E 7� P. SHEETS OF ____ R G. LAND SURVEYOR t"yr �)j, 1 4 20 r-MIN '01. 40A 'Aw"Val r,A 7"N A 4ffffz:O.6v jp Pff A NCR r &AP 90 A Ob-C F'77 IrO OArA 04W.,�A' N -410 S.4-M c v-/A.- 0/?/vo W,4 Y- r2 C A C C4 C)DEER - -4.�4 Al .5*AAIO. A 4"CA57 IRON ' : OF M)N oirc/i GAG." 0 0 d P SEPTIC k TANK :DIST • AWASH ED STOYCVA �tz.Tli" . A90) A WA Nvv&Arr &A e vA vadv-s qp or - -r AT aalzolmc, '�7 0 c FrAm. lwxeA TAWLAT) 'J. 5 SEPTIC 7;4MK .aSE FT:..,VIA, C(SEE 47 r J#VA< 96-3 r SEPTIC -rA 74z OV-VD PWA 7EX 7A 4R' eox 9'� 0 C7- dR ec /40,V �7 Y� CZ - 0- 'n AOMATIO# 44 bim I=A W ON A -3 FT.. po%jj cm r,=nm, T - 2; AIMAf 4- 424 A SAF AWSROSA A.,!/.V.*Y s0/L 'LOG - T". MM4 '7 &W 40A CMIVrr P/7"- A4re NOM b P/7- Err— pr- dY • X-3 JOTT'OM 464CNINO PER PI; pr IF '2 7'OrA4 i�WHMWF 4R&A 2'0 ESERKEL4 CAII&W AREA Pr 6A 'k CA-r. 7-Hg" IV,4s- A IL IS, 'aA4 r t -Af' J 777-- IFUMKIS" N&22lk t �45? cap, SOIL TES 21CMiARK Vo_:3 DATE OF SOIL TEST Zf FT. MINIMUM FROM CELLAR TOP OF FOUNDATION SOIL TEST DONE BY 10 FT. MINIMUM FROM SLAB OR CRAWL SPACE 10 FT. MINIMUM ELEV. 100.00 CLEAN SAND WITNESSED BY (ASSUMED) CONCRETE OBSERVATION HOLE 1 ELEV. ZA- LOAM AND SEED COVERS 4- SCHEDULE 40 PVC PIPE PERCOLATION RATE MINJINCH AT 4_?=_4f:Y_ INCHES MIN. -PITCH 1/8" PER FT, 2". LAYER OF DEPTH HORIZ TEXTURE COLOR MOTT. OTHER 1/8" TO 1/2* WASHED STONE Ae 4" CAST IRON PIPE 6 'MA MAX. OR EQUAL) MINIMUM PITCH 1/4- PER -FT. a 14 A y- 4z Ar 4 oer V. FLOW LINE 0 CL --,-s e J0ly/z ELEV. 00[30clo 17 1�4_ TMIN 0 ELEV.­ coommomoboo L2'OE 0 LEVEL 0 Mp 9 ell AAp GAS LE SUMP 0 0 ELEV. E V. ELEV. - 2-1 10- 000000000 o 2 9 0 0 C3 BAFFLE 0 000000 0 n o DISTRIBUTION ELEV,,;/. 13 cl rl 0 0 ELEV. LIQUID OUTLET 12-4, 1 1 � BOX , P , I I I I DEPTH TEE (TO 8 E PLACED ON FIRM BASE) GALLON DRYWELLS WITH 4 FEET ' 14 INCHES TO BE WATER TESTED,, STONE IN AN AT _ZZ�4 ELEV. IF 'MORE THAN ONE OUTLET .2 , A-12. WA TER ENCOUNTERED 5 FEET 19 INCHES 6 FEET , 24 INCHES 1000 GALLON I >?O�xz TRENCH FORMATION WELL 7 FEET 29 INCHES (TO BE PLACED ON FIRM BASE� ZONE 8 FEET 34 INCHES CHES . ,,SEPTIC TANK TO 1 1 ABSORPTION 3/4 ./2 CLEAN SOIL, INDEX .5 rl tv c7 DOUBLE WASHED STONE -ADJUST DESIGN CALCULATIONS FREE OF FINES SILT SYSTEM . (SAS) NUMBER OF BEDRobms , U5GS PROBABLE WATER TABLE ELEV -rb 1B e- GARBAGE DISPOSAL UNIT ,SEWAGE DISPOSAL SYSTEM. PROS" 'OBSERVED WATER TABLE TOTAL ESTIMATED FLOW ELEV. = NOT TO SCALE BOTTOM OF TEST HOLE _ELEV, = ,GAL. AY REQUIRED SEPTIC TANK CAPACITY . J-E-- GAL ACTUAL SIZE OF SEPTIC TANK GAL. SOIL CLASSIFICATION DESIGN PERCOLATION RATE < MIN./IN. 'EFFLUENT LOADING RATE GAL./DAY/S.F. LEACHING AREA a 74 SQ. FT. Y (AREA X RATE) GAL./DAY LEACHING CAPACIT RESERVE LEACHING CAPACITY GAL./DAY, NOTES: 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. TITLE 5 AND THE TOWN RULES AND REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO WITHIN 6" OF-FINIS HED GRADE. 3.ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE USED UNDER OR WITHIN 10 'FT. OF.,DRIVES OR PARKtNG'AREAS., .00,_ 98.0 4. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SHALL BE MORTARED IN PLACE. 5.,N0 DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH LOT IJ -DEEDED OR 'ZONING'-REGULATIONS: OWNER / APPLICANT IS TO C�L9�3 AREA 14,400 OBTAIN SUCH DETERMINA71ON FROM APPROPRIATE AUTHORITY. 6, UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCAVATION CONTRACTOR IS TO CALL "•DIG-SAFE" AT 1-888-344-7233 AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE. 98.2/ 7, CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL •AS SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. ANY VARIATION', fc) 98.0 IS 'TO BE BROUGHT TO THEATTENTION OF THE DESIGN ENGINEER -DRIVE IMMEDIATELY. C 8.' PARCEL IS IN FLOOD SHOWN ON ASSESSORS MAP 19 AS PARCEL 9.'LOT IS 10, ALL UNSUITABLE MATERIAL SHALL BE REMOVED FROM UNDER, AND FOR A MINIMUM OF 5 FEET FROM AROUND THE SOIL,ABSORP 7.8 TION SYSTEM, 9 AND BE REPLACED WITH SAND AS SPECIRED IN 310 CMR 15.255: (3) 1W (I.E. TITLE 5) IF ENCOUNTERED BELOW S.A.S. PIPE INVERT. 11. EXISTING -LEACH jP/IrTO BE PUMPED AND FILLED WITH SAND F R 0 OR CRAIG SHORT f 1�5 ks:�ox Z�e.,a 98.8 AP PROVED. .'BOARD OF HEALTH CIVIL' No. 27483 o GIST o:3 :DATE AGENT B .8 98.4 SHED I PROPOSED SEPTIC DESIGN FOR .9 /988 WX ROBINSONSR NEIL CAMEIRA LOC. LOT 13, - 43 ST. CATHERINE AVE. BARNSTABLE, MASS HYANNIS kn wk 120.00, cocasQWG A SHORT P.X 235 GREAT WESTERN ROAD 508- P. 0. BOX 1044 SOUTH DENNIS, MASS. 398-8311 02660 97.1 -x_ I I DATE DA SCALE 7_ APR 11 20 20' 4�1 44S REVISED JOB No. 01-0963 LOCATION MAP REVISED [SHEET 1 OF FBK-19J C.��S8kPROJ\24JI-00�dwg�2431-OO.DWG 0 2002 CRAIG R. SHORT, P.E.