HomeMy WebLinkAbout0050 SAINT JOHN STREET - Health 50 Saint John Street
Hyannis P
• A 291 037
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-r TOWN OF BARNSTABLE 1�
LOCATION U k^a`.L SEWAGE # a�0 y• (�9
• �':rII.LAGE=�S�� 07 /
I
���r ASSESSOR'S MAP & LOT " 37
INSTALLER'S NAME&PHONE NO. WtK,6 . 96blAf4 n S'eAl Ser✓lte SU€
SEPTIC TANK CAPACITY ZQ o o Gg
T EACHING FACILITY: (type) d Xp3W DEX G—el b (size) X �a S ICE
NO.OF BEDROOMS
�SUILDER OR 00 . Ad m eJ
PERMTTDATE: Io11 o y 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 X
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 7b17 �s
L4cV of Ho 0 .K
O
� -3 YIP � 3
,3s3 - 71 '
TOWN OF BARNSTABLE
LOC; TION 60 f,MA,%,5 SEWAGE #
VILLAGE ASSESSOR'S MAP & LOT o�!
z �
�Yt'SPic?y 'S NAME&PHONE N0.
SEPTIC TANK CAPACITY 100 o!�d t
.LEACHING FACILITY: (type) B-E' C.(-5A- (size)
NO.OF BEDROOMS -
13`IJILDER OR OWNER
PERMTTDATE: COMPLIANCE DATE: at s
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 306 feet of leashing facility) Feet
Furnished by-`
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„ No. a0 0 —(P .r - F41 00 .is
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THF'� OMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
0(pprication for ]i5po.5al bpgtem Construction Permit
Application for a Permit to Constnict( )Repair( X�Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No. 7 7 5—0 2 8 4
0 S1�. John St, HYannis Tom Holmes
Assessor's ap/Parce 291 /37 51 Woodbury Ave, Hyannis
Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. 3 6 4—0 8 9 4
Wm E Robinson Sr Septic Eco—Tech
PO Box 1089, Centerville 43 Triangle Cir, Sandwich
Type of Building:
Dwelling No.of Bedrooms _ Lot Size sq. ft. Garbage Grinder J10)
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 Re airs or Alterations(Answer when applicable) Install a new Title 5 leach
system to plans of Eco—Tech, YETE-1888.
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 , de not to p ce the system in operation until a Certifi-
cate of Compliance has been issued by this of He G
gned Datr/1-Z'
Application Approved by Date
Application Disapproved for the following reasons
Permit No. Date Issued �`�
.a .,.. ,.•�)v a ti..',wM' w...w.�..ti r v^ ., _ I . Y))w. - _Y N -... t+ _
GNo, � .hd-«. _ 1 fic ._... '!. Fee 1 00.00
x ' ) THE CO 'MONWEALTH OF MASSACHSSE•TT'S Entered in computer:
4
PUBLIC HEALTH DIVISION -TOWN OF-BARNSTABLE., MASSACHUSETTS /Yes
�` Yicatio4,1-fo io ogal ztem Construction ertnit
Application for a Permit to Construct( . )Repair( X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No. 5—0 2 8 4
50 St. John St, HYannis Tom Holmes
Assessor'sMap/Parcel 291 /37 51 Woodbury Ave, Hyannis
Installer's Name,Address,and Tel.No. —8 7 7 6 Desi ner's Name,Address and Tel.No. —0 8 9 4
Wm E Robinson Sr Septic E co-Tech
PO Box 1089, Centerville 43 Triangle Cir, Sandwich
Type,of Building: Go A
Dwelling No.of Bedrooms _ Lot Size sq.ft. Garbage Grinder(no)
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
Install a new Title 5 leach
Nature of cep resnorAloterpian�Ano` r co a eCh,e) fE I;— 1888
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance o he afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental de . d riot to place the system in operation until a Certifi
Cate of Compliance ha�e issued by this of H altt. / L
Signed Dat/—� �J
Application Approved by' Date
Application Disapproved for the following reasons
Permit No. � Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
Holmes BARNSTABLE, MASSACHUSETTS
Certificate of Compliance a g,J'rwm5
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired ( X)Upgraded
n ( )
Abando by Wm E Robinson Sr, Septic Service
at � �t. Jo tin Street, Hyannis has been construct d i accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. a Ot1� dated
Installer Designer
The issuance of t�Iis ermit shall not be construed as a guarantee that the sy tern-wi 1 function as�'eL�gned.
ff
Date f � inspector
� '_.
'f r
No.
Holmes ' THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
1=i!6po5a1 *pgtem Construction Permit
Permission is hereby granted to Construct( )Repair(X )Upgrade( )Abandon( )
System located at 50 St., John Street, Hyannis _
� 1
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 must�be completed within three years of.the date'of this pe it.
Date: 11/U / Approve.
roved b
-.. PP Y
4
JJ TOWN OF BARNSTABLE
LOCATION r• kN S SEWAGE # 2?00�l'
VILLAGE ffiA^^rr ASSESSOR'S MAP &LOT a9�' 3-7
INSTALLER'S,NAME&PHONE NO- W M.e - Q6b[o sa n SeA Servue V€ *2? ,6
SEPTIC TANK CAPACITY- D O
• xse Dv w�i6 x U-1 X-
LEACHING FACII.TI'Y: (type) �_ (size)
NO.OF BEDROOMS � ►�°m�
BUILDER OR OO Lo ImeJ
PERMTTDATE: ! jig o y 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 facility) Feet
Furnished by 7-6 13 G eS
RAC1, OF ' OS
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f3-3 ' 7/ '
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Town of Barnstable
Regulatory Services
.� Thomas F. Geiler,Director
• saiwsrasce,
9�A MASS. ,e�' Public Health Division
Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer & Designer Certification Form "-
Date:
Designer: Eco-Tech Installer: Wm E Robinson Sr Septic .
y,
Address: 43 Triangle Circle Address: PO Box 1089' Service.
Sandwich Centerville
R On at Wm E Robinson Sr Sept*as issued a permit to install a
(date) (installer) Service
septic system at 50 St. John Street, Hyannis based on a design drawn by '
(address)
Eco-Tech dated 12-20-04
(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.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system) but in accordance with State & Local Regulations. Plan revision or
certified as-built by designer to follow.
(Installer's Signature)
BANIT
�rt
(Designer's;Signature) (Affix Designer's Stamp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
Q:Health/Septic/Designer Certification,Form
N REC4 ED
COMMONWmvm OF KPOSSACHUSETTS p EC 2 7 1999 I-1
Re
EXECUTIVE OFFICE OF ENVIRONMENTAL AF AI
Tp''JN OF EARNSTABLE
DEPARTMENT OF ENVTRON CENTAL PItOTEC QN '�Lp' APT
ONE WINTER STREET, BOSTON MA 02108 (617)292-6500
Ile
TItL"Ur("OU
8scrstary
ARGEO PAUL CELLUCCI DAI-M B.MIUK8
Goo�as+wr Cotaaus�aoner
11Ni UMACE SEWAGE 01E11POIS"SY117M hff SPECTION FOAM
PART A
C�CATIOIIO n l
PsapNip Adders: � S`� —Tb�'IL 5 "asset of Oomar _ e `�- Lk
H h u S Addnw of 0wnu ----5��2— % St
0na+sf luepesllate: 1 � j 1�4�`� 1 tt a n rt,►S , ma,SS
aarr�e al h asww obsoo rAw ur i c e e l Cif
1 an►s 00 eyso__ In�se.prwrwant to 8er00rt 1 ds40 of TWO 6(310 CM 15.0001
00"MT Name: _ ► w` t v.s pe cr'���d�S
Mafimg;4ddrorc _ 3�_ �°• �.S�f Y1 c�S s, U� b�!
TaMrltasa Nw1bw: — p
9EMEMMMAMOM
I cortlily that I lows personally Inspected tho sewage disposal system at this address and that tho information reported below is tru/U,accur;au
and calmplots st of tho time of Inspection. The Inspection was performed based on my trainIng and expstionco In the proper functd,m and
mointimence of on.-site sewage disposal systems. The system:
Passes
r Conditionally Passes
Needs Pwr"W Ewslustion By the Local Approving Authority
Falls
btapsotar'a sNEefafws: _:�c�:cs_..c� � "uc/ Daft:
The Svstsm Mepsotsf shall submit a copy of this Inspection report to the Approving Authority(board of Msaith or DEP)withtn Rhhty(30)days of
eomplot(ng this Inspection. If tho system Is a shared system or has a design flow of 10,000 gpd or gnaa+r,the Inspector and the system shall s+abmit the report to the appropriate r.•egionN office of the Department of Environmental Protection, Ths original should be ssmi to ghe
system owner and copies sent to the buyer, If applicable, and tho approving authority.
NOTES AND COMMENTS
revised 51/2198 PWaor11
Printed an RecwW r',w
8tlMmAM 26WAGIE Dwom sysr wi srspecT m F0 a
PAST A
CERT>IsiCATIM(owwnum/)
Owm ,C�
oabr ei bnPeatias: t 0-t- ` ` 1 q
(A PGI-IW"0LMlwtY: Chm* A, R. C, a D
A. BYBTM PASM:
�. I heve not found any informsom which Indicates that any of the fwNur*conditions
aritaria not Dvdw&sd sne indiouted below. described in 310 CMN 16.303 exist. Any fefunr
COMMIMM;
•. *1811 ONNOWf10MALLY PASM:
Ono er more system aompenents as described in the "Conddonai Pass"section need to be replaced or r
completion of the replacoment or repair,as approved by the Board of Health, III pass. repaired. The stnitem, ufwm
Inlicess yes,no,,as not determined IY.N,or NO). Describe basis of determinstion all In*tones. If "net dotsrmined`,explain why not.
The septic teslk is metal,unless the owner or operator has vidsd the system inspector with•copy of a C miflcate of
Compi)ance(attachod)Indca"0*4 the tank was instal within twenty(20)ysers prior to the dote of the iniopectiori;or
"sptk tank, whether or not motel,is crooked, rsAlr unsound. sh iwo substantial infiltration or exfiltratjion, or rank
falkrre is InwWrtent. The system will pass inapectlo the owlstino*optic tank is replaced with a complying spdc twnk all approved by the Bowel of HaaIM.
sows backup or breakout or high* c*star level obsorwrd In the distribution box Is due to broken or obstrwctsd pywlr)
or due to a broken,settled or une distribution box. The system will pass Inspection if(with approval of the Iloord of
He").
broken gips w e rsplacod
obt Is removed
dolt box is levelled or replaced
— The system rdquired pi pine more than four times a year duo to broken or obstructed pipets). The system w(a pass
Inspection If(with• vvel of the Board of Health):
ken pipets)are replaced
obstruatlon is removed
I
reviiied 9/2/96 I10hp2atIt
SUSS MACE UWAQE MPOSAL SYSTEM NSPECTIOM Food
PART A
CERTVNCATMN loenrnmeo
S O S t; c,k r1►S S f
o "( ;'"
Data eR bnPeekm. a i , h
C. Ft1RTHEIt EVALUATM iN REO11M ED BY THE MOARD OF HEALTH:
Condhlaes exist which regain tuMer evaluation by the Board of Heath in order to ermine 11 the system is faring to protect the
public:healM.sefaty and the siwironrnent.
to SYSTIMI MILL PASS UMIJS 11OARD OF HEALTH DETEIE1IWM M A WITH 310 CM 16.3031101 THAT Tiff:S'tS'1T M
IS MCFT PUWTW M11p N A M I mL*0811009 H HALL PROTECT THE pLIS�1C HEALTH AMO SAFETY AM THE EUVIIIMIM gff:
Cesspool Or privy Is vdOdn 60 feet of surface wstsr /
-- Cesspool or Privy Is Width 60 teat of a bordering we ad wettand or a salt Marsh.
21 SYSTIM WILL FAIL,UKM nIE OF HEALTH IAIrD►UMKjc vtATE11 SUppUM.IF AMyi OETEAM�THAT TFIrc STSTIE M is
FUM1C P10N1t1O Sr A MA MER THAT TECTS THE 71C
HEALTH AND SAFETY ANDTHEIWVM MMBIIT:
Thesystemhasasep+ tank and soli absorsystem(&IS)and the SAS Is wkMn 100 feet of a su►fsce rvater supply or
tributary to a suds voter supply.
_ The system,has a >c tank and"N absorption system and tM SAS IS wiMrin a Zone t of a pubiie water 4"gjO p welt.
The system has eptia tank and so11 abao►Ptlon system end pre SAS is within 60 fail of a I�,�
prirate waiter su r wMi.
The System h" saptIc tank and Soil ebsorpgon system and the SAS Is leas then t00 feet but 60 foot or mcwe from a
private water veer.untsss a well water analysis for Colitarm beeteria and vois"I organic compounds indicates that the
well to free poikrtkon from that facility and Mee proverwo of wnmoNa nitrogen ant nitrate nitrogen Is
then !P Method goad to detwmhw dbtsne• Squal le a less- .lappraxintelleen not vMtq.
3) OTHP
� I
F
i'
revised 5/2/98 P"e3otil
f
Mf UT*ACE UWAM DOWOM fti"STEM gOW411ON FORO6
PART A
C81Tf1+IClATIM 1oosUrnssgi
Dow elf linsiseen.n:
D. SIISOM ffA":
You rntart indlsass sMher"Yes"or"No" to each of the following:
I h8w)determined than one of►pore of the following faik+re conditions exist described in 310 CMR 15,303. The bads for this
dete►miriation is Identified beloln. The hoard of MUM should be cents to dots,- ne.what will be neeasuy to correct the%&wo.
Yes No
lookup of saweao into facility or syatern conrponont to an overloaded or clogged SAS or oesepoof.
Dfsohnge OF pending of effluent to the surface of ground or surface waters due to an overloaded or elogileel$A,' or
cosepooi.
Static liquid level In tea dlatOW21 boa outlet invert due to sn overloaded or de rPged SAS or cosepooi.
—. Liquid depth In ca»psol is leas than below inven or eveliabls volume Is less than 1;2 day tow.
-- Required pumping more than 4 ti a in the last year�due to cogged of obstructed pipeial.
Number of*me Pu 4od
-� Any portion of the IioN Also ►ption S",am,osaspeci o►privy is below the high greurhd►vater elevation.
-- Any plan of a css pp&or privy is within 100 feat of a surface water supply or tributary to,a surfaco water supply,
-- ,. Any portion of a $pool or privy Is within a Zone I of a public wel.
Any portion of eesspsol or privy is within 50 feet of a private water supply was.
® Any po of a sasspr)ol or privy In less-then 100 feet but greater then 50 fast from,a private water supplY vrsiP with nt�
eeoepte s water quSMY analysis. If the well has been onslysed to be acceptable, atteh:h copy of wen water ensigals for
401 bacteria,volasie organic compounds.ammonia nitrogen and nitrate nitrogen.
L 1AME SYSTEM FALS:
You mvlst indfeats ehhsr"Yoe" or'No" to each of the folowin
The following crltaria apply to ia+ae system$in ad in to the criteria above:
The system sarvoa a faality with a design of 10,000 gpd or greaten fLsrps 8ysternl end the system is s el
Malth and safety and the on a one or more of the follow front threat to public
late eorhditlons exist: ,
Yes No
the system is wM in�I�feet of a surface drinking water supply
.... _. the system Is 204)feet of a tributary to a surface drinking water supply
the systanr Is ated in a nitrogen aansitivs area(interim Wellhead Protection Area:IWPA)or a mapped Zone II of a publlc
water well
This orhm,a or Operator of such system i"upgrade the system in accordance with 310 CMR 15.304(2). Please consult the lochnt regional
*in"elf the Depastrnent fur#w Information.
reviasoad 9/:/98 rhhge4aftt
SUNSURFACE UWAOE DGIPOSAL BYSTM VSBMCTWU FORM
'ART•
CHGCKLWT
Ptegwll, 0. S° 5+
Agdt..
LAow of btnpaedan:
Check if the following hove bean done: You trust Indicate either "Yes" or "No" as to each of the foliowinq:
YN No
Pumping Information was provided by the owner,occupant,or good of health.
_ None of the system oanrponenta haw bean pumped for at loost two weeks and the system has been recNvWq iwrnsl flour
rotes during that period. Large volumes of wetter hove not bow Introduced into the rrsterrr recently or as taut of We
Inspection.
As bull plans have been obtained and examined, Note if they are not available with NIA.
The faclky or dwdllMi was inspected for signs of sewage book-up.
The system does not recolve non-sanitary or krdua Aal waste flow.
The eke was Inspectonl for signs of brookout.
Alt system compomme,excluding the loll Absorption Systern,have been located on the site.
The septic tank manhtles wars uncovered, opened,end the iinlorior of the septic tank twos Inspected for concNim of bafflies
or toes, material of conaVuetlon,dimensions,depth of liquid,depth of sludge,depth of scum.
The Was and location of the Sol Absorption System on the she has been determined blassd on:
Existing information. For example, Plan at I.O.M.
_ Determined In the field;if any of the faYure Criteria related to Part C is at Issue,approximation of distance is unacceptable)
`. 1116.30263Hbll
The facility owner lenti occupants,If d tforant from owner)wars P►ovidod with Information on the prop«meintanaurce of
SuNurfaoe Disposal Systems.
revised S/2/98
!'!ge!at 14
f '
SUINU IIrACE SEtI1fA41E DISPOSAL.SYSTEM N8p*CTNM ROM1
PAIR C
SYSTEM NhOIIfYU1T1ON
--Vtopr■ty Addraas:
Ownw: ,
Del)ec►I1nj c� 011 1 1�
MOOMMSi A.Ow COgO1410�i
D�siFK►1fow:1 t0 �.p.d.lbad►oorra.
Numhw•of bod, Ideslp►1:� Number of bedroome(actual):�
Tatar DESHM flew' w "—
Number of cement r"Idwrts-
Gwbqp S
gr+m W(yes or no):—=
Laundry(sapwow system) (yes or no):_00 If yes,separate)nspaetian required
LeuncMy syslsan MnpoeN Iyu or no)
11*mi al use lya or no):W Q �j
waft,meter reodlmgs,if a+ ebb(lost tvro year's usage(ow): �f r% Y�
Stm+p P�smp(Vol or no):dam" 'T""�"`'
UN dMe of eaewpanoy:-Qyr(2v�
Type 0 ssuNshrmer
Design flow:_, Ug 1 Based con 16.203)
sasb Of design low
*NMI)trap Pro4nt:(yes at no)_ -- -
hrdust+del WSsa Holding Tank present:IV, or no)_
Nea-simita►y waste dschsrged to the it 5 system: (yes or no),�
wear meter medings,M evspWg,
Lest daa of ooespeneyr:
Olmh(Da"40)
eat d+rtit of eoa�pa y:_
�--'- 9101�IIAl NIPOMMATION
PIlSNIL1fi IIECO1SDi enQ soyiyee o� fA �,
Sysam pumped w part of lnsptMon:(yes or no)
If yes,volume pumped.���
Reason for pumping:
TYR 0f SYSTEM
,. SpivIank/dielaSlldisUmweve o bsorption system
Sim is oeespod
_. Overflow cesspool
Privy .
Shared system(yes or no) (it yet•, attach previous Inspection records,If any)
ILA TOCNmilegy aft.Attach copy;of up to date*paragon and rmMn wmm*con""
TWO Tani: Copy of DE►App►ovd
oar«
APPIIDfOMATS Aft of aY eomperaereq, dote insagsd te4 known)and seuree of Mfaxmetion:
Sewase adlwe detected when arrlvMg at f ,sRe: (yes or no)
revisled 9,%'�:'/g8 r it6at11
SUSSLIMACE SEWAGE Ws►OIAL sysTEM mini ECTim r-omi
PART C
SYSTEM 01POPmTm fomrliearedl
'A PMY Atavism SCE —s+ t"
Dust brspeotlon: 1 cZ t i V 1 i C
OULOM SEll O:
f6ocato on trite pat)
it r
Depth lelow grad o:,L
Meftial of conatruotloa:_,apt iron-1 40 PVC _otlra lsxpain)
D'stsnte honf�Iivttts water supply won IN auction line
DiernntKer
Com m"r lc&Wh$en of joints,van", evidence of le"op,ott.I
SEfrTIC TAIMr:_L
Occoao on tdte pkem)
Dept+below ends:�
Material of construction:40ncrate,,,_nnstal,_Aboromss _Polyethylene_ettw(expain)
ff tank it;metal,Not sp` Is ape confirmed by Cerificata of Complient:o^lyes/No)
Q QC 4
sludge depth:_, ,7..��
Dist 20 from tap of siu�Qpe to bottom of outlet too or baffle:
satrrn'NNoknnas:.,,:� /l
Distemae frog+top of ecum to top of outlet to or bef0o: r �/
Distamn troni be►ttem of eceme to bsf outlet a baffte:_„[�
tow dVmornions were dstsrrnMted; c�
y..
Comnrwm:
(tyaomtrwr Wmhm for pumping.condition OfJolet and ouvot toes or beftles,
evidence of koekspe,etc.) depth of liquid IAvs{In relation to outlet invert, s t:tu tM intef{rit+,l,
u/Ci to
Deem or)site prom
Depth kelow reds:
Material 0 oontroatroteon•`oarmets�nwtal—Rilwolese y&thVI*ft r.oNntorfaxphin)
Sawn thickness:
Dartanco*am top of aawrn to top of otrlm both:
Dlstento Isom bottom of soum to bottom
Do"of bltet puntiinp: outlet two or bttfAe:
rnr Carents:
lraeommendetien far 'on
an of'nlet and outlet to"Or bef s,depth of liquid level In relation to outlet Invert, structural lea
trvldancu trf'takoge,etc.) v t.p+'ty,
revised 9/2/98
A{s 7 of!1
'111 URFACE SEWAGE IDISIMSAL SVSUM MPECTION FORM
PAINT C
SYSTttM/DWOrMATMw tesrrtbwof)
Owner: k k C-�
tee.of tgeMewK
T MHIT ON NOl �INO TANK: (Toni:must be pumped prior lo. or a time of, Inspection)
Notate on MN Nw+)
Depth Isolew ErMle:_
MoUdI l of eenmtructton:_concrete rmetel Fiber a,_Polyethylene_othor(explaln)
Divivertsions.,
CePvcb,V Iiallone
Dodtpe low-T Sal)or Odey
Alarm preswo__r
Alernn IwN:,_ Alarm in w i order:Yes Ne
DOW of prevlo��e pumping: -- —
lconftom of hviet tee,c o4 alarm and float awitchos.etc.)
OMTIIrWsION tKiX:
notate on wa plan) '^
Depth aR U*dd Iwel above outlet Invert:
Comments:
(note if level and dstribuhon is equal. ovide ce of solids qerryover evidence f lsakel@e into or out of box, etc,)
4�...L�Y � �p
�_ _L� �A Lam_V --•--�._.p
Mw C11AI I:r
tlotaar an site lion)
►umwi In wor&v wdw-.(Yes w No)
Alarms in working order(Yes or No}
Camnenu:
Owle condition of pump chamber, n d M of puntoa and appurtenonces,eto.)
revised 9;2/98 hee6of11
f -
sUMURFACE SEWAGE D1iPOSAL SYSTM IMMECTION FOAM
PART C
SYSTM NFOAMATWN(esatlbarsdl
d► 5^� S-f
Otn"n P c�
n10p1 J1rSOR�M srS�elll aAs��'
pocatu an sits plan.H possible:oxcavotion not required,location may be approxkmsted by nonantruaive methods)
If not basted,a pleb►:
Type:
leeold►G pits.number:,
looddr0 ohm*w ,number—
lose"galleries.number:__
loaotlre too has,number.length:
Ioad*tg fields,numtber,dimensions:
ova w cesspool,number•_
Aherne rWee system:
Name of Tochno ogy:,
Com marts:
(note condition of sop, signs of hydraulic Failure,level of pending, damp gall, condition,of vegetation, eta.)el
t
ul
c�sF�aols:_
notate se site plan)
Number wed"nftwrwdon:�„.,�,,�
'►epth,W of Swid to sdet invert:
spit at sonde bwer:
Ospilh of sewn lever:
Oimenrdans of oeosp"..
Msterbds of aonrtetien:
lndcetlon of Wosidwatsr:,�,�,r
Inflow ICesspoo must be pumpVinepeftiow)_��
Comm wts:
frwte condition of soli,61 of hydraulic fidkne, level of pondinp, Condition of vegetetlon,Ott.)
!locate at site ohm)
Metwiab of cat""wicdon:
Depth of Widr_ DIn+ensiDole:
Comrrtemx:
(nots c*ndhiot of sop, eipes of hyd fallurs,level of pondhp, cond ilm of vpertation, ou,)
revs:;led 9/2 f 98 rake 9 of 11
lRIISStMACE SEWAGE DISPOSAL SYSTEM NSFECTIOM FORM
PART C
SYSTEM NFOQMATIOM taaobwd!
_� togr SO 54, i01n
r
SRETCIt OF UWASM DISPOSAL SYMM:
hiclucle tics to at leaf two pennenent reference landmarks or benchmarks
kwb►al wale witW 100' (tomato when public water supply comes into house)
b `
o
revised 9/2/98 Pep 10 of II
SUBU WFACE SEWAGE DISPOSAL SYSTEM POPECTUM FORM
PART C
SYSTEMI gwwam"TWN 4eanlbaal
t9'Adrasen SU st, J
Ownw. k. ".
Dow aR;k"Ov"I ( oL ( 1 C(( l SS
MRCS now name _
Sell T14"
TvAu depth to groundwater
USGS Dow webeito vWW
ObsW%v* n Waft checked
Groamiwater depth: Shallow t Modsrste_ —Deep
SITE EKAM $lop.
Surface wow
Cheek Caller
Shafow walk
Eadmetted D*W to Groundwater bZ}feen.
Floats Indketa on the methods used to dorlarmine High Groundwater Elevation:
CWlainsd from Design dens on rscoa•d -,
fteetwed $Ito(Abuttlng property,olisavetion hole,besemont sump ate.)
Determined from local conditions
Checked with local Board of health
_Chocked FEMA Maps
Chocked pumping records
Chocked lveal axenvators,instafws
Us*d USGS Date
Describe hOw tnnru established the High Groundwater Eleva6m. (IfiM be Competed)
e
revised 9/2/98 Pw11dll
FLOW PROFILE
I TOP OF FOUNDATION RAISE COVERS TO WITHIN
6 in OF FINAL .GRADE
/ EL m 51.60 +- ONE INSPECTION RISER FOR
�b LEACHING GALLERY
2- LAYER OF 1/8-
7,1
/D BOX 1/2- STONE
�3" DROP r
FLOW LINE
10 rL-
U = 14' PRECAST ryK
48' GAS " t .; DRYWELL �}�'' 3i4--1 v4-
BAFFLE it)3+ar s., s STONE
6 in BOTTOM OF
47.60}- SOIL ABSOF,, TION
EXISTING STONE 46.53 LEACHING SYSTEM
EXISTING BASE
EXISTING 4��70 GALLERY
46.40 5.00 rt
EXISTING 1000 GALLON (END VIEW) 44.40
EXISTING SEPTIC TANK 39 It 5 rt , 12.5 ft_-- --- �
i — b> 12 rt
ESTIMATED P 29.00
SEASONAL HIGH
GROUNDWATER
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m �v O Z m C1 <� ��y y Zp O ` 1 ST JONN ST
�a� p �/� Imo Z III z
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A
. . ,,SOIL TEST- LOB "S:F DESIGN._ (ZULAT IONS .
DATE OF TEST: DECEMBER 17, 2004 -
SOIL EVALUATOR: DAVID D. COUGHANOWR. RS DESIGN FLOW: ��� s 10 GPD - 330 GPD
WITNESS REQUIREMENT WAIVED - NO VARIANCES SOUGHT
SEPTIC TANK: 330 GPD X 2 DAYS - 660 GALLONS
NO GROUNDWATER ENCOUNTERED
TEST PIT -1 PARENT MATERIAL: PROGLACIAL OUTWASH USE EXISTING 1000 GALLON SEPTIC TANK IF IN SOUND STRUCTURAL
PERC AT 78 in : 2 MIN/INCH IN C SOILS
ELEVATION - 49.40 CONDITION. IF NOT. INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED)
DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER DISTRIBUTION BOX: USE 3 OUTLET D-BOX.
(INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING
SOIL ABSORBTION SYSTEM: A 24 ft x 12.5 ft x 2 ft LEACHING GALLERY CAN LEACH
0-8 AP SANDY LOAM 10 YR 3/2 NONE FRIABLE A b o t - ( 24 x 12.5 ) - 300 s f
8-34 B LOAMY SAND 10 YR 4/4 NONE FRIABLE Asdw - ( 24 { 24 12.5 - 12.5 ) x 2 - 146 sf
Atot - 446 sf
34-72 Cl COARSE SAND 10 YR 6/4 NONE LOOSE 10% STONES Vt 0.74 x 446 - 330.04 GPD
72-144 32 MEDIUM SAND 10 YR 6/3 NONE LOOSE USE A 24 ft x 12.5 ft x 2 ft GALLERY. Vt - 330.04 GPD > 330 GPD REQUIRED
GROUNDWATER ADJUSTMENT `
EXISTING GROUNDWATER LEVEL LEACHING GALLERY-
BASED ON TOWN OF BARBSTABLE
GIS DEPARTMENT RECORDS. CONSTRUCTION DETAIL
INDICATED GW 23.00 7 DRYWELL UNIT STONE
INDEX WELL AIW-230 8'-6'x 4•-10'x 2'-9'
ZONE D \ 2 fi EFF. DEPTH
READING DATE DEC. 2004 24.0 ft
READING 25.00
ADJUSTMENT 6.0 0
ADJUSTED GW 29.0Eli
c:
NOTES
_ I M
1) GARBAGE GRINDER NOT ALLOWED WITH THIS DESIGN
2) ALL LINES TO BE SCH 40 PVC AND PITCH AT 1/8 INCH PER FOOT MINIMUM. 24 0 NOT ro
{t
SCALE
3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REQUIREMENTS
OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15)
4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES
BEFORE EXCAVATING FOR SYSTEM.
5) EXISTING LEACH PIT TO BE PUMPED, COLLAPSED. AND FILLED, OR REMOVED
6) ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON. FINES AND DUST IN PLACE
7) LINES EXITING D-BOX TO RUN LEVEL FOR 2'-0" BEFORE PITCHING DOWN SEWAGE DISPOSAL SYSTEM PLAN
8) ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION OF LOW FLOW FIXTURES -TO SERVE EXISTING DWELLING
AND APPLIANCES. AND BIANNUAL PUMPING OF THE SEPTIC TANK
9) SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. DO NOT THOMAS & SHIRLEY HOLMES
PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM.
SO SAINT JOHN STREET HYANNIS. MA
10) INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE STARTING WORK.
11) SEPTIC TANKS SHALL BE INSTALLED LEVEL AND TRUE TO GRADE ON A LEVEL ECO-TECH ENVIRONMENTAL
STABLE BASE THAT HAS BEEN MECHANICALLY COMPACTED AND ON TO WHICH
SIX INCHES OF CRUSHED STONE HAS BEEN PLACED TO MINIMIZE UNEVEN SETTLING 43 TRIANGLE CIRCLE SANDWICH MA 02563
12) SEPTIC TANK TO BE PUMPED DRY AT TIME OF SYSTEM REPAIR AND CHECKED
FOR STRUCTURAL INTEGRITY. INSTALL PVC OUTLET TEE FITTED WITH GAS BAFFLE. ETE-1888 DEC 20. 2004 2/2