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HomeMy WebLinkAbout0067 SAINT JOHN STREET - Health 67 Saint John Street Hyannis A = 251 027003 a i a ;�S Commonwealth Of Massachusetts Executive Office Of Environmental Affairs Department Of Environmental Protection TITLE 5 Official Inspection Form -Not For Voluntary Assessments Subsurface Sewage Disposal System Form Part A Certification Property Address: 67 St.John St.Hyannis Ma.02601 Owners Name: Aliete Andrade Owners Address: Date of Inspection: 11/8/2008 Name of Inspector(please print)Sean M.Jones#SI4522 Company Name: S.M.Jones Title V Septic Inspection Mailing Address: 74 Beldan Ln. Centerville Ma.02632 Telephone Number: 774-248-4850 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 the inspection.The inspection was performed based on my training and experience in the proper function and maintenance 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 X Passes Conditionally Passes Needs further evaluation by the Local Approving Authority Fails Inspectors 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. Notes and Comments: ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Page 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(cowmmD) Property Address: 67 St.John St.Hyannis Ma.02601 Owners Name: Aliete Andrade Owners Address: Date of Inspection: 11/8/2008 Inspection Summary:Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X 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:N/A 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 the 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 structurally sound,not leaking and if a Certificate of Compliance Indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or Obstructed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with Approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(S).The system will Pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(cowuquED) Property Address: 67 St.John St.Hyannis Ma.02601 Owners Name: Aliete Andrade Owners Address: Date of Inspection: 11/8/2008 C.Further Evaluation is required by the Board of Health:N/A 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 310CMR 15.303(1)(b)that the System functioning in a manner that protects the public health,safety and the environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a Surface water supplyor 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 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 and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other Failure criteria are triggered.A copy of the analysis must be attached to this form. 3.Other: r OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CON MUD) Property Address: 67 St.John St.Hyannis Ma.02601 Owners Name: Aliete Andrade Owners Address: Date of Inspection: 11/8/2008 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than 'h day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of cesspool or privy is within Zone 1 of a public well. T Any portion of cesspool or privy is within 50 feet of a private water supply well. X Any portion of cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 pp,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] X (Yes/No)The system fails.I have determined that one or more of the above 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:N/A To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd- You must indicate either"yes"or"no"to each of the following: 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 H of a public water supply well If you 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 CM 15.304.The system owner should contact the appropriate regional office of the Department. OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 67 St.John St.Hyannis Ma.02601 Owners Name: Aliete Andrade Owners Address: Date of Inspection: 11/8/2008 Check if the following have been done.You must indicate"yes"or"no"as to each of the following_ Yes No X Pumping information was provided by the owner,occupant,or Board of Health X_ Were any of system components pumped out in the previous two weeks? X_ Has the system received normal flows in the previous two week period? X _Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out? X_ _ Were all system components,excluding SAS,located on site? _X_ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tee,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No X _ Existing information.For example,a plan at the Board of Health. _X_ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance Is unacceptable)[310 CMR 15.302(3)(b)] OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 67 St.John St.Hyannis Ma.02601 Owners Name: Aliete Andrade Owners Address: Date of Inspection: 11/8/2008 FLOW CONDITIONS RESIDENTIAL 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): 353 gpd provided Number of current residents: 0 Does residence have a garbage grinder(yes or no): no Is laundry on a separate sewage system(yes or no): no [if yes separate report required] Laundry system inspected(yes or no): n/a Seasonal use:(yes or no)_no Water meter readings,if available(last 2 years usage(gpd): Sump pump(yes or no): no Last date of occupancy/use: COMMERCIAL/INDUSTRIAL:N/A Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping records Source of information: Was system pumped as part of the inspection(yes or no): no If yes,volume pumped: gallons--How was this quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _x_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 the system owner) Tight tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: no Were sewerage odors detected when arriving at the site(yes or no): No OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 67 St.John St.Hyannis Ma.02601 Owners Name: Aliete Andrade Owners Address: Date of Inspection: 11/8/2008 BUILDING SEWER(locate on site plan) Depth below grade: 2.5` Materials of construction: cast iron 40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): Joints were in Food condition,no sign of leakage. SEPTIC TANK:_X (locate on site plan) Depth below grade:_1.5` Material of construction:_X_concrete metal fiberglass_polyethylene other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: 8`6"X5`6"X4`10"= 1000 Gallons Sludge depth: 10" Distance from top of sludge to bottom of outlet tee or baffle: 3` Scum thickness: 4" Distance from top of scum to top of outlet tee or baffle:_4" Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions determined:Opened covers and took measurements Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels As related to outlet invert,evidence of leakage,etc.): Tank needs to be cleaned soon and again every 2years to maintain systems useful lifeMan.Outlet tee intact,water level was at bottom of outlet invert.Inlet cover is under deck. GREASE TRAP: N/A (locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels As related to outlet invert,evidence of leakage,etc.): OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 67 St.John St.Hyannis Ma.02601 Owners Name: Aliete Andrade Owners Address: Date of Inspection: 11/8/2008 TIGHT or HOLDING TANK: N/A (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm present(yes or no): Alarm level:-- Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX_X_(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 0" 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.): D-box was level and in good condition.No solids carryover.Water level at bottom of outlet invert. PUMP.CHAMBER: N/A (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): I�i OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 67 St.John St.Hyannis Ma.02601 Owners Name: Aliete Andrade Owners Address: Date of Inspection: 11/8/2008 SOIL ABSORPTION SYSTEM(SAS):_X (locate on site plan,excavation not required) If SAS not located explain why: Type Leaching pits.Number: _X_Leaching chambers,number:_2_ Leaching galleries,number: Leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternitave system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Soil was dry and not saturated.No sign of past hydraulic failure. CESSPOOLS: N/A (cesspools 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 or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: N/A (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.): OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 67 St.John St.Hyannis Ma.02601 Owners Name: Aliete Andrade Owners Address: Date of Inspection: 11/8/2008 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 12+_feet Please indicate(check)methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: 1/29/2004 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: Design plan on file at Town of Barnstable Board oh Health dated 1'29'2004 shows no groundwater encountered @ 144". I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 67 St.John St.Hyannis Ma.02601 Owners Name: Aliete Andrade Owners Address: Date of Inspection: 11/8/2008 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent referencelandmarks or Benchmarks.Locate all wells within 100 feet.Locate where water supply enters the building rear of home a b deck TANK A-1=29' B-1=2T 0 1 D-BOX 2 A-2=29'6" B-2-UV C7 o 3 S.A.S. A-3=36' 8,3=44V _TOWN OF BAARNSTABLE Ec, LOCATION V �T ����-3" --�T� e SEWAGE #o2oH•� �c �ii __ VILLAGE ASSESSOR'S MAP & LOT �9 'dal-ua3 IIrSTALLER'S NAME&PHONE NO.,e2ke SEPTIC TANK CAPACITY }LEACHING FACILITY: (h'PeD��2J —c am' C11-9 -4c-4V (siae),2�,<' �3 X NO. OF BEDROOMS ` ' •BUILDER OR OWNERS PERMITDATE: 36LO COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by Z 4 l t1 Y No. Fee THE COMMONWEALTH OF MASSACHUSETTSr Entered in computer: 1_ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for 3h6poeal *p5tem Cott!6truction Permit Application for a Permit to Construct( . )Repair( )Upgrade( )Abandon( ) O Complete System O Individual Components Location Address or Lot No. s'lr-- Owner's Name,AddressZel.No. Assessor's Map/Parcel yA/Yov) �' � /v Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. l Type of Building: Dwelling No.of Bedrooms_ Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 d gallons per day. Calculated daily flow 5 zT 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 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 h ed board of Si Date 3d Application Approved Date a O Application Disapproved for the following reasons Permit No. 4 --OLlee Date Issued No. O�J�-� '—�)y Fee � .. �i3 V ;' Entered in computer THE COMMONWEALTH OF MASSACHUSETTSr Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS ZIppYication for Migozal *potent Con!5truction Permit I Application for a Permit to Construct( . )Repair( )Upgrade( )Abandon( ) O Complete System El Individual Components Location Address or Lot No. S% Owner's Name,Address7andel.No. Assessor's Map/Parcel / yA/Y�" S 4 Q '5 Installer's Name,Address;and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 CS gallons per day. Calculated daily flow 3 S -2 9 e 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 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 beerrissued by ' Board of 1jealth. Si ned Date Application Approved bq Date a_ O Application Disapproved for the following reasons T Permit No. ® —0L/<P Date Issued 1-Y 6/0 -------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate -of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded Abandoned( )by 149 at % Sc�.•�� S�T, has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 2,00L1`Qq� dated 11.0 16 LI Installer 2 e%` Designer A2 2 F '+-' 21`2-1 L 2 The issuance of s permit shall not be construed as a guarantee that the yst w ll4functiob as designed. Date ��q n y Inspector 1AA M� 1 t � . . No. `'f —a Fee Ii THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLES MASSACHUSETTS Mizpooar *pgtem Con5truction Permit Permission is hereby granted to Construct( )Repair( )Upgrade(_ )Abandon System located at G Y7 J As..S ��"� ""o, 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:Construc "on mus be completed within three years of the date of this pe, Date: G Approved bye-, house Lo 7 2 /2-7 LOCATION SEWAGE PERMIT NO. YI. LLAGE sY A1fs m INS LER'S NAME i ADDRESS S U 11 D E R OR OWNER t DATE PERMIT ISSUED DATE COMPLIANCE ISSUED V" ti No....��5-.... :. Z :..� ' FE$� `..-........... '~ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appluttiion for Dispaoul Works Tonstrwtiun Virmit Application is hereby made for a Permit to/Construct ( or Repair ( ) an Individual Sewage Disposal. System at: .........................................................i7e� J Location-Address /fir /f/J-fJ ---.or Lot No. ��z,' ) Address (:l I Installer Address' S feet Type of Building Size Lot._..t.Z©fie -p-I Tc c g q( ) .-� Dwelling—No. of Bedrooms......................................:....Expansion Attic ( ) Garbage Grander Other—Type of Building ......_. No. of a+ YP g ---•--•--•-----•--•- persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures Design Flow............ .......................gallons per person per day. Total daily flow.......... 3�'�._.._.........gallons. Septic Tank—Liquid ca.pacity4'? .gallons Length.8:.�. Width:4.�.�.. Diameter:............... De &4.:�r� xDisposal Trench—No..................... Width,,;....---_-_._-_____ Total Length.................... Total leaching area................ ...sq. ft. 3 Seepage Pit No..!��.a.... Diameter.!a_A�f Depth belpw mlet..Ca.:& Total leaching area._•'_ �:!�Nq. ft. Z Other Distribution box ( Dosing tank ( ) '-",, `'' Percolation Test Results Performed b .__.._...�: ......J .? Ate, c w !9a 3 a Y r # j.............. Date--_. A. `"8 Test Pit No. 1__lam•_ ._.minutes per inch Depth of Test Pit....�.'Ll ...... Depth to ground water...t!<?N�' ._ •....:.............................:.......... . O tTest Pit No. 2...............minutes per inch,-Depth of Test Pit._.....;2._..._..... Depth to ground water........................ ....--- ........................................................ Description of Soil..._Cac' Z•.`�Y..�;. ca«rvti: ••5 t�6-rJ--�a i- - t`}' --`l 2'�� G rx--A?'S E,S`{`-`� ...._. x ---••------------ --- -----•---•---•---------•-----•------------•---•--••------•-•----......---------•----••----•-------•-••-=-------•----•--••---.....................1�,(�:a. U Nature of Repairs or Alterations—Answer when applicable'.................................................................................... { ` . -•---------•.................................................................••-----•-••---••--•--------.........----•-•----••------....__..._._..----•--•--._.... .. Agreement: '' The undersigned agrees to install`the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITU 5 of the State Sanitary Code— The undersigned further agr s n t ty lacc the system in operation until a Certificate of Compliance has been issued by the board of health. �^^� ` ..................................................... ........................ -•-- Application Approved B ------_-••- ...... J3te�;, PP PP Y= ----•-•.................... -• .... ' ...... Date Application Disapproved f or,the following reasons:..................-•-•-•--•-•--...:-----.._............-----_----•-------..:._._........_ .....-------_- �--�._ --•-•-•.............•--.....................................••-- •:\---•--....................._.......--•- ...........------......_..-----•-----••.... ---•-•--... . ••---••---- Date - PermitNo............................................. ....._._.. Issued-.---.....`.....:...--------------.................._. Dalep G� 1 �1 ou i A-) 11 �— THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �? ...OF.. o Appltratiun for Disposal Works Tonstrudiun Vrrmft ' Application is hereby made for a Permit to Construct (*�. or Repair ( ) an Individual Sewage Disposal System it: ....... a ::.... S T: J c�;-,,..s S T c3z L i A4 #,j M , S....... ........................................_... ---• -•---•----------......----•---�-------------- - ------------- --.--- Location-Address or Lot No ..................................................... Owner .. .............................................. Ad ress dr I Z�Ooo q Installer - • Type of Building Size Address ...... S . feet Dwelling—No. of Bedrooms__.. ! .4........................Expansion Attic ( ) Garbage Grinder ( ) Other—Type e of Building 4 ............... No. of persons....................._...._. Showers ( ) Cafeteria ( ) a YP g •----•----�- — QOther fixtures . ----------------------W Design Flow...........1�1�......-------------."gallons per person per day. Total daily flow........... ..............gallons. WSeptic Tank—Liquid capacity!��n?t.Tgallons LengthA5.:__"�. Width.`a;:.'S. Diameter................ Depth-.-�F;rF—_ xDisposal Trench—No. .................... Width.................... Total Length.................... Total leaching area:...................sq. ft. 3 Seepage Pit No..5?!!�!a..... Diameter.!e.9! . Depth below inlet.<a..`-c? Total leaching area-�:5s7:!5;?sq, ft. Z Other Distribution box (, Dosing tank ( ) aPercolation Test Results Performed by.........FEZ..��°!!.'� -Test Pit No. 1.. ... --minutes per inch Depth of Test Pit.....1.:Z-'...... Depth to ground water.. f� Test Pit No. 2................minutes per inch Depth of Test Pit.......:............ Depth to ground a water......................_. .. __O Description of Soil.... .---------------------------------------•----•-•-------••--------•-------•......•-• --...•_•-•...•-••••..........--•-•-•................----•-•...-•--•••................ ,1sa VNature of Repairs or Alterations—Answer when applicable....................:....................................................................:..... ¢ ........................................•---------••-----.....-•---....................------.....--- ...............=................................................................................... Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of.TITLZ 5 of the State Sanitary Code-The undersigned further agrees—not to place the system in operation uiltil a Certificate of Com liance has been issued bythe board of health. We )ne ... ....Idx ............................................. APPlication.Approved By...................................... :...... . lD�t3'S Date Application Disapproved for the following reasons:................................................................................................................ ......................•----•-•---------..............--------•----------------------•------•-----------....--=-----•-----.........-•----.......--------......------........•-•--...••---.....-•--•--•--- Date PermitNo.......................................................... Issued..................................................... l -./U IAI� C.1vlo<NFr2 /ytJ t A?L Hate ` ;�• w7 -- 1J`t l Ahoy ,7 i9,t,c.Afal? - I. Nam. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF...:......... ............. CIrrtif fritty Of Tour rlittnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by lnnt� x�. ._......1...... ----- -----------------•-----•-.........----........-----...................-- at. -` ' �;�► -----•------• „y .. .. . ..... has been installed in accordance with the provisions of Tl i' �5 of jib State Sanitaryd as dgscribed in the application for Disposal Works Construction Permit No.............. ......... .._-...._... dated_....._.. t_L�l ...'.................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO STRUED AS GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................... ` .......................,........... Inspector-------- ........ sb THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Y, ..........................................OF.... ............................................................................ iVo................... .-.... ..... Flea ... .......... Disposal Wrks 05Onstrurtiun 1rrutit Permissionis hereby granted.......................................................................................................:..:................................. to Constru t ( ) or air .fin Individual Se Disp System atNo. .... ............................ .. = -=....--Y1.....-•----....... .:.. -- n'`°..---•-•--..._ ......... .. ---........ treet as shown on the application for Disposal Works Construction, Permit No -Dated....� ..1... z�r............ _ . =•�•.B = oa fUHealth 3 ............. DATE...-- ---- ............................................. ca N (AA5 rz-O TAS 7r .yy 362.4541 926 main street yarmouth mass. 02675 dOW cape effifteeriag civil engineers&land surveyors structural design Arne H.Ojala P.E.,R.L.S. Richard R.Fairbank P.E. land court surveys site planning sewage system September 4, 1985 designs Barnstable Board of Health inspections Barnstable Town Hall South Street Hyannis;, MA 02601 permits This is to certify that on September 3, 1985, Down Cape Engingeering inspected the construction of the sewage systems for lots 5,6, & 7 on St. John Street and that they are installed in accordance wiht our plans # 84-.427 dated March 19, 1985. Sincerely, Arne . :0 a P.E. , .L RDO/kmk cc: Steve Seymour _TOWN OF BARNSTABLE Ec, LOCATION SEWAGE ## j ....VILLAGE 1` sew r ASSESSOR'S MAP & LOT II/-0�17-oa3 INSTALLER'S NAME&PHONE NO.I-Pe.0 AY t sT SEPTIC TANK CAPAC`ITy I �LEACH LEACHING FA�ILIY: ((type pe)aj (size)o2.�`-Ca 13 X a 1 NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: a .0` if COMPLIANCE DATE: D Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Wate r Supply Well and L P Y Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Edge of Wedand and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by Feet Z 3' P,D �3 �G V -L.00AION7 SEWAGE PERMIT NO. *mil ate- - � 40 •V I LLAc E Gllt-,,A AJ INSTALLER'S NAME i ADDRESS BUILDERR OR OWNER 2 / A0 ' IQ DATE PERMIT ISSUED 4 _3c) P '9_5 DATE COMPLIANCE ISSUED _� ' � //-�'� /� � VY V� k. `� \� '(�f ® �� fJ . -___ J SECTION - SEWAGE-; . -SEPTIC TANK - - "D"BOX - -LEACH �! TOP OF FDN 1 - (MSL)i► "2.1 OF IISTO 1/2" WASHED STONE 1 HAD, S7 aDLv l 1 \ Z_2_ 44- Y .v • IN OUT:. ov IN OUT. - I.N. g 3_Z 4_7-:qs SEPTIC TANK 41 Za e I TF ELEV. ELEV. ELEV. ELEV.- ELEV. ELEV. If O 1 WASHED STONE j T=- / 1 3 TEST. HOLE LOG ..,TEST,BY -S L.L;>ti TEST DATE WITNESS € BEDROOM HOUSE DESIGN T.H. H. # 1 T.H.-# �- ELEV: i ELEV.4 NO d.Z DISPOSER DISPOSER PERC RATE Z- MINAN. �j 1 FLOW RATE 33ta(GAL./DAY) 330 c �5 SEPTIC TANK REO'D SEPTIC TANK SIZE ii c a LEACH'TACI LITY J \ t 1 'lZ ii n i 43.Z SIDE.WALL "tiT�'a�c��=��sas 2..> 4'l I .z 1 1 BOTTOM .r/�! - 'rs.S ( ) "��d S G/D. 4-o TOTAL _ Il ' USE: o'`'� LEACHING. 144 � '3�•Z � �� L' WATER ENCOUNTERED F=r=. A /O NOTES: (UNLESS OTHERWISE NOTED) . 1. 2-MUNICIPALWATER,CIPAL KEN FROM -------AVAILABLE MAP OF Masfq� 3.PIPE PITCH:w"PER FOOT �0 ARNE yG� ARNE H. N I A.DESIGN LOADING FOR ALL PRE-CAST UNITS:AASHO• -44 Fj f^ 5.MIN.GROUND COVER OVERALL SEWAGE FACILITIES: (1) FT. c H CD, O.IAV► CIVIL, H 6.PIPE JOINTS SHALL BE MADE WATER TIGHT (iZ6348 OJALA 7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. o No.30792 SITE PLAN STATE ENVIRONMENTAL CODE TITLE 5 o'f�e "PECISTERt�O � .O� ��01 LAMS SJ� FS E l \ � LOCUS: ST . ��+=��l ST:e=-i HYi9�ti�s REG.PROFES AL NGINEER ((/ REF: d�Wn CQp@ P.IIg�IIP+P.I�IIg PREPARED FOR: CIVIL ENGINEERS _---__------ BOARD OF HEALTH LAND SURVEYORS REG.LAND SURVEYOR "� i, CONTOURS (EXISTING)•----......__ �o..Z_y�r.�3" 0� �i/1$1<.,' SCALE �Z� '3 \� e (PROPOSED)—O-0-O—O— APPROVED DATE MA I Y �.YA DATE ASSESSORS MAP : Z� NOTES: �s g ePoer ,C ° d " TEST NGLE LOGS Re 1 oMIL f I�c HY w _ q< e PARCEL : 02-'7 003 1) THE INSTALLATION MUST BE IN SUBSTANTIAL COMPLIANCE WITH G�7E. THIS PLAN, 1995 MASSACHUSETTS TITLE V & TOWN OF & x s SOIL L EVALUATOR :OR :,/ I (ir �, FLOOD ZONE �ON HZ��zo �j BOARD OF HEALTH REGULATIONS. WITNESS : N o T 1f Coy l R.- � T-- �{�e-RI`3 T1q` E y r p�U REFERENCE : L �j�js DATE : JfT- JU�a Il. 2) THE INSTALLER SHALL VERIFY THE LOCATION OF UTILITIES, PERCOLATION RA1TE: SEWER INVERTS AND SEPTIC COMPONENTS PRIOR TO A-5,5 S (, �i'1 (L� U 7`'P INSTALLATION. oo p Ma r�Sw p WAINO �tiNS ^ '� TH- 1 . 6L 51.5 TH-2 3) THIS PLAN SHALL BE USED FOR SEPTIC SYSTEM INSTALLATION p ` jL j ' o�� s 0 --a ONLY, AND SHALL NOT BE USED FOR PROPERTY LINE n L�U(AM\r DV�3I DETERMINATION. 'Y�,.�w ni• � r Ynn•o �Or) h, l'"� J r—K D 4) ALL PIPING TO BE 4" SCHEDULE 40 @ 1/8 "/ FOOT. (UNLESS MAIN S r ° �ljl6 C �� J E2 `� ��Y� /� SPECIFIED OTHERWISE) S1 v N LOCATION MA KN•T-S� yO (��'s7 5) THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A PIED(vvi GARBAGE DISPOSAL. Sp(f�D 6) SEPTIC TANKS AND DISTRIBUTION BOXES (WHEN INSTALLED) MUST BE PLACED ON A MECHANICALLY COMPACTED BASE OR ON A BASE OF 6"OF CRUSHED STONE. E> Pt VV GEnc w r (/M -r � i3� P PEJ) cRuShllF_D � No �w oPfc�!/E� � � TL6 izc / Wo--,�yownl__f'9►_t/�%>✓ ln/St.(,5 w�/ j _/S0 or- Ida wEn rJras.- W/r1 /so' oF -�/zaf�s� t64c*l� SEPTIC SYSTEM DESIGN _ c, (a)/�lo ✓ I AXLES.. 1=�oN� I ►fL� V 0►2- -rvw+J Ot= FLOW ESTIMATE s) 22 51xS /00 BEDROOMS AT 110 GAL/DAY/BEDROOM -�J� GAL/DAY _- 5�xo SEPTIC ?ANK 22' 32OGAL/DAY x 2 DAYS - �960GAL USE ) 000 GALLON SEPT I C TANK - lz�y/S77 N� - f L�r W i S dU G S�PT-1<, r3� ✓ S01 AB�>ORP►ION SYSTEM vN06eS r7-,-_,C>TA 1 e \ 25' _ SIDE AREA 2- 4- 5) Z- X 0, 7 k-( _ BOTTOM; AREA. Z'�_ ? 33o G P b rer(' N -r-l�� I a SEPT I C SYSTEM SECT I ON 0ss u o T�IZrrv4 cevE1?s Wfj�� n a, 67\- 5ar') ( II --�- 1.. Co' �-t ►Sln G fu c. q •MCI � I 3b r EG, g, ro I I / EXl S7ti !n s I a A I / 23 2''-3 "�0✓6 Ngsiv-_ ao� GAL -BOX k,63 u >� I 937 f SEPTIC TANK11 'I le of 765T NOt E E L 10 ?" S7, _ Fo1-w SITE AND SEWAGE PLAN �N s D R End LOCATION : (,( 5F � O AIs OF sEY R ll(w*nl Nl�2 EVEN `yNS�����R,. PREPARED FOR : g UMB '^ NI R�A '1 � ra _ a ✓�� "�� I �� FSS'ooQ SCALE :l`,-� DARREN M. MEYER R.S. , U t I! su�v 6 43 VINE STREET DATE : 2 a DUXBURY, MA 02332 z I -G t2. /9SaG_ DATE HEALTH AGENT (781) 585-0293