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Home My WebLink About0032 SAINT JOSEPH STREET - Health 32 ST. JOSEPH STREET, HYANNIS A=291221 y TOWN OF BARNSTABLE LOCATION 73DL b� �o-� ►/�(n ST SEWAGE # VILLAGE �(,e, fc,�% S ASSESSOR'S MAP & LOT,? / �,� INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY T r LEACHING FACILITY:(type) P\q-e P�TS (S1Ze) NO. OF BEDROOMS PRIVATE WELL OR UBLIC WA GG BUILDER OR OWNER 0 �� 5 DATE PERMIT ISSUED: 2, � ,DATE COMPLIANCE ISSUED: 'ARIANCE GRANTED: Yes No a 4 Nl � K e, o Tp � "Y f FEic THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliration for Di plagal Works Tnnstxnrtinn ramit Application is hereby made for a Permit to Construct ( ) or Repair �K) an Individual Sewage Disposal System at: ................ ..... ............. k e l Location-Address or Lot No. ................ ..-----D.=..S --if 5.----•---....--------.. ..........�` `!`� ........:......_ Owner ........................................ .. •-•--------------.----....... Installer ..-^--• Address d Type of Building Size Lot............................Sq. feet U Dwellin No. of Bedrooms............................................Ex ansion Attic g— p ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures -------------------------------------------------------------------------------------------------•---------------------------...--------------------- W Design Flow..........S..157......................gallons per person per day. Total daily flow------ 3_C?........................gallons. WSeptic Tank—Liquid'capacity........___.gallons Length................ Width................ Diameter__.__________.._ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.___...I------------ Diameter....__V D....... Depth below inlet.....(CF.......... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of.Test Pit...:................ Depth to ground water........................ ----------------------------------- •------------------------------------ --------------- -............ .......................................................... 0 Description of Soil.....................................................................................................-•----------------•-------------------------------•--------------- W V .---------------------------------------•--•----------------------------------------------......----------------------------•------------•--•---------.................................................. W x -------•----•----------------------------------------------------------•-------------------•-------------------------.._....------. ---------------•------------------------------------------••------. U Nature of Re airs or Alterations—Answer when applicable______) _ �____or �?��.__NP�5_1______v 1-.! L -- •... -- --- ------...��c�-----7 �---�-Y-r. - a`.S�c�s ...............L ��.__--�----------------------------•-•-----.-. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the oard of health. Signed ---- --- ----- ........... ----- ------ -- .--......------ -----7?-"a_.�.t..(...-- -- pDate Application Approved BY ........... �/` - ......: . ............. ;7`-f .-- Date Application Disapproved for the following reasons- ------- ---- -- -------------------------------------------------------------------------------------- ------------------------ .......................---------- ---------------- ------------------------------------------------ -------------------------------- --------- -- ----- ---------- ----------------- -- - .... ------... Date Permit No. / '- - Issued ....... •y. ? 1 -------------- Date No.. .. Fss...3Q:... + THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH F TOWN OF BARNSTABLE Appiira#ion for Dispas ai Works Tnnitrnrtiun runfit Application is hereby made for a Permit to Construct ( ) or Repair (X') an Individual Sewage Disposal System at: -� -------------- _ ...... °P� -s` ............. .................. '� K K..r ................................... 1 Location-Address or Lot No. .................Y:-_PY a........ t.c....................... ----------• ._.c� .................................................... Owner P p n Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.....3..................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons...........................!,Showers ( ) — Cafeteria ( ) Otherfixtures -------------•------------------------------------------------------ W Design Flow......_...'.S.5......................gallons per person per day. Total daily flow.-.... .......................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width....... ------ Diameter--._--__•__:--_ Depth................ x Disposal Trench—No..................... Width.................... Total Length.........:......... Total leaching area....................sq. ft. Seepage Pit No._-____I------------ Diameter____--�.U...._.. Depth below inlet_....�f.......... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) \1 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 Description of Soil...........................................................................................................................................-•............................. x w U Nature of Repairs or Alterations C—Answer when applicable_____01 _+�J!� ____n W�...... ...6'?! .�... �.._...�. .........__. ..................................( 5......T_Y� � s ........f J ......................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the koard of health. Signed .... . .....\ ��. .............................`7-�- .C -- ... /J Dare Application Approved By --- ------ .. .. '-'. /... Da[e Application Disapproved for the following reasons: ................. ................. .............................................................................................. ....... ..............0 / I�j�l �w�' ..............----------..................------------.-------.---------------..,.----------......., Dare T !/.Y ,—//—If7L ........................................ PermitNo. .... .................................................... Issued --------........�.............---. .-��-----------.... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Cexttftctt#.e of CIJoxnlalianee THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by .... G- �--c�r"- 7 "_(77\3..C----------------------------------------------------------------------------...........................................---- _ Installer _ at ................................... ........................... 3..c�-.... s-------..-------v-vY S .:..... 5 c has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ... .-r .. -- dated ..:. ...G'"-.� ... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE �... ........................f-----`-------------------------- ---- -_---------- Inspector ....------ .. .... ..------ f � I THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH C'� •� TOWN OF BARNSTABLE �� No._1............... .. FEE........................ �i��n��ti �rk� �nn�#rUan rrnti� , Permission is hereby granted............... •---------------•--••........-----...----•---............---...... to Construct ( ) or Repair (-A-c) an Individual Sewage Disposal System at No------------------- - -ST.d..__ taY:.4 y .......:5.�._.._.. C l ry --------------------------------- Street as shown on the application for Disposal Works Construction Permit _�5sated........ --.--.q.... --------------- :�� .--''.............................................. !/............................. Board of Health DATE........ ----/- FORM 36508 M088S 6 WARREN,INC..PUBLISHERS r i Commonwealth of. Massachusetts Executive Office of Environmental Affairs E:r- TrudED Department of gg& Environmental Protection T. William F.`weld ABLE Governor . i y Coxe 3ecretnry,ECEA David B. Struhs Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address:r�c �'\ .1 L,c�c'�� 1�` Address of Owner: �,� Date of Inspection: (D•- -��'-�—� (If different) Name of InspectorrY�,�(� t• c�U�� Company Name, Address and' elephone Number: CERTIFICATION STATEMENT / I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: V Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Sign atsue� —� C%L j Date: &_40 4, The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the s�'stem is a shared system or has a design flow of 10,000 gpd or greater, the inspector and.the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should pe sen tL- ME, system owner and copies sem to the buyer, if applicable and the approving au;hority. INSPECTION SUMMARY: Check A, B, C, or D: A) ,SYSTEM PASSES: C I have no►;found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B) SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes, no, or not determined(Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not) The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent, The system will pass inspection if the existing septic tank.is replaced with a conforming septic tank as approved by the Board of Health. (revised 8/15/95) 1 One Winter Street • Boston,Massachusetts 02108 a FAX(617)556-1049 a Telephone(617)292-5500 `*Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: ' c,)- ST t \S O Iv�-\ Owner: Date of Inspection: B) SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced _ The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed 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 the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: -.. t. _ 1he wsiem ha,, a Septic tank anu Soli absorption System anU IS wilnut iOG fcei iu a 50 J tta�c 'Wu ci �upN t or trlbutar) i0 d surface water supply. _ The system ha, a Septic tanl, and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. _ The systerrt itas a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 pp► . DI SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. f.f Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. 2 (revised 8/15/55) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: .3�� ✓t r Q��e� - ��il Owner: ` -vk-l 1� Date of Inspection: '=f D] SYSTEM,, FAILS (continued): /y Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. lLiquid depth in cesspool is less than 6" below invert or available volume is less than 112 day flow. 1Y Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped AZ Any:portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. 2 Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Ly1 Any portion of a cesspool or privy is within a Zone I of a public well. L.Y Any portion of a cesspool or privy is within 50 feet of a private water supply well. lY Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from.a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: LL The design flow of system is 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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 su piy well, P . The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00, Please consult the local regional office of the Department for further information. .y • (revised 6/15/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property dress:"�- ��( ' , D•'c.P " �� Owner: Ue Stiklri5 Date of Inspection: Check if the following have been done: Opump.ing information was requested of the owner, occupant, and Board of Health. one;of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. ., As built plans have been obtained and examined. Note if they are not available with N/A. 4/The facility or dwelling was inspected for signs of sewage back-up. .,`(he system does not receive non-sanitary or industrial waste flow _,-(he site was inspected for signs of breakout. All system components, excluding the Soil Absorption System, have been located on the site. G'The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. C The size and location of the Soil Absorption System on the site has been determined based on existing information or a proximated by nun-intrusive methods. The facilit) occupants, if difie_- - from ovmer; were provided with information on the proper ro maintenance of Surface Disposal System. p p Sub (revised 8/15/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION cz Property Address: L t U Owner: Sit tti. 1 Date of Inspection: FLOW CONDITIONS RESIDENTIAL- Design Design flo gallons Number of bedrooms: '3 Number of current residents: o�- Garbage grinder (yes or no): Laundry connected to system (yes or noY Y Seasonal use (yes or no):/V f Water meter readings, if available: �/t4- Last date of occupancy: ��'t't COMMERCIAUINDUSTRIAL Type of establishment: Design flow:_ allons/day 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)_ Neater meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information l System pumped as pan of inspection: (yes or no)_/\/ If yes, volume pLimnrd. gallons Reason for pumping: TYPE SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Other(explain) APPROXIMATE AGE.of all components, date installed (if known) and source of information: Sewage odors detected when arriving at the site: (yes or no) (revised 8/15/95) 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: TO ��.c,�� J', 1 Y r Owner: D-e t ti►t c Date of Inspection: /4W SEPTIC TANK: .V (locate on site plan) dJl Depth below gtade:� Material of construction: _concrete _,metal _FRP_other(explain) Dimensions: X' Sludge depth: 311 Distance from top of sludge to bottom of outlet tee or'baffle: y+ Scum thickness:-_ 7 Distance from top of scum to top of outlet tee or baffle: /�/� Distance from bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation:for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) Q1C7d`JQ '5 .,a.Q__ GREASE TRAP:9 (locate on site plan) Depth belo", grade: Material of construction: _concrete _metal _FRP other(explain) Dimensions: Scum thickness: Distance from top,of scum to top of outlet tee or baffle: Distance from bottom ni Irtim to hntinm o! outlet tee o, hatlte• Comments: (recommendation,for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (revised 81:51W 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 57,jd:5 .e-k Sl i � Owner. Date of Inspection: TIGHT OR HOLDING TANK:—t/ (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: (locate on site plan) Depth of liquid level'above outlet invert: 1Vy2yu�L� Comments: mote n ievei ano distribur,w: > eyua:, eti.uence of sulid: ca;r)u,er, evidence of leakage into or out of box, etc.) PUMP CHAMBER:,[ (locate on site plan) Pumps in working order:(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 8/15/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 5 vZ Jj '� 0 5pk `57 Owner: D✓ - S toxti7'13 Date of Inspection: SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number:_`" leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) CESSPOOLS: (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 ground+ate.-. inflow (cesspool must be pumped as part of inspection) 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.) (revised 8/15/95) B SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' U J DEPTH TO GROUNDWATER Depth to groundwater: / feet method of determination or approximation: d YTa w� U Q 1 ,r S U ✓— fJj (revised 8/15/95) 9