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Home My WebLink About0041 SAINT JOSEPH STREET - Health 41.ST. JOSEPHS ST HYANNIS ,. �, � tiF►+ q + >fRai3 A = 291 215 4 i J d 1 i I ° 1-7 TOWN OF t�RNST�.BLE LOCATION JGy t .r SEWAGE # VII AGE � - ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY _�`� LEACHING FACILITY: (type) 0 (size) NO. OF BEDROOMS �S _.:.,,BUILDER OR OWNER ,. G PERM. rrDATE: 6 OMPLIANCE DATE: `� 6 Separation Distance Bet/lehing Maximum Adjusted Groule e Bottom of Leaching Facility Feet PrivaWWater Supply Wng Facility (If any wells exist on site or within 200 ing facility) Feet Edge of Wetland and Lelity(If any wetlands exist within 300 feet of leaty) Feet Furnished by j c w y -Q 5 r 4 '4 4', _ TOWN OF BARNSTABLE LOCATION C 57 V6 c� lY `5' 3 l SEWAGE # VILLAGE i ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. 1`0� 5 6 ��9 SEPTIC TANK CAPACITY ,�� G 93 LEACHING FACILITY:(type) 16 (size) NO. OF BEDROOMS PRIVATE WELL OR'P.UBLIC WATER. BUILDER OR OWNER ��- DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: a M4 VARIANCE GRANTED: Yes No ,�` --1 ' / �;� ^ � � y �- �� p�v 1 b �. d� — �.� .4.a� • (�M1 .� `r� - ., No. `0�'�1 -� Ov t Fee $50 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for ]Di9;pogar *pgtem Con6truction Permit 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. 41 Sir J�,osgphs St, Hyannis Cape Erma Trust 31 Wernick Properties Assessor s Map arce '-1 S Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service Craig R Short P O Box 1089, Centerville P O box 1044, S Dennis , Type of Building: Dwelling No.of Bedrooms -21 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building QAS. No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 _gallons per day. Calculated daily flow 3 gallons. Plan Date . alal Number of sheets Revision Date Title Size of Septic Tank �MkY � C Gl . Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Title-5 leach system to the plans of Craig R Short 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 EnvironmenA Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by V10 of Health. Signed � ✓�- / Date 17— J Application Approved by G _ C Date Application Disapproved for the following reasons Permit No. Date Issued �. tt 'a r�'y c�"�1.9, r.�d :9'�nc"�''�'�':.a. '�' i i..t•+,_'a ��"u� r,M3 7.:�"s'1,tj �v FAr, i+.y:� t i 5''"" � �'z,..� �S i ti- ' ....& JL•: .!s:,. :. .. - are ' TOWN OF ARNSTABLE LOCATION Z J p: SEWAGE # vE LLAG ; ASSESSOR'S MAP & LOT- .' INSTALLER'S'TV &z PHONE NO 6 SEPTIC TANK CAPACITY LEACHING FACILITYY (type) L/ ! �� - J� .(size) NO. OF BEDROOMS. BUILDER OR OWNER: PERMIT DATE: . 61 J, COMPLIANC E-DATE:. . Separa6on Distance Between the . Maximum Adjusted Groundwater Table e.Bottom:of Leaching Facility Feet Private Water Supply Well and Lea ng Facility (If any wells exist on site or within 200 feet of le hing facility). Feet . Edge of Wetland and Leachin acility(1f any wetlands exist within 300 feet of leac g facility) Feet Furnished by o' _ No r Fee $5 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ZippIication for �Dioogal *raem Congtructton J)ermit Application for a Permit to Construct( )Repair(X)Upgrade( )Abandon( ) El Complete System 9 Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Asses St�vla Josephs St, Hyannis Cape Erma Trust Wernick Properties Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E: Robinson Septic Service Craig R Short P O Box 1089, Centerville P O box 1044, S Dennis Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( ) Other Type of Building (tAS. No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 gallons per day. Calculated daily flow _ gallons. . Plan Date . 1S/�)I / a CAD� Number of sheets' I Revision Date Title .. Size of Septic Tank �CYJC� C c: 1 . ., Type of S.A.S. '`� r,�� >�X tD_T�er`Ck Description of Soil Nature of Repairs or Alterations(Answer when applicable) Title-5 leach system to the plans of Craig R Short 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 by this o of Health. Signed )� '07� Date'VV.!.7- a�G Application Approved by C _ lac r.._ U Date Application Disapproved for the following reasons Permit No. S%U Date Issued U ——=——— ———--- ————--—— ——— — THE COMMONWEALTH OF MASSACHUSETTS 2-L) L,c--J. Wernick BARNSTABLE, MASSACHUSETTS Certificate of Compliance . THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( X)Upgraded( ) Abandoned( )by Wm. E. Robinson Septic Service at 41 St. Josephs St. , Hyannis has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. -� dated 2� Installer Wm. E.,_ Robinson Sr. Designer Craig R Short The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector No. ��1�"' '�O --------------------------Fee $50 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Wernick Migogai 6pgtem Construction J)ermit Permission is hereby granteg jo CBo .trust( )Re airs t.) JpH ade( .)Abandon( ) System located at 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 nerillit. Date: I�Z L_-) Approved by FF"-If( 'ED,EE T'1:E F' 5087901G,94 P.073 INOTICE: This �'orm Is- To Be Us Forthe Repa�Ir Of Failed Septic, Systems C)wlv. FIE', COLAIIJON' TEST 2-'-.NND -SOILE VA L'I_'A Tf 710!1 E XEN 1 P T 10 N- t cf;mt fy tit itth_- Oov 'nc MIK"Mm"Ilp- 'he prr)ptfl�y zat /"o T'his io,cono,_c,,'ed 4-o a rc�wenti,'.�l &.,,e�iir;g; on!v. 7'nierc, f�,rc no or busl"np'S6 uS,-S SS7OCUA,,.d '11,,'tth th-C 611.'��'Tn,?,. rt Is 011 c In-s111 iv-,(I' as C-1-AS S 1�a:id t -liar., o,- enuz! to 'N�:' L 1,;v: appl;-'mr may e data :0 C*nclude this 'M"':tt ')r, '-n1.'v MITIUV25 IR r r C;);)6 u"'-t re1N-n.T-,aj:v ies""s at "h?, �v h Qo k, a -p-'nt I V-n- oosi.dl w. Th�,re art no v-,,xianots ot, nfavjled, TIN- bo"tori of fln't pr-opwieul ]i-ac;-Jnq_ facillity wtli noz ine iocaite,,i iess ttlan fouiteen w az�-r tvd Ic ,�Il-viardon. LAdj ust tha fcf,' 'Ibo�'t unt vf")Und k) at,le e-as"a c o tv P i C e, tit e ff;1 0 vj n g A) 11'elp.of GrOLind Surf act, Elev;i o on (tLoi ng GIS i r. orm.a.:1 olri) + 3 V 81 G.VJ. Elevxion adj s!n A tni t for h i o h G W` FT 3,E_ 'r-EN A on NE D N OTI iC*E iBdsed tipor, ,he abo, Information, .1 'ceowl pei-rill C S s U C d o f. rr d- A I m Li i rt. ' fj) t d d it.!o n a! be d ro o m,5 4;- al TOTOL P.073 l . ,per ti COMMONWEALTH OF MASSACHUSETTS ID EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION i TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 41 St. Joseph St. Hyannis Owner's Name: Cape Erma Trust Owner's Address: Wernick Properties RECEIVED Date of Inspection: - "0 Name of Inspector: (please print) Wi 1 1 i am E_ Robinson Sr. AUG 3 1 2001 Company Name: William E. Robinson Septic Service TOWN OF BARNSTABLE Mailing Address: P O Box 1089 HEALTH- DE-'-Centerville, MA Telephone Number: (508) 775-8776 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 Z. 15.340 of Title 5(310 CMR 15.000) The system: asses Conditionally Passes -- Needs Further Evaluation by the Local Approving Authority ; Fails Q Inspector's Signature: Date: The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of HeaRh,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. t Title 5 Inspection Form 6/15/2000 page 1 Page 2 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 41 St. Joseph St. Hyannis Owner: Wernick Date of Inspection: Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. Sys m 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: LS Q 5 B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaire .The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer es,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain. Th septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound, xhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the existing ta A is replaced with a complying septic tank as approved by the Board of Health. •A metal eptic 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 expla : 01 servation of sewage backup or break out or high static water level in the distribution box due to-broken or obstruct pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with approval f Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND expla' system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass insp ction if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND n: Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 41 St. Joseph St. yannis Owner: Wernick Date of Inspection: 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 fai ' g 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 ystem 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. yytem will fail unless the Board of Health(and Public Water Supplier,if any)determines that the syst 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. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more front a pr vate water supply well**.Method used to determine distance ** his system passes if the well water analysis,performed at a DEP certified laboratory,for coliform ba feria and volatile organic compounds indicates that the well is free from pollution from that facility and the resence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other faill Te criteria are triggered.A copy of the analysis must be attached to this form. 3. Ot er: 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 41 St. Joseph St. Hyannis Owner: Wernick Date of Inspection: ��^D. System Failure Criteria applicable to all systems:. Yo 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 _ Liquid depth in cesspool is less than 6"below invert or available volume is less than'/2 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. _ Any portion of a cesspool or privy is within a Zone 1 of a public well. _ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [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.] (Yes/No)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. La a Systems: To be c nsidered a large system the system must serve a facility with a design now of 10,000 gpd to 15,000 gpd- You mus indicate either"yes"or"no"to each of the following: (The foll wing criteria apply to large systems in addition to the criteria above) 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 h ve answered"yes"to any question in Sarxina E the system is considered a significant threat,or answered "yes"i Section D above the large system has failed.The owner or operator of arty large system considered a signifi ant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR ]5.30 .The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 N OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 41 St. Joseph St .- Hyannis Owner: Wernick Date of Inspection: Check if the following have been done You must indicate`yes"or"no"as to each of the following: Yes o 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? J(/ 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) Was the facility or dwelling inspected for signs of sewage back up _d 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: Yes no _ 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 15302(3)(b)J 5 Page 6 of l I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 41 St. Joseph S-Trt. yann1s Owner: Wernick Date of Inspection: �® 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)#6 Number of current residents: 2_ Does residence have a garbage grinder(yes or no): / D Is laundry on a separate sewage system(yes or no):k o [if yes separate inspection required] Laundry system inspected(yes or no):A_O Seasonal use:(yes or no): A— Water meter readings,if available(last 2 years usage(gpd)): 2 pin—01 196,000 gal. Sump pump(yes or no):a® 1 9 9 9—0 0 128, 250 gal. Last date of occupancy: a C MMERCIAL/INDUSTRIAL T e of establishment: Des gn flow(based on 3I0 CMR 15.203): gpd Bas s of design flow(seats/persons/sgft,etc.): Gre a trap present(yes or no): Ind strial waste holding tank present(yes or no): No sanitary waste discharged to the Title 5 system(yes or no): Wa r meter readings,if available: Las; dateof occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: ;L 0 Was system pumped as part of the inspection(yes or no):,&L!d If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: TY) OF SYSTEM l 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) Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of informations- d �� Were sewage odors detected when arriving at the site es or no :/�d g g (Y ) — 6 ° Page 7 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 41 St. Joseph st. Hyannis Owner: Wernick Date of Inspection: X—P- "5:r BUILD G SEWER(locate on site plan) Depth belo grade: Materials f construction:_cast iron _40 PVC_other(explain): Distance om private water supply well or suction line: Comme is(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:v(locate on site plan) t Depth below grade: ) Material of construction: 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) ' ° I ' Dimensions: J $ 6 Sludge depth: or baffle: 6!'g Distance from top of sludge to bottom of outlet tee Scum thickness: 0 ° %, Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: I Zy � How were dimensions determined: O 6 �'�^— TA A- 4 Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of.l akage etc.): J /b ® .4 / is x /� v A. G ASE TRAP:_(locate on site plan) Depth elow grade:_ Matey' 1 of construction: concrete_metal_fiberglass_polyethylene_other (expl ) Dime sions: Scu thickness Dis ce from top of scum to top of outlet tee or baffle: Dis nce.from bottom of scum to bottom of outlet tee or baffle: Dat of last pumping: Co ents(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as re ted to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 41 St. Joseph St. Hyannis Owner: Wernick Date of Inspection: TI T or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Dept below grade: Mate ial of construction: concrete metal fiberglass_polyethylene other(explain): Dim nsions: Cap cit}: gallons Des'gn Flow: gallons/day Al present(yes or no): Al level: Alarm in working order(yes or no): D e of last pumping: C mments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert:butio _ Comments(note if box is level and distrin to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PUMP HAMBER: (locate on site plan) Pumps i working order(yes or no): Alarms n working order(yes or no): Comm is(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 1 I y OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 41 St. Joseph St. Hyannis Owner: Wernick Date of Inspection: SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type aching pits,number:_ leaching chambers,number: 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.): 06Z 0 44-4 t2l 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: t, 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.): r. PR (locate on site plan) Ma rials of construction: Di ensions: D pth of solids: C mments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 i 1 Page 10 of 11 4 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address. 41 St. Joseph St yannis Owner: erne ck ns ✓d )ate of Inspection:r SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference land marks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. 3� 6 1 ' .,OL 10 f Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 41 St. Joseph St. yannis Owner: Wernick Date of Inspection: 50 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: /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, o yqu established the high ground water elevation: L-S yy''�� / a ",� O M' 11 BErtcHMM SOIL TEST TOP OF FOUNDATION 20 FT. MINIMUM FROM CELLAR DATE OF SOIL TEST _ 50.8 10 FT. MINIMUM 10 FT. MINIMUM FROM SLAB OR CRAWL SPACE SOIL TEST DONE BY CRAIG R__S_H_O_RT`P.E_ ELEV. _ _ CLEAN SAND WITNESSED BY _NIA______________ (NGVD CIS) CONCRETE OBSERVATION HOLE 1 ELEV.=__4&3_ COVERS 4' SCHEDULE 40 PVC.PIPE LOAM AND SEED PERCOLATION RATE <_ 2 MIN./INCH AT 54=66 INCHES MIN. PITCH 1/8" PER FT. 2" LAYER OF DEPTH HORIZ TEXTURE COLOR MOTT. OTHER 49.7 MAX. 1/ " TO 1/2" LEGEND: MAX 6" ,/a SHED STONE 0-12 Ap LOAMY SAND 10YR4/2 NO ROOTS N/A 4" CAST IRON PIPE EXISTING SPOT ELEVATION OOxO 47.7 MIN. EXISTING CONTOUR ----00---- (OR EQUAL) MINIMUM FINAL SPOT ELEVATION 00.0 12-36 B LOAMY SAND 10YR5/6 NO ROOTS PITCH 1/4" PER FT, z G y� SIOILL CONTOUR TEST LOCATION COARSE AND 10YR4/6 4-132 C1 FLOW LINE 46,7 UTILITY POLE -C~ PLUMBING ELEV. _ _NIA_ 10. N WATER =W�` W X C2 MEDIUM NE 10YR6/4 MIN. TOW TO BE RAISED - 55 2'0" o 0 ooa0000000aoo�oo�00000 o CATCH BASIN G`®� SAND ELEV, _ oa o 0 oa ao 0 0 AND RE-PIPED BY o = ______ LEVEL o 0 45.7 8 GAS _ 6" SUMP ELEV. = 46.3__ H 0o ao 6 EL V. GAS LINE LICENSED PLUMBER ELEV. - _ ___ o ELEV. - _ 46.47 ��'��`��'�� CLEAN OUT C BAFFLE DISTRIBUTION CESSPOOL C.P. O LIQUID OUTLET ELEV. = 4 STANDARD INFILTRATORS WITH, DEPTHT (TO BE PLACED ON FIRM BASE) BOX - - STONE IN AN z , 4 FEET 14 INCHES TO BE WATER TESTED 11'X27'X6" TRENCH FORMATION 3 8.4 15.5 5 FEET 19 INCHES IF MORE THAN ONE OUTLET NO WATER ENCOUNTERED AT ]� ELEV. 6 FEET 24 INCHES 1000 GALLON WELL N/A 7 FEET 29 INCHES (TO BE PLACED ON FIRM BASE) SOIL ABSORPTION 8 FEET 34 INCHES SEPTIC TANK ZONE 3/4" TO 1 1/2" CLEAN INDEXX EXISTING DOUBLE WASHED STONE SYSTEM (SAS) ADJUST_ FREE OF FINES & SILT DESIGN CALCULATIONS NUMBER OF BEDROOMS 3 USGS PROBABLE WATER TABLE ELEV. = _20.2._ GARBAGE DISPOSAL UNIT SEWAGE DISPOSAL SYSTEM PROFILE OBSERVED WATER TABLE ( / / ) ELEV. = TOTAL ESTIMATED FLOW NOT TO SCALE BOTTOM OF TEST HOLE ELEV. _ _3 _ ( 110 GAL/BR./DAY X 3_ BR.) __NQ_ GAL./DAY REQUIRED SEPTIC TANK CAPACITY --OGQ_ GAL. ACTUAL SIZE OF SEPTIC TANK _1000 GAL. EXISTING SOIL CLASSIFICATION DESIGN PERCOLATION RATE <5__ MIN./IN. EFFLUENT LOADING RATE _Q�74_ GAL./DAY/S.F. LEACHING AREA -AM- SQ. FT. (11'X37')+(96'XO.5') LEACHING CAPACITY (AREA X RATE) _-.3¢_ GAL./DAY 455 X 0.74 RESERVE LEACHING CAPACITY _1VIA_ 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 FINISHED 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 PARKING AREAS. 4. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SHALL BE MORTARED IN PLACE. 5. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING REGULATIONS. OWNER / APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORS"iY. 123.58' x 48.6 6. UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCAVATION CONTRACTOR 46.5 IS TO CALL "DIG-SAFE" AT 1-888-344-7233 AT LEAST 72 HOURS x 48.7 i PRIOR TO COMMENCING WORK ON SITE. x 48.9 7. CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. ANY VARIATION I \` IS TO BE BROUGHT TO THE ATTENTION OF THE DESIGN ENGINEER 1 / IMMEDIATELY. 4�,7 8. PARCEL IS IN FLOOD ZONE SHED g 9. LOT IS SHOWN ON ASSESSORS MAP __291__ AS PARCEL _ 215_. 10. ALL UNSUITABLE MATERIAL SHALL BE REMOVED FROM UNDER, AND ,� , 46.5� FOR A MINIMUM OF 5 FEET FROM AROUND THE SOIL ABSORPTION SYSTEM, 48.5 T.1t AND BE REPLACED WITH SAND AS SPECIFIED IN 310 CMR 15.255: (3) '' ` DRIVEWAY (I.E. TITLE 5) IF ENCOUNTERED BELOW S.A.S. PIPE INVERT. �iF y��{ ,.tip, r'r)S1t Lt �D -49 Q ��• �5;\.g� z� r�� ? , 11. EXISTING SEPTIC TANK & PIT TO BE PUMPED AND FILLED WITH SAND C>n 49.4 .5 it3 46 y% ,� t r KOLif 4 1 I+ i>\,' �t� L k;: `r OR REMOVED pia ��_ ;� � APPROVED: BOARD OF HEALTH S.A.S. Q) bECK �--- 49.5 EXISTING x 4J.2 / fl 2206 DATE AGENT 8.8 DWELLING I / z � S.T. z o 48.0 - :- --_� x PROPOSED SEPTIC DESIGN FOR 47. 4 6.6 PHIUP WERNIC K TRS. \ 1 'O 48,8 "� z PROJECTALQCAT�g11n• JOSEPH STREET µ , � � x 49.3 4e x 49.9 i ELDRIDG VE 8 ST. � IS CIR. �BARNSTABLE MA r a Locus o N CRAIG R. SHORT, P.E 47 4 A sT. PAuL FL. 235 GREAT WESTERN ROAD x 48.6 MITCHEL 508 SOUTH-DENNIS,MASS. 46.i7 398-3922 02660 DATE SCALE 1 " _ 2 0' AUGUST 2 REVISED JOB NO. 1-896 LOCATION MAP REVISE° SHEET 1 OF 1 0 2001 CRAIG R. SHORT, P.E.