HomeMy WebLinkAbout0052 SAINT JOSEPH STREET - Health —Repel
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Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
52 Saint Joseph Street, Hyannis, MA 02601
Property Address
Thomas E. Muser, 92 Conant Street, Danvers, MA 01923
Owner Owner's Name
information is Hyannis MA 02601 10/17/2013
require. Y d for every
page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way.Please see completeness checklist at the end of the form.
Important:When filling out forms A. General Information
on the computer,
use only the tab 1. Inspector.
key to move your
cursor-do not REID C. ELLIS p
use the return Name of Inspector w�
key. :,, r M
ELLIS BROTHERS CONSTRUCTION x.r
Company Name s u
23 ENTERPRISE ROAD
Company Address"
am
YARMOUTH PORT MA 02675 "
City/Town State Zip Code
508-362-6237 S121891 -- rn
Telephone Number License Number
B. Certification
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. 1 am a DEP approved system inspector pursuant to Section 16.340 of
Title 5(3 0 CMR I6.000).The system:
Passes ❑ Conditionally Passes ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
011
Z61�k
Inspector' Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
This report only describes conditions at the time of inspection and under the conditions of use
at that time.,This inspection does not address how the system will perform in the future under
the same or different conditions of use.
t5ins-3/13 Title 5 Official Inspection Form:Sus Sewage Disposal System ,P.,age 7 of 17
a
.„ X
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
52 Saint Joseph Street, Hyannis MA 02601
Property Address
Thomas E. Muser
Owner Owner's Name
information is Hyannis MA 02601 10/17/2013
required for every y
State Zip Code Date of Inspection
page. Cityrrown
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
Z�] I have not foun ny information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
B) System Conditionally Passes:
❑ One or more system components as d scribed in the"Conditional Pass" section need to be
replaced or repaired. The system, upor completion of the replacement or repair,as approved by
the Board of Health, will pass.
Check the box for"yes","no"or"not deterlined" (Y, N, ND)for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years Id*or the septic tank(whether metal or not) is structurally
unsound, exhibits substantial infiltration or xfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced w th a complying septic tank as approved by the Board of
Health.
*A metal septic tank will pass inspection if't is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less ban 20 years old is available.
❑ Y ❑ N ❑ ND(Expla n below):
------------
Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17'
t5ins•3/13
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
52 Saint Joseph Street, Hyannis, MA 02601
Property Address
Thomas E. Muser
Owner Owner's Name
information is Hyannis MA 02601 10/17/2013
required for every page. Cityfrown State Zip Code Date of Inspection
B. Certification (cont.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes (cont.): /6
1114
❑ 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 b oken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below):
❑ distribution box is leveled or replace J Y ❑ N ❑ ND (Explain below):
❑ 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 ❑ Y ❑ N ❑ ND(Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below):
C) Further Evaluation is Required by the oard of Health:
Conditions exist which require further eva uation by the Board of Health in order to determine if
the system is failing to protect public heal h, safety or the environment.
1. System will pass unless Board of H alth determines in accordance with 310 CMR
15.303(1)(b)that the system is not fun tioning in a manner which will'protect publicihealth,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feE t of a bordering vegetated wetland or a salt marsh
Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page,3 of 17
t5ins•3113
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
52 Saint Joseph Street Hyannis, MA 02601
Property Address
Thomas E. Muser
Owner Owner's Name
information is MA 02601 10/17/2013
required for every Hyannis
page. Citylrown State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of/�ealth (and Public Water Supplier,if any)
determines that the system is functionin in,a manner that protects the public health,
safety and environment:
❑ The system has aseptic tank and soil a Dsorption system(SAS)and the SAS is within
100 feet of a surface water supply or tributay to a surface water supply.
❑ The system has a septic tank and SAS nd the SAS is within a Zone 1 of a public water
supply.
❑ The system.has a septic tank and SAS 3nd 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 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 fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other fa ure criteria are triggered. A copy of the analysis must
be attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate"Yes"or"No"to each of the following for all inspections:
Yes No
Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
Discharge or.ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
Static liquid level in the distribution box above outlet invert due to an overloaded
0 or clogged SAS or cesspool
❑ r Liquid depth in cesspool is less than 6" below invert or available volume is less
than '/2 day flow
Tiue 5 official Inspedion Form:Subsurface sewage Di
t5ins•3113sposal System•Page 4 of 17
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
, 52 Saint Joseph Street Hyannis, MA 02601
Property Address
Thomas E. Muser
Owner Owner's Name
information is Hy MA 02601 10/17/2013
Hyannis required for every State Zip Code Date of Inspection
page. Citylrown
B. Certification (cont.)
Yes No
❑ 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 fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered. A copy of the analysis
and chain of custody must be attached to this form.]
❑ The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact th Board of Health to determine what will be
necessary to correct the failu
E) Large Systems: To be considered a large sy em/the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feat of a surface drinking water supply
❑_ ❑ the system is within 200 feat of a tributary to a surface drinking water supply
❑ the system is located in a Aitrogen sensitive area(Interim Wellhead Protection
El Area—IWPA)or a mappe Zone II of a public water supply well
If you have answered"yes"to any question in Si.ction E the system is considered a significant threat,
or answered"yes" in.Section D above the large 5ystem has failed. The owner or operator of any large
system considered a significant threat under Se tion E or failed under Section D shall upgrade the
system in accordance with 310 CMR 1,5.304.T e system owner should contact the appropriate
regional office of the Department.
Title 5 Official Inspection Form:Subsurface sewage oisposai system•Page 5 of 17
t5ins 3113,
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
52 Saint Joseph Street, Hyannis, MA 02601
Property Address
Thomas E. Muser
Owner Owner's Name
information is MA 02601 10/17/2013
required for every Hyannis
page. CitY/To'nm State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes"or"no"as to each of the following:
Yes No
❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ Were any of the system components pumped out in the previous two weeks?
❑ Has the system received normal flows in the previous two week period?
El this
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?
❑ Was the site inspected for signs of break out?
[/ ❑ Were all system components, excluding the SAS, located on site?
(� ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)on the site has
been determined based on:
( ❑ Existing information. For example, a plan at the Board of Health.
❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
�- 3
Number of bedrooms(design): Number of bedrooms(actual):
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms).
��� .
t5ins•3113 t Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 6 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
M 52 Saint Joseph Street Hyannis, MA 02601
Property Address
Thomas E. Muter
Owner Owner's Name
information is required for every Hyannis MA 02601 10/17/2013
page. Citylrown State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents:
Does residence have a garbage grinder? ❑ Yes �No
Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ((No
information in this report.)
Laundry system inspected? ❑ Yes [!]/No
Seasonal use? ❑ Yes [!T/No
Water meter readings, if available(last 2 years usage(gpd)):
Detail: '
e llv . vu,5,4
14
Sump pump? ❑ Yes No
Last date of occupancy: Date
Commercial/industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present?. ❑ Yes ❑ No
R Industrial waste holding tank present? ❑ .Yes ❑ No
Non-sanitary waste discharged to the Title 5 sy em?
.., ❑ Yes ❑ No
Water meter readings, if available:
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-.,Page 7 of 17
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
52 Saint Joseph Street, Hyannis, MA 02601
Property Address
Thomas E. Muser
Owner Owner's Name
information is H annis MA 02601 10/17/2013
required for every y
page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
General Information
Pumping Records:
Source of information:
Was system pumped as part of the inspection? �es ❑ No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping: � s�`7 0A/
Type of System:
10/ Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy,
❑ Shared system(yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
t5ins•3/13 TAIe 5 official Inspection Form:Subsurface Sewage Disposal System•,Page 8 of:17
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal.System Form-Not for Voluntary Assessments
52 Saint Joseph Street, Hyannis, MA 02601
Property Address
Thomas E. Muser
Owner Owner's Name
information is required for every Hyannis MA 02601 10/17/2013
page. Cityfrown State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known)and source of information:
Were sewage odors detected when arriving at the te? ❑ Yes No
Building Sewer(locate on site plan): Ay
tr'
Depth below grade: feet
Material of construction:
❑ cast iron 0 4O PVC ❑ other(explain):
1
Distance from private water supply well or suction line: v` e�
Comments(on condition of joints, venting, evidence of leakage, etc.):
Septic Tank(locate on site plan): ,
Depth below grade: feet
Material of construction:
concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain)
If tan/isetal, list age: / ars
Is e c firmed by a Certificate of Compliance? (attach a copy of certific�e) Yes ❑ No
Dimensions: ' ,
IY
Sludge depth: r
'
t5ins-3f13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 9 of 17
Commonwealth of Massachusetts
Title 5 official Inspaection Form
s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
52 Saint Joseph Street, Hyannis, MA 02601
Property Address
Thomas E. Muser
Owner Owner's Name
information is Hyannis MA 02601 10/17/2013
required for every y
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle
C)
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
i How were dimensions determined?
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liqui levels as related to outlet invert, evidence of leaks , etc :
i 4fj}/ A
v _
A4 0P4*j ,'kjn' j9,2+A4--- T42� �
�` rWc�d'✓i .. -S - A �J
I ,
(crease Trap(locate on site plan):
7
s Depth below grade: feet
Material of construction:
i
i
❑concrete ❑ metal ❑ I iberglass ❑ polyethylene ❑other(explain):
i
Dimensions:
Scum thickness
Distance,from,top of scum to top of outlet tee r baffle
Distance from bottom of scum to bottom of oui let tee or baffle
Date of last pumping: Date
t5ins-3113 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page'10 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Forums
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
52 Saint Joseph Street Hyannis, MA 02601
Property Address
Thomas E. Muser
Owner Owner's Name
information is required for every Hyannis MA 02601 10/17/2013
page. City/Town state Zip Code Date of Inspection
D. System Information (cont.)
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank(tank must be pump�ftihte of inspection)(locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑ berglass ❑ polyethylene ❑other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments(condition of alarm and float switch as, etc.):
*Attach copy of current pumping contract(req ired). Is copy attached? ❑ Yes ❑ No
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
52 Saint Joseph Street, Hyannis, MA 02601
Property Address
Thomas E. Muser
Owner Owner's Name
information is H annis MA 02601 10/17/2013
required for every y
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box(if present must be opened)(locater site plan):
Depth of liquid level above outlet invert
Comments(note if box is level and distribution to outlets equal, any evidence of solids rryover, any
evidence of leakage into or out of box, etc.):
�f
A
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
Alarms in working order: ❑ Yes ❑ No*
Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.):
*If pumps or alarms are not in working order, system is a conditional pass.
Soil Absorption System(SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Z-7
t5ins.-3/13 Title 5 official Inspection Forth:Subsurface Sewage Disposal System•Page 12 of 17
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
M 52 Saint Joseph Street, Hyannis, MA 02601
Property Address
Thomas E. Muser
Owner Owner's Name
information is required for every Hyannis MA 02601 10/17/2013
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.) -->
Type:
❑ leaching 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.):
a
Cesspools(cesspool must be pumped as rt of inspection) (locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
t5ins-W13 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
52 Saint Joseph Street, Hyannis, MA 02601
Property Address
Thomas E. Muser
Owner Owner's Name
information is required for every Hyannis MA 02601 10/17/2013
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
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.):
t5ins•3H3 Title 5'Oficial Inspection Form:Subsurface Sewage Disposal System•Page 14 or 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary:Assessments
52 Saint Joseph Street, Hyannis, MA 02601
Property Address
Thomas E. Muser
Owner Owner's Name
information is required for every Hyannis MA 02601 10/17/2013
page. CitylFown State Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
;her public water supply enters the building. Check one of the boxes below:
hand-sketch in the area below
❑ drawing attached separately
E'
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IV
E
13 •��'
2A
a
' t -3S 3
t5ins'•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15.of 17
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
52 Saint Joseph Street, Hyannis, MA 02601
Property Address
Thomas E. Muser
Owner Owners Name
information is required for every Hyannis MA 02601 10/17/2013
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
❑ Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow wells
9-
Estimated depth to high ground water: � ei " sue ✓�
Please indicate all methods used to determine the high ground water elevation:
❑ Obtained from system design plans on record
If checked, date of design plan reviewed: Date
__ ❑ 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 ow you established the high ground water Xlevation:
J
--�- V 7 9'
12
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins•3/13 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 16,of 17'
• -C\-% Commonwealth of Massachusetts
uMtitle 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
52 Saint Joseph Street, Hyannis, MA 02601
Property Address
Thomas E. Muser
Owner Owner's Name
information is required for every Hy annis MA 02601 10/17/2013
page. Cityfrown State Zip Code Date of Inspection
E. Report Completeness Checklist
III/Inspection Summary: A, B, C, D, or E checked
0 Inspection Summary D(System Failure Criteria Applicable to All Systems)completed
LB' System Information—Estimated depth to high groundwater
Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
TOWN OF BARNSTABLE V
LOCATION 52 SANT JOSEPH STR`E-L-T HYANN4&A6E #2002- 121
VILLAGE H Y A N N I S ASSESSOR'S MAP & LOT 2 91 /21 9
INSTALLER'S NAME&PHONE NO. ELLIS BROTHERS CONST . CO 362-6237
SEPTIC TANK CAPACITY DOD
LEACHING FACILITY: (type) (size)
NO. OF BEDROOMSV
BUILDER OR OWNER SAMMY SH I NA.
PERMTT DA I E: 3/21 /02 �:� COMPLIANCE DATE:
Separation Distance Between the: ,�N k1
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility nf(j J U 'W Feet
Private Water Supply Well and Leaching Facility (If any wells exist /�r
on site or within 200 feet of leaching facility) +�`� Feet
Edge of Wetland and Leaching Facility(If any wetlands exist N Feet
within 300 feet of leachingfa��t ) .-
Furnished by
r
�1
d
a
` TOWN OF BARNSTABLE 1✓
LOCATION 6� 2 \165 F S 5' SEWAGE #
VILLAGE ASSESSOR'S MAP &
INSTALLER'S NAl4E&PHONE NO. I Y ����� 3 3
SEPTIC TANK CAPACITY 4'CS
LEACHING FACILITY: (type) 3Z k 02—k al
NO.OF BEDROOMS
BUILDER OR OWNER '.
PERMITDATE: 7' .�S= 5�, 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) Ajd Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) A,/ Feet.
Furnished by
�> I
N
U3
0 e
MN
N� O
• r � �/0/ Fee
No. �
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
01pprication for Migool *p5tem Con!truction Permit
Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No.S'a S'� 7"��� S Owner's Name,Address and Tel.No.
q t'1 s n jYl" 5h h I" rlMl �, mt�v/
Assessor's Map/ParcelC�� �' �� SOh
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.11fo.
T3 9 _h .7A M
Type of Build' g:
Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( )
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 X /uoo Type of S.A.S. ``// d
P Description of Soil &19^ �o t L a q �h'c t/J i e) f
Nature of Repairs or Alterations(Answer when applicable) f' S 4. L.70
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 be issued by this mf
alth. a n
Signed Date J'� C,�►f
Application Approved by !!i y Date
Application Disapproved fo the following reasons
e s1
� r
Permit No. Date'Issued
9
._t+.,,�'hr.*`!+'w�+�*...Ta.a;+.a.p�:,yg,;y.+a..r-r.e .��'+.�.....,..+..�-^.,^^'.^-.•...—'.-...--- ..�. .�._.. ..., .�.. .,,..�...,,,'e��,+,y. _, .. ..r. ,-.,u .f�=�s:.. Y--/r�.
>�� _ _ Fee
ti P ; THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS
pprication for Mi_qpozar *pgten Gott`5truction Permit
—TIA(P4licat�on for a 31� p�
t to Construct( )Repair )� e( )Abandon( ) El Complete System []Individual Components
Location Address or Lot No. Sa S} �" S>o/1 h St T Owner's Name,Address
and Tel.No.
Assessor's Map/Parcel. 'J � , /�q
kA San �� r-9rv�,� /70_�7 "k►9 9, O l
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.f1fo.
(3CC- CCnS✓ U-k-n- C`f�'t. l�h,('•Af�/���� .NG
/L ra 1�d J
AV 4fi T3 7 FA rr i rvt G-1
ng:
17 r
Type of Buildi
Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( )
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 L�
Nature of Repairs or Alterations(Answer when applicable) SF' P
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 issued by this of lkalth. +`
Signed i^Date
Application Approved by Date
Application Disapproved fo�he following reasons
-61
Permit No. Date Issued
e
THE COMMONWEALTH OF MASSACHUSETTS
d
BARNSTABLE, MASSACHUSETTS
(Certificate of (Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded( )
Abandoned( )by _ IK 13 fb-J_' /j Con al-,
at .�i ;T fj ! -Pf" hasbeen constructed in accordance
with the provisions_ of Title 5 and the for Disposal System Construction Permit No dated
Installer [` /I I 0_0,7�4 115 CC11 J C_(besigner h C / h , , `.
The issuance o tl s permit shall not be construed as a guarantee that the sys em a ill notion as desi'.n�edd
Date L) U�- Inspectors ,.i• Xn.✓1J
1
_--
e
---����---- --------------------
No. Fee C-f
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
Mizpaar *p.5tem Construction Permit
Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( )
System located at Zc S P,0
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.
i
.Provided: Constructi must bd'comveted within three years of the date of this p ' 't.
Date: k2r ,--' Approved by '/
TOWN OF BA.RNSTABLE
LOCATION 52 SANT JOSEPH STR`E T H"YANNJ&AGE #2002- 121
VILLAGE H Y A N N I S ASSESSOR'S MAP & LOT 2 91 /219
INSTALLER'S NAME&PHONE NO. ELLIS BROTHERS CONST. CO 362-6237
SEPTIC TANK CAPACITY Z
t�O/'D
LEACHING FACILITY: - A �/ �3 x .3
(type): C�4�_/� (size)
NO.OF BEDROOMS .
BUILDER OR OWNER SAMMY SH.I NA
PERMITDATE: 3/21 /0 2 ' COMPLIANCE DATE:
Separation Distance Between the: ft W
Maximum Adjusted Groundwater Table to the Bottom.of Leaching Facility N I u W Feet
Private Water Supply Well and Leaching Facility (If any wells exist /�r
on site or within 200 feet of leaching facility) /`� '� Feet
Edge of Wetland and Leaching Facility (If any wetlands exist A'
within 300 feet rof�lle2a hing facili N Feet
Furnished by 1v
P •n ,q t.
,q V3
SYSTEM PROFILE TEST HOLE LOGS
TOP FNDN, AT EL, 44.7' (NOT TO SCALE)
ACCESS COVER TO WITHIN 6' OF FIN. GRADE
AH OJALA, PE
ACCESS COVER (WATERTIGHT) TO ENGINEER,
MINIMUM .75, OF COVER OVER PRECAST /! WITHIN 6' ❑F FIN. GRADE 2% SLOPE REQUIRED OVER SYSTEM 42 7' DAVID STANTON
WITNESS;
DOUBLE WASHED PEASTON DATE; 2/19/02 I �ST. FRANCI
42.1' RUN PIPE LEVEL
FOR FIRST 2' 40,2' _ < 2 MIN/INCH
EXISTING 1QOO j PERC. RATE
GALLON SEPTIC 7' CLASS mv AAI SOILS P# 10175 2 a ,��ocus
o w
TANK (H- 10 > GAS 0 39,7 c 3.5' @SIDES
RE-USE BAFFLE 39.97' � 39.8 2.5' C ENDS
N
6' CRUSHED STONE OR MECHANICAL 2' 4 ELEV. ' MiTGNEL�s
COMPACTION. (15.221 [27) MIN $g o�$ 14' „„$ 37.7' 0" 43.5'
DEPTH OF FLOW = 4' ( 5 % SLOPE) (_1-% SLOPE) A
TEE SIZES: 3/4' TO 1 1/2' DOUBLE WASHED STENE LS
INLET DEPTH = 10" 9„ IOYR 3/1
OUTLET DEPTH = 14 E3 FLOCATION MAP NTS
i
�
FOUNDATION EXIST SEPTIC TANK LEACHING 13 D' BOX 3 FACILITY 4.2> LS ASSESSORS MAP 291 PARCEL 219
36„ 10YR 5/6 40.5'
15.7'
C
ELEV. 33.5' �
PERC
G-W EXPECTED AT EL. 22't �L�•� MS &
GRAVEL
2.5Y 6/4
BENCH MARK - TOP OF FNDN
THIS AREA 44.7'
120" 33.5'
t 7.8 L'' NO WATER ENCOUNTERED NOTES:
+ 42.1 + 42.5
120.00' �T �� 1. DATUM IS APPROXIMATED FROM_ QUAD
�.0 . r S1,E TIC DESIGN! (GARBAGE ')ISPOSER Is NOT LON D )
�O, -41
39.3 + T��r,F 12,000t SQ. FT. DESIGN FLOW: 3 s_ T .� -
-_ r�EDROGMS � 110 (.1PD) = ^��0 G}D 2, MUNICIPAL WADER IS
` '('S , ��ry
10" CHEa ` USE A 330 GPD DESIGN FLOW 3. MINIMUM PIPE PITCH TO BE 1/8' PER FOOT.
4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H-10 .
+ 4 . + 43.2 x -SEPTIC TANK1 330 GPD ( 2 ) = 660
I �-.-- -..- 5. PIPE JOINTS TO BE MADE WATERTIGHT,
4 .5 J U'SE:. A 1500 GALLON SEPTIC TANK 6, CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS,
TH� _ 5 "t ,,, LE_ACNING: ENVIRONMENTAL CODE TITLE V.
EXIST, DWELL. 4AP-43.9 _ 2(30 + 9.83) 2 (.74) = 117.9 7, THIS PLAN IS FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT
co 39.1 + 43.5 SIDES' TO BE USED FOR ANY OTHER PURPOSE,
44.7 ,
I .1 + 43.5 16' OAK 30 x 9.83 (.74) - 218 8. PIPE FOR SEPTIC SYSTEM TO SCH, 40-4' PVC.
TOP FNON = 44.T -1 B[JTTOM: - --
I o V. L-- 335 9 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT
►�' a TT'AL, 454 S,F, GPD
+ 43.7 INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED
i PATIO + 43,6 L-z'= (4) H-20 HIGH CAPACITY INFILTRATORS WITH 3.5' FROM BOARD OF HEALTH.
cl? I DECK 1~ 4 7" OAK STONE AT SIDES, 2.5' AT ENDS AND 14" UNDER 10, PUMP & REMOVE (OR FILL W/CLEAN SAND) EXISTING LEACH PIT
' 39.
N 10
• G .o 0
CIO) 1 4 43 +143. 2 LEGEND
PAVED RIVE 2 TWIN 0" OAKS + 43.3
43. :' 100,0 PROPOSED SPOT ELEVATION OF
+ 40.0 9•9 �" 43.0 52 ST. JOSEPH STREET
SHED 100x0 EXISTING SPOT ELEVATION
I IN THE TOWN OF:
0o PROPOSED CONTOUR ( HYANNIS) B A R N S TA B LE
l.0 -- 100 EXISTING CONTOUR 40,1 120.00' PREPARED FOR: SAM M Y SH N A
z
+ 42.9
20 0 20 40 60
BARD OF HEALTH
A`.)F'RgVED DATE MA SCALE: 1„ = 20' DATE: FEBRUARY 25, 2002
off 508-362-4541
fax 508 362-9880
1
Down cape engineering inc, OF 0
T T �� A1IIU H. 7��� A N.E
CaV._L ENGINEERS c LA r
LAND SURVEYORS VIL ,, 6348
939 main st. yarmouth, ma 02675 "
?-0 1 A. s � �tl, ,, .L.S. DATE