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Home My WebLink About0142 SEVENTH AVENUE (HYANNIS) - Health Hyannis .,., A- 245-068 I VX TOWN OF BARNSTABLE LOCATION /4 A. 5Z tic: Al r� /911 E - SEWAGE#2oo1- 3a 1q VILLAGE IVY A A/tiV-3 / dt ASSESSOR'S MAP&PARCEL- V — ObT' INSTALLER'S NAME&PHONE NO.j411 c i4 l A,�.S T y SEPTIC TANK CAPACITY /.,1"w LEACHING FACILITY:(type) -/ 3,0 Sfj 1A1,1,;/r e.*; ,?(size) 7JK;Z Tx20X 2 NO.OF BEDROOMS _ OWNER 01 4,q t PERMIT DATE: P b AIog 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 U, I' Z�j Y/ C.v s . Jai S p r No. Fee /0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 9pphtatlon for Misposal *pstrm ConstrUttion VPrmit Application for a Permit to Construct( ) Repair( ) Upgrade V/bandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. l /�Y's7rv�v�s�° Own r'Name,Address and Tel.No. Asses o Map/Parcel 5 p Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �gft�r,+ o.rsT Co e.40204 9 A/ S AY Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(A/ Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 d5P gpd Design flow provided . 6 gpd Plan Date f o�Sr�o? Number of sheets Revision Date d 0 I Title Size of Septic Tank I L'—G-0 Type of S.A.S.(.3) 3,0 i 0 2 n' �` lr2 a r c Description of Soil r � . 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 Certificate of Compliance has been issued by this Board of Health Signe � Date/0 " Application Approved by /Z.e$ Date Application Disapproved by 10or Date for the following reasons Permit No. (`) '1 — 3 2, Date Issued / G 9 i�iii-------------- "r-'-»r•e'y,r+rv,+..r,.:l�<.-.rT'+„• .,,.�••.-«,,:,, «. _�,-wt-:,,-,-a7sM'_........p --.-...-.- .,,.�.�.-...�. ._........... ... .„.9. ,�.,.--« �r'v.«.g.,..r,,,« ,, ..... ,.,,,, .-...- � . ENO. { """"-a°'^f,+Jl / d G qp n fi t _ ,, Fee 0 a :x A , � O f * Entered in computer: t/ THE COMAIIONWEAL'TH OF MAS�S�ACHUSETTS Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 1 ' ftplitation for ]Disposal *potent Construction permit Application for a Permit to Construct Repair Upgrade Abandon Complete System Individual Components PP ) ( ) P ( ) P�' � ( ) ❑ P Y ❑ P Location Address or Lot No:' /�yAwivis Owner's Name Address,and Tel.No. ,�� /�f ,cU E^'' /�is e��• �U.- E �- Assessor's Ivfap/ParcelS Z y S o G Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. S'3-7 -7 Ci h 6 Type of Building: r` Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( Other Type of Building No.of Persons Showers( ) Cafeteria Other Fixtures Design Flow(min.required) 3 3 d gpd Design flow provided 3 G/ 3, 3 G,, 1 gpd 0� Plan= Date / o,/S% ✓ Number of sheets Revision Date I o�J 14) Title f Size of Septic Tank Type of S.A.S.C3 �72 a r o Q. 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 Certificate of r CAipliance has been issued by this Board of Health. / Signed��;Z— Date f o 7 Application Approved by Date /0 �� 6 Application Disapproved by Date for the following reasons Permit'No. Date Issued 16 9 6 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( vY Upgraded( ) Abandoned( )by 1'�)A / at / SE y ti 7 vE has been constructed in accordance ey with the provisions of Title 5 and the for Disposal System Construction Permit No.2o o -.3 21 dated 6/ 9 4 y Installer Designer(-i4 GZ " F_ f} y #bedrooms Approved design flow 330 gpd The issuance of this permit shall not be constrq"ed as a guarantee that the systeM will funcC'ot n° 'as,designed. Date p/ J J Inspect 60 9b.-, -- --_- ------- --------------- No. U!5 -' C( Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Bisposal 6pstetn Construction J)ermit Permission is hereby granted to Construct( ) Repair( ) Upgrade Abandon( ) System located at /41 Z_ SF y C .✓T /I/ 14 V Z 5-`i ,,E 2- and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constru tion must be completed within three years of the date of this permit. Date_ /0 "-3/04 j Approved by Town of Barnstable y�•°Ft"E l°wti°� Regulatory Services Thomas F. Geiler, Director * BARNSTABLE, 9q, 16g9 Public Health Division AIFD�'�p Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax 508-790-6304 Installer& Designer Certification Form Date: 11`�a�`bq Designer: Shay Environmental Services, Inc. Installer: R`ZeAA 3rtzJc��r1 Address: P.O. Box 627 Address: T, 0 ,2!2< 1 East Falmouth, MA 02536 Qpcln i5 A-lR 1 , On�C�1 l0 �QCkA C�%)C-�00 was issued a permit to install a (date) (installer) septic system at 1'4 0-L — "' (:N�"k ��',5R '�based on a design drawn by (address) Shay Environmental Services, Inc. dated IQ)Ice OBI (designer) I certify that the septic system referenced above was.installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. �� - UDS, e ip .S' Mew a,q Goo 005, zJ,9 's, s-tr �s s.s 6Saxe --of I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. -\N OF I4,1 N. CARVEN . i (Installer's Signa re o. E. Ia 0 : SHAY � No. 1181 �FGIsTS S P� 3 (Desi r ignatur (Affix Desi p Here) PLEASE RETURN TO ARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form document 001jpg 1700x2352 pixels 4/13/10 12:39 MORTGAGE INSPECTION PL (THIS PLAN WAS NOT CREATED FROM AN INSTRUMENT SURVEY AND IS FOR MORTGA MACDOUGALL. SURVEY WILL NOT ASSUME LIABILITY FOR ANY OTHER 6 FOREST STREET CMV y0.00�s� m r ^ y.� r17 rIO � ) M 0 �� I X W #142 0 o 0 > _ - = PARCEL IC 245/068 /0 "" 100,00 PARCEL ID: 245/069 http://sz0088.wc.maii.comcast.net/service/home/—/document%20001.jpg?auth=co&loc=en_US&id=102960&part=2 Page 1 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 142 Seventh Ave Property Address• Paul Chambre Owner Owner's Name information is Hyannisport MA 02647 12/12/11 required for every page. City(rown 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: vI key to move your cursor-do not Michael Kellett. use the return Name of 4nspector .:key. Aardvark Environmental Inspections �y Company Name _-- P.O.Box 896 1�1 Company Address >� East Dennis MA 026411 City/Town State Zip Code 508-385-7608 S13742 Telephone Number License Number �8. Certification u R�I certify that I have personally inspected the sewage disposal system at this address and that the jnformatibn 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: i `--}r ® Passes ❑ Conditionally Passes El Fails ❑ Needs Further Evaluation by the Local Approving Authority 12/20/11 Inspector's 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•11/10 Title 5 Official Inspection Form:Subsurfa Se gems osal S. •Rage 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 142 Seventh Ave Property Address Paul Chambre Owner Owner's Name information is required for every Hy p annis ort MA 02647 12/12/11 page. Cityrrown State Zip Code Date of Inspection B. Certification (cons) Inspection Summary:Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 1:5.303 or in 310 CMR 1.5.304 exist.Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ 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. Check the box for"yes","no"or"not determined"(Y,N, ND)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 orexfiltration ortank 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 is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins-11/10 Tide 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts y Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 142 Seventh Ave Property Address Paul Chambre Owner Owner's Name information is p required for every Hyannis port MA 02647 12/12/11 page. City/Town State Zip Code Date of Inspection B. Certification (cont) B) System Conditionally Passes(cont.): ❑ 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, ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is'leveled or replaced ❑ 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 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 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 system 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 t5ins•1 ii i4 T09 5 CfStCial lnq*tbon Fa m..Subsurface Swi age Disposal System•Page 3 or 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 142 Seventh Ave Property Address Paul Chambre Owner Owner's Name information is p required for every y H annis ort MA 02647 12/12/11 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier,if any) determines that the system 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 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 failure 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 or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6°below invert or available volume is less than Y day flow t5ins-11/10 Tile 5Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 142 Seventh.Ave Property Address Paul Chambre Owner Owner's Name information is required for every Hy p annis ort MA 02647 12/12/11 page. Cityrrown State Zip Code Date oflnspectim 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 cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of 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 otherfailure 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 the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system,must serve a.facility with a design flow of 1109000 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 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 11 of a public water supply well If you have 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 CMR 15.304.The system owner should contact the appropriate regional office of the Department. t5ins-11/10 Titie 5 Official Inspection Form:Subsurface Savage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 142 Seventh Ave Property Address Paul Chambre Owner Owner's Name information is required for every Hy annisport MA 02647 12/12/11' page. Cityfrown 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? ❑ ® 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? ® ❑ 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 (f any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 1.5.302(5)]'' D. System Information Residential Flow Conditions: 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): 330 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts w W Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 142 Seventh Ave Property Address Paul Chambre Owner Owner's Name information is required for every Hyannisport MA 02647 12/12/11 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? Z Yes ❑ No Water meter readings,if available (last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 09/11 Date Commercial/lndustrial 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 Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form Not for Voluntary Assessments 142 Seventh Ave Property Address Paul Chambre Owner Owner's Name information is required for every Hyannisport. MA 02647 12/12/11 page. Cityrrown 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? ❑; Yes No If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of 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) ❑ 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 142 Seventh Ave Property Address Paul Chambre Owner Owner's Name information is H annis ort MA 02647 12/12/11 required for every y p page. Cityfrown state Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components,date installed (d known)and source of information: 10/24/09 per BOH Were sewage odors detected when arriving at the site? ❑, Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.0 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet, Comments(on condition of joints,venting,evidence of leakage,etc.): Septic Tank(locate on site plan): Depth below grade: 0.4 feet Material of construction:. ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal,list age:. years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gal Sludge depth: 3„ t5ins-11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 142 Seventh Ave Property Address Paul.Chambre Owner Owner's Name information is required for every Hyannisport. MA 02647 12112/11 page. Citylrown State Zip Code Date of Inspection D. System Information (cunt.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 27" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? measured. Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): The tank was sound and tight with tees in place and liquid at outlet invert. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete Q:metal ❑fiberglass ❑ polyethylene El'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: Date t5ins•1 Ili 0 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 A Commonwealth of Massachusetts Tale 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments. 142 Seventh Ave Property Address Paul Chambre Owner Owner's Name information is required for every Hyannisport MA 02647 12/12/11 page. Cityfrown 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 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 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 switches,etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 TfUe 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 142 Seventh Ave Property Address Paul Chambee Owner Owners.Name information is required for every Hyannisp ott MA 02647 12X12/11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert even 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.): The box was level and tight with no sign of carryover. 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.):. Soil Absorption System (SAS) (locate on site plan,excavation not required):. If SAS not located,explain why: t5ins-11/10 Title 5 Official Inspection Form: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 142 Seventh Ave Property Address Paul Chambre Owner Owner's Name information is required for every Hyannisport MA 02647 12/12/1:1. page. City/Town State Zip Code Date of Inspection D. System Information (coat.) Type: ❑ leaching pits number: ® leaching chambers number: 3 ❑ 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.): This system has three infiltrators surrounded by 4'of stone.The infiltrators were dry with no sign of failure. 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 Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•11/10 Title 5 0lficial 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 142 Seventh Ave Property Address Paul Chambre Owner Owner's Name information is required for every Hy p annis ort MA 02647 12/12/11 page. City/Town 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•11/10 Title 5 Official inspection Farm:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 142 Seventh Ave Property Address Paul Chambre Owner Owner's Name information is required for every Hy annisport MA 02647 12/12/11 page. Citylrown 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 where public water supply enters the building.Check one of the boxes below: hand-sketch in the area below ❑ drawing attached separately P.0.r �� 31 I{ate. a� t5ins•11/10 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form 's Subsurface Sewage Disposal System Form Not for Voluntary Assessments 142 Seventh Ave Property Address Paul Chambre Owner Owner's Name information is required for every Hy p annis ort MA 02647 12/12/11 page. City/Town state Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: 5.8 feet 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 how you established the high ground water elevation:; I augered to 8.0 feet and found no water. I adjusted to 5.8 feet. Bottom of leaching is at 4.1 feet. Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal,System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 142 Seventh Ave Property Address Paul Chambre Owner Owner's.Name information is required for every Hy p annis ort MA 02647 12/12/1'1 page. Cityfrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B,C,D,or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•11/10 This 5 Olfkial Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Permit Number: Dam: Completed by: HIGH GROUND-WATER LEVEL COMPUTATION Site Location: tat NO. Owner: Address: Contractor: : Notes: STEP i ire de1-.h to water table tonearast 1/10 ft .»........._...__...._ ....Y__.._..... ...:.....r............._ Dame STEP •2 Using Water-Level Ram Zone aexl Index Well Map lode site wW determine: m Appropriate index wrfR...._._.._....._...._......._.. _--_. Watw-evei ram z .._...._...:»__....__......_..::.:...._... STEP 3 Using mmrthly'report"CtirraM i ii'ifatsr Resoumn Candt iorW' deten.ine tx.rrent depth to ?.C3 v for index well--------- __» I STEP 4 UsMnB Tattle of Water-!ems Adjustments for index well(STEP 2A).ctirneret depth . to vow level for index vv1(STEP 3). and wmr4wid zww(STEP 2B) . I detem,ine wacer4evel adkistrient STEP 5 Es"ate depth to,high wow by suboactift the water- level adjustment(STEP 4) front mnea unid depth to water S r 8 S �,t+E Town of Barnstable P# Department of Regulatory Services / VICABLM Public Health Division Date � &63y. 16� 200 Main Street,Hyannis MA 02601 prED � 9 e Date Scheduled Time Fee Pd. 0' Soil Suitability Assessment for Sewage Disposal Performed By: CAQM��J CJ�aP!'j Witnessed By: �,vr(D ✓"1�^ ^ LOCATION (&� G�ENERAL INFORMATION Location Address I�/� 5'�\yC117'�fY� Owner's Name Address v J Assessor's Map/Parcel: "I,� / Engineer's Nameeje,(� NEW CONSTRUCTION REPAIR Telephone# Land Use �2,& Cdl�iA� Slopes(%) r Surface Stones Distances from: Open Water Body_L—ft Possible Wet Area ft Drinking Water Well Drainage Way�ih ft Property Line _ 6 ft Other A#A ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) 00 �F;nr X�,. Parent material(geologic) Depth to Bedrock /�► �} Depth to Groundwater. Standing Water in Hole: t fofl0- M5 Weeping•from Pit Race 005' Estimated Seasonal High Groundwater r DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: ___ ____in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in, Groundwater Adjustment fr. Index Well# Reading Date: Index Well level,�.�. Adj.factor Adj.Groundwater level PERCOLATION TEST bate e,._(j; � Observation Hole# Time at 9" (f Depth of Perc 3b _ Time at G" l\ t Start Pre-soak Time @ 1� ` Cib _ Time(9"-6") -eYlln End Pre-soak Rate Min./Inch Site Suitability Assessment: Site Passed— Site Failed: Additional Testing Needed(Y/N) Original; Public Health Division Observation Hole Data To Be Completed on Back----------- 5 ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. P ` Q:SEPTICVERCFORM.DOC <i a DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture ..Soil Color Soil Other P - USDA Munsell Mottling +•(Structure,Stones;Boulders. I•�,� � Surface (USDA) (Munsell) g on i tenc % ravel AJl4- I s Y 1 C.ecK�,, L G9c, DEEP OBSERVATION HOLE LOG Hole#t- a Depth from Soil Horizon Soil Texture 4 Soil Color y t° Soil , I `Other Surface(in.) (USDA) (Munsell) Mottlingl 1(Structure Stones,Boulders. ` Consi ten %Qbvel)f s A DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Cnitec %Gravel) DEEP OBSERVATION HOLE LOG. Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consi t n Flood Insurance Rate Man: Above 500 year flood boundary No_ Yes __ Within 500 year boundary No f/ Yes Within 100 year flood boundary No I! Yes Depth of Naturally Occurring Pervious Material . Does at least four feet of naturally occurring pervtou aterial exist in all areas observed throughout the area proposed for the soil absorption system? S_ If not,what is the depth of naturally occurring pervious material? Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Envir ental Pr tection and that the above analysis was performed by me consistent with . the required train' g, p tis a rience described in 310 CMR 15.017. Signature Date 1d� Q:\S.EPTIC\PERCFORM.DOC 3" of 1/8" - 1/2" Washed Peastone *NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. " �--10' min. from 3/4 to 1 1/2 ' DOUBLE Washed Crushed Sto wig r •.f Existing Foundation I house to septic tank ' 20" Min Septic tank covers must be D-BOX cover must be '%` '-°+yl { �ggf a TOP OF FOUNDATION ELEV. 100.00 (Assumed) within 6 In. of finished grade within 6" of Grade 4" PVC (CAPPED) INSPECTIOL6� TO BE i$ ;77, Grade over Septic Tank- 99.50 Grade over D-Box - 96.00 rode over SAS - 96.00 INSTALLED AND TO BE WITH GRADE 3 HOLE H-10a ,r DIST. Baap t c 1al ; ,E S 0.02 3' Maximum CoverNEW I l EKiS7, PIPE : 7L(D u) 1,500 GAL. S O.Ot or Greater s< pSystem- a, To OF Etev. -94.00 ,1 �p FROM EXIST. FDUNDATION dN SEPTIC TANK 15' 0pj"per foot / 24 .,L:.f fectiv 11 sidewal CONCRETE FULL FOUNDATIO II H-10prj'w ; a' 2' EFFECTIVE DEPTH4 Units @ 7 =28 SYSTEM 6 In.of 3/a^-i 1/2" II Mcompacted stone > 2' 4 2 Not to ScaleNot to - 11 A 81 II Effective Length i s NOTE; SEPTIC TANK & D-Box TO BE CONSTRUCTED ON LEVEL COMPACTED BASE 'c S w Effective width AS SHOWN' NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE a in.of 3/4"-1 1/2" p 5' Separation 5i SECTION A -A GENERAL NOTES compacted atone a From Bottom of SAS to PROFILE VIEW OF LEACHING SYSTEM 1. Contractor is responsible for Di safe notification, Verification of Utilities Bottom of Test Hole a and protection of all underground utilities and pipes. o TO BE VERIFIED AT 11ME OF INSTALLATION ' SOIL ABSORPTION SYSTEM SAS p g p p (SAS) 2. The septic tank and distri ution box shall be set w Bottom of Test Hole 1 Elev.= 86.50 level on 6 of 3/4 -1 1�2 stone. CULTEC 3050 INFILTRATOR CHAMBER H-20 (OR EQUIVALENT) 3. Backfill should be clean sand or gravel with no Groundwater Observed NONE OBSERVED NOTE: OVERALL HEIGHT OF INFILTRATOR IS 30 EFFECTIVE HEIGHT IS 24 stones over 3" in size. PERCOLATION TEST ALL OUTLET plpEs FROM THE 4. This system is subject to inspection during installation DISTRIBUTION BOX SHALL BE 12' - CONCRETE COVER by Carmen E. Shay Inc. SET LEVEL FOR AT LEAST 2 FT. � - y - Environmental Services, Date of Percolation Test: OCTOBER 1, 2009 3-5" OUTLET „ . .,,,',,." 2 NOTE: FLOOR OF CRAWL SPACE IS ELEVATION 9$-00 5. The contractor shall install this system in accordance �`�<, KNOCKOUTS TOP OF SAS IS @ ELEVATION 93.50 with Title V of the Massachusetts state code, the approved plan '• /r t '• •� slid Local Regulations..Test Performed By: CARMEN E. SHAY, R.S., C.S.E. 12" INLET THEREFORE, TOP OF SAS IS BELOW THE ELEVATION OF Results Witnessed By: DAVID STANTON BARNSTABLE BOH -"- - 5'S" aiTLEr +, Y ( ) 6. If,,during installation the contractor encounters any EXCAVATOR: SHAY ENVIRONMENTAL SERVICES, INC. `�� ..' +: 6" �4;• CRAWL SPACE FLOOR ELEVATION. soil conditions or site conditions that are different Percolation Rate: Less Than 2 MPI 0 30"' 0 TP1 '.�'•..I *' �% -+ ; , '' 2 from those shown on the soil log or in our design 18b" 4" - SCH. 40 Te 1,75" installation must halt & immediate notification be Test Hole Test Hole PLAN SECTION CRQ$S-SECTION made to Carmen E. Shay - Environmental Services, Inc. No. 1 No. 2 PROJECT BENCH MARK 7. No vehicle or heavy machinery shall drive over the DEPTH SOILS ELEV. DEPTH SOILS ELEV. TOP OF FOUNDATION septic system unless noted as H-20 septic components. 0 99,50 0 99.50 3 HOLE H-10 DISTRIBUTION BOX ELEV. = 100.00 (Assumed) 8. Install Tuf-rite gas baffles or equals on all outlet tee ends. Loamy Loamy NOT TO SCALE 9. All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipes. �Vl 0 Jl �� 7' � T_"�.� 7 10, All solid piping, tees & fittings shall be 4" diameter 10 YR 3/2 10 YR 3/2 Schedule 40 NSF PVC pipes with water tight joints. A 99.00 0"-s" A s9.00 (40 FOOT RIGHT OF WAY) p p g Loam 11. Municipal Water is AVAILABLE to ALL OF The Residence and Abutting Sandy Loamy Sand r.96 9S Properties Within 150 Feet. NO PRIVATE WELLS PRESENT W/IN 200' 10 YR 5/e 10 YR 5/6 _-->e--/-------------_ - --- -----------------------------_- 6"-30" Bw 97.00 6"-30" Be 97.00 r' - -.i/ - THE PROPERTY LINES ARE APPROXIMATE AND Med-Coarse Med-Coarse ,.! ___-------- COMPILED FROM THE PLAN BY ALAN W, JONES & ASSOC., ENTITLED PLAN OF LAND OF SEASIDE PARK, HYANNIS, MA Sand Sand � / PLAN PLAN BOOK 34 PAGE 23 2.5 Y 7/4 2.5 Y 7/4 / // �' PL 30"-132" C. 6B.5o 30"-132" c, ssso �/i /� 100.00 DATED AUGUST 1893, / // LOTS #563 & 565 AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN IT US FOR NO 8,000 Square Feet +/ HE H EOUL PTIC BSYSTEM INSTALLATIONRPOSE OTHER THAN TEST HOLE #1 ELEV.= 99.50 EXISTING CESSPOOL TO BE PUMPED OUT AND FILLED IN PLACE it OR REMOVED TO FACILITATE NEW SEPTIC SYSTEM INSTALLATION 98 NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE I ( FROM THE EXISTING CESSPOOL TO BE DISPOSED p #f42 OF AS PER BOARD OF HEALTH SPECIFICATIONS. F'erc #1 i ,\� i TIEST HOLE #2 EXI5TING Depth to Perc: 30" to 48 THERE ARE NO WETLANDS ARE PRESENT WITHIN 200' OF THE PROPERTY ___-__ I 1-- ---I G Perc Rate- <2 MPI Assumed .-.I I I ELEV• 99.50 QP 3 BEDROOM Groundwater Not Observed i i I Ap, HOUSE aPG� �'7, f0' ASSESSORS MAP 245 LOT 068 No Observed ESHWT ADJUSTED H2O Elev. None I ASPHALTl `�' LEGEND OI o DRIVEWAY Screen Roomr G��/0o r; o DENOTES PROPOSED Cape Cod rT-9� 904X1 SPOT GRADE Cellar Design Calc latigns X « f ti i /�^ � Concrete �, f' �' �. Failed X 104.46 DENOTES EXISTING 0 1 r I 5" ,, SPOT GRADE Number of Bedrooms: 3 Equivalent to 330 Gal./Day (330 Gal./Day Min. per Title V) Q I I I PATIO -ii CESSPOOL ,,,•11 Garbage Grinder: No L'- I I I - / 'i�M°• , Leaching Capacity Proposed: 330 Gal./Day Minimum (Min. Per Title V) p .-" 000 " „,,:r . �,• - PL PROPERTY LINE Septic Tank : - 2 x 330 Gal./Day = 660 USE NEW 1500 GAL. Septic Tank. 1 i R -64$• 6bAlE. . !� �- r 9 ,� NEW 7 SOIL ABSORPTION AREA: Using percolation rate of <2 min./inch ; i i f ' 150.9 Tank > ' rr- 96P PROPOSED CONTOUR Bottom Area: 0.74 gal/sq. ft. x 288 sq. ft. = 213.12 gallons r T ,r Sidewall Area: 0.74 gal./sq. ft. x 176 sq, ft. = 130.24 gallons i i i - - - - - -97 EXISTING CONTOUR Providing: 343.36 gallons (�` i aC! g6- 100.00 i Use: (4) 3050 H-20 INFILTRATOR CHAMBERS, HAVING A 2 DEEP TEST HOLE &EFFECTIVE DEPTH, I (4' W x 7' L) TO BE USED WITH 2' OF WASHED STONE ON THE SIDES AND i PERCOLATION TEST LOCATION 4' OF WASHED STONE ON THE ENDS. L-SHAPE AS SHOWN. 6 FOOT STOCKADE FENCE I REV.: 11/12/09 -- ADDED CRAWL SPACE FLOOR ELEVATION NOTES TYPICAL 1500 GALLON SEPTIC TANK I /40MIL POLYETHYLENE LINER REV.: 11/9 09 - System in Back Yard CAP Owners Request NOT TO SCALE j M ELEV. 97.00 to 93.00 AND 3-24" DIAM. ACCESS MANHOLES (H- 10 LOADING) Both I TO EXTEND 10 FEET PAST SEPTIC TANK I T PLAN AND 10 FEET PAST SAS AS SHOWN (_ •Jt tom•:+`,..,+,,.±.*�.,*�."..Tf1• ••• L. .lr'.t�l Bedroom OF SEPTIC SYSTEM UPGRADE 0 i IN INLET 1; / ` / ��/ ou T m Bedroom TEST HOLES PERFORMED IN FRONT YARD PREPARED FOR THE ACCESS COVERS FOR THE SEPTIC TANK, I 5 Separation THE KUSHNER h` DISTRIBUTION BOX AND LEACHING COMPONENT ;' .._, �. ,T ?,4_' ,�,r SHALL BE RAISED TO WITHIN 6" OF E Bath i From Bottom of SAS to AT " '• " FINISHED GRADE, o Bottom of Test Hole 142 SEVENTH AV E N U E STEEL REINFORCED PRECAST CONCRETE INSTALL TUF-11TE GAS BAFFLES OR EQUALS X TO BE VERIFIED AT TIME F INSTALLATION LAN VIEW ON ALL OUTLET TEE ENDS Crl c Dining r r H YA N N I S P 0 R T, MA 02601 ,- •... r 3-24" REMOVABLE COVERS �/ • .,.••. 1• .,,. 4„ ,�•::. Kitchen �2e C REPARED BY: 3 min. clearance " +w n ] �7 INLET 8� min�T D 2 min, inlet to outlet 8"mim 13" INLET"r Screen /T �1�/ /1 a INL - - - Ltqu-I�level- OUTLET Room -� ii f a .11 MM i v L/ SHAY a"min. OVER THE COUNTER VARIANCE REQUESTED: �Y ' 5' _7" a• ___ , "5. _7" , °� r, (ENVIRONMENTAL SERVICES, INC. €,: -4 E 4'-0" m' 1 1 1 THORNBERRY CIRCLE "o Liquid depth 1. REQUEST A VARIANCE TO INSTALL THE SAS LESS THAN 6.7 FEET FROM �., fic FLOOR SCHEMATIC A CRAWL SPACE TO THE DWELLING AND 11.7 FEET FROM A CAPE COD CELLAR S�,S MASHPEE, MA 02649 HE DWELLING- A 40 MIL POLYETHYLENE LINER HAS BEEN PROVIDED 1 �NITARiP TO T TEL/FAX 508-539-7966 �;•, +.. s;":r;' ,, 3 BEDROOM RANCH 10'-0" 5' -6" DESCRIPTION BY OWNER 2• REQUEST A VARIANCE TO INSTALL A SEPTIC TANK 5 FEET FROM A FOUNDATION SCALE: 1 „=20' DRAWN BY: CES DATE: OCTOBER 5, 2009 CROSS SECTION END-S CE_ TION TO THE DWELLING- A 40 MIL POLYETHYLENE LINER HAS BEEN PROVIDED PROJECT#SD1 157 FILENAME: SD1157PP.DWG SHEET 1 OF 1