HomeMy WebLinkAbout0082 WALTON AVENUE - Health 82 Walton Avenue
Hyannis P
A = 310 442
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TOWN OF BARNSTABLE rC
LOCATION (ill A LI'0& Ave SEWAGE #, U b
VILLAGE ASSESSOR'S MAP & LOTS, y "''�yA,
INSTALLER'S NAME&PHONE NO. / /4 A C ® ,Q 9, S 6,41
SEPTIC TANK CAPACITY Z, 6 O Q Q L .0
LEACHING FACILITY: (type) — /C y W ells (size)
NO. OF BEDROOMS r
BUILDER OR OWNER c- l o c V1
PERMTT DATE: —COMPLIANCE'DATE: Gz U 3 _
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 of 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
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ell
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No. Fee $5 0. 0 0
t
iz
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
2pprication for Miopool 6pg;tem Con.5truction Permit
Application for a Permit to Construct( . )Repair( )Upgrade( )Abandon( ) O Complete System XMIndividual Components
Location Address or Lot No. 82 O a i•f o n Ave Owner's Name,Address and Tel.No./2 O tx e 2•t O C O J o n
Kyanni.6, t7a,s,s. 02601 82 Garton Ave
31 -s0 4s42p�arcel Hyann.i..6, Na,6h. 026 01
Installer's Name,Address,and Tel.No.5 0 8-7 7 5-3 3 3 8 Designer's Name,Address and Tel.No.5 0 8-2 7 3-0 3 7 7
a. P. Nacompen & Son Inc. JC. Cnginee2.ing Inc. 2854 CZanFezz
Box 66 Cen•teltvi ie, Mas.3. 02632 Highway East OaAeham, Nazz. 02538
Type of Building:
Dwelling XX/Vo.of Bedrooms 3 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
N&ture ff Repai or Alterations(4.inswer when applicable) Adding •two 500 g a e L o n l e a c h i n g
c am e2 o e ex.ch ng 6e� -Zc 3y,3 em.
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 issu d by this 94d of ealth.
Signed �✓ Date 11 5/0 3
Application Approved by o
.s Date /Z 3 d
Application Disapproved r the following reasons
Permit No. ZOO *s—.51 Date Issued 2- 3 D
-- ---------------------------------
No.' U3 ` L/ �.. '` ; '+ Fee $5 0. OO /
c ""°' '
THE COMMONWEALTH OF MASSACHUSETTS Entered incomputer:� yes
PUBLIC"HEALTH DIVISION'-TOWN OF BARNSTABLE, MASSACHUSETTS_.
,•� +� y:Y� 4, fir+;.-. -
2ppfitation for Migpogaf *pgtem Congtruction Permit
Application for a Permit to Construct( . )Repair( )Upgrade( )Abandon( ) El Complete System X. aIndividual Components
Location Address or Lot No. 82 Qa fl t o a 4 v e Owner's Name,Address and Tel.No.�?o g e rt t o C o e o n
"Arse SS ol%_Va�i/P�arcce' h' 02601 82 l�l a L t o n ,4 v e
0_ 4 Ryann.i.s, Na s.s.�02601
Installer's Name,Address,and Tel.No.5 0 8-7 7 5-3 3 3 8 Designer's Name,Address and Tel.No.5 0 8-2 7 3-0 3 7 7
. %. Nacomgert T Son Inc. �C. Cng-ineea.iny Inc. 2854 Caang.ez
Pox 66 Nas.j. 02632 Highway fast Yaae.ham, Na3,3, 02538
Type of Building:
Dwelling X pNo.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
Natu eofy.RjepairsorAlterations(Answerwhena plicable) 4ddin9 two 500 ya.-'Lon eeach.in,
chamKe2e to the e-r.izt.iny .6ep tc 6ya. em. 2 'X 3'X2'
Date lastinspected:
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 th4,Boatd.of Health.
Signed Date 111251,03
Application Approved by / '� f P Date /Z 3 G
Application Disapproved r the following reasons r t
Peermit` 2 cad 3- S�' Date Issued t< 7 No. G
----------- -----------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
(Certificate of Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired(VX )Upgraded( )
Abandoned( )by 17. 2. fln.nom0ea R Son Tnr.
at 82 Qatt on Ave Huann i.6, ('la ss. ~' has been constructed i 'ac ordance
with the provisions of Title 5 and the for Disposal System Construction Permit No.20G� 9z dated. ? 2
Installer\ '1. 14, /7n r n m 4 n n P C n n T n r, Designer
The issuance,of this permit shall not be construed as a guarantee that the system will function as designed.
���-N� C.Date Al 24 Z Inspector_�o..,�� �/ :,
"1 <ZJ
ell
No. 9—o -�c! t� Fee $5 0. 00
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
ltgogaf bpgtem Congtruction Permit
Permission is hereby granted to Construct( )Repair( )Upgrade(�X)Abandon( )
System located at R 2 61 n 11 n n A v o f/ii n n n ;.A., Mri A A
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 us,(be completed within three years of the date of this permi�
i
Date: I Approved by '' '
i
TOWN OF BARNSTABLE
LOCATION 11- '—�y y e SEWAGE #,�U b �
VILLAG ASSESSOR'S MAP &LOT
INSTALLER'S NAME&PHONE NO. d All
SEPTIC TANK CAPACITY / 10 D
I' LEACHING FACILITY: (ty P (size) 2-9
NO.OF BEDROOMS 2
BZJII,DER OR OWNER
PERMIT DATE: COMPLIANCE DATE: 0 3
Separation Distance Between the:
Feet
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility
Private Water Supply Well and Leaching Facility (If any wells exist Feet
on site or within 200 feet of leaching facility)
Edge of Wetland and Leaching Facility (If any wetlands exist Feet
within 300 feet of leaching facility)
Furnished by
i
U* b —
i
Liti
i
I'
I 'O 'y
Date:LJIZ10I '0617
TOWN OF BARNSTABLE
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAME OF BUSINESS: <c G CZ1,/17 A /1
BUSINESS LOCATION: a/la-L/e,-1- �-- INVENTORY
MAILING ADDRESS: ' Aw TOTAL AMOUNT:
TELEPHONE NUMBER:
CONTACT PERSON:
EMERGENCY CONTACT TELEPHONE NUMBER: 3-0 V 52=j� S^ 2td6 MSDS ON SITE?
TYPE OF BUSINESS: 12 ,
INFORMATION / RECOMMENDATIONS: Fire District:
Waste Transportation: Last shipment of hazardous waste:
Name of Hauler: Destination:
Waste Product: Licensed? Yes No
NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use,
storage and disposal of 111 gallons or more a month requires a license from the Public Health Division.
LIST OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health and the Public Health Division have determined that the following products exhibit toxic or
hazardous characteristics and must be registered regardless of volume.
Observed / Maximum Observed / Maximum
Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive
❑ NEW ❑ USED Cesspool cleaners
Automatic transmission fluid Disinfectants
Engine and radiator flushes Road salts (Halite)
Hydraulic fluid (including brake fluid) Refrigerants
Motor Oils Pesticides
❑ NEW ❑ USED (insecticides, herbicides, rodenticides)
Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers)
Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED
Miscellaneous petroleum products: grease,
Photochemicals (Developer)
lubricants, gear oil ❑ NEW ❑ USED
Degreasers for engines and metal Printing ink
Degreasers for driveways&garages Wood preservatives (creosote)
Caulk/Grout Swimming pool chlorine
Battery acid (electrolyte)/Batteries Lye or caustic soda
Rustproofers Miscellaneous Combustible
Car wash detergents Leather dyes
Car waxes and polishes Fertilizers
Asphalt& roofing tar PCB's
Paints, varnishes, stains, dyes Other chlorinated hydrocarbons,
Lacquer thinners (including carbon tetrachloride)
❑ NEW ❑ USED Any other products with "poison" labels
(including chloroform,formaldehyde,
Paint&varnish removers, deglossers hydrochloric acid, other acids)
Miscellaneous. Flammables Other products not listed which you feel
Floor&furniture strippers may be toxic or hazardous(please list):
Metal polishes /vim Lv
Laundry soil &stain removers
(including bleach)
Spot removers&cleaning fluids
(dry cleaners)
Other cleaning solvents
Bug and tar removers
Windshield wash
WHITE COPY-HEALTH DEPARTMENT I CANARY COPY-BUSINESS Appli n 's Staff's Initials
COMMONWEALTH OF MASSACHUSETTS 9 1p
f EXECUTIVE OFFICE OF ENVIRONMENTAL AFFA
RECEIVEO
DEPARTMENT OF ENVIRONMENTAL PRO TION
• ONE WINTER STREET. BOSTON, MA 02108 617-292-5500 c0 AUG 21 1997
N
TOWN OF BARNSTA81 E
S HEALTHDEPI'
4
WILLIAM F.WELD COXE
Governor $ Secretary
E
ARGEO PAUL CELLUCCI AVID B.STRUHS
Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioner
PART A
CERTIFICATION
Property Address: 82 Walton Ave, Hyannis Address of Owner: Lynne Wheeler
Date of Inspection: F/-$`"97 -7 (If different) 20 Cau f i e l d St "'
f
Name of Inspector: Wm E Robinson SrIewtGpn, MA 02159
1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CM 15.0 8)
Company Name: Wm E Robinson Septic Service
Mailing Address: PO BOX 1 0891 Centervi 1 1 a r MA 02632
Telephone Number 5 0 8 7 7 5—R 7 7
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewa a disposal systems. The system:
_ Passes
_ Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
�Fails
Inspector's Signature/
s Date: Z�
The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this-
inspection. If the 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 Department of Environmental Protection. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
INSPECTION SUMMARY: Check A, B, C, or D:
A] SYSTEM PASSES:
have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303.
�27Any failure criteria not evaluated are indicated below.
MENTS:
B] SYS CONDITIONALLY PASSES:
e or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon
c mpletion of the replacement or repair, as approved by the Board of Health, will pass.
Indicate ye , no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not.
The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of
Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or
the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank
failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank
as approved by the Board of Health.
254d 04/25/97) Page 1 of 10
DEP on the World Wide Web: http:ltwww.magnet.state.ma.usldep
j Printed on Recycied Paper
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f ,
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
(C4
PART A
CERTIFICATION (continued)
Property Address: 82 Wheeler Ave, Hyannis
Owner: L nneWheeler
Dafe'of`Irisp.�ection:
.19jut*aa (�
1 .
B] SYSTEM CONDITIONALLY PASSES (continued)
! �'fSewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed
pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the
Board of Health). Describe observations:
broken pipe(s) are replaced
obstruction is removed
distribution box is levelled or replaced
The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass
inspection if(with approval of the Board of Health):
broken pipe(s) are replaced
obstruction is removed
C] FU THEIR EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the
public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER
WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
_ Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT
THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or
tributary to a surface water supply.
The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a
volatile or anic com compounds indicates that
for coliform bacteria andp
I well unless a well water analysisg
rivate water supply
P PP Y
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. Method used to determine distance (approximation not valid).
3) HER
(revised 04/25/97) Page 2 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 82 Walton Ave, Hyannis
Owner: Lynne Wheeler
Date of Inspection: IS
D] SYSTEM FAILS:
You must indicate ei;!;er "Yes" or "No" as to each of the following:
I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis
for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct
the failure.
Yes No
Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or
cesspool.
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 1/2 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation.
Any portion of a 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 I 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
E] LAR E SYSTEM FAILS:
You mu indicate either "Yes" or "No" as to each of the following:
The+following criteria apply to large systems in addition to the criteria above:
he system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to
ublic health and safety and the environment because one or more of the following conditions exist:
Yes o
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)
The owne or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirem nts of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(revised 04/25/97) Page 3 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 82 Walton . Ave, Hyannis
Owner: Lynne Wheeler
Date of Inspection:
Check if the following have been done: You must indicate either "Yes" or"No" as to each of the following:
Yes No
_ Pumping information was provided by the owner, occupant, or Board of Health.
k&I None of the system components have been pumped for at least two weeks and the system has been receiving normal
flow rates during that period. Large volumes of water have not been introduced into the system recently or
as part of this inspection.
_ As built plans have been obtained and examined. Note if they are not available with N/A.
The facility or dwelling was inspected for signs of sewage back-up.
The system does not receive non-sanitary or industrial waste flow.
J _ The site was inspected for signs of breakout.
All system components, excluding the Soil Absorption System, have been located on the site.
The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of
r
baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum.
The size and location of the Soil Absorption System on the site has been determined based on:
_ The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of
Sub-Surface Disposal System.
y _ Existing information. Ex. Plan at B.O.H.
_ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is
unacceptable) [15.302(3)(b)]
(revised 04/25/97) Page 4 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 82 Walton Ave, Hyannis
Owner: Lynne Wheeler
Date of Inspection:
FLOW CONDITIONS
RESIDENTIAL:
Design flow:-S3 0 p.d./bedroorn for S.A.S.
Number of bedrooms.
Number of current residents:
Garbage grinder (yes or no):L—A-
Laundry connected to system (yes or no) ,!�
Seasonal use (yes or no): /L
Water meter readings, if available (last two (2)year usage (gpd): 9/9 5 — 6/9 6 4 6:-'5 0 0
Sump Pump (yes or no):is— 9 9 6 - 6/9 7 - 98, 2509
Last date of occupancy:
C MMERCIAUINDUSTRIAL:
Type of establishment:
Desig flow: gallons/day
Grease trap present: (yes or no)_
Industr I Waste Holding Tank present: (yes or no)_
Non-sa itary waste discharged to the Title 5 system: (yes or no)_
Water eter readings, if available:
Last to of occupancy:
OT ER: (Describe)
La date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS d source of information:
Syste umped as part of inspection: (yes or no) �
If yes, volume pumped: sallons
Reason for pumping:
TYPE OF S TEM
eptic tank/distribution box/soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system (yes or no) (if yes, attach previous inspection records, if any)
I/A Technology etc. Copy of up to date contract?
Other
APPROXIMATE AGE of all components, date installed (if known) and source of information: ��112 "
Sewage odors detected when arriving at the site: (yes or no) CJ
(revised 04/25/97) Page 5 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 82 Walton' Ave, Hyannis
Owner: Lynne Wheeler
Date of Inspection: T IV -.77
BUIL G SEWER:
(Locate on site plan)
Depth belo , grade:
Material of construction: _cast iron _40 PVC_other (explain)
Distance rom private water supply well or suction line
Diameter
Comment : (condition of joints, venting, evidence of leakage, etc.)
SEPTIC TANK:"�
(locate on site plan) 1
Depth below grade:
Material of construction: 64ncrete _metal _Fiberglass _Polyethylene _other(explain)
If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No)
Dimensions: Je
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffler
Scum thickness: >O ,
Distance from top of scum to top of outlet tee or baffle:_ o
/Distance from bottom of scum to bottom of outlet tee or baffle:_
How dimensions were determined: 4ti e'0,&L:. tie/
1
Comments:
(recommendation for pumping, condition of.inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert structural
integri vidence of leakage, etc.)
GR SE TRAP:
(locate n site plan)
Depth bel w grade:
Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain)
Dimension
Scum chic Hess:
Distance om top of scum to top of outlet tee or baffle:
Distanc from bottom of scum to bottom of outlet tee or baffle:
Date o last pumping:
Comments.
(recommen ation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural
integrity, ev dence of leakage, etc.)
(revised 04/25/97) Page 6 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 82 Walton Ave, HYannis
Owner: Lynne Wheeler
Date of Inspection: g'�-l,S Qj -
TIGH HOLDING TANK: (Tank must be pumped prior to, or at time, of inspection)
(locate on si plan)
Depth below rade:
Material of nstruction: _concrete _metal _Fiberglass _Polyethylene —other(explain)
Dimensions:
Capacity: gallons
Design flow: gallons/day
Alarm level: Alarm in working order_Yes; _ No
Date of previo s pumping:
Comments:
(condition of inlet tee, condition of alarm and float switches, etc.)
DISTRIBUTION BOX:_v
(locate on site plan)
Depth of liquid level above outlet invert:_
Comments:
(note if.lev�I d distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.)',
PUMP AMBER:_
(locate on i e plan)
Pumps in wor ing order: (Yes or No)
Alarms in wor ing order (Yes or No)
Comments:
(note conditio of pump chamber, condition of pumps and appurtenances, etc.)
(revised 04/25/97) Page 7 of 10
ti
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 82 Walton Ave, Hyannis
Owner:. Lynne Wheeler
Date of Inspection:
SOIL ABSORPTION SYSTEM (SAS):
(locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods)
If not determined to be present, explain:
Type,
leaching pits, number:
-LZ
leaching chambers, number:_
leaching galleries, number:
leaching trenches, number,length:
leaching fields, number, dimensions:
overflow cesspool, number:
Alternative system:
Name of Technology:
Comments:
(note condition of soil, signs of hydraulic failure, vel of ponding, condition of vegetation, ear `� °
/
CE POOLS: _
(Iota on site plan)
Number nd configuration:
Depth-top of liquid to inlet invert:
Depth of s lids layer:
Depth of sc m layer:
Dimensions of cesspool
Materials of construction:
Indication groundwater:
i flow (cesspool must be pumped as part of inspection)
Comments:
(note conditio of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
PRIVY:_
(locate on site pl n)
Materials of cons r ion: Dimensions:
Depth of solids-
Comments:
(note condition of soi, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
(revised 04/25/97) Page 8 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 82 Walton Ave, Hyannis
Owner: Lynne Wheeler
Date of Inspection: s-9
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100' (Locate where public water supply comes into house)
t
4
fb 6 8
(revised 04/25/97) Page 9 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C .
SYSTEM INFORMATION (continued)
Property Address: 82 Walton Ave, Hyannis
Owner: Lynne Wheeler
Date of Inspection:
Depth to Groundwater Feet
Please indicate all the'methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
Observation of Site (Abutting property, observation hole, basement sump etc.)
Determine it from local conditions
S:-
Check with local Board of heaffh;'-
Check FEMA Maps
Check pumping records
Check local excavators, installers
Use USGS Data
Describe in your own words how you established the High Groundwater Elevation. (Must be completed)
�L� r 1'6`" 02 , os��s A wdy /rr' 9� s
. I
,(revired 04/25/97) Page 10 of 10
TOF = 50.59' PROVIDE PRECAST CONCRETE EXTENSION 5" DIA. OUTLET(S) FINISH GRADE OVER CHAMBERS = 49.2' - 49.8' GENERAL NOTES
RISER WITH CONCRETE COVER TO WITHIN REMOVABLE COVER SLOPE @ 2% MIN. OVER SYSTEM 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION
6"OF FINISH GRADE OVER OUTLET COVER FINISH GRADE OVER D-BOX= 49.5� 4"SCHEDULE 40 PVC MIN SLOPE 1% 3/4"TO 1-1/2" DOUBLE WASHED STONE TO CROWN OF PIPE METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE
FINISH GRADE @ FND. EL.- 49.0'-49.2' FINISH GRADE OVER TANK EL.= 49.05' 2"OF 1/8"TO 1/2"DOUBLE WASHED STONE ENVIRONMENTAL CODE AND ANY APPLICABLE LOCAL RULES.
2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD
20" MIN.ACCESS COVER 12" MIN. TOP OF SAS= 46.93' PLACE RISERS ON ALL CHAMBERS OF HEALTH AND THE DESIGN ENGINEER.
(TYPICAL FOR 3) 36' MAX. 36"MAX. 9"MIN. TO 6 OF FINISHED GRADE 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL
EXISTING 4" 46.10� 36"MAX. BREAKOUT EL - 46.60' BE USED IN DISPOSAL SYSTEM UNLESS OTHERWISE NOTED.
SCHEDULE 40 PVC 4. TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE LESS THAN
MIN.SLOPE�2% 6" 3" 2"DROP MIN. 3" 9„ PROVIDE WATERTIGHT ELEVATION =46.60' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS
3 DROP MAX. JOINTS (TYP.) o 0 0 0 0 o A 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF
0T 4"PVC IN FROM O 0 pop 0 0 �� oo THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION.
14" 47.10' SEPTIC TANK 4"PVC OUT TO o cep oo c� 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM.
47.35 LEACHING FACILITY oo 0 0 0 0 o 0 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL.
47.55' INSPECT ALL 12^ op 7. LOCAL BOARD OF HEALTH TO BE NOTIFIED PRIOR TO BACK FILLING WHEN
TEES AND OUTLET TEE 46.50� MIN. 46,33' 2 0 0 0 0 0 0 o 0 0 = = = o� SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS NOT TO
5 8' 48" REPLACE IF pp p o pp BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH.
NECESSARY 6"CRUSHED STONE po 0 0 0 0 0 0 0 o 0 0 = 0 = = 0 8. ELEVATIONS BASED ON ASSUMED DATUM OF 50.00'MSL OBTAINED
GAS BAFFLE OVER MECHANICALLY 4, I 4' FROM A NAIL IN An OAK TREE AS SHOWN ON PLAN.
4.0' 4.9' 4.0'
COMPACTED BASE 8.5' 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION
6"CRUSHED STONE 5 OUTLET DISTRIBUTION BOX 25.0' (TYP.) THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE
OVER MECHANICALLY TO BE INSTALLED ON A LEVEL STABLE <38.80 12 9' AT 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY
COMPACTED BASE BASE. FIRST TWO FEET OF OUTLET /'d4.10' GROUND WATER ELEV.= DISCREPANCIES TO THE DESIGN ENGINEER.
PIPES TO BE LAID LEVEL. 2- 500 GAL. CHAMBERS 5'MIN. 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONCRETE
EXISTING 1000 GALLON CONCRETE SEPTIC T NK STRUCTURES SHALL BE MADE WATERTIGHT.
LENGTH 8.5 WIDTH 4.83 DEPTH 5.58 CROSS SECTION VIEW TYPICAL CHAMBER PROFILE CHAMBER DETAILS CHAMBER END VIEW 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR
SEPTIC TANK PROFILE DISTRIBUTION BOX DETAIL ZONING REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH
NOT TO SCALE NOT TO SCALE NOT TO SCALE DETERMINATION FROM APPROPRIATE AUTHORITY.
- 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS
TEST PIT DATA
LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE
THEY SHALL WITHSTAND H-20 LOADING.
MAP 310 AGENT: N.A. 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND
FINES.
PARCEL 441 , . •ty • SOIL EVALUATOR: Samuel Philos Jensen
14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND
N/F " �• � * �! ` t2\ DATE: September25, 2003 UNSUITABLE MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF
���\ DOS SANTOS MAP 310 / TEST PIT#: 1 COARSE SANDLEACHING ILITY. REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN
FREE FROM CLAY, FINES OR OTHER UNSUITABLE MATERIAL IN
I� PARCEL 444 ., •� `� ELEV TOP: 48.80' ACCORDANCE WITH 310 CMR 15.255(3).
N/F no ELEV WATER: < 38.80
15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN
+
S77°1Q4j^E \ � THEOHARIDIS ���� ., ' SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK.
�/ '`.-' PERC RATE: <2 Min./In.FX
�\ �'X �X`V /' 16. PROPOSED PROJECT IS LOCATED WITHIN:
n I 80.00, /� '�-X� # • DEPTH OF PERC= 30"-48" ASSESSORS MAP 310 PARCEL 442
-4X--
o , TEXTURAL CLASS: 1 17. OWNER OF RECORD: ROBERTO&GAIL COLON
TP 1 §a 0 48.80' ADDRESS: 82 WALTON AVE
/ � - ft '0 • HYANNIS, MA 02601
PAVED DRIVEWAY 48 80' ? A Sandy Loam
f / l 9 10YR 3/2 FEMA FLOOD ZONE C
I �
5" 48.38' AS SHOWN ON COMMUNITY PANEL# 250001 0005 C
•/% Sandy Loam
MAP 310 / / �- -� / ` a. • • I Bw 10YR 5/8 18. PLAN REFERENCE:
• Q 10-20%Gravel, 1. PLAN ENTITLED"SUBDIVISION PLAN OF LAND IN BARNSTABLE,
U
PARCEL 19 ' . Cobbles NORMAN GROSSMAN, SURVEYOR"SCALED 60 FEET TO AN INCH,
((J m # / +� . ! � 25 AND DATED NOVMEBER 4 1978. L.C. 17201J.
N/F f • 30"" 46.72 46.30' ,
GIBSON Q - I / " . Perc
ram" �+ 48" Loamy Sand 44.80' 19. DEED REFERENCE:
1 EXISTING STOCKADE - -1 2.5Y 7/4 1. C146012
C
I FENCE f c� 10-20% Gravel,
Cobbles 20. ALL DISTURBED AREAS SHELL BE RESTORED TO ORIGINAL CONDITION.
\ ` \ e f�•' `- 21. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY
FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY
Q \ r- • Z Res FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE.
96" 40.80'
M-C Sand
C-2 10YR 7/6
\ LOCUS PLAN 120" 38.80'
No Standing Water,Weeping,
MAP 310 SCALE: 1" = 1000' or Mottling Observed
MAP 310 _w #82 f EXISTING 1000 GALLON
°' i SEPTIC TANK
o I
PARCEL 18 Z/ °� PARCEL 442 EXISTING DESIGN DATA
LU N/F / Z 10,000 SQ.FT. (+/-) 3-BEDROOM LEGEND
j DWELLING NUMBER OF BEDROOMS: 3(ASSESSORS)
MAP 310
RICHARD aQ NUMBER OF BEDROOMS: 3 (DESIGN) -- -- - 50 - - - EXISTING CONTOUR
o TOF=50.59' / DESIGN FLOW: 110 GPD/BDRM
\ cu PARCEL 443 TOTAL DESIGN FLOW: 330 GPD 50 PROPOSED SPOT GRADES
4 9� N/F DESIGN FLOW X 200 % = 660 GPD
\ / °) LYNCH �� PROPOSED CONTOUR
/ o USE EXISTING 1000 GALLON SEPTIC TANK
7 E/T/C EXISTING OVERHEAD UTILITIES
CV
/ HC(1) INSTALL TWO 500-GALLON CHAMBERS
1„/O - ---- EXISTING WATERLINE
5.81 SIDEWALL CAPACITY
GAS EXISTING GASLINE
HC(2) B.M. (LENGTH +WIDTH)(2 SIDES)(EFF. HEIGHT)(.74 GPD/SQ.FT.)= GPD
\ G Nail in Oak Tree TEST PIT LOCATION
(25'+ 12.9')(2)(2')(.74 GAL/SQ.FT.)= 112.2 GAL. LEACHING/DAY
Elev. =50.00'
Assumed Q Q EXISTING 1000 GALLON SEPTIC TANK
\ / / BOTTOM CAPACITY -
(LENGTH)(WIDTH)(.74 GPD/SQ.FT.) GPD 4"SOLID SCHEDULE 40 PVC PIPE
N ( 5)( 2.9)(.74 GAL/SQ.FT.)- 238.7 GAL. LEACHING/DAY
(3) I l ❑ DISTRIBUTION BOX
TOTALS: 0 500 GAL. LEACHING CHAMBER
\ I TOTAL LEACHING AREA 474.1 SQ.FT.
\ ` f TOTAL LEACHING CAPACITY 350.9 GPD
/ \ I LP REV. DATE BY APP'D. DESCRIPTION
19.0, _
PROPOSED 900 PROPOSED SEPTIC SYSTEM UPGRADE
/ o (4) LONG SWEEP PREPARED FOR:
- 25.0' ' \ ROBERTO COLON
UF' � EXISTING CESSPOOL TO
/ CB/DIj (5) BE PUMPED AND FILLED LOCATED AT
_ :
(FND/ LDS__ N>>°1v-41" 3g- WITH CLEAN SAND
82 WALTON AVENUE
00
a0 w - X�'C HYANNIS, MASS.
SWING TIES PROPOSED D-BOX X� RESERVED FOR BOARD OF HEALTH USE
DESCRIPTION HC (1) HC (2) PROPOSED 500 GALLON SCALE: 1 INCH = 10 FT. DATE: NOVEMBER 5, 2003
LEACHING CHAMBERS MAP 310 / 0 5 10 20 40 FEET
D-BOX (3) 21.7' 24.7' - �►sHOF1j1ss,
CHAMBER COVER 4 27.7' 36.3' PARCEL 025 � JOHN L. c `�^, PREPARED BY:
O
N/F EXISTING PICKET CHU JR.
�R-RCH JC ENGINEERING, INC.
CHAMBER COVER(5) 29.0' 31.1' FARRENKOPF FENCE EXISTING STOCKADE CML
W.4
FENCE 1607 2854 CRANBERRY HIGHWAY
' - - EAST WAREHAM, MA 02538
SITE PLAN / 508.273.0377
SCALE: 1"= 10' /Jj�°;� j Drawn By: DS Designed By:DS Checked By: JLC JOB No.545