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0137 WALTON AVENUE - Health
137 Walton Avenue Hyannis P . : A = 310 328 i i i h, i i f t i §r i i x i f f - TOWN OF BARNSTABLE SEWAGE # rGE- ASSESSOR'S MAP & LA"6 < 3Z3 NAAE,& ONE N0. p SEPTIC TANK CAPACITY QIoG,Ic ����JJ(SC�I S LEACHING FACILITY: (type) (size) NO. OF BEDROOMS BUILDER OR OWNER PERMTTDATE: 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) Feet .Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by e oC� ac% t11 i oC i s' Apt I I 0 TOWN OF BARNSTABLE ,4OCATION 131 I/VAf..—r&-J AMS SEWAGE# VILLAGE W/14mQ(S ASSESSOR'S MAP&PARCEL _ (® INSTALLER'S NAME&PHONE NO.etPr--tJ- 106-5- ; tc. , 77 SEPTIC TANK CAPACITY (;0 1 500 (Wk,1-010 5i5FD C `tOW K>r LEACHING FACILITY.(type)b)50O CMG.14 00 G�ize) NO.OF BEDROOMS OWNER HAZO.6U.t) € KELXY F®d•�5 PERMIT DATE: (,-5 COMPLIANCE DATE: 16 (3-vZ O i 57 Separation Distance Between the: No G.W. Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility C—&)a)L 4SZQb Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) N1A Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) / A Feet FURNISHED BY CAPG )tb lr G1JT�P�(�ttS (✓� cDlr �4{=55 ` 8-5 ,T -1=709r w �,-r = Isla =Ln g A-3 :7x�9 ! co �® No. ✓ Fee�n_� THE COMMON TH OF MASSACHUSETTS Entered in computer: � " PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes RppliLation for Disposal *pstem (Construction Permit Application for a Permit to Construct( ) Repair 00 Upgrade( ) Abandon( ) ;(Complete System ❑Individual Components Location Address or Lot No. 1'3-7 WAsmP AV s N� Owner's Name,Address,and Tel.No. Assessor's Map/Parcel �� -RW[.� ��A VS 14VrWU1 Installer's Name,Address,and Tel.No.jCg-C4 77-ZIR-71 Designer's Name,Address,and Tel.No. 5'08-a73—03-11 C 4.0CW rPj5 ErJTs2.P4L9eC; LL,.-- ZG. � e�J�19Cd�-6c -Z�G at c1 s s E,WAR04 Type of Building: Dwelling No.of Bedrooms Lot Size 3 1 sq.ft. Garbage Grinder( ) Other Type of Building RKL 1D ),,'T1 (, No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3_3Q sue,-tWj0%( gpd Design flow provided b�C�`4�.., gpd Plan Date- Number of sheets Revision Date Title 131 WA=04V6ajo6 '"tifl OAS` Size of Septic Tank(�l� f (yQ ( � i4r PO /Type of S.A.S.t/3<) �cp C-AL CJ4 C � Description of Soil GO���(7�� � `5AIMP /*6) 4( B Nature of Repairs or Alterations(Answer when applicable) 'W5 A (W�) 15- Cam oQ 4L H-(Q �ru( , ���' -19096 TD (/� gap C-A( N Ecol� 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 igned Date l® � Application Approved by Date Application Disapproved by Date for the following reasons Permit No.— A ,� Date Issued 160 Fee THE COMMON TH OF MASSACHUSETTS Entered in con prl of � Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Nplitation for Disposal *pstem Construction Permit Application for a Permit to Construct( ) Repair 00. Upgrade( ) Abandon( ) Complete System ❑Individual Components Location Address or Lot No t3,7 (A)*A(-T& 1�V � Owner's Name,Address,and Tel.No. MAW_C— p colt'§cCA Assessor's Map/Parcel :3 tQ .2 13-1 kI&L.TDO AUS 14\MA)U15- Installer's Name,Address,and Tel.No.$_01il-4 77-gg-71 Designer's Name,Address,and Tel.No.j d$-a7 3-0311 ) c. 0f ; 4-t4SA41 a S GAA1J8t290-Iw E,W14a&t4AUA TI pe of Building: Dwelling No.of Bedrooms a Lot Size 3(4p, 714 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures a Design Flow(min.required) 330 P6R-rtTL0V gpd Design flow provided 3!q g,;L. gpd Plan Date cf-eZ 1 -aQ('S Number of sheets 'Revision Date ' Title I3y f¢ ,r�AU1=U06 4 YV4X)1V1 Size of Septic Tank( Q 1500 &*L 14-10 ^^Typee of S.A.S.C3J V60 G+L CC'�6L4I� Description of Soil &4GD Z&27 � 5�41.lD (.`�'i �{� Nature of Repairs or Alterations(Answer when applicable) 2ZU$T/¢([, (; 1 500 ��. H"l0 f 8Ou TD 03) goo C-74c, tN-;�v Date last inspected: Agreement:The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in r accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operatiop'until a Certificate of Compliance has been issued by this Board of t Signed I Date-10 -t-01121 Application Approved by Date Q Application Disapproved by Date - for the following reasons Permit No. -- -r-/�j 1O Date Issued --------------------------- '----------------------------------- ---------------------- THE COMMONWEALTH ' OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( Upgraded( ) Abandoned( )by O A Pr:W(A 6 ENTE*26 0J,< L LC! at 377�A Le�n ur— N oxit has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit NON S --33 dated 16/ Installer(�Ae6ax5 Igo i ' C.L��. Designer`Zc �[)(�(aJ��C t�JGa Xxic, #bedrooms Approved design flow TrTu3 V gpd The issuance of thi permi shall not be construed as a guarantee that the system WI i l:ncti �as desi ,ed. Date�� J Inspector ---------------------------------------------------------------------------------------------------------------------------------------- No. %��� 3 _ Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair(� Upgrade( ) Abandon( ) System located at l a 7 W�(HMO A U e k yM�.11CJ!S 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:Construction must be c mpleted within three years of the date of this permit. Date / / .S Approved by 1 ■10/15/2015 10:51 5082730367 4i4o4o r ' vv1/ vv1 i ■ Town of,Barnstable " 'Regulatory Services Thomas F.Geiler,Director MYrAM . Public Health Division KAM i6j Thomas McKean,Director 200 Main Street, Hyannis,annis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: 1 0"1 5-15 Sewage permit# a615 33 Assessor's Map/Parcel 3 0I3 2 Installer&Desiener Certification Form j Designer: 5 �C: E� ioeeCi0 , To Installer: Ga(ew;ck� ��tketPcises Address: 2i54 Cc oerr: I44MO— Address: 1 53 Comme.rcr'al Sfree{ ro51 ►u�rckn&YA, 11A 0253E 02GLI J 0377 On ly r l ao[� C�ezwtd� G-n�z,pns� was issued a permit to install a (date) (installer) septic system at l 3-7 a i}° R0 eou e— based on a design drawn by address) S G En5t6e_ec h�4n5 , TV) dated g ` 2 r (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. Stripout (if required) was inspected and the soils were found satisfactory. .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 ci rtiifted as-built by designer to follow. Stripout (if required) s ected and.the soils were.found satisfactory. JOHN L. i IN C CHURCHILL JR. ' (I let's Sig tore) ML 4180 esigner s Signature (Affix De gn Here) P ASE RETURN TO ARNSTABLE PUBLIC HEAL DIVISION. CERTIFICATF OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoffice formsWesignercertification form.doc i t Town of Barnstable P#. Z �Ti4E • Department of Regulatory Services _ Public Health Division NAM Date 1el>1 200 Main Street,Hyannis MA 02601 p fEL16M1I+t A r y Date Scheduled ( Tftne_ Fee Pd. i- Soil ► Suability Assessmentfor Sew e Disposal PerformedDy:. MI(.blu�,l fine✓ W (FZ c 1 LJ Witnessed By: LOCATION& GENERAL INFORMATION Location Address137 Owner's Name / Address �)fJ � A S� �IYAW is Assessor's Map/Parcel: d / 3 X8 Engineer's Name CSC"BG ' NEW CONSTRUCTION 1ZEpA1R X CC Teleph'onelk J O ri—({"T - �8-7 5Q8-273-Q377 Land Use-_Str4e.fcoiti jweAh,7 S10 es P ( Surface Stones . Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line 7/U R Other ft SIM''TCH:(Street name,dimensions of lot,exact locations of test holes&Pere tests,locate wetlands in proximity to holes) see a4dcAvl (tcyl Parent material(geologic) Depth to Bedrock Depth to Groundwater. Standing Water in Hole. Weeping fl'om Plt Fnce Estimated Seasonal High Groundwater 7 3 DETERMINATION FOR SEASONAL•HIGH WATER TABLE Method Used: Direct bbSetU�}tCul Depth Observed standing in obs.hole: 78 ib, Depth to soil Iriottles: Depth to weeping from side of obs.hole: Itt. Index Well Y — _ In, Groundwater Adjustment ft. Reading Date: Index Well IF-YaI _ Adj.fhotor ,�� A,�.Clt-vundwater Level PERCOLATION TEST bate /'l—FTh ra �O.% 4Wj Observation Hole It t`y i Time at 4"Depth of Pere 6x Time at G" Start Pre-soak Time @ �0•/q�tla'► - I� Time(9"•6") End Pre-soak Rate Min./hrch L Z a Site Suitability Assessment: Site Passed e5 Sito Failed: Additional Testing Needed(YM) Al Original: Public Health Division Observation Hole Data To Be Completed on Back---------- ***If percolation test is to be conducted within 100' of wetland,you must-first notify the Barnstable Conservation Division at least one(1) weeIt;prior to beginning. Q:\SEPT IC\PERCFORM.DOC z fl IDEEP.OBSERVATION HOLE LOG hole# i t 2 Depth from Soil Horizon Soil Texture Shcl Color Soil- Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. ors_ istency,%Oravel) FW iZ- Iy A- 6 LS 3/3 I `I- y8 !3 L-S I sIto - �! G ('4 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsis en % ra ]DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%G DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones:Boulders. Consistency. Flood Insurance Rate Maps Above 500 year flood boundary No— Yes Within 500 year boundary No Yes, Within 100 year flood boundary No,-l� Yes . Depth of Naturally occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? ` If not,what is the depth of naturally occurring pervious material? Certiffcation I certify that on. l0 Z7�9q (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise andjperience described in 10 CUR 15.017. Signature Date Q:\SEP'1'1C\PBRCFORM.DOC i YOU WISH TO OPEN A BUS INESS? ForlYour Information: Business certificates (cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which youlmust do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1"FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) � f r,a t' �► ' a` DATE:/ ill in please: APPLICANT'S YOUR NAME/S: © 4>jA7jv BUSINESS YOUR HOME ADDRESS: i `5 Wv9 � ,1:3 V TELEPHONE # Home Telephone Number 3 O _ NAME OF CORPORATION: NAME OF NEW BUSINESS i e 5 R TYPE OF BUSINESS Lo 6 JZ 1 IS THIS A HOME OCCUPATIOI%? YES NO ADDRESS OF BUSINESS l MAP/PARCEL NUMBER �/ "3�� (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 20D Main St. — (corner of Yarmouth v Rd. &Main Street) to make sure�you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: 2. BOARD OF HEALTH This individual has . en informed Vh;epmitr u`reme is that pertain.to this type of business. Authorized ign ure MWCOWLYWMALL COMMENTS: "AZ4R000S MATERIALS REG A71ONg .3. CONSUMER AFFAIRS (LIPENSING AUTHORITY) This individual has inf r e the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: i COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION < Iz Recei TITLE 5 OFFICIAL INSPECTION FORNI - NOT FOR VOLUNTARY ASSES N ENTS o 2003 SUBSURFACE SEWAGE DISPOSAL SYSTEM FORIN TOWN OF BA HEALTH RNSrpgLE PART A nEPr. CERTIFICATION Property Address: Owner's Name: Owner's Address: / 3 [✓o, ��•��r. Dd 6�� MAP y �2� Date of Inspection: rj PARCEL, !r 2/ ' Lo 9 Name of Inspector. (please print) �� p f� i Company Name: blailine Address: Telephone Number: p S— CERTIFICATION STATEivIENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP' approved system inspector pursuant to SS a 15.340 of Title 5(310 CLNIR 1S.000). The system: G!' passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails, Inspector's Signature: G1J�/L Date: D The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Hca[Ch or DEP)within 30 days of completing this inspection. If the systern is a shared system or has a design flow of 10.000 gpd or grcatcr, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer. if applicable, and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform is the future under the same or different conditioas of usc. Pagc 2 of t l OFFICL-kL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSyIENTS SUBSURFACE SEWAGE DISPOSAL SYSTEtiI INSPECTION FOF;0vI PART A � CERTIFICATION (continued) y Property Address: �I / I,✓o,/ �, 1"e Owner U e ;2;E�1 � — Date of Inspeaion:. Inspection Summary: Check A,B,C,D or E I ALIV,kyS complete all of Section D A. System Passes: �ave not found any information which indica 15.303 or in 3 l0 C�IR 13.304 exist. Any failure criteria snot e Lhat aivated are y of the aindicated tx;lo vs�nL�d ut'10 C�L� Comments: B. System Conditionally Passes: & One or more system components as described in the"Conditional Pzi��- sec on need to be replaced or repaired.The system, ti upon completion of the replacement or repair, as approved by the Board oHealth, will pass. Answer yes, no or not determined(Y,N,ND) in the for the follo«ing statements. If"not determined" please The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound,e-Jubits substantial inMtrsdon or exfiltrstion or tank failure is imminent. Scstem«ill pass inspection if Elie existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank Hill pass inspection if it is structurally sound not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water lei.of in the distribution bo-x due to broken or obstructed pipe(s) or due to a broken, serried or uneven distribution box. System will pass approval of Board of Healch): inspection if(with broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed i pass inspection if(%%ith approval of the Board of Health): P Pc(s)• The system «ill broken pipe(s)arc replaced obstruction is removed ND explain: v r OFFICL-kL INSPECTION FORIM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEIN1 [ SPECTION FOR"'yI PART A CERTIFICATION (continued) Property A,,d//dress: Owner: /`f� oz 6 D Date of Inspection: :��� C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the is failin v g to protect public health safetyor the environment. E°ard of Health in order to determine if the system 1. Svstem,will pass unless Board of Health determines in accordance with 310 CNIR 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 pricy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a se tic p 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 «chin 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 coliform bacteria and volatile orgaruic compounds indicates that the well is free from pollution from that facibry and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, prodded that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: OFFICL-kL LYS P ECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM LYSPECTION FORi-vf PART A CERTIFICATION (continued) Property Address: Gt`tvllJ a,-c c/ Owner: Date of Inspection: .5 D. System Failure Criteria applicable to all systcros: You must indicate—yes— or,-no- to each of the following for all—inspections: Yes No acicup of se"vage into facility or system co;iponent due to overloaded or clog Discharge or ponding of eciluent to tkie surface of the wed SAS or cesspoo, logged SAS or cesspool ground or surface waters due to an overloaded or —. Static liquid level in the distribution box above outlet invert due to an overloaded or clo ged S -sspool �S or — l/ Liquid depth in cesspool is less than 6"below invert or available volume is less than '/:dsv flow _LZRequired pumping more thin 4 dmes in the last year it OT due to cloaged or obstructed t Hof times pumped pIpe(s). Number — I y 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 14-tter supply or tributary to a surface /water supply. 2�7V �y portion of a cesspool or privy is within a Zone 1 of a public well. y portion of a cesspool or privy is within 50 feet of a private water supply w ty portion of a cesspool or privy is less than 100 feet but eater than pp y well. .A supply well with no acceptable water quality analysis. [Thissystem pas es if the well watervater analysis, p--rfonr.c ° DEP certified laboratory,for coliform bacteria and Volatile oceanic compounds indicates t::... ;ne well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria /�/ arc tri;ore ed.A copy of the analysis must be attached to this form.l " O(Yes/No) The svYtcm fails. I have determined that one or more of the above failure described in 3 10 C' Health to deter -M 13.303, therefore the system fails.The system owner should contact the Board of mine what will be necessary to correct the failure. E. Large Svstems: To be considered a large syg*,err the system must serve a facility Nits a design flow of iq,iNh) gpd to 15.004) gpd. You must indicate either—yes— or"no" to each of the following: (The following criteria apply to large s'stems in addiuon to the criteria above) Yes no — — the S%stem 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 sIf you have answered"yes" to any question in Section E the system is considered a significant thrcaL or answered yes" in Section D above the I -3C 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 olHce of the Department. Pa6c5ot ll OFFICIAL INSPECTION FORINI - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISP OSAL SYSTEM INSPECTION FORM. PART B CHECKLIST Property Address:' /-?/ �,✓0�/10� -14-61 Owner: 1q, try Date of Inspection: � Q� Check if the follo«ing have been done. You must indicate"ves" or"no" as to each of the folloMn3: Ye No ; Pumping information was provided by the owner, occupant, or Board of Health ZWere any of the system components pumpedout in the %i pre zous two weeks ; _ /Has the system received normal flows in the preNious rwo, week period V Have large volumes of water been introduced to the s`,stem 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 w o ape' gns se age buck up Was the site inspected for sip s of break out Were all system components, excluding the SAS located o ed on site Were the septic tank manholes uncovered,opened and the interior of the tank inspected for the condition :f;Lhe es or tees, material of construction, dimensions,depth of liquid, depth of sludge and depth of scum Was the facility owner(and ocatpants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems The sizeand location of the Soil Absorption System (SAS) on the site has been determined based on: Yes no/ Existing information. For example, a plan at the Board of Health Determined in the field any if ( , of the failure criteria related to Part C is at issue approximation of disunce is unacceptable) (310 C1%IR 15.302(3)(b)l Page 6oCll OFFICLkL INSPECTION FORi1-1 -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORjNLkTION Property Address: Owner- f•1 e,t" �• Date of Inspection: RESIDENTLU FLOW COND[TIONS Number of bedrooms (design): C� Number of bedrooms (actual): DESIGN flow based on 310 Cj%lR 13.203 (for eeample: 110d x T of bedr°oms): a- 0 Number of current residents: .S gp Dees residence have a garbage grinder(yes or no): Is laundry on a separate sewage system Lees or no):�0 [ip yes separate inspection rcquircdl Laundry system inspected(yes or no): Seasonal use: (yes or no): �'J _ Water meter readings, if available(last 2 years usage Sump Pump(Yes or no): /Yo SON)): Last date of occupancy: 77 L,/;-A-04 CONDIERCIAUTND USTRUL Type of establishment: Design flow(based on 310 CNM 15.203): g Basis of design flow(seats/persons/sgf�etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title S system(yes or no): _ Water meter readings, if available: Last date of°c::upancy/use: OTHER :, bc): Records Pumping GENERAL LNFOR-NUTION p• a Source of information: /f 1-0/ �y,, f _ �„� Was system pumped as part of the inspection(yes or no): �5,� If yes, volume pumped:_dons _How was uanti Reason for pumping; quantity Pumped determined'. TYPE OF SYSTEM _Septic tanK distribution box, soil absorption system Single cesspool Overflow cesspool 13d f4 a - Cj l 6 ry — CGrf /Jl�s fni _Pricy Shared system(yes or no) (if yes, attach previous inspection records, if anv) _Innovative/Aitemative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system o%mer)- Ttght tank Attach a copy of the DEP approval Other(describe): Approximate age of all components, date insta d if known) and so a of info ° S �es��000/S 8 ns��►� Were sewage odors detected when arriving at fie site(yes or no): OFFICIAL INSPECTION FORD[— NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM IINFO RINIATIO N (continued) .. Property Address: 132 "I rho t, ��e `'— �ctymii�-! �o cam/ Owner: u Date of Inspection: �r f�� BUILDL`IG SEWER(locate qn site plan) Depth below grade: Materials of construction: cast iron _4� '0 PVC yother(explain): Distance from private water supply well or suction line: Comments (on condition of joints,venting,evidence of leakage, etc.): SEPTIC TANK:_(locate on site plan) Depth below grade: Material of construction:_concrete mess! fiberglass_polyethylene —other(explain) _ — If tank is metal list age: Is age confirmed by a Certificate of Com liance(yes or no :certificate) (attach a copy of Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: 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: How were dimensions determined: Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): GREASE TRAP:_(locate on site plan) Depth below grade:Nia _ serial of construction: concrete metal—fiberglass i ' g1 _polyethylene other" 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: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural inte tv, lid d levels as related to outlet invert,evidence of leakage, etc.): �'• q`i' Vzlgc S of t 1 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM( IIYSPECTIOiY FORMS PART C n SYSTEM INi IFORINLATION(continued) Property Addrem: (,./o.-fO yr gve., // �6Of Owner: Tit� Date of Inspenioa: p TIGHT or HOLDII(G TANK: Z/ (=k 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 day Alarm present(yes or no): Alarm level: Alm in working order(yes or no): Date oft pumping: ) Comments (condition of alarm and float switches, etc.): D ISTRIB G ilv,"d N(if present must be opened)(locate on site plan) Depth of liquid level abo.-: invert Comments(note if box is lc.cI ;;:d distribution to outlets ems.any evidence of sands carryovec,any evidence of leakage into or out of box, etc.): PUMP CENSER:/ (locate on site plan) ) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): r OFFICUL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORINI PART C / SYSTEM LYFORNLATION (continued) Property Address: / GV"- qV VI Owner: Date of Inspection: S0[L ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required) If SAS not located explain why: T?iC leaching pits,number: �` V /'o 17dr f c leaching chambers, number: L � S't`'"7 Cr IL a�r� leaching _ /_,�e e galIeries, number: /L'0 %r�✓,1 0 l c% /,� 3/r/ �n leaching trenches, number, length: ��, ,G SS 1,75 leaching fields,number,dimensions: Overflow cesspool, number: innovative alternative system Typc/name of technology: Comments (note condition of sail, signs etc.): of hydraulic failure, level of ponding, p soil,condition of vex�etztion, CESSPOOLS: (cess�ooi m be pumped as of i r �Zia�:(locate on site plan) Number and configuration: . :--. Depth--top of liquid to inlet invert: G" 111 N `M r i)eptn of solids layer: oZ�� 6r &eeds Depth of scum layer: __Go G u Dim=ions of cesspool:!Vofsoil, ,6 ,c Materials of constructionc vC Indication of groundwateryes or no): o /CEO Cggtm�nts(note conditio signs pf by ,ulic failure, lel of ponding, condition o v/°�' "' o+� "� J leer, �/ �1 / ,etation etc/): ti e e ova 1 h4 p is T /h vie✓`7 PRIVY y(locate on site plan) Materials of con=uction: Dimensions: Depth of solids: Comments(note condition of sail, signs of hydraulic failure, level of ponding,condition of vegetation,etc.): OFFICIAL LNSPECTION FORINI — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORIti1ATION (continued) Property Address: Owner: l uo Date or[nspe�- n: ') U SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the se:vagc disposa benchmarks I systern including tics to at least nco pem=cnt reference landrnarik-s or . Locate all «ells within 100 feet. Locate where public winter supply enters the building. �X 6 Cesspool 13 1 Fro 11 4- r �> Lem V� T ( Marc 17 1-41e �eu�ti``O f 5� OFFICIAL INSPECTION FORA'( — NOT FOR VOLUNTARY ASSESSMENTS • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORNLkTION (continued) Property Address: Owner. Li Date or Inspection: p . SITE E X.Vy Stope , Surface water Check cellar Shallow wells Estimated depth to ground water a3 feet Please indicate(check) all methods used to determine the high ground water elevation: Obtained from system design plans on record-Vchecked,date of design plan reviewed: served site(abutting property/observation hole%viLhin 150 feet of SAS) Checked with local Board of Health-cxpWrt: Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You Must cn how ou a blished the high ound water elevation. � �l OGv ctIZ G�otih wo I ! !Z i m H r G� Ta P of 6,JG �m e C. I lc� � f� •.. � Tv O F lrr�q c(;I coo lc' <<J 0 0000`�" 0 0 0 0 0 m o o o C) 000 ^ TR 7 , 9"y ti COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAI AFFAIRS John Grad DEPARTMENT OF ENVIRONMENTAL PROTECTION DEP Title V Septic Inspector ONE WINTER STREET BOSTON MA 02108(617)292-3500 P.O.Box 2119 TeaTicket,Ma. (508)564-6813 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address:, 137 WALTON AV. HYANNIS LEFT SIDE SYSTEM Name of Owner JEANNE LAMONT Address of Owner: BOX 432 E.SANDWICH MA.02637 r 1 1 � Date of Inspection: 11/9/99 Name of Inspector:(Please Print)JOHN GRACI I am a DEP approved system inspector pursuant to Section 15.340 of T►tie 5(310 CMR 15.000)(rep LEedECompany Name: n/aOff/Mailing Address: n/a Telephone Number: n/a TOWN OF BARNSTABLE HEALTH DEPT.CERTIFICATION STATEMENTI certify that I have personally inspected the sewage disposal system at this address and that the informaej be s4rue accurate and complete as of the time of inspection.The inspection was performed based on my training and experience in the proper functi n and maintenance of on-site sewage disposal systems.The system: X Passes The Inpection Is based on criteria defined in Title V Conditionally Passes code 310 CMR 15.303.My findings are of how the system is _ Needs Further Eval ation By the Local Approving Authority performing at the time of the inspection.My Inspection does _ Fails not imply any warranty or guarantee of the longgevity of the septic system and any of Its components useful life. Inspector's Signature: y' Date:10/10/99 The System Inspector sh II submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)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. NOTES AND COMMENTS THE SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING THE SYSTEM EVERY ONE TO TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE.RECOMMEND KEEPING ALL GROWTH OFF SYSTEM.RECOMMEND RAISING COVERS TO SYSTEM. revised 9/2/98 Page 1 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 137 WALTON AV.HYANNIS LEFT SIDE SYSTEM Owner: JEANNE LAMONT Date of Inspection:11/9/99 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. COMMENTS: System passes Title V inspection B. SYSTEM CONDITIONALLY PASSES: n(a 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. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances.If"not determined",explain why not. nLa 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 complying septic tank as approved by the Board of Health. nla Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box.The system will pass Inspection if(with approval of the Board of Health). _ broken pipe(s)are replaced _ obstruction is removed _ distribution box is levelled or replaced n& 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 I , y revised 9/2198 Page 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 137 WALTON AV.HYANNIS LEFT SIDE SYSTEM Owner: JEANNE LAMONT Date of Inspection:11/9/99 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 16.303(1)(b)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 surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER.IF ANY)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 of 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 private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,Method used to determine distance nLa-(approximation not valid). 3) OTHER n& revised 9/2/98 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 137 WALTON AV.HYANNIS LEFT SIDE SYSTEM Owner: JEANNE LAMONT Date of Inspection:11/9/99 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: I have determined that one or more of the following failure conditions exist as described 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 X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet Invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow, X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped nla. X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well, X 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 ompounds, ammonia nitrogen and nitrate nitrogen. X The liquid level in the SAS is over the invert pipe,is in Hydraulic Failure. E. LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: The following criteria apply to large systems In addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X 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 owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 137 WALTON AV.HYANNIS LEFT SIDE SYSTEM Owner: JEANNE LAMONT Date of Inspection:1119199 Check if the following have been done:You must Indicate either"Yes"or"No"as to each of the following: Yes No X Pumping information was provided by the owner,occupant,or Board of Health. X 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. X As built plans have been obtained and examined.Note if they are not available with N/A, X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout, X All system components,excluding the Soil Absorption System,have been located on the site. X The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for,condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been determined based on: X Existing information,For example,Plan at B4O,H, X Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) (1 5.302(3)(b)] X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. revised 9/2/98 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 137 WALTON AV.HYANNIS LEFT SIDE SYSTEM Owner: JEANNE LAMONT Date of Inspection:1119/99 FLOW CONDITIONS RESIDENTIAL: Design flow: N g.p.d./bedroom Number of bedrooms(design): 2 Number of bedrooms(actual):2 Total DESIGN flow: 220. Number of current residents:A Garbage grinder(yes or no):MQ Laundry(separate system)(yes or no): XG If yes,separate inspection required Laundry system inspected(yes or no):JMQ Seasonal use(yes or no):JNQ Water meter readings,if available(last two year's usage(gpd): Wa Sump Pump(yes or no): NQ Last date of occupancy: 11/1/99 COMMERCIAL]INDUSTRIAL Type of establishment: n& Design flow: n(a gpd(Based on 15.203) Basis of design flow: n1a Grease trap present:(yes or no):AQ Industrial Waste Holding Tank present:(yes or no): NO Non-sanitary waste discharged to the Title 5 system:(yes or no):No Water meter readings.if available:nta Last date of occupancy: n& OTHER: (Describe) n1a Last date of occupancy: n& GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of Inspection:(yes or no):NQ If yes,volume pumped n/a_ gallons Reason for pumping: n(a TYPE OF SYSTEM X 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) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other: n/a APPROXIMATE AGE of all components,date installed(if known)and source of information: THE ORIGINAL YSTEM IS 30 Y AR OLD_ Sewage odors detected when arriving at the site:(yes or no) NQ revised 9/2/98 Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 137 WALTON AV.HYANNIS LEFT SIDE SYSTEM Owner: JEANNE LAMONT Date of Inspection:11/9/99 BUILDING SEWER: (Locate on site plan) Depth below grade: 4 Material of construction:_ cast iron X 40 PVC _ other(explain) Distance from private water supply well or suction line: TOWN Diameter: n& Comments: (condition of joints,venting,evidence of leakage,etc.) nta SEPTIC TANK: X (locate on site plan) Depth below grade: 2 Material of construction:X concrete_ metal_ Fiberglass _ Polyethylene _ other(explain) n/A If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): MO n/a Dimensions: S'X6'BLOCK CESSPOOL EMPTY Sludge depth: EMPTY Distance from top of sludge to bottom of outlet tee or baffle: n A Scum thickness:-nLa Distance from top of scum to top of outlet tee or baffle:_v& Distance from bottom of scum to bottom of outlet tee or baffle: JVA How dimensions were determined: MEASURED Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level In relation to outlet invert,structural integrity,evidence of leakage, etc.) MAIN CESSPOOL AND ALL COMPONENT ARE STRUCTURALLY SOUND RECOMMEND PUMPING SYSTEM EVERY ONE TO TWO YEARS GREASE TRAP: (locate on site plan) Depth below grade: Material of construction:_concrete_ metal_ Fiberglass _ Polyethylene_other(explain) Iva Dimensions: n& Scum thickness: nLa Distance from top of scum to top of outlet tee or baffle:-n/a Distance from bottom of scum to bottom of outlet tee or baffle jVA Date of last pumping: nLa Comments: (recommendation for pumping,condition of Inlet and outlet tees or baffles,depth of liquid level In relation to outlet invert,structural integrity,evidence of leakage, etc.) nla I revised 9698 Pa e 7 of 11 9 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 137 WALTON AV.HYANNIS LEFT SIDE SYSTEM Owner: JEANNE LAMONT Date of Inspection:11/9/99 TIGHT OR HOLDING TANK: NQ (Tank must be pumped prior to,or at time of,Inspection) (locate on site plan) Depth below grade: nta Material of construction:_ concrete_ metal_ Fiberglass _Polyethylene_ other(explain) nla Dimensions: nla Capacity: nla gallons Design flow: n& gallonstday Alarm present: NQ Alarm level:jV& Alarm in working order:Yes_No_ NQ Date of previous pumping: n(a Comments: (condition of inlet tee,condition of alarm and float switches,etc.) nLa DISTRIBUTION BOX: _ (locate on site plan) Depth of liquid level above outlet invert:n1a Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) I PUMP CHAMBER: NQ (locate on site plan) Pumps in working order:(Yes or No): MQ Alarms in working order(Yes or No): NQ Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) Wa revised 9/2198 Page 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 137 WALTON AV.HYANNIS LEFT SIDE SYSTEM Owner: JEANNE LAMONT Date of Inspection:11/9/99 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: n/a Type: leaching pits,number: 1000 GALLON LEACH PIT leaching chambers,number: -n/a leaching galleries,number: _n/a leaching trenches,number,length: n/a leaching fields,number,dimensions: n/a overflow cesspool,number: n/a Alternative system: n/a Name of Technology: ja/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE LEACH PIT IS STRUCTURALL SOUND AND FUNTIONINC PROPERLY THE PIT WAS EMPTY AT THE TIME OF THE INSPECTION. CESSPOOLS: _ (locate on site plan) Number and configuration: Wa Depth-top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer. WA Dimensions of cesspool: n/A Materials of construction: n/a Indication of groundwater: Wa inflow(cesspool must be pumped as part of inspection)n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a PRIVY: _ (locate on site plan) Materials of construction:n/a Dimensions:WA Depth of solids: n& Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) WA y , revised 9/2/98 Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 137 WALTON AV.HYANNIS RIGHT SIDE SYSTEM Owner: JEANNE LAMONT Date of Inspection:11/9199 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) n/a 5S 0 Cl - �� s Epe, revised 9/2198 Page 10 of 11 s' } ; SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART c SYSTEM INFORMATION(continued) Property Address: 137 WALTON AV.HYANNIS LEFT SIDE SYSTEM Owner: JEANNE LAMONT Date of Inspection:11/9/99 NRCS Report name: n/a Soil Type: n& Typical depth to groundwater: n1a USGS Date website visited: nla Observation Wells checked: N Groundwater depth:Shallow _ Moderate _ Deep _ SITE EXAM _ Slope _ Surface water _ Check Cellar Shallow wells Estimated Depth to Groundwater 12 Feet Please indicate all the methods used to determine High Groundwater Elevation: _ Obtained from Design Plans on record _ Observed Site(Abutting property,observation hole,basement sump etc.) _ Determined from local conditions _ Checked with local Board of health _ Checked FEMA Maps _ Checked pumping records _ Checked local excavators,installers X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS revised 9/2/98 Page 11 of 11 LOCQTIOKI SENAMC,E PERMIT UO. Al VILLAGE - - - - - - - IWSTQLLER'S UWE ADDRESS BUILDER 5 tJAMF-`\\ &.DDRESS DATE PER"VT 15SUED DATE COMPLI &MCE ISSUED : `i`Z--7Z yEa I /'ram �� ;, ,,, . >�.Y; i Fug.. �— THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALT OF.......... .. .�:all, �.............------ Appliration -fur Biipusal Works Tiattatrnrtijan Vrrni t Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal Syst al: --------•----- ....` /�< 6� —............. or Lot No. ; ...... J-G-�.h_. on ............. -^......... .........^-.•......... W �d Owne�a Address a .A. ...._ ..@ll - ------•------------------------------------------------ --------------------- Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling ZNo. of Bedrooms------------------------------ ------------.Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures ------------------------------ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons Length------------_- Width................ Diameter................ Depth.__..-._-.--_. x Disposal Trench—No--------------------- Width-------------------- Total Length.................... Total leaching area....-.--•--_.--_---_sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet-------------------- Total leaching area------------------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date......... ----------------------------- Test Pit No. 1________________minutes per inch Depth of "Pest Pit-.-_-___-_-_..______ Depth to ground water......._..--..-.-_.-__-- 44 Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water--.----..--.---.----.._. O of Soil--- ... -.----Description I - _V- v ----------------------------------------------- --------- 4-------------------------------------------------------------------------------------------------------------- W ------------------------------------------------------------------------------------------------------------- x U Nature of Repairs or Alterations—Answer when applicable.-. A( _..__ .�J__�__.______.__ ...... ....... ................. -----------------------------------------------------------------------------------------------•----------------------------------------------------------------------------------- ------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article \I of the State Sanitary Code— The undersigned further agrees not to place the system in ' operation until a Certificate of Compliance has bee is d by the board he Sign ": ... _Jr` �— ;- Date Application Approved By.._... . ---/L 4. ______ ____ _____ _ �`• ` Date Application Disapproved for the following reasons: --• --•..............•-.....__..........----•-------•-•---•---......--••-•-•-••-•--•-----•--•------------•--•- ...........................................................--------•--...--------•---.....--••------........--•--•-•---•--..._...........--•---•-- ... ..... --•--•-------- Date Permit No......................................................... Issued........ 1 Date v. IV:�..-• --- Fiz ..................�........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OE HEALTH .......j....G .... -- .OF.........� ✓�� ... . Gam ..... •.._................ Application -for I-4pooal Workii C onot u tion Vanift Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System ate: 6,ei" ---•--- •---.s..._...-----•-•---... "=~�..................... ....••.... ._............ . -•••-'-•---••---'•-•-•-'......--'-----•-- -----•. �t Locon:tr4 or Lot No. f \ fJ f r ........................•...... Address I. Owner !" ................................................................................................. fit} Installer Address Q Type of Building Size Lot----------------------------Sq. feet Dwelling eNo. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ---------------------------- No. of persons--.-__--.---------.-----_-- Showers ( ) — Cafeteria ( ) dOther fixtures --------------------------------------------------------..----------------------------------------------•--•---------------------•------------------- W Design Flow------------------..........................gallons per person per day. Total daily flow........................................-...gallons. WSeptic Tank—Liquid capacity------------gallons Length................ Width..--------- .... Diameter................ Depth....-..----_--- x Disposal Trench—No. .................... Width-------------------- Total Length-------------------- Total leaching area....--.-_---..._-_-_sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet-------------------- Total leaching area............__.._.sq. ft. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by------- ----------------•-----........•--...........-•-•- .... Date-------•------------------------------- ,� Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water........._-............. �14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water............------------ G --------------/---------_/------------------------- ------ '------•------------- .......-----...------------. Descriptionof Soil------ ---------- -rf---------•, - = k`! ...................................................... -------------------------- x f U ------------------------------------------•--.....---------------------........_....-- -------------------- ------------------------------------------------------------------------------- ------------------------------ --- } ,�} Nature of Repairs or Alterations—Answer when applicable....__ .. �r U P` l •-•---....----•------------------------------------ -------------------------------------------------------------------------------------------------------------- ------------------- ----- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been�i s d by the board of healt . S i g n e i ° - ' �' � ��-/. --- . ...-.�- V Date Application Approved BY------- --cam'. ----._. ... �_. /,t���... -------------- ---�--- S"- J�------------ Date Application Disapproved for the following reasons:----••---------------------•----•--•-----------••-•----•--------••-•--- ----------------.------------------ •................•........•-••--•--------------------------------------------------•.................................................................................................................. Date PermitNo........................................................ Issued.................................................. Date THE COMMONWEALTH OF MASSACHUSETTS,- BOARD OF SALTH� '.?...........O F.............I.. ...... G2- ..,....... ,/2 01rrtifiratr of �11mp iaurr IDS IS TO CE_ !%IFY, That the Individual Sewage Disposal System constructed ( ) or Repaired byl._ot✓da- c -------- I ---•-•---..�e"'d'\-•-•----•-•-•- -•-----••---.....- ----------- 0 �f- ` � I has been installo in accordance with the provisions of : c�tiflel XI of The State Sanitary Code s described in the application for Disposal Works Construction Permit No------------------------------ ��____-----_.- dated.._—:.. � ---?'--- - THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARA EE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE . ' /` Inspector ------ ---- 77- _ THE COMMONWEALTH OF MASSACHUSETTS 6110) BOARD OF HEALTFJ �-4.. No.........................'•--•• FEE----................... Dinpwittl orkii Tonstrurtion Prrmit Permission is hereby granted------• > 1'��'t�`� ------------------- ............................................. to Construct1( ){br Re}air ( •�an Individdua ewa e : is System at No.------- r........I. !'° � F 7 .... - �2. stre t ' _ as shown on the application for Disposal Works Construction Per No.-. ._.:.. _✓ ated----- '. '... 7 Board of Health DATE------" ' ---------------------------- ----------------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS No......91::.2 3 Yuj; �, THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH I.A0 Lbw ......OF .....wl.� V.-.4t;...��p........................................ Appliration for Bhnposal Works Tonstrurtion ramit Application is hereby made for a Permit to Construct or Repair ( LT*an Individual Sewage Disposal System at: ....Va.7......... ... . ....%............ ...................R4..A.P:-mu�.5.................................................. Location-Address or Lot No. V.N MIN M.47 .:k.....V...................... .................S-kot it, ...............!� JF......................................................... Owner Address ................... ............ ......... ............. ....................................Installer Addres`s" M Typ e of Buildifig Size Lot............................Sq. feet U Dwelling'—No. of Bedrooms ................................Expansion Attic Garbage Grinder Other—Type of Building ____________________________ No. of persons............................ Showers Cafeteria Otherfixtures .............................................................................................................. ................................. Design Flow............ .....................gallons per person per day. Total daily flow...... �'0......................gallons. 9 Septic Tank—Liquid*capacity............gallons Length................ Width__.............. Diameter.............._. Depth................ Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......1.............. Diameter..__._.LZ)`...... Depth below inlet......6(......... Total leaching area..................sq. f t. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit_____.__....__...... Depth to'ground water...___.............._... ............................................................................................................................................................. 0 Description of Soil..................................................................................--------------------------------------------......................................... W U ........................................................................................................................................................................................................ W ......................................................................................................................................................................................................... U Nature of Repairs or Alterations—Answer when applicable.-----4-4-0 ....)e-r-4a..... ................. ......P4:-(------ ............................................................................ .......................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TL I Tx 1E 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board ofAiealth. Signed----------------- Z%...... ............................................. ......IS ........ Date Application Approved By............ ....................................... Date Application Disapproved for the following reasons:................................................................................................................ .........................................................................................................I.............................................................................................. Date PermitNo........ .................... Issued....................................................... Date No...... Fma....D6.. ...._.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ... ......Z_70��......OF .................................................................... Appliration for Disposal Works Tonotrurtion Prrmit Application is hereby made for a Permit to Construct or Repair (�n Individual Sewage Disposal System at: ........... ...... .......... ....................... .......................................... Location-Address or Lot No. ........................ .......... ............................ ..................... .................................................... Owner ddress (�A ............ .................. .............. ..'............................... ................................... Installer -Mress M U 14 Type of Buildifig Size Lot............................Sq. feet Dwelling—No. of Bedrooms.......&................................Expansion Attic Garbage Grinder Other—Type of Building ............................ No. of persons___.___..._.........._.._... Showers Cafeteria PL4 Other fixtures ---------------------------------------------- -------------------------------------- .................................................................. W Design Flow..................... .......--__gallons per person per day. Total daily flow.......... ................gallons. 9 Septic Tank—Liquid capacity............gallons Length................ Width....._.____..___ Diameter_........._..._. Depth................ Disposal Trench—No..................... Width...`.............. Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.........I........... Diameter....k..G?.------- Depth below inlet.._............ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit_..._...........___. Depth to ground water------------------------ rX4 Test Pit No. 2................minutes per inch Depth of Test Pit._.................. Depth to ground water.________.__.._......... 04 ...............................................................................*............................................................................... 0 Description of Soil.................................................................I...................................................................................................... �4 U ........................................................................................................................................................................................................ --------------------------------.............................................................................................................................................................. U Nature of } ep 'rs or Alterations—Answer when applicable........... .".)0........ ............... ............ .............................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The Undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by tktJ)_oard of healt Signed. ......�S\, .......�S'. ---- ....... ........... ..... Date Application Approved By............ . ...................................... k..�..... Z� Date Application Disapproved for the following reasons:................................................................................................................ ......................................................................................................................................................................................................... Date PermitNo....... ....... .................... Issued.----------------....................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...OF. ...... ok. ........................ ........ .. (Intifiratr of Tontpliaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired by--------------------- ........r..........�_.K_VIA..... -- -------------------------------------------------- .............................4.. 7......��V N_ - Installer ...�.Xrj 411-. ............. --------t-- ------------------------------------------------------- has been instilled in accordance with the provisions of T-1 T'I" f The State Sanitary Co s 4 c *bed in the 0 C. application for Disposal Works Construction Permit No.-___-___ -9- -a-1.. ....... di --------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.................... .......�.7....................... Inspector................ .............................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH L. ....................... No.u.-�I..'?.... FEE..011u............. Disposal Works TIMnstrurtion Prrmit .0,Permission is hereby granted......... - . ..... ................................................................... "t6'Construct or Repair (,') _�,UIndividual Sewage Disposal System at No. L. -------------------------------------------------------------------- �...... ............ 2),....... ............I- 47-Street as shown on the application for Disposal Works Construction Permit No9'n)-R__..Dated.......................................... ................................... -------- -------------------------------------------Board of Health DATE------------ ............ • /...................................... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS TO"lN.OF BARNSTABLE 02ATION VJ X Xc-)W AV-f- SE We GE # "tM f L- VILLAGE 0--/(AV X A 5 ASSESSOR'S MAP LOT INSTALLER'S NAME & PHONE NO. �A4 SEPTIC TANK CAPACITY 09?< r f 0 LEAGHING FACILITY:(type) 46'V' PM— (st%-e)_ .NO. OF BEDROOMS 3 PRIVATE WELL O PUBLIC_W BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUEDr VARIANCE GRANTED: Yes No `. �,, ;, �� .:� \ �1�'� f �✓�/ + � ` W ,. sz. No(i Fins...... ................... THE COMMONWEALTH OF MASSACHUSETTS BOARD 0 HEALTH 61 ............................................... e ......OF.......... Appliration for Disposal Works Tonstrurtion Vrrmit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal stem at* . ... .......... . ...a................................... ........... -------- .................... .............................. Ltali:;-.Address or Lot No. ... .................................. ......... .... .. ....... ........... .. ....................................... w er, Address ....................... ........... ........... ............................ In r Address T of Building j Size Lot............................Sq. feet Dwelling—No. of Bedrooms............... ..........Expansion Attic Garbage Grinder Other—Type of Building anc. o. of persons............................ Showers Cafeteria Otherfixtures ...................................................................................................................................................... Design Flow............g..0......................gallons per person per day. Total daily flo'w......../9 ......................gallons. 1:4 Septic Tank/—Liquid capacity/407t'Allons Length................ Width__....._.....___ Diameter................ Depth________._._._.. Disposal Trench—Ny I...................... Width....._.............. Total Length......._...... Total leaching area....................sq. f t. Z)Seepage Pit No..._.... .... ...... Diameter......./ ........ Depth below inlet..Y�,�. Total leaching area..................sq. ft. Z Other Distribution box Dosing tank C) C Percolation Test Results Performed by---C/1--s.................................................... Date... ...dfpf. �4 Test Pit No. 1................minutes per inch Depth of Test Pit.____._._____._...__ Depth to ground water.... . .../1'r,_ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.._................. Depth to ground water.....____..........._... ............................... ... "i,*------------ . . ........... hZ,,t-',VV------------P/- ... ........ ..... ... ..... ...... 0 Description of Soil .......Y. A,--- ------------- ....... .. ..... .......... ........... ................ .... ....................................... .................................... . ........... ............................................. .............................................................................................. .. . . ........... 2-7.7,9--.- .. ........... ............ U Nature of Repairs or Alterations—Answer when applicable------------------------------------------------------------------------- ...................... ..................................................................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TL IT�!Z- 5 of the State Sanitary Code— The i gned further agrees not to place the system in operation until a Certificate of Compliance ha en i ed b %:: oarof I xigne .... . ......... ...........t............................ .................. ............................... 'r Date Application Approved By......... .. .. ...... ... .. .. !n.7.f...I..... .1.. ....... CT_-.F Date Application Disapproved for the following reasons:..................................... ................................................................... .................................................................................................................................................................................................... Date PermitNo......................................................... Issued...._'_........................................ Date 07f No. ........ ...... . Fizs .... . ........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........OF.......... . tr!' 'b 'h.` Appliration for Ui4pns al Works Tonstrurtinn anti# Application is hereby made for a Permit to Construct. ( ) or Repair ( ) an Individual Sewage Disposal System at .... .... ..� ............... :_ .-=--•-----••-•................................. ............ ---------- ............- ----- --------------------.....: .� ... L .at,on dress or Lot No ' . ................................................. ... _ .. ...... .... A§............................ er .i.. W A dd re e � I r Address T of Building ` Size Lot---------------- q. feet Dwelling—No. of Bedrooms._.. } "'�°"r_._.___Expansion Attic ( ) Garbage Grinder ( ) `4 a Other—TYP of Building -e �--Y �o. of persons............................ Showers ( ) — Cafeteria ( ) d�*�' i P' Other. fixtures .................................................... W Design Flow_........... ..._...'.................... gallons per person per day. Total daily flow---=,__, ......................gallons. WSeptic Tank/Liquid capacity// allons Length................ Width................ Diameter................. Depth................ x Disposal Trench—N ................... Width.................... Total Length...... ._ Total leaching a�ea----_...............sq. ft. Seepage Pit No ......::....... Diameter ..A?....... Depth below inho_�1..._ otal leaching area..................sq. ft. Z Other Distribution box ( ) Dosingtank ( ) 0 `� v Percolation Test Results Performed by...C/TS..................................................... Date...1 _:.__. ��a Test Pit No. I................minutes per inch Depth of Test Pit...........___....._ Depth to ground water.....49_ p � p •-. ,.., ,.. , -fs, Test Pit No. 2.......:.:.....mmutes per mch Depth of Test Pit..................... Depth to ground water----------------------- r ....ODescrip'on of S �� y .ld -- - ---------- •__ .. x .................................................... -----•--•---•--•---•---------------------••-----------•----•------•---------:- ••••. t ...... W ............................................ •...............................................................................:_........................................................................ Nature of Repairs or' U p ' Alterations—Answer when applicable..................=----------------............................................................. -----------------------•........................................... ...................::::............................................................................................................ Agreement; The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the.provisions of TIT1,;,,. 5 of the State Sanitary Code— The igned further agrees not to,place the system in operation until a Certificate of Compliance h I -en i ed b oa of al Signe -- •---- Date '. Application Approved By--•••..•t•----•--••.--• ... ..... •--- -' .G:4....... .•• "` ------- Date Application Disapproved.for the following reasons:.....................................................................................--•----••-••••-•............................ --•---•-------•------•----•----------•---••-----------•------------------------------------------------•-•------•---•--_.----••--•------•-•-•---•••----•••------•------•-•---•-•--------••-•-•••........ ate •-- Permit No......................................................... Issued..• - • _11-----=`-----•.--------...--- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD 09 HEALTH . .. OF.. * it - L ,►..,,. .............. (9rdifiratr of TnntfliFanrr LT ISTO RTI Y, T the Individual Sewage Disposal System constructed ( or Repaired �y Ipst ler ._. .._._ at has been installed in accordance with the provisions of TI 5 f The State Sanitary Code described in the application for Disposal Works Construction Permit No."!_: ____ _ ______________ dated. .. _. € "'. .._. y.,,THE,ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE ' .A. � CO ED S UARA' N J,E�E_THAT THE TSYSEI: A L FUN TION SATISFACTORY. .. .................................... Inspector----- -------------••----- ..._.DATE THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .. ... -'t<,.'`.... k ..................................... - No._.......1 �........ FEE ._ .......... Dis01a arks n nlr inn rrntit Permission is hereby grant ?.to Construct ) or pair ( tr I ivid al Sew Dispos S stem --C� atNo`" ,�'�-......! ?'-... . .�...�....... ---.w------------------------------- -------- -------- -------- ---•-••-- Street as shown on the application for Disposal Works Construction�Pc No. ,n...._._. Dated.._ .�....'� ......... ' �. . .... r + oarti dHealth DATE....: ............................................................ I FORM 1255.-HOBBS & WARREN, INC., PUBLISHERS - :,:. 4 i �o ,ee.sac sJr `U X \ ? ive � CvAE�E.yoIJSE Q (� o� C o�C 2ETL •� � � "1 �gsSa #534445—! — _ z97 IA vi 4 CT o l' Tom ,ANON. yl�•�/,/oG�S ` 425 Aelq I •p p: c4vvc Scft yo _ wit • 'yc .scf-/ Sao sE.�ric'7.9N,�C 75'c7 �' 3 1p ❑° - 3 R ° s --� GA�Q AG s r- _ LEY cgG y"T��1 .O G�el�n�� _ z« �`. y L�LEy ov llJ.q 401 P,e o,0©.5 '=4D �q�c Q ` L G. IJ!•- 3C = f� /ZSc All CP F 7'rAl r� Tc } /,S O'ss/r, '/ --/.0 Ale, �o� �AG/0'O9 Y . f .'/9/� IPA?C)uThl i SITE PLAN SHOWING PROPOSED CONSTRUCTION r FOR : . ��' y� �`�'�,= ,�; APPROVED 1 9 7 7 SCALE ���_= A � . � ,� , TE• BOARD OF HEALTH REFERENCE : ./ G La ' .3-9 2o ;`�`' J��+../ DATE A G E N T - *LStt 4r ke,, M K. Cs JOSEPH M. , 3 �a ' C M S ASSOCIATES, INC . a MORAHAN A, I TEP�@►``�� REGISTERED ENGINEERS & LAND SURVEYORS " 13660 Fss�UNAIE��'� MID-CAPE OFFICE BUILDING - 1265 ROUTE 28 su _tl_l "fe SOUTH YARM OUTH, MASS. 02664 � 7! f j t FINISH GRADE OVER D-BOX= 41 .6'± FINISH GRADE OVER CHAMBERS= 41.1' - 42 PROP.VENT WITH CHARCOAL FILTER TO ABOVE GRADE GENERAL NOTES .3' TOP OF FOUNDATION PROVIDE EXTENSION RISER WITH SLOPE @ 2% MIN. OVER SYSTEM 3/4"TO 1-1/2"DOUBLE WASHED ELEV.= 50.1'± COVER OVER INLET&OUTLET TO E WATER-TIGHT COVER OVER STONE TO CROWN OF PIPE 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION WITHIN 6"OF F.G. (TYP OF 4) ITHIN 6"OF FINISHED GRADE 4"SCHEDULE 40 PVC INSPECTION PORT WITH ACCESS METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL 5"DIA. OUTLETS MIN SLOPE 1% 2"OF 1/8"TO 1/2" DOUBLE WASHED ( ) BOX TO F.G. (SEE NOTE 20) CODE AND ANY APPLICABLE LOCAL RULES. 20"MIN.ACCESS fi7 _ -_ _ __._^ STONE OR GEOTEXTILE FILTER FABRIC F.G. OVER TANK EL.= 4g,2'± F.G. OVER TANK EL.= 44,1'± (TYP OF 6) I -- - - - - - - -- -- - - -- - -- -- - -- --------- -- 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE F.G. OVER TANK EL.= VARIES , PLACE RISERS ON ALL DESIGN ENGINEER. n 9"MIN. TOP OF SAS =38.30 CHAMBERS WITH 9 MIN. 4"PVC TEE 36"MAX. 4.0 MAX. 3. 4 SCHEDULE 40 PVC PIPE WITH WATERTIGHT JOINTS SHALL BE USED IN DISPOSAL PROPOSED 36"MAX. PROPOSED 39"MAX. PROP.4" 37.30' SEE NOTE 21 BREAKOUT EL= 37.80' INLET PIPES TO 6"OF SYSTEM UNLESS OTHERWISE NOTED. 4"SCH. 40 PVC 4"SCH. 40 PVC I FINISHED GRADE SCH.40 PVC I 4. TO PREVENT BREAKOUT,THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN 3" 3" TO D-BOX L = 16'± ELEVATION = 37.80 FOR A DISTANCE OF 15 AROUND THE PERIMETER OF THE SAS. UNLESS A SLOPE 1°�min. L=89'± 7 PROVIDE WATERTIGHT -� 3"DROP MAX_ 9" min. 6"0 3" 9. 3' f 4" PVC IN FROM JOINTS(TYP. o 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF SEE PLAN 13" = 3"DROP MAX. 1 9 min. SSEPTIC TANK 4"PVC OUT TO O o o O THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. -- --- 4'-0" 14" 46.25 13 f 14„ LEACHING FACILITY o � LIQUID _� 4'-0" oo 0 0 0 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. 46.50' �INLET LE ELL 40.00' LIQUID 39 75' 12~ 6" o0T + OUTLET TEE GAS BAFFLE LEVEL 37.67' MIN. 37.50' 2' oo 00-0 0 0 'DC" 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. 0.7 00 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK ALL TEES SHALL BE PLACED DIRECTLY INLET TEE TEE LET 6"CRUSHED STONE °° o00 oo FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS UNDERNEATH CENTER OF RISERS OVER MECHANICALLY 00 0 0 C) NOTTO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH GAS BAFFLE COMPACTED BASE AND DESIGN ENGINEER. uuiv r tau i+Jr� i o V r�i t- �f t�Lz_ EXISTING 5 OUTLET DISTRIBUTION BOX 2.75' 8.5'(TYP) - I 2.75' 3.5' 3.5' ELEVATIONS PRIOR TO CONDUCTING ANY 6" CRUSHED STONE 4.83' 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM, BENCHMARK ELEVATION OF 50.00' n,�r r�r,. r�lf ±r.�FFt I� n(FF PF7NjT OVER MECHANICALLY TO BE INSTALLED ON A LEVEL STABLE 31 0� (TYP.) ESTABLISHED ON A NAIL SET IN 18"TREE AS SHOWN ON PLAN. LENGTH 10'-6" WIDTH 5'-8" DEPTH 5'-8" COMPACTED BASE LENGTH 10'-6" WIDTH 5'-8" DEPTH 5'-8" PIPES TO BE LAID LEVEL BASE. FIRST TWO FEET F OUTLET 1,45.30' GROUND WATER ELEV.= 30.00' 11.83' 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION PROPOSED 1 ,500 GALLON PROPOSED 1 ,500 GALLON 3 - 500 GALLON H-20 CHAMBERS 5' MIN' CHAMBER END VIEW THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT CROSS SECTION VIEW 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES H-10 SEPTIC TANK #1 H-10 SEPTIC TANK #2 H-20 DISTRIBUTION BOX DETAIL TYPICAL CHAMBER PROFILE H-20 CHAMBER DETAILS TO THE DESIGN ENGINEER. NOT TO SCALE NOT TO SCALE NOT TO SCALE NOT TO SCALE 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT. • TEST PIT DATA 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING SWING-.TIES R I ; REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM b 2 PERC NO. 14815 APPROPRIATE AUTHORITY. DESCRIPTION HCA HC-2 SC DC INSPECTOR: David Stanton, R.S. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS ♦ EVALUATOR: Michael Pimentel, EIT, CSE LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE TANK#1 INLET COVER(1) 44.3' 17.8' -- -- MAP 310 ® *• C.S.E.APPROVAL DATE: Oct. 1999 THEY SHALL WITHSTAND H-20 LOADING. TANK#1 OUTLET COVER(2) 47.9' 17.0' -- -- MAP 311 LOT 330 Q ~ 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. LOT 75 X�X\ ! . � DATE: Sep 15, 2015 TANK#2 INLET COVER(3) -- -- 34.9' 38.6' k� TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE F • MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. TANK#2 OUTLET COVER(4) -- -- 39.8' 44.1' 40x6' ' ""v ENCE ROPOSED 4" PVC VENT PIPE; 0 ELEV TOP= 41.50 REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, 40x8 X-,X\ (Type k _ EXACT LOCATION PER OWNER i4 ELEV WATER= <3 ) i�0 FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). CORNER OF STONE(5) -- -- 48.7' 61.3' PROPOSED 3-500 GALLON X�X • H-20 LEACHING CHAMBERS 1 ` 40 9�k��. -- • PERC RATE _ <2 min./inch 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN CORNER OF STONE (6) -- -- 59.5 71.3 SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. T 1' WITH AGGREGATE 40x8 X� o " " LOCUS DEPTH OF PERC= 48 -66 16. PROPOSED PROJECT IS LOCATED WITHIN: CORNER OF STONE(7) -- -- 76 62. k , 41x0' 41x4' nN CORNER OF STONE 8 -- -- 68 50.3' PROPUSED H-20 TEXTURAL CLASS: 1 O .T ASSESSOR'S MAP 310 LOT 328 ' • DISTRIBUTION BOX \ter' 8" 12"' 41x7' S77° 10'41"E J /l. O _ - OWNER OF RECORD: MARCELO$KELLY FONSECA \ 6) TP 1 iy 183.01, a 41 x5' N� d 0" 41.50' 41 x3 ADDRESS: 137 WALTON AVENUE \ - 5" (7 TREEL1NE T( YPj_ -42 Fill HYANNIS, MA 02601 40.50 O TP 2 _ k. I M ° aE 2 Loamy Sand FEMA FLOOD ZONE X "' "- -� APPROX. LOC. OF EXISTING _ -- \ 42x0 �42x4' �' � 10 Yr 3/3 COMMUNITY PANEL# 25001C0566J EXISTING CESSPOOL TO BE \ �_ LEACHING PIT TO BE "� g 14" 40.33' PUMPED, FILLED w/ CLEAN 46- 31• , 8) (3)-12" OAKS 5) 42- 0 42x3' � PUMPED, FILLED w/ CLEAN 17. DEED REFERENCE: L.C.0#169940 SAND & ABANDONED \ SAND & ABANDONED B Loamy Sand LP � 10 Yr 5/6 18. PLAN REFERENCE: L.C. PLAN#17201-G MAP 310 \ 4) STONE DRIVE 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. 1 `C?LOT 301 48 37.50' X \ �� O 4 P Perc 20. A 4" PERFORATED SCH. 40 PVC PIPE SHALL BE PLACED IN A VERTICAL POSITION TO A 4�� '42xT DEPTH OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3"OF FINISH GRADE. A 66 PROPOSED 1,500 GAL. / 1 s° \ I 36.00' REMOVABLE THREADED CAP SHALL BE PLACED ON THE TOP TO ALLOW FOR INSPECTIONS. H-10 SEPTIC TANK#2 / 14" 4 3) '" Med.to Coarse Sand \� 6 4 5„ \ F3JT D C 21. IN ACCORDANCE WITH 310 CMR 15.401 -15.405,T-HE FOLLOWING LOCAL UPGRADE APPROVAL IS REQUESTED FROM 310 CMR 15.221(7): S \ _ - 0%gravel)C iNV.=40.5'± 43x0' (5-10°� \ es (1.) A 1.00'WAIVER(3.00'-4.00') FOR THE MAXIMUM COVER OVER THE LEACHING SYSTEM. 48_ S 43x6' SHEDLu--- LOCUS PLAN a 2 43x2' W Z j SCALE: 1"= 1000' 138" 30.00' LEGEND N h 48x PATIO C rn , No Mottling, Standing or Weeping Observed „ ^ Q 50xO EXISTING SPOT GRADE DECK ti- Z W _ TEST PIT DATA _ _ 5a �'�\ ° 0 o DESIGN DATA EXISTING CONTOUR O� s' MAP 310 #137 N' o PERC NO. 14815 EXISTING 50 PROPOSED SPOT GRADE LOT 300 BEDROOM °� INSPECTOR: David Stanton, R.S. 20 NUMBER OF BEDROOMS(ASSESSOR) 2 rpm PROPOSED CONTOUR EVALUATOR: Michael Pimentel, , I x DWELLING y��. EIT CSE �r x TOF=50.1'± °may NUMBER OF BEDROOMS (DESIGN) 3 MIN. PER TITLE 5 C.S.E.APPROVAL DATE: Oct. 1999 0/H/W-- EXISTING OVERHEAD UTILITIES 18" BFE=43.3'± DESIGN FLOW 110 GAUDAY/BEDROOM Benchmark � DATE: Sep 15,2015 T� C-2 w G A`'�R�X LO \°iy� TOTAL DESIGN FLOW 330 GAUDAY GAS EXISTING GAS LINE Nail Set in 18"Tree 49x0' r-1NV` AS ,C. � TEST PIT#: 2 Elev. =50.00' 49x2 49x2' ,� 47 7 \i cqs ��� _,_ °�y�w DESIGN FLOW x 200 % = 660 GAUDAY ELEV TOP = 42.00' W W EXISTING WATER LINE A rox. M.S.L. / 2 1R• '�-,. ( CAS - USE PROPOSED 1,500 GALLON SEPTIC TANK ELEV WATER I 49x0' (1 O INV.=47.4'± C-1 CAS- TEST PIT LOCATION � 49x2' PERC RATE _ EXISTING CESSPOOL TO BE O O O PROPOSED 1,500 GALLON H-10 SEPTIC TANK PUMPED, FILLED w/CLEAN MAP 310 INSTALL 3 - 500 GAL. H-20 CHAMBERS W/ STONE DEPTH OF PERC = � SAND &ABANDONED- - - ._. __. ROPOSE 1,500 GAL. TEXTURAL CLASS: 1 CID H-10 SEPTIC TANK#1 LOT 328 PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE 49x1' 36,719 S.F.± SIDEWALL CAPACITY (LENGTH + WIDTH) (2 SIDES) (2' HIGH) (0.74 GPD/S.F.) = GAUDAY O PROPOSED H-20 DISTRIBUTION BOX 486'-- (31.0'+ 11.83')(2 ) (7 ) (0.74 GPD/S.F.) = 126.8 GAUDAY 0" 42.00' PROPOSED 500 GALLON H-20 LEACHING CHAMBER r 49 x 3' 60'WIDE TELEPHONE EASEMENT Fill� LP BOTTOM CAPACITY 12" 41.00' APPROX. LOC. OF EXISTING (LENGTH x WIDTH) (0.74 GPD/S.F.) = GAUDAY A/E Loamy Sand MAP 310 j LEACHING PIT TO BE 49x0' 49x1' (31.0'x 11.83') (0.74 GPD/S.F.) = 271.4 GAUDAY 14„ 10 Yr 313 LOT 299 PUMPED, FILLED w!CLEAN b 40.83' SAND & ABANDONED o Loamy Sand _ TOTALS: + B 10 Yr 5/6 REV, DATE BY APP'D. v _�,�_,.- - _ - - - - - - - - -X-X-X-X-X-X-X-X-- S880 34'00"E DESCRIPTION/ 183.37' TOTAL NUMBER OF CHAMBERS 3 TOTAL LEACHING AREA 538.1 SQ.FT. 48" 38.00' PROPOSED SEPTIC SYSTEM UPGRADE i TOTAL LEACHING CAPACITY 398.2 GAL./DAY PREPARED FOR: Med.to Coarse Sand CAPEWIDE ENTERPRISES C 2.5Y 6/6 (5-10%gravel) LOCATED AT 60'WIDE TELEPHONE EASEMENT 137 WALTON AVENUE HYANNIS, MA 02601 NOTES: MAP 310 138" 30.50' SCALE: 1 INCH = 20 FT. DATE: SEPTEMBER 21, 2015 ' 0 10 20 40 80 FEET LOT 327 1 No Mottling, Standing or Weeping Observed `t\oF MASS4C 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF EACH SEPTIC SYSTEM COMPONENT. �P� yGs __ ___�___,___,_--_._ -_ _�___ mow FT PREPARED BY: RESERVED FOR BOARD OF HEALTH USE - Jy �oHez �s�' JC ENGINEERING INC. 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF THE PROPOSED LEACHING SYSTEM TO CHURL 1` �- ENSURE CONSISTENCY WITH TEST PIT DATA SHOWN ON THIS PLAN. REPORT TO ENGINEER AND LOCAL BOARD ` 2854 CRANBERRY HIGHWAY OF HEALTH IF SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. EAST WAREHAM, MA 02538 3). ENTIRE PROPERTY IS LOCATED WITHIN THE GROUNDWATER PROTECTION OVERLAY DISTRICT. SITE PLAN 0 .508273.0377 _ ---_ -.2 wn By - SCALE: 1" =20' Dra : JC Designed By MCP Checked By: JLC JOB No. 3242