HomeMy WebLinkAbout0046 WASHINGTON AVENUE - Health 46.Washington Avenue,Hyannis
I
It I
0
i
i
TOWN OF BARNSTABLE
LOCAI'ON SEWAGE#
VILLAGE / �'a����'>�lfi i� ASSESSOR'S MAP&PARCEL ���9�
INSTALLERS NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) �"�� � (size)-/
NO.OF BEDROOMS
OWNER -f�(->eetrO
PERMIT DATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist
on site or within 200 feet of leaching facility) ,/ Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) �� Feet
FURNISHED BY � �G' �
S � t
1- - =�k
J
- � � � � �
s � �`" �
� � � � ! � o
� � �'` �
. ,
n :�
�� � �� I�
� � � �
�� � t � �
� � o � `�
�.�e �
�. :�,,
� -
No.::==� Fee
THE COMMONWEALTH OF MASSACHU.SETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION TOWN OF BARNSTABLES MASSA"CHUSETTS
01pplication for MtopooY Permit
Application for a Permit to Construct( �epair( )Upgrade(114bandon( ) El Complete System O Individual Components ,
Location Address or Lot No. ?A,i 'd Owner's Name,Address and Tel.No.
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No:
,row
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date.
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been iss
Signed Date
Application Approved by Date 7
Application Disapproved for the following reasons
Permit No. Date Issued
�X, •'t
Fee l� V
No. \.
THE COMMONWEALTH'OF MASSACHUSETTS` Entered in computer: Yes
PUBLIC HEALTH'.DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
ZIpplicatton-for Ziopoal *pztem Con!5truction Permit
Application fora Permit to Construct( Wepair( )Upgrade( bandon( ' ) 0 Complete System 7 Individual Components
Location Address or Lot No. �7P/L/,'d_ wner's Name,Address and Tel.No. .
Assessor's Map/Parcel ,,-
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms S 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 �'1 -gallons.
Plan Date :5�e— 3"o Number o'"sheets Revision Date
_. Title
,:. Size of Septic Tank Type of S.A.S. L r
Description of Soil ^~°
r
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected: r
Agreement:
The undersigned`agrees to ensure the construction and maintena c of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and riot to place the system in operation until a Certifi-
cate of Compliance has been issue :his Boar of ealth
Signed Date
11r-7—d61
Application Approved by Date-
L 7 CY
Application Disapproved for the following reasons
Pernut No. '"1 no _(h 1 Date Issued
————-—————————————— ———————————————— —
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate ,of Compliance
THIS IS TO CERTIFY,that the On-site��e Disposal System Constructed( )Repaired ( s�pgraded( A)
Abandoned( )by C//h C�"�®�``
at- 15_--,< "_., r,�l i k< 9"o w .4!� �t%��'�'dt;1' has been constructed i accordance
with'the provisions of Title 5 and the for Disposal System Construction Permit No. 6nY Q /A 2 dated Li -7 (7
Installer J A M L e f U Designer --)c,� .r M
The issuance of this permit shall not XP5
constru d as a guarantee that th system t n tion as designed;
Date !:5 A Inspector 1
V
No. Fee nr� J)
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
]0igooal *potent Con!6truction Permit
Permission is hereby granted to Construct( pair( )Upgrade( A),Kbandon( ) '
System located at �� lilii4.r.�/i�✓� rO'/✓ ALA �dY,���� T
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided: Construction must be completed within three years of the date of this permit.
Date: Approved by _ iJ
l
Mau 17 06 09: 07a p. 1
s
, Town of Barnstable
�TM
'.. Regulatory Services
Thomas F.feller,Director
19A'�kNFP.1�Bk�
q ftblic Huth Division
Thomas McKean,Director
200 Main Street,Hymnis,MA 02601
Office:.508-8624644 kax: 508-790-6304
Installer&Designer Certification Dorm
Date:
Desi er: Installer:.
Address: . L Address.- {
Oa was issued a permit to install a
(date) (installer)
septic system at L�1 based on a desiign drawn by ,
(address.)
b dated r
ing t
T o'GGrtlyt at the septic s tem refertmecd above was installed substantiall accord-
the design, which may include r aimr approved Uumges such as lateral �relooation of the
llib on boX: xt1/rflr. tt iL V;W� 0 lh
°1 cerkitfy that the septic syst= referenced above was iwtadled with major ch,mges
X=telr tkzan 10, lateral rolocati on of the SAS Or any veitcal rclocat ions of any componc nt
of the sclptic system)but in accordance with State&Local Regulations. Plan.revision or
cmtiled as-bunt by designer to follow.
�ytN OF R4q
DAVID '
�•
e s Signn re) MASOt4
No.1066 o G;
CIS TV.S
s'INI7ARta
(i)cs gu Si nit (Affix Igner's Stamg Here) —
,PLEASE RETURN TO BA i S'1CABLE PUBLIC: HEALTH D S10N. C ,1R'R'JFJC:�NTP,
Cab' COI ffL CE '4 ML NOT BE ISSUED I3N'lt'IL BOTH :MIS FORM AND AS-
IiUI f CAR?ARE RE,ECEWE T)BY THE.]B.A_ R NSTABLE PUBLIC HEALTH DI'vISION.
THAW YOU.
Q: Hen1th/Septic Dosit ner Certification Point
/ TOWN OF BARNSTABLE
L
OCATION I
t)2.4 �� SEWAGE #
;LAGF? ASSESSOR'S MAP & LOT O �3y
PHONE N -
SEPTIC TANK CAPACITY —
LEACHING FACILrrY: (type) (size)
NO.OF BEDROOMS S�
BUILDER R OWNE 4222 .Po P A
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
i'rivate 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 !b 7
_.._ _.�
�/'�l� �,
V
�1
r---- - _
- --- - - - �
aY�� —
�e
OM
BORTOLOTTI CONSTRUCTION,INC. tiN -"(' eyls�ebg�p�y
765 WAKEBY ROAD,MARSTONS MILLS, MA 02648 6'l
6�
508-771-9399 508-428-8926 FAX: 508-428-9399 ,•n 9�4/
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FO �j�A
PART A .
CERTIFICATION V
Property`Address:✓
Date of Inspection:V1101q-7 Inspec Na '
ees ame and Address: ,
CERTIFICATION STATEMENT.
I certify that I have,personally inspected the sewage disposal system at this address and that the informa-
tion reported below is true,accurate and complete as of the time of inspection. The inspection was per-
formed based on my training and experience in the proper function and maintenance of on-site sewage
disposal0stems. The System:
Passes
Conditionally Passes
Needs Further Ev luation B the Local Aproving Authority
Fails
Inspector's Signature: Date:_ �11f�7
The System Inspector shall submit .copy of this inspection report to the Approving authority within thir-
ty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 I
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.
iNCPECTION SUMMARY:
A)SYS17f#PASSES:
y' I have not found any information which indicates that the system violates any of the failure
criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated :
below. ra
B)SYSTEM CONDITIONALLY PASSES;
One or more system components need to be replaced or repaired. The system,upon comple-
tion of the replacement or repair, passes inspection,
Indicate yes,nor,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,cracked,structurally unsound, shows substantial infiltration or
exfiltration,or tank failure is imminent. The system will pass inspection if the existing sep-
tic tank is replaced with a conforming septic tank as approved by The Board of Health.
Sewage backkup 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):
1
_ 1
_ .sl�ffi
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
_ PART A
CERTIFICATION(continued)
Broken pipe(s)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):, x
'Broken,pipe(s)are replaced j
Obstruction is removed
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,
system is failing to protect the public health,safety and the environment, ,
1),SYSTEM WILL'PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE p �
:SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE �;
HEALTH AND SAFETY AND THE ENVIRONMENT: ;a
�PUBLIC a�r
Cesspool or privy is within 50 Feet of a surface water ;
Cesspool or privy is within 50 Feet`of a bordering vegetated wetland or a salt.marsh.
2 SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER
SUPPLIER;IF APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTION-
ING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
The system has a septic tank and soil absorption system and 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 is with a Zone I of a public
water supply well. „<
The system has a septic tank and soil absorption system and is within 50 Feet of a private,,,..
water supply well.
The system has a septic tank and soil absorption system and 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
the,facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less
than-5 ppm:
D)SYSTEM FAILS:
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.
Backup of sewage into facility or system component due to an overloaded or clogged SAS
or cesspool.
Discharge or ponding of efluent 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 clog-
ged.SAS or cesspool.
Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2
day flow:
more than 4 times in the last year NOT due'to.clo ed or obstructed
Required pumping Y BS
pipe(s). Number of times pumped
-2-
I
t
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
'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 portionof 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)LARGE:.SYSTEM FAILS:
The following criteria apply to a large system in addition to the criteria above:
The design flow of a system is 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:.
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 wateusupply
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
1l bring th
e system
and facility into f 11 co m liance with thet''1
groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult'the local
regional office of the Department for further information.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Check if the following have been done:
L_JeoPumping information was requested of the owner,occupant,and Board of Health.
None of the system components have been pumped for atleast two weeks and the system`has ° l
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.
//The site was inspected.for signs of breakout.
_ J-All system,components,excluding the Soil Absorption System, have been located on site.
1/The septic tank manholes'were uncovered,`opened,and the interior of the septic tank was in-
Zpected 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
existing information or approximated by non-intrusive methods.
-3
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST(continued)
The facility owner(and occupants,if different from owner)were provided with information on
the proper maintenance of Subsurface Disposal System
a
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION,FORM
PART C
SYSTEM INFORMATION.
FLOW CONDITIONS
RESIDENTIAL: tJ�
Design Flow: gallons Number of Bedrooms#� N ber of Current Residents.
Garbage Grinder: Laundry Connected To Systemz2 Seasonal Use:
Water-MeterReadings,if available:
Last Date of Occupancy:
CO MER A /rNDC1STRI_AL.: �l)
Type of Establishment:
Design.Flow: Grease Trap Present: (yes or no)
Industrial Waste Holding Tank Present:
Non-Sanitary;Waste Discharged.To The Title V System:
Water Meter Readings„If Available: Last Date of Occupancy:
OTHER: Describe) };
Last Date of Occupancy:
GENE INFORMATION
PUMPING RECORDS and source of information.
System Pumped as part of inspection: 1f Q If yes,volu umped: Vgallons.;.
Reason for pumping:
TYPE 9FSYSTEM:..
I ,,vSeptic Tank/Distribution Box/Soil Absorption System
Single Cesspool
Overflow Cesspool
Privy
Shared System(If yes,attach previous inspection records, if any)
Other(explain):
r
APPROXIMATE AGE of all components,date installed(if known)and source of information:
Sewage odors detected when arriving at the site:
-4-
t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
GENERAL INFORMATION (continued)
SEPTIC TANK: f/
Depth'below,grade' Material of Construction: 'concrete metal FRP Other
(explain)
Dimisions:K76 Sludge Depth:�� �!Scum Thickness:
Distance from top of sludge to bottom of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Comments: (recommendation foe pumping,condition of inlet and outlet tees or baffles;depth of liquid
1avp
1 in lation to utlet invert,structural integrity,evidence of 1 age,etc.) V
y
GREASE.TRAP:
Depth Below Grade: Material of Construction: concrete l FRP Other
(explain) — —meta— —
Dimensions: Scum Thickness:
Distance from top of scum to top of outlet tee or baffle:
Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid
levelIn-relation to outlet invert;structural integrity,evidence of leakage,etc.)
F
TIGHT yOR,HOLDING TANK:14—)o
Depth Below Grade: Material of Construction: concrete—metal—FRP Other(explain) '
Dimensions: Capacity: gallons Design Flow: gallons/day
Alarm Level:
Comments: (condition of inlet tee,condition of alarm and float switches,etc.)
DISTRIBUTION BOX:
Depth.of liquid level above outlet invert:
Comments: (note Tel and distribution is equal,evidence of solids carryover,evidence ol leakage into
or out of box,etc.
PUMP CHAMBER./Lb
Pump is in working order:
Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.)
.-5-
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
SOIL ABSORPTION SYSTEM(SAS): P-'
(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: Leaching chambers, number: ,-._Leaching galleries,number:
_Leaching trenches,number,len gth
�
im ions.number, ens a: Leaching fields, ,d
1:-Overflow cesspool,.number:
Comments: (note condition of soil,signs of hydraulic failure level of ponding,condition of vegetation,
etc.)
i
CESSPOOLS: Aw i
Ntunber and configuration: Depth-top of liquid to inlet invert:
Depth of solids layer: Depth of scum layer: Dimensions of Cesspool:
Materials of construction: Indication of groundwater:
Inflow(cesspool must be pumped as part of inspection)
Comments: (note condition of soilk,signs of hydraulic failure, level of ponding,condition of vegetation,
etc.)
PRIVY:
Materials of construction: Dimensions:
Depth of Solids:
Comments: (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,
etc.)
t
-6-
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
KETCH OF SEWAGE DISPOSAL SYSTEM:
Include ties to atleast two permanent references, landmarks or benchmarks.
Locate all wells within 100 Feet.
� I �
i x
i
DEPTH TO GROUNDWATER:
Depth to groundwater: /r Feet y�
Method of Determination orAppr ximation:
rv�
-7-
i -
ASSESSORS MAP. Z -
- TE
ST HOLE_ S r LOGS
9 O
' PARCEL:
� Csa oar <, ao
`
� 1
#1
NOTES
:
CLUB E AL A R �Vb FLOOD ZONE. ILf / ���C. 0 SOIL
�e��
s
o ~ W , .
. . WIT SS
M
P
m REFERENCE:
Rde
, . 2
ed n C � _ TE Co O .`- - - ---
-/Jf/� Th 1_ ) e installation shall comply wit
h th Title V and Town of Barnstable�,.,� C
Y ab a Board of
AT10 RATE. NA1
r
Health Regulations.
q A
n --------- __.-: . ------
3 -s
d •
P
2 The ins
taller shall verify the location of utilities,
i - e�,a• � + fYsewer inverts and septic ,
w
T H I - m
P
TH 2 - component nor to installation P at on and setting base P g se elevations.
3 All gravity septic
c piping t) o be 41nch S h 4
� �b �• ty P P P c 0 PVC at 1/8 r a �A .�- g e foot. The first
Q LoKtN^ P
0
'f
two
feet out f fl o the 1 1 1 dbox to the leaching 2 � is to be level.
P
4 T
t his lan is not to be utilized for P o roe line determination nor an
property rtY other
1 a
Y
I purpose other than the proposed o sed system installation.'
� P Po Y :
- 5
All septic com nent s must meet Title tle V specifications.
Po
1jIL
L� 1L
5
LOCATION MAP S'
1
t
s Parking shall no
t be constructed
- t ) cted over H10 septic
1 `i � 8 components.
P
. Z t i
7 The roe i property rty s bounded by roe corners and property lines.
,Y property rtY P PAY es.
2
8 The.property owner shalL
P p rty review design consideration
g s to approve of total
_ design flo
w and nu
mber f$ o bedrooms to be considered� for design. Receipt of
- g P
Y
payment f
I e t or the plan n
P y and installation based I 1 P on the plan shall be deemed
/ r a oval of th, e design flow b the
owner.
1
8 Y
9 T
_ �✓ he existing leach i� i s tank and cesspool(s) h g P O, shall be pumped and filled with
i ,
material
� al r Title V abandonment r
Pe procedures. Those within the proposed
W P P
- .
SAS shall be removed--1� a ed alongwith contaminated soil
y
and replaced with clean
-� washed sari 1
S,o d per Title V specs.
a w
v
P
la Sy
stem components y to be l0 feet from water line.
SEAT` I C SYSTEM .
E DESIGN
11 If a
a - ) garbage rider exists it is to be removed n� � and is the responsibility of the
y
1
V
. owner.t o ensure such.
Ow FL ESTIMATE
p
i
� 2
,�
BEDROOMS AT n GAL/DAY/BEDROOMJV
GAL/DAY-
L n�. -
2 _
,.
`�C; TANK
1
I
:, GAL/DAY x 2 DAYS
�� � GAL
r
'U
SE GALLON
LL N SEPTIC T ,
� ANK
!.
W- I
,AB.O 1Q�fj�P I 0 S�STEM -LVIM .
I
5 83
P
- 5
,7 �-
M
lit
B0 _
TTOM `AREA.. � , DAV
Z , 1 1
vim' ID
i I �
MASON m
i
a
� I No.106 'y-1 v 6
—1
Q
I3T
, SYSTEM }_ s
, I
SECTION
w
f _
s
w t�
a M1
� 3 ,
3
zo
1 7
'�/ -
Gi - A
r
. . e
r
o b
D
¢5
GAL � •
„
SEPTIC T
M ANK
� � Z of
F
TOLO v �I ,5
l _
I
_ I
Y
g-
...• ,
SITE
AND WA. E GE PLAN
i LOCATION . 4 � 1
1� 1
-, ,
�
PREPARED FOR 1
1 ` fir/
V /
. a
y
-.-
LjI
�.-_--=---- e - ` SCALE.
.. .
DAV I D B: MASON OCR
��_,.�---.--- - R� DATE
DBC EN IRONMEN�TAL DESIGNS
_ W EAST SANDWICH . MA -
DA
TE ` T T p
W MEAL H AGENT
I 508 3- 17
Z t ) 83 2 7
5
;
i