Loading...
HomeMy WebLinkAbout0006 SAINT JOSEPH STREET - Health 6 ST. JOSEPH STREET, HYANNIS A = e r t�� TOWN OF BARNSTABLE — L 7CATICi�1 ��1�'�,e.7 SEWAGE# `.m LAGE. ASSESSOR'S MAP& LOT LNSTALLER'S NAME&PHONE NO S SEPTIC TANK CAPACITY LEAmm FACILITY: (type) l—� �� �l` (size) I�®� NO.OF BEDROOMS 1y 41 ` BUILDER OR O)VNER PfRMTTDATE: 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 fecLnfl'�facility) Fee: Furnished by r t�c!G� Jr e /. y LL r - a r s Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 6 St Josephs Street Property Address Felis Barreiro Owner Owner's Name information is required for every Hyannis MA 02601 1-19-13 - page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way.Please see completeness checklist at the end of the form. Imng out forms n A. General Information filling out forms on the computer, use only the tab .`���•' "' •`rq ��i 1. Inspector: key to move your Q p; '•.SG cursor-do not James D.Sears = ; JAM ES : , key,e the return Name of Inspector =_v ;�; Capewide Enterprises, LLC - -o .o- Company Name %A' ..I?I 153 Commercial Street Company Address '�` Mashpee. MA 02649 City/Town State Zip Code 508-477-8877 S 1623 Telephone Number License Number B. Certification I certify that I have personally inspected the sewac a 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 Section 15.340 of Title 5(310 CMR I S.000).The system: ® Passes ❑ Condit onally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Ap roving Authority 1-22-13 _ jspgedo�rrs Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of.10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the me of inspection and under the conditions of use at that time.This inspection does not address,how the system will perform in the future under the same or different conditions of use. t5ms- iry p Title 5 spe. n Form Subsurface Sewage Disposal System-Page 1 of 17 Jan 22 13 06:24p p.3 c . Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 6 St. Josephs Street Property Address Felis Barreiro _ Owner Owner's Name information is required for every Hyannis MA 02601 1-19-13 page. Cityfrown Slate Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E I always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: S) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. if"not determined,"please explain. The septic tank is metal and over 20 years old' or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): N t5ins-11110 Title 5 Official Inspection forth:Subsurface Sewage Disposal Syslem•Page 2 of 17 j Jan 22 13 06:24p p.4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form=Not for Voluntary Assessments w 6 St Josephs Street Property Address Felis Barreiro Owner Owner's Name information is Hyannis MA 02601 1-19-13 required for every page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require.further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water El Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•1 W..0 TUIa 5 Oftictal Inspection Form:Subsurface Sewage Deposal System•Pago 3 of 17 Jan 22 13 06:25p p.5 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 6 St. Josephs Street Property Address Felis Barreiro Owner Owner's Name information is H annis MA 02601 1-19-13 required for every y page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: z You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above-outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in 4aftpud is less than 6" below invert or available volume is less than day flow 46'W 0111A1C !Sins.11110 Title 5 Official rnspecdon Form:Subsurface Sewage Disposal System•Page 4 of 17 J Jan 22 13 06:25p p.6 Commonwealth of Massachusetts Title 5 official Inspection . Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 6 St Josephs Street Property Address Felis Barreiro Owner Owner's dame - requinform r on is Hyannis MA 02601 1-19-13 requiredd for every y page. City/Town State Zip Code Date of Inspection c B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen Is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ Eg The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 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 I I of a public water supply well If you have answered "yes'to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department t5irs•11/10 Title 5 Official►ispedion Form:Subsurface Sewage Disposal System-Page 5 of 17 Jan 22 13 06:25p p..7 Commonwealth of Massachusetts Title 5 Official Inspection Form 10�1 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �r 6 St Josephs Street Property Address Felis Barreiro Owner Owner's Name information is Hyannis MA 02601 1-19-13 required for every page. Cityfrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as NIA) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? 0 ❑ Were all system components, excluding the SAS, located on site? M ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner)provided with ❑ information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information_ For example, a plan at the Board of Health. ® Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 -- Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 t5ins.11110 Title 5 Official inspection Form:SubsuAace Sewage Disposal System.Page 5 of 17 Jan 22 13 06:26p p.8 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments - 6 St Josephs Street Property Address Felis Barreiro Owner Owners Name information is Hyannis MA 02601 1-19-13 required for every page. City/Town State Zip Code Date of Inspection D. System Information Description: The system is a 1000 Gal precast tank D box and 20 chambers 0 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage 201112,000Ga1s g ( y g �9Pd))' 2011-78,000GaIs Detail: Sump pump? ❑ Yes ® No NA Last date of occupancy: Date Commercia III ndustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/personslsq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: I5ins-11/10 Till's 5 Official Inspection Form;Subsurface Sewage Disposal System-Page 7 of 17 Jan 22 13 06:26p p.9 Commonwealth of Massachusetts Title 5 Official Inspection Form ro Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 6 St Josephs Street Property Address Felis Barreiro — Owner Owner's Name information is H annis MA 02601 1-19-13 required for every y page. Cityrrown State Zip Code Date of Inspection D. System Information (cant.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: 199612006 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box,soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Altemative technology. Attach_a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval ❑ Other(describe): s 1 t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 or 17 Jan 22 13 06:26p p.10 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4 6 St. Josephs Street Property Address Felis Barreiro Owner Owner's Name information is required for every Hyannis MA 02601 1-19-13 .page. CityrTown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 2010 Permit#2010- 153 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 26 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): pipeing is 4" PVC SCH 40 Septic Tank(locate on site plan): Depth below grade: 18, feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 Gal precast Sludge depth: 3„ r t5ins•11110 Tile 5 Official tnspecdon Form:Subsurface Sewage Disposal System-Page 9 of 17 Jan 22 13 06:27p p.11 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 6 St Josephs Street Property Address Felis Barreiro Owner Owner's Name information is MA 02601 1-19-13 required for every �BnnIS Zip Code Date of Inspection page. City/Town state D. System Information (cont.) Septic Tank (cont.) 2710 Distance from top of sludge to bottom of outlet tee or baffle 2" Scum thickness BR Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 16 How were dimensions determined? As S lu-. Plan -Tape Sludge Judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level, Tank and covers at 18"below grade w/outlet tee. No sign,of leakage or over loading Tank should be pumped Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ o#her,(explain): Dimensions: Scum thickness -- Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date l5ins-11110 Title 5 ofiiWl Inspection Form:Subsurface Sewage Disposal System-!Page 10 of 17 1 Jan 22 13 06:27p p.12 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 6 St. Josephs Street Property Address Felis Barreiro Owner Owner's Name information is Hyannis MA 02601 1-19-13 required for every page. CityfTown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallors -.. Design Flow: gallons per day Alarm present ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.)-- Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 _ Title 5 Official Inspedian Form:Subsurface Sewage Disposal System•Page 11 of 17 Jan 22 13 06:27p p:13 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 6 St.Josephs Street Property Address Fells Barreiro Owner Owner's Name information is required for every Hyannis MA 02601 1-19-13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 16"x16"-43" below grade w/cover at 10". Box is solid w/four lines out. No sign of over loading. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan,,excavation not required): If SAS not located, explain why: t5ins•1111 o Tige 5 ORdal Inspection Form:Subsurface Sewage Disposal System•!Page 12 of 17 .Jan 22 13 06:28p p.14 Commonwealth of Massachusetts • Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not For Voluntary Assessments _ a 6 St Josephs Street - Property Address Felis Barreiro _ Owner Owner's Name information is. H annis 'MA 02601 1-19-13 required for every y page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: Cl leaching pits number: - 20 ® leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length. ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology. Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is 20(arc 36 he biodiffusers chambers stone less) Leaching at around 45" below grade wltwo inspection ports Chambers are clean and dry. No sign of over loading or solid carry over Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer —� Depth of scum layer — Dimensions of cesspool -- Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins,11110 Title 5 Official hispeaion Forth:Subsurface Sewage Disposal Systan-page 13 of 17 r Jan 22.13 06:28p p.15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 6 St Josephs Street Property Address Felis Barreiro Owner Owner's Name information is Hyannis MA 02601 1-19-13 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 151ns•1111 D Title 5 official hspection Form:Subsurface Sewage Disposal System•Page U or 17 Jan 22 13 06:28p p.16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 6 St. Josephs Street _ Property Address Feiis Barreiro -. Owner Owner's Name information is Hyannis MA 02601 1-19-13 required for every y page. CitylTown State Zip Code Date of Inspection D. System Information (cunt.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately a � o 0 A ay 3 e -1 = 5 -1 13- y. 3 1..s e-s = 'V ri 151ns-11/19 TWO 5 Official Inspection Form:subsurtsoe Sewage Disposal system-Page 1s of 17 Jan 2213 06:29p p.17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not For Voluntary Assessments 6 St Josephs Street Property Address Felis Barreiro _. Owner Owner's Name information is Hyannis MA 02601 1-19-13 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells 1 Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record - If checked, date of design plan reviewed: 10-99Date ❑ Observed site(abutting propertylobservation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: T H on Design plan No G.W..at 10+' Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15ins-11r10 Title S 01ficial Inspection Form:sub sunat a sewage Disposal System•Page 16 of 17 Jan 22 13 06:29p p.18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,. 6 St. Josephs Street Property Address , Felis Barreiro Owner Owner's Name information is required for every Hyannis MA 02601 1-19-13 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—.Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 16 or attached in separate file t5ina-11110 TWO 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 Or 17 TOWN OF BARNSTABLE LOCATION (Q �S� SEWAGE# low L J 3 VILLAGE / icsa h r S ASSESSOR'S MAP&PARCEL .9 Sf Z INSTALLER'S NAME&PHONE NO. &11�. 1 � ,van Ss <Zy yy 2 JC SEPTIC TANK CAPACITY I by p• It es fy Is LEACHING FACILITY:(type) 10 f�',/'C 3(, t to l�2 J (size) (t,S NO.OF BEDROOMS .3 OWNER o_ " PERMIT DATE: OMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility .0v ® /i 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 ( L/1. '06 5 e S �� ri N CO alVn NW �1 C' u^ l r r 4 . i r No. 1016""3 Fee J THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 7` 4 PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Application for �hgponl *pmem Cou5truction Verna Application for a Permit to Construct( ) Repair}() Upgrade( ) Abandon( ) ❑Complete System'i4l Individual Components Location Address or Lot No. (o Sri'kt To5-�,1-%5 11-NIA- 1i Owner's Name,Address,and Tel.No. /=-e-t-L-L Assessor's Map/Parcel '2-9 1 t.k'Z Installer's Name,Address,and Tel.No. Lll,,ew,p(, ia2 k1r its Designer's Name,Address and Tel.No. J C P o 28 i y Type of Building: Dwelling No.of Bedrooms Lot Size 2 i0o 1� sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided 3 2-o gpd Plan Date 57'Z y 2(b to Number of sheets Revision Date Title & $,%lzt ks L) Size of.Septic Tank A5�r�. {oo%., �f4 k- Type of S.A.S. �q�1, S F�If.) Description of Soil Nature of Repairs or Alterations(Answer when applicable) �C S� Z, ��1�� (b ^Z, l 6a C"r C ��> �,� e.�l� An c 3� r� 3c�,c� t-► -zo Date last inspected: .7001 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 BoardofHealt . Sign . Date T' 2-^2-0 1 Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. �' Date Issued J, No. JL ' Fee ` THE COMMONWEALTH OF MASSACHUSETTS Entered in computes: 1 - 1 ��PUBL.IC HEALTH DIVISION'- TOWN OF BARNSTABLE, MASSACHUSETTS ,;Yes ' ZlppYicattiowfor Cow6truction Permit Application for a Permit to Construct( ) Repair/,) Upgrade( ) Abandori( ) ❑Complete System 0 Individual Components Location Address or Lot No. G SrQ-,'r't SV S��) 11,�p Owner's Name,Address,and Tel.No. F—cG c 3 Assessor's Map/Parcel 29 1 Installer's Name,Address,and Tel.No. C4O2w•o(s P? ��-. fps Designer's Name,Address and Tel.No. J C t c 1-30+ lb1 24i,j C�os�trnl Il't w ti C ei^4 y�.:Alt �►r"+ O�j 1 6 `.DIV)- r Type of Building: .r Dwelling No.of Bedrooms Lot Size 2('��O ¢ sq. ft. Garbage Grinder ( ) ti Other Type of Building 5,a e ,(,o ,.y No.of Persons Showers( ) Cafeteria Other Fixtures w Design Flow(min.required) Q gpd Design flow provided 3 55 Z O gpd Plan Date 5-Z N - Zb Is, Number of sheets I Revision Date I Title t? 5✓4,kt Yoi,Ql-1 _ Size of Septic Tank fz•),�-.I (O V y n l Type of S.A.S. ' Le ,w t° j „ Description of Soil Nature of Repairs or Alterations(Answer when applicable) C,< I Zn��.• 6A 04 r �-J� 1, J C,.���. Qf1 G 34. 0 C Ltl(,IC_ ?� tl I-1 ' ZO Date last inspected: -X0 01 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 Healt :-, Sign • Date Z Application Approved by Date Application Disapproved by: Date r for the following reasons J � Permit No. !1 / "� Date Issued ` 6 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (4-) Upgraded Abandoned( )b- V.C, L� at 6- `J 4,ot 5'c» 4e �( Fk 1/Y+'1, / has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. �(� � � dated J'2c. L%.. staller . In ��.J'tJ� b-A-t^r19') tI Designer �. r #bedrooms Approved design flow q gpd - The-issuance o this e `ilt shall-not-be construed as a guarantee that the system will- c i�n as de igned. S Date 1 Inspector n No. � h �-�� ------------—•---------------——-- Fee_s r THE COMMONWEALTH OF MASSACHUSETTS ` t UBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Mwi5po!5al �bpfStem Con!9truction Permit Permission is hereby granted to Construct ( ) Repair Q ) Upgrade ( ) Abandon ( ) System located at 6, 5 q,t. J7 3�� S J-u_k 1 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: Constru �tion m st be com leted within three years of the date of this p 'lt: r ! Date � Approved by ;' t Town of Barnstable Regulatory Services Thomas F. Geller,Director M'��"B`� ' Public Health Division 'q� tali. Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508462-4644 Fax: 508-790-6304 Date: 5-2-b"10 Sewage Permit# ZO lO- I S 3 Assessor's Map/Parcel 29 f /`!Z Installer& Designer Certification-Form Designer: SC En5t()ee.c(o5 'Tvlc.. Installer: Ca(�ewtde ��Eer�cfses Address: 2854 Cccwj, eccy 4-4)voy Address: PO 3 ox 7 b 3 rAsl Warclnuwl riA 02538 CAI- , C- �►Nt� 508-273 p377 0?—G3Z On 5-ZG— Zo(o l�a ;c�Q GX (On,WS was issued a permit to install a (date) (installer) septic system at G S'r• 5osepin M(ee-k based on a design drawn by (address) 1�C En4yoe ctf)5 dated_Nay 2 `/, 2410 (designer) 1 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. 1 certify that the septic system referenced above was installed with major changes (i.e. greater than 1.0' lateral relocation of the SAS or any vertical relocation.of any component of the septic system)'�but in accordance with State•& Local-Regulations. Plan revision or certified as-built by designer to follow. Stripout(if required) s ected and the soils were found satisfactory. �Tri of JOHN L. . CHURCHILL Ier's Sign. re) JR. IVIL 4180 • esigner s Signature (Affix De gn "Here) P ASE RETURN TO. ARNSTABLE PUBLIC HEAL DIVISION. CERTIFICATE OF COMPLIANCE"WILL NOT BE ISSUED UNTIL BOTH. THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. r gAoffice fonnsWesignercertification fonn.doc i y i Town of Barnstable P# _ oaTME Department of Regulatory Services I F Public Health Division Date s C sue. 1639. �� 200 Main Street,Hyannis MA 02601 Date Scheduled o a Time / h� Fee Pd. Soil Suitability Assessment for Sewage Qisposal Performed By: }{c&i "( ZT Os Witnessed By: U, LA)- „ 9S LOCATION& GENERAL INFORMATION Location Address (a 5A-rwr Owner's Name ��( '��;�, Address SC. Jo3aQ41 5�� �jyttinr<l�lti{{ G2b©1 Assessor's Map/Parcel:2 ^0 %4 2- Fv Engineer's Name n �n }} e'' SC L> neu� g �.a e.��cxe �. ky '/ NEW CONSTRUCTION REPAIR Telephone# Land Use Slt4e_ f r,-A(y d.u. Ai(;ti5 Slopes(%) '2 Surface Stones Distances from: Open Water Body /U14 ft Possible Wet Area M ft Drinking Water Well L/A ft Drainage Way ~/ ft Property Line 7 b(� ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) sL-Z- a.00 P i cti Parent material(geologic) Bu'4141 Depth to Bedrock Depth to Groundwater. Standing Water in Hole:_ y t i3h. 35 Weeping from Pit Face 7 12 8, iDSS Estimated Seasonal High Groundwater .7 i 2 6"635 DETERMINATION FOR SEASONAL HIGH WATER R TABLE Method Used: D'reCX 6b0-"JQ'hdio ,712 a 7 12 a Depth Observed standing in obs.hole: in, Depth to soil mottles: in. Depth to weeping from side of obs.hole: _1 1 2 in. Groundwater Adjustment Index Well# Reading Date: Index Well level Adj.}detor Adj.C)roundwater Level,e PERCOLATION TEST bete Thne jo q n Observation Hole# _1_ Time at 9" - 4 Depth of Perc 2y 112- - Time at 6" Start Pre-soak Time @ i 6=6 8 AH Time(9"4") I End Pre-soak 0 21 A N Rate Min./Inch C 2- Site Suitability Assessment: Site Passed eS Site Failed: Additional Testing Needed(Y/N) 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 Conseli'vation Division at least one(1)week prior to beginning. Q:ISEPTICIPERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# i _ Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. i tem y.R6 Gravel) I L5 J(�•i 3/1 LI'2`1 L5 toVr 5/1, _ 4-1,2$ G 2.5y '*4 DEEP OBSERVATION HOLE LOG Hole# Z Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,% rav a- `/ A. L S fC) Yr - 2 y-Ws C- l7-05 5 Y co se ' 5 lO� Iaue-1 DEEP OBSERVATION BOLE LOG Hole# Depth from, Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling' (Structure,Stones,Boulders. Consistency, DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones',Boulders. ons' a Flood Insurance Rate Man: Above 500 year flood boundary . No_ Yes ✓_ Within 500 year boundary No Yes Within 100 year flood boundary No,;>/ Yes Death 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? Yes If not,what is the depth of naturally occurring pervious material? , Certification I certify that on 1°"2 H (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,expertis and exper'e ce described in 310 CMR 15.017. 6 Signature Date "20-f 0 ` Q:\.SBPTICkPERCFORM.DOC Commonwealth of Massachusetts W Title 5 Official Inspection F0m Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 6 Saint Josephs St. Property Address Patricia Gray Owner Owner's Name information is required for Hyannis Ma. 02601 6/22/09 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out A. General Information S1 � 5b5l forms on the computer,use 1. Inspector: only the tab key to move your Robert Paolini cursor-do not Name of Inspector use the return key. C_apewide Enterprises,LLC. Company Name t� P.O.Box 763 Company Address Centerville Ma. 02632 City/Town State Zip Code (508)428-4028 S14454 Telephone Number License Number B. Certification I certify that I,have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (3.10 CMR 15.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 6/22/09 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. �U t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Di osal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form I=, Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 6 Saint Josephs St. Property Address Patricia Gray Owner Owner's Name information is required for Hyannis Ma. 02601 6/22/09 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title, 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 6 Saint Josephs St. Property Address Patricia.Gray Owner Owner's Name information is. required for Hyannis Ma. 02601 6/22/09 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑. Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•09;08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 6 Saint Josephs St. Property Address Patricia Gray Owner Owner's Name information is required for Hyannis Ma. 02601 6/22/09 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be. attached to this form. 3. Other: B D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ® ❑ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less' than %day flow t5ins•09F78 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 6 Saint Josephs St. Property Address Patricia Gray Owner Owner's Name information is required for Hyannis Ma. 02601 6/22/09 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the-well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 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 If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•09.'08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form 1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 6 Saint Josephs St. Property Address Patricia Gray Owner Owner's Name information is required for Hyannis Ma. 02601 .6/22/09 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth.of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health: ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M s 6 Saint Josephs St. Property Address Patricia Gray Owner Owner's Name information is required for Hyannis Ma. 02601 6/22/09 every page. City/Town State Zip Code Date of Inspection D. System Information Description: The septic system consists of a 1000 gallon septic tank,distribution box and a 1000 gallon leaching pit. Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection.required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d NA 9 ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 6/22/09 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(g"pd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 6 Saint Josephs St. M Property Address Patricia Gray Owner Owner's Name information is required for Hyannis Ma. 02601 6/22/09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins 09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 6 Saint Josephs St. Property Address Patricia Gray Owner Owner's Name information is required for Hyannis Ma. 02601 6/22/09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1985 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 14"feet Material of construction: ❑ cast iron E 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented through the house vents. Septic Tank (locate on site plan): Depth below grade: 16"feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑, No Dimensions: 1000 gallon Sludge depth: 6" t5ins•09/38 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 6 Saint Josephs St. Property Address Patricia Gray Owner Owner's Name information is required for Hyannis Ma. 02601 6/22/09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 26" Scum thickness Distance from top of scum to top of outlet tee or baffle 4" Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump septic tank every two years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears to be structurally sound. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 6 Saint Josephs St. Property Address Patricia Gray Owner Owner's Name information is required for Hyannis Ma. 02601 6/22/09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 6 Saint Josephs St. Property Address Patricia Gray Owner Owner's Name information is required for Hyannis Ma. 02601 6/22/09 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert Yes Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Box is Ievel.Box has one outlet lateral.Evidence of solids carryover.Evidence of leakage. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 6 Saint Josephs St. Property Address Patricia Gray Owner Owner's Name information is required for Hyannis Ma. 02601 6/22/09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Sandy soil.Leaching pit is in hydraulic failure.Pit was full at time of inspection. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 6 Saint Josephs St. Property Address Patricia Gray Owner Owner's Name information is required for Hyannis Ma. 02601 6/22/09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 6 Saint Josephs St. Property Address Patricia Gray Owner information is Owner's required for Hyanni Name s Ma. 02601 6/22/09 every.page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of-Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ❑ drawing attached separately 37 •-------- ---~-� A. �all t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 • Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 6 Saint Josephs St. Property Address Patricia Gray Owner Owner's Name information is required for Hyannis Ma. 02601 6/22/09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: Bottom of LP 25' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: As-Built ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: USED:USGS Observation Well Data.USED:Technical Bulletin 92-0001 plate#2 annual ranges of groundwater elevations. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Paga 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 6 Saint Josephs St. Property Address Patricia Gray Owner Owner's Name ' information is required for Hyannis Ma. 02601 6/22/09 every page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 mc#AQN S E W A G E PE RMIT NO. VI LL AG E INSTALLER'S NAME i ADDRESS p-6lye cvz,5 °T Cam, -, B U I L D E R OR OWNER DATE PERMIT ISSUED_ l DATE COMPLIANCE ISSUED � � i � �i 4.. ' �. i �� � . �,p O � o M W � � t� � :� y �' o�. e �y a �, r�, W ^'� _T L �` �� �'� , .._ _ _.._ � �-. J '0................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......OF..DO.. . ............................. ............Apphration for Bhipwial Workg Tonarurtion runfit Application is hereby madg fora Permit to Construct or Repair an Individual Sewage Disposal L ) System tv: ifs f W7 14V.ann.6................ ..................................... ........<.............. ........jjp� cial.��A or Lot No. 1--- ................... ................................................................................................ ....... �ner Address, ............................ , * -- --------------------*------------- -------------------------------------........................................................... Installer ..IZ)D / 0.*7' Address Type of Building coA,.rrAe,1,e-D Size Lot.c)0+02W.....Sq. feet Dwellinglelo. of Bedrooms......4...............................Expansion Attic Garbage Grinder Other—Type of Building ..................... ...... No. of persons............................ Showers Cafeteria-T— Othfixtures ............................I...................................------------------------------------ Chb................................... x Design Flow______. --!__________________________gallons gallons per person pfr day. Total daily flow---------........I..........................gallons. Septic Tank—Liquid capacity.IQ-Tgallons Lengthld..- 0. Width__6!-.0--- Diameter________________ Depth__._.________.-. Disposal Trench—No. __................ Width_____.._._.___.__.__ Total Length...... ... Total leaching area....................sq. ft. Seepage Pit No.......I------------ Diameter----110_1....... Depth below inlet..... .... Total leaching area---a&7...sq. f t. Z Other Distribution box ( ) Dosin ank Percolation Test Resu s Performed64) --------- Date_._'8_-.1fD_j. Test Pit No. _--.._.._.minutes per inch Depth of Test Pit. ............... Depth to ground water.-O M-'Aq882j Test Pit No. 2.5amaminutes per inch Depth of Test Pit____________________ Depth to ground water-___________________._. -- --------------- ....M.... ...........s," I...... -------------- ------i-1--5----------------------------------- dt 4 '(um 0 Description of Soil..----6...... .. ......to.... .. .............................. --------------------------------**------------------------------------*----------------------------------------------*---------------*----------------------------------*------------ -------------- ..................................................................................................................................................................I..................... 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 I TI LE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certific tp of C mpl'i i ce has n issued by the board of health. Sign .. ......... ........ ... X D t 7 Appli ....................... ... ...... ........ .... .... . .. ............. ...... .................- ............ Date Application Disapproved for the following reasons:....................... --- ------------------------------------------------------------------- ................................................................................................................................. ............................. ........... .......................... Date Permit No.1.1 ..........)..t. q------------------- Issued.............t...........I.. JD r t• � . No.........�_sn:f t/P F� ..t�-'s..... 0.`........... .4 THE COMMONWEALTH OF MASSACHUSETTS a BOAR® OE HEALTH ... OF-.;D.!�.`... ... ........ :.... Allp iratinn flat Ua�putial Morks Tnaa5trnrfinan ramit Application is hereby made for a Permit to Construct ( ),or Repair ( ) an Individual Sewage Disposal `� p y�a SySteTt B * f � i r i �� f � q e 9 Lot ........... .................... _--_.. ....... -- ---_-- ......... e j` or Lot No. •.....................�._.. ...._ _.._.. ........................................................... Oialler Address W d ... ...... ;n_ w_:_.�__ _______________•---____•----------_------------------- ck F n -------------------------------------------------------- Address UType of Buildipg_,, "r� .�•vl�Ract Size Lot 04�Q......Sq. feet .., Dwelling—'�To. of,Bectrooms Expansion Attic �' Garbage Grinder CJ aOther—Type of Building ........ No. of persons. ...................... Showers ( ) — Cafeteria( ) dOt Mures a -- --------------- v1-0,__.•---_.___-•-------•---_•-__----- W Design Flow....... _•._......... gallons per perso r ay. Total �tl flow....... . ............................•....gallons. fy Septic Tank—Liquid capacity. t _ gallons ,Length . tiVidth ___ Diameter................ Depth................ Disposal Trench NTo,--.................. Wid h t Total Length o Total leaching area_._. sq. ft. Seepage Pit No------- -- --------- Diameter.___,..__. ..,.._. Dept�i below inlet___.._.............. Total leaching area...._..____ ____sq. ft. Z Other Distribution box ( ) Dosin an Percolation Test Results. Performed by -�� $ Date r t ----•--- -- f _Fr Test Pit No 1 °�';_.minutes per inch Depth of Test Pit ......... Depth to ground water SV.VMm Test Pit No. 2......t minutes,per inch . Depth.of Test-Pit Depth to ground water........................ O Description of Soil !��_ 1 ... � �P� �f------ ---- --- -- -------•---------------------- U ----------------------------------------- -- W --------------------------------------------------- -- .................... -- ......... ..............................................•............... U Nature of Repairs or Alterations Answer when applicable --------------------•-- ................... ------- Agreement: '- The} undersigned agrees to 'install the:_afor6described Individual Sewage Disposal System in accordance-with the provisions of TT':IE 5 of the StatezSanitary;Code The undersigned further agrees not to place the system in 4 operation until a Certificate of Compliance has b issued by the board of health. ��, ig y , Si- ____ ________ _____ y-___ ._/_ T6Ii7W1IZJ�.wj i -_--•_ -•••_ _ - Application Approved By........7-•------ ...................................... r� f ........................% > s9 ............... Date Application Disapproved for-,tfie following reasons: ... ......._..- ................................................................................. hH Date Permit No.... .......`......�. ________________ Issuedx `g -_�_4-'��__ THE COMMONWEALTH OF MASSACHUSETTS '~ ` BOARD OF HEALTH i ri .........................................OF......................................I.........................................I...... Marr ifira#r of Tuntph anrr THIS IS TO CERTIFY, That the Individual Individual Sewage Disposal System constructed ( or Repaired ( ) by... - C ......................... ........................•...-----•--.........._............./..............• •-------••-•--•-----•-•- nstaller m has been installed in accordance with the provisions 1 IITS of The State SanitaryCode a .desc ibed in the application for Disposal Works Construction Permit No----` r���'�/ � --___- da.ted_...._._.I.�__�_.� . . '......... THE ISSUANCE OF THIS CERTIFICATE SHALL N.OT BE CONS UED AS A GUAR TEE THAT THE SYSTEM WILL UNCT ON SATISFACTORY. DATE.------........ .........................>---------•--_. inspector................ . '••---••-- .. .......--•--- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......................�f .............. ..... O F...................................•---..__...---....._._.........._................. No / FEE......._ 1........... Disposal arks Twnntr ion frranit Permission is hereby granted.............. . .... ... ..-----•••-•--••••-•••......---•--•--•-•-----•---•----•......•••-••..........................•-_.. to Construct ( ) or Repair ( ) an Individual e�,`age Disposal System S- �,, as shown on the application for Disposal Works Construction Permit No...................... Dated.......................................... ........................ Z,. ........................................................... Board of Health DATE.......................................................... --•---------•-- FORM 1255 HOEBS & WARREN, INC., PUBLISHERS Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of 4 Environmental ProtectionR 'Y Wllllant F.Weld Trudy Coxe cioar►wr s.uK:ry Ar Paul Celluoci �A vld B.Struhs tL Gwomor VH Cartunbeloirt l d se C + SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION ` PART A CERTIFICATION Boylston Trust Co. Property Addres: -6 St. Joseph Street Hyannis Address of owner. 241 Perkins Street Date of Inspeogow 3�26/9 6 `' (If different) Boston,Mass .0213 0 Name of Inspector. Joseph P. Macomber Jr. Company Nam Address and Telephone Number. J.P.Macomber & Son Inc. Box b6 Centervi;te,Mass. 02632 508-775-3338 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: zPall s _ Conditionally Passes _ Needs Further Evaluatiozr By the Local Approving Authority _ Fails Inspector's stgnature: %� Date: �i-pw—z The system Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner And copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A,B,C,or D: A) SYSTEM PASSES: 1� 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. Bj SYSTEM CONDITIONALLY PASSES: One or more system components used to i i replaced or repaired. The system,upon completion of the replacement or repair,passes Inspection. Indicate yes,no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined",explain why not) The septic tank is metal,cracked,structurally unsound,shows substantial infiltration or exilltration,.or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved �J by the Board of Health. (revised 11/03/95) 1 One Winter Street a Boston,Massachusetts 02108. o FAX(617)556-1049 a Telephone(617)292.5500 ie Printed 00 Recycled Paper SUBSURFACE SEWAGE,DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) PropertyAddres%' 6 St. Joseph' s Street Hyannis,Mass . Owner. Jack Dunklass Date of Inspeotion:3/2 6/9 6 B)SYSTEM CONDITIONALLY PASSES(coutinu0d) e ,LD Sewage backup or breakout or 0 static water level observed in the distribution boat L due to broken or obstructed pipe(,) or due to a broken,settlad or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipes)are replaced obstruction is removed distribution box is levelled or replaced The system required Pumping more than four times&year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)s)a replaced obstruction is removed Cl FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: �l1 Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS'NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: / Cesspool or privy is within 60 feet of a surface water Q� Cesspool or privy is within 60 feet of a bordering vegetated wetland or a salt marsh. Z) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM I3 FUNCTIONING 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. N1} The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. �Q The system has a septic tank and soil absorption system and is within 60 feet of a private water supply well. J The system has a septic tank and soil absorption system and is less than 100 feet but 60 feet or more from a private water supply well,unless a well water analysis for ooliiorm 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 6 ppm. 3) OTHER (revised 11/03/95) 2 O SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Owner. Date of Inspection: • s DI SYSTEM FAILS; • A) 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. . t!/Q Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of thtground or surface waters due to an overloaded or clogged SAS or cesspool. �!Q Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. L"Ch RAT Liquid depth in eaaapeoi is less than 6"below invert or available volume is less than ll2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Q1� Any portion of a cesspool or privy is within 60 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 60 feet f)•om a private water supply well with ao 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. El LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: •VO 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: A the system is within 400 feet of a surface drinking water supply IJ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for Anther information.. (revised 11/93/95) 3 J , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 6 St. Joseph Ia •Street Hyannis,Mass. Owner. Jack Dunklass • ' Date of Inspection:3/2 6/9 6 Check if the following have been done: , ,pumping information was requested of the owner,occupant,and Board of health. None of the system components have been pumped for at least two weeks and the system has been receiving Hormel flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. 2AA built plans have been obtained and examined Note if they are not available with N/A. ,ZThs facility or dwelling was inspected for signs of sewage back-up. ZThe system does not receive non-sanitary or industrial waste flow , The site was inspected for signs of breakout. . ZAll system component',Alcluding the Soil Absorption System,have been located on the site. ,-The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of bames or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum. ZThe size and location of the Soil Absorption System on the site has been determined based on a dsting information or app tad by non-intrusive methods. facility owner(and occupants,if different from owner)were provided with information on the proper maintenanoe of Sub. Surface Disposal System. (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION PropertyAddress:6 .St. Josephts Street Hyannis ,Mass. Owner. Jack Dunklass Date of Inspection: 3/2 6/9 6 • FLOW CONDITIONS RESIDENTL I- • De4►flow- • Number of bedrooms: Number of current residents: Garbage grinder(yes or no): Laundry connected to rystem(yes or no):2�6 Seasonal use(yoo or no):!�O Wate meter• ,if available: 1�� �� c3�.7�•�dS 2 aid •' .. � r b Last date of occupancy:,, COMMERCIAL/INDUSTR.IAL: Type of establishment AJR Design flow: !l�i� galions/day Grease trap present:(yes or no)VA Industrial Waste Holding Tank present:(yes or no)" —� Non•sanitary waste discharged to the Title 5 system: (yea or nong Water meter readings,if available: A)� Last date of occupancy: OTHER:(Describe) 11A Last date of occupancy: A)-,q GENERAL INFORMATION PUMPING 3 an source of iqf tion: System pumped as part of inspection:(yes or no) If yes.volume um Reason for pumping. AJ Y too t TYPE OF SYSTEM Septic tank/distribution box/soil absorption system _sZ Single cesspool Overflow cesspool ' Privy Shared system(yes or no) (if yea, attach previous inspection records, if any) Other(explain) APPROXIMATE AGE of all components,date installed(if known)and source of information: b !"•� Sewage odors detected when arriving at the site:(yes or no) v (revised 11/03/95) 6 CUS-TOPIER CONSUMPTION HISTORY ACCOUNT NLJ11BER 241 042 CCUSTOMER NAME JACK DUNKLESS SERVICE LOCATION 46 ST JOSEPH STREET- READING DATES READINGS USAGE PERIOD (MMDDYY> ICCF) ( CCF) ALLOWA14CE BALANCE FIRST 02 06 96 1212 A SECOND 11 06 95 1212 A AVERAGE WATER USE 26 THIRb OB 04 95 i i8ri A 28 YEAR -TO DATE WATER USE FOURTH 05 07 95 1156 A 27 r FIFTH 02 02. 95 1129 A 24 NCNJ SEWER USE: SIXTH 11 03 9l1 1 i 05 A 26- CE a OTHER USE SEVENTH 08 02 94 1079 A 37- E v EIGHT I I 05 03 94 1040 A 29- ce NINTH 02 04 94 . 1015 A 28- TENTH 11 02 93 987 A 27 a NON SEWER FIRST READING ELEVENTH 09 03 93 960 A 34 3 J NON SEWER SECOND READING TWELFTH 05 04 93 926 A 23 Q NON SEWER METER NO, TH*IRTEF-NTH 02 03 93 903 A 26 FOURTEENTH 11 03 92 877 A z a CL ENTER = FIRST SCREEN PFKEY 14 = PRINT SCW--EN m m N m o-� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Propertyaddresa: 6 St. Joseph' s Street Hyannis ,Mass . Owner. Jack Dunklass Date of Inspection:3/2 6 9 6 SEPTIC TANI(:_Cl 'V r'Q • , e (locate on sit•plan) ,/rr Depth below grade.lam. Material of construction:Zncrete_metal_FRP--other(explain) Dimensioas: l l 6 Distance from top of sludge to bottom of outlet tee or baffle: 6 Scum thiclmess: n _ Distance f mm top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffie:-_ 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 ,etc.) _ •I n 1 e lace and func ionin •No structurally sound No rP3aAir4 Ara neerjerl a:L+rbptima GREASE TRAP-,,djXe (locate on site plan) Depth below grade:AM Material of construction:AA oncrete_metal_FRP_other(ezplain) Dimensions: Scum thickness:, AM Distance from top of scum to top of outlet tee or baMe:_" Distance from bottom of scum to bottom of outlet tee or baffle:, 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.) Ala �.ste�A� (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) Property Address: 6- St. Joseph' s Street Hyannis,Mass . Owner. Jack Dunklass p Date of Insectlon:3/2 67 9 6 TIGHT OR HOLDING TANIOAZyVe,., (locate on site platy • Depth below grader Material of construction: concrete metal_FRP other(ezplain) Mon Dimensions: h2A Capadty: i0A gallons b Design flow: Wday r Alarm level: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BO&,,,K-111" (locate on site plan) Depth of liquid level above outlet invert: A49 Comments: (note if ImlL and di#nbu�tion is equ41,evidence o solids over,evidence of leakage into or out of box,etc.) Bol is level,no evidence of sofids carry over,no evidence of learcage in or ou o e box. No repairs are needed at this time. . PUMP CHAMBER:,, (locate on site plan) Pumps in working order:(yes or no)_40 Comments: (note condition of pump chamber;condition of pumps and appurtenances,etc.) /Ur_ COrYl,{'!/IioiflT S (revised 11/03/95) 7 r SUBSURFACE SEWAOE DISPOSAL SYSTEM INSPECTION FORM I'.'. ^^ C SYST::'.: .: N (ooutinuod) PropertyAddressr 6 St. Joseph' s Street Hyannis ,Mass . 02601 owtion Paul Dunklass Data of Inspeottons 3/2 6/9 6 ' SOIL ABSORPTION SYSTEM(SAS)S • . (locate oc sits plan if possible;excavation not r•qu*but may be approximated by noadatruaive method•): If not detarmined to be pracit,expl lim • V '" Type: ksdat pits,number.'.. . .. . . kachiag mile,nnumber:,,Q ` .. _ . .,..•w;s,l:: lathing trenches,numbar,length: leaching Selds,number,dim---ions- _ overflow cesspool,cumber. Comments:(note condition of soil,signs of hydraulic f"ure, 1-,! condition of ve tation,etc.) Ta Amy sand to medium sand:No siSns..._of_.h_ydraulic failure or pon i _All vPgPtstion is nprmal . Leaching_,pit is' dry. No repairs are ase(10A at. C.ha nraaant, ti ma \J CESSPOOI,Ss F _ (locate on site plan) Number and con4mition:_ IUR Depth-top of liquid to inlet invert: Depth of solids layer, 1� Depth of scum Lyres: , Dimeasions of ceaspmb Materials of construction: Iodisation of groundwater. • inflow(cesspool must be pumped as part of inspect:,,••) Lf Comments:(note condition of soil,aigas of hydraulic failvro, 1?%�1 c'^cr''n condition of vegetation,etc.) �e rsMv»en%TS • PRIVYtA6W_ (locate on sit*plan) Material of ooastruction. Dimeasions: Depth of solids:,�[�, - --- (note ooaditioa of soil,aigas of hydraulic failure, :cn of vegetation,itc.) /!/{� (revised•11/03/.95)� g s ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 6 St. Joseph' s Street Hyannis,Mass . Owner. Jack Dunklass Date of Inspeotion:3/2 6/9 6 SKETCH OF SEWAGE DISPOSAL SYSTEM: • inchide ties to at least two permanent references landmarks or benchmarks locate all wells within 100, Hyannis Water Company 775-0063 0O S DEPTH TO GROUNDwA Depth to Voundwater,_ 6 +feet method of or ap n: Plans -onNo file. Have instalied systems in the area. Ro wn+.or An"untArAd at 16t'. I (revised 11/03/95) >i .•.rmnr:rn:•rrr••.r•.e.rrmr•nmrrrnrt rerxmn:srt-rerarr:+rr"'*n'*+..s-tiv rra•mrer.rrR —. — trra*sss•�snavrerrr-r��e-.Zer-.es+r.r—••t 'TOWN OF Barnstable BOARD OF HEALTH 1 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOItM - PART D .- CERTIFICATION h•••41•t-T••,•••.-T.II7.••.T1T17RT.11I'n:R71TTJRT.fSTTrt•T-:•1�StTR�fZTltTlr•TnlnCitfYRT'R�TiTrnT! n*nitTrfrrrsl�lyrrre•r':•.+4rrr•rr•1r•-••� -TYPE OA PR1NT CI,EARLY- PROPERTY INSPECTED STREET ADDRESS 6 St. John' s Street Hyannis,Mass. 02601 ASSESSORS MAP, BLOCK ANUOPARCEL # OWNER' s NAME Jack Dunklass PA1?7` D - CER7'IFXCATI0N I NAME OF INSPECTOR Joseph P. Macomber Jr. . 4 COMPANY NAME J.P.Macomber & Son INc. COMPANY ADDRESS Box 66 CgntPrvi ,Maaa _ 02632 Street Town or City State LIP COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX (508 ) 790 - 1578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true, accurate, and complete as of the time of :inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check • one: ; XXXXXXXSysteui PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 16 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. System FAILED* Tlie inspection which I have conducted 'has found that the system fails to protect the public Health and the environment in accordance with Title 6 , 310 CMR 15.. 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form , Inspector Signatu � 1 Date 3/29/96 One copy of this certification must be provided to the OWNER, the BUYER ( where applicable ) and the DOARD oir. 112AL711. * If the inspection FAILED, the owner orpoporator ahall upgrade Pgrado ' tho eyotem within one : year of the date of L•he__inspection , unless allowed or reaair-.,i 7�Ln s�j1f 3��1 THE COMMONWEALTH OF MASSACHUSETTS . DEPARTMENT OF ENVIRONMENTAL PROTECTION BE IT KNOWN THAT ` Joseph P. Macomber, Jr. Has satisfied the Department's qualifications as required and is hereby authorized to use the title CERTIFIED TITLE 5 SYSTEM INSPECTOR as provided in 310 CMR 15.340 and Section 13 of Chapter 21A of the General Laws. Issued by The Department of Environmental Protection. June 8, 1995 Acting Director'of the ' '•ion of Water Pollution Control I ' UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid LISPS Permit No.G-", ° Sender: Please print your name, address, and ZIP+4 in this box• I� U1111JI!fill!id S E N D E R:"1CO' MPiLE TE THIS SECTION COMPLETE THIS I SECTI I ON 1 0 1 N DELIVERY ■ Complete items 1,2,and 3.Also complete A. Sign item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse X ❑Addressee so that we can return the card'to you. B. Rece' ed by(Pint Name) C. ■ Attach this card to the back of the mailpiece, pry/ or on the front if space permits. J D. Is delivery address different from item 1? ❑Yes , 1. Article Addressed to: If YES,enter delivery address below: ❑No POW L ZA �). k \ o ` s -30%v-�4\ s 3. Service Type ❑Certified Mail ®Express Mail egistered CR'F-turn Receipt for Merchandise ( h ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes i 2. Article Number 7001 1940 0004 9042 1679 (transfer from service labeq CPS Form 3811,August 2001 Domestic Return Receipt 102595-02-M-1540 7--r ;; --a=•--�r..-��r`r.,,^^h}..�...;"'"'`"�e1=+;'..+.."�.r-^"w"a%eta S4'.+r� •:*ce,: t n�wct�art sr+-r?.7. rnr�r-•+...-^ r-H'r�..-- - mr ,".-.-n k T^'x-*--^k-....i-m-n. ::nr x.-„, TOWN OF iBARNSTABLE BAR-Wa Ordinance or Regulation WARNING NOTICE Address of Of fender ' 7 �J MV/MB Reg.# Village/State/Zip /ra `1I Business Name — am/ m on e Tw Business Address . ,.""" (t t Signat° e of Enforcing Officer Village/State/Zip <ooAto Location of Offense <q'my ./`7420 1144 Enforcing Dept/Division Offense /u zn i /* ij, �: +Ott If Facts.) <S s '1"bar This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. i. Town of Barnstable MAW Regulatory Services os Thomas.F..Geiler,Director Public Health Division Thomas.McKean,Director 200 Main Street,Hyannis,MA 02601 Officer 508-862-4644 Fax: 508-790-6304 August 18, 2003 AMY PAUL, TR MATT PAUL TRUST 6 ST. JOSEPH ST. HYANNIS,MA. 02601 NOTICE TO ABATE. VIOLATIONS OF TOWN OF BARNSTABLE BOARD OF HEALTH REGULATIONS,NUISANCE CONTROL REGULATION NO 1 The property owned by you located at 28 Phillips Rd (6 St. Joseph St.), was inspected on August 12, 2003,by Donald Desmarais, RS, Health Inspector,because of a complaint. The following violations of the Town of Barnstable Board of Health Regulations, Nuisance Control Regulation No. 1 were observed: Nuisance. Control Regulation. No.. 1, Part VII, Section 1.00: Numerous trash bags on deck and ground, tree limbs, Christmas tree,buckets, cans,bottles and assorted trash. You are directed to correct the violations within seven days of receipt of this. order letter. You may request a hearing before the Board of Health if written petition requesting same is received within ten(10) days after the date the order is served. Please be advised that failure to comply with an order could result in a fine of$100.00. Each days failure to compl, ith an:order shall constitute a separate violation. PER ORDER OF THE OA OF HEALTH A. McKean,R.S. Director of Public Health r Town of Barnstable Q:Health/orderletters/refuse/274 South.doc 446 l.O C AT ION W S-E W A L E PERMIT NO. Ck �� 3�%, 01 y, R; y V I L L A C E Olt 0,wr, I N S T A LLER'S NAME & ADDRESS V� BUILDER OR OWNER �. DATE PERMIT ' ISSUED DATE CORIPLIANCE ISSUED / $ � N r � SOIL LOG SITE PLAN NO. 1 NO_ 2 7 O ---- f 2 ,. - 3 -- ----� 4 TOP OF FOUNDATION EL .. __ 7 '�yIVL' •er �`, ' O 9 ., IN.EL. • oro ' n • • r • •— � 10 r IN.EL --�-T IN.EL. �`- IN.E l -_ -- T T -. 2 COVER 1/8 3/8 WASHED STONE 1 f n° I N E L l9 O =EL --- - - - 12 4" ' LIQUID LEVEL �; D/B W/ 6 SUMP oo a d r` i of o "oo - 3/4 1 1/Z WASHED STONE �,,,���,�,,,���;� v _ 13 � bo��o b •` VEFF. OEPTHI­ 14 0 15 Y 'j 6pba PERC TEST RESULTS PRECAST SEPTIC TANK WITH 0 0 Aoob - ° v U 0 0 0 � . ° D ° PRECAST LEACHING PITS PERC RATE : -------- CAST IN PLACE INLET AND EL. �� --0o • _ _ -> 66 NO.: !__ SIZE: � '��� � ' ��� WHITNESSEO BY: =- � OUTLET T 'S PER TITLE � �� �-o i;f�, .lr ��11a - /- BOARD OF HEALTH SIZE : t 2 s o c� . : ;�,�: I 2 ' �-- D I A . - - z �,� �,.,. _ F _ � ,���� .�,�<��%�,io DATE: '~/D -o L-c:3� -� x 5- �} " ;.z��. = X s-4 d��o,) l-•--- ��? D I A . i PROFILE OF PROPOSED SEWAGE SYSTEM SYSTEM DESIGNED BY THE TOWN OF REGULATIONS AND T a STATE TITLE V FOR SUBSURFACE DISPOSAL OF SEWAGE . SCALE 1/4"= 1 ' 0 N . B . 1. ALL PIPES SHALL BE SCHEDULE 40 P.V.C. SEWER PIPE 2. All PIPES SHALL BE SLOPED 1/4 "' PER FOOT EXCEPT FOR THE FIRST 2 FEET OUT OF THE D / B WHICH SHALL BE LEVEL ' � � r -7 1 3. DESIGN FLOW _ BEDROOMS AT 110 GALDAY PER BR . ,A,-�_ GAL/DAY -'- It v�r ! `, ��►m: SEPTIC TANK SIZE X Llv =_ GAL . - R USE _-_ GAL. W/ GARBAGE DISPOSAL LEACHING SYSTEM : USE QAhF ;r ' ,� ;vi 6 '-o"UOVD Ff o� rK EFFECTIVE AREA ; SIDE T-- K !p z 6 = 4 f G Y ,. BOTTOM z--x t, 0 -=--7y 6zn TOTAL FLOW 55o GPQ �� L07 ' -.;r7 �� TOTAL REQ 'O FLOW - 440_ X f = _— W/_____- GARBAGE DISPOSAL / L�,,,f�� 2�3,_� o, RESERVE FLOW --- GAL/ DAY _- vq REFERENCE PLANS - -- - - APPROVED O : ------ - -- - BOARD OF HEALTH DATE PROPERTY OWNER : T � r d _ _ _ — SITE AND SEWAGE PLAN VA OR _ 08tR.� C � - ,t b< BEDROOM SINGLE FAMILY DWELLING M DATE . & ASSOCIATES /.57-"` DOYLE FALMO TH A U , MASS . . y,. ___.__ r 4'.; .'::.._. ...� :.• ;.. *:. "? .c iy'it.l�'.'«'"': ..,. ,> u ��r„. L,.. .i.Y k T.O.F. EL.= 47.8'± INISH GRADE OVER D-BOX= 46.3'± 4"SCHEDULE 40 PVC MIN. SLOPE 1 % PROPOSED PVC VENT FINISHED GRADE OVER BIODIFFUSERS = 46,2' - 46.5' GENERAL NOTES PROVIDE EXTENSION RISER SLOPE @ 2% MIN. INSPECTION PORT WITH WITH COVER OVER INLET& REMOVABLE WATER-TIGHT COVER OVER 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION FINISH GRADE OUTLET TO WITHIN 6"OF F.G. RISER TO WITHIN 6"OF FINISHED GRADE „ACCESS BOX PER WITHIN METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL @ FND. EL.= '46.2'± F.G. OVER TANK EL. = 46.0'± 5" DIA. OUTLET(S) 3 OF F.G. (ONE PER ROW) _ _ CODE AND ANY APPLICABLE LOCAL RULES. I 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. EXISTING 4" PROPOSED 4" 36"MIN.AX. 44" MAX. TOP OF SAS/B.O. = 42,8Q 3. 4 SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL SEWER PIPE 1j" PVC SEWER PIPE " �� ' " l (SEE NOTE 21.) SYSTEM UNLESS OTHERWISE NOTED. 6" 3" 3" DROP MAX _ --i PROVIDE WATERTIGHT 4. TO PREVENT BREAKOUT THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN 2 DROP MIN 3 9 7GAS L 47± JOINTS (TYP.) ELEVATION =42.80 FOR A DISTANCE OF 15 AROUND THE PERIMETER OF THE SAS. UNLESS A � ,10" 4" PVC IN FROM ,� 1.33' 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S. AND THE TOP OF 14" SEPTIC TANK 4 PVC OUT TO (TYP.) „ THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. OLEACHING FACILITY 0.90' 10.75 (TYP) 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. CONTRACTOR CONTRACTOR SHALL 12" 6" 42.37' - 41 .47' laid flat 2.875'(34.5")--I 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. SHALL VERIFY SIZE 48" VERIFY CONDITION OF '42.7Q MIN. 42.5j3 ( ) (STONELESS SYSTEM)AND CONDITION OF EXISTING TEES5.0' (TYP.) 7• LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK 6" CRUSHED STONE (TYP.) FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION, SYSTEM IS EXISTING SEPTIC AND REPLACE AS OV (ER MECHANICALLY 5'MIN. 11.5' NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH TANK NECESSARY COMPACTED BASE 25.0' (TYP FOR ALL ROWS) AND DESIGN ENGINEER. 5 OUTLET DISTRIBUTION BOX 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM OF 47.00'ESTABLISHED TO BE INSTALLED ON A LEVEL STABLE BASE. FIRST TWO FEET OF OUTLET GROUND WATER ELEV.= < 35.33' ON A NAIL SET IN CORNER OF BULK-HEAD AS SHOWN ON PLAN. EXISTING 1,000 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION 20 - BIODIFFUSERS PROFILL BIODIFFUSER 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 DISTRIBUTION BOX DETAIL C } TO THE DESIGN ENGINEER. `CONTRACTOR TO VERIFY EXISTING ELEVATION PRIOR SEPTIC TANK PROFILE �0 - ARC 36HC #3616 B D H-20 BIODIFFUSERS O D I F F U S E RS O ANY WORK & NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE NOT TO SCALE NOT TO SCALE 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT. 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING I ' . „ ; • '� -�/ c� - �� TEST PIT DATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM "U.P. 1270/ 6 • V APPROPRIATE AUTHORITY. ' < - • * o PERC NO. 12945 w If INSPECTOR: David W. Stanton, R.S. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS EVALUATOR: Michael Pimentel, E.I.T. LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE I tiZ- MAP 291 _ THEY SHALL WITHSTAND H-20 LOADING. C.S.E. APPROVAL DATE: Oct. 1999 \ EXISTING LEACHING PIT TO BE ► O 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. �( PUMPED AND FILLED WITH CLEAN,. LOT 223 �� � � DATE: May 20, 2010 v COARSE SAND & ABANDONED MAP 291 ; TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE w y PROPOSED PVC VENT PIPE � A MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. �\ -,TREELiN (LOCATION PER OWNER) LOT 248 �.• 5 ELEV TOP = 46.00' REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, S84 1340 "E -' E ELEV WATER= <35.33' FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). 1 �, PROPOSED INSPECTION PORT WITH / 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN G 120.00' ACCESS BOX TO GRADE (TYP OF 4) PERC RATE _y C ,r 16. PROPOSED PROJECT IS LOCATED WITHIN: w "� DEPTH OF PERC = 24"-42„ W ` ' a W a LOCUS TEXTURAL CLASS: 1 ASSESSOR'S MAP 291 PARCEL 42 CO j d / 11 5' / rx. 1 o OWNER OF RECORD: PATRICIA M. GRAY -T O I (3 '1. m ZONE 2 T ; 0" 46.00' ADDRESS: 6 SAINT JOSEPH STREET a. J \ / T 1 4 ^/ g LJ ' O 74 A Loamy Sand HYANNIS, MA 02601 L / 46 0' ) /� a 4„ 1 OYr 3/1cf) 45.67' O X 10' ® �8 B Loamy Sand FEMA FLOOD ZONE C MAP 291 10Yr 5/6 COMMUNITY PANEL# 250001 0005 C z o TP 2 x LOT 249 t 24 44.00' 17. DEED REFERENCE: DEED BOOK 22831, PAGE 140 r W ) Z- N p'� �. Perc h 18. PLAN REFERENCES: 1. P 1 46 0' ""---_-_.- � x '= � ) LAN BOOK 67, PAGE 85 / \ j 42' 42.50' \ _ i ��• A � 2.) PLAN BOOK 150, PAGE 17 O / x \ y 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. / \ � x � � C Medium -Coarse Sand • ( 2.5Y 6/6 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY PROPOSED TOTAL 20 ARC 36HC • ! 'D ! (5-10%gravel) FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY (2 x (#3616BD) H-20 BIODIFFUSERS IN A rr �I r+l..re� ^ D (loose) I OR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. ti 1)ZB x 11.5'x 25.0' FIELD CONFIGURATION 21. IN ACCORDANCE WITH 310 CMR 15.401 -15.405,THE FOLLOWING LOCAL UPGRADE X APPROVALS ARE REQUESTED FROM 310 CMR 15.221 (7): \ PROP. CISTRIBUTION BOX x I LOCUS PLAN (1.) A 0.70'WAIVER(3.0-3.7') FOR THE MAXIMUM COVER OVER THE LEACHING FACILITY. 5 io O x N O CV H O or a, d w � o SCALE: 1" = 1000' 10 0 ,� SHED x? to M 128" 35.33' 18 I o iv rn No Mottling, Standing or Weeping Observed z X� DESIGN DATA PEST PIT DATA LEGEND MAP 291 18" x I PERC NO. 12945 LOC.)TO BE ABANDONED Nail Set in B.H. Comer INSPECTOR: David W. Stanton, R.S. HC-1 NUMBER OF BEDROOMS (DESIGN) 3 f I EXIST. D-BOX APPROX. Benchmark LOT 42 I 50xO EXISTING SPOT GRADE / x Elev. =47.00 DESIGN FLOW 110 GAUDAY/BEDROOM EVALUATOR: Michael Pimentel, E.I.T. 26,000 S.F. t I \` f-HC-2 Approx. M.S.L. C.S.E. APPROVAL DATE: Oct. 1999 - - - 50 - - - EXISTING CONTOUR I TOTAL DESIGN FLOW 330 GAUDAY cqs DATE: May 20, 2010 PROPOSED CONTOUR X �--�__ \ / DESIGN FLOW X 200 % = 660 GAUDAY I x i TEST PIT#: 2 O/H/W cgs / B H x USE EXISTING 1,000 GALLON SEPTIC TANK I ELEV TOP= 46.00' EXISTING OVERHEAD UTILITIES x ELEV WATER= <35.33' GAS - EXISTING GAS LINE �9f STOOP #6 X co S X ; PERC RATE = W W EXISTING WATER LINE Teti \�q EXISTING / I INSTALL 20 - ARC 36HC (#3616BD) BIODIFFUSERS (H-20) ! _ 3-BEDROOM - 0 ` DEPTH OF PERC - TEST PIT LOCATION DWELLING x TEXTURAL CLASS: 1 \ cq TOF = 47.8'± SYSTEM CAPACITY ,r (TOTAL L.F. OF BIOS)(4.8 SF/LF)(0.74 GPD/SQ.FT.)=GPD EXISTING 1,000 GALLON SEPTIC TANK _-45 Cqf /tx1O x EXISTING 1,000 GALLON SEPTIC (100.0')(4.8 SF/LF)(0.74 GAUSQ.FT.)= 355.2 GAL. LEACHING/DAY TANK TO BE UTILIZED AS PART 0„ 46.00 PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE W'--\W W \ W DECK �6\ x OF THIS DESIGN A Loamy 10Yr 3/1nd TOTALS: 4" 45.67' p PROPOSED DISTRIBUTION BOX TOTAL NUMBER OF BIODIFFUSERS: 20 \ Loamy Sand TOTAL NUMBER OF COUPLINGS: 0 B 1 OYr 5/6 Q PROPOSED ARC 36HC(#3616BD) BIODIFFUSER \ TOTAL LEACHING AREA: 355.2 \ TOTAL LEACHING CAPACITY: 480.0 24" 44.00' _�lSl C�\ \QS \ STOOP REV. DATE BY APP'D. DESCRIPTION \ MAP 291 NOTE: PROPOSED SEPTIC SYSTEM UPGRADE \ !I EFFECTIVE LEACHING AREA OF 4.80 SF/LF OBTAINED FROM THE LOT 250 DEPARTMENT OF ENVIRONMENTAL PROTECTION APPROVAL LETTER Medium-Coarse Sand PREPARED FOR: "MODIFIED CERTIFICATION FOR GENERAL USE" ISSUED TO ADVANCED C 2.5Y 6/6 CAPEWIDE ENTERPRISES 42\ srsr\ r ( DRAINAGE SYSTEMS, INC. ON OCTOBER 3, 2003 (LAST MODIFIED (5-10%gravel) .�, FEBRUARY 18, 2010). TRANSMITTAL NUMBER-W000052. (loose) SWING-TIES LOCATED AT NOTES: DESCRIPTION HC-1 HC-2 6 SAINT JOSEPH STREET HYANNIS, MA 02601 BIODIFFUSER CORNER(1) 35.0' 28.1' - 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF 128" 35.33' SCALE: 1 INCH = 10 FT. DATE: MAY 24, 2010 EACH SEPTIC SYSTEM COMPONENT. BIODIFFUSER CORNER(2) 27.T 29.6' No Mottling, Standing or Weeping Observed )"OF �, o s io 20 ao FEET BIODIFFUSER CORNER(3) 50.8' 53.9' r 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF RESERVED FOR BOARD OF HEALTH USE CIIUk PREPARED THE PROPOSED LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST BIODIFFUSER CORNER(4) 55.2' S3.0' Cl`18,- 2854 CRANBERRY HIGHWAY)j JC ENGINEERING, INC. PIT DATA SHOWN ON THIS PLAN. REPORT TO ENGINEER AND LOCAL ; BOARD OF HEALTH IF SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. EAST WAREHAM, MA 02538 SITE PLAN- 508.273.0377 3). PROPERTY IS LOCATED WITHIN A DEP APPROVED ZONE 2. - --._. - ) SCALE: 1"= 10' � Drawn By: MCP Designed By:MCP Checked By:JLC JOB No.1824