HomeMy WebLinkAbout0028 WALTON AVENUE - Health 28 WALTON AVENUE, HYANNIS
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TOWN OF BARNSTABLE
LOCATION -2 tJ�wo,� A SEWAGE#_a6t-7-;1,:g3
VILLAGE YtJtrS ASSESSOR'S MAP&PARCEL
INSTALLER'S NAME&PHONE NO: ,A&F,
SEPTIC TANK CAPACITY E�(f Yh�UC
LEACHING FACILITY: (type) -3 ' (size) Fj X
NO.OF BEDROOMS
OWNER �P(NPC
�T
PERMIT DATE: °- _ -7 COMPLIANCE DATE: 7 %7
Separation Distance Between the: niGNC C-t-t"CAlf. df�-
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility pa Feet
Private Water Supply Well and Leaching Facility(If any wells exist on T
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�� - C(*,i .�
o c�
a
No. yr � Fee /d O
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:�
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
Zlpphration for -Misposal *pstem Construction Permit
Application for a Permit to Construct( ) Repair(:�pgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 2Y3 We l i-0.0 4r 0�. Owner's Name,Address,and Tel.No.
(�y��,'J4 S
Assessor's Aap/Parcel re Nc.u�C�.S
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size 1��7hK— sq.ft. Garbage Grinder( )
Other Type of Building (r'sffJN No.of Persons Showers( ) Cafeteria( )
Other Fixtures 4
Design Flow(min.required) 3 3 Q gpd Design flow provided :3 qf',_77 gpd
Plan Date �'j` j _1? Number of sheets 2-- Revision Date
Title
Size of Septic Tank e)Cjc�l—,-) Type of S.A.S. 2 To(:D Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Sign �t ���_ Date —�
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit NoL)D l •� Date Issued 0
ti•r
c t /d 0
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes
�
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
, , 1.
2"plication for tisposd *pstrm Construction Permit
Application for a Permit to Construct( ) Repair( Upgrade( )^Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. a$wc,I►ao A a� Owner's Name,Address,and Tel.No.
yywv�rS k;
Assessor's 1Vlap/Parcel T"t'✓n)C,4C)r S
In�s^taaller's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
i—wo 7/" I �,uG 1N ra•�-rn�S i.*.�.✓/�C
Type of Building:
Dwelling No.of Bedrooms Lot Size 167,76 — sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) ?1 -3 U gpd Design flow provided 3 yp,,`7 gpd
Plan Date 0-I "j`l Number of sheets Revision Date
Title
Size of Septic Tank 1_.-1t,4-- Type of S.A.S. t
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
�r
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signe Date 0 -Y.—/'7
Application Approved by Date R l y ) -
Application Disapproved by Date
for the following reasons
Permit Now Date Issued
` THE COMMONWEALTH OF MASSACHUSETTS s.
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(t/}�Upgraded( )
Abandoned( )by �•$.,o; cz y wVN l !9 t �� n1C
- ���
at- 21�� we,l !-ts.y A J P ..,,,....�r`� � has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No`X17--45 ?' dated �y
Installef�,)�G s A "r,.c Designer ct,*e- Wc,
#bedrooms Approved design flow '� '�,lJ gpd
The issuance of this perm' shall pot be construed as a guarantee that the system willfunction,asde'-1.
Date c/�� l Inspector
---------------------------------------------------- ------- - ------
No. :ggj 9 '` J T, Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS
Disposal 6pstentkonstrUction Permit
Permission is hereby granted to Construct( ) Repair( 1/l� Upgrade( ) Abandon( )
System located at 9- 05 (iJ,�a ` PG N >� V f' 1 Y vv�j•j t t
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions. .
Provided:Construction must be completed within three years of the date of this permit.
Date �l��/I Approved b�,,
Town of Barnstable
I"E'Owti Regulatory Services
Richard V. Scali,Interim Director
+ BARN5fABLE,
y MASS. (h Public Health Division
i639• �0
Thomas McKean,Director
200 Main,Street,Hyannis,'MA,02601
Office: 508-862-4644 Fax: 508-790-6304
.Installer& Designer Certification Form
Date: Y 17 1-7 Sewage Permit# � 6 Assessor's Map\Parce:1 i C 44- i 5�
Designer: n�lnee�;n� WOY�tS� 1nC , Installer: 17tA, 3 : . y w
7` 1 i
Address: I (l�, C�s��e (cJ �c`1 Address: 0 . dXy
Tore s ol+ule Ce��,—�{'� '1i'4 OZ6
i
On h-7 f), -dk:= (--%k, was issued a_permit to install a
(da (installer) '.
septic stem at v2 Y- vJ�1"t'�^. � t r
p y yam'^ 's based on a design drawn by
�ete r %, Mc
6n,
(address)
Ey!Pne-e-r'eig tic;-(.0 /K C,. _ dated S t
(designer)
i
I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such.as lateral relocation of the
distribution box tend/or septic tank. Strip out (if required) was inspectediand the soils
were found satisfactory. t
1
I certify that the septic system referenced above was installed with niajorl changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system) but in accordance with State & Local Regulations. Plan revision or
certified as-built.by designer to follow. Strip out (if required)was inspected and the soils
were found satisfactory.
I certify that the system referenced above was consfructe nee with the terns
of the RA approval letters(if applicable) THOF
G
F%TER
/ WENTEE l
CIVIL.
Installer's Signature) No.35109
(Designer's Signature) (Affix Designer tamp Here)
PLEASE RETURUNI TO BARNSTABLE PUBLIC .HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
QASeptic\Designer Certification Form Rev 8-14-13.doc
- oF�
Town of Barnstable P# 3 vim-
Department of Regulatory Services
i t taT"M : Public Health Division Date 1
200-Main Street,Hyannis MA 02601 ,
Date Scheduled �/Jdh� Time Fee Pd. O U
Soil Suitability Assessment for S ge Disposal
Performed By: P,Ki" Al Witnessed Witnessed By:
_ LOCATION& GENERAL INFORMATION
Location Address -2!F W t j+a-i A-v,-P Owner's Name
�Yl�rrr-+Q ll�ly�J/�ne
{-tyA I N,rs Addresst—
S4-4 r/, 9 VA 2o I �5F
Assessor's Map/Parcel: 10/ Engineer's Name
NEW CONSTRUCTION 0 REPAIR Telephone# 73 7—y 7
ct.' C�1 Land Us@ S CJ�v��-\tt-1 Z"�'f',_
--I t'•3 � Slopes(3'0) Surface Stones ,1
Distances`,from: . Open Water Body N � ft Possible Wet Area�ft .'Drinking Water Well> r�Vft
Drainage Way aft Property Line ft Other ft
co
Cs SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands fn proximity to holes)
lam. r"
JJJ
zz ZS�
ab-
tr'1 9—
1 j,
�l
Parent material(geologic) vU Depth to Bedrock �Y�
Depth to Groundwater. Standing Water in Hole: AJIA' Weeping from Pit Face
Estimated Seasonal High Groundwater
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used:
Depth Observed standing in obs.hole: in. Depth to soil mottles:
Depth to weeping from side of obsThole: -o,in•_ (3raundwatkr Adjustment ft.
Index Well#` Reading Date: w Index Well lever Adj,factor— Adj.Groundwater Level o
PERCOLATION TEST Date®, Thne.�
Observation
Hole# eJ`c- Time at 4"
Depth of Perc CT:ime at 6"
Start Pre-soak Time® r C Z ,~�c d\ f Mme(g+'.G+')
End Pre-soak S�vL r
Rate Min,Inch.
Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N)
Original: Public Health Division ' Observation Hole Data To Be Completed on Back-----------
***If percolation test is to be conducted within 100' of wetland,you must first notify the.
Barnstable Conservation Division at least one (1)week prior to beginning.
Q:\SEPTIC\PERCFORM.DOC
DEEP.PBSERYATfp&HO Hole#
Depth from Soil Horizon Q(USDA)
oil Tex .Soil Color Soil Other
Surface(in.) unsell) Mottling (Structure,Stones;Boulders.
Consistency.%Gravel)
,y�y�-.. /71 � te...�'.., :{;fit,,. ����.,//G�': .'� •yx , t
3.2:�, :. c• cr fir% S �� r`'`�►
_1zo GZ
DEEP OBSER HO Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) USDA) (Munse Mottling (Structure,Stones,Boulders.
Consistency.% ray
LO � S
20'
---,DEEP OBSERVATION.HOLE LOG_ Hole# "
Depth from s Soil Horizon i Soil Texture I Soil Color Soil''- ' - ' Other
Surface(in.) _ "'_' (USDA) - (Munsell) Mottling (Structure,Stones,Boulders.
Consistency.%Gravel)
' f
r E
. r
DEEP OBSERVATION HOLE LOG Hole#
.Depth from Soil Horizon Soil Texture Soil Color < Soil Other
Surface(in.) - (USDA) ,(Munsell) Mottling (Structure,Stones,Boulders.
Flood Insurance Rate Man:
Above 500 year flood boundary No_ Yes
Within 500 year boundary No Yes
Within 100 year flood boundary No Yes
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the
area proposed for the soil absorption system?
naturally occurring i material?
If not,what is the depth of n y ger ous p
Certification'
I certify tliaYon -jI k Qqf\(date)I have.passed'the soil evaluator.examination approved by the
Department.of Environmental Protection;and.that the above analysis Was performed by me consistent with .
the required training,expertise and experience described in 310 CNM 15.017.
�► �,��— i 0 ` IZ
Signature Date2 ,
QASBPTI VERCFORM.DOC
TOWN OF BARNSTABLE
LOCATION ;Z 5 0,),-1+Qt,) Le SEWAGE# 20(;� -O 4�
VILLAGE„I S. ASSESSOR'S MAP.&PARCEL 316 — 5
INSTALLER'S NAME&PHONE NO. ���l�s A 3rrua� a n�c So8-4,Z0-tis3y
SEPTIC TANK CAPACITY 1Er.,5 i-W5
LEACHING FACILITY:(type) �2 3G f{C. f�-20 (size) GO %/e,-c-h
NO.OF BEDROOMS 3
OWNER
PERMIT DATE: 22-/2 COMPLIANCE DATE:
Separation Distance Between the:
t. h 1 ss 3-
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility A,C cD CZ+ 8`1,3 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,,P,,e; /�/U�iyi✓
O i
s dp tTi b� ?O
-i
i I
� X
1
0
LA
2 � .
q, J,
b
W
ON .►.
t
No. � `�1 Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: LX
PUBLIC HEALTH DIVISION -TOWN OF RARNSTABLE, MASSACHUS:ETTS Yes
ftplitation for bispo8AY 6pstem. Construction permit
Application for a Permit to Construct( ) Repair(w6pgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 28 A✓ e- Owner's Name,
Address,and Tel.No.
Assessor's Map/Parcel 10 •- q1 �rA1', " -eS
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size /p,7G SS. sq.ft. Garbage Grinder( )
Other Type of Building No.No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) ? 3() gpd Design flow provided :5 -Zs; q gpd
Plan Date Zh.-b-, Number of sheets 12 - Revision Date
Title
Size of Septic Tank ?�/ Type of S.A.S. A-4- 36 14C
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) /.✓!5 A iv r-,✓ /� 5
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board Health.
Signed Date `�—
Application Approved by DateZ--
Application Disapproved by Date
for the following reasons
Permit No. U 0 a— Date Issued °Z
No. ?0 (� 1 L( Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWItOF B�4RNSTABLE, MASSACHUSETTS Yes
Application for ]Disposal �6pstem Construction permit
Application for a Permit to Construct( ) Repair(L,<Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 28 6,-L//&-j A✓`e- Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel 3/0 — //
rY�vr.- ems
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size /Q,7G 5- sq.ft. Garbage Grinder( )
Other Type of Building �i„�� No.of Persons Showers( ) Cafeteria( )
Other.Fixtures
Design Flow(min.required) 3 '3 0 gpd Design flow provided gpd
Plan Date 2 /a — Number of sheets `Z-- Revision Date
Title
Size of Septic Tank r 1i 5 k r Type of S.A.S. A-6 36 14C
Description of Soil
r
Nature of Repairs or Alterations(Answer when applicable) /nl7 A • 5
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board o. Health.
Signed (� Date `L-
Application Approved by D Date
Application Disapproved by Date
for the following reasons
Permit No. 'D U .. 0 L1 Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
r>
Certificate of Compliance
f. S IS TO CERTIFY,that the On-site.Sewage Disposal system Constructed( ) Repaired(� Upgraded( )
Abandoned( ')by ti s / iU,, G
i
at Z P5 /`a /�,r ,u„r!ee-,4'5 has been constructed in accordance
with the provisions of Tittle 5 and the for Disposal System Construction Permit No..201 L^0��2 dated ,Z
Installer o ✓r 4 q /`/ /�jr,,,✓.✓ �`,/ G Designer /,•ter Y/I•� Lc/p�/�
#bedrooms _� Approged-desi flow ?& `j and
The issuance of this permits all not be nstrued as a guarantee that the(ystem will 'on/as designed.
D �+
ate _3�/� G' Inspector _ �-�� t�
------------------------------------------------------Fee------
-------------
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS
Misposal 6pstem Construction J)ermit
Permission is hereby granted to Construct( ) Repair Upgrade( ) Abandon( )
System located at 'L g G"O/hG•✓ //r,• /-/•i a.v.✓i 5
i
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date of this permit.
Date a 2 ^ f>" Approved by
02/23/2012 13:01 5084775313 ENGINEERING WORKS PAGE 01
To*n of Barm#oble
letery Services
Thomas F.Geiler,DkwWr
Public HeMh Division
Thomas MCKeaa,Director
200 Main street, $y"nis,MA 9M.,
0MW. 508-862-4644 Pax: 508-79"304
Date: Z 3 iI Sewage Permit# Assessor's Map(Pareel 1 a 1
Ias er& r Cerdn l?grm
Designer:
Address: 17 W. lei Ind. Address., Pa. fax !AV_y---
on I n- V'A, a n 1�.c, was issued a permit to install a
(date) {in sit a-ler)
septic system at 'Zo LiNk l+o r. Av-e i !-1 0k.-�%,` based on a design drawn by
a s)
Blew MeI5„d-*e 'R C dated 2 r o I_Lz _
{designer) •
i,C_ r certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved Qhanges such as lateral relocation of the
distrAwtion box and/or septic tank. Stripout (if required) was inspected and the soils
vwecres found satisfactory.
I certify that the septic system referenced aborre was installed with ma or changes (i.e.
&renter than 10' lags/relocation of the SAS.or any verti+;,al relocation o'�any ccaaponent
Of the septic system)but in accordance with State&Local Reguladons. Plan revision or
certified as-built by designer to follow. Stripout(if required)w and this soils
were found satisfactory, ,
PEM T.
Cris Signature McENTEE
No,"109 0
(Designer's Signature) (Affix Design )
MnIRN TO BARNSTABLE PIMLI HEALTH b A
F )E WILL NOS` BE SUED UNTIL BOTH THIS FORM AND
T ARE RE EIVED BX B S"TABL UBLI HEAL D ON,
U.
tq:loflia fo msteefieoeo rOAccion 16rm.doc
�I
COMMONWEALTH OF MASSACHUSETTS
f EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
d DEPARTMENT OF ENVIRONMENTAL PROTECTION
A
t
V�
V•
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 28 Walton Ave
Hyannis MA 02601
Owner's Name: Sherrie Claybrone
Owner's Address: Same c zr G
Date of Inspection: September 8,2005 Job#05-278
Name of Inspector: PATRICK M.O'CONNELL
Company Name: SEPTIC INSPECTION SERVICES CO.
Mailing Address: 189 CAMMETT ROAD
MARSTONS MILLS MA 02648
Telephone Number: 508-428-1779
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 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 D �
%I fill���
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: �������
Passes 2
X Conditionally Passes `O� •G
— — onay
Needs Further Evaluation by the Local Approving Authority
Fail •� �y�
Inspector's Signature: Date: 9/8/05 '�'�i�� '":1 • Q'*�
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Hea�tt 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.
Notes and Comments: Overflow pit empty with no definite high stains,liquid level in primary pit is 6"below
outlet pipe. Septic tank outlet pipe is partially collapsed and tank shows evidence of backup caused by a clog
in collapsed pipe.Precast baffle must be replaced with a PVC tee when pipe is replaced.
****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.
Title 5 Inspection Form 6/15/2000 page I
, Page 2 of I 1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 28 Walton Ave,Hyannis
Owner: Sherrie Claybrone
Date of Inspection: September 8,2005
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: XX
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.
Answer yes,no or not determined(Y,N,ND) in the 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.
ND explain:
_XX_ 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):
_X_ broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will
pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
Titl.r lncnnrtinn 17-All cnnnn 2
I
Page 3 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 28 Walton Ave,Hyannis
Owner: Sherrie Claybrone
Date of Inspection: September 8,2005
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(l)(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
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 I 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 and volatile organic compounds indicates that the well is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other
failure criteria are triggered. A copy of the analysis must be attached to this form.
3. Other:
Titla i lnenart:nn Fnrm Oil 3
Page 4 of I I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 28 Walton Ave,Hyannis
Owner: Sherrie Claybrone
Date of Inspection: September 8,2005
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections:
Yes No
_X_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
_X_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
—X_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
_X_ Liquid depth in cesspool is less than 6"below invert or available volume is less than ''/z day flow
—X— Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped
_X_ Any portion of the SAS,cesspool or privy is below high ground water elevation.
_X_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
X Any portion of a cesspool or privy is within a Zone 1 of a public well.
_X_ Any portion of a cesspool or privy is within 50 feet of a private water supply well.
—X— Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis. [This system passes if the well water analysis,
performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria
are triggered.A copy of the analysis must be attached to this form.]
No_(Yes/No)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•
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
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.
Titles 1�incnartinn Pnrm 6/1 VIMA 4
Page 5 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 28 Walton Ave, Hyannis
Owner: Sherrie Claybrone
Date of Inspection: September 8,2005
Check if the following have been done. You must indicate"yes"or"no"as to each of the following:
Yes No
_X_ _ Pumping information was provided by the owner,occupant,or Board of Health
_X_ Were any of the system components pumped out in the previous two weeks?
_X_ _ Has the system received normal flows in the previous two week period?
_ _X_ Have large volumes of water been introduced to the system recently or as part of this inspection?
_ _X_ Were as,built plans of the system obtained and examined?(If they were not available note as N/A)
_X_ _ Was the facility or dwelling inspected for signs of sewage back up?
_X_ _ Was the site inspected for signs of break out
_X_ _ Were all system components,excluding the SAS, located on site?
_X _ 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?
_X _ 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:
Yes no
_X_ Existing information. For example,a plan at the Board of Health.
X _ 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(3)(b)]
Tifla G Incnanf;— P—A/1;11nnn 5
Page 6 of 1 I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 28 Walton Ave,Hyannis
Owner: Sherrie Claybrone
Date of Inspection: September 8,2005
FLOW CONDITIONS
RESIDENTIAL
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
Number of current residents: 2
Does residence have a garbage grinder(yes or no): No
Is laundry on a separate sewage system(yes or no): No [if yes separate.inspection required]
Laundry system inspected(yes or no):
Seasonal use:(yes or no): No
Water meter readings, if available(last 2 years usage(gpd)): Two years total: 150,750 gal.=206 gpd.
Sump pump(yes or no): No
Last date of occupancy: Currently Occupied
COMMERCIAL/INDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): Qpd
Basis of design flow(seats/persons/sgft,etc.):
Grease trap present(yes or no):_
Industrial waste holding tank present(yes or no):_
Non-sanitary waste discharged to the Title 5 system(yes or no):
Water meter readings, if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records: None
Source of information: Owner
Was system pumped as part of the inspection(yes or no): No
If yes,volume pumped:_gallons--How was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM
_X_Septic tank,distribution box,soil absorption system
_Single cesspool
_Overflow cesspool
Privy
_Shared system(yes or no)(if yes,attach previous inspection records, if any)
_Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
Tight tank _Attach a copy of the DEP approval
Other(describe):
Approximate age of all components,date installed(if known)and source of information:
1975-1976
Were sewage odors detected when arriving at the site(yes or no): No
T;t1P S incn.pttnn Fnr All cnnnn 6
Page 7 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 28 Walton Ave,Hyannis
Owner: Sherrie Claybrone
Date of Inspection: September 8,2005
BUILDING SEWER: XX (locate on site plan)
Depth below grade: 1'
Materials of construction:_cast iron _X_40 PVC_other(explain):
Distance from private water supply well or suction line: 35'
Comments(on condition of joints, venting,evidence of leakage,etc.):
SEPTIC TANK: XX (locate on site plan)
Depth below grade: 3"
Material of construction:_X_concrete_metal_fiberglass_polyethylene
_other(explain)
If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of
certificate)
Dimensions:8.5' long x 5.2'wide—1000 gal.
Sludge depth: 3"
Distance from top of sludge to bottom of outlet tee or baffle: 27"
Scum thickness: 4"
Distance from top of scum to top of outlet tee or baffle: 6"
Distance from bottom of scum to bottom of outlet tee or baffle: 9"
How were dimensions determined: STICK WITH HINGE FLAP.
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 shows evidence of past backup from partially collapsed pipe.Liquid level is currently at
bottom of outlet invert. Recommend pumping tank.
GREASE TRAP: No (locate on site plan)
Depth below grade:_
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:
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.):
Titla G Inenantinn Rnrm (/I snnnn 7
I
Page 8 of 1 I
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 28 Walton Ave,Hyannis
Owner: Sherrie Claybrone
Date of Inspection: September 8,2005
TIGHT or HOLDING TANK: No (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/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: XX (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.):
No high stains,trace of solids carryover.
PUMP CHAMBER: No (locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no):
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
I
Title C Inenortinn i7nrm rli,;mnnn 8
Page 9 of I I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 28 Walton Ave,Hyannis
Owner: Sherrie Claybrone
Date of Inspection: September 8,2005
SOIL ABSORPTION SYSTEM(SAS): XX (locate on site plan,excavation not required)
If SAS not located explain why:
Type
_X_leaching pits,number: Two pits in series
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.): First pit has 6"effective leaching below outlet pipe,overflow pit is empty with no definite high stains
CESSPOOLS: No (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 or no):
Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
PRIVY: No (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.):
Titles S incnartinn Fnrm Ail;nnnn 9
Page 10 of 1 I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 28 Walton Ave,Hyannis
Owner: Sherrie Claybrone
Date of Inspection: September 8,2005
SKETCH OF SEWAGE DISPOSAL SYSTEM .
Provide a sketch 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.
Walton Ave
Driveway
Water service
32
32 37 # 28 Garage
39
24 17 8
19
Titla i Inrnartinn 17nr All cnnnn 10
Page I 1 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 28 Walton Ave,Hyannis
Owner: Sherrie Claybrone
Date of Inspection: September 8,2005
SITE EXAM
Slope None
Surface water None
Check cellar Dry
Shallow wells None
Estimated depth to ground water: More than 20 feet
Please indicate(check)all methods used to determine the high ground water elevation:
Obtained from system design plans on record- If checked,date of design plan reviewed:
Observed site(abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health-explain:
Checked with local excavators, installers-(attach documentation)
_X_Accessed USGS database-explain: USGS topo map and town GIS
You must describe how you established the high ground water elevation:
Town groundwater contour map shows water below el.25 and topo map shows property above el.45.
T41.C Tnenor*inn Pn 4/1 ciinnn I 1
Commonwealth of Massachusetts
Executive Office of Environmental Affairs
Department of RECEIVED
Environmental Protection5
Wllllam F.Weld tE
t3ovemor L/
Trudy Coxe /S
Secr.tZ EOEA
David B.Struhs
comminloner
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
n7G �1 /j PART A
CERTIFICATION
Property Address: Address of Owner:
Date of Inspection: <<'S Z 0'-C ! (If different)
Name of Inspector: W.E. Robinson Sr.
Company Name, Address and Telephone Number: W.E. Robinson Septic Service
P.O. Box 1089
Centerville MA�
CERTIFICATION STATEMENT �77 77
I certify that I have personally inspected the sewage dispBs�I-spsU t 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:
_ Passes
_ Conditionally Passes
_ Needs Further Evaluation By the Local Approving Authority
_ Fails
Inspector's Signature: 6<..) lea�� ✓�" Date: I U —a-0 v✓
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:
AJ SYSTE PASSES:
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 CONDI ONALLY PASSES:
One or ore system components need to be replaced or repaired. The system, upon completion of the replacement or repair,
passes inspection.
Indicate yes, o, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why notl
The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is
imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as
approved by the Board of Health.
(revised 8/15/95) 1
One Whiter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500
Printed on Recycled Paper
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
�
Property Address: J M�
Owner:
Date of Inspection:
B]SYSTEM CONDIT/Hea
ASSES ontinued)
_ Seup o reakout or high static water level observed in the distribution box is due to broken or obstructed
pi t a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the
EE
Bl ):
broken pipe(s)are replaced
obstruction is removed
distribution box is levelled or replaced
_ Tquired pumping more than four times a year due to broken or obstructed pipe(s). The system will pass
in (with approval of the Board of Health):
broken pipe(s) are replaced
obstruction is removed
C] FURTHER EVALUATION IS REQUI _ BY THE BOARD OF HEALTH:
Conditions exist which req re further evaluation by the Board of Health in order to determine if the system is failing to protect the
public health, safety and a environment.
1) SYSTEM WILL PASS U LESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER
WHICH WILL PROT T THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
_ Cesspool r privy is within 50 feet of a surface water
Cesspool r privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL F L UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT
THE SYSTEM IS UNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMEN :
_ The s stem has a septic tank and soil absorption system and is within.100 feet to a surface water supply or tributary to a
surfa a water supply.
_ The •stem has a septic tank and soil absorption system and is within a Zone I of a public water supply well.
_ The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well.
_ Th system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water
su ply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is
fre from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5
p M.
D] SYSTEM FAILS:
I have det rmined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis
for this de ermination is identified below. The Board of Health should be contacted to determine what will be necessary to correct
the failure
ackup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
ischarge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or
c $spool
(revised 8/15/95) 2
A—
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:
Owner: 7,1,rh e3 W c�l-a
Date of Inspection:
D)SYSTEM FAILS(continued):
Static liquid level in th distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
Liquid depth in cess of is less than 6" below invert or available volume is less than 1/2 day flow.
Required pumping ore than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times umped
Any portion of a Soil Absorption System, cesspool or privy is below,the high groundwater elevation.
Any portion o a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
Any portion of a cesspool or privy is within a Zone I of.a public well.
Any porti of a cesspool or privy is within 50 feet of a private water supply well.
_ Any po on of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no
accepta le water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for
colifor bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
El LARGE SYSTEM FAILS:
The following criteria a ply to large systems in addition to the criteria above:
The design flow of s stem is 10,000 gpd or greater (Large System) and the system is a significant threat to public health and salety
and the environme because one or more of the following conditions exist:
the syst m is within 400 feet of a surface drinking water supply
the s stem 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
pu lic water supply well)
The owner or operat.r 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 further information.
(revised 8/15/95) 3
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address:
Owner:
Date of Inspection: d "b [3—
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 normal flow rates
during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection.
As built plans have been obtained and examined. Note if they are not available with N/A.
�4hefacility or dwelling was inspected for signs of sewage back-up.
17(esystem does not receive non-sanitary or industrial waste flow
0/he site was inspected for signs of breakout.
All.system components, excluding the Soil Absorption System, have been located on the site.
J/he septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or
tee , material of construction, dimensions, depth of liquid, depth of sludge, depth of scum.
t�The size and location of the Soil Absorption System on the site has been determined based on existing information or
ZThe
roximated by non-intrusive methods.
i facility owne, (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-
Surface Disposal System.
4
(revised 8/15/95)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 2 ? W 9 jt n /�& y /�
Owner. 7 f}ryi ems yn C- Jo-w�h /r n
Date of Inspection: 10-V�-O
FLOW CONDITIONS
RESIDENTIAL:
Design flow:
llons `
Number of bedrooms:
Number of current residents:
Garbage grinder(yes or no):
Laundry connected to system (yes or no):
Seasonal use (yes or no):A/
Water meter readings, if available:
Last date of occupancy: � J
COMMERCIAUI N D USTRIAL:
Type of estab ishment: '
Design Flow: Ilons/day
Grease trap resent: (yes or no)_
Industrial aste Holding Tank present: (yes or no)_
Non-sani waste discharged to the Title 5 system: (yes or no)_
Water m er readings, if available:
Last dat of occupancy:
OTHE . (Describe)
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information: ' [� Y
-Pt,P� ,® s 4 9 3 ✓z®6 L S 6 '— S ,a_7,G 5,'
System pumped as part of inspe ion: (yes or no)-L1/
If yes, volume pumped. gallons
Reason for pumping:
TYPE O 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)
Other(explain)
APPROX TE AGE of all components, date installed (if known) and source of information:
�J-a 97 )"^'s
Sewage odors detected when arriving at the site: (yes or no)_
(revised 8/15/95) 5
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: p2
Owner: -4 m ej M?��q�i /1 i7 y
Date of Inspection: 60 0 s S
SEPTIC TANK:_v
(locate on site plan)
r �
Depth below grade: 4)
Material of construction: _concrete metal FRP—other(explain)
Dimensions: t `E
Sludge depth: t,,
Distance from top of�sludge to bottom of outlet tee or baffles
Scum thickness:_
t Distance from top of scum to top of outlet tee or baffle: '7
Distance from bottom of scum to bottom of outlet tee or baffle: 1 .
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.) f p 4 s &
GREASE TRAP:_
(locate on site plan)
Depth below grade:
Material of constructi : _concrete _metal _FRP—other(explain)
Dimensions:
Scum thickness:
Distance from to of scum to top of outlet tee or baffle:
Distance from b ttom of scum tn hottom of outlet tee or bathe:
Comments:
(recommendal ion 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.)
(revised 8/15/95) 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: v4 I ,
Owner: T,jrp.e,S Inc_ a.k_flr 1�n
Date of Inspection:
TIGHT OR HO DING TANK:_
(locate on site Ian)
Depth belo grade:
Material of onstruction: _concrete_metal _FRP—other(explain)
Dimensio s:
Capacity: al Ions
Design fl w: gallons/day
Alarm le el:
Comme s:
(conditi of inlet tee, condition of alarm and float switches, etc.)
DISTRIBUTION X:_
(locate on site an)
Depth of liq d level above outlet invert:
Comments:
(note if le I and distributiun is equal, evidence of solids carr)•ovc., evidence of leakage into or out of box, etc.)
PUMP CHAMBER,
(locate on site p n)
Pumps in wo ing order:(yes or no)
Comments-
(note con ition of pump chamber, condition of pumps and appurtenances, etc.)
(revised 8/15/95) 7
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: �` 04a17
Owner: ' i 01 PS ni G/a A-/h /7
Date of Inspection: f 0 X O--9 3
SOIL ABSORPTION SYSTEM (SAS):
(locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods)
If not determined to be present, explain:
Type:
leaching pits, number:
leaching chambers, number:_
leaching galleries, number:
leaching trenches, number,length:
leaching fields, number, dimensions:
overflow cesspool, number:
Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.1
6 0 -6 A I Q e" f N &W Al 5 ,e J/
L ti44 7 g -- 2- 7
CESSPOOLS: _
(locate on site plan)
Number and configu tion:
Depth-top of liquid o inlet invert:
Depth of solids la r.
Depth of scum la er:
Dimensions of c sspool:
Materials of co struction:
Indication of oundwater.
infl w (cesspool must be pumped as part of inspection)
Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
PRIVY:_
.(locate on site an)
Materials of nstruction: Dimensions:
Depth of sol ds.
Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
(revised 8/15/95) 8
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:
Owner: q
Date of Inspection: 6 u—off-
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100'
� 1 �
I �
I � �
I �
l
DEPTH TO GROUNDWATER
Depth to groundwater: �:!5 tfeet
method of determination or approximation: 1,0 „ > b Ga
(revised 8/15/95) 9
A. TOWN OF BARNSTABLE
--CATION 1 Ctj(a A i/ SEWAGE #
VILLAGE ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO. J�d b
SEPTIC TANK,,CAPACITY G
LEACHING FACILITYAtype) (size) Z p 0 0 X
NO. OF BEDROOMS PRIVATE WELL OR,PUBLIC WATER
BUILDER OR OWNER �' Licr
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
u
J.1
��� �,
�� �Y
��
' \`
A
r � _\
�V i
t
���:
� � 4Fr
' Y
TM
No..- 3-.-L1 Y Fizs. 3 0.'..0.0........
APPROVED ns le Conservat THE COMMONWEALTH OF MASSACHUSETTS
Depa me
BOARD OF HEALTH
igned Data TOWN OF BARNSTABLE
. ppliration for Disposal Works Tons#rurtion J[rrntit
Application is hereby made for a Permit to Construct ( ) or Repair ( x) an Individual Sewage Disposal
System at:
28 Walton Ave Hyannis
................_.......................................-----•--------------------............... ........-----------------.......----------------------------------........------............-----•
ealt Address or Lot No.
Craigville Re ..........------------....---------•------------......-----------------------------..............
Owner Address
a W,.,--E._-Robinson_Septic,_Service_,____„_ P_,0 Box___1.089 Centerville,__,•_______________________
...... ...--
Installer Address
d Type of Building Size Lot--- -------- ----------Sq. feet
U Dwelling No. of Bedrooms ...................................Ex Expansion Attic
g— p ( ) Garbage Grinder ( ) -
a44 Other—T e of Building No. of persons............................ Showers
YP g -------------•-•--•--------- P ( ) — Cafeteria ( )
dOther fixtures ---------------------------------------------------------------•-•--------------------------------------............................................
W
Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date--------------...------------.......----
Test Pit No. I................minutes per inch Depth of Test Pit--.................. Depth to ground water.......----.............
44 Test Pit No. 2................minutes per inch Depth of.Test Pit---_................ Depth to ground water.......--...............
9 -------------------------------------------------------•-------.....------.......------------------..........................................................
ODescription of Soil........aand.....................................................................................................................................................
x
U --------------------------•----••----------•---------------------•-•---•-•----------•---------------------•----------------•------------•-----------•---------------------.....---.......--------------
W
x -•---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•---------------...
U Nature of Repairs or Alterations—Answer when applicable.........................................................................:.....................
.......nsta.1-1---s...1•,-0-0-0...gal----p-r-cca&t...s-tonepacked---ave r f l aw------------------------•-----•-•--------•-•-•--•--•-----
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has b sued by the board of health. ^p
9
Signed . .-- ----- ------ ------ ----------------------------------------------------------- ---9- 7�3 ---I---------
Date
Application Approved BY ............... ........................................... �.. .. -
Date
Application Disapproved for the follow) g reasons- ------------------------------------------------------------------------------------------------------------------------------------
........... ----------------- ------------------- -------------
y Dace
PermitNo. _—----Lf--`---7-------------_-- Issued -- . ---------------.........----------
Date
�.I
9 1^/ 79 f $30.00
/17 THE COMMONWEALTH OF MASSACHUSETTS
BOARD "bF HEALTH
TOWN OF BARNSTABLE
Apphration for Disposal Works Tonstrnrriion ramit
Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal
System at:
.....2S...uUILI Oxa...kme.....34ya?leis................._........... ----------------------------------------------------------------------------___....._--
Location-Address or Lot No.
-Ciraiavills Real -- _...... . .........._ .
...___ Owner Address
--------- -A 0--Rom m 10.8a _aat n y ZZ e l-1 a-----------------_-------
Installer Address
Type of Building Size Lot---------------------------Sq. feet
., Dwelling—No.-of Bedrooms......3....................................Expansion Attic ( ) _ Garbage Grinder ( )
Other—T e of Building g ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
Other fixtures
W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons.
WSeptic Tank—Liquid capacity------------gallons Length................ Width................ Diameter---------------- Depth----------------
x Disposal Trench—No..................... Width.................... Total Length__..--_.___--------- Total leaching area--------------------sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area------------------sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
W
Percolation Test Results Performed by-------------------------------------------------------------------------- Date----------------------------------------
Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water---•____________________
44 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water_-__-_-•-_--------..--._
a -----------------------------------------------------------------------------------------------------------------------------------------------------------
"� Description of Soil w jrd------------------------------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
U Nature of Repairs or Alterations—Answer when applicable____.--__-_•____________________________________________________________•--••-••------._----_-.
------'- , . -- .--' --------------------------
1.iY'�Cad- a-•--�--� v� �� ---NIC'OL��L_._�V�iT"icp?u%'Fi-Ou---v5t��- �Bva-•-----------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
--f system in operation until a Certificate of Compliance h e issued by the board of health.
A� r f
' A Signed '---- ------------------------------------------------------------------------------- -
----------------
Application Approved By -------- r "="�..... ------------------------...-------------------------------------------- --9- �[- ------
`/ l Dare
Application Disapproved for the following reasons: ............................_----------------------------------------------------------------------------------------------------------
.....................................---------------------------------------------------------
-- --------------------------------------- ----------------------------------------
Dare
Permit No.
'— 71-- ------- Issued --------------------------------------------------------------------
Dare
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
(ger#ifirak of Tantplianre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( 3{ )
by-- W.E. ..... obinson...Se tic Service
Installer
at -----2 A--I^Ja--l--ton--Ave---------Ryan??s-------------------------------------------------------------------------------------------------------------------- ---------------------------------
has been installed in accordance with the provisions of TITLE 5 The State Environmental Code as described in
0
the application for Disposal Works Construction Permit No. _...___ ___3____" �___ -. ........ dated ________________________________________________
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION
SATISFACTORY.
DATE------------------------ 73
--------- �--- -..------------------------------ ------ Inspector ---------------
--------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH -
/� TOWN OF BARNSTABLE
FEE...............0.-0.....
Disposal lVarkii Tonstrurtion tirrnti#
Permission is hereby granted....... ---Servi ae--------------•-•••-------....---.......------_-_
„
to Construct ( ) or Repair ( >) an Individual Sewage Disposal System
at No.------. 8---VBLL..t0X1...Aye-----Tuna t3?is-------------------------------- ---------------------------------------------------- ----•---------------------------
Street q� U
as shown on the application for Disposal Works Construction Permit No G_ ----- �ated..........................................
� 0
--------------------------------------- ------------------------------------------------------
-----------------•••---•--•--- Board of Health
DATE.............. _•�--�-"--- --•3
FORM 36508 HOBBS R WARREN.INC..PUBLISHERS
r
TOWN OF BBjjARNSTABLE
LOCATION , U l/ I YI lR�y-e SEWAGE
6� ?. :LAGE 1ant* ASSESSOR'S MAP & LOTJfi� A115
r
IN�'6 NAME&PHONE NO r�GIC onne 0 4126-r775
SEPTIC TANK CAPACITY /000 S
LEACHING FACILITY: (type) (size) _140W QJ DeZ
NO.OFBEDROOMS
BUILDER OR FTIZ S KeC I e f-0Nt
PERMITDATE: DATE: ®S.
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
j
DO
QJ
.. ,:,,
No..........
�t�....4.... ......... ...........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HEA TH
----- OF......... ....
Appliration for Bi4vuiitt1 Workii Tonstrnrtion ramit
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposals j.,
System at
......... / . ....-- ....... - /---P .. . - ..---....
Location- dress or Lot No.
- - -------------•--------- _._}� ..........._.....
ner r. Address
14
Installer dress g�
d Type of Building Size Lot-___-/07.1-,1._._Sq. feet
U Dwelling—No. of Bedrooms. Attic ( ) GartS°age Grinder ( )
.,
aOther—Type of Building __ _ No. of persons......... .............. Showers ( ) — Cafeteria ( )
dOther fixture . -•--•-••-------•••-•..............•••----- ----------- ----....---•••-•---•--.....••---
w Design Flow...............•' . ..._ gallons per personf�..
i da�s�, Total da•lf flgy�________.___ gallons.
=---------------------
WSeptic Tank—Liquid capacity./. gallons Length.. Width.__7_.�.._ Diameter________________ Depth....__..._..._..
x Disposal Trench—No..................... Width_...`........._.... Totalngth.__......._..��Total leaching area....................sq. ft.
Seepage Pit No. /---------- Diameter Depth below inlet 6 Total leaching area sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.... _.. /f.- Date.
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground wa r.___......_..._____-�__
Gr4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.__/)/&. __
-------------- ----- ................................ -- •--•-•---
Description of Soil ---- ...C? ��•�1
x
w
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 TITLi, 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been i d by the board of health.
ig -V---- - ..................
Dat
Application Approved BY` �- !� _----------------•---- {� " ............
Date
Application Disapproved for the following reasons:------•--••••••---- •-•-------;••--•--•---•--••-•-------••-•---------•-••-••----•--•--••----•-••------••....
--------------------••----•--r...........-•••-••-•••-•-----•......-•--•-------•............................................................
Date
` .. Issued...... --
Permit No.---•..............................•-----.....-...-.... Date- ---..
`.-.�....:..
! /
THE COMMONWEALTH OF MASSACHUSETTS {
r. t
BOARD OF HEA TH
n
�. ��...OF...... ~
Appitration for Dtiipos of Works Tun.5trnrtinn Vrkmit
Application is hereby made for a Permit to Construct (-/1-6r Repair ( ) an Individual Sewage Disposah"
System at• I'
r
Location- ddress fr or Lot No
/ ... .
o �
Owner r r Address {1j ~
W art J}gf *}"f/ r d.� Y N--.) /� ��1 V
..................:''...�. ........ ..!f.. •`:C. - .__f__S!"S .... ........-_-____..__.»__ -a ..I.!y.y�y.` `Zi°!:Y.'-". r.
Installer Address .
d Type of Building Size Lot__.._ *'tq. feet
Dwelling—No. of a Bedrooms,.r_......w,,�..____________________________Expansion Attic ( ) Garbage Grinder ( )Other—Type of Building ..S-�' i,!¢—�:�4 No.' _of persons......... _ Showers Cafeteria
Other fixture =---------------------------- ----••---•-•--...---------
Design Flow............... ....................gallons per person ,ef day: Total d ily fl w.._.... gallons.
WSeptic Tank—Liquid capacitylgallons Length___ _ �___ Width._/ __ Diameter______ ________ Depth......._........
x Disposal Trench No_____________________ Width..../............. Total Length .... a , Total leaching area._._.,....................sq. ft.
Seepage Pit No __�.._______--
Other Distribution box Diameter .......... Depth below inlet __ Total leaching area�,r sq. ff.
Z ( ) Dosing tank
Percolation Test Results Performed by.._.,/_ 'Z .._
Test Pit No 1 ______________minutes per inch Depth of Test Pit-_.,............... Depth to ground waar "
P P -----•-•-•-•... Depth to ground.,water C� -t€
Test Pit No 2_______________minutes per inch Depth of Test Pit
x .
................. ................•-----•--
Description of Soil-
U ---------------------=------------------------------------------------------
____------------------
`U W ••--•-----------------------------•---....._.•-----------------------------------......-••-•••••••-••----•-----------------------...--•------•--•-----....................................................
Nature of Repairs or Alterations—Answer when applicable_______________________________________________________________________________________________ ;
.................
Y . • }y...
Agreement
The undersigned agrees 'io install the aforedescribed Individual Sewage Disposal System .in''accordance with.
the provisiQns.o,f,"LITY-L 5 of the State Sanitary Code—The undersigned ether agrees not to place the system in
operation until a'Certificate of Compliance has been issued by the board of l ealth.-;
ig
D t
Application A roved B
Date:,
Application Disapproved for the following reasons:--•---•------•-•-•-- ri: --•---••-•---------•••-----•----•-••-----------••..... ...:.. .........
---•--------------••----.........--------.....------•-------•-----•-•-•..... ...--------------•------------ -----------------------------------.........-•----•.---'- .........
Daate.
PermkNo----------------- ---------------------------------_ Issued-...............................•`-•. ----
Date
1 ,
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF
F HEALTH
9V7.OF........./ ,f.. ~� ?�:--' `. ......r :...
TatifirFatr of Tompfiaurr
! ~ THIS IS TO`CERTIFY, That tWInd.vidua ewage Dis� sal System constructedpair
THIS
�I by_--•---•---------- ' • mot? _.•"� -�'G`.- '�' o •• . .......................
a ,I,
at-------•-•1 �- .� t;� t�-�... ------•-•------ -------- -------- - .
Ins
`KJ
has been installed in accordance with the provisions of 5 of The State Sanitary Code as described in the
. '
application for Disposal Works Construction Permit No i!_�.,............. dated �_ _._ '"'.1�Ap--_....._.__._.
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTf E® AS A GUARANTEE THAT THE
SYSTEM WILL PYNCTION SATISFACTORY
DATE...........-•-f-•---1--�--•-•-��- ;-----• ---•------.: Inspector---•-�:---�
THE COMMONWEALTH OF MASSACHUSETTS
r BOARD OF HEALTH r;
r f`
...OF.....
1 FEE ......................
Disposal ja ra irrn err it
Permission 's hereby granted =! . ..._? � - � r :� -' .........7 ...
to Construct ( " or Repair ) an Individual Sevt�a -e s^osal Syst � �
A�' _ __''
r r treet .
k as shown on the application for Disposal Works Construction Pe t No. Dated...4'f'`'_ft �
.......... ..._
h „ Board of Health
DATE.-----•(1. ""
FORM 1255 HOBBS'& WARREN, INC., PUBLISHERS
LEGEND N
A{ L x 100.98 EXISTING SPOT GRADE
EXISTING CONTOUR �y
OVERHEAD WIRES 3
2 �o
LCP j7201H (Sheet �' W EXISTING WATER SERVICE
TEST PIT
LOCUS
BENCHMARK
Ui
y 6tJMP�s RO u+
n
O CHESTNUT ST
1 C O
BENCHMARK SET
EXISTING SEPTIC TANK Outside Cor./ Bulkhead CHERRY ST
`WITH SAND & ABANDONED
(TO REMAIN) EL.=101.17 (Assumed) EXISTING LEACH PITS LOCUS MAP
TOP ,OF TANK, EL.= 100.7.t TO BE PUMPED, FILLED NOT TO SCALE
INV.(OUT) = 99.37E
GENERAL NOTES:
N 14°08'17" E �100
145.00' 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL
(LOT 13) x 100,72 �� 99 27 BOARD OF HEALTH AND THE DESIGN ENGINEER.
100.30 \� x 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS
100,92 APN 310-415 1 D-BOX OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE
10 765±SF - I I LOCAL RULES AND REGULATIONS.
101 ___ -0 �_____ O O
BM TP 2 1 U 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR
101,59 1 1 .1 TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE
xQEE
�\ DECK ��\ 1 �� 1 DESIGN ENGINEER.
�1 100,68 TP-1 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING
r-1 FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN
i�
1-1 ENGINEER BEFORE CONSTRUCTION CONTINUES.
LO EXISTING 1 �`� Cf) jU O w 5. ALL ELEVATIONS BASED ON AN ASSUMED DATUM.
1 zo I HOUSE 28 I 1 I z z 99.27 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF
1, x 10 1.31 GARAGE 02 � THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF
T.D.F.=102.6t 1 ���. ,% 09 i i U)
Z i r i N � } HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION.
01 ----I 1- I 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE.
i T 101.09 x �101.62 t-20'
00,59 I 4 UNITS I 1 N 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S.
10}-_�'•4_-___ -p1------1 y� J I�_T2EIVH_2-_+ 1 O 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS
Im 1 10L40 / ? I AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE
� 11 �J{�1.32 1l"`-20—� SIDEPORT COUPLER
I \ �1 ,r� CONNECT USING LOWER DIRECTED BY THE APPROVING AUTHORITIES.
,� ,� --1pa------- a \ CD r S PIPES KNOCKOUTS 10, IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY
I� -1,ici A P _ CP `t�r� 99.98 - THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING
1 x-1-0e CONSTRUCTION.
100.56 C45.04 _ --� split rbil fence CB
100,4 -- --+r--- ---->< 100.26 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS
N 12°49'19" E �00--- ---- ---�00-----__ 100,3 IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND
_ _ __- 100.00 :-- 00 REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3).
100.45 100,14 edge 100,0 00 of pavement UP 99,95 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE
catchbasin
99.76 INSPECTED BY HEALTH DEPARTMENT PRIOR TO BACKFILL.
13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND
IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY.
of *s WA L TON A VENUE i PROPOSED SEPTIC SYSTEM UPGRADE PLAN
o PETER T.
McENTEE 28 WALTON AVENUE, HYANNIS, MA
o CIVIL
No. 3IL i Prepared for: D. A. Brown, Inc., P.O. Box 145, Centerville, MA 02632
o R£PSTE��`� Q j OWNER OF RECORD Engineering by: SCALE DRAWN JOB. NO.
9 F , CLAYBRONE, SHERRIE D
& FERNANDES, FERNANDO A Engineering Works, Inc. 1"=20' P.T.M. 111-12
111 NAILS COURT 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO.
2-1 b(l2-- STERLING, VA 20164 (508) 477-5313 2/10/12 P.T.M. 1 Of 2
n.
s
NOTE: TO PREVENT BREAKOUT, THE PROPOSED
FINISH GRADE SHALL NOT BE < EL.96.8
FOR A DISTANCE OF 15' AROUND THE .
PERIMETER OF THE S.A.S.
SEPTIC TANK PROPOSED D—BOX PROPOSED SAS I I I
INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & WATERTIGHT INSTALL INSPECTION PORT OVER END UNIT DECK 42 A'�
OUTLET AND SET TO 6" OF FINISH GRADE
T.O.F. COVER SET TO 6" OF GRADE I
EXISTING F.G. EL.=100.6t F.G. EL: 99.7t F.G. EL: 99.8(MAX.)
I I
MAINTAIN 2% GRADE (MIN.) OVER S.A.S.
EXISTING i7
WWW
L - 49' L = 4' HOUSE(#2 Izi
® S=1% (MIN.) ® S=1% (MIN.) I INSPECTION PORT
CH40 PVC 4!'S 4"SCH40 PVC
6.. VC TF. I I
I I
10"1 14•' s" 10.75" TO I I
INVERT I I
EXISTING as" LIQUID INV.=96.40 i— I 1!'-20.1' 0'3' - ----- J
LEVEL qpp TRENCH 1: 8 UNITS = 40.0' -TRENCH_2_J
GAS BAFFLE INV.=96.67 PROPOSED INV.=96.50 TRENCH 2: ;4 UNITS = 20.0' -----
INV.=99.37t D-BOX TOTAL EFFECTIVE LENGTH = 40' + 20' = 60'
• EXISTING SOIL
S MUST BE STAMPED H20 SI (PROFILE)
NIT
EXISTING SEPTIC TANK S.A.S. LAYOUT
ESTABLISH VEGETATIVE COVER
BACKFILL WITH CLEAN NATIVE OR
PERC SAND TO TOP OF CHAMBERS ,r 2"
NOTES: (�-15. 4
1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE
.v
INVERTS, PRIOR TO INSTALLATION. TOP ELEV.=96.83 `
2) D-BOX SHALL BE SET LEVEL AND TRUE TO INV. ELEV.=96.40 1 12'
GRADE ON A MECHANICALLY COMPACTED SIX 15.5" '
INCH CRUSHED STONE BASE, AS SPECIFIED IN
BOTTOM ELEV.=95.50 6" r' 8
310 CMR 15.221(2). 2.83' , P T •, ..
3) INSTALL INLET & OUTLET TEES AS REQUIRED. 5' MIN. ABOVE BOTTOM OF I
4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE T.P. EXCAVATION OR G.W. 3 OUTLETS - H-10 LOADING 2"
AS MANUFACTURED BY TUF—TITE, ZABEL OR EQUAL. EXISTING SUITABLE D—BOX
NO G.W., EL=89.3 T MATERIAL
SEPTIC SYSTEM PROFILE ADS Arc 36HC UNITS TO BE INSTALLED IN
63.25"
TRENCH CONFIGURATION WITH NO STONE
N.T.S. TYPICAL SECTION
16"
DESIGN CRITERIA SOIL LOG 34.5"
DATE: FEBRUARY '.10, 2011 (REF#13,542)
NUMBER OF BEDROOMS: 3 BEDROOMS SOIL EVALUATOR: PETER McENTEE PE
WITNESS: DONALD DESMARAIS R.S. HEALTH AGENT
SOIL TEXTURAL CLASS: CLASS I TOP VIEW
TP— 1 DEPTH ELEv. TP—2 DEPTH on DESIGN PERCOLATION RATE: <2 MIN/IN ELEV. �„ END CAP END CAP —60"
DAILY FLOW: 330 G.P.D. 99•3 FILL Q„ 99.3 FILL FRONT VIEW SIDE VIEW
DESIGN FLOW: 330 G.P.D. 98.6 A g 98.5 A 10 END CAP
SANDY LOAM SANDY LOAM REAR/TOP VIEW -11 11",
GARBAGE GRINDER: NO 10YR 4/2 10YR 4/2
98.3 12" 98•1 14' NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT SIDE VIEW
LEACHING AREA REQUIRED: (330) = 445.9 S.F. B B TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY
74 SANDY LOAM SANDY LOAM
DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE.
I 10YR 5/8 10YR 5/8 4640 TD, EMANOHIO BLVD akEXISTING SEPTIC TANK: 1000 GALLON CAPACITY 96.6 32" 96.5 34" lff4z HILLIARD, OHIO 43026
PROPOSED D—BOX:: 1 INLET, 3 OUTLETS, H-10 RATED CMED. SAND C1 . Arc 36HC DETAIL
MED. SAND AnvaNceo DwuNAce srsreMs. INC, UNITS MUST BE STAMPED H-20
10YR 5/8 j 10YR 5/8
95.3 10% GRAVEL 48" 95.3 10% GRAVEL PROPOSED SEPTIC SYSTEM UPGRADE PLAN
SOIL ABSORPTION SYSTEM C2 C2
USE ADS Arc 36HC UNITS IN STONELESS TRENCH CONFIGURATION MED. SAND MED. SAND 28 WALTON AVENUE, HYANNIS, MA
(GENERAL USE APPROVAL FOR 7.79 SF/LF IN TRENCH CONFIGURATION) 2.5Y 6/4 1 2.5Y 6/4 Prepared for: D. A. Brown, Inc., P.O. Box 145, Centerville, MA 02632
12 UNITS = 60.0 FT 89.3 120" 89.3 120" Engineering by: SCALE DRAWN JOB. NO.
60' x 7.79 SF/LF = 467.4 SF PERC RATE <2 MIN/IN. (IN SAND — MAY 26, 1978) Engineering Works, Inc. NTS P.T.M. 111-12
467.4 S.F. = 345.9 G.P.D. SOILS ENCOUNTERED ARE CONSISTANT WITH RECORD PERC RATE 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO.
DESIGN FLOW PROVIDED: 0.74
( ) NO GROUNDWATER ENCOUNTERED (508) 477-5313 2/10/12 P.T.M. 2 of 2
i�
t;M
v
LEGEND
100.98 EXISTING SPOT GRADE i N
EXISTING CONTOUR '
OVERHEAD WIRES 3
LCP j720 heet 2) W EXISTING WATER SERVICE
TEST PIT
BENCHMARK LOCUS
,n
v BUMPUS RO u+
A
- O
Z
CHESTNUT ST
ORIGINAL LEACH PITS -o ,o
BENCHMARK SETrr
FILLED & ABANDONED CHERRY ST
EXISTING SEPTIC TANK Outside Cor./ Bulkhead
(TO REMAIN) EL.=101.17 (Assumed) EXISTING LEACH TRENCH LOCUS MAP
TOP OF TANK, EL.= 100.7f TO BE ABANDONED NOT TO SCALE
1NV.(OUT) = 99.37t
GENERAL NOTES:
N 14'08'17" E �Op
LOT .3 -pa 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL
145.00' x 100,72 l BOARD OF HEALTH AND THE DESIGN ENGINEER.
10,765±SF 100.30 99 27 2• ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS
} 1 OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE
QPARCEL ID: 310-415 LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW:
TP-2 310 CMR 15.405(1)(b) CONTENTS OF LOCAL UPGRADE APPROVEL
_ B /� I 1) A 2' variance, S.A.S. to cellar wall, for an 18' setback.
DECK 'D� 101.59 ;�,0 muI i 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR
�
x� TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE
3 k �� 100,68 - I TP-1 DESIGN ENGINEER.
4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING
ih
rn L i
FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN
� EXISTING ��� Ix ENGINEER BEFORE CONSTRUCTION CONTINUES.
I w
' x 101,31 GARAGE HOUSE(#28) I O i i 99 6. THE ENGINEERDESIGN ONS ISASED NNOT RESPONSIBLE AN ASSUMED FORTHE FAILURE OF
T.O.F.=fO2tif i `�__� r� Lo THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF
Z I I I cv ;n HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION.
i° , 101.09 x 1 — — ^ n 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE.
) 100.59 r• `�: -•• T 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S.
101-- pa — ---�01-------� a ..;
Im 101.40 i ? I.. " ao 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS
O ------- �JtiL32 ' O O N AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE
j` DIRECTED BY THE APPROVING AUTHORITIES.
A P b {� 25 9.98 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY
= 0 __x�-00 THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING
' 100,56 - 45.04' — --� splits it fence CB CONSTRUCTION.
100.4 —. --I----- --- 100,26 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS
N 12°49'19" E ----- ---- - _ 100,3
-00- 100.00—�� — IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND
-- ------100 REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3).
100.14 edge 100,0 OO of catchloln Pavement UP 99,95 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE
y1HOFMgSsgc 99.76 INSPECTED BY HEALTH DEPARTMENT PRIOR TO BACKFILL.
EXISTING LEACH TRENCH 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND
PETER T. „ IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY.
McENTEE `� TO BE REMOVED WHERE
CIVIL WALTON A VENUE WITHIN 5 OF PROPOSED PROPOSED SEPTIC SYSTEM UPGRADE PLAN
.35109 a S.A.S.
°� RF ST �� �� 28 WALTO N AVENUE, HYAN N I S, MA
i Prepared for: D. A. Brown, Inc., P.O. Box 145, Centerville, MA 02632
Engineering by: SCALE DRAWN JOB. NO.
OWNER OF RECORD 1„=20' P.T.M. 240-17
ERNANDES, FERNANDO A Engineering Works, Inc.
111 NAILS COURT 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO.
STERLING, VA 20164 (508) 477-5313 8/1/17 P.T.M. 1 Of 2
NOTE: TO PREVENT BREAKOUT, FINAL GRADE
SHALL NOT BE AT, OR BELOW, EL.=97.0
" FOR A DISTANCE OF 15' FROM THE EDGE
OF THE PROPOSED S.A.S.
SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. p ,
INSTALL RISERS & COVERS OVER INLET "& INSTALL RISER & WATERTIGHT INSTALL RISER & COVER OVER ,ONE CHAMBER AND
T.O.F. COVER SET TO 6"
OUTLET AND SET TO 6" OF FINISH GRADE OF GRADE SET TO 3" OF F.G. TO'jSERVE AS INSPECTION PORT EX1S77NG
�
EXISTING F.G. EL.=100.Of HOUSE(
j, #28) �, R9
9,
F.G. EL.=100.6t F.G. EL: 99.7t T.O.F,.=102.6f
MAINTAIN 2% SLOPE OVER S.A.S. S>
L = 62' L = 4' 17.9' ���M�
® S=1% (MIN.) ® S=1% (MIN.) 2" LAYER OF 1/8" TO 1/2" 2.90
4"SCH40 PVC 4"SCH40 PVC DOUBLE WASHED STONE 45. + OR
6"
io"1 g aaa�aaa (OR APPROVED FILTER FABRIC) N
i4" aaEaaa6 PROP. S.A.S.
EXISTING 48" LIQUID aBaaaaa �3/4" TO 1-1/2" DOUBLE �-----;
LEVEL 4' S.2' 4' WASHED STONE Imo--25
ADD INV.=97.17 PROPOSED INV.=97.00
GAS BAFFLE EFFECTIVE WIDTH = 12.8'
INV.=99.37f D-BOX
EXISTING INV.=96.50 i
EXISTING SEPTIC TANK 2-500 GALLON LEACHING CHAMBERS S.A.S. LAYOUT
SURROUNDED WITH STONE ,AS SHOWN
H-10 RATED
NOTES: TOP CONC. ELEV.=97.3f
1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE BREAKOUT ELEV.=97.00
INV. ELEV.=96.50 eases
INVERTS, PRIOR TO INSTALLATION, aaaaaaBaaaB
a®aaaaaaaa6
2) D-BOX SHALL BE SET LEVEL AND TRUE TO BOTTOM ELEV.=94.50
GRADE ON A MECHANICALLY COMPACTED SIX 4' 2 x 8.5' = 17.0' 4'
INCH CRUSHED STONE BASE, AS SPECIFIED IN 4' OF NATURALLY OCCURRING EFFECTIVE LENGTH = 25.0'
310 CMR 15.221(2). PERVIOUS MATERIAL
3) INSTALL INLET & OUTLET TEES AS REQUIRED. 5' (MIN.) ABOVE G.W. LEACHING SYSTEM SECTION ®®®® 0
4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE NO G.W., EL=89.3 z 1- Ea®®®®® ® ®®®® 33"
AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. W ®®®®®® ® ®
SEPTIC SYSTEM PROFILE N z ®LEI-E3
N.T.S. TYPICAL SECTION
102"
DESIGN CRITERIA SOIL LOG
it
DATE: FEBRUARY 10, 2012 (REF#13,542) 4" KNOCKOUT
NUMBER OF BEDROOMS: 3 BEDROOMS SOIL EVALUATOR: PETER McENTEE PE 20" DIA. COVER
SOIL TEXTURAL CLASS: CLASS I WITNESS: DONALD DESMARAIS R.S. HEALTH AGENT
"
DESIGN PERCOLATION RATE: <2 MIN/IN ELEV. TP- 1 DEPTH' ELEV. TP-2 DEPTH 4" KNOCKOUT 4 KNOCKOUT 58"
0„ . 0„
DAILY FLOW: 330 G.P.D. 99'3 FILL 99.3 FILL 0
98.6 8" ° 98.5 10"
DESIGN FLOW: 330 G.P.D. A A 4" KNOCKOUT
SANDY LOAM SANDY LOAM
GARBAGE GRINDER: NO 98.3 98 1 10YR 4/2 10YR 4/2
14
LEACHING AREA REQUIRED: (330) = 445.9 S.F. B 12"I B " 500 GALLON CAPACITY, H-10 LOADING
74 S ND 5O M S ND 5O M CHAMBERS
EXISTING SEPTIC TANK: 1000 GALLON CAPACITY 96.6 C1 32" 96.5 C1 34 N.T.S.
PROPOSED D-BOX:: 1 INLET, 3 OUTLETS, H-10 RATED MED. SAND MED. SAND
10YR 5/8 t 10YR 5
10% GRAVEL f 10% GRAVEL
USE 2-500 GALLON LEACHING CHAMBERS IN SERIES 95.3 C2 48 95.3 C2 48" PROPOSED SEPTIC SYSTEM UPGRADE P
SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES 28 WALTON AVENUE, HYANNIS, MA
MED. SAND MED. SAND
SIDEWALL AREA: 2(12.8' + 25.0') X 2 = 151.2 S.F. 2.5Y 6/4 2:5Y 6/4 Prepared for: D. A. Brown, Inc., P.O. Box 145, Centerville, MA 02632
BOTTOM AREA: 12.8' x 25.0' = 320.0 S.F. i Engineering by: SCALE DRAWN JOB. NO.
89.3 120' 89.3 120" NTS P.T.M. 240-17
TOTAL AREA:.............................................................. 471.2 S.F. PERC RATE <2 MIN/IN. (IN SAND - MAY 26, 1978) Engineering Works, Inc.
O.
DESIGN FLOW PROVIDED: 0.74 GPD/SF(471.2 SF) = 348.7 GPD SOILS ENCOUNTERED ARE CONSISTANT WITH RECORD PERC RATE 12 West Crossfield Road, Foestdale, MA 02644 DATE CHECKED SHEET NO GROUNDWATER ENCOUNTERED (508) 477-5313 8/1/17 P.T.M. 2 of 2
2
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