HomeMy WebLinkAbout0040 ARBOR WAY - Health ,„=40 ARBOR;WAY,y HYANNIS r
i
° °
TOWN OF BARNSTABLE
LOCATION qO kkolt 6JAy SEWAGE # 206 t -475
VILLAGE flJlq r N 15 ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. R06�NSor i - N&,Of C.
SEPTIC TANK CAPACITY 1 S O O
LEACHING FACILITY: (type) 3 'D?441 M (size) [OL2,a247Xa
NO. OF BEDROOMS
BUILDER OR OWNER ?, LkE2.tNC1
PERMITDATE: Ig-g l O COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feety
Edge of Wetland and Leaching Facility(If any wetlands exist Ilk
within 300 feet of leaching facility) Feet
Furnished by
O .
o_
t
s
� ss�
0
d
i
a8 9- a�b
Commonwealth of Massachusetts r.
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
40 Arbor Way
Property Address _
FEDERAL NATIONAL MORTGAGE ASSOCIATION
Owner
Owner's Ne^�'
Information Is Hyannis r MA 02601 9/04/20
required for every
page, Clyrrown 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 checidist at the end of the form.
Imng out f:ms A. Inspector Information J 4r P5p q LO filling out forma �.
on the computer,
use only the tab Robert Paolini
key to move your Name of Inspector
use cursor
re do at Robert Paollni
return
key. Company Name j
67 Tanbark Rd. -
pp Company Addreso ,
Mar_stons Mills MA 02648
State Zip Code
CiyRown J.
(506)280-9499 S14454
Telephone Number Ucense Number
B. Certification
I certify that:I am a DEP approved system Inspector In full compliance with Section 15.340 of Tide
6(310 CMR 15.000);1 have personally Inspected the sewage disposal system at the property address �)
listed above;the information reported below Is true,accurate and complete as of the time of my
inspection;and the inspection was performed based on my training and experience in the proper function
and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined
that the system:
1. 12 Passes
2. ❑ Conditionally Passes
3. ❑ Needs Further Evaluation by the Local Approving Authority
4. ❑ Fails
9/04/20
inspec ors Sign-fie- oats
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 has a design flow of
10,000 gpd or greater,the Inspector and the system twner shall submit the report to the appropriate
reglonal office of the DEP.The original form should be sent to the system owner and copies sent to
the buyer,if applicable,and the approving authority.
Please note: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 some or different conditions of use.
t9trnp.doo.,ay.T/40"s TBb 5 RM I I Impation Pomr.eubWAI a 8we9e MP"I eyebm•POP'of 1a
In the future under the same or different conditions of use.
C. Inspection Summary
Inspection Summary:Complete 1,2,3,or 5 and all of 4 and 6.
1) System Passes:
® 1 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:
2) 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 exflltration 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):
C. Inspection Summary (cont.)
2) System Conditionally Passes(cont.): g
❑ Pump Chamber pumps/alarms not operational.System will pass with Board of Health approval if
pumps/alarms are repaired.
S
t5lnsp.doc•mv.U28/2018 TIM 5 Ofliclal Inswc1lon Form-Sunsurfam Sam-Qlawml System•Pma 2 of 1 S
i
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 El El ND(Explain below):
❑ obstruction is removed El Y ❑ N ❑ ND(Explain below):
3) 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 falling to protect public health,safety or the environment.
a. 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:
E
C. Inspection Summary (cont.)
❑ 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
b. System will fall 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".
t5insp.doe•rev.712620111 - Title 5 Official Inspection Form:subsurface sewage Disposal System Pape 3 of 18
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.
c. Other, {
4) 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
C. Inspection Summary (cont.)
4) System Failure Criteria Applicable to All Systems:(cont.)
Yes No
❑ ® 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
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s).Number of times pumped: E
❑ ® 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. i'
❑ ® Any portion of a cesspool or privy Is within a Zone 1 of a public water supply
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
•y system passes if the well water analysis,performed at a DEP certified
* laboratory,for fecal coliform bacteria Indicates absent and the presence
' x of ammonia nitrogen and nitrate nitrogen Is equal to or less than 5 ppm,
F provided that no other failure criteria are triggered.A copy of the analysis
" and chain of custody must be attached to this form.]
• - 15insp.dop•rev.7Y262018 Title 5 Olfldal Inspecdon Fenn:SubsuRaee Sewage Disposal System•Pepe 4 of 18
1
The system is a cesspool serving a facility with a design flow of 2000 gpd-
10,000 gpd.
❑ ® 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.
5) 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 CA.
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
C. Inspection Summary (cont.)
If you have answered"yes"to any question In Section C.5 the system is considered a significant
threat,or answered"yes"to any question in Section CA above the large system has failed.The
owner or operator of any large system considered a significant threat under Section C.5 or failed
under Section CA shall upgrade the system In accordance with 310 CMR 15.304.The system owner
should contact the appropriate regional office of the Department.
6. You must Indicate"yes"or"no"for each of.the.following for an inspections:
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? j
® ❑ 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.
t8lnsp.doc•rev.M612018 Title 6 Official fnspea8on Form:Subsurface Sewage Disposal System•Pape 5 of 18
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
1. Residential Flow Conditions:
Number of bedrooms(design): 4 - I Number of bedrooms(actual): 4
DESIGN flow based on 310 CMR 15.203(for example:110 gpd x#of bedrooms): 440
Description:
Number of current residents: na
Does residence have a garbage grinder? Yes ® No
Does residence have a water treatment unit? Yes ® No
If yes,discharges to
Is laundry on a separate sewage system?(Include laundry system inspection El Yes ® No
information in this report.)
Laundry system inspected? ® Yes ❑ No
Seasonaluse? ® Yes Cl No
Water meter readings,if available(last 2 years usage(gpd)): ------ -- -
Detail:
Sump pump? El Yes ® No
Last date of occupancy: NA
Date
15lnsp.doc•rev.726/2018 TWe 5 OBldal In5pee8on Form:Subsurface Sewage Disposal System•Page 8 of 18
I
i
I
D. System Information (cont.)
2. Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203):
Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft.,etc.):
Grease trap present? El Yes 11 No
Water treatment unit present? 13 Yes No
If yes,discharges to:
El
El
Industrial waste holding tank present? Yes No
Non-sanitary waste discharged to the Title 5 system? 11 Yes 13 No
Water meter readings,if available: -----
Last date of occupancy/use:
Date
Other(describe below):
3. Pumping Records:
Source of information: -
Was system pumped as part of the inspection? El Yes ® No
If yes,volume pumped: —•- -.__.. ._--
gallons
How was quantity pumped determined?
Reason for pumping: _ ..
D. System Information (cont.)
q
4. Type of System:
`I
® Septic tank,distribution box,soil absorption system
El Single cesspool
El Overflow cesspool
Mnsp.doe•rev.7/26/2018 Title 6 Official Inspection Form:Subsurtace Sewage Disposal System•Pape 7 0118
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 VA system by system operator under contract
❑ Tight tank.Attach a copy of the DEP approval.
❑ Other(describe):
Approximate age of all components,date Installed(if known)and source of information:
Were sewage odors detected when arriving at the site? Yes ® No
5. Building Sewer(locate on site plan):
Depth below grade: 3
feet -
Material of construction:
❑cast iron ®40 PVC other(explain).
Distance from private water supply well or suction line:
teat
Comments(on condition of joints,venting,evidence of leakage,etc.):
Joints appear tight.No evidence of leakage.System vented through house vents.
D. System Information (cont.)
6. Septic Tank(locate on site plan):
Depth below grade: 3
feet
Material of construction:
®concrete 11 metal ❑fiberglass polyethylene El other(explain)
If tank is metal,list age:
years
Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) El Yes No
186rep.doo rev.7/262018 Title S OfBdal trspection Fome Subsurface Sewage Disposal system•Page 8 of 18
i
E
E
Dimensions: 1500 GI.
Sludge depth: 2"
Distance from top of sludge to bottom of outlet tee or baffle 48"
Scum thickness 4"
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 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 every:two.years.Inlet and outlet tees in:place.No signs of leakage. _ ....
D. System Information (cont.)
7. Grease Trap(locate on site plan):
Depth below grade: feet
Material of construction:
concrete metal fiberglass ❑polyethylene other(explain):
Dimensions:
Scum thickness
i
Distance from top of scum to top of outlet tee or baffle —"
E
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping:
Date
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,
liquid levels as related to outlet invert,evidence of leakage,etc.):
Official bi Farts:Subsurface a Disposal System•P 9 of 16
ISlnsp.dac-rev.72&20/8 Title 5 Ol(k speaUon Sewep pose) yele Page
8. 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
D. System Information (cunt.)
8. Tight or Holding Tank(cont.)
Alarm present: ❑ Yes ❑ No
El El
Alarm level: Alarm in working order: Yes No
Date of last pumping: -bate
Comments(condition of alarm and float switches,etc.):
'.Attach copy of current pumping contract(required).Is copy attached? Yes No {
9. Distribution Box(If present must be opened)(locate on site plan):
1
Depth of liquid level above outlet invert
No
Comments(note If box is level and distribution to outlets equal,any evidence of solids carryover,any I
evidence of leakage into or out of box,etc.): I
Box is Ievel.Box has one outlet laterals.No signs of leakage.
t5lnap.doc•rev.7/282018 Title 5 Oftklal bnspecdon Farm:Subsurface Sewage Olsposal System•Page 10 of 18
D. System Information (cont.) 4
10. Pump Chamber(locate on site plan):
Pumps in working order: Yes No'
Alarms in working order: ❑ Yes El No*
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
i
If pumps or alarms are not in working order,system is a conditional pass.
11. Soil Absorption System(SAS)(locate on site plan,excavation not required):
,. If SAS not located,explain why:
- r .
Type:
• Ell leaching pits number: - <
q r
® leaching chambers number: 3/500
leaching galleries number: -
.y leaching trenches number,length: -
I
leaching fields number,dimensions:El J
overflow cesspool number: — --
t.• t�� Innovative/alternative system
Type/name of technology:
` D. System Information (cont.)
••a ,t51nsp.dac•rev.7126=18 T8b 5 Official bapec8on Forth:Subsurface Sewage D15poea1 System•Pape of is
11..Soil Absorption System(SAS)(cont.)
Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of
vegetation,etc.):
Sandy soil.No signs of hydraulic failure.Leachirfg was dry at time of inspection.
12. 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 El Yes No
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,
etc.).
D. System Information (cont.) I
13. Privy(locate on site plan):
Materials of construction: -- -
Dimensions __..
Depth of solids --
Comments(note conditlon of soil,signs of hydraulic failure,level of ponding,condition of vegetation,
etc.):
tSlnsp.dw•rev.7/26/2018 Me 5 Oftil Inspection Form:subsurface Sewage Disposal System•Pape 12 0118
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Four-Not for Voluntary Assessments
40 Arbor Way
Property Address
FEDERAL NATIONAL MORTGAGE ASSOCIATION
Owner Owner's Name
information Is required for every Hyannis MA 02601 9/04/20
pope. Cfty/Town State Zip Code Date of Inspection_,
D. System information (cunt.)
14. 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
' onct. ot'- Iapost:
0
0 0 -
• I
D. System Information (cont.)
15. Site Exam:
® Check Slope
® .Surface water
® Check cellar
El Shallow wells
Estimated depth to high ground water: 16
feet
Please indicate all methods used to determine the high ground water elevation:
El 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
El
Checked with local excavators,installers-(attach documentation)
Accessed USGS database-explain:
i
t5lrep.doc-rev.7/26/2018 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 14 of 18
You must describe how you established the high ground water elevation:
Used USGS observation well data.Used technical bulletin 92-0001
Before filing this Inspection Report,please see Report Completeness Checklist on next page.
E. Report Completeness Checklist
Complete all applicable sections of this form Inclusive of:
® A.Inspector Information:Complete all fields in this section.
® B.Certification:Signed&Dated and 1,2,3,or 4 checked
® C.Inspection Summary:
1,2,3,or 5 completed as appropriate
4(Failure Criteria)and 6(Checklist)completed
® D.System Information:
For 8:Tight/Holding Tank—Pumping contract attached
For 14:Sketch of Sewage Disposal System drawn on pg.16 or attached
For 15:Explanation of estimated depth to high groundwater included
F
• 9
d
1
i
t5imp.doo•rev.7/2612018 Title 6 O Wel Inspectlon Form:SubsurWoa Sewage Disposal System•Page 1501 to
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal.System Form-Not for Voluntary Assessments
40.Arbor Way:. -
Property Address
FEDERAL NATIONAL MORTGAGE ASSOCIATION
Owner _.__.
Information Is Owner s Name
required for every Hyannis MA 02601 _ 9/04/20
page. city/Town State Zip Code Date of Inspection.
D. System Information (cont.)
14. 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
1
I
t5lnsp.doc•rev.71262018 Title 5 Of dal hspedon Form:Subsurface Sewage Dlsposel System•Page 16 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
_40 Arbor Way,_ _.
Property Address
FEDERAL NATIONAL MORTGAGE ASSOCIATION
Owner _
Inwner tlon Is Ownel's Name
required for every _@nnis _ MA 02601 9/04/20
_ -
page. Clty/Town State ZIp Code_. Date of Inspection
D. System Information (cont.)
15. Site Exam:
® Check Slope
® Surface water
® Check cellar
❑ Shallow wells
Estimated depth to high ground water: 16,
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:
I
You must describe how you established the high ground water elevation: I.
Used USGS observation well data.Used technical.bulletin 92-0001
Before filing this Inspection Report,please see Report Completeness Checklist on next page.
t5ln3p.d0c•rev,7/26IM18 - Title 5 Official Inspection Farm:Subsurface Sewage Disposal System•Page 17 of 1S
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
40 Arbor Way
Property Address
FEDERAL NATIONAL MORTGAGE ASSOCIATION-
Owner Owner's Name
Informrequired tion
Is H ennis MA .02601 .9/04/20-.._,
required for every —y - — -- --
page. City/Town. State Zip Code Date of Inspection
E. Report Completeness Checklist
Complete all applicable sections of this form Inclusive of:
® A. Inspector Information:Complete all fields in this section.
® B.Certification:Signed&Dated and 1,2,3,or 4 checked
® C.Inspection Summary:
1,2,3,or 5 completed as appropriate
4(Failure Criteria)and 6(Checklist)completed
® D.System Information:
For 8:Tight/Holding Tank—Pumping contract attached
For 14:Sketch of Sewage Disposal System drawn on pg.16 or attached
For 15: Explanation of estimated depth to high groundwater included
3
,i
i
t5insp.doc•rev.7126=16 Title 5 Official Inspecdon Form:Subsurface Sewage Disposal System-Page 16 of 16
No. 0 Fee$5 0
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
2pplication for Wood *paem Construction Vertu
Application for a Permit to Construct( )Repair(X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No.
40 Arbor Way, Hyannis Jane Pickering
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. Designer's Name,.Address and Tel.No.
Wm. E. Robinson Septic Service
P O Box 1089, Centerville
Type of Building:
Dwelling No.of Bedrooms 4 Lot Size sq. ft. Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
'Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
p
Descri tion of Soil Sand
Nature of Repairs or Alterations(Answer when applicable) Title-5 septic system con—
sistin of a 1 ' 500 gal. tank D—
with stone' all._around.
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has bee ' sued by this Board f Healt
'Sigrt4d Date
Application Approved by Aate
Application Disapproved or the following reasons
Permit No. Date Issued
< 1 No:� filr�'�� 2 Fee 5 O ✓ /
THkCOMMONWEAL'TH OF MASSACHUSETTS '�i Entered in computers
s w _ _ Yes
a ,PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
tltlYiCat Ol for Mi4po5a[ *pgtem Construction Permit
Application fora Pen-nit to Construct( )Repair(X)Upgrade( )Abandon( ') ❑Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No.
40 Arbor Way, Hyannis Jane Pickering
Assessor's Map/Parcel
9 -O• o
Installer's Name,Address,and Tel.No. s. Designer's Name,Address and Tel.No.
Wm. E. Robinson Septic Service
P O Box 1089, Cent�ery ,Ile
P4,{•v
Y Type of Buildin_'g:�
Dwelling No.of Bedrooms 4 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building ' No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
- Title
Size,of Septic Tank Type of S.A.S.
Description of Soil Sand
Nature of Repairs or Alterations(Answer when applicable) Title-5 septic system Con-
sisting of a 1 ,500 qal. tank, D-box and 3 precast leach chambers`.
with stone all around. ' 1 n L/l
1
Date last inspected: 1
Agreement:
The undersigned agrees to enure the construction and maintenance of the afore described on-site sewage disposal system
+ in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has bee ' medl by this Board •f Healthe
Sign d Date\
v ,y
Application Approved by I _ D ate I�
Application Disapproved for the following reasons v
r 1
Permit No. Date Issued AN
I _' J
THE COMMONWEALTH OF MASSACHUSETTS
BAR NSTABLE, MASSACHUSETTS
W.. Pickering Certificate of Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( X )Upgraded ( )
Abandoned( )by Wm. E. Robinson Septic Service
at40 Arbor Way, Hyannis has been construe ed in accordance
with the provisions of Title 5 and the for Disposal System Construction Pern?l Tell � dated 4-_
Installer Wm. E. Robinson. Sr. Designer
The issuance of this pe t shall not be construed as a guarantee that the syste" will fu,'nction as
1 es ned.
Date (�I Inspector h�
• v
A.
No. r!/ L j �. Fee $5 O
THE COMMONWEALTH OF MASSACHUSETTS,"
PUBLIC HEALTH DIVISION- BARNSTABLE: MASSACHUSETT-S /
I
Pickering lwigool 6potem Conotruction Permit
Permission is hereby granted to Construct( )Repair(X )Upgrade( )Abandon( )
l 40 Arbor Way, Hyannis
System located:at •.
and as described in the above'Application for Disposal System Construction Permit. The applicant recognizes his/her duty to
comply with Title,5 and the following local provisions or special conditions.
Provided:Constr/�ictio U st b- o led within three years of the date of this.-p it.
Date: I� - Approved by i
r
�t4OTWF-z This Form Is To Be Used For the Vtepmir Of Failed
Septic Systems Only_
G t/ C�l'II�iC.+►'i'iON OF wKD aY�°ILIC�►'IgOI�FOR A DISY06,AI.
WORKS CONSMUCT[ON 4offT'(wITSOUT DEMNED PLARM
L Wiil iatn E. Robinson,5%creby certify thm the application fa disposal works
Soon pmmu siatied by me&mmd G ra$`C-1 amcerning the
I
ply located 40 Arbor Way, Hyannis meets all of the
following criteria_. '
• Vx failed symm is comtemd m a miWk� dwdtwg ouly- I-Im::art:no camummial or business
wed with the daeffin&
soil is as CLASS i an6 tAc pncotafim tdie is'Uss unn or aquae io 5 mimmm per inch.
yrc no wxt}a mb within 100 feet of the pmpasod scptc a}3tcm —
• 'acr no pawa€c Wd1s wehin Ijo ia=0i th c Pmpomd mptiac SrAwl
I
is nD imc=m in ftw 2ndkw`hmzP in mm p gxlscd
• Me no tad of needed.
- bmom af'd!c �a�p wilt ode iao�ed tens theses fia��abanr�alae
�rm°m° table dmom [ the groundwater mWe Ong the Frimptor
when appbmbkl
It the S.kS.wit!be with 250 fm Of nay vM=md wabads.the boa=of the proposed
ranching b cdityr wdl M be located lcss than%unem 114)fiat above the ntaVanu m add
grOandwa=table dmadon.
the ftftamr
?+) Top of Gmand:kuhm amanM tud ag GiS bioamunal
1k MAX MO G. A111
DIFFERENCE BET111EEN A asd S A
SIGNED DATE:
[ pmPoecd Plan of symm on beck).
i
A
• �y
•. �L_
"` \\\ � '
`-^• ^ �
_ Y
n
� � �
• Y..
':
T
TOWN OF BARNSTABLE EL
LOCATION 40 AQko2 6 JAY SEWAGE # 206 ( - (75
VILLAGE riN i S ASSESSOR'S MAP & LOT_2L OY D
.INSTALLER'S NAME&PHONE NO. P?ob�r &r; l ScOfeC
SEPTIC TANK CAPACITY —ISO
LEACHING FACILITY: (type) (size) _tt42X'117Xa..
NO. OF BEDROOMS
BUILDER OR OWNER TI k C.kerZ�LQ3
PERMIT DATE: Q COMPLIANCE DATE: I-aIl-3 IOl
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
GACL o� 60Se
r
1A
0 O
__
� ��3
: �
i
�.
�\(��.j!� CJ
\ � �
r �' j �
� � ; �
��
e
�_
S ..
�� - ..
� .. . . 4
� �
� �
i
y
� -3
t�
� � � - � }
kyy
. . � ;4
T.
- ----
4
a -
vJ '
s
i
�— 1
it . . G✓� - �
3 1 I
O/Y7
- i
,i
/,
U'
gev
i Vi�✓
m SENDER:
'o ■Complete items 1 and/or 2 for additional services. I also Wish to receive the
i ■Complete items 3,4a,and 4b. following services(for an
0 ■Pdnt your name and address on the reverse of this form so that we can return this extra fee):
card to you.
permit. _this tone to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Addres s Z
Write Receipt Requested'on the mail lece below the article number. 01
m a � a 2. ❑ Restricted Delivery N
■The Return Receipt will show to whom the article was delivered and the date .,
c delivered. Consult postmaster for fee. a
-o 3.Article Addressed to: ; ,J 4a Article NumberIx
g
2-0
E 4b.Service Type
' ti y� Registered CertifiedIx
_" J ..' - of
W ❑ Express Mail ❑ Insured
❑ Return Receipt for MerchapdI4 ❑ COD
0
7.Date of D e •-
5.Received By:(Print Name) t3.Ad_ es a dr ss(Only if requested
W and feb is paid) t
H
Si : ( dto e e ) A
o X
0rm 38 1, Dec mbar 1994 102595-97-13-0179 Domestic Return Receipt
UNITED STATES POSTAL SERVICE First-class Mail
Postage&Fees Paid
LISPS
Permit No.G-10
1
• Print your name, address, and ZIP Code in this box•
Public Health Division
Town of Bamstable
PO Box 534 ' I
Hyannis,Massachusefts 02601
Fax(508)775-3344
Phone(508)700-0205
2 203 498 564
US Postal Service
Receipt for Certified Mail
No Insurance Coverage Provided.
Do not use for International Mail See reverse
Sent
re�Nu�
Posit Office,State,&ZIP Cod
P ge $
Certified Fee
Special Delivery Fee
Restricted Delivery Fee
Ln
CO Return Receipt Showing to
Whom&Date Delivered
Return Receipt Showing to Whom,
Date,&Addressee's Address
0 TOTAL Postage&Fees is
co) Postmark or Date
LL
Stick postage stamps to article to cover First-Class postage,certified mall fee,and
charges for any selected optional services(See front).
1. If you wan:this receipt postmarked,stick the gummed stub to the right of the return
address leaving the receipt attached, and present the article at a post office service
window or hand it to your rural carrier(no extra charge).
2. If you do not want this receipt postmarked,stick the gummed stub to the right of the
cc
return address of the article,date,detach,and retain the receipt,and mail the article.
u7
3. If you want a return receipt,write the certified mail number and your name and address rn
on a return receipt card,Form 3811,and attach it to the front of the article by means of the
gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article a
RETURN REZEIPT REQUESTED adjacent to the number. Q
4. If you want delivery restricted to the addressee, or to an authorized agent of the
addressee,eidorse RESTRICTED DELIVERY on the front of the article. j M
5. Enter fees for the services requested in the appropriate spaces on the front of this
receipt. If ream receipt is requested,check the applicable blocks in item 1 of Form 3811. li
6. Save this eceipt and present it if you make an inquiry. 102595-97-13-0145 r a
Town of Barnstable
BAMSeaBM
9� Department of Health, Safety, and Environmental Services
Public Health Division
P.O. Box 534, Hyannis MA 02601 j
I
Office: 508-790-6265 Thomas A.McKean,RS,CHO
FAX: 508-790-6304 Director of Public Health
September 8, 1998
Christine & Jane Hopkins
40 Arbor Way,
Hyannis, MA 02601
NOTICE TO ABATE VIOLATIONS OF THE TOWN OF BARNSTABLE
REGULATION REGARDING FUEL AND CHEMICAL STORAGE SYSTEMS
Our records indicate that you have an underground fuel oil tank located at 40 Arbor Way,
Hyannis,MA . This tank is listed on Parcel 289 on Assessor's Map 040 and registered as tank tag
#457.
This tank is located in a critical zone of contribution to our public drinking supply wells and is 20
years old or older. You must have your underground tank removed within 30 days.from the
receipt of this order letter.
For the removal of the tank you must first obtain a removal permit from the Fire Department. I _
have enclosed tank removal information for you. Upon removal of your tank, please return valve
tag# 457 to the Health Department.
You may request a hearing before the Board of Health if written petition requesting same is
received within seven (7) days of receipt of this notice.
Sincerely yours,
J"
Thomas A. McKean
Director of Public Health
Town of Barnstable Health Inspector
oFt r Office Hours
do Regulatory Services, 8:30-9:30
Thomas F.Geiler,Director 1:00—2:00
• SARNSrABLE,
MASS. r Public Health Division
1 .
ArEo �A Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508=862-4644 Fax: 508-790-6304
AMNESTY PROGRAM APPLICANT SEPTIC QUESTIONNAIRE
1. General Information: Size of e Pro :(�� 3 Z
� L pHY
Address: `7 c) A r�� Map Parceloy
Name: Phone#: 77 I —S
2a. How many bedrooms exist at your property now?
2b. Are you planning to add any bedrooms? lk--,p If yes, how many?
2c. How many bedrooms total are proposed at this property (including the amnesty unit)?
2d. Please include a copy of the floor plans for the entire property - showing the existing
rooms in the home plus the proposed amnesty apartment and/or addition. Please'label
each room clearly on the plans.
3. Is the dwelling connected-to public sewer? . YES or. O
If the dwelling is connected to public sewer,skip questions#4 through#9 below.
4. Location of dwelling is EDE or OUTSIDE a Zone of Contribution to public supply wells?
5. Is the dwelling connected to an NSITE WELL or to LIC WA
6. Is a disposal works construction permit on file? S or NO
6a. If yes,how many bedrooms were approved according to this permit? Bedrooms.
7. Were any building permits obtained for construction of additional.bedrooms? YES or NO
8. Is there an engineered septic system plan on file at the Health Division? YES or NO
9. Has the septic system been inspected by a DEP certified inspector within the last two years? YES or NO
-------------------------------------------------------------=-----------------------------------------------------
FOR OFFICE USE
ONLY
The Public Health Division has no objection to -1 bedrooms at this property.
Special Conditions:
Signed: - Date:
Q;/health/wpfiles/amnestyapp a
. Find�Map/Parcel 269040 �� r• "
' gam Health DepartmenE Health System
MaplParcel.` 289040 ,��
TankNb�:,;01 Tag,Nbr 00457"" { Installed: 01/01/1969 -:Location ';�B��.
s
Test Notification Date: 06/21/1993 Status Date
Removal NotificationDate: 09/10/199�.9
,�.. i . :. Test [r 02/01/,969
q
4,
. 77/02/1992
Removal:- >.
+ Variance:
z
Fuel S'toretl: FO,. � Fuel Storage F�eason: �� - -
Capacity Construction Cea" Detection " �CathotJ c Detection:
Storage Tank Info 000500 SS
Atlditional Details SEE FILE.
C'
,'. - /. ;• �R.. ., - •, •,� ..,F t° as
t
PAR ] Real Estate System - General Property Inquiry] Help [Q ]
Parcel Id: 289 040- - Account No: 193828 Parent :
Location: 40 ARBOR WAY HYANNIS Neighborhood: 55CC Fire * Dist : HY
Devel Lot : 19 Lot Size : . 32 Acres
Current 'Own: HOPKINS, JANE E & State Class : 101
HOPKINS, CHRISTINE LYNN No. Bldgs : 1 Area: 1344
40 ARBOR WAY Year Added:
HYANNIS MA 2601 '
Deed Date : 110191 Reference : C124799
January 1st : HOPKINS, JANE E & Deed MMDD: 1191 Deed Ref : C124799
Comments :
Values : Land: 33000 Buildings : 80800 Extra Features :
Road System: 40 Index: 36 (ARBOR WAY ) Frntg: 100
Index: ( ) Frntg:
Control Info: Last Auto Upd: 092196 Status : C Last TACS Update : 011392
Land Reviewed By: Date: 0000 Bldgs Reviewed By: ML Date : 0688
Tax Title : Account : Taken: Account Status : Hold Status :
Cancel [ ]
Press XMT for more data
Next screen (PAR ] Action [ ]
Owners Name [ ]
Road Index [ ] Road Name [ ]
Parcel Number [289] [041] ( ] ( ] [ ]
i
HM ] 71 H E A L T H M A S T E R ] HELP [ ]
R E C O R D ] ACTION C]
For Parcel Number 2891 0401 ] ] Rental Property(Y/N) [ ]
Owner Name HOPKINS, JANE E & . ] Zone of Contrib (Y/N) [N]
Location 40 ARBOR WAY HYANNIS ] Contaminant Rel (Y/N) [ ]
Business Name ( ] Area Number
Contact Person [ ] Phone (000] (77154141
Fuel Storage Tank Permit [N] Card on File [Y]
Perc Test Well Septic
File/Permit No. [ ] ( ] [ ]
Issuance Date ( ] [ ]
Completion Date
Last Communications [0531881 (MMDDYY)
Comments [ ]
Cancel [ ]
NEXT SCREEN [HM ] ACTION ( ]
PARCEL NBR [ ] [ ] [ ] TANK NBR [ ] ]
[ ]
TANKS] 81 FUEL STORAGE TANK RECORDS ] HELP [ ]
FOR PARCEL NBR: 2891 0401 1 ] MAIN ACTION C1
Action Tank Nbr Tag Nbr Installed Location ----Notification Dates-----
L l [ 11 [ 4571 [0101691 [B ] Test 0621931 Rem 0910991
---- Test --- --Abandoned-- -- Removed -- -- Variance -
[11 [0201891 [ 1 [ 1 [ l [ l [ l [ 1
Fuel Reason Capacity Constr Status Leak-Det Cath-Det
[FO] [H ] [ 5001 [SS] [NT] [N] [N]
Additional Details [ ]
--------------------------------------------------------------------------------
Action Tank Nbr Tag Nbr Installed Location ----Notification Dates-----
[ ] [ ] [ l [ l [ l Test ] Rem ]
---- Test --- --Abandoned-- -- Removed -- -- Variance -
Fuel Reason Capacity Constr Status Leak-Det Cath-Det
[ l [ 1 [ 1 [ l [ l [ l [ l
Additional Details [ ]
--------------------------------------------------------------------------------
Cancel [ ]
END OF DATA
NEXT SCREEN [HMENU] ACTION [ ]
PARCEL NBR [ ] [ ] [ ] ] TANK NBR [ ]
[ 1
i
{
CAMBRIDGE PRINTING SYSTEMS ,
INCORPORATED -- '
56 CREIGHTON STREET, CAMBRIDGE, MA 02140 • (617) 547-5700 • FAX (617) 547-4405
\3c(
---- -�� - co ��� - - �irS— --- -- - --- .
FORMS PWS/CAMBRIDGE OtMET PRINTING-DIVISIONS OF CAMBRIDGE PRINTING SYSTEMS
HYANNIS MARINA '
Arlington Street- Hyannis, Mass. 02601 NQ 42986
Telephone: 508-775-5662
Fax: 508-775-0851
Marine Store-Restaurant, Pool
Full Services - 35 Ton Open End Travel Lift
TROJAN - FORMULA - WELLCRAFT
PHONE '7"-[\- � V DATE 19Bz
NAME
ADDRESS QI
� �C�aon�� �s \ZSr i���LZ�� sC A
SOLD BY CASH C.O.D. I CHARGE I ON ACCT. MDS.RETD. I P.O4
OUAN. DESCRIPTION PRICE AMOUNT
i
All claims and returned odds MU be ccom by this bill.
TAX
EIV C
ZBY TOTAL e Cf
TERMS:10 DAYS NET Past due accounts are subject to a FINANCE CHARGE
' which Is computed by a"PERIODIC RATE"of 2%per month(OR A MINIMUM
CHARGE OF 50 CENTS FOR BALANCE UNDER S25) which Is an ANNUAL
-:+ - PERCENTAGE RATE OF 24%, plus legal fees and all costs related to
r.
. � collections.
fb
rS