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0129 ARROWHEAD DRIVE - Health
2y9 A roWbel and Drive yannis P --- - - _ _ - - -- -- -- - - - -- r 71 125 ° ° ° ° ILLj CA SEWAGE v A G E ASSESSOR'S MAP g LOT P,-STALLERS N"M 3- PHOKEE NO. _-- SEPTIC TAINK CAPACTn' —LbW" LEACHLNG FACU-171f: (tYpe),--IkU— tjUv0fT-MZS (size) LAI NO. OF BEDROOMS -q BIMDEP,OR OWNER DATE: Separation Dist�ancc Be,-;/etn the: Maximum Adjusted0 Or und,;-ater Tableto the Bottom of Leaching Facility F t iV Private Water Supply Well and Leaching Facil"I"ity (.0 ar.y WCUS Czist n site or wi 0,n 2*9)fret of leaching f?,c;'-,;t),) A F Edge of Wedan.-j'and Leach!nii Fac"ilcy 1,Lf iuvv vicuands czist Within 3CA"feft,rifleaching f:Ic,.*btj,).Ir �� W�� � �? .. t� ���o � �,, cv J' c� � —n _ �, � . A C , ' � i �'. P rr ({ =, '�. TOWN OF BARNSTABLe LOCATION� �. FC(���L�U �� SEWAGE# o9Ql\- C LI3 .h VILLAGE .�'. `/S,n � �, ASSESSOR'S MAP&PARCEL -7/ �j• ,Z� INSTALLER'S NAME&PHONE NO. co I !-z-� C)�g J SEPTIC TANK CAPACITY i ,��} / a�-U �� aU LEACHING FACILITY.(type) 'N1 1.. C- /aZ� (size) Z� X � _3 k / NO.OF BEDROOMS ����� � t � p .. OWNER PERMIT DATE: l,-I I 1 y I 1 S COMPLIANCE DATE: / a I I7 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 faci" ) - Feet r FURNISHED BY 1 �� •:t•. p _ s a � S t - a "1 r c.,) LJ L � No. �"'I`� 'I 3 -Fee (�•00 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2(pplitation for Mispo8al *pstem ConstCULtion j3Prmit I Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.s\� C'C'O k-% C Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 7 1 S In ller's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. e j,, co rot (t, J.(/- Type of Building: ? . 4 ^C-t•t,� SO 36 \4 Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.tequired) gpd Design flow provided �4 O,s 1 gpd Plan Date \ \ \S Number of sheets Revision Date Title Size of Septic Tank C X %G t\ Type of S.A.S4 L C,1p Description of Soil S G.n ` 55,"�$��(:•\a.Z�G1� -eip nn Nature of Repairs or Alterations(Answer when applicable) �?�A�G.c,� Q_y 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' f Health. _ d. Date Application Approved by Date Application Disapproved• Date for the following reasons Permit No. Lj y 3 Date Issued Z l v _/s- -- --------------------------------------- rKj'17 r Y,,Fy,r '...:y w •,y„a..M f;J" 1.•M+c;,,.n�v.v" ti _ \?"`.' .: - y, _ i( i9 a 'FtiY.f1:'kr+Y +rt .rd•t`•� 'C"' i ,,t'„ti. ..�• � •.fr.�nb � i 5.lwr�,,1F"•'yo°e�{"'0 t� u4.f.,•.i c.ay i .6. No.�" y 3 M�e Fee ��( C� ; THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: V PUBLIC HEALTH DIVISION,...- TOWN OF BARNSTABLE, MASSACHUSETTS '.'Yes / 9pphrad—on for Disposal *pstrm ConstrULtloll:."llermit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot NoA t r ro ( owner's Name,Address,,and Tel.No. Assessor's Map/Parcel ` `j j a S" i In taller's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. L�►\' r� ►JIB A6% g^c o-�mac,`. 1 S� Cs c � c, o � Type of Building: � S. C cn.n Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building ,No'.i of Persons Showers( ) Cafeteria( ) Other Fixtures xs A-.: tiDesign Flow(min.required) �� gpd;;' Design flow provided �(d� 1 �; gpd s, 'Plan Date \7L k\N ��S Number of sheets,.` Revision Date Title Size of Septic Tank", QXW \r•L k 00 .�R b� 6 Type of S.A.M L C to CVC, Gr'� ,S'�nt✓CJ/ r Description of Sod" MP d S(",\J 1 'Y :33 i n Nature of Repairs orAlterrations(Answer when applicable) Q,ptG�t�' `�' �C�5 l��cAy 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. _ - d Date Application Approved by Date I /5- M Application Disapprove,O y Date for the following reasons ' Permit No. t S t4 4 3 Date Issued IL _ _---- - --- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certifitate of tompliartte THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(� Upgraded( ) Abandoned( )by - - -- at- -U CN (kCr[a.-J�r4 C(/ �� V� �kS has been constructed-in accordance- _ with the provisions of Title 5 and the for Disposal System Construction Permit NoZ017—43 dated /211 Y I-Z-/S Installer S as M V c—o.1,-V Designer ZS_4 o ye r- #bedrooms .3 Approved design flow. gpd - The issuance of thi pe 5t shall not be construed as a guarantee that the system will fiction designed. n< Date 1 I Inspector _ - -----'---'------------- --------------------=----- No. ��S `7�+� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposaf .pstem ConstrULtlon prrmlt Permission is herebyanted to Construct Repair V ) Upgrade Abandon �' ( ) Dr P��l" ) �t P� ( ) ( ) Systemlocatedat— ( dC! krD`^4 1—t- a Dr 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 Approved by /�/ THIS PLAN IS INTENDED SOLELY FOR INSTALLATION OF THE SEPTIC SYSTEM DEPICTED ON IT. FOR ANY OTHER CHANGES TO THE PROPERTY INCLUDINGPLACE SHOULID CONSULT DDWI ONS. SHEDS. FENCES OR SWIMMIN MASSACHUSETTS EG 5 EREDGLA DOSURVEEYOR. LEGEND OWNER SEPTIC COMPONENTS D _ EXISTING 1000 GAL SEPTIC TANK / GARB EXISTING 'I (a LEACH PIT/ G R CESSPOOL 35 LOT A OWED N\ DISTRIBUTIO BOX � ft AREA = 11294 sf+-. - — TEST PIT PLAN BOOK 159 PAGE 41 ASSR MAP 271 PCL 125 PROPOSED SOIL OK A ABSORPTION SOIL ._ SYSTEM REMOVAL \ AREA ❑ 35 -SEE DETAIL . \ �$ ON BACK , O 2 OZT� r� WATER LINE 36 WATER GATE O \0 h ® C7 Sto F� \ GAS LINE =Q_ THIS IS IS A 18 in COLOR 37\ P O � OAK 5�5 \ /ST/iy HYDRANT PLANI� \ \ \a�`�SPP� USE COLOR PLAN ONLY U`O P�o0d FOR INSTALLATION P8 FULL DETAIL IS BEST 118 in J 36 VIEWED IN OAK \ FULL COLOR �— \ 38 �� \ 0 40 37 �. O ea �ae�e Glsoar� ELEVATION r 42 �r � A'�TSP37. 1\o� � o \ \40 10 44 ELF E VA T§ 00 nNl S 42 ELEVATIONS SPECIFIED ARE INVERT ELEVATIONS (BOTTOM OF PIPE) EXPRESSED IN DECIMAL FEET 9� /I �p c. SEPTIC TANK OUT 35.45ID Et PJ� Ax �z D-BOX IN 34.25 cl OF '" D-BOX OUT 34.08 \ t - 44E� , 0 LEACHING SYSTEM IN 33.97 E,: O BOTTOM OF LEACHING 32.97 o � NOTES � oyw PLAN COLLAPSE AND FILL EXISTING CESSPOOL. D � = SOIL REMOVAL AREA El REMOVE 1. in 20 ft REMOVE ALL FILL AND UNSUITABLE SOILS DOWN TO THE 0 20 40. C STRATUM AND REPLACE WITH CLEAN - - --- MEDIUM SAND PER TITLE_5 �.`�, O 10 20 (310. CMR 15.255(3)). ,` PRINT ON 8-112 x 14 in PAPER FOR PROPER SCALE HYANNIS. MA of SEWAGE . DISPOSAL FALMOUTH ROAD DAVID q`yGJ, DAVID Sp9CyG ✓ J OJ \ ` ` SYSTEM PLAN W (Rt 28) ` D. D. -TO SERVE EXISTING DWELLING COUGHANOWR H COUGHANOWR N m No. 1093 No. 461 PAUL KELLEY & { z Q N CHRISTINE SAVINO OJ _ 0 , ... OWNER(SI OF `�\ •• ' RECORD 2 I NOT v 1 v SOYA UPS r0 Q TO - 2 129 ARROWHEAD DRIVE SCALE HYANNIS, MA Q 155 Geo Ryder Rd S PROPERTY ADDRESS Chatham, MA 02633 'WEST MAIN ST David<ou®HotmoiLCom DATE: DECEMBER 11, 2015 L O C U S M A P 508 364=0894 PG.1/2 Joe, ETE-4o18 SOD TEST L�OG PE C* 14904BER 3, 2014 DESIGN CALCULATIOO SOIL EVALUATOR: DAVID D. COUGHANOWR. ASE *461 WITNESSED BY: DAVID STANTON. HEALTH DEPT. DESIGN FLOW: 3 BEDROOMS X 110 GPD = 330 GPD GROUNDWATER ENCOUNTERED AT 120 In. SEPTIC TANK: 330 GPD X 2 DAYS = 660 GALLONS TEST PIT PERC AT 60 In - 2 MIN/INCH IN : SOILS USE EXISTING 1000 GALLON SEPTIC TANK IF IN ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER SOUND STRUCTURAL CONDITION. IF NOT. INSTALL INCHES HORIZON TEXTURE (MUNSELL) MOTTLES NEW 1500 GALLON SEPTIC TANK. 35.05 0-9 A LOAMY SAND 10 YR 3/3 NONE FRIABLE P DISTRIBUTION BOX* INSTALL UNIT DEPICTED BELOW. 32.30 9-33 Bw LOAMY SAND 10 YR 4/6 NONE FRIABLE SOIL ABSORBTION SYSTEM: 33-126 C MEDIUM SAND 10 YR 5/4 NONE LOOSE 24.55 THE LONG TERM ACCEPTANCE RATE FOR A CLASS ONE NO GROUNDWATER ENCOUNTERED SOIL WITH A PERCOLATION RATE BELOW 5 MINUTES TEST PIT 2 2 MIN/INCH IN C SOILS PER INCH = 0.74 GALLONS PER DAY PER SQUARE FOOT. ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER THE 33.75 ft x 11 ft x 1 ft LEACHING GALLERY INCHES HORIZON TEXTURE (MUNSELL) MOTTLES DEPICTED BELOW CAN LEACH: 35.45 0-10 Ap LOAMY SAND 10 YR 3/2 NONE FRIABLE BOTTOM AREA = (11 X 33.75) = 371 sq. ft. 32.78 10-32 Bw LOAMY SAND 10 YR 5/6 NONE FRIABLE 32-120 C MEDIUM SAND 10 YR 5/4 NONE LOOSE SIDEWALL AREA = (33.75+33.75+11+11) =89.5 sq. ft. 25.45 TOTAL AREA = 460.5 sq. ft. - FLOW CAPACITY 0.74 x 460.5 _ 340.77 gal/day INSTALL A 33.75 ft x 11 ft x 1 ft GALLERY AS CONFIGURED BELOW. FLOW CAPACITY = 340.77 gal/day WHICH EXCEEDS D 1 S T R 1 BUT I O N BOX OREY THE 330 gal/day REQUIRED FOR A THREE BEDROOM DESIGN. DIMENSIONS OLEVEL • ► DOWN MIN SOIL �1 BSORPTION (V RONK �, ro SYSTEM • • p ^ SAS • 0 �4 DISTRIBUTION BOX 6 In STONE BASE 21 in 2� \ CROSS SECTION VIEW LC-6 STONE CHAMBER 33.75 ft Q N -INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE � � ' STARTING WORK. ® ® ,I ® -W ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM w REQUIREMENTS OF MASSACHUSETTS TITLE 5 SEPTIC (� v CODE (310 CMR 15). -INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND 1' 6 ft 6 ft 3 ft 3 ft 6 ft 6 ft 1' T UTILITIES BEFORE EXCAVATING FOR SYSTEM. 1.75 ft -ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION E OF LOW FLOW FIXTURES & APPLIANCES. AND PERIODIC LC-6 PRECAST LEACHING CHAMBER PUMPING OF THE SEPTIC TANK. S -SYSTEM NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. DIMENSIONS & DETAIL INSTALL ONE INSPECTION DO NOT PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM. RISER TO WITHIN THREE INCHES OF FINAL GRADE & INDICATE LOCATION ON AS-BUILT 22 in 0p�� 3b -'2in SEPARATION BETWEEN INLET AND OUTLET TEES NO LESS THAN LIQUID DEPTH CROSS SECTION VIEW INSTALL AN APPROVED GEOTEXTILE FABRIC OVER STONE '• 1 ` 1 OBSERVED GW AT 25.05 16 3/4 In TO 12 in ■ 3/4 In TO INDEX WELL AlW-230 1-1/2 in GRAVEL ■ EFFECTIVEu 1-1/2 in GRAVEL in ■ DEPTH ■ ZONE D READING DATE NOV 2015 48 in 36 in 48 in READING 22.71 ADJUSTMENT 2.91 132 in ADJUSTED GW 27.96 F L 0 W p 0 F7E TOP OF FOUNDATION RAISE COVERS TO WITHIN ALL PIPE TO BE SCH. 40 PVC EL = 44.74 +- 6 in OF FINAL GRADE AND TO PITCH AT 1/8 in/ft MIN 36.0 -BO� 3. USE H-20 . M A X EXISTING 34.80 EXISTING `0000 GALLON Q�o o PRECAST SEPTIC TANK 35.45 34.08 ;��� ' DRYWELL 4oaaooSo°n . in EXISTING REFER TO DETAIL BOX 34 25 STONE SOIL ABSORPTION' BASE 33.97 ������ -REFER TO !n STONE A E 1 NEW EXISTING 47 ft 5-12 ft DETAIL BOX Ln Iri 32.97 ADJUSTED SEASONAL Vjr HIGH GROUNDWATER _ 27.96 SEWAGE DISPOSAL SYSTEM PLAN 129 ARROWHEAD DRIVE HYANNIS, MA DECEMBER 11, 2015 ETE-4018 PG 2/2 From: David davidcou@hotmail.com Subject: 129 Arrowhead Cert form attached +s Date: Today at 5:44 PM r ' To_ : Scott Frank scottfrankl @hotmail.com r. J Town of Barnstabb Regulatory,Servige's • 4�o�dstavl�f,S�ali,lirtc�r;t>7 I� ilatr . E +�� Public Houlttli OWL-Lon o��� �'Ih�tm�s i1Tr'1�San.l;�irasOn� - 21.110 Malu Simet,liyftnnis MA 02601 Offis c:. M862.4644 I=a� 5f1�•i4t9�39i rnetaClrR Tlc.'��ner striilsestllrin„ lit*1t 021e:\ate I13 Sewage Vermild ZU/S--4�-1.2-Asscssoes.NT--4AAtilcd 2 at tier: David D. Coughartowr RS Insl►allfr: sL6 k-� FrU - r�lPtlr 155 Goorge Ryder Rd Soillh Add'►rss: \l,'-S 6 1 d 'Yc.r a cJh" Chatham, MA 02533 `� M On_ a 14 I o t F�,.,.,.r - rAW i$31lt 8V&.M t*k4ftil Z,y ' (do10 (il s>lal'Wr) %rlic systwn at 29-Artowhead Driva based on a design Chown by (d s David 0. Cougllanow, RS VI1t2015 •.: i�agnettl . : - • I occtiry i}wt t'he splie 3ystcrta t ferc wcxI a'bovo %%4.9 att�t�IIlo 4M t>)' lilt lr�l 11W it go, %V)Lide nivy iuclu& minor atl4at�a+trt(l c�tal► es +�Rl ; I ict l fQ 4).r k, • dWribtaiion boa andrar septic larlk. Swap out {if mquinel.)) sa+ttq i'nspecco The . - ��f.+�nd srtiisf�ctory•. d CoAify €licit lbe.sep ic,sgslOIri ferctromed AINrwo rstia lwqlalled wililt irtli or-duatf"��ij"'C' great€r than 10` lnittl ftloeasf)9119f.il c SA$Orally vCHIt<-I lvl.w fiol!@FMI c0gw1pon :of the seftic syscem)but in accordnncc W-uh Stow,R I;,tv.il Rcgtiilali��l�c, Putt ttnacirrsn or certirod ns—builE bydesigosr to follow. Sirilrout(itre-qui ed)t�s inspected uej—W,.Wild • - n�� Pi.�tsl�atif�tcioty. 1 cclaify Nit the:syst;cill ttica Cd 44* «rfs ctlastfC16IcIt 1(t cUiiIp111nCl" E1'iti the (CYIL]S T f; ofIfic RA approval lel.octl+Ci'f.'tpj.lipb)c �t0ht VAVIU f.;lets t2�IC r s turd a. G4 �+ t Nap 1093. JAI 1 ki / < M.. I. (l;tcsrrc� tgoatu ) 4t` Cr'Scu is - _ r F''Ilel..._C LI, 1 Tl IL DJ VISION. @a '1'11 :I'.P _ R v A3E119.'I c1 n ARE It-F. FJVJ 1)R ' F Tt. '�T JAC HEALTH 1)IVI JON • ' n ' ' z �1:'tiiy�ic? -bilAr l 7tsflt o F*ma Rcv d-14-Mlic '• � t ..` wF 1 �z ,aye?• - y ,' Town of Barnstable P# Department of Regulatory Services I a&merABiA, Public Health Division Date 200 Main Street,Hyannis MA 02601 • �prFD t,A1d� 1��.. Date Scheduled a0. 1'' Tune Fee-Pd., 10,aw Q1 Soil Suitability Assessment for Sew ge isposal : . Performed-B i, i y Witnessed By: �/.S inn J LOCATION&.GENERAL INFORMATION' Location Address Owner's Name a.v eJ%y iZq ••A(�wl�ca�( p.� � IP 1 � hVl Ili Address �9�15� Z� 12-1 AttolAe,?4 1�r EtYA. Assessor's Map/Parcel: Engineer's Name f'�v..,a C aV� 7hcth owy- NEWCONS�TftUCnON REPAIR , ; Q Telephone# S2c6 364 0,62 Land Use Slopes(46) Surface Stones n he Distances from: Open Water Body. too } ft Possible Wet Area 10 ft Drinking Water Well V+ ft Drainage Way 1P ft Property Line `D ft Other ft SKETCH.'(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands f1n proximity to holes) } S©. 6� i • N_ . . I'% (DTIP^� o � �- S6 Parent material(geologic) �hC t I Depth to Bedrock �Izvt e_ Depth to Groundwater. Standing Water in Hole: .�.h Weeping from Pit Fpee v�ohe Estimated Seasonal High Groundwater S t DE FRMINATION FOR SEASONAL-HIGH WATER TABLE Method Used: 6-1�t1' VK e 1,1* Depth Observed standing in obs.hole: In, Depth to soil mottles: In. Depth to weeping from side of Pbs.hole: In. arnundwnter Adjustment fY. Index Well-4 Lt -23QReading Date:11 '201 Index Well level 22-11 Adj,thotor?.-9j Adj.Groundwoter.Level�09 PERCOLATION TEST bate t2I31 IS IS Time'1 o R M Observation to 9 Hole# Time at 9" Depth of Pero �© t h Time at 6" Y\ G) Start Pre-soak Time® c-D 0 Time(91,41 L End Pro-soak Rate Min./Inch Site Suitability Assessment: Site Passed Sit;Failed: Additional Testing Needed(Y/N) YV 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 Conseirvation Division at least one(1) week prior to beginning. Qi1SEPT1CIPERCFORM.DOC DEEP-OBSERVATION HOLE LOG Hole# I Depth from Soil Horizon Soil Texture Sdil Color Soil. Other Surface(in.) (USDA) (Munsell) Mottling (Stnucture,Stoneit;Boulders. k • t�ntY 96't3ravell O _c� Av to k St��sD t0 �k V DnP L,:;, a -33 1�w ur+yq`< SRLip bn. R,s& 11. �rl'ab [<✓ C. Lo0 �e_- - j DEEP OBSERVATION HOLE LOG Hole# 2 _ j Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. U l A.P LOAMY '/Z ke Fr el10 tkEW14A S�+V) [0Yk Sl4 11 Loose—.' DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling' (Structure,Stones,Boulders.. Consistency,%Gravel) I ' i i DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizoir" Soil Texture Soil Color Soil Other j Surface(in.) (USDA) (Munsell) Mottling (Structure,SSoaes;Boulders, Consistency. I ' Flood Insurance Rate Map: 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 Materlal Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? � If not,what is the depth of naturally occurring pervious material? Certification I certify that on N�� 1v` I (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 wit the required training,0pertise and experience described in 10 CNM,15.017. iH of A4,q Date �e, 7j, �t S moo`' DAVID • cyGN Signature o D. — U � COUGHANOWIR 0O 410ENSE'0 Q Q:\.S.BF'nMBRCFORM.DOC /4 FVALUP�O 0�y0ftHEr�``�w The Town of Barnstable D artment of Health, Safety and Environmental Services 6;9• ,� _Public Health Division 367 Main Street,Hyannis,MA 02601 Office 508-790-6265 Thomas A.McKean FAX 508-775-3344 Director of Public Health December 15, 1997 I To Whom This May Concern: Donna Miorandi,Health Inspector for the Town of Barnstable,went to 129 Arrowhead Drive,Hyannis on Friday,December 12, 1997 for a re-inspection. According to the tenants all violations of December 3, 1997 at the above address have been corrected. Ge ly"yours, �, e Donna Miorandi Health Inspector a i 2 3 sw 4iAP ? , RECEIVED ECOJECH PARCEL 12 5 AUG 1 7 2004 Environmental LOT TOW-- N OF BARNSTAQLE w.wweco-tech.us HEALTH DEPT. THIS FORM IS A FACSIMILE OF THE STANDARD SEPTIC INSPECTION FORM ISSUED BY THE MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION(revised 6/15/2000) TITLE 5 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 129 Arrowhead Drive Hyannis Owner's Name: Robert and Marcia Chaves Owner's Address: 88 Acre Hill Road Barnstable,MA 02632 Date of Inspection: August 14, 2004 Name of Inspector: (Please Print) David D. Coughanowr,R.S. Company Name: Eco-Tech Enviromnental Mailing Address: 43 Triangle Circle Sandwich,MA 02563 Telephone Number: (508)364-0894 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 DEP approved system inspector pursuant.to section 15.340 of Title 5(310 CMR 15.000).The system: X Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature a�C C Y �j Date: u f P g T The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or. DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority NOTES AND COMMENTS Inspector's Note==> A septic system is deemed to pass this Real Estate Transfer Inspection if it does not trigger any of the failure criteria listed below. The septic system has been evaluated according to the conditions observed on the day it was inspected No estimate or guarantee of system longevity is made or implied by a passing determination. ""Thus 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 1 Page 2 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 129 Arrowhead Drive Hyannis Owner: Robert and Marcia Chaves Date of Inspection: August 14, 2004 INSPECTION SUMMARY: Check A,B,C,D or E/ALWAYS complete all of section D: A] System Passes: Yes I have not found any information which indicates that any of the failure criteria described in 310 CNM 5.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. COMMENTS: B] System Conditionally Passes: One or more system components as described in the"Conditional Pass" section need to be replaced or . repaired.The system, upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes, no,or not detenuined(Y,N,or ND). in the for the following statements. If"not determined" please explain. The septic taint is metal and over 20.years old*or the septic tank(whether metal or not),is structurally unsound,exhibits substantial infiltration or enfiltration, 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: Observation of sewage backup or breakout or high static water level in the distribution box is due to broken or. obstructed pipe(s)or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval.of Board of Health). broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced. ND explain . The system required pumping more than four times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain i 2 Page 3 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 129 Arrowhead Drive Hyannis Owner: Robert and Marcia Chaves Date of Inspection: August 14, 2004 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 and environment. 1 System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2) System will fail unless the Board of Health (and public water supplier,if any) determines that the system is functioning in a manner that protects the public health,safety,and environment The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "Thus system passes if the well water analysis,performed by;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 i • 3 Page 4 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 129 Arrowhead Drive Hyannis Owner: Robert and Marcia Chaves Date of Inspection: August 14, 2004 D)System Failure Criteria applicable to all systems: You must indicate either"yes" or"no" to each of the following for all inspections: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. yes no X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped X Any portion of the SAS,cesspool or privy is below high groundwater 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 by a DEP certified laboratory, for colifonm 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 detennined 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 detennine 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 wider section E or failed tinder section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact die appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 129 Arrowhead Drive Hyannis Owner: Robert and Marcia Chaves Date of Inspection: August 14,2004 Check if the following have been done: You must indicate either"Yes" or"No"as to each of the following: Yes No Y _ Pumping information was provided by the owner,occupant or Board of Health. N Were any of the system components pumped out in the last two weeks? N Has the system received normal flows in the previous two week period? N Have large volumes of water been introduced to the system recently or as part of this inspection? Y = Were as built plans of the system obtained and examined?(If they were not available as N/A) Y _ Was the facility or dwelling inspected for signs of sewage back-up? Y _ Was the site inspected for signs of breakout? including Y _ Were all system components,exeluding the SAS. located on site? Y Were the septic tank maiilioles.uncovered,opened,and the interior of the septic tank inspected for the condition of the baffles or tees, material of construction,dimensions,depth of liquid, depth of sludge and depth of scum.? Y _ Was the facility owner(and occupants,if different from owner)provided with information on the proper maintenance of subsurface disposal systems? For information on the proper maintenance of subsurface disposal systems please go to: WWW.ECO-TECH.US The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Y _ Existing information. For example,Plan at the Board of Health. N _ 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)] 5 Page 6 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 129 Arrowhead Drive Hyannis Owner: Robert and Marcia Chaves Date of Inspection: August 14,2004 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): n/a Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): n/a—No plan on file at Health Dept. Number of current residents 0 Does the 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): n/a Seasonal use(yes or no): no Water meter readings, if available(last two year's usage(gpd): 205 gpd Sump Pump(yes or no): no Last date of occupancy: July 2004 . COMMERCIALAND US TRIAL: Type of establislument: Design flow(based on 310 CMR 15.203):: gpd 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 Source of information: System last pumped about 18 months ago(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/Alternate 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 lanown)and source of information: Age: 4+years Disposal works permit issued 10/6/99(Board of Health files) Were sewage odors detected when.arriving at the site: (yes or no) no 6 Page 7 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 129 Arrowhead Drive Hyannis . Owner: Robert and Marcia Chaves' Date of Inspection: August 14,2004 BUILDING SEWER_(Locate on site plan) Depth below grade: 2 ft Material of construction:_cast iron X 40 PVC_other(explain) Distance from private water supply well or suction line 20+ Comments: (on condition of joints,venting, evidence of leakage, etc.) Sewer is vented through roof and appears structurally sound with no evidence of leakage or backup into dwelling SEPTIC TANK:Yes (locate on site plan) Depth below grade: 6 inches Material of constriction:_concrete_metal_fiberglass X polyethylene _other(explain) If tank is metal, list age_ Is age confinued by Certificate of Compliance_(yes or no):_(attach a copy of certificate) Dimensions: 8.5 ft x 5 ft x 5 ft(1006 gallon) Sludge depth: 4 in Distance from top of sludge to bottom of outlet tee or baffle: 30 in Scum thickness: 2 in Distance from top of scum to top of outlet tee or baffle: 9 in Distance from bottom of scum to bottom of outlet tee or baffle: 13 in How dimensions were deternuned: Probe to top of tank Comments: (on pumping recommendations, irdet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Pumping not required at this time but maintenance pumping is recommended within and every 2 years. Liquid level at outlet invert.Tank and tees appear structurally sound and functioning as intended. No evidence of leakage in or out. GREASE TRAP: none (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: Continents: (on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION..FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 129 Arrowhead Drive Hyannis Owner: Robert and Marcia Chaves Date of Inspection: August 14,2004 TIGHT OR HOLDING TANK: none (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 inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX: Yes (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: at outlet invert Comments:(note if box is level and distribution to outlets is equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.) D-box appears structurally sound with no evidence of leakage in or out.Effluent level at outlet invert. Some solids in sump. PUMP CHAMBER: none (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.): f I 8 Page 9 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ' SYSTEM INFORMATION(continued) Property Address: 129 Arrowhead Drive Hyannis Owner: Robert and Marcia Chaves Date of Inspection: August 14,2004 SOIL ABSORPTION SYSTEM(SAS): Yes (locate on site plan;excavation not required) If SAS not located, explain why: Type: _leaclung pits,number_ —leaching chambers, number X leaching galleries, number 1 _leaching trenches,'number, length _leachi ig fields,number,dimensions _overflow cesspool, number, —innovative/alternate system Type/name of Tecluiology Comments: (note condition of soil, signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.) Soils above leaching gallery appeared unsaturated. No evidence of surface ponding,breakout,lush vegetation,or other evidence of hydraulic failure was observed. Observation hole due into leaching a�llery stone showed no evidence of effluent contact staining and no level of standing effluent was observed in the top 12 inches of stone. CESSPOOLS: none (cesspool must be pumped at time 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: none (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.): I i 9 n I Page 10 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 129 Arrowhead Drive Hyannis Owner: Robert and Marcia Chaves Date of Inspection: August 14,2004 SKETCH OF SEWAGE DISPOSAL SYSTEM: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benclunarks.Locate.all wells within 100'(Locate where public water supply enters the building) i LEACHING GALLERY, LOCATIONS ❑ D-BOX A Bt 1 21 ft 27.5 ft 2 30 ft 31 ft 3 33 ft 39 ft z 4 44 ft 39 ft SEPTIC TANK a I B A EXISTING DWELLING # 129 Z J W F Q 3 ARROWHEAD DRIVE NOT TO SCALE 10 Page 11 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 129 Arrowhead Drive Hyannis Owner: Robert and Marcia Chaves Date of Inspection: August 14, 2004 SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to ground water: 10+ feet Please indicate(check)all methods used to detennine high ground water elevation: I • Obtained from system design plans on record-If checked. date of design plan reviewed X Observed Site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of health-explain: Checked local excavators, installers-attach documentation) Accessed USGS database You must describe how you established die high ground water elevation: A test boring was augured to a.deptli of 5.5 feet below the bottom of the leaching gallery and no groundwater was encountered. Applying_a groundwater adiushnent of 4.9 feet(Index well Al W-230 Zone D July 2004 reading= 24.2)demonstrates that the soil absorption system is above adjusted high groundwater. 11 r Q` COJI.�IO\��'E.�I,TH OF I�LaSSACHUSETTS - _ EXECLTr\E OFFICE OF E1'VIROhA4E\TAi. AFFf,�IRS �. DEPARTMENT OF ENVIRONMENTAL PRO G PION a ONE n\INTER STP.EE`. BOSTON \LA 02106 (617J 292•:. na. OCT2. 8 VTR Sec 1999 �_ J ARGEO PAIL CELLUCCIHTMAB(E DAD { Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FO ' a PART A g CERTIFICATION L Property Address:\,201 _�kw . Name of Owner Address of Owner: Date of Inspection:. � l Name of Inspector: (Please Print) •c�a cs 'l ��EC-/<U 1 am a DEP approved system inspector pursuant to Section 15.((340 of T-rtfe 5(310 CMR 15.000) Company Name: t: .._1r? Ek.L:t.'kne—,t.._ &ws C Mailing Address:�, &,, . L —ZZ-4"y ## Telephone Number: / sow ) 4. 7 /4 �G 1 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, eccura 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 E ati n y he Local Approving Authority Fail Inspectors 5ignatur Date: 7 i The System Inspector shell submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty (30) da i completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greeter,the inspector and the system } 'shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to rtre 1 system owner and.copies sent to the buyer,if applicable. and the approving authority. NOTES AND COMMENTS revised 9/2/98 Pace IofII - 4; Pnrtted on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) 4operty Address: .�f�� E 1 rvx-lJLA `1u�[!► )wrwr: 1 Date of Inspection: INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: I have'not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: B. SYSTEM CONDITIONALLY PASSES: One or more system components as described in the 'Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Indicate yes. no. or not determined (Y, N. or ND). Describe basis of determination in all instances. If 'not determined%explain why not. _ The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached)indicating that the tank was installed within twenty (20) years prior to the date of the inspection; o• the septic tank, whether or not metal, ie. cracked. structurally unsound, shows substantial infiltration or exfiltration, or tan, failure is Imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. _ Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe( or due to a.broken, settled or uneven distribution box. The system will pass inspection if (with approval of the Board of Health). broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass Inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed I ; revised 9/2/98 Page 2of11 .rasa•_tea•-A SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) property Address: Owner: ` Date of Inspection: / C. FURTHER EVALUATION IS REQUIRED BY THE,BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 11 SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303 (1)(b)THAT THE SYSTi IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is'within 50 feet of surface water ' Cesspool or privy is within 50 feet of a bordering vegetated wetland CV a salt marsh. 21 SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND P BLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC EALTH AND SAFETY AND THE ENVIRONMENT: _ The system has a septic tank and soil absorptio' system (SAS)-and the SAS is within 100 feet of a surface water supply tributary to a surface water supply. _ The system has a septic tank and soil absorpt• n system and the SAS is within a Zone I of a public water supply well. _ The system has a septic tank and soil absor ion system and-the.SAS is within 50 feet of a private water supply well. _ The system has aseptic tank and soil abso tion system and the SAS is less than 100 feet but 50 feet or more from a j private water supply well, unless a well w ter analysis for coliform bacteria and volatile organic compounds indicates that well is free from pollution from that facili y and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER i - ti f 7 revised 9/2/98 Page 3 'of II SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: D. SYSTEM FAILS: You must indicate either "Yes" or "No" to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR .303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will b necessary to correct the failure Yes`' No Backup of sewage into facility-or system component due to an overloaded or clogged AS or cesspool. _ Discharge or ponding of effluent to the surface of the ground or surface waters due o an overloaded or clogged SAS c, cesspool. . Static liquid level in the distribution box above outlet invert due to an overload d or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is ss than 112 day flow. Required pumping more than 4 times in the last year NOT due to clogge or obstructed pipe(sl. Number of times pumped_. I Any portion of-the Soil Absorption System. cesspool or privy is bet the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surfac water supply or tributary to a surface water supply Any portion of a cesspool or privy is within a Zone I of a publi well. Any portion of a cesspool or privy is within 50 feet of'a pri ate water supply well. Any portion of a cesspool or privy is less-than 100 feet ut greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has bee analyzed to be acceptable, attach copy of well water analysis for coliform bacteria. volatile organic compounds, ammo ra nitrogen and.nitrate nitrogen. E. LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" to each of the following: The following criteria apply to large systems in addition o the criteria above: The system serves a facility with a design flow of 10 00 gpd or greater(Large System) and the system is a significant threat to put health and safety and the environment because one r more of the following conditions exist:' Yes No the system is within 400 feet of a su ace drinking water supply the system is within 200 feet of a ibutery to a surface drinking water supply the system is located in a nitrog sensitive area(Interim Wellhead Protection Area•IWPA) or a mapped Zone 11 of a public water supply well) r The owner or operator of any such system shall pgrade the system in accordance with 310 CMR 15.304(2). Please consult the local region; office of the Department for further information revised 9/2/98. page 4orll i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ` PART B CHECKLIST r'roperty Address: Owner: Date of Inspection: Check if the following have been done: You must indicate either "Yes': or "No" as to each of the following: Yes No \f' _ Pumping information was provided by the owner, occupant, or Board of Health. d for at least two weeks and-the system has been-receiving no*mal flow None of the system components have been pumpe . have not been introduced into the system recently or as part of this rates during that period. Large volumes of water inspection. As built plans have been obtained and examined. Note if they are not available with N.'A. _ The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout. . _ All system components, excluding the Soil Absorption System, have been located on the site. _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffle of liquid, depth of or tees, material of construction, dimensions, depth sludge, depth of scum. Absorption System on the site has been determined based on: The size and location of the Soil Existing information. For example. Plan at _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) 115.302(3)(b)I The facility owner (and occupants,if ditierent from owner) were provided with information on the propermaintenaar-&-0f Subsurface Disposal Systems. revised 9/2/98 Page Sor11 s d � SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION 'roperty Address: \Z-1 ►' "� E'`�+� '` Owner: Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow _g.p.d./bedroom. Number of bedrooms (design): - Number of bedrooms !actual): Total DESIGN flow?� Number of current residents: Garbage grinder(yes or no): Laundry(separate system) ( es or no):fQ ; If yes, separate inspection required Laundry system inspected a or no) Seasonal use (yes or no): Water meter readings, if available (last two year's usage (gpd): Sump•Pump (yes or no)- .� Last date of occupancy: e V� COMMERCIALANDUSTRIAL: Type of establishment: Design flow: qpd ( Based on 15.2031 Basis of design flow 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: OTHER: (Describe) Last date of occupancy: GENERAL-INFORMATION PUMPING RECORDS and source of information System pumped as part of inspection: (yes or no)—t-* If yes, volume pumped: gallons Reason for pumping: TY OF SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes. attach previous inspection records,if any) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other n APPROXIMATE AGE of all components, date installed(if known) and source of information: Sewage odors detected when arriving at the site: (yes or no) revised 9/2/98 Pnrgcaaf11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C 1 SYSTEM INFORMATION (cor*tirwed) `roperty Address: .t�� ��w✓�`�`] { Owner: \ Date of Inspection: BUILDING SEVVER: (Locate on site plan) Depth below grade:_ Materiel of construction:_cast iron_40 PVC_ other (explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK (locate on site p n) h Depth below grade:,Q_ Material of construction:]concrete_metal_Fiberglass _Polyethylene—other(explain) If tank is metal,list age— Is age confirmed by Certificate of Compliance_(Yes/No) Dimensions: 1=4 I Sludge depth:--L�— Distance from top of sludge to bottom of outlet tee or baffle: Ll Scum thickness: Distance from top of scum to top of outlet tee or baffle: 5`r ti Distance from bottom of scum to bottom of outlet tee or baffle: 1 14 _ ` How dimensions were determined: VA p� 'omments: nd outlet eesI o affl depth of liquid level in.relatio to outlet in rt, tructur tegrity, (recommendation for pumping, conditio o inlet a • ' ante o akage,et 1 w GREASETRAP: (locate on site plan) Depth below grade: Material of construction:_concrete_metal_Fiberglass _Polyethylene_other(explainl i 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: outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity (recommendation for pumping, condition of inlet and evidence of leakage,etc.) revised 9/2/98 Page 7of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) 'roperty Address:- 0 w r--f: Date of Inspection: II \\ TIGHT OR HOLDING TANK: 64(Tank must be pumped prior to, or 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 Alarm level: Alarm in working order: Yes _ No_ I Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches.etc.) DISTRIBUTION.BOX:Up (locate on site plan) ,�(\�� -}— Depth of liquid level above outlet invert:c=�LW` Comments: •(note if level nd distri uti n is quajevidence of solids rryover, ev ence of leakage into or out of box, etc.) - PUMP CHAMBER: (locate on site plan) Pumps in working order:(Yes or No) Alarms in working order(Yes or Not Comments: (note condition of pump chamber.-condition of pumps and appurtenances,etc.) revised 9/2/98 Page 8ofII _ s Fly SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (corrtinued) � 4operty Address: Owner: Date of Inspection: SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible; excav U n not required. location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits, number:_ leaching chambers, number: lro- leaching galleries, number:_ leaching trenches, number, length: leaching fields, number, dimensions: overflow cesspool, number:_ Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydrau c failure, level ponding, damp soil, conditio of vegeta n. etc.) i CESSPOOLS. (locate on site plan) Number and'configuration: Depth-top of liquid to inlet invert: Oepth of solids layer: )epth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as part of inspection) 1 Comments: 1 (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: (locate o site plan) Dimensions: Materials of construction: ' Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) t ) revised 9/2/96 Page 9ofIt SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) 'roperty Address: )wner: Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) � Z y . At A5 33 revised 9/2/98 Page 10of11 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (corrbnued) roperty Address: Owner: Date of Inspection: NRCS Report name Soil Type_ Typical depth to groundwater _ USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope (Jb Surface water Check Cellar Shallow wells /. Estimated Depth to Groundwater'C)`Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site (Abutting property. observation hole, basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators. installers Used USGS Data a l I Describe how you established the High Groundwater Elevation. (Must be completed) 1 revised 9/2/98 Pascuof11 Z 2173 498 744 US Postal Service Receipt for°Certified Mail No Insurance Coverage Provided. Do not use for International Mail See reverse) Sent to Street&Numb Post Owl ,State ZIP Cod Postage $ c Certified Fee b Special Delivery Fee I Restricted Delivery Fee Return Receipt Showing to Whom&Date Delivered Return Receipt Showing to Whom, Date,&Addressee's Address Q TOTAL Postage&Fees $ ch Postmark or Date LLL � , �yy� Stick postage stamps to article to cover First-Class postage,certified mail fee,and charges for any selected optional services(See front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt atwhed, 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 ar cc return address of the article,date,detach,and retain the receipt,and mail the article. I Ln 3. If you want a return receipt,write the certified mail number and your name and address � on a return receipt card,Form 38'1,and attach it to the front of the article by means of the gummed ends it space permits. Otherwise,affix to back of article. Endorse front of article Q RETURN RECEIPT REQUESTED adjacent to the number. � Q e 4. If you want delivery restricted to the addressee, or to an authorized agent of the G addressee,endorse RESTRICTED DELIVERY on the front of the article. a M 5. Enter fees for the services requested in the appropriate spaces on the front of this E receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. li t 6. Save this receipt and present f.if you make an inquiry. 102595-97-6-01 a5 d Fo;M3o Hoses Wn\C�IC. THE COMMONWEALTH OF MASSACHUSETTS r A&rAl H E l CIT OWN q Wgif -A o a DEP EN� '/ q NN I Ajlc_c�u)pant G TEL PHOAddress I9AWWWO e� � 'AA \� u floor Apartment No. No.of Occupa 1 No.of Habitable Rooms No.Sleeping Rooms No.dwelling or rooming units N .Ar'es Name and address of owner INA AlJV W 'f" 1t � Remarks Reg. Vlo. oA YARD Out Bld' s.: Fences: Garba e'and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs,Porches: C� Dual Egress:and O-bst'n.: 0 ❑ B ❑ F ❑ M Doors,Windows: J(nO N J -Reef 1 lW SiL�' O k Gutters, Drains: �snKZ9 N� '( S ^/ h Walls: TN FKDWT N 2 w�E I Foundation: Chimney: BASEMENT Gen.Sanitation: Dam n ss: Stairs: �I Li htin • / ' r ' STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: o ca AMP: Gen.Cond. Distrib. Box: yI 7U 75w FIT 1 n as a Ifi M4 ' Gen. Basement Wiring: DWELLING UNIT Ventil. L to Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room �y 1 Bedroom 1) (,460,S51 Bedroom 2 Bedroom 3 ' r• Bedroom 4 Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove o Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: J _ hLVD01, Wash Basin,Shower or Tub: r) /' IA Infestation Rats, Mice,Roaches or Other: Egress Dual and Obst'n: General .Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REPORy IS SIGNED AND CERTIFIED UNDER THE PAINS-AND PENAL IE OF PERJURY.' INSPECTOR ITLE V z� A.M. DATE /cT/� TIME P.M. A.M. THE NEXT SCHEDULED REINSPECTION P.M. f 410.750: Conditions Deemed to Endanger or Impair Health or Safety t The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of these items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.000 through 410.499 state minimum requirements of fitness for human habitation, any violation has the potential to fall within this category in any given situation but may not do so in every case and therefore cannot be included in this listing. Failure to include shall in no way be construed as.a determination that other violations may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of the violation(s) pursuant to 410 CMR 410.830 through 410.833 nor shall it affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant In accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B) and 410.202. (C) Shut-off and/or failure to restore electricity or gas. (D) Failure to supply the electrical facilities required by 105 CMR 410.250(B); 410.251(A), 410.253(A), 410.253(B) and the lighting in common area required by 105 CMR 410.254. W Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage system in operable condition as required by 105 CMR 410.150(A)(1) and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by an object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450 and 410.451. (H) Failure to comply with the security requirements of 105 CMR 41D.480(D). (I) Failure to comply with any provisions of 105 CMR 410.600 through 410.602 'which results in any accumulation of garbage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects .or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of lead-based paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regualtions for Lead Poisoning Prevention and Control 105 CMR 460.000. -([) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or iiptirllent to health or dafety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilities as are required by 105 CMR 410.351 and 410.352 so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to.health or safety. (M) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (i) lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either operable. (2) failure to provide a washbasin and a shower or bathtub as required in 105 CMR 410.150(A)(2) and 410.150(A)(3) and any defect which renders them inoperable. (3) any defect in the electrical, plumbing, or heating system which makes such system or any part thereof in violation of generally accepted plumbing heating, gas-fitting, or electrical wiring standards that do not create an immediate hazard. (�) failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A) and 410.503(B). (5) failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (N) Any other violation of Chapter II not enumerated in 105 CMR 410.750(A) through (M) shall be deemed to be a condition which may endanger or materially Impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the board of health. L_ February 5, 1998 Judy, Initially got a complaint from Walter Neale and addressed his problems via an inspection on December 3, 1997. The tenant, Walter Neale,had received an eviction notice from his brother,the owner,prior to placing his complaint. Sent a letter to owner and all the problems were corrected. On December 12, 1997 went to the property and tenant stated that everything was satisfactorily fixed. House was to be sold on December 30, 1997 but was held up due to Mr. Walter Neale. Then according to the brother house was to be sold on January 30, 1998. I assumed it was sold and tenant was out but obviously not since he was going to court on this issue again today(2/5/98). Mr. Walter Neale called again on 2/4/98 to the health department with some NEW problems and wanted me to drop everything and do an inspection so that I could give him another document to bring to court with him on 2/5/98. My schedule was booked and I did not have time to get there until Thursday,2/5/98. That was not satisfactory for him. Mr. Neale came into office for a copy of the report-what he wanted was a copy that the complaint was placed. This office gave him a copy of the complaint JUST placed. When he came in he was unclear of what he actually wanted-first asking for the county number and giving it to him repeatedly and then realizing he wanted the state Department of Childhood Lead Prevention in Jamaica Plain for a copy of the Lead-free certificate. I told him he would have to call Jamaica Plain and gave him the number and he said that Jamaica Plain is not a state but I said that is where the state Department is located so he therefore asked for the number again all the time getting more irate. Att d are some copies. r q I Donna Miorandi Health Inspector -TOWN OF BARNSTABLE LOCA11ON a� 22c � � 0�. SEWAGE # _( L VILLAGE ASSESSOR'S MAP & LOT:4 1- � INSTALLER'S NAME&PHONE NO.��< SEPTIC TANK CAPACITY o d LEACHING FACILITY: (type) (size)NO.OF BEDROOMS BUILDER OR OWNER --'\-) PERMIT DATE: — 7 COMPLIANCE DATE: , -� Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist . on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by �� 1 ..,.., N �" �- .. N � ' i -O v �g ' (� li r l .. _. �' ,' ,{ r I No. 7 _ Fee Sv THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,, MASSACHUSETTS ZIpplicatton for �Bigpogaf *pgtern Congtruction Permit Application for a Permit to Construct( )Repair(U11/upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. %2'I 1j W0 Nam'�� �-Z Owner's Name,Address and Tel.No. M Y11NN2S b t;NR 1JE�P►�-E Assessor's Map/Parcel 2—7/ ] �S Installer's Name,Address,and Tel.No. ! l l Designer's Name,Address and Tel.No. ��a5�� �o\.��� S 20 ex ha+.a. S Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 33 0 gallons per day. Calculated daily flow `1s� gallons. Plan Date Number of sheets Revision Date Title N e—c t 0— Size of Septic Tank • l_50 Type of S.A.S. I` H Cc. 0-C.( `�T 1 ahS Description of Soil Nature of Repairs or Alterations( nswer when apE icable) 1-h �� � lah - go c.� ILt 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 Co �ad-not to place the system in operation until a Certifi- cate of Compliance has been issued b this B Signed Date �' (mil Application Approved by Date `11: Application Disapproved for the following reasons Pern '' 9 7- V Date Issued 9' — 0T — ------------_ . �...—.._--- ——————— ——— - - BAN l � Jr f f J to ,5/, � � ;� c ". No. / f Fee S� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: f :1c Yes _ PUBLIC HEALTH DIVISION{-`TOWN OF'BARNSTABLE, MASSACHUSETTS ZlopYication for ;Digpogal'* ' teiu Con5truction Permit Application foi a Permit to Construct"( )Repair(,grade( )Abandon( ) ❑Complete System ❑Individual Components :l Location Address or Lot No. 2_`l. H\C O0 N` 2Z Owner's Name,Address and Tel.No. -0 �►Jl� IVt�LC Assessor's Map/Parcel 2—7 F' Installer's Name,Address,and Tel.No. t Designer's Name,Address and Tel.No. 2 o c, 2lc Type of Building: /1 Dwelling No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder( ) Other Type of Building i No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 0 gallons per day. Calculated daily flow ySL gallons. Plani Date t Number of sheets Revision Date v Title N Size of Septic Tank 15D 0 Type of S.A.S. i 0-1 a C 1 h f f'1 ahS r Description of Soil /+ Nature of Repairs or Alterations.( nswer when applicable) �►� � 1 so 4'1oh S� i C. C�t�� go c.0 e.t i h o a J Date last inspected: _ r A ement: e undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage,disposal system " in accordance witti,the provisions of Title 5 of the Environmental Cod a -not to place the system in operation until a Certifi- cate of Compliance has been issued b this B >: Signed Date CP'V 91 -.. ApplicationApproved.by_ - / - �� Dat e' /' �2 Application Disapproved'for the,following reasons -' Permit No. 9 7- 4 /O e/ Date Issued - —— —————————————— — ————————————'————— ` THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS 4�Cer-tificate of Compliance /r \ THIS IS TO CERTIFYY1,that the O -site Sewage Disposal System Constructed( )Repaired ( Upgraded'( Abandoned( )by- o dChe S at - O W -C k LAC,r h S has been constructed in accordance with the provisions of.Title 5 and the for Disposal System Construc ' n Permit No. — YY dated 9— 1/ — 9'). Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date - Inspector � v _ / No. �. � � �y ——————————————————-------Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Zi5pozar *pgtem Construction Permit Permission is hereby granted to Construct( '")Repair(Apgrade( - )Abandon( ) ;. ., System located at t '.L9 �-1 r otA;Ne A 0 R�- C {f MCA N and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. Date: 9" Approved by 1 i .r NOTICE: This-Form is to.hc llse(1 for. the Repair of Failed • • ��'� Septic Systems Only CEI( TIFICAT•ION OF SKETCH AND'APPLICATION FORA DISPOSAL 1VUItKS C UNS"1'ItUC 7'ION I'hIt(191'I'(1V1'1'110W' DES16NEll 1'LANS1 c�o hereby certify that the application for disposal works construction permit signed by me dated concerning the property located at 2� (��rcow\�e a� 'bY�ge `-.��CD�'� 5 mks all of the pro p following criteria: • There are no wetlands within 300 feet of the proposed septic system • There are no private wells within I So feet of the proposed septic system The observed groundwater table is 14 feet or greater below the bottom of the leaching faciI y • There is no increase in now and/or change In use proposed • There are no variances requested or needed. SIGNED DATB: — � LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER IAllach a sketch plan of the proposed system. Also if(lie licensed installer posesses a certified plot plan, (his plan should be submitted]. 1 1 s/ t� 1' i TOWN OF BARNSTABLE :LOCATION 1 a� K,C ����� � SEWAGE# 93—(19 YILI;AGE I �1F�N.NZS ASSESSOR'S MAP & LOT_d.7!- /1 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 1 C 00� LEACHING FACILITY: (type)* Ak (size)NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: — 7 COMPLLANCE DATE: Separation Distance Between the: -Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist ;-on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist ' ••within 300 feet of leaching facility) Feet .:Furnished by i • d a 1Jd ti p._339 578 768• - US Postal Service . Receipt for Certified Mail r�• No Insurance Coverage Provided. Do not use for International Mail See averse Se o Street swupdr Post Office,State,&ZIP Code i Postage - $ t Certified Fee Special Delivery Fee Restricted Delivery Fee N - Retum Receipt Showing to Whom&Date Delivered Return Receipt Showing to Whom, r Date,&Addremee's Address 0 TOTAL Postage&Fees $ M Postmark or Date 0 rn 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 want 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). m 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the a) return address of the article.date,detach,and retain the receipt,and mail the article. 3. H you want a return receipt,write the certified mail number and your name and address on a return receipt card,Form 3811,and attach H 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 RETURN RECEIPT REQUESTED adjacent to the number. 4. H you want delivery restricted to the addressee, or to an authorized agent of the C addressee,endorse RESTRICTED DELIVERY on the front of the article. CV) D 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt. H return receipt is requested,check the applicable blocks in item 1 of Form 3811. �o 6. Save this receipt and present H if you make an inquiry. CO �• �TM� .� Town of Barnstable « Department of Health, Safety, and Environmental Services BARNSTABM t6Jq.": ,� Public Health Division � pTFO^�A 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Thomas A McKean,RS,CHO FAX: 508-790=6304 Director of Public Health September 3, 1997 Mr. Wayne and Dana Neale 6 Highridge Lane Sandwich, MA 02563 NOTICE TO ABATE VIOLATIONS OF 310 CMR: 15.00 THE STATE ENVIRONMENTAL CODE TITLE V: MINIMUM REQUIREMENTS FOR THE SUBSURFACE DISPOSAL OF SANITARY SEWAGE, AND 105 CMR 410.00 STATE SANITARY CODE 11 - MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION. The property owned by you located at 129 Arrowhead Drive, Hyannis, listed as Parcel 125 on Assessor's Map 271 was inspected on August 29, 1997 by Jerome Dunning, Health Inspector for the Town of Barnstable, because of a complaint. The following violation of 310 CMR 15.00, the State Environmental Code, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage and 105 CMR 410.00 State Sanitary Code 1I- Minimum Standards of Fitness for Human Habitation was observed: REGULATION 310 CMR 15.02 (207) AND 105 CMR 410.300: Overflowing sewage onto the ground. This violation is a serious public health hazard. 1) You are directed to hire a licensed septage hauler to pump the overflowing cesspool within twenty-four(24) hours of receipt of this letter. 2) You are also directed to keep the on-site sewage disposal system pumped as many times as necessary to keep from overflowing onto the ground. 3) You are further directed to contact and hire a licensed Disposal Works Installer within seven (7) days of receipt of this letter in order to repair this system or connect to town sewer. You may request a hearing before the Board of Health if written petition requesting same is received within seven (7) days after the date the order is served. Non-compliance could result in a fine of up to $500.00. Each day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean V Director of Public Health I `S NOTICE TO ABATE VIOLATIONS OF 310 CMR: 15.00 THE STATE ENVIRONMENTAL CODE TITLE V: MINIMUM REOUI REMENTS FOR THE SUBSURFACE DISPOSAL OF SANITARY SEWAGE, AND 105 CMR 410.00 STATE SANITARY CODE II - MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION. I J. 7 1:; The property owned by you located at , listed as Parcel on Assessor's Map was inspected on , 1996 by Edward Barry, Health Inspector for the Town of Barnstable, because of a complaint. The following violation of 310 CMR 15.00, the State Environmental Code, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage and 105 CMR 410.00 State Sanitary Code II - Minimum Standards of Fitness for Human Habitation was observed: REGULATION 310 CMR 15.02 (207) AND 105 CMR 410.300: Overflowing sewage onto the ground. This violation is a serious public health hazard. 1) You are directed to hire a licensed septage hauler to pump the overflowing cesspool within twenty-four (24) hours of receipt of this letter. 2) You are also directed to keep the on-site sewage disposal system pumped as many times as necessary to keep from overflowing onto the ground. 3) You are further directed to contact and hire a licensed Disposal Works Installer within seven (7) days of receipt of this letter in order to repair this system or connect to town sewer. You may request a hearing before the Board of Health if written petition requesting same is received within seven (7) days after the date the order is served. Non-compliance could result in a fine of up to $500.00. Each day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean Director of Public Health PAR ] Real Estate System - General Property Inquiry] Help [ ] Parcel . Id: 271 125- - Account No: 180752 Parent : Location: 129 ARROWHEAD DR Neighborhood: 50AC Fire Dist : HY Devel Lot : 70 Lot Size : . 25 Acres Current Own: NEALE, WAYNE E & State Class : 101 NEALE, DANA No. Bldgs : 1 Area: 1040 6 HIGHRIDGE LANE Year Added: SANDWICH MA 2563 Deed Date : 100189 Reference : 6904/069 January 1st : NEALE, WAYNE E & Deed MMDD: 1089 Deed Ref : 6904/069 Comments : Values : Land: 25100 Buildings : 49100 Extra Features : Road System: 129 Index: 39 (ARROWHEAD DRIVE ) Frntg: 75 Index: ( ) Frntg: Control Info: Last Auto Upd: 050695 Status : C Last TACS Update : 060790 Land Reviewed By: Date : 0000 Bldgs Reviewed By: ML Date : 0989 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 (271] [127] [ ] [ ] [ ] m SENDER: -0 ■Complete items 1 and/or 2 for additional services.- I also wish to receive the ■Complete items 3,4a,and 4b. following services(for an. ■Print your name and address on the reverse of this form so that we can.return this extra fee): .. card to you. d ■Attracc t this forth to the front of the mailpiece,or on the back if space does not 1, ❑ Addressee's Address m ■Write'Retum Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery to ■The Return Receipt will show to whom the article was delivered and the date a C delivered. Consult postmaster for fee. 0 v 3.Article Addressed to: 4a.Article Number d�o 0 3 c. E 4b.Service Type 0 ❑ Registered 01 Certified N �' of o ❑ Express Mail ❑ Insured 5 171 rn ❑ Return Receip COD 7.Date of Del Srn Gl c�� To2��,� -• Gl p 5.Received By:(Print Name) 8.Addresse dressly if eq sted m and fee is t t— g 6.Sign or Agent) LISPS =°a` i X �1 Ps Form 811. ece ber�ssa ,o2sss-s7-8-o17s Domestic Return Receipt l UNITED STATES POSTAL SERVICE First-Class Mai Postage&Fees Paid USPS Permit No.G-10 • Print your name, address, and ZIP Code in this box• Public Health Division 'own of Barnstable P.O.Box 534 Hyannis,Massachusetts 02601 II{ ►�l,hil It 1111 Health Complaints 29-Aug-97 Time: Date: 8/27/97 Complaint Number: 996 Referred To: JEROME DUNNING Taken By: k.s. Complaint Type: TITLE V SEWAGE Article X Detail: UNSANITARY CONDITIONS Business Name: Dona Waynel Number: 129 Street: Arrowhead Dr. �3 Il4 LOCATION - � SEWAGE PERMIT NO. /- oT VILLAGE INSTA LLER'S NAME i ADDRESS VF T©/ziti0 X S .�"�C od Ale, TI-1-Ac.F i U LL D E R OR 0Wil ER :%. -5 A4 ITN DATE PERMIT ISSUED - �- g O DATE-: COMPLIANCE ISSUED II-1 Oo a M� _. � " J \� r �� �� 1 � u �„� o �7 � \ � � � � �'1� � ' � r �- - -- - �J THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ' Ov,on..........oF........... �..s. ................... -............. ............ Appliration for Diopooal Workv Tonotrnrtion Ilermit Application is hereby made for a Permit to Construct (✓) or Repair ( ) an Individual Sewage Disposal S stem at Loca Adare s or Lot No. V.,...... .................. .........................cUt61 s 1....------.............-------•-- � �r �•e � - Owner Address Installer Address Q Type of Building Size Lot_.R� J.........Sq. feet U Dwelling—No. of Bedrooms................................ .....Expansion Attic t,�Q Garbage Grinder (nQ .............. No. of ersons.........._..........__.___. Showers — a Other—Type of Building .............. p � ( ) Cafeteria ( ) G4 Other fixtures --------------- •-------•-• . i W Design Flow............ .......................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Llquid capacityX.....Q.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.__.. N�.._. _._.J.:..` ..................... Date... ��aa— � .a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water......................... GZ, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ GG . O Description of Soil----.•.Q A..•••••. ............................................••;.. . ...... •........ __....... - ..........----------- x i U w ---------------------- ----------3...V�--.A . ..._.._�1 �,......---.s::�<�A..55---------------------...---------....------------------------------....--------------•- V Nature of Repairs or Alterations—Answer when applicable..........................................................:.................................... ---------------------------------•--••••................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TL I TiLLj 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of Health. 4 . . .......... .................... �- a Application Approved BY -----••--•- •............... ly _. _ :_. .__ Date Application Disapproved for h lowing reasons:...................................................•---•-----------------------•----------=--•-•••............_ ...................•••..••.........._........._..... .-•----...................------.........................................•......_--••••••..•••••......-•--••••••••----•----•---Da.............--- te PermitNo.......................................................... Issued-......................................................... �_ Date No......................... FEs.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH W ....-.....OF........... .C n...S.. :.......................... --...--.-._... Appliration for MopuoFal Works Tonotrurtion Permit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal N77 m at:O u�Yl Po �6`� � . -t--- __-••--•------ cans ..........................•-••-----......-----•--•-----------•-•...--------........ Locatiow Addre s or Lot No. ��..�.1-..�-�------ :........ M.�. ............................ �c�..l.---•....... \e_..-------------...-•----.....------•---......... Owner JU \ Address :1 .......•C �- Installer Address Q Type of Building Size Lot__ 49—q.,____.._..Sq. feet Dwelling— No. of Bedrooms___________ ____________________________Expansion Attic Q Garbage Grinder (AP aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures _________________________________________________________________________________________________________^ W Design Flow............VU.......................gallons per person per day. Total daily flow__._..... �_____.__-.____....__gallons. WSeptic Tank—Liquid capacity� __.___.gal Ions 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 b �.1 I_.__ ..._J..:.� _..______________________ Date..�\_Jaa �3--••--•. a Y--- ._. . ,a Test Pit No. l________________minutes per inch Depth of Test it.................... Depth to ground Water........................ L� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R: ............ -:----1 ODescription of Soil........ ----- -1- ._...: .................................... ---------------------___-- ---..__-._:-------._-_.___._.._..___--- U .__..._..._-••••-----•--•••••- `, }�?���`!� h v l_� ......................................................... xl_a•, 1'- 1 e_��.._._._.:s a a=------------------•-------...-------.._._..---------------------...................... 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 TITLL 5 of the State Sanitary Code— The undersigned'furthet agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. S. � 1m. 19 .q -- i.1'+-. .. - lgned- ............................... Date ApplicationApproved BY................................................................................................... ........................-•••-••••-- Date Application Disapproved for the following reasons:............................................................................................................... -••-•-•••••••••••--••-••.............••••-•-•-•••-...--•-••-••-•--•-•-••••-••-•••••••••••---_._.........-.--•--•-•-••-.....••--•-••-••--••••-••-•--•------••••--••••-•-•- .-•--•••-•••••••-•---....._.... Date PermitNo......................................................... Issued-........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............ .........OF......�1�. . .s.. .... - '.-.................... (11"rrtif irFatr of Tomplittnrr THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed K) or Repaired ( ) by........ :f'.�C n. ....._... .5.....-•-•-----•-------•---•----- /a " Install er at........ .__.. __....(wUL(111JQ "_fAnf - has been installed in accordance with the provisions of TITLE 5 of The"State Sanitary Code as described in the application for Disposal Wor Construction Permit No......................................... dated................................................ THE ISSUANCE O TINS CERTIFICATE SMALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM 1d JLL U N SATISFACTORY. DATE... ..........----------- .......---------------------- Inspector . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1 ^ .............\. )..n...........OF......... ............................................. No......................... FEE........................ DWpo,s\Fal, - orko Tonot_rurtion Permit Permission is hereby granted........-�!. - ..__..__....�`_ .' --•••---•-•••-•. .................•••••-•._............_...........---- to Construct ( ✓j or Repair ( ) an Individual Sewage Disposal System at No........W.- ......... •-•••• L =�' {._ ......-•-- lr�l d �. hu- ------------ ----Q--�-��--•-----•--------•................ Street as shown on the appli ion for Disposal Works Construction Permit No..................... Dated.......................................... -•-----------------------------------------------------------------••---------._.....•••••••--......._..- DATE. �� �� Board of Health FORM 1255 A. M. SULKIN, INC., BOSTON ' pt= SIG► A pA,TA 151QGL& FAMtL'� - 3 BCOR0oM q WO GAd-ttAGE 6cLwDEQ- D/*►Ly FLOW = 110 X 3 = 33oG.P�? 11 SEPTIC, TASK = 33OX15o% =A95G.P. P - - Usti= 1 000 015P06AL P►T v6E tc�o0 6AL. .�oT 50TTOM AREA -IOTA I- o F-516-N = .4.2 G.P D. -TOTAL- 'PA I L*( FL-OV•( = 33o G.Po v P���'' n-Bob 9B•g f PE2COLaTION- RATE-: I,IIN 2MIN. oVLE55 - T _ . u sT "_a, tN OF Mks ALAN v R;Ci IARD S ;��� JONE �� 3 -A. c3 �BAXTER vi ¢ No. 25� • Na 21C43Q °' i y ,y `4 T`1SY% Q� \onAd F..: +' �'el Q Ida sort'= /8 7W K//rfFrW TEST WP273/ , .. 3 Top FND=Ioo•o I / D I ST. lN./. O�►L. 9S'7,G6 JF 0v?c SS PT IC. .Sl�,�.So/� !ooQ 111�: J 9f'� •TA�tK: . : � 3 LEACH PIT INY INV. WITH yyB 9S� 4 v Yi '�JE�• WASNGD G1=wrirztso� PLoT• PLAN .,/o rt�•drE.2 WO SCALE.. c - 5 ALE /I ram laur �ry NG Fw ::5"0 YN p L.A t, REF S ZE" Ce � � GEQTIFY 'THAT 'THE Exl - ti N6 26o►.1 COMPL`(5 1nl ITN"T NE S t oEL1N� /o.T- Al.it� 56TP�.GK R.6QvIti2.EMENT� oFTµt= -fo W N C7 t= AND 1 S dJor /`�G.4�✓ fU� Tv�/Tj�/S��- L.00p.T 0 NNITHIW TN• C%000 PL,&.IN O.d7-,5.2:), ,S�,ar //��3 DA'T E t(, t3AXT E tZ t tv`{E INC. R.E.G t S-T o 5 u my E�o>zS 7W5 PlLt Ki ► S KiOrr E3�5�o ob ati� " _ �',,n os-r1=e.vtLLE • �KASS. hn be, � .e�`n-,t Lo-� u kQ2 ' �;Ca�n�- -� c�rY.� K Sm���