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HomeMy WebLinkAbout0045 BETH LANE - Health 45 Beth,Lane Hyannis P A = 272 174 s r r, 0 - I' - i o n J K g 7YCommonwealth of Massachusetts W Title 5 Official. Inspection Form VNSubsurface Sewage Disposal System Form - Not for Voluntary Assessment 45 Beth Lane '? Property Address' Ny Tony and'Cheryl Rambert Owner Owner's Name" a information is required for every Hyannis _ MA 02601 12/22/2015 'i page. Cityrrowli - State Zip Code Date of Inspection •fi Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, • 614 ` use only the tab 1. Inspector, key to move your cursor-do not David B.'Mason use the return Name of Inspector key. David B. Mason , rea Company Name 4 Glacier Path Company Address East Sandwich -MA 02537 City/Town State Zip Code -508-367-1617 ;. S1287 - Telephone Number License Number °B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system-. E Passes E Conditionally Passes 0 Fails ❑ -Needs Further Evaluation by the Local Approving Authority - � 12/22/2015J Inspector's Sign*VeV Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board` of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the .report to the appropriate regional office of the DEP. The original should be sent to the system owner . and copies'sent to the buyer, if,applicable, and the approving authority. ""This report only describes conditions at the time of inspection and under the conditions of use � at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts . w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M .45 Beth Lane Property Address Tony and Cheryl Rambert Owner Owner's Name information is required for every Hyannis MA 02601 12/22/2015 page. City/Town State Zip Code Date of Inspection B. Certification,(cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. ' Comments: s - The observations noted in this report represent the condition of the system observed only on this date of inspection and the information contained herein does not guarantee the continued operation of the -system. B) System Conditionally Passes: ❑, One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair,'as approved by the Board of Health, will pass. Check the box for"yes" "no" or"not determined" (Y, N, ND) for the,following statements. If"not, determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or no is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent..System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic,tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less.than 20 years old is available. ❑ Y ❑ N� ❑ ND (Explain below): k t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 45 Beth Lane Property Address Tony and Cheryl Rambert Owner Owner's Name _ information is required for every Hyannis MA 02601 12/22/2015 page.. City/Town, State Zip Code Date of Inspection B. Certification(cont.)` ° { ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation' of sewage backup or breakout 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): R broken pipe(s)'are replaced ❑ Y ❑, N El ND (Explain below): aft ,., ,. .. • El 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(§).The', system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced r ❑ Y ❑ N ❑ ND (Explain below)-., ❑ 'obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): r C) Further Evaluation is`Required by the Board of Health: ❑ Conditions exist which require further,evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1.'System will..pass unless Board of Health determines in accordance with 310tCMR'- 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or.privy is within,50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3113 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 11 Commonwealth of Massachusetts W Title 5 Official• Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments . 3r 45 Beth Lane Property Address Tony and Cheryl Rambert Owner Owner's Name information is required for every Hyannis MA 02601 12/22/2015 page. City/Town State Zip Code Date of Inspection. ' R Certification (cont:) 2. System will fail unless the Board of Health (and Public Water Supplier, if any). determines,that the.system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has'a septic tank and SAS and the SAS is within a Zone 1 of a public water, supply. ^ :. ❑ The system'has a septic tank and SAS and the SAS is within 50 feet of a private water supply well., ❑ The system has a septic tank and SAS.and the SAS is less than 100 feet but 50 feet or more from a,private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal. coliform bacteria'indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the;analysis must be attached to this form:. 3. Other: k D) System Failure,Criteria.Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ' ❑ ®," Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or.clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 'h day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form =Not for Voluntary Assessments ,M 45 Beth Lane Property Address Tony and_Cheryl Rambert Owner Owner's Name ' information is required for every Hyannis MA 02601 12/22/2015 page. City/Town state Zip Code Date of Inspection B. Certification (cont.) Yes No a?> ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed,pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground„water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. El ® Any portion of a cesspool or privy is within a Zone 1 of a public well. . ❑ ® - An p of a cesspool or:privy is within 50 feet of a private.water` - Y portion. p P Y p er supply Well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] The system is`a cesspool serving a facility with a design flow of'2000gpd 10,000g`pd. ❑ The.system fails. I have determined that one or more of the above failure criteria exist as described esc bed in 310 CMR 15.303, therefore the sY stem fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered alarge system the system must serve a facility with a design flow of 10,000 gpd,to 15,000'gpd. For large systems,-you must indicate either"yes"or"no" to each of the following, in addition to the questions in Section.D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply El ❑ the system is within 200 feet of a tributary to a surface drinking water supply 0 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 haveanswered '.`yes':to any question in Section�E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 45 Beth Lane Property Address Tony and Cheryl Rambert Owner Owner's Name information is required for eve Hyannis MA 02601 12/22/2015 ry page. City/Town State Zip Code Date of Inspection C. Checklist _ Check if the following.`have been done ;You must indicate"yes" or'no" as to each of the following: Yes No F ® ❑ 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? • ® ,re ❑ M1 Were as built plans of the system obtained and examined?,(If they were not available note as N/A) F ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? M. ❑ ". 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 El information on the.proper maintenance of Subsurface sewage disposal systems? x The size and location of the Soil Absorption System (SAS) on the site has =been determined based on: ® ❑` Existing information. For example, a plan at the Board of Health. ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions:, Number of bedrooms (de 3 3 sign): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): : 330 ,t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 , Commonwealth of Massachusetts W Title 5 Official, Inspection Form Subsurface Sewage'Disposal System Form - Not for Voluntary Assessments 45 Beth Lane Property Address Tony and Cheryl Rambert Owner Owner's Name information is required for every Hyannis MA 02601 12/22/2015 page. City/Town State Zip Code Date of Inspection D. System Information Description: . Number of current residents: Does residence have a garbage grinder? ❑, Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection El Yes ® No information in this report.) � r Laundry system inspected? Yes ® No Seasorial use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d yes 9 ( Y 9 (gp ))� Detail: ' Sump pump? ❑ Yes ® No -Last date of occupancy: Current 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 ® No Industrial waste holding tank present? Q Yes E No Non-sanitary waste discharged to the Title 5 system? ❑ .Yes H No Water-meter readings, if available: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 45 Beth Lane Property Address Tony and Cheryl Rambert Owner Owner's Name information is required for every Hyannis MA 02601 12/22/2015 page. City/Town State Zip Code Date of Inspection D: System Information (cont.) t Last date of occupancy/use: Date Other(describe below): a General Information Pumping Records: Source of information: Board of Health Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1000 gallons How was quantity pumped determined? sight glass on truck Reason for pumping: maintenance Type of System: ® Septic tank, distribution box, soil.absorption system ❑ Single cesspool ❑ Overflow cesspool a' ❑ Privy El Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and „ maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system'by system operator under contract` ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official: Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 45 Beth Lane = Property Address LL € k Tony and Cheryl Rambert Owner Owner's Name information is required for every ,Hyannis ;' 4 MA 02601 12/22/2015 page., City/Town' State2 Zip Code Date of Inspection D. System Information (cont") ° Approximate age of all corn' -date installed (if known) and source of information: Compliance issued 4/02/08 Were sewage odors'detected when arriving at the site? ❑ Yes ® No Building Sewer,(locate on site,plan):' , Depth below grade: 2 5. a feet Material of construction: ❑ cast iron, ® 40{PVC: k ❑ other(explain): 10+ �A _ i .Distance from private water supply well or suction lin feet _ a s .. � .: t , r. Comments(on con'dition,ofjoints;,venting evidence of leakage, etc.): a r r N " i a • Septic Tank(locate on site plan):.' Depth"below grade: a 2 r feet' . *r, i Material of construction ® concrete t.*❑ metal :_ ❑ fiberglass ❑polyethylene ❑ other(explain) If tank is metal Ilst age h b " years Is age confirmed byR;a Certificate of Compliance?,(attach a copy of certificate) ❑".Yes ❑ No Dimensions: , �' � - •1000•Typical211 " Sludge-depth:' t5ins°3113 .,: i +: t " ,Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 r . Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �^M 45 Beth Lane Property Address Tony and Cheryl Rambert " Owner Owner's Name information is required for every Hyannis MA 02601 12/22/2015 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont:) Distance from top of sludge to bottom of outlet tee or baffle 47" Scum thickness . 3„ ,Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of,outlet tee or baffle 16 How were dimensions determined? Scour Stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Effluent level with outlet invert. Tank is 9" below grade. Grease Trap(locate on site plan): Depth below grade: feet Material of'construction: ❑ concrete ❑ metal' . 0-fiberglass ❑ polyethylene ❑'other(explain): Dimensions: t ; Scum thickness Distance from top of scum to top of outlet tee or baffle Distance frombottom of scum to bottom of outlet tee or baffle Date of last pumping:, Date l5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage.Disposal System Form - Not.for Voluntary Assessments 45 Beth Lane Property Address Tony and Cheryl Rambert Owner ' Owner's Name information is. required for every. y Hyannis MA 02601 12/22/2015 page. r Cityrrown State Zip Code Date of Inspection D. System Information-(cont.) Comments (on pumping`recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related.to outlet invert,evidence of leakage, etc.): Tight or,Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: - Material of construction: ❑ concrete ❑ metal - '.,❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions:' '.Capacity` gallons Design Flow- r gallons per day Alarm present: El Yes . ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? '❑ Yes'' ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Y ' Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for.Voluntary Assessments 45 Beth Lane Property Address Tony and Cheryl Rambert Owner Owner's Name ` information'e required for every Hyannis MA 02601 12/22/2015 _ - page. zCity/Town, *. State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert effluent level with outlet invert Comments (note if box is level'and distribution to outlets equal, any evidence of solids carryover, any ' evidence of leakage into or out of box, etc.): No evidence of solids'carryover. Dbox is 17 inches below grade. There is a riser within 2 inches of grade. - Pump Chamber(locate on,site'plan): Pumps in working order. , ❑ Yes ❑ No` Alarms in working order: ❑ Yes ❑ NO. Comments(note conditiori.of pump chamber, condition of pumps and appurtenances,,etc.): If.pumps or alar`ms'are not in`working order, system is a conditional pass. ' Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why" • (Sins•1113 r Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 45 Beth Lane Property Address Tony and Cheryl Rambert Owner, Owner's Name information is required for every Hyannis MA 02601 12/22/2015 _ page. City/Town State Zip Code Date of Inspection D. System Information (cont) Type. ❑ leaching pits number: 4-3050's ® ; leaching.chambers � - number: � , ❑ leaching galleries number: El leaching trenches number, length: ❑ leaching fields ' . f number, dimensions: ❑ overflow cesspool number: El innovative/alternative system Type/name of technology: Comments (note condition of soil,,signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): ' No effluent standing at time of inspection. No excessive growth of vegetation. 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 w. . Depth of scum layer - Dimensions of cesspool _ Materials of construction Indication of groundwater inflow, ❑ Yes ❑ No l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts L Title 5 Official Inspection Form Subsurface Sewage,Disposal,System Form - Not for Voluntary Assessments �M 45 Beth Lane Property Address Tony and Cheryl Rambert Owner Owner's Name information is required for every Hyannis MA 02601 12/22/2015 page. City/Town State Zip Code Date of Inspection D. System Informati n y o .(cont.) Comments (note;condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids ' Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of,vegetation,' etc.): t5ins•3/13 r Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 4 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 45 Beth Lane Property Address Tony and Cheryl Rambert Owner Owner's Name information is required for every Hyannis MA 02601 12/22/2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch'in the area below ® drawing attached separately t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -''Not for Voluntary Assessments wM 45 Beth Lane Property Address Tony and Cheryl Rambert Owner Owner's Name information is required for every Hyannis MA 02601 12/22/2015 page. City/Town State Zip Code Date of Inspection D. System Information (cost.) ti Site Exam: ® Check Slope ® Surface water ❑ Check cellar ❑ Shallow wells 18' Estimated depth:to high ground water: feet Please indicate all methods used to determine the high ground water elevation:.. - ;® Obtained from system design plans on record if checked, date of design plan reviewed: February.2bm Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Groundwater Contour Map { ❑ Checked with local excavators,.installers-(attach documentation) ❑ Accessed USGS database-ex p lain: P .. t - You must describe how you established the high ground water elevation: Groundwater Contour Map • s ' Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form _ Subsurface Sewage Disposal System form Not for Voluntary Assessments 45 Beth Lane Property Address Tony and Cheryl Rambert' Owner Owner's Name information is required for every Hyannis MA 02601 12/22/2015 page. _ City/Town State Zip Code Date of Inspection E. Report Completeness.Checklist ® Inspection Summary: A, B, C, D, or E checked '® Inspection Summary D,(System Failure Criteria Applicable to All Systems) completed System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Assessing As-Built Cards y Page 1 of 2 ? f TOWN OFBARNSTABLE LOCATION ��y�/� �' G�aY SEWAGE#aGIJg W.Z VILLAGE`fi�aani5. ASSESSOR'S MAP&PARCEL /7 INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY /OOp G.l ET�c�JTiNS LEACHING FACILITY:(type) Iy ( - NO.OFBEDROOMS OWNER %oft C s PERMIT DATE: 3'1$'O Y COMPLIANCE DATE: - • Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility S Feet' Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 fect,of leaching facility) Feet, Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching �- Feet ing facrli FURNISHED BY DOwJ LA/t G'Hs�ree-r-,yL l h % r, W _ D .I7 j (01 FT 1 3 , S http://www.townofbamstable.us/Assessing/HMdisplay.asp?mappar=272174&seq=1 12/15/2015 TOWN OF BARNSTABLE A:.00ATION SEWAGE#A2d?-/.;2,Z VII AGE hhiJ _ASSESSOR'S MAP+&PARCEL-na 1"7S/ INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY /0029 G,CJCIJ�ia4 ,�LEACHING FACILITY:(type),3®s'y.r�'C/ , & (size) /O' X X—.Z( NO.OF BEDROOMS J OWNER01 �O�e PuL CCs PERMIT DATE: COMPLIANCE DATE: �'. Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility S 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 facilii Feet FURNISHED BY �Ow+/ Gg�r Z-- /V-,O�e-,go?p , 3 G o w ! _ � �. ' � � A v.1 w s�., J v c.�' J - o. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes pprication for �Dtgogal *pgtem Cottgtructtou Permit Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑.Complete System ndividual Components Location Address or Lot No. Y Owner's Name,Address;and Tel.No.7a_Jq� !2� Assessor's Map/Parcel - �7 Y -WO Installer's Name,Address,and Tel.No. /�Gs'�/p�J`+ GO'�J i�/ Designer's Name,Address and Tel.No. 22I.-Y t EY`4`� yrry�.� 4J 939 /,�&w 54 Type of Building: Dwelling No.of Bedrooms ✓ Lot Size �rOGO sq.ft. Garbage Grinder (W Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures ' Design Flow(min.required) 330 gpd Design flow provided 17ya gpd Plan Date J / -6 Number of sheets Revision Date t 0� �- Title �-r I- S��+ i'�Qsr d � y3` � � Last /fjG�!ale 5 Size of Septic Tank /,Qdl3 Type of S.A.S. y- 1,v `l-g-e l 30Sa Description of Soil i Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the co truction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 o nvironmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Bo. d of ealth. Signe to 3 e' Application Approved by ate Application Disapproved by: Date for the following reasons .Permit No. !� 6� Date Issued o. ,..�•..�c � Fee V A Entered in computer: THE COMMONWEALTH OF MASSACHUSEETTS Yes PUBLIC HEALTH DIVISION- TOWN OF BARNSTABLE, MASSACHUSETTS Zipprtcatton;for �h5pogat6p.5tem Cons;tructio ; ,Vermtt Application for a Permit to Construct( Repair(�)e Upgrade O Abandon( ❑.Complete System © nI dividual Components Location Address or Lot No. VT �h ay,, Owner's Name,Address,and Tel.No.7 Va /l33 „ Assessor's Map/Parcel 97 y eo AVA9- Installer's Name,Address,and Tel.No."� � G/7tof�'� �./ Designer's Name,Address and Tel.No. `t Type of Building: Dwelling No.of Bedrooms Lot Size /3,060. f sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 336 gpd Design flow provided /!S gpd Plan Date 3 i,Q- Gr Number of sheets / /Revision Date Title /, 11, !` si/+ ��G� Q'� VJ-f r7`4 Gcp, �ftliyN� Size of Septic Tank 4 GOG e"Y L'a�J�i6rti Type of S.A.S. y 7-rr .Description of Soil j 9141 t Nature of Repairs or Alterations(Answer when applicable) I " N Date last inspected: Agreement: The undersigned agrees to ensure the co truction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of t1 ejEnvironmental Code'and not to place the system in operation until a Certificate of . Compliance has been issued by this Board of ealth. Signe L n ate Application Approved by �, _ / ate Application Disapproved by: Date for the following reasons �-, t t Permit No. "� Date Issued ___ _ __ .o, THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( 011�Upgraded ( ), 4 G Abandoned( )by �/ v f� , ��J vr�f/`fv✓ r `at yf ff L.ci� GHQ!/ has b en constructed in acco dance r i s with the provisions of Title 5 and the for Disposal System Construction Permit No. "' ated / / Installer !7d-����, �vp S7`w/�Te Designer �� f�j�t �"l.�siw,•rv-�s�� #bedrooms Approved design flow g.dG The issuance of this permit sh not e co st:rued as a guarantee that the system w IIYunktion as designed. Date Inspector v lbl No. /) �J l_7" Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS Itgpool �&p!tem Con tructton Permit Permission is hereby granted to Construct ( ) Repair Upgrade ( ) Abandon ( ) System located at yr. /3-rA .. ,#7- and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local`provisions or special conditions. - Provided: Construction mus bir competed within three years of the date of thisffm it. n .:::V Date roved A ✓( z � ���/1) PP b Y I . FROM :down cape engineering inc FAX NO. :15083629880 Apr. 03 2008 12:03PM P1 Town of Barnstable V/ Regulatory Services A 'Thomas F.Geiler,Director MAMr Public Health Division ate" Thomas%IGKean,Director 200 Main Street,Hyannis,M.A 02601 O flce: 508-862-4644 Fax. 509-190-6304 Installer &Designer Certification Form Date: Y" Sewige Permit# 'Ott ^ M° ,. Avgessor's Moffarcel ' I7 Designer: "),, pet ; )o V_'1_4 14/ „r__e l Address: �Gl �J (. ,----,— Address: I - •. ....� �C� ��� f U s A,) /L/f . Oil -AQ �c/,c.iwas tssued a permit to install a (date) --- installer) septic system.at T ..- _±^�-. ..........._.. based on a design drawn by (address) 01 Q� �'-�•=- '� _ �u?..-...— dated (desi er) I certify that the septic system referenced above was instilled substantially according to the design, which may include minor approved.changes such as Lateral relocation of the distribution,box and/or septic tank-. T. certify that the septic :system referenced above was installed with major changes (i.e. greater than. 10' lateral relocation.of the SAS or any vertical.relocation of any component of the septic system)but in accordance with State& Local. R.ebul.aticros. Plan revision or certified as-built by designer to follow. 4�* ARNE H 7_. .. .. . (In er' OJAiAs Signature} CUM. �En No 30792 4 ION AL (Designer's Signature (Affix l)esig 5 Siarnp Here) PLEASE _RETURN TO BARNSTABLE PtlflLIC ff'V.A1I.TH DTVISTON. CERTIFICATE OF C:OMPLIANCF WILL NOT BE ISSU.F.D UNTIL BOTH TWS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PURI,iC HEALTH,DIVISION. THANK.YQIJ. Q:i-lcalthh/SeptiVNsigner Ccrtific:ation Form 3-26-04.doe t t Health Complaints 10-Mar-06 Time: 10:40:00 AM Date: 3/9/2006 Complaint Number: 18682 Referred To: DAVID STANTON Taken By: RITA Complaint Type: CHAPTER II HOUSING Article X Detail: ILLEGAL OPERATIONS Business Name: Number: 45 Street: BETH LANE Village: HYANNIS Assessors Map_Parcel: 272-174 Complainant's Name: Address: Telephone Number: Complaint Description: OVERCROWDED!!!!!!! 12 PEOPLE-3 BEDROOM HOUSE-ADDED 5 MORE IN BASEMENT WITHOUT BLDG. PERMIT AND ADDED DOOR TO BULKHEAD FOR ADDITIONAL ENTRY. SEPTIC IS FOR 3 BEDROOMS- Actions Taken/Results: DS WENT TO SAID LOCATION. NO ANSWER. WHITE CHEVY PRIZM LIC. PLATE# 1061 JV PARKED IN THE DRIVEWAY. THERE IS A NEW STONE PATHWAY LEADING TO THE BACK LOWER LEVEL ENTRANCE THAT HAS A DOG HOUSE BUILT OVER THE FORMER BULKHEAD. SEVERAL PARKING AREAS AT SAID LOCATION. WILL REFERENCE FOR FUTURE"BIRST"TEAM AND OR BUILDING DEPT. IF THERE ARE NO BUILDING PERMITS. Investigation Date: 3/9/2006 Investigation Time: 2:30:00 PM 1 Town of Barnstable �F THE 1p� o Regulatory Services vsrAsLe Thomas F. Geiler,Director BA •�� Public Health Divisio p n TEO NIA' Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax:.508-790-6304 January 10.2007 Ms Delores.V..Chaves c/o David Holt 45.Beth Lane. Hyannis, MA.02601 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, Title 5 The septic system owned by you located 45 Beth Lane, Hyannis, MA was last inspected December 10thth 2006 by Michael DeDecko, a certified septic inspector for. the.State of Massachusetts. The inspection of your septic system showed that your system"Fails" under.the guidelines of 1995.TITLE 5 (310 CMR 15.00).due to.the following: System is in hydraulic failure You have 2.years from the date of the system failure to bring the system into compliance... If there are any questions about this.reminder,please feel free to contact the.Barnstable. Health Department. BARNSTABLE HEALTH DEPARTMENT Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health TOWN OF BARNSTABLE iJN SEWAGE # '/1f/' � -- u,LAGE ^PI�L14c-s ASSESSOR'S MAP & LOT "/ 1 SEPTIC TANK CAPACITY - ,>� LEACHING FACILITY: (type) (size)�� NO. OF BEDROOMS BUILDER OR OWNER PERMIT DATE: <\ COMPLIANCE DATE: - Separation Distance Between '�� 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 TOWN OF BARNSTABLE SEWAGE # q.LLAGE ASSESSOR'S MAP& LOT NS��'e arms ,s'��•�e�s-_ a� INSTA14�F,R'S NAME&PHONE NO. � '41AIC® ' SEPTIC TANK CAPACITY Cic. LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER ��✓ 6.! may ' .:PERMPTDATE: COMPLIANCE DATE: k 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 � � a 9 M 10 ® 3 49 W �fit�s Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 45 BETH LN Property Address C/O DAVID HOLT Owner Owner's Name information is required for HYANNIS MA 12/19/06 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important:When filling out A. General Information �qa forms on the computer,use 1. Inspector: only the tab key to move your MICHAEL DEDECKO cursor-do not Name of Inspector use the return key. COMPASS REALTY DEV CORP Company Name V 2 P.O. BOX 2384 Company Address MASHPEE MA 02649 'ef0 City/Town State Zip Code 508 221 5003 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of 'Title 5(310 CMR 15.000). The system: ❑ Passes ❑ Conditionally Passes ® Fails ;sue ❑ Needs Further Evaluation by the Local Approving Authority t. l)TJ, D((Jojel-� tl 12/19/06 Ins ectors igrI tore Date d 4 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 hared systemr6r has a design flow of 10,000 gpd or greater, the inspector and the system owner sPall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp-08/06 �I 071��p !/ ���� Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 15 I Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 45 BETH LN Property Address C/O DAVID HOLT Owner Owner's Name information is required for HYANNIS MA 12/19/06 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ 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 ❑ obstruction'is removed t5insp-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 45 BETH LN Property Address C/O DAVID HOLT Owner Owner's Name information is required for HYANNIS MA 12/19/06 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ Any portion of the 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. t5insp•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts u W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 45 BETH LN Property Address C/O DAVID HOLT Owner Owner's Name information is required for HYANNIS MA 12/19/06 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form..] ❑ The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in.310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5insp•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 45 BETH LN Property Address C/O DAVID HOLT Owner Owner's Name information is required for HYANNIS MA 12/19/06 every page. City/Town State Zip Code Date of.Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ Were any of the system components pumped out in the previous two weeks? ❑ ( Has the system received normal flows in the previous two week period? ❑ Have large volumes of water been introduced to the system recently or as part of. this inspection? ❑ Were as built plans of the system obtained and examined? (If they were not available note as IN/A) ❑ Was the facility or dwelling inspected for signs of sewage back up? ❑ Was the site inspected for signs of break out? ❑ Were all system components, excluding the SAS, located on site? ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ Existing information. For example, a plan at the Board of Health. ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 45 BETH LN Property Address C/O DAVID HOLT Owner Owner's Name information is required for HYANNIS MA 12/19/06 every page. Cityrrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): - Number of bedrooms (actual).- DESIGN flow based on 310 CMR 1.5.203 (for example: 110 gpd x#of bedrooms): d Number of current residents: Does residence have a garbage grinder? ❑ Yes KX No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes 14 No Laundry system inspected? ❑ Yes K No Seasonal use? ❑ Yes K No Water meter readings, if available(last 2 years usage (gpd)): Sump pump? ❑ Yes D� No Last date of occupancy: Date 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? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): t5insp•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 45 BETH LN "M Property Address C/O DAVID HOLT Owner Owner's Name information is required for HYANNIS MA 12/19/06 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ASeptic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Were sewage odors detected when arriving at the site? ❑ Yes No t5insp-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 45 BETH LN Property Address C/O DAVID HOLT Owner Owner's Name information is required for HYANNIS MA 12/19/06 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: I feet Material of construction: ❑ cast iron X40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet feet Comments(on condition of joints, venting, evidence of leakage, etc.): 1 Septic Tank(locate on site plan): ` 1 Depth below grade: feet Material of construction: concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: GI Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle Scum thickness I VI Distance from top of scum to top of outlet tee or baffle dc�U L)FLo— Tr, Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? t5insp•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 45 BETH LN Property Address C/O DAVID HOLT Owner Owner's Name information is required for HYANNIS MA 12/19/06 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 9 4cf > t�.�STc2Ui✓t-UrzVY11 ✓ —40L)r-_ ,�j Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): t5insp•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° ., 45 BETH LN Property Address C/O DAVID HOLT Owner Owner's Name information is required for HYANNIS MA 12/19/06 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert trP`'Ut �YvCw� o�n� r (M� y- Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): c,1`lL t L)a T7 ti vJ u?tk t-i Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No t5insp•06l06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments y 45 BETH LN Property Address C/O DAVID HOLT Owner - Owner's Name information is required for HYANNIS MA 12/19/06 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why.- Type: [ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): �1J(�7—r" LKJ .� G c� dl��C�iwiti/nJ, t5insp•08/06 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 0 45 BETH LN Property Address C/O DAVID HOLT Owner Owner's Name information is required for HYANNIS MA 12/19/06 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp-08/06 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 13 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 45 BETH LN Property Address C/O DAVID HOLT Owner Owner's Name information is required for HYANNIS MA 12/19/06 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Qeq IC— I t5insp•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 a Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7M 45 BETH LN Property Address C/O DAVID HOLT Owner Owner's Name information is required for HYANNIS MA _ 12/19/06 every page. CityFrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: Check Slope EU/'Surface water UVCheck cellar V'Shallow wells a� Estimated depth to ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Usc-7�2 JU UfOs t5insp•08/06 Titlb 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 TOWN OF BARNSTABLE • LOCAT10N � � 7/ SEWAGE # ro VII LADE ASSESSOR'S MAP & LOT Q 2 l 2) INS R'S NAMEA PHONE.NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER D�✓ �.���'®� 'T--;PERMIPDATE. COMPLIANCE DATE: Separation Distance Between the,--, ...... Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within.200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist T within 300 feet of leaching facility) Feet Furnished by 9-3 i i TOWN OF BARNSTABLE C- LOCATION 14: 26A 4--' SEWAGE # VILLAGE ASSESSOR'S MAP & LOT 272 '�7 INSTALLER'S NAME&PHONE NO.d f/ OV IL CC) •5 r3 E -2 95 1 SEPTIC TANK CAPACITY LEACHING FACIL=: (type) (size) 'NO.OF BEDROOMS BUILDER OR OWNER J26Wd, PERMIT DATE: 7 Y COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet- Furnished by � I V a Co +� 0 v + it' o a� No. — oo� Fee V l' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Zipphratton for ;Ngw6al *pztem Conztructton Vermtt Application for a Permit to Construct( )Repair( KUpgrade( )Abandon( ) ❑Complete System LAiiidividual Components Location Address or Lot No.. Owner's Name,Address and Tel.No. mod'- a70) Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 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. IT Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue by th' d of Health. Sig d - �Date �✓ Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued i �l ' r 4 No.. .1�i7 L Vo� Fee /r--- THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: c/✓' Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Application for Misspo!6al *pgtem Conotruct on Permit Application for a Permit to Construct( )Repair( PUpgrade( )Abandon( ) ❑Complete System [Al dividual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel '7 .'' BFair/ Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling --No»of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers,( ) Cafeteria( ) Other Fixtures , Design Flow gallons per day.,'Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) ill 4 C£ Q a X Date last.inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this.-Board of Health. Sign d Date " U Application Approved by Date G Application Disapproved for the following reasons Permit No.Q C)Q Date Issued I 7 l U THE COMMONWEALTH OF MASSACHUSETTS ` BARNSTABLE, MASSACHUSETTS Certificate f o Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired ( I-)-Upgraded( ) Abandoned( •j.by A i ,q /o,4/y ro -3--*.o w - at �"~' ,q r 1�y has been constructed in accordance j with the provisions of Title 5 and the for Disposal System Construction Permit No. GUy nn dated I/-71 a N Installer �..Q..,.�'.�.. Designer \ The issuance of this permit shall not be construed as a guarantee that the s st m�will function as desiqq ned. Y g i P t Date V'li f2� Inspector 1 J � A-, ��'�'l P,3 - --------------------------------------- ri ^ , -►- No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION BARNSTABLE, MASSACHUSETTS li5po5al 6pgtem Construction Permit Permission is hereby granted to Construct( )Repair( 4.4-Upgrade( )Abandon( ) System located at IrIl e 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 t date o t. Date: /0 Approved by _ �I yv TOWN OF BARNSTABLE LOCATION P�¢� SEWAGE # VILLAGE ��`i�.•��dl ASSESSOR'S MAP & LOT 22 17 INSTALLER'S NAME&PHONE NO. A.1 0 61 'r)9 S ?OV SEPTIC TANK CAPACITY LEACHING FACILITY: (typ (size) CE NO.OF BEDROOMS / BUILDER OR OWNER ,a 0—ad-k PERMITDATE: �.' �,�_COMPLIANCE DATE: / ' Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by I' 1 s �neL/ 0 f a COMMONWEALTH OF MASSACHUSETTS Z w EXECUTIVE OFFICE OF ENVIRONMENTALfAFFAIRS m d DEPARTMENT OF ENVIRONMENTAL PROT �CTI�QN ` J A1! Oo+v SVOw TOWN A TH rP1- ' 350 MAIN STREET BE & WEST YARMOUTH,MA 508-775-2800 TITLE 5 ' OFFICIAL INSPECTION FORM—`NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION MAP 272 PAR 174 Property Address: 45 BETH LANE MAPZ�._ HYANNIS,MA 02601 PARCEL Owner's Name: CROWE,JOSEPH - x Owner's Address: 45 BETH LANE LOB` HYANNIS,MA 02601 Date of Inspection JANUARY 7,2004`, Name of Inspector:(please print) JAMES D. SEARS Company Name: A&B Canco Mailing Address: 350 Main Street West Yannouth,MA,02673 Telephone Number:.. 508-775-2800 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: ✓ Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: The system inspector shall suPimittopy 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 tot he buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. r 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 1 Page 2 of l l i OFFICIAL INSPECTION-FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A r CERTIFICATION (continued) Property Address: 45 BETH LANE HYANNIS,MA 02601 p Owner: CROWE,JOSEPH Date ofInspection: .' JANUARY,7,2004 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: I have not.found any infonnation which indicatesdthat any of the'failure criteria described in 310 CMR' 15,303 or in 310 CMR,15.304 exist. Any:failureefiterianot evaluated are indicated below. 1 Comments: ° s B. System Conditionally Passes: N/A '- 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 approvedrby,•the Board of Health;will pass Angwer yes,no or,not determined(Y,N,ND)`in the for the following statements. If"not determined please explain. a The septic tank is met al and over 20•years old*or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank+failure is imminent.- System will pass inspection if the existing-, tank is replaced with 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 Complianceay- indicating that the tank is less than 20 years old is available. ND explain: 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): g=. broken pipe(s)are replaced obstruction is removed,. distribution box is leveled or replaced k ND explain: -„ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval:of the Board of Health)'-', broken pipe(s)are replaced obstruction is removed ND explain: Title 5 Inspection Form 6/15/2000 2 Page 3 of 11 OFFICIAL INSPECTION.FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION FORM + ` r PART A- CERTIFICATION(CONTINUED) Property Address: 45 BETH LANE HYANNIS,MA 02601' Owner: - CROWE,JOSEPH ". Date of lnspection:_.._ JANUARY 7,2004 f' C. Further Evaluation4s Required,by'the Board of Health: N/A ; Conditions exist which requirefurther evaluation by.the Board of Health m order to determine if the system is . failing to protect public.health,safety,or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR45.303(1)(b)that the system is not functioning in a manmer which,will protect public health safety and the environment: ' Cesspool or privy is within 50 feet'of a surf ace.water Cesspool or privy is within 50 feet of a bordering vegetated wetland or 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 tank8 nd 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 J of 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 Meet or more from'a private water.•supply well**. Method used to determine'distance t **This system passes if the well water-analysis,performed at a DEP certified laboratory,for coliform bacteria and'volatile"organic compounds indicates that the well is free from pollution from that facility x 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: y Title 5 Inspection Form 6/15/2000.. '° '' 3 �` Page 4 of l 1 Y OFFICIAL INSPECTION FORM„"N' OT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . ... PART'A - f M• CERTIFICATION(CONTINUED) Property Address: 45 BETH LANE . HYANNIS,MA•02601 Owner: : CROWE,-J.OSEPH Date of Inspection: JANUARY,7;-2004 D. System Failure Criterii applicable to all systems: N/A You must indicate"Yes"or"no"to each of the•following for all inspections: y., Yes No ✓ Backup of sewage into facility or system component due to overloaded'or.clogged SAS or cesspool ✓ Discharge or ponding`of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due'to an overloaded or clogged SAS or cesspool h ./ Liquid depth in pit 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). e Number of times pumped -' Any portion of the SAS,cesspool or privy is below high ground water elevation ' 'N/A Any portion of cesspool or privy is within 100,feet"of a surface water supply or tributary to a " surface water supply .Y N/A: Any`portion of a cesspool or"privy is within a Zone 17of a public welly, N/A Any portion of a cesspool cVprivy iswithin 50 feet of a private water'supply well N/A Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water ^- supply well with no acceptable water:quality analysis. (This system passes if the well water analysis performed at a DEP certified laboratory,for coliform bacteria and volatile organic, compounds indicates`that the well is free from pollution from that facility and the presence.of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm,provided that no other' failure-criteria are triggered.'A'copyof the analysis must be attached to this form.) a. - T NO (Yes/No)The system fails:I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: N/A To be considered a`large,system the system must service a facility with a design flow of 10,000 gpd to 15,000 gpd•. T You must indicate either"yes"or"no to each of the following: (The following criteha'apply to large systems in addition to the criteria above)s Yes No the system is within 400 feet of a surface drinking iwater 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 11-of a public water supplyweli. 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 is failed. The owner or operator of any large system-considered,a significant threat under Section E or failed under"SectiomD shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. . '$ Title 5 Inspection.Form 6/15/2000" 4 x ` is Page 5 of l l OFFICIAL INSPECTION FORM-NOYFOR VOLUNTARY ASSESSMENTS -SUBSURFACE'SEWAG.KDISPOSAL SYSTEM INSPECTION FORM PART B v CHECKLIST Property Address:, 45 BETH LANE HYANNIS;-MA 02601: Owner: ;. CROWE,JOSEPH Date of Inspection: ` JANUARY 7,2004•" <- Check if the following have been done. You must indicate"yes"or"no"as to each of the following e Yes No , w, ✓ Pumping information novas provided by.the owner,occupant,or Board of Health ✓ Were any the system components pumped out in the previous two weeks? ✓ Has the system received normal-flows in the previous two week period?, i ✓ Have large volumes of water been introduced to the system recently or as part of this inspection?, H ✓ . -*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 backup? ✓ p Was the site inspected for signs of break out? • ✓ Were all system components,excluding the SAS;' ocated'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 or - ✓ 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)has been determined based on Yes No ✓ Existing nfonnation. For example;a plan of the Board of Health. ✓* Detennined in the field(if any the failure criteria related to Part C is.at issue approximatiori of` distance is unacceptable)[310 CMR 15.302(3)(b)] . - IN Title 5,Inspection Form 6/I5/2000 >' S 4 u Page 6`of 11 , ,- OFFICIAL INSPECTION FORMS NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM "PART C SYSTEM INFORMATION Property Address: ,A4 BETH LANE a+r. HYANNIS,MA 02601 Owner: • CROWE,JOSEPH Date of Inspection: 7ANUARY 7,2004 FLOW CONDITIONS . RESIDENTIAL Number of Bedrooms`(design): '3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203'(f6r example:r110 gpd x#of bedrooms: 330_ , Number of current residents: N/A a Does residence have a garbage grinder(yes•or no): NO '. Is laundry on a separate sewage-system(yes or no): ,NO [if yes separate inspection required] Laundry system inspected(yes or no): YES" Seasonal use(yes or no): NO' Water meter readings,if available last 2 ears usa e d Sump'pump(yes or no) NO: . y Last date of occupancy: PRESENTS C OMMERC IALANDUS TRIAL Type of establishment: _ Design flow(based on 310 CMR 15 203):.. ` Basis of design flow(seats/persons/s ft;etc:):: s ` Grease trap present(yes or no),". Industrial waste holding tank present(yes or rio): ' Non'-sanitary waste discharged'to the.Title 5 system(yes or'.no ` r Water meter readings,if available: Last date of occupancy/rise: OTHER(describe) ` GENERAL INFORMATION Pumping Records i• Source of information:�' SEPTEMBER 2003 _e 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 ./ Septic tank,distribution box,soil absorption system Single cesspool a r Overflow cesspool ' Privy z.. Shared system(yes or no)(if yes,attach previous inspection records,if any) Innovative%Alternative=technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank Attach copy of the DER approval 'Other ,(describe): Approximate age of all components,date installed(if known)and source of information: - SYSTEM 1980 PERMIT 09-792.NEWDISTRIBUTION BOX PERMIT#2004-009 Were sewage odors detected when arriving at the site(yes or no): : NO t• _ Title 5 Inspection Form 6/15/2000 �«,, 6 ' OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C -SYSTEM INFORMATION(continued) Property Address: 45 BETH LANE HYANN IS,MA 0260 P r Owner: CROWE,JOSEPH Date of Inspection: JANUARY 7,2004 BUILDING SEWER(locate on site plan):. .'. ./ Depth below grade: 1' Materials of construction: Cast iron 40 PVC other(explain) Distance from private water supply well or suction line-.- Comments(on condition of joints,venting;evidence of leakage,etc.): SEPTIC TANK(locate onsite plan): ./ Depth below grade: 1' Material of construction: ✓ concrete metal fiberglass polyethylene other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1,500 GALLON PRE CAST.,, Sludge depth: 1" Distance from top of sludge to the bottom of outlet tee or baffle: 29" Scum thickness: 0" Distance from top of scum to top of outlet tee or baffle: 12" Distance from bottom of scum to bottom of outlet tee or baffle: 18 How were dimensions determined: ' ASBUILT AND TAPE Comments(on pumping recommendations,inlet-and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,'etc.): MAIN TANK AT WORKING LEVEL.TANK AND COVERS P BELOW GRADE.INLET TEE,OUTLET BAFFLE.NO SIGN OF OVERLOADING OR LEAKAGE.: p GREASE TRAP(located on site plan) N/A Depth below grade: Material of construction: concrete metal fiberglass polyethylene other (explain): — , — Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle. Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): • Y Title 5 Inspection Form 6/15/2000� 4 7 Page 8 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 45 BETH LANE HYANNIS,MA 02601 Owner: CROWE,JOSEPH Date of Inspection: JANUARY 7,2004 ` TIGHT or HOLDING TANK: N/A -(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: Alann in working order(yes or no): 'Date of last pumping Comments(condition of alarm and float switches,etc,): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 0 Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.,): DISTRIBUTION BOX IS 16"x16",2 1"BELOW GRADE WITH COVER AT 6".ONE LINE IN,ONE LINE OUT BOX IS NEW JANUARY 7,2004. PERMIT#2004-009 PUMP CHAMBER: N/A (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.): Title 5 Inspection Form 6/15/2000 8 Page 9 of 11 OFFICIAL INSPECTION FORM='NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIONFORM �. PART C SYSTEM INFORMATION(continued) Property Address: 45 BETH LANE a HYANNIS;MA-02601 Owner: CROWE,JOSEPH Date of Inspection: , JANUARY7,2004 SOIL ABSORPTION SYSTEM(SAS): ./ `�+(locate on site plan,excavation not required) If SAS not located explain why: 1. t _ .Type - - ,� -,. �x F ._ � .: - 9 ,- • ✓ leaching its number: 1 leaching chambers,number:. t ` leaching galleries,number Teaching trenches,number,length 'leaching fields,number,dimensions: overflow cesspool,number:„ innovative/alternative system Type/naive of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.). :. " LEACHING IS ONE 1,000 GALLON PRE CAST PIT.COVER ANT PIT 30"BELOW,GRADE.20"WATER IN PIT.NO HIGH,STAIN LINE.,NO SIGN OF OVERLOADING OR SOLID.CARRYOVER. T CESSPOOLS: N/A.. (cesspool must Be pumped as part of inspection)(locate on site plan) Number and configuration: Depth.-.top of liquid to inlet invert: I Depth of solids layer: " .•a Depth of scum layer: ; Dimensions of cesspool: ` Materials of construction: Indication of groundwater inflow(yes or no):. Cominents'(note condition of soil;signs of hydraulic failure,-level of ponding,condition of vegetation etc.): PRIVY: N/A (locate on site plan) Materials of Construction: Dimensions: Depth of solids; Comments(-note condition of soil,signs of hydraulic failure,'levelof ponding,condition of vegetation,etc.) �p e,j . 21 �, Title 5 Inspection Form 6/15/2000s � Page 9 of i l H OFFICIAL INSPECTION FORM'NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE'SEWAGE DISPOSAL SYSTEM INSPECTION FORM , PART,C SYSTEM INFORMATION(continued)` Properq,..Address: .45 BETH CANE f HYANNIS;`MA,02601"- !, Owner:. CROWE,JOSEPH Date of Inspection: JANUARY 7,2004 SKETCH OF SEWAGE DISPOSAL-SYSTEM Provide a sketch of the sewage disposal,system incl"uding ties to at least two pennanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. 4. • r I, e t e " P 'q f Title 5 Inspection Form• /15/2000 10 Page l l o_f I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 45 BETH LANE . HYANNIS,MA 02601 Owner: CROWE,JOSEPH Date of Inspection: JANUARY 7,2004 SITE EXAM. Slope Surface water Check cellar Shallow wells Estimated depth to no groundwater 12 feet' Please indicate(check)all methods used to detennine the high ground water elevation: `Obtained from system design plans on record-if checked,date of design plan reviewed: ./ Observation site(abutting property/observation hole within 150 feet of SAS) -Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation Accessed USGS database-explain: You must describe how you established the high ground water elevation: r HAND DUG TEST HOLE 12' NO WATER. TEST HOLE 3'6"BELOW BOTTOM OF PIT. • • . - 4.777 v zt Title 5 Inspection Form 6/15/2000 11 f/ �3 Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of Environmental Protection ocr 6 1s Wham F.WNdArpm ,� �Tndy Coxe . Goremor j`t Paul CNluccl OaridCBR!' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 45 Beth Lane, Hyannis AddressofOwner. Ed Flynn Date of Inspection: 9—2 5-9 6 (If different) Name of Inspector. W.E. Robinson SR Company Name,Address and Telephone Number. ( 5 0 8 )7 7 5-8 7 7 6 W.E. Robinson Septic Service P.O. Box 1089 Centerville MA CERTMCATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site se disposal systems. The system: 1� Passes _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signature: !� , Date: 9 `S' / The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent.to the buyer,if applicable and the approving authority. INSPECTION SUMMARY: Check A,B,C,or D: A] f37!81'E�[PASSES: //I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 16.303: Any failure criteria not evaluated are indicated below. TCONDITIONALLY PASSES: or mot•system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes ection-o,or not determined(Y, N,or ND). Describe basis of determination in all instances. If"not determined",explain wily not) The septic tank is metal, cracked,structurally unsound, shows substantial infiltration or ezfiltration,.or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a ponforming septic tank as approved by the Board of Health. (revised 11103/95) 1 One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292•SM, i Printed on Recycled Paper - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(oontinued) PmpedyAddrese 45 Beth Lane, Hyannis Oar. Ed Flynn Dats of In`PwU n: 9—2 5—9 6 B]SYSTEM CONDITIONALLY PASSES(continued) _ Sewage backup or breakout or high static water level observed in the distribution boa is due to broken or obxbvcted pipe(s) or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed distribution boa 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 C] THER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require Anther evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. I SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT. Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank'and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. _ The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and in within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is Gee from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. 3) 1 03 95(revised 1 / / ) S li SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(oontinued) Property Address: 45 Beth Lane, Hyannis Owner. Ed Flynn Date of Inspection: 9—2 5—9 6 DI FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 ChM 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to am. the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. _ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of tunes pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for ooliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. El LAR SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public and safety and the environment because one or more of the following conditions exist: the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supple' _ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a mapped Zone 11 of a public water supply well) The or operator of any such system shall bring the system and facility into Arll compliance with the groundwater treatment program b of 314 CM t 5.00 and 6.00. Please consult the local regional office of the Department for Anther information.. (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Pmpariy 45 Beth Lane, Hyannis Owner. Ed Flynn . Date of Iarpeadon: 9—2 5—9 6 Chs&if the following have been done: 4/m, ping.information was requested of the owner,occupant,and Board of Health. None of the system components have been pumped for at'least two weeks and the system has been receiving normal flow rates hat period. Large volumes of water have not been introduced into the system recently or as part of this inspection. 2AZ 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. L'The system does not receive non-sanitary or industrial waste flow L/ne site was inspected for signs of breakout. system components,excluding the Soil Absorption System, have been located on the site. t'he septic tank manholes were uncovered, opened,and the interior of the septic tank was inspected for`condition of baffles or tea,material of construction, dimensions,depth of liquid,depth of sludge,depth of scum. a/The rise and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM.INFORMATION Property Address: 45 Beth Lane, .Hyannis Owner. Ed Flynn Date of Inspection: 9—2 5-9 6 FLOW CONDITIONS RESIDENTIAL - Design flow•3 3�llon3 Number of bedrooms: Number of current residents:® _ Garbage grinder(yes or no):-. 0 Laundry ommocted to system(yes or no): _ Seasonal use(yes or no):jQ Water meter readings,if available: 9 4 9 5 1700 cubic f - 95—.96 1100 cLbis ft-_ Last date of occupancy:~ ' CCObIMERCIAL/INDUSTRIAL Type of establishment: Design flow: NdlonWdaY Grease trap present:(yes or no)_ Industrial Waste Holding Tank present: (yes or.no) Non-sanitary waste discharged to the Title 5 system: (yea or no)_ . Water meter readings,if available: Last date of occupancy: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDSDS a:pt d source of�lormation: / System pumped an part of inspection: (yes or no)_ s. If yes,volume pumped: gallons Reason for pumping TYPE OF STEM Septicnk/distnbution bos/soil absorption system. Single cesspool Overflow cesspool Privy: Shared system(yes or no) (if yes,attach previous inspection records,if any) Other(explain) APPROXIMATE AGE of all components,date installed(if known)and source of information: � Sewage odors detected when arriving at the site: (yee or no) (revised 11/03/95) tt SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) PropertyAddeess: 45 Beth Lane, Hyannis Owner. Ed Flynn . Date of Inspection: 9-2 5 9 6 SEPTIC TANK ✓ (locate on site plan) Depth below grade:10 Material of construction:!concrete_metal_FRP_other(e:plain) L )6 Dimensions: Sludge depth: 0 t Distance from top of sludge to bottom of outlet tee or baffle:_'?_2: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Isr_ Distance f)-om bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) C&e.� (i TRAP:_ (kkate on plan) Depth below Material of _concrete_metal_FRP—other(explain) Dimensions: Scum Distance top of scum to top of outlet tee or baffle: Distance bottom of scum to bottom of outlet tee or baffle: Comments: (reoommen on for pumping,condition of inlet and outlet tees or banes,depth of liquid level is relation to outlet invert,structural integrity; evidence of ,etc.) (revised 11/03/95) 6 • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address~ 45 Beth Lane, Hyannis Owner. Ed Flynn Date of Inspeo"m 9—2 5—9 6 TI OR HOLDING TANK_, (locate site plan) Depth be tom: Material construction:_concrete_metal_M_other(explain) Ca sallons Design sallone/day Alarm 1: Commen (oonditio of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX - (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) PUMP ER:_ (locate on plan) Pumps in order:(yes or no) . Comments- (note(note on of pump chamber,condition of pumps and appurtenances,etc.) (revised 11/03/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Addrew 45 Beth Lane, Hyannis Owner. Ed Flynn Date of Inspection: 9—2 5—9 6 SOIL ABSORPTION SYSTEM(SAS)-•✓ (bate an site plan,if pomble;eaavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: Type: leaching pits,number:L leaching chambers,number:_ leaching galleries,number: leaching trenches, number,length: leaching fields,number,dimensions: overflow cesspool,number: ( 1 / Comments: (note coo tion of soil,signs of hydraulic failure, level of ponding condition f ve tion,etc.) d U O S 2dA IF CESS)an _ (basteplan) Numbnfiguration: Depthquid to inlet invert• Depthlayer:Depthlayer: Dimencesspool: Maternstruction: Indicagroundwater: (cesspool must be pumped as part of inspection) Comments:( condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) PRIVY: (locate on site Ian) Materials of o0 n• Dimensions- Depth of solids• Comments: ( condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) (revised 11/03/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 45 Beth Lane, Hyannis Owner: Ed Flynn. Date of Inspection: 9—2 5—9 6 SKWVCH OF SEWAGE DISPOSAL SYSTEM: , include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' i �'g C l i DEPTH TD GROUNDWATER Depth to groundwater. d 2_-4 feet method of determination or approximation: 6 G'V (revised 11/03/95) 9 r Health Complaints 23-May-96 Time: 1:44:25 PM Date: 5/23/96 Complaint Number: 195 Referred To: CHRISTINA KUCHINSKI Taken By: CHERYL PAOLINI DUTRA Complaint Type: NUISANCE CONTROL REG. 1 RUBBISH Article X Detail: Business Name: Number: 45 Street: Beth Lane Village: HYANNIS Assessors Map-Parcel: C , Complaint Description: Rubbish is piled up inside&outside of an abandoned house at the above address. Actions Taken/Results: �e �1 p���-- 1/�l�ti / lJ — Investigation Date: Investigation Time: S VZ i r 1 ] PAR ] Real Estate System - General Property Inquiry] Help [ ] Parcel Id: 272 174- - Account No: 183018 Parent : `"`Location: 45 BETH LN Neighborhood: 50AC Fire Dist : HY Devel Lot : 47 Lot Size : . 35 Acres Current Own: BROCK, JOANNE R State Class : 101 45 BETH LANE No. Bldgs : 1 Area: 960 Year Added: HYANNIS MA 2601 Deed Date : Reference : 3397/325 January 1st : BROCK, JOANNE R Deed MMDD: 0000 Deed Ref : 3397/325 Comments : Values : Land: 27200 Buildings : 48100 Extra Features : Road System: 45 Index: 119 (BETH LANE ) Frntg: 125 Index: ( ) Frntg: Control Info: Last Auto Upd: 050695 Status : C Last TACS Update : Land Reviewed By: Date : 0000 Bldgs Reviewed By: ML Date : 0691 Tax Title : Account : 5813 Taken: 082495 Account Status : Hold Status : Cancel [ ] Press XMT for more data Next screen [PAR ] Action [ ] Owners Name [ ] Road Index [ ] Road Name [ ] Parcel Number [272] [175] [ ] [ .] [ ] 4 TOWN OF BARNSTABLE BAR-W 1 221 Ordinance or Regulation WARNING`NOTICE Name of Offender/Manager.. aft Address of .Offender 7 �� rTl(�fyr MV/MB Reg.# Village/State/Zip V1 L4 Business . Name pm; on 19 PIC Business Address Signature of Enforcing Officer *,J Village/State/Zip Location of Offense ,_ n Enforcing Dept/Division I Of f en s e Facts V Imo'hk.t-w At)4W G6 t 4. 7-� A 10 Ut-s- This will serve only ast a warning. At this, time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance. of Town .Ordinances, Rules and Regulations: Education efforts and warning notices are attempts to gain. voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. 46 - t7. ^� '.F`1.. ,.,..� z :};'•- r i•n4 -r n k.., F. a'r'.. r, .i'. :.",..N rM.:.. ,j.. 1�l}{ TOWN OF BARNSTABLE B*v 1221 Ordinance,`or Regulation :< WARNI.NG NOTICE: ` Name of .Offender/ManagerGa�p '�'"" '`` dob "'Address Offender .2 �� _ "f'?� MV%MB Reg # Village/State/Zip V f 6.36.«. a SS# Business ! �'f pm, on19 Business Address Signature of Enforcing Officer= J Village/State/Zip Location .of Offense . { _ - 4ca. ,'.t'° !'A Enforcing Dept/Division Offense Aktaidi LYr Facts Q40Q v • 46Jrlf Y t,� ? urAr: This will serve only as la warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town .Ordinances, Rules and Regulations,- Education:;efforts and warning notices. are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town TOWN OF BARNSTABLE k BAR-W . F Ordinance or Regulation WARNING NOTICE Name of Offender/Manager Address of Offender roll ,. MV/MB Reg.# Village/State/Zip .,#i4t of 4 L )9,J. 5 Business Name pm; on to 219 7f'� Business Address ��'` ,t. ; Signature of Enforcing Officer` Village/State/Zip Location of Offense . . .� a t r,,I l a) Enforcing Dept/Division Offense , tttlr,41rf Facts + + f t' r1f Flo r� ) a kiuLe4 64 jek- d This will serve only as fa warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. Health Complaints 26-Jun-96 Time: 1:44:25 PM Date: 5/23/96 Complaint Number: 195 Referred To: CHRISTINA KUCHINSKI Taken By: CHERYL PAOLINI DUTRA Complaint Type: NUISANCE CONTROL REG. 1 RUBBISH Article X Detail: Business Name:, Number: 45 Street: Beth Lane Village: HYANNIS Assessors Map-Parcel: Complaint Description: Rubbish is piled up inside&outside of an abandoned house at the above address. Actions Taken/Results: CK observed abandoned house with trash, furniture and other household debris in back and side yard.Assessor information shows owner living at that address, but obviously no ? one is living there. Investigation Date, 5/24/96 Investigation Time: 3:00:00 PM 3 0 ?9,2 l_OCAT10.Rf,,, SEWAGE PERMIT 00. 4 VILLAGE I NjbXm%Al L44ACKAW/ICE� ADDRESS 150 41'-?Inut Street est Barnstable, Mass. 02668 BUILDER OR OWNER DATE PERMIT ISSUED* 79 DATE C 0 M P L I A N C E ISSUED l " .., � S.. +. i � / � i � i � �` � %/ � i� �/ �'.'' `\ \� .� ��• �� •-� ,� � , � .� r ti ° ,� -t Ott No. ----..--49,.A•- FmB.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD' OF HEALTH .............OF............ /..!.r!1�.. L.-- --------•---- Appliratinn for Bt_q#nsal Workii Tomarnrti orn ramit Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal System at: --. `5 ZFZTyr 2�ti�.. .......................... b Loca'on-A re or Lo No �.f ---- ------------------- ----- Ow r Address W .1 f �/...--- fJL7 1�------------------------- a ��,�/ __..�7-L: _ �I Td.�1 I/11 Installer Address d Type of Building Size Lot............................Sq. feet aDwelling—No. of Bedrooms........._............................Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures .--------- =---------------Q W Design Flow.............. ......_._____.____ ._gallons per person ner day. Total daily flow............... 3 C'-.5.._.._____._ga1lo�Is. WSeptic Tank—Liquid capacaty.l® gallons Length___ ___________ Width....19�' ____ Diameter_______________ Depth... ......... x Disposal Trench—N Widt Widt -/. .,:r..._.... Total Length........ ......... Total leaching area.___._. __, sq. ft. Seepage Pit No._..__!-..__ I- Diameter__ _.•__ Depth below inlet..... Total leaching area.;.? q. ft. Other Distribution box ( ) Dosing tank ( � / Percolation Test Results Performed by.__._.___ - ✓!'...S,p ........... Date---- :/__ f.-_.__. Test Pit No. 1.4/ _.____minutes per inch Depth of Test Pit_ _ .._. Depth to ground water__ _ (s, Test Pit No. 2_! ....minutes per inch Depth of Test Pit...Q ------- Depth to ground water---------------P­____ O Description of Soil----- - .__ - . xGv - c., x ----------------------------------------------------------------------------------------------------------- ----------- ............................................................................... 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 rovisions Of�i p 5 Of the State Sanitary Code—The undersigned further agrees not to place the system in - operation until a Certificate of Compliance has beeg issued by the boar health Signed----- - ----�---- ---�-------- ---........ ------------------ .................. -- Date (42 Application Approved By � �- �--- --•-- s Date Application Disapproved for the following reasons--------------------- ------------------------------------------------------------......•---••......--•-•- a -....................--.................................................................................................. ...................---------------------------------------------- Dale Permit No. Issued.. . •------.... Da ..._.. Date No.._........T 'L:. FEs," .. . THE COMMONWEALTH OF MASSACHUSETTS t * , BOARD ;:Of HEALTH firation for Elhgposa1 Works Tomotrurtiuii Frrmft Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal Systemat._ !`f °,1y / it ; O ....- --. •••- •••-------------•• ..................................................... f. 4`: a ............ .....• 6 tv.•...OS--•*--r i...ft!:..:.... ..!""lr140 .........l.l.. +6,+Gww Installer Address / /1 law Type of Building Size Lot.... ......... Sq. feet Dwelling—No. of Bedrooms:__:. . ..:.....................Expansion Attic ( ) Garbage Grinder ( ) a Other—Type of Building _.- :- _•_-_--____ p 1 ( ) — Cafeteria ( ) ___. No. of ersons____________________________ Showers d Other fixtur s ..•--• wDesign Flow............. ..._. gallons per person day Total da• flow....... ......" ................ s. WSeptic Tank—Liquid capacity gallons Length---- Width.... Diameter________________ Depth......_ ____--.. x Disposal Trench N ..................... Widt �Jj ,s ._._.. Total Length___...__,.r� 7; Total leaching area____ sq. ft. Seepage Pit No.__... .. ___ Diameter.. _! _..._. Depth below inlet.__..ir+✓'___:.___. Total leaching area_ .sq. ft. Z Other Distribution box ( 1 Dosing to ,/ '-' 711 Percolation Test Results Performed by. __-_ _._. Date.. "f " a .___minutes per inch Depth of Test Pit ,r p ground # Test Pit No. 1___._�". P p I�,t Depth to ound water � .._ 44 Test Pit No. 2_11_- ......minutes per inch Depth of Test Pit__.! Depth to ground water....................... x r � .. D Description of - � _ .+`__ x -• ' w _'P U Nature of Repairs or Alterations—Answer when applicable---------------------------------------.:....................................................... -----------••-----------•----•----•--------------•--•...•------•-----•-------••------ .................................... Agreement: The undersigned agrees to install the afor edescribed Individual Sewage Disposal System in accordance with the provisions of T ?.�. p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in _ P Y h- • operation until a Certificate of Compliance has bee issued b the b ai health. ^ Sig ed •••--- . • ---- to T APPlication Approved By-•--- .� -•-_ ... ' Date Application Disapproved for the following reasons: ----•----- --------------------•-•-.._...-------••-•----------------------------•-•---------•-•-•-------•-----------•----•----•-•••---•---•----••--•-••••-•--••---••-----------••---------••-•••------------••-_._ Date Permit No................. =77­ Issued---•----------•----- - Date t. THEE COMMONWEALTH OF MASSACHUSETTS` �] µ BOARD OF HEALTH .............. ............... OF......-.l ?! ................................ (9rdifiratr of 'W"ampliaurr THIS IS T�6#T. I Y Tat he I a vidual Sexage Disposal System constructed or Repaired y ..:................. .b ( ) _•---• -----------------------------------.....----------------........._..---------......--••-..... .......:_ has been installed in accordance with the provisions of T j r of The State Sanitary Code as described in the application for Disposal Works Construction Permit No... ...�144"............. dated---. ,. ""___- �: THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTI ATISFACTORY. .��- ---DATE .. ..... ................... .. etor..... .. ------------ THE COMMONWEALTH OF MASSACHUSETTS Y BOARD OF HEALTH , lGi. O ..:.. .... F..... I / No............7fZ ........__ 9: FEE .......--•-•••...•-•-- Ar Permission hereby granted_____________. _ __...._ _. . - ••. .... to Constru t or Re air ndiv dual age DIs s '/ Street as shown on the application for Disposal Works Construction Pe No. ___ Dated_.... '��� � �> ..----- -----• ... _ _. DATE..............C _ / Board of Heal t FORM 1255 HOBBS & WARREN, INC., PUBLISHERS- . .. . F ' r°° ' TYPICAL SYSTEM PROFILE FDN TOP FINISH GRADE= .OD AREA PLAN D NOT To SCALE SCALE : I ( FINISH- GRADE OVER ,TANK= 3.UC7 ' FINISH GRADE OVER PI'T= `, ,0( LOT .-# B -� 4 WS NE -/r 1 PVC OR r O O ° • • r o a o a Q.6 7 0 C. 1.-TEES ,`{yam//) �� .- .5•Q � F. I BSMT , C�JO 00 1 � � GAL. .. <.4i r ° • j DI ST. BOX � REINFORCEDo � • •,. • • ' • e • o 0 ° ° ° ° ° • at a • o o CONCRETE . F TO BE INSTALLED ON .: A LEVEL STABLE BASE C, ^ ° e o • •'' • • o o ° o e n SEPTIC.: TANK C .. .,, TO BE INSTALLED ON A • • ° • • , • e • r :_ — • � .,, ., � ' LEVEL_ STABLE BASE ° o • • •; � o ° 2 I/8 , 1/2 WASHED PEASTONE ALL a • e • • 1 0 0 0 T 3.9' BRICK a ,MORTAR COURSES AS ® •' • e S . AROUND FREE OF IRONS, FINES ,...z • - REQUIRED TO BRING COVER TO GRADE ,• AND DUST IN PLACE LEACHING ' PIT . T , 1-1 2 "WASHED CRUSHED 24 C.I. MANHOLE COVER' 81 3/4 0 / S 2S D A T V I STONE ALL AROUND FREE OF BASE 0 BE _ LEVEL FRAME SEE DETAIL IRONS FINES AND DUST, IN , _. 4 �.,.,r� PLACE C , F , °- FOR IN. RARE lavo GAL ;, { �,� � m. SE SYSTEM PROFILE Pk: -:. E � Tl� - . , ..� � _ . , SOIL AND PERCOLATION .• : ., , -� 4 o� �qw` � � �x,, W. � , , : � DATA sr — _ D!5T, /-- Ft OCR Q } x t9s 1/ � . � �"� _ . �.,-�.� - MIN. IN. s •. �.,,_ .. PERC. . RATE. _ �: 2.. / r - G FOR 1NV. ELEV SEE �. ,_ 4 v o o C. D: SPOHR P!T ;. , TAKEN :BY . .- - - :.L ---- .• . - I T - a SYSTEM PROFILE t, .. NLE , .-,...x,.. ....a Y., :......s- .. , 4 LINE ,ate E , . _ r :- WITNESSED BY..gAtz,ys7-' ,. � ,..•: . ,. . . - . �.:; f : _ _ o -,OPENINGS W 4 18 r ,. OUTER DIA. a I, 3/4 , DATE D - 0 / O 4� � r 7 INSIDE DIA. TEST PIT ELEV. , TOTAL o ja AREA Lr D o _ /VQL1, T` L.4*fit-, c 02 66 2 7 D D 0 ©e w,q Tom• `` . D 0 0 p 0 D Q ., ; >m D D D p D 0 — � .4 2 6 ` 6 D I A. ,t; ,� ,�r'Q BOT: PERC. HOLE Z 0 1 /C) EFFECTIVE DIA. DOWN „_r CEPT-lr.. rf/,47. r AzC PP+�Pu�_Fr)`, sue LEACHING PIT - SECTION r W d �� o T� � No SCALE DESIGN DATA : , , r ': NOTE: DO NOT RUN HEAVY EQUIPMENT OVER SYSTEM ,5'i',� h ,a•T"9�' F_CF4:57k" 0 NOD� DISPOSAL AS I ,27/ , 4!9- LEACHING PIT NOTES EST. TOTAL DAILY EFFLUENT GALS. I . CONC. TO BE 4000 P.S.1 a 28 DAYS :, - SEPTIC TANK ✓000 GAL. j 2. REINF W 6 If X 6„ �6 GA. W. W. M. 1 a 3. 2 SAND 4 SECTIONS ARE AVAILABLE FOR GREATER DEPTH REQUIREMENTS GENERAL NOTES I . ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN NOTE : •��• ACCORDANCE WITH TITLE OF THE STATE SANITARY CODE EXCAVATE TO ELEV.'`�_,00- OR LOWER AS { DATED .DULY 11977 8► ANY LOCAL RULES. APPLICABLE. , REQUIRED TO REMOVE ALL LOAM AND .CLAY CONTAINING -2. ANY CHANGETO THIS -PLAN MUST BE APRR D. IN ' OWNER� � (� , C [� i �j + MATERIAL BENEATH PIT. REPLACE EXCAVATED MATERIAL WRITING BY MR. CHARLES D. SPOHR. S �r CCU I LDER WITH CLEAN CLAY FREE GRAVEL MECHANICALLY ' ' 3.,WHEN CONSTRUCTION IS COMPLETED, PRIOR TO BACKFILLING, COMPACTED IN PLACE. ` NOTIFY`THE ENG I NEER AND BOARD OF HEALTH FOR INSPECTION. CLAkK rL YAIAl 0//-0 "P,..� SIDE AREA = / 9 S. F.@ S.F./GAL �' `� GALS T- r 4: FOUNDA I ION ELEV..MUST BE CHECKED WHEN COMPLETED. _81Q C �R•/ FAkA 4' RC),,? BOTTOM AREA=- / S.F. '�''S. F./GAL 8� GALS -� 5.`THESE ELEVS. MUST NOT BE CHANGED WITHOUT WRITTEN A"17 L"00 T j "� Q S, TOTAL AREA S. F. TOTAL , GALS APPROVAL BY-CHARLES D. SPOHR. , LEGEND -6. FOUNDATION INSPECTION REQD. WHEN EXCAVATED. p p �{ NOTE : + 50.0 EXIST. GROUND ELEV. U. 1V1. ill f 50.0' FINISH GROUND ELEV.2tUNDERLiNEDtt t REV. DATE DESCRIPTION �ZI- LE ,�, ; ' OAY pAy� 47 50 PIPE INVERT. ELEV. I-or � O 'TEST PIT LOCATION SEWAGE DISPOSAL SYSTEM FOR 0 o SEPTIC TANK AREA PLAN CL.ARK FL.YNN BUILDERS E 0 DISTRIBUTION BOX �_._r . NOTE: Z_0T u r~,� rc{,� LOT 4 7 B E T N S LANE 5 r® .. 4 `� C. I . PIPE T UC7', �9 8 y �'19F��' � O�L. 1�/..��' .',� ��,:��� �P'` �'.�j . E -tttt-t+tti- 4ttBiT. FIBER PIPE `TIGHT JOINTS �' i ShC7 i' � C P I T C H ERS WAYS, HYA N N P S 10 © '•``c No. 7Gt'8 ` �, DESIGNED: C.D.SPOHR DATE b r ' DRAWI N G NO. -- --- PROPERTY LINE 3O C 7� Ay - isrE ti Z Z / � . pfifss�onA� DRAWN, �.�, ' SCALE:ASSHOWN< MAP SEC P CL LOT HOUSE \Al 7—a ;+ `� MlN. ,CODE DISTANCE �- I C� � #� ats. CHECKED: C. D. S . SYSTEM PROFILE NOTES a� 01 TOP FNDN. AT L. COVERS TO WITHIN 6" OF 1. DATUM IS APPROXIMATE NGVD ACCESS FIN. GRADE L� TO �� ACCESS COVER (WATERTIGHT) TO PROVIDE INSPECTION PORT TO WITHIN 3" OF FlNAL GRADE WITHIN 6" OF FIN. GRADE 2. MUNICIPAL WATER IS EXISTING 66.8' MINIMUM .75' OF COVER OVER PRECAST 2X SLOPE REQUIRED. OVER SYSTEM 3. MINIMUM PIE PITCH TO BE t/8" PER FOOT. I61 4 *EXISTING FOR 66.0 FIRST 2LEYEL _t N 2' DOUBLE WASHED PEASTONE 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO o ti **EXISTING 1000 * /// OR GEOTEXTI FABRIC H- 1 0 I EXISTING GA11.ON SEPTIC; TANK 6GAs�6 , 63.5 �° wn 63.18' 63.0171 5. PIPE JOINTS TO BE MADE WATERTIGHT. \� LOCUS o� c 63.0' 2.8' AT SIDES tir 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH 3 Q 6" CRUSHED STONE OR MECHANICAL 2- 0.8' AT ENDs MASS. ENVIRONMENTAL CODE TITLE V. DEPTH OF FLOW = 4 COMPACTION. (15.221 [21) o 61.0' TEE SIZES: 7. THIS PLAN IS FOR PROPOSED- WORK ONLY AND NOT TO- Route 28 o s INLET DEPTH - 10' BE USED FOR LOT LINE STAKING OR ANY OTHER PURPOSE. a OUTLET DEPTH = 14" - 3/4" TO 1 1/2" DOUBLE WASHED STONE r (7.3 X SLOPE) ( t X SLOPE) 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. ° FOUNDATION EXISTING SEPTIC TANK 11 D' BOX 2' LEACHING 7' 9. COMPONENTS NOT TG BE BACKFILLED OR CONCEALED FACILITY WITHOUT PECTION BY BOARD OF HEALTH AND ERMISSIONSOBTAINED FROM BOARD *OF HEALTH. LOCUS MAP 10. CONTRACTOR SHALL BE .RESPONSIBLE FOR CALLING SCALE: 1" = 2,000't *THE INSTALLER SHALL VERIFY THE , DIGSAF€ (1-888-344-7233) AND VERIFYNO THE LOCATION- ASSESSORS MAP 272 PARCEL 174 LOCATIONS OF ALL UTILITIES AND ALL **THE INSTALLER SHALL CONFIRM MIN. BOTTOM TH-1 EL. 54.0 OF ALL UNDERGROUND & OVERHEAD UTILITIES PRIOR TO BUILDING SEWER OUTLETS AND ELEVATIONS SEPTIC TANK SIZE AT 1000 GALLONS AND COMMENCEMENT OF WORK: LOCUS IS WITHIN GP OVERLAY DISTRICT PRIOR TO INSTALLING ANY PORTION OF ITS SUITABILITY FOR RE-USE SEPTIC SYSTEM ALL SYSTEM COMPONENTS SHALL BE 11. EXISTING LEACHING FACILITY SHALL BE PUMPED AND . MARKED-WITH MAGNETIC TAPE OR REMOVED OR PUMPED AND FILLED WITH CLEAN SAND- COMPARABLE MEANS FOR FUTURE LOCATION. 12. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE REMOVED 5' BENEATH AND AROUND THE PROPOSED LEACHING FACILITY. LEGEND 100.0 PROPOSED SPOT ELEVATION BENCH MARK - TOP OF , SYSTEM DESIGN: CONC. BOUND EL. = 65.8 +100.00 EXISTING SPOT ELEVATION 120.00, GARBAGE DISPOSER IS NOT ALLOWED . ss 1 PROPOSED CONTOUR DESIGN FLOW. 3 BEDROOMS ® 110 GPD = 330 GPD 100 EXISTING CONTOUR GRAVEL USE A 330 GPD DESIGN FLOW PARKING SEPTIC TANK: - 330 GPD (2) = 660 c j ° TEST HOLE LOGS - � **RE-USE EXISTING 1000 GAL. SEPTIC TANK r LEACHING: rn ENGINEER: DAVID FLAHERTY, R.S., SE2755 2 LP p O \o SIDES: 2 (30 + 10)- 2 (.74) = 118 GPD B EXISTING 3 DON DESMARAIS, R.S. o �, BR DWELLIN WITNESS: 0 BOTTOM 30 x 10 (.74) = 222 GPD DATE: MARCH 17, 2008 N TH-1 FNDN 1 TOP OEL. TOTAL: 460 S.F. 340 GPD PERC. RATE _ < 2 MIN/INCH ? T ` 2 67.9' / USE (4) STANDARD "3050" INFILTRATORS POSSIBLE 5' REMOVAL OF r 2Q.0' / WITH 0.8' STONE AT ENDS AND 2.8' AT SIDES I 12133 UNSUITABLE SOIL ON THIS SIDE CLASS SOILS P# OF LEACHING AREA, DOWN TO SUITABLE SOIL LAYER. REPLACE O / V WITH CLEAN MED. SAND. DECK w C ELEV. ELEV. (SEE TEST HOLE LOGS.) \w N " 4 0 0.s6 ' -0- 4 66.0' SHED w o � V MA \ APPROVED DATE BOARD OF HEALTH FILL PAVED DRIVE 18" 66 6`� �� A/B A GRAVEL PARKING TITLE 5 SITE PLAN (MIXED) LS OF 24" 10YR 3/2 `O 7 45 . BETH LANE 50" 61.8' B / (HYANNIS) BARNSTABLE, MA LS LOT 47 1OYR 5/6 15,000t SF / PREPARED FOR 34" 63.2' 0.3± AC. ER Pc C �X�X� 12p'00' BORTLOTTI CONSTJ X-X--X `° MS C X � TODAY . REAL ESTATE DATE: MARCH 20, 2008 2.5Y 7/4 MS NOFMgssgc �(\AOFM,q off 508-362-4541 DAN I F L yGs �k3 Ssgc fax 508 362-9880 A. ' tiG 2.5Y 7/4 OJALA � DOJALA a 144" 54.0' 132" 55.0' q No.40980 CIVIL Cn down cope en gin eerin g, inc. ' ty FFs 5\ P a 1 No.4650 Cl WL ENGINEERS Scale:1 = 20 3/ ap UR\J fs R a`` NO GROUNDWATER ENCOUNTERED Zp Fs LAND SURVEYORS mm- 939 Main Street - YARMOUTHPORT, MASS. 0 10 20 30 40 50 FEET DATE DANIEL A. OJALA, P.E., P.L.S. DCE #08-041 08-041 BORTOLOTTI_TODAY.DWG (DDF)