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HomeMy WebLinkAbout0015 BIRCH DRIVE - Health 15 BIRCH ST. HYANNIS A=245 134 o a I TOWN OF BARNSTABLE LOCATION SEWAGE # 3 ' VILLAGE ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO. Z�5 L ig121GU �7�7S-D?,7W SEPTIC TANK CAPACITY /� 6'9lfOnJ J�ri/iC ��T�h /fiYX� 6,0�41, LEACHING FACILITY: (type) �e�tc �o�e�e (size) /01 X CAD NO.OF BEDROOMS 'S-'eye k.�o�S BUILDER OR OWNER PERMITDATE: /�� COMPLIANCE DATE: 7 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet ' Edge of Wetland and Leaching Facility.(If;any wetlands exist within 300 feet of leaching facility) Feet Furnished by V ` a D ^� 4 � Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments rri 15 Birch Street Assessor's Map: 245 Parcel: 134 Property Address to Birch Street Realty Trust- Raymond L. Quinlan, Tr Owner Owner's Name �7 information is H annis >/ MA 02672 February 8, 2017 required for every y ry page. City/Town State Zip Code Date of Inspection M 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 A. General Information filling out forms S'I�j- J a13 ' on the computer, use only the tab 1. Inspector: key to move your - cursor-do not David D. Coughanowr use the return Name of Inspector key. Eco-Tech Rapid Response r� Company Name 155 George Ryder Road South Company Address Chatham MA 02633-1621 Cityrrown State Zip Code 508 364-0894 1328 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 OF MgSS El Conditionally Passes ElFails ?����N �C [Ell Needs F viR Mon a Local Approving Authority COU AN WR 0.13 8 scI February 8, 2017 Inspector's Signatu TI�M INSPe Date The system inspector submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system 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.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 k OMW P 1 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 15 Birch Street Assessor's Map: 245 Parcel: 134 Property Address Birch Street Realty Trust- Raymond L. Quinlan, Tr Owner Owner's Name information is Hyannis MA 02672 February 8 2017 required for every y ry page. Citylrown 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: Inspector's Notes==> The septic system described herein is deemed to pass this Real Estate Transfer Inspection if it does not meet any of the failure criteria enumerated in Section D on pages 4- 5, or specified by local regulations. The scope of this inspection is limited to health and environmental compliance and the septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. Removal of garbage grinder is recommended. 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"rot determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. Y, C *A metal septic tank will pass inspection if it is structu'rally'sound, riot leaking and if a Certificate of Compliance indicating that the tank is less than years old-is available. 6 ❑ Y ❑ N ❑ ND (Explain below):` t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 15 Birch Street Assessor's Map: 245 Parcel: 134 Property Address Birch Street Realty Trust- Raymond L. Quinlan Tr Owner Owner's Name information is required for every Hyannis MA 02672 February 8, 2017 page. Cityrrown 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 break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health:, ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh l5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 I Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Birch Street Assessor's Map: 245 Parcel: 134 Property Address Birch Street Realty Trust- Raymond L. Quinlan, Tr Owner Owner's Name information is Hyannis MA 02672 February 8 2017 required for every y ry page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal ti 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 '/2 day flow t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 15 Birch Street Assessor's Map: 245 Parcel: 134 Property Address Birch Street Realty Trust- Raymond L. Quinlan, Tr Owner Owner's Name information is Hyannis MA 02672 February 8, 2017 required for every y rY page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 15 Birch Street Assessor's Map:.245 Parcel: 134 Property Address Birch Street Realty Trust- Raymond L. Quinlan, Tr Owner Owner's Name information is Hyannis MA 02672 February 8 2017 required for every y 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 ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facil ty or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 gpd t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 L Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 15 Birch Street Assessor's Map: 245 Parcel: 134 Property Address Birch Street Realty Trust- Raymond L. Quinlan, Tr Owner Owner's Name information is required for every Hyannis MA 02672 February 8, 2017 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? . r" ❑ Yes ® No Water meter readings, if available last 2 ears usage 315 gpd 9 ( Y 9 (gpd)): Detail: 2015: 148,114 gallons 2016: 81,538 gallons Sump pump? ❑ Yes ® No Last date of occupancy: current 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: t5ins.doc•rev.6/16 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 15 Birch Street Assessor's Map: 245 Parcel: 134 Property Address Birch Street Realty Trust- Raymond L. Quinlan, Tr Owner Owner's Name information is Hyannis MA 02672 February 8 2017 required for every Y rY , page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determiied? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ® Other(describe): pump chamber t5ins.doc•rev.6/16 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 15 Birch Street Assessor's Map: 245 Parcel: 134 Property Address Birch Street Realty Trust- Raymond L. Quinlan, Tr Owner Owner's Name information is Hyannis MA 02672 February 8 2017 required for every y rY , page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Age: 17+ years Certificate of Compliance for a new pump chamber and leaching field was issued 7/13/1999 (Permit#99-311 at Health Department). Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.5feet Material of construction: ® cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Sewer line appears structurally sound with no evidence of leakage or backup into dwelling. Septic Tank(locate on site plan): Depth below grade: 1 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: 8.5'x 5'x 6-1000 gallon Sludge depth: 6 inches t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 15 Birch Street Assessor's Map: 245 Parcel: 134 Property Address Birch Street Realty Trust- Raymond L. Quinlan, Tr Owner Owner's Name information is Hyannis MA 02672 February 8, 2017 required for every y ry page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 28 inches Scum thickness 1 inches Distance from top of scum to top of outlet tee or baffle 9 inches Distance from bottom of scum to bcttom of outlet tee or baffle 14 inches How were dimensions determined? Permit application Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping not requireded at this time. Maintenance pumping is recommended every 2-4 years with year round occupation. Tank and tees appear structurally sound and functioning as intended. No evidence of leakage in or out was observed. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins.doc•rev.6/16 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 15 Birch Street Assessor's Map: 245 Parcel: 134 Property Address Birch Street Realty Trust- Raymond L. Quinlan, Tr Owner Owner's Name information is Y required for every Hyannis MA 02672 February 8, 2017 � - page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 15 Birch Street Assessor's Map: 245 Parcel: 134 Property Address Birch Street Realty Trust- Raymond L. Quinlan, Tr Owner Owner's Name information is Hyannis MA 02672 February 8 2017 required for every y y page. Cityrrown State Zip Code Date of Inspection D. System Information (cost) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert at outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): No adverse conditions observed. Pump Chamber(locate on site plan): Pumps in working order: ® Yes ❑ No* Alarms in working order: ® Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Pump chamber appears in sound ccndition. Pump, switches, and alarm were operational. * If pumps or alarms 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: t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 15 Birch Street Assessor's Map: 245 Parcel: 134 Property Address Birch Street Realty Trust- Raymond L. Quinlan, Tr Owner Owner's Name information is Hyannis MA 02672 February 8, 2017 required for every ry page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 1 ❑ 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.): No evidence of surface ponding, breakout, lush vegetation, or other evidence of hydraulic failure was observed. A hole was dug into leaching field stone and no standing effluent or effluent contact staining was observed in the stone or overlying soils. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1M , 15 Birch Street Assessor's Map: 245 Parcel: 134 Property Address Birch Street Realty Trust- Raymond L. Quinlan, Tr Owner Owner's Name information is required for every Hyannis MA 02672 February 8, 2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal Syster-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 15 Birch Street Assessor's Map: 245 Parcel: 134 Property Address Birch Street Realty Trust- Raymond L. Quinlan, Tr Owner Owner's Name information is Hyannis MA 02672 February 8, 2017 required for every Y ry 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, _ L 0C A T§Oo NNE --- �� I�Y —OF SEPTIC COMPONENTS E C®_ —DISTANCES IN DECIMAL FEET A B C 1 47 14 ——— 2 32 26 ——— 3 ——— 32 so 4 ——— 62 80 EEC#SST§NG DWELUNG LEACHING FIELD O�O� 15 `3 4 A QB a 1000 GALLON Q 1000 GALLON 3 Z NOT � PUMP CHAMBER cc cc SEPTIC TANK TO o � ok SCALE o Q THIS SKETCH IS S j 3 BEST VIEWED IN COLOR FORMAT _j B§RCH STREET 508 364-0894 Lt5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 15 Birch Street Assessor's Map: 245 Parcel: 134 Property Address Birch Street Realty Trust- Raymond L. Quinlan, Tr Owner Owner's Name information is Hyannis MA 02672 February 8 2017 required for every y ry page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 10 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: 5/26/99 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: Approved design plan on file with the Board of Health shows bottom of system to be 5.3 feet above groundwater. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.6/16 Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 15 Birch Street Assessor's Map: 245 Parcel: 134 Property Address Birch Street Realty Trust- Raymond L. Quinlan, Tr Owner Owner's Name information is required for every Hyannis MA 02672 February 8, 2017 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 CA- a J Z................................................... ((nn BOTTOM OF W L EACCC=;ING FIELD LEACHING PER DESIGN Z 0 C.,) PLAN In ti GROUND WA TER t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: s PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for IDigozat 6potem Conotruction Permit Application for a Permit to Construct(X)Repair( )Upgrade( )Abandon( ) O Complete System O Individual Components Location Address or Lot No. %57&eLlA Av r- Ow is Name,Address and Tel.No. k J K "t l�s�O t2 T f©Y A u T qi o wl" Assessor's Map/Parcel Z-A1i / ZSZ GXew1S' PraCZ Q D 1 ;�A.kj(Ott, VAP, Installer's Name,Address,and Tel.No. De igner's Name,Address and Tel.No. -A Z16--�?j AA e� 5VL-L%VA" PG �� �CO� Type of Building: Dwelling No.of Bedrooms _ Lot Size 1 g Vn sq. ft. Garbage Grinder(� Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow AA 0 gallons per day. Calculated daily flow 444' gallons. k�Plan Date K 19 w 1999 Number of sheets Revision Date Title t Cn �e_a n9 �¢O��fl �'y l� �4� OS'&ec" AUG Size of Septic Tank 10006�a�:.o►� � vU(� Type of S.A.S. 1 DX(op 130 10006 A LLO AJ W,inn P O � Description of Soil 1�"9`' �ali.a Lt)Ayvl �=3 ' Ct YC,' �tA S,UD Ir.Ye. 39 — sa 91C 2 Cpsesm SA-�-XQ :&J)a %06" 1e k1.EvAT100 2.Z t,►6V� AaOGORtZ6(leN �,u�Ztt.vy ZCX�' O�vw�l�J 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 Environ nta Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by t ' and ea . D Signe Date 6 Application Approved by /J Date Application Disapproved for the following reaCW eni Permit No. Date Issued 11 Fee O THE COMMONWEALTH F MASSACHUSETTS " Entered in co-- mputer: r s PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 1pplication for ;Diopoat *pgtem ConotrUctton Permit Application for a-Permit to Construct(X)Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. {j L`.1 G(-{ A v � Owjer's Name,Address and Tel.No. � E\4 A P-A S�o v2.T i Owl A z r KI o wi"i G c:.►20 S Assessor's Map/Parcel 2�^j/' �� 7%Z. GA Q_-wAS tglaC.0 QA 14v�u N\S vvl A Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. q.G, f , 0`> d1 C.L cr Type'of Building: Dwelling ! No.of Bedrooms _ Lot Size 1 sq.ft. Garbage Grinder(A Other "Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures IF-0—TWAA r y! Design Flow gallons per day. Calculated daily flow 444 gallons. Plan Date MA�( 16 1 19`.9 Number of sheets_ Revision Date MAC/Z \hn9 Title S t M V91 A n) 1FeO Gib cD ry Etrl► .G UArs r_A O` \S g G I A A u G' Size of Septic Tank Type of S.A.S. 1 O Xld0 31v5j I or p"a �U vA CKA,-%taCj2.. Description of Soil 0-9 - SAtit CL,( LOAM' 9=3 (' 1 Y t= �¢ Sk,v,7 to V(L S'/ a �tal7� t06'' tt t..r_C-yAZlO►lJ 2�-i ►.t6VD t..�pGo2tzGLT1a 1.U�ih.vU LCY>' Ot'wIKW 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 Environs nta Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by t i oard )ea fh. Signed"; Date Application Approved by VAWLIMT © Date Application Disapproved for the following reasons Permit No. -- Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certif irate of tompliance THIS IS TO CERTI)Y,tha the,On-site Sewage Disposal System Constructed( )Repaired(K )Upgraded(X ) Abandoned )by - .A /V� _o at S t has b en constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. i dated Installer I Designer G The issuance of thiC eht sha not be construed as a guarantee that the system will fu do as designed.} e Date 'f 0 Inspector 1 �;Ll -�' , -- ----------------------------------- No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Mizpogar *potern Construction Permit Permission is hereby granted to Construct( )Repair()( )Upgrade(X )Abandon( ) System located at 1 S 6 1 e,--tA - AU 1= w Aw"'Ki e`!tS e0LT' x " 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:ConstruC"4,? must be completed within three years of the date of this t. f < Date: � �� A roved b l PP y 85- ��3 LOCAT ON "' SEWAGE PERMIT NO. 15 B, rch Street, West `Hyannisport, MA 02672 VILLAGE A & B CESSPOOL SERVICE 128 BISHOPS TERRACE, HYANNIS, MA 02601 li BUILDER OR OWNER Rene' L. Poyant - 15 Birch Street, West �vannisport, MA 02672 DATE PERMIT ISSUED 4/11/85 DATE COMPLIANCE ISSUED 4•/11/85 L i ;> e , No....... Y1 71, Fim THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................Town.....OF........Barnstable ........... .................................................................................. Allpfiration for Dhipoiial Works Tomitru' rtion Vrrmit Application is hereby made for a Permit to Construct or Repair (X ) an Individual Sewage Disposal System at: 02-6 A .72 ..................................................................... ........................... b ..... � Location-Address or Lot No. Rene-'...L...22yant ............................................ 15..P.irc.h__S.treet.....W.,...HyAMi§_p ........... . ....... .............. ... Owner Address A & B Cesspool Service, Inc. 128 Bisho-Ds Terrace, a 02601 ...................... ......................................................................... ....................Bishops ..................Hya nnis,..n....................... Installer Address U Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms...................3 .........................Expansion Attic Garbage Grinder a Other—Type of Building ............................ No. of persons___..__................__.. ................ Showers Cafeteria Otherfixtures ....................................................................................... ............................................................. Design Flow............................................gallons per person per day. Total daily flow.............. I..........................gallons. I 94 Septic Tank—Liquid*capacity............gallons Length................ Width................ Diameter---------------- Depth..._.........._. Disposal Trench—No. .................... Width__..._......._...... Total Length__....._............ Total leaching area....................sq. f t. Seepage Pit No____________________ Diameter.._...__.__......... Depth below inlet................._.. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ ►_4 Test Pit No. I................minutes per inch Depth of Test Pit...._.._............ Depth to ground water-._._._______-__-______. G%, Test Pit No. 2................minutes per inch Depth of Test Pit._____.._........... Depth to ground water____._.............._... CA ............................................................................................................................................................. 0 Description of Soil..................Sand.._.______..__._ ...................................................I.......................... ............................................................................................................................................... ......................................................... -------------------------------------------------------------------------------------------------...................................................................................................... U Nature of Repairs or Alterations—Answer when applicable..installat I on of a pre-cast le ach..pit;.. ---------------------------------------------------------------------------- ..... abandon an old -blIck cesspool._____._ ..... ................................................. ........................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TL I TiUj 5 of the State Sanitary Code—,The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by e b and o ea 4/11/85 .. .. ....... ....... ....................... Signe ......j...................... D te ..............� Application Approved By................................................................................................. /. A785 .......... Date Application Disapproved for the following reasons:............................................................................................................... ............................................................................................................................................................................................... Date Permit No.._.8 .......!ya............................. Issued................. /11/85..................... Date ----------------- ------------------------------- No.......R '.. if Fss..w....�:5•r�D.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........................ own......OF.......TAX table Apli iration for Disposalarks Tonstrurtiun Famit j Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal System at: ;a Y 3 e-ort;.. *.....a�6?2 .......................................-.......................................................... Locatio dress or Lot No. Rene' L. Foxant .............. ------__------------------•.......... 1,S..i'3z�h__ ties +..��..uyann.is�pAxt,.--1'lA....D2672 ....................•---- Owner Address aA & n Cesspool--_Ser...... .._Inc,----------•______________••---__ 1 _. lshQj2s ?' N rtni }_.^A._..SI2I 1._..__. Installer Address Type of Building Size Lot.................... .....Sq. feet I•-I Dwelling—No. of Bedrooms................3_.........................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons........a........_........ Showers ( ) — Cafeteria ( ) dOther fixtures -------------------------------•---•------------------------------------------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter________________ Depth................ x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) `"a Percolation Test Results Performed by.......................................................................... Date........................................ �_4 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ----------•----------------•--------------------•--------------••------•••---------.......---_--••••........................................................ 0 Description of Soil.................S ............................................................................................................................................. x U w UNature of Repairs or Alterations—Answer when applicable._iins-tallat10II__of_.a__pre_-Cast_1eaeh_.pit_I...... abandon-an--old•-beck cesspool. --------------------------------------------------------•............................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board o ea h. a Signe Datp ApplicationApproved By..................................................................... .-----•----------•-__----- �� iL Bra Date Application Disapproved for the following reasons--------------------------------------------------------------------------------•--------------------------•••••- •....................................•--••--•------------•-----------•---------------._...-------------...--------------••-•---------------------------------------- ---------------------------------•- \. f Date 85- � 4/11 8 Permit,' -------------==-- ='----------------•----------- Issued_--------••----- 1 .. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �' { .....................Town..........OF........PAa tlkb!0.................................................. Cprrtifiratr of ToutpliFatty THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (X ) bysho e--g; _.Cesspool_•Se�vice� Znc. ----128-Bi_---- .....04'601........................ at iS.Birch-_Street!- W. Hyannispct� "A 02172 Rene' has been installed in accordance with the.provisions of TITLE j of The State Sanitary Cod as/described in the application for Disposal Works Construction Permit No.__.___ _____a__ ....3-_______ dated__..._/._11/.85_ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE COf4STRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. 11/ C- DATE.....4-/1/--8s ................................... Inspector.---- - -------------------------------------•--••---••--- THE COMMONWEALTH OF MASSA HUSETTS \ BOARD OF HEALTH O F..............� IlS. g5_ �, ,; ....................'t'.aan.......... B + �1�... No........................ FEE---..._-•-$__13 00 0 Disposal Works Tnnitrt inn rrnti# Permission is hereby granted..................A & B Cesspool--Ser_ CO... IJJIQ_.... to Construct ( ) or•Repair x( ) an 'Individual Sewage Disposal System at Noi . Birarh. Street-t---�'---�Iyannisport,--.'�----•02672---_Rene'..L., Street as shown on the application for Disposal Works Construction Permit No85_"..._---------- Dated_.____.._4/1Z.�$5............... . t .__ C ----------------•-------•----•-•------ =' --------............................................ /11/8C �J Board of Health DATE...........................- ---_.__----------_..._..__.......-----•--.....-••- ` FORM 1255 A. M. SULKIN. INC.. BOSTON TOWN/OF BARNSTABLE LOCATION�� i��/ �T SEWAGE # VILLAGE .�.01�.*rAPl/ ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 104,570 6�Vion.! --1^0 / 0 4tg1, LEACHING FACILITY: (type) �Ac/� � �'�tC' (size) %Of X40 i NO.OF BEDROOMS BUILDER OR OWNER X*�f-W-e 7UVA�'I. PERMTTDATE: COMPLIANCE DATE: i Separation Distance Between the: i Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by i O � QS 2WG cos Ala j I. 00 c + N a `Hio.N or, f O f I tM I w I —77 1 m } , I AVOIT .loDiTION v R 1" - o toll. j rj G 8 r r c , 24"0 Opening Above For M.H. Vent,. F.G: 10.0 DESIGN DATA I&b Gahc Pipe Fbr From a Cover. F.G. 11.0 Single Family-4 Bedroom Float Support Inv 8.5 With no Garbage Grinder ::• ; >�� •`r,•. TO El.9.0 Daily Flow=110 x 4=440 GPD 1 9.6 mp 8.7 Bot 18.0 Septic Tank:440 GPD x 200%z 880 GPD g A Existing " ' - Use 1500 Gcllon Septic Tank a� Pump Power&Float Control a To D-Box Septic Tank Chamber 3_3' Cables Installed inAccordonce LEACHING AREA With.Local Bldg.&Elec.Codes. \� j- Bedding as Bottom of Test Hole El.2.7 440 GPD/0.74=595'SF Required Per Title 5 Ground Water at El.2.7 Use Bottom Area Only iA � a. 4"0 From.Septic Bottam Area=10 x60'=600 S.F Tank.Sch.40 PVC Precast Pump DEVELOPED .PROFILE OF PROPOSED SEPTIC SYSTEM 600 SF.Total Provided 9.0, Chamber LEACHING.BED DESIGN �. j; Not to Scale All Pipes to be Schedule 40.PVC .��r ,:tee,•.s; ..;:�, j Perforated With Capped Ends.Use 3-4"Distribution Line in a 10'x 60'washed Stone as Shown. PLAN Finish Grade 4"0 Sch.40 PVC Finished v From Septic Tank Grade __. __ _... Filter __.__ _._�. : _ --Compacted Fill:`3``Maximum . ____.___ _ —____ w__-._ __.__._._.__......._ _ _ 41QTES _ ,.. .a i - rotwic L Water Supply ForThis Lot is Municipal Wader. A Conduit Thru Chamber I/e"-Ile I.Location of Utilities Shown on This Plan Are Approx. ' For Power&u Chamber GaIv. To D-Box a , Pea Stone f . At Least 72 Hours Prior to Any Excavation ForThis Emergency Storage Cables. Chain a° Min.2'Cover 4"0 PerM�ote " " Pro ea The ContractorSholl Make The Required ° • 3/4-11/2 Doutik q Vo 1.490 Ga l l o s PVC Pipe Notrficotion b Dig Safe(1-800-322-4844). • Washed j 3 The Contractor is Required to Secure A Alarm on EI.7. �O 2"0 Sch.40 PVC �� �� q Appropriate PumponE1.7.0 Mercury Float i Threaded Pipe 2-0 3-0 3-O 2-d Permits From Town Agencies For Construction Switchs-3Req+d Defined byThis Plan 10-0 .� Pum off E1.6.0 Check Valve 4 InstallRisersasReq%iredtoWithin 12 of Secure Pipe at Top& Finished Grade. Bottom of Chamber ¢. 5.A11 StructuresBu�i Bottom El 5.0 ed Four •��.. ,,. I � "washed 1 to Vehicular Traffic bbe H-20 Loading. • 'E > IrIF, 6one Min. CROSS SECTION OF LEACHING BEAD 6 Septic System to be Installed in Accordance With SECTION l— Not to Scale j 310 CMR 15.00 Latest,Revision And The Town of SEC SEC Gallon Barnstable Board of Health Regulations. IPOO PUMP CHAMBER DETAIL 7 All Piping tobe Sch 40 PVC `• Not to Scale OF f4,, PETER � O SULLIVAN T.l1 EL . tt . o sAK DY `� NO CVIL3 3 A r LOA M - S►�.G'OSTE��e Y , YeL. i3RN ,COARSt= C, -SAND 516 ��f® L 39 - LT• YCL . f3RowN Sy, G1 FINC SAND 2.T YR 6/4" L-r yo-L BlZm. COARSE !/ CS 5A mt> toYR (./4/ There are wetlands within 100 feet of the proposed leaching facility. �o+ _ There are no private potable wells within 150 feet of the proposed septic system. (3RN,YEL. GCARSE C� 5ANt> GRC)UND WATER There are variances requested or needed. /oo - The design of the system Is based on bottom area only. -M14. z'-y S.C.1. 5 25/g4 GRoV tv D 'wATE R IW ra L. Z . There is no increase in flow anWor change in use proposed. Sheet 2 of 2 Prepared By. Prepared Par. Sullivan Engineering, Inc. capes Iry POYANT NOMINEE TRUST PO Box 659 PO Box 718 282 BARNSTABLE ROAD Osterville, MA 02655 H)nnnis MA 02601-0718 P® ®®X K (&W)428-3344 (508)428-J113 limr (5W)7eo-7oz (soe)7so-rags . _ HYAN N IS, MASS MRPEaool.mn of .4 3 •!RQAO 1 - •_: hl. LOCUS PLAN L&J \2 \�#10 ` 7O 0 Assessors Map 245 �� \� �jA V �' lt7 N \ \ •\ 2X3 •�• Parcel 134 PETER - iFnd 87•00 1 5» E \ p �\ s� #9 CIVIL /01 wood / WIF \ Br Garage ,� \\ A\• / #8 14,177tSF V a �c s F�-�a v F. J A A , - - , �o RM#15 0=10.0' \ Top of CB110H \\ i ° \ mo \\ Amphdt o tN, p \ Z / Q / / //�// Saltmarsh w Q� AS 87 21 35 E\ 15 Q PRIMARY 100 00 Fnd 1-112 Sty \ /�/////® I \ lv . c, W/F Dwelling a l l l p I -o TN FF—]J5• - Aj • / / /// %/ A a // O �'1 009y'0 D-60X Y ReuSE EXlsr� Gross A. O (, I RES�RvE \ \ SEPTIC TANK. '� /// �/ �� J- / (L r y Approxlmote Location z _ a Septic system _ _ I °Q o I N c o / / r 14 1 S N 8T21'35" W 165."83' -8 CHAMBER tow, 10 BIRCH AVeNYE ' #3 Edge of Po►emetn (40' Wde �\Private Way) 05 10 15 20 30 40 FEET J d,#2 Prepared By. Qap(q, non Prepared Por: Title: North Scale— Sheet # Sullivan Engineering, Inc. p l�lll V POYANT NOMINEE TRUST SITE PLAN 1 -20 PROPOSED SEPTIC UPGRADEGRADE O PO Box 65s PO Box 718 282 BARNSTABLE ROAD May 18 1999 1 of 2 Osterville, MA 02655 Hyannis MA 02601-0718 PO BOX K 15 BIRCH AVENUE (508)428-3344 (508)428-3115 fox (508)790-7902 (508)790-iso5 fox H YA N N I S, MASS WEST H YA N N(SPORT, MASS. Job # PSU11PEO0o1.eom c°pesurvOrapecodnet