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Home My WebLink About0092 BLUEBERRY HILL ROAD - Health 92 Blueberry Hill Lane Hyannis A= 249 — 135 q L A ION SEWAGE 'PERMIT NO. VILLAGE INSTA LLER'S "NAME & ADDRESS 0UILDER1 OR OWNER f DATE PERMIT ISS.UEDAJVA%�--�` DATE COMPLIANCE ISSUED --� II c�0 o J� �� .- . ..� —J TOWN OF BARNSTABLE �-)CATION SEWAGE# 'VILLAGE `Fy ic.�a ✓�;, �_AS SSOR'S MAP&PARCEL Q 4-t / t/ss INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY i cv Q0 �� 5 LEACHING FACILITY:(type) L:r,,cam @`:ram ro7 (size) �'er C --�- NO.OF BEDROOMS OWNER PERMIT DATE: 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 c � � r W 1, nl9� OXI� / n V W 2 ` A y lV W j LU-) V U1( t9 c 6 _ J JGLJG-26-2203 16:25 LANE LANE AND KELLY P.01"ol ( $, LANE, LANE AND KELLY, LLP • ATTORNEYS AND COUNSELLORS AT LAW 5; E336 WASWINGTON STREET, BRAINTREE, MA 02184 MAILING ADDREsg ` P.O. BOX IS50270 FlC�E3E,RT P.KELLY Y.. b-'Wlt)S.LANE ®RAINTREg, MA OE193 RIC14ARD 6.LANg,OF COUNSIEL I_E)MigIqD®. MsOONALO' August 26, 2008 TELEPHONE(781) e4a• OOs1g -AOM!T'N,-D IM tqA,NT,6 P6 FACSIMILE(7al) 380-4136 6Y:r r Mr, Thomas McKean www.LLIaLAw.cOM Health Department 4.x Town of Barnstable Town Hall i$. 367 in lV1a Street, a iHyannis, MA 02601 - '- 92 Blueberry Mill Road, Hyannis <.1 =r Dear Mr. McKean: F f I've been asked to handle the sale of the property at 92 Blueberry Hill ` Road, Hyannis. On the issue of the septic inspection I've been given copies of a 711tle 5 Inspection Form, dated October 23, 2007, signed by Patrick T. Sullivan : s . steady Rooter Sandwich, an of 9 MA and also a copy of a Certificate of Compliance dated November 27, 2007 (see copy attached) indicating that the sewage aI disposal system has been abandoned, i ' `. I've been told that part of the septic system was located under the garage r <` (as noted in Mr. Sullivan's report), that to bring the system into compliance the° . portion under the garage had to be abandoned, that the abandonment occurred i))i means of the pumping, excavation, backfilling and compacting of the leaching Pit located under the garage, and that as a result of that work the remainder f' er of the septic system was brought into compliance with the provisions of Title 5, at } I,s,nt as of the date of the Certificate, November 27, 2007. *; If this information is true, it would be a big help if you could confirms b Signing below and returning this letter by fax transmission as we are attempting to complete the transaction tomorrow (Wednesday). Thank you for y your help. to Ve 5"kr; my EDMtwwp ar aid ( -1frmed: a, .r TOTAL. P,:01 No. � 3 Fee 1-5 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Application for lotgpool 6pgtem Co 0truction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( .Complete System ❑Individual Components Location Address or Lot No. 1��L)Cbe2Zy RLL,R.0 Owner's Name,Address,and Tel.No. HywvNtS �Stc�#e o f McA.rcjolln J' Assessor's Map/Parcel A y 9 1 3S 9;k, n VIVe N 1 7V Q,(�lI1J 5 T'I taHer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. obm-r U I l.Fa —19t d �-X,CQvQJ-(D 6L• Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3 gpd Design flow provided gpd Plan Date A)IA 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) CL.nd t) a- I P A e h_J3 f'.p 6L Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. L Signed �-- v Date 11 (2b [D-1 Application Approved by Date Application Disapproved by: Date for the following reasons 2 Permit No. 09[3 l Date Issued �I '1 6`0 a.► - - -- - — -.— —— ———————————————— ------------ �.wr••`Y�+,.-....a( �., A.'""�fi.+..r,vy....v y,+r. �r"7'"` ,..�s..,d :`il w.�l:.:!r,...,.t J��T'•. .. „�vwva.e,.I-`44!°.,.r 'ar'1-.r"'-i ..,. . . � 530 Fee j THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes a Application for Migpogal �&pgtem Cougtruction Permit Application for a Permit tc Construct O Repair O Upgrade O Abandon(0ye"❑.Complete System ❑Individual Components j i Location Address or Lot No. ��U�b C fZ.ey f�� (� p Owner's Name,Address;and Tel.No. H1,/AA)AlI!a 5-I�{ e G T mct,rci pl i n Assessor's Map/Parcel i I�t I T?)I L) { i In taller's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Ub�C1 �-71i.C'Uy - �j� cxfCtvCtlrU�-- _)j�.A 7T P 5 A ht_L, Type of Building: { Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( ) .� Other Type of Building No.of Persons Showers( ) Cafeteria Other Fixtures d Design flow provided Design Flow(min.required) 3 3(�. _ gp g p gpd Plan Date Al I z_ ;Numbenof sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil - I t Nature of Repairs or Alterations(Answer when applicable) r��y !\ P F, r tk Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. f Signed �u V Date 11 (2-1, (4)-1 Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. Date Issued / `1 6-d j —————————————— ——————————————— r THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS 1 l� Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded ( J Abandoned( ✓)by 31 ( X Lk t t/_'a.1. 1 c_;✓,-.S IV L at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 2d0 tZ �/z d dated If-16`0 Installer Designer #bedrooms -A, Approved design flow gpd The issuance of this permit/shall o;l be co trued as a guarantee that the systei Kqdl�* ction as designed P O Date Inspector J i -- U— —.— �` ---- — No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Wigpool *pgtem Construction permit Permission is hereby granted to Construct ( ) Repair_( ) Upgrade ( ) Abandon System located at )P h pf2 P H I L t En (i c'i .n_( 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 must be completed within three years of the date of this erm' . Date ( �-�6" Approved by t v ,. COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION r TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 92 Blueberry Hill Road 1 Hyannis 1� Owner's Name: Estate of Stan Margolin/Sue Dunn Owner's Address: P.O. Box 924 Centerville,MA 02362 Date of Inspection: October 18,2007 Name of Inspector: (please print) Patrick T. Sullivan Company Name: Ready Rooter Mailing Address: P.O.Box 371 Sandwich,MA 02563 Telephone Number: (508) 888-6055 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 Authority Fails Inspector's Signature: Date: 104 ln 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 10,600 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of fie" DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the appr6wing authority. Notes and Comments �Y gs.aaSn`ssi�', cctic r-• i° L--e�ev.,,, �`;-�'. ",5 \�r.,.s.r.Sr•�:� C.a.�,<�a��.r— e�.,�.:�.-.��•�,.,.. � �r',,� �4,y: e 7 ****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. Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 92 Blueberry Hill Road Hyannis Owner: Estate of Stan Margolin Date of Inspection: October 18,2007 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 distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 92 Blueberry Hill Road Hyannis Owner: Estate of Stan Margolin Date of Inspection: October 18,2007 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 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: f �1 -ag.•C c�� ".�c a� '�A -Z r Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 92 Blueberry Hill Road Hyannis Owner: Estate of Stan Margolin Date of Inspection: October 18,2007 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 y/ 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 and 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 _Z 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 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] (Yes/No)The system fails. I have determined that one or more of the above 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 facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the Mowing: (The following criteria apply to large systems in ad tion to the criteria above) yes no the system is within 400 feet of a sur ce drinking water supply the system is within 200 feet of a ibutary to a surface drinking water supply _the system is located in a nitre en 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 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 owners,ould contact the appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 92 Blueberry Hill Road Hyannis Owner: Estate of Stan Margolin Date of Inspection: October 18,2007 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? -ZHave large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined?(If they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up? 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? Z _ Was the facility owner(and occupants if different than owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No _/ 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(3)(b)] r Page 6 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 92 Blueberry Hill Road Hyannis Owner: Estate of Stan Margolin Date of Inspection: October 18,2007 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):_ Number of bedrooms(actual):3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): ' Number of current residents: I Does residence have a garbage grinder(yes or no): +n cn) Is laundry on a separate sewage system(yes or no): yes separate inspection required] Laundry system inspected(yes or no): JP Seasonal use: (yes or no):a.9<"� ~ Qc !) = ac) G,P°�' �� w � U 5 Water meter readings, if available(last 2 years usage(gpd))t a<30 6 a q I S' P • `�"�� S ""'°"�` �''� Sump Pump(yes or no):Qp Last date of occupancy: C Q H COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 5.203): gpd Basis of design flow(seats/per ns/sq. ft. etc.): Grease trap present(yes or _ Industrial waste holding t present(yes or no): Non-sanitary waste disc arged to the Title 5 system(yes or no): Water meter readings f available: Last date of occup cy/use: OTHER(descr' e): GENERAL INFORMATION Pumping Records ti Source of information:'jk,,-..,,-1A, �'�, ,r- t-�� -�s ��,,��,��Q, ��►\�� O'1 Was system pumped as part of the spection(yes or 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 _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: l �\ Were sewage odors detected when arriving at the site(yes or no): A-)6 Page 7 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 92 Blueberry Hill Road Hyannis Owner: Estate of Stan Margolin Date of Inspection: October 18,2007 BUILDING SEWER(locate on site plan) Depth below grade: �y" 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 leaf age,etc.): SEPTIC TANK: (locate on site plan) Depth below grade:�2' Material of construction: oncrete_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: �- Sludge depth: <n Distance from the top of sludge to bottom of outlet tee or baffle: 3 Vt Scum thickness: i f a" Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: (,S " How were dimensions determined.�,��,� Comments(on pumping recommendations, inlet and outlet tee or baffle c ndition, structural integrity,liquid levels as related to outlet invert, evidence of leakage,etc.): ` (� VCR �C r! ,-- G. A- �IpS °ivy �`.F�ie+ , L- 'J-, -, + \•eL'Gn\ ••- 6 1�1 LJ GREASE TRAP:_(locate on site plan) Depth below grade: Material of construction:_concrete_meta _fiberglass polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of o let tee or baffle: Distance from bottom of scum to bo om of outlet tee or baffle: Date of last pumping: Comments(on pumping reco endations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evi nce of leakage,etc.): � I 1 Sc� _ Q^� JDAC J/ Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 92 Blueberry Hill Road Hyannis Owner: Estate of Stan Margolin Date of Inspection: October 18,2007 TIGHT or HOLDING TANK: (tank must be umped at time of inspection)(locate on site plan) Depth below grade: Material of construction:_concrete_met _fiberglass___polyethylene_other(explain): Dimensions: Capacity: Xandfloiat Design Flow: day Alarm present(yes or no): Alarm level: Alarder(yes or no): Date of last pumping: Comments(condition of arm switches,etc.): DISTRIBUTION BOX: Z(if present must be opened)(locate on site plan) r/ Depth of liquid level above outlet invert: Comments(not if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): l ca V G-&-, \ �c,�ca,• (� - C1�X `oa �( ` I3c�Vaea,� � .-.+.�,�, �( r"�a�•T" W;Z`:vr. �`� ca-� `fir • PUMP CHAMBER: /no . ite plan) Pumps in working order(yes Alarms in working order(yesComments(note condition ofber,condition of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 92 Blueberry Hill Road Hyannis Owner: Estate of Stan Margolin Date of Inspection: October 18,2007 SOIL ABSORPTION SYSTEM(SAS):_yz!�(locate on site plan,excavation not required) If SAS not located explain why: Type —2—leaching pits,number: _22 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.): 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 or 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.): Page 10 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 92 Blueberry Hill Road Hyannis Owner: Estate of Stan Margolin Date of Inspection: October 18,2007 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. f j O� �1 Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 92 Blueberry Hill Road Hyannis Owner: Estate of Stan Margolin Date of Inspection: October 18,2007 SITE EXAM Slope Surface water_ Check cellar f Shallow wells Estimated depth to ground water >-4,- feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record—If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with the 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: Town of Barnstable �p THE Tpw Regulatory Services ,nRxsrAB Thomas F. Geiler, Director r Public Health .Division lEp��A Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-8624644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the"Disposal Work Construction Permit". If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection. I F��.....e�.... ..... THE COMMONWEALTH OF MASSACHUSETTS E®A RD F H E LTH _ � OF..... . ... , , -`--' --------------------------- Appliration for Bigposat Works Tomilrurtion Prrmit Application is hereby made for a Permit to Const t or Repair ( ) an Individual Sewage Disposal Syst at: Z +--' • ........ • _.-•-•- .. ..---- - -- --- -- ............................ ............... _.. . ..cation- or Lot N1 ?6"' irE Address W � - ./ ..__� ... . ... •......... ...............Y---.A,�`^,.`'-.usv-•-. Installer Address / U Type of Building Size Lot...Al-- t -__(_�__�__[_f____Sq. feet DwellingANo. of Bedrooms---------- ...........................Expansion Attic ( ) GaZage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures-.- --•---------------------------------------•-•-------•---------------------------- -----•--•-•---......... Design Flow ................. .. ... gallons per person per day. Total daily flow....._....�..------------------------------gallons. W Septic Tank Liquid capacity__-_____gallons Length----'_.__._... Width---------------- Diameter________________ Deptll_________.__--. Disposal Trench— o...................... Wid h_----_-_ . Total.Length........ la� ....:.. Total leaching area._..__. _.____ __:•sq. ft. Seepage Pit No_________ ________ Diameter _ ___-____ Depth below inlet..... Total;leaching area --------.___sq. ft. Z Other-Distribution box (. ) Dosing tank ( ) aPercolation Test Results Performed by-•-......................................................................... Date---------------------------------------- a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-_---_--_-_------._---.. Test Pit No. 2................minutes er inch Depth of Test it._______.........._. Depth to'ground water-_--_--_-__-_______----: ------.---• 7 ; O Description of Soil.-._-- ,. Y d ��.. ------ ------ - -------- ------------------------------------------------------------------------------------------------ -------- W V Nature of Repairs or Alterations—Answer when applicable------------------------------------------------------------------------------------------------ --------------------------------------- - ------------------------------------------------------------------------------------------- Agreement: The undersigned',agrees to install, the aforedescribed Individual Sewage Disposal System inaccordance with the provisions of Article XI of the State Sanitary Code The unfibr ned further agrees not to place the system in operation until a Certificate of Compliance has bee d b e of healt Signe - ------ -• --.......' --------------- ................................ �Application Approved By � a D-- te ------ D Application Disapproved for the following reasons:-----------•-------•------•--- •----------------- ............................................................. -----------•--•---------------•-----.....---------------------------...------------------------------------•-------------------------------------------- -----------------------------------•--------- Datte Permit No.. Issued.- =�g ---- Dat ----""""-`-----`----•---------------------------------- - ----- �- -- - - - - - - - - - - -- - -� THE COMMONWEALTH OF MASSACHUSETTS BOARD E HEALTH L .. OF. `'. . . ------ Apli ravott for DiiiVnlial Worko C omitrurtiou tirrmit Application'is hereby made for a Permit to Constr ct . for Repair ( ) an Individual Sewage Disposal Syst at � � _: -x" "cation•Add, ! -- ---- ---• ------ r s i e V. • ...Y .. i r_. t.No. ________ _____ _____________ O { der'/ {r" Address J d� a ¢ r _... ---------------- � Installer Address ' UType of Building, s ' Size Lot._ r�_ __:____Sq. feet �-, DwellinNo. of Bedrooms---------..................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons.......................... Showers ( ) — Cafeteria ( ) POther fixtures ---•----------- ------•----•------------------------------------------------------------------__---- Desi nFlow_ -•------------------------ W g __ __., __ ______ _gallons per person per day. Total daily flow___________ •� ______-_ _____gallons. WSeptic Tank=Liquid capacity/ '__gallons Length_... --_--- Width__________ _____ Diameter___-- ___ Depth---_----_----- 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 No Percolation Pit e i Results mnutes pe sults d g r nch Depth of Test Pit____________________ Depth to round water_______-_-_-______-_--. (3, Test Pit No. 2................minutes er inch Depth of Test Pit.................... Depth to ground water_________--____________- a - --- ---- ------•---• -----------------''-•-------=---......................................................... Description of S ...... - - ------------------------------------------------------------------------------------ x V --•---------------------•---•---------.----•-•------------•-•----------------•-------------------•---------------------•----------•--•------=----------------------------------------------------------- W V Nature of Repairs or Alterations—Answer when applicable.-______________________________________________________________________________________________ -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been si�,ed by the b9Qrd of healft ,X: Sign e n-- -- t A _. ------------- -------------------- f Date Application Approved By----- .._ ' te Application Disapproved for the following reasons:---------------------------•-- ........................................................................... ..........................................................................................................•-----•--------------------------------------•------------------•----------•------------------- Date PermitNo......................................................... Issued:---------------------.................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH ..mow.............OF..... . . �" ° ,,. :..:. ............. . Currtif irate of Tome ana �. T I IS 4.CERTIFY hat t dividalvage Disposal System constructed ( ) or Repaired ( ) by = a fir... ---- Ile 0119 at. � a f �"- - - ------- ------------•--•••---------------------------•------- has been installed in accordance with th provisions of Article.XI�of reSt4ateSanitary Code as des ibed in the application for Disposal Works Construction Permit No------_'_-........ ______________________ dated.// �_�#�c�_ ............ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. ,F DAT-E'-•-----3 a-./ ' Inspector's "� f . " THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTHo ........OF...... �. r ram. No. FEE_ :-.............. ISpT17 ,rhii Ton trur;vPermission is'hereli ranted. ... _`Z :_._ :__ F it " .' _______________ to Constr t� or 2ep1t ( ) atf 1.Indivldual ew ge is,osal S s m at No. �� 9 : � � st *101-- ------- -__- ---- . r t ZS as shown on the application for Disposal _.orks Construction P it No. ated�'�'__7 ,___ - of DATE__ ' ° Health Board ------ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS -