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HomeMy WebLinkAbout0015 BRIARWOOD AVENUE - Health � Y I_Briarwood Ave. Hyannis A 289 090 ° o a 4 a a o TOWN 9F BARNSTABLE ti ATION W130 AJ(- S # -�r►a� VILLAGE ASSESSOR'S MAP&PARCEL o2 - fJ91� IN1%tbLv9RS NAME&PHONE NO. e^c 0&i1r ) SEPTIC TANK CAPACITY LEACHING FACILITY:(type) Ls he.rA bA4-> (size) �5 Gy NO.OF BEDR OMS OWNER r&,: PERMIT DATE: Ct DATE: ` 7 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 f 38 30 45 24 Water 39 21 Service Briarwood Ave Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .wr. M 15 Briarwood Lane 39 Property Address C Michael Dumaine -� Owner Owner's Name information is Hyannis MA 02601 6-21-17 required for 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. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms cn the computer, /�Ll0?_D "11 use only the tab 1. Inspector: �'�'�� pe � ,q , �. � . key to move your ?; C, ;.y cursor-do not James D.Sears _'�°� JAMES use the return T'.S gin' ke Name of Inspector 'o. SEARS ' y Jim The Inspector Man t►�flrea II Company Name ?'RTIIF P.O.Box 784 Company Address �►umnuuu�I � re West Yarmouth MA 02673 City/Town State Zip Code 508-364-4398 S1623 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 ❑ Needs Further Evaluation by the Local Approving Authority 6-28-17 nspector's Signature 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 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.6/15 Title 5 Official Inspection Form:Subsurface Sewage DisposalSSystem•Page 1 of VS �`0 Commonwealth of Massachusetts a W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °wM 01 15 Briarwood Lane Property Address Michael Dumaine Owner Owner's Name information is required for every Hyannis MA 02601 6-21-17 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: The system is a 1000 Gal. Tank- D Box and two chambers 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 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. ❑ 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 Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w o 15 Briarwo d Lane M Property Address Michael Dumaine Owner Owner's Name information is required for every -Hyannis annis MA 02601 6-21-17 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 break out or high static water level in the distribution box due ❑ Ob g p 9 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: s ❑ 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 •.5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts 4 Title 5 Official Inspection Form A Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Briarwood Lane Property Address Michael Dumaine Owner Owner's Name information is Hyannis MA 02601 6-21-17 required for every 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 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 MOM= is less than 6" below invert or available volume is less than '/z day flow;-VcYfiwG k5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Briarwood Lane Property Address Michael Dumaine Owner Owner's Name information is required for every Hyannis MA 02601 6-21-17 page. City/Town 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 f M h o Massachusetts w _ Title 5 Official Inspection Form . Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 15 Briarwood Lane Property Address Michael Dumaine Owner Owner's Name information is required for every Hyannis MA 02601 6-21-17 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 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)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form m Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 15 Briarwood Lane Property Address Michael Dumaine Owner Owner's Name information is required for every Hyannis MA 02601 6-21-17 page. City/Town State Zip Code Date of Inspection D. System Information Description: The system is a 1000 Gal. tank D Box and two chambers. Number of current residents: 0 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 Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): NA Detail: Sump pump? ❑ Yes ® No Last date of occupancy: NA 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.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 r Commonwealth of Massachusetts _ - Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Y M 15 Briarwood Lane Property Address Michael Dumaine Owner Owner's Name information is Hyannis MA 02601 6-21-17 required for every 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: 10/24/12 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: ® 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): 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 Briarwood Lane Property Address Michael Dumaine Owner Owner's Name information is required for every -Hyannis annis MA 02601 6-21-17 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: 2001 Permit # 2001 -704. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 20" Depth below grade: feet 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.): Pipeing is 4" PVC SCH 40. Septic Tank(locate on site plan): 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: 1000 Gal. Precast H-10 2, Sludge depth: t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 15 Briarwood Lane Property Address Michael Dumaine Owner Owner's Name information is required for every Hyannis MA 02601 6-21-17 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" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 17 How were dimensions determined? Asbuilt-Tape Sludge Judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level. Tank and cover's at 8" below grade. Inlet baffle,outlet tee. No sign of Ieakage.Or over loading. I 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 15 Briarwood Lane Property Address Michael Dumaine Owner Owner's Name information is required for every -Hyannis annis MA 02601 6-21-17 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: p ty 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 t51ns.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts r Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °w 15 Briarwood Lane Property Address Michael Dumaine Owner Owner's Name information is required for every Hyannis MA 02601 6-21-17 page. Citylrown 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 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.): D Box is 16"x16"-21" Below grade. Box is clean and solid w/one line out. No sign of over loading or solid carry over. 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.): * 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 r Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments • 15 Briarwood Lane Property Address Michael Dumaine Owner Owner's Name information is Hyannis MA 02601 6-21-17 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 2 ❑ 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.): Leaching is two 500 Gal. dry well chamber's. Chamber's are 45" below grade w/cover at1'.Bottom of chambers wet,wall's clean and dry. No sign of over loading or solid carry over. 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 F . Title 5 Official Inspection Form Wo Subsurface Sewage Disposal System Form Not for Voluntary Assessments li M 15 Briarwood Lane Property Address Michael Dumaine Owner Owner's Name information is required for every Hyannis MA 02601 6-21-17 page. CitylTown 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.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 II Commonwealth of Massachusetts u . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 0''r 15 Briarwood Lane Property Address Michael Dumaine Owner Owner's Name information is required for every Hyannis MA 02601 6-21-17 page. Cityf 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 13 3 `� a � O EAR C-3= �23' -3- j _6r, t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 ii Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,w 15 Briarwood Lane Property Address Michael Dumaine Owner Owner's Name information is required for every Hyannis MA 02601 6-21-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells N® Estimated depth t high ground water: 25 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: Per plan ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Per Plan on file ADJ High G.W. at 19' below bottom of leaching. 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 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a 9 p Y rY 15 Briarwood Lane Property Address Michael Dumaine Owner Owner's Name information is required for every Hyannis MA 02601 6-21-17 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 d ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file I' i t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Apr 2415 09:14a p.1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Briarwood Lane Property Address Michael- Katherine Dumaine Owner Owner's Name information is MA 02601 4-17-15 required for every Hyannis State Zip Code Date of Inspection page. Cityrrown 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 on the computer, use only the tab �J' ,�, - �y•4 1. Inspector: , o:• key to move your _ JAM ES cursor-do not James D.Sears use the return Name of Inspector V' key. CapewideEnterprises,LLC Company Name N � 153 Commercial Street �'"/"���I�+u►w"��� Company Address MA 02649 Mashpee Cityrrown state Zip Code 508-477-8877 S1623 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the true, ac curate and complete as of the time of the inspection.The inspection information reported below is tr P 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 ❑ Needs Further Evaluation by the Local Approving Authority 4-24-15 spectors Signature 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•3113 Title 5 Official inspection Form;Subsurface Sewage Disposal System•Page 1 at 17 v Apr 2415 09:14a p.2 Commonwealth of Massachusetts Tale 5 Official Inspection Form � p " Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 15 Briarwood Lane Property Address Michael- Katherine Dumaine Owner Owner's Name information is MA 02601 4-17-15 required for every Hyannis page. Citylrown State Zip Code Date of Inspectlon 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: The system is a 1000 Gal Tank-D Box and two chambers Tank need's to be pumped. 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 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. ❑ Y ❑ N ❑ ND(Explain below): t5ins•3113 Title 6 Official Inspection Form subsurram sewage Disposai system•Page 2 of 17 Apr 2415 09:15a p.3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 15 Briarwood Lane Property Address Michael-Katherine Dumaine Owner Owner's Name Information is Hyannis MA 02601 4-17-16 required for every State Zip Code Date of inspection page cityrrown B. Certification (cost.) ❑ Pump Chamber pumps/alarms not operational.System will pass with Board of Health approval if pumps/alarms are repaired. B) System conditionally Passes (cont.): static in the istribution box ❑ Observation tob oken p or obstruc ed p ()or duet a b okennhsettled or uneven level even di distribution on 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 t5ins•3113 Tire 5 CM4Ed irtspecdon Form:Subsurface sewage Oispowi System•Page 3 of 17 Apr 2415 09:15a p.4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 15 Briarwood Lane Property Address Michael- Katherine Dumaine Owner Owner's Name information is Hyannis page. MA 02601 4-17-15 requiredCrtylTown for every sty Zip Code Date of Inspection P 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 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 El ® 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 is less than 6'below invert or available volume is less than Yz day flow ,L E4C 111,vi ' t5ins-3113 Title s officiai inspection Form:Subsurface Sewage Disposer System•Page 4 of 17 Apr 2415 09:15a p.5 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Foam -Not for Voluntary Assessments 15 Brierwood Lane Property Address Michael -Katherine Dumaine Owner owner's Name information is required for every Hyannis MA 02601 4-17-15 page. Cityrrown State Zip Code Date of inspection B. Certification (cunt.) Yes No ❑ Required uired 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 D EP certified laboratory,for fecal coliform bacteria indicates absent and the presence a ry, o m of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 PP , 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 16.303, 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. indicate either"yes"or"no"to each of the following, in addition to the For iar e systems,you m u st n 9 Y •Y y 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 Elthe 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. 15ins^3113 Title 5 Official tnspadlbn Form:Subsurface Sewage oisposafsystem-Page 6 of 17 Apr 2415 09:16a p.6 Commonwealth of Massachusetts Tithe 5 Official Inspection Form �= Subsurface Sewage Disposal System Form Not for Voluntary Assessments 15 Briarwood Lane Property Address Michael- Katherine Dumaine Owner owner's Name information is MA 02601 4-17-15 required for every Hyannis State Zip Code Date of Inspection page CitylTown C. Checklist Check if the following have been done. You must indicate"yes "or no" as to each of the following: Yes No to ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or as part of ® this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ 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): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 ISins•3113 Title 5 olfidal Inspection Form:Subsurface Serfage Disposal System•Page 6 of 17 Apr 2415 09:16a p.7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments a 15 Briarwood Lane Property Address Michael- Katherine Dumaine Owner Owner's Name information is required for every Hyannis MA 02601 4-17-15 page. city/rown State Zip Code Date of Inspection D. System Information Description: The system is a 1000 Gal. tank D Box and two chambers. Number of current residents: 3 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? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): 2013-37,000Gals 2014-54,000Gel s Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Present Date Commerciallindustrial 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: 15ins•3/13 Tile 5 Ortidal rnspedion Form Subsurface Sawage Disposal System-Page 7 of 17 Apr 2415 09:16a p.8 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Briarwood Lane Property Address Michael - Katherine Dumaine Owner Owner's Name information is MA 02601 4-17-15 required for every Hyannis page. City/fown state Zip Code Date of Inspection D. System Information (cont.) Last date of occupancyluse: Date Other(describe below): General Information Pumping Records: Source of information: 10/24/12 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: 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 DER approval. ❑ Other(describe): t5ins-3113 Tide 5 official Inspection Form:Subsurface Sewage Disposal System•Page B of 17 Apr 2415 09:17a p.9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 15 Briarwood Lane Property Address Michael- Katherine Dumaine Owner Owner's Name information is required for every Hyannis MA 02601 4-17-15 _ page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed(if known)and source of information: 2001 Permit # 2001 -704. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 20"feet 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.): Pipetn is 4" PVC SCH 40. Septic Tank(locate on site plan): Depth below grade: 8' 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: 1000 Gal. Precast H-10 Sludge depth: 6" t5ins-3113 Title 5 Official Inspection Form Subsurface Sewage Disposal System-Page 9 of 17 Apr 2415 09:17a p.10 Commonwealth of Massachusetts Title 5 Official Inspection Form k Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 15 Briarwood Lane Property Address Michael-Katherine Dumaine Owner Owner's Name information is Hyannis MA 02601 4-17-15 required for every page. City/Town State Zip Code . Date of Inspection. D. System Information (cont.) Septic Tank(cunt.) Distance from top of sludge to bottom of outlet tee or baffle 24- 4" Scum thickness Distance from top of scum to top of outlet tee or baffle 8 14" Distance from bottom of scum to bottom of outlet tee or baffle Asbuilt-Tape How were dimensions determined? Sludge Judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, .liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at Working level. Tank and coveys at 8" Below grade. Inlet baffle, outlet tee. No sign of leakage Tank to be pumped after inspection 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 15ins•3113 Title 5 Official Inspection Farts:Subsurface Sewage Disposal System-Page 10 0117 Apr 24 15 09:17a p.11 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 15 Briarwood Lane Property Address Michael-Katherine Dumaine Owner Owner's Name information is required for every Hyannis MA 02601 4-17-15 page. Cityrrown State Zlp Code Date of Inspection D. System Information (cost.) 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 15ins•ar73 - Title 5 Olsdel Inspection Form SLovirface Sewage Disposal System-Pape 1i of 17 Apr 2415 09:18a p.12 Commonwealth of Massachusetts IVTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 15 Briarwood Lane Property Address Michael-Katherine Dumaine Owner Owners Name information is MA 02fi01 4-17-15 required for every Hyannis page. Citylrown State Zip Code Date of Inspection D. System Information (cunt.) 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.): D Box is 16"x1T-21" Below grade. Box is clean and solid w/one line out, No sign of over loading or solid carry over. 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.): " 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-3113 Title 5 Official Inspection Form:Suhadace Sewage Disposal System.Page 12 of 17 l . Apr 2415 09:18a p.13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 15 Briarwood Lane Property Address Michael-Katherine Dumaine Owner Owner's Name information is required for every Hyannis MA 02601 4-17-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number. 2 ❑ leaching galleries number. ❑ leaching trenches number, length: ❑ leaching fields number,dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Typeiname of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation,etc.): Leaching is two 500 Gal. Dry.Well Chambers. Chambers are 45" below grade w/cover at 1'. Bottom of chambers wet, wall's clean and dry. No sign of over loading or solid carry over. I 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 t5irs-3113 Tille 5 Official Uispection Form.Subsurface Sewage Disposal System-Pape 13 of 17 Apr 2415 09:18a p.14 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Briarwood Lane Property Address Michael-Katherine Dumaine Owner Owner's Name information is required for every Hyannis MA 02601 4-17-15 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•3113 Tille 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Apr 2415 09:19a p.15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 15 Briarwood Lane Property Address Michael- Katherine Dumaine Owner Owner's Name information is required for every Hyannis MA 02601 4-17-15 page. Cityfrown State Zip Code Dale 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 F1 drawing attached separately P o 0 C,a-33 - Fj4 33 r = C 0 0 3 t5ins-311.3 Title 5 Otfidal inspection Form:Subsufaoe Sewage Disposal System.Page 15 of 17 Apr 2415 09:19a p.16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 15 Briarwood lane Property Address Michael - Katherine Dumaine Owner Owner's Name information is required for every Hyannis MA 02601 4-17-15 page, Citylrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high round water 25 p 9 9 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: Per Plan ❑ Checked with local excavators,installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Per Plan on File ADJ High G.W. at 19'below bottom of leaching. Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5ins-Y13 Title 5 OfGdal Inspection Form Subsurface Sewage Disposal System•Page 16 of 17 Apr 2415 09:19a p.17 Commonwealth of Massachusetts : Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 15 Briarwood Lane Property Address Michael-Katherine Dumaine Owner Owner's Name information is req u ired for every Hyannis MA 02601 4-17-15 page. Cily/Town State Zip Code Date of Inspedion 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 I 15ins-3r13 Title 5 Official Vwectlon Form:Subsurface Sewage Disposal System•Page 17 of 17 =ILE No.d AM 1 2 U ;I ULU I I I JJ AX: 2� 0`�41-39 PAGE � srsro; NOTICE; This Form Is To Be Used For the repair Of Failed Septic Systems Only. U pERCOLATIUN TEST' ANDS lI. FVALUATION EXEMPTION FORM 1, .q(�ia al • c�,����►. hereby certify that the engineered plan signed by me dated d ,concerning the property located at meets all of the following criteria: • This failed system is connected to a residential dwelling only. There are no —� ss uses assaciated with the dwelling. comn.etc,rnl or bustne g • The soil is classified as CLASS i and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or may conduct preliminary tests at the site without a health agent present. • There is no increase in now and/or change in use proposed i'here are no variances requested or needed. * The bottom of the proposed leaching facility will not be located less than fourteen (14) feet above the maximum adjusted grvundw•atzr table elevation. LAdjust the groundwater table using the l 1-irnptor method when applicable] Please complete the following;: A) Top of Ground Surface Elevation (using GIS information) 3-Z— B) G.W. Elevation 5+�+ adjustment for high G.W. DIFFERENCE BETWEEN A and 13 SIGitiED DATE: i NOTICE Based upon the above information, u repair permit will he issued for bedrooms n.aximum. No additional bedrooms are authorized in the future without engineered �e tic system plans. y;health inlder:perminr TOWN OF BARNSTABLE LOCATION kW./ ffvr SEWAGE #o7oal VILLAGE—_� S v ASSESSOR'S MAP & LOT F A0 INSTALLER'S NAME&PHONE NO. /�< � �onbiu ✓ �. pub SEPTIC TANK CAPACITY LEACHING FACILITY: (type) G,G l ,,4) (size) I.2XfA-9S X2` NO. OF BEDROOMS BUILDER O o PERM ITDATE: /� 9�/ COMPLIANCE DATE: f 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 E���.J Furnished by � \ : � a, � � .� � � s .., c �, � � � i `I— � Q w 0 �, � ate" z ,� � _Y COMMONWEALTH OF MASSACHUSETTS w EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS d DEPARTMENT OF ENVIRONMENTAL PROTECTION a 00 I V 1_, 1 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 15 Briarwood Ave Hyannis MA 02601 "1 Owner's Name: Cathy Dumaine Owner's Address: 269 Tarbell Ave Oakville CT 06779 Date of Inspection: July 30,2007 Job#07-142 Name of Inspector: PATRICK M.O'CONNELL Company Name: SEPTIC INSPECTION SERVICES CO. 0 Mailing Address: 189 CAMMETT ROAD MARSTONS MILLS MA 02648 Telephone Number: 508-428-1779 CERTIFICATION STATEMENT I certifythat I have personally � c." p y 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 0. ' approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system::". Cr, €1 X Passes — —_ Conditionally Passes --� -- Need her Evaluation b the Local Appr ving Authority Fai r Inspector's Signature: Date: 7/30/07 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments: Leaching chambers were empty at time of inspection with a high stain line 6"from bottom of structure. ****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 DISPO SAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 15 Briarwood Ave,Hyannis Owner: Cathy Dumaine Date of Inspection: July 30,2007 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _XX_ 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 ass inspection if with approval of Board of Health): P P ( 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: 15 Briarwood Ave,Hyannis Owner: Cathy Dumaine Date of Inspection: July 30,2007 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. I. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(l)(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: Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 15 Briarwood Ave,Hyannis Owner: Cathy Dumaine Date of Inspection: July 30,2007 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _X_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool —X_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool —X_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _X_ Liquid depth in cesspool is less than 6"below invert or available volume is less than_day flow _X— Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _X— Any portion of the SAS,cesspool or privy is below high ground water elevation. —X— Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _X_ Any portion of a cesspool or privy is within a Zone 1 of a public well. —X_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _X_ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed 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.1 _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: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply _ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat 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. Page 5 of 1 I OFFICIAIL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 15 Briarwood Ave,Hyannis Owner: Cathy Dumaine Date of Inspection: July 30,2007 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No _X_ Pumping information was provided by the owner,occupant,or Board of Health _X_ Were any of the system components pumped out in the previous two weeks? — _X_ Has the system received normal flows in the previous two week period ? _ _X_ Have large volumes of water been introduced to the system recently or as part of this inspection? _X_ — Were as built plans of the system obtained and examined?(If they were not available note as N/A) _X — Was the facility or dwelling inspected for signs of sewage back up _X_ _ Was the site inspected for signs of break out _X _ Were all system components,excluding the SAS,located on site? _X _ 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? _X_ — 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: Yes no _X _ 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)) Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 15 Briarwood Ave,Hyannis Owner: Cathy Dumaine Date of Inspection: July 30,2007 RESIDENTIAL FLOW CONDITIONS Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):330 Number of current residents:0 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): Seasonal use:(yes or no):No Water meter readings, if available(last 2 years usage(gpd)): Two years total:35,250 gal.=48 gpd. Sump pump(yes or no): No Last date of occupancy: One week prior to inspection. COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):— Non-sanitary waste discharged to the Title 5 system(yes or no):— Water meter readings, if available: Last date of occupancy/use: OTHER(describe): Pumping Records: None GENERAL INFORMATION Source of information: 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 _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: Leaching system compliance date: 12/5/01 Were sewage odors detected when arriving at the site(yes or no): No I Page 7 of 11 OFFICIAIL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 15 Briarwood Ave,Hyannis Owner: Cathy Dumaine Date of Inspection: July 30,2007 BUILDING SEWER:XX (locate on site plan) Depth below grade: I Materials of construction:_X_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: X.X (locate on site plan) Depth below grade: 6" Material of construction:_X_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:8.5'long x 5.2'wide—1000 gal. Sludge depth: 6" Distance from top of sludge to bottom of outlet tee or baffle:24" Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle:6" Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions determined: STICK WITH HINGE FLAP. Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tees are intact,observed trace of solids in outlet tee Recommend aumaine tank GREASE TRAP: No (locate on site plan) Depth below grade:_- Material of construction:_concrete_metal— fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top-of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 15 Briarwood Ave,Hyannis Owner: Cathy Dumaine Date of Inspection: July 30,2007 TIGHT or HOLDING TANK: No (tank must be pumped at time of inspection) (locate on site plan) Depth below grade:_ Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: XX (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.): Liguid level is at bottom of outlet oioe with no hieh stains PUMP CHAMBER: No (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.): I Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 15 Briarwood Ave,Hyannis Owner: Cathy Dumaine Date of Inspection: July 30,2007 SOIL ABSORPTION SYSTEM(SAS):XX (locate on site plan,excavation not required) If SAS not located explain why: Type _leaching pits,number: _X_leaching chambers,number: Two 500 gal drywells. 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.): Chambers have no standing water with a sidewall stain indicating chambers have never had more than 6"of standing water. CESSPOOLS: No (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: No (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: 15 Briarwood Ave,Hyannis Owner: Cathy Dumaine Date of Inspection: July 30,2007 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. t;. + v. i tl 38 30 45 24 XXX Water 39 21 Service Briarwood A ve Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 15 Briarwood Ave,Hyannis Owner: Cathy Dumaine Date of Inspection: July 30,2007 SITE EXAM Slope None Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water: More than 15 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 local Board of Health-explain: Checked with local excavators, installers-(attach documentation) _X_Accessed USGS database-explain: USGS topo map and town GIS. You must describe how you established the high ground water elevation: Town groundwater contour map shows water below el. 10 and topo map shows property at el.30. Town of Barnstable OF 1HE Tp� Regulatory Services BA STABLE, Thomas F. Geiler,Director O 11SS 0 9. ATFpkip Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 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. < Ni. CTD U L , ®/ '_ � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: V(/ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zipplication for �Diq ool * 5tem Conotrurtiott Permit Application for a Permit to(' astFtto )Repair( )Upgrade(V/)Abandon( ) ❑Complete System LYIttdividual Components Location Address or Lot No. 4 � �11 U1®®0 a°Ae Owner's Name,Ad ss and Tel.No. Assessor's Map/Parcel /�` •L I vol"i5 ^s9- Core, Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 7W-9,,Q 31?_ -j/- 5` Type of Building: Dwelling No.of Bedrooms 3 Lot Size 1z�o sq.ft. Garbage Grinder Other Type of Building Ge-No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow ///� gallons per day. Calculated daily flow 33,0 gallons. Plan Date D , © Number of sheets Revision Date Title 1),C Size of Septic Tank /® Type of S.A.S. 2 p Q' clla",12 Description of Soil " ° Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees io 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 ' o d Health. _ Signed Date Application Approved by Date 0 2w-1 Application Disapproved for the following reasons Permit No. Qo0 I — 70 Date Issued P711 0 ar U d L < '} �,(1 "w* ""7 Fee THE COMMONWEALTH OF M/ SSACHUSETTS Entered in computer: Yes ' PUBLIC HEALTH-DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 0ppYi`cation for 10ioozal bpotem Con!aruction Permit Application for a Permit to Tons i u.a )Re air()Upgrade(/Abandon( ) O Complete System l Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. / •l Designer's Name,Address and Tel.No. �D/ ��oli CUrISy` Oo�v� j= Type of Building: z- + Dwelling No.of Bedrooms A Lot Size / sq.ft. Garbage Grinder(leo Other Type of Building C'J`% pike No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow Al� gallons per day. Calculated dairy flow 330 gallons. Plan Date BCD Pumber of sheets Revision Date Title f)•l`_l4 - Jc / �4'� 4 Z y 9r4 1/'Aley.'4 Size of Septic Tank /��G' Type of S.A.S. Z -3 aeq,W cllawh Description of Soil Nature of Repairs or Alterations(Answer when applicable) 1 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 t oard He lth. /f J1��j Signed Date �f Application Approved by Date Application Disapproved for the following reasons Permit No. goof 70 Date Issued :Zdl o THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of compliance THIS IS TO CERTIFY, that the O!n7site S wage Disposal System Constructed( )Repaired Upgraded Abandoned( )by at iQY k/LVd1,7 411aff. >11"W5 has been constructed in ccordance with the provisions of Title 5 and the for Disposal System Construction Permit No. .200 I-7 y dated D 9 du Installer Designer The issuance f thisfermit shall not be construed as a guarantee that the system will.ftIliction as de ig ed. Date a f Inspector 1 �v o 1— 70 0 Fee- J t/ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migpozal *pztem Con.91ruuction Permit Permission is hereby grante to Construct( )Repair( )Upgra e( )Abandon( ) System located at Z 9/,/a�`4yeoy 'e o�/-` and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this nermit. Date: °!/�� Approved by 0('� LOCATION 75ff"/S� SEWAGE PERMIT N0. VILLAGE INSTA LLER'S NAME i ADDRESS A'A /3 f.6,- G R U.ILDE R OR OWNER Ls cc T-e & s3 l9 DA.T E P ERMIT I S S U ED /o-ac�gS MATE COMPLIANCE ISSUED // 0 s No......�._-.6j 4-4 Fss......$2 5�..00.... THE COMMONWEALTH OF MASSACHUSE TS BOAR® OF HEALTH l ................Town.............OF...........Barn.stable-.--.-.--------.....--------..........._.......... Appliratiun for Disposal Works Cfuns#.rur#iun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal System at: . Ts;arwoo -42647 .........#24.. ........................................................... Location-Address or Lot No. .. o l �. .............. ........ -.. - .....#..29t.. x .. is Porgy 026�7� . -jjy n .. W A & B CanCo Owner 350 Main St. W:d`�farmouth, Ma. 02673 Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.......3................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria a+ Other 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 ( ) 1­4 Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. I................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........................ ----------------------------------------------------------••-••...........:..:......_....................................................................... 0 Description of Soil.........................................................:.............................................................................................................. W ----------- ...•-----------•--- ---------------------------------------- V Nature of. Repairs or Alterations—Answer when applicable____1000 gad lon �tptic tank with D—box .................................................... --.=d.aIIOQ--9aUan...stone._packs.�d..Ieach...p.�a_I...._�t0i....P!te��:;-�'/� --------------------------•-----------............... Agreement:- The undersigned agrees to .install the aforedes6ribed Individual Sewage Disposal System.in accordance with the provisions of TITIE 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in operation,until a Certificate of Compliance has been issued by the board of health. Signed ( I�p ..........................�p� !Ali►v!q �.---•----•-•---•---------•-----•----.... _.... 7Date Application Approved By........-- ........ ... ••---•.............................. ••-•••-1 Date Application Disapproved for th following reasons----------------•----------------........--------------------------------------------------------------......... --......-•-----------------------------------------------------------•----•-----................----•------•••••-•••--••••••••--....•----•-•-•--•-•--•--•------••-...... ............................... Date PermitNo......................................................... Issued........................................................ Date No................_....._ Fxs....... 2t.�£3 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................TOWP.............OF............ a`xnstable---....----....-----------------......: Appliration for Dispusttl Works Tons#rur#ion Errant Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal System at: _Briarwood Rom.Hyannis P®xt_,_.Ma,__02¢47 #24 Location-Address or Lot No. a......--•- -• .... .............. 2 .$ oo�l.Rdt.---•Hya n sPostx..Ma. 02647 W A & B Caneo owner 350 Main St. W;ddyKrmouth, Ma. 02673 Installer Address Type of Building Size Lot............................Sq. feet �.. Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons. Septic 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 ( ) Percolation Test Results Performed by.......................................................................... Date................ 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........................ -------------•-------------.............--•---•---•----......__.....................•-----------••••......................................................... 0 Description of Soil..............•----•-•-----......-------•---....._..................................--••------...._.........----••------•-----.....................................--- U ................ W UNature of Repairs or Alterations—Answer when applicable..__. ©�._ga..lon_._septic tank faith Tl-box .......and_.1Q9Q. .............................................................................................. 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 of health. Signed.....................................................•-------......----••...---------• ..........................- `�� Date Application Approved By_________ - 4.� �c�a� _._....1:Q...-__ ......---- •-•--.......-•-•---• --- •--•-------------•--------•• Date Application Disapproved for the ollowing reasons: ...............................•--•--•--------------•--....---._................••--•-... ••--•--•-•-• --•--- •--.._..••-•--.. . .----•-••---•........................................................... . --•---------. Date PermitNo..................................................._.... Issued......................................................-- :,, Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...............:..To rn............OF.........Barnstable............................................... Trr#ifiratr of Toutpliatur THIS IS TO CERTIFY, That the Individual Sewage Dis osal S stem constructed ( ) or Repaired (X by • ) A & B Canco 3S0. ..Main St W. Yarmouth,..pMa. &;�3 ... -• --...--•........ ....... ........... ..... .... ...... .... - ... ......-- •- . ........ _.__..._ at._..:'4'.4 Briarwood Rd, Hyannis Port._�_.._.._..l+�a,a110264�' ----------------•-•---------.-._.._...-----------...... .._ - has been installed in accordance with the provisions of TITLE 5 of The State Sanitary. Code as described in the application for Disposal Works Construction Permit No....... q44 dated________________________________________________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE---------•• -f� 4 `q -------••--------------............ Inspector...........(.. . .. ...................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH g S-q$g. ...................�'��...........OF....:tt.VYOO_�......... Jjr..aG Disposal Works Tons#rurtion ferinit n Permisslon Is hereby granted.. l..:Of3 ' 1 C"�. -!" 0.:........:....................•--•------...................._...... to Construct ( ) or Repair O an Individual Sewage Disposal System at Nod................ :. .�~ Cr%^ w c..... . ..... A.... -- ._ `�44�?:(�t`_ � ............................................................ Street Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... t ...............14.......................---- ........................... rd of Health DATE........... .......................1U.................: ............... FORM 1255 A. M. SULKI44,INC.• BOSTON COMMOWEALTH OF MASSACHUSETTS ` OFFICE FOR CHILDREN HEALTH INSPECTION REPOR' This is to certify that 13zLIEWo_2d - Name of Facility located at Briarwood Lane Hyannis. MA 02601 �~ Address City was inspected on byTo�x, Date Name of Inspector Barnstable _Health Devartraent - - Inspecting Board, Agency or Department The above facility complies with applicable regulations regarding: . Water Supply Yes No _ Sewa a St stem Yes No Disposal of Garbage and Refuse 5tes Na ¢ Lighting and Ventilation Yes No Laundry Yes No Food Storage and Preparation Yes No r 1 Approved: Yes No Conditionally* w Signed (inspector or representative of inspecting authority) r ° Recommendations: Please send a copy of this report to: Lynda V . Allen RegionVTT Licensing Specialist Office for Children L�.ke v i l l t- Hnsp i tom_ Lakeyi l 1p - 14sss - op346 f *Conditional approval ri`1 be given only when, in the opinion of the inspecting,authorit:y childrenls health .could not be end��vngered in the facility prior to correction of note:' non-compliance items. Conditionaljpproval will satisfy provisional licenAi1g require- rmcnt 101.1(€) , but certification must be obtained before a regular license can.be issued. `l� p V'c D4RE SCHCOLS on OPE COD ' Stephen R.Andrew 477-0554 Director Advisory Committee Kevin Chase Phyllis Cosand ,.. Margaret Greene �J"1 Debbie Jo Lancifear Louis Larrey Gardner Miller Pamela Oliver BOX 460 Peter Sessa Harry Seviour Sponsors , MASHPEE, MASS, 02649 Briarwood Community Living Project June 18, 1980. Horizons Morning Star Roadside Sojourner Truth John Kelley, Health Inspector Town of Barnstable Town Offices Hyannis, Massachusetts 02501 Dear Mr. Kelley: �� I am writing to inform you that DARE/Briarwood, at 24 Briarwood Avenue, Hyannis, will close on June 30, 1980. The decision was made by the staff of Briarwood and the administration of DARE . Schools on Cape Cod, and is based on fiscal constraints and the impossibility of providing high quality services. within these limitations. The amount of money allotted for household mangge- meat and daily living expenses has been quite insufficient. One area that has been greatly hampered by the lack of money is, as you know, the maintenance and upkeep of the building itself. Since we will not be occupying the premises after June 20th, we do not plan to make substantial repairs to the floor, pooch, or bathtub. We do understand that the new landlord is planning to make these repairs, however. In closing, thank you for your time and efforts in helping us provide a decent "home" for our young women. We look forward to working with you again. Sincerely, DARE/Briarwood , Suz�helhlllips Program Supervisor Those who wipe our children': tears Will never weep alone VE NRE SCHCOLSon c4PE COD Stephen R.Andrew 477-0554 Director Advisory Committee Lou Cerrone Kevin Chase Larry Frye Margaret Greene p^ Debbie Jo Landfear BOX 46, Louis Larrey Gardner Miller MASHPEE,MASS, 02649 Harry Seviour Sponsors June 10, 1980 Briarwood Community Living Project Horizons Morning Star Roadside Sojourner Truth John Kelley Health Department Town Hall/Building Hyannis, Massachusetts 02601 Re: 24 Briarwood, Hyannis Dear Mr. Kelley, This letter is to inform you that as of June 30, 1980, we are no longer occupying the house located at 24 Briarwood Avenue, Hyannis. Sincerely, Susan P. Lindquist Acting Director cc: Jane Kavanaugh, OFC SPL:bcj �U d r THE T�y TOWN OF BARNSTABLE (COPY � OFFICE OF BAHA36. MA66. E, : BOARD OF HEALTH q p� o�A 1639- �0 TEOmif 397 MAIN STREET HYANNIS, MASS. 02601 May 6 , 1980 Ms. Artha C. Freebury Coordinator Office for Children -Region 5 Lakeville Hospital Lakeville, Ma. 02346 Dear Ms. Freebury: I recently requested and received your licensing addendum con- cerning the Dare School facility, named Briarwood. Please be advised the Health Department has only inspected Briar- wood twice. The first time was for the initial licensing at which time the form was signed approving licensure. Approximately a year later we received a form and a telephone call from Suzanne Phillips requesting an inspection. This inspection was conducted on January 3, 1980. The major discrepancy noted at this time was the nailing of windows to only open one quarter of the way. Ms. Phillips stated the Building Inspector authorized the nailing of the windows for se- curity reasons. I contacted the Building Inspector who stated he had not authorized the nailing of the windows. I asked the Building Inspector, as a matter of safety, to inspect. Enclosed is a copy of the memo sent me by him. At the time of inspection, Ms. Phillips could not give me any time table as to when the bathtub would be replaced. I suggested several possible remedies but stated the tub appeared so pitted they might not work. Oxalic acid, one part to ten parts water, is a last resort and I cautioned that even using rubber gloves they probably shouldn' t use it. Violations concerning bathtubs and showers are considered major items in 105 CMR 410. 000 Minimum Standards of Fitness for Human Habitation. If a tenant complained of this condition, we would be mandated to require the landlord to replace it. I understand your position but would appreciate some communication prior to your reaching a conclusion. I have no objection to your conducting your own inspections and accepting the responsibility for the health and safety of the chil- dren involved if this is what you desire. . Ms. Artha C. Freebury Page 2 May 6, 1980 However, hopefully our agencies could work together for the mutual benefit of the children involved. Very truly yours, hn M. Kelly J irector of Publi Health JMK/mm cc: Building Inspector ti W GO r d O^M SV ey`e� we JOHN M. ISAACSONLT� c �Gt�aG DIRECTOR727-8900 GLORIA J. CLARK CJ�f REGIONAL DIRECTOR May 1, 1980 947-1231 Mr. John Kelly Barnstable Board of Health 367 Main Street Hyannis, MA 02601 Dear Mr. Kelly: Y Enclosed please find the licensing addendum written by my supervisor, Artha Freebury. Thank you for your cooperation regarding the DARE Schools on Cape Cod. Sincerely, M. Jane Kavanagh Group Care Licensor Region V MJK:jb Enclosure F I, m ✓/( '�/C-o/l//%l</liG'l�U !L'fz (' ��l (d:'Cf/6/��✓���J . I JOHN M ISAACSON c/✓CS(O/l, ���1 flJ�(IC/!.!!S< 1 tn, 7/�� Area Code (617) Director 727-8900 LICENSING ADDENDUM DARE - BRIA.RWOOD The licenisng of Briarwood has been held up for a 'considerable period of time because of re-occuring difficulties in acquiring a health certificate. Each time the health inspector visits, at the request of DARE, new and different issues are cited preventing them from receiving certification. Three checklists have been provided with remarks and checked areas of violation - non of which appear to be major problems. All were corrected with the exception of the latest report showing the reason for denail of certification as a badly stained bathtub. The tub does have severe staining from chemicals and minerals in the water and is very unaesthetic. However, through close inspection (during a monitoring visit January' 18 1980 by the- under signed OFC staff) it was de termined that the tub was clean and not a health risk. The staff have attempted various remedies to satisfy the health inspector without success. He has usggested use of some type of acid which he says will remove the stain which they will try. However, it appeared as if the surface enamel is badly worn and cannot be corrected with- out re-serfacing. The building is on the market to be sold by the owner who is declaring bankruptcy and therefore replacement of the tub is not possible. DARE°s financial difficulties at the moment also prevent purchase of a new bath tub. Because the assessed health situation does not appear to endanger the health and safety of residents it is recommended that licensure not be withheld for ' this reason. January 24, 1980 Jane Kavanagh, Licensing Specialist, .Region V Artha L. Freebury, Coordinator { is I Speed Letter, TOWN OF BARNSTABLE TO, Mr. John M. Kelly From MASSACHUSETTS s Director of Public Health Joseph D. DaLuz Town of Barnstable Building Inspector Subject BRIARWOOD/Dare School -No.S91OFOLD MESSAGE John: I inspected Briarwood with Steve and told him of the corrections to be made - the floors, bath tub as you had mentioned and the windows. He said he would start on the items. I will follow through. He had one student leaving and wasn't sure when they would get more. Thanks Date 2/27/80 Signed REPLY -No.S FOLD -No.10 FOLD Date Signed Wilson Jones Company GRAYLINE FORM 4"T 3-PART _ RECIPIENT—RETAIN WHITE COPY, RETURN PINK COPY C 1976•PRINTED IN U.SA ii 11 G SENDER: Complete items 1,2,and 3. Add your address in the"RETURN TO"space on 3 reverse. The following service is requested (check one). r ® Show to whom and date delivered. .. .. .. .. . ¢ ❑ Show to whom,date,and address of delivery. . ¢ RESTRICTED DELIVERY Show to whom and date delivered. .. .. . . .. . ❑ RESTRICTED DELIVERY. Show to whom,date,and address of delivery.$ (CONSULT POSTMASTER FOR FEES) 2. ARTICLE ADDRESSED TO: Mr. Arthur Thurber m 14 Main Street HYANNIS MA 02601 Z 3. ARTICLE DESCRIPTION: n REGISTERED NO. CERTIFIED NO. ! INSURED NO. I 1532070 71 m I (Always obtain signature of addressee or agent) 2 I have received the article described above. mSIGNATURE ❑ Addressee ❑ Authorized agent y a. C DATE rF� DIVERY ±a� PO'WARK Z 5. ADDRESS (Complete only if requested rn m 6. UNABLE TO DELIVER BECAUSE: CCRK'S R" INITIALS O 3 D i= {r GPO: 1978-272-382 1 I I UNITED STATES POSTAL SERVICE OFFICIAL BUSINESS SENDER INSTRUCTIONS PENALTY FOR PRIVATE I Print your name,address,and ZIP Code in the space below. USE TO AVOID PAYMENT • Complete items 1,2,and 3 on the reverse. OF POSTAGE,$300 nt=LS&MAIL Attach to front of article if space permits.Otherwise affix to back of article. • Endorse article"Return Receipt Requested"adja- cent to number. I RETURN I TO I I HEALTH DEPARTMENT I (Name of Sender) P. 0. Box 534 (Street or P.O. Box) HYANNIS MA 02601 (City.State.and ZIP Code) rr Olt June 27, `1979y . r` < •K { 41 r # ' g1 ��s{I-, r a- i f r' ♦ Y A. � .ta' r .y' r �,� �"r '.�" z '.s• ~ Mr. ^Arthur Thurber. 14.. Main Street � s i MAC!' 026.01 NOTICE TO ABATE 'A. PUBLIC HEALTH 'NUISANCE F u" W { y , e to ..:' ;'i 4 -..' , '« .. .•. '.. ;The property owned by you. on--Briarwood Lane, Hyannis, and occu-- pied by the Dare School .'.`was :inspected on ,June 25;, 19,79, by Barnstable, be+ Paul C. Murray, Heal th Inspector. for 'the;Town,:of, . xb a pcause- of `�' 'several comply ntas. , •TYie' fry iciwing"'viol .ons -at Title 5, ,.'. Minimum YRequirements for'.The. Subsurface :Disposal=;of Sanitary "Sew- acge, State ,EnviroiarnentaVF Cody:, ,were'° found � � ♦a REGULATYON 2,A9 MAINTENANCE: ,:,Present `sewage syistem inadequate. R , Observed,ov.,erflowir4i i:constitutirig a :health hazard to„occupants and ,ne r hbors. ,You '«are directed 'to,-•hav6 c4ispo6l pumped'.immedi,-` ately° ..In- ,addition nyou'.are di.rected,. to`f install ari c�n�o�te �sAewage .tystein P that wig.].. comply to Title= 5`, 'Minimum"Rec,�u iem6nt�s' for 4the"Sub- surface' DispC of .Sanitary sews e;.State Environmental Cold, r" within fourteen 0'4) .daya. of. receipt of this order.' r Yau may,>rec nest a hearincl before Board:of H 'Alth ,if-°written ,m r petition requeatig same- is received seven §?) days after the date-.., order �seirved,. w r,. Non-`compliance could result in 'a fine' of';`up to $50t}, each days £ai.lure -to comply with ,an 'order shall constitute a,,aepar"ate,:Vigo-- : k; �;. lation. y >•r w .fix t «d xy r r ^1 p EA ER 0 FIE B�R�.0 F RD� OF HEALTH• «E RD T John 'M. 'Kelly P#ector-of Public Health , F,. iY .. „M' •, . ' '. ' '.}.V ,•, .. j ` ryrc t 'r Y. nF7 9.�i .+ N A;, s I v� !:. ._ 1 Ysr. .4• 4'Y_ ��"~ , .. {KV l . r r ' ' A Y �! TOWN OF BARNSTABLE - BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date /'1,f d . Owner T�`q A i 21U/2 - / 7C- Tenant Address Address Compliance Remarks or Regulation # Yes No Recommendations 2. Kitchen Facilities 3. Bathroom Facilities r tJlj l fJ 63 1L 4. Water Supply 5. Hot Water Facilities 6. Heating Facilities 1, 7. Lighting and Electrial Facilities _t T. �<c�� • >` /'� rj 8. Ventilation 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal 17. Temporary Housing PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Person(s) Interviewed }' Inspector s_..-X----------- ------------------------ If Public Building such as Store or Hotel;Motel specify here ____-_-._____________________________________________________________.-____..._-_____-_..______-.-_ THE q MMONWEAL OF MASSACHUSETTS BOARD OF HEALTH l . . NOTICE TO A TE A NUISANCE ----- - --- ----- --------------------19 `' '. .............................. T ----------------- - -- -- =--------•-- ----• -- owner A% jJ � ` �g= Af nnnnt _ � - - -- - v ✓ you are hereby notified to remedy the conditions named below within ___________________days o1 the service of this notice, Sundays and legal holidays excepted, or to show cause why you should not be required so to do: ..� ��---•---- •v----•---•-•--••-- •----------••-------------••------••------------------•--------- -----------------—----------------- --- ------�-- ------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------ -------------------------------------------------------------------------=---------------------------------------- r: _ ___ __ ____:__:_: -------- ---- - --- -- -- --- ------- , ) at the expiration of time aIlowed these conditions have not been remedied and no cause aforesaid be shown, such further action will be taken as the law requires. Z By order of the Boar /HpIlt /. - ` - ------------ pec�tor. Mail------------------------Personal Service--------------------._----- Any objection or inquiry in reference to this notice should be filed before the expiration of the time allowed for the/abb tement oft isance. Address all communications,//Board of Health_/ s •-------------------------------------------- Mass.>; FORM 600 HOBBS & WARREN, INC. THE C MMONWEAL H OF MASSACHUSETTS it BOARD OF HEALTH NOTICE TO A TE A NUISANCE --- ------- 5=----------------------19-7, -------- -- M - ...ownerhs-esca�g�nt�of ��1 - _ .yy���t -x you are hereby notified to remedy the conditions name �6elow within -------------------days of the service of this notice, Sundays and legal holidays excepted, or to show cause why you should not be required so to do: /� --- --- v-�-� ------• --------- ---_-----••----•--•--•-----------••-•--------------•----------e------•--------------•---•---------- ---- ------ S t------------------------------------------------------------------------------------------------------------------ ----------------------•----------.-..-_-__------_---.--.-.----.-.--_-_-__--_____---------•-----------__----------- ------------------------------------------------------------------------------------------------------------------ ------ -- -- ----/----------- -------------- ------------------------------- If at the expiration of time allowed these conditions have not been remedied and no cause aforesaid be shown, such further action will be taken as the law requires. By order of the Board,. /Halt n � ctor. Mail _Personal Service.-_.______-_-.____.._______ Any objection or inquiry in reference to this notice should be filed before the expiration of the time allowed for the ab tement of the:pisance. Address all communications,"Board of Health /[_�'_ 4f/ -, v -----------------------------------------------------------------------------------Mass. FORM 600 HOBBS & WARREN, INC. - CO E D4RE SCHCOLS on CRE COD VN, l Stephen R.Andrew 477-0554 Director Advisory Committee Kevin Chase Phyllis Cosand ,.. Margaret Greene Debbie Jo Landfear Louis Larrey Gardner Miller Pamela Oliver BOX 460 Peter Sessa Harry Seviour A. Sponsors MASHPEE♦MASS, 02647 Briarwood Anril 29, 1980 Community Living Project Horizons Morning Star Roadside Sojourner Truth John Kelly Barnstable Board of Health Hyannis, MA 02601 Be : Briarwood Lane f Dear Mr. Kelly, Per agreement with our conversation on Friday AlDril 25, 1980, we will replace the bathtub within two weeks in order to comely with your recent health safety study. We are in the ?process of changing landlords. We have had a difficult time negotiating for ,improvement costs during the mort- gage exchange. We will notify you on or before May 9, 1980 when the new bath- tub is installed. We hobe you can instiect the facility again at that time. Bespectfully, Stethen B. Andrew Director cc : Jane Kavanaugh - OFC Those who wipe our children's tears Will never weep alone r orr. JOSEPH D. DALuz TELEPHONEt 775.1120 Building Intparo. EXT. 107 TOWN OF BARNSTABLE BUILDING INSPECTOR TOWN OFFICE BUILDING NHYANNIS, MASS. 02601 ► April 15 1980 P Ms. Susan Lindquist Dare School on Cape Cod Box 46 Mashpee, Ma. 02649 RE: 24 Briarwood Dear Susan: Listed are the items which must be addressed as soon as possible: 1. Missing Floor Tieles must be replaced. 2. The Bath Tub must be cleaned as per Board of Health. 3. Windows must be openable for emergency. 4. The Front Porch has screening that needs replacement. 5. General Cleanups of the grounds. Peace dJose' D. DaLuM B ilding Inspector JDD/df cc: Board of Health .:IHE .D 4RE SCHCOLS on C4PE COD Stephen R.Andrew 477-0554 Director Advisory Committee Lou Cetrone 1W Kevin Chase Larry Frye Margaret Greene p� Debbie Jo Landfear BOX 46, Louis Larrey Gardner Miller MASHPEE,MASS, 02649 Harry Seviour Sponsors April 16, 1980. Briarwood Community Living Project Horizons Morning Star Roadside Sojourner Truth — John Kelly Health Department South Street Hyannis, MA 02601 Dear Mr. Kelly, Enclosed is a copy of the Briarwood"- license. Joe Daluz requested we mail this to you. Sincerely, 4us"anP. Lindquist ssociate Director }r.Y % ya ,• II 4 3} ?I r R , r -� .. - 11.t s as 11 - ��„ '€'d'•q+. - ".'•s ,, , .. . t t _` o• _ '` 1. G fi Ate ��-'t t , S ?: In . fix:.. Y.q+r f > ,, �„,-xr .+�+,,,L a,.... a :. ;x �, t �;* '` THE.COMMONWEALTH OF, MASSACHUSEr. Y, s � ,W` 'i s ;' ^ y _ �,,, 5'x0 }? a r x ,c �.'•*�.*i ;.c;,'. �.,,, 1 "r rr r x,. :;g' ..' y < ,,J[*§;"i: � e ,t"�" d �yn„yq;�-t 'V:� �. tt,• e a �11,,y x: yp '§ } r '� t N A ,t. �'.Y'i. Y ''�: •{t{ -� ! �, �.H J,p/- :k.,y i.�i'i 1,. _ L:7 A.Y1d'.+..M1t a! r"t �'t„i•;k' l..a: !qwf. ",, r�,eqr_ ;.... 4*Zsn,.. t}'.F .. 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',«..,e ^,,,,s } 5"'� i :s 'is x q.y... ri? :a. 11 w. .Iq p rr',1 `, '.`'�L rt,G ,:' ,ta s -1 11 �ea-F , •� '1<. Y:, r ram'"L'�,::,: d ..a«...,e. i ' ` a '. ' x 3�,,�> ,6�" 1. :: , , :�.:_, DARE�ti INC.~� . �, . :" xr <». 7. ..e. ••. •' i•• n• ••.••'• r...••:•.• •-• •.• •.•..• •i • i i •,.:i•..;•'�:. • i' f .:!'•.l• •,�t;`• •• • r.y T•'r.;}• a r'. i.� •. •• ••4• -,•R•R• F-, , �11• • R .?.`fr !. �. y '�- i ."tin tk ,.',g- y },7„ ,,,a"6:: k 'F x�i -: .:} a-` - .r '-.: ¢ , ', am w.,, .rr. . .,,,.,'.-., , ,a:at„ r' ' „,ty'.;.. ...k-. p i a,s, iiY 7... �.+ . max: :;: R P :, v.. �,. &� , .NeME OF LICENS-',. . #g * "£ .2,....'" A'. , *,x^. Ty...... y'.�`. n„ - �. .,v 7- ;.'y,: e .:�, i, .:, .:tea, .er,.' au - ,C 6 +`-" .v, g . f / a-`••r s•,,ry x2"'g,` x S' 7 # ,, ., a ...�' F. - ,1 > h.t: 'f- �w',' ,...,-..,. - '�a s C e� Ka'n25u :'wS s. 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GRADE (NOT TC SCALE) ACCESS COVER (WATERTIGHT) TO { MINIMUM .75' OF COVER OVER PRECAST WITHIN 6' OF FIN, GRADE 2% SLOPE REQUIRED OVER SYSTEM Y el I 2' DOUBLE WASHED PEASTIDNE ! EL 31.3 RUN PIPE LEVEL I ( I FOR FIRST 2' 3' MAX. // TARA HOTFt. I I � i EXISTING�0-4 -J?-E-- { + GALLON SEPTIC 29.8� E 29.0' - - - TANK t€-1- ._1.Q�) GAS _ - '` I�� '�t .� 28.19 QOOO O (�� C7O ,P AQ( (RE-USE) BAFFLE 28.36 � �' 28.17° �I ® "' ?� L O Q O r-1000 ( P ) OOOED O 00CD0 I Io�us r a ---- SLtJ 6' CRUSHED STONE CAR MECHANICAL I 8 ,,w �' COMPACTION. (15,221 123> 2' Q Q Q Q [� .O Q O O c" 26,17' c> I DEPTH OF FLOW '4 1.5 , 1 SLOPE) ( % SLOPE) 3/4 TO 1 112 DOUBLE WASHED STONE: I ,. TEE SIZES, ra.� INLET DEPTH OUTLET DEPTH u -14 �LtJCATI[1N MAP NTS FOUNDATION-- EXIST SEPTIC TANK 95 D' BOX 4 LEACHING � CONTRACTOR TO CONFIR,.a SUITABLE SOILS IN AREA of , FACILITY- PROPOSED LEACHING FACILITY FOR 5' F3FNrAT1•1 SYSTEM ASSESSORS MA(' 289 PAP, 90 � ! 19.2 j PRIOR TO INSTALLATION. INVERT 17.1-EVATION MUST BE ! WITHIN .SOITABL.F SOILS. )F UNSUITABLE ONDITK)NS FOUND, REMOVE. FOR 5 AROUND FACILITY AND REPLACE WITH CLEA14 MEDIUM SAND. ENGINEER TO INSPECT AND CERTIFY IF ENCOUNTERED. j f ADJUSTED GRO-NDWATER EXPECTED AT EL. 7.0'k i A_ 32 8 4 � 33.1 2.5 I .4.3 LOT 24 Ll 11,250± SO. t�T. j�6 / �� + 32.8 //- 4,P 32.1 32.9 2.4 �� A) SEPTIC DESIGN: (GARBAGE DISPOSER 1S f '2 / 33.7 / .)ESIGN FLOW 3- BEDROOMS C 110 GPD) -- 330 GPD IN(I T . �c / USE A 330 GPD DESIGN FLnW `;EPTIC TANK 330 GPD ( 2 ) = 660 1. F)(aTUM IS _APPROXIVA 'a ,L�.Q GIS_,-MA .---__-__..__._..-_.-____.. 5 i a• �. �� + A 1000 r W A ___....._X._.l._S_T_IN._._;+ 31.6 EXIST. SEPTIC TANK USE A GALLON SEPTIC TANK (EXIST) c JNI I LA ( R EkST. DWELLING (RE-USE) - ,- _TOE' FN=�N 32.7' ..,.F�l �93Id� y �, DRYS#IFiN F�61DIN� FGR? / 32.7 \ 2(30 + 9.83) 2 (.74) 11F� ALL PRECCAST UNITS TH B'f.: AA SH'] 31.3 r 3 �✓ l SIDES - -- -- --_--- - --- '). PIPE JOINTS Tp BF MADE. WATERTIGHT. > ��/ / 30 x 9.83 (.74) 218 +� 31.E 3E_,TTOM: _. _- _ _ _ 6, CONSTRUCTION DETAILS TO BE IN A(]C[7RDA�F€... WITH MAS.,. t � 31.a i ENVIRONMENTAL CODE TITLE V. 30,9 ' (;TALI 454 S.F. 336 GPD PO L �_`°q ='-\. / __ _._____ _.,_ 7, THIS PLAN IS FOR F'ROPiJSC-D SEPT'C SYSTEM [INL.Y AND IS NOT c � , \ I?C (2) 500 GAL, LEACHING CHAMBERS (ACME OR __ �C O BE USED FOP ANY OT4-Ifi R PURPOSE. G,I,c i , + 2 W �" [OUAL WITH 2.5' STONE AT SIDES 4' AT ENDS AND 5' R PIPE FOR SEPTIC SYSTEM TO SCII. 40--4 F'VC'. ES.TWEEN UNITS 9, COMPONENTS NOT TO BE BACKFILLED OR CONCE_AI_.ED WITHC.ivr '� INSPECTION BY BOARD OF HEALTH ANTI PERMISSION OBTAINED '4 / ASSUMED WATERLINE LOCATION ONLY. CONFIRM -ROM BOARD OF HEALTH. �Q)� PRIOR TO EXCAVATION 10. PUMP & REMOVE (OR FILI__ W/CLEAN. SAND) EXISTING SEPTIC SYSTEM 9,7 30.0 i3 EXISTING LEACHING FACILITY 1-5I 29.6 / � + 30.0 °1 UNKNOWN LOCATION {/29.6 ....., _. .. _ _.._.-wrrn.. _ _ _, .... ._ _.. ...vr-rmx•-.mx^_^..-rr^a-a•exees..n--n-,uc--..-.�.+ ..�.•,--.x•are•-mc.-r.n:r-. 29.6 100,0 PROPOSED SPOT ELEVATION 0_F ?9,�3 24 BRIARWOOD AVENUE 9.e 100 x 0 EXISTING SPOT ELEVATION -' IN THE TOWN OF: F1001 PROPOSED CONTOUR �� _ABLE - ( HYANNIS ) RARN � � AI_E +/29.7 U'CH MARK - CTR OF 100 t_XISTING CONTOUR PREPARED FOR: BORTOLOTTI N c.E3ASIN EL. - 29.8 CON STRUCTION/COTEI_l_ESSA 20 0 2.0 40 60 1 .BOARD OF HEALTH APPf�(JVED DATE MA SCALE: 1" - 20' DATE: OCTOBER 31, 2001 -� -� } off 50t$-362-4!i41 s Fax 508 362-9"0 aaws�a.q � iN i'/_.uc� I �•a� down cape engineering, inc, 4RNI I1, qr , W O,)AI.A " s , O,IA._/1 r+ � �� �, Na CIVIL FNCANF F Fla N CIVIL s o. 30792 A LAND SURVEYORS '/s 01 ��9 9 s ya a�, th, rla 02675 � +,