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0015 BUCKWOOD DRIVE - Health
1.5 Buckwood Drive NY Zan. n :SO A -272-033 0 u k I TOWN OF BAkNSTABLE LOCATION SEWAGE# VILLAGE y\VC C\ ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SCg,\C 1;rc,-\VL ,S—OY .2 r74 6065 SEPTIC TANK CAPACITY (2 56^Sk t�O O LEACHING FACILITY.(type)7�} k kkrC\kO (size) a 4 NO.OF BEDROOMS OWNER C.V3 S CCO r"'i!\ PERMIT DATE: 1 i I.1 COMPLIANCE�DATE: �� Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Tj A Feet Private Water Supply Well and Leaching Facility(If any wells exist on �J site or within 200 feet of leaching facility) l�A Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) /V Feet FURNISHED BY 0 C3- ' sue ;0 bos x ® � s s ;zoo 1 �.1� y� rl c J ,ftzajdqps Materials Inventory Sheet Checklist JZ3v —Date Physical Street Address-Check database to ensure it exists_ —�Working Phone Number Actual Amounts -(ie. gas being used to fuel machines, thinner to clean brushes all count as hazardous Materials-no blanks) �- Storage Information -location of storage, how long is storage for? ,, If none, note that. ���j�f- Disposal Information -where and who? If none, note that. Applicant Signature - understand what is listed and noted Staff Initial -any questions, know who to ask V, /j- Vehicle Washing/Rinsing? -give a vehicle washing policy and �-�A tee— xplain it // Attach the Business Certificate with your sign off and comments **The inventory form should explain what the business consists of and the procedures they are doing. Notes need to be left to explain what you discussed with them. YOU.WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by.M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601. (Town Hall) and get the Business Certificate that is required by law_ GG DATE: I y 1J Fill In please: APPLICANT'S YOUR NAME/S:_ _ ,'o �»,c� �,(,'Ze2 vi INESS YOUR HOME ADDRESS:_ rk r velcage !p Z3 8- �, - ----- ` f TELEPHONE # Home Telephone Number NAME OF CORPORATION: NAME OF NEW BUSINESS ,i, O TYPE OF BUSINESS IS THIS A HOME OCCUPATION? YES NO '�— AOORE55 ❑F HU5INESS l MAP/PARCEL NUMBER_ 3{-)� O (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the.information you may need. You MUST GO TO 200 Main St. - ,(corner of Yarmouth Rd. & Main Street) .t❑ make sure you have the appropriate permits and licenses required to Ieggi P'OMPT- W M9gOUl�IVGCpIPJPATION 1. BUILDING GO I(/115510 ER'5 ❑FFICE RULES AND REGULATIONS. FAILURE TO This individu I hsPs n i9.r nf ny rmit re ui ements that pertain to this type of bus!RQMPLY MAY RESULT IN FINES. Au ho d igna e** - COMMENT .2 f . BOAOU HEALTH ct"T��r This Individual has, ormed rm r. uira that pertain to this s type of business, ure** Must-COMMY WITH"A L Authorized Sign COMMENTS: HAZARDOUS MMTEFOALIS 9EGUlaIO-VS 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This Individual has been informed of.the licensing requirements that pertain to this type of business. Authorized Signature** xr COMMENTS: Date: TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: k i. f ,'- -?,'Nc ®,c Cgj C,2a� BUSINESS LOCATION: /S_ �� � ,� INVENTORY MAILING ADDRESS: TOTAL AMOUNT- TELEPHONE NUMBER: CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: INFORMATION / RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene,#2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED - Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Apo ant's Signature Staff's Initials { Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 15 Buckwood Drive Property Address Cronin Owner Owner's Name information is required for every Hyannis Ma 02601 3/30/2013 page. Cityrrown 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:Ming out frms " A. General Information filling out forms n on the computer, use only the tab 1. Inspector: key to move your cursor-do not Sean M. Jones use the return Name of Inspector Y S.M.Jones TitleV Septic Inspection td Company Name 74 Beldan Ln. Company Address ICI Centerville Ma 02632 Cityrrown State Zip Code 774-248-4850 smjonestitle5@gmail.com S14522 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 C7 r„ ❑ Needs Further Evaluation by the Local Approving Authority , 3/30/2013 r.�,v r�ri Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approv ng Authori (139'jd of Health or DEP)within 30 days of completing this inspection. If the system is shared systemc4 has a design flow of 10,000 gpd or greater, the inspector and the system owner shall sull it thi; 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. G( 1 t5ins•11/10 Title 5 Official Inspection ubsurface Sewage Disposal System•Page 1 of 17 Y • Commonwealth of Massachusetts = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 15 Buckwood Drive Property Address Cronin Owner Owner's Name information is required for every Hyannis Ma 02601 3/30/2013 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: ® 1 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 dwelling located at 15 Buckwood Dr Hyannis is served by a Title V septic system consisting of a 1000 gallon septic tank, distribution box and 24 quick 4 chambers in a bed formation. The system was found to be in proper working condition at the time of inspection. 13) 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 117 f � ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Buckwood Drive {' Property Address Cronin Owner Owner's Name information is required for every Hyannis Ma 02601 3/30/2013 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) , B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): j ❑ broken pipe(s) are replaced ❑ Y ❑ N FIND (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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Buckwood Drive Property Address Cronin Owner Owner's Name information is required for every Hyannis Ma 02601 3/30/2013 page. Cityrrown 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 cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 15 Buckwood Drive Property Address F Cronin Owner Owners Name information is required for every Hyannis Ma 02601 3/30/2013 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate Lt5in. 1/10regional office of the Department. 1/to Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 r Commonwealth of Massachusetts G Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments < 15 Buckwood Drive Property Address Cronin Owner Owner's Name. information is required for every Hyannis Ma 02601 3/30/2013 page. CityfTown State Zip Code Date of Inspection C. Checklist k x 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? ® El Were as built plans of the system obtained and examined? (If they were not available note as NIA) ® ❑ 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)] } i 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): pro gpd provided t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 15 Buckwood Drive Property Address Cronin Owner Owner's Name information is required for every Hyannis Ma 02601 3/30/2013 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Detail Sump pump? ❑ Yes ® No Last date of occupancy: vacantDate 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments G M , 15 Buckwood Drive Property Address Cronin Owner Owner's Name information is Hyannis Ma 02601 3/30/2013 required for every y page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 15 Buckwood Drive Property Address Cronin Owner Owner's Name information is required for every Hyannis Ma 02601 3/30/2013 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: system repaired 3/19/2013 per town records Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 15feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10+feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints ok, no leakage, vented through roof Septic Tank(locate on site plan): Depth below grade: 10"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 gallons Sludge depth: 6" t5ins•11/10 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 Buckwood Drive Property Address Cronin Owner Owner's Name information is required for every Hyannis Ma 02601 3/30/2013 page. Citylrown 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 3' Scum thickness 3" 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? opened covers, took measurements 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 does not need to be cleaned now but should be done soon and again every 2 years for proper maintenance. Water level was even with outlet invert, tank was not leaking and was structurally sound. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: s ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): i Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 15 Buckwood Drive Property Address Cronin Owner Owner's Name information is required for every Hyannis Ma 02601 3/30/2013 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No I t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 15 Buckwood Drive Property Address Cronin Owner Owner's Name information is required for every Hyannis Ma 02601 3/30/2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Distribution box was new with system repair 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.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 15 Buckwood Drive Property Address Cronin Owner Owner's Name information is required for every Hyannis Ma 02601 3/30/2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 24 quick 4's ❑ 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.): s.a.s. was installed 3/19/2013 with permit#2013-015 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 15 Buckwood Drive Property Address Cronin Owner Owner's Name information is required for every Hyannis Ma 02601 3/30/2013 page. Citylrown 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M y 15 Buckwood Drive Property Address Cronin Owner Owner's Name information is required for every Hyannis Ma 02601 3/30/2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: hand-sketch in the area below ® drawing attached separately t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 I T 6WN OF BAk STABLE — LOCATION ,- `,LI,Z,C�(j� ®� ' SEWAGE# VILLAGE_ �� ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. Cc SEPTIC TAN CAPACITY e LEACEING FACILITY: (type)? (size) a q C,*J' ��lv.i NO. OF BEDROOMS {-w.J1�•� < OWNER C-���Se l �vcrr �- �U!� PERMIT DATE: /'►`� 1 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching � Private Water Supply Well and LeachingFacility(If any wells exist Facility "� Feet site or within 200 feet of leaching facility) st on �l/y Edge of Wetland and LeachingFacility l�� Feet ty(If any wetlands exist within 300 feet of leaching facility) ,V U FURNISHED BY Q \cll'� Feet I i i A a a --- a�i _ A4:: yt� 4 r I1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Buckwood Drive Property Address Cronin Owner Owner's Name information is Hyannis Ma 02601 3/30/2013 required for every Y page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12+ 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: 1/10/2013 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Design plan indicates that no groundwater was observed at 12'and system is designed to have a seperation of 5'+ between bottom of s.a.s. and adjusted water table. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 NiTThomas F,Ceiler,Director eeeaui nr.ar o�t t� Public Health Division �Y Thomas McKean,Director 2G0,14aill Stree4 RYannis,NIA 02601 Office: 508-862-4E4 iai:: Anstai er&Designer Certiiication Form Date; Y ep:Jage a yr A 4 o.0�3 —v lJ Assessor's iv�a P arcet 7 a 3 I� Designer: RG,.3 k. 144A Installer: Address: �_Z3 A Address: On I ,f tzss114,=d a per�it.to install a (date) (installer) septic system at Q y(; ;o cJ based on a design rlray.m by (address) ' S€E PFI_k� A. PE�;_ dated 1 O \3 (designer) / I certify that the septic system referenced above was installed substantially a ccordu-�g to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. i certify that the septic system referenced above was installed,Ev_1th rvajor.changes greater than 10' lateral relocation of the SAs or any vertical relocation of any component of the septic system) but in accardancejth Site& Local Regutaons. Plan revision or certified as-built by designer to (installer's Signature) . ` R e t (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE I'UgI C HEALTH DIVISION. CERTIFICATE OF COWLIANCE '�V3[LL, NOT BE ISSUED 'UNTIL BOTH:TIHS FORM AND AS- BUIL,T CARD ARE RECEIVE BY TBE+ BARNSTABIN PUBLIC HEALTH DIVISION, TANS YOU. WSeptic0esigner Certification Form Revised.doc Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 15 Buckwood Drive Property Address Cronin Owner Owner's Name information is required for every Hyannis Ma 02601 3/30/2013 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 -..i-=... I oWn Ot Btarnst -hi L RegulatOY Services t Thomas FW Ceiler Director 1"9. �� Public Health Division Arm M Thomas McKean,Director 200.Maio Street,Hyannis,MA 02601 Office: 509-862-4644 Fax: 508-790_53 jr Installer&Designer Certification Form Date; 3 e Permit.# 7 l 3 g Assessor's Ma Sewage o� Designer: RC A. x PE Installer:. i". �•. ���e._.. Address: _3 Z3 pOj TZ g A Address: tl 5 est-b Y .t6-ro-j-1� 2.�b. On, \ '`A ` \ .,-I was issued pem it to:install a (date) (installer) septic system at_\ U(;�t.w o o� `Q r, kA yc`r.n�1 based on a iasigt�clrau}n by (address) S—K P Ok-4� A. 1-A dated \O 1 ' 3 (designer) I certify that the septic system referenced above was installed substantial) according the design, which may y or�� t� y include minor approved changes such as lateral relocation of the distribution box.and/or septic tank. I certify that the septic system referenced alb"ave was installed tth:major changes (i.e. greater than l 0' lateral relocation of the;SAS r any vertical relocation of any component of the septic system) but in accordance �°�th ate& Local Regulati©ns. Plan revision or certified as-built by designer to follo-N. ., f T / A I IRE tlnstaller's Signature) r t: � .. F" (Designer's Signature) (Affix Designeils Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH:THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BAR. STABI;E I'IIB AC_ 3EALTH DIVISION. THANK YOU. QASepticlDesigner Certification Form Revised.doc Town of Barnstable .P# Departiment of Regulatory Services Public Health Division DateMAM 1 200 Main Street,Hyannis MA 02601 Date Scheduled / Ti nme Fee Pd Soil Suitability Assessment for e Disposal Performed By: Witnessed By: �' � � LOCATION&PENERAL INFORMATION Location Address t S V (�j(� �,�/�_ T bwner's Name ( C�� \ S S C% C-Ir J Address Assessor's Map/Parcel: G 7 O j j _ Engineer's Name NEW CONSTRUCTION REPAIR `/ Telephone# b (o Land Use: Slopes(% Surface Stones , Distance9 from: Open Water Body ft ' Possible,Wet Area ft Drinking Water Well ft Drainage Way ft , Property,Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands-in proximity to holes) a Parent material(geologic) 04P7— ..r A'1-14. Depth to Bedrock Depth to Groundwater. Standing Water in Hole: 'A''f.'� Weeping from Pit Fnce Estimated Seasonal High Groundwater DETERM[NATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs,hole: In. Depth to soil mottle!: In, Dcpth to weeping from side of obs.hole: In, Groundwater Adjustutent Index Well# Reading Date: Index Well level._. Adj.factor_Adj,Groundwater Level , j PERCOLATION TEST butt: Thne Observation ��• Hole# Tinto at 9" Depth of Perc rL c } Time at 6" Start Pre-soak Time Time -G") End Pre-soak L.��ti ins Rate Min./Inch L—Z— Site Suitability Assessment: Site Passed V Sit.A Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back--------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the, Barnstable Conservation Division at least one(1)week prior to beginning. Q:\S P-nlC\PERCFORM.DOC DEEP.-OBSERVATION HOLE LOG Hole# l Depth from Soil Horizon Soil Texture Sdil Color Soil• Ofher Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency,%'Gravel) �t DEEP OBSERVATION HOLE LOG Hole# Z Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. o istency,%Grave t . DEED B. O SERVA7CION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. ConsistenrL.ygGravel) DEEP`OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color loll Other Surface(in.) (USDA), (Munsell) Mottling (Structure,Stories;Boulders. Co si t y Flood Insurance Rate Map: Above 500 year flood boundary No— Yes Within 500 year boundary No✓ Yes ' Within 100 year flood boundary No. ✓ Yes Depth of Naturally Occurring Pervious Material 1 Does at least four feet of.naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Y If not,what is the depth of naturally occurring pervious material? Certification I certify that on ��' �� S7 (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training, p ctise and experience described in�10 CMR 15.017. Signature Datts QNSEPTIC\PERCPORM.DOC No. Fee (� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes \ 2pplication for Disposal stem Construrtion Vermit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. VS Uf•�(4JCb r Owner's Name,Address,and Tel.No. Assessor's Map/Parcel a-)a— 3 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. NcoNA �rw�VL 11 SUX d�,� Op(o� Type of Building: Dwelling No.of Bedrooms Lot Size ?cj(o U sq.ft. Garbage Grinder(N Q) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) u gpd Design flow provided 2(o 0 gpd Plan Date \ C7 Imo; Number of sheets \ Revision Date Title Size of Septic Tank QUO Type of S.A.S. � �krL4n r `� L��3,.i LVC I S 9IJS Description of Soil 's C L-, J Nature of Repairs or Alterations(Answer when applicable)�p �.Q {X k c, k1 m. fs Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Clign d Date Application Approved by Date Application Disapproved W. aw _ Date for the following reasons qF Permit No. Date Issued AVNo Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTHPIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pphrat%on for -Misptosar 6pstem Construction Permit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon(,') ❑Complete System ❑Individual Components Location Address or Lot No. V ,_z(% Owner's Name,Address,and Tel.No. a— b c.. Assessor's Map/Parcel a 3 3 Installg� me,Address,and Tel.No. � Designer's Name,Address,and Telo. YG(r-(xw\*\,— �J 11 ^� sox 3 Xi3` t Type of Building: Dwelling No.of Bedrooms Lot Size �1 U sq.ft. Garbage Grinder(N[� ti Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures t Design Flow(min.required) 330 gpd Design flow provided 2(.0 gpd Plan Date \ I ac��3 Number of sheets Revision Date '. Title rr Size of Septic Tank vC�O Type of S.A.S. n`t G.\A.'TAo 01 L� C%v%CVC l{ J p tjS Description of Soil �"\cJsy, SCVJ, S J� Nature of Repairs or Alterations(Answer when applicable) `4 p\C L C <X` {�^ Date last inspected: t Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. gn 1 O Date - Application Approved by r / Date Application Disapproved by Date for the following reasons 44 Permit No. Date Issued it ---------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(t/< Upgraded( ) Abandone (AX,K0)00_1 C o �( rat , //f) / has been consotruc in c�•o ce with the provisions of Titl d e D' a e Construction Permit No *'Ial dated Installer t"`S`v ' A"tWVtf Designer #bedrooms Approved d`es'ignn flow 3 �o'U gpd The issuance of this permit sh Il' of b�construed as a guarantee that the system will fund on as de 'gned. fDate � / Inspecto - - -------------- - ----------- - -- - -------------- - -- -- -------------------------- - No. �' Fee---� � THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction Vermit Permission is hereby granted to Construct( ) Repair(\/� Upgrade( -) Abandon( ) System located at \S Q V cu W 6d d Or �A y and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:C stru m st be completed within three years of the date of this permit. Date / Approved by ! Quick4® Chambers Sizing Chart for Bee! Systems in Massachusetts ' ' • SYSTEMS INC Number of Chambers in Aggregate-Free Bed Systems (See note below) Percolation . '330 GPD Design Flow -3 Bedrooms or Less 440 GPD Design Flow-4 Bedrooms 550 GPD Design Flow- 5 Bedrooms Soil Class Rate Quick4 Quick4 Quick4 Quick4 Quick4 Quick4 Quick4 Quick4 Quick4 Quick4 Quick4 Quick4 (min/in) Standard Standard Standard Equalizer 24 Equalizer 36 High Capacity Equalizer 24 Equalizer 36 High Capacity Equalizer 24 Equalizer 36 High Capacity 2.23 SF/LF 3.05 SF/LF S.72 4.72 SF/LF 2.23 SF/LF 3.05 SF/LF 4.72 4.72 SF/LF 2.23 SF/LF 3.05 SF/LF 4.72SF/L 4.72 SF/LF Class 1 <=5 50 37 24 24 67 49 32 32 84 61 40 40 Sandy, 6_ . 53 39; 25 25, 71 52 34 34 ' 89 - 65 42 42 Loamy 7 55 40 26 26 73 54 35 35 91 67 43 43 Sands 8 57, 41 -27 27 75 55 36 36 94 69 45 '. 45 <=5 62 46 '30 30 83 61 39 39 103 76 49 49 6 , 62; 46 :_: _ 30. 30 . 83 :.. 61. 39 . : 39 103. 76' 49:;.. w49 7 62 46 30 30 83 61 39 39 103 76 49 49 Class 11 8 $2„ 46 Sandy 30 ., 30 > 8$, 61 .7 39 39` 103 6 49 49 Loams, 10 62 46 30 30 83 61 39 • 39 103 76 49 49 r 1.5 67.: 49 32 32'` 89: , -65 42 ... ,. 42 111 81 53 53 Loams 20 70 52 33 33 94 69 44 44 117 86 55 55 25 �93 68." = 44 44 :, 124 91 59' '59" :155 "';' 113 7g,; 73 30 113 82 53 53 150 110 71 71 187 137 89 89 15.,., 100. :` 74 4g". . . ' . 48 134 .' 98 63 63 167 „ 122 79:. 79 20 109 80 52 52 146 107 69 69 182 133 86 86 Class III 25 113, 82 53 53 .150 110 71 71 187 137 X 89 89 Silty 30 128 94 61 61 171 125 81 81 213 156 101 101 Loams ''40 148 109 70 :. : 70' 198 :145 949 94 , 247 81 117 117 50 185. 136 88 88 247 181 117 117 309 226 146 146 60 : . - 247 181 : ; 75 ' 117`` 329; ' 241 156 156 412. 301. . 195 9,195 Class IV 50 185 136 88 88 247 181 117 117 309 226 146 146 Clays, Silty Clay Loams 60 ' 247;. 181 117 117 329 241 158 156 412 301 195 195 NOTE., 1.For new construction, no system shall be designed and constructed with a soil absorption system area of less than 400 square feet. 2. Combined, the Quick4 chamber MultiPort inlet and outlet end caps add an increased sizing benefit to the system. Two end caps are required for each row of chambers. The appropriate sizing factor may be applied in a bed or trench to account for the MultiPort End Caps. The minimum number of chambers shown above may be reduced by accounting for the area/length provided by the MultiPort End Caps. 3.All Quick4 chambers are 4 feet long. Average additional length added by each MultiPort End Cap: Model Average Length Added Quick4 Equalizer 24 chamber..................................0.9 linear feet Quick4 Equalizer 36 chamber..................................1.1 linear feet •Quick4 Standard chamber.........:...... . --A -...:.4.1 linear feet Quick4 High Capacity chamber................................1.2 linear feet C5712051SI-0 Z: 348 651 U77 Receipt for Certified Mail No Insurance Coverage Provided UIRrED sib s Do not use for International Mail POSTAL SERVICE (See Reverse) C.) Sent to O) t Str;elle L . c0 M P.O.. to and ZIP Code OF O p Postage 1 CID c9 E Certified Fee � 12 Special Delivery Fee :a t 'R.estrictedReliveryYee Xtetu rn 9A eceipt=Showing to Whom&Date Delivered //O Return Rec bowing to Whom, Datey,an 's Address TOT Qqs" �tP & �'' $O •� P rli r D i STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES(see front). a 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached and present the article at a post office service window or hand it to your rural carrier(rio extra charge). R .. 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the return rn address of the article,date,detach and retain the receipt,and mail the article. rn i r 3. If you want a`return receipt,write the certified mail number and your name and address on a return receipt,card4orm 3811,and attach it to the front of the article by means of the gummed co `ends if space permits.,Otherwise,affix to back of article.Endorse front of article RETURN RECEIPT REQUESTED adjacent to the number. L 00 4.,If'you want delivery restricted to the addressee,or to an authorized agent of the addressee, M a endorse RESTRICTED DELIVERY on the front of the article. \-ol1-.%-- tp 5. Enter fees lor-the services requested in the appropriate spaces on the front of this receipt.If return receipt is requested,check the applicable blocks in item 1 of Form 3811. W a 6. Save this receipt and present it if you make inquiry. 105603-i&B•0218 SENDER: I also wish to receive the o ■Complete items 1 and/or 2 for additional services. rn ■Complete items 3,4a,and 4b. following services(for an d ■Print your name and address on the reverse of this form so that we can return this extra fee): card to you. v ■Attach this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address dpermit. ■Write'Return Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery N t ■The Return Receipt will show to whom the article was delivered and the date .. C delivered. Consult postmaster for fee. .s 0 a S.Arti le Addressed to: 4a.Article Number d / ° E 4b.Service Type c°, / ❑ Registered 40 Certified rn ❑ Express Mail ❑ Insured S UJI N ¢ ❑ Return Receipt for Merchandise ❑ COD ��G w 7.Date of Delivery ° z v�v'd �- cc 5.Received By: (Pint Name) 8.Addressee's Address(Only if requested X/v At and fee is paid) 6.Signatu Ad ressee rA.gent) o X I � N PS Fo 811, Decem er 1994 Domestic Return Receipt UNITED STATES POSTAL SERVICE First-Class MailPostage&Fees Paid USPS Permit No.G-10 • Print your name, address, and ZIP Code in this box • Health Department Town of Bamstabie P0.Box 534 Hyannis,Massachusetts 02601 Fax(508)77s- i I Town of Barnstable • Department of Health, Safety, and Environmental Services WWWABLE. M& Public Health Division 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Thomas A McKean FAX: 508-775-3344 Director of Public Health November 1, 1995 John L. Jordan 103 Enterprise Road Hyannis, MA 02601 ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located at 15 Buckwood Drive, Hyannis was inspected on October 17, 1995 by Robert Bortolotti a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Liquid depth in each pit is less than 6" below invert or available volume is less than 1/2 daily flow. You are directed to hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office (Town Hall, 367 Main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within (14) fourteen days of receipt of this notice. You are also directed to bring the septic system into compliance within thirty (30) days of receipt of this order letter. You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health [Installer letter] sl TO: U-,'6 i' >t/ (Date) ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. ,��, The septic system owned by you located at was bR!'7-e by '�� � a Massachusetts licensed septic inspected on / inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00)due to the following: a. c You are directed.to hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office (Town Hall, 367 main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within (14) fourteen days of receipt of this notice. You are also directed to bring the septic system into compliance within thirty (30) days of receipt of this order letter. You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Any person 88 erson aggrieved by any order issued by the local approval authority may appeal to. any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health Town of Barnstable TOWN OF BARNSTABLE LOCATION O SEWAGE # VILLAGE ASSESSS�OR'S MAP&�/LOT zvs�� s � b�/0Vi Ll; r�NAME&PHONE NO. o� SEPTIC TANK CAPACITY 16ZO q_atI�W �4 LEACHING FACILITY: (type) Pi ��� (size) /O C50 NO.OF BEDROOMS �- BUII DER OR WNER Q�0 PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility a Feet Private Water Supply Well and Leaching Faciity (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 f ty) _IV A Feet Furnished by ar-k 1 crk7'�kw, j 1 � Cry ILI -� 3a --f .3' i r Commonwealth of Massachusetts Executive Office of Environmental Affairs Department ofIV IV 0 �T Environmental Protection ocT 3 G) 1 Wllllam F.Weld1Vpr � �' Goamor Trud t:oxe p Beem y EO e David B.Sbuha Comminioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION jProperty Address:/u-ZuC4KGc oo Address of Owner: /03 �7�P�/Ong e UQCJ Date of Inspection:/6 7- 9 S / (If different) (Gfl9/li.S Name of Inspectorr� ��¢ �, 1Qp1_40 ' �' .Company Name, Address and Telephone Number: ��/U��y' ���g v�[_ rC/�j —�-� -7&y-�crIre6y /�Cca�J CERTIFICATION STATEMENT I certify that t have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: _ Passes AM SSOASWKlk Conditionally Passes PARCELNO. (j�' Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: , Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: Al SYSTEM PASSES: 1 have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. Bj SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not) The septic tank is metal,cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised S/15/95) One Wlnbr Str:.t a 8oaton,Maaaachuse t.02108 a FAX(6fl)U6.1049 a Tdoomw(611)202.a60p 0 vmhe a,RecydW Pep:: a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:lf� Gc700 of Owner:✓O�c"�7 SI /7 r5��P h 7 Date of Inspection:/,t�,/7-9S-- B) SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed Cl FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health;;•safetywand the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. _ The wstem has a septic tank and soil absorption system and is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. _ The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm: D] FAILS: 7ave determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis � for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or dogged 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. tsevieed S/15/95) 2 a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: D]SYSTEM FAILS(continued): Static liquid level in the distribution box above outlet invert due to an overloaded or clogged.SAS or cesspool. i Liquid depth in! is than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. _ Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary.to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. _, Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E]LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The design flow of system is 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 8/15/95) 3 *J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: �4C_4—_4)0 od (h°' Owner. Jard�n Si �7 �Q�pGr7c�/ Date of Inspection: A Check if the following have been done: _!�'Pumping information was requested of the owner, occupant, and Board of Health. —LeNone of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period, Large volumes of water have not been introduced into the system recently or as part of this inspection. LL As built plans have been obtained and examined. Note if they are not available with N/A. UThe facility or dwelling was inspected for signs of sewage back-up. v The system does not receive non-sanitary or industrial waste flow 1--The site was inspected for signs of breakout. L-'All system components, excluding the Soil Absorption System, have been located on the site. G_—The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. /r _The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. _The facility o•„ner !and.occupants, if differen! from owner) were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 8/15/95) 4 J' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INNFPRMATION. Property►ess- /j Owner: Date of Inspection: FLOW CONDITIONS RESIDENTIAL, Design flow:6allons Number of bedrooms: Number of current residents Garbage grinder(yes or no): Laundry connected to system (yes or no):TP� - Seasonal use (yes or no):-A� Water meter readings, if available: Last date of occupancy: COMMERCIAUINDUSTRIAL: A/ Type of establishment: Design flow: gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RE ltj and Sourceof informs lo n:/ C System pumped as pan o spection: (yes o no)LO If yes, volume pumped: gallons Reason for pumping: TYPE OF SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy hared system (yes r no) if yes, attach previous inspection re c krds, if any) Criher(explain) �i L APPROXIMATE AGE of all components, date installed (if known) and source of information: 2 ,1 ` "P o �r oze Sewage odors detected when arriving at the site: (yes or no) (revised 0/25/95) 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Add,ress:/,7��C'F � orl c l�� �c�4 Owner:,_ Czn �f�1-2 /"Pa 1-17 Dale of Inspection: SEPTIC TANK: l/ (locate on site plan) Depth below grade:L Material of construction: concrete _metal _FRP _other(explain) Dimensions: S Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: J� 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:-V— Comments: (recommendation for pumping, condition of inlet and outlet tees or baH s, depth of liquid level in relation to outlet in vert, structural s Otegrity, evidence of lea age, etc.) 552 ii & 42 lye SG GREASE TRAP: (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP _other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of turn t^hot-tom of outlet tee or baffle: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) 6 (revised 6/Is/9S) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: �3euc'& OGOf. Owner:Wr'Z�4/9 Date of Inspection: /4 TIGHT OR HOLDING TANKy"� (locate on site plan) Depth below grade: Material of construction: _concrete_metal _FRP—other(explain) Dimensions: Capacity:- gallons Design flow: gallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:blunt - (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distributior, is equa!, evidence of solids carryover, evidence of leakage into or out of box, etc.) PUMP CHAMBER: (locate on site plan) Pumps in working order,(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) i (revised 8/15/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFO "TION (continued) Property Address:15— i Owner: rdGnCrn�G�l� Date of Inspection: /D SOIL ABSORPTION SYSTEM (SAS):_L___' . (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number: leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of spil signs of hydraulic allure, level of ponding, c ndition of vegetation,etc S /J e CESSPOOLS: (locate on site 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 (cesspool must be pumped as part of inspection) 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.) (revised 0/15/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property�Address: /� rcn),).? G'p� `�J�j f� (/�lj7l�is Owner: v5�i a� s%�I'I � � Date of Inspection' SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' 1� DEPTH TO GROUNDWATER Depth to groundwater. 2/ feet method of de rmination or approximation: /O,Y/11 ljr 5 (revised 8/1S/9S) 9 No. QrOFTHFTO�y OFFICE OF THE BOARD OF HEALTH OF THE BnaasTMMX : TOWN OF BARNSTABLE, MASS. 9�O MASS. 'F0 MAY A" -=r-=- a—r + -- 19 SEWAGE DISPOSAL PERMIT R Permission is granted to _ '__?_ ____F * �a •��` ' to construct _' ---- Upon the Premises of t; ° r Sketch (, �,r _; _-d`j '�;L..s �*�•t v�i -.•a�r�—�r*' r�..�,%E',,s.J4.u` .._. `"._"'.""`....`"."�*°--•-^---�-�........_._ V In the village of 100 or more feet from any source of water supply 20 feet from l�iilding 10 feet from property line k j "� Health O icer: Barnstable Assessing Search Results Page 1 of 2 w Home: Departments:Assessors Division: Property Assessment Search Results <<back to search 15 R UCKWOOD DRIVE Owner: JORDAN,JOHN L Property Sketch Legend Map/Parcel/Parcel Extension 272 /033/ Mailing Address JORDAN,JOHN L CRONIN, COLIN B&MELISSA W 15 BUCKWOOD DRIVE HYANNIS, MA.02601 1 Assessed Values: Appraised Value Assessed Value Building Value: $62,700 $62,700 Extra Features: $3,900 $3,900 Outbuildings: $400 $400 Land Value: $37,600 $37,600 Interactive Property Map: ap requires Plug in: Totals:$ 104,600 $ 104,600 1 have visited the maps before Show Me The Map April 2001 photos available Sales History: Owner: Sale Date Book/Page: Sale Price: JORDAN,JOHN L 5/15/1996 C140844 $80,250 JORDAN,JOHN L&PRISCILLA 4/15/1996 C140203 $1 JORDAN,JOHN L 4/15/1995 C136985 $1 JORDAN, SARAH M C784350 $0 JORDAN, SARAH M-792 C78435 $1 Tax Information: Tax Rates: (per$1,000 of valuation) Town Tax $983.24 Town Fire District Rates Other Rates 9.40 Barnstable 2.88 Land Bank 3%of Town Tax Hyannis FD Tax $302.29 C.O.M.M. 1.54 Cotuit 1.88 http://www.town.barnstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/A... 4/3/2003 Barnstable Assessing Search Results Page 2 of 2 Land Bank Tax $29.50 Hyannis 2.89 West Barnstable 1.96 Total: $ 1,315.03 Due to rounding differences these values may vary Land and Building Information Land Building Lot Size(Acres) 0.17 Year Built 1968 Appraised Value $37,600 Living Area 942 Assessed Value $37,600 Replacement Cost$75,580 Depreciation 17 Building Value 62,700 Construction Details Style Ranch Interior Floors Minimum/Plywd Model Residential Interior Walls Drywall Grade Average Grade Heat Fuel Gas Stories 1 Story Heat Type Hot Air Exterior Walls Wood Shingle AC Type None Roof Structure Gable/Hip Bedrooms 2 Bedrooms Roof Cover Asph/F GIs/Cmp Bathrooms 1 Bathroom Total Rooms 4 Rooms Extra Building Features Code Description Units/SQ ft Appraised Value Assessed Value BRR Bsmt Rec Room 336 $1,400 $1,400 FPL1 Fireplace 1 $2,500 $2,500 SHED Shed 48 $400 $400 Property Sketch Legend BAS First Floor, Living Area FST Utility Area(Finished Interior) UAT Attic Area(Unfinished) BMT Basement Area(Unfinished) FTS Third Story Living Area(Finished) UHS Half Story(Unfinished) CAN Canopy FUS Second Story Living Area(Finished) UST Utility Area(Unfinished) FAT Attic Area(Finished) GAR Garage UTQ Three Quarters Story(Unfinished) FCP Carport GRN Greenhouse UUA Unfinished Utility Attic FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story(Unfinished) FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck FOP Open or Screened in Porch TQS Three Quarters Story(Finished) http://www.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/A... 4/3/2003 Property Location: 15 BUCKWOOD DRIVE MAP ID: 272/033/ Vision ID: 20710 Other ID: Bldg#: 1 Card 1 of 1 Print Date:04/03/2003 15:07 m m �G�RItEt�7'.C1WLy.�m.. . ryR4...Q�.,_. ,U'T�Z�T`TES :SZ'.Z:/,RO.AD� �LOC�1,TrON . ,�} ,,. r.�,. ,, ..N7" S,„S,,SS. E:,� ,::� ,;• � �: .�,�„. ORDAN,JOHN L Description Code Appraised Value Assessed Value RONIN,COLIN B&MELISSA W RESLAND 1010 37,600 37,600 $t7l 15 BUCKWOOD DRIVE ESIDNTL 1010 66,600 66,600 ANNIS,MA 02601 RESIDNTL 1010 400 400 Barnstable 2003,MA ccount# 182037 Plan Ref. Tax Dist. 400 Land Ct# er.Prop. Not VISION Life Estate DL 1 LOT 3&3A Notes: DL 2 GIS ID: 20710 Totall 104,6001 104,600 d } _�. OIRD O x:OWNERS _�OUS 455 S MEIYTSMn' 3 : ; ORDAN,JOHN L C140844 05/15/1996 Q I 80,250 Yr. Code Assessed Value Yr. Code Assessed Value J Yr. Code I Assessed Value ORDAN,JOHN L&PRISCILLA C140203 04/15/1996 U I 1 A 2002 1010 37,600 001 1010 37,600 000 1010 23,600 ORDAN,JOHN L C136985 04/15/1995 U I 1 A 2002 1010 66,600 001 1010 66,600 000 1010 54,700 ORDAN,SARAH M C784350 Q 0 2002 1010 400 001 1010 400 000 1010 200 ORDAN,SARAH M-792 C78435 U 1 A Total: 104,6001 Total:1 104,600 Total: 78 500 �XEM�'TIQNS,�}. •' ;. k �•. This signature acknowledges a visit by a Data Collector or Assessor Year T e/Descri tion Amount Code Description Number Amount Comm.Int. .. ..': >.. Appraised Bldg.Value(Card) 62,700 Appraised XF(B)Value(Bldg) 3,900 Appraised OB(L)Value(Bldg) 400 Total P Appraised Land Value(Bldg) 37,600 }_ .. ,. =a.. ... fir„ .Y., 1�OTE5 ,.;,.'.. ... .., ., .: , .3 ,.�, ,,.: pec ( g) mr S ial Land Value Total Appraised Card Value 104,600 Total Appraised Parcel Value 104,600 Valuation Method: Cost/Market Valuation Net Total Appraised Parcel Value 104,600 .. O .N.G�EI�!fS1"UR�Y :;vx ,, ,• ..,._, �• . . ... .. .... .. � �,..,. 3 __BUtl Ii!?G 3 ERMIT RECRDtS"ITICNfI Permit ID Issue Date Type Description Amount Insp.Date %Comp. Date Comp. Comments Date ID Cd. Pur ose/Result 6/10/1997 AM 00 eas/Listed 9/15/1990 ML ..,. ....... ...... ......\\.. .....y.. ,vl .. .... ..... .. >x._,... .,.. <. .> z ,... ...... ..-. ,,,....a .. g�....... sue:':: ,•�. , ,,, � .: B# Use Code Description Zone D ronta e Depth Units Unit Price I.Factor S.I. C.Factor Nbad. Ad Notes-AdYS ecial Pricing— Ad Unit Price an Value 1 1010 Single Fam RC1 4 0.17 AC 347,000.00 1.00 5 1.00 50AC 0.60 PCL(.17,U10)Notes:10 1BLD 37,600 Total Card Land Units 0.17 AC Parcel Total Land Area: 0.17 AC TO Land Valu 37,600 Property Location: 15 BUCKWOOD DRIVE MAP ID: 272/033/// Vision ID:20710 Other ID: Bldg#: 1 Card 1 of 1 Print Date: 04/03/2003 15 ,. _. _.� _.._ ,.�, � �. O1�.S'�CRUCTI'�INDET Z. . �.. � ,. ,.3 3 .: =SKE•TCH 3. �� :.-::b� �....rl�.'.,r. ..._„�.-7 ,.,z'�.,,.— .u... ..., �..,x ,,z._,.,M_,n.: .. .� �,.-�.!� "_,a v. �A, », ,' ,P .ra' f„,,::. _�,..,�<.,- "a�,�r•.__ � ...,UM ,., Element Cd. Ch. Description Commercial Data Elements tyle/Type 01 Ranch Element Cd. Ch. Description odel 01 Residential Heat&AC ade - Average Grade Frame Type 16 36 Baths/Plumbing tories 1 1 Story ccupancy 00Ceiling/Wall ooms/Prtns Exterior Wall 1 14 Wood Shingle /a Common Wall 2 Wall Height Roof Structure 3 able/Hip Roof Cover 03 sph/F GIs/Cmp 2 GAR 2 G l�'DQ/MOBXL HOM1 DST 5 BAS Interior Wall 1 5 Drywall _ � " 2 Dement ode Description actor BMT 2 interior Floor 1 02 inimum/Plywd omplex Z Floor Adj Unit Location eating Fuel 3 Gas 16 Heating Type 4 of Air umber of Units C Type 1 None Number of Levels Ownership 22 % Bedrooms 2 2 Bedrooms FOP 22 athrooms 1 1 Bathroom ".;', CUSMi ' f. iYA ;. ATDIY 22 14 10 1 Full nadj.Base Rate 60.00 Total Rooms Rooms Size Adj.Factor 1.18444 ath Type ade(Q)Index 0.84 Kitchen Style Adj.Base Rate 59.70 Bldg.Value New 75,580 Year Built 1968 ff.Year Built (A)1983 rml Physcl Dep 17 i uncnlObslnc 0 con Obslnc 0 Code vrrinfinn Percentage pecl.Cond.Code 1010 Single Fam 100 Specl Cond% Overall%Cond. 83 eprec.Bldg Value c,inn a orrzrr�zv G zrEnls z /X1BZTI�D1NGExTRf1 FEAzcrRE (/$S - Code I Description LIB I Units Unit Price Yr. Dp Rt %Cnd Apr. Value BRR Bsmt Rec Room B 336 5.00 1983 1 100 1,400 FPLI Fireplace B 1 3,000.00 1983 1 100 2,500 SHED Shed L 48 8.00 1900 0 100 400 B_,IL�: CnSB A14SUMARySEG770/v?; .. .x ' Code Description LivinjzArea Gross Area E .Area Unit Cost Unde rec. Value BAS First Floor 942 942 942 59.70 56,237 BAIT Basement Area 0 942 188 11.91 11,224 FOP Open Porch 0 66 13 11.76 776 GAR Attached Garage 0 352 123 20.86 7,343 M. Gross Liv/Lease Area 9421 266 Bldg Val: 75,580 Q N a� v W 10�1 I- Pr TOWN OF BARNSTABLE /p — �.,_ ✓. .r.,.� �i SEWAGE# 5' LO zZ LOCATION V1I,LAGE e' ` ASSESSOR'S MAP&LO 7 INSTALLER'S NAME&PHONE NO. .1 g SEPTIC TANK CAPACITY /O O O ' 0 i�rc�A� r/c: (size) r �D��L 1 � � LEACHING FACILITY:(type) 11 13 No.OF BEDROOMS_7__�_— BUILDER OR OWNER //..•�,, g COMPLIANCE DATE: PERMUDATE: Separation Distance Between the: - t . i Feet Adj usted Groundwaier Table and Bottom of Leaching Facility Maumum J Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) j Edge of wetland and Leaching Facility(R any wetlands exist Feet within 300 feet of leaching facility) Furnished by ° I e - s TOWN OF BARNSTABLE LOCATION /5, IvP.,�r:>�7nG� �/ SEWAGE # �✓ L a -VILLAGE ASSESSOR'S MAP& LOT Zg_—j .3 INSTALLER'S NAME&.PHONE NO. SEPTIC TANK CAPACITY /a®O r r LEACHING FACILITY: (type),? /�Yc�ia'Ji rS (size) 04f-* NO.OF BEDROOMS ., II BUILDER OR OWNER Ord-4—A G7051�iS/l/ / PERMPTDATE: 9A.'f'COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by v $ 30 00 THE COMMONWEALTH OF MASSACHUSETTS -7 BOAR® OF HEALTH 03-3 TOWN OF BARNSTABLE App irativaa for Diripniial Workii Cnomitrnrtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair JX� an Individual Sewage Disposal System at: 1.2.Buckwood...Drive---Hyannis.,Mass--------_--- Jack Jordon Location-Address or Lot No. W J.P.Macomber Jr. °`"°" Address Installer Address UType of Builg 2 Size Lot............................Sq. feet Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic I`(0 ) Garbage Grinder (No) aOthe;U Type of Building _.RES----------------- No. of persons.__1_.__.-_.__-___--__-._ Showers ( ) — Cafeteria ( ) QOther fixtures --------------------------------------------------------------------------------------- -----•----------•----------••---•-•-----.....---------------- W Design Flow...........55............................gallons per person per day. Total daily flow----------220.___.____.._..__...,......gallons. W Septic Tank�Liquid capacity1000-galIons Length-g'_6_"-____ Width_4_'_1_0."_ Diameter_--.-__.-._-._ Depth.5.1_7it._-. 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_.-.__-____.____..-__--- fs.t Test Pit No. 2................minutes per inch Depth of Test Pit__.____-_-.______- Depth to ground water........................ a ----------------------------------••--......--•---.....--•-•---•--•-•--------•-------....-----------......................................................... 0 Description of Soil_Sand... -__gravel............................... W V Nature of Repairs or Alterations—Answer when applicable._-Installing leach trench. 3-330.. rechargers_ with.__tree--feet_ o.'__.stone-.-- 28.-8-- x 1.0._/0 With existing Agreementtank, & pit. The undersigned agrees to install the aforedescriibed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b eA is ed by t e oard of health. Signed �.. .... --------------------------------- Due Application, 5:...... Application.Approved BY - y{ \ \.. ---------- ------��. . ................................... Date Application.Disapproved for the following reasons: ................................ .... ......... ................. . .......... . ..... -------------------------------------------.................._---------------------------------------------------------- --------------------------......------------------------------ .. ..... .. .. .._....... _Permit No. 5 1. ..`�-�..................._ Issued ............{/1�.....--- j_vf gJ� .'—Date....... P `Date • F NO.._ 4P�:_1 Fr$.. ....30.00... M h4. THE COMMONWEALTH OF MASSACHUSETTS '27� Y I % BOARD OF HEALTH 03,3 TOWN OF BARNSTABLE Ali,iliration for Di-niv sttl Varks Tomitrurtiun Prrutit Application is hereby made for a Permit to Construct ( ) or Repair jftjj an Individual Sewage Disposal System at: 1A-.RnQkyaOd.... r e $y nrx _,Mass `" p ------------ ----- Lot -- -- 1 Location ess�' Jaek Jordon •-----.._...-•----•----------------------------------------------------------•-•--• -•---•-•-----------------------------•....-------•-•-----------•••--...-----......._........----•- W J.P.Maeomber Jr. Owner Address Installer Address d Type of Building =r Size Lot............................Sq. feet U Dwelling 11 No. of Bedrooms..--._-.2................... . . .....Expansion Attic 1(0 ) Garbage Grinder (NO) ---f�'-IS----------------- No. of persons--I-----------. -------- Showers — 9 a Other"d�Type of Building a � ( ) Cafeteria ( ) Other fixtures -------••------- er er ,r � $Septic Tank l=squid capacityl.M. Ilonss p L person gt .8P6_aayWidt1L._al 0" Diameter�a---..-_. - Depth.5'7lons. X t tt t .. i tt 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. I.............!-minutes per inch Depth of Test Pit........._-_--_---- Depth to ground water-----------------...... is. Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water..... ...... a -------- ---------------------•-•....--••-------...-----•-•-------•------•-•-•------------•-•------......-----------•-•----•-----•-••----........-----...._. D Description of Soil.SAxld...a.._XAY01---•-----•--•----------•------------------------ W , x ............-................................................................................................................................................................................... U Nature'of Repairs or Alterations—Answer when applicable.-_Tn s taling__leaCh___trench_._________________________ 3_--33.0__reenar ®rs__with-__tree___feet of _ 28.8___x_ 1_U.-40-___ _With__existin-at. Agreement�a.nk & pit The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with e the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b e issued by t e board of health. Signed �' Approved By . -'+.� ...E ..., -- ;' e Application. ' -" Dace �i------------ ----------".-----.................--' Application."Disapproved for the ollowing reasons- -----------------------------------------------------------------------------.........--------------------------------------_. .. .................. --------- ---..--.....-------- -- - -------- ---------------.-..........-..------.........-----------.-.........---------------- --------......-.-------------=I............. . ... ' -. ........-------- - - .......... Permit No. ....� ----...-� ` �w------------------ Issued ------------- e Dare V r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Q-1,er#tft.ca e of Complinure THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (XXX) by ._....1-0.p.,.1vtP-c- bar zTr.Q......_...-_---..------------------- --------------.--- -----_------_--- -- 15 Buckwood Drive Hyannis,Massh,."ue at ................' ..-..-.,............-....' - --- - ' '' ... has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. .. dated .... .... ...._..................... ...... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST_RUEA AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE....-_.- ...../...".'...... . ..... ..--- --- Ins ect,_ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No. p TOWN OF BARNSTABLE ...30....00 ... G' FEE.. ...... ..... Disposal Works Tomitrurti.un rrrmit Permission is hereby granted a,A mb P_? Tr:.............................................................................................. to Construct ( ) or Repair (KX) an Individual Sewage Disposal System at No......... a--L,;vnvtni'�YNjs;- Street as shown on the application for Disposal Works Construction Permit No,`,7=f7J, ,..- Dated.......r.f.�-.. -. .- C...... ------------------------------ 3'-------------------------------------------------- I (5. Boane'o?Health ! ! 7•-----•-•--••--••----•----•--------- DATE.. V FORM 36508 HOBBS&WARREN.INC..PUBLISHERS Q J CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) I, Joseph P. Macomber J r., hereby certify that the application for disposal works construction permit signed by me dated 1 1 /14/9 5 , concerning the property located at 15 Buckwood Drive Hyannis .Mass . meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • The observed groundwater.table is:.4 feet or greater below the bottom of the leaching facility • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. SIGNED : DATE: 1 1 /1 4/9 5 LICE N D SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. II ACCESS COVERS MUST BEWITHIN INSPECTION 9' MINIMUM. INVERT ELEVATIONS : DESIGN CR I TER I A : GENERAL NO TES : 6' OF FINISH GRADE PORT 3 MAX/MUM COVER FIRST 2' TO INVERT OUT SEPTIC TANK: 99.6 DESIGN FLOW: 2 BEDROOMS. DESIGN FOR BE LEVEL INVERT IN DIST. BOX: 99.37 3 BEDROOMS MINIMUM AT 1/0 G.P.D. PER 1. THIS PLAN /S FOR THE DESIGN AND CONSTRUCTION IT INVERT OUT DIST. BOX: 99.2 BEDROOM EQUALS 330 G.P.D. OF THE SEWAGE DISPOSAL SYSTEM ONLY. 4' 0lAM PIPE CLEAN SAND BACKF I L L INVERT IN LEACH CHAMBER: 99.07 AROUND AND 2" OVER CHAMBERS BOTTOM OF LEACH CHAMBER: 98.4 NO GARBAGE GRINDER 2. VERTICAL DATUM IS ASSUMED. FOR BENCH MARKS GAS 99 6 a 9 8 98.4 ADJUSTED GROUND WATER: N/A SET. SEE SITE PLAN. ° BAFFLE 99.3 7 SEPTIC TANK REQUIRED: OBSERVED GROUND WATER: N/A J. ALL CONSTRUCTION METHODS AND MATERIALS AND EXISTING 3 OUTLET 24 QUICK 4 PLUS STANDARD 330 G.P.D. X 2OO�K - 660 GAL, D-BOX INFILTRATOR CHAMBERS IN BED FORMATION BOTTOM OF TEST HOLE I : 9/ 4 SEPTIC TANK PROVIDED: 1500 GAL. MIN. MAINTENANCE OF THE SEPTIC SYSTEM SHALL l 000 GAL CONFORM TO MASS. D.E.P. TITLE 5 AND LOCAL SEPTIC TANK 6' CRUSHED STONE OR SOIL ABSORPTION SYSTEM REQUIRED: BOARD OF HEALTH REGULATIONS. COMPACTED BASE DESIGN PERC RATE � 5 MIN/INCH !" ROF I L E :NOT TO SCALE SOIL TEXTURAL CLASS - l 4. ALL SEPTIC SYSTEM COMPONENTS LOCATED UNDER EFFLUENT LOADING RATE - 0.74 GPD/SF AREAS SUBJECT TO VEHICULAR TRAFFIC OR GREATER 330 GPO / 0.74 GPD/SF - 446 S.F. REQUIRED THAN 3' IN DEPTH SHALL BE CAPABLE OF W1TH- STANDING H-20 WHEEL LOADS. PROVIDED: 24 QUICK 4 PLUS STANDARD INFILTRATOR CHAMBERS. 96'x 4.73 SF/FT - 5. ALL SEWER PIPE SHALL BE SCHEDULE 40 PVC OR N 454 S.F. x 0.74 - 360 GPD APPROVED EQUAL. 6. SEPTIC TANK AND 0-BOX SHALL BE REINFORCED SOIL TEST PIT DA TA & PRECAST CONCRETE OR APPROVED POLYETHYLENE. INDICATES INDICATES BOTH SHALL BE WATERTIGHT. D-BOX SHALL BE WATER PERCOLATION = OBSERVED TESTED FOR LEVEL WHEN THERE lS MORE THAN ONE TEST - GROUNDWATER OUTLET. TP #/ Ps138/5 TP #2 7. BEFORE CONSTRUCTION CALL "DIG-SAFE" . HORIZON TEXTURE COLOR HORIZON TEXTURE COLOR 1-888-DIG-SAFE AND THE LOCAL WATER DEPT. 0' 10I.4 0" 101.4 FOR LOCATION OF UNDERGROUND UTILITIES. Q LOAMY I OYR A LOAMY !OYR \� I, SAND 2/2 SAND 2/2 8, SEPTIC SYSTEM INSTALLER SHALL NOTIFY THE 4" - - - - - - - - - - - - - - - - - - - - 101. 1 5" - - - l0/.0 1 � " - DESIGN ENGINEER TWO DAYS PRIOR TO CONSTRUCTION 1 ` LOAMY SAND !OYR n LOAMY SAND !QYR EXISTING ` B © OF THE SYSTEM TO ALLOW FOR SCHEDULING OF THE o ` UP AND GRAVEL 4/6 AND GRAVEL 4/6 pWEtt I Nc CONS TRUCT i ON /NSPECT l ONS. 24" - - - - - - - - - - - • - - - - - - - - 99.4 26' - - - - - - - - - - - - - - - - - - - - 99.2 MED!UM !OYR / MED l UM I QYR i i I SAND AND 5/6 SAND AND 5/6 9. EXISTING SAS TO BE PUMPED DRY, REMOVED IN THE 1 AREA OF THE NEW SYSTEM AND BACKF I LL ED WITH 101.9 00 o` 1 -F N i° GRAVEL GRAVEL 4.93' �\ I SAND. II 1 L 0 T 31 52 to m r 7.960* S.it. f 5 \02 1 - BOX 24 OUICK 4 PLUS STANDARD .. :•: EXISTING I INFILTRATOR CHAMBERS SEPTIC TANK _ _ , _ _ -,- '•:..1•,;::• EXISTING TWO I 120- NO WATER 91.4 120" NO WATER 91.4 101.4 BEDROaV DWELLING 1 DATE: DECEMBER II. 2012 EXISTING SAS - BM CORNER BH EL-102.6 TEST BY: STEPHEN HAAS / WITNESSED BY. DONALD DESMARA I S w PERC RATE. 2 MIN/INCH j TPw2 201 \ G 1 / 3 / CATCH ' BASIN h TPs! 1 o GARAGE 101.9 CTR CB / ORa VEWAY CB FND d TUP - / S ' 1 1 l�I t PT /SE C S YS TEM C> ES l ON 15 BUCKWOOD OR V VE' . MAP 272 . PARCEL 33 BARNS TABL E7 . ( HYANNI S ) M,.. PREPARE0 FOR �N < LEGEND V"` ■ co CONCRETE SOUND MEL_ l S SA CR ON l N L 0 US -W WATER L I NE m O HYDRANT SCALE : l 20 ' JANUAR Y l O . 2013 e -G GAS L INE OHW- OVER HEAD WIRES S T E P H E N A . H A A S ROUTE LIGHT# LIGHT POST --£- UNDERGROUND ELECTRIC LINE _ E N G I N E E R I N G , INC -T- UNDERGROUND TELEPHONE L I NE / � ° 923 Route 6 A -CTV- UNDERGROUND CABLEV 1 S 10N LINE Y ar mo u t h p co5 t M A . ©2 6 5 / 08 362-8 'I 32 -►-40.4 SPOT ELEVATION /I I C j ._.•-40....... EXISTING CONTOUR 40 PROPOSED CONTOUR LOCUS MAP Q IO 20 4o JOB NO: 12- 153 - - - --