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0033 CANDLEWICK LANE - Health
` U3 CANDLEWICK LANE I annis' A 268 - 242 >J SHE Town of Barnstable T Barn Board of Health Mlf,erica0v + BARNsrABLE, ' MASS. g 200 Main Street, Hyannis MA 02601 D ATfD MP'�A, 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Saw anagi Q BOARD OF HEALTH MEETING RESULTS Thursday, April 26, 2012 at 3:00 PM 9� o Town Hall, Hearing Room, 2ND Floor — -� 367 Main Street, Hyannis, MA I. Hearing - Housing (Cont.): �A YLili-Seely, owner 33=Candlewick L_ane,_Hyannis,_housng:and`septi issue(continued-from-Dec-201-1_and'Feb-2042) The`Board7Voted-to have-Ms..Seely-return-ti -theBoard-of_Heaitli at the,July-AG,; ? • 2012_meeting_if-the septic-permit-has:nof'been_complete_d_orr-if-the-1ist-of-housir �repairs_has-not-been-completed: h B. Kenneth Carey, owner— 439 (a.k.a. 441) South Main Street, Centerville, 3 units, housing violations (continued from Dec 2011 and Feb 2012). The Building Department inspected the new porch last week and it passed inspection. The septic system has been engineered and is on the agenda for next month — May 8, 2012. The Board will review the septic plans at that time. II. Hearing — Show Case: Housing (Cont.): Cancelled. Craigville Motel, 8 Shootflying Hill Road, Centerville, insufficient heat to Repairs occupants and use of space heaters, operation of motel without a valid Completed license for 2012 (Continued from March 2012). III. Hearing- Connect to Sewer (Cont.): 30 Thornton Drive — Business Condos. Barnstable. Owners: A. William and Rita Amaral 1 Unit Map/Parcel 296-008-OOA B. Richard Fleming 2 Units Map/Parcel 296-008-OOB & OOC C. Bert Mosher 1 Unit Map/Parcel 296-008-OOD D. Michael Michnay 2 Units Map/Parcel 296-008-OOE & OOF Page 1 of 4 BOH 4/26/12 .I t Town of Barnstable -Of Toh, Barnstable P 1` Bard of Health amerieacily • naatvsrasLE, 9 MASS. O 200.Main Street, Hyannis MA 02601 i639• �� a ptFb MA'S a, 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi BOARD OF HEALTH MEETING AGENDA Rev.1 Thursday, April`26,.2012 at 3:00 PM Town Hall, Hearing Room, 2ND Floor 367 Main Street, Hyannis, MA I. Hearing - Housing (Cont.): �. A./Lili Seely' owner= 33 Candlewick Lane, Hyannis,-housing and septic ,issue (continued from Dec 2011 and Feb 2012). B. Kenneth Carey,owner-439 (a.k.a. 441) South Main Street, Centerville, 3 units, housing violations (continued from Dec 2011 and Feb 2012). •) II. Hearing — Show Case: Housing (Cone.): Craigville Motel, 8 Shootflying Hill Road, Centerville, insufficient heat to occupants and use of space heaters operation of motel without a valid license for 2012 (Continued from March 2012). ` 111. Hearing = Connect to Sewer (Cont.): 30 Thornton Drive — Business Condos. Barnstable. Owners: A. William and Rita Amaral 1 Unit Map/Parcel 296-008-OOA B. Richard,Fleming 2 Units Map/Parcel 296-068-OOB & OOC C. Bert Mosher 1 Unit Map/Parcel 296-008-OOD-- D. Michael Michnay 2 Units Map/Parcel 296-008-OOE & OOF IV. Hearing — Housing (New): Fisherman's Village Condo Association, violation — draining, grade is slanting down towards foundation. V. Hearing — Septic Failure: Peter Sullivan, Sullivan Engineering, representing Richard Callahan, owner- 120.Bridge Street, Osterville, septic failure, house is not in use, requesting an j extension. - Page 1 of 2 BOH 4/26/12 VI. Variances — Septic (Cont.) Peter Sullivan, Sullivan Engineering, representing C. William Carey, owner— 986 Sea View Avenue,#A, Osterville, Map/Parcel 091-002, 2.72 acre parcel, proposal to grandfather four bedroom without installing new septic system (continued from June 2011). V91. Variances — Septic (New): A. Peter McEntee, Engineering Works, representing Richard Largay, owner— 75 Indian Trail, Barnstable, Map/Parcel 336-002, 3.55 acre parcel, septic repair of failed system, three variances. B. Theodore Skirvan, owner— 114 Long Pond Rd, Marstons Mills, discrepancy of bedroom count on septic permit in.file. VIII. Informal Discussion: A. Peter Sullivan, Sullivan Engineering, representing Michael Barnfield, owner - 233 Bay Lane, Centerville, Tight Tank Modification, discuss grey water system possibility. IX. Variance — Food (New): A. Jason O'Toole, owner— Pizza Barbone, 390 Main St, Hyannis, toilet facility variance. B. Temporary Food Event: Ragnar Relay Series — May 11- May 12, 2012, mobile truck at Dowes Beach,. Osterville. X. Policy/ Regulation: A. Touchless Faucet- modification for automatic shut-off button type. B. Ban on Pharmacy Tobacco Sales. XI. Correspondence: Fred Safford, Esquire, representing Zale Corporation at Cape Cod Mall. regarding violation of piercing ear cartilage. - - - - XII. Old / New Business: A. Cooper— 131 Skating Rink Road, Hyannis, septic has been replaced. IPA i i i L Page 2 of 2 BOH 4/26/12 Town of Barnstable �OFTHE TOly,Y Barnstable Board of Health BARNS-TABLE, • , ' MASS. g 200 Main Street, Hyannis MA 02601 � O 1639. ArE0 MAC A, 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi BOARD OF HEALTH MEETING RESULTS Tuesday, February 14, 2012 at 3:00 PM Town Hall, Hearing Room, 2ND Floor 367 Main Street, Hyannis, MA I. Hearings — Housing / Septic (Cont):' A. (Lili Seely, owner— 33 Candlewick Lane, Hyannis, housing and septic issue (continued from Dec 2011). Lili said today she had installed the smoke detectors, CO2 detector and had the two, ;door locks installed. The Board voted to continue to the April 10, 2012 meeting to follow up and see that; all the housing violations have been fixed and the septic permit has been pulled. B. Kenneth Carey, owner— 439 (a.k.a. 441) South Main Street, Centerville, 3 units, housing violations (continued from Dec 2011). Kenneth Carey explained that the additional replacement of the porch has added a large cost. His goal will be to have all work completed by April, if possible. The Board voted to continue to the April 10, 2012 meeting to see whether the septic inspection and the three units' repairs have been completed. II. Hearings — Septic: A. Bonnie Cooper, owner— 131 Skating Rink Road, Hyannis, failed septic. Bonnie has taken out a septic loan with the. County and is working with B&B for the septic installation. B&B has made an appointment for the perc tests. The Board voted to continue to the April 10,2012 meeting. B. Freerk Jilderda, owner— 78 Pontiac Street, Hyannis, failed septic. y Mr. Jilderda lives in Canada and has not contacted us to resolve the issue. Page 1 of 2 BOH 2/14/12 t f� A ;k i pos �� -11 Barnstable Health Department 200 Main Street Hyannis MA 02601 RE: Septic Work Being Contracted for.33 Candlewick Lane, Hyannis L To Whom it May Concern: I left a letter with the Health Department on Monday,January 9, 2012 explaining that I have decided to proceed with the steps necessary to bring the septic system at the above address up to code. I have been told that I need to formally request an postponement of today's hearing to allow for the work to be done. I am requesting same. Thank you for your consideration. Yours truly, Lili Seely , k - • 33 Candlewick Lane Hyannis MA 02601 (508)771-2269 Fritz02601 cr,aol.com January 6, 2012 7 Mr. Thomas Mckean, Director Town of Barnstable Health Dept 200 Main Street Hyannis MA 02601 Dear Mr. Mckean: I have used the extension I was given last month for a further evaluation of my septic system, and am satisfied that replacement is the only option at this point. This last month has allowed me to sort through conflicting reports, so that I could have the time to make an informed decision. It was prolonged as I have been sick for the last six weeks and have had very limited energy. I am only just starting to feel better. • I am'in the process of getting bids, applying for the septic loan, and preparing the property so that • changes can be made to allow equipment to navigate through what are presently small openings. We are looking at shortening a deck, to make room for the above, as one of our options. My thanks to the Board for giving me the time to understand the process. You will be hearing from an installer of my choosing very shortly. We are working diligently to make this happen while the weather is still favorable. Please note that I have enclosed a copy of an e-mail I sent to Mr. Parziale on Thursday. I am going to.try and go into work for a partial day on Monday to "test the water" and sincerely hope that Mr. Parziale's inspection can carry over to the following week. This will allow me some time to continue doing what I have been doing all the while, which is essentially rehabbing the house from top to bottom I am balancing priorities of work already underway with. an emphasis on prioriti2in Health Department mandates: Should you have any questions relative to my physical condition you have my permission to contact my supervisor, Mark Lavoie, at Hyannis Water System, at (508) 775-0063. Thank you. Yours truly, m Lili;Seely o¢ M Cc:Jim Parziale, R.S. Town of Barnstable ell*rat• Barnstable w Board of Health AlAmmicaCity IIAF3LE,MAM. 9 ^�' g' 200 Main Street, Hyannis MA 02601 i639• ArFp MAC A. 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi BOARD OF HEALTH MEETING MINUTES Tuesday, January 10, 2012 at 3:00 PM Town Hall, Hearing Room, 2ND Floor 367 Main Street, Hyannis, MA A regularly scheduled and duly posted meeting of the Barnstable Board of Health was held on Tuesday, January 10,2012. The meeting was called to order at 3:00 pm by Chairman Wayne Miller, M.D. Also attending were Board Members Paul J.Canniff,D.M.D and Junichi Sawayanagi. Thomas McKean,Director of Public Health,and Sharon Crocker,Administrative Assistant,were also present. I. Hearing - Housing / Septic (Cont): POSTPONED A. Lili.Seely, owner— 33 Candlewick Lane, Hyannis — • UNTIL FEB 14 housing and septic issue (continued from Dec 2011). 2012 POSTPONED, B. Kenneth Carey, owner— 439 (a.k.a. 441) South Main UNTIL FEB. 14 Street, Centerville, 3 units, housing violations 2012 (continued from Dec 2011). II. Variances — Septic (New): A. Stephen Wilson, Baxter Nye Engineering, representing David Brito, P&S Agreement with owners — 31 and 43 Church Hill Road, Centerville, Map/Parcel 207-138 and 207-139, total two lots is 32,045 square feet, multiple variances. Stephen Wilson presented a revised plan which changed the design from a 3 bedroom to a 2 bedroom and reduced the amount of soil cover. Two neighbors spoke on this. The neighbor across the street, Nancy, had photos of the area's flooding during the rain. Another person in the area, Eben Johnson, spoke on the need to protect • Shirley Fisher, works at the Historical Society, and agrees fully with Mr. Johnson's technical analysis of the area. She feels common sense would tell us that the Page 1 of 2 BOH 1/10/12 A °Ft1MME r°wti Town of Barnstable Barnstable ' . r Board of Health 4� AARNS"CABLE, ' MASS. 200 Main Street, Hyannis MA 02601 1639- �ATFD MAy A`0 m 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi BOARD OF HEALTH MEETING MINUTES Tuesday,.December 13, 2011 at 3:00 PM Town Hall, Hearing Room, 2ND Floor 367 Main Street, Hyannis, MA A regularly scheduled and duly posted meeting of the Barnstable Board of Health was held on Tuesday, December 13,2011. The meeting was called to order at 3:00 pm by Chairman Wayne Miller,M.D. Also attending was Board Member Junichi Sawayanagi. Board Member Paul J. Canniff,D.M.D,was unable to attend. Thomas McKean,Director of Public Health,and Teresa Wright,Division Assis ant,were also present. J I. Hearing — Housing / Septic: .,A. Lih Seely, owner— 33 Candlewick Lane, Hyannis - housing and septic • issue. ;Lili Seely was present. 5 1) Septic needs full inspection be for next meeting on January 10, 2012. 2) Needs to remove one of the tenants. No more than two tenants allowed. .3) Rental needs fullinspection be for next meeting on January-1 0, 2012. The Board voted to: Continue to next meeting on January 10, 2012. Motion to Approve by: Dr. M (Jim/Dr.M), Seconded by:_Jim (Jim/Dr. M.) B. Kenneth Carey, owner— 439 (a.k.a. 441) South Main Street, Centerville, ,6 3 units, housing violations. E , Kenneth Carey was present and discussed the three apartments and the housing {' violations with the Board: Apt#1 — Ceiling Height too low— older house. Apt#2 - Protective railings must be installed for outside railing. Apt# 3 — Back Unit: Hot Page 1 of 3 BOH 12/13/11 A • Health Master Detail http:%-ssql2/intranet/healthMaster/HealthMasterDetail.aspx?ID=268242 I-ogged In As: TOWN\flynnj Health Master Detail Wednesday,January 1 J 2012 ADolication Center Parcel Lookup Selection Items Reports Parcel Septic I Pere I Well I Fuel Tank Parcel: 268-242 Location:33 CANDLEWICK LANE,HYANNIS Owner:SEELY,LILI Septic 1,08/16/1996 New Septic... Permit number: 1996402 Permit type: I Select type Complete system: F Issue date: 0-8/16/1996 Tif- Complete date : 08/19/1996 Septic tank size: F- Type/Size of SAS: Her: I Select installer Installer: Card on file: F I/A service type: FSelect service_] Innovative/Alternative Technology type: Select A type variance date Abandon complete date F- Abandon permit number: F- /10/2011 Repair notification date F- Repair deadline date F1 1 Keyword: Comments: IREPAIR T5. Failed septic,On 11/10/09 BOH gave 2 years to repair syster Delete Septic I It Inspection 07/15/2009 Inspection 10/04/2004 New Inspection.. Number Inspection Date Inspector Result 15568 07/15/2009 !an- I Williams,Troy NFE(Needs further evaluation) Received Date Comments Leaching problem. Owner questioned evaluation. On Delete Inspection 11/10/09 BOH evaluated and determined must replace w/in 2 yrs. Owner must monitor and if any issues, must notify Health within 24 hr and replace septic at that j point within 60 Days. Otherwise—replace by 11/10/2011.jmf Per BOH - 1/10/12 deferred until 2/14.jmf Save Septic Changes I Return to Lookup http://issql2/intranet/healthMaster/HealthMasterDetail.aspx?ID=268242 1/11/2012 I oFVE r Town of Barnstable Barnstable P Board of Health . MI-wmericacK 1 RARNSrABLE, 9 MASS. $ 200 Main Street, Hyannis MA 02601 �pl 1639. FD MAC _007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi BOARD OF HEALTH MEETING RESULTS Tuesday, January 10, 2012 at 3:00 PM Town Hall, Hearing Room, 2ND Floor 367 Main Street, Hyannis, MA I. Hearing — Housing / Septic (Cont): `,'POSTPONED A. Lili Seely, owner— 33 Candlewick Lane, Hyannis UNTIL FEB 14 housing and septic issue (continued from Dec 2011). 2012 POSTPONED B. Kenneth Carey, owner— 439 (a.k.a. 441) South Main UNTIL FEB. 14 Street, Centerville, 3 units, housing violations 2012 (continued from Dec 2011). II. Variances — Septic (New): A. Stephen Wilson, Baxter Nye Engineering, representing David Brito, P&S Agreement with owners — 31 and 43 Church Hill Road, Centerville, Map/Parcel 207-138 and 207-139, total two lots is 32,045 square feet, multiple variances. Many spoke of their concerns with the property. The Board will conduct a site visit on Monday, February 6, 2012 at 11:30am and will visit the property if it rains before the next meeting. The Board voted to continue to February 14, 2012 and will review a revised plan which should be available in a couple weeks, showing an I/A Microfast System and a new floor plan once it is available. I Mr. Wilson will bring in extra copies of the plan, once completed, for the interested public. The Health Division will also have information about the Microfast System available. • I Page I of 3 BOH 1/10/12 TOWN OF BARNSTABLE LOCATION 3:3 CarA1,M 1r_fC L#J SEWAGE# ZO/a ' J01 VILLAGE ASSESSOR'S MAP&PARCEL A g pZ99;)� INSTALLER'S NAME&PHONE NO. a j_R EXCGt Val o.�� SEPTIC TANK CAPACITY JDOO ga,I LEACHING FACILITY:(type) 50pq cal chouvt.S "-z (size) g X 33 X Z NO.OF BEDROOMS .3 OWNER Li Lt �GG�CI./ PERMIT DATE: y ZG •1 Z COMPLIANCE DATE: G•/y-�2 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 Al' I 1 AZ- 17 ' .. A3' !9'(p if 03- X706 " RCAR A4- 251 DEG Sq- 3(o'G " AS- 3o'( '' ems• 5o ' a c , Commonwealth of Massachusetts p Title 5 Official Inspection Form r = 11. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 33 Candlewick Lane �u= Property Address Lilly Seely ; Owner Owner's Name / information is Hyannis ✓ Ma 02601 7-13-2020 required for every y 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 filling out forms A. Inspector Information (0 on the computer, use only the tab Daniel Hawkins key to move your Name of Inspector cursor-do not B&B Excavation use the return Company Name key. 374 Route 130 ua Company Address Sandwich Ma 02563 OIL Alf City/Town State Zip Code rx�1 (508)477-0653 S114324 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ❑■ Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails Dan "awl ins },Digitally signed by Dan Hawkins rl k 'Dale:2020.07.1410:26:06-04'00' 7-13-2020 Inspector'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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 } 1 Commonwealth of Massachusetts ' �u Title 5 Official Inspection Form += I1. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �o t 33 Candlewick Lane V Property Address Lilly Seely Owner Owner's Name information is Hyannis Ma 02601 7-13-2020 required for every y page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ❑■ I have not found any i-iformation 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 was in working order at the time of inspection. 2) 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 ears old"or the septic tank whether metal or not is structural)P Y p ( ) Y 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): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form +' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 33 Candlewick Lane u! Property Address Lilly Seely Owner Owner's Name information is Hyannis Ma 02601 7-13-2020 required for every y page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) 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. a. 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: l5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments „ 33 Candlewick Lane Property Address Lilly Seely Owner Owner's Name information is Hyannis Ma 02601 7-13-2020 required for every y page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. 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. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ a Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ondin of effluent to the surface of the round or surface waters x 9 P 9 9 ❑ ❑ due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form i?I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 33 Candlewick Lane Property Address Lilly Seely Owner Owner's Name information is Hyannis Ma 02601 7-13-2020 required for every y page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cost.) Yes No ❑ Q Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ a Liquid depth in cesspool is less than 6" below invert or available volume is less than '/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: ❑ 0 Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ 0 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 water supply well. ❑ El Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ 0 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.] ❑ 0 The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ 0 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. 5) 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 CA. 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 t5insp.doc•rev.7/26/2018 Title 5 Offidal Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 c Commonwealth of Massachusetts �v Title 5 Official Inspection Form 1,, Subsurface Sewage Disposal System Form -Not for Voluntary Assessments l; 33 Candlewick Lane V� Property Address Lilly Seely Owner Owner's Name information is Hyannis Ma 02601 7-13-2020 required for every y page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No 0 ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ 0 Were any of the system components pumped out in the previous two weeks? El ❑ Has the system received normal flows in the previous two week period? ❑ 0 Have large volumes of water been introduced to the system recently or as part of this inspection? 0 ❑ Were.as built plans of the system obtained and examined? (If they were not available note as N/A) ❑ El Was the facility or dwelling inspected for signs of sewage back up? 0 ❑ Was the site inspected for signs of break out? El ❑ Were all system components, excluding the SAS, located on site? 0 ❑ 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? ❑ a 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: El ❑ Existing information. For example, a plan at the Board of Health. ❑ Q Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts �? ,ip Title 5 Official Inspection Form col Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 33 Candlewick Lane v Property Address Lilly Seely - Owner Owner's Name information is Hyannis Ma 02601 7-13-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: 3 Number of bedrooms(design): Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 344/G P D Description: 3 Number of current residents: Does residence have a garbage grinder? ❑ Yes El No Does residence have a water treatment unit? ❑ Yes 0 No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes No information in this report.) Laundry system inspected? ❑ Yes El No Seasonal use? ❑ Yes (E No �Water meter readings, if available (last 2 years usage(gpd)): See below Detail: Only one years usage was available from the water department. 2019- 9,724gallons Sump pump? ❑ Yes ❑® No Last date of occupancy: currentDate t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form w Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 33 Candlewick Lane Property Address Lilly Seely Owner Owner's Name information is Hyannis Ma 02601 7-13-2020 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) _. 2. Commercial/Industrial Flow Conditions: NA 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 Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding to-ik present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Owner- last pumped 4 years ago Was system pumped as part of the inspection? ❑Q Yes ❑ No 1000 If yes, volume pumped: gallons How was quantity pumped determined? tank size Reason for pumping: For maintenance after inspection t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form ?I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 33 Candlewick Lane Property Address Lilly Seely Owner Owners Name information is Hyannis Ma 02601 7-13-2020 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: El 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): Approximate age of all components, date installed (if known)and source of information: New SAS added to existing tank in 2012 Were sewage odors detected when arriving at the site? ❑ Yes ❑■ No 5. Building Sewer(locate on site plan): 4' Depth below grade: feet Material of construction: ❑ cast iron X 40 PVC ❑other(explain): Town water Distance from private water supply well.or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments e� 33 Candlewick Lane u Property Address Lilly Seely Owner Owner's Name information is Hyannis Ma 02601 7-13-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 3' 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 1 Dimensions: 000gallons 5" Sludge depth: n 31 Distance from top of sludge to bottom of outlet tee or baffle 611 Scum thickness 511 Distance from top of scum to top of outlet tee or baffle 1211 Distance from bottom of scum to bottom of outlet tee or baffle measured How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The tank was in working order at the time of inspection. The tank was pumped after inspection for maintenance. t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 I cam, Commonwealth of Massachusetts �m Title 5 Official Inspection Form + Subsurface Sewage Disposal System Form -Not for Voluntary Assessments (F' 33 Candlewick Lane Property Address Lilly Seely Owner Owner's Name information is Hyannis Ma 02601 7-13-2020 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): NA Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): NA Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts �m Title 5 Official Inspection Form �= �i� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 33 Candlewick Lane v— Property Address Lilly Seely Owner Owner's Name information is Hyannis Ma 02601 7-13-2020 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cunt.) 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 9. Distribution Box(if present must be opened) (locate on site plan): oilDepth of liquid level above outlet invert Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): The d-box was in working order at the time of inspection. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal Systerr•Page 12 of 18 Commonwealth of Massachusetts ,�.p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Al 33 Candlewick Lane Property Address Lilly Seely Owner Owner's Name information is Hyannis Ma 02601 7-13-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. 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.): NA * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: (2)500 gallon chambers 0 leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 33 Candlewick Lane u Property Address Lilly Seely Owner Owner's Name information is Hyannis Ma 02601 7-13-2020 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The SAS was in working order at the time of inspection. Chambers were dry when viewed with no evidence of past back up. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration NA Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 • I Commonwealth of Massachusetts Title 5 Official Inspection Form +' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 33 Candlewick Lane �v .Property Address i Lilly Seely Owner Owner's Name information is Hyannis Ma 02601 7-13-2020 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): NA Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form �= Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 33 Candlewick Lane Property Address Lilly Seely Owner Owner's Name information is Hyannis Ma 02601 7-13-2020 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. 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: ❑0 hand-sketch in the area below ❑ drawing attached separately 7t9/2020 Assessing As-Built Cards 'TOWN OWBARNSTABLE LOCATION_, «'..... ar>r1.r�t�..�G.K L+•.t SI;WAIsF N,.,. 4./.♦..a1,.-.�'�''._ V'1LS,ACrE-NS}.H[Eri:. S2 C'f:.�_.,._ASStiSSOR•S MAP R.PARC:F1..,0?fT�:...2l�.i • SEPTIC TANK CAPACITY LEACHiNC3 r•AclLrrv:(tyres) NO.OF BEDROOMS P€:t;MTT DATE: +f._;ZG COMPLIANCE DArE /..jsy_f.y'*,_....,. . ` S>;Fameion Diatnnee.3letaerx she: .... `, M'aaimum Adjuuei[firottndw.Y TBelc to tht Botiom of I.encltio8['�.ci.lin+ Fxt Private Waror Supply well and'LeachinaFaci13lY(ff-tu.y wells existon __,�....._.._,_....,�-. aiie ar wi6,i..?txl fwx.af Icacnma f ility) Pees. .Fdge.oF W.I—d and Le ftipg'FaeiHty(IP a y—0—d,_jat within. 300[L t ofle-hina:f iliv) Feet FURNISHED BY Az- 17, .82' A3- g' A4-: 251 2 eR AS, zo'6" tis'- 5d' m 0 Q hops:/nownbarnstable,ma;us'Departmen[slAssessing/Property Values/HMtllsplay.asli?mappar=268242&sag=2 �r2 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 33 Candlewick Lane Property Address Lilly Seely Owner Owner's Name information is Hyannis Ma 02601 7-13-2020 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ■❑ Check Slope 011 Surface water ❑■ Check cellar ■❑ Shallow wells Estimated depth to high ground water: No GW @ 138"feet Please indicate all methods used to determine the high ground water elevation: 0 Obtained from system design plans on record 4-12-12 If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: A plan on file at the local Board of Health was used to determine high groundwater. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 - Title 5 Official Inspecfion Form:Subsurface Sewage Disposal System•Page 17 of 18 I� c Commonwealth of Massachusetts Title 5 Official Inspection Form � Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 33 Candlewick Lane Property Address Lilly Seely Owner Owner's Name information is Hyannis Ma 02601 7-13-2020 required for every y page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ■❑ A. Inspector Information: Complete all fields in this section. B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ■❑ C. Inspection Summary: 1, 2, 3, or 5 completec as appropriate 4 (Failure Criteria)and 6(Checklist)completed ■❑ D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 i Z'o No. Fee THE COMMONWEALTH-OF-MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftphration for ]Disposal stern Coustructiou prrmit Application for a Permit to Construct( ) Repair(V/Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. . �d elf G Ow er's Name,Address,and T�l No. /, Lot— Assessor's Map/Parcel �o 2 y0� �if S / 1 3 W d/eu)z IQ f-1 I tall ''s e,Address, nd Tel.No.60 � 4 7-7�-Q 6 gner's e,Address,and Tel.No. 8 7�,5 7� `�' CQ.tJG'c. D� id�i ounoah Type of Building: \ Dwelling No.of Bedrooms v Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures //,, Design Flow(min.required) 33 V gpd Design flow provided gpd Plan Date 'T 1 i a.l I-a- Number of sheets Revision Date Title sj f' Play r b l i S Size of Septic Tank IdO Q0J P_X f5fin Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date 4(1 251(Z Application Approved by � Date 12 Application Disapproved b Date for the following reasons Permit No. 7 01 Z���7�2 Date Issued 7-0 t L - ±�y.,..... .J.-�_T.,y.�s+.�^n..a"ova+w..+,..,�r.r.•..+�..aawo�y.-rt .... a.+.-+-.. y c .-•..ter . _-�-�. - h 5 '{ 1 �a No. Z��� �. ! Fee ` yD,1J THE COMMONWEAL ' v ASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplication for Disposal Opstein Construction Permit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 3 �Qndl �c�' Owner's Name,Address,and Tel No Assessor's Map/Parcel ��(} vZ�/ see/Y } 3 and/e(,v/c.�" i llP I tall s Nzme,Address,and Tel.No. S69.q 7 7-0/p D gner's Name,Address,and Tel.No. �,�� �-�. ' �x(-atz �� / t coo,i �' 7-P Pr , rn ( D ( Ce O 6 0) G ")u-f - - 7 J Type of Building: Dwelling No.of Bedrooms V Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 33 CJ gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title 51+(', P Cc n �d L 1 .Sigo<< ,4 Size of Septic Tank l aol) 0121 -(�x 15 f) Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Application Approved by c+G- Date 0/2 Application Disapproved by Date for the following reasons Permit No. 7 01 Date Issued V76 f Zo iZ THE COMMONWEALTH OF MASSACHUSETTS r BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ✓S Upgraded( ) Abandoned( )by T�'t"B �Yr rw n bo n at 3 3 C C,l has been constructed in accordance u with the provisions of Title 5 and the for Dis osal System Construction Permit No.70 'L' 1 dated t Z 6/Z 0 1 Z Installers b C Designer #bedrooms Approved design flow gpd The issuance of this permit shall n g be co trued as a guarantee that the s Y ste. will fun t' s ne P / Date Inspector --------- - - ------ --- - - -- - - - ----- -._ - -- -- No. 1-2- ' 0?} i Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Disposal *pstem Construction 3permit Permission is hereby granted to Construct({ ) Repair(V ) Upgrade( ,) Abandon - ( ) System located at 3 L _Q(�f i (� ja ( / . (-t on LC;h)F-T— 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. i Provided:Construction must be completed within three years of the date of this permit. Date y Z-6 / Z o�z- Approved by Town of Barnstable oFzxe r Regut tory Services Thomas F. Geiler, Director BAMSfABIA 9q, 16 9. 10m Public Health Division �FO1A°yp Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: 12- n Designer: ROW 2-S Installer: y 5<CA �J Address: F0-box Z63 Address: 14TkO Q 6 y 4-A NA).YAP-M05U . �Y1 P►- 'ire&),4nn oz�� ®z6 T On + G ,CA L9 as issued a permit to install a (date) (installer) 11 septic system at 3 3 C�le w�b C.K, L_..R• based on a design drawn by q� 1 (address) `\©y. RUJ .��1�1�i-t.�C� ��5 dated f5hod IZ (designer) I certify that the septic system referenced above was installed substantially according 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 with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. OF RONALD cy� JAMES � (Installer's Signature) CADILLAC 1060 QO i. r-oa& (Designer' i ature (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- 13UILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form w EXCERPT FROM THE BOARD OF HEALTH MEETING MINUTES ON 04/26/12: I. Hearing - Housing (Cont.): A. Lili Seely, owner— 33 Candlewick Lane, Hyannis, housing and septic issue (continued from Dec 2011 and Feb 2012). Lili Seely was present. She stated a septic permit was taken out. She is working on her list of housing items to repair. An inspection is set up with Health Inspector, Jim Parziale, for next Thursday, 5/3. At this time, the deck stairs have not been fixed because they must be removed to put in the new septic. They will be fixed after the septic is in. The baseboard covers are still missing because she is getting a new boiler and that person will do the baseboard at the same time. The other item undone is the ceiling tiles. Mr. McKean spoke of the continuous delays at this property. The septic is in hydraulic failure and was given 60 days to repair. It has been two years and the system is still not in. Ms. Seely has taken a great deal of time to repair the items on the list and has expended a lot of the health inspector's time. Upon a motion duly made by Mr. Sawayanagi, seconded by Dr. Canniff, the Board voted to have Ms. Seely return to the Board of Health at the July 10, 2012 meeting if the septic permit has not been completed or if the list of housing repairs has not been completed. (Unanimously, voted in favor.) EXCERPT FROM THE BOARD OF HEALTH MEETING MINUTES ON 11/10/09: I. Hearing — Septic Failure: A. Lili Seely, owner— 33 Candlewick Lane, Hyannis, Map/Parcel 268- 242, septic failure. Lily Seely summarized that when she bought the house she had the garbage disposal taken out as it harms septic. Septic worked fine. She was out of town for 5 years and when processing refinancing, they incorrectly required her to do a septic inspection. At that time, the system appeared to fail. She questioned whether that was accurate because the refinance company then decided to waive their fees etc. For the past four years, only three people have lived there. The inspection at the time of the refinance showed a failure. Now there is a new inspection in 2009 which again shows a failure. This failure is of the leaching chambers. The Q:\MINUTES\EXCERPT OF MINUTES\Excerpt BOH Multiple Seely 33 Candlewick Hy.doc leaching had been connected to flow into the leach pit (which is what had originally failed.). Upon a motion duly made by Susan Rask, seconded by Mr. Sawayanagi, the Board voted to request a septic replacement within a two year period , monitoring by the homeowner, notify the Health Dept within 24 hrs, and have the system pumped and then replace the system at this point within 60 Days. (Unanimously, voted in favor.) Q:\MINUTES\EXCERPT OF MINUTES\Excerpt BOH Multiple Seely 33 Candlewick Hy.doc i 66 Town of Barnstable P# _rzJ Department of Regulatory Services F Public Health Division MAW Date IFD j 200 Main Street,Hyannis MA 02601 Date Scheduled /!®` l Time Fee Pd. d Foil Suitability Assessment fog- Sewa e Disposal Performed•By: ROA) CAdlI/�C. /2S- Witnessed By: LOCATION&GENERAL INFORMATION Location Address 3 C����,/L / Owner's Name h`'!%�-i�li�fSJ f i�/•7 Address if:I�•J�UX Assessor's Map/Parcel: / 268 j -24 Z Engineer's NameVV NEW CONSTRUCTION REPAIR Telephone# 'Land Use Y ff YLi7 i'y�c9� �y �A�SIoP�(` ) Surface Stones 1 1 0 Distances from: Open Water Body ft Possible Wet Area__.�d ft Drinking Water Wellft Drainage Way 040 ft Property Line -- 5 ( ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands In proximity to holes) :5 7 Zf Lc� - Lo` - A & 5�l -�1161 ►5 Cv2tiC re 13prAl oyy wR S�I. P.i�.� �. Parent material(geologic) Depth to Bedrock Depth to Groundwater. Standing Water in Hole: h Weeping from Pit Face n I , Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE C-71ei . / Method Used: Gr0va�d tv4-�i�. W ,S h4u9S �5 GI•/�74 Depth Observed standing in obs.hole: ln, Deptli to so pules: ^ in. /:� � Depth to weeping from side of obs.hole: In, Groundwater Adjustment ft. b Index Well# Reading Date: Index Well level^ _._., Adj.factor- Adj.Groundwater level PERCOLATION TEST bete ZlYme 0lza Observation Hole# Time at 9" /T Depth of Perc ' Du -� —f Time at 6" 7 Start Pre-soak Time @ �Q /D Time(9"-6") End Pre-soak /0. Z 0 Al r r // V / Rate Min./Inch Z Z jl/ I/✓l�L Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(YIN) av 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:ISEPTIC\PERCFORM.DOC r - DEEP-OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Sdil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,'Boulders. i ten cv.%'Gravel) !/ /19 (� DEEP OBSERVATION HOLE LOG Hole# 2— Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. C—Onsistency.%Gma e I/ DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil . Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, Gravel) 1 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Boll Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consi t n 96 6 Flood Insurance Rate Map: Above 500 year flood boundary No— Yes .V__ Within 500 year boundary No Yes ' Within 100 year flood boundary No._ Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? -- YES _^ If not,what is the depth of naturally occurring pervious material? Certification I certify that on ��V, L'� date)I have passed the soil evaluator examination approved by the Department of Environmental Protection an hat the above analysis was performed by me consistent with . the required rung,a esed in 310 CMR 15.017. Signature Datt: Z 0 2-- Q:1S.EPTICVERCPORM.DOC I y , s , 2-/f y �� Barnstable Health Department 200 Main Street Hyannis MA 02601 RE: Septic Work Being Contracted for 33 Candlewick Lane, Hyannis To Whom it May Concern: I left a letter with the Health Department on Monday,January 9, 2012 explaining that I have decided to proceed with the steps necessary to bring the septic system at the above address up to code. I have been told that I need to formally request an postponement of today's hearing to allow for the work to be done. I am requesting same. Thank you for your consideration. Yours truly, Lili Seely f 33 Candlewick Lane Hyannis MA 02601 (508)771-2269 Fritz02601 Qaol.com January 6,2012 Mr. Thomas Mckean, Director Town of Barnstable Health Dept 200 Main Street Hyannis MA 02601 Dear Mr. Mckean; I have used the extension I was given last month for a further evaluation of my septic system, and am satisfied that replacement is the only option at this point This last month has allowed me to sort through conflicting reports, so that I could have the time to snake an informed decision. It was prolonged as I have been sick for the last six weeks and have had very limited energy. I am only)ust starting to feel better. I amain the process of getting bids, applying for the septic loan, and preparing the property so that changes can be made to allow equipment to navigate through what are presently small openings. We are looking at shortening a deck, to make room for the above, as one of our options. My thanks to the Board for giving me the time to understand the process. You will be hearing from an installer of my choosing very shortly. We are working diligently to make this happen while the weather is still favorable. Please note that I have enclosed a copy of an e-mail I sent to Mr. Parziale on Thursday. I am going to .try and go into work for a partial day on Monday to "test the water" and sincerely hope that Mr. Parziale's inspection can carry over to the following week. This will allow me some.time to continue doing what I have been doing all the while,which is essentially rehabbing the house from top to hbottom I am balancing priorities of work already underwav with an emphasis on priori.d-z' ,Health Department mandates. Should you have any questions relative to my physical condition you have my permission to contact my supervisor, Mark Lavoie, at Hyannis Water System, at (508) 775-0063. Thank you. .a —4 ._ Yours truly, 01 Lili Seely Cc:Jim Parziale, R.S. 00 THE r Town of Barnstable �oF oty,L Barnstaule O . Board of Health Al�AmericaCitY * BARNSCABLE, MASS. $ 200 Main Street, Hyannis MA 02601 a '639. pIFD MA'S A m 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi BOARD OF HEALTH MEETING MINUTES Tuesday, December 13, 2011 at 3:00 PM Town Hall, Hearing Room, 2ND Floor 367 Main Street, Hyannis, MA A regularly scheduled and duly posted meeting of the Barnstable Board of Health was held on Tuesday, December 13,2011. The meeting was called to order at 3:00 pm by Chairman Wayne Miller,M.D. Also attending was Board Member Junichi Sawayanagi. Board Member Paul J. Canniff,D.M.D,was unable to attend. Thomas McKean,Director of Public Health,and Teresa Wright, Division A s ant,were also present. I. Hearing — Housing / Septic: l A. Lili Seely, owner— 33 Candlewick Lane, Hyannis - housing and septic issue. Lili Seely was present. 1) Septic needs full inspection be for next meeting on January 10, 2012. 2) Needs to remove one of the tenants. No more than two tenants allowed. 3) Rental needs full inspection be for next meeting on January 10, 2012. The Board voted to: Continue to next meeting on January 10, 2012. Motion to Approve by Dr. M (Jim/Dr.M), Seconded by:_Jim (Jim/Dr. M.) B. Kenneth Carey, owner— 439 (a.k.a. 441) South Main Street, Centerville, 3 units, housing violations. Kenneth Carey was present and discussed the three apartments and the housing violations with the Board: Apt#1 — Ceiling Height too low-older house. Apt#2 — Protective railings must be installed for outside railing. Apt# 3 — Back Unit: Hot Page 1 of 3 BOH 12/13/11 L < Health Master Detail http://**.ssql2/intranet/healthMaster/HealthMasterDetail.aspx?ID=268242 Health Master Detail AL)[mc�t;on nMI PaiceiLoolow, Rz.!-,oft, F rcei septic Perc I Well j Fuel Tank P Parcel: 268-242 Location: 33 CANDLEWICK LANE, HYANNIS Owner:SEELY,LILI Septic 1, 08/16/1996 New Septic... Permit number: F1996402 Permit type: I select type Complete system: F Issue date : 108/16/1996 'LE Complete date : FO8/19/1996 Septic tank size: Type/Size of SAS: Installer:I select installer Card on file: F I/A service type: Select service Innovative/Alternative Technology type: Select A type Variance date Abandon complete date F Abandon permit number: Repair deadline date F11/10/2011 Repair notification date F Keyword: Comments: IREPAIR T 5. Failed septic,On 11/10/09 BOH gave 2 years to repair systet Delete Septic Inspection 07/15/2009 1 nspection 10/04/2004 New Inspection... Number Inspection Date Inspector Result NFE(Needs further evaluation) F5568 F07/15/2009 Williams,Troy Received Date Comments Leaching problem, Owner questioned evaluation. on -Delete Inspection 11/10/09 BOH evaluated and determined must replace ., w/in 2 yrs. owner must monitor and if any issues, must notify Health within 24 hr and replace septic at that F point within 60 Days. Otherwise..replace by 11/10/2011.jmf Per BOH - 1/10/12 deferred until? 2/14.jmf Save Septic Changes I Return to Lookup http'.-Hiis sql2/intranet/healthMaster/HealthMasterDetail.aspx?ID=268242 1/11/2012 raw 1 J Tad, Town of Barnstable Regulatory Services + BARNSrAB" MAS g Thomas F. Geiler, Director 1639. .m 01A�`A Public Health Division Thomas McKean, Director 200 Main Street,Hyannis, MA 02601 --Office: 508-862-4644 Fax: 508-790-6304 February 13, 2012 Lili Seely 33 Candlewick Lane Hyannis, MA 02601 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 33 Candlewick Lane, Hyannis, MA, was inspected on February 13, 2012 -by Jim Parziale R.S., Health Inspector for the Town of Barnstable. This inspection was conducted in accordance with the 2006 Barnstable.rental registration ordinance requiring yearly inspections of all rental properties. The following violations of the State Sanitary Code were observed: 105 CMR 410.351 —Owner's Installation and Maintenance Responsibilities Upper level rear exterior door does not latch: Rear deck stairs do not have any railing system. Rear deck is missing sections of railing. Lower level rear exterior door is missing door knob. Lower level rear exterior screen door is missing handle mechanism. Numerous baseboard heating covers are missing. - Missing outlet with exposed electrical wiring observed in laundry room. Dishwasher panel is missing with exposed electrical wiring; 105 CMR 410.500—Owner's Responsibility to Maintain Structural Elements Large areas of lower level are missing drop panel ceiling sections and electrical wiring is exposed. i ` Hole was observed in wall in lower level hallway. Two windows in upper level living room are broken. 105 CMR 410.480-Locks Upper level rear exterior door does not lock. Lower level rear exterior door does not lock. 105 CMR 410.482—Smoke Detectors and Carbon Monoxide Alarms There is no CO alarm located byupstairs bedrooms. Smoke detector located by upstairs bedrooms is not functional. 105 CMR 410.190—Hot Water Hot water temperature measured at 155'F. You are directed to correct the State Sanitary Code violations 105 CMR 410.480 and 105 CMR 410.482 within twenty four.(24) hours of your receipt of this notice. You are directed to correct all other State Sanitary Code violations listed above within thirty (30) days of your receipt of this notice. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the, order is served. However, noted violations must be corrected within twenty four hours regardless of any request for a hearing. Non-compliance will result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and 'ask,to speak with the inspector who performed the inspection. PER ORDER OF THE BOARD OF HEALTH om"A. ciea2n, 1M,., CHO Director of Public Health Town of Barnstable ti 33 Candlewick Lane Hyannis MA 02601 (508)771-2269 Fritz02601 Qaol.com January 6, 2012 Mr. Thomas Mckean, Director Town of Barnstable Health Dept 200 Main Street Hyannis MA 02601 Dear Mr. Mckean; I have used,the extension I was given last month fora further evaluation of my septic system,and am satisfied that replacement-is the only option at this point. x. This last month has allowed me to sort through conflicting reports, so that I could have the time to make an informed decision. It was prolonged as I have been sick for the last six weeks and have had very limited-energy. I am only just starting to feel better. I am�ih the process of getting bids, applying for the septic loan, and preparing the property so that changes can be made to allow equipment to navigate through what are presently small openings. We are looking at shortening a deck, to make room for the above, as one of our options. My thanks:tb the Board for giving me the time to understand the process. You will be hearing from An installer of my choosing very shortly. We are working diligently to make this happen while the weather is still favorable. Please note that I have enclosed a copy of an e-mail I sent to Mr. Parziale on Thursday. I am going to try and go into work for a partial day on Monday to "test the water" and sincerely hope that Mr. Parziale's inspection can carry over to the following week. This will allow me some time to continue doing what I have been doing all the while, which is essentially rehabbing the house from top to bottom. 1 am balancing,priorities of work already tilnd,envaz, with an emphasis on..priorir,zing Health" ' Department mandates. 1 Should you have any questions relative to my physical condition you have my permission to contact my supervisor, Mark Lavoie, at Hyannis Water System, at (508) 775-0063. Thank you. Yours truly, :m. Lili Seely - CP 0� Cc:Jim Parziale, R.S. i 33 Candlewick Lane, Hyannis MA 02601 5bf8.771.2269 1=ritz02601 naol.com December 13, 2011 Barnstable Health Department Main Street Hyannis MA 02601 RE: Request for Postponement To Whom it May Conc ern: I am respectfully requesting a postponement of a hearuig that was scheduled for this afternoon at 3:00 pm. I have been sick for the past three days and feel that I am not at peak clarity to represent myself in a matter that aught require more technical expertise than I am capable of, or can muster. Richard Capen, of Cape Enterprises, performed an informative inspection on Thursday, December 8"', as a follow-up to a routine maintenance pump of six months ago. He opened the septic tank to check on the operating level, and the pit to check the water level. He determined that there were no runbacks and that the system was at a proper operating level. Mr. Capen is unable to attend this hearing as my representative and a January hearing would be much appreciated. Thank you for your consideration. Sincerely, M ~ v X Uj Lili Seely 7-D Hand Delivered �v 11 oF1HE Taw Town of Barnstable Barnstable Board of Health All.f,�caCity 1� BARN6TABLE, 9 MASS. $ 200 Main Street, Hyannis MA 02601 I., i679• ArEG MA'S A, m 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi BOARD OF HEALTH MEETING MINUTES Tuesday, December 13, 2011 at 3:00 PM Town Hall, Hearing Room, 2ND Floor 367 Main Street, Hyannis, MA A regularly scheduled and duly posted meeting of the Barnstable Board of Health was held on Tuesday, December 13,2011. The meeting was called to order at 3:00 pm by Chairman Wayne Miller,M.D. Also attending was Board Member Junichi Sawayanagi. Board Member Paul J. Canniff,D.M.D,was unable to attend. Thomas McKean,Director of Public Health,and Teresa Wright, Division Assistant,were also present. I. Hearing — Housing / Septic: A. Lili Seely, owner— 33 Candlewick Lane, Hyannis — housing and septic issue. Lili Seely was present. 1) Septic needs full inspection be for next meeting on January 10, 2012. eeds to remove one of the tenants. No more than two tenants allowed. 3) Rental needs full inspection be for next meeting on January 10, 2012. The Board voted to: Continue to next meeting on January 10, 2012. Motion to Approve by: Dr. M (Jim/Dr.M), Seconded by: Jim (Jim/Dr. M.) _ B. Kenneth Carey, owner 439.(a.k.a. 441) South Main Centerville Street, , 3 units, housing violations. Kenneth Carey was present and discussed the three apartments and the housing violations with the Board: Apt#1 — Ceiling Height too low— older house. Apt#2 — Protective railings must be installed for outside railing. Apt# 3 — Back Unit: Hot S Page 1 of 3 BOH 12/13/11 Excerpt from the Board of Health Meeting Minutes on 12/13/2011: I. Hearing — Housing / Septic: A. Lili Seely, owner— 33 Candlewick Lane, Hyannis — housing and septic issue. Lili Seely was present. 1) Septic needs full inspection before the next meeting on January 10, 2012. 2) Needs to remove one of the tenants. No more than two tenants allowed. 3) Rental needs full inspection be for next meeting on January 10, 2012. Upon a motion duly made by Dr. Miller, seconded by Mr. Sawayanagi, the Board voted to continue to next meeting on January 10, 2012. (Unanimously, voted in favor.) U � , Ih r: To Whom It May Concern: I inspected the property owned by Lili Seely located at 33Tandlewiek:Cane;rHy�anni n 10/28/201.1. This was due to a complaint filed with the Health Division on 10/17/2011. Ms. Seely has a failed septic system which the Board had given her two years to replace in November of 2009. The system has not been replaced. Furthermore, the failed septic system was designed for three bedrooms and during the inspection I observed four rooms being used as bedrooms, two on the top level and two on the lower level. The last issue Ms. Seely is facing is that the two lower level rooms, being used for sleeping, do not have proper secondary egress (the window sill heights are>44" off the floor and they do not provide the minimum opening of 20" X 24"required). Ms. Seely is renting out three of the four rooms being used for sleeping and has s` registered the property as a rental. Sincerl , R � C.47�. LN PJim rziale R.S. l Health Inspector Town of Barnstable J Public Health Division 25 r �s lti Town of Barnstable Barnstable Regulatory Services A*AmedeaCft BARNSTABM MASS. $ Thomas F. Geiler,Director Public Health Division 2007 Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 October 28, 2011 Lili Seely PO Box 77 W. Hyannisport, MA 02672 NOTICE TO ABATE VIOLATIONS OF 105 .CMR 410.000, STATE SANITARY CODE II — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 33 Candlewick Lane, Hyannis, MA, was inspected on October 28, 2011 by Jim Parziale, Health Inspector for the Town of Barnstable. This inspection was conducted in response to a complaint filed with the" Town of Barnstable Public Health Division. The following violations of the State Sanitary Code were observed: 105 CMR 410.300 and 310 CMR 15.00: Sanitary Drainage System There were a total of four (4) bedrooms observed in this dwelling; two (2) were observed on the top floor and two (2) were observed on the lower level, however, the existing septic system is designed for three (3) bedrooms. The current three bedroom septic system on site (permit# 96-402) is failed. 105 CMR 410.450 : Means of Egress Two rooms observed in the lower level, being used for sleeping, are lacking proper secondary egress. Sill heights are>44" from floor and minimum opening of 20" X 24" is not met. You are directed to correct the State Sanitary Code violations 105 CMR 410.300 and 310 CMR 15.00 within thirty (30) days of your receipt of this notice. You are directed to correct the State Sanitary Code violation 105 CMR 410.450 within twenty four(24) hours of your receipt of this notice by ceasing using these rooms for sleeping., You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. However, violation 105 CMR 410.450 must be corrected within twenty four hours regardless of any request for a hearing. Non-compliance will result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., CHO Director of Public Health Town of Barnstable f Town of Barnstable Barnstable Regulatory Services Department y' CaC P BAMSPABLL "tA. Public Health Division 9 i639, 10 m 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO 11/10/11 Lili Seely P.O. Box 98 West Hyannisport, MA 02672 FINAL ORDER ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 33 Candlewick Lane, Hyannis on 11/10/2009 was order by the Board of Health to be repaired within two years. The deadline for repair has gone by. We, The Department of the Board of Health, have not been informed that you have taken any steps to bring your failed system into compliance. Therefore, you are ordered to repair, or replace the septic system within 60 days from the date you receive this notification. You may request a hearing before the Board of Health, a written petition requesting a hearing on the matter, within seven (7) days after the day this order was received. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health V. Hearing — Septic Failure: A. Lili Seely, owner— 33 Candlewick Lane, Hyannis, Map/Parcel 268-242, septic failure. The Board voted to request a septic replacement within a two year period, monitoring by the homeowner, notify the Health Dept within 24 rs, and have the system pumped and then re lace the system at this point within 60 Days. �v r BARNSTABLE HEALTH DEPARTMENT RE: 33 CANDLEWICK LANE, HYANNIS PO Box 77 West Hyannisport MA 02672 (508) 771-2269 Fritz02601 gaol.com Town of Barnstable Regulatory Services Department Public Health Division 200 Main Street Hyannis MA 02601 To Whom It May Concern: I am respectfully requesting an additional period of time to repair,what was determined to be a failing septic system, in 2005. In 2009 I was given two years to complete the repair, and was told to pump and monitor the system, all of which were done. I would like to be able to make a case, at the next hearing of the Board, that the system is continuing to function without significant impact. I can be reached at (508) 771-2269 should you have any questions. Thank you:--- Sincerely, : w Cd s 4 3 Lili Seely �, A oF�HE to Town of Barnstable Barnstable . � Regulatory Services -�,�;��c-rt„ =�- '4� BARNSTABLF: r'.�I _...-*---m+-- ��� �bs9. �g/( Thomas F. Geiler, Director 3 � p p \rf � Public Health Division m 2007 Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 —._- Office: 508-862-4644 Fax: 508-790-6304 p October 28, 2011 Lill Seely P O Box 77 W. Hyannisport, MA 02672 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000 STATE SANITARY �— CODE II —MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 33 Candlewick Lane, Hyannis, MA, was m inspected on October 28, 2011 by Jim Parziale, Health Inspector for the Town ofµ " Barnstable. This inspection was conducted in response to a complaint filed with the ~ Town of Barnstable Public Health Division. --._: The following violations of the State Sanitary Code were observed: 105 CMR 410.300 and 310 CMR 15.00: Sanitary Drainage System There were a total of four (4) bedrooms observed in this dwelling; two (2) were observed on the top floor and two (2) were observed on the lower level, however, the existing septic system is designed for three (3)bedrooms. The current three bedroom septic system on site (permit# 96-402) is failed. -- 105 CMR 410.450 : Means of Egress Two rooms observed in the lower level, being used for sleeping, are lacking proper secondary egress. Sill heights are >44" from floor and minimum opening of 20" X 24" is not met. You are directed to correct the State Sanitary Code violations 105 CMR 410.300 Mom' and 310 CMR 15.00 within thirty (30) days of your receipt of this notice. You are directed to correct the State Sanitary Code violation 105 CMR 410.450 within n` twenty four (24) hours of your receipt of this notice by ceasing using these rooms for sleeping. �` •lam You may request,a hearing before the Board of Health if written petition requesting same is received within ten 10 days after the date the order is served. However, violation 105 CMR 410.450 must be corrected within twenty four hours regardless of any request for a hearing. Non-compliance will result in a fine of $100.00 per violation. Each days failure to comply with an order shall constitute a separate violation. -- Should you have any questions regarding the above violations, please contact the Town --- Health Division and ask to speak with the inspector who performed the inspection. -- PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., CHO Director of Public Health Town of Barnstable y Town of Barnstable Barnstable Aff-America CRY pF THE Tp� * "o„ Board of Health . ■ARNSTABLE, . 200 Main Street,Hyannis MA 02601 O D D % MASS. 1639. 2007 Argo��p OFFICE: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Junichi Sawayanagi Paul Canniff,D.M.D. BOARD OF HEALTH MEETING RESULTS Tuesday, November 10, 2009 at 4:00 PM Town Hall, Hearing Room 367 Main Street, Hyannis, MA I. Executive Session II. Monitoring (Cont.): APPROVED Peter McEntee, Engineering Works representing The 699 Main Street; LLC — Fancy's Market— 699 Main Street, Osterville, Map/Parcel 141-011, 0.17 acre parcel, discuss results of aerating. The Board voted to approve a reduction in monitoring based on the results of aeration. III. Hearing — Underground Storage Tanks (Cont): Peter Doyle and Dale Saad, Water Pollution Control Division, Town of Barnstable, owner— 382 Falmouth Road (a.k.a. 617 Bearse's Way), Hyannis, Map/Parcel 293-001. Board voted to approve a two-year extension for the replacement for the Chlorine tank and one year extension for the Fuel Tank. IV. Hearing — Tobacco: Tobacco violations as reported by Bob Collette of Barnstable County Tobacco Control. A. Sav-On Service Station, 590 lyannough Road, Hyannis —Observed Violation of Smoke-Free Workplace Law. The Board voted to approve a $100 fine for the first offense. B. Barnstable Road Getty, 112 Barnstable Road, Hyannis — Observed Violation of Smoke-Free Workplace Law. The Board voted to issue a warning. V. Hearing — Septic Failure: A. Lili Seely, owner— 33 Candlewick Lane, Hyannis, Map/Parcel 268-242, septic failure. The Board voted to request a septic replacement within a two year period, monitoring by the homeowner, notify the Health Dept within 24 hrs, and have the system pumped and then replace the system at this point within 60 Days. CONTINUED B. Michael Santos, owner— 26 Bishops Terrace, Hyannis, UNTIL DEC 8 Map/Parcel 251-215, septic failure. 2010 BOH The Board voted to Continue until Dec 8, 2009 meeting and Mr. Santos will have an inspection report done prior to that for the Board to evaluate. CONTINUED C. Rosanie Joseph and Severe Philogene, owners — 33 UNTIL DEC 8 Stetson Street, Hyannis, Map/Parcel 306-055, septic 2010 BOH failure. The sewer is scheduled to arrive in two years. The Board voted to Continue to the December 8 meeting for final approval. VI. Septic Variance: DENIED Adam Hostetter representing John and Shama Fulham, owners — 76 Nelson Lane, Hyannis, Map/Parcel 125-072, existing 1,000 gallon tank (undersized per Title V), proposal to add additional bathroom with sewer injector pump. No one was present. Mr. McKean had asked Mr. Hostetter to speak to the DEP prior to meeting to clarify new/old construction limitation. The Board voted to approve the system. DENIED — Unanimously. (person may resubmit in the future.) VII. Old Business/New Business: A. Regulation Revision - Septic Repair Deadlines for potential sewer hook-ups. 1. Sue Rask and Dr. Miller suggests sending letters out to the homeowners (124 homeowners/condo owners) and Installers and Engineers to contact the Health Division if they have a client who lives in the Stewart Creek Sewer Hookup Area. V. Hearing — Septic Failure: A. Lili Seely, owner— 33 Candlewick Lane, Hyannis, Map/Parcel 268-242, septic failure. Lily Seely summarized that when she bought the house she had the garbage disposal taken out as it harms septic. Septic worked fine. She was out of town for 5 years and when processing refinancing, they incorrectly required her to do a septic inspection. At that time, the system appeared to fail. She questioned whether that was accurate because the refinance company then decided to waive their fees etc. For the past four years, only three people have lived there. The inspection at the time of the refinance showed a failure. Now there is a new inspection in 2009 which again shows a failure. This failure is of the leaching chambers. The leaching had been connected to flow into the leach pit (which is what had originally failed.). Upon a motion duly made by Susan Rask, seconded by Mr. Sawayanagi, the Board voted to request a septic replacement within a two year period , monitoring by the homeowner, notify the Health Dept within 24 hrs, and have the system pumped and then replace the system at this point within 60 Days. (Unanimously, voted in favor.) 1t• Fr^OM :HYANNIS WATER SYSTEM FAX NO. :508 790 1313 Nov. 08 2011 08:40AN P1 Fax . Phone@ (508) 771.2269 To: Hyannis Health Department Subject: .pate: Fax: Pages(including cover).- Urgent[ ] For Review[ ] Reply[ ] f ec�:j,i"!1i '111���9k =3'•yci�t? 'y, m _. . . .;, «:s; �E �► (,:<,�,�;. :111f'i!��,; ,t: �1lEf# I am faxing a letter requesting an extension of an order to repair a septic system at 33 Candlewick Lane. I have been told that this can be heard at the December meeting. I will bring in the hard copy of the letter later today. Thank you. Lill Seely FROM :HYANNIS WATER SYSTEM FAX NO. :508 790 1313 Nov. 08 2011 08:40AM P2 PO Box 77 West Hyannispoiy NiA 02672 (508) 771^2269 Fdt702601&aol.cotn Town of Barnstable Regulatory Senriccs Department Public Health Division 200 Main Street Hyannis M11 02601 c, �zLyi ,L�- - u�nis /mil/P a68= a�� To Whom It May Concern: I a1n respectfully-requesting an additional period of time to repair, what was determined to be a failing septic system, in 2005. In 2009 I was given two years to complete the repair, and was told to pump and monitor the system, all of which were done. 1 would like to be able to make a case, at the next hearing of the Board,that the system is continuing to function without significant impact:. I can be reached at (508) 771-2269 should you have any questions. Thank you. Sincerely, Lilt Seely I To: Town of Barnstable Health Department From: Lili.Seely Property: 33 Candlewick.Lane, Hyannis Date: November 10, 2009 RE: REQUEST FOR TEMPORARY RECONSIDERATION OF NOTICE TO UPGRADE SEPTIC SYSTEM When I bought my house in December of 1996 I was told the septic was recently. upgraded. A disposal existed when I first bought the house but, knowing they can wreak havoc with a septic system, promptly had it removed. I have a receipt for the work. From that time to the present, there has never been a problem. However, in 2005 I applied for a lower mortgage interest rate with Wells Fargo, while I was working in Utah, and they stated that a septic inspection was required. I was surprised, and a little dubious, to be told that my leaching field was supposedly in failure. There had been major errors in processing my application, and Wells Fargo was making good, under the direction of their regional office, by giving my new mortgage to me with zero closing or processing costs. I was, therefore, leery of the report, and even suspected chicanery.based on a reconsideration of their agreement to waive these fees. I returned to Cape Cod a few months later, after having been gone for nearly five years to discover that my house was in shambles from tenants. Until I left in 2001, for six months, to work for the Olympics in Salt Lake City I had shared.my house with two responsible adults. My two excellent tenants remained at the house Six months became nearly five years and the two tenants moved on with others taking their place. When I returned I discovered that there were six people living there! I quickly moved back in and reduced the housernates to two and, occasionally, three. The septic continued, in my mind, to function without a problem. Page Two 33 Candlewick Lane, Hyannis November 10, 2009 In the meantime, I researched the county loan program, met.with Kendall Ayers, and had two installers out to review the situation. However, as time went by the urgency seemed less and less until I received a letter from the Health Dept stating'I was in violation. Troy Williams performed an inspection several months ago and noted that the liquids are being redirected to an old pit which seems to be working fine as evidence by-the small amount of liquid in the pit. He also observed that there was no grease in the system which would be consistent with the fact that the three adults living here, including me, have jobs, areaway for much of the day and usually eat out. I am applying for a reconsideration of the requirement to have the system upgraded, at this time, for the following reasons: 1. A state requirement to have an inspection for a refinance did not exist at the time of my application with Wells Fargo 2. The system was impacted by the tenants living there in my absence 3. I returned in 2005 and restored sanity to the situation 4. I have no intention of leaving again 5. The system is working fine, I intend to have it pumped, and will continue to maintain it at your direction 6. The present impact, under my direction, is minimal; this is a house in which recycling is almost a religion and I have thoughtful, responsible tenants. At this time, even the extended payback arrangements of a county loan would be significant although I realize that that is a non- issue. However, should this be something that can be put on hold for the time being, and carefully monitored, I would be grateful. Thank you. Lili Seely P.O. Box 77 West Hyannisport MA 02672 (508) 771-2269 Frit7.02601&aol.com Town of Barnstable Board of Health Main Street Hyannis MA 02601 RE: Septic Failure at 33 Candlewick Lane, Hyannis To Whom it May Concern: Please schedule me for the next Board of Health hearing relative to the above. I can be reached at the above number if you have any questions. Thank you. Sincerely, i Lih Seely ,o w =r ca c N 0 sa: L Excerpt from the Board of Health Meeting Minutes November 10, 2009: I. Hearing — Septic Failure: A. Lili Seely, owner— 33 Candlewick Lane, Hyannis, Map/Parcel 268- 242, septic failure. Lily Seely summarized that when she bought the house she had the garbage disposal taken out as it harms septic. Septic worked fine. She was out of town for 5 years and when processing refinancing, they incorrectly required her to do a septic inspection. At that time, the system appeared to fail. She questioned whether that was accurate because the refinance company then decided to waive their fees etc. For the past four years, only three people have lived there. The inspection at the time of the refinance showed a failure. Now there is a new inspection in 2009 which again shows a failure. This failure is of the leaching chambers. The leaching had been connected to flow into the leach pit (which is what had originally failed.). Upon a motion duly made by Susan Rask, seconded by Mr. Sawayanagi, the Board voted to request a septic replacement within a two year period , monitoring by the homeowner, notify the Health Dept within 24 hrs, and have the system pumped and then replace the system at this point within 60 Days. (Unanimously, voted in favor.) Excerpt from the Board of Health Meeting Minutes December 13, 2011: I. Hearing — Housing / Septic: A. Lili Seely, owner- 33 Candlewick Lane, Hyannis — housing and septic issue. Lili Seely was present. 1) Septic needs full inspection before the next meeting on January 10, 2012. 2) Needs to remove one of the tenants. No more than two tenants allowed. 3) Rental needs full inspection to be done for next meeting on January 10, 2012. Upon a motion duly made by Dr. Miller, seconded by Mr. Sawayanagi, the Board voted to continue to next meeting on January 10, 2012. (Unanimously, voted in favor.) Page 1 of 2 Excerpt from the Board of Health Meeting Minutes January 10, 2012: II. Hearing — Housing / Septic (Cont): POSTPONED A. Lili Seely, owner— 33 Candlewick Lane, Hyannis — UNTIL FEB 14 housing and septic issue (continued from Dec 2011). 2012 I Page 2 of 2 KQ�QV�� �f��e i 5 -I'v�Q -�►I 4r 33 Ca�r�Iew� ck. reUM -Wit 5 re�o�f f� r( ueAa C . - � ward ar ovo(4 a n S Malkus, Karen From: Ma►kus, Karen Sent: Wednesday, July 22, 2009 11:42 AM To: 'fritz02601 @aol.com' Subject: BOH hearing 9/08/09 Dear Lili, spoke to Sharon Crocker who is the Health Division's Administrative Assistant. She said to send your request for a hearing/extension with your address and phone#and a brief explanation of your situation. Her phone number is 508-862-4644 And her e-mail is sharon.crocker@town.barnstable.ma.us Best wishes, Karen Karen Malkus Coastal Health Resource Coordinator karen.malkus@town.barn stable.ma.us 508-862-4641 vvl_k � ors� = Al 7t 0 Z6� Commonwealth of Massachusetts Title 5 Official Inspection For P - M,01 �z 2 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 33 Candlewick Lane,-Hyannis _ j Property Address — ---- Lili Seely Owner Owner's Name I information is P.O. Box 77, West H annls ort MA 02672 Jul 15 2009 required for every —.-- . _Y _�__—__ _— _ _—Y—_,— --- _- 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. f Important:When A. General Information filling out forms on the computer, O �� use only the tab 1. Inspector: key to move your # cursor-do not TroyWilliams 1 use the return — --- — ---- --- — -- key. Name of Inspector Troy Williams Septic Inspections---_-_-_. -- - --- Company Name 19 Hummel Drive I Company Address �•� South Dennis r MA 02660 City/Town -- -------�,— -- -- . State----- Zip Code 508 385-1300 S1682 _ Telephone Number }} License Number' 1 r ; 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: t. ❑ Passes ❑ Conditionally Passes ❑ Fails Needs Further Evaluationlby the Local Approving Authority I J v n r-�s...�. Jyly 15, 2009 Inspector's Signa re Date r 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 1.0,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DER 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 . -33 Candlewick Lane,Hyannis•.03/0B Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments M 33 Candlewick Lane, Hyannis Property Address LIII Seely -- Owner Owner's Name information is required for every P.O. Box 77, West HY �annis ort _MA--- 02672, Jul 15, 2009 - -- - - y---- -- page. Cityrrown 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 1.5.304 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 0 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: N/A \ ----- -- - -- --—- -------- ------ — Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s).are replaced ❑ obstruction is removed 33 Candlewick Lane.Hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 33 Candlewick Lane, Hyannis Property Address -- ------ --------- ---------- Lili Seely Owner Owner's Name information is P.O. Box 77, West H annis ort _ MA 02672 Jul 15„ 2009 required for every ___ _—_—__�—�__ �__ page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: N/A ❑ 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 pipes) are replaced ❑ obstruction is removed ND Explain.- N/A . C) Further Evaluation is Required by the Board of Health: ® Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,;safety or.the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which,will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a,surface water' ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. E 33 Candlewick Lane,Hyannis•03/08 - ': ._ Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 1 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �w 33 Candlewick Lane, Hyannis Property Address Lili Seely Owner Owner's Name information is P.O. Box 77 West H annis ort MA 02672 Jul 15 2009 required for every �_ y ,Y P _ page. Cityfrown State` Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well*": Method used to determine distance. N/A This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form: 3. Other: Past inspection for bank refinancing failed.system in 2004 that required upgrade. System at this time is not backing up, and leaching is being done with leach pit that had failed in,96, and then had some rest after new infiltrators were installed. Infiltrators at this time are in hydraulic failure. Home is not for sale at this time and home has been occupied by 4 people since 04 failure with only 1' of water present in original pit at the time of inspection. Pit can be monitored through steel cover to grade. 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 El ® Discharge or ponding of.effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool 0 ® 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 '/z day flow ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: El ®I . 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. 33 Candlewick Lane,Hyannis•03108 title 6 Official Inspection Form:.Subsurface Sewage Disposal System•Page 4 of 15 i Commonwealth of Massachusetts Title 5 Official Inspection Farm Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4� 33 Candlewick Lane, Hyannis _ Property Address T Lili Seely Owner Owner's Name —- ---— information is P.O. Box 77, West H annis ort MA 02672: Jul 15, 2009 required for every Y p Y page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): . Yes No ❑ 'Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. El E 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.. 33 Candlewick Lane,Hyannis•03/08• Title'5 Official Inspection Form:Subsuiface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts . Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r 33 Candlewick Lane, Hyannis Property Address Lili Seely Owner Owner's Name information is p O. Box 77, West H annis ort MA 02672 Jul 15, 2009 required for every y p y page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done..You must indicate"yes" or"no"as to each of the following: Yes No f ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ® Have large volumes of water been introduced to the system recently or as part of this inspection?, El 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? Q 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)] 33 Candlewick Lane,Hyannis.•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 33 Candlewick Lane, Hyannis Property Address Lili Seely Owner Owner's Name information is required for every Y p O. Box 77, West H annis ort MA 02672 July 15, 2009 --� page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 5 Number of bedrooms(actual): 4 to 5 DESIGN flow based on 310 MR,15.203 (for example: 110 gpd x#of bedrooms): 550 gpd Number of current residents: 4 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes 0 No Laundry system inspected? ®. Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage (gpd))-.. 08=113,000gals 9 ( Y 9 07=1 1 1,000gals Sump pump? ❑ Yes ® No. Last date of occupancy: Dateupied Commercial/Industrial Flow Conditions: Type of Establishment: N/A _ Design flow(based on 310 CMR 5.203): N/A 1 _ Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): N/A 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: N/A Last date of occupancy/use: N/A Date Other(describe): p N/A 33 Candlewick Lane,Hyannis•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 3 Commonwealth of Massachusetts - Title 5 Official Inspection Farm Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 33 Candlewick Lane,.Hyannis---- Property Address Lili Seel__ Owner Owner's Name information is required for every P.O. Box 77, West H annisp ort MA 02672 Jul 15, 2009 _ —_�___ -- _ --- _.� page. City/Town State ' Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Lastpumped approx. 3 years ago_per home owner. Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: N/A ------ — —------ ------ gallons How was quantity pumped determined N/A Reason for pumping: N/A-- ------ — ------ 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 l/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval: ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: Tank& leaching pit are original to home built approx. 30 years ago. 5 infiltrators with stone were installed on 8/19/96 per compliance._ { Were sewage odors detected when arriving at the site? ❑ Yes ® No 33 Candlewick:Lane,Hyannis•03108 - " - Title 5 Official Inspection Form:Subsurface Sewage.Disposal,System-Page 8 of 15 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 33 Candlewick Lane, Hyannis Property Address Lili Seely Owner Owner's Name information is P.O. Box 77, West H annis ort _MA 02672 Jul 15, 2009 required for every Y P July page. Citylrown State Zip Code. Date of Inspection D. System. Information (cont.) , Building Sewer(locate on site plan): Depth below grade: fe1t—t et: ' Material of construction: ❑cast iron ® 40 PVC ` sch 30 �other(explain): Distance from private water supply well or suction line: , N/A feet Comments (on condition.of joints,venting, evidence of leakage, etc.): Flushed lines and found clear at the time of inspection. Septic Tank(locate on site plan): Depth below grade: 2.5'with riser to 1' feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: N/A years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 5'X 9'X 6' 1000 gallon Sludge depth: 4,. Distance from topsludge,of to bottom of outlet tee or baffle 2 8 V. Scum thickness 6 Distance from top of,scum to top of outlet tee or baffle 14„ Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Probe Measured 33 Candlewick Lane,Hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w„ 33 Candlewick Lane, Hjrannis Property Address — ---_-- -- Lili Seely Owner Owner's Name --- information is P.O. Box 77, West.Hyannis port MA 02672 Jul 15,2009 required for every -- p _ y page. Cityrrown State Zip Code Date of Inspection D. System Information (cont:) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Concrete inlet tee and only one outlet tee were present. No evidence of leakage or damage was found. Tank appeared p good working condition. Grease Trap (locate on site plan): N/A Depth below grade: feet Material of construction: EI concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): N/A N/A Dimensions: -- Scum thickness N/A- ----------- Distance from top of scum to top of outlet tee or baffle N/A —---- — -- -- Distance from bottom of scum to bottom of outlet tee or baffle' N/A Date of last pumping: NIA Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): N/A Tight or Holding Tank(tank must be pumped at time:of inspection) (locate on site plan): N/A - Depth below grade. — — Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain): N/A .33 Candlewick Lane,Hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 33 Candlewick Lane, Hyannis Property Address Lili Seely Owner Owner's Name information is P.O. Box 77, West H annls ort MA 02672 Jul 15, 2009 _ required for every yP y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) Dimensions: N/A Capacity: N/A — gallons N/A Design Flow: gallons per day Alarm present." ❑ Yes ❑ No Alarm level: N/A -.Alarm in working order: El Yes El No Date of last pumping: N/A_ Date. Comments(condition of alarm and float switches, etc.): N/A Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of.box, etc.): . No d-box recorded onus-built or past inspection. Pump Chamber(locate on site plan): Pumps in.working order: ❑ Yes ❑ No Alarms in working order. ❑ Yes ❑ No 33 Candlewick Lane,Hyannis•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 33 Candlewick Lane, Hyannis _ Property Address Lili Seel__ Owner Owner's Name information is required for every P.O. Box 77, West Hyannisport MA 02672 July 15, 2009 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.)-. N/A Soil Absorption System(SAS) (locate.on site plan, excavation not required): If SAS not located, explain why: N/A - Type: ® leaching pits . number: 1 originally failed 6'X6 pit w/stone ® leaching chambers number: 5 infiltrators w/3' stone leaching galleries number: ❑` leaching trenches number, length. ❑ leaching fields number, dimensions: - ❑ overflow cesspool number: -- ❑ innovative/alternative system Type/name of technology: ,r Comments (note condition of soil, signs of.hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soil was sandy: Leach pit was found with 1' of water present with a visible light stain line approx. 18" above inlet invert from when pit failed in 1996. Pit was not in hydraulic failure at the time of inspection. :. Infiltrators were found saturated and in hydraulic failure at the time of inspection. 33 Candlewick Lane,Hyannis•03/08 Tdle.5 Official.lnspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form.-Not for Voluntary Assessments 33 Candlewick Lane, Hyannis Property Address Lili Seely_ Owner Owner's Name information is required for every ��P.O. Box 77, West H annis ort MA 02M July 15, 2009 — _ _ page. City[Town State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be.pumped as part of inspection) (locate on site plan) Number and configuration N/A N/A Depth-top of liquid to inlet invert - - Depth of solids layer N/A Depth of scum layer '` N/A Dimensions of.cesspool. N/A Materials of construction N/A _ Indication of groundwater inflow El Yes ® No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)- N/A .Privy (locate on site plan): Materials of construction: N/A Dimensions N/A ------ ---- — Depth of solids N/A Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/A 33 Candlewick Lane,Hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 33 Candlewick Lane, Hyannis Property Address -- Lili Seely _ Owner Owner's Name information is P.O. Box 77, West H annis ort MA ' 02672 Jul 15 2009 required for every Y p Y , page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building: P1 3 b { 33 Candlewick Lane,Hyannis 03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for.Voluntary Assessments 33 Candlewick Lane, Hyannis Property Address Lili Seely Owner Owner's Name information is p O. Box 77, West H annis ort MA 02672 Jul 15, 2009 required for every Y _�_ Y page. City/Town State Zip Code Date of Inspection D. System Information (cont ) Site Exam: ® Check Slope ❑ Surface water ® Check cellar ❑ .Shallow wells 15'+ Estimated depth to high ground water: feet Please indicate all.methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: pate ® 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: MIW 29_Zone C_7.8' 2.8' adjustment You must describe how you established the high ground water elevation: Soil was sandy. Past test hole showed no water found at 14.0'. Groundwater adjustment in area at the time of inspection was 2:8'. Bottom of leaching at 10.5'was found not to be located in the high groundwater elevation at the time of inspection,Visual drop in grade was a minimum of 15'+. i 33 Candlewick Lane,Hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 F D m Ln CO . I L .� p ' p Ln Gb Postage $ p Certified Fee 00 fiJ Postmark p y return Receipt Fee Here (Endorsement Required) r(9 p Restricted Delivery Fee f j p (Endorsement Required) y � Total Postage&Fees $ ��N ; r9 N Sent To l,l I i S ptreef,Apt.No.------------ •----- p or PO Box No. X N ---------- City,State,Yffi;w �-n hU o- 4. .4/1 ?� :r. w .r. MMEMIMM Certified Mail Provides: to A mailing receipt o A unique identifier for your mailpiece e A record of delivery kept by the Postal Service for two years Important Reminders: e Certified Mail may ONLY be combined with First-Class Maile or Pricrity Mailre.. o Certified Mail is not available for any class of international mail.l o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. to For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attao q,Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPSe postmark on your Certified Mail receipt is required. n For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery. o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the CertHed Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT.Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02.000-9047 1 ■ Complete items 1,2,and 3.Also complete A. Sig{Pure item 4 if Restricted Delivery is desired. X ❑Agent ® Print your name and address on the reverse l ❑Addressee so that we can return the card to you. B. Receiv v y(Printed-Name) C. Date of Delivery ® Attach this card to the back of the mailpiece, r`yon ke front if space permits. D. Is delivery address diffe nt from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑ No LiIiS� �y iF> 0. Tax �S �/� vies 4 -I-Ida h o i S p o A I r V I 3 Service Certified Mail ❑Express Mail �/^ ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number 70(]8 1830 ���2 0500 8345 0 (Transfer from service label) PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 i UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid LISPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box • VI �o VLA w Sfrv+ a-AY anrm. OA i i I Town of.Barnstable Barnstable YSHE t "Y"'�"` Regulatory Services Department ;ca City z}�FR"tN ULE 9 6 Public Health Division ' 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO i 03/16/09 Lill Seely P.O. Box 98 O West H annis ort MA 02672 Y p FINAL ORDER ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at, 33 Candlewick Lane, Hyannis was last inspected on 10/04/2004,by James D. Sears, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: "Single Backup of sewage into facility or system component due to overloaded of clogged SAS or cesspool" The deadline for repair has past. We, The Department of the Board of Health, have not been informed that you have taken any steps to bring your failed system into compliance. Therefore, you are ordered to repair or replace the septic system within 60 days from the date you receive this notification. You may request a hearing before the Board of Health, a written petition requesting a hearing on the matter, within seven (7) days after the day this order was received. 1 Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH �DasWcKean, R.S., CHO Agent of the Board of Health F.; PARCEL, LOTFAILED INSPECTION COMMONWEALTH OF MASSACHUSETTS = F EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS w a DEPARTMENT OF ENVIRONMENTAL PROTECTION e� c�O"er v0y` 350 MAIN STREET WEST YARMOUTH,MA Cc�'1CO 508-775-2800 RECEIVED TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY SSF1'�I11�52�04 SUBSURFACE SEWAGE DISPOSAL SYSTEM F RM PART A TOWN OF BARNSTABLE CERTIFICATION HEALTH DEPT. MAP 268-PARC 242 Property Address: 33 CANDLE WICK LANE HYANNIS,MA 02601 Owner's Name: WELLS FARGO Owner's Address: 7333 SOUTH HARDY DRIVE TEMPE,ARIZONA 85283 Date of Inspection OCTOBER 4,2004 Name of Inspector:(please print) JAMES D.SEARS Company Name: A&B Canco Mailing Address: 350 Main Street West Yarmouth,MA 02673 Telephone Number: 508-775-2800 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Dater 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 tot he buyer,if applicable,and the approving authority. Notes and Continents *** 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. Title 5 Inspection Form 6/15/2000 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 33 CANDLE WICK LANE HYANNIS,MA 02601 Owner: WELLS FARGO Date of Inspection: OCTOBER 10,2004 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: N/A 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:N/A One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as 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 exfrltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health)" broken pipe(s)are replaced obstruction is removed ND explain: Title 5 Inspection Form 6/15/2000 2 Page 3 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 33 CANDLE WICK LANE HYANNIS,MA 02601 Owner: WELLS FARGO Date of Inspection: OCTOBER 10,2004 C. Further Evaluation is Required by the Board of Health:N/A 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 waver Cesspool or privy is within 50 feet of a bordering vegetated wetland or salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic 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 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: Title 5 Inspection Form 6/15/2000 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS k SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM I PART A II CERTIFICATION(CONTINUED) Property Address: 33 CANDLE WICK LANE HYANNIS,MA 02601 Owner: WELLS FARGO Date of Inspection: OCTOBER 10,2004 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 J Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool N/A Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool J Liquid depth in leaching is less than 6"below invert or available volume is less than%z day flow J Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped J Any portion of the SAS,cesspool or privy is below high ground water elevation J 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.) YES (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CNIR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: N/A To be considered a large system the system must service a facility with a design flow of 10,000 gpd to 15,000 gpd. 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 11 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 is 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. Title 5 Inspection Form 6/15/2000 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 33 CANDLE WICK LANE HYANNIS,MA 02601 Owner: WELLS FARGO Date of Inspection: OCTOBER 10,2004 Check if the following have been done. You must indicate"yes"or"no"as to each of the following Yes No J 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) J 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)has been determined based on: Yes No ✓ Existing information. For example,a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CUR 15.302(3Xb)] Title 5 Inspection Form 6/15/2000 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION f Property Address: 33 CANDLE WICK LANE HYANNIS,MA 02601 Owner: WELLS FARGO Date of Inspection: OCTOBER 10,2004 FLOW CONDITIONS RESIDENTIAL Number of Bedrooms(design): 5 Number of bedrooms(actual): 5 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms: 550 Number of current residents: 4 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): N/A [if yes separate inspection required] Laundry system inspected(yes or no): N/A Seasonal use(yes or no): NO Water meter readings,if available(last 2 years usage(gpd)): N/A Sump pump(yes or no) NO Last date of occupancy: PRESENT COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): 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): GENERAL INFORMATION Pumping Records Source of information: N/A 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 J 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 copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known) and source of information: REPAIR IN 1996 PERNUT#96402 Were sewage odors detected when arriving at the site(yes or no): NO Title 5 Inspection Form 6/15/2000 6 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 33 CANDLE WICK LANE HYANNIS,MA 02601 Owner: WELLS FARGO Date of Inspection: OCTOBER 10,2004 BUILDING SEWER(locate on site plan): Depth below grade: Materials of construction: Cast iron _ 40 PVC _ other(explain) Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc..): SEPTIC TANK(locate onsite plan): J Depth below grade: 40" Material of construction: concrete metal fiberglass polyethylene _ other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1000-GALLON PRE CAST Sludge depth: 4" Distance from top of sludge to the bottom of outlet tee or baffle: N/A:TEE TO LEACHING NOT IN OPENING Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle: N/A Distance from bottom of scum to bottom of outlet tee or baffle: N/A How were dimensions determined: AS BUILT&TAPE Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): MAIN TANK AT WORKING LEVEL,ONE OUTLET HAS TEE,ONE OUTLET NO TEE. GREASE TRAP(located on site plan) N/A Depth below grade: Material of construction: concrete metal fiberglass _ polyethylene other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): f Title 5 Inspection Form 6/15/2000 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 33 CANDLE WICK LANE HYANNIS,MA 02601 Owner: WELLS FARGO Date of Inspection: OCTOBER 10,2004 TIGHT or HOLDING TANK: N/A (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass polyethylene other(explain) Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no) Alarm level: Alarm in working order(yes or no): Date of last pumping Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: N/A (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.,): PUMP CHAMBER: N/A (locate on site plan) Pumps in working order(yes or no): Alanns in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Title 5 Inspection Form 6/15/2000 8 Page 9 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 33 CANDLE WICK LANE HYANNIS,MA 02601 Owner: WELLS FARGO Date of Inspection: OCTOBER 10,2004 SOIL ABSORPTION SYSTEM(SAS): J (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: leaching chambers,number: 5 leaching galleries,number leaching trenches,number,length leaching fields,number, dimensions: overflow cesspool,number: 1 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 ONE CESSPOOL WITH STEEL COVER AT GRADE.FIVE INFILTRATORS OVER 5'BELOW GRADE.CHECKED INFILTRATORS WITH VIDEO CAMERA,FOUND THEM FULL&SOLID CARRY OVER. CESSPOOLS: N/A (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: 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: N/A (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.) Title 5 Inspection Form 6/15/2000 9 Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 33 CANDLE WICK LANE HYANNIS, MA 02601 Owner: WELLS FARGO Date of Inspection: OCTOBER 10,2004 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. 1 ' r qq n \ Title 5 Inspection Form 6/1 5/2000 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 33 CANDLE WICK LANE HYANNIS,MA 02601 Owner: . WELLS FARGO Date of Inspection: OCTOBER 10.2004 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to groundwater 20 feet Please indicate(check)all methods used to determine the high-,round water elevation: Obtained from system design plans(ASBUILT)on record-If checked,date of design plan reviewed: Observation site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators;installers-(attach documentation Accessed USGS database-explain: You must describe how you established the high ground water elevation: /l` 9 i — /� C/V Title 5 Inspection Form 6/15/2000 11 7z No. ZFee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 21pprication for 30iopooal *pgtem Construction 3permtt Application is hereby made for a Permit to Construct( )or Repair( )an On-site Sewage Disposal System at: Lo3ioon Add�'+ess or L t to. Own is ame,Address el.No. �-!r;� ` Assessor's Map/Parcel <1 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Description of Soil Nature of Repairs or Altera�wer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provision t of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issu by this Board o e _ Signed Date Application Approved by Date Application Disapproved for the 6howingAasons Is Permit No. L �2� Date Issued r` -� - ��,, ,+ ` .. 0�► l "l 4 . No: 74- _ Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS ZippYication for Migogal *pgtem Cowaruction Permit Application is hereby made for a Permit to Construct( )or Repair( )an On-site Sewage Disposal System at: Location Address or Lot No. Own 's ame;Address Tel No. t Assessor's Map/Pazcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. f R ------���---� Z f ; h �l j Type of Building: Dwelling No.of Bedrooms 7�1 Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow y gallons per day. Calculated daily flow gallons. { Plan Date Number of sheets Revision Date Titlea I , Description of Soil i If Nature of Repairs or Alterations(Answer when applicable) s 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 issu by thi1B and ofAjeal Signed // �2 �.., Date Application Approved by Date f Application Disapproved for the&wingIsons f Permit No. / Date Issued _——————————— ————— THE COMMONWEALTH OF MASSACHUSETTS .y:.. 1A, BARNSTABLE MASSACHUSETTS Certificate of Compliance THIS I TO CERTIFY,that the On-site Sewage Disposal System installed( )or repaired/replaced("-Ton by I staller at has been constructed in accordance with the provisions of Title 5 and the for Disposal SystefCConstruction Permit No.g'/_. d , dated 4,/-I!< .� Date Inspector lev THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SY - TEM WILL FUNCTION SATISFACTORY. { --------------------------------------- No. Fee THE COMMONWEALTH OF MASSACHUSETTS' PUBLIC HEALTH DIVISION . BARNSTABLES MASSACHUSETTS Migpo r /6pgtem Congtruction Permit Permission is hereby granted to / to cons ct( )repair( C)_an-On-sitelgewage System located at No.# _4� r Street and as described in the above Application for Disposal System Construction Permit. ., l� No. f Date 4 The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. All construction must be completed within three years of the date below. Date: Approved by !�,n board of Health i CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) I, hereby certify that the application for disposal works construction permit signed by me dated concerning the ` property located at meets all of the following criteria: ti a 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�14 feet or greater below the bottom of the leaching facility • There is no increase in now and/or change in use proposed • There are no variances requested or needed. SIGNED: DATE: LICENSED SEPTI 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]. r v v i. J J2WN OF BARNSTABLE LOCATION - ;�& SEWAGE # VILLAGE O S R'S MAP & LOT /a INSTALLER'S NAME&PHONE NO. a SEPTIC TANK CAPACITY 4 LEACHING FACILITY: (type) size) NO. OF BEDROOMS BUILDER OR OWNER �TC�i4ZY d�j I� .:� PERMITDATE: /7 4 COMPLIANCE DATE: Separation Distance Between the: ' tMaximum Adjusted Groundwater Table and Bottom of Leaching Facility 2� feet Private Water Supply Well and Leaching Facility (If any wells exist on site,or within 200 feet of leaching facility) l•U __-.FC�t. rge-of Weiland an(I•I,eacljng Facility(If any wetlands exist w ifdfi 300.feet'o€�leachinkfacility e /t//G feet If urnisoed by ... ,� 4 . � r � � � � , 1 � t ` � - Nw � � 'i � .� � �, � ,�� � i � � (b � i t� �i '� � r a 1 J � � (�„ _a. � v , �� ��� -� _ i __.. .�, � � I ---- --- �. ` - . A" Fsa c� THE COMMONWEALTH OF MASSACHUSETTS. BOARD HEA TH . ..... ...or.-- ..-_...-.OF........ . ... .. ... ._..... Appliratinn -fur Uiipuial 10orkii T om4rurtion Vamit , Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal h Syst at: ._. ._ .A _. _ ...... ....... --_- - - s L Address of No. _" - -- ...... ----- -yss� x = W Own Address 0 � . ✓ a Installer Address < d Type of Building �-, / Size Lot./Dr_`35 Sq. feet U Dwelling eNO. of Bedrooms------------ v.-__-__--__:-__-Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---_-._---_--------------- No. of persons.-----_...__._____._-____--_ Showers ( ) — Cafeteria ( ) a' Other fixture .._.. .__........ -------- --------- ---------- -------- Design Flow.............................. ... tllons per person per day. Total daily flow......... _... .: ------.gallon~. WSeptic Tank 7 Liquid capacit allons Length________________ Width.--_--.---- .... Diameter._._.__---._--- Deptll.___---_...--. x Disposal Trench— Width. ._.... Le T al leaching area--------------------sq. ft. Seepage Pit N ------------- Diameter.. __ D elo met____________________ ofal leaching area...... -----------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed bY.......................................................................... Date--•-•-----•---------------------•------- ,� Test Pit No. 1________________minutes per inch Depth of Test Pit-------------------- Depth to ground water--------.-------_.------ ri Test Pit No. 2----------------minutes per inch Depth of ' est Pit..........:......... Depth to,ground water------------------------ 4/ O x Description of Soil----------------------------------;1 . . = = �`'? ��� �:... L. --- --------------------------------------------------------------- W ------------------------------------------------------------------------------------------------------------.---.--.-.------------------------------------------------------------------- U Nature of Re sirsor Alterat'ons—Answer when applicable............... . . . , ------------ ------ ----------- - ----------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in.accordance with the provisions of Article \I 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 t e board of health. s igned- -- D--e Application Approved BY --------------------•--•. ate Application Disapproved for the following reasons----------------•--------•------------- - ---- ------•------------------- ................................. ----••---------• ---•---•----•---•--•------••---------•-------------------•--•-----••----------------------•----------•------•-----••- -----_-•-•-- ---------------------------------..----- /` Date Permit No. Issued ------------•- -----•------- Date .0 FE1,2 :................... THE COMMONWEALTH OF MASSACHUSETTS BOARD H(EA TH '/.. OF....... ..... ..���.. .... ................................................... ApplirFatiott -for Diopooal Norks Towitratrtion Vrrufit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage -Disposal S st Y ' at./ v - = _ -- ,. t �! fJ�L c�a/ti}on lAddr�ess� !� ( oe_- No....1.. '� ,- ....... �''�-- - --- — "t/-••-_-mac f!� p Own r Address O l Installer Address ` d Type of Buildi g Size Lot. .......Sq. feet U DwellingkNo. of Bedrooms-------------- --------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Otherfixtures_ ------------------------------------------- ------------------------------------- ------ ------- ------ �r -- - ----- -- W Design Flow--------------_------ _ gallons per person per day. Total daily flow....................................----..gallons. WSeptic Tank-f—Liquid capacit_�_______.gallons Length________________ Width---------------- Diameter---------------- Depth.-..----__.-.... x Disposal Trench— Width.__.____ ___ _ VotL�inet T tal leaching area____________________sq. ft. Seepage Pit No----- -------------- Diameter_ ._"D l _____�_-___• 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...--_-_-__-------.-.--- (i Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water-_._-._.-_--__-.--__---. Description of Soil-------•-----------------------•--1-•------•----------- - --==- - ---- - ---•-------•--•- -- x W ••-----•------------------------------- ---------------------------------------------------------------------------------------------------------- --------------------------------------------•-------- VNature of Repairs or Alterations—Answer when applicable..---------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board ofhealth. fG :S1gne:dX-,,2re,n'.. •...... .. . " ,. ate Application Approved By.--------- --� . ..........................—----1-----�"�-•-- - •-------1�Dace �'" Application Disapproved for the following reasons:-------------------------------------------- . ............................................................... ---•-•---••N ........................•-•- 4DatPermit No..----•-----•--•-•--------•-•----•--••-----•-----•....... Issued.... ------ ---••--•--- ate THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH —1 �rrtifiratr of 01,omliaatrle TaHIS - 0 C W .�iIFY, That,�he� n�vidt}a swage Disposal System constructed 4- ) or Repaired ( ) Im Ins Ile ! f�� . f� at = ----- ---- ---------- -----•- :_..!{v'�4 L L.1 f :��----- a� - �? =..-•-:. yl -------•--------- has been installed in accordance with the provisions of Article XI of The State Sar>Lary Cocjk Zscribed in the application for Disposal Works Construction Permit No-------------i,7?---l.______-.___- dated...._ __ -.... ------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTE FUN DATEM- ,WILL fCT.IdOGN�SATISFACTORY: Inspector..! _ / -------=--------------------------------- V _ �- G THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..............0F...�..44,4_ .-.• ----------- No. --'Z.....----- FEE Tinpoii al Worko ClIon tratrtioat pr Wri'' / !Permission is hereby granted------:--;l,__I.-/Ul -- - - - �n n ------------_--------- Val4 to Construct ) or Repair R( ) aVi Indivviduale Disposal S stem s S �at -•-- � .. e � -----. . � t as shown on the application for Disposal Works Construction Permit No--------------------- Dated-7 ...... ------------ DATE--------------------------------------•------i-- ------------------------------ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS �1 - 0 , +r ,✓' lop" t `f�•', l 'i�r"" 41 o f � t ALWAYS DIG SAFE PRIOR TO CONSTRUCTION-UTILITY LOCATIONS- SHOWN INCOMPLETE. JOE NO._ B12--02 NINES Seely,dwg M FB27/17 SB12/70 1. LOCUS IS A.M. 268, PARCEL 242. 2. ELEVATIONS SHOWN ARE ASSIGNED. Candlewick La. 3. LOCUS IS IN- FLOOD ZONE C- ON FIRM_ .DATED- JULY 2, 1-9-92. a 4 4. ALL PIPES TO BE 4" SCH 40 AND PITCHED AT 1/4" PER FOOT. (UNLESS NOTED) x 5, MUNICIPAL WATER IS AVAILABLE. LOTS WITHIN 100' ARE ON TOWN WATER:. ' N 32,33 6. COMPONENTS TO BE AASHTO H-10, UNLESS NOTED. o 7. INLET TEE TO PROJECT DOWN 13", OUTLET TEE DOWN 14". m &_ IF TWO OR_ MORE LINES,_ WATER_ TEST. D-BOX FOR EQUAL FLOW z D-BOX EXIT PIPES TO BE LEVEL FOR FIRST TWO FEET. J x 34.08 S. DEPTH" OF COMPONENTS NOT TO EXCEED 3!, OR VENTING MUST BE PROVIDED. NOT TO, COVERS: BUILD UP COVERS TO 6" BELOW GRADE--2 ON TANK, 1 ON D-BOX, 2 ON LEACHING SCALE 10. STONE TO BE DOUBLE WASHED 3/4 TO 1 1/2" WITH 2" MIN. 1/8 TO 1/2" PEA STONE ON TOP. rLOCAT(0N MAP 1.1. IF UNSUITABLE SOILS, OR SOILS DIFFERING FROM THE SOIL LOG- ARE FOUND, CONTACT THE BOARD OF HEALTH, OR R.J. CADILLAC. x 5.05 34, �33.30 1"2. IF AN OVERDIG IS'CALLED FOR BELOW, FILL MATERIAL FOR 5' AROUND AND UNDER LEACHING. 3 NO GRADE CHANGES- IS TO BE CLEAN GRANULAR SAND MEETING SPECIFICATIONS OF 310 CMR 15.255(3). TEST HOLE 'I i 13. PUMP AND FILL ANY EXISTING `CESSPOOL/LEACHPIT. REMOVE ANY CLOGGED -SOIL, BLOCK, �35, x 3 2 ARE PROPOSED . AND STONE IN LEACH AREA, AND DISPOSE OF AS DIRECTED. BY HEALTH AGENT. ,,� � 32,37 DI=P�"I-I (inches) EI.EV,{feet)' 3• 14. ALL CONSTRUCTION TO MEET TITLE 5 AND LOCAL REGULATIONS. 0 - 38.7 / OO. 1 A layer 1"Oyr 4/4 .: ' 8. R ` ; TEST HOLE DATE: February 10 2012. 7» sandy loam 35,51 // A� 9 LOT 44 '/ _. PERFORMED BY: Ran Cadillac, Soil Evaluator / 32, 1 ® L67 RS B -layer 1Oyr 6/8 + (� WlTNESSEi3 BY: Donald Desmarais, P ,ter 1 0 2 6 3 S.F. 2 PERC RATE: <2'-00"/inch (C layer) sandy loam 37 BENCH MARK--RIM OF CONC. SOIL SURVEY(1993): Carver coarse sand RISER = 37.25 ASSIGNED GEOLOGIC MAP. 1986 Barnstable lain deposits 26" 36-5 / 26.75t (AT WHITE PAINT SPOT) { p p ( ® 5, 9 / �x 7 8 p \ x 38 38 Top foundation 2 DRY WELLS j(_D C Layer 2:5y 6�4 OS ' Invert 34.63t H-20 UNITS FOR DEPTH S/ 32. 44" m.edium sand- Use.6 / Qi' Current 3 e�E F Gas Baffle i0-RISERS de COVER / System UTC7 I Existing_ Invert 34.35 w/20% gravel ' RE 35 o=Top Cbno, � 8,5 iQ I Proposed 26 1 G` s 3F/ �e � J3.5 -- --__ (� 34.6=Top Peastone/Filter Cloth 'r"'--�____0 _-_ S=1 f8"Jft 6" Max. / 37,9 8.4 G� 38,9 I Existing_ S=1/8 /ft �.- .. ..... •••'• x 39,2 Invert 34C .91 � 1000 Gal � - Screened Vent mm. / - I I Septic Tank 37.7 TH 1 38: Existing __-------- o / :: I t ----------� 24" 138" 27.2 o 38.9 38. no wa er Q N 38.2 I 98 , - 32.2 : Invert 34.52 Invert 34.2t Bottom TEST HOLE 2� 6" Stone or compact 5 TH Z - Pro osed Proposed i = 38.3 / ` ' 39.1 33,1 CAUTION 00 NOT INSTALL EITHER i t 1`Iv 1` 3' r DEPTH inches i 9 ---+ I -I-- i-t Bottom. TH1=27..2 (inches) ELEV.(feet) SYSTEM HIGHER THAN SHOWN WITH- M I OUT PUTTING IN AN IMPERVUIOS 35,87 / C� r '� r' BARRIER FOR BREAKOUT- 1ri t #'1 /t T 1t A layer 10yrr 4/4 x 35.79 jo / _ 2a 3 134.1 t DESIGN DA DATA cu 7» sandy loam ' �36 0 - N / s'xs'Pos7 i I f 1} B layer 10yr 5/8 .-4 2 / � BEDROOMS: 3 sandy loam \> GARBAGE GRINDER: No ::... k D O 39.0 38,6 6.8 REQUIRED CAPACITY 33D "GPO 28 3 -3fy03 Pq V :•..:.:: �S`S;k A CAUTION':SHED MAY EXISTING SEPTIC TAME: 10130 GAL. SET 2 500 GALLON DRY WELLS 8' APART FQ 8 9 7'1 I NEED SUPPORT OR AND CENTERED IN A 9' X 33' X 2' DEEP C layer = 37, _ ' i - BOTTOM LEACHING AREA: 297 SF 2.5 6 Y Y /4 SHORING IF FOOTINGS STONE LEACHING AREA. OF STONE ON medium sand BENCH MARK TOP CORNER ORI V M i DO NOT GO DOWN [(33' X 9')] s. ( CONC= 38.25 ASSIGNED x 3,� E =2 8,7 x 71 x 33,53 S BELOW GRADE SIDE' LEACHING AREA:' 168- SF ENDS AND-APPROX., 2. OF- STONE=ON SIDES) w/20Rb gravel `a� �, X [34,4 (CHECK DEPTH OF [2(9'+ .33) X .2' DEEP)] i ro 35.76 DECK FOOTINGS ALSO) x 38,H_� :: i ::. DESIGN CAPACITY: 344 GPD ' 38,5 EXIST I [(297 SF + 168 SF) X .74 GPD/SF] 107,51' 'a SHED Z I S 82'48'14" E i1�0 INSPECTION SCHEDULE 138" 27.6 8. /''`` CALL R.J. CADILLAC TO no wo er CHOP DECK 38�''-- --� I -`../} INSPECT PRIOR TO BACKFILL. I 37,8 7,1 N F OFF HERE - I 37,7 AMARAL REMOVE PAVEMENT OVER 4,8 LEACHING AREA PER OWNERS >33.e5 3 ,72 ::::::::......• .. DIRECTION 37,1 CONSTRUCTION NOTES .....:.�:.::•::.: :: 37.5 X 33 0 SYSTEM IS PROPOSED 4 DOWN-PROVIDE VENT- ING AND H-20 LEACH UNITS. USE H-10 RISERS. REMOVE PAVEMENT OVER PROPOSED SYSTEM N/F PROVIDE BARRICADE AT END OF SHORTENED THflMAS DRIVE IF USING INFILTRATORS. SITE PLAN -° EDRR THUS PLAN IS A VALID COPS ONLY IF `IT BEARS AN ORIGINAL RED STAMP AND SIGNATURE. LILI SEELEY - ,9 " LEG ���� qs, /� F gs9c,� LOT 44, 33 CANDLEWICK LANE, HYANNISPQRT, MA TH 1 TEST HOLE LOCATION, NUMBER / L �Q ,I\AE- �o J APRIL 12, 2012 SCALE. 1 =20 W WATER LINE MARKINGS " CADILLAC " CADILLAC E OVERHEAD ELECTRIC WIRES (IF SHOWN) 1060 a #35779 G GAS- LINE MARKINGS- �� FGISV_ � tgc�Ess\0 o� x 9.5 xg,7 EXISTING & PROPOSED ELEVATIONS ('X' MARKS POINT) SgNIrAR�a 1. ��`°sukvE RQI�J/�11.D J. CADILLAC, PLC} RS, P.C. /6'>> EXISTING CONTOUR g---- PROPOSED CONTOUR PROFESSIONAL LAND SURVEYOR & REGISTERED SANITARIAN 0 UTILITY POLE (IF .SHOWN) P.O. BOX 258 ID EXISTING DRAINAGE CATCH SA.--$jN- WEST YARMOUTH,- MA 02673 X - FENCE (IF SHOWN, NOT ALL SHOWN) HEALTH AGENT APPROVAL (508) 776-9700 HATE �C 2012 BY R.J. CADILLAC PAGE I OF REV 5/12/12--ALTERNATE LEACHING REMOVED