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HomeMy WebLinkAbout0090 CHESTNUT STREET - Health ,g0 Chestnut street Hyannis P 09 049 0 0 TOWN OF BARNSTABLE LOCATION o C � n�.* 54 SEWAGE# 0906 4`a b 6 VILLAGE ��,,, rS ASSESSOR'S MAP&PARCEL wq 0" INSTALLERS NAME&PHONE NO. Sc..O H dcjf/ Q D 6 5 i SEPTIC TANK CAPACITY LEACHING FACILITY: (type) _ u &c k- C�.c Wd(size) X o1(o p1 NO.OF BEDROOMS _ OWNER k clrkk PERMIT DATE: ; �"r4 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist �J/ on site or within 200 feet of leaching facility) 'V1 Feet Edge.of Wetland and Leaching Facility(If any w s exist / within 300 feet of leaching facility) (U Feet FURNISHED BY __ J V-4 Is A An A � A �D 2 qo A 3 a C) o 47 6 4o 3 l 0 0 pox No. (!? c (Q Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE;�MASSACHUSETTS es application for Di!9pozaY 6p!5tem Cow5truction Permit Application for a Permit to Construct Mf Repair( ) Upgrade( ) Abandon( ) ❑ Complete System Individual Components Location Address or Lot No. e--,O GVIQS�1\3 Owner's Name,Address,and Tel.No.Assessor's Map/Parcel �V s 7 a^��S �— �(;�^"�!� cv ' Installer's Name,Address,and Tel.No. r Designer's Name,Address and Tel.No. r n s c-L&k.( n\Ke M. oAa Type of Building: SS n Dwelling No.of Bedrooms Lot Size l�0� sq.ft. Garbage Grinder (�u� Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 9 3 V gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S.�U)k C)C [, Description of Soil Nature of Repairs or Alterations(Answer when applicable) no,K_ 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 -to place the system in operation until a Certificate of Compliance has been issued by Board of Health i S' ned Date (�o l0 1 Application Approved by Date G (p Application Disapproved by: ..,Date -for the following reasons Permit No. oco Date Issued 6 6,140 No. 1:�: W C9 d f0(lam Y Fee LJ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE!, MASSACHUSETTS es 2pplication for Thgpo5a[ �&p!tem Construction Permit Application for a Permit to Construct(4 Repair( ) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. T Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 3oc, — q(i Ins ler's Name,Address,and Tel.No. Designer's Na�e,Address and Tel.No. co f CIA J Type of Building: Dwelling No.of Bedrooms --I Lot Size sq. ft. Garbage Grinder 03) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) b gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank of S.A.S. �T6 Description of Soil �-c-�• (��tn.-- 'h 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 nand-not to place the system in operation until a Certificate of Compliance has been issued b is Board of Health, r I. S'gned Date � 1 Application Approved by Date (0 �to (p Application Disapproved by: Date for the following reasons i Permit No. ;:40 060 — (D �0 Date Issued 6 --------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed (V ) Repaired ( ) Upgraded ( ) Abandoned.( )by 'Z Cr`(\ C�r,..f�A . at q (� (=fig S �� \fit 16A ter' has been constructed in accordance l^ with the P Y provisions of Title 5 and the for Disposal System Construction Permit No. dated Jbl r✓ Installer Designer #bedrooms Approved design flow ?Jo , gpd The issuance of this permit shall n b co tr d as a guarantee that the syste will functtilo as dEs' n d. Date L Inspector y No. r- )lO r" 6(o Fee /�O THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Digo!gat i§pgtem Con$truction Permit Permission is hereby granted to Construct (V ) Repair ( ) Upgrade ( ) Abandon ( ) System located at 90 C� /,0 5� ►Uo-k Jk .4-1N�� and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special condition . Provided: Construction must be completed within three years of the date of this e t. r_ t Date r fJ k(J Approved b Town of Barnstable Regulatory Services Thomas F.Geiler,Director Public Health Division Thomas McKean,Director 200 fain Street,Hyannis,MA 02601 Office:.508-862-4644 Fax: 508-7.90-63 Installer&Designer Certification Form Date: �W� Designer: Installer: Address: . f UAt La TA 1 W Address: - �c� S on -was issued a permit to install a (date) (installer) septic system at - .9 O 6RfVF 4 r '• f 1QW w1) based on a design drawn by I (address) ,J Vi �' �`^-'►I dated (designer) I/' certify that septic system referenced above was installed substantially according to Jhe deign, which may include minor approved-changes such as lateral relocation of the distribution box and/or septic tank- 0 I certify that the septic system referenced above was installed with major changes (-i' e. greater tlm 1.0' lateral relocation of the SAS or any vertical relocation of any component of the.septic system)but in accordance with State&Local Regulations. Plan revision.or certified as built by designer to follow. . "(histallee ) DAVID y B. CO c MASON y No.106 4 y �GISTe . (Designer's Signature) fK Xear's Stamp Here)- PLEASE RETURN TO C HEALTH SIOM CERTMCATE' 4P' COMPLIANCE .- N®T BE ISSUED IMM BOTH -TMS. J HEAFIO,TRVSAND BUMTC RECEVD �THE$ARNSTAM FtBLIC IDV �A—IY®U.THANK S- Q:Health/Septic/Designer Certification Form TOWN OF BARNSTABLEL_ LOCATION �� cJy�'✓'Ti . ' �� SEWAGE # I ELLAGE �yj�i✓�O J' ASSESSOR'S MAP & LOT WSTALLER'S NAME&PHONE NO. l��/�° .�� '© �• �� ��a;�o,� SEPTIC TANK CAPACITY <,LEACHING FACILITY: (type) (size) NO..OF BEDROOMS EgUDER OR OWNER PERMIT DATE: _ V COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility L 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 , o 0 ' AeA Street Address o avAl'z (number) (stre 1 (village) E owner's Name i (first) last) Ii Cj Gallons Pumped Date Pumped 'Source: ❑•Cesspool, ❑ Septic Tank ❑ Grease Trap Reason: ❑ Scheduled Maint. ❑ Unscheduled Maint. ❑ Overflowing ❑ Backing Up into Building I hereby certify that the information contained on this ticket is true and correct to the best of my knowledge and belief,and is made under the penalties of perjury. Signature of Pumper Pumper Company Form 33 //� h ( '��Z� / ' 7/` © w CA , x U , �l 1 r L/ No. Fee sti THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS application for Miooal *Peu t comaruction Vermit Application for a Permit to Construct(Y)Repair( )Upgrade( )Abandon( ) Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel J® P Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms -3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building A* S', No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow .?11<� gallons per day. Calculated daily flow gallons. Plan Date :�' ea� Number of sheets .00 Revision Date Title - - Size of Septic Tank �S'�® .�.1E' /� Type of S.A.S. -�eZ-Q 10022r42 OXO 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 Certifi- cate of Compliance has been issue this Board of H alth. Signe J Date Application Approved by Date Application Disapproved or the following reas) Permit No. Date Issued Y No. ..'-' .. w Fee 1t THE COMMONWEALTH OF fASSACHUSETTS 'y Entered in computer: Yes PUBLIC HEALTH DIVISION—TOWN QPBARNSTABLE., MASSACHUSETTS rication for 3Dig o�1Zr,f" i 5tim Conztruction Permit Application for a Permit to Construct(y)Repair( )Upgrade( '``)Abandon( ) ©Complete System ❑Individual Components Location Address or Lot No. 9,0 ' Owner's Name,Address and Tel.No. Assessor's Map/Parcel ,,}�o +�lpJ'• Installer's Name,Address,and Tel.N�o..,C- / Designer's Name,Address and Tel.No. 1vo y Type of Building: r Dwelling No.of Bedrooms '3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building 440 No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 gallons per day. Calculated daily flow J30 gallons. Plan Date �—071`o j! Number of sheets Revision Date Title Size of Septic Tank /S-�o , Q�(G`� /�=�� Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) ' Date last inspected: Agreement: f ,� The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system r 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 4ssuLedA7 this Board of Health. �!o� Signed ' ,-- Date Application Approved by Date PP PP r Application Disapproved for the following reaso s ,t I Permit No. I SOWDate Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On site Sewage Disposal System Constructed( ) Repaired ( )Upgraded( ) Abandoned( )by ��/$ -e��`'o�''/�' at 90 G yE,rJ/Y �T px- !!ey. has been constructed in' accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. QL-Ajy_Loa dated Installer (J>,0* .L 442FP6`4,00t' Designer The issuance of thils peo its all not be construed as a guarantee that the sys - 'll fu c onus de g� Date Inspector — -------- —————————— — No. >� , Fee C/C/ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS x1h5pogal *p.5tem Construction Permit Permission is hereby granted to Construct( Repair( )Upgrade( )Abandon( ) System located at PO G,od P,.'.>wA r and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construc ' ust /e�co ted within three years of the date of thi erm t.. Date:_. l Approved by TOWN OF BARNSTABLEC.- LOCATION � �./`�c�f�/�� SEWAGE# ",VILLAGE �w' `�' ASSESSOR'S MAP & LOT 32'�� INSTALLER'S NAME&PHONE NO. Z 0,7 SEPTIC TANK CAPACITY_ ��`®O Z• LEACHING FACILITY: (type) �"�'66 (size) NO.OF BEDROOMS -3 BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) / Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) / Feet Furnished by 6f ° I Town of Barnstable Regulatory Services P ti Thomas F. Geiler,Director snxivsTnsLe, NAW Public Health Division ArEo � Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office:.508-862-4644 Fax: 508-790-6304 Installer &Designer Certification Form Date: NJ w Designer: �✓ Installer: ` > Address: V ���-� Address: On "�' was issued a permit to install a [ (date) (installer) septic system at !b L"`'�'/ Lj `� ased on a design drawn by (address) �� " �I-� - p /►-K�l % 3. � '15 dated '1 ZZ ", (designer) Y D certify that the septic system referenced above was installed substantially accordingto ; e design, which may include minor approved changes such as lateral relocation o he th :'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 staller's Signature) L , ��4t1 ''T. esi 's Signature Affix D`esr''"er Stamp Here PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE "WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH'DMsION. THANK YOU. Q:Health/Septic/Designer Certification Form 1)ATE: 8/1•7./9.8 . PROPERTY ADDRESS: •90 CtMstnut' Street Hyannis,Mass. 02601 On the above date, I Inspected the septic system at the above address. This system consists of the following: 1 . 2-6 ' x8 ' -block -cesspools. based bn my Insc�action, I certify the following conditions: 2 . This is-"not a -title five septic sys•tem.•- . 3 . This -is a sewage system that is '35-40 years old. 4 . "The overflow- line from the main cesspool must be ` replaced with a new sch_. 40 4" PVC pipe aril fittings . ko ry At this time a sanitary tee will also be installed. This will -contain the 'solid waste in the main cesspool and then it will act as a septic tank. ` ." SIGNATUM7, Name -J P Macomber Jr• i ------,--------------- Company:_`. P_Macomber & Son- 'Inc .. Address:_-Beac-b -----=3-- - __CencervilLe AUs__Q2.632 ` Phone:___S0$.�ZJ�..3338___-__- . 1 THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P. MACOMBER & SON,. INC. Tanks-Ceupools-Leach(lelds . Pumped 9, Installed Town Sower Connections P.O. Box 66' Centerville, MA 02632.0066 77.5-33U 775-6412 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON, MA 02108 617.292.$500�� - WILLIAM F.VELD /Q�!` �TRUDY Govcmor . �`F Se, ARGEO PAUL CELLUCCI !� O DA 40 .ST Lt.Govcmor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECfIO' RM 8 �C mmi: Op PART A y�iryopslgB '998 CERTIFICATION Audrey Rau I ley s Pize,Valley DrPro arty Address: 90 Chestnut Street H annis,MA AddressofTner. Tob'yhafnna, :PA118-4 6 6 Date of Inspediong/17/g 8 (If different) Name of Inspector: Jose-ph .P.Macomber Jr. 1 am a DEP approved ;, inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: J.P.Macomber & Son Inc. Mailing Address: Box 66_Centerville,Mass . 02632 Telephone Number: 50R_?.75-333R CERTIFICATION STATEMENT I certify that I have personally it . d the sewage disposal system at this address and that the information reported below is true, accur and complete as of the time c: .,on. The inspection was performed based on my training and experience in the proper function ar maintenance of on-site sewage d systems. The system: Passeg$ _ Condi:ior. Passes Needs Ft Evaluation By the Local Approving Authority Fails Inspector's Signature _ Date: The System Inspe all su!,mi. _tpy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a :ha; ,stem or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall subs the report to the appropriate r•agi( :nice of the Department of Environmental Protection. The original should be sent to Ov system ov and copies sent to the buyer, If a; 1)1e, and the approving authority. INSPECTION SUMMARY: =h B C or D: AI SYSTEM PASSES: I have not found any inf on which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.3( Any failure criteria n 4 t .:mod are indicated below. COMMENTS:The overflow line must be replaced with a new Sch. 40 4" pvC , 11P and.. .f; t•t-; nqs _ At thi-stime a sanitary tee will be installed. This will contain the solids in place. Main cesspool— actBI SYSTEM CONDITIONALLY P. as a septic tank. dOne or more system _or, nts as described in the "Conditional Pass" section need to be replaced or repaired. The system, ul completion of the re;la( or repair, as approved by the Board of Health, will pass. Indicate yes, no, or not determine . N, or ND). Describe basis of determination in all instances. If"not determined', explain why not. /t"d,Je The septic t ink :tal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (a: ) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; the septic t:.nk, er or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or to failure is in-nir. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approve: b� .`.oard of Health. (revised 04/25/$7) Pegs 1 of 10 DEP on the Wortd Wide Web: http:Nwww.magnel.state.ma.us/dep Printed on Recyded Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Propeny Address90 Chestnut Street Hyannis,Mass. Owner: Audrey Rutley Date of Inspection: 8/1 7/9 8 B) SYSTEM CONDITIONALLY PASSES (continued) &ap< Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipes) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipets). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed 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 the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water 4K_lb Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. ,10 The system has a septic tank and soil absorption system and the SAS is within 50 feet of,a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than S ppm. Method used to determine distance ty'd (approximation not valid). 3) OTHER (revised 04/35/17) Page 2 o1 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 90 Chestnut Street Hyannis,Mass. Owner: Audrey Rutley Date of Inspection: 8 9 8 D) SYSTEM FAILS: You �,ffmust indicate ei:�.e( "Yes' or 'No' as to each of the following: 40 1 have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis T for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correa the failure. Yes No Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. _ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. 1/O�G 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 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipets). Number of times pumped _. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is.within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E) LARGE SYSTEM FAILS: You must indicate either "Yes" or "No' as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please.consult the local regional office of the Department for further information. (s•vi••d 04/7S/S7) a49. 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 90 Chestnut Street Hyannis,Mass . . Owner: Audrey Rutley Date of Inspection: 8/1 7/9 8 Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No, Pumping information was provided by the owner, occupant, or Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. J_/ As built plans have been obtained and examined. Note If they are not available with N/A. Z _ The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or Industrial waste flow. _ The site was inspected for signs of breakout. _ All system components,44luding the Soil Absorption System, have been located on the site. _VON The septic tank manholes were uncovered, opened,and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. — The size and location of the Soil Absorption System on the site has been determined based on: The facility owner (and occupants, if djHerent from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. Existing information. Ex. Plan at B.O.H. _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) (15.302(3)(b)) Crevis•d 04/35/37) P&ge 4 of 10 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 90 Chestnut Street Hyannis,Mass . 0%rier: Audrey Rutley Date of Inspection/17/98 FLOW CONDITIONS RESIDENTIAL: Design flo%.'3:50 e.p.d/�droom for S.A.S. Number of bedrooms: .Number Oi Cur(en) residents: ZZ Carciage grinder (yes or no) laundry connected 10 system lye$ Or no).,,7 Seasonal Lose dyes or nol.Qlb /� r Water meter readings• if available (last two (2) year vsage (gpch: -7p e Svmp Pump lye$ or no):A22 �4 4 G qc�' _ Q/y��s^ p KLyO /ZS7d�" J :ast Cale of occvpanc)• � COMMERCIAUINDUSTRIAL: .IA Type of establishment:__ Des,gn flow A-J,4 gallons/day -- Crease Irap present: (yes or no" fndvstrial waste Molding Tank present: (yes or no),& Non•sanitat)• waste discharged to the Title S system: (yes or no) Waler meter readings, if available— A4V Last date of ocCvpancy. OTHER: :Descfibef __ VA last date Of oCcvpancy, GENERAL INFORMATION PU•MPINC RECORDS and W.Litce,o(information. T � System pumped as pan of inspection: (yes or no) If Yes, volvme pvmped: 0 gallons all Reason for pvmping s 9k'a S TYPE OF SYSTEM NO Septic tank/dislribunon box/soil absorption system Single cesspool Overflow cesspool d)b Privy Shared system (yes or no) (if yes, anach previous inspection records, if any) VA Technology etc. Copy of up to date contraaf Other �U19 APPROXIMATE AGE of ail components, date installed (if known) and source of information: Se..agc odors delected when arriving at the site: (yes or no) .oh of 10 r i 1 SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 90 CHESTNUT Street Hyannis,Mass . Owner: Audrey Rutley Date of Inspection:8/1 7/9 8 BUILDING SEWER: (Locate on site plan) cC Depth below grade: Material of construction: cast it 40 PVC_other (explain) Distance from privati water s pply ell or suction line O'er Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) Joints a22ear ti h e nouse vent. SEPTIC TANK.A)Att, (locate on site plan) Depth below grader Material of construction;(Mconcrete 4metaLAFiberglass4/tPolyethyleneo&other(explain) If tank is metal, list age_�J" Is age confirmed by Certificate of Compliance (Yes/No) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle:_&A_ Scum thickness:A_ Distance from top of scum to top of outlet tee or baffle: rol Distance from bottom of scum to bonom of outlet tee or baffle: X$_ How dimensions were determined: d)Od Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) Septic tank is not present GREASE TRAP: l�fC)- (locate-on site plan) Depth below grade: 440 Material of construction vYOconcrete,CetmetalA4 Fiberglass�,4 Polyethylene 44,other(explain) Dimensions: Scum thickness: AI Distance from top of scum to top of outlet tee or baffle:-/t, Distance from bottom of scum tq bottom of outlet tee or baffle: Date of last pumping: -Ave Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,-etc.) Grease trap is not nrPGPnt- I (revised 04/35/97) Page 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 90 Chestnut Street Hyannis,Mass. Owner: Audrey Rutley Date of Inspection: 8/1 7/98 TIGHT OR HOLDING TANK:A&Wj�ffank must be pumped prior to, or at time, of inspection) (locate on site plan) Depth below grade:." Material of con struction:,A,concretet.4 metal 4/�Fiberglass&Polyethylene�other(explain) 44-4 APA Dimensions: A16 Capaciry: AM gallons Design (low gallons/day Alarm level: Alarm inin working order Yes; No Date of previous pumping: Alf Comments: (condition of inlet tee, condition of alarm and float switches, etc.) Tiqht or holding tanks are not present. DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet inven: VA Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or,out of box, etc.) Distribution box is not present PUMP CHAMBER:• ILV— (loca(e on site plan) Pumps in-working order: (Yes or No)�2 Alarms in working order (Yes or No) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) Pump Chamber is not present. (s.via.d 04/25/17) Y.g. 7 of 10 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 90 Chestnut Street Hyannis,Mass. Owner: AUDREy Rutley Date of Inspection: 8/1 7/9 8 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible; excavation not required, but may be approximated by non intrusive methods) If not determined to be present, explain: Type: . leaching pits, number:Q leaching chambers, number:-0— leaching galleries, number:_ leaching trenches, number,length:— _ -- leaching fields, number, dime sionS: V overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) Loamy sand o medium coarse sand;NO signs of hydrauli_r failnrA Or pondina;A 1 v -gpt'atinn is nnrmal , CESSPOOLS: (locate on site plan) Number and configuration: v2 Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: $ Indication of groundwater: inflow (cesspool must be pumped as part of inspection) Intlow cesspooi was pumped. No signs of water intrLsinn_ Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) Same as above. PRIVY:A20,9/d_ (locate on site plan) Materials of construction: ip 4 Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) Privy not present (revised 04/2S/97) raga 8 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continved) Propeny Address: 90 Chestnut Street Hyannis,Mass. O"nef7 Audrey Rutley Date of Inspection: 8/1 7/98 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (locate where public water supply comes into house) 6x,) '" i5 `fib• t /81 Qo. CheSf nv+ .6t. l ktiftln i 5 tr.�s•.a o�/�s/rat t.g. .r or 10 SUBSURFACE SEWAGE DISPC;:.',1 SYSTEM INSPECTION FORM 1, T C SYSTEM INFORM.'. JION (continued) Property Address: 90 Chestnut Street Hyannis,Mass. Owner: Audrey Rutley Date of Inspection: 8/1 7/9 8 Depth to Groundwater Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of Site (Abuttin prope bservat(on hole, basemersh sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps /Check pumping records heck local excavators, installers Use USGS Data Describe in your own words how you established the High Grounclva,er-E►evation. Must be completed) Used water contours map. Gahrety & Miller Model 12/16/94 (r.vis-d 04/2$07) . P49-. Ibor 10 a•rn.n a•r.-n i•r�r-.•a-r-..n.-..r•nr.wr�art a�.x+•r*nr.�.•'i+nrm�rtm r.rrn-.0 a.aa-+v..n mn .rn-rr-.-.anr.--"..t.. TOWN OF Barnstable BOARD OF HEALTH SUBSURFACE SEWAGE DISPOSAL .SYSTEM INSPECTION FORM - PART D •- CE11T1 FICATION �� h-•ter,-T•:-::.—�.pia-rrnmrw•nnnrnr�r=w�nr+s�-n,.nuew�mesr--r+w•+v�wra.�+�n+mrn� a.+nn�+.+r�.+ts�-.m+...r.•.+..- .T'R-1. -TYPL OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRESS 90 Chestnut Street Hyannis,Mass. ASSESSORS MAP, BLOCK AND PARCEL OWNER' s NAME Audrey Rutiey PART D - CERTIFICATION NAME OF INSPECTOR Joseph P.Macomber Jr. COMPANY NAME J-P.Macomber & Son Inc':' COMPANY ADDRESS Box 66 Centerville,Mass . 02632 Street Town or City State LIP COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX ( 508 ) 790 _ 1 578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system i this address and that the information reported is true , accurate , and complete as of the time of ,inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on site sewage disposal systems . Chuck ne: System PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public healtli or the environment as defined in 310 CMR 15 , 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED* The inspection which I have �concted has found that the system fails t( Protect the i-iublic health and the environment in accordance with Title 5., 310 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form , Inspector Signatur �l Date One copy of this certification must be provided to the OWNER, the BUYER ( where applicable ) and the 130ARD OF IiEAL'1'I1. * If the inspection FAILED, the owner or oparator shall upgrade ' the ayetem within o•ne year of the date of the inspection, unless allowed or required otherwise as providdd in 3.10 CMR 16 , 306 . partd .doc ASSESSORS MAP: `�Q _-� - TEST HOLE LOGS PARCEL: 5T NOTES: *f7 SOIL EVALUATOR. ,4Y( �I FLOOD ZONE AlCrl -- WITNESS:., ht G REFERENCE )C jq y, � __�_�o� DATE: V l The installation -- . _- ) o shall comply with Title V and Town of Barnstable Board of fir► PERCOLA ION RATE: 1 Health Regulations. aooe 6- Z� w/ _�• Z� 2) The installer shall verify the location of utilities, sewer inverts and septic Ah-�iID / TH- 1 TH-2 components prior to installation. 3 All gravity septic piping to be 4 Ir gr y p p p g inch Sch 40 PVC at 1/8 per foot. }p 4) This plan is not to be utilized for property line determination nor any other L vstN� ss b �� � purpose other than the proposed system installation. 5) All septic components must meet Title V specifications. 7 6) Parking shall not be constructed over H10 septic components. ' 7 The roe is bounded b property corners and roe lines LOCATION MAP�i.IT.s,, -'r��� ) property rtY Y P P Y property rty es as depicted. - — 8) The property owner shall review design considerations to approve of total ' lu number of bedrooms to be considered for design. Receipt of payment for the plan and installation based on the plan shall be deemed approval of the P PP /h number of bedrooms. 9) The existingcesspools shall be pumped and backfilled per Title V P P P I Abandonment Procedures. 10)Proposed leaching is to be within 36 inches of grade or provide venting or cut - grade as permitted by the Board of Health. 11)System components to be 10 feet from water line. 12)Septic tank to be a minimum of 1000 gallons. If tank is less than 1000 al. SEPTIC, SYSTEM DESIGN gal., - then replace with 1500GST_ r FLOW ESTIMATE BEi►ROOMS AT I GAL/DAY/BEDROOM GAL/DAY ID Old 1, SEPTIC TANK �- Gi L/DAY x 2 DAYS GAL p o USE le00GALLON SEPT I C TANK SOIL A3SORPT I ON SYSTEM 1 . 7 1 DE AREA: 2—�C ?la /3 �( X — �Oy,�Z AVID - ` 'IOTTOM AREA: i i 7 = 3Or l�r�j 1 v ,-rw SEPT �, SYSTEM SECTION (, ►-�s- 04 1 �N 14" D- i r ` / p GAL �Q 1 SEPTIC TANK 1 / - y- o -- -- - - -- I t: 7' o� TVhT 6C' 30 Z `� SITE AND SEWAGE PLAN LOCATION : 7U P PREPARED FOR : 5 ) 0 Of 0 SCALE: 1 DAV I D B . MASON 95 _DATE: 27 g q (� --- DBC ENVIRONMEN AL DESIGNS EAST SANDWICH . MA W 3 ' GATE HE LTH AGENT ( SO8 ) 833- 2 177 W Z ASSESSORS MAP: � O TEST HOLE LOGS PARCEL: yV SOIL EVALUATOR: NOTES: FLOOD ZONE: I-/p/ - WITNESS ;fit r .REFERENCE: 1 ��� � DATE --- LA,( ZADOL4---- The installation shall comply with Title V and Town of Barnstable Board of ~� - -- - Health Regulations. �S' PERGOLA 10 RATE• I. l gu 2 The installer shall y ' ,�� ) verify the location of utilities, sewer inverts and septic �'1 �+� TH- l TH-2 components prior to installation: qqrl> 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8"per foot. � I r 4) This plan is not to be utilized for property line determination nor any other L oA/f'1 purpose other than the proposed system installation. �✓ t�, 5) All septic components must meet Title V specifications. r 6) Parking shall not be constructed over H10 septic components. LOCATION MAP s.LT,S. s A property � Y P P rtY property p. - ,__ '!�f�1 7) Theis bounded b roe corners and ro lines as depicted. ' 8) The property owner shall review design considerations to approve of total number of bedrooms to be considered for design. Receipt of a /�J���� g �P payment for the plan and installation based on the plan shall be deemed approval of the number of bedrooms. 9) The existing cesspools shall be um and backfilled per Title pumped p e V Abandonment Procedures: 10)Proposed leaching is to be within 36 inches of grade or provide venting or cut 1�— - P grade as permitted by the Board of Health: 11)System components to be 10 feet from water line. 12)Septic tank to be a minimum of 1000 gallons. If tank is less than 1000 gal., SEPTIC SYSTEM DESIGN then replace with 1500GST. d FLOW .ESTIMATE .. BEDROOMS AT 1 GAL/DAY/B D OOM GAL/ AY E R ?f o D 6 - --- oO SEPTIC TANK I %�;�GAL/DAY x 2 DAYS W00 GAL USE GALLON SEPTIC TANK ' tn11DL1t. W6i 1�K,IJ�x � - SOIL ABSORPTION SYSTEM = e �. O` , 2 r X p ✓ �` y v�aCJ511 ISO ... "4- 's ®A�: ZZ 7 SIDE AREA. X ?� /3 X X � �J�2 _ BOTTOM AREA: IT w SEPTIC SYSTEM SECTION 10 N I K ' d. , r4w - � GAL `Di?! 11h4� i.: 1=1 Cl I=rt - r SEPTIC TANK - Ou 1 �, IthT u Lam, 501 Z / ?� :. ' I ► SITE AND SEWAGE PLAN _J LOCATION : C�1457k�' t�V66T 00" PREPARED FOR : Z71ki LV,6U FXPr G a / o _ SCALE: � W DAV I D B . MASON � DATE: 27 0 41, DBC ENV I RONMEN�'AL DESIGNS AGENT DATE HEALTH . _ EAST SANDWICH . MA W ( 508) 833-2177 MAV 31 -.00t 1l lyi d104 ' ti-LO(h 60111& 6ki