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HomeMy WebLinkAbout0142 CHESTNUT STREET - Health 142 ChestJuStreet Hyannis A= 309—034 � o I I No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2ppl Latlon for Misposaf Opstem Construction Permit Application for a Permit to Construct( ) Repair(4 Upgrade( ) Abandon( ) ❑Complete System [Individual Components Location Address or Lot No. GW69 UUT -5'i Owner's Name,Address,and Tel.No. 1-�CI�JA�4 ar ��" L 4W;k Assessor's Map/Parcel ,309 163 q � V,;L- 04aVrour ST WYA0 JO( Installer's Name,Address,and Tel.No. 502 07-8,$"7� Designer's Name,Address,and Tel.No. CAt 06WC7D sR Z'a OctAZ c_O < tv1e� Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures 144 Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) djj2(:E [lwe; 74A_;V--- kia to v-wk_ l o jsT- - ICE 4S I 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 Healt . Signed Date Application Approved by Date - ,2 r- Application Disapproved by Date for the following reasons Permit No. _ Date Issued — — dai K�..n. f3tt C: d No. . .. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: / Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS l 20plitation for Misposal *pstrm Construction 3permit Application for a Permit to Construct( ) Repair�k Upgrade( ) Abandon( ) ❑Complete System VIndividual Components Location Address or Lot No. CA -.,51r )4/7' Owner's Name,Address,and Tel.No. Assessor's Map/Parcel �Qt� G�y W coR14 Ap �C�cjT S w1k Installer's Name,Address,and Tel.No. '1? Designer's Name,Address,and Tel.No. 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) gpd Design flow provided /V gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. - Description of Soil Nature of Repairs or Alterations(Answer when applicable) (-(6(j*tG e dAJ6. FA J-M C,Jf - 5 6)06r jC oka `o6bfcL. !tic Ei- -?fir, Date last inspected: - Agreement: €. A r" . 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::-oard of Healt Signed Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. O Date Issued i ------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance O THIS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(�O Upgraded( ) Abandoned( )by '`` at. 1 T a` (HaEcr i uT S� -��- _ has been constructed in accordance with the provisions of Title and the for Disposal System Construction Permit No.a O/ ,2 04ated Installer ! _ p O Designer #bedrooms Approved design flow gpd K The issuance of t °s permi shall not be construed as a guarantee that the system will'Uncti 11aldesigned --2 - . Date al1 Inspector i ------------------------------------------------------------------------------------------------------=-------------------------------- No. Fee / J THE COMMONWEALTH OF MASSACHUSETTS �. �UBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS ,C,&C jBisposal *pstem Construction 3dermit Permission is hereby gr ted to Construct( ) Repair(4) Upgrade( ) Abandon( ) System located at_ and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. h— Date 2 Approved by u Commonwealth of Massachusetts y Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 142 Chestnut Street Property Address Helen M. Cunningham Owner Owner's Name — information is required for every Hyannis MA 02601 _ May 7. 2012 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 forma A. General Information on the computer, use only the tab 1. inspector: key to move your cursor-do not David D. Coughanowr, R.S. use the return key. Name of inspector Eco-Tech Environmental Company Name 43 Triangle Circle Company Address Sandwich MA 02563 Cityrrown State Zip Carle 508 364-0894 1328 Telephone Number License Number B. Certification 1 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 Tide 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes 0 Falls ❑ Weeds Further evaluation by the Local Approving Authority "mil�• L�'n'Vi---. 1�-- May 7 2012 Inspectors Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. ""*'This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perrorm in the future under the same or different conditions of use. Wns•11110 Tft s offisialVonft= bsurfece Sewage oiapasal System•Page 1 or 17 i Commonwealth of Massachusetts ' UiTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 142 Chestnut Street Property Address Helen M.Cunningham Owner Ownees Name information is Hyannis MA 02601 May 7,.2012 required for every � page. Cityrrown State Zip Cade Date of Inspection B. Certification (cant.) Inspection Summary: Check A,B,C,D or E J always complete all of Section D A) System Passes: ® 1 have not found any information which Indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: Inspector's Note==> The septic system described herein Is deemed to pass this Real Estate Transfer Inspection if it does not meet any of the failure criteria enumerated in Section D on pages 4-5.The scope of this Inspection is limited to health and environmental compliance and the septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Check the box for"yes°,*no"or"not determined"(Y, N, ND)for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 years old"or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exltradon 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): !Sins-I Itio Tilts 0Wd91 hVOCdan Farm:SubsWOM Sewage Olaposal System-page 2 or 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 142 Chestnut Street Property Address Helen M. Cunningham Owner Owner's dame required for formation re Hyannis MA 42601 May 7,.2012 — page. cRy/Town ^� State. Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cost,): ❑ Observation of sewage backup or break outer high stage water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box,System.wili pass inspection if(with approval of Board of Health): El 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 then 4 times a Year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: -Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1.. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functloning`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 151ns•W10 TWO 6 dr@oaf Inspection Form:Subsurface Sew"a Oispoaef 8yatem•PW 3 oI f 7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 142 Chestnut Street Property Address Helen M.Cunningham Owner Owner's Name information is Hyannis required for every MA 02601 May 7 2012 page. City/Town state Zip Code Date of Inspection B. Certification (cons.) 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. El 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 asses if the well water analysis,performed at a D p y ,p EP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other. D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each,of the following for all inspections: Yes No ❑ Z Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Cl ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ E Liquid depth in cesspool is less than 6"below invert or available volume is less than %day flow Mns•1lhO Me 5 Orri WI inspaction Form subaud=Sown a pi g sposel System•Pago a of 17 Commonwealth of Massachusetts Title 5 Official Inspection ,Form Subsurface.Sewage Disposal System Form-Not for Voluntary Assessments 142 Chestnut Street Property Address Helen M. Cunningham Owner Owner's Name Information is required for every Hyannis _ MA 02601 May 7 2012 page, city/Town state Zip Code Date of inspection B. Certification (font.) Yes No a ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s)• Number of times pumped: ❑ ® Any portion of the SAS,cesspool or privy is below high ground water elevation. ❑ �. Any portlon of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of 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, perfiormed 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. ❑ 9 The system fails, l have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system falls.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.16,000 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 it 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. 15fns•11hu Tege 5 Of dal rnspac8mt Fmm:Subsurraoe 50"90 Oispam 1 System•Pape 5 o117 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 142 Chestnut Street Property Address Helen M.Cunningham Owner owners Name Information is required for every Hyannis MA 02601 May 7 2012 page. cityfrown State Zip Corte Date of Inspection C. Checklist Check if the following have been done. You must Indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as NIP,) ® ❑ 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, , o ened and the interior of the tank opened, inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field(if any of the failure criteria related to Part is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): nla Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): n/a-no plan lsins•11110 Tft 5 Olriaal Inspection fan:Submrtaw Some Disposal Sri=•Pago 6 or 17 Ceenmonwealth of Massachusetts A ' Subs.Wrface Sewage D.isposal-Systerh'Forrn:-.Not'fot Voluntary Assessnierits' }= D` y 1,,M astnu_t<Street t Prop�ty:Address. - HeleniM:•Cunnin ham ._ Owner Owner's Name information is required for every Hyanni&a_ - MA 02t30"1' 1VIay°.7"2092..'° page: CK own: State` dip Cotle; Date of Inspection D, Sys_t rn Informa` ion � :� T ����, 00 cripfion:. No�plan was found at town,offices. Numberof'current residents: 0 Doesresidence have:a garbage grinderTr; - El Yes 9, No Is laundry on;a separate sewage system?(if yes separate Inspection:_required] 'Yes ® No Laundry.system inspected? { ❑ Yes ❑ No Seaso ;❑nal use, a Yes 0 No UUatei:rrtete'rreadin s, ifavailable: last.2 earsusa 41h pd g 4 ,Y 9 (9P )) -Detail: 2010, 2011 Sump-;pump?' F ❑ Yes No Lust date of occupancy: 1 J-6 i L-..'a�0! .Date: Commerciallindusfrial;Flow Conditions: 'TYPe o.f:Estab_lishment; Des(gni.flow°(,based'-on 310;CMR•1'5`203) Gallons.pei day(9Pd) 'Basis of design flow--(seats/p'ersons/sq ft:;,etc.) Grease-trap:present? :' ❑ Yes ❑ No: Industrial waste holding tank present? ❑ Yes' ❑ No Non-sanitary waste discharged:to the Title'5 system? ❑ Yes ❑; :No Water meter readings, if available: lsim:-111.10 7iUo 5:Olficial tnspcclion Fotn 'Subsuifoco'Sewago Oispas8l Syslcrtj` Page 7io(if7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 142 Chestnut Street Property Address Helen M. Cunningham Owner Owner's Name information is Hyannis required for every MA 02601 May 7,2012 page. citylrown state Zip Code Date of Inspection D. System Information (cant.) Last date of occupancyluse: Date Other(describe below): General Information Pumping Records: Source of information: owners agent Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank,distribution box,soil absorption system ❑ Single cesspool pool ❑ Overflow cesspool ❑ Privy ❑ Shared system(yes or no) (if yes,attach previous inspection records, if any) ❑ InnovativelAlternative 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): 15ma•t iri0 Tote 5 Official inspection Form:Subsurface Sewage g O'spesal System•Page 8 or 17 F Commonwealth of Massachusetts -_ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 142 Chestnut Street Property Address Helen M. Cunningham_ Owner ownef+s Name information is Hyannis MA 02601 May 2012 required for every .._ ._ y 7, page, cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Age 20+years.A title 5 system was.installed in 1992- ermit at Health Dept. Were sewage odors detected when arriving at the site? - :❑ Yes No Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: El cast iron Z 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting,evidence of leakage, etc.): -: Sewer line appears structurally sound with no evidence of leakage or backup into dwelling. Septic Tank(locate on site plan): Depth below grade: 1 reel Material of construction: ®concrete ❑ metal El fiberglass ❑ polyethylene []other(explain) If is metal, list age: years Is age confirmed by a Certificate.of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 8_.5 x 5 x 6-1000 gallon tank Sludge depth: 5 in 15bts•1111110 Title$Offidel inspacllgn Form:Subsuiface 8owageDispesel System•Pago 90117 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 142 Chestnut Street Property Address Helen M. Cunningham Owner Owner's Name require for every is Hyannis MA 02601 May 7, 2012 required every page• citylrown state Zip Cade Date of Inspection D. System Information (cunt.) Septic Tank(cost.) Distance from top of sludge to bottom of outlet tee or baffle 29 in Scum thickness 4 in Distance from top of scum to top of outlet tee or baffle 8 in Distance from bottom of scum to bottom of outlet tee or baffle 12 in How were dimensions determined? permit application form Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Pumping not required at this time, but maintenance pumping is recommended within 2 years and every 2-4 years thereafter.Tank and tees appear structurally sound and functioning as intended. No evidence of leakacte in or out was observed. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping Date Was•1Ina Me S Otruial Us peclion Fo=Subacuraeo Sowagu Otsposol Systom•Paga loaf 17 'r t, Commonwealth of'Massachuseits Title 5 Off ids n I � �1 ®°ate r = Subsurface;,sewage Disposal'System Form Not for Uoluritary.Assessinen't`sp i — 142 Chestnut Street: s = Property'Address Helen M. Cunningham 0wner owner's Name information.is' required,forevery Hyannis: _ MA 026011 May:7; 2612`._ : pager CltylTowri State Zip Code Date of Inspection.. D°. 'System Informafion (cone.) x ;Comments (on pumping recommendations; inlet and outlet.tee or;baffle,conditlon, structural—integrity, liquid levels as related to outlet invert, evidence of leakage, etc:): i t `Tight or Holding Tank {tank must'oe pumped'at'"ime of inspection) (locate on site plan). Depth below grade: :Material of construction: concrete ❑ metal ❑ fiberglass: ❑ polyethylene, E other.(`expla►n)' 'Dimensions: 'Gapacity: gallons Qesign:Flow: - gaAons<perday,� Aiarm°,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're uired . Isicopy a ❑ 'Yes ❑ No° tSlns••f:tl10, TiUo'S'O(iieiol tnspddion Form:Subsurface Sewage'.0posai Syslom`:•.paga 1lcro 17 Commonwealth of(Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 142 Chestnut Street f7raparty Address Helen M.Cunningham Owner Owner's NameInformat - '-- requiredion is Hyannis MA 02601 May 7,required for every 2012 page. cityrrown State Zip Code Date of InspaWan D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert at 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.): Unit appears sound and functional. Few,solids in sump. No evidence of leakage in or out was observed. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: Win 11010 Me 5 Wiidal Inspecann Farm:Sabsurf=Seaage OispoaW System•Pape 12 of 17 ' r C.ohlMonwealth of Massachusetts Subsurface Sewage Disposal System Form.-Not forV untary Asst7ssments ` 142 Chestnut Street Aropeit -Address Helen M. Cunningha_m Omer Owners'Nanie: , 1 :. Ma 2012i< information required:for,:every Nyannls MA 0260 yt7,t> page., C1tylTown _ State Zip Code Date of tnspectfon + D. Sys:tem Information (corn.) 4 Type: leaching pits number: 1 ❑ leaching-chambers numbers leaching galleries number: . .: leaching trenches number, iength' ❑ leaching fields number; dimensions: ❑ overflow cesspool - number.; ❑ innovative/alternative:systern i Type/.name of technology: Comments (note condition of soil, signs of hydraulic.failurei.'level of,ponding damp soil 'condition of vegetation,'etc:): Soils above leaching pit appear unsaturated. No evidence,of surface ponding breakout, lush vegetation, or other evidence of hydraulic failure was observed,.An observation hole was dug into leaching..pit stone and no effluent contact staining was observed to the'stone.or overlying soils. No standing-effluent was observed to a depth of 3 feet below'the top.of ttie leachpit. 'Cess pools,(cesspool must:be pumped as,part�of inspection) (locate on sife,Ian) Number.and configuration Depth top of liquid`to inlet invert Depth of solids layer Depth of scurn layer - 'Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑`: Yes: ❑ No t5hSI.-11110 rillo 5 otrow Inspection Form:$ubsuA6 60v;i6e Oispii al System'.'Page 13 gf tY CornrnonWeAlth-of'Massachtasetts I I�ni ''tion Form Subsurface Sewage Disposal System-Form'-Not-for Voluntary Assessments ` 142 Chestnut.Street Property Address Helen M. Cunningham Owner Owners Name' information ie H annlS. MA 02601 May, required:for every., �, `"' � y 7;:2012i ;. _. page, citylTown -, - State Zip-Code Date of lnspectiow D. System Lnformatio_n Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate-on.site.plan): Materials'of construction:. Dimensions Depth,of solids Comments (hate condition-of!soil,signs.o4.hydraulicfailure, level of ponding„condition of vegetation; etc.); s , (Sins•111f0 Tille 5 Official InspaclionForm:Subsurface Sotvaga Disposal Syslem f Page.l4 af.17 L Commonwealth of Massachusetts Title 5 ®fflcW Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 142£hestnut Street Property Address Helen M. Cunningham Owner owners Nance information is required for every Hyannis _ . MA 02601 Ma .7.2012 page. cityrrown State - Zip Code Date df faspecUon D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including.ties to g. at least two permanent reference landmarks or benchmarks. Locate all wells within 100 fait.Locate where public water supply enters the building. Check one of the boxes below: hand-sketch in the area below ❑ drawing attached separately `3q [42 � 3 0 0 d DtT SHE 7-Wv T- � r(:L i tins•11110 '611a 5 010dol ImpoeUon Fe=Submdeco Sawago 01spoel System•Page 15 at 17 Commonwealth of Massachusetts ` ., Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 142 Chestnut Street Property Address Helen M. Cunningham Owner Owner's Name information isquired for every Hyannis MA 02601 May 7, 2012 page. citylrown Stale Zip Code Date of Inspection D. System Information (corn.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 20 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation ® Accessed USGS database-explain: Barnstable GIS Department records You must describe how you established the high ground water elevation: Town of Barnstable GIS Department records indicate that the property is over 20 feet above groundwater table. Before filing this Inspection Report,please see Report Completeness Checklist on next page. Wns•11110 Me 5 offidw Ins pocGon ForrR Subsurface 5evrdg0 Oisposat system•Pago 16 of 17 . Commonwealth of Massachusetts _ Title 5 Official Inspection Forrn Subsurfaoe Sewage Disposal System Form-Not for Voluntary Assessments 142 Chestnut Street Property Address Helen.M. Cunningham Owner Owner's Name information is Flyannis __ MA 02601 May 7 2012 required For every __._, _... „ .,_• page. Cttyrrown State Zip Code Data oftnspection E. Report Completeness Checklist Inspection Summary:A, B, C D, or E checked ® inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information-Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file I - I t5ins•t U1D T11W 5 Mrkw Impeudw Form:subt;urraee 89"Be Qisposel SYs1am•Page 17 of 17 '+ TOWN OF BARNSTABLE BAR-W 5954 Ordinance or Regulation WARNING NOTICE Name of OffenderJAaaetyLmT fillr/� L � /�'i Address of Offender L,/v , MV/MB Reg.# Village/State/Zip I J ► V I 1 © o�To 0 Business Name ? pm, on 20ff Business Address Signature of Enforc' g Officer Village/Stat Zip Location of 0 ense En oorc-�inn�gDept/Division Of f e n s e_s Facts This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. JAW "LET US DARE TO READ, P`QFTIIE,Tp�'� Town of Barnstable - ..:__.2— THI EAK ANDIVRITE. . Public Health Division 07 APR. t : ,�'� ifn Adavfi�k 176 RARrWAB � 200 Main Street T ^'s> .i....,r.,.....,..».e,,. . Hyannis, MA 02601 PITNEY BOWES 02 1A $ 00.410 .0064606238 APR 07 2008 MAILED FROI ',tIPCODE 02601 Matti K. Saariaho Lr 92 Rosary Lane i Hyannis, MA. _26.01._-!_ cn NIXIE 029 DIE 1 �00 041-.0YOS -- RETURN TO Sle1 ER NOT DELIVERABLE AS ADoRassca UNABLE TO FORWARD 026010400 TOWN OF BARNSTABLE LOCATION 141.2 frN�yy�� s i SEWAGE # VILLAGE ASSESSOR'S MAP & LOT 3® D'j INSTALLER'S NAME PHONE NO. I- my—C-� (SorisG- '27/ -VI SEPTIC TANK CAPACITY I , o o o LEACHING FACILITY:(type) (� t-- (size) NO. OF BEDROOMS PRIVATE WEL R PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes o � � ill '� ® �- n r � N1 L �� �I Z �" _,[ -� � O V.j L � �� .�-- No.- ...... .. Fps... . ............._ �`p g^ THE COMMONWEALTH OF MASSACHUSETTS [\ J ►//� l�``� �� BOAR® OF HEALTH ,. ti � TOWN OF BARNSTABLE ��©3 �jlpl' t#iaa� for �i� u tt1 ,ark C otrurtiou Permit Application is hereby made for a Permit to Construct '( ) or Repair 3� / an Individual Sewage Disposal System at: �Jt-)'C"" ... ----•-•--• -------•••---------•-----•----•-------...--•---•-----•--•----•.........................•--........ ..... ........-•---.._.............•-----.....-- ---------...---------- Location,.,Address or Lot No. ..................................... .........•--------------...----••-•---.....------....-••-••-•-----•---•..........................• • Owner Address ,1 ................ ...`......--•---.... 1.--......._.; �-------- -•--•--•-•--------------.`sf......------..6_ ,�.............--•-----•--•----............-- Installer Address dType of Building Size Lot............................Sq. feet aDwelling=No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ------------------------_-- No. of persons.....--.----............--.. Showers ( ) — Cafeteria ( ) P4 Other fixtures -------------------------------- . -- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length---------------- Width.------......... Diameter--.----......... Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No---------------_--- Diameter.................... Depth below inlet................. Total leaching area...................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ~' Percolation Test Results Performed b ........................................ Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.....................--. fi Test Pit No. 2................minutes per inch Depth of.Test Pit--- ................ Depth to ground water..--.................--- -------------------------------------------------------------------•----•------•------•-------.............----------------•------------------....•---.•--- 0 Description of Soil........................................................................................................................................................................ x V ----------------•-----•-------------------•--------••-•----------------------------•-----......-----------------•----•-----•----------------------•-------------------..........----•--•---------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------•-------------------------•----------•---. U Nature of Repairs or. Alterations—Answer when Applicable----l a i-t............ ...........tk.lam.......--.�:-T............. " �f ------a------s aw` ............................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—'The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed .... .. ....s'.��YZ .... .. .. ............................................... Date -..........-... ApplicationApproved By ............... ter^^^ ... -------------------------------------------------------------------------------- .......... '✓� .. V Date Application Disapproved for the following reasons- --------------------------------------------------------------------------------------------------------------------------------------- --- ------------------ --- ---- -------------------------------- ---- ----- --------- ---- -------------------------------------------------------- -- ------ -- ----- -- ---- ........................................ Date Permit No. ......... ... .......... -- .. ---....- -- --------- Issued -.--...--------------.Da..te-----------I--------------------- ---- � - j 3 o � _ o-3 01\( T`` p q r THE COMMONWEALTH OF MASSACHUSETTS J Y BOARD OF HEALTH I TOWN OF BARNSTABLE tinn for Uhiposal Workii Tonstrnr#'inn ramit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal J PP Y ( ) P (�', g p sal Sd�System at: Location pAddress or Lot No. --- -•4_ . ................ ............•---•--•---------•-•-•-....--•-••••----....._......---••-•••-•---Q•-•.............-•--•- ner Address a ----•-... c-K ......---•-------_...._�.`�_1..- -�c �............. ...�$------•-fit.. ...•----...................................................... Installer Address UType of Building l Size Lot..,-.............:......:....Sq. feet 0-4 Dwelling—No. of Bedrooms............................................Expansion Attic (. ,) ; .Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) � Other fixtures -------------------------------------------------------------------------------------------------------------------------------------- ----------- w Design Flow............................................gallons per person per day. Total daily flow__._____.____.__......................._....gallons. WSeptic Tank—Liquid*capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width........._._.__..... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water._____.____.__.-....._-. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -------------------------------------------------•--------•-------------•----------......-•--------......................................................... 0 Description of Soil............................................................................... -----------------------------------------------•---------- .._........... x c, •--••-----------------------------------------------------------------------------------------------------------------------------------•------------------------------------------•........------------ w x = >applicable._..1-,n? �_w _.----____ U Nature of Repairs or Alterations—Answer when N ---------- ..........S-1.:............ ` Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with. the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the `t system in operation until a Certificate of Compliance has been issued by the board of health. — - -- - n .. 3--V. - Z Signed .:... - .a ts� ,: z-. �a.- �•o ... ........ I . --....... Application Approved BY ... ^-t 3 '-te "�- ------------------------ Date Application Disapproved for the following reasons- ----- ----- - --------------------------------------------------------------------- -----------__------------------I....... - -------------------------------------- ........................................ p� Date PermitNo: .......... 02 D. --------------------------- ----- Issued ................. ------.............----- ......... Date t i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Cer#tftrate of C omplinure THIS IS TO CERTIFY, That the Individual Sewage,Disposal System constructed ( ) or Repaired by.....................................................CH��v1v'C Sir 'mot A-MrvtS --------------------------------------_--.......................-.------------------------------------------ Installer at ............ k-\et ..................C'O..NS� ....... -- ------------------------ ...........---........-- has been installed in accordance with the provisions of TITLE 5 f The State Environmental Code as described in the application for Disposal Works Construction Permit No. ..... _-. .----.-..l-z----------- dated ...........---------------....................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONVRJ4ED AS A'GU RANTEE THAT THE SYSTEM WILL FUNCTI N S TIS;)44CTORY. rF O G DATE................ / .�� ... ............................... Inspector LL1/ '�¢ � THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH pp TOWN OF BARNSTABLE No... :..Q.(o... FEE._.30............. Disposal Work$ Cnnnitrndinn amit Permission is hereby granted........M�:�c«-£`' f'®�%N - ----------------- to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at No......1`;12.---....----0 -3 N — .. 4 r'Aw n., ---------•---•--------------------------------------•••........... Street as shown on the application for Disposal Works Construction Permit No.____! ___��a___- Dated..................................s------- -------------------------------- ------------ ------------------------------......----•- DATE.. Board of Health -----..a- FORM 36508 HOBBS R WARREN,INC..PUBLISHERS �3'