HomeMy WebLinkAbout0080 CROCKER DRIVE - Health (2) 80 Crocker Drive
Hyannis
A= 306-028-002
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INNAS- ENKOVSKY TR
35,�KINE STREET
+MEDFIELD, MA 02052 3. Se ice Type
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2. Article Number I� 7 Q 12 1010 0000 28.48. 0127
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PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540
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UNITED STATES POSTAL SERVICE First Mass hJlail.
Fees.Paid.. ,
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• Sender: Please print your name, addr'ess,and,'Z��n�this 4-u
I
I
Sewer Connect `
F�e2jPublic Health Division
C Town of Barnstable
I 200 Main Street a
Hyannis, MA' 02601
I - I
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M I
N
U.S. Post' bevice � Y
a TM
CERTIFIED MAILTM:RECEIPT��
(Domestic Mail,Only;,No,InSL rice,Coverage"Provided)
— OF&,-61ivery,inforrnation—yisit&u-- wetisite M A w sps:com €
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PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047
Town of Barnstable Barn
Regulatory Services Department AlAm e`CeC ily
BARNSrABM
MASS. -. .---.-- Public Health_Division.
200 Main Street, Hyannis
Office: 508-862-4644 Thomas F.Geiler,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
CERTIFIED MAIL#7012-1010-0000-2848 -0127
March 28, 2013
INNA SENKOVSKY TR
35 PINE STREET IMPORTANT NOTICE
MEDFIELD, MA 02052 Map & Parcel: 306-028
The Department of Public Works informed us that public sewer lines are now
available in your neighborhood. According to our records, your property has a septic
system. This letter directs you to connect your dwelling, at 80 Crocker Drive,Hyannis,
MA, to public sewer on or before 3/30/2015.
The old septic system must be either removed or filled in due to future safety
concerns. This may be done by the same contractor who connects you to the sewer.
Septic Abandonment Permits ($ 25) are issued at the Public Health Division, 200 Main
Street, Hyannis.
Failure to comply with this Board of Health Order may result in a complaint
against you, in a court of law.
For additional information pertaining to the sewer connection, please see the
reverse side of this page.
PER ORDER OF TH BOARD OF HEALTH
E'
a C. cKean, R.S., C.H.O.
Agent of the Board of Health
Cc: Barbara Childs,WPC/Roger Parsons, Town Engineering, DPW
Enc.
QASEWER connect\Letters Stewart Creek Sewer ConnectsWAILING LetA Sewer 2Pgs Merged 3-28-13 Yr2015.doc
'a
Public Health Division March 28, 2013
ADDITIONAL INFORMATION AND REMINDERS FROM OTHER DIVISIONS:
SAVINGS AVAILABLE/GRINDER PUMP:
A reminder to those of you who need a grinder pump for your connection:
Department of Public Works (DPW) sent you a letter in December 2012 stating the town,
for a limited time of two years, only from the receipt of the DPW letter, would provide
you with the pump at no charge. (This can save you thousands of dollars.) Please note:
You must pay the installation cost through y�jur own contractor. Please make your
contractor aware of this, if interested. Also be aware: this is a shorter deadline than
the Public Health Division's deadline on the reverse side of this page.
SAVINGS AVAILABLE/PERMIT FEE:
The Town offers a waiver of the residential sewer connection fee of $420.00 for those
properties that connect within two years of the receipt of the DPW December 2012 letter.
LOANS:
For loan(s) available, please.see the enclosed brochure, or see the town website:
http://www.town.barnstable.ma.us/cdb�4 (under the "CDBG Programs", see "Sewer
Connection Loan Program). For loan specific questions, you may contact Kathleen
Girouard, Growth Management, at 508-862-4702.
CONTRACTORS:
Information on Licensed Sewer Installers is available on our web site at
www.town.barnstable.ma.Lts/PubllcWorksTech/sewerinstallei-s. Contractors, approved to
perform sewer connection work in the Town of Barnstable must obtain and file a Sewer
Connection Permit with DPW-Water Pollution Control Division, 617 Bearse's Way,
Hyannis —contractors, please call Dave Anderson at (508) 790-6244.
FOR ANY QUESTIONS /ASSISTANCE:
Len Gobeil at the Town Manager's Office is available to provide you with direction you
may need in reference to the Stewart Creek Sewer Connections. You may contact him at
508-862-4701.
QASEWER connect\Letters Stewart Creek Sewer Connects\MAILING L.etA Sewer 2Pgs Merged 3-28-13 Yr2015.doc
0
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF.ENVIRONMENTAL PROTECTION
TITLE 5
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
:SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART.A
CERTIFICATION
Property Address: 80 Crocker Drive �.
Hyannis, MA 02601 I .
Owner's.Name: Rita Kapish
Owner's Address:
Date of Inspection: September 16, 2012 '
Name of Inspector: (Please Print) JaniesM.Ford
Company Name: James M. FOd
Mailing Address: Ad.'
Oster^ville,MA 02655-0049
Telephone Number: (5,08)862-9400
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 DER,
approved system'inspector pursuant to Section15.340 of Title,5(310 CMR 15.000). The system: -�
3 -r�
Passes
conditionally Passes .a
eds Further Evaluation by the Local Approving Authority
.Is -U
Inspector's Signature: Date: October 2, 2012
The system.inspector shall s.0 it 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.systerir;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.♦ €,.:.c;a I:L� : F t 3�r!r r' '
Notes and C.ornments ' ?011 F [ e
****This reportl-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 of different
conditions o.-use.,,,,
Title 5 Inspection>.Fotin a,,'t,6/1.5/2g00!;t o.. page l
Page 2 of 11 ±s Y
OFFICIAL INSPECTIG:I�i FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
6 CERTIFICATION (continued)
t
Property Address: 80 Crocker Drive
Hyanis,MA
Owner: Rita Kayis{t
Date of Inspection: Seyteniber 16, 2012
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D :
A. System Passes: Is.:
✓ I have not found any infrmation which indicates that any of the failure criteria described in 310 CMR
15.303 or in 310 CMR 15.3.04 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,�u"on�completionp "of the re replacement or repair,as approved b the Board of Health will ass.
ppp p Pp Y p.
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 riifiltratron or exfrltration 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:
Observatibn 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 pipes)are replaced
obstruction is removed
ND explain
. 1
Page 3 of 11 ^;•
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
�.. PART A
f. CERTIFICATION (continued)
Property Address: 80 Crocker Drive
Hya`"ihis.MA.
Owner: Rita Kapish
Date of Inspection: September 16, 2012
C. Further Evaluation is Required by the Board of Health:_
Conditions exist which require further evaluation by the Board of Health in order to determine if the system
is failing to protect public health,safety or the environment.
I
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
I
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:
+ 1 ::;The system has`a septic,tank and soil absorption system(SAS)and the SAS is within 100 feet of a
surface water supply or,tiibuta.N,to,z surface water supply.
LL. r::!;6The system has a septic tar k and SAS and the SAS is within a Zone 1 of a public water supply.
rL �JThe systerri has aseptic tank and SAS and the SAS_is within 50 feet of a private water supply well..
iI 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.passes1if:the.wel1 water,analysis,performed at a DEP certified laboratory, for coliforin
bacteria and,volatile omanii3 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 Copyf the analysis must be attached to this form.
3. Other
ie ). iiFLfil';
y _
al.'s
Page 4 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 80 Crocker Drive
Hyannis,MA
Owner: Rita Kapish
Date of Inspection: September 16, 2012
D. System Failure Criteria'applicable to all systems:
You must indicate either"yes or"no"to each of the following for all inspections:
Yes No
✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
✓ Static liquid level in the distribution box above outlet'invert due to an overloaded or clogged SAS or
cesspool
✓ Liquid depth in cesspool is less than 6" below invert or available volume is less than%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_
✓,i ,1,lAny 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
' 9. .LS
water supply:
✓ Any portion\of a cesspool oil privy is within a Zone l.of a public well.
✓ Any portion of a cesspoollor 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
upply well with noacceptable water quality analysis. [This system passes if the well water analysis,
performed at a:DEP,cei_tified laboratory,for coliform bacteria and volatile organic compounds
indicates that;tlie weli.is,free from pollution from that facility and the presence of ammonia
,l i >i.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.]
No (Yes/No):iT.liei system.fails. `I•have determined that one or more of the above failure criteria exist as
described in 3l0 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 System Iblct. t
To be considered'a large system,thei system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd r, 1.
You must indicate`.erther`yes=':or`°no". to each of the following:
(The following criterialapplyto.,large systems in addition to the criteria above)
Yes No
the system is;within;4.00 feet of a surface drinking'water supply
_ thei .steM s.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;Il�of a public:;water.supply well
a ,Iy,,
.If:you have answeredl"yes�'.to any;question in Section E the system is considered a significant threat,or answered
"yes"in Section DE,abto:ve theaarge system has failed. The owner or operator.of any large system considered a
significant threat under,S`ection.E brfailed under Section D shall upgrade the system in accordance with 310 CMR
15.304. The'system�oi bier should contact the appropriate regional office of the Department:
-
4
Page 5 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
r CHECKLIST
Property Address: 80 Crocker Drive
Hyannis,MA
Owner: Rita Kayish
Date of Inspection: September 16 20,12
t .
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?
fi
✓ . Has the system received normal flows in the previous two week period
I Have large volumes of water been introduced to the system recently or as part of this inspection
✓ _'i,t ,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
i
✓ t r. I °Were all system coinporients,excluding the SAS, located on site?
✓ Were the_septJc_tank manholes uncovered,opened,and the interior of the tank inspected for the condition
of the baffles or tees,material of,construction,dimensions,depth of liquid,depth of sludge and depth of scum?
✓ Was the facility.owner'(and occupants if different from owner)provided with information on the proper
maintenance of subsurface sewage disposal systems?
`The size and location of the Soil Absorption System(SAS) on the site has been determined based on:
'�r ;>> {Its: e•^
Yes No
•✓ Existing infortmatiom F'or example,a plan at the Board of Health.
✓ Determined inl.the field(if any of the failure criteria related to Part C is at issue approximation of distance
is.unacceptable).[310 CMR 15.302(3)(b)].
,
',
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Page 6 of 11 `
F
OFFICIAL'INSPECTIOiN FORM-NOT FOR VOLUNTARY ASSESSMENTS
.SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION -
Property Address: 80 Crocker Drive
Hyannis,MA
Owner: Rita Kavish
Date of Inspection: September 16. 2012
FLOW. CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 3 N'umber of bedrooms(actual): 2
DESIGN flow based on 310 QMR 15.203 (for example: 110 gpd x#of bedrooms):. 330
Number of current residents: 0
Does residence have a garbage grinder(yes or no): N/a
Is laundry on a separate sewage system(yes or no): N/a [if yes separate inspection required]
Laundry system inspected(yes or no):.: no. _
Seasonal use(yes or no): no
Water meter readings,if available(last 2 years usage(gpd)): Unavailable
Sump Pump (yes or no): No
Last date of occupancy: Unknown
COMMERCIAL%<INAU$TRIA4.
Type of establishment !. . `_ ° s
Design flow(based on 310 CMR 15 203), gpd
Basis of design flow(seats/persons/sq/ft etc.),`
Grease trap present(yes or no):
Industrial waste holding tank present(yes or no)
Non-sanitary4asto discharged:fo'the Title._5-system(yes,or no):
Wafer meter readings,if available; i I f:i
Last date of occupancy/use:. e.t !
r.
OTHER(describe): k
g1 .
.... ...,:__;_ .'GENERAL~INFORMATION
Pumping`Records
Source of information. �,—Unavailable
Was system pumped aspart of the inspection,(yes or no):
If yes,volume pumped ::gallons-:How was quantity pumped determined?
Reason for,pumpmg. } i ;-1 f+c i `-r
TYPE .OY,SYSTEMr`it 1 t I 'tri•E .;i '
Septic.tank,distribution,box,soil absorption system
Single cesspool t
Overflow.cesspool
Shared' ystem(yes or no)..(if,yes,attach previous inspection records,if any)
Imiovative/Alteriiative technology.._Attach a copy of the current operation and maintenance contract(to be
obtained.from sykem,owner) ...
'..TighttTank, :i -Attach a.copy of t1ie.DEP approval
Other(describe):', j l a t, 'eul r
Approxuna.te cage of all components,date installed(if known)_and source of information:
Date ofii4tallationi3/26/91 Pei-as-built card
Were sewage odors detected when arriving at:the site(yes or no):- No
6
�y
Page l of 11
OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 80 Crocker Drive
Hyannis MA
Owner: Rita Kavish
Date of Inspectiom SeptemUer16 r2012
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:
Cominents(on condition of joints,venting,evidence of leakage,etc.):
SEPTIC'TANK: ✓ (locate on site plan)
Depth below grade: ! 8 (.
Material of construction t✓ concrete _r';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) 1 1
Dimensions: 1000-ad H-20
Sludge depthl(iI i r ; 2''
Distance from top of sludge 10'h ttoln of outlet tee or baffle: 30"
Scum thickness:. 3"
Distance from top lof scum to top of outlet'tee or baffle: 6"
Distance from bottom of scum to bottom of outlet tee or baffle: 101,
How were dimensions determined: Measurinzsticic
Commeiits (on:punnping lrecommendations,l inlet and outlet tee or baffle condition,structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.).
The tees were present The liquid level was even with the outlet invert. There did not aDVear to be anv si ns of leaka e.
Recomiliend.steehcovers:be installed up to Jzride. The tank is in the dri.veiva .
lip
GREASE TRAP? h7Vonef(lo'cate on'site-plan)
Depth below grade:
Material of construction: _concrete _metal _fiberglass _polyethylene _other
(explain): 3 , ,};. u.:
Dimensions:
Scum thickness is
Distance from topp-of scum,to top of outlet.See.or baffle:
Distance'.from bottom,of scum.to.bottom of outlet tee or baffler
Date of last puiriping
Comnients,(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid:levels
as related-to outlet.invert;:evidence,of leakage,.etc.
t I' .�f.'
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Page 8 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 80 Crocker Drive
Hvannis,MA
Owner: Rita Kavish
Date of Inspection: September 16, 2012
TIGHT or HOLDING TANK: None (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:):
l�l: l•',! :I:'! [ �+' '',�''' +� III"' "' } _
DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan)
Depth of'liquiMovel above.ouflet:invert Even
Comments(note if box is level ands distr>liuti_on to outlets equal,any evidence of solids carryover, any evidence of
leakage into or out of box,
The D-b'ox';was!nonnal. The cover.was 8"'below and the D-box was H-20
PUMP CHAMBER: None (locate on site plan)
Pumps in.workingtorder.(yes or.no)t° ; - .r
Alarins.in working;order,(yes or no)
Conunents(note.condit>on..of pump chamber,condition of pumps and appurtenances,etc.):
,. ..
p
._..._.—. -. .:_ ......_..:_ 8.
tt. r ii s I. ,, L�i :lti� .:1'..:•i
• Page 9 of 11.
OFFICIAL INSPECTION FORM= NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued).
Property Address: _ _ 80 Crocker Drive
Hyannis.
'MA
Owner: _ Rita Kapish
Date of Inspection: September 16'2012
SOIL ABSORPTION SYSTEM (SAS): ✓ (locate,on site plan,excavation not required)
If SAS not located explain why:
Type
leaching pits,number:
leaching chambers,number:
leaching galleries,number:
✓ leaching trenches,number, length: 32'long per as-built
leach ng'fiel°ds;tiumbO .dimensions;
overflow cesspool,number
Innovative/alternative system Type/name of technology:
Comments (note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.):
The Trench ivas dr 7. There did not appear to'be it signs o ailure.A camera ivas used for the ins ection.
CESSPOOLS:. , None (ces5po'ol.inust,be pumped as part of inspection)(locate on site plan)
Number and,00nfiguration:_
Depth=top of liquid to inlet invert:
Depth ofaolids-layerf„ y i 1:., Tf.
Depth of scum layer
Dimensions of cesspool
Materials-of construction:
Indication of groundwater inflow{yes or.no)_
Commments.(note condition of soil,signs of Hydraulic failure,level of ponding,condition of vegetation, etc.):
PRIVY: None:.(locate oil siteiplan) -
•
Materials'of co ls.tiuction :•. mis `. n
Dimensions .flni i, 1 Is: ru,i ,cr i , n;i;,'r:
Depth of solids ,, ;
p
Comments(note condition of soil,signs of hydraulic failure,level ofponding,condition of vegetation,etc'):
'iti:;'it
�s 1 it`_7;l t 1i1;L ti t,tfii";
Page 10 of .11 r.'
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address 80 Crocker Drive
Hyannis,MA
Owner: Rita Kanish
Date of.Inspection: September 16,�'012
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.
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Page 11 of 11
11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C , -
SYSTEM INFORMATION (continued)
Property Address: 80 Crocker�Drive
Hyannis•MA
Owner: Rita Kapish
Date of Inspection: Septernbei=l6. 2012
4
SITE EXAM k
Slope
Surface water
Check cellar
Shallow wells !
Estimated depth to ground water 10+./ feet
Please indicate(check) all methods used to determine the high ground water elevation:
Obtained from system design plans on record : If checked, date of design plan reviewed:
Observed site.(abutting property/observation hole within 150 feet of SAS)
✓ Checkedi:w fhllocal Board of?.He'alth-explain: " Topographic and water contours inaps
Checked with local excavators,.installers-(attach documentation)
Accessed USGS database-explain:,
ra
You must describe how you established the high ground water elevation:
Usi),K Bar�nsila!ble,topoQral2hic--aiid iva`ter contours maps-the maps were showing approxintately 10 +/-toQround water at this
site.
kt'lil
t1 =.:1:?
. . .t'ull•This report has been prepared only for the septic system and components described herein. This septic system has been
insi pected andpassed as;of the.date pfinspection. This report is nota.warranty or•guarantee that the system vvill-
ftutctiori,proper(y'in the frrtur e !Therel l ave been no warranties or guarantees, either expressed, written or implied,
relatang!to the septic system the,inspection, this report arid/oa^any comporrerils of the septic systein lvhicb have not been.located and inspected: {
AsBuilt Page 1 of 1
TOWN OF BARNSTABLE
LOCATION gO Cr0 C 4( 'b(WIL SEWAGE#
VILLAGE H YAWI _ASSESSOR'S MAP&PARCEL
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) 7(18A (size) 3
NO.OF BEDROOMS 3
OWNER
PERMIT DATE: 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) [ O� Feet
FURNISHED BY L
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FEB leg
No. ....
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
TOWN OF BARNSTABLE
Appliration for MgpotiFai Works Tnntitrnrtilan Frrutit.
Application is hereby made for a Permit to Construct VW
( or. Repair ( ) an Individual Sewage Disposal
Sysjtemmaa ``
-4 .4A1 6--
.V�
- - ----------------
r` �j �J0)
... � 1.L Locaytgn A qK //+-fi.// ---- ---- ----------------•---------------Lot-No----•----•-----------------------•--------
�� /%=11 �l fT
'/ 1, A010 (Aner 'r Address
,.a ...... ... y
Installer Address
U Type of Building . • Size Lot............................Sq. feet
Dwelling—No. of Bedrooms___--_ ...................:....Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building .............. No. of persons__......................____ Showers — Cafeteria
Q' Other fixtures --- -•-----••----•-•--------------
W Design Flow.............. gallons per person per day. Total daily flow............._ lons.
W Septic Tank—Liquid capacity�� gallons Length---------------- Widt Diameter--------------- Depth _- ----__-_--
d
x
Disposal Trench—No. ............... idth----_____-_-._-_-__ Total Length...��....... Total leaching are a.. ft.
s Seepage Pit No---------------_---- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed bY......................................................................... Date.................•-•-----------•------..
aTest Pit No. I................minutes per inch Depth of Test Pit___-__-__..__.--___- Depth to ground water........................
f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
------------------------------------------------------------------------------------••••--•..............................................................
0 Description of Soil......................................................................_..------=----------------------...-------.-------...-----------------------•--••---•-•------
U
W -•••---------------------------------------------------------------------------------------------------------------- - ------•-----......................U.'? Nature 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 TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Comp}'ance has been issued by the board of health.
Signed ...... ....... t...- ` �. rr c
�� ut.SIGN;fv�,� y� IJPFF
---------------------------------------
Application Approved BY --- f --.... 0
rS-i'ALL, .-
�ie
Application Disapproved for the following r ons: (�/�y'�
HE SYF
ACCORI-d.i-U'. .. `...r tSV.
----------------------------------------------------------------....-------------....---------------...-------------------------------------------......----`......------------ --------------------------------------
Permit No. //J`�..!.(---(U---------- ---- -------- Issued ----- ----------- e
_ l e
C
No.,Y
THE COMMONWEALTH OF MASSACHUSETTS \
BOARD OF HEALTH
TOWN-OF BARNSTABLE
AMirtttt�u f x Dig nmtt1 Marks C9nntr inn ami#
Application is hereby made for a Permit to,Constructt ( or Repair,( ) an Individual Sewage Disposal
system
DLocat/' A r s or Lot No.
....... ..........o ...._ .,..� - ---cJ'- - ^_ ..... _......-•--'•---------..__.._..._......_._...................---._._.._................_..._.....
Address
a
........RUAA;... 7 _ - ...-
�"� y`Installer V Address`\
d Type of Building �'��` Size Loth.........................Sq. feet
U" Dwelling—No. of Bedrooms------- ...............Expansion Attic ( ) Garbage Grinder,( )
aOther—Type of'$uilding __._f •-_.__-..___.. No: of persons____________________________ Showers ( ) — Cafeteria ( )
Other fixtures '= .�_`_..._..: ---�--•-------:�„
W t Septic Tank—Liquid r _ Ions. Length' '), ( ➢ •--ll ' .
W Design Flow.............. .... .......•- gallons per person per day. Total daily flow_-_---_----.._ gallons.
q r v tom'.v„, = .
P q P Yo gallons. -----•--•---••-• Width Diameter--------------• Depth
Disposal Trench—No__________________ idth....................Total Length._.-_...._ Total leaching area. ft.
Seepage Pit Na____________________ Diameter._...__.__......... Depth b�el`ow inlet-_-_---•--------- Total leaching area..................sq. ft.
z.-- Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed bY--------------------------------------------------------- -. Date
aTest Pit No. I...............:minutes per inch Depth of Test Pit................i4.. Depth to groundwater........................
t Pit No. 2--_---_.__�._minutes per inch Depth of Test Pit.................... Depth to.ground water........................
"
Is. � Test .....................................................t........•--•.._.......-•----------------........-................................................
' Qw' Description of Soil -..--•••---•--•---•-•...... ! .....------•-••-------=-------•--•--•-•-•----••••----------......•-----••---••----•-•--•---•--•----------
xti t...-•-_---•....•-••••-•••--•---••----•----------------••-----••......-- ...............
. ----------------
----------------------------------------------------------------------------------------------------------
x ----------------
.0 Nature of Repairs or Alterations—Answer when applicable._.____ .rv.. ��----_---•--_{.
[�
----------------••------._...----------..------------......----------------------•-••----•-••••-•----..----- ;r
Agreement: -- y U
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 . --------------------------------- ---
Application -
l/
i Approved B �---- f _f. t--
Application Disapproved for the following r fons -----_--_ i
t:
-------=-------------------------------
/ Da e
Permit No. -_---.. /�. Issued .-
�.--................... .................---........ + ......................Dpe ----�� i
s d
` THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
C�ex#t�tctt#e"�£ C�um�Xtaxnre ` / '
THIS IS /�CERTIFY, That the I dividual Sewage Disposal System constructed ( �( ) or Repaired ( )
�� Inst er �� )
has been installed in accordance with the provisions of TILE 5�,f The State Environmental Cod/adesc ibed n
the a lication-for Dis osal Works Construction Permit No. .... - .. .. �2..- dated .../'PP P ....... +�THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTR=fDAS A GUARANTHA��HE
SYSTEM WILL F NCTION SATISFACTORY.
DATE4 ... Inspector .. /1i1 � ....................................` ` ; V
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE -
No.....�.o_......y....... FEE......................
Disposal nxko Tnnstrnr#ion "pami#
Permission hereby granted............... .mil/"- —c .........................................................
to Constru p t ( i) or Repair ( ) an ndrvidual S.�cra �,Disposal S`y tem
at No.....-• ..... ,� �r� �a � �.•.. ! / !_,./.�. ...---•---- ......
.....• ••••
as shown on the application for Disposal Works Construction Permit No..,.7J ' � ated. �. r..... ....
v— r. ..
rr J Board o ealt]�
DATE....I---� �d ._........•----•...........................•--.--.... t � {
FORM 38E08 HOBBS&WARREN.INC..PUBLISHERS
t
y�fTHE T TOWN OF BARNSTABLE
OFFICE OF
= as$ &MAB& BOARD OF HEALTH
M0.
039.
0U 367 MAIN STREET
� P'�k'
HYANNIS, MASS. o26oi
Stephen S . and Rita Kapish August 24, 1987
251 Doyle Road
Holden, Ma . 01520
NOTICE TO ABATE A PUBLIC HEALTH NUMANCE
The property owned by you at 8080 Cro,^ker Street, Hyannis .
Ia. was inspected on August 21 , 1987 , by Dale L . Saad,
Coastal Health Resources Coordinator for the Town of
Barnstable, because of a complaint . The following
violations of 310 CMR 15 . 00 , the State Environmental Code,
Title 5, were observed:
REGULATION 15 02
( 11 ) Discharge to Watercourses : Sanitary sewage flowing
from back of house down the northwest corner of the lot
into wetlands .
( 14) T-rne of System: System does not discharge it's
effluent to a suitable subsurface sewage disposal area.
( 19) Maintenance : Owner has not kept disposal system in
proper operational condition.
You are hereby notified to have the cesspool pumped after
receipt of this notice as many times as necessary to
prevent contamination until permanent repairs are made .
You are directed to upgrade your on-site sewage disposal
system to conform to Title 5 , of the State Environmental
Code and the Town of Barnstable Health Regulations , within
five (5) days of receipt of this order.
If no action is taken in this matter: the Board of Health
will consider condemnation of the dwelling.
You may request a hearing before the Board of Health if
written petition requesting same is received within seven
(7) days after the date order is served .
Non-compliance could result in a fine up to $500 . 00 . Each
days failure to comply with an order w—i � " ' shall
constitute a separate violation.
PER ORDER OF THE BOARD OF HEALTH
jirhn M. Kellyector of Public Health
r
ll +4
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
1 NOTICE TO ABATE A NUISANCE
a� 19� left w/ o
t . Kof�iS
$
.. owner Q • Cr"O Ce C' 'S" - )�n i
., As occupant of G G
you are hereby notified to remedy the conditions named below4ithin
24 hours of the service of this notice,..according to Massachusetts
General Laws,Chapter III,Section 123: C) f. illy sictilo&5. 31� /22
ahO\, t�Q„ �O win: 04- oar v`ec F w lam. (A'i:S a-3n,e le,
'
C hAtrl
1 t2e vc�
t
�- r •
c� w act o
k
�lA►tio� vc t>o w r.�ce�-s e�C I•e co w.r.•.o►.t�rcal� ,
t 1 o W j rvi S� p S _. I'I a S e . .�a h t tAr� bdQ
If at the expiration of time allowed these conditions have not been
f .remedied, such further action will be taken as the law requires and a
4' 'fine of$29A per day may be charged. '
2 By Order of the Board of Health
• 1. - .. t A{;.•:-` t
f:
' FORM S600 A.M.SULKIN,INC REVISED 1979
1 � a
1510
7i 6 U'
s----
WS'
so•Gi9It D �^'o`D
�--' EL.
Poe G / . 6G
TOP OF FOUNDATION
�
�v s NbKAUS • o� ` � D CONCRE;c COVERS
Sr Z•�9 •�; 2 MAX
n
sa�eY dO �, PVC
. PIPE MIN.
I/4"?ER.,=T.OR SCHEDULE 40 a"SCHEDULE 40 PV.C. (ONLY)
i I2"MIN
, P .
PIPE- MIN. I LEACHING TRENCH (... ..REQUIRED)
0 PITCH I/4"PER.FT. t R.U.o3
I/9"- 1/2IWASHEDA STONE Z"
o''• INVERT N Z� WAS STONE
INVERT
EL... SEPTIC INVERT ic.
SEPTIC TANK DIST 3/4"- 11/2"
` r ,•° INV ERT BOX
w /oQo. . . ... . INVERT
gCFgN 'e; ' GAL INVERT INVERT
�.� N ��
NyA "t4l S Nq�o� EL.�4:...:.
7 .qc' Jo ., ---��
3z
PRIOR LE OF I
\ 1 • °' I' I GROUND WATER
\ \\ A SEWAGE DISPOSAL SYSTEM TYPICAL CROSS SECTION
SOIL LOG
DATE ��` . �:� TIME . NO SCALE' LEACH No G�LETRENCH
/- .m TEST HOLE I TEST HOLE 2 ter. iz.o
- DESIGN DATA '.
� ELEV. .//. 7o ELEV. . . . . . . . . . . 77m7N D
- -- / WASHED
, . • '� NUMBER OF BEDROOMS I STONE
TOTAL ESTIMATED FLOW . . . zZ e' GALLONS/DAY ¢"
�� / �. /0.70 4"PERFORATti7�
/ 3OT70M LEACHING AREA . .. SOFT./TRENCH/C•PP. PLASTIC PIPS iz'
SIDE LEACHING AREA . . . . .. SO.FT./TRENCH
r Z / A GARBAGE DISPOSAL .A/� �..(50% AREA INCREASE) WASHED
STONE
TOTAL LEACHING AREA /��. . ... C '-- i S0.FT.
Z —...--
_ 1 Bor S.� 3
/ PERCOLATION RATE PER. INCH
/�.T Mr9. �z G¢7 y8" -.-w o � �
✓ .� LEACHING AREA PER PERCOLATION RAT_ rd�- SO.FT./
CON t>�0✓NQ c .�.B^J /
SA'T•rEi GROUND WATER TAKE
/. 70 _ — _ _ APPROVED . . . . . . . . . . . . . BOARD OF HEALTH
VAI
98. . ..WATER ENCOUNTERED DATE . . . . . . . . . . . .
_ r • L �j
/ /� / V AGENT OR INSPECTOR
.` WITNESSED BY .
0 BOARD OF HEALTH
Add Gl ENGINEER
PETITIONER
�/
f+E•GE k
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I
t Jo
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in.
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_ - - .� I '' �� , ( �- ►�.vG � y .elCNr o/=- WAY 8 'w,ne To .5Z`•�1 sr�e&Z-r ---*P-
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DESIGNING ENGINEER MUST SUPERVISE
INSTALLATION AND CERTIFY IN WRITING
THE SYSTEM WAS INSTALLED IN STRICZ
ACCORDANCE TO PLAN._----. ��rrs��v6 4„�rnru,G �T�P��-N „S'• go' ,e/ 7;9
I P/ j&v aAi? �t
`OL LJ s Lo T
� PL. 13.e. .3Z4 /4G. ,�8
ax�sriNG �" w�rix G.../cr C'(v/y/7��(�/D
/assT�osT/saFv.(�lr EG s f�o't1�,A��CE.i/LJtL A3aor jjG a l3�Z/5 S'Q3. /�T-
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.gam e,q cF 1NE7- l,4.,�Z. PGS V. T 1'
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. 26100 c DESIGNING ENGINEER MUST UPERVI': E
INSTALLATION AND CERTIFY IN WRITIr:a.
9 �o � / SANITAR��� ��7r—� _ �ZE F/�97'lv.�. THE SYSTEM WAS INSTALLED IN STRICT,
f61STER @ Yam./ `-�
C A&o195ty o.v j
i'�•�pces't•r� c�-�/e ACCORDANCE TO PLAN.
-X/ S rr."/'4Ir. 6r&A- /F Z- DID/11/E -5A*m>e-D
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