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Home My WebLink About0039 DELTA STREET - Health 39 DELTA STREET Hyannis A= 292 -213 i C7 No. Fee _ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 4plitation for MispoBal *pstem Construction permit Application for a Permit to Construct( ) Repair Pei Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.39 DXIrA ST. i YPrYIn IS Owner's Name,Address,and Tel.No. LOIS E . CALpv.AtA1 Assessor's Map/Parcel 29 2. 12,13 39 bE L i a1 ST. 1A yA-r1rIIS , MAt Installer's Name Address,and Tel No. .5 ^�l 11 ^$bb Tl Designer's Name,Address,and Tel.No. CApe—%DR- p;lrc1 7 Ro&a_r is• 430R 053 ST• IMf}SIAPt?- MA- . 02GYQ T� Type of Building: Dwelling No.of Bedrooms l 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 AT 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) R tp�Ace YV\(N IA [ly►.c {,ww. 'j 0 IMAiA eesS pool CZtPLikCf- Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health-. Sicmed V, Date _ 'A01C, Application Approved by Date Application Disapproved by Date for the following reasons Permit No. d Date Issued l No. Fee THE'COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2pplication for 30ispoBaY 6pstem Construction Permit Application for a Permit to Construct( ) Repair()<5 Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.?,9 UZLtil 51 14 VA Yr r)I: Owner's Name,Address,and Tel.No. LoiS E . CiALI�wi;.tl Assessor's Map/Parcel Z 9 Z 2 13 D C l i A !,ST. 14 y t n n 15 , M A . 02 o f Installer's Name,Address,and Tel.No.5 d 11 Designer's Name,Address,and Tel.No. CPPCwiDt_ EvnT'erFr15Cf / Acre2T (3 . 0 J R 15 � ri✓ e �� 1 S� • ►u+�sliP{e n�11- . Oz6Y? N '�} Type of Building: f y., Dwelling No.of Bedrooms eV 7 Lot Size sq.ft. Garbage Grinder( ) Other_ Type of Building l No.of Persons Shower( ) Cafeteria( ) Other Fixtures 9 Design Flow(min.required) 4Z gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title ,I Size of Septic Tank Type of S.A.S. Description of Soil x� l Nature of Repairs or Alterations Answer when applicable) P ( Pp ) �R D�fa r r �A y C S i ISe "1:0 vAAI'A CeSS Pco1 RC?LA(t t4t0 Date last inspected: Agreement: NThe 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 systemin operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date — 01 Application Approved by (I ) Date 2 r Application Disapproved by Date for the following reasons Permit No. o 107 G -71 Date Issued 9 � t -------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Comptiance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired V,) Upgraded( ) Abandoned( )by Olal Ee-,o1 i)e C�Tt�('i�RrVS R08e,2r' 6. puk I at T)�IrTA 5 T • �y 6 hh I S NA • 0 21<01 has been constructed in accordance _ i with the provisions of Title 5 and the for Disposal +System Construction Permit No. dated Installer ('lq i'l i EN i ur pin,te< t a L f' . 6 U R Designer #bedrooms 4Z le4— Approved design flow /^V # gpd The issuance of this permit shall not be construed as a guarantee that the system w'`1 fimc o a designed. Date ez&t3 h Inspector ------------------p--�------------------------------------------------------------------------------------------------------------- ------ No. �y ( � V Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair(X Upgrade( ) Abandon( ) System located at. I� �Tik SiRr I-!`j�hhls IMF D��ot 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. Date — ( '/ Approved by v r Commonwealth of Massachusetts 02 ai3 Title 5 Official Inspection Form M o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 39 Delta Street Ii Property Address "qq' Elaine Eaton Owner Owner's Name G" information is Hyannis MA 02601 2-4-19 r. required for every H y page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. `\`pu�uttOF wru/��i Important:When p A. Inspector Information 6 4 I8S�I filling out forms P 9 02; yG on the computer, James D.Sears _ JAM M E S :m use only the tab — key to move your Name of Inspectorco z cursor-do not Capewide Enterprises use the return =c key. Company Name '-i�� F R. .... 153 Commercial Street '��iisf iNSIPa��``` Company Address Mashpee MA 02649 City/Town State Zip Code 508-477-8877 S 1623 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 2-15-19 spector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form . Subsurface Sewage Disposal System Form Not for Voluntary Assessments 39 Delta Street Property Address Elaine Eaton Owner Owner's Name information is required for every Hyannis MA 02601 2-4-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The system is a main pool - D Box and two over flows. 2) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"'yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 39 Delta Street Property Address Elaine Eaton Owner Owner's Name information is required for every Hyannis MA 02601 2-4-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Fo rm F Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 39 Delta Street Property Address Elaine Eaton Owner Owner's Name information is Hyannis required for every y MA 02601 2-4-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Fio Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 39 Delta Street Property Address Elaine Eaton Owner Owner's Name information is required for every Hyannis MA 02601 2-4-19 page. City/Town State .Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in eepapsat is less than 6" below invert or available volume is less than %day flow 4 E19ehlilv6: ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped'Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 39 Delta Street V Property Address Elaine Eaton Owner Owner's Name information is required for every Hyannis MA 02601 2-4-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CM 15.304.The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (if they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 39 Delta Street V Property Address Elaine Eaton Owner Owner's Name information is required for every Hyannis MA 02601 2-4-19 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): NA Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Description: Pipeing is 4"cast iron & PVC. New main line-2-2019. Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage 2012-11,220Gais g ( y g (gpd))' 2018-10,472Gal's Detail: Sump pump? ❑ Yes ® No Last date of occupancy: NA Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 39 Delta Street Property Address Elaine Eaton Owner Owner's Name information is required for every Hyannis MA 02601 2-4-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: 12-2018 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 39 Delta Street Property Address Elaine Eaton Owner Owner's Name information is Hyannis MA 02601 2-4-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ® Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 1992 Pit 2-2019 New main Line &D Box. Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 16" feet Material of construction: ® cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Pipeing is cast iron and PVC SCH -40 t5insp.doc•rev.7/26/2018 Title 5 Official Inspecdon Form:Subsurface Sewage Disposal System•Page 9 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form , Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 39 Delta Street Property Address Elaine Eaton Owner Owner's Name E information is Hyannis MA 02601 2-4-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank (locate on site plan ): Depth below grade: feet ee Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed b a Certificate of Compliance? attach a co of certificate ❑ Yes ❑ No 9 Y P ( PY ) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 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 How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): I I t5insp.doc•rev.7/26/2018 Title 5 Official Inspecdon Form:Subsurface Sewage Disposal System-Page 10 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 39 Delta Street u Property Address Elaine Eaton Owner Owner's Name information is required for every Hyannis MA 02601 2-4-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. 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 Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form M1110 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 39 Delta Street •LI Property Address Elaine Eaton Owner Owner's Name required for is every Hyannis required for eve MA 02601 2-4-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 16"x16"-22" below grade w/two line's out Box is new 2 2019 w/cover at 6" t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 39 Delta Street Property Address Elaine Eaton Owner Owner's Name information is required for every Hyannis MA 02601 2-4-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ® overflow cesspool number: 1 ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;u 39 Delta Street Property Address Elaine Eaton Owner Owner's Name information is required for every Hyannis MA 02601 2-4-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is an old Block C pool and Pit. One old block c.pool w/cover at 8", dry, 8' Deep. One 100 gal precast pit at 1' below grade. Dryw/clean like New wall's. Stain line at 3' off Bottom. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 39 Delta Street Property Address Elaine Eaton Owner Owner's Name information is required for every Hyannis MA 02601 2-4-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts 92 Title 5 Official Inspection Form is Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 39 Delta Street Property Address Elaine Eaton Owner Owner's Name information is required for every Hyannis MA 02601 2-4-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 s O-J--,T,� Ste" � Y SUS 30 i c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 39 Delta Street Property Address Elaine Eaton Owner Owner's Name information is Hyannis MA 02601 -4-1 required for every 2 9 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar i ❑ Shallow wells yva Estimated depth toFh ground water: 13'-8" 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: You must describe how you established the high ground water elevation: Auger T.H. 13'-8"'Dry. Bottom of pool at 8'-8" below grade. Bottom of pool at 5' above T.H. Depth. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 c Commonwealth of Massachusetts ip""011,0 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 39 Delta Street Property Address Elaine Eaton Owner Owner's Name information is required for every -Hyannis annis MA 02601 2-4-19 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6 (Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t , I ap/Tof C. �fly t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 TOWN OF BARNSTABLE LOCATION 3 /,',�_� Ta,¢„� SEWAGE # 8c/ VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. 5Z14 SEPTIC TANK CAPACITY LEACHING FACILITY:(type) /� (size) NO. OF BEDROOMS PRIVATE. WELL OR PUBLIC WATER BUILDER OR OWNER 6:�,- 0== U CALLA DATE PERMIT ISSUED: J A DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No ._} �� 1\ \ `� �� }�- � \ 9 \ � \ \� G _ y '�, / � i � � �I � � � i � ® � i� �� If �i� /�� i �_�� `i ASSESSORS MAP NO: 7 �— PARCEL NO: 30-00 APPROVED THE COMMONWEALTH OF MASSACHUSETTS /F 8arnstable Conservation Depefunm BOARD OF- HEALTH OWN OF BARNSTABLE Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal System at: 39 Delta Street Hyannis ................__.............................................................................. ......••••--..........._..........---••-•--•---•-•----••----•••-••.................---..........-- Location-Address or Lot No. ,Gerald._ Cad,c-Sad. .7....---•-••---------•---••--.._....--•---......-••--••. ...•--------------------------•••-..........._._......_ W J.P Owner Address ..Macomber Jr. Address .. Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling x-No. of Bedrooms..............._._......._.._ .. .....Expansion Attic ( ) Garbage Grinder ( ) __..___.... No. of ersons____________________________ Showers — p`�., Other—Type of Building _________________ p ( ) Cafeteria ( ) Q' 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 by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fZ4 Test Pit No. 2................minutes per inch Depth of Test Pit---:................ Depth to ground water........................ P4 ....---•----------------•------------•----------•-••--••-----------•-•---•------•---••••......------................................................... .•---- 0 Description of Soil............................................................................................=...........................---------------------------.................. W ......................Sand...&... rave 1 W UNature of Repairs or Alterations—Answer when applicable...______._................................................................................. ............................................................. 2..1lon.--lea..hin0:._ it. ... 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 Complia e has ee issued by the oard of health. Signed - -- - -- ------- 'e....% l -----��1`��92 - - ------ Date ApplicationApproved By .......... ................................................................. ............n G ..�.s ' Date Application Disapproved for the following reasons- ------------------------------ ---- - ----- -------------------------------------.................. ------------ ---------- Date PermitNo. �a... v2. ................. .. Issued ------------. ------- ......---------- --.....------. -- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE �1 App iration for Di ipmal Workii Tongtrurtinn ramit Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal System at: 39 Delta Street Hyannis ................_................................................................................ .......---......••-•--••-•••--•••-•--•--••--•...-----•--•---•••---...........-•••................_ Location-Address or Lot No. G� �` •.� iIP 1 1.... -••-•.............................................. -•._.....•--•--•------...._._...------........•--•••--•-•••-•-----•---..._.._.............._..--•- Owner Address r..................................................... --•----•-•---•---------•------•---•-•-------•--•------•-•-----........._..----•---•-•---•--------• Installer Address Type of Building Size Lot............................Sq. feet U Dwelling Y—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) a`4 Other—T e of Building __._.___.. No. of ersons____________________________ Showers YP g ---•--•--•-------- P ( ) — Cafeteria ( ) POther 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 by.......................................................................... Date........................................ 4 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Lz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------_................. .---------•------------------•••-••-•-•----•••••....-----------....----------••......-------•-•••---......................................................... 0 Description of Soil..................................................................................................................................................... •--•----------••- vSand-•&...Gravel.................................................................................................. W VNature of Repairs or Alterations—Answer when applicable_____________________________________1_...___._____._..__.._._..___._..._____________._______. ------------------------------------•-••---_1--10J_�---�-allon_-leachin ---pit 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 Cornjliace has b.20 issued by the board of health. Signed /r....% .......... - .......... ...... �1��=-2------- Date Approved BY tf............ �.,.,,,-•-, ..... =-------------------------- --------- Application Date Application Disapproved for the following rea.yns- ------------------ -- ----------------------- -------------------------------- ---------------------- ---------------------- ........................................... .................... . ............ ... .. .................... .. .... ........................................................ . .. .................................... q Date Permit No. -.........f� . .°Z. 9-/........................ Issued Date i - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE . (Tertiftirate of C�omylian.ce TxIS IS C oMtFY hat the Individual Sewage Disposal System constructed ( ) or Repaired ( XX) J t'. �Orn� � . 39 Delta Street Hyannis Installer at ............ ............. ............... ... has been installed in accordance with the provisions of TITLE 5 pof The State Environmental Code as described in the application for Disposal Works Construction Permit No. .......-{--?..-.-..� . ........-- dated ------------------------------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE----- -- ------ --- . -.. .............................. Inspector .........--- --------------------------------------------------- THE COMMONWF$ALTH OF MASSACHUSETTS mow/ BOARD OF HEALTH Q TOWN OF BARNSTABLE No... _........ FEE........................�•O� 14sposal Ifork.5 Trnnitr #unlit rrntit Permission is hereby granted......J,:P.Macomber Jr_.____................._.................................................................... to Construct ( ) or Repair (XX) an Individual Sewage Disposal System at No......3a__De�ta._S_treet H-amnis ----------------------------•------.---------------------------•--•--------------------..----------.....---•••••-----......._--•--- Street �� as shown on the application for Disposal Works Construction Permit No._:_ '._.___,____ Dated......................:................... .......................... ........................................................... Board of Health DATE------------•••••••f�• 3� : FORM 36508 HOBBS&WARREN,INC.,PUBLISHERS AsBuilt Page 1 of 1 TOWN OF BARNSTABLE LOCATIONS ��_JTa,¢,k.` SEWAGE # VILLAGE ASSESSOR'S MAP G LOT INSTALLER'S NAME 6i PHONE NO. rc�c.-I SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: G, ) J-1 DATE COMPLIANCE ISSUED; I '10'9�, / VARIANCE GRANTED: Yes No �Y '7 i i 'i q c11y=1 0 http://issgl2/intranet/propdata/prebuilt.aspx?mappar=292213&seq=1 2/l/2019