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HomeMy WebLinkAbout0117 DOLPHIN LANE - Health 117' Dolphin Lane Hyannis ry ---85_Lot A = _268 1 � 47 . . o e a o � oo o Certified Mail #70060810000035248349 P�°F SHE Tp�y Town of Barnstable * MRNSTAQLE, " MASS.3 . Regulatory Services Department ArEO MAl a, Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO February 12, 2007 Kaye McFadden P.O. Box 182 Provincetown, MA 02657 Dear Kaye, The.Town of Barnstable Public Health Division Office received a complaint regarding your property located at 117 Dolphin Lane, Hyannis. The complaint included allegations regarding the overcrowding of occupants and vehicles, including commercial vans. On January 29, 2007, Timothy O'Connell, Health Inspector for the Town of Barnstable knocked at the front door but nobody answered. He observed four vehicles parked on the property, three of which were unregistered. Local ordinance limits the number of vehicles allowed at residential properties, depending on number of bedrooms. Please telephone me at (508) 862 4644 to schedule a date and time for an inspection of the interior of this dwelling. Sincerely, Thomas A. McKean Director of Public Health s f J' ! TOWN OF BARNSTABLE LOCATION I9l►�►u�„ a,nG SEWAGE# VILLAGE Ei�lpntl,S -� ASSESSOR'S MAP&PARCEL ` INSTALLERS NAME&PHONB.NO.&ekAo�V, COL\, ,A�cja SEPTIC TANK CAPACITY loco�� 11 LEACHING FACILITY:(type)Z Soo Chcem Lrs (size) Y, ',�'Z NO.OF B1E`DROOMSM S , 1 OWNER ll�• _. d"!c ��.d�er+ j PERMIT DATE: tvCL/O{„ COMPLIANCE DATE: IO Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility F+ Private Water Supply Well and Leaching Facility(If any wells exist j on site or within 200.feet.of leaching facility) F, Edge of Wetland and Leaching Facility(I£any wetlands exist within 300 feet of leaching facility) - B FURNISHED BYn�..� c �. erina t`I Z �3-3►2 t� - � 30 2 e O i I I F k a ' b xe f ' • s ,y b Ids � w s. ,. r a (I t, v i to l .•�. - -.: .e 3 i} *.. �i. � ,.,eta.. - I �� w • f f ■�y b x 4 } v ' r gj ot S� Y � Y .� �� �� 4 f p35 �b • Cy t 9QM51! F e �a r3 � i dA �•, :rw _� I 3 .,i,} 4 � *aS�'� ° jp � � �4 � i e -�7y Ar� ,i• ��, , : r r 3DAJ i " - � Tf 4 r ti. ° 3 ��I r t k I xr ; a e 4� T 's F J � c .wi. Lz 41 i 014 ' '�•� - '4 R> �' ^ cowl,r t ; -, � 1 a Y i r f f { f. K 7 ' 6 1 ry V f: 1 - � g i r _ �'� l Ajia . .... m.- �� +r •.+►•� III .m..aMa�„h$ -"i. m 4•-:M .. P '.i , +to°:.y;.. '4" " -y M: tw. r r�f s, I b ! t � f q t1e 'y k1. 4 r I' Fr. R •� 1 r . r P E t r � � 1 r i 1 1 'A, ny716 0CAT10 - AF-Irs SEWo,C;E PERMIT k10. 2 W5TALLER 5 W IA e, ADDRESS _ --BUILDER-5- IL __ _Dt.,7E P-ER►-A1T _ISSUED_ z�D AT.E COMPLI Q,MCE ISSUED `z� . . , , .-� r r �� � �� `' � ,�o v .. .L �`' .. 1 r No. --...- F��....1.................... THE COMMONWEALTH OF MASSACHUSETTS 1� b/ofJ, BOARD OF HEALTH � l Y _.oF............... � ,. 11-7 Appliratinn -for Uiq aiittl Vork,6 Tomitrur$ion rrutit t^ET�1 cation is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal (� PP Y ( ) P ( ) a P System at: Lo es catis or,�gt No. ..... ----- ------ -9... _ Address W 7 Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling No. of Bedrooms______ ---------------------------------Expansion Attic ( ) Garbage Grinder (K) Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) A.' Other fi�ures ----------------•------------- Design Flow.................... W ....................gallons per person per day. Total daily flow..... ©..........................gallons. WSeptic "Tank/Liquid capacity/,W __gallons Length--------------_ Width................ Diameter_-.---_-_._-_ Depth._ --.--__...... x Disposal Trench—No-____________________ Width....................Total h_�. ....._.----•--_. Total leaching area.__._._.____..._____sq. ft. Seepage Pit No........./......... Diameter/0P(?cr�lr_ I) �p/ oifv"ii4tle4~'`�� . Total leaching area-------.__---__..sq. ft. z Other Distribution box (_ ) Dosing tan ( ) �. r ✓ � f— 7 �� W Percolation Test Results Performed by._. .�______A _------_____ _ _________________________ Date----. W Test Pit No. 1................minutes per inch v Depth of "lest P ---------------- Depth to ground water.._.----------------__.. r3:4 Test Pit No. 2................minutes per inch Depth of 'Test Pit-------------------- Depth to ground water-..--._--_-_--.-----. - �' -------------- 1._.. ---------------- - / Description of Soil-.------- - ------ •-------- x 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 Article \I of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued by t e boa f he h. Signe - ----------------------- _Date Application Approved BY---------- --------------- ---. ... . ---•-- ------- --------------------- •--- -- 'SC1 ------</-- Date Application Disapproved for the following reasons--------------------------- ---_---------------• ---•-----------------•--------•-------------------------••--- ---------------------••--•---------•--------••--...-•------------•.....---------------•-••-•-------_ ------------------------------------ Date r Permit No......................................................... Issued........................................................ Date ft No.......................... ._ THE COMMONWEALTH OF MASSACHUSETTS 5 BOARD' OF HEALTH . _ ... _'.-41- ------ OF...............16,01 C.44.001, c................................................ Appfiration -for M,�ipuiiFal Workii Tonstrur#tnn Vrrmft Application is hereby made for a Permit to Construct ( V) or Repair ( ) an Individual Sewage Disposal System at: Y t D , ;Le!S! ' Az_�k L cat o -Address L t No. o. Address r W -------••------------------------•----•----••-- t Installer E" " A ess dType of Building 40 Size Lot-----------------------------Sq. feet U Dwellin ___-Ex ansion Attic Garbage Grinder.-, g No. of Bedrooms P," ( )'' g . ( ) Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) P I Other fi_ ures ----- ---------- ----- ------ -------- -•-•-•_._.-- d W Design Flow__ _________________0____________________gallons per person per day. Total daily flow.._.. .Q....._._.._._.__........__gallons. WSeptic Tank T Liquid capacity/0,0_0_gallons Length................ Width................ Diameter.................Depth.--__..__..._. x Disposal Trench—No-____________________ Width_____--_____-_-___�Tottll ' I _. � .. Total leaching area--------------------sq. ft. 3 Seepage Pit No........./......... Diameter�Q�> L 13€pt1Q hello v i1i--________ _. Total leaching area------------------sq. ft. Z Other Distribution box ( ) Dosing tan �+• 'R " -Z 1--7 A-t aPercolation Test Results Performed bY.__ ( ______ __________ _ �___..____._.-._..____ Date._.______..._._.._.__._____________._. Test Pit No. 1................minutes per inch Depth' of Test Pi :_.._.__._____.___ Depth to ground water-..-_--_------_,__._.... Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ r , C• ------- •-----_•---- ' D Description of Soil-------- - --- A.....-- --- -� x � --- /. { ------ W ------------------------------------------------------------------------------------------------------- ------ UNature of Repairs or Alterations—Answer when applicable------------------------------------------------------------------------------------------------ ----------------------------------------------------- ------------------------------------------- -•----..._._......------••---•------•---------------•-----------•-. Agreement: - The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued by t e boar he h. igne q ................. - -----•---------...__._....----- .. a_4e '. Application Approved BY ._._.- -- -- --• . .... .................... -- l --'--- �U'-�'7�� f Date Application Disapproved for the following reasons----------------•--••---•-- . ............................................................................ ---•-•----------------------•------•-•----•----------------------•••-------------•-•-•-•--------......--------•••--------•-... ------------------------------------------------------------------------ Date " PermitNo........................................................ Issued........................................................ i Date THE COMMONWEALTH OF MASSACHUSETTS f- BOARD OF EALTH > ....OF......... . .. .... ... .... W. rrtafirFate of Tamplianre IS PTO C TIFY, Tl�at the Individ Sew S stem constructed ) or Repaired ( ) by __ - .------ Install at (�'� r! ?- --- has been installed in accordan with tl�fe provisions of Article X of Th State Sanitary Code as described in the application for Disposal Works Construction Permit No_____________ d....----__..._. dated ..._!__ .-.s'v._- 1'._.._. THE ISSUANCE OF THIS..CERTIFICATE SHALL NOT BE CONSTRUED A GUARANTEE THAT,&THE SYSTEM WILL N TIO S ISFACTORY. DATE................ - . ........_----•-•--_.... Inspector-------t l------- --...-- THE COMMONWEALTH OF MASSACHUSETTS BOARD F"HE 'L H /... ... .......O F .... No._.. '-s /-:1_ FEE_/ Perm siory ►hereby granted_- ...... .. .. . .. ........... ............... to Cons t ( 0gr Rep S ) In ivid 1 Sew e is sa �ysterp ., ff jj ......... / ------- ------------------- --- ------------ Street _ �' as shown on the application for Disposal Works Construction Per �' `�d �.' � t ---•-------• � � / (r ---•-••-- Board4ofealth i DATE. ----------- •--••--•---i---------------• -FORM 1255 HOBBS & WAR.REN.,INC., PUBLISHERS • t 4 0 ca + Y 14X OD . 8,0r _ _ TOWN OF BARNSTABLE LOCATION ,`7 �csll��t�r► �cia�� SEWAGE# ZG06_y VILLAGE j>p4 ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. \c Cotrar� SEPTIC TANK CAPACITY 10 0 crxj LEACHING FACILITY:(type)Z'bco.*A C�q Lf 5 (size) 10-A 3Cix'Z' NO. OF BEDROOMS 3 OWNER.Lye- Mc VJJer. PERMIT DATE: �V f'G/(j( 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 LEdgeof Wetland and Leaching Facility(If any wetlands exist hin 300 feet of leaching facility) Feet ISHED BY Dom,,,,,, ��ci►nett ts�a a 4 :O ' O N CN Yy No. / Fee A THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: LZ! PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZppYicotiou for �Dizpoq;al �bpgtem Coustructton Per 't Application for a Permit to Construct( ) Repair(/pgrade( ) Abandon( ) ❑ Complete System Individual Components Location Address or Lot No. �/-7" �2_*)f40h1 h L Owner's Name,Address,aU Tel.No. Assessor'sMap/Parcel Installer's Name,Address,and Tel.No. � �iJ�I<! c—�Vf Designer's Name,Address and Tel.No./ jci/✓ CPS ry��""' �� Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 33o gpd Design flow provided gpd Plan Date SrP/ Number of sheets / Revision Date Title 4_2 a i� i/7 0040410 Lv c✓. /;/.,Q�n�3'/J��/ Size of Septic Tank 6ar GGC. Type of S.A.S. — SZ+c 6iaL Description of Soil el 021A P7 1• 3 � Nature of Repairs or Alterations(Answer when applicable) R�PG�r— L �/v15 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 B rd f Health. Signed Date Application Approved by Date P Application Disapproved by: Date for the following reasons Permit No. oU Date Issued 0 4 _ � Y3 No. _00 �' Fee 1 _� n THE-GdMMONWEALTH OF MASSAGHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01ppli.cation for � gpogal *pgtem Conztructton Permit Application for a Permit to Construct( ) Repair(0111,U'pgrade( ) Abandon( ) ❑ Complete System Individual Components Location Address or Lot No. �/7 1:141-pAIh G ti/ Owner's Name,Address,and Tel.No. ///7ygHf5'CL- hoc/ iyJ`?1-4 cl Assessor's Map/Parcel ' �/ i/ v�C�y,,, G _ -•3 Ol In /�(5-" J U�''"/.� Installer's Name,Address,and Tel.No. 11, A61 1 �-�'V�/ Designer's Name,Address and Tel.No. /�rur✓ p� "�� "" "'3 d3�•�i/l, rylV� 4�a wov/Ir o� / 5'?E Type of Building:} Dwelling No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder ( /v Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min,required) gpd Design flow provided 3 36. gpd Plan Date 1 Co Number of sheets / Revision Date Title 3' 311r &,,n 4r 1f //7 1�O�,oti�v L t. �✓. /�.,aaniSAGrf Size of Septic Tank E' X,S/lhG /, GCd Ge,U Type of S.A.S. y2- S-e c S Description of Soil -;ory •SC�f ` ?_� Nature of Repairs or Alterations(Answer when applicable) ge6al_ r L rG��CVCe, Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed �!� J'% - %'° _ Date Application Approved by r `.• 2. Date /Ada 4. Application Disapproved by!:;",- Date for the following reasons ..-._PermitN.o. .._ U ."- % �j. . �. Date Issued - _ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that/the On-site Sewage Disposal System Constructed ( ) Repaired ( -,_�Upgraded ( ) Abandoned( )by /, iy �z/��7Cj� Cc�w r r,e 40 M at //`7 �Jo�2h�U Lw �XZIAIINI �iJor-t has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 0006 - YZ dated Installer Designer #bedrooms Approved design flow 3 � gpd The issuance of this permit shall not belcoonstrue/d/as a guarantee that the system wil"� 11 fu—nction A d N ned. Date j61- !cam / t0 Inspector',__. No. Fee (p Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Wtgpogal *pgtem Cori trurtton Permit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) System located at //7 &-ZAI*0 G /yCirl�1�I,/ and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this perm1it. Date )c1 /lJb Approved by i Town of Barns table 06 - Regulatory Services Q' Thomas F. Geiler,Director Public Health Division Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: / !a Gfb Sewage Permit#v-eVf '11/36 Assessor's Map\Parcel Designer: Dint t) io C `✓�2n Installer: r I" ��tG� � gn �1 `� Address: Nq �G ►v�. J' Address: l00 • 60 x 20T Ya,-A40(A�� Pof M6 1'�dt MA On /l - 06, �r ��/ •- C J�` was issued a permit to install a (date) (installer) septic at ` se O r h I\ based on a design drawn by p y (address) a t Q dated a 2 d 61 esigner) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. DANIELA. o OJALA (Install Signature) CIVIL No.46502 F G�S Tt G� � 1 s r ^ l (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/S.eptic/Designer Certification Form 3-26-04.doc A, - �8 P TROY WILLIAMS y SEPTIC INSPECTIONS Certified by MA Department of Environmental Protection (508) 385-1300 19 Hummel Drive South Dennis, MA 02660 COMMONWEALTH OF MASSACHUSE'I-I'S EXECUTIVE: OFFICE OF ENVIRONMENTAL,AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTF,CTION TITLE 5 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Properh Address: 117 Dolphin Lane Hyannis, MA RECEIVEDO"ner's Name: Margaret Higgins Estate Owner's Address: C/o Mark Higgins 37 Butler Avenue,Maynard, MA 01754 C 112001 Date of Inspection: November 30,2001 Name of Inspector: TOWN OF STABLE P Troy M. Williams O HEALTH DEPT. Company Name: Troy Williams Septic Inspections Mailing Address: 19 Hummel Drive South Dennis,MA 02660 Telephone Number: (508)385-1300 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. 1 am a DEP appros ed system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The sv�tenv V/ Passes Conditionall% ('asses Needs Further Evaluation by the Local Approving nuthorit) Fails Inspector's Signature: / Date: 12 /s /o I —T_ The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of I lealth 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. Notes and Comments Although system meets the minimum requirements set forth by the Massachusetts Department of Environmental Protection,certification is not to be construed as a guarantee of future working condition of system,piping or components. This inspection represents the conditions of the system on the Date of Inspection noted above. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 paee I , I Page 2 of 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 117 Dolphin Lane Owner: Hyannis,MA Date of Inspection: Margaret Higgins Estate November 30,2001 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CN4R 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be r laced or repaired. The system, upon completion of the replacement or repair,as approved by the Board o ealth, will pass. Answers es. no or not determined(Y,N,ND)in the for the following statements. I 'not determined"please explain. The septic tank is metal and over 20 years old* or the septic tank(whet r metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is im nent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by th oard of Health. *A metal septic tank will pass inspection if it is structurally sound,no eaking and if a Certificate of Compliance indicatine that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or 'gh static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or une n distribution box. System will pass inspection if(with approval of Board of Health): broken ' e(s)are replaced obs tion is removed di tbution box is leveled or replaced ND explain: The system require pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with proval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of i 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 117 Dolphin Lane Owner: Hyannis,MA. Date of Inspection: Margaret Higgins Estate November 30,2001 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 1 .303(1)(b)that the system is not functioning in a manner which will protect public health,safety an 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 salt marsh 2. System will fail unless the Board of Health(and Public ater Supplier,if any)determines that the system is functioning in a manner that protects the pubb ealth,safety and environment: _ The system has a septic tank and soil absorpt' n system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface w­ er supply. _ The system has a septic tank and S and the SAS is within a Zone I of a public water supply. _ The system has a septic tank d SAS and the SAS is %%thin 50 feet of a private water supply well. _ The system has a septic ank and SAS and the SAS is less than 100 feet but 50 feet or more front a private water supply well' . Method used to determine distance "This system pass if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and vol a organic compounds indicates that the well is free from pollution from that facility and the presence ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure cr' ria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 117 Dolphin Lane Hyannis,MA Owner: Margaret Higgins Estate Date of Inspection: November 30,2001 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool 2 Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool &-4 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 ''/2 day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped Any portion of the SAS,cesspool or privy is below high ground water elevation. AL.3 Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. A Any portion of a cesspool or privy is within a Zone t of a public well. IVII 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 eater quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this forma Ny (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR d 5.303. therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a de gn flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the crite ' above) yes no the system is within 400 feet of a surface drinkin ater supply the system is within 200 feet of a tributary. a surface drinking water supply the system is located in a nitrogen s sitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply ell If you have answered"yes"to any scion in Section E the system is considered a significant threat,or answered "yes"in Section D above the lar system has failed.The owner or operator of any large system considered a significant threat under Sectio or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner ould contact the appropriate regional office of the Department. 4 I Page 5 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 117 Dolphin Lane Owner: Hyannis, MA Date of Inspection: Margaret Higgins Estate November 30,2001 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No _ t'._;:,ping information was provided by the owner. occupant, or Board of I le iltl 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? . — V1 Have large volumes of water been introduced to the system recently or as part of this inspection? _ x 9 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: Yes no Existing information. For example,a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part'C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] 5 Page 6 of l l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 117 Dolphin Lane Owner: Hyannis,MA Date of inspection: Margaret Higgins Estate November 30,2ftow CONDITIONS RESIDENTIAL Number of bedrooms(design): .3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x k of bedrooms): ,3 36 Number of current residents: 0 / P, —, ) Does residence have a garbage grinder(yes or no):�/v Is laundn on a separate sewage system (yes or no): `& [if yes separate inspection required) Laundry system inspected(yes or no): A(/,1 Seasonal use: (yes or no): AN Water meter readings,if available(last 2 yearsltsage(gpd)): 66/u� Sump pump(yes or no): Wo Last date of occupancy: !Ju,,. 7'61. COMM ERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 syste (yes or no):_ Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: � 'a, Was system pumped as pan of the inspection(yes or no): _Lilo If yes, volume pumped: gallons-- How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM // Septic tank, he*,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) Tight tank _Attach a copy of the DEP approval _Other(describe):. Approximate age of all components. date installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no): 6 Page 7 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 117 Dolphin Lane Owner: . Hyannis,MA Date of Inspection: Margaret Higgins Estate November 30,2001 BUILDING SEWER(locate on site plan) . Depth belo�� grade: 18" r Materials of construction:_cast iron Z40 PVC other(explain): /i s �, f- tea,}L V Divanrr fron, private water supply well or suction line: 'L/ Comments(on condition of joints,venting, evidence of leakage,etc.): A Iv1 �t�utiul 5�,a. ltit rA `..t ✓..tJl ( Gam.✓ ci + '1hr�, SEPTIC TANK:Z(locate on site plan) Depth below grade: ► ' Material of construction: ✓concrete_metal_fiberglass_polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: ,x ti "k 6 Sludge depth: y Distance from top of sludge to bottom of outlet tee or baffle:o2' " Scum thickness: a,' Distance from top of scum to top of outlet tee or baffle: _6 " Distance from bottom of scum to bottom of outlet tee or baffle: 2" How were dimensions determined: /f,,,,6,. Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etcc..): un ov *,I,T ,,✓ca..� �-a_.��ai.,_ . w.��Fi•�^�...__Q✓_°x=1r_..---/V 0!27' u ti �•�. w..+l ✓.w ( .�-�. ri w.ra.�a..�.c .A A& t a)t1-t U.� Gs.. !ti..:..$t J .� 4++,.�j t, .�/'^j ✓,.�f- �hya_ --�✓ )- /u°-w-f' .l h / f' �'w I w ✓• /�-� c.._.n1�t� Jt GREASE TRAP:_(locate on site plan) .;(.� �/l, ,��R.,v.c I`,� ✓+�� ...i c..� .,�v,i,.,,..f Depth below grade:_ `' s Material of construction:_concrete_metal_fiberglass holy ylene_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 o affle: Date of last pumping: Comments(on pumping recommendations,inlet d outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leaka ,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 117 Dolphin Lane Owner: Hyannis,MA Date of Inspection Margaret Higgins Estate November 30,2001 TIGHT or HOLDING TANK: . (tank must be pumped at ti /ofriction)(locate on site plan) Depth below grade: Material of construction: concrete metal fibergla _polyethylene other(explain): Dimensions: Capacity: gallons Design Flo%N: gallons/day Alarm present(yes or no): Alarm level: Alarm in working or (yes or no): Date of last pumping: Comments(condition of alarm and flo witches, etc.): DISTRIBUTION BOX:AL11 (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover, any evidence of leakage into or out of box,etc.): PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,con ' on of pumps and appurtenances,etc.): 8 f Page 9 of 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 117 Dolphin Lane Owner: Hyannis,MA Date of Inspection: Margaret Higgins Estate November 30,2001 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain wh). Type leaching pits,number: 1 - C�X C L leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: innovative/altemative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.): L«mot. Y°• r �y s �cu ,..( c.�v v �.. s � �• TL. c�, v� 5 � l t S 4�i ti .!t ►�II o-J f / ✓v .� p.-0 6 l{. .. s c. s w ti. v ,a N t CESSPOOLS: (cesspool must be pumped as part of inspection) cate on site plan) Number and configuration: _ Depth—top of liquid to inlet invert: _ Depth of solids layer: Depth of scum laver: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs o ydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydrauli ailure, level of ponding,condition of vegetation,etc.): 9 Page 10 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 117 Dolphin Lane Hyannis,MA Owner: Margaret Higgins Estate Date of Inspection: November 30,2001 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. T (A— 10 Page l l of I 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 117 Dolphin Lane Owner: Hyannis,MA Date of Inspection: Margaret Higgins Estate November 30,2001 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water d0t- feet Adjusted high ground water elevation - feet Please indicate(check)all methods used to determine the high ground �%ater elevation: _,O� btained from system design plans on record- If checked,date of design plan reviewed: ? 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: .t, ,, L 5 2 owrz S' S. You must describe how you established the high ground water elevation: ✓l C C��s.O /f-. Jam' �y 7 ' �'o u r��c.,.G✓�C..i f= U ly. 9 ta.o 007 , IL_eA Uf 11 TOWN OF BARNSTABLE . Lr'CATION j ( � �o f a1.`,�. L,,.. SEWAGE # .s;A �4 1 VitLAGE ASSESSOR'S MAP & LOT-.)-(.,4 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) 1'-"X L NO.OF BEDROOMS 3 BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist . on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) " Feet Fumished by �� j J �`!l ,. N .� � � . , cJ �Y." I i SYSTEM PROFILE NOTES y �. /y .S' 9rf C NOT TO S oo/ FTOPN. AT EL. 44.2 ACCESS COVERS TO WITHIN 6' OF FlN. GRADE S � ACCESS COVER TO WITHIN 3" OF FlN. GRADE 1. DATUM IS APPROXIMATE NGVD r. ACCESS COVER (WATERTIGHT) TO 42,0' MINIMUM .75' OF COVER OVER PRECAST WITHIN 6" OF FIN. GRADE 2. MUNICIPAL WATER IS EXISTING . 2% SLOPE REQUIRED.OVER SYSTEM 41.8' \ � " \e I ti 2 DOUBLE WASHED PEASTONE 3. MINIMUM PIPE PITCH TO BE 1/8 PER FOOT. RUN PIPE LEVEL ti t OR GEOTEXTiLE FABRIC *EXISTING FOR FIRST 2' \\o 0\a .• ••ExlsnNc 1000 � 3 MAX. 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO � L US *EXISTING GALLON SEPTIC TANK *40.50 38.8' ova GAS 38 07' 5. PIPE JOINTS TO BE MADE WATERTIGHT. BAFFLE 38.24' p p p p p p p 1J 0 38.0' p O p O p p p [:3''p 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH DEPTH OF FLOW = 4' 6" CRUSHED STONE OR MECHANICAL p p p p p p p p p TEE slzEs: COMPACTION. (15.221 [2D 2' p p p p p p p p r] MASS. ENVIRONMENTAL CODE TITLE V. „ 36.0 \ o INLET DEPTH 1Q_ _D 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO n 3/4" TO 1 1/2" DOUBLE WASHED STONE c h e B a OUTLET DEPTH 14" BE USED FOR LOT LINE STAKING OR ANY OTHER PURPOSE. a (Aa% SLOPE) ( 1 x SLOPE) 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. caP�• LEACHING 5' 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED FOUNDATION EXISTING SEPTIC TANK 47' D' BOX 9' FACILITY WITHOUT INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED FROM BOARD OF HEALTH. SCALE: 1" 2,000' f *THE INSTALLER SHALL VERIFY THE **THE INSTALLER SHALL CONFIRM MIN. ASSESSORS MAP 268 PARCEL 185 LOCATIONS OF ALL UTILITIES AND ALL SEPTIC TANK SIZE AT 1000 GALLONS AND 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING BUILDING SEWER OUTLETS AND ELEVATIONS ITS SUITABILITY FOR RE-USE DIGSAFE (1-888-344-7233) AND VERIFYING THE LOCATION LOCUS IS WITHIN GP OVERLAY DISTRICT PRIOR TO INSTALLING ANY PORTION OF BOTTOM TH-1 EL. 31.0 OF ALL UNDERGROUND & OVERHEAD UTILITIES PRIOR TO SEPTIC SYSTEM COMMENCEMENT OF WORK. LEGEND _ 11. EXISTING LEACHING FACILITY SHALL BE PUMPED AND REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. 100.0 0 PROPOSED SPOT ELEVATION 12. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE REMOVED 5' BENEATH AND AROUND THE PROPOSED+100.00 EXISTING SPOT ELEVATION LEACHING FACILITY. SYSTEM DESIGN: 100 0 PROPOSED CONTOUR GARBAGE DISPOSER IS NOT ALLOWED 100 EXISTING CONTOUR RUQQ UTIL DESIGN FLOW: 3 BEDROOMS ® 110 GPD = 330 GPD W EXISTING WATER LINE ER R�At� POLE USE A 330 GPD DESIGN FLOW G EXISTING GAS LINE SEPTIC TANK: 330 GPD (2) 660 LP EXISTING LEACH PIT **RE-USE EXISTING 1000 GAL. SEP11C TANK +42.38 � LEACHING: TEST HOLE LOGS SIDES: 2 (30 + 9.83) 2 (.74) = 118 GPD ! DAVID FLAHERTY, R.S. B w R P o I301 I OM 30 x 9.83-(.74)4) - 218 GPD ENGINEER: TOTAL: 454 S.F. 336 GPD DON DESMARAIS, R.S. I r. ��� S WITNESS. •.» 3 � SEPTEMBER 13, 2006 DATE: �; USE (2) 500 GAL. LEACHING CHAMBERS (ACME = I ,: -„ ,t: �. / OR EQUAL WITH 4' STONE AT ENDS 2.5' AT SIDES PERC. RATE < 2 MIN/INCH � AND 5' .BETWEEN .UNITS CLASS 1 SOILS P 11431 �- z �� „„:••r DIRT N /sro E MA ELEV. ELEV. ►� +42.3s DRY APPROVED DATE BOARD OF HEALTH Lu O/A/E O/A/E EXISTING 3 BR DWELLING Q LS - Ls TITLE 5 SITE PLAN TOP OF FNDN 44.2' o n 10YR 5/2 Z 10 41.2 7" 10YR 5/2 co 41.4 w < OF B B OAK T. ST B- 0 0 G G 0 LS LS O LP 117 DOLPHIN LANE 10YR 5/8 10YR 5/8 " 0 0 27„ 39.7 28" 39.7' a W (W.. HYANNISPORT) W STOCKADE FENCE CHERRY BARNSTABLE MA C C 126.2g• PERC BENCHMARK: COR CONC PREPARED FOR x CMS CMS BULKHEAD ELEV. BORTOLOTTI CONSTRUCTION/ I 2.5Y 6/4 2.5Y 6/4 KAYE McFADDEN Scale:1"= 20' off 6- - DATE: SEPTEMBER 22 2006 132" 31.0' 12, 31.5' \1H OF,Pt4 9c \pA OF qs� fox W8 362-980 ' 0 10 20 30 40 50 FEET �o? ARNE H ..tics �o`a ARNE NO GROUNDWATER ENCOUNTERED U oJALA H. down cape engineering, in c. CIVIL OJALA Cn No 3 792 No. 26348 Cl WL ENGINEERS �0 PFO 90 P e LAND SURVEYORS C 939 Main Street - YARMOUTHPORT, MASS. DCE #06-203 DATE A _ OJALA, ., .L.S. 06-203 bort-mcfadden_SP.DWG (DDF)