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HomeMy WebLinkAbout0110 DUNN'S POND ROAD - Health 110 Dunn's Pond Road Hyannis A.7 270. .014 „F x k o I o o I o 0 tIt r' F SHE Town of Barnstable 1p� Regulatory Services AB Thomas F. Geiler, Director 639: ••� Public Health Division AjEp�,�A Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 January 12, 2006 THIRD NOTICE Mr Leonardo Calle 110 Dunn's Pond Road Hyannis, MA 02601 NON-COMPLIANCE WITH STATE ENVIRONMENTAL CODE TITLE V. The septic system owned by you located at 110 Dunn's Pond Road,Hyannis, MA,was inspected on, September 23rd 2005 2005. By Patrick T. Sullivan, a certified septic inspector for the State of Massachusetts. The inspection of your septic system showed that your system had"FAILED"under guidelines of 1995 STITLE 5 (310 CMR 15.00)DUE TO THE FOLLOWING: Very large cesspool w/signs of sidewall caving. Not structurally sound 'You have 2 years from the date of the system failure to bring the system into compliance. If there are any questions about this reminder, please feel free to contact the Barnstable Health Department. BARNSTABLE HE TH DEPARTMENT Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health No. lD "� Fee J �® THE COMMONWEALTH OF MASSACHUSETTS a Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIPPYication for i�Po5al �&p5tem Con5truction Permit Application for a Permit to Construct ) Repair( ) Upgrade(Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. n Owner's Name,Address,and Tel.No. /d Assessor's Map/parcel ;_P 7 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ell 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) 3 0 gpd Design flow provided 3-3 r 5 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) 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 thisZoard of Health. Si Date ` v Application Approved by Date I Q Application Disapproved by: Date for the following reasons Permit No.Sri.(J� (p "�, ��� Date Issued No. tL 6 ���`` ��` �c � """r ., Fee 160, THE COMMONWEALTH OF MASSACHUSEuTTS�, Entered in computer: Yes , PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ppYication for �D_it,po5ar �&p!tem Con.5truffiou Ferro "Application for a Permit to Construct Repair O Upgrade(/4*'Abandon O ❑Complete System ❑Individual Components'_ Location Address or.Lot No. Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No._ Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3 3 gpd Design flow provided 3 3 y r 5 gpd Plan Date f Number of sheets Revision Date ` Title Size of Septic Tank Type of S.A.S. a. Description of Soil i Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this-Board of Health. Signe = Date 3 114t4 .. Application Approved b Date PP PP Y - Application Disapproved by: Date for the following reasons Permit No. (p O , Date Issued � ' o —� — 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 at // �ii,✓ .c.s o,�G has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. a�Q 6 3 �1 dated �a Installer f�7 `Z Designer 15 04 #bedrooms _� Approved designAow /'t gpd The issuance of this permit shall not be construed as a guarantee that the system will \nc onus designed. Date Inspector ✓ ?� ——————— /————————————————————————————————————— No. ` AQC�'l9 ^ © 9 Fee ) 00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Digont *g5tem Con5tructiou Permit Permission is hereby granted to Construct (Repair ( ) Upgrade ( ) Ab andon ( ) System located at ��y �y<v NS �Q y' ✓�� and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Constructio must be completed within three years of the da e of this pet 't. Date �J I b Approved by T owni of Barnstable Regulatory Services Thomas F.Geiler,Director BARNSl•.B$E, 176 Public Health Division RTFp °r Thomas McKean,Director 200 Fain Street,Hyannis,MA 02601 Office:.508-862-4644 Fax: 508-790-6304 Installer &Designer Certification Form Date: Designer: eC Installer: �-� �� s T QQ 'I /� Address: . �V &7x Address: C> On �� P 4 AAA/� �N' 5-?— was issued a permit to install a (da e) (installer) septic system at I d opi N S POND RD . based on a design drawn by �p (address) dated (designer) kI 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 he distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i' e. i 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. N OF f� o� DAR M. taller's Sign re) ER of o. 1140 (Designer's Signature) (Affix Designer's.Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION(. CERTIFICATE OF COMPLIANCE MU NOT BE ISSUED UNTIL BOTH THIS FORM AND AS_ BUILT-CARD ARE RECEIVED BY THE.BARNSTABLE PUBLIC HEALTH DI'VISI4N. THANK YOU. Q:Health/Septic/Designer Certification Form i CF THE?I Town of Barnstable MMM LE, * Regulatory Services 9 MASS. g �A 16.59. Thomas F. Geiler,Director rFD MA'S A Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 SECOND NOTICE November 3, 2005 Mr. Leonardo Calle 110 Dunn's Pond Road Hyannis, MA 02601 NON-COMPLIANCE WITH STATE ENVIRONMENTAL CODE TITLE V. The septic system owned by you located at 110 Dunn's Pond Road,Hyannis MA was inspected on September 23rd, 2005, by Patrick T. Sullivan, a certified septic inspector for the State of Massachusetts. The inspection of your septic system showed that your system has "FAILED"under guidelines of 1995 TITLE 5 (310 CMR 15.00) DUE TO THE FOLLOWING: Very large cesspool w/signs of sidewall caving. Not structurally sound You have 2 years from the date of the system failure to bring the system into compliance. If there are any questions about this reminder,please feel free to contact the Barnstable Health Department. BARNSTABLE H ALTH DEPARTMENT t i COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS Z DEPARTMENT OF ENVIRONMENTAL PROTECTION r �y Sys TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 110 Dunn's Pond Road, 6 Hyannis Owner's Name: Leonardo Calle > Owner's Address: C =� Date of Inspection: 7/27/2005 C,i Name of Inspector: (please print) Patrick T. Sullivan ��� i , Company Name: Ready Rooter ( Cn Mailing Address:Address: P.O. Box 371 J '� t Sandwich,MA 02563 Telephone Number: (508)888-6055 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 DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The System: Passes Conditionally Passes Needs Further Evaluation by the Local Authority _jZ--Fails Inspector'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 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 I_c,�.�. �.L"-.-7.s�ca� �A�J �`��`� •��<Q\�`�" �ifr`a�.����---�A 4Ca.I'.. ****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. Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 110 Dunn's Pond Road Hyannis Owner: Leonardo Calle Date of Inspection: 7/27/2005 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D C. System Passes: I have not found any information/which 'cates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Anriteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"ConditionalJ ss"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as proved by the Board of Health,will pass. Answer yes,no or not determined (Y,N,ND) in the for t e following statements. If"not determined"please explain. The septic tank is metal and over 20 years old* o the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltratio or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic to as approved by the Board of Health. *A metal septic tank will pass inspection if it is st cturally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup o break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, ettled 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 req ' ed pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(w' approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: r Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 110 Dunn's Pond Road Hyannis Owner: Leonardo Calle Date of Inspection: 7/27/2005 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the oard 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 det mines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner w ' h will protect public health,safety and the environment: _Cesspool or privy is within 50 fe of a surface water Cesspool or privy is within 50 eet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public W/safe er,if any)determines that the system is functioning in a manner that protects the public healtd environment: _The system has a septic tank and soil absorption system( 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 Arithin a Zone 1 of a public water supply. The system has a septic tank and SAS and the SPA'S 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 d termine distance "This system passes if the well water anal is,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indic es that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrat nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the nalysis must be attached to this form. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 110 Dunn's Pond Road Hyannis Owner: Leonardo Calle Date of Inspection: 7/27/2005 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 co� o_n_e_nt due to overloaded or clogged SAS or cesspool _Discharge or ponding of effluent to the sur ac" e of the ground or surface waters due to an overloaded or clogged SAS or cesspool _NZ Static liquid level in the distribution box above outlet invert due to and 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 _' Any portion of the SAS,cesspool or privy is below high ground water elevation. _L 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 well. -Az Any portion of a cesspool or privy is 50 feet of a private water supply well. �L 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 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 �G rj (Yes/No)The system fails. I have determined that one or more of the above 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. E. Large Systems: To be considered a large system the system must serve a f lity with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the foll ing: (The following criteria apply to large systems in additi to the criteria above) yes no k the system is within 400 feet of a surfa drinking water supply the system is within 200 feet of a tr' utary to a surface drinking water supply _the system is located in a nitrog sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water sup p well If you have answered"yes"to any q estion in Section E the system is considered a significant threat,or answered "yes" in Section D above the large ystem has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner shou contact the appropriate regional office of the Department. Page 5 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 110 Dunn's Pond Road Hyannis Owner: Leonardo Calle Date of Inspection: 7/27/2005 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No Pumping information was provided by the owner,occupant,or Board of Health Were any of the system components pumped out in the previous two weeks? Has the system received normal flows in the previous two week period ? _ Have large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined?(If they were not available note as N/A) _ Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out? i 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 than 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)} I I Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 110 Dunn's Pond Road Hyannis Owner: Leonardo Calle Date of Inspection: 7/27/2005 FLOW 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#of bedrooms):'330 �• O, Number of current residents: LA Does residence have a garbage grinder(yes or no):tack Is laundry on a separate sewage system(yes or no):Oci[if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use: (yes or no):oc.) '-� Water meter readings, if available(last 2 years usage(gpd)): Sump Pump(yes or no):,De) Last date of occupancy: C COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203) gpd Basis of design flow(seats/persons/sq ,etc.): } Grease trap present(yes or no): Industrial waste holding tank pre nt(yes or no): Non-sanitary waste discharge o the Title 5 system(yes or no):_ ! Water meter readings, if av ' able: Last date of occupancy/us OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: � aQ �®o�. ►r i Was system pumped as part of the inspection(yes or no):Ly-r If yes,volume pumped: gallons--How was quantity pumped determined? � Reason for pumping: TYPE OF SYSTEM _Septic tank,distribution box,soil absorption system 'Single cesspool _Ne 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)a.a cZ� Page 7 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 110 Dunn's Pond Road Hyannis Owner: Leonardo Calle Date of Inspection: 7/27/2005 BUILDING SEWER(locate on site plan) Depth below grade: 3 Materials of construction:_cast iron_40 PVC ether(ex lain): ©r,.,&- Distance from private water supply well or suction line: ;. ' Comments on condition ( o of joints,venting,evidence of leakage,etc.): SEPTIC TANK:_(locate on site plan) Depth below grade: Material of construction:_concrete_metal fiberglass_polyethylene —other(explain) If tank is metal list age:_ Is age confirme y a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: Sludge depth: Distance from the top o;vidence bo om of outlet tee or baffle: Scum thickness: Distance from top of sc f outlet tee or baffle: Distance from bottom obottom of outlet tee or baffle: How were dimensions : Comments(on pumpinndations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet inve of leakage,etc.): GREASE TRAP:_(locate on site plan) Depth below grade:_ Material of construction:_concrete_metal fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outl tee or baffle: Distance from bottom of scum to botto of out tee or baffle: Date of last pumping: Comments(on pumping recomme ations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,eviden a of leakage,etc.): �� I Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 110 Dunn's Pond Road Hyannis Owner: Leonardo Calle Date of Inspection: 7/27/2005 TIGHT or HOLDING TANK: (tank must b umped at time of inspection)(locate on site plan) Depth below grade: Material of construction:_concrete_m al_fiberglass_polyethylene_other(explain): Dimensions: Capacity: /gaDesign Flow: /dayAlarm present(yes or no): Alarm level: Alarmorder(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: (if present must be ened)(locate on site plan) , Depth of liquid level above outlet invert: Comments(not if box is level and distributi to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): I ii i PUMP CHAMBER: (locate on site/ Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chambemps and appurtenances,etc.): f I I it i i i 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: 110 Dunn's Pond Road Hyannis Owner: Leonardo Calle Date of Inspection: 7/27/2005 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: leaching fields,number,dimensions: -A,!!,-,"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.): n _ 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: a" Depth of scum layer: 3 Dimensions of cesspool: '7 k _ Materials of construction:_ �c�c S.L cc�.tea ri3os� �•� =3 vde•''`� Indication of groundwater inflow(yes or no): &D<n Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): � . �On 9- PRIVY: (locate on site plan) i Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs /yydraulic failure,level of ponding,condition of vegetation,etc.): f I i i • i 4 i Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 110 Dunn's Pond Road Hyannis Owner: Leonardo Calle Date of Inspection: 7/27/2005 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. i I f I Qcr 13 I( o ,a : 'iC ` t i ?D 3�( i i Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 110 Dunn's Pond Road Hyannis Owner: Leonardo Calle Date of Inspection: 7/27/2005 SITE EXAM Slope Surface water Check cellar✓- Shallow wells Estimated depth to ground water 2t��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: j/Observed site(abutting property/observation hole within 150 feet of SAS) _�,ZChecked with the local Board of Health-explain: �z- �— ,e, --3- Q Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: - � � T� K•a s c�5 c� �c5 �i 09-23-2002 07:23AM FROM JOE MARTINS TO 5087906304 P.11 Page 10 of 1 i OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 110 Dunn Pond Rd,Hyannis,MA Mancini Owner: 9/16/02 Date of Inspection: 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. w a �isTANCUS AC:: 6-0 BC =5'1.5" ' � B,D = 3q , C � l i 09-23-2002 07:24AM FROM JOE MARTINS TO 5087906304 P.12 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 110 Dumps Pond Rd,Hyannis,MA Owner- Mancini Date of Inspection: 9/16/02 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water q, P&M tip p 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) Checked with local Board of Health-explain: Checked with local excavators..installers-(attach documentation) __(,.,Accessed USGS database-explain: $ 9/)'1 �R*-A AU4.-Cph � M F44AfftL plc. You must describe how you established the high ground water elevation: 4�F/.e votbol CV- S��P' Is G 9444W A elm 3 • G rude mall,. Cess (js ) Zi 77tm = ' ' S TOTAL P.12 YOU WISH.TO OPEN A BUSINESS? For Your Information: Business certificates(cost$30.00 forj'41:years). A business'certificate ONLY REGISTERS YOUR NAME in town'(which you must do by M.G.L.-it does not give you permission to operate,:) Business Certificates are,available at the Town Clerk's Office, 1"FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) DATE, 11410E I/Old � P Fill in lease:` } ` MAN APPLICANT'S YOUR NAME BUSINESS' YOUR HOME ADDRESS: o/ j Soa'��'3�/= o- �K S 6 I man o TELEPHONE # Home Telephone Number -�`� Y- 6 i i NAME OF NEW BUSINESS �I? G 2 TYPE OF BUSINESS �'1 />�1 IS THIS A HOME OCCUPATION? YES NO ' Have you been given approval from the building division? YES NO ADDRESS OF BUSINESS MAP/PARCEL NUMBER `l 3 i When starting a new business there are several things you must do in order to be in compliance with the rules and reguladons.of the Town of. Barnstable. This form is intended to assist you in,obtaining the information you may need ,You MUST GO TO 200 Main St. -,(corner of Yarmouth Rd.&Main Street) to make sure you have the appropriate permits and licenses required to;legally operate your business in this town. i 4 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements;that pertain to this type of business. . �, a m Authorized Signature* COMMENTS: ' 4 6.. HEALTH , D OF HEAL .•,, OAR ,2. B . • This individual has been i e e it requirements that pertain to this type of busin,ss. horized Signa ure** (: COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. I • Authorized Signature** ' COMMENTS: ' Hazardous Materials Inventory Sheet Checklist i/ Date • ��Physical Street Address-Check database to ensure it exists — Working Phone Number ctwal Amounts-(ie•gas being used to fuel machines,thinner to G O clean brushes all count as hazardous materials) a for? Pb ✓ Storage Information-location of storage,how long is storag if none,note that. Disposal Information-where and who?If none,note that. Applicant Signature-understand what is listed and noted ^Staff Initial-any questions,know who to ask Policy and ✓ Vehicle WashinglRinsing? -provide a vehicle washing p Y gXplain it-note that it was given ,,"Attach the Business Certificate with your sign off and comments .-The inventory form should expl ain what the business consists of and the procedures they are doing. Notes need to be left to explain what you discussed with them. � Date: �� /� l Of� TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: _Tr, C.4/1P -Ofn tln eR BUSINESS LOCATION: l Y4jlfS INVENTORY MAILING ADDRESS: - 0. 60y- f TOTAL AMOUNT: TELEPHONE NUMBER: 6209 3 42—aD,51 6 CONTACT PERSON: S« '?r42 C/!:� &, EMERGENCY CONTACT TELEPHONE NUMBE 5-34 9SU MSDS ON SITE? 0 TYPE OF BUSINESS: o,-k 0 INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum Antifreeze (for gasoline or coolant systems) Misc. Corrosive NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways &garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda - Rustproofers Misc. Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt & roofing tar PCB's 100i I' Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) NEW USED Any other products with "poison" labels Paint & varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor&furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): Laundry soil & stain removers W (including bleach) Spot removers &cleaning fluids - (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS f Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM hereby certify that the engineered plan signed by me dated 01-Z7-106 ,concerning the property located at 1D ( V N N S PG/V Q 949A-0 meets all of the following criteria: • Two soil evaluations excavated for detailed examination(no hand augering) and two percolation tests shall be conducted. • This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] Please complete the following: A) Top of Ground Surface Elevation(using GIS information) 40 I v G B) G.W. Elevation Z 6•0+adjustment for high G.W. DIFFERENCE BETWEEN A and B SIGNED : DATE: O r NOTICE Based upon the above information,a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. gASeptic\percexemp.doc 09-23-2QO2 07:19AM FROM JOE MARTINS TO 5087906304 P.02 � I COMMONWEALTH OF MASSACHUSETI'S EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS II DEPARTMENT OF-ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: f l vv A A l S ��/)d �� Owner's Name: Name: Ph t 1 1 p M 4 Owner's Address: A fA Date of Inspection: 6?l/(p 'O Z Name of Inspector:(please print) Joseph M.Martins Company Name: Accu Sepcheck Mailing Address: 17 Northside Drive, South Dennis,MA 02660 Telephone Number: 508-385-5891 CERTIFICATION STATEMENT 1 certify that I.have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the tune of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes _Needs Further Evaluation by the Local Approving Authority Fails A WOZ Inspector's Signature: Date: � a0 402— ffAF1f"ffr- ItThe system inspector shall suiac4opfyof�tlhis 4inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments �� 9 ****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. 09-23-2002 07: 19AM FROM JOE MARTINS TO 5087906304 P.03 i Page 2 of i l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 110 Dwms Pond Rd,Hyannis,MA Mancini Owner: 9/16/02 Date of Inspection: Inspection Summary: Cbeck 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 CMR 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 replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements.if"n ined"please explain. The septic tank is metal and over 20 years old*or the septic ether metal or not)is structurally wtsound.exhibits substantial infiltration or exfiltration or tank ' cis imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as a ved by the Board of Health. `A metal septic tank will pass inspection if it is stru ly sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old' vailable. ND explain: Observation of sewage ckup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due t broken,settled or uneven distribution box.System will pass inspection if(with approval of Board of th): broken pipe(s)arc 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 pipe(s)are replaced obstruction is removed ND explain: � I 09-23-2002 07:20AM FROM JOE MARTINS TO 5087906304 P.04 I Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 110 Dun=Pond Rd,Hyannis,MA Mancini Owner: 9/16/02 Date of Inspection: 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. 0 5 &`evj 1. System will pass unless Board of health determines in accordance with 310 CMR 15.303(i)(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 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone l 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 we)1. 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and j 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. (1) Malmo LessPV�o 11S COV14,�ec�.-h ah ovPr�larJ cress oo). `rke oji-1.ef-ete has an 0Vt1fF 14Veoe7- �� , a+<bov� 'M)R ft c. MileMile)3. other: CePSs de 1 YKA hambeam b j(Mrs 1 t i wmvd MiV-& CrZ) �at n �tssPQo � ! S �� /� d ra�,�r �.0�� o► i block ce"ele cap -Aefv� 1 � sv pa, ( b� q� I Crna I dui F M W ry, 4 bc�fi w V�2��a � .S'v a✓LT3 01}� �wh�ch �;S ��a c�rttbvf" � ' 09-23-2002 07:21AM FROM JOE MARTINS TO 5087906304 P.05 Page 4 of 11 i OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWACE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 110 Dunns Pond Rd,Hyannis,MA Mancini Owner: 9/16/02 Date of Inspection: 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 ✓Discharge or ponding of e>}luent to the surface ofthe 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 '/a day flow _✓ Required pumping more than 4 times in the last year NNOTduc to clogged or obstructed pipe(s).Number ✓aftimes 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 Zane 1 of a public well. —-Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from,a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, 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 form.) (Yes/No)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_ F094NA- QVal�car,�o► E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15, gpd• You must indicate either"yes"or`no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no _ the system is within 400 feet of a surface drinking supply the system is within 200 feet of a trib to a surface drinking water supply the system is located in a ' gen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone 11 of a public supply well If you have an s"to any question in Section E the system is considered a significant threat,or answered "yes"in Secti above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 09-23-2002 07:21AM FROM JOE MARTINS TO 5007906304 P.06 Page 5 of 11 OFFICIAL INSPEC TION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: l 10 Dunns Pond Rd,Hyannis,MA Owner: Mancini Date of Inspection: 9/16/02 Check if the following have been done.You must indicate`W'or`ne'as to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant,or Board of Health Were any of the system components pumped out in the previous two weeks? Has the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or as part of this inspection? _L IA 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? L/_ 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 side and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no �E sting 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(3xb)] I � II 09-23-2002 07:22AM FROM JOE MARTINS TO 5087906304 P.07 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 110 Dorms Pond Rd,Hyannis,MA Owner: Mancini Date of Inspection: 9/16/02 FLOW CONDITIONS 3 RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual). DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Number of current residents: -2-- Does residence have a garbage grinder(yes or no):St> Is laundry on a separate sewage system(yes or no): W (if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no):,fro Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no): /V Last date of occupancy: COMMERCIALA NDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): Basis of design flow(seats/persons/sgft,etc. Grease trap present(yes or no): Industrial waste holding tan t(yes or no): Non-sanitary waste arged to the Title 5 system(yes or no): Water meter mgs,if available: Last of occupancy/use: OTIIER(describe): GENERAL ORMATION Pumping Records E(2IC/OZ ( /9 2001. & (/31 too l f gill-�Ood Source of information: Was system pumped as part of the ink ection(yes or no): S If yes,volume pumped: d gallons--How was quantify /7 pumped determined? 4 ci..► �6 Reason for pumping:_& Q,_jCj2jf 3;W$�. 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/Altemative 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): /I�� 09-23-2002 07:22AM FROM JOE MARTINS TO 5087906304 P.08 Page 7 of 11 OFFICIAL INSPECTION FORM --NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 110 Duns Pond Rd,Hyannis,MA Owner: Mancini Date of Inspection: 9/16102 BUILDING SEWER(locate on site plan) Depth below grade: l 3' Materials of construction: st iron _40 PVC_other(explain): Distance from private water supply well or suction line: 7 101 Co ents(on condition of joints,venting,evidence of leakage,etc.): SEMC TANK:_(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 iance(yes or no):^(attach a copy of ocrtificate) Dimensions: Sludge depth: Distance from top of sludge to bottom of o tee or baffle: Scum thickness: Distance from top of scum to t outlet tee or baffle: Distance from bottom of to bottom of outlet tee or baffle: How were dimensi etearmined: Comments(on ping recommendations,inlet and outlet tee or baffle condition,structwal integrity, liquid levels as relat utlet invert,evidence of leakage,etc.): GREASE TRAP:(locate on site plan) Depth below grade: Material of construction: concrete metal glass_polyethylene other (explain): Dimensions: Scum thickness: Distance from top of scum op of outlet tee or baffle: Distance from bott scum to bottom of outlet tee or baffle: Date of last pu ' g: Comm pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as relat to outlet invert,evidence of leakage,etc.): 09-23-2002 07:23AM FROM JOE MARTINS TO 5087906304 P.09 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 110 Dunns Pond Rd,Hyannis,MA Owner: Mani Date of Inspection: 9/16/02 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal glass polyethylene other(explain): Dimensions: Capacity_ ttal Design Flow: ions/day Alarm present(yes or no): Alarm level: arm in working order(yes or no): Date of last pum Comments dition of alarm and float switches,etc.): DISTRIBUTION BOX: (if present must be ed)(Iocate on site plan) Depth of liquid level abo>outletvert: Comments(note if box is ' ibution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box 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 dition of pumps and appurtenances,etc.): IBM- 09-23-2002 07:23AM FROM JOE MARTINS TO 5087906304 P.10 Page 9 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 110 Dunns Pcnd Rd,Hyannis, MA . Owner:. Mancini Date of Inspection: 9/16/02 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: J leaching fields,number,dimensions: �raRe 7D PI?- �D 7• overflow cesspool,number: I innovativelaltcmative system Ty*name of technology: Comments(note condition of soil, signs of hydraulic failure,Ievel of ponding,damp soil,condition of vegetation, etc.): T is DR pi Scl»e STL 0-le aloo4fdo *1 o.e • ri M 4) e aeoiT ®o 7% -P*ls ofr . CESSPOOLS: (cesspool must be pumped as part of inspectionxlocate on site plan) Number and configuration: IQdvnd CJ"ede �1 Depth—top of liquid to inlet invert: a�1��j�j =-8 Depth of solids layer: pool Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow or.no : 0 ���V /�r hT svNP� >��r P gt (Y ) s Comments`note condition of soil,sign of hydraulic f#ilur lev f ponding.00gdit1 n o v et tion. ci.c.`: co Al 6144760), 60W-d ap?w woop e4-4971��th�p PRIVY: (locate on site plan) Materials of construction. Dimensions: _ Sv a Depth of solids: l�S l l4 cam• J Comments condition of soil,signs of hydraulic failurc, cve o dingCo;tt on of vegetation,etc.): r � ��� ��,�:,�r /I✓ram/ �u1..l�t'/ 4 O O tD f-+ -J � G7 (D 1-' 1� l 1 T r z G t {� h oQ 4;�'',�.. r ,1�. a. ..a< �� _ tr it y. .. ,�- . .� �.;». .'�._.t s •�� � ��' �,,, a ; -� ,.. \� /�� � %- `� `� y + � ,i1 .I � )` 1 3 9 rv'-/Amu-i J- I t , �i • gl�, 7/0� o %u - D C r TOWN OF BARRNS�TJABL ad Gee, LOCATION f/� �u _� i/�, SEWAGE # I VILLAGE � ASSESSOR'S MAP & LOT,,'70 —e-fI!q INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY c5 ° ' LEACHING FACILITY:(type) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER����. BUILDER tOR OWNER I DATE DATE COMPLIANCE ISS ED: VARIANCE GRANTED: Yes No V oyd7 i y I TOWN OF BARNS"T�AfBLE 'LOCATION lld an A 'S �O%I �Ou.qt SEWAGE # VILLAGE A( amo,, ASSESSOR'S MAP & LOT 70 D1 y -�Clz5r.CAT Su L L , ✓v-� /. ) r SEPTIC TANK CAPACITY LEACHING FACILITY: (type) �� ' ` ize) NO.OF BEDROOMS OWNER Yo/Ict w C�0CL C PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: v X Maximum Adjusted Groundwater Table the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by TOWN OF BARNSTABLE �lG �"�° LOCATION SEWAGE # 2av J VILLAGE ASSESSOR'S MAP & LOTe7a ..ldlil INSTALLER'S NAME & PHONE NO. `1'/ /— 3 SGS� SEPTIC TANK CAPACITY c5 LEACHING FACILITY:(type) (size) NO. OF BEDROOMS- PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE : / DATE COMPLIANE C ISS ED: VARIANCE GRANTED: Yes No � _ � i' �. �. � � _. � � J � � � V . � �� - , � \ � . . � - _�. .,__ ' �� �, �, f,. �' � �' ,�, TOWN OF�ARNSTABLE _LOCATION ILQ SEWAGE # V%,LLAGE .5 ASSESSOR'S MAP & LOT -Vt STALLER'S NAME&PHONE NO. S CAPACITY 23=02 �•►�� ` LEACHING FACILITY: (type) Ck►"Im- t-Ax� (size) X NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 411du ® n I b ll 1! �A TOWN OFF BARNSTABLE 1 '.00ITION�f J�ey•i/s �O NCX 4�d�� SEWAGE JII.:LAGE !a dYN 1-5 ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. 13�� SEPTIC TANK CAPACITY LEACHING FACILITY: (type6-3)3 8J-0 (size),' �C NO.OF BEDROOMS WELDER OR OWNER C"— PERMITDATE: f jj o COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by { p�g i It iG _ r O No. Fee $5 0.0 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,, MASSACHUSETTS Zipprication for Migpogar *pgtem Congtruction Vermit Application for a Permit to Construct( )RepairXX)Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No.110 Dunns Pond Road Owner's Name,.Address and Tel.No. 5 0 8—7 71—3-9 9'� Hyannis Mass. (12601 Mancini Assessor's Maph;arcel 9 --01 1 1 0 Dunns Pond Road Hyannis,Mass. Installer's Name,Address,and Tel.No. 5 0 8—7 5 —3 3 3 8 Designer's Name,Address and Tel.No. 0 J.P.Macomber & Son Inc. J.P.Macomber & Son Inc. Box 66 Centerville,Mass. 02632 Box 66 Centerville,Mass.02632 Type of Building: DwellingXXX No.of Bedrooms 4— Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. 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) Replacing over'€low line from the _tmq_,44�1 This hoc; hppn viewed by the Town Of Barnstable Board Of Health. -NV, Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issuQd by this RoAd of Health. Signed Date 1 0/1 /0 2 Application Approved by Date Application Disapproved r the following reasons ,a 17) Permit No ' Date Issued No. Fee $5 0.00 � ''.• Entered in computer: « THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH IVISION -TOWN OF BARNSTABLES MASSACHUSETTS Y s Zippl.t action for �Digpooaf *pe;tem Construction i3ermit Application for a Permit to Construct( )Repairxx)Upgrade( )Abandon( ) ❑Complete System O Individual Components Location Address or Lot No.1 10 Dunns Pond Road Owner's Name,Address and Tel.No. 5 0 8—7 7114. i5 ` 'gat "� Hyannis,Mass. 02.6.01 . Phil Mancini Assessor'sMap/Pazcel ► f1 .- /")' 110 Dllinns Pond Road •Hyannis,Mass. Installer's Name,Address,and Tel.No. 5 0 8_7 5 W 3 g Designer's Name,Address and Tel No. 0 01 J.P.Macomber &! Son Inc. J.P.Macomber & Son Inc. Box 66 Centervlle,Mass.02632 Box 66 Centerville,Mass.02632 Type of Building: DwellingXXXNo.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers O Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date v Title Size of Septic Tank Type of S.A.S. Description of Soil Xw Nature of Repairs or Alterations(Answer when applicable) R P 1 m n i n cr s?y 'f12o m, line frd'm the '' --em main eP t- - i This e3 v 4-him Town Of Barnstable Board L � , _ r Date last inspected: 8 Agreement•. The undersi ned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this oatd of Health. aJ Signed +� Date 10/1 /0 2 �d Application Approved by A Date ! Application Disapproved ar the followin PP PP g reasons Permit No 'W Date Issued C�'�'" c�o,��h�^ �v� Q�y;,�,► THE COMMONWEALTH OF MASSACHUSETTS r BARNSTABLE, MASSACHUSETTS 0 v s( ire Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired KXh)Upgraded( ) Abandoned( )by J.R_Macnmbn r P. Snn Tncv,, at 110 Dunns Pond Road Hvannis,Mass. h;soconstructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No ated Installer.Td-P mAC0,t,e,- P_ oo„ rn,. Designer ;comber & SOXI Tnc_f The issuance of this ermit shall not be construed as a guarantee that the sysm' wili function as d�i ed. Date lb i 0 Inspector . v — ------- ----------- ————— . _ t.^ No. 50 � � � Fee ,00 v THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS lizpool *raem Con.5truction hermit Permission is hereby granted to Construct( )Repair( X)Upgrade( )`Abandon( ) System located at 110 Minn. Ponrl Rr,aA T4Vann3 _S,Ma&M P and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must begs 1 ted within three years of the date of this r1 Date: Aa Approved by p; i yr v ABM 4 S AssEssoRs MAP : NOTES: TEST HOLE LOGS 3 MAR PARCEL : p(� 1) THE INSTALLATION MUST BE IN SUBSTANTIAL COMPLIANCE WITH 1000 PATH i1 �jj� 1995 MASSACHUSETTS TITLE V & TOWN OF Hyannis 325 FLOOD ZONE : OIL �1�� SOIL EVALUATORj: V�PI�P,� THIS PLAN, 3 WITNESS : (\IOT R` '1'fl8L9 BOARD OF HEALTH REGULATIONS. MS e R= D DR o gORy `, o z o REFERENCE : (.CP C ����� DATE : ZOIJ 2) THE INSTALLER SHALL VERIFY THE LOCATION OF UTILITIES, r�q PERCOLATION RATE :\ c- IN SEWER INVERTS AND SEPTIC COMPONENTS PRIOR TO a Ai INSTALLATION.Barnstable w�N s " TH- 1 ►► TH-2 ,S� 3) THIS PLAN SHALL BE USED FOR SEPTIC` SYSTEM INSTALLATION r � HS q� S a crA o3� 0 D A _ -0 �� ONLY, AND SHALL NOT BE USED FOR PROPERTY LINE o !1 D 4 p � � ��� ,ko __-__- - r► '1 S LAB Icy�.3/Z 3 ''' LOAM (2 DETERMINATION. 1 o � A oy RADF o T I " � !� 41,�O7 4) ALL PIPING TO BE 4" SCHEDULE 40 @ 1/8 "/ FOOT. (UNLESS Smo SPECIFIED OTHERWISE) LOCAT I ON MAP (N , r c �OA1M 4p LOAM / 5) THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A A OF Mg moo`' ARRE tiGN� ..�-,�^ �Z-N 45.ZS GARBAGE DISPOSAL. M. `f 1 uM8 VEN R N IN ra - �Iv�~t' _ gy �, 6) SEPTIC TANKS AND DISTRIBUTION BOXES (WHEN INSTALLED) o 2 4 MUST BE PLACED ON A MECHANICALLY COMPACTED BASE OR ON C �7r ( R t, r1� q Fc �� © VM C y �l 1 �- l O"Gol I C �3.5 I A BASE OF 6"OF CRUSHED STONE. AQ�F b�; S SST a �} n ESS\ �ti gNITAR\P h 5,,'v� r ?� '(h r""J gtio s�R���° �� e�, (S(o 3� !�y 7� CX! iNG CC-55FxL6 Tb.13 - �(o No �O o0aveig _ !i.I D--PErz.. T1TL Pr.�ov. _tall Cc J,_�Er�►UM_Sq�(0 _ 8)No__P� _ .r .rso' o _ pRop. L him Xrsi SEPT I } SYSTEM DESIGN _ ---------- �vo a � �� �� No w�T w �ni l of Ra --w-- ��rt.� W Note�� FLOW ESTIMATE !d , J BEDROOMS AT i GAL/DAY/BEDROOM -J�GAL/DAY SEPTIC TANK Zi '330GAL/DAY x 2 DAYS - Ada GAL a a 23� USE ( 00GALLON SEPTIC TANK —/ /61/J v -�i3M Co SOIL ABSORPTION SYSTEM $Xp 10 of Pia , E� 4�� f.z� IN>=1t,T,etcTa2- 3oSo UNI7S w l.3 SANE o� Room �p .AIDE AREA: 22.5) �+ ��Z•1G,�2� K2 t 'BOTTOM AREA: 2rj X 12.! a X �3 0.7y = ZZL (o IT g `f .9� r o K _ 7 33C� G P.D rect cj I 1z _ I SEPTIC SYSTEM SECTION T B v- ccrve,e s tb a- 40,S �► ,r �,N (p'' o�.�n►s��ra ,-I)- .e 9 Mrnl3b�► 4'' Map wi- •te S ____ �7•�1 Z Id if 14 I� 4 � (alrStf p� Z s •0� • . . • • • • 2.� ���� D-BOX 7 S" z 4�.00 GAL 7S, (�cc�r�St 8 • . . . . . . , v // � SEPT I C TANK ' T Z .�y /`f ve/htsS) r I A b / LEflCrf�N�, Gros S SC—(-77 d,'�,dBol ..,,.... mg eL .e' Dn UZ lvlvs ,moo Ajc SITE ..AND SEWAGE PLAN 24 S'ra ot LL A tl 1 N u LOCAT 1 ON --l_I0 �()/\/A)S f o/up �r� �<< 48`' — ' 2 {- Yt1yNIS a MA— Wasltc� 71q PREPARED FOR : t"&H L'DiyST / � p A CRIL W T DARREN M. MEYER, R.S. SCALE P.O. BOX 981 DATE : 01-27-0� w EAST SANDWICH, MA 02537 W J•tp FL��, DATE HEALTH AGENT Ph: (508) 362-2922 Z - -