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HomeMy WebLinkAbout0009 EDGEHILL ROAD - Health �d 'ge � lRoar�' �¥� t�23�' " ;;"Y.a ° A 287 �>i �i Ap T • `� u d � I� i 0 M TOWN OF BARNSTABLE, LQ,f ATION SEWAGE# VILLAGE Q 1 S ASSESSOR'S MAP&PARCEL��� Lb-T bl Q ( INSTALLER'S NAME&PHONE NO. -P_C�F:00_�_ Up - SEPTIC TANK CAPACITY Sa a_Lfl a^ � LEACHING FACILITY.-(type) (size) NO.OF BEDROOMS OWNER >J 1 0 ri Av.,>qE4 l PERMIT DATE: �. COMPLIANCE DATE: g b-Joc o7 Lc) Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility ►J Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) [4� Feet Edge of Wetland and Leaching Facility(If any wetlands exist within p ,p 300 feet of leaching facility) (" n Feet FURNISHED BY �� 1V O b � s o r . r a-a 4, 9} �a�-o No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for Misposal 6pstrm Construction Permit Application for a Permit to Construct( :), :;Repair(,/Upgrade( ) Abandon( ) ❑Complete System Z dividual Components c. Location Address of'Loi No z 3 er's Nape,Address,and Tel.No. gaN�S4��=e AM'e�gli�N��'�y Assessors Map/Parcel _ �� t 1 N I-C, AAC4 IWtall is Name Address,and Tel.No. 6 �°� '� Designer's ame,Address,and Tel.No. K atRcNa Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) , gpd Design flow provided 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) e�J�ra i�(1��'�i�C6 L-Rajc (e)ilk W.I Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. /� l Si 6l $! Date ©F/-I) anao Application Approved by Date v Application Disapproved by Date for the following reasons Permit No. �d �o �� Date Issued 6 No. 2d 7(p Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ,/A PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftplitation for ]Bispasal 6pstem Construction Permit Application for a Permit to Construct( ) Repair(- Upgrade( ) Abandon( ) ❑Complete System [O jedMdual Components Location Address or Lot No. G 1 ( I a 1 K 9 Owner's N e,Address,and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No.56`6-4r7j-fib V) Designer's'`Name,Address,and Tel.No. Type of Building: :.4v Dwelling No.of Bedrooms !A Lot Size sq.ft. Garbage Grinder( ) l Other Type of Building No.of Persons Showers( ) Cafeteria( ) t Other Fixtuiles Design Flow(min.required) i� ,� gpd Design flow provided )J 14 gpd " Plan 'Date Number of sheets Revision Date , Title Size of Septic Tank Type of S.A.S. Description of Soil ; 4 . Y Nature of Repairs or Alterations(Answer when applicable) KR O IIA Date last inspected: Agreement: t 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 Com fiance has been issued b this Board of Health. f P Signed ��' „iL,s Date V;t,!'Zo Application Approved by Date �l (/�k o V Application Disapproved by Date for the following reasons w Permit No. ° p b Date Issued ------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS (�„¢ �L. 'BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS-IS TO CERTIFY,that theOste`S ' y { `RePaired , UP eDisPosalsstem Const cte graded ' ( ), : Abandoned( )by Ro kr-r B• ou y. (-,b- at. ; 'FA r Idn 1 3 A R CQ has been constructed in accordance ) f with the provisions of Title 5 and the for Disposal System Construction Permit No: d JO b dated Installer Designer #bedrooms, Q+1 /r Approved design flow a i1/3- gpd The issuance of this permit shall not be construed as a guarantee that the system will function asAe-signed. Date 1 N 2�1 i Inspectors` __1__V `~- No. . 2_0 20 D Fee J�7� - THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Ve-posal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair(y� Upgrade( ) Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permi. r Date tr-h yk_v Approved by d rr w No. Cf Fee G �� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes � PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYitation for Disposal *pstem Construttion Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Ci Z neq# e,Address,and Tel.No. Assessor.'s Map/Parcel 0 1 01 A,11 r, &QA01 r R I�s taller's Name Address,and Tel.No.5 tr�S 7 —��;31� Designer's Name,Address,and Tel.No. 1— �C( ercw t t-� .�' Cc-� So;.)�1�l�ne��� _o. aZ i c' terA&5 d23_ Type of Building: Dwelling No.of Bedrooms •. Lot Size DO sq.fr. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures / Design Flow(min.required) '�i' gpd Design flow provided gpd Plan Date Q a j (X0,)-0 Number of sheets Revisi Date Title Size of Septic Tank aZ O00 50.11 otj Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Cc�cr��.,��T 0t->1Le_ Pipe— Frz),✓ -, 1&) �C3JN���Lb1�1 To 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 Boar of He C, Signed Date I Application Approved by 4ftDate ' � —ao Application Disapproved by Date for the following reasons Permit No. Date Issued E, 4� y,h.''T:'r•-'a"' t�v�r-vw.ri"5 r4,1 ' �1 t � � ',"'`,:ti F��N�Y"��.;i���M"4.i`t. 'd••.�'�.'t.r''1�Yd+trri,tt,fir;e'^:,;.... . Ta'9 r � 6 IY .� No.. �'ll� Fee (` THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pplication for Misposat *pstrm Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. (^Sh. �1 Owner'Name,Address,and Tel.No. f/cD t V Sd /p10llnP-L4 5q;dtj RLO-ty 0Assessor's Map/Parcel Installer's Name,Address,and Tel.No.5 bSC, 17-•��,�1� Designer's Name,Address,and Tel.No. i.,. (�.Ct_;K �vbc -r. 1a.2 VIL C6 . Merril I z &A I-sG -al So% A1"MoA .D � • trf.r Type of Building: e - Dwelling No.of Bedrooms ry Lot Size a,® sq.ft. Garbage Grinder( )� Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date. pa 0 v Number of sheets,. RevisiolDate Title x• Size;of Septic'Tank 000 aOil Otj Type of S.A.S. Descriptioik of Soil Nature of Repairs or Alterations(Answer when applicable) CII I--I__JIMC»'T zQ(>'S j °;' f 1� fv✓v� 11� TO ,t,l S'Sl►�r '�7�fJ Ti C. �r PJ�� Date last inspected: s - _ 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 BoardKZ�Z »- Signed Date Application'Approved by / Date Application Disapproved by Date for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of QComplianc>e THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(,/) Upgraded( ) Abandoned( )by R O�Qe�-' , Ov'Z C.6 1�,j C_ at �_r)6.0 1.1 e has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit NoNQ9-.:, t,( dated Installer CXV fZ C 0 . 0 C- Designer_AA C.R(Z. , '1 FN #bedrooms Approved design flow gpd The issuance of this permit shall not Pe construed as a guarantee that the system w 4-fungi o designed. Date 3 pp Inspector ------------- No.40afi 0 t 1 i - Fee v V THE COMMONWI&MBWF MASS C USETTS PUBLIC HEALTH DIVISION-BARNSTABVMASSACHUSETTS Nsposal 6pstem Construction 3permit Permission is hereby granted to Construct( ) Repair wll Upgrade( ) Abandon( ) System located.at e Ik Rd 9-1„ r 4a c : and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date 3 1 Li o Approved by 0*1HE . Town of Barnstable Regulatory Services ^RNAS. 01' Public Health Division- i639• �0 AlEo r,,a+" Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 November 7, 2017 Mark H. Boudreau, Esquire Boudreau&Boudreau 396 North Street Hyannis, Ma 02601 Dear Attorney Boudreau: The septic system at 9 Edgehill Road, Hyannis, Map / Parcel 287-111 has passed. It is a six- 'bedroom septic and has passed the Title V Septic Inspection. If you have further questions, please feel free to contact me at 508-862-4644. Sincerely, Thomas McKean,RS, C Director QASEPTIC\9 Edgehill Road Hy Septic Passes Nov20l7.docx a87- //i Commonwealth of Massachusetts 'Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,;: M . 9 Edgehill Rd Property Address Keeler Owner information Owner's Name °w is required for H annis ort ✓ MA 02647 8/24/17 '$ every page. y p Cityrrown State Zip Code Date of Inspection +' Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. General Information S1# AWZ3 1. Inspector: Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 City/Town State Zip Code 508.272.6433 13010 Telephone Number License Number B. Certification 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 ❑ Fails ® Needs Further Evaluation by the Local Approving Authority j 8/24/17 Inspecto4etignatire Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 9 Edgehill Rd Property Address Keeler Owner information Owner's Name is required for every page. y p H annis ort MA 02647 8/24/17 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 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 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. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old'or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts 'Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 9 Edgehill Rd Property Address Keeler Owner information Owners Name is required for every page. Hyannisport MA 02647 8/24/17 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ® Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not 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 t5ins.doc-rev.6/16 Title 5 Dfficial Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 9 Edgehill Rd Property Address Keeler Owner information Owner's Name is required for every page. Hy p annis ort MA 02647 8/24/17 City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 7 bedroom house and BOH record shows 4 bedroom permit with compliance date of 12/18/91. No engineering on file to verify if system is adequate for 7 bedrooms 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 El ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded ❑ ® or clogged SAS or cesspool - El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than day flow t5ins.doc-rev.6/16 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 S Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 9 Edgehill Rd Property Address Keeler Owner information Owner's Name is required for every page. Hyannisport MA 02647 8/24/17 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® 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. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA) or a mapped-Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 9 Edgehill Rd Property Address Keeler Owner information Owner's Name is required for every page. Hy p annis ort MA 02647 8/24/17 City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): n/a Number of bedrooms(actual): 7 DESIGN flow based on 310 CMR 15.203 (for example:,110 gpd x#of bedrooms): n/a t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts 'Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w„ 9 Edgehill Rd Property Address Keeler Owner information Owner's Name is required for p every page. y H annis ort MA 02647 8/24/17 City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ® Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commerciallindustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 9 Edgehill Rd Property Address Keeler Owner information Owner's Name is required for every page. Hy p annis ort MA 02647 8/24/17 City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: No pumping per owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy " ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , 9 Edgehill Rd Property Address Keeler Owner information Owner's Name is required for every page. Hyannisport MA 02647 8/24/17 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1991 per BOH record Were sewage odors detected when arriving at the site? ❑ Yes ❑ No Building Sewer(locate on site plan): Depth below grade: 12"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: >10' feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 12"feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) H-20 2000g Septic tank If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 2000g Sludge depth: trace-1/2" t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M , ' 9 Edgehill Rd Property Address Keeler Owner information Owner's Name is required for every page. Hyannisport MA 02647 8/24/17 City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle '12 Scum thickness trace-1/2" Distance from top of scum to top of outlet tee or baffle >2" Distance from bottom of scum to bottom of outlet tee or baffle >2" How were dimensions determined? measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank appears to be structurally sound Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle a Date of last pumping: Date t5ins.doc.,rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M s. 9 Edgehill Rd Property Address Keeler Owner information Owner's Name is required for every page. Hyannisport MA 02647 8/24/17 City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping suggested every 3 years to prolong the life of the system Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts 'Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 9 Edgehill Rd Property Address Keeler Owner information Owner's Name is required for every page. Hy p annis ort MA 02647 8/24/17 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): H-10 D-box 2'T below grade was excavated and is in very good condition Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No` Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: I + ,15ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 9 Edgehill Rd Property Address Keeler Owner information Owner's Name is required for every page. Hy p annis ort MA 02647 8/24/17 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ® leaching galleries number: 4 ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Top of gallies is 3' below grade, galley depicted as"C"on pg. 15 was excavated, damp at this time, there is a stone surround, no indication of past backup Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9 Edgehill Rd Property Address Keeler Owner information Owner's Name is required for p every page. y H annis ort MA 02647 8/24/17 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Soils are compact and dry Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts _ - 'Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , ' 9 Edgehill Rd Property Address Keeler Owner information Owner's Name is required for every page. Hyannisport MA 02647 8/24/17 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately � 3s o � LA t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 9 Edgehill Rd Property Address Keeler Owner information Owner's Name is required for every page. Hyannisport MA 02647 8/24/17 Citylrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 20 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: TOPO mapping You must describe how you established the high ground water elevation: The area of the SAS is approximately 20'above sea level Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9 Edgehill Rd Property Address Keeler Owner information Owner's Name is required for every page. Hy p annis ort MA 02647 8/24/17 Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file L15,ns,.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 yl r 2a l 7 z to/ x 1 6 x.__1, 0 CA , LEACHING GALLEY H-20 18"DIA,COVER 3,5"DIA. KNOCKOUTS ®®®®® ®® ®®' y o 0 0 o 0 0 o 0 0 ®®®®® ®®®®® I CM 0 0 ®®®®® 4-1 ®®®®® I 3'-3'/2" ®®®®® ®®®®® 3"WALLS �- ®®®®® ®®®®® o 0 0 ®®®®® ®®®®® I 4'-0" —I 4'-6" END SECTION 2,5" DIA. KNOCKOUTS Ir - --------- !� ® ®® r 4" i i I 1 I ®® ®®® 4 -1 3"WALLS Fo E3 C3 El El co I I I ®® ®®®. 4'-0" h---4'-0"---J -6" MIDDLE SECTION SPECIFICATIONS • Concrete Minimum Strength: 4,000 P.S.I. Q 28 days • Steel Reinforcement: ASTM-A-615 &A-185,Grade 60 o Design Loading: AASHO- HS-20 • Weight: 2,200lbs, ��trow� Town of Barnstable Barnstable MRNMBLF, • Board of Health 16S9, 200 Main Street Hyannis MA 02601 a V 2007 Office: 508-862-4644 Paul J.Canniff,D.M.D. FAX: 508-790-6304 Junichi Sawayanagi Donald A.Guadagnoli,M.D. Alternate:Cecil Sullivan,RN,MSN October 6, 2017 RE: 9 Edgehill Road, Hyannis, MA. 02601 Mrs. Dana Delorey, According to our records we show that 9 Edgehill Rd. Hyannis, MA. 02601 were permitted to be a four bedroom in 1991. Since then., a Title five inspection report showed it to be a seven bedrooms which is not valid. In order to meet code, one of the bedrooms must be removed before the real estate transfer is processed. According to the records provided by Steve Wilson with Baxter and Nye Engineering Company, the septic system has a capacity for a maximum of six (6) bedrooms. This property, located at 9 Edgehill Road Hyannis, is authorized to have a total of six (6) bedrooms. Sincerely, Tho ksc Kea �RS., HO Agent of the Board of Health JA9 Edgehill Road.doc 1 i No..?/ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH APPROVED TOWN OF BARNSTABLE Qemstable onservation De �rtment Appfiratiuu for Disputia1 arks Tun sign .t Q� Application is hereby made for a Permit toConstruct ( ) or Repair (OC) an I vidual Sewage Di9glad System at: n �ry � d�rl'.E h'� stmll ---v� c tion-Address or Lot No. pcle ..........................•--_._ .- -- �o ner Address a ,2 c/y Go. s Installer Address � Type of Building Size Lot...........................S q. feet Dwelling—No. of Bedrooms..........1 .�_---•--_---_--_______-Expansion Attic ( ) Garbage Grinder ( ) PL4Other—T e of Building No. of persons............................ Showers — Cafeteria P4Other fixtures -----------------------------------•------......------•---------------•--------------------•---•--------------..............--------•---•--......---• d W Design Flow.............................. ............gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacityrl d—o gallons Length................ Width---------------- Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..._�........... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box 04)--" Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date------•--............................. a Test Pit No. I................minutes per inch Depth-of Test Pit-------------------- Depth to ground water........................ fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 •-•-•-----------•-------•------------•••...........-•--••--•-•-•--•-------------------••----•---------------------------------------- •----------------------- 0 Description of Soil....................................................................--••-•-----------------------•--------------------•---.....--------------------------•------------- x U •--••-••-•--•-•------•-----.....--•----••---------------•-----•-----••--•--•------•-._.......-----•--------•---------••------•---••----•--•------•-••---------------•---•.......-••-••---•-------•--••- W U (�/P�<LL---�Q .��-�-��-••�---------------------- Nature of Repairs or Alteratipjns—Answer wh applicable..-__-/---------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compl�hasissue by board alth. _Signed - ------- ---------------- ---- Date Application Approved By ----- .. - -------------- ------f,1 ......................................................... Date Application Disapproved for the following reasons- -- ----------------------------------------------------------------------------------------------------------------- ------------ ------------------------------------------------------------- ----------------- ---- -------- - --------.................................................... -- ------------------ - ---------------------------------------- Dare Permit No. �..:':L--- ..................... Issued Date No. 9/ Sd 3.. a Fim$.....�,-) - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ApplirFation for Dispaaii al Works C onotradw'. Application is hereby made for,\ Permit to Construct ( ) or Repair (.X) an In i'vidual Sewage Disposal System at: , , �- �a Z ��F � / �� �,/y�,�, ,s�or" r .............. -- - ---- .. �. •--• ....------ ----...-•-............ ._........----•---------..............--- Nf�NG or Lcaner S Address O^ Insfallen Address UType of Building ` 4 Size Lot............................Sq. feet t Dwelling—No.. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) per, Other—Type of Building ............................ No. of persons............................. Showers ( ) —Cafeteria ( ) Q' Other fixtures ......................................................... W Design Flow...........................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity U_gallons Length.........::..... Width................ Diameter__.__-__-___--_ Depth................ x Disposal Trench—No..........._.......... Width.................... Total aLength..........J-------- Total leaching area....................sq. ft. Seepage Pit No.___` ----------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (')-L)- Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water____--_--_.-____-- --. Lzt Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water................_....... �+ --------•----------r-------------------------------•---.....------------.................................................................................... 0 ' Description of Soil...............................................................................----------------------------------------••---.....-------------•--------- ------------- x Uw ----- t---------------- -r---------------_-...----............... Nature of Repairs or Alterat'ons—Answer when applicable.!1 ��2 L 7-o /�7 �� v ooa 5 T ra,,%c , - ---------------------•-----------------------------------`�---�x....//cry.. ......."°=". r �-�----------------------------------------------•--------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board Ofhealth. _ . . Signed f Dace Application Approved By -----------------Cr Date ----------------------------------------------------------------------- 1 - Application Disapproved for the following reasons- ----------------------------------------------------------------------------------------------------------------- --------- ---- ------------------------------------------------------------------------------------------------------------------------------ --------- ------------------------------------..........---------- ---------------------------------------- Date Permit No. 9! ...��---------------- ---- Issued ----------------------------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (ger#tftra e of Contlatia re THIS IS TO CERTIFY, That thIndividual o S wape-Disposal System constructed ) or Repaired ( . ) by .. -----------------------------------.................................... .....�.......--`---------------.--�---....-------:.. Cep f7 .. �I'V n...... �� / Installers r /" /� �J at ------- / L i/ �r(j� r has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No........7/......... .?a......... dated ................................................ ' THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEEJHA�THE1�( SYSTEM WILL FUNCTION SATISFACTORY. t l DATE.. " - Inspector - - ------ f t , -r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE '^ No...-/-.�.J.�� FEE13>.--•----.... Ropoottl lVarkii Tonstrudivit FarAit Permission is hereby granted......... .C c.."- S to Construct ( ) or epair (7L ) an Individual Sewage Disposal System / // k e" y%�J.vrr//57 /�02 7 - atNo.....................................................�.......:........-•------•................----.......--------------•--•--•--••----••-------------------•---••----------........-------- Street as shown on the application for Disposal Works Construction Permit No..lqq �:-'?2 3 Dated.......................................... �,---��--------------•-•-------------------------.--••--......._ I Board of Health DATE..................../..I'... ... ./---- FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS TOWN OF BARNSTABLE LOCATION L T ��' L h111/KW SEWAGE # 3 VILLAG ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO.AZ61'1(a1s r SEPTIC TANK CAPACITY a 6:)0 0&_ i9 LEACHING FACILITY:(type) q 62i611e ys (size) ff NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER pj°I3/ice� BUILDER OR OWNER //9 `/ lrF ��e2 DATE PERMIT ISSUED: 1�z DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No c� /�'1/��5io.�s �9v� .—�, �v t� c� r - ^'� O � � , �� � w Q .,� - �� � � ��