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Home My WebLink About0014 ELAINE ROAD - Health 14 ELAINE RD. HYANNIS A = 248 111 i li I' i i I i I I I I i Lead Paint Inspections by Fred Hemmila 1.6 Quaker Road, East Sandwich, MA 02537-1027 Tel� 508�888'837x8� I�r%Mass 800 28�6�8378 ,� ,y Fi��508 888�8397, k Email`lead-palm{ �fred.k�e�r�rr�i,la .com � ��IVebste�www.fredfier�mr(a.com` LETTER OF FULL INITIAL LEAD INSPECTION COMPLIANCE DATE: 4A-R, Y 1, I-AX 16- 000145 1� DL,D l�LT71 aJ /�d�-D Dear l (14 M bf)US This letter is to certify that l inspected your property located at 1 CL 1M5 Ro&W apartment no. ! / ,and relevant common areas,in the City or Town of Aj IDS for dangerous levels of lead according to 105 CMR 460.730 of the Regulations for Lead Poisoning Prevention and Control,and determined that there were no violations of the Lead Law, Massachusetts General Laws,Chapter 111, section 197. The inspection was conducted on 2�7 VN I also certify that I observed no evidence that unauthorized deleading activities may have occurred in this unit or in its associated common areas. Please be advised that Massachusetts law.requires that only certain residential surfaces be free of lead paint. Thus,this letter does not mean that your property contains no lead paint. The premises or dwelling unit and relevant common areas shall remain in compliance only as long as there continues to be no peeling,chipping,or flaking lead paint or other accessible materials and as long as coverings forming an effective barrier over such paint and materials remain in place.The law grants you a 30-day maintenance period to repair deteriorated lead paint or detached coverings over such paint,and to clean up,during which time this Letter remains valid. The initial inspection report indicates which surfaces,if any,contain a dangerous level of lead, as well as those surfaces, if any, that were covered upon initial inspection. Should you have any questions about this letter,-call the Department of Public Health at l-800-532-9571. _ rely, Ins ector 13� DPH License Number July 22, 2007 Barnstable Town Board-Health (508) 862-4644 200 Main St Hyannis, MA 02601 Attn: Katie Hi Katie, I stopped in last week to see you and complete a registration form for homes/dwellings that may be rented for some period of time. A gentleman from the Board did come by later that day, so I'm sure you have the paperwork he completed for my file. Anyway, he had also asked me to forward you a copy of my letter of full initial lead inspection compliance. I've enclosed a copy for you to add to my file. Also enclosed is our check for $90 payable to the Barnstable Board of Health. Thanks for your assistance and cooperation. It was nice to deal with someone so kind and helpful. Sincerely, Laurie & HarryMoulis of rental address: 14 Elaine Road, Hyannis, Ma Hyannis phone: 508-778-7822 Hudson phone: 978-568-1914 Town of Barnstable Regulatory Services �oFt"f r�ti Thomas F. Geiler,Director Public Health Division 9� b S `eg Thomas McKean,Director r�r►�" 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 August 1, 2007 Lorraine &Harry Moulis 17 Old Bottom Road Hudson, MA 01749 RE: 2007 Rental Registration Fees Dear Lorraine &Harry, I am writing in regards to the new rental ordinance. Please be aware that we have yet to receive the fee to register the rental property owned by you located at 14 Elaine Road, Hyannis. An inspection was done July 19, 2007 by Health Inspector Donald Desmarais. It was noted that there were no violations at the time of the inspection. As soon as we receive that $90 fee we can issue the Certificate of Registration. Please send payment to: Town of Barnstable Health Department 200 Main Street Hyannis, MA 02601 Please reference the address of the rental unit on the check(or on a note enclosed in the mailing). Once the payment has been received, I will input the information into our registration database, and send the certificate. Respectfully, Caitie Barrett Health Division Rental Program Coordinator #508-862-4072 TOWN OF BAP.NSTABLE LOCATION ,go-AT:) SEWAGE # L 61,AGE AILS ` ASSESSOR'S MAP & LOTOO t�f/// " INSTALLER'S NAME&PHONE NO-, RA, pJ SE tC SEPTIC TANK CAPACITY 1O®CS LEACHING FACILITY: (type) (size) x j 3 aS NO...OF BEDROOMS, . BUILDER OR OWNERl� �� PERMIT DATE: , ( 0 L - COMPLIANCE DATE: I61 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. wid ri 30)feet I .thing f -'•ty) o Feet Ftuiushed by-= �� O� vs, R fl - �� -- � _ - - �' ,s� ,�'�� ` � 6. � �►• L _ AD f) G rAM LY "'DOrdl TOWN OF BARNSTPLEY L6cATI.ON � ` - --! '�-4�'•' - -)—- . -SE W AGE VILLAGE `�/ _ ASSESSOR'S MAP &- LOT0, 61-4 INSTALLER'S NAME & PHONE NO. SEP11C TANK CAPACITY OLSe LEACHING FACILITY:(type � 59 ( ) 8w- NO. OFBEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER - DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED_ VARIANCE GRANTED- Yes No __ i �}�• =Brim 350 Main St. • W. Yarmouth, MA 02673 • 775-6264 Division of Canco Energy Corporation Septic Services • Pumping • Installation August 25, 1988 Re: Septic Evaluation - 14 Elaine Rd. , Hyannis MA To Whom I.t'-May Concern: The septic system at 14 Elaine Rd. , Hyannis MA was evaluated by A&B/Canco on August 24, 1988. The system is located at the rear of the dwelling and consists of one (1) 1 ,000 gal- lon precast septic tank connecting by 4" Orangeburg piping to a single blocked cess- pool. The system was found to be in good condition and .good working order, but does not meet the requirements of the, State Environmental Code, Title 5: Minimum Requirements for the Subsurface Disposal of Sanitary Sewage. .- because of the blocked cesspool and the Orangeburg piping. It is allowable under the current Board of Health regulations- until it fails. If you have any questions, please feel free to call me at 508-775-6264 8:3Oam to 4:3Opm, Monday through Friday. Sincerely, Robert 0; Murphy rom:rlt LA//V aw p 9 /00co �o �. CESsPaoi.. TQ Aj/L r Fee $50 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 2pplication for Migogal *pgtem Congtruction Verna Application for a Permit to Construct( )Repair(X )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. /. d Owner's Name,Address and Tel.No. 1 4ssoZlft /Irearc 2519 -11 Rd. , Hyannis Henry Werrick Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. WM. E. Robinson Septic Service Craig R Short P O Box 1089, Centerville P O Box 1044, S Dennis 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 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 Sand Nature of Repairs or Alterations(Answer when applicable) Title-5 leach s y s t Pm t o t h e plans of Craig -R Short. 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 E vironm�Ode and not to place the system in operation until a Certificate of Compliance has been issugd by this f Health )� Signed � Date Application Approved b Date �,�,1'. f Application Disapproved for the following reasons Permit Na:-" � �� Date Issued' ZK--4::Te- No. �a - - m1 Fee $5 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: J j es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,,' MASSACHUSETTS 'Application for iigpon'l *pgtem Construction Permit Applicatii,ff'or a Permit to Construct( )Repair(X )Upgrade( )Abandon( ) ❑Complete System ❑Individual.Components, 1 Location Address or Lot No. d: ® Owner's Name,Address and Tel.No. _ 14 E i' e Rd. , Hyannis Henr Werrick Assessor's Iv�'ap arcel � r / Henry Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm.. E. Robinson Septic Service Craig R Short P O Box 1089, Centerville P O' ox 1044, S Dennis Type of Building: Dwelling No.of Bedrooms / Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures - 9 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 Sand Nature of Repairs or Alterations(Answer when applicable) Title-5 leach ststem to the plans of Craig.R Short. '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 E vironmental P9de and not to place the system in operation until a Certifi- cate of Compliance has been issued by this ar A6 Health. Signed Date Application Approved b i--'� Date ' Application Disapproved for the following reasons Permit No. ._7 jr-04 ; Date Issued" �"Cs THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Werrick € ` Certificate of Compliance THIS IS TO CERTIFY that the On-site Sewage Disposal System Constructed( )Repaired ( X)Upgraded( ) Abandoned( )by Wm. j�• Robinson Septic Service at 14 Elaine Rd. , Hyannis has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction PerZt0p'/,_!6r dated Installer Wm. E. Robinson Sr. Designer The issua of this permit shall not be construed as a guarantee that th�ee--s--y t�s t ill functio as d sign-. — Date . �t �G� ( Inspect6r.� I= r r - No. Fee$50 THE COMMONWEALTH OF,MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Werrick ligozar *pztem Construction Vermit Permission is hereby granted to Construct( )Repair(X )Upgrade( )Abandon( ) System located at 14 Elaine Rd. , Hyannis 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. i Provided:Construction must be completed within three years of the date of th' -p'rmit. Date: ��' .d-a tr~ Approvedl/ .a Jul -13-01. 1.2 : 24 BARNSTABLE HEALTH OEPT 5087906304 P _.01 5/25101 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 �� `'I , concerning the property located at t•� ,E/� —,c Rom! 2 meets all of the following criteria: a� This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. W/The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or may conduct preliminary tests at the site without a health agent present. There is no increase in flow and/or change in use proposed There are no variances requested or needed. V--"-T'he bottom of the proposed leaching facility will not be located less than four-teen (14) 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) Sa B) G.W. Elevation 2 u +adjustment for high G.W. DIFFERENCE BETWEEN A and B en, vV/ e, &-,Ll— V. 2 O 4e r' ! 9*4 Gtr,mw *%.J _ vcr.�Ctr J�Q.SOttrGC. e C omm a C�►�,� �+as S. b < 4 ,a/0-0e., CP 4AS Fr.••.�•�Ce.- ,or 4., a L. SIGNED : DATE: Jye tf 3 *" '¢- 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. q:health folder:percemp s i T,e" � E'G�' ✓ �'a .ter G v a P�2 vS G S Cj v�9 a, �s,q P Ju.1 -13-01 1.2 : 24 BARNSTABLE HEALTH OEPT 5087906304 P-01 5/2510I NOTICE:- This Form Is T&Be Used For the Repair Of Failed Septic Systems Only.. PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FOPLM hereby certifythat the engineered plan signed b m b p gn y e dated. 71 i'I , concerning the property located at �¢O/c, ' n c Rat 2 c"`-tr_`"�/fie meets all of the following criteria: -we 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. The applicant may use historical data to conclude this fact or may conduct preliminary tests at the site without a health agent present. There is no increase in flow and/or change in use proposed tr There are no variances requested or needed. V----T-he bottom of the proposed leaching facility will not be located less than fourteen (14) 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) Sa B) G.W. Elevation 2 cl +-adjustment for high G.W. -"DIFFERENCE BETWEEN A and B C. vV (_�N &-/ e—V Z 4 p a r- 1 11&4 Gs, •.J _ ..arm t�.- Jae sot�rGe s e Ca►%oa Cel� o"44S. b .44.4'/,�s�� CWc.%S4"4%, F'r.».�SCC.- � Layrd elis� J SIGNED : DATE: 7J 7/d 1 oe I NOTICE Based upon the above information, a repair permit will be issued for 3 bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. y:health folder:percezmp s i T.�" (.� 6'G�' ✓ �'O .�'G v D P�2 VSG S C;7v rg�. r�Af' .'3 c .;ss,,""'a'.' .'• ^rei�n-ji- ri •� G 5�`i*r§• x X a SUN' x yC fIy a akt s �3 i: t S J. ti a TOWN OF BARNSTABLE LOCATION,.. I'q - QAI duF _P,&AT SEWAGE # VILLAGE_ A��1 S _ { " ASSESSOR'S MAP &.LOT "�// INSTALLER'S NAME.&PHONE NO. bi�tcr, SE(J�iC 17�i'g�'2L SEPTIC TANK° APtiCITY 1�00 C� LEACHING FACIL=: (type) 2 1 -(size) NO:OF,BEDROOMS 3 F t .. .. : - _.. � BUILDER'OR OWNER PERIvIITOATE '1 COMPLIANCE DATE �a .w Separation Dxstance:Between,the: Max>murn Adjusted Groundwater Tableaq the Bottom of Leaching Factaty eet'F Private Water'SupplyWell 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 I Ching f ty) Feet Furnished by J. ..: th _ i _ \ COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 14 Elaine Rd. Hyannis Owner's Name: HanrV WorrJok Owner's Address: samg Date of Inspection: Name of Inspector: (please print) William E_ • Robinson Sr. Company Name: William E. Robinson Septic Service Mailing Address: P O Box 1089 Centerville, MA Telephone Number: ( 508) 775-8776 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.1 am a DEP approved system inspector pursuant to Suction 15.340 of Title 5(310 CMR 15.000� The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: �, - Y� Date: r"3—6 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health of 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 approxing authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page I Page 2 of l l w OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 14 Blairip R r3 HyanniG Owner: WPrrirlt Date of Inspection: C-3—[37 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. Sys m 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. Co ments: B. S tem Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repair .The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answ r yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please expl The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally un ound,exhibits substantial infiltration or exfiltration or tank failure is imminent System will pass inspection if the e isting 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 dicating that the tank is less than 20 years old is available. explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or ob tructed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with ap roval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND xplain: 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 D explain: •Page 3 of 1 l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 14 Elaine Rd. Hyannis Owner: Werrick 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 fai ing 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. 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the sy tem 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 front 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 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. Other: 3 Page 4 of 11 v OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 14 Elaine Rd. Hyannis Owner: Werrick Date of Inspection: X- -a D. System Failure Criteria applicable to all systems:. must indicate"yes"or"no"to each of the following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool 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 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. 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 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. E. Large Systems: T be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gp Yo must indicate either"yes"or"no"to each of the following: (Th following criteria apply to large systems in addition to the criteria above) 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 drmldng 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 I ou have answered"yes"to any question in Section E the system is comsidered a significant threat,or answered " es"in Section D above the large system has failed.The owner or operator of any large system considered a s' nificant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 1 .304.The system owner should contact the appropriate regional office of the Department. 4 Page 5 of l 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 14 Elaine Rd. Hyannis Owner: Werrick Date of Inspection: —6 Z Check if the following have been done You must indicate"yes"or"no"as to each of the following: Yes /3Qo — — Pumping information was provided by the owner,occupant,or Board of Health V 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? 3/ Have large volumes of water been introducedto 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? t/ 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 'th/baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no/Existing Existing information.For example,a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] 5 Page 6 of 11 w OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 14 Elaine Rd. Hyannis Owner: Werrick Date of Inspection: C' FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): . DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 3`�02 Number of current residents: .1. Does residence have a garbage grinder(yes or no): !-v Is laundry on a separate sewage system(yes or no):_" [if yes separate inspection required] Laundry system inspected(yes or no)4z 0 Seasonal use:(yes or no):O/i O Water meter readings, if available(last 2 years usage(gpd)): 2 0 0 0—01 101 ,250 gal. Sump pump(yes or no): /1,J 1 9 9 9-0 0 117,750 gal. Last date of occupancy: CO MERCIAL/INDUSTRIAL Type f establishment: Design flow(based on 310 CMR 15.203): gpd Basis o design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Indus ial waste holding tank present(yes or no): Non- itary waste discharged to the Title 5 system(yes or no): Wat meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Ao;' Was system pumped as part of the inspection(yes or no): .ti e� If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: TYPE,OF SYSTEM eptic 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 ob_tained 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: ki-z.✓ 5 --V 'S 7- — :3— & Were sewage odors detected when arriving at the site(yes or no): /i., C) 6 . Page 7 of 11 1l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 14 Elaine Rd. Hyannis Owner: Werrick Date of Inspection: A/ B DING SEWER(locate on site plan) Depth below grade: Mater' is of construction:_cast iron _40 PVC_other(explain): Dista ce from private water supply well or suction line: Co ents(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: + (locate on site plan) Depth below grade: Material of construction: oncrete_metal_fiberglass polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) t v Dimensions: q L 'z Sludge depth: 0 y 1 Distance from top of sludge to bottom of outlet tee or baffle: _ Scum thickness: -0 c G ,� Distance from top of scum to top of outlet tee or baffle: p , Distance from bottom of scum to bottom of outlet tee or baffle:J� How were dimensions determined: 0 P- i �-- Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet vert,evidence of.leakage,etc.): GR SE TRAP:_(locate on site plan) Depth b low grade: Material of construction:_concrete_metal_fiberglass polyethylene_other (explain) Dimensi ns: Scum t ckness: Distan from top of scum to top of outlet tee or baffle: Distan a from bottom of scum to bottom of outlet tee or baffle: Date f last pumping: Co ents(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as r ated to outlet invert,evidence of leakage,etc.): 7 II Page 8 of l l a OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 14 Elaine Rd_ —Hyanni s Owner: Date of Inspection: 1 TI T or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Dept below grade: Mate al of construction: concrete metal fiberglass polyethylene other(explain): Dime sions: Capa ty: gallons Desi Flow: gallons/day Al present(yes or no): Al level: Alarm in working order(yes or no): Dat of last pumping: Co ents(condition of alarm and float switches,etc.): DISTRIBUTION BOX: V(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert:6 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.): PUM CHAMBER: (locate on site plan) Pump in working order(yes or no): Al in working order(yes or no): Co ents(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9ofII ,r OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 14 Elaine Rd. Hyannis Owner: Werrick Date of Inspection: K-3-t>I SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type eaching pits,number::]—,)leaching chambers,number: leaching galleries,number: 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 veget tion, etc.): i® 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 or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PR (locate on site plan) Mat rials of construction: Di nsions: De h of solids: Co ents(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): i 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 14 Elaine Rd. Hyannis Owner: Werrick Date of Inspection: ":�'�1 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. G� o v 10 Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 14 Elaine Rd. Hyannis Owner: Date of Inspection: —0 SITE EXAM Slope Surface water Check cellar Shallow wells ac, Estimated depth to ground water zP*6 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: /Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how y,o}u'established the high ground water elevation: 11 c SOIL TEST TOP OF FOUNDATION 20 FT. MINIMUM FROM CELLAR DATE OF SOIL TEST _7/17/01 SOIL TEST DONE BY 0-A1� R_�HQgT El ELEV. _ 1�•�_ _\ 10 FT. MINIMUM 10 FT. MINIMUM FROM SLAB OR CRAWL SPACE CLEAN SAND WITNESSED BY (ASSUMED) CONCRETE OBSERVATION HOLE ELEV =-_97.3_ COVERS LOAM AND SEED ' 4" SCHEDULE 40 PVC PIPE PERCOLATION RATE _ < _2 MIN./INCH AT __ 48_60"INCHES MIN. PITCH 1/8" PER FT. � 2" LAYER Of ' C��D� ' DEPTH I HORIZ TEXTURE COLOR MOTT. OTHER 1/8" TO 1/2" L.L i WASHED STONE EXISTING SPOT ELEVATION 00.0 10-6' A LOAMY SAND 10YR4/2 NO UNSUITABLE AX, ELEV. =99 MAX. EXISTING CONTOUR ----00---- UNSUITABLE �■ 4" CAST IRON PIPE LEV, 97,8 MN.(OR EQUAL) MINIMUM J FINAL SPOT ELEVATION 6-20" B LOAMY SANG 10YR5/8 NO ELEV 95.63 PITCH 1/4" PER FT z FINAL CONTOUR 0 2 SOIL TEST LOCATION 20" C MEDIUM 10YR7/6 NO FLOW LINE m UTILITY POLE -0- _132" COARSE SAND ELEV = 97.5 _ 96 TOWN WATER =W .- W ' M0. ❑ ❑ ❑ ❑ ❑ 0 ❑ ❑ ❑ L_: == 77 CATCH BASIN �® EXISTING �� _95.75_ E,0" o ° GAS LINE ELEV. = L VEL ° ° ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ o °° ° C. . V. GAS _ 6" SUMP ELEV. _ _� _ 0 0 0 CLEAN OUT ELEV. ELEV _ __95.80_ ❑ ❑ ❑ ❑ ❑ 000000 0 2' 10( CESSPOOL C.P. O BAFFLE DISTRIBUTION ° 0 ° 0 ELEV. = 0 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ LIQUDEP,IID OUTLET BOX -$5.2.1- I° ELEV. _ -93.25- -- 4 FEET 14 INCHES (TO BE PLACED ON FIRM BASE) 2 500 GALLON DRYWELLS WITH TO BE WATER TESTED STONE IN AN NO WATER ENCOUNTERED AT 1L'_ . ELEV 6 FEET 24 INCHES leAr tW GALLON s 7 FEET 29 INCHES (TO BE PLACED ON FIRM BASE) 13' X 25' X 2' TRENCH FORMATION WELL MIA 8 FEET 34 INCHES SEPTIC TANK SOIL ABSORPTION '�5 ZONE 3/4" TO t 1/2" CLEAN ul INDEX DOUBLE WASHED STONE C ADJUST DESIGN CALCULATIONS 1 G FREE OF FINES do SILT A SYS M _(SAJ NUMBER OF BEDROOMS _ 3 SEWAGE DISPOSAL SYSTEM PROFILE UWATERSGS ROBBBEE( WATER 8_) ELEV. _ _-- OBSERVED TORAL ESTAGE DiMATOEDAFLOWTTO 8E REMOVED NOT TO SC BOTTOM OF TEST HOLE ELEV = _�Q.�_ ( 110 GAL./8R./bAY X _ 3 BR.) _�Q_ GAL./DAY REQUIRED SEPTIC TANK CAPACITY _i GAL. ACTUAL SIZE OF SEPTIC TANK _1 GAL. SOIL CLASSIFICATION DESIGN PERCOLATION RATE < ',� MIN./IN. EFFLUENT LOADING RATE Q �_ GAL./DAY/S.F. LEACHING AREA _ 4 7_ SO. FT. (13X25)+(78'X2') LEACHING CAPACIT`, (AREA X RATE) GAL./DAY 477 X 0.74 RESERVE LEACHING CAPACITY _ ILA_ GAL./DAY NOTES: ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO C E.P. TITLE 5 AND THE TOWN OF _ BARN,5TA=---_ RULES AND x REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT To WITHIN 6" OF FINISHED GRADE. 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10 F'. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. 4. ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL BE MORTARED IN PLACE. 5. NO DlETERMINATION HAS BEEN MADE AS TC "OMPLIANCE WITH DEEDED OR ZONING REGULATIONS OWNER I APPLICANT IS TO OBTA'N SUCt: DETERMINATION FROM APPROPRIATE AUTHORITY. 6. UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCAVATION CONTRACTOR x X IS TO CALL "DIG-SAFE" AT 1-888-344-7233 AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE Q 7. CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. ANY VARIATION IS TO BE BROUGHT TO THE ATTENTION OF THE DESIGN ENGINEER \ SHED IMMEDIATELY. gj 8. PARCEL IS IN FLOOD ZONE ___C____ �� cb 9. LOT IS SHOWN ON ASSESSORS MAP _z48_ AS PARCEL 10. ALL UNSUITABLE MATERIAL SHALL BE REMOVED FROM UNDER AND x FOR A MINIMUN OF 5 FEET FROM AROUND THE SOIL ABSORPTION SYSTEM, + I AND BE REPLACED WITH SAND AS SPECIFIED IN 310 CMR 15.255: (3) �h r (I.E. TITLE 5) IF ENCOUNTERED BELOW S.A S. PIPE INVERT. c 11. EXISTING SEPTIC TANK& PIT TO BE PUMPED AND FILLED WITH SAND X DRIVEWAY r;'t OR REMOVED EXISTING DWELLING — s °RT APPROVED: BOARD OF HEALTH ISOClvt� No. 27483 CRAWL / Z/ �( DATE AGENT SPACE X cn — «: oT < b GARAGE S.T PROPOSED SEPTIC DESIGN O x .. � � ' HENRY �ERRICK X : . . u moo, r ---- - --_— Q PROJEC, LOCAT�a4 t� ocus EUT X A AVE. BARNSTAB C A 1E) �[A% 130 09, x /' - P x - -- :c y PROFESSIONNAL SHORT . X x -. 508- P.O. BOX 1044 CARL 0 T TA A VE � L 398-8311 SOUTH DENNIS, MASS 02660 GAP` DATE DULY 22, 2001 SCALE O 4 REVISED I JOB N0 1 _.892--- - --- EE LOCATION MAP I REVISED G SHEET 1 OF 1 I C 2001 CRAIG R. SHORT, F E