HomeMy WebLinkAbout0044 ERIN LANE - Health 44 Erin Lane
Hyannis
A= 291-017-004
WIN-
•'`'" Commonwealth of Massachusetts
Title 5 Official Inspection Forme
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
M s 44 ERIN LANE
Property Address
RBS CITIZENS BANK
Owner Owner's Name
information is required for every HYANNIS MA 02601 02/13/2012
� - � F
page. Cityrrown State; Zip Code Date of,Inspection` -
g
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.
Important:when A. General Information
filling out forms �'(�F'�
on the computer,
use only the tab 1. Inspector. V
key to move your e
cursor-do not LOUIS LABATE III
use the return Name of Inspector
key. Louis�aaat�m
BAY STATE SEWAGE DISPOSAL, INC.. N
Company Name
105 KINGMAN STREET ,. � F41 I �
Company Address
LAKEVILLE - MA 02347
City/Town State Zip Code
508-947-2636. . S15014
Telephone Number. License Number
a
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. 1 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 Evaluaiion by theLocal Approving Authority -
t
n 1 4 02/13/2012
nsp 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 DER 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.
u�
L,5ins-'11/10 Title 5 Official Inspection Forth:Subsurfa VeDisposal System• age 1 of 17
Commonwealth of Massachusetts '
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 44 ERIN LANE -
Property Address .
RBS CITIZENS BANK
Owner
Owner's Name
information is required for every HYANNIS MA 02601 02/13/2012
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
s 3
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes,
0 I have not found"any information which indicates that any of the failure criteria described
{IT3w1,07CMR)15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
f= mdicated,belo� ) W .
Comments lit , t
O�USE WAS VACANT AT TIME OF INSPECTION FOR APPROXIMATELY 1 MONTH AND NOT
RECEIVING ANY FLOW. RECOMMEND THAT SYSTEM BE PUMPED ONCE A YEAR.
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):
t
t5ins-11/10 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
44 ERIN LANE
Property Address
RBS CITIZENS BANK
Owner Owner's Name
information ie
required for every HYANNIS MA, 02601 02/13/2012
page. City/Town State Zip'Code Date of Inspection
y
B. Certificatidn cont.
B) System Conditionally Passes(cont.): a
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(Ex plain,below):
❑ distribution box is leveled or replaced ,,E] Y ❑. N ,F,❑ 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):
El 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
i 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17
Commonwealth of Massachusetts '
W Title 5 .Official Inspection Form, .
Subsurface Sewage Disposal System Forra Not for Voluntary Assessments
M s 44 ERIN LANE
Property Address
RBS CITIZENS BANK
Owner Owner's Name
information is required for every HYANNIS MA 02601 02/13/2012
page. Cityrrown ,," 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:
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
El
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
El
® Liquid depth in cesspool is less than 6" below invert or available volume is less
than '/2 day flow
l5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
,L Commonwealth of Massachusetts
_ Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
44 ERIN LANE
Property Address -
RBS CITIZENS BANK T
Owner Owner's Name
information is required for every HYANNIS MA 02601 02/13/2012 k
page. CityrFown State. Zip Code Date of Inspection.
B. Certification.(co6t.) fi. , .
Yes No
❑ ®• Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:'--
El ® 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
;rand chain of custody must be attached to this form.] ,
i
The system is a cesspool serving a facility with a design flow of 2000gpd-
❑ ® 10,000gpd.
ElThe 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
r 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 ' Jihin;400 feet ofAa 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'l l 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
t,
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
N
44 ERIN LANE
sV ,Property Address
RBS CITIZENS BANK
Owner Owner's Name
information is required for every HYANNIS MA 02601 02/13/2012
page. Cityrrown 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 the were not
® ❑ P Y ( Y
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): 4 - Number of bedrooms(actual): 5
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 GPD
t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17
Commonwealth of Massachusetts.
W Title 5 Official Inspection Form
e Subsurface Sewage Disposal System Form -Not for Voluntary Assessments "
' M
44 ERIN LANE
Property Address
RBS CITIZENS BANK
Owner Owner's Name
information is required for every HYANNIS MA 02601 02/13/2012.
page. City/Town r State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents: 0
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No
Laundry system inspected? ❑ Yes ® No
Seasonal use? ❑ Yes 0 No
Water meter readings, if available last 2 ears usage d 264 GPD
9 ( Y 9 (gP ))� -
Detail:
15+26+58+17+10+33+45+20= 224 x 100 x 7.5 = 1.68,000/638'days =264 GPD
Sump pump? ❑_Yes ® No
1 MONTH
Last date.of occupancy: Date
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based'on 310 CMR 15.203). .
. Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? 0--Yes ❑ No
Industrial waste holding tank present? ❑ 'Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
i
Water meter readings, if available:
t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17
ex
Commonwealth of Massachusetts
Title' 5 Official Inspection Form
'Subsurface Sewage Disposal System Form,Not for Voluntary Assessments
'44 ERIN.LANE `
Property Address W
''RBS CITIZENS BANK
Owner Owner's Name
information is
required for every HYANNIS' MA 02601'` 02/13/2012
page. ,City/Town State .Zip Code Date of Inspection
D. System information (cont.)
Last date of occupancy/use:`
Date
Other(describe below).
t .
' General Information
Pumping Records:
"Source of information: v k n3EMANUEL.CORREIRO, REALTOR
y
Was system pumped as part of the inspection? ® Yes ❑ No
3t
If yes,`volume pumped: n ry 1000 GALLONS
gallons
v f s GAUGE ON TRUCK ,
How'was quantity pumped determined?
{ .`Reason for pumping: y i CHECKING INTEGRITY OF TANK
"Type of System:
Septic tank, distribution box,'soil absorption system
t . E , Single cesspool
Overflow cesspools
..` 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
s maintenance,contract(to be obtained from system owner)and a copy of latest
inspection of the l/A system,by System operator under contract
❑ Tight tank. Attach a copy of the DEP_approval ,
7 4
❑' Other(describe):
t a ..
t5ins•11H 0 ? n a 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 44 ERIN LANE
Property Address
RBS CITIZENS BANK
Owner Owner's Name
information is required for every HYANNIS MA 02601 02/13/2012
page. CitylTown State Zip Code Date of Inspection
D. System Information (cont) ti
Approximate age of all components, date installed (if known) and source of information:
t
1984
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 32"
feet
Material of construction: -
❑ cast iron ®40 PVC. [:]'other(explain):
Distance from private water supply well or suction liner 10+
feet
Comments(on condition of joints., venting, evidence of leakage,etc.):
SYSTEM IS VENTING OKAY..WATER AT OUTLET INVERT. NO SIGNS OF LEAKAGE.
Septic Tank(locate on site plan): 2511
Depth below grade: feet
Material of construction:
® concrete ❑ metals 0 fiberglass ❑polyethylene ❑ other(explain)
If tank is metal,•list age: a yeas
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 8'6"x 5'x 56"
Sludge depth: 0
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 9 of 17
Co'm'monwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
4M , 44 ERIN LANE - - -
Property Address.
RBS CITIZENS BANK
Owner Owner's Name _
information is required for every HYANNIS MA 02601 02/13/2012
page. City/Town State Zip Code Date of Inspection
D.-System Information (cont.)
Septic Tank(cont.)
r Distance from top of sludge to bottom of outlet tee or baffle 0
Scum thickness 0
Distance from top of scum to top of outlet tee or baffle 0
Distance from bottom of scum to bottom of outlet tee or baffle 0
How were dimensions determined?' PUMPED OUT
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels'as related to outlet invert, evidence of leakage, etc.):
INLET HAS A COVER 10 INCHES BELOW GRADE. THERE IS A PVC 40 TEE IN PLACE.
OUTLET HAS NO RISER AND A TEE IN PLACE. WATER AT FLOW LINE AT TIME OF
INSPECTION. NO SIGNS OF HIGH WATER IN TANK.
Grease Trap (locate on site plan):
Depth below grade:_ feet
Material of construction:
El concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions: .
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: bate
t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of V
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments.
M 44 ERIN LANE
Property Address
RBS CITIZENS BANK
Owner Owner's Name;
information is required for every HYANNIS MA 02601 02/13/2012
page. Cityrrown 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.):
Tight or Holding Tank(tank must be.pumped at-time of inspection) (locate on site plan):
Depth below grade:
j
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•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17
Commonwealth of Massachusetts'
f Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
44 ERIN LANE
Property Address
RBS CITIZENS BANK
Owner Owner's Name
information is required for every HYANNIS MA 02601 02/13/2012
page. City/Town 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,.):
NO HIGH WATER STAINS IN D-BOX. WATER AT FLOW LINE. ONE PIPE LEAVING TO A 6 x 6
PIT . DISTRIBUTION BOX IS 30 INCHES DEEP.
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.):
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins•11/10 Titlej5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17
II
t
Commonwealth of Massachusetts
Title 5 Official Inspection Form
_ Subsurface Sewage Disposal System form-Not for Voluntary Assessments
44 ERIN LANE
Property Address x
RBS CITIZENS BANK
Owner Owner's Name
information is required for every HYANNIS MA 02601 02/13/2012
_
page. Cityfrown 'State Zip Code Date of Inspection
D. System Information (cont:)
Type
EJ leaching pits number.;
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
® leaching fields number, dimensions:
❑ overflow cesspool number:
a ❑ 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.):
PIT WAS BONE DRY AT TIME OF INSPECTION. THERE IS A WATER STAIN ABOUT 14 INCHES
FROM FLOOR.,NO SIGNS OF HIGH WATER.ASTONES IN HOLES OF PIT LOOK DRY AND
CLEAN. NO SIGNS OF HYDRAULIC_ FAILURE. SYSTEM HAS NOT RECEIVED NORMAL FLOW
FOR APPROXIMATELY 1 MONTH.
s
Cesspools (cesspool must be pumped as'part of inspection) (locate on.site plan):
Number and configuration
Depth—top of liquid to inlet invertw
Depth of solids layer
A . .
Depth of scum layer
,:
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17
' Commonwealth of Massachusetts ' s
Title 5 Official Inspection Form
Subsurface Sewage Disposal System,Form -Not for Voluntary Assessments
M ,.•' 44 ERINIANE y
Property Address
RBS CITIZENS BANK
Owner Owner's Name '
information is required for every HYANNIS MA 02601 02/13/2012
page. City/Town 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.): ,
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.):,.
F
. r
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17
hq
�a • -
�\ Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M a` 44 ERIN LANE
Property Address
RBS CITIZENS BANK
Owner Owner's Name
information is HYANNIS MA` , 02601" 02/13/2012
• required for every
page. City/Town 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
i below:
where public water supply enters the building. one of the boxes be o
P P P Y 9
❑ hand-sketch in the area below
® drawing attached separately
i
a
I
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
I
FAsBuilt Page 1 of 1
LOCATION SEWAGE PERMIT NO.
1-07
VILLAGE l Of7_A�
I N S T A L ER'S NAME j ADDRESS
B U I L D E R OR OWNER
DATE PERMIT ISSUED d 7Ll
DATE COMPLIANCE ISSUED � 1,r,�
.30
2 j10 '119A14-r
http://issgl2/intranet/propdata/prebuiLt.aspx?mappar=291017004&seq=1 2/13/2012
R Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
' M
44 ERIN LANE
Property Address
RBS CITIZENS BANK
Owner Owner's Name
information is required for every HYANNIS MA 02601 02/13/2012
page. Cityrrown State Zip Code Date of Inspection
D. System Infotmation (cont.)
Site Exam:
❑ :Check Slope
® Surface water
® Check cellar
❑ Shallow wells
10+
Estimated depth to high ground water: 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-,7 explain: F{
ONLY HAD HAND DRAWING ON FILE AT BOARD OF HEALTH
❑ Checked with local,excavators, installers-(attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established*he high ground water elevation`
BASEMENT IS DRY. NO SUMP PUMP. NO SIGNS OF WATER IN BASEMENT. YARD WHERE
PIT IS, IS 4.5 FEET ABOVE'STREET. PIT WAS BONE DRY AT TIME,OF INSPECTION.`NOTHING
IN FOLDER AT BOARD OF HEALTH. SYSTEM IS FROM 1983.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17
INS
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 44 ERIN LANE
Property Address. -
RBS CITIZENS BANK
Owner Owner's Name
information is required for every HYANNIS MA 02601 02/13/2012
page. 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,.
t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17
Date: 2/912012 Meter Reading History Page I of 1 1. 3
Customer# 603732-1 ,I
Premise#603732 / D
Serv€ce:Water-Regular Metered z
METER READING TRANSACTION INFO N
]:teed pate 91muenoe2 Meted Ema,Sad Read Code Rwdirta Consumption Skip Count Ijlp_, Code StaEus Hill Period Trans Date 3)
0110412012 01 60199177 0 23020250 1 1,201 20 0 REG A R 201201 0111212012 m
M
09/3012011 D1 60199177 0 23020250 1 1,181 45 0 REG A R ZD1104 10/12/2011 U)
07/05/2011 01 6D199177 0 23020250 1 1,136 33 0 REG A R 201103 07/18/2011
04/0512011 01 60199177 0 23020250 1 1',103 10 0 REG A R 2D1102 04/14/2011 3
01/042011 01 60199177 0 23020250 1 1,093 17 0 REG A R 2D1101 01/17/2011
101152010 01 60199177 0 23020260 1 1,D76 5B 0 REG A R 201004 102612010
07/09/2010 01 60199177 0 23020250. "1 - 1,018 26 6 REG A R 201003 07/16/2010
04/0712010 01 60199177 0 23020250 1 992 15 0 REG A R 201002 04121/2010 '
01/122010 _. 01 60199177 0 23020250 1 977 ry ._ Q_ :., REG—A, R _ -_20100101/1812010
10/0712009 01 60199177 6 23020250 1 957 15 0 REG A R 200904 10/1412009 X
07/10/2009 01 60199177 0 2302D250 1 942 20 0 REG A R 200903 07r"2009 zo
04106MG09 01 60199177 0 23020250 _ 1. 922 19 0 REG A R 200902 06,I2912009
01l09/ = 01 60199177 0 23020250 1 903 22 0 REG A R 200901 01/0912009 m
101072008 D1 OD199177 0 23020256 1 881 22 0 - REG A R 200804 10107/2008
071082008 01 60199177 0 23020250 1 850 22 0 REG A R 200803 07/08/2008
iD
m
04/12120D8 01 60199177 0 23020250 1 837 22 0 REG A R 200802 04/12/2008
01/102D08 Oi 60199177 0 23020250 1 - 815 22 0 REG A R 200801 0111=008
10I0812007 01 60199177 0 23020250 1 793 96 0 REG A R 200704 10109/2007
07/10/2007 01 80199177 0 23020250 1 697 54 0 REG A R 200703 07/10/2007
04/1012007. 01 $0199177 0 23020250 1 . 643 27. 0 REG A R 200702 04/1012007,
01/092O07 -01 60199177 0 23020250 1 616 45 0 - REG A R 200701 01/0012007
10/1012006 01 60199177 0 23020250 1" 571 120 0 REG A R• 200604 10/10/2006
fD
07/102006 01 60199177 0 23020250 1 451 35 0 REG A R 200603 07/10/2006 r
04112►2006 U1 60199177 0 23020250 1 416 0 0 REG A R 200602 04/1212006 CD
01/102006 D1 60199177 0 23020250 1 395 0 0 REG A R 200601 01/10/20D6 N
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AsBuil�;, Page 1 of 1
LOCATION 5` SEWAGE PERMIT NO.
,C=:12 r 1:� z"glAy /Ayr r 83 -87,g
VILLAGE j—Of7-M
INSTAL ER'S NAME i ADDRESS
I U I L D E.R OR OWNER
DATE PERMIT ISSUED 7 �,
DATE COMPLIANCE ISSUED !! 1 3
3s� ,
,Za 7-
30
_ AZOV 3� -
1
http://issgI2/intranet/propdata/prebuilt.aspx?mappar=291017004&seq=1 2/13/2012
YOU WISH TO OPEN A BUSINESS?
For Your Information: Business certificates (cost$40.00 for 4 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.] You must first obtain the necessary signatures on this form at 200 Main St.,'Hyannis.
lyannis.
-I ake the completed farm to the Town Clerk's Office, 1st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and stet the Busin6s Certificale that is
required by law.
I , ,_� a � ,
DATE: ( 2� Fill in please:
„ I , I j APPLICANT'S YOUR NAME/S: fZ- CL /3Z—
BUSINESS YOUR HOME ADDRESS: [-/y F i'L 1``' L_
-
" ' TELEPHONE # Home Telephone Number
rt ,��ms' ulrr
II II(�VILA.r I .,..aa
NAME OF CORPORATION:. n- SS
NAME OF NEW BUSINESS_ TYPE OF.BUSINES.S
IS THIS A HOME OCCUPATION? _YES - NO
ADDRESS OF BUSINESS /1�/`� L MAP/PARCEL NUMBER � �D 7(Assessing)
When starting a new business there are several things you must do in order to be in compliance with the rules and regulations 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 yo'-'err business in this town.
1 BUILDING COMMISSIONER'S OFFICE
This individual has been informed of any permit requirements that pertain to this type of business.
Authorized Signature*
COMMENTS:
2. BOARD OF HEALTH
This individual has bee ' forVed f the permit requirements that pertain to this type of business. MUST"OMPLYWITH ALL
I�GI � )HAZARDOUS MATERIALS RFGr rf.ATIOnpr
_1
Authorize Si riat r
COMMENTS: ad l-a✓)I
3. CONSUMER AFFAIRS (LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature*
COMMENTS:
TOWN OF BARNSTABLE Date:Sl
TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY
NAME OF BUSINESS: '6 sS G®w r—ltti< </ 00'"
BUSINESS LOCATION: y�1 ��'" �A- INVENTORY
MAILING ADDRESS: TOTAL AMOUNT:
TELEPHONE NUMBER: �;O9119 ('5• 6 Y( c
CONTACT PERSON:
EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE?
TYPE OF BUSINESS: C aeS(a f1 T,,- caw
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 material 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) Miscellaneous 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
Miscellaneous 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 Miscellaneous Combustible
Car wash detergents Leather dyes
Car waxes and polishes Fertilizers
Asphalt& roofing tar PCB's
Paints, varnishes, stains, dyes Other chlorinated hydrocarbons,
Lacquer thinners (including carbon tetrachloride)
❑ NEW ❑ USED Any other products with "poison" labels
(including chloroform,formaldehyde,
Paint&varnish removers, deglossers hydrochloric acid, other acids)
Miscellaneous. Flammables Other products not listed which you feel
Floor&furniture strippers may be toxic or hazardous (please list):
Metal polishes
Laundry soil &stain removers
(including bleach) /v
Spot removers&cleaning fluids
(dry cleaners)
Other cleaning solvents
Bug and tar removers
Windshield wash
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS PPlicant's Signature Staff's Initials
LO.,CAT10N `f SEWAGE PERMIT NO.
V I L L A G E 7-AXI
INSTAL ER'S NAME g ADDRESS
Az
B U I L D E R OR OWNER
D VS
DATE PERMIT ISSUED 7
. DATE COMPLIANCE ISSUED , '71
O
3�'
� T f
r
Nola—. i F3.cis . ..............
THE COMMONWEALTH OF MASSAG �USETTS 4
__'bOARD OF HEALTH
r"`. ID! .................OF..... . . ..........
Appliration for Bi-spnsal Works Tonitrnr#plan ramit
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
System
ssat:
..........6-L;_1.../La....(��Lti41 vrt.....�1.A. ----•-----•----•---- ---------------------------•------• `f----.----------------------•-----.-----------------
Location-Addr or Lot No.
........ je..................... _..__ ............
Owner � Address
a .._... ................................... ........... �.... ....................................................
Installer Address
Type of Building Size Lot...A .f®__4-_-----Sq. feet
�. Dwelling—No. of Bedrooms.........................................Expansion Attic ( ) Garbage Grinder ( )
`4 Other—Type T e of Building ..... No. of persons............................ Showers
G� YP g ----------------------- P ( ) — Cafeteria ( )
04 Other fixtures -----------------•-•---••------. .
W Design Flow...........1./D.........................gallons per person per day. Total daily flow.--....... ......................gallons.
WSeptic Tank—Liquid capacity/ gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..................... Diameter..--..--.---.--..... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------
(T4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.....----...............
P4 -------------•--•-•--•--•--••--••-••---•••-•----......--....---.....------.. •-•••--•-•-•--..............................................................
0 Description of Soil........................................................................................................................................................................
x
U --------------------------------------•--•-----------------------.......--•---....-------•--•---.......-•--------------------------------------....--------------------••-----------•••....-----------•.
W
U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of ITT La 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has n issued by t boa1 of health.
........... .
.....1�---
....... ...
Application Approved By.-4eing
-- -------•.........................••-•-------------.....--•---••--..----•- ---�-• ••--•• ---d--•.--.----
ate
Application Disapproved fo reasons:------------------------------------------------------------------------------------------------------••......_
....................•-•--------------.....---•---•-------------...---•--.....--------------•---------------------------•--------------------------------------------- ........................•...
Date
PermitNo.............................................=.............. Issued.......................................................
Date
No. 17 Ficii ...............
THE COMMONWEALTH OF MASSACe USETTS
BOARD OF` ' HEALTH
777 7 ..............OF... .. ..............................................
Appliration for Dhiposal Works Tontitrurtion thrutit
Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal
System at:
... ......0._._..e._.._......9-5sAwe...... ----------------- ............. . _i y...' . . ...........
Location or t K0*— .. .. .. cl ! �%*..... .....3.6..... - ... .............. Q & ......
-----
Owner Address jr
...............A.C_ ..................................... ........ ....................................................
$-� Installer Address
PQ
1� Type of Building Size Lot-__/a_&..2......Sq. feet
U
Dwelling—No. of Bedrooms..............�.....................Expansion Attic Garbage Grinder
Other—Type of Building ............................ No. of persons............................ Showers Cafeteria
A4Other fixtures ......................................................................................................................................................
W Design Flow..........!/C>........................gallons per person per day. Total daily flow..........22_�?....................gallons.
1:4 Septic Tank—Liquid*capacity.AXV..gallons Length................ Width................ Diameter................ Depth....._......._..
Disposal Trench—No..................... Width.................... Total Length..._.._......._..... Total leaching area....................sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. f t.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
as
Test Pit No. I................minutes per inch Depth of Test Pit__.._..........._... Depth to ground water_._._.__.__._._......_
Test Pit No. 2................minutes per inch Depth of Test Pit____........_.__.... Depth to ground water_.__.........._......___
..............................................................................................................................................................
0 Description of Soil....................................................................................................................................................1...................
W
---*-------------------*----------------------------------------*------*........*------****--------------------------------------------------*-------*-------------------------------*--------*------
........................................................................................................................................................................................................
U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
...............................................................................................................:........................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of'T':12 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has n issued by thebboaro of health.
0 atA
ApplicationApproved By.... ......................................................................... ..... ......
ate
Application Disapproved fo e doing reasons:................................................................................................................
.................................................... .................................................................................................................................................
Date
PermitNo........................................................ Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
77...77T� ...........OF..... ..............................
Turdifiratr of Toutpliatta
THIS IS TO CFATI Y, T at the Ipdividua e, Sewage Disposal System constructed j_,,yor Repaired
b
_6�n.................................. (_
y ....... ...... . ........U3 ...._Q. ...................................................................................
Installer
at............................. ...... .................................................................................................................... ...............
has been installed in accordance with the provisions of TIkF5
5 of Th State Sanitary Code, a in the
"'0 141;
application for Disposal Works Construction Permit No 'PT......... dated..................... ..........................
THE ISSUA C F E 0 THIS CERTIFICATE SHALL NOT BE CONST.RVD AS A GUARANTEE THAT THE
SYSTEM WILI/FII�iiACTION SATISFACTORY.
----------------------------------------------------
DATE..... Inspecto . .. . ........7--------------------------- ...............................
THE COMMONWEALTH OF MASSACHUSETTS
BOA OF HEALTH
. ...............................
NFEE........................
Diapollat
Permission is hereby granted.---_-- �...... .....................................................
to Construct (___�'or Rep�ir,( ) an ;ndivi ua .wage Disposal System
atNo......................9 ...............................................................-- ---------------------------- ---------------------
Street
--------------------------
0
------------ - --------------
as shown on the ion for Disposal Works Construction Permit No.....,... ........ Dated._/.........I.........................
/a7;1a/� /�;
� ...............•.......• ....... ....................................................................
7 Board of Health
DATE...............................................................................
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS
I
S011 L 0 6
SITE PLAN
N0. 1 D NO. 2
-----
3 -------
4 M
TOP OF FOUNDATION EL.: �a�'Ass n>`r� �2 'H Lwt`i�owz))
�3 5
f
%] SLo4E/ C,� LE-Pc- t.;c=, 1=�'�c.�A . ... __.�.__� s
` e: ^� ' /V 1�vY. �G'?v� �• 7 Y �� Ln.�i r i +�' L-CJ / 1',_, 1: r � ! L-__.-ti..+_ 7 r-----
i
8 �-
�, 9 G
IN.EL. 7 '3 EL `
IL 3 C
1O
rZ ° IN.Eli. A w f
%.. i _ � �--- %.- IN-E� _r� _ �EL ��L��TT_z� ,,• �--�--`. 2' COVER 1/8 3/8 WASHED STONE ,�,I \� , . .
N.E L. `�Z_ a I N.E L. _ - -- d___ __r- — __ �% o J`� �_ 12
.> IN. El. 9ro'
• O/B W/ 6 SUMP ' �� ' ° -•F 3/4 1 1/2 WASHED STONE " `'-13
•° 4 LIQUID LEVEL • ' b�•'
n ,� {' 14
bo�-� c° ' I•`i6' EFF. DEPTH � r . 15
• ' E� �� ` •� c ° PERC TEST RESULTS
n
PRECAST SEPTIC TANK WITH n ° � 8�4
0 ���' c ° ; PRECAST LEACHING PITS P E R C RATE :
CAST IN PLACE INLET ANDo � �
EL. __-- o -- _ --__ NO.. -1 _ SIZE . _ � N1a �.# < < , WHITNESSED BY
• OUTLET T "S PER TITLE �� �. :� BOARD OF HEALTH
SIZE : �,�� x �/ '�a' �.,,, n= s ` �' �,�H �' DIA . --� - }
i
PROFILEOF ' PROPOSED SEWAGE SYSTEM
SYSTEM DESIGNED BY THE TOWN OF REGULATIONS AND
STATE TITLE V FOR SUBSURFACE DISPOSAL OF SEWAGE . SCALE 1/4"= l ' O " Lc'T� /0, 910 sf=
N . B .
1. All PIPES SHALL BE SCHEDULE 40 P.V.C. SEWER PIPE
2. ALL PIPES SHALL BE SLOPED 1/4"' PER FOOT EXCEPT FOR
I THE FIRST 2 FEET OUT OF THE O / B WHICH SHALL BE LEVEL
3. DESIGN FLOW BEDROOMS AT 110 GALDAY PER BR. : _ GAL/DAY .+ r00 30,. cry
I SEPTIC TANK SIZE X z. s- = -',.p GAL.
f USE moo GAL. W/ GARBAGE DISPOSAL -
LEACHING SYSTEM: USE 1 LcAc-.Hjv�
EFFECTIVE AREA: SIDE 314
BOTTOM a-,
TOTAL FLOW In
TOTAL REQ D FLOW X = _ .. W/ GARBAGE DISPOSAL
RESERVE FLOW__-�.�� - � 44 GAL/DAY __ f
1—
Ir
r
REFERENCE PLANS
tf,'.v
---- - - - ----- --- - _ -- --- - APPROVED BY : ; gig_ _ - --
' BOARD OF HEALTH
PERT� PR N DATE :
PROPERTY OWNER :E R : - --- _- ----- S/ TE AND SEWAGE PLAN
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