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HomeMy WebLinkAbout0183 FAWCETT LANE - Health 183 Fawcett Lane Hyannis P A = 270 105 k t J t 0 s i TOWN OF BARNSTABLE L&A T ION 1 �A�L��"r AN SEWAGE # - VIL; AGE NYAKWI S ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. Wr SEPTIC TANK CAPACITY C'�Z)� LEACHING FACILITY: (type) ,PIT ' (size) G V3 x-ef,1) a.OF BEDROOMS .�S 1 N S, BUILDER OR OWNER A �F r PERMITDATE: COMPLIANCE DATE: { Separation Distance Between the: ` 4) t U N* _ 1� Feet Maximum Adjy Eed roundwater Table and Bottom of Leaching Facility 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 f, within 300 feet of leaching facility) Feet Furnished by q REAP OF \AsC _ Al = Zoe t3 12 A 8 E Z.= ` G,'5' O A3 =z,4-s' G3 2% 3 4- _ COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENviRoNMENTAL PROTECTION RECEIVED AUG 2 6 2003 TITLE 5 TOWN OF BARNS ABLE EA' _ _ OFFICIAL INSPECTION FORM—NOT FOR VOLUNTAR .S T SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: �� ��(�re1�t �� , 4.1.1!3 j Owner's Name: es���'� ®14 ' " 4 IlWqjrtbA'A ; �M4q re5t 0—I47y'.', Owner's Address: 0 #*1+40 A Date of Inspection: S(7 m a! 4 or-legs 1 4- 0 Z6 S3 & /it 12®o3 Name of Inspector:(please print) Joseph M.Martins �.r_ ,. .. Company Name: Accu Sepcheck MAP �-� Mailing Address: 17 Northside Dr., S.Dennis,MA 02660 PARCEL Telephone Number: 508-385-5891 LOT CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000k The system: too/Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fa 2/ Inspector's Signature. Date:(A 3 I The system inspector shall su it 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 shard system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments RVAPIILI(- 4(s ho Ve l is o/ e- T-7 V0 Ithw� ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address bow the system will perform in the future under the same or different conditions of use. Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 183 Fawcett Ln,Hyannis,MA Demarest Owner: August 11,2003 Date of Inspection: Inspection Summary: Check AA,C,D or E/ALWAYS complete all of Section D A. 5yst 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 of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the fol ng statements.If"not determined"please explain. The septic tank is metal and over 20 years or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or tration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a comp g septic tank as approved by the Board of Health. *A metal septic tank will pass` on if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is I than 20 years old is available. ND explain: tion of sewage backup or break out or high static water level in the distribution box due to broken or o cted 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 obstruction is removed distribution box is lever or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 4. Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) 183 Fawcett Ln,Hyannis,MA Property Address: Demarest August 11,2003 Owner: Date of Inspection: C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of 1Ieai etermines in accordance with 310 C1VIR 15.303(1)(b)that the system is not functioning in a r which will protect public health,safety and the environment: — Cesspool or privy i thin 50 feet of a surface water _ Cesspool or is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Z. e I of a public water supply. The system has a septic tank and SAS and the S 'thin 50 feet of a private water supply well. The system has a septic tank and SA the SAS is less than 100 feet but 50 feet or more from a private water supply well's*.Meth ed to determine distance "This system passes if well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volati rganic compounds indicates that the well is free from pollution from that facility and the presence onia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure cr' 'a are triggered.A copy of the analysis must be attached to this form. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) 183 Fawcett Ln,Hyannis,NIA Property Address: Demarest August 11,2003 Owner: Date of Inspection: D. System Failure Criteria applicable to all systems: You must indicate`yes"or"no"to each of the following for all inspections: Yes Nof _ m 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 V day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped �1ny portion ofthe 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. �/- iAny 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: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either`des"or`no"to each of the following: (The following criteria apply to large systems in addition to the ' a above) yes no — the system is within 400 feet ofa ce drinking water supply _ the system is within of a tributary to a surface drinking water supply the syste ' in in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone 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 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 183 Fawcett Ln,Hyannis,MA Demarest Owner: August 11,2003 Date of inspection: 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 LX 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 t/_ 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? lZ_ Was the site inspected for signs of break out Inclu Were all sy stem components,e g the SAS located on site � W1/_ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffies or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _�_ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no Existing information.For example,a plan at the Board of Health. _�_ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] I Page 6 of l I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 183 Fawcett Ln,Hyannis,MA Demarest Owner: August 11, 2003 Date of Inspection: `LOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): ��� DESIGN flow based on 310 CUR 15.203(for example: 110 gpd x#of bedrooms): Number of current residents: O ^f� Does residence have a garbage grinder(yes or no): '°' Is laundry on a separate sewage system(yes or no):E [if yes separate inspection required] _ Laundry system inspected(yes or no):- -7k/- 7/p 4 (v' �®� - 14LIC L 6) Seasonal use: (yes or no):-N Water meter readings,if available(last 2 years usage(gpd)): ? 2-' 3 a�J��� = a 3 Sump pump(yes or no): /V0 Lastdate of occupancy: [ O[L. ? AG( / � A�" �,037,- one eq COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgketc.): — Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title em(yes or no): Water meter readings,if available: Last date of occupancy/u OTHER ): GENERAL INFORMATION Pumping Records , Source of information: PU fnp� j ��q g07-S �`�g / t?RA�WQ��a. Was system pumped as part of the inspection(yes or no): / f 0 �- 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) _Tight tank T Attach a copy of the DEP approval —Other(describe): Approximate age of all com ts,date in ll 4(if known)and source of information: P S . Were sewage odors detected when arriving at the site(yes or no): � Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 183 Fawcett Ln,Hyannis,MA Demarest Owner: August 11,2003 Date of Inspection- BUILDING SEWER(locate on'site plan) Depth below grade: ✓�a Materials of construction: cast iron _40 PVC_other explain}: • Distance from private water supply well or suction line: S 60 Comments(on conditioo o'omts,venting,evidence of leakage,etc.): aei P SEPTIC TANK:_(locate on site plan) 1 Depth below grade: Ok Material of construction: 'concrete_metal_fiberglass_polyethylene _otha(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) �,�© p F�// Dimensions: D Sludge depth ® 1% �,/// Distance from top of slud��to bottom of outlet tee or baffle: Scum thickness: ® Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of ouget tee or baffle,: dHow were dimensions determined: Pit v - < C %5' aComments(on pumping recommen ions,inlet and outlet tee or baffle condition, liquid levels as elated to,outlet invert,evidence of 1yakaffe.etc.): ek ,R6 p Sit- GREASE TRAP:_(locate on site plan) Depth below grade:_ Material of construction:_concrete metal_fiber _polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top utlet tee or baffle: Distance from bottom of s o bottom of outlet tee or baffle: Date of last pumping: Comments(on purr ' g recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to out invert,evidence of leakage,etc.): Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 183 Fawcett Ln,Hyannis,MA Demarest Owner: August 11,2003 Date of Inspection: 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_polyethyl other(explain): Dimensions: Capacity: 2Z . lons Design Flow: lonslday Alarm present(yes or Alarm level: k' der(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ' (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: S 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.): Poo S 0 vl/ C C mevot doA 10 c?(p tom- w' 4 2- c0 a PUMP CHAMBER: (locate on site plan) Q r 4jeda/it of /n le Pumps in working order(yes or no): d vIL'le�" �lI �j• Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Page 9 of I 1 OFFICIAL.INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: - 183 Fawcett Ln,Hyannis,MA Date of Inspection: Demarest Au st 11 2003 SOIL ABSORPTIOl�I SYSTEM(SAS): (locate on site plan, xcavaflion not required) If SAS not located explain why: Tye leaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number,length: �e P 7— leaching fields,number,dimensions: overflow cesspool,number: innovativeJaltemative system Typelname of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): CESSPOOLS: (cesspool must be pumped as part of inspectionXlocate 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 groundw inflow(yes or no): Comments(not tion 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 e,level of ponding,condition of vegetation,etc.): 5. Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 183 Fawcett Ln,Hyannis,MA Owner. Demarest Date of Inspection: August 11,2003 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. F! V� � 3 r Dts7-ffoces! .� Atje rl 1 �=ads • �2= 2� �- l 1 �3 4- Page 11 of 11 OFFICIAL INSPECTION FORM--NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: 183 Fawcett Ln,Hyannis,MA Date of Inspection: Demarest August 11,2003 SITE EXAM Slope Surface water Check cellar Shallow wells ' Estimated depth to ground water ' l�4 pd J y,S-teq� 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 you established the high ground water elevation: N jW ' Zo #V)ln 3 6ra-4waile".-, c®r"-�V e- 15 Pp- 2 6- �- ALA � J s r PVR Al oa 2, P o/. 3 TOWN OF BARN.STABLE LOCATION 4,-VI SEWAGE # 33 G VILLAGE ASSESSOR'S MAP & LOT07Q--A� NSTALLER'S NAME &`PHONE NO. FPTIC TANK CAPACITY j _ ofo/� LEACHING FACILITY:(type) la��% ��' ( iu) 6J�5 NO. OF BEDROOMS .'~ PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER < s A& C't/A�� DATE PERMIT ISSUED: - DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No li 1} A'-�-�.. S ,� �'� ,, \ �, � � � � � �� o � � � r I • �. No------- ---- 3 0 0 0 THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE , ppliration for Dim m5al Worlw C omitrurtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal System at: 183 Fawsett Ln Hyannis ......................•------•--.......--•------.....---•---•------------------•---•--••----...... .................................... ............................................................. Location-Address or Lot No. .....Syd_Huckvale....... ------------------------------------------------------------------------------------------------- Owner Address a W.E. Robinson Septic Service _ P.O. Box 1 089 Centerville Iiistatter� Address Q Type of Building 3 Size Lot..............: ..........Sq. feet V Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building _-_-_--_---------------- No. of persons---.--------_---_----.__-. Showers ( ) — Cafeteria ( ) a' Other fixtures -------------------------------- - W Design Flow--------------------------------------------gallons per person per day. Total daily flow--------------------------------------------gallons. WSeptic Tank—Liquid capacity------------gallons Length---------------- Width_------------- Diameter_._.__.._----. Depth................ 114 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........................................ 1.4 Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water-.----.-.----.--_....__- 44 Test Pit No. 2----.-.-_----_minutes per inch Depth of Test Pit-------------------- Depth to ground water-..- __:-.-..--..-.----- a •-••----•-------------------•-----------------••••-•--•--••••--••-----••......----------------------........................................................ 0 Description of Soil-------- sand ---------------------•----------------------------------...----------------------------------•-- V ------------------------------------------------------------------------------------------------------------------------ W .............. ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- UNature of Repairs or Alterations—Answer when applicable.----install-_-a___---tone paCked___additional. ..... verf•low---and__d_-box. to_-.existing..septic.... ank.------------------------------------------------------------------------- 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 of health. Signed --------------------------------------------------------------------------------------....._._ ------------------------------- Da,e Application.Approved By .......... ,c/,__ __1- - - ...---------------- —._�D---. Application Disapproved for the following reasons: ------------------------------------------------------------------------------------------------------------------------- .............................._.............._....._......_.........................................................._....__......_........-.__...........---------------------------------------------------------- ...._..._..---- ._............... Dare Permit No. --------f 6J '� - ��--------------- - Issued ........................ --------------...................... Dace - a--76 I o 5 No...... � Fxs....3�.......�......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Apphration for DioVo!3al Vorlw Cnonotrnrtion Famit Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal System at: 183 Fawsett Ln Hyannis .........................................•--------•---.....------------------------......--------- •----------------------------•------------------•------•-.....--•---------------------•--------•-- Location-Address or Lot No. .� ayA..B3ACkv.a.1.e........................................................... ----•-••----------------------•--.......----------•-.......------•......-----•----•-•--•--•-----•. Owner Address W W.E. Robinson n Septic-- Service___ P.O. Box 1089 _Centerville ` - - - Installer � Address UType of Building 3 Size Lot............................Sq. feet ,.� Dwelling—No. of Bedrooms.-------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) 04 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 capacitv...._-._--_gallons Length______________ Width..............._ Diameter--- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No...................... Diameter-------------------- Depth below inlet-------------------- Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by---------- ............................................................... Date........................................ Test Pit No. I------_-__._---minutes per inch Depth of Test Pit.................... Depth to ground water_........-._.._.-_...... L% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ --:...d................................................................................................................................................... 0 Description of Soil........-sand U ------------------------------------------•------------------------•----------------------------------------------------------------------------------- •----------------•--------••-----------------... W UNature of Repairs or Alterations—Answer when applicable..install---a...Stonepaeked additional. ....over-flow...and_ d_-box--to---existinq•--septic---tank-..•-----------•---------- --------•----•--••-------•-----•---•------------. Agreement: The undersigned agreeg 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 of health. Signed ---------------------------------------------.-------------------------------------------------------------- ----------------------------------- -- Application Approved By ------)____ ..- e�c. =-------------------------- ---------------__._......_.-..---------.----- --- - Date Application Disapproved for the following reasons- ------------------------ ................................................................._......-----------------------------------------------------------------"'---_----....---------._---.. ---------------- .---------.------- Date Permit No. ------�� G'� - -... ..?>/------------------ Issued --------.._ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE C�ex#ifi ate of C�umpliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( X ) by W.E. Robinson Septic Service Installer 183 Fawsett Ln Hyannis at .............. ..........__......---..........-......... .. .. .....- ---------- ------- ----...---....----------------------------...------------------ ------ ----------- -----------------..------------- 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. .......`�. :.- _�.:?. _.- dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRU ,A AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.. .... 'r`. ----..... Inspect `2 :.. � � `..... Syd Huckvale THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ` G TOWN OF BARNSTABLE 30.00 No. = �! FEE........................ r. �i��n�ttl urla� �un,�tr�trtUan �rrmit W.E. Robinson Septic Service Permissionisl hereby gran(ted------- --------------- •---•--••-----------------••---•---------•----------•-----•--------•••-------•----------•--•--•-•--•-------...... to Construct Wjeo f ejn FiyjnniSdtvidual Sewage Disposal System atNo----------------------------------------------------------------------------------------------------------------------------.......------------------------------------------------------------ Street _ as shown on the application for Disposal Works Construction Permit Nod/. -._ /.- Dated.......--1 ------------------------------- Board of Health DATE................. ---"---------•=--�--�- FORM 36508 HOBBS 6 WARREN,INC..PUBLISHERS Health Complaints 04-Sep-02 Time: 1:00:00 AM Date: 7/30/02 Complaint Number: 3678 Referred To: LEE MCCONNELL Taken By: LEE MCCONNELL Complaint Type: CHAPTER II HOUSING Article X Detail: Business Name: Number: 183 Street: FAWCETT LANE Village: HYANNIS Assessors Map-Parcel: Complaint Description: LM RECEIVED CALL FROM HYANNIS FIRE DEPT. REGARDING ELDERLY WOMEN LIVING IN FILTH AT 183 FAWCETT LANE, HYANNIS. THE WOMEN WAS TAKEN FROM HERE HOME AND BROUGHT TO THE CC HOSPITAL FOR MENTAL AND PHYSICAL EVALUATION. Actions Taken/Results: LM and SHW inspected house on 07/30/2002 @ 10:30AM. House was completely in shambles, blood and feces smeared throughout house. Dishes piled high in sink, books and trash in every room. Lm called elderly services regarding condition of house. Please see file for photos... Investigation Date: 7/30/02 Investigation Time: 10:30:00 AM 1 K _ � r PF 7,4 1-4 Jet,' - i' i 1 nn ail i r >. t p I I i i �:. t 5• �� ZO02 7 39, ��SJ� �, k� ,� . _ .�: � _ _ ""` �`. �.� ,. i��f°�`' ' �. aid �rt �i � ' g �� .. �� _ x'� x= .. �, •JI r. 1 t `"` f _ : . 1 �; � �4"4 .�+ � .. '� ,� r`�' ..- _ � ., J i .__� _ � Y ,: ,�" .:. .i .�,�".. 1:. .. a o. .�- _.�. . . �: t ' } ,../ e,�;,�,,,� 4�a -! r �� ter !. ^►% !�� ���'�.�:, _ F � P r 3 :, yr,�...�r-� b - t ,mob � � ., -� >.. -�:.,# a iw.-.,. _ �+ . _ �' _ ,� w ,� , i r � �l t s �p J � .. .: � q .t 4' � �'� _ Zfi, r 1 �{i.n i .Y s'iyyl�i V� �� .. + �. - e dT16„�,.. yr, �Q, f a _-- -` m _�, :: �, .,. .�� ,��,� Y �:� '° .r t� ° � C.rs� , t� - • .E ® 1 I, �n ry� 1 Pt . i3pp zi, - I � a �` � x..t`. .ter - ..,�"'1� ___^•,� _ W e 1 Olt i it �; fq e +s� ���.�� '�„ ,yyam.• �: F t ' 1r / lrA. I >r VIC a� a f • t y. .w. ..y .. y r..I vv .._, r � .�..• T .a • f M.f t a 9 S ^ j0 COMMONWEALTH OF INIASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFF.A AUG 1 3 19?' l DEPARTMENT OF ENVIRONN ENTAL PROTE ON97 ft%0F i ONE \%INTER STREET. BOSTON. MA 0_2108 61 ]9_-5:00. NEAADEPTLE .' 1 V1'ILL1.AM F.WELD E Y C0XE Govemc• Secretaf) ARGEO PAUL CELLUCCI D.AVID B.STRULS Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissiortr PART A CERTIFICATION Property Address: %S-6Tc.WUL T UN \ 4,�virN N IS Address of Owner: Date of Inspection: .$IcIZ (If different) J Name of Inspector: tm, ir_o I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: dtf�-W1�YctC� YV./trQ,oraw�Z�.J�W Mailing Address: .O� €3o z.3 v�(/t, e Z(oy 5 Telephone Number: SO - - l L CERTIFICATION STATEMENT I certify that I have personall, inspected the sewage disposal system at this address and that the information reported below is true. accurate and complete as o�the time of rnspectoo The inspection vas penormed based on my training and experience in the proper function and maintenance of on-site sev,age disposa systems. The system: Passes _ Conoltlonali� Passes '.eeos Funhe, E�aluat;on 5� the Local Approving Authority Fars Inspector's Signatur J- 4,u Date: The System Inspector shal' Submit a copy of this inspection report to the Approving Authoritv within thirty (301 days of completing this inspection. If the system is a shared system o, has a design flow of 10,000 god or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authoritn. INSPECTION SUMMARY: Check A, B, C, or D: A] SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. 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. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is,imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revimed 04/25/97) Page 1 of 10 DEP on the world Wide Wet) htT rrwww magnet state ma.usroec Pnnteo on Recycied Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM l PART A CERTIFICATION (continued) 431 yt fa Property Address: Owner:,- VV,41 Date of1nspection: IB] SYSTEM CONDITIONALLY PASSES tcontrnu-cl Sewage backup or breakout or high static water level observed in the d stribution box is due to broken or obstructed pipets) or due to a broken, settled or uneven distribution box. The sy tem will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year d e to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): broken pipets) are replaced obstruction is removed C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEA H: Conditions exist which require further evaluation by the B and of Health in order to determine if the system is failing to protect the public health, safer and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH D ERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AN SAFETY AND THE ENVIRONMENT: Cesspool or pr»,\ is within 50 feet of a s rface water Cesspool or pri%) is \,+)thin 50 feet of a ordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MAN ER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank an soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water su ply. _ The system has a septic tank nd soil absorption system and the SAS is within a Zone I of a public water supniv well. _ The system has a septic tan and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic to k and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply wel , uniess a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from po ution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Met od used to determine distance (approximation not valid). 3) OTHER (rovioed 04/25/97) Page 2 of 10 r ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1'�3 Owner: \ Date of Inspection: D] SYSTEM FAILS: 1 You must indicate either "Yes- or 'No' as to each of the following: I have determined that the system violates one or more of the following failu a criteria as defined ;n 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be matted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to a overloaded or clogged SAS or cesspool. Discharge or pond;ng of effluent to the surface of the grou d or surface waters due to an overloaded or clogged SAS or cesspool. Static Dowd level rn the distribution boa above outlet vent due to an overloaded or clogged SAS or cesspool. Liquid depth it cesspool is less than 6" below rove or available volume is less than 1/2 day floe, Required pumping more than 4 times in the last ear NOT due to clogged or obstructed pipes . Number of time; pumped _ ,Any pon,on o`the Soil Absorption System, sspool or privy is below the high groundwater eievanon An% port;on of a cesspool or privy ;s wit ;n 100 feet of a surface water suppiv or tributar to a surface water supply. An\ portion of a cesspoo: or pr;%-, is ;th;r. a Zone I of a public well. Am po^;or of a cesspool or prw1 is within 50 feet of a private water supply well Am por,ton of a cesspool or pr vy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable v%ater qual;t\ anal _!s. If the well has been analyzed to be acceptable. attach cope of well water analysis for col;iorm bacter;a. volatile or an;c compounds, ammonia nitrogen and nitrate nitrogen. E) LARGE SYSTEM FAILS: You must indicate either -Yes' or "No" a to each or the following: The ioiiow,ng cr;ter;a appi% to arge systems ;n addition to the criteria above: The system serves a iacil;n -ith a design flow of 10,000 gpd or greater (Large System; and the system is a significant threat to public health and safety a, the environment because one or more of the following conditions exist: Yes No the system s within 400 feet of a surface drinking water supply the syst is within 200 feet of a tributary to a surface drinking water supply the s stem is located in a nitrogen sensitive area (Interim Wellhead Protection Area- IWPA) or a mapped Zone II of a pu ;c water supply well) The owner or oper for of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 4 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04/25/97) Page 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Owner: 8-�bgll , Date of Inspection: Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No Pumping information was provided by the owner, occupant, or Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as pan of this inspection. As bull, plans have been obtained and examined. Note if they are not available with N/A. X The facility or d%%eliing �%as inspected for signs of sewage back-up. _ The system does not receive non-sanitary or'industrial waste flow. The site %%as inspected for signs of breakout _ All system components. excludine the Soil .Aosorption System, have been located on the site. •. _ The septic tank manhoies %%ere uncovered, opened. and the interior of the septic tank was inspected for condition of baffles or.tees. material o'construction, dimensions, deptn of liquid,.depth of sludge, depth of scum. The size and location of the Solt Absorption Svstem on the site has been determined based on: The facilm o%%ne• tano occupants. if different from owner) were provided with information on the proper maintenance of Sub-Suriace Disposal Svstem. ]� Existing information Ex. Plan at B.O.H. Determined in the field of an, of the failure criteria related to Part C is at issue, approximation of distance is unacceptable (15.302.31:1b'j (revised 04/25/57) page 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIO% FOR.tit PART C SYSTEM INFORMATION Property Address: 1 C63C Owner: � b Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design floes e p.d..bedroom for S.A.S Number of becrooms �J Number o'current residents' aZ Garbage g•, der (yes or no, Laundry co--^ected to system (,yes or no' <X Seasonal use ryes or no-:—Ek) Water meter readings, if available (last two ;2 year usage tgpd):rlX� Sump Pump Ives or no) Las; date o-occupanc-, yJ� COMMERCI AL'INDL'STRIAL: Type of establishment Design fio%% ¢aGonvoa+ Grease trap present ryes or no' Industna! %%ante Holding Tani; present. -ves or no_ Non•san,tarn v,zste discnargec to the Trtie 5 system Ives or no_ %%ater meter readings. if availabie Las:pave o7 c, �z^c OTHER: Describe Last cafe of occudanc. GENERAL INFORMATION PUMPING RECORDS and source of information 5�ST�.v►-� \S r`�y}r„�,—��i r avo �-c��� �T Z'ln,� �f'�t System pumped as par, of inspection. Ives or no "7 If ves, volume pumped eallons Reason for pumping TYPE OF SYSTEM Septic tank/distribution bo)Lsorl absorption system Single cesspool Overflow cesspool Prny Shared system (yes or not (if yes, attach previous inspection records, if any) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: fi t+12.S I Sewage odors detected when arriving at the site. ayes or no)_ (revised 04/25/91) Page 5 of 20 SUBSURFACE SE�%AGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMAT10% (continued) Property Address: l$j Owner: f-(UK X,l '�' Date of Inspection: 01 09-7 BUILDING SEWER: (Locate on site plan) Depth below grade. Material of construction: _cast iron _ 40 PVC _other (explain? Distance from private water supply well or suction li-t Diameter Comments: (condition of)oints, venting, evidence of leakage. etc.) SEPTIC TANK:—W3 (locate on site plan Depth below grade q material of construction: l&•concre:e _meta _Fiberglass _Polyethvlene _otheriexplam If tank is metal, Ifs: age _ Is age confirmec b� Cen.fica:e of Compuance _(Yes.-No Dimensions UUb�w Sludge depth kL Distance from top o:ss udge to bottom of outle: tee o, ba`4 -- Scum thickness_�_ ( Distance from top o: scum to top o+ outle: tee or bade g_ ` �) Distance from bonorn of 5curn to bor.o—. ci outle: tee o• bare How dimensions %kere determined Mery )VAA Comments. trecommendauon for pumping condition of inlet and outlet tees or baffles. depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage. etc.i d 10 T T 1 GREASE TRAP:-IJ-0 (locate on site plan: Depth below grade: Material of construction: _concrete _metal Fiberglass _Polyethylene _other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle. Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles• depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.; (reviiod 04/25.17) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Propert,. Address: I Fj3 wCc�v ,'r Owner: Date of Insp" ion: �t$` TIGHT OR HOLDING TANK: 'Tank must be pumped prior to, or at time, of inspection: (locate on site plan, Depth below grade: Material of construction. _concrete _metal _Fiberglass _Polyethylene _other(explain) Dimensions Capacity: gallons Design flog. galions,da, Alarm level Alarm in working order _ Yes: _ No Date of previous pumping Comments. (condition of inlet tee. condition o`alarm and float switches, etc.) DISTRIBUTION BOX: doraze on site plan. Depth of liquid le.e! aoo�e outie: inner Comments: (no e rf level and distnbui,or is eoua'. evidence of solids carryover, evidence of leakage into or out of box, etc.) a— C UDC PUMP CHAMBER: dJC� (locate on site plan. Pumps in working order: (Yes or No' Alarms in working order (Yes or No- Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) I (reviaad 04/25/97) Pagi 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Properi� Address: Owner: Date of Inspection: SOIL ABSORPTION SYSTEM (SAS):_ (locate on site plan, if possible, exca,ation not required, but may be approximated by non-intrusive methodsi If not determined to be present, explain: Type: leaching pits, number._ leaching chambers, number:) leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensjon.s overflow cesspool, number Alternative system Name of Tecnnolog�. Comments: inote condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) CESSPOOLS: _ (locate on site plan Number and configuranon Depth-top of liquid to inlet Inver Depth of solids layer: Depth of scum layer: Dimensions of cesspool. Materials of construction Indication of groundwate- inflow (cesspool must De pumpeC as par, of inspection: 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.) (revised 04/25/97) Page a of 10 a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) PropertN Address: Owner: Nvx�,>� Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reierences landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) pr (AZ_a,, (IT3 -,1.g !33 aS (revised 04!25/51) Page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM M PART C SYSTEM INFORMATION (continued) Property Address: Owner: � c� Date of Inspection: '�19 1 Depth to Groundwater WFeet Please indicate all the methods used to determine High Groundwater Elevation: Obtained irom Design Plans on record Observation of Site (Abutting property, observation hole, basement sump etc.) Determine it from local conditions Cneck with loca! Board o: nearth ChecK FEMA Maos Check pumping records Check loca! exca,ators. installers Use L SCS Da-a r• Describe in your own %%oral nog+ �o-- estabLshed the 1iig� Ground%ater Elevation. (Must be completed: �,S,�loci►c� �,e.�� � mod,ec,���c �N�esT 5 w-�o;N � 6t"�1.t9r-5 -�}.(�. �-�`� (zav:sad 01,'25'5- Page 10 of 10