The URL can be used to link to this page

Home My WebLink About0014 FIDDLERS CIRCLE - Health 14 Fiddlers Circle Hyannis P A = 288 161 --------------------------------------------------------- 4 0 a , LOCA7710N 14 Fiddie2-6 Ci/tcie '- DATE 11/15/03 ------------ �'IAGE HUanniz, Na-6.6. 02601 ASSESSOR'S MAP do LOT -INSPECTOR Zo4p_12h P. Nacomge z ;2. SEPTIC TANK CAPACITY None 1-6 'X8' &lock ce_67poo e. an LEACI1NG FACII.ITY: (rype) 1-1000 gai eon LP 25 ga flon (size) NO.-OF BEDROOMS 3 BUILDER OR OWNER 13. 4-Pe a zd OWNER MAILING ADDRESS . Same I S p 1 3 0 V No. y FEE _ COMMONWEALTH OF MASSAC14USETTS Board of Health,&a J 4.4ble, MA. APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandony) -)(Complete System 0 Individual Components Location L/ A.'r Owner's Name y i-)) J �M Map/Parcel# Da / Address / To,Jn )�70 aolj5an& Lot# Telephone# 5 —, 93 -°06 �7 Installer's Name Js w�f AAnn Designer's Name 1� 3 -. e� Address � - 1 jvk,, Jul� Address Z Telephone# 4eS 3 S Telephone# 5(1? 617 Type of Building )A n o , Lot Size /0 sq.ft. Dwelling-No.of Bedrooms Garbage grinder ( ) Other-Type of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures Design Flow(min.required) �� gpd Calculated design flow Design flow provided gpd Plan: Date flz—WI�C Number of sheets f Revision Date Title � /J 14A) Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS /S ` - 1 -W r t! The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further a e to no o plac stem in operation until a Certificate of Co p'an, has been issued by the Board of Health. Signed Date Inspections y ' L ' , "F •' ,..:.y,v j�M ±.•+4fY 'tt_ rY... p' `+4a�� ..� wrry+ w•cw-'y-,'a .k�i i,. .• .�.w*::A-tim '«.r"rw'a u-:a-•�-•-`� �% a/ FEE COMMON LT14 Of MASSA US ETTSIe -4b'Board of Health,� �a�• �'�` , MA. x. FOP, ISPOSAL-SYSTEM CONSTRUCTION PERMIT Application for a Pe ni.A6onstructO Repair( )',Upgrad6( Abandon` ,- Complete System O,Individual Components' • Location_ -. /� (` 1 C` Owner s Name pp f / Map/Parcel# ;Z ag • 6 F / x Address I .' Q�i? ,: (�(/£X Lot# : :—>.' Telephone# Sl/d 9 53. ®r3PQ Installer's Name fQ s t S � �� Designer's Name av ( (1 r1 l✓)C- Address j� ~ ` Address 1 Telephone#, _48 773 Telephone#, C7cX5 .J�—llCil' Type of Building, �(-Vo n ., Lot Size. �V,;�� - sq.ft. CCC , Dwelling-No:of Bedrooms, \ 1Jr r. t ,� /. n I t t ,_,f 0 Garbage grinder ( ) OtherT Type of Building # F f I IT p " - No of ersons Shiers OCafeteria ( ) is _E, ¢, <_ -- „ Other Fixtures ` Design Flow (mini.required) gpd Calculated design flow Design:flow provided gpd Plan: Date {'Z - `f Number of sheets ( Revision Date Title Zkwe r <ZC/3_l A- CQAd (' �)0, .:"AgN Description of Soil(s) .,Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation DESCRIPTION OF REPAIRS OR TERATIONS ) - S . 1 \' 1s V SO. � f. rl✓, v rE?f :G `t l � t t n � =. J f ✓1> CSC ' • k 'fib, 1 The undersigned ag ee�nstall the aboveldescribedIndividual Sewage Disposal System in accordance with the provisions of TITLE 5 and further,agr to noott tto place e_system-in operation until a Certificate off Co,inpli ` `: (has been issued by the Board of Health. "§ Signed . . lid .--�' DDate Inspections N No. COMMONWEALT14 Of MASSAC14US ETTS ' b, 4�f . Board of Health, CERTIFICATE OF COMPLIANCE , Description of Work:, ❑Individual Component(s) ❑Complete System �),Aba.�d..ed The undersigned hereby certify that the Sewage Disposal System; Constructed O Repaired ( ) Upgraded{ � n y4 r / ! x at �-� le"Al - r rL ,f � - . h s been installed nn"accordance with the provision of 310 CMR 15.00 ( �i-tle 5) and they approved desngn�"plans/as=built plans relating to y application IVo.�" 3 'datedt ! ,� App\r rove Des gn Flow` t� /� - (gpd) / Installer Designer: Inspector: l / d cng._ d l Date: The issuance of this permitshall�not be construed as a guaran`tee.that the system will function as d:aigned: No. d y 7 ( FEE —2- t; Board of Health, Permission is hereby�gir(a!/d�te to; Construct( ) Repair(,_)` pgrade( Abandon( . )ar iridividual sewage disposal system at �7/ `� K i� C Q / as described in the application for Disposal System Construction Permit No. d l (dated Provided: Construction shall be completed within three years of"the date,of this perr it: :All to hl conditions must be met. z. Form 1255 Rev.5/96.A A.M.Sulkm.Co.Boston,MA Date x"tt Board of Health f I PROPOSED 4'SHC-40 PVC BUILDING SEWER CLEANOUT AT CONNECTION MADE TO EXISTING SEPTIC SYS. PIPE, IN ACCORDANCE WITH BARNSTABLE SEWER DEPT. SPECIFICATIONS. __- ANA DONEED� OL TO BE PUMPED E 10IN- ORDANCE WI HMPTY TITLE AND BOH REGULATIONS. BUIDLING SEWER 1 20.o PIPE TO BE CUT AND CIQPPED WHEN SEWER CONNNECTION IS MADE.. HED XISTING \ BUILDING SEWER ROPOSED 4'SHC-40 PVC BUILDING SEWER, L=36', \ \ S=0.035 FT/FT 2�C EXISTING INVERT=19.25 t , XISTING 1,000 GAL LEACHING PIT TO BE ABANDONED PER TITLE 5 AND BOH REGULATIONS -rt d 14 FIDDLERS t XISTING CIRCLE 18' DIA OAK TREE EST -�} G , ROPOSED CLEANOUT, INVERT=19.Ot V) ROPOSED 4'SHC-40 PVC (� v 'BUILDING SEWER, L=20', CONNECT TO EXIST, SERV CE �� S=0.024 FT/FT CONNECTION (INVERT=17.52 t) c r PER DPW REQUIREMEN S AP #68/2 IT1 \ �� 21,30 p FIB D- RS s \ S 6' DIA, SERVI ,,,,__ S LATERAL (TYP,) \ �'y PVC SEWER \ _ _(TYP,) _ TM GENERAL CONSTRUCTION NOTES 1.3T CTOWOTOFIDULLONTFAW"DDSAFAW m A 7..,nXOUft$WSOR70ANY eD'AVAIDNAIDDRSIR9NFACE � IESTNOTOWSORYTEVIIUiYCdPMOFBOFANYeTAVA710N. i 2 PLLCONSTRUCTIORABMODHANDTMTM4"ASWELLASAUVAIUJ&DATANWIBENACCORWnW17HTf MMGF . *C SOMM MAmOff OFMlcYIDiBCBa®BeMDOARMWTP10.E AMFEiAATM S nEBAMSEWERQEP MAWSMfMLA ERALCOWeMMASBWOWNDNMISMVMBHALLBECONSMt WM A7TTEOFSDNBNAZMMDNSMIWAOWRDMMWRHTE7 MW,&RMREAEMSOFTETOWNOFBARNSMn � A�^E� �eqA�'� 9ESNNIa MAUATOMS CAMIWBUUMSEWERCM(Ef.TIONSLWREVSMWNI MI.jNVF" ' A,TMWMGDESSPOO NMMAC"PRSHNLBEABNOONAOWRDMMWIMTHEFRW MOFWU5.rrEMN -'YVB OFBV WANEBOAMOFIE TH EOIAATR7NBNIDDEPJ9IEDBEPMSYWMA811CMWPERW FMTOSPRDPEM MORMBREAMAWFIMOMECE3WOMAW EIONNPR.TEWASTE9N=WAMBEKWWMARNIOJFDBYA Wil i/Ai L UCENSWWTAM IWMMDD OFATANAP ROKOFACM RW9"OFRNWWDSWALLBENIOWOEDTOTE OWENAIGBW FNE RDONM cmS MECMURACM NYVL PROWADGI PROP8tMFRWONSnC=FRUCFIWTPCINRESAF✓FSMAW VN� BFDDEMTORD®Po90EP09REDTfREWT BW�URELY. ft4 7.MECOtRWW1gi8N41.PP0'VIDENL8IFEIYEOIIREfONECFSBMYTONVNTANAS1iE WOPI{SREN n ACCCFWNQWRNA➢PUUNERE(WUTIMFRONTWETOWFASTATEN®OSWA MMUCAVATOMALLBEMOMIN + V� ACDOWANCEMN SEPR®AS PARTOF ME SEWER I V CONNIECRRIAPPUCATMTOTETOWW 4 MEAMTBWHSMDCMTMVMOFALLPROPOSODUTME UALLCONFORTFTOTWENAS&OLPW.STANDARMANO IQ Al l'ATMLA7EBTENHON.ASWULAS3iOCMf5MDMESSTATED POM WALCODE,GMDaMFORTTEDEOION• CM MICTDFLOPERATTONANDMMNTSWDEOFMM WASTEWATERTRFATMENTFACDOESWOHTMDNSPMSAT.ATDTE LOCAL BDWDOF WA TH MMADREWLArM. &TECONTRACTOR M WLBERESPONOMFmiDtl1BGTNTOFASBULTNPORTMTON,WDU DNGSWNMTIESANDBEVAT40 q, TOBEUSEDINFREPARATRNOFMASBUILTOFTTESEWERCOIWECRON_ M W OONT ACTOR 63 PROVW ADVAILTD NDTRE ON THE COT$MUCTDN SD*UU M ME SEWM DBVRDIBO ND B0ND0FIEALMSOPROP MPECnMGANSEARPATDFDNTDMEWORNCMPROWONAOMM=WkWM 4 ONSITE SEWER SYSTEM FIGURE NO. 1 ENGINEERING ! CONNECTION PLAN Project No..2014-12 Water,Wastewater and stormwaterspeciunaM 14 Fiddlers Circle Date: December 2014 Scale: 1"=30' 279 East Central Street 508-553-0616 FranMin,MA02038 WWW.0n8ft"ng.0DM Hyannis, Massachusetts w r �,� l./ — FEE COMMONWNo. EA ., . Board of Health, �T T MA. - - DISPOSAL SYSHl�[ CONSTRUE Permission is hereby gja ed to; Cgnstruct( ) Repair pgrade Abandon( ividual sewage disposal system at Z as described in the application for Disposal System Construction Permit No. l `Y dated Provided: Construction shall be completed within three years of the date ofj 4pe t. All to 1 conditions must be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date f13oard of Health 1 .rr-r�- .-r.-+rr.'nmis-�r•:z+r.rr..r.:•.r-r�rr:-rr-r•�•-:m-tip.:+rcv-rrr rrn .. � .. .t�rrrr-r.—r-..- ..- ��^' 'I'OWN OF [gc t 4u& WARD OF IIE,A-LLTII _ 6 ��1°`'►P Sl1f1Sl1RFACR SEWAGE f)dSfUSAL SYSTEM INSI'FCTION FORM - �PART�D -QVI1'IF1Ch ilON ..•—....T......., —�.IIT.•'.CT.T..�n.•O.YSI 1•{TT.LSTi RZT19'.r'".'1 TITrtZ Ti'tCl—'n"�7tIT�T�Ta - mrtn•.mr�rramrmrrtn.•.—rrr'r•�• -..^ -TYPZ OR PRINT CLEARLY- DEC 2 2003 PROPERTY INSPECTED _ TP`V%t,Ur SkRNSTABLE STREET ADDRESS 14 Fiddeert� C-i2cee 11yarzn-i'6' Nazz. 02601HEAtTHDEPT. ASSESSORS MAP , BLOCK AND PARCEL # oC �Pj OWNER' s NAME B. 4.9.9alLdl IWAR PART D - CERTIFICATION PARCEL ; NAME OF INSPECTOR Joseph P. Macomber Jr LOX COMPANY NAME Joseph P. Macomber &ton Inc COMPANY ADDRESS Box 66 Centerville Mass 02632 Street Town or City Stat• lIP COMPANY TELEPHONE ( 508 ) 775-33.38 FAX ( 508 ) 790-1.578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposaLl system at this address and that the information reported is true , accurate , and omplete as of the time of .- inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . • n i I I ':.i 1. Check one ; System PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or, the environment as defined in 310 CMR 16 . 303 , Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED* \ The inspection which I have con' `reted has found that the system fails to protect the j)ublic health and the environment in accordance with Title 5 , .3.10 CMR 15 , 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection. form . Inspector Signature Date _ e C ne copy of this��c.ification must be provided to the OWNER , the BUYER where applicable ) and the 130ARD OF HEALTH : * I � the inspection FAILED , the owner or "operator shall upgrade ' the aye tem wit:tiin one year of the carte of the inspection , unless allowed or required otherwise as provided in 3.10 CHR 16 , 305 : partd . doc Page I I of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued). Property Address: 14 77.idd.ee/t,6 C.i2e.ee yannzz' Owner: B. A e east Date of lospectioo: 11115103 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate (check) all methods used to determine the high ground water elevation: NO Obtained from system design plans on record • If checked, date of design plan reviewed: NA YFSObserved site (abuning property/observation hole within 150 feet of SAS) No Checked with local Board of Health-explain: NA _ -Checked with local excavators, installers- (attach documentation) Accessed USGSdatabase•ezplain: ht.tp.Il.town. gaznz.taPx-ee. mu. u.6. You must describe how you established the high round water elevation: LLzed. Cah2e.t & (7.i.e:ee2 Node.e. 121161 4 G/zound wate2 e.eeva.t.ionz move sea -eeve.e. U.6ed: CISgS:O9ee2va.t.ion we.e-e data. Junz 7992 11,6ed: USGS •TPahn.iaa.P lu.Pigt—i.n 92 000 1 P.ea.te #2 Aiznuai ltange.6 01Pg2oun ,,,nfon v..AP»nf,inn� Leaching Pit ; ect e Groundwatcr:!O cct Below Bottom of Pit High Groundwater Adjustment 1.8 ft per Fri.mpter Method I hercfore, the vertical. separation distance between the bottom Of the leaching pit and the adjusted groundwater table is feet. ,-- II Page 10 of I I OFFICIAL. INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) PropertyXddress:B' Ai-ea2d Owoer8.1/anniz, Pla,3e. 02601 �,.• Date of Inspectioo: 1 1/15103 SKETCH OF SEWAGE DISPOSAL SYSTEM Providc 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. 10 Page 9 of 1 I -OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 14 7-iddie2z C-i/tcie yann.i,., Na�s s. 02607 Owner/3. 4i,ea/td Date of Inspection: 11 1�/0 3 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, excavation not required) /he .6eG1(LCjQ�/3U,3tPm .iA Jn ,nnn,non )innk n n ado a a-A j 4 Q 'Q4Q A a Q � If SAS not located explain why: Loco P r/ • See pritge 9 Q Type leaching pits, number: leaching chambers, number:12 leaching galleries,number: 0 t Q leaching trenches,number, length: ��ej leaching fields,number, dimensions: Z) overflow cesspool, number: /VU 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.): Loamy nand to PoneU 4,.nP Aarzd No AJgn.s n.4 hyr/nn,i0ic 4CLi Cl/40 nn a nding. So-iL,3 ate d2y VegP aL1oa L6 anama CESSPOOLI$: -t.11—(cesspool must be pumped as part of inspect ion)(]ocate on site plan) Number and configuration: / Depth-top of liquid to inlet invert: Depth of solids layer: r' Depth of scum laver: 46 Dimensions of cesspool: �— `n f� Materials of construction: � �eZK s�/r Indication of groundwater inflow(yes or no):, Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): Same i.6 nPot)P PRIVY/4&k locate on site plan) Materials of construction: - Dimensions: .i1,4 Depth of solids:4221 Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): P aiUu i'� not �2e,52n 9 Page 8 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 14 7.l.ddie zz C.i2cie yann.c,3, a 2601 Owner: B. R.tea Td Date of Inspection: 1 1/15/0 3 TIGHT or HOLDING TANK &.(tank must be pumped at time of inspect ion)(locate on site plan) Depth below grade: WA Material of construction: A10 concrete A/Xmetal !&�berglass & polyethylene4�Lother(explain): Dimensions: ItM Capacity: ',W gallons Design Flow: gallons/day_ Alarm present(yes or no):.Kf .Alarm level: t)h_ Alarm in working order(yes or no):,0,4 Date of last pumping: AI Comments(condition of alarm and float switches, etc.): Zi9r�f �� hn0din y irink,3 ate noit j2,,ze.6eni DISTRIBUTION BO (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover, any evidence of leakage into or our of box, etc.): DI. AIRIffal_iOn PDX .ins nOi P2eZen PUMP CHAMBER4A '(locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): /!1� Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Pam.p chamge z .i'3 n04 plze�en . 8 I Page 7ofII OFFICIAL INSPECTION-FORM.-NOT FOR VOLUNTARY ASSESSMENTS SUBSU"RFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 14 f.idd Pe2z C.i2e Pe Ryann,776, 77776. Owner: 13.. A.P Pat" Date of Iespectiom' 11/1103 BUILDING SEWER(locate on site plan) _,�t�>I Depth below grade: e wieght l VC pIi/Ze 4Q // �.L.it�.i:tt.ingh. Materials o:f conswiction: cast iron 40 PVC �othcr(explain) Distance from private water supply well or sucilon line: �L- Comments(on condition of joints,ventins, evidence of leakage,etc.): o.intz appgaatight. No evidence .oe,..Pgaka!�e. The 3y'3tem .iz ventecl .thrzough the zoos ventz. SEPTIC TAN (locate on site plan) DVth below grade: _4 Material orconstrvction: concrcic f)hmetalVAf AP bcrglass olycthylene '#othcr(cxplain) irw*ismcuiijst.4&c, .0 is age confirmed by a Certificate of Compliance(yes or no)AIA(attach a copy of ccrtificue) Dimensions: Sludgc depth, Distance from top or sludge to bottom of outlet tee or baffle:"' Scwn thickness: Distance from top of scum to top of outlet tee or baffle: 7- Distance from bonom.of scum to bottom of outlet tee or.baffle:_Ahl How were dimensions determined: Comments.(on pumping recommendations, inlet and outlet tee or baffle conditio.n,:structural integrity, liquid levels as related to outlet invert,cv.idcnce:of.leakage,etc): Se/?t.ic ..tank i.6- not �ezent dump :the .-m.a.in -ce,3�.Roo e eve.'z J_ 3 yrorjaA CeAApao, dA A Ia.j4r'lu•aa.PP 4 36Aa l as ii6 .the Leaching R.it. GREASE TRA Ilocatc on site plan9 r' ; Depth below grade: Wd Material of consavction: aconcrete�i¢mctaL),e fiberglass& .olyethylent fRother (explain): Dimensions: Scum thickness; Distance from top of scum to top of outlet fee yr baffle: ? Distance from bottom of scum to bottom of outlet tee or baffler rW . Date of last pumping: V11 Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structwal integrity, liquid levels as related to outlet invert, evidence of leakage,ete;): C/tea.6e .t/taR -iz .not i22ehen.t. 7 I Page 6 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C l SYSTEM INFORMATION Property Address: 14 F.tddierz.3 C.i/zcie Owt)er: B. Aeialtcz Date of Inspection: FLOW CONDITIONS ,... R.ESIDENTLAL Number of bedrooms(designs): Number of bedrooms(actual): 1 DESIGN now based on 310 CMR 15.203 (for example: 110 gpd x M of bedrooms): 04M Number of current residents: _at_ Does residence have a garbage grinder(yes or no):otV Is laundry on a separate sewage system ( cs or no) (if yes separate inspection required) Laundry system inspected (yes or no):A Seasonal use: (yes or no): Water meter readings, if available (last 2 years usage (gpd)): 2002=6 6, 000 ya.e.eonz=180. 83 C%D Sump pump(ycs or no): 2003=2 tip ya.e eon.a=57. 54 G%D Last date of occupancy: COMM ERCIAULNDUSTRIAL Type of esublisbmen►: Design now(based on 310 CMR 15.203): ,QA- gpd Basis of design now(seats/penons/sgft,ete.): Grcase trap present (yes or no): Indusrrial waste holding tank present (yes or no): Non sanitary waste discharged to the Title 5 system (yes or no): ) Water meter readings, i(available: Im Last date of occupancy/use. OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: !um/2ed ,cezz/?ooi at .t-ime o,R .in,3/2ec.t ion. was system pumped as pan of the inspcction(yes or no): If yes, volume pumped: gallons — How was quantity pumped determined? ��.�/r✓.® Reason (or pumping:/ieavu 3eum 9 3o e-idz ea(de2-6 weae 2 2ezen.t. Checked /o2 z.t2uctu/za.e condi.t.ion. TYPE OF SYSTEM Septic tank distribution box, soil absorption system J Single cesspool Ovcrflow-errfpeel �( Privy ,Q0Sharcd system (yes or no)(if yes, attach previous Inspection records, if any) do InnovativcJAlternative technology. Atuch a copy of the current operation and maintenance contract (to be obtained from system owner) dUO Tight tank /A0 Atucb a copy of the DEP approval Other(describe): XW Appr ximate ate of all components, date' stallgd (If knowry� and source of information: Were sewage odors detected when arriving at the site (yes or no):,4-1� 6 u Page 5of11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:14 F.eddte2,3 C.iAcie uann.iz, ah,s. Owner: 13• A i ga/zd Date of Inspection: i l/15/6 3 Check if the followinp,have been done.You must indicate`. s"or no as to each of the following: Yes No/' _ o/ 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 9. — Has the system received normal flows in the previous two week per ? Have large volumes of water been introduced to the system recently or as part of this inspection? _ Z Were as built plans of the system obtained and examined?(If they were not available-note as N/A) Was the facility or dwelling inspected for signs of sewage back up Was the site inspected-for signs of break out? Were all system components, ' eluding 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 Z 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 r/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 4 of 1 I OFFICIAL INSPECTION FORM —NOT.FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A ' CERTIFICATION (continued) Property Address: 14 T-idd-ee2z Ci/zcie H4 ann.iz, 1Pa,,6. 02601 Owner/3. 4ZZa2 r... Date of Inspection: 11115103 D. System Failure Criteria applicable to all systems: You must indicate "yes"or"no" to each of the following for allinspections: Yes No/ e�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 __g,lh k 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 'h•day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped I 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 j are triggered. A copy of the analysis must be attached to this forma /VB (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"yes"or"no" to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no .-/the system is within 400 feet of a surface drinking water supply P//the system is within 200 feet of a,tributary to a surface drinking water supply vthe system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—TWA)or a mapped Zone 11 of a public water supply well "il 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. 4 rage..) oI I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 14 F iddeeizz C-iae ee Hoann.iz, a7z. Owner: B. �i� Date of lospectioo: C. Further Evalua(ion is Required by the Board of Health: t)@ 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. I. System will pass unless Board of Health determines in accordance with 310 CMR 15,303(I)(b) that the system is not functioning in a manner which will protect public hea.ith,safety and the environment: A/0 Cesspool or privy is within 50 feet of a surface water Ke Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health,safety and environment: t✓6 The system has a se` t' and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply.or Tributary to a surface water supply. �Q The system has a se tic and SAS and the SAS is within a Zone I of a public water supply. Vil The system has a septicla& and SAS and the SAS is within 50 feet of a private water supply well. 0 The system has a ;,gp t' , and SAS and the SAS is less than 100 feet bu 50 feet or more from a private water supply well''. Method used to determine distance 'This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria arc triggered. A copy of the analysis must be attached to this form. 3. Other 7h.i,6 .is a Sewage zy.6tem. 7he zewage zybtem conziztz o� I-6 'X8' 9. P.nnk ces.6Roo.e w.i t ha 7 U U 0 ga rj A_n n QVea-""eow. Wazhzng mac .t.n *�e�-t��--�A Z T t i�, u ncl e conciceted a2ea.. L),i no oca e, IL i19 - -1 jr,rrhJn�_! machine .into the main hewa.ge. ,-3y3tem.: 3 Page 2 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A ' CERTIFICATION (continued) Property Address: 14 'T idd ee2.6 Ci/l cie yarzaiz, a,3.6. Owner: /3. 4i ea d Date of Inspection: 11115103 Inspection Summary: Check A,B,C,D or E/ALWAY§complete all of Section D A. System Pusses: 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: ho . pmrigo Ay,s.t_n_n .ins .in p/zo/2e2 . woltk.ing oadea a.t the--��-4.e.rat Erna The n1>on40n1A Pvor ,g .12.i.t .iz /?2e,6en.tiy d1ty. B, System Conditionally Passes: ,V6 One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined (Y,N,ND) in the for the following statements. If"not determined"please explain. Aladov. 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 PP Y s tic tank as approved b the Board of Health. •A metal sepric 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. ND explain: V&I& 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 obstruction is removed distribution box is leveled or replaced ND explain: ,V61 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: 2 ,per �•\ COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFIC.E 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 Fidclieaz C.i2 cie yann.iz, Nazz. Owner's Name: B. 4,e ea�zd Owner's Address: S cL m P Date of Inspection: 111151.03 Name of Inspector: (please print)Jo,seR/z %. Nacom6,e�z aa. Company Name: I. ?. 8 comge2 & Son Inc. Malling Address: t3o x 06 ( onfoolf/ iUa 4z 1 -02632 Telephone Number: 5 0 8=7 7 5— 3'3 3 R CERTIFICATION STATEMENT 1 certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed,based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system Inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ; passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: r Date: The system inspector shallfbmit"a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner.shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments ""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 f DATE : Z1115103 --- PROPERTY AOORESS 14_;'-iddie2,3 Cizcie J f �flb/1----------- --��- ------------------ On the above date, I inspected the septic systern—at the above address. Tnis system consists of the foll.owing: 1-6 'X8' &.dock ce-s,sizoo.Q. .'. 1- 1000 ga""eon Paecazt ieach.ing 12.i.t, ldazh.ing, machine goez to SAS that .iz cone?etd a2ea. Baseeo on my inspection, I certify the following conditions: 7hiz .is not a LiUe ,give ze/2t.ic zyztem. 7h.iz .is a sewage zyztem. The zewage zyztem iz in /2aoi2e c wo2k.ing o zde2 at the. /22ezernt t.ime. . Puml2ed main eezzlQooi at time o,,P .inns/2ect.ion. 7he ceps.3/200-e .is ztAuctaAaiey zound The eeach.ing /2 it .i,6 /?2ezent ey d zy. C Bean nand .i s v-iz.i ee on the Bottom. No Zta.inz iirze. (lave Zuggezted that the wazh.ing machine d.i.3 hat e 9e, tied .into the main �y�5tem. %2e�ent Qy undea conc2et ed a2ea. S I G N AT U R 'Fame ompany : J45QPh -P_ M.499Tk Pr d_ Son, Inc . ----- - --- -- Ce:.nje YL UP—- �ja - _2Z632-0066 P^one : _ _508 . 775_ TmiS CERTIFICATION OOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P. MACOMBER & SON, INC. Tanhs-Cesspooh-Le�chltelds Pumped & Installed Town Sewer Connections P 0 Box 66 Centerville. MA 0263?-0066 775.3338 775.6412 i Qlf -4 Town of Barnstable Barn .� Regulatory Services Department AFAmerleaC j EARNSTABM MAS& Public Health Division . 200 Main Street, Hyannis Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7012-1010-0000-2848 -0189 March 28, 2013 DAVID & SONJA FORMATO 13 TOWNLINE RD IMPORTANT NOTICE FRANKLIN, MA 02038 Map & Parcel: 288- 161 The Department of Public Works informed us that public sewer lines are now available in your neighborhood. According to our records, your property has a septic system. This letter directs you to connect your dwelling, at 14 Fiddlers Circle, Hyannis, MA, to public sewer on or before 3/30/2015. The old septic system must be either removed or filled in due to future safety concerns. This may be done by the same contractor who connects you to the sewer. Septic Abandonment Permits ($ 25) are issued at the Public Health Division, 200 Main Street, Hyannis. Failure to comply with this Board of Health Order may result in a complaint against you, in a court of law. For additional information pertaining to the sewer connection, please see the reverse side of this page. PER ORDER OF THE BO RD OF HEALTH Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health Cc: Barbara Childs, WPC/Roger Parsons, Town Engineering, DPW Enc. QASEWER connect\Letters Stewart Creek Sewer Connects\MAILING LetA Sewer 2Pgs Merged 3-28-13 Yr2015.doc Public Health Division March 28, 2013 ADDITIONAL INFORMATION AND REMINDERS FROM OTHER DIVISIONS: SAVINGS AVAILABLE/GRINDER PUMP: A reminder to those of you who need a grinder pump for your connection: Department of Public Works (DPW) sent you a letter in December 2012 stating the town, for a limited time of two years, only from the receipt of the DPW letter, would provide you with the pump at no charge. (This can save you thousands of dollars.) Please note: You must pay the installation cost through your own contractor. Please make your contractor aware of this, if interested. Also be aware: this is a shorter deadline than the Public Health Division's deadline on the reverse side of this page. SAVINGS AVAILABLE/PERMIT FEE: The Town offers a waiver of the residential sewer connection fee of $420.00 for those properties that connect within two years of the receipt of the DPW December 2012 letter. LOANS: For loan(s) available, please see the enclosed brochure, or see the town website: http://www.town.barnstable.ma.us/cdb (under the "CDBG Programs", see "Sewer Connection Loan Program). For loan specific questions, you may contact Kathleen Girouard, Growth Management, at 508-862-4702. CONTRACTORS: Information on Licensed Sewer Installers is available on our web site at www.town.barnstable.ma.us/PublicWorksTec1Vsewerinstal le is. Contractors, approved to perform sewer connection work in the Town of Barnstable must obtain and file a Sewer Connection Permit with DPW-Water Pollution Control Division, 617 Bearse's Way, Hyannis—contractors, please call Dave Anderson at (508) 790-6244. FOR ANY QUESTIONS /ASSISTANCE: Len Gobeil at the Town Manager's Office is available to provide you with direction you may need in reference to the Stewart Creek Sewer Connections. You may contact him at 508-862-4701. QASEWER connect\Letters Stewart Creek Sewer Connects WL.ING L.etA Sewer 2Pgs Merged 3-28-13 Yr2015.doc