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HomeMy WebLinkAbout0070 FIDDLERS CIRCLE - Health 70 FIDDLERS CIRCLE, HYANNIS A = i I 4 i f \ Town ®f Barnstable Barnstable � Regulatory Services Department ;edcac j snxivsraet.E, 9 ,�� Public Health Division m 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard Scali,Interim Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7012 1010 0000 2851 1302 January 13, 2014 I! David L.& Patricia A. Donavon 70 Fiddlers Circle IMPORTANT NOTICE Hyannis, MA 02601 Map &z Parcel 288-164 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 70 Fiddlers Circle, Hyannis, MA, to • public sewer on or before 10/30/2019. 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 enclosure PER ER OF THE OARD OF HEALTH o a McKean, R.S., O. Agent of the Board of Health • Cc: Barbara Childs, WPC/Roger Parsons, Town Engineering, DPW Enc. Q:\SEWER connect\Sample order letters for sewer connection\70 Fiddlers Cir Hy Jan 2014.doc Parcel Detail http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=21914 r 'USSEY�ttts 6,OLiLE�1 , e� r,� f - Y Logged In As: _ Parcel Detail Monday, January 13 2014 Parcel Lookup Parcel Info _ ...... _..... ... __ ...... Parcel 288-164 Developer LOT 26 ID Lot Location 170 FIDDLERS CIRCLE ) Frontage 189 # Sec('_—._ I Sec Road Frontage ___ _ Fire —" Village[HYANNIS JHYANNIS District Town sewer exists at this _ _ Road address Yes — _ �� Index 0532 Asbuilt Septic Scan: Interactive � ��� x z . 288164 1 Map 31.el Owner Info Owner IDONO NAVE, DAVID L& PATRICIA A I Co- —� Owner Streetl r185 MECHANIC ST Street2 i City I FOXBORO ��� State MA Zip 02035 Country Land Info _ Acres F0.23 Use ISingle Fam MDL-01 Zoning RB N`J Nghbd j0106 Topography Road I Utilities -� Location Construction Info Building 1 of 1 Year 1965 Roof Gable/Hi Ext Wood Shingle Built F ^ �I Struct p Wall g Living�1400 Roof Asph/F GIs/Cmp AC None Area cover m ( Type a Int "—��" Bed �i "S s. Style; ch Wall Drywall -� Rooms 1' Bedrooms AL Int, Bath Model!Residential Floor lCarpet Rooms1 Full �- _._ Heat! . ____ _. Total r—_. _ __ sns* A Grade!Average Plus ( Type,HotAir Roomsl6 Rooms Bck FOP Stories;1 Story Heat Gas I Found-[Conc. lo Fuel ation Gross http://issgl2/intranet/propdata/ParcelDetail.aspx?ID-21914 1/13/2014 COMMONWEALTH OF MASSACHUSETTS f EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS d DEPARTMENT OF ENVIRONMENTAL PROTECTION d'9M gJe" i ET /\ 350 MAIN STR, ♦�`� WEST YARMOUTH,MA 508-775-2800 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION MAP 288—PARC 164 Property Address: 70 FIDDLERS CIRCLE HYANNIS PORT,MA 02646 '�W Owner's Name: AMARAL,PAUL - Owner's Address: 70 FIDDLERS CIRCLE _ +; HYANNIS PORT,MA 02646 <t Date of Inspection JANUARY 3,2006 Name of Inspector:(please prim) JAMES D. SEARS Company Name: A&1.3 Canco N) Mailing Address: 350:Main Street West Yarmouth,MA 02673 � Telephone Number: 508-775-2800 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 inspectior:.was performed based on my training and experience in the paper hmction 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: X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority ---- Fans Inspector's Signature: ' Date: 1-6-06 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 ,.vstem owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to tl,e system owner and copies sent tot he buyer,if G t;p1'icable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under,,he 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 6/15,11.000 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 70 FIDDLERS CIRCLE HYANNIS PORT,MA 02646 _ Owner: AMARAL.PAULO Date of Inspection: . JANUARY 3,2006 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CUR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: N/A 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. I he 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 muninent. System will pass inspection if the existing tank is replaced with 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. ND explain: 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 brckcn,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 replac(1;J 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: Title 5 Inspection Form 6/15/2000 2 a , Page 3 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 70 FIDDLERS CIRCLE HYANNIS PORT,MA-02646 Owner: AMARAL,PAULO Date of Inspection: JANU ARY 3, 2006 C. Further Evaluation is Required by the Board of Health:N/A Conditions exist which require further evaluation by the Board of Health in order to determine if the system is_ failing to protect public health,safety,or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health safety and the environment: Cesspool or priv,, is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or 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. ;rhe system has a septic tank and SAS and the SAS is within a Zone 1 of 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 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. 3. Other: Title 5 Inspection Form 6/15/2000 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 70 FIDDLERS CIRCLE HYANNIS PORT,MA 02646 Owner: AMARAL,PAULO Date of Inspection: JANUARY 3, 2006 D. 'System Failure Criteria applicable to all systems: N/A You must indicate"yes" or"no"to each of the following for all inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due:to an overloaded or clogged SAS or cesspool X Liquid depth in leaching is less than 6"below invert or available volume is less than%day flow X Required pumping more than 4 tunes in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped X Any portion of the SAS,cesspool or privy is below high ground water elevation N/A Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply N/A Any portion of a cesspool or privy is within a Zone I of a public well N/A 'Any portion of a cesspool or privy is within 50 feet of a private water supply well N/A 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 or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.) NO (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 31.0 CNIR 15.303.therefore the system fails. The system owner should contact the Board of Health to detennine what will be necessary to correct the failure. E. Large Systems: NIA To be considered a large system the system must service 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 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 11 of r. i .hlic 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 is 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 CNIR 15.304. The system owner should contact the appropriate regional office of the Department. Title 5 Inspection Form 6/15!2000 4 i Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY•ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:) 70 FIDDLERS CIRCLE HYANNIS PORT,MA 02646 Owner: AMARAL,PAULO Date of Inspection: JANLJARY 3, 2006 Check if the following have been done. You must indicate"yes" or"no"as to each of the`following Yes No X Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks? X Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recentiy'or as part of this inspection? X Were as built plans of the system obtained and examined?(If they were not available note as N/A) X Was the facility or dwelling inspected for signs of sewage back up? X Was the site inspected for signs of break out? X Were all system components,including the SAS,located on site?- X Were the septic tank itra.-,�oles uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of constriction,dimensions,depth of liquid,depth of sludge and depth of scum X 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)has been detennined based on: Yes No X Existing information. For example,a plan at the Board of Health. X Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 C.MR 15.302(3Xb)] 1 Title 5 Inspection Form 6/15/2000 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM , PART C SYSTEM INFORMATION Property Address: 70 FIDDLERS CIRCLE HYANNIS PORT,MA 02646 _ Owner: AMARAL,PAULO Date of Inspection: JANUARY 3, 2006 FLOW CONDITIONS RESIDENTIAL X Number of Bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms: 330 Number of current residents: 2 ?�Does residence have a garbage grinder(yes or no): YES Is laundry on a separate sewage system(yes or no): NO [if yes separate inslr ction required] Laundry system inspected(yes or no): YES) Seasonal use(yes or no): NO Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no) NO Last date of occupancy: PRESENT C OMMERCIALANDUSTRIAL 'Type of establishment: Design flow(based on 310 CMR 15.203): Basis of design flow(seats/perso:±�isgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary.waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: N/A _ Was system pumped as part of the inspection(yes or no): NO If yes;volume pumped: gallon's—How was quantity pumped det(, nined? Reason for pumping: TYPE OF SYSTEM X 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) hmovative/Alternative teclulology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) 'Tight tank Attach copy of the DEP approval Other(describe): Approximate age of all component,,.,date installed(if known)and source of in?ormation: 1999 PERMIT#99-583 Were sewage odors detected when arriving at the site(yes or no): NO Title 5 Inspection Form 6/15/2000 6 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 70 FIDDLERS CIRCLE HYANNIS PORT.MA 02646 Owner: AMARAL,PAULO Date of Inspection: JANUARY 3, 2006 BUILDING SEWER(locati on site plan): X Depth below grade: 1' Materials of construction: Cast iron X 40 PVC _ other(explain) Distance from private water supply well or suction line: Continents(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK(locate onsite plan): X Depth below grade: 14" Material of construction: X concrete metal fiberglass polyethylene other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1500-GALLON PRE CAST Sludge depth: 6" Distance from top of sludge to the bottom of outlet tee or baffle:- 24" Setup thickness: 3" Distance from top of scum to top of outlet-tee or baffle: 8" Distance from bottom of scum to bottom of outlet tee or baffle: 15" How were dimensions determined: ASl3UILT&TAPE Continents(on pumping reconwnendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): TANK AT WORKING LEVEL,TANK&COVERS AT 14". INLET TEE—OUTLET TEE. NO SIGN OF LEAKAGE OR OVER LOADING. GREASE TRAP(located on site plan) N/A Depth below grade: Material of construction: a.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: Conunents(on pumping reconunendations,inlet and outlet tee or baffle condition, ;tructural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Title 5 Inspection Form 6/15/2000 7 I Page 8 of 11 • OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 70 FIDDLERS CIRCLE 14YANNIS PORT.MA 02646 Owner: AMARAL,PAULO Date of Inspection: JANUARY 3, 2006 r TIGHT or HOLDING TAN K.- N/A (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass •polyethylene other(explain) Dimensions: Capacity: gallons Design Flow: gallons/day Alann present(yes or no) Alarm level: Alanni in working order(yes or no): Date of last pumping Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: X (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.,):, D-BOX IS 16"X 16"—2 0"BELOW GRADE. ONE LINE IN—ONE LINE OUT. BOX IS CLEAN&SOLID. NO SIGN OF OVER LOADING O:Z SOLID CARRY OVER. PUMP CHAMBER: N/A (locate on site plan) Pumps in working order(yes or no): Alarns in working order(yes or no): Conmients(note condition of pump chamber,condition of pumps and appurtenances,etc.): Title 5 Inspection Form 6/15/2000 8 _ i I ' 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: 70 FIDDLERS CIRCLE HYANNIS PORT,MA" 02646 Owner: AMARAL,PAULO Date of Inspection: JANUARY 3, 2006 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: , J Type leaching pits,number: X leaching chambers,number: 2 _ leaching galleries,number leaching trenches,number,length leaching fields,number, dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Continents(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) LEACHING IS(2)500-GALLON DRY WELLS 10'X 20'X 2'. LEACHING IS 30"BELOW GRADE WITH 6"WATER STAIN LINE. NO SIGN OF OVER LOADING OR SOLID CARRY OVER. CESSPOOLS: N/A (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 groundwater inflow(yes or no): Continents(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation etc.): PRIVY: N/A (locate on site plan) Materials of Construction: Dimensions: Depth of solids: F` Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) Title 5 Inspection Form 6/15/2000 9 f Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 70 FIDDLERS CIRCLE HYANNIS PORT,MA 02646 Owner: AMARAL,PAULO Date of Inspection: JANUARY 3, 2006 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benelunarks. Locate all wells within 100 feet. Locate where public water supply enters the building. 6v �R0N� F o 39 3� 3 � O 3 .3 Title 5 Inspection Form 6/1�4,2000 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 70 FIDDLERS CIRCLE HYANNIS PORT,MA 02646 Owner: AMARAL.PAULO Date of Inspection: JANUARY 3, 2006 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to no groundwater 9 feet Please indicate(check)all methods used to deternime the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: X Observation 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 IJSGS database-explain: You must describe how vou established the high ground water elevation: TEST HOLE 9' NO WATER. 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'+ t, 1 ''F f x'ja J• ,gy/,F f Ii � k s # K/ • ",;jr ��'",�'" !.•q t + '� f q/ ice^a 10 } � l i f ' I r.. �. -`��' `� � `tea .• .r "y 40 . n f lw r+e ' $C 1 _ _ n. • r a ? clW a, t� ril s . .: .,::fir+ 8::.j" �., ,' '. � '` ' � '��r'1�R ✓' rv/' � �d' ' � n a r } el L t� ax_ 9 r� F 9 Sd ip plow Jr `+ X", 0. .',.� i t `AF . �� 3d y a}j ,s q9' v It r . a a a q i tL T" S 0 r- T sQ r °a w" + y F r— 440 IM ,A r'^ r h 1 ' t €, _ r 3w sa THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA i : ' rN i i I WMWA C � : : cam, ;:: I '� I I i I a ,,. .�� I , "'�q ,�, .. i � ....a '�' .� d I I i I I 4 TOW?Y OF EAKNSTABLE LOCAnON 1404/y(� r SEWAGE # VI LLAGE 78 'AQUI&t25 ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO.Wlh R0btN56-IN1 5"� (, :Z 7 S-?-7 7ti SEPTIC TANK CAPACITY i S G o LEACHING FACILITY: (type) 2V G- (size) NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: -COMPLLMNCE DATE: Separation Distance Between the: ^ Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by - _ \ ,- ��,�, ,. - - _ o _ , � �� -� t � a �o �� � �,� o � '' C O 'f t � �') s` w .. n:..�, . . No. Fee $5 9 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 1210 ication for loioo!gar 6p.5tem Construction Permit Application for a Permit to Construct( )Repair t )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. N Tel.No, 70 Fiddlers Circle , Hyannis, MA � � � b 0 Assessor'sMap/Parcel 4.30 Everett St . , Westwood, MA / 6L 02090 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. m. E . Robinson Septic Service P 0 Box 1089, Centerville , MA Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Sand. Nature of Repairs or Alterations(Answer when applicable) Title-5 septic , tank, D-box and. 2 leach chambers . Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Doard of Hgalth. Signed Date —?— Application Approved b Date 19, Application Disapproved for the following reasons Permit No. Date Issued ' 9 No. _7 I Fee$59 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS Yes Zi pYication for ;Di!6po!5aY_*p9;tent Construction Permit Application for a Permit to Construct( )Repair )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location 9c� o N Hannis, MA ay N c r�s a� Tel.No. 70 F1 �ersrs circle, Hyannis, Assessor'sMap/Parcel g. G� 430 Everett St. , Wes420w0000d, MA 0 6 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Alm: E . Robinson Septic Service 0 Box 1089, Centerville, MA Type of Building: - _ Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers yp g ( Cafeteria( ) Other Fixtures /f; OP Design Flow gallons pet'day. Calculated daily flow gallons. h Plan Date Number of sheets Revision Date •. Title Size of Septic Tank Type of S.A.S. Description of Soil Sand. s" r Nat a of Repairs or Alterations(Answer when applicable) Title-5 ,Sept iC, .;tank,,,, D—box and 2 leach chambers.,, ;Zee!- _ Date last inspected:. ' Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until,.a Certifi- cate of Compliance has been issued by is oard of H Ith. ` { Signed Date Y —?-7 Application Approved Date 9, A - *.. Applica�pii Disapproved for the'following reasons i off/ Permit No. r Date Issued ' THE COMMONWEALTH OF MASSACHUSETTS il Krukonas BARNSTABLE, MASSACHUSETTSCertificate of Cons lianceTHIS IS TO CERTIFY,th t tl�e,On-site S a e Di o Constructed( )Rep ed �� Abandoned( )by Wm. E. 1 O�inson ePT, 9%MU at 70 Fiddlers C irel H. aris MA 'has been constru ted i�i accordance with the provisions bf Title 5 and the for Disp stet�Construction Permit No dated f Installer Wm. Es R ob iris on Sr. _Designer The issuance of this permit ,o e n ued as a guarantee that the el will func ion as� s gn� Date Inspector —————— —--—————----.—_— —— Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Krukonas a d . Xtgpogar 6petent Construction Permit Permission is hereby granted to Construct( )Repair(X )Upgrade( )Abandon( ) System located at 70 Fiddlers C ire le, Hyannis, MA and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:: Construction must be completed within three years of the date of thiy67mit. Date: ! ` ���� Approved r t1 116/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) I William E . Robinson,S,rllereby certify that the application for disposal works construction permit signed by me dated 9-T"9 g , concerning the property located at 70 Fiddlers Circle , Hyannis, MA meets all of the following criteria: • The failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. 4/The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. le There are no wetlands within 100 feet of the proposed septic system %- There are no private wells within 150 feet of the proposed septic system `},There is no increase in flow and/or change in use proposed C There are no variances requested or needed. The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. (Adjust the groundwater table using the Frimptor method when applicable] If the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed leaching facility will not be located less than fourteen(14) feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) I J B) G.W. Elevation +the MI AX. High G.W. Adjustment ._= n DIFFERENCE BETWEEN A and B SIGNED : ti DATE: [Sketch proposed plan of system on back]. q:health folder:cent 4 1 TOWN OF BARNSTABLE LOCATIONy�4T�sr SEWAGE # �VILLAGE 26 N 0-5 ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO. 1 IM r- 86rN. 2J 5&0k(: ?7 S—T7 7� SEPTIC TANK CAPACITY 5�nO c LEACHING FACILITY: (type) V l�V( (� } (size) %0 5C 2b jt NO. OF BEDROOMS BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE:� TQ Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist i on site or within 200 feet of leaching facility) Feet - Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by �� �� V t�� C0'.%1.10\N"7EA1TH OF MASSACHUSETTS EXECUTIVE OFFICE OF EINVIRO\ME\TA AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE NNINTER STREET, BOSTON T&A 0210S (617) 292.550(i TRUDY CONE Secretan ARGEO PAUL CELLUCCI DAVID B. STP.:-HS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address:70 Fiddlers Circle Name of Owner Dave Krukonas Hyannis , MA AddressofOwner: 430 Fver tt S . ,_Xastwood.,MA Date of Inspection: 9 A O—C�9 Name of Inspector:(Please Print)WM. E . Robinson Sr. I am a DEP approved systerq inspector rsuant to Section 15.340 of Title 5(310 CMR 15.000) rn CopanyName: Wm. E . Robinson Ieptic Service Mailing Address: PO Box 0 9, Centerville . MA Telephone Number: 8 7(� 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: !/Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: Date: o`---77 Q 9 The System Inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within thirty (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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. NOTES AND COMMENTS 1 I�EC�I1�E0 �'�� OCT 1 5 1999 i►� TOWN OF BARN5TABLE ,9 HEALTH Bet A� revised 9/2/98 Page Iof11 N i� ✓ranted or+Recrclyd Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) 'top"Address:7Q Fiddlers Circle , Hyannis owner: Dave Krukonas Date of Inspection: INSPECTION SUMMARY. Check A, B, C, or.D: A. 7SY�AMPASSES: Ll I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: B. STEM CONDITIONALLY PASSES: ne or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon ompletion 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 complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced _ The system required pumping more than four 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 revised 9/2/98 Page 2of11 �I � I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION fcontinued) Property Address: 70 Fiddlers Circle , Hyannis Owner: Dave Krukonas < Date of Inspection: c `02.6-9- C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Co ditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the pub is health, safety and the environment. 11 SYS WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310.CMR 15.303(1)(b)THAT THE SYSTEM IS N T FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 21 SY WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS FU CTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis 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. Method used to determine distance (approximation not valid). d.. 3) 0 HER 1. f f , revised 9/2/98 Page 3of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) t Property Address: 70. Fiddlers Circle , Hyannis Owner: Nave. Krukonas Date of Inspection: D. SYSTEM FAILS: You mus -ndicate either "Yes" or "No" to each of the following: I ave determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this de rmination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility-or system component due to an 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 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a 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 I 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E. LARGE S STEM FAILS: You must indic to either "Yes" or "No" to each of the following: The f Ilowing criteria apply to large systems in addition to the criteria above: The s stem serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public healt and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA) or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the apartment for further information. revised 9/2/98 Prgc4ofII f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST e Prop"Address: 70 Fiddlers Circle , Hyannis Owner: Dave Krukonas Date of Inspection: q��-$ 9 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 part of this inspection. _ As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. _ All system components, excluding the Soil Absorption.System, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: _ Existing information. For example, Plan at B.O.H. _ Determined in the field (if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) (15.302(3)(b)) - _ The facility owner (and occupants,if different from owner) were provided with information on the propermaintenauco-0f Subsurface Disposal Systems. I revised 9/2/98 Page of II I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION ',.party Address: 70 Fiddlers Circle , Hyannis Owner: Dave Krukonas Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow:_�150 g.p.d./bedroom.. Number of bedrooms(design): Number of bedrooms lactual):3 Total DESIGN flow y ,SD Number of current residents: Garbage grinder(yes or no):_e(,O Laundry(separate system) (yes or no):AVo ; If yes, separate inspection required Laundry system inspected Yilable (yes or no) Seasonal use (yes or no)Water meter readings, if (last two year's usage(gpd): 9 9 Q Sump Pump (yes or no): Last date of occupancy: COMMERCIAL/INDUSTRIAL: Type of establis ment: Design flow: d 1 Based on 15.203) Basis of design fl w Grease trap prase t: (yes or no)_ Industrial Waste H Iding Tank present: (yes or no)_ Non-sanitary wast discharged to the Title 5 system: (yes or no)_ Water meter readi gs,if available: Last date of occu ancy: OTHER:IDescri e) Last date of oc ancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped ifs part of inspection: (yes or no)rt a If yes, volume pumped: gallons Reason for pumping: TYPE OF,SYSTEM VV 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) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other ,7 APPROXIMATE AGE of all components, date installed lif known)and source of information: Sewage odors detected when arriving at the site: (yes or no) 41 d revised 9/2/96 Page 6(if II I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C " SYSTEM INFORMATION Icontinued) 'roperty Address: 70 Fiddlers Circle , Hyannis Owner: Dave Krukonas Date of Inspection: a BUILDIN SEWER: (Locate on ite plan) Depth belo grade:_ Material of onstruction:_cast iron_40 PVC_ other(explain) Distance f om private water supply well or suction line Diameter Comme s: (condition of joints, venting, evidence of leakage,-etc.) SEPTIC TANK:_ (locate on site plan) 1 Depth below grade: / Material of construction: (_/concrete_metal_Fiberglass _Polyethylene_other(explain) If tank is metal,list age_ Is.age confirmed by Certificate of Compliance_ (Yes/No) , v � Dimensions: �' ' / b � Sludge depth:_ Distance from top of sludge to bottom of outlet tee or.baffle:� Scum thickness: V Distance from top of scum to top of outlet tee or baffle:_ G/ Distance from bottom of scum to bottom of outlet tee or baffle:r How dimensions were determined: 'omments: (recommendation for pumping, condition of inlet a9d outlet tees or affles,s,—depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) _f�L�LtJ l �'� C' fr h— 7� 1 �� a a1. 42 4 1 'C GREAS TRAP: (locate o site plan) Depth belo grade:_ Material of construction:_concrete_metal_Fiberglass _Polyethylene_otherlexplain) Dimensions Scum thick ess: Distance fr m top of scum to top of outlet tee or baffle: Distance fr m bottom of scum to bottom of outlet tee or baffle: Date of la t pumping: Comme s: (recomme dation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence o leakage,etc.) revised 9/2/98 Page 7orI) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) " 'ropertyAddress: 70 Fiddlers Circle , Hyannis. OwrwC Dave Krukonas Date of Inspection:p ©_ TIGHT R HOLDING TANK: (Tank must be pumped prior to, or at time of, inspection) (locate o site plan) Depth bel w grade:_ Material o construction:_concrete_metal_Fiberglass_Polyethylene_other(explain) Dimensio s: Capacity: gallons Design fl w: gallons/day Alarm pr sent Alarm le el: Alarm in working order: Yes_ No Date of previous pumping: Comm nts: (con n of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOXXV, (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) - PUMP C MBER:_ (locate on site plan) Pumps in orking order: (Yes or No) Alarms in orking order(Yes or No) Comments (note con ition of pump chamber, condition of pumps and appurtenances,etc.) I revised 9/2/98 Page 8of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 'rop"Address: 70 Fiddlers Circle , Hyannis : ... ; ;. Ownw: Dave Krukonas Date of Inspection: SOIL ABSORPTION SYSTEM(SAS): L' (locate on site plan, if possible; excavation not required,location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits, number:_ leaching chambers,number: leaching galleries,number:_ leaching trenches,number, length: leaching fields, number, dimensions: overflow cesspool, number:_ Altemative system: Name of Technology: Comments: (note condition of soil, si ns of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.) CESSPOO _ (locate on site plan) Number and co figuration: Depth-top of liq id to inlet invert: Depth of solids I yer: )epth of scum la er: Dimensions of ce spool: Materials of cons ruction: Indication of grou dwater: inflow ( esspool must be pumped as part of inspection) Comments: (note condition o soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY:_ (locate on site plan) Materials of onstruction: Depth of soli s: Dimensions: Comments: (note conditi n of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) revised Pagc9ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C , SYSTEM INFORMATION Icontirwed) r. Nop"Address: 70 Fidd.lers .Circle , Hyannis t - )wner: Dave -Krukonas Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) ono� P o v'.9 L� 3 ` o revised 9/2/98 Page 10of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) ropertyAddress: 70 Fiddlers Circle , Hyannis Owner: Dave Krukonas Date of Inspection: q f 'off-0-a Qj NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells at Estimated Depth to Groundwater /ll Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site (Abutting property, observation hole, basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators, installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) F0 revised 9/2/98 Page 11of11 x. TOWN OF BARNSTABLE LOCATION s)L-E/P 5 C SEWAGE# VILLAGE /ASSESSOR'S MAP&LOT N�NAME&PHONE NO. d�— SEPTIC TANK CAPACITY -� ®�/ ti S.� G/1y/t., LEACHING FACILITY.(type) (size) NO.OF BEDROOMS BUILDER OR OWNER U /o y hI//PA4 L- / PERMIT DATE: C61GtldCE DATE: b `® Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by T- w w �Q h