Loading...
HomeMy WebLinkAbout0006 FIRST AVENUE (HYANNIS) - Health (2) 6 First Ave. Hyannis. MA A= 267 - 023 Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 6 First Ave (AKA 347 Craigville Beach Rd) Property Address Richard Egan Owner Owner's Name information is required for every y W. H annisp ort ✓ MA 02672 4-30-16 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. General Information s/!*. /Wo 1. Inspector: Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 - Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S 13971 Telephone Number license Number B. Certification I certify that I have personally-inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation b the Local Approving Authority 4-30-16 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under _ the same or different conditions of use. t5ins-3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 1 of 17 ADpaVs Commonwealth of Massachusetts q Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments U�M ,0 6 First Ave (AKA 347 Craigville Beach Rd) Property Address Richard Egan Owner Owner's Name information is required for every W. Hyannisport MA 02672 4-30-16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or'E/always complete all of Section D A) System 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: System is in good working order with no sign of failure. B) System Conditionally Passes: ❑ ,One or more system components as described in the "Conditional Pass";section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 6 First Ave (AKA 347 Craigville Beach Rd) Property Address Richard Egan Owner Owner's Name information is required for every y P W. H annis ort MA 02672 4-30-16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: - ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 S Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M s 6 First Ave (AKA 347 Craigville Beach Rd) Property Address Richard Egan Owner Owner's Name information is required for every y p H annis ort MA 02672 4-30-16 page. City(rown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The"system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: E D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ® Discharge or ponding of effluent to the surface of the ground or surface waters El due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins,-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °7M 6 First Ave (AKA 347 Craigville Beach Rd) Property Address Richard Egan Owner Owner's Name information is required for every y p W. H annis ort MA 02672 4-30-16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to dogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® . The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® 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. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is 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 It of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3113 TRIe 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection .Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 6 First Ave (AKA 347 Craigville Beach Rd) Property Address Richard Egan Owner Owner's Name information is W. Hyannisport MA 02672 4-30-16 required for every page. Cityfrown . State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ' ®. . ❑ . Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ e ' Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ®' ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D.-System Information •. Residential Flow Conditions:, Number of bedrooms (design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins•3113 Tile 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °�M 5 6 First Ave (AKA 347 Craigville Beach Rd) Property Address Richard Egan Owner Owner's Name information is required for every y p W. H annis ort MA 02672 4-30-16 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)):, Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 4-2016 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR•15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 3 Commonwealth of Massachusetts W Title 5 Official Inspection- Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 6 First Ave (AKA 347 Craigville Beach Rd) Property Address Richard Egan Owner Owner's Name information is W. Hyannisport MA 02672 4-30-16 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Owner--pumped 2014 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Maintenance 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) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 6 First Ave (AKA 347 Craigville Beach Rd) " Property Address Richard Egan Owner Owner's Name information is required for every W. Hyannisport MA 02672 4-30-16 page. City[Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 2001 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 18"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): Depth below grade: 12"feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gal 12" Sludge depth: t5ins•3/13 Title 5 Official Ins pection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form =Not for Voluntary Assessments M 6 First Ave (AKA 347 Craigville Beach Rd) Property Address Richard Egan Owner Owner's Name information is required for every W. Hyannisport MA 02672 4-30-16 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 20" Scum thickness a 1" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet 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: Date t5ins•3/13 Title 5 Official Inspecdon Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 6 First Ave (AKA 347 Craigville Beach Rd) Property Address Richard Egan Owner Owner's Name information is required for every y P W. H annis ort MA 02672 4-30-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 6 First Ave (AKA 347 Craigville Beach Rd) Property Address Richard Egan Owner Owner's Name information is required for every y P W. H annis ort MA 02672 4-30-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box if resent must be opened) locate on site plan): ( p P ) ( P ) 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.): • Good condition with water at working level and no sign of back-up from field. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts N Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M ,••' 6 First Ave (AKA 347 Craigville Beach Rd) Property Address Richard Egan Owner Owner's Name information is required for every y p W. H annis ort MA 02672 4-30-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number. 6-Infiltrators ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Infiltrator leach field in good working order with no sign of back-up into d-box or surrounding stone. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top-of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official InspecOon Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 6 First Ave (AKA 347 Craigville Beach Rd) ' Property Address Richard Egan Owner Owner's Name information is required for every W. Hyannisport MA 02672 4-30-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 6 First Ave (AKA 347 Craigville Beach Rd) Property Address Richard Egan Owner Owner's Name information is required for every y p W. H annis ort MA 02672 4-30-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building.Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 3C, o e � e- A 7L 4 76 Of t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 6 First Ave (AKA 347 Craigville Beach Rd) Property Address Richard Egan Owner Owner's Name information is required for every y p W. H annis ort MA 02672 4-30-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: - 10+ feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: ® Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database- explain: You must describe how you established the high ground water elevation: Original design plans show no groundwater at 10'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 6 First Ave (AKA 347 Craigville Beach Rd) Property Address Richard Egan Owner Owner's Name information is required for every Y p W. H annis ort MA 02672 4-30-16 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3f13 Title 5 Official Inspectlon Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE LOCATION 75 7 �e��cyr/Z 4 �/� SEWAGE #�'G�/' VILLAGE ASSESSOR'S MAP & LOTo?67-®a3 INSTALLER'S NAME&PHONE NO. 89.ow/ SEPTIC TANK CAPACITY LEACHING FACILITY: (type)ZedA4y1r,S ) (size) NO. OF BEDROOMS -� y BUILDER OR(O NV�R 41-4. PERMITDATE: COMPLIANCE DATE: Z G Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by ILA) el®a �p�y7 of i 0 "741' 7S✓ QbV. -TOM dr Zt�ISTABI.E ��I p ea cvnil - GE 2AA d- ASSESSO 77 WSTALLER'S N' &PHONE<ivO Sl in Z'A-NX CAPAQT' Y 6 I. CMG-FACII iT1t..( r) :NO,i�FBE13f.00 BUUDER OL 0 1NM PR1ITDATE C©11+€ I.t�,t�ICE OA'F . Sepatauon I?istance°Betvre�n�c - - - Maximum AdJastedGroundwater Table to the Bottom of l eachtng Aamlity Feet_ Pnvate water�upplg�TeII Ltd L.�ac�nD Faculty .E�any galls exist `am site Qr within 2�feef_ofle Rg faciltcy). g Edge o€�l and and I.eacing Faa'Itty(If any wetlands exist witts�n:3t Feet o le= ng Ie facility) f EeeE Furnished iiy. ,4C -2 dD ° 1 Fee r THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes UBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0[ppYication for Mizpooar 6potem Couotruction permit �Apif r a Permit to Construct( . )Repair( )Upgrade(!')Abandon( ) Complete System El Individual Components Location Ad or Lot No. wner's Name,Address and Tel.No. - Assessor's Map/Parcel 41` � t Installer's Name,Address,and Tel.No. / Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size �sq.ft. Garbage Grinder( ® Other Type of Building PGE' No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 11V gallons per day. Calculated daily flow 1�7® gallons. Plan Date /f L11a/ Number of sheets / Revision Date Title Size of Septic Tank 5y® Type of S.A.S. 1 Description of Soil yt�� 9,r3X Nature of Repairs or Alterations(Answer when applicable) � lw&e 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 s ofjJealth.__ f Signed Date Application Approved Date Ufa" G Application Disapproved for the following reasons Permit No. IV Z7611 7�4-ar- Date Issued `�" 7. —4:iL No.go / Fee 1. TH�°Vic...E._COMMONWEALTH OF MASSACHUSETTS Entered in computer: r��R1 - Yes _P UBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Ztppiication-fof aigaaf *pgtem Construction Permit 6 �— pi'c for a Permit to Construct( )Repair( )Upgrade(✓)Abandon( ) Complete System El Individual Components Location Ad res o r Lot No. ������f_�1//� / w �'ner's Name,Address and Tel.No. Assessor's Map/Parcel307 /// b r /`OTC Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 77 - Type of Building: //,, Dwelling No.of Bedrooms Lot Size �i Mf sq.ft. Garbage Grinder Other Type of Building /�>' C�° No.of Persons Showers( ) Cafeteria( ) Other Fixtures /J,1 ,11';Dee. Flow �� gallons per day. Calculated daily flow 7 7� gallons. Plan Date /Me Number of sheets / Revision Date Title Size of Septic Tank LType of S.A.S. t' "n i ✓off`®/S Description of Soil y�X 9.t3A 2- d a Nature of Repairs or Alterations(Answer when applicable) Date last inspected: 'Agreement: ` t 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 issu of .,ealth. ed this Signed Date Application Approved N Date Application Disapproved for the following reasons Permit No. oV adQ1, 716 4C Date Issued /'�� '' .�-a THE COMMONWEALTH-OF MASSACHUSETTS j �7'-"�Z--3 ' �BARMS' TABLE, MASSACHUSETTS " w certificate of Coi'priance THIS IS TO CE TIFY, that the On-site S wage Disposal System Constructed( )Repaired( )Upgraded(e,) Abandoned( )by //0'/ 15PAK,92`i at G7 C 6 6 !1/1 e" e /'"' - y has been constructed in accordance with the provisions of Title 5 an the for Disposal System Construction Permit No,0'*1D'4:k/-/'0b°dated Z✓o�, -01' Installer Designer The issuance of is permit shall not be construed as a guarantee that the system will f nction 8 designed. Date GI t l Inspector /�A { No./Y � '� / 6�' f! 7-'4AY Fee ! ' THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Miqual *pgtem Congtruction Permit Permission is hereby granted to Construct( )�/// e �G�C Re,P r( )Upgrade / )/( Abandon( ) System located at 3 G1 7 Iq/9 /G!� /DY w 10vrT 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 thts`f`rinit. Date: Approved by 7 ' 1 1 Town of Barnstable i Regulatory Services ' °cn*Tpyy� Thomas F.Geiler,Director " Public Health Division aaxrrsrnB[.E. v� is Thomas McKean,Director aT fo Mpl a 367 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Mr. John Tillman August 11, 2000 347 Craigville Beach Rd. Centerville, MA 02630 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY CODE II, MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE, ARTICLE 51 The property occupied by you located at 347 Craigville Beach Road, Centerville , was observed on August 10, 2000 by Thomas McKean, R.S., C.H.O. Health Agent for the Town of Barnstable, because of a complaint. The following violations of 105 CMR 410.00, State Sanitary Code II, Minimum Standards of Fitness for Human Habitation were observed: 410.502 No lid provided on top of one of the refuse containers. The refuse container was filled to the top with rubbish and garbage without a lid, exposing the refuse. This violation was also observed on June 5, 2000 at 10:05 am. Also at that time, the Health Agent observed two wading.pools containing stagnant water. In addition, there were excessive amounts of dog feces (approximately 24 piles) in the dog pen area. A slight foul odor could be detected in the rear yard. These violations were documented by the Health Agent and a 24 hour abatement order was issued to you to correct these violations. The violations were them corrected by you as ordered. On July 7, 2000 at 3:30 p.m., stagnant water was again observed in a small wading pool. No other violations were observed. Also, no foul odors were detected. The Health Agent documented this finding and handed you a 24 hour abatement order to remove the stagnant water. - You are directed to correct this violation within twenty-four (24) hours of receipt of this - notice, by covering the refuse container with a-rodent-proof tight7fiq* g lid. You may request a hearing if written petition requesting same is received by the Board of Health within seven (7) days after the date.order is received.` However, these violations must be corrected regardless of any request for .a`.hearmg. Please be advised that failure to comply with an order could.result in a fine of not more than$500. Each separate day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH c ean Director of Public Health �FZHE ray, Town of Barnstable # Regulatory Services * BMWSrABLE. • y Mass. g, Thomas F.Geiler,Director s6;q. �0 prEOMA'�A Public Health Division Thomas McKean,Director 367 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Mr. John Tillman August 11, 2000 347 Craigville Beach Rd. Centerville, MA 02630 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY CODE II,MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE,ARTICLE 51 The property occupied by you located at 347 Craigville Beach Road, Centerville , was observed on August 10, 2000 by Thomas McKean, R.S., CHO Health Agent for the Town of Barnstable, because of a complaint. The following violations of 105 CMR 410.00, State Sanitary Code II,Minimum Standards of Fitness for Human Habitation were observed: • 410.502 No lid provided to cover refuse container. Refuse container was filled to the top with rubbish and garbage without a lid, exposing the refuse. it You are directed to correct these violations within twen -four 24 hours of receipt o -� s notice.T is vio ation was also observed on June 5, 2000 at 10:05 am.laziQer, at that time, I detected a chicken manure odor in the rear yard. In addition, there were excessive amount of dog feces (approximately 24 piles) in the.do area. These violations were ^� p v rs. ' i9 C17 ay request a hearing if written petition requesting same is received by the Board of lrf ealth within seven (7) days after the date order is received. However,these violations V,0 ust be corrected regardless of any request for a hearing. %-(8 ho Please be advised that failure to comply with an order could result in a fine of not more than$500. Each separate day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean Director of Public Health bu� e�pyo�twETo�� The Town of Barnstable Health Department 1 'A"0"a 367 Main Street, Hyannis, MA 02601 039• Office 508-790-6265 Thomas A. McKean FAX 50b-oj3344 Di of Public Health M1k NOTICE TO ABATE VIOLATIONS OF 105 CMR 0.00 STATE SANITARY CODE II MINIMUM STANDARDS OF FITNE FOR HUMAN HABITATION c J 6 The property eyed by you locat at Cry' �� was on flv��s� /O z003 by, lh�s 1'i'1cj-4�_Iq, /2.sj G" Health Ia ��. for /he Town of Barnstable, because of a aint. The following violations of 105 CMR 410.00, State Sanitary Code II, Minimum Standards of Fitness for 7 '�J Human Habitation were observed- �� �� 6 l,� V CZ�r� st, V_C� 3r`vZ You are directed to correct these violations within twenty- four (24) hours of receipt of this notices.. ` ' v(014,ia. was �[6a D66e," y oI cJLJn e �, ZdD , mod-- You are alan d to correct wi days/hours of receipt of this noti-ee: You may request a hearing if written petition requesting ar same is received by the Board of Health within seven (7) �^ days after the date order is received. However, these G,ZQ violations must be corrected regardless of any request for a hearing. LA;;E� -..ees wej,,- Please be advised that failure to comply with an order could --e0ce®j,V-e result in a fine of not more than $500. Each separate day's failure to comply with an order shall constitute a separate violation. y PER ORDER OF THE BOARD OF HEALTH Z�J jov(a�i� 1 Thomas A. McKean -a-CC,4. ' Director of Public Health i0 , � olY we�- I T ui- J2ALnMMrAAA6A 8Wo8T SUP.P WTI caw WARS (rass. F:as:. xraaLrL- I �p onrism�r IDS" gosz cm►r_ o8ssaca::�xs-::stcru nrtoarcg. ssAi e � �.� 4 �C� UW� (1 �J �D + �L• V10—ri'l IltYlj aA.W, aj TS;le6nf4. "�lP. Go1r/�2s- Cif 4-1 t QV } This is an in42rdepartr!'montal ropo;t. It �s a summary anu,aoe;, not in o.rrnatiCn knovvr)i;; tt;-r-1 !i 1 SJBN::'r!) By i phGc r I Zd Wd0t:20 000Z 80 'd3S SLZ906L Ord XUJ a31SM6088UH 8NQ W08J 5- t / tea d®w er 267023 t e�giborhood 58AC v ye of. LOT 23 _ .47re Acres ; CiirUw AROLE&BARBARA Sta e C I ss 101 CHARLES,C Fs4". a N � s 1 A ea � �00001632 �� �a 36 HARMONY RD SPRING VALLEY NY 10977 gweC arc s 00-0000-000 x ram: �$ •^. e t r a F� ;:.+5 \ Dee sate 010187 '` Re�ere ce.°r 5525 224� ,anuaryl�s �� CHARLES,CAROLE&BARBARA Deed�VlMY,Y` 0187 Deed 5525/224 �� 000041300 Bu11 "g f 000058700 Ec£r a tures ' 0000000000 0 347 CRAIGVILLE BEACH ROAD Road Index '0369 tgy 0108 '" k\F FrDt �f HY FIRST AVENUE a Nn „ 0543 Fr tg: 0176 r ' WN -s Z \ v 3 o �e ti a ,yam r Em ff � ;��nd�lllla xareel< 267023 nd Ow er Farce old s.267023 el= V 6 n 001683 Aa nt: 0000000 r ' 58AC / %e oti LOT 23 1 0 1 .47 C n�Curr wn CHARLES,CAROLE&BARBARA S 101 f 36 HARMONY RD e 1dder1:. 00 SPRING VALLEY NY . 10977 sew�e a C„ 00-0000-000 Dg 010187 "`f R ere e' 5525 nua N1 h f CHARLES CAROLE&BARBARA pe d�[ 0187 r d of 5525/224 a es- , hand. 000041300 B, mgs 000058700 E ra Fea u espy 00000000000 347 CRAIGVILLE BEACH ROAD pa„ ndex 0369 r11g;0108 y, y FIRST AVENUE eC 1 d x 0543rr g 0176 \ / y NOTICE: This Form Is To Be Used For the Repair Of Failed septic Systems Only. PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM f. Aw4, /-7 • 0404 , hereby certify that the engineered plan signed by me dated ,concerning the property located at ,VZ 6--T/cull 1� 2c- meets all of the fallowing criteria: This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The sail is c.assified as CLASS I and the percolation rate is lesh than or equal to 5 minutes per inch. The applicant may use hi`torical data to conclude this fact or may conduct preliminary tests at the site without a health agent present. e There is no increase in flow andlor change in use proposed rhere are no variances requested or needed. a The bottom of the proposed leaching facility will not be located less than fourteen (14) feet above the maximum adjusted groundwater table elevation. LAdjust the groundwater table using the FI-imptor method when applicable] Please complete the following; A) Top of Ground Surface Elevation (using GIs information) �o B) G,W. Elevation + adjustment for high G.W. _ — DIFFERENCE BETWEEN A and 13 a SIGN ED : � DATE: f— NOTICE Bzsed upon the above information, a repair permit wilt he issued for bedrooms natximum. No additional bedrooms are authorized in the i'uture without engineered septic system plans. y,health Folder.peroezmp _ SYSTEM PROFILE TOP FNDN EL. 39.2' (NOT TO SCALE) ACCESS COVER TO WITHIN 6 OF FIN. GRADE E, ACCESS COVER (WATERTIGHT) TO WITHIN 6' OF FIN, GRADE 37 MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 36.0' w � w RUN PIPE LEVEL 2' DOUBLE WASHED PEASTON N FOR FIRST 2' CRAIGVILLE eEAGH ROAD 36.0 t �' 33.0' PROPOSED1500 _._ GALLON SEPTIC 34.75' -'"--- 1.oc��s 35.0' TANK (H- 10 ) GAS 177, BAFFLE lEg�4 \32�_ 0 32.5' jo 3.5' @ SIDES a 32.87 MIN 1.5' @ ENDS ( 2 % SLOPE) _6' CRUSHED STONE OR MECHANICAL 2 � Af'LE - COMPACTION. (15.221 123) 4 iJ{ iX DEPTH OF FLOW = 4 ( 6.5% SLOPE) �g 5' $ r14 "tS 4S9 30.5' TEE SIZESt INLET DEPTH = 10 3/4' TO 1 1/2' DOUBLE WASHED STONE OUTLET DEPTH = 14 CONTRACTOR TO CONFIRM SUITABLE SOILS IN LOCATION MAP-� NOT T❑ SCALE LEACHINi ' AREA OF LEACHING FACILITY, FROM INVERT FOUNDATION- 13' SEPTIC TANK 31' D' BOX 3' 20t ELEVATION EXTENDING TO 5' BELOW ASSESSORS MAP _67 7 PARCEL 23 FACILITY LEACHING FACILITY. ANY UNSUITABLE SOILS ENCOUNTERED, REMOVE FOR 5' AROUND FACILITY AND REPLACE WITH CLEAN MED. SAND. ENGINEER TO INSPECT AND CERTIFY, ADJUSTED GROUNDWATER ELEV. EXPECTED AT 10.5't IF ENCOUNTERED A cII R OA'� A�GV1 I'E BE 37.7 _ + C " * ASSUMED WATERLINE LOCATION i + (CONFIRM PRIOR TO 00. 00' EXCAVATION) � .a 1 , t 7.3 / L=16.11, �� W � w / R=10.00' + 36.4 7,$ o NOTES: t NOTE: GAS ON LOCUS (DIG-SAFE ��_� SEPTIC DESIGN: (GARBAGE DISPOSER IS NOT ALLOWED > 1. DATUM IS APPROXIMATED FROM GIS MAP ELEVATION � _. _ PRIOR TO DESIGN TLOwi 4_ BEDROOMS ( 110 GPD) = 440 GPD 2. MUNIC;IPAL WATER IS EXISTING 37 37.4 C/ CAV^' ION _ , ..._,_h _.F1.t1 -r -r, -_-. - _ m....._._. t ) U, r, �' �71 u L`Siuid FLG / ;:3. MININO_'M PIPE N1I CH 11j BE 1/8' PEP, EXIST. 'DWELLING t TOP FNDN 39.2' W SEPTIC 'TANK 440 GPD ( 2 > = 880 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BF AAS1.ICJ I-I-10 5. PIPE JOINTS TO BE MADE WATERTIGHT. t 1 USE A 1500 GALLON SEPTIC TANK 37.6 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH M AS' . 1 LL'ACHING= ENVIRONMENTAL CODE TITLE V^ t + 35.6 IDES: 2(40.5 + 9,8,3) 2 (.24) = 149 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO BE t ,o USED FOR LOT LINE STAKING. t LOT 23 BOTTOM! - 40.5 x 9.83 (.74) = 294 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4' PVC. t 20,619t SQ. FT. 37 0 1 0.47t ACRES TOTAL, 598 S.F. 443 GPD 9. COMPONENTS NOT TO BE: BACKF ILLED OR CONCEALED WITHOUT INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED 1 U:aE (6) HIGH CAPACITY INFILTRATORS WITH 3.5' STONE FROM BOARD OF HEALTH. ` LOCUSTS A SIDES 1.5' AT ENDS AND 14" UNDER 37.2 + 37.6 "IAT10, PUMP & REMOVE (OR FILL.. W/CLEAN SAND) EXISTING CESSPOOL.(`). t � t c� 35. C 1 w 7' 5A LEGEND t _TITLE 5 T E PLAN i \ t + 35.1 100.0 PROPOSED SPOT ELEVATION OF t t 347 CRAIGVILLE BEACH ROAD 1 100x0 EXISTING SPOT ELEVATION 1 \ OVERGROWN t IN THE TOWN OF: t \ GARDEN + 35.3 t 100 PROPOSED CONTOUR \ , W. HYANNISPORT BARNSTABL E 36.7 \ t -- 100 EXISTING CONTOUR PREPARED FOR: BORTOLOTTI 1 \ 1 i \ t CONSTRUCTION/CHARLES \ 20 0 20 40 60 t \ t BOARD OF HEALTH t \ + 33.4 MA 1> = 20' NOVEMBER 1, 2001 t \I--3&7 _ t APPROVED DATE SCALE: DATE: t 35.7 t BENCH MARK - TOP OF _ 362-4541 508 t CONCRETE BOUND fax 500 36 2-99m t 0 ' EL. = 36.1 (ASSMD G.I.S.) ��`1N UIc `N OF MR�Ja. ` 40 0 + 36,2 I o� ARNE H. �G cati* AR{NE �Ss 36.2 3 + 35.9 down cape engineering inc. Z JALA `^ o CIVIL OJAI.A r I + 35.8 30792 , o. 4_ CIVIL ENGINEERS A v p 70.11 �QF� CIST � �`` ,* �crst ?? d LAND SURVEYORS ---24G 939 rya in S t, ya r rnau t h rn a 02675 - --- -------- -�- -� �----- - I, ARNE H. OJALA, P.E., P.L.S, DATA'