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Home My WebLink About0058 FIRST AVENUE (HYANNIS) - Health 5 8 First Ave Hyannis A-267-028 y(�p pg•TRE P 1Departn-aent of Regulatory Services o / / o i+nnraarnst.t:, ^ ��U��➢� ��f'��1t�.A �Il�'A'SllUDAII ]Date e� 200 Main Street,Hyanuis MA 02601 9 Date Scheduled Time 1� �ee�°� /D o� I r `oil Suitability Assessmentfor SPPW cge Disposal Perfonned BY: —,C. �+•/y Witnessed By: P ^' LOCATION �� Q�rJiNERA7L ][1V]f+O7[V.ilA'TION -- Location Address Owner's Name / Address V Assessor's Map/Parcel: a67//�y Engineer's Namc b0 t'%)'__ Gyp' NEW CONSTRUCTION REPAIR Telephone It &oe) Ad C Y ! / Land Use Slopes(%) Surface Stones r +_ ft Driukin Distances from: Open Water Body � � Possible We[Area W1 g Water Well ft Drainage Way_ _ft S If— Property Line �� ft Other Ct l �TCH' (Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlunds 7,❑proxinuty to holes) �C. • r `/a ( Al i f v 2'S f2l 0i d GP Parent material(geologic) Depth lQ Bedrock Depth to Groundwater: Standing Water in Mole:JV Weeplhg I'I'oltl hit Noe .4VC*'VL0CVr r Estimated Seasonal High Groundwater DE,TERAUNA.'TION FOR SEASONAL 111011 WATER TABLE E Mcthod Used: Depth Ob�served-sLarding in obs.hole: _ In, Depth Id 5011 31041-r3: Depth to weeping from side of obs.hole: l!1, Clrouadwuter Adjusllnetlt..e._ Index Well M Reading Date: Index Well level AcLI,hwtwP Aaj.drtluntlwttter Level 1[']CRCOLATlIONTEST Observation Hole#t 'Gimp at 9" .4 I>; Depth of Perc .0 Time at 6" Stott Pre-soak Time @ �U� _ Time(9"-6") t End Prc-soak 10;&q Rate Min./Intl] Site Suitability Assessment: Site Passed __ SitG.Failed: Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Coinpteted on Back----------- *-**If percolation test is to be conducted vviditian 100' of wetland, you mush first Uotify tine. Barnstable Conservation jAvision at least onne (1) Weelc prior to begillininog. Q:\SCPTIC\Pl3lKCF0RM.DOC DE1 R IID.®BS]ERVATI®lOT]E1®JL f LOG Depth from Soil Horizon Hole # �— Surface(in.) Soil Texture `Soil Color Soil ��— (USDA).. Other (Mansell) Mottling . (Structure,Stones;Boulders, 77—/z Con istenc % ravel /U!P2 S//z /Z— LS / fZs"/ h' ,fly • 1 ti I I .IL.Y.IL LL.'JPV tYTI®LvJ �L.4®L..., ®`l,D i Depth from Soil Horizon IIole Surface(in.) Soil Texture Soil Color Soil �^ (USDA) (Mansell) Other Mottling (structure,Stones, Boulders. Consi ene %Qra% G 5 Z,sy Depth from DIC1Ep OBSERVATION HOLE, ]LOG Soil Soil Horizon ,-role#' Surface(in.) Tcxhire Sall Color (USDA) Soil (Mansell) Mottling (Structure,Stones,Boulders. Cc si to c 0 vel c DREPOBSERVATIONHOLE, LOG Depth from Soil Horizon Surface(in.) Soil Texnire Soil Color Soil (USDA) Other (Mansell) Mottling (Structure,Stpneq; Boulders, Cons! ten p a I Fllood In'sul-a ace Rate iVda Abovc 500 year t7ood boundary No Yes Within 500 year boundary No Yes Mthin 100 year flood boundary No Yes . Depth ®�I ttteulr�ll� en¢1411p kE ttvious Material Does at least four feet of naturally occurring pervious materlal exist in all areas observed throughout the areI proposed for the soil absorption system? �Gr7 If not, what is the depth of naturally occurring pervious matarinl Co?¢�dll-- ]Mflon Ir certify that on _ q date I have passed the soil evaluator examination approved by the Department of Environmental.Protection'and that the above analysjs was performed by me consistent with dhe required trainin , epertis and eri ee described in CIO CMR 15.017. Signature �9 )1 Datb 1 Id Q\SEPT[cpE[CEORM.DOC J TOWN OF BARNSTABLE LOCATION P'3 SEWAGE#.,?4/0 `,03K VILLAGE ASSESSOR'S MAP&PARCELa7� INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY. LEACHING FACILITY:(type)�b ,.., �1a lt�) (size) NO.OF BEDROOMS r OWNER Li��` PERMIT DATE: a—'V•/ COMPLIANCE DATE: C 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. J� st, r � � • o L y CA - 1 V No. 0 00 0 i Fee /4-90 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS �_ l Yes appliLAtion for bispoBAY bpstem Construction 30Prmit Application for a Permit to Construct( ) Repair(V/Upgrade( ) Abandon( ) afComplete System ❑Individual Components Location Address or Lot No. a' �'�rQ' Owner's Name,Address,and Tel.No. sor's Map/P�cel q'��p 4011 Ug Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. qew 'I;pe of Building: j� Dwelling No.of Bedrooms / Lot Size sq.ft. Garbage Grinder Other Type of Building LOJ/ " (�/fC� No.of Persons Showers( ) Cafeteria( ) Other Fixtures ,J Design Flow(min.required) gpd Design flow provided / S 3 gpd Plan Date Z Z,/ : /j!q Number of sheets Revision Date Title 5 Size of Septic Tank 1�j®� Type of S.A.S. �S Description of Soil 41,1 $—,,)° Nature of Repairs or Alterations(Answer when applicable) 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 Certificate of Compliance has been issued by this Board of He lth. Signe f Date Z ?) Application Approved -- Date Application Disapproved by Date for the following reasons Permit No. d Date Issued l +,� :� ' ram« ;i ,�, w :� _ ,,�,.,,"�•-� No. �G✓ �1 g Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: � � -•- , "'-'` - �', Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS fppritation for Bisposal *pstem Construction permit Application for a Permit to Construct( Repair(�Upgrade Abandon( Complete System El Individual Components Location Address or Lot No. ��'�c�" a j� Owner's Name,Address,and Tel.No. Assessor's sor'sMap/Parcel Installer's Name,Address,and Tel.Nod — Designer's Name,Address,and Tel No. for��/oy`� Co�ts�" 7 7/-� � dwy Type of Building: Dwelling No.of Bedrooms -/ Lot Size sq.ft. Garbage Grinder( ) Other Type of Building A&5/�PWCC No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided % '573 gpd Plan Date Z/ z /zp Number of sheets / Revision Date Title ,5 J%zt 4�e a, Size of Septic Tank ��, /�� Type of S.A.S. S d r17` i ��✓`// ee-- Description of Soil /a f 5- �® Nature of Repairs or Alterations(Answer when applicable) 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 Certificate'of Compliance has been issued by this Board of Health. / Date ZApplication Approved(:S:igne Date .� / Application Disapproved by Date for the following reasons i Permit No. C0/ Date Issued � ` ��6 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certifitate of Compliance THIS IS TO CERTIFY,that the On-site Sewage�Disposal system Constructed( ) Repaired( Vr Upgraded( ) Abandoned( )by 06o/, /�?�,09 atg /�/��)` 17 W �• /has been constructed in accordance i with the provisions of Title 5 and the for Disposal System Construction Permit No C_79dated Installer A01-151,�� % Designer &W/4' #bedrooms Approved design flowp gpd The issuance of t 's permit shall not be construed as a guarantee that the system wifW, fun)ction�as designed. Date 2 � �1 J Inspector f _ a No. � 3E- Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal opst em Construction J)ermit Permission is hereby granted to Construct( ) y Repair( Upgrade( ) Abandon( ) System located at `' `U and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction , us t be completed within three years of the date of this permit. Date'/0 Approve b FROM :down cape engineering inc FAX NO. :15083629880 Feb. 16 2010 10: 11AM P1 Than➢➢➢Au F. Q'efl .rr,'gDi➢ector ( .k;ADYN '/,M, " `= ��"- '�'�aaDl➢➢ka;�IVla.Y��.kna➢, 1fAnD•a,ctrtar 200Maiu SIR-ct, 11irvinuds,.MA 02601. 411'tl.Oc- 508-962-116/14 1.101: 508-790-6604 1➢�4iQ941liC'F' lLFltr�o9 llllir �.Q'lCQ9 DU KiS10$DD➢ Form 1lDgnrn�a, _`. . . I / a Adld Artjlalresq: - L� Or ZAll'o �O�/�`��l C�D�c$� was,issued a pciinit to install. u (dale) (installer) septic system ai ( 1.._� . 4A' _--based tali a desi&m dnami1. 1) (adilrc;ss) � �w�I CAPE, J1 eekj AI dated c�A 11D T ceitify t1hit the septic system referenced abow was installed gubstantially aceoiicling to the de- gn, Which May include minor approved chungus such, as latt:rai rul u,atio> of the dist.ribll.tion box audios-Sel7Llc Larlk. _ 1 cetti.fy t1lat the septic sysLeirI TBIe1'enced above was .iii.sta.l.led w fili. aij:�lor c.h.an., e i.i:e. O'rcater•than. l 0' ILItel'al relocatim.i of the SAS or an.y velti.cal.r•etoc,Lion.of lJ1y corri.ponent ol'tlic septic System) but in accordance with Statc,& Local Regulations. Plau revIsiirll or cerii lied as-built by designer to follow—, (Irist er's Siguattarej WALA {,1VIL IDNAIL (1.�e:;1 7lc.:Y'S 5lgtlatlli'�) (Affix Do:sign jc s `�taJ.11l7 11Crl.) °�.fl A.tiDt lfd�11TfBN TO B,,11Ft1MS'Jl1§1i 1Z A'Cl1LIC 1}flJl;A9.,TH iD1VISIOIN. t`Dfau!IA'.LC'.A: '9; lBlf+ �;6'uWd,gANC F WILL NOT Yih ISSUED U N$'LL_A30`p'IA.-:g'HlS. kC)&Ly& A1°1:V3 AS-BflJ.iL.d.' .CAflJL_B_ASRI BECI',iNTT)Hif'H-HE ffRAti.NSIABILflI R'V-)BLIC IAE L'4 H DIVI' RON _i'9. ANIC YOU. — C�;J r.r,lihr'Sr.��.ic/l7esi�;ner t.:eriitkation obi Barnstable Town of Barnstable ►Regulatory Services Department eac ,�; ' 1A�NSTABM ; 16.39. A Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 FAX: 508-790-6304 Thomas F.Geiler,Director Thomas A.McKean,CHO CERTIFIED MAIL# 7008183000020500 7� September 11, 2009 W - I Jane Spillane P.O. Box 281 West Hyannisport, MA 02672 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 The septic system located at 58 First Avenue, Hyannis MA was inspected on September 2, 2009 by Robert Paolini, certified Title'V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system FAILED under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: A single cesspool system is an automatic failure in the Town of Barnstable. You are ordered to repair or replace the septic system within Two (2) years from the date of this notification by upgrading to a Title V system. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF T E BOARD OF HEALTH omas McKean, R.S., CHO Agent of the Board of Health Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 58 First Ave. M Property Address Jane Spillane Owner Owner's Name information is required for W Hy p annis ort Ma. 02672 9/2/2009 every 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. Important: A. General Information When filling out �'"► � /f forms on the C•IE computer,use 1. Inspector: only the tab key to move your Robert Pao'lini cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC. Company Name r� P.O.Box 763 Company Address Centerville Ma. 02632 'r City/Town State Zip Code (508)428-4028 S14454 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 valuation by the Local Approving Authority 9/2/2009 Inspector's Signat ' Date � � Y The system inspector shall submit a copy of this inspection report to the Appro ding Authiity(Brd of Health or DEP)within 30 days of completing this inspection. If the system Is a shared s steco m�r has a design flow of 10,000 gpd or greater, the inspector and the system owndshall 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. O t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal'System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 58 First Ave. Property Address Jane Spillane Owner Owner's Name information is required for W.Hy p annis ort Ma. 02672 9/2/2009 every 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 fails due to single cesspool.System needs to be upgraded to title V. 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official` Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 58 First Ave. Property Address Jane Spillane Owner Owner's Name information is required for y p W H annis ort Ma. 02672 9/2/2009 every page. City/Town State Zip Code Date of Inspection B. Celrtification (cont.) 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 FIND (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 15ins•01108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts L W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 58 First Ave. Property Address Jane Spillane Owner Owner's Name information is required for W Hy p annis ort Ma. 02672 9/2/2009 every page. City/Town 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 coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or 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 Y2 day flow t5ins•09/08 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts F W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 58 First Ave. se` Property Address Jane Spillane Owner Owner's Name information is required for W.Hy p annis ort Ma. 02672 9/2/2009 every 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 clogged 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 II 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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 I , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 58 First Ave. Property Address . Jane Spillane Owner Owner's Name information is required for yannp W H is ort Ma. 02672 9/2/2009 every page. City/Town 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? ® ❑ 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): 3 Number of bedrooms (actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 oft 7. Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 58 First Ave. Property Address Jane Spillane Owner Owner's Name information is required for y p W H annis ort Ma. 02672 9/2/2009 every page. City/Town State Zip Code ' Date of Inspection D. System Information Description: The septic system is a split system which consists of two single cesspools with no overflows. Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ® Yes ❑ No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail Sump pump? ❑ Yes ® No Last date of occupancy: 9/2/2009 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 58 First Ave. Property Address Jane Spillane Owner Owner's Name information is p required for y W.H annis ort Ma. 02672 9/2/2009 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: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ❑ Septic tank, distribution box, soil absorption system ® Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) 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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° 58 First Ave. M Property Address Jane Spillane Owner Owner's Name information is required for yannp W H is ort Ma. 02672 9/2/2009 every 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: Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 1' Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented through the house vents. Septic Tank (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed b a Certificate of Compliance? attach a co of certificate Yes No 9 Y P ( PY ) ❑ ❑ Dimensions: Sludge depth: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 58 First Ave. Property Address Jane Spillane Owner Owner's Name information is required for W Hy p annis ort Ma. 02672 9/2/2009 every page. City/Town 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 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 How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts N Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 58 First Ave. Property Address Jane Spillane Owner Owner's Name information is required for W.Hy p annis ort Ma. 02672 9/2/2009 every 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 58 First Ave. Property Address Jane Spillane I Owner Owner's Name information is required for W Hy p annis ort Ma. 02672 9/2/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 58 First Ave. Property Address Jane Spillane Owner Owner's Name information is required for W.Hy p annis ort Ma. 02672 9/2/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ 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.): Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration 2 single cesspools Depth—top of liquid to inlet invert 4.5' Depth of solids layer 0 Depth of scum layer 1" Dimensions of cesspool 6'x6' Materials of construction Concrete block Indication of groundwater inflow ❑ Yes ® No t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Dispcsal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 58 First Ave. Property Address Jane Spillane Owner Owner's Name information is W H annis ort Ma. 02672 9/2/2009 required for y p every 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.): system is failed due to single cesspools. 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.): I t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Map Page 1 of 2 Town of Barnstable Geographic Information System Parcel ViewerIF Custom Map Abutters Map Size ■ ■ Zoom Out jIn A R IC 1d , L t h i xf'k' - , M � ON >µ s rs��F _. fi 4�3a�S, 9 04 .x1 nu fi- h �t'y _r�" "�91d� r�r t �",ss�7a a +� 1 T Blimp I fAP .0 f I - f, { f ryry �o Set Scale 1" = 20 1 I Aerial Photos I MAP DISCLAIMER rr..,„ri�hf onnr_onnQ r,,... ,r Ro t.hln r.en All A ht. t Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 58 First Ave. Property Address Jane Spillane Owner Owner's Name information is required for W.Hy p annis ort Ma. 02672 9/2/2009 every 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Commonwealth of Massachusetts L Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 58 First Ave. Property Address Jane Spillane Owner Owner's Name information is required for Y P W H annis ort Ma. 02672 9/2/2009 every 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: Bottom of cesspool 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: USED:USGS Observation Well Data.USED:Technical Bulletin 92-0001 plate#2 annual ranges of groundwater elevations.. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 =4-t 'tt . I 71 ! Q s w� i 3,v z cr 0 oO Cho � z G m t� a R� a n ti • r j 1 I \\ \ i i : V - T' lD 11 i w i t i �f f a 1 a N7 7�lzxCZ O �1 O� O S m SYSTEM PROFILE ALL SYSTEM COMPONENTS SHALL BE NOTES MARKED WITH MAGNETIC TAPE OR COMPARABLE MEANS FOR FUTURE LOCATION. PROVIDE MIN. 20" DIAM. WATERTIGHT (NOT TO SCALE) T. DATUM IS APPROX. NGVD ACCESS COVERS TO WITHIN 6" OF FIN. GRADE o T% PROVIDE INSPECTION PORT TO WITHIN 3" OF FINAL GRADE 2. MUNICIPAL WATER IS EXISTING \ 36.9 35.0' MINIMUM .75' OF COVER OVER PRECAST 2X SLOPE REQUIRE/OVER SYSTEM 34.0' 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. ° ey PRECAST H-lo MIN 8" DIAM 4. DESIGN LOADING FOR ALL PROPOSED PRECAST a C�°i ville Be h RISERS (TYP.) UNITS TO BE AASHO H-M 2'0 4"0SCH40 PVC 2" DOUBLE WA HED PEASTONE y s; PIPES LEVEL 1ST 2' 1 5. PIPE JOINTS TO BE MADE WATERTIGHT. _ *34.9' OR , EOTEXTILE FABRIC 31•$ 10" 1500 GAL H-10 14• 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE ° Locus 000 0 00o WITH 310 CMR 15.000 (TITLE 5.) 32.46 TEE SEPTIC TANK TEE \32.29' 6" MIN. SUMP o 31.15' o�33.9' OOOOOO * GAS BAFFLE °0000a000000 12" MIN. INT. DIM. `D go 1.85' 7 THIS PLAN IS FOR PROPOSED WORK ONLY AND �So 9 29.3' NOT TO BE USED FOR LOT LINE STAKING OR ANY 4' LIQ. LEVEL (ACME OR EQUAL)J000? 31.49 31.32 �� o•.- :::...,•..: H-20 3050 INFILTRATORS OTHER PURPOSE.00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 {. Ip0p0p0p0p0p0p0p0p0p0p0p0p0p0p0p0p0p0p0p0p "OOOOOOOnO'O'O'O'00000000000•00000 3/4" TO 1 1/2" DOl1'BLE WASHED STONE 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4 PVC. NalZluCkBl 6" CRUSHED STONE OR MECHANICAL 9. COMPONENTS NOT TO BE BACKFILLED OR Sound , MIN COMPACTION. (15.221 [2]) OVERALL DIMENSIONS TO OUTSIDE OF STONE: 41.5' X 10.25' CONCEALED WITHOUT INSPECTION BY BOARD OF MIN. 5' HEALTH AND PERMISSION OBTAINED FROM BOARD ( 2 X SLOPE) ( 2 X SLOPE) (-!-X SLOPE) OF HEALTH. i FOUNDATION 13' SEPTIC TANK 40' D' BOX 4' LEACHING 10. CONTRACTOR SHALL BE RESPONSIBLE LE OR FACILITY CALLING DIGSAFE LOCUS MAP VERIFYING THE LOCATION OF ALL UNDERGROUND & *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL BOTTOM TH-1 & TH-2 24.3' WORK.EAD UTILITIES PRIOR TO COMMENCEMENT OF NOT TO SCALE UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS NO GROUNDWATER FOUND PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM 11. ANY UNSUITABLE MATERIAL ENCOUNTERED ASSESSORS MAP 267 PARCEL 28 SHALL BE REMOVED 5' BENEATH AND AROUND THE PROPOSED LEACHING FACILITY. 12. EXISTING LEACHING FACILITY SHALL BE PUMPED LEGEND AND REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. 99- EXISTING CONTOUR X 99.1 EXIST. SPOT ELEV. 99 PROPOSED CONTOUR SYSTEM DESIGN: 198.4] PROPOSED SPOT EL rH1 GARBAGE DISPOSER IS NOT ALLOWED TEST HOLE Zq° SLOPE OF GROUND DESIGN FLOW: 4 BEDROOMS ® 110 GPD =440 GPD �3 USE A 440 GPD DESIGN FLOW Cob UTILITY POLE BENCH MARK - USE TOP of Oo, 45 SEPTIC TANK: 440 GPD (2) = 880 _ FIRE HYDRANT _ FOUNDATION HERE;® 36.9 10• NOTE: NOT ALL SYVMLS MAY AFAR IN DRMM c 3 USE (1) 1500 GAL. H-10 SEPTIC TANK 4 x 34.66 \ 33.74 LEACHING:, TEST HOLE LOGS 135.3 3 34 3,1 SIDES: 2 (41.5 + 10.25) 1.85 (.74) = 141 GPD 1 s 1 TH TH 2 10" P.PI BOTTOM 41.5 x 10.25 (.74) = 312 GPD ENGINEER: ARNE H. OJALA, PE, SE 1 x x 34 o cP TOTAL: 613 S.F. 453 GPD 1 .94 WITNESS: 33 IRS �35.3 7 o USE (5) 3050 INFILTRATOR CHAMBERS DATE: 2/1/10 1 yxO .59 _-------- 3 �- O WITH 3' STONE AT ENDS AND 3' AT SIDES 1 Y _- #35.07 12' 6 PERC. RATE _ < 2 MIN/INCH y t GRASS GRAVEL DR►VE----' . 7 0 34.32 1 ' 12831 �35.4 _ x CLASS I SOILS P# �--o 8 INVERT EL 33.V* ® 124 OAK O/H UTILS. _ _I_o - - x .65 ELEV. ELEV. � 1 �S W1 .45 C. l� EXIST. DWELL. 0" 34.3' 0" 4 34.3' C 1 TOP FNDN. - i cP 3s 6" OAK A A ; I11 - MA 36.9• , Z �35.5 81 APPROVED DATE BOARD OF HEALTH LS LS 1 INVERT EL 34.9't 34.80 1OYR 4/2 1OYR 4/2 n 1 T S.F 12" 12" soot s.F. TITLE 5 SITE PLAN B B 1 1 .85 110.0' OF LS LS 1 . 35.5 58 FIRST AVENUE 36" 10YR 5/4 31 3' 36" 10YR 5/4 31.3' WEST HYANNISI'ORT PREPARED FOR c c BORTOLOTTI CONSTRUCTION/ PERC �ySN OF" �(N OF M4& o�� DANIEL SgcyG� ��DANIELA.9c� LIGUORI MS MS A. 0 o OJALA CIVIL FEBRUARY 2, 2010 .0 N ,40980�, No. 502 2.5Y 6/4 2.5Y 6/4 .. 2- 1� ��® - � r el off 508-362-4541 cti ssq� I fax 508-362-9880 �o t IEL sow DANIIFLA. y�� downcape.com o A. � OJALA 20" 24.3' ,20" 24.3' OJALA N CIVIL N down cope engineeri/1g, h No.40980„ No.46502 NO GROUNDWATER N Scale: 1 = 20 - ND �o� �" � TER = C%Vll en %neerS ENCOUNTERED Z Z- `� ss�� ^\�/0 9 land surveyors r 939 Main Street ( Rte 6A) DATE DANIEL A. OJALA, P.E., P.L.S.' O_O ' 9 0 10 20 30 40 50 FEET YARMOUTHPORT MA 02675 10-019.DWG(SBO)