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HomeMy WebLinkAbout0025 FISHER ROAD - Health 25 Fisher Road Hyannis . P A 309 040001 pr 1 �i r I i9 O O 0 o RAI— d-00 , — 12 No k�,,7 1 V7 ,Bt�FooM �eG�f G d m ec, ara/ye to f��y r e w -1 Lcvc"19 o Qod� ixv f� Fro" f 13c( E ,?mem pt'aki f t oover door s� «\JJJ SLL�`7 Ell L S Cc�,�fi flair Pea`,� QI kl7l hY I<DOr'► {o ke,-,od a e.. �0d 177 d sf� ye Soy a cease c F t:'tc [rc'c--i Serv, r-i (o Rj 92d a WIN L6 oil Cuo.- 47 S i� ✓r�° s7� �.,�f`o'Y' 2v� vd i J 2�� ��`..�.�. m �.. � .� �. m � i � v^;J• .:Bi:. ea.....-ti-.+ r^-..4!V� r..^9` -..ems .-� k 1 1 N � G ; c{ i i � 3 ay� s � � 4 i a ®+ y � _ S S j Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M Inspection results must be submitted on this form or on the official Title 5 Inspection Form dated 6/15/2000. Inspection forms may not be altered in any way. A. Certification �g� 1. Property Information: 25 Fisher Road Property Address Ana Matias Owner's Name same Owner's Address Hyannis MA 02601 Cityrrown State Zip Code Date of Inspection: 7/29/10 Date 2. Inspector: d Matthew L. Childs Name of Inspector same Company Name 4 Orchid Ln. Company Address W. Yarmouth MA 02673 c City/Town State Zip Codd- 508-989-1479 c Telephone Number fJ —n ; CO m D Certification Statement: —v I certify that I have personally inspected the sewage disposal system at this address and tl; the! information reported below is true, accurate and complete as of the time of the inspection.(Tbe iWection was performed based on my training and experience in the proper function and maintenanEq�of¢$site sewage disposal systems. I am a DEP approved system inspector pursuant to Section1b.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails 4wo Needs Further Evaluation by the Local Approving Authority Itf qy m 7/29/10 to pector'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. matias.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 1 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments N S Disposal 9 Subsurface Sewage Dis stem Form ,M p Y A. Certification (cont.) 25 Fisher Road Property Address Hyannis MA 02601 Cityrrown State Zip Code Ana Matias 7/29/10 Owner's Name Date of Inspection 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: passes 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. . Answer yes, no or not determined (Y, N, ND) in the ❑ 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. ND Explain: N/A II matias.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System• . Page 2 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments iG^M Subsurface Sewage Disposal System Form A. Certification (cont.) 25 Fisher Road Property Address Hyannis MA 02601 City/Town State Zip Code Ana Matias 7/29/10 Owner's Name Date of Inspection 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 ❑ obstruction is removed ❑ distribution box is leveled or replaced ND Explain: N/A ❑ 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: N/A 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 matias.doc•11/2004 Title 5 Official Insp4tion Form:Subsurface Sewage Disposal System Page 3 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M A. Certification (cont.) 25 Fisher Road Property Address Hyannis MA 02601 City/Town State Zip Code Ana Matias 7/29/10 Owner's Name Date of Inspection C) Further Evaluation is Required by the Board of Health (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: N/A **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: N/A matias.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4 of 16 i Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M A. Certification (cont.) 25 Fisher Road Property Address Hyannis MA 02601 CityFrown State ZipCode Ana Matias 7/29/10 Owner's Name Date of Inspection D)System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ Z 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 'h day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] Yes No ❑ 0 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. matias.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 5 of 16 Commonwealth.of Massachusetts Title 5 Official Inspection -Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cont.) 25 Fisher Road Property Address Hyannis MA 02601 City/Town State Zip Code Ana Matias 7/29/10 Owner's Name Date of Inspection 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. matias.doc• 11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 6 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M B. Checklist 25 Fisher Road Property Address Hyannis MA 02601 City/Town State Zip Code Ana Matias 7/29/10 Owner's Name Date of Inspection Check if the following have been done. You must indicate"yes" or"no" as to each of the following: YES NO ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? h ® ❑ 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(3)(b)] matias.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 7 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments iV^M SV 0 Subsurface Sewage Disposal System Form C. System Information 25 Fisher Road Property Address Hyannis MA 02601 City/Town State - Zip Code Ana Matias 7/29/10 Owner's Name Date of Inspection Residential Flow Conditions: 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 gpd. 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)): Sump pump? ❑ Yes ® No current Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: N/A Design flow(based on 310 CM N/AR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): N/A � 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:. N/A Last date of occupancy/use: N/A Date Other(describe): N/A matias.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 8 of 16 I Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form p Y �M C. System Information (cont.) 25 Fisher Road Property Address Hyannis MA 02601 City/Town. State Zip Code Ana Matias 7/29/10 Owner's Name Date of Inspection General Information Pumping Records: Source of information: owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: N/A gallons How was Y uantit pumped determined? N/A q Reason for pumping: N/A Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool III ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe),- Approximate age of all components, date installed (if known) and source of information: installed in 2000 per disposal works construction permit. Were sewage odors detected when arriving at the site? ❑ Yes ® No matias.doc.11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 9 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M C. System Information (cont.) 25 Fisher Road Property Address Hyannis MA 02601 City/Town State Zip Code Ana Matias 7/29/10 Owner's Name Date of Inspection Building Sewer(locate on site plan): Depth below grade: 1.5' 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.): All in good working order at time of inspection. Septic Tank(locate on site plan): Depth below grade: 2'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 ❑ Yes ❑ No certificate) Dimensions: 9'x6'x5' outside 1500 gal. Sludge depth: .2' Distance from top of sludge to bottom of outlet tee or baffle 2.9 Scum thickness 2' Distance from top of scum to top of outlet tee or baffle .5' Distance from bottom of scum to bottom of outlet tee or baffle .9 How were dimensions determined? sludge judge Lmatias.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 10 of 16 Commonwealth of Massachusetts u Title 5 Official Inspection Form Not for Voluntary Assessments ,M Subsurface Sewage Disposal System Form C. System Information (cont.) 25 Fisher Road Property Address Hyannis MA 02601 City/Town State Zip Code Ana Matias 7/29/10 Owner's Name Date of Inspection 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 shows no signs of leakage and appears to have been maintained properly at time of inspection. Grease Trap (locate on site plan): Depth below grade: N/A feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): N/A Dimensions: N/A Scum thickness N/A Distance from top of scum to top of outlet tee or baffle N/A Distance from bottom of scum to bottom of outlet tee or baffle N/A Date of last pumping: N/A Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): N/A Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: N/A Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): N/A matias.doc• 11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 11 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M C. System Information (cont.) 25 Fisher Road Property Address Hyannis MA 02601 CityFrown State Zip Code Ana Matias 7/29/10 Owner's Name Date of Inspection Tight or Holding Tank (cont.) Dimensions: N/A Capacity: N/A gallons Design Flow: N/A gallons per day Alarm present: ❑ Yes ❑ No Alarm level: N/A Alarm in working order: ❑ Yes❑ No Date of last pumping: N/A Date Comments (condition of alarm and float switches, etc.): N/A Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0.0' 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 level with no leakage or solids carryover at time of inspection. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No matias.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 12 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments iG^M yVy Subsurface Sewage Disposal System Form C. System Information (cont.) 25 Fisher Road Property Address Hyannis MA 02601 City/Town State Zip Code Ana Matias 7/29/10 Owner's Name Date of Inspection Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): N/A Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 2 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ Teaching 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.): 2 500 gal drywells with 4' of stone had 2'of water and no higher stain lines at time of inspection. SAS is not in failure. matias.doc•1.1/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 13 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form �M C. System Information (cont.) 25 Fisher Road Property Address Hyannis MA 02601 City/Town State Zip Code Ana Matias 7/29/10 Owner's Name Date of Inspection Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration N/A Depth—top of liquid to inlet invert N/A Depth of solids layer N/A Depth of scum layer N/A Dimensions of cesspool N/A Materials of construction N/A Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/A Privy (locate on site plan): Materials of construction: N/A Dimensions N/A Depth of solids N/A Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)-. N/A I matias.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 14 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments iG^M Subsurface Sewage Disposal System Form C. System Information (cont.) 25 Fisher Road Property Address Hyannis MA 02601 City/Town State Zip Code Ana Matias 7/29/10 Owner's Name Date of Inspection Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. #25 A 2-193 B-2-2T AM 8-3.30' /S A4-31' B4-39' Fisher ®a matias.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 15 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments ,M Subsurface Sewage Disposal System Form C. System Information (cont.) 25 Fisher Road Property Address Hyannis MA 02601 City/Town State Zip Code Ana Matias 7/29/10 Owner's Name Date of Inspection Site Exam: Slope Surface water Check cellar Shallow wells Estimated depth to ground water: Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If clhecked, date of design plan reviewed: 4/21/00 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: Checked test hole data from system design plans. System was installed within reasonable limits and has adequate groundwater seperation. matias.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 16 of 16 f COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 25 Fisher Road Hyannis Owner's Name: Demick Feliz Owner's Address: d Date of Inspection: 5/19/2006 Name of Inspector. (please print) Patrick T. Sullivan Company Name: Ready Rooter Mailing Address: P.O.Box 371 Sandwich,MA 02563 Telephone Number: (508)888-6055 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The System: asses Conditionally Passes Needs Further Evaluation by the Local Authority Fails Inspector's Signature: Date: co 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 J.0,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office=o€the =3 DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable,,and the approving-,-) authority. -- -; Notes and Comments n 1 a .. ;V Cal ****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. Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 25 Fisher Road Hyannis Owner. Demick Feliz Date of Inspection: 5/19/2006 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ve not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditio ass" section need to be replaced or repaired.The system,upon completion of the replacement or repair, approved by the Board of Health,will pass. Answer yes,no or not determined (Y,N,ND)in the for following statements. lf"not determined"please explain. The septic tank is metal and over 20 years old*or�fe septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration of 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 structY rally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is mailable. ND explain: / Observation of sewage backup or break ut or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled r uneven distribution box. System will pass inspection if(with approval of Board of Health): roken pipe(s)are replaced obstruction is removed 7distribution box is leveled or replaced ND explain: , The system required pump' g more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval f the Board of Health): broken pipe(s)are replaced iobstruction is removed ND explain: .r� f , Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 25 Fisher Road Hyannis Owner: Demick Feliz Date of Inspection: 5/19/2006 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the and 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 determi es in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which w' protect public health,safety and the environment: _Cesspool or privy is within 50 feet of a ace water Cesspool or privy is within 50 feet of a ordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Wat Supplier,if any)determines that the system is functioning in a manner that protects the public health afety and environment: _The system has a septic tank and soil absorption syste (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 S is within a Zone 1 of a public water supply. _The system has a septic tank and SAS and th AS is within 50 feet of a private water supply well. The system has a septic tank and SAS an e SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used t determine distance "This system passes if the well water sis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds in cater that the well is free from pollution from that facility and the presence of ammonia nitrogen and ni to nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of analysis must be attached to this form. I r r' 3. Other. Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 25 Fisher Road Hyannis Owner: Demick Feliz Date of Inspection: 5/19/2006 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 and overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6"below invert or available volume is less than%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 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. _ —Z' Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this forma �Yes/No)The system fails. I have determined that one or more of the above 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 facili with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either`yes"or"no"to each of the follo g: (The following criteria apply to large systems in addition t the criteria above) yes no the system is within 400 feet of a surface g water supply — _the system is within 200 feet of a trio to a surface drinking water supply the system is located in a nitrogen itive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply w 11 If you have answered"yes"to any qu n in Section E the system is considered a significant threat,or answered "yes"in Section D above the large m has failed.The owner or operator of any large system considered a significant threat under Section E or ailed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should ntact the appropriate regional office of the Department. i i i Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 25 Fisher Road Hyannis Owner: Demick Feliz Date of Inspection: 5/19/2006 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 a�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? Z Was the facility owner(and occupants if different than owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No ✓ — Existing information.For example,a plan at the Board of Health. ✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CNM 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 25 Fisher Road Hyannis Owner: Demick Feliz Date of Inspection: 5/19/2006 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Number of current residents: -3 Does residence have a garbage grinder(yes or no):w7� Is laundry on a separate sewage system(yes or no):,_-_.%--jif yes separate inspection required] Laundry system inspected(yes or no):— Seasonal use:(yes or no): 'd Water meter readings,if available(last 2 years usage(gpd)): Sump Pump(yes or no):ocn:, Last date of occupancy: c COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): Basis of design flow(seats/persons/sq.ft.etc. . Grease trap present(yes or no): Industrial waste holding tank present(y or no):_ Non-sanitary waste discharged to the T' e 5 system(yes or no):_ Water meter readings,if available: Last date of occupancy/user OTHER(describe): GENERAL INFORMATION Pumping Records Source of information Was system pumped as part of the inspection(yes or no): If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM Septic tank,distribution lox,soil absorption system _Single cesspool _Overflow cesspool —Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all components,4ate installed(if known)and source of info lion: Were sewage odors detected when arriving at the site(yes or no)A.>(ZD r Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 25 Fisher Road Hyannis Owner: Demick Feliz Date of Inspection: 5/19/2006 BUILDING SEWER(locate on site plan) Depth below grade: ex)` Q" Materials of construction:_cast iron ,40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:AZ(locate on site plan) Depth below grade: Material of construction:_,,!<oncrete_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: f 1 )e (y- Sludge depth: `a" Distance from the top of sludge to bottom of outlet tee or baffle: 3S ' Scum thickness: I(w' Distance from top of scum to top of outlet tee or baffle: G„'' Distance from bottom of scum to bottom of outlet tee or bale: f.7 " How were dimensions determined: hti .^e v Comments(on pumping recommendatio4 inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): ` s d&'kc L s t-= ►s ►tz. GREASE TRAP:_(locate on site plan) Depth below grade: Material of construction:_concrete_met —fiberglass polyethylene_other (explain): Dimensions: Scum thickness: f Distance from top of scum to top of out)6t tee or baffle: Distance from bottom of scum to bottgin of outlet tee or baffle: Date of last pumping: f Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity,liquid levels as related to outlet invert,evidenc,6 of leakage,etc.): r r Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 25 Fisher Road Hyannis Owner: Demick Feliz Date of Inspection: 5/19/2006 TIGHT or HOLDING TANK: (tank must be pyihped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal/ fiberglass_polyethylene_other(explain): Dimensions: Capacity: gallons/F Design Flow: gallo s/day Alarm present(yes or no): Alarm level: Alarm in wo g order(yes or no): Date of last pumping: Comments(condition of alarm d float switches,etc.): DISTRIBUTION BOX:—Z(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert:_e5)� Comments(not if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): 04r� ° ./\��\ csJ�'� trJ e,���U� rJ" _ � "� G• 'P � '�1 F'i �ceJ rz,cs et, LJO PUMP CHAMBER: (locate on site pl Pumps in working order(yes or no): Alarms in working (y or no)order es : Comments(note condition of pump c ber,condition of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 25 Fisher Road Hyannis Owner: Demick Feliz Date of Inspection: 5/19/2006 SOIL ABSORPTION SYSTEM(SAS):,(locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: leaching chambers,number: 54nc:�. 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.): far $c 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 Oles or no): Comments(note condition of so' ,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): r PRIVY: (locate on site plan) Materials of construction.- Dimensions: Depth of solids: Comments(note condition of so (signs of hydraulic failure,level of ponding,condition of vegetation,etc.): r r Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 25 Fisher Road Hyannis Owner: Demick Feliz Date of Inspection: 5/19/2006 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. .3 D3 ` I � �4 3 � ` -2� '33 o 0 I . S3 3c . f � 3 g� 3 O q I "q- Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 25 Fisher Road Hyannis Owner: Demick Feliz Date of Inspection: 5/19/2006 SITE EXAM Slope Surface water Check cellar---' Shallow wells Estimated depth to groundwater feet Please indicate(check)all methods used to determine the high ground water elevation: ✓,Obtained from system design plans on record—If checked,date of design plan reviewed: �8 Observed site(abutting property/observation hole within 150 feet of SAS) Checked with the local Board of Health-explain: 1;Pr- Checked with local excavators,installers-(attach documentation) ��Accessed USGS database-explain: —tz'.., u, , n q-1Ls You must describe how you established the high ground water elevation: � �L� �LG �d.S� lyre.--� i�-.� � �c�t ..�-� .• �c-� ..xa..- � C'$]c'Z'.f"' i I 9 PARCEL. �4-O O I LOT ' COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PRO ION m t tl APR 7 2004 � W TOWN OF BARNSTABLE HEALTH DEPT. ' TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 25 FISHER ROAD HYANNIS,MA 02601 3c)g Owner's Name: CARLOS JUSTUS Owner's Address: 23375 SERENE MEADOW DR S. BOCA RATON FL.33428 Date of Inspection: 3/5/04 Name of Inspector: (please print) JOHN GRACI,INC. Company Name: SEPTIC INSPECTIONS Mailing Address: P.O. BOX 2119 TEATICKET,MA.02536 Telephone Number: 508-564-6813 FAX 508-564-7270 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: X Passes _ Conditionall P. 'sses _ Needs Furth, r {valuation by the Local Approving Authority _ Fails Inspector's Signature: Date: 3/5/04 The system inspector shall submit aI�o of this inspection report to the Approving Authority Board of Health or DEP within Y P PY P P PP g ty( ) 30 days of completing this inspectio't. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shal submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments SYSTEM PASSED TITLE V INSPECTION. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. RECOMMEND RAISING ALL COVERS TO SEPTIC COMPONENTS ****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. Titles 5 ImnPntinn Fnrm F/1 VM00 1 Page 2 o+f 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 25 FISHER ROAD HYANNIS,MA 02601 Owner: CARLOS JUSTUS Date of Inspection: 3/5/04 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 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: SYSTEM PASSED TITLE V INSPECTION.RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. RECOMMEND RAISING ALL COVERS TO SEPTIC COMPONENTS 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. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. n/a 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. ND explain: n/a n/a Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): _ broken pipe(s)are replaced _ obstruction is removed _ distribution box is leveled or replaced ND explain: n/a n/a 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: n/a i Wage 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 25 FISHER ROAD HYANNIS,MA 02601 Owner: CARLOS JUSTUS Date of Inspection: 3/5/04 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(i)(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 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 n/a "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: n/a I Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 25 FISHER ROAD HYANNIS,MA 02601 Owner: CARLOS JUSTUS Date of Inspection: 3/5/04 D. System Failure Criteria applicable to all systems: 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 cesspool is less than 6"below invert or available volume is less than %2 day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped NOT IN THE LAST TWO YEARS PER OWNER. X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] NO (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no X the system is within 400 feet of a surface drinking water supply _ X the system is within 200 feet of a tributary to a surface drinking water supply X 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. a Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 25 FISHER ROAD HYANNIS,MA 02601 Owner: CARLOS JUSTUS Date of Inspection: 3/5/04 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 recently 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,excluding the SAS, located on site'? X _ 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? 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)on the site has been determined 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 CMR 15.302(3)(b)] 5 I - Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 25 FISHER ROAD HYANNIS,MA 02601 Owner: CARLOS JUSTUS Date of Inspection: 3/5/04 FLOW CONDITIONS RESIDENTIAL 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: 0 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): NO Seasonal use: (yes or no):YES �� Water meter readings, if available(last 2 years usage(gpd)):*a 03. �O,'1 vd c N i Sump pump(yes or no): NOP- Last date of occupancy: n/a v L COMMERCIAL/INDUSTRIAL Type of establishment: n/a Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sqft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no):NO Water meter readings, if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: NOT IN THE LAST TWO YEARS PER OWNER Was system pumped as part of the inspection(yes or no):NO If yes,volume pumped: n/agallons--How was quantity pumped determined?n/a Reason for pumping: n/a 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) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank Attach a copy of the DEP approval Other(describe): n/a Approximate age of all components,date installed(if known)and source of information: M 2000 PER AGENT Were sewage odors detected when arriving at the site(yes or no): NO Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 25 FISHER ROAD HYANNIS,MA 02601 Owner: CARLOS JUSTUS Date of Inspection: 3/5/04 BUILDING SEWER(locate on site plan) Depth below grade:34" Materials of construction:_cast iron X40 PVC_other(explain): n/a Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): TOWN WATER SEPTIC TANK: X(locate on site plan) Depth below grade: 28" Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: H 10' 6" H 5' 7" W 5' 8"-" Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle: 33" Scum thickness: 0" 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: 18" How were dimensions determined: MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. GREASE TRAP: _(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): n/a 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 25 FISHER ROAD HYANNIS,MA 02601 Owner: CARLOS JUSTUS Date of Inspection: 3/5/04 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX:X(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE 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 WAS VIDEO INSPECTED AND APPEARS TO BE STRUCTURALLY SOUND. PUMP CHAMBER:_(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a Page 9 of 11 i i OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 25 FISHER ROAD HYANNIS,MA 02601 Owner: CARLOS JUSTUS i Date of Inspection: 3/5/04 i I i SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: i n/a i Type n/a leaching pits, number: n/a 500 GALLON DRY WELL leaching chambers, number: 2 CHAMBERS leaching galleries; number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a n/a overflow cesspool,, number: n/a n/a innovative/alternative system n/a Type/name of technology: n/a i i Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): CHAMBERS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. CHAMBERS WERE PROBED DRY AND ARE EMPTY. BOTTOM IS AT 6 FT. i CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) I Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a i 9 L j Page 1�of 11 i OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 25 FISHER ROAD HYANNIS,MA 02601 Owner: CARLOS JUSTUS Date of Inspection: 3/5/04 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. A z 16 0f A f G AA 1 c .379 � 3G i in r Page 1 I of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 25 FISHER ROAD HYANNIS,MA 02601 Owner: CARLOS JUSTUS Date of Inspection: 3/5/04 SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 12 feet i Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record- If checked,date of design plan reviewed: n/a YES Observed site(abutting property/observation hole!within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) NO Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: HAND AUGER- 12 FT. i i { i 11 YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates cost $30.00 for 4 years. A Business Certificate ONLY REGISTERS THE BUSINESS NAME in town (which you must do by M.G.L.- it does not give you permission to operate.) You must first obtain :the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1st FL., 367 Main Street, Hyannis, MA 02601 (Town,.Hall) and get the Business Certificate that is required by law. Fill in please: Date113, : s` APPLICANT'S NAME: i p ; ' rfi�y � k YOUR HOME ADDRESS: p BUSINESS TELEPHONE # HOME TELELPHONE #: .3 : NAME OF CORPORATION: FID # 1-16 D O NAME OF NEW BUSINESS rIU5 f ro 7 U PT T y PA N T 1 hJ TYPE OF BUSINESS /,q IS THIS A HOME OCCUPATION? X YES N �?Dc(_OL4( ADDRESS OF BUSINESS q6 S , h Zr A D 1 f Y.A N 01 bO I MAP/PARCEL NUMBER (Assessing) When starting a new business there are several things you must do to be in compliance with the rules and regulations of the Town of Barnstable. This form is to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. (corner of Yarmouth Rd. & Main Street) to make sure.you have the appropriate permits and licenses required to legally operate your business.in town. 1. BUILDING COMMISSIONER'S OFFICE _ This individual has.been informed of any permit requirements that pertain .to this-type of business. Authorized Signature`* COMMENTS: 2. BOARD OF HEALTH MUST COMPLY WITH ALL This individual has be formed of the permit requirements that pertain to this type of business. HAZARDOUS MATERIALS REGULATIONS Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has b n infor, d of the licensing,requirements that pertain to this type of business. Auth rized Signature** COMMENTS: Date:3 / L5 /001 TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAMEOFBUSINESS: (� PLO CA7'nIrrNCa BUSINESS LOCATION: C1 .1; 59 E k P p 14 y fi,v A r S NO o I INVENTORY MAILING ADDRESS: i Gh E 2 2 D k v ���yv s , M A n iL 4 6 .1 TOTAL AMOUNT: TELEPHONE NUMBER: n 9 L3 2;,— J _/ �]7 CONTACT PERSON: 0 A N L �5. R n rro ► C 5 ja-r EMERGENCY CONTACT TELEPHONE NUMBER:(SGS) .7. i j,— �_ 16 MSDS ON SITE? TYPE OF BUSINESS: INFORMATION/RECOMMENDATIONS: Fire District: Waste �ast Transportation: shipment of hazardous waste: p (�`rl���7�b/.� Y� e Name of Hauler: f)dL(�A t-rj, Copt Destination: Waste Product: '� Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The board of health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel LFloor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers 14including bleach) Spot removers&cleaning fluids L(dry cleaners) Other cleaning solvents Bug and tar removers 1 "indshield wash a WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials fZ;/Uvv TOWN OF BARNSTAnBLE LOCATION i S Q o 11 to SEWAGE #2-600 VILLAGE .9al A/ ASSESSOR'S MAP & INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY / S'o O LEACHING FACILrrY: (typo) C.9,0,13 6',4 Y (size) . NO.or-BEDROOMS — � / J BUILDER OR OWNER 77 / e / PERMITDATE: CONFLIANCE DATE: 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 ------------ -t 9� b 35) d?/0f� I TOWN OF BARNSTABLE LOCATION SEWAGE.# - `,:�q VILLAGE ASSESSOR'S MAP&PARCEL 3M — c) INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY A EOO LEACHING FACILITY:(type) (size),Q g<un !ra-^ NO. OF BEDROOMS C'Le Y OWNER t__ . PERMIT DATE: COMPLIANCE DATE: 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 ��ciiz:,r�,. .,��a � ,a,3,Q 'a-/� j`. Cg-Lo 41 ' L)i UA O �s e 0 -j w r • � d r 0- TOWN OF BAMSTABLE �CJ LOCATION � � Jr 4/F 4. Qo ' SEWAGE*2,b0D 'VILLAGE / " ASSESSOR'S MAP & LOT-30 9 - f'� 0 INSTALLER'S NAME&PHONE NO. J A) m ' <' G J:7 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) C/(9/�S 6 $ (*— (size) NO.OF BEDROOMS RIBUILDER OR OWNER �, % e PERMTTDATE: COMPLIANCE DATE a 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 �t G � tto ti V PI V . Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓ v� Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYication for Miopooar *pztem Construction Verinit Application for a Permit to Construct(L11 repair( )Upgrade( )Abandon( ) L?Complete System ❑Individual Components Location Address or Lot No. $—/Ci S � lock Owner's Name Address and Te.No., Assessor's Map/Parcel ?.4VC", 5 r 3o°� — � C> o - 6 /7- 211V -69-s- Installer's Name,Address,and Tel.No. > Designer's Name,A ress and Tel.No. �1 Lel_ Type of Building: Dwelling No.of Bedrooms Lot Size A7i sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 3 gallons per day. Calculated daily flow 3 �'• - gallons. Plan Date 2,- Number of sheets Revision Date Title f e: UQ oS c-s sue. �7J oje w Size of Septic Tank �S Type of S.A.S. ZS'X t Z,g Xz L J Z-Svyga�. C, Description of Soil: 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 Certifi- cate of Compliance has been i t by ' Board of Hea h. Signed Date Application Approved by Date ?✓ �`�'' Application Disapproved for the following reasons Permit No. l Z`T� Date Issued 3 Z 2�'� 1 tt 7 r THE COMMONWEALTH'"d MASSACHUSE•TTS Entered in computer: Yes �- N- 6BLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 3ppitcatton for Migpogar *pgtem Comaructton Vermtt t ` Application for a Permit to Construct( , epair( )Upgrade( )Abandon( ) L�'Complete System El Individual Components Location Address or Loi No. 7 S F Shy¢•_ 1 Owner's Name Address and Te.No.� L " 0*50 ;' 1.Cl k /!/ice cap, ; Assessor's Map/lTarcel _ 1���. , i 3o9 Z/ ate+ Gig 7qq 'Z691- Installer's Name,Address,and Tel.No. /^y Desig er's Name,Address and Tel.No. L� /�/t Jf_ .-J-1 fn t Type of Building: �' { Dwelling No. Bedroor't �, Lot S'iz'e i sq.ft. Garbage Grinder( � Other Type'of/B&Id ng No.of Persons - Showers( ) Cafeteria( ) 'Other Fixtures V Design Flow 3 3 gallons per day. Calculated daily flow 3 y 9• gallons. Plan Date 2- �" Number of sheets Revision Date Y... Title plc 5--c Cf �ywF ¢ �.So S a� S7�dew Size of Septic Tank /S Type of S.A.S. Z S A 17, T xZ 1-'7 / Z-1w5Q C am,y. Description of Soil 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 Certifi- cate of Compliance has been i d by t_hi9tBoard of Hea th. - , te- Signed Date dp"'" 4. Application Approved by r�� • Date 3 7 ' Y Application Disapproved for the following reasons Permit No. �'�'� Z Date Issued 3 Z � THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS,._...- - .-_���er-t��%ra��of•�ontpYiat�ce - THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( Repaired ( )Upgraded( ) Abandoned( )by at �- r S Ze, ea ou__v has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ?.uz y— Z`ldated 3/V Zoa0 Installer IDesigner The issuance of this pen-nit shall not be construed as a guarantee that the system will function as designed. Date Y, - k2 - (UZ7 Inspector (Z�\ S"` ---------------------------------------- No. �l�". L Fee ti . - THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS &5pogar �p ens (to.ngtruction Vermtt Permission is hereby granted to Qonstruct( Repair( )Upgrade )Abandon( ) System located at i 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. / a Provided:Co tructio must be completed within three years of the date of thi t! Date: f W191Approved by ia_01—?0PA 1 1 r1(aM FR1'11Y1 T Fin F-RnTHFR9 P 1 L im v a IN r.V,K I .NU PLANNING SchON21d Brothers of Now tin9land,ire. 151 CW15&ry Highway R.O Box 101 Crioar%z MA 02533.0101 July 31 2000 5=20-2098 of8M38t3 3311 FAX W&1201215 . Tows of Barnstable Health Department 367 Main Street Hyannis, MA 02601 i Re: Michael Alti0ri, Property at 25 Fisher Road., Barnstat.le, MA Acm-Ce^r°o AAor 2CI0, 40,L,C.1%, 10�?..T-.c't, 7..V lS'49 tllill Jt) To t}ho Dopartrno,t! On Friday, July 28,2000,this office irlsvected the recentiv t` n.gtrllnt4m.A ci-ptir- zAmtorr, at tho abOvO i'O1!ClGt1Gc.3 Sltt.. '<t'Atl:1UbPCC:L L41 I'hn Ar'f9rr)vecj Stan,the eeptio tn>,1r '.6:fked / 1'Y i/-Atuayl finrn }}.a nnr+l�.s.rotorIl•PrOr&rtr^Sin:, viral LI,� tvat111, .Y(Gd wYL.�t2131L'Q 40 ft. j/• Closer to the northvve;terly property line. With this exception, we hereby certify that t1�P tnrtir. 031Lturn hac baan 00-'t1vetQd LAl oet iata11l12tt uumpliancc wAn me approved Anna n—A n.-...oi-•..;tc 1 i.. �vr,ryliurr��„r 'with Tltlz J a,u1 WC 1,1411INUIU1C t5uiirrl or meann regulations, "� r-v---• - •• �•. d.... �a,Uu,u Iuu „arC 4UGJtlulls. Very truly Fours, Schofield Brothers of New England, inc. i Daniel J. Sullivan 1.7JS.1,llu 0-9800 i I 1 �OULk'MEAD I oc 110 - G` s 5 IDE DooR --_DL, o4G ' ..all FOLD 4 LONG. 5NEL( i—1 SI N -- I - i d0 L Z ur,Rowaoo' . . it t!1-FOLO- moon is 9 1 � -ru^�rT•��— 2;,p o° T3 _ .. I . s G T1LE�j HARDWOOD FLOOR 1 � coNc FLOOR I . SHELVES;'N SlN1K j 1 k � I � :ARGHE6"OPENING 1`� �Il:.E 7s 1�= 7�y!bE.F-� -(3jZxiv�Itl �3�1Z1°.L . � ,�' :� r�• ,__�Ix- II d NON SK1D'.jl l-fi� •. i a V I'C� � 4 I 1�•.HARDV'<OOD-FLR:� � �. a �� �p• NAN 017AIL 1 I ,99 ��I l u taaalxhi �cae� s ooSCH®LIELID BROTHERS ENGINEERING • SURVEYING PLANNING Schofield Brothers of New England, Inc. 161 Cranberry Highway P.O.Box 101 Orleans,MA 02653-0101 508/255-2098 or 508/398-3311 July 31, 2000 FAX 508/240-1215 Town of Barnstable Health Department DO !I 367 Main Street0 Hyannis, MA 02601 0 Re: Michael Altieri, Property at 25 Fisher Road, Barnstable, MA Assessor's Map 309, Parcel 40, L.C.P. 18327-A, Lots 49 and 50 To the Department: On Friday, July 28, 2000, this office inspected the recently constructed septic system at the above referenced site. With respect to the approved plan,the septic tank was shifted 7 ft. +/- away from the northwesterly property line and the leaching area was shifted 10 ft. +/- closer to the northwesterly property line. With this exception, we hereby certify that the septic system has been constructed in substantial compliance with the approved plans and constructed in compliance with Title 5 and the Barnstable Board of Health regulations. Thank you for your cooperation with the project. Please call should you have questions. Very truly yours, Schofield Brothers of New England, Inc. Daniel J. Sullivan DJS:mkr 0-9800 8-02-2000 9:52AM FROM SCHOFIELD BROTHERS 5082401215 P. 1 BBSCHOFIEED BROTHERS ENGINEERING • SURVEYING PLANNING ® Schofield Brothers of New England,Inc. 161 Cranberry Highway P.O.Box 101 Orleans,MA 02653-o1 of t' 7 July 31,2000 50e/255-2M or 5o8/398-3311 FAX SM/2aP1215 � 7r b Town of Barnstable Health Department 367 Main Street, Hyannis,MA 02601 Re: Michael Altieri, Property at 25 Fisher Road,Barnstable,MA Assessor's Map 309,Parcel 40,L.C.P. 18327=A, Lots 49 and 50 To the Department: On Friday, July 28,2000, this office inspected the recently constructed septic system at the above referenced site. With respect to the approved plan,the septic taljk was shifted 7 ft. +/_away from the northwesterly property line and the leaching area was shifted 10 ft. +/-closer to the northwesterly property line. With this exception, we hereby certify that the septic system has been constructed in substantial compliance with the approved plans and constructed in compliance with Title 5 and the Barnstable Board of Health regulations. Thank you for your cooperation with the project. Please call should you have questions. Very truly yours, Schofield Brothers of New England, Inc. Daniel J. Sullivan DJS:mkr 0-9800 V PLOT PLAN DEEP HOLE OBSERVATION LOG # 1 LOCUS MAP NSCALE . -- - - - -• GATE 06r29,69 11;XIAM JOB ALrIERI LOT' NO. `* & © 3}•T'�A?`J BK; C1�' 1� PERFORMLOBY R A R"TER WIINESSEU 81 fI'W< rAPNSTABLE BOH _ _ �� \\ ELEVATION DEPTH FROM $f)Il 1 1JRV SOILL71- COLOR SOI- OTHER 0. L-07 AREA ._ I O O O 0 6.1�L_± �F r st rrir AGEr�oR�toN Usu.,, My I,,•.c /j 100 0-99 5 0 6 A SANDY LOAM 10 YN y2 NONE 1 L,-f•' / 99 5-98 0 6"-24" B LOAMY SAND 10 YR 5,3 NONE ff 960-900 I4"-120•' SANr)y,,­?Avu 10YRB+F nnr.if 0A rC J �` Ittt PARENT GEOLOGIC MATFRIAL GLACIAI.0-:T-AS' STANDING WATER 0'.'K!1 F NO ✓IEEPING FROM FACE NO __.._. Zvi \x k ESTMATED SEASONA! HIGH GROUNDWATER AT EL =90•+ i - r 0.a PERCOLATION TEST ;1NABLF TO SATURATE I;r PTH Of PERC=36" 54' PERC RATE<2 MPI / 4 DEEP HOLE OBSERVATION LOG # 2 DATE 06t79/99 11 DUa� JUB A..TIERi SCALE: 2000 ERFCRMEDBY R A BAX,ER WITNESSEOBY EDBARRY BARNS TABLEBOH ELEVATION DEPTH FR(,W SOIL 64i 'OE OR SOIL- OTHER ,w E r� t { I� •( • .� N O`� (FT) SUR,-A;:i:. HORIZON (LISDA) w,;rTLw-, vt.:l�L �a�. IiVT[..�? } y1 nCi vR +0�0 1tac5 A NDVLOAM 1JYR3/1 Nc.++r 1 E:LEVATIONS REFER TO AN ASSUMED DATUM SEE: BE;NCHMAFtK, C>^ \� t7' / i 1005-9i 0 6 -24 B LOAMY SAND 10Y,•'.,.., NONL � CONCRETE BOUND LOCATED AT THE EASTERLY LOT CORNER 990-911, 24 -120 c SANDY GRAVEL t0YR6"; NONE 6%G12A.r.. 2 AL. . CONSTRUCTION AND MATERIALS TO CONFORM TO TITLE 5 OF ; n t.' o�- �© �` \ THE MASSACHUSETTS STATE Ei'JVIRONMENTAL CODE t ND THE 4 U "''J i BOARD OF HEALTH REQUIREMENTS FOR THE TOWN 01 O Q \ BARNSTAEIt F �- J 3 ANY CHAN(JES TO THIS PLAN MiST BE APPROVED BY THE BOARD PARENT GEOLOGIC MATERIAL GLACIAL OUTWASri NO OF HEALTH AND SCHOF IEL D P"ETHERS. 0 •-.� \L WFEPIN'G FROM FACE N,, 4. NO PERMANENT STRUCTURES SHALL BE CONSTRUCTED OVER THE `O "-'`t ih ESTIMATED SEASONAL HIGH GROUNDWATE R AT EL =90-1 RESERVE AREA j! C? PERCOLATION TEST. NAaLE To SA'I DEPTH Of PERC=3F 54' PER( RATE• 2 Mi'I ) 5 FOR PROPER PERFORMANCE, THE SEPTIC TANK TANK DBE INSPECTED AT LEAST ONCE A YEAR. THE SEPTIC TANK SHOULD BE PUMPED WHEN THE TOTAL DEPTH OF SOLIDS EXCEEDS 1/3 THE NcqN Q ,� 1 . t �L NOTE SOIL TESTS PERF ORMED BY BAXTER AND NYE, INC. DEPTH OF LIQUID IN THE TANK m \ 6 ANY DELETERIOUS MATERIALS ENCOUNTERED MUST BE 0I EXCAVATED AND REMOVED 10 A DISTANCE Or t, FROM ALL SIDES c OF THE S.A S EXCAVATION TO BE BACKFILI ED WITH CLEAN SAND MATERIAL MEETING TITLE 5 SPECIFICATIONS CONTACT SCHOFIELD BROTHERS IF ANY DOUBT OR QUESTIONS ARISE REGARDING SOIL 0 QUALITY SCHOFIELD BROTHERS DOES NOT ASSUME r� v RESPONSIBIL!TY FOR MATERIALS ENCOUNTERED DURING ' I* , ,,) . $ \ EXCAVATION ----- '� 7. INSTALLATION CONTRACTOR SHALL CONTACT SCHOFIELD BROTHERS PRIOR TO BACKFILLING FOR SYSTEM CERTIFICATION 8. NO KNOWN WELLS EXIST WITHIN 200' OF THE PROPOSED LEACHING Iof AREA. ATION REQUIRES At L STRIPPED TO BE STOOCKPILED AND REUSED AT OWNER'S OPTIOIN.AREDSPRE DiL OVER ALI. DISTURBED AREAS TO PROMOTE OPTIMAL c �� irl LEGEND ` �� •ljY' .� \.ro 10. BENCHMARK TO BE TRANSFERRED TO WITHIN 50' OF THE ---- - PR0.005ED covrot_w L//VE PROPOSED SEPTIC SYSTEM PRIOR TO CONSTRUCTION. ff v� % 11. INSTALLATION CONTRACTOR SHALL VERIFY THE /�9 Ex/9T1NG COA-47o( R LOCATION OF UNDERGROUND UTILITIES PRIOR TO X/S T/NG GE S.S POC1L EXCAVATION AND CONSTRUCTION N 0T F- : A15VTTII�I (T L("JT 3*5 R-EFE-P- Wa--- WITL°R LWE 1D S/CAI .)AT4 1 t? F TO U8D►Vf5iON t'�LAN I $ 3Z-7 -A /. 6sr1A4AT90 A/YTWALXJC 10-117 fix-" OCAT E D 1 N PLAN T300K 3' oeo P.40P+OsED t X c.ALLoH SEPrr rAnliic C�1-Io� _r�f;t C7 otoxoovo A m:t I;ALLDNs rck DAr- rrr d[UKDoM- �3c�CTPS PACE E 18 $ARNSTA6LE CouNTY 0 PROPOSED D/SrR/BL1TbN t30X 6ACG.06e Or9r0SaL is 14d r .QLLD►NEp W/TN n!/y LDS/G.1. fREfTt STR� of pE Ej>5. ® / z. _&&onC TANK sIZE 1� PROPOSED 500 drAL. LikCFIIN(r CN�IBF_k� �IJ-10) AVEA:.46-L aAlLY AtOW - 33d K ZOO _4 . 6C>C� LALLQIJ i (M/AIIMUnr) / * sA.rAc TANK f'Aror/uF.O - 15��� O,�LLon/S 1� PROPOSED LG•ACH RESERVE AREA pt P4!.fC0LAT0N X.47t < AI P. I. ` Z. S/DEPWALL LOADING - CYi C�PD/SF.h'X.h' EXIST/NG SiZ/T ELE✓A7/ONS 5oT-rcA.4 LOAD/NC. - QrtTA} \ . g TEST HOLE LOCATION LE�GN/h'o �+RGA v1 rvrAL NDCOWA" A,PGA PRO✓/OGD _ 1�I,2 Sr. .. 0, CTpD/a PROPERTY' LINE Z r 2'(25+ 12.8') ! I l•9 (TpD 70To1L 60MM AA10A PROVIDED . 3Zp•0 :F .• 'm �4 C�PD/SF• PROPOSED SPOT ELEVA7/ON �5 ,, ,z,g- - L7S(0� I)NDERC3R0wNb C3TtLtTtts MAXIAIVM ALIOWMLC LDAOrNu (UA,D&W T/rLe 5) _ (� ACrUU NT RALx/C LOAD/Mc . 33C> (TPD < -- 6' J M/n//MUM S/CE L4A1C.WAj6 AREA 1'XCefD.5 THAT ALLOWED 11ND: DOrN T,4 7pwA10F _E'A1XN5TA LZ 60-11 'D Or I-IEALrq A:[L?/A:EMEAl1S ANO r1rLB S. PF2OF/L.E OF SYSTEM TYPICA4 CROSS - SEC '10N 5, 61 T E 161 NO-r i-ocATED tN A NiTRIOGFN SENNT)VE AZEA. 10Z 3L No SCALE CONCRETE A1AM1roLE � COolfR - MIN. D1A - [s' 2•!,^ 1=R �8-� �' wig.. � M.L�i\!I-iOI.E W(T_l 5,eov6Nr up ro YV/TH//✓ 6' of 1`IN,SNED GRADE vv/ss E D STL7N X/Ns51tiRiD GRADE PL A7 �L Atr S W (R '`Iti� 174CuRA7�E, / R4_ 101. r I PROPOSED SEWAGE ,DISPOSAL S71STEM � r3 Iw,N t �'wr,v. 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