HomeMy WebLinkAbout0085 FRANKLIN AVENUE - Health SS Frar�kl�njr �veiiu
.� Hyannis
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No. !tom ��/ Fee :75
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
0(pplitation for Bisposal *pstem Construction permit
Application for a Permit to Construct( ) Repair(,:0) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No.S� / „1:���n 9p Owner's Name,Address,and Tel.No. s✓ ✓ ��vp/
T� ,2 a4o2-�7s
Assessor's Map/Parcel YA,t^.t•S 96-
Installe/r's Name,Address,and Tel.No.D��I&J q-u 5 a,_,..�✓ Designer's Name,Address,and Tel.No.
S
4' 3k/�Y 14-V
Type of Building:
Dwelling No.of Bedrooms 'Al/� Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures Design Flow(min.required) A'Iq gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) iZ e- Or-cc D;S t- ho
Date last inspected: l
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
i
accordance with the provisions of Title 5 of the Environmental Code and not to place t ystem in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signe Date
Application Approved by Date >�
Application Disapproved by Date
for the following reasons
Of
Permit No. /(R. " ) Zp Date Issued ./3 6
No. �(L ��/ d Fee'
THE COMMONWEALTH OF,MASSACHUSETTS Entered in computer:
F
PUBLIC HEALTH.DIVISION - TOWN-OF-BARN STABLE, MASSACHUSETTS r Yes
Notation for aisposaY 6pStem construction Permit
Application for a Permit to Construct( ) Repair(-Pl) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. n I' h 0-9 Owner's Name,Address,and Tel.No. Fdw 4/�
Assessor's Ma /Parcel ,0 C q t c
Installer's Name,Address,and Tel.Not>I $A 4-n u s e._ �.✓ Designer's Name,Address,and Tel.No.
Ty"S Pr tf S Ya PC c 644,
Type of Building:
? Dwelling No.of Bedrooms 'Al A Lot Size sq.ft. Garbage Grind( )
' Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank" � ,�Cp� Type of S.A.S. j
T I
Description of Soil
i
Nature of Repairs or Alterations(Answer when applicable) 12 e 6c C t D-,.S+✓ b A-r I c,
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 t esystem in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signe Date
Application Approved by Date 3 /
Application Disapproved by Date
for the following reasons
Permit No. a�Q/�p '" ) 5 t) Date Issued 43 4
THE COMMONWEALTH OF MASSACHUSETTS
lR -� y BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(pO Upgraded( )
Abandoned( )by /�; L�o✓�a ��c tN'y. y ,%e—
at" �( � T/c�.��I j ,/t 0 has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No5>-- /6) 5 i�dated
Installer + Designer
r#bedrooms 1 / Approved design flow n ✓� gpd
.. i
The issuance of is pe it shall not be construed as a guarantee that the system will c' a�designed.
Date Inspector
- ---------------------------------------------------------------------:---------------------------- - - -
No. — —, (O Fee 7 5
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS
Misposal 6pstem Construction i9ermit
Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( )
System located at ya+ V), 15
—V — ,
and as described in the above Application
plication 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 mus a completed within three years of the date of this pe it.
j Date 3&69 Approved by
AsBuilt Page 1 of 1
LOCATION SEWAGE PERMIT NO.
/G i%cf 5` �iE'A".,k,L 1 w A 2-7
VILLAGE
INSTALLER'S NAME i ADDRESS
BUILDER OR OWNER
DATE PERMIT ISSUED '�a ? 1-7 7
oor
DATE COMPLIANCE ISSUED l�_a,p_ 77
LU "1 'ji0v1 %C '/�
LA r�'1 F3 c>-t - 13
C L 3� ' 16
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http://iss'ql2/intranet/propdata/prebuilt.aspx?mappar=292275&seq=1 5/13/2016
Commonwealth of Massachusetts �9a -a77Z-!>"
Title 5 Official Inspection Form �ra-��.
o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
85 Franklin {
Property Address W
Edward Dewolf
Owner Owner's Name O~?
information is
required for every y H annis Ma 02601 5/7/16
page. City/Town State Zip Code Date of Inspection .v
. m'
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:When filling out forms A. General Information
on the computer,
use only the tab 1. Inspector:
key to move your
cursor-do not Michael DiBuono
use the return Name of Inspector
key.
DiBuono Sewer and Drain
Company Name
8 Johns path
Company Address
S Yarmouth Ma 02664
Cityrrown State Zip Code
508-364-9587 S103522
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5 (310 CMR 15.000). The system:
❑ Passes ® Conditionally Passes ❑ Fails
❑ Needs Further Evaluation by the oc oving Authority
5/13/16
Ins ector's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use.
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17
Commonwealth of Massachusetts _
Title 5 Official Inspection Form
R Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
rt' 85 Franklin
Property Address
Edward Dewolf
Owner 1 Owner's Name
information is*�
required for everyy H annis Ma 02601 5/7/16
page. Cityrrown 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 iinformation 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"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):
l5ins-3/13 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 85 Franklin
Property Address
Edward Dewolf
Owner Owner's Name
information is required for every Hyannis Ma 02601 5/7/16
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes (cont.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
® distribution box is leveled or replaced ® Y ❑ N ❑ ND (Explain below):
Leach pit has only 2 ft of water in it and is working well. Tank is in good shape, system will pass with
replacement of the Dbox.
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
Commonwealth of Massachusetts
r
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
85 Franklin
Property Address
Edward Dewolf
Owner Owner's Name
information is required for every Hyannis Ma 02601 5/7/16
page. Citylrown State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well**.
Method used to determine distance:
** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
3. Other:
i
D) System Failure Criteria Applicable to All Systems:
You must indicate"Yes" or"No"to each of the following for all inspections:
Yes No
El ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
El ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than 1/day flow
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
1
. Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
85 Franklin
Property Address
Edward Dewolf
Owner Owner's Name
information is required for every Hyannis Ma 02601 5/7/16
page. Citylrown 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 85 Franklin
Property Address
Edward Dewolf
Owner Owner's Name
information is required for every Hyannis Ma 02601 5/7/16
page. Cityfrown State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes" or"no" as to each of the following:
Yes No
❑ ® Pumping information was provided by the owner, occupant, or Board of Health
❑ . ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (if they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ 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): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
wM 85 Franklin
Property Address
Edward Dewolf
Owner Owner's Name
information is required for every Hyannis Ma 02601 5/7/16
page. Cityrrown State Zip Code Date of Inspection
D. System Information
Description:
Leach pit has only 2 ft of water in it and is working well. Tank is in good shape, system will pass with
replacement of the Dbox.
Number of current residents: 2
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system inspected? ® Yes ❑ No
Seasonaluse? ❑ Yes ® No
Water meter readings, if available last 2 ears usage d 229 Gpd
9 ( Y 9 (gP ))�
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: Date
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form T
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
85 Franklin
Property Address
Edward Dewolf
Owner Owner's Name
information is required for every Hyannis Ma 02601 5/7/16
page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: Occupied
Date
Other(describe below):.
General Information
Pumping Records:
Source of information: Not Provided
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•3/13 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
85 Franklin
Property Address
Edward Dewolf
Owner Owner's Name
information is Hyannis Ma 02601 5/7/16
required for every y
page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known) and source of information:
30+ Years
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 1.5
p g 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.):
Vented through the roof
Septic Tank(locate on site plan):
Depth below grade: 1feet
Material of construction:
® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
1,000
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions:
Sludge depth:
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
85 Franklin
Property Address
Edward Dewolf
Owner Owner's Name
information is required for every Hyannis Ma 02601 5/7/16
page. City/Town State Zip Code Date of In3pection
D. System Information (cont.)
Septic Tank (cont.)
Distance from top of sludge to bottom of outlet tee or baffle
24"
Scum thickness
3"
Distance from top of scum to top of outlet tee or baffle
42"
Distance from bottom of scum to bottom of outlet tee or baffle 1" Sludge stick
How were dimensions determined?
Tape Measure
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
No evidence of Ieaking,Tees and or baffles in place at time of inspection.
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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
85 Franklin
Property Address
Edward Dewolf
Owner Owner's Name
information is required for every Hyannis Ma 02601 5/7/16
page. Cityrrown 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.):
Tees are in place and levels are normal.
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):
I
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•3113 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
85 Franklin
Property Address
Edward Dewolf
Owner Owner's Name
information is required for every Hyannis annis Ma 02601 5/7/16
page. Cityfrown 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 Rotted and needs replacement
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.):
* If pumps or alarms are not in working order, system is a conditional pass.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
I
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
85 Franklin
Property Address
Edward Dewolf
Owner Owner's Name
information is required for every Hyannis Ma 02601 5/7/16
page. City(rown State Zip Code Date of Inspection
D. System Information (cont.)
Type:
® leaching pits number: 1
❑ 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.):
Leach pit has only 2 ft of water in it and is working well.
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
Commonwealth of Massachusetts
oo
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 85 Franklin
Property Address
Edward Dewolf
Owner Owner's Name
information is required for every Hyannis Ma 02601 5/7/16
page. Citylrown 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.):
No ponding no break out
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
i
I
i
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 85 Franklin
Property Address
Edward Dewolf
Owner Owner's Name
information is required for every Hyannis Ma 02601 5/7/16
page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
❑ hand-sketch in the area below
® drawing attached separately
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
85 Franklin
Property Address
Edward Dewolf
Owner Owner's Name
information is required for every Hyannis Ma 02601 5/7/16
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
❑ Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow wells
Estimated depth to high ground water: 10+ft
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 ycu established the high ground water elevation:
Usgs maps indicate ground water is well below 1 Oft in this area
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
5/13/2016 Assessing As-Built Cards
LOCATION SEWA G E PERMIT NO.
VILLAGE
INSTALLER'S NAME & ADDRESS -
lT'.
BUILDER OR OWNER
DATE PERMIT ISSUED ZZa -? 1-77
DATE COMPLIANCE ISSUED 77
GSAc-k
Lci k105 -F,4wk
http://www.townotbarnstable.us/AssessingtHMdisplay.asp?mappar=29M75&seq=1 1/2 /'
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
85 Franklin
Property Address
Edward Dewolf
Owner Owner's Name
information is required for every Hyannis Ma 02601 5/7/16
_
page. Cityrrown 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17
YOU WISH TO OPEN A BUSINESS?
For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you
must do uy 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 [lie completed form to the Town Clerk's Office, l.st. FI., 367 Main St., Hyannis,MA 0 601 (Town Hall) and get the Business Certificate that is
required by law.
. DATE: "' o `1 Fill in please:
twnr_? ,ruLq,Rs v� to APPLICANT'S YOUR NAME/S: ✓ -(� �/
w'-* �`) 3` x BUSINESS YOUR HOME ADDRESS:
.. , . aJ —j68 -31I� v,1S o 0
' TELEPHONE # Home Telephone Number Cott - 9
0-�.4 Elan
(h7�' r:rxr p
NAME OF CORPORATION:
NAME OF NEW BUSINEss-3 A TYPE OF BUSINESS
IS THIS A HOME OCCUPATION? Y NO r/
ADDRESS OF BUSINESS MAP%PARCEL NUMBER - ( (Assessing)
When starting a new business there are several things you must do in order to be' in compliance with the rules and regulations of the Town of
Barnstable. This form is intended 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 this town.
1. BUILDING CO Zorized
'S OFFICE, J
This individ arr€or e o an pe it re uire ents that pertain to this type of business.
MUST COMPLY WITH HOME OCCUPATION
S gaatur -��MMENT RULE AND REGULATIONS. FAILURE TO
t —FINES.
2. BOARD O H TH
This individual has formed t=re uir_ !nts that pertain to this type of business.
Authorized Signatures*
COMMENTS:
3. CONSUMER AFFAIRS(LICENSING.AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature**
COMMENTS:
TOWN OF BARNSTABLE Date:L j 17iU l
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAME OF BUSINESS:::Y C,\eCXm lA
BUSINESS LOCATION: �SS F�QC1n)C ' h INVENTORY
MAILING ADDRESS: '8S rchk\vn 6k, K nrNu TOTAL AMOUNT:
TELEPHONE NUMBER: '171� -3 ibf'- 3113
CONTACT PERSON: MCQ2� Lh(rc/l .
EMERGENCY CONTACT TELEPHONE NUMBER: 50$ c9qc9-8SIS MSDS ON SITE?
TYPE OF BUSINESS: C\eUY1V(1�
INFORMATION / RECOMMENDATIONS: Fire District:
Waste Transportation: Last shipment of hazardous waste:
Name of Hauler: 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 %1 Gu1 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
Floor&furniture strippers may be toxic or hazardous (please list):
Metal polishes C1� -to "nou) ccyn m,
Laundry soil &stain removers `
qQMLa(including bleach)
Spot removers &cleaning fluids
(dry cleaners)
Other cleaning solvents
Bug and tar removers 1 )0
Windshield wash
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS AV p cant's Signature Staff's Initial
V r
J
oF41.
VE r4 Town of Barnstable
Regulatory Services
v MASS Thomas F. Geiler,Director
o39. a 200 Main Street
Hyannis,MA 02601
www.town.barnstable.maxs
Telephone: 508-862-4672 Fax: 508-778-2412
August 11, 2005
Terrence E. Vient
85 Franklin Avenue
Hyannis, MA 02601
Dear Mr. Vient:
Thank you for your letter of concern relating to your neighbor at 75 Franklin Avenue. The
Town Manager has asked that I look into this matter to see what the town might be able to do
to help with this issue.
I have read your letter, looked at the pictures you attached and have driven by the property. "
There are regulations that prohibit a homeowner from maintaining trash in their yard.
However, trash is defined as organic material that will decay and attract insects or vermin.
There are no regulations that say when you must mow your lawn or paint your house or
prohibit you from storing items in your yard.
. i
Appearance of property is governed by an. unwritten code. Being a good neighbor is
something most people desire to be. Perhaps your neighbor does not see the value of being a
good neighbor.
There have been several attempts over the years by the town, to adopt new regulations setting
standards for the appearance of residential properties. All have failed to gather popular
support and were not adopted. Perhaps the opposition came from residents who have not
experienced a neighbor who chooses not to follow society's obligations.
Respectfully,
Thomas F. Geiler
Director Regulatory Services
TFGflfl
c John C.Klimm,Town Manager
q/consumer/regsvc/05vient.doc
j.
oFIK,
+ BARNSTABLE,
9�A MASS. ,.� The Town of Barnstable
'�OjA°rA Office of Town Manager
367 Main Street,Hyannis MA 02661
www.town.bamstable.ma.us
Office: 508-862-4610 John C. Klimm,Town Manager
Fax: 508-790-6226
Email: john.khmmRtown.barnstable.ma.us
MEMORANDUM
TO: Tom Geiler,Director of Regulatory Services
FR: John C. Klimm, Town Manager
DT: 08/09/05
RE: 75 Franklin Avenue,Hyannis
Tom, for your information I am-sending a letter from Terry Uient on the above said
matter.
Thank you.
JCK: smo
Attachment
Q p 2005
A
SOwN�F 6P?W,W6R"V
CAMS&MI�ICENSEI
i LO-CAT ION SEWA G E PERMIT NO.
L G i c�5— r;?1oN1s-,L au A tI c 77 V V 7
VILLAGE
/-✓ �%.�w�i� Aga -�'�'S'
INS TA LL'ER'S NAME & ADDRESS
B UILDE R OR
OWNER
DATE PERMIT ISSUED ��� -71-7
DAT E COMPLIANCE ISSUED C�_a,d _ 77
\_.
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� �� � _
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l•_
THE COMMONWEALTH OF MASSACHUSETTS'
BOA
Application is hereby made for a Permit to Construct (&,-<or Repair an Individual Sewage Disposal
System at: r
-------------
or Lot No,g
Owner I Address
Seepage Pit No..... Diameter---_--------------- Depth beloyv inlet Total leaching area._2�.d../......sq. f t.
-',-.-------___-__- -'-_'_---_.---'-_.-'-.-_-._--.---_'--____-
Agrceozcor:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of'LIT LE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until uCertificate of Compliance
.....g, n.a,
............................... ................................
Application By.--. '�0' �*��� -.--------- --�.- ��^'v*� -_ �
. ' Date
Application Disapproved for the following reasons:................................................................................................................
.......................................................................................................................................................................................................
Date
Permit � -
- Date
a
7 4P
No....... FEB......... ........
THE COMMONWEALTH OF MASSACHUSETTS
BOA OFF ALTH
.................,-.oF..............� -C
-----------------------------------------------------••----............_..--
Appliration for 111spoottl Works Tonstrurtiot mamit
Rom .
Application is hereby made for a Permit to Construct 4t( ) or Repair ( ) afi Individual Sewage Disposal
t� 1��. a�►�v;� od /ate
' ess r t
- -........ ------------------------------------------------+ Owner
W •• �,j jAAddress�
Installer Address u.+_lO�
Type of Building Size Lot___ ......:...............Sq. f
Dwelling—No. of Bedrooms......................................._----Expansion Attic ( ) Garbage Grinder ( eet t
Other—Type e of Building No. of ersons____________________________ Showers
P.t YP g --•------•---•-------------- P ( ) — Cafeteria ( )
a' O r fixtures
W Design Flow I........................
�b0� gallons per person per day. Total daily flow..� ...............................gallons.
WSeptic Tank—Liquid'capacity._.._._____.gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—�pT �'' Width.................... Total Length_.__._.__.__.__.____ Total leaching area.............. sq. ft.
�. Seepage Pit No-_-/..___._�. Diameter.................... Depth be i4.nl��__ r4i �tayq�hWrea_�:d_�......sq. ft.
Z14 Other Distribution box ( ) Dosing t )
F 7 'I' ♦4/ Y ••----•••-• •--•••-•--••-------••• ... ....... �te•--•-...--•-----•-•-•-•Y•0------
a Percolation ...
Test Pit NoRisu Performed
nuteser inch Depth of Test Pit____________________ Depth to ground water........................
rl� Test Pit No. 2................minute per inch Depth of Test Pit.................... Depth to ground water........................
0 4 'f--'' �; ;,�:, yr t - t y s, ' Ja _
V
P ---
W
UNature of Repairs or Alterations—Answer when applicable...............................................................................................
•------•--•-----------------------•---------------------------•-•--•---•--•-...•-------=-••--------•-••---•--•----•-•----------------•--•----•-•------------•--•------•••--••-•--•-•--•.....-----------
Agreement:
The undersigned agrees to install the aforedescribed individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary ode— The unAfed further agrees not to place the system in
operation until a Certificate of Compliance has a su by th�; 1 lth.
Sig -- ----- - ---------••----`-- -------.._...------•---...----------•- ................................
t •y
' Application Approved By_._.... .f '�" Q...
Date
Application Disapproved for the following reasons________________________________
•---•------•------_..--•-•----••-•-•---•--------•-•-------.. ..............
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD HEALTH ,
.r
............... ......OF........ ........: ..............................................................
Tri if iratr of f�ontpliatta
r 'w'.
PS TO CER at the Individual Sewage Disposal System constructed ( ) 3Qr Repaired ( )
b ..........
a_( A CQ V?he
at>.. ..__.............................•-•----•-----•-•••••...........................
has been installed in accordance with the provisions ofjp{ The State Sanitary Cade4s,:le� in the
application for Disposal Works Construction Permit No________________ ------------------------ dated_.../ -----------••
' •
..
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY
DATE...........4?_" R D • .... 7 ''ImspectorY .y.Cl !j
. .,. :s.. ti ,"Y ice. ... _ ._ ,,.. •''�.... .r_.. iro'l�:i. � _.
THE COMMONWEALTH OF MASSACHUSETTS
►� BOARD OF EALTH
r
FEE......:.................
LtrtivIn �rrmit
Permission is hereby„granted................. ..............
to Construct ( ),Pr, Repair ( ) Individu wage Dis o Syst r
at No. "
_ - ---- - -------•.-'-.------._..__...__..____..__._......._.......
�. Strcet r+��•� G
�as shown on the application for Disposal Works Construction Perm No______ _____ ____ D .........._<___`_2' -77__._
7
ATE--F-•-•-• rd of 4ialt6
D •--•---•--_---- ..
-+�.✓ FORM 1255 HOBBS & WARREN. INC., PUBLISHERS
' -;F'LY -.STRTE HOUS.W& fIUTHORITY ,
/00. 00 .'
g5/t
F
'e
4EACHNO3- r /009'0
A/ BA4
a;
\ /.0
00G44. O
(LOT /06) 20�oT, (-0? /0'7')
PROP'QSEO
2 BEOROMI
3G/':t
-OIL h
/00. 00 I -
LEGEND `
EXISTING SPOT ELEVATION Ox0 CERTIFIED PLOT PLAN
EXISTNG CONTOUR --- 0 -
FINISHED SPOT ELEVATION 0.0 p+� ROBERT y
FINISHED CONTOUR 0 s BRUCE _LoT-
ELDREDGE IN
APPROVED : BOARD OF HEALTH .p♦ a�� ��i�,�� ��j, �� M ��, `-, �� ��,4:ik. ^! 4No use •il �.i� �
DATE AGENT SCALE: / =3Q, DATE 7 27 7
LDREDGE ENGINEERING CO. IN CLIENT 015KI
_ _ I CERTIFY THAT THE PROPOSED
EGISTERE REGISTERED JOB NO.F�OSS BUILDING SHOWN ON THIS PLAN '
CIVIL LAND OR.BY CONFORMS TO THE ZONING LAWS ,
ENGINEER SURVEYORS OF BARNSTABL MASS.
33 NO: MAIN ST 712 MAIN ST. CH. BY: RBE: 7��� 7 �
S0. YARMOl1TH, MASS. HYANNIS, MASS. SHEET OF 'DA�EZ `DREG. LANQ SUR YOR 'S
20 FT.�MIN. •
I0 FT MIN:f
411 PVC PIPE CLEAN SAND-7
CONCRETE MIN PITCH - I
' COVERS 1/811 PER FT I CONCRETE
d
A 1011 f COVER
1011
•-- �,;, LIQUID LEVEL—? o
4a`EAST , ii, -. i F -�L 211 LAYER 11
IRON °, • • OF I/8 — 3/6
• MIN, p TICH_ F TANK } d 1 / • . . . / . • o , + WASHED STONE .
1/4 SEPTIC DIST.
PEER FT BOX B r °
. .� EFFECTIVE' ' 3/411— 1 1/2"
lot DEPTH • ' ' ' WASHED STONE
its . • • , , , / , PRECAST SEEPAGE
/ ' , 1 . • . . . / / ' ' ° PIT OR EQUIV.
INVERT ELEVATIONS L^l 6 FT DIA. 7
' 10 FT. DIA. �C (SEE TABULATION)
INVEI T AT BUILDING FT. rr
INLET SEPTIC TANK FT. GROUND WATER TABLE
OUTLET SEPTIC TANK FT. SECTION OF
1 ` W T DISTRIBUTION BOX T. 4.
SEWAGE DISPOSAL SYSTEM
T DISTRIBUTION' BOX I FT. SCALE 1/4 / O ,
>LET SEEPAGE PIT FT. TABULATION
• DIMENSION A -_FT.
DESIGN CRITERIA DIMENSION B FT.
NUMBER OF BEDROOMS Z DIMENSION C FT
GARBAGE DISPOSAL UNIT NdNE
TOTAL ESTIMATED FLOW _ZQGAL./DAY SOIL LOG SOIL TEST
NUti 4tli OF SEEPAGE PITS _L— E EVATION
SIDE LEACHING PER PIT SS. $p. FT � �{ Lo�IM DATE OF SOIL TEST _T�����'�
RESULTS WITNESSED BY 2 t-fi. P,M,
BOTTOM LEACHING PER PIT 1��SQ. FT 15-:waS0/4 PERCOLATION RATE 0,L1 _MIN/INCH •�
TOTAL LEACHING AREA 7 SO. FT
RESERiIE LEACHING AREA 2l07 SQ. FT o '
u PHILIP
4
_ ED w WEINBERG 1. o
`' ELDREDGE ENGINEERING CO INC.
33 NO. MAIN ST- -: - 712`MAIN'ST.
�ss�,y L�� SO'YARMOUTH MASS: HYANNIS MASS
JOS NO. /QS'.� SHEET,? OF
1 -"'=
-riw+ F -- -