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Home My WebLink About0017 HAMPSHIRE AVENUE - Health 17 Hampshire Avenue Hyannis- P A = 309 022 1 6 �i u p r F Y C 0 a ° 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M s 17 Hampshire Ave Property Address Chris Coy Owner Owner's Name information is H annis MA 02601 11/25/11 required for every y page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, x use only the tab 1. Inspector: key to move your cursor-do not David J Burnie use the return c a key. Name of Inspector _ David Burnie Management Inc Company Name ' C 3 Perrys Way ..Z7 Company Address Harwich MA 02645 City/Town State ;Zip Code ;, 9 1-866-980-1440 S1386 ? Telephone Number License Number r t7 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 Local Approving Authority 11/25/11 Ins ector's Sin re 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-11/10 Title 5 Official Inspection Form:Subsurf Sewage Disposal System•Page 1 of 17 T Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 17 Hampshire Ave Property Address Chris Coy Owner Owner's Name information is required for every Hyannis MA 02601 11/25/11 page. Citylrown 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: S v ® 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: The system was found in good working order at the time of inspection. . 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 exflltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 r Commonwealth of Massachusetts `` Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments G M , 17 Hampshire Ave Property Address Chris Coy Owner Owner's Name information is Hyannis MA 02601 11/25/11 required for every y page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: I ❑ Cesspool or privy is within 50 feet of a surface water El Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 17 Hampshire Ave Property Address Chris Coy Owner Owner's Name information is required for every Hyannis MA 02601 11/25/11 page. Cityrrown 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: 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 ❑ ® -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 '/2 day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 17 Hampshire Ave Property Address Chris Coy Owner Owner's Name information is Hyannis MA 02601 11/25/11 required for every y page. Cityrrown 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 El ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ El 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments N 17 Hampshire Ave Property Address Chris Coy Owner Owner's Name information is required for every Hyannis MA 02601 11/25/11 _ page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? El ® 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): SAS@ 332gpd t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 17 Hampshire Ave Property Address Chris Coy Owner Owner's Name information is Hyannis MA 02601 11/25/11 required for every y page. CityrFown State Zip Code Date of Inspection D. System Information Description: Septic tank, pump chamber, d-box and leach trenches Number of current residents: 0 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 Seasonaluse? ❑ Yes ® No =224gpd 10 Water meter readings, if available(last 2 years usage(gpd)): 10= 193gpd Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Spring of 2011 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M s 17 Hampshire Ave Property Address Chris Coy Owner Owner's Name information is Hyannis MA 02601 11/25/11 required for every y page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: None per Barnstable BOH 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•11/10 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 M 17 Hampshire Ave Property Address Chris Coy Owner Owner's Name information is required for every Hyannis MA 02601 11/25/11 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1998 per plan on file at the Barnstable BOH Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 5' Depth below grade: 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.): We ran a sewer camera up the line and it was ok Septic Tank(locate on site plan): Inlet cover is 6"the outlet cover is Depth below grade: 416" Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000ga1 5" Sludge depth: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 TOWi�1 OF BARNSTABLE :,?Y�ATION SEWAGE# F� V;Z,LAGE ASSESSOR'S MAP&LOT ' IIcSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 1410o e L /I601�646 4'A' g LEACE IldG FACILITY: (type) egg ( (size) NO.OF BEDROOMS 3 BUILDER OR OWNER PERMIT DATE: /0"/ COMPLIANCE DATE: Separation Distance Between the: tl �/ Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 7�s Feet Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility).) i Furnished by 4pclU641- /.��-Cc �i iN I Fr�df �r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 5 17 Hampshire Ave Property Address Chris Coy Owner Owner's Name information is required for every Hyannis MA 02601 11/25/11 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 2+ Scum thickness 3 Distance from top of scum to top of outlet tee or baffle 4"+ Distance from bottom of scum to bottom of outlet tee or baffle 1'+ How were dimensions determined? estimated Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): We recommend the tank is pumped out every 2 years. 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 17 Hampshire Ave Property Address Chris Coy Owner Owner's Name information is required for every Hyannis MA 02601 11/25/11 page. CityTrown 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.): . I Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): 7 .. w _ "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No L15m.-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 17 Hampshire Ave Property Address Chris Coy Owner Owner's Name information is required for every Hyannis MA 02601 11/25/11 page. Cityrrown 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 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.): The box was found in good condition. The cover is 1' deep. 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.): We tested the pump and alarm and both worked good at the time of inspection. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11/10 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 M 17 Hampshire Ave Property Address Chris Coy Owner Owner's Name information is required for every Hyannis MA 02601 11/25/11 page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 2-26'L x 4'W x 2'D ❑ 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.): The SAS was found to be dry.We confirmed this with a probe into stone and sewer camera. 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ' M 17 Hampshire Ave Property Address Chris Coy Owner Owner's Name information is required for every Hyannis MA 02601 11/25/11 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments , 17 Hampshire Ave Property Address Chris Coy Owner Owners Name information is Hyannis MA 02601 11/25/11 required for every page. Cityrrown 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 o D , 3 1, E - ► �f� K C, i� -C thing-11110 fib@ p off ill trtopodw Form:8Ubft6WGMg@ 9WpOW 0y0m•Pogo 15017 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 17 Hampshire Ave Property Address Chris Coy Owner Owner's Name information is required for every Hyannis MA 02601 11/25/11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 10' per test hole on plan dated 1998 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: 1998 on file at the Barnstable BOH 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: AIW-230 Zone D water level 21.2 2.3x12=2'4" You must describe how you established the high ground water elevation: A test hole was done showing water was found at 10'where the SAS is. From grade to bottom of SAS it is 3'. If you add 3' + a seperation of 4' +the adjustment of 2'4"you have a total of 9'4". You are out of groundwater by 8". Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 17 Hampshire Ave Property Address Chris Coy Owner Owner's Name information is required for every Hyannis MA 02601 11/25/11 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 ��YI�try Town of Barnstable MRNSfiIHl.;r,HAM a Board of Health 200 Main Street,Hyannis MA 02601 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,DMD Junichi Sawayanagi August 23,2007 Stephen and Tammie Jefferson 17 Hampshire Avenue Hyannis, MA 02601 Dear Mr. and Mrs. Jefferson: Your request to remove Condition #1 from the variance letter dated September 14, 1998 which restricts your home at 17 Hampshire Avenue, Hyannis to two (2) bedrooms maximum, is granted. Therefore, you are granted conditional permission to increase the number of bedrooms to three (3) bedrooms at this property. CONDITIONS You are granted permission to increase the number of bedrooms to three with the following conditions: 1. When the existing septic system fails, the owner shall hire a professional engineer to design a replacement septic system incorporating innovative/alternative technology designed to reduce nitrogen levels in the effluent. .y 2. No more than three (3) bedrooms maximum are authorized at this property. Dens, study rooms, sleeping lofts, and similar-type rooms of f sufficient size and which offer privacy are considered bedrooms according "• ;. to the MA Department of Environmental Protection. BACKGROUND Several variances from the State Environmental Code, Title V, were granted in September of 1998 in order to upgrade the septic system at this site. The septic system is located 4.5 feet above the groundwater table, with no reserve area provided. The Board authorized a maximum of two bedrooms at this property as a condition to granting the variances. This permission is granted because there is a three bedroom capacity septic system in existence at this property. Also, the October 1, 1998 disposal works construction permit was issued for three (3) bedrooms. Q MPFILESUefferson17HampshireAvenue2007.doc I Since e y yours, Wayne iller, M.D. Chair n Board of Health Town of Barnstable QAWPFILESVefferson I7HampshireAvenue2007.doc Town of Barnstable Health Inspector oFTHE rp� Office Hours o Regulatory Services 8:30—9:30 Thomas F.Geiler,Director 1:00—2:00 • saiuvsrnaLe, « 1639: ,. Public Health Division AjEGMO''�A Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 �) Fax: 508-790-6304 v AMNESTY PROGRAM APPLICANT — SEPTIC QUESTIONNAIRE 1. General Information: Size of Property: Address: l Z ffamlOSAir2 AU2• i7YCrI Map Parcel y Name: S) L /e J efE f S o n Phone #: SO 2a. How many bedrooms exist at your property now? 3 ba'(50fi I S 2b. Are you planning to add any bedrooms? AJ0, If yes, how many? 2c. How many bedrooms total are proposed at this property(including the amnesty unit)? 2d. Please include a copy of the floor plans for the entire property- showing the existing rooms in the home plus the proposed amnesty apartment and/or addition. Please label each room clearly on the plans. 3. Is the dwelling connected to public sewer? YES or O� If the dw Ming is connected to public sewer,skip questions#4 through#9 below. ;a.., 4. location f dwelling is INSIDE or OUTSIDE a Zone of Contribution to public supply wells? - � � � � 5. LIs the dwel�� P g connected to an ONSITE WELL or to UBLIC WATER? 6. A a disposa orks construction permit on file? YES or NO 6a.,--f yes,how many bedrooms were approved according to this permit? 3 Bedrooms. c, 7. Were any building permits obtained for construction of additional bedrooms? YES or NO 8. Is there an engineered septic system plan on file at the Health Division? OYESor NO " 9. Has the septic system been inspected by a DEP certified inspector within the last two years? YES or NO ------------------------------------------------------------------------------------------------------------------- FOR OFFICE USE ONLY The Public Health Division has no objection to stk:) bedrooms at this property. t(J Special Conditions: Signed: Date: Q;/health/wpfiles/amnestyapp i - i I _ v 4 IA- 40 I � p 0 a l I 7, d v � ck 0 o � r6 o I �CC � S Q 41 CO 1 � C r COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS c DEPARTMENT OF ENVIRONMENTAL PROTECTION 4 e aVrn L.EC 3 0 ZO02 ,, TITLE 5 OFFICIAL INSPECTION.FORM—NOT,FOR VOLUNTARY:ASSESSMENTS. SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 7"-Owner's Name: MAP _ Owner's Address: Z PARCEL. : Date of Inspection LOT 2.! Name of Inspe lease print) 1 , Company Nam '� Mailing Address: Q _ UC)&� Telephone Number: 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: {/ Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority. /� / Fail Inspector's Signature: Date: The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within.30 days of completing this inspection.If the shared system or has a design flow of 10,000 system is a y b . 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. Notes and Comments ****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. Title 5 Inspection Form 6/15/20.00 page 1 1 Page 2 of I 1 } OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART.A CERTIFICATION (continued) Property Address: Owner: ) �, Date of Ins ectio �,) C o Inspection Summary: Check A,B;C;D or E/ALWAYS complete.all of Section D A. ystem 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: 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 xeplaced 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: 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: 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: 2 Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE.DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: "A Owner rc ' Date of In pection. 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 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 surface water.supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and.SAS.and the SAS is within 50 feet of a private water supply well- The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a. private water supply well".Method used to determine distance **This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria 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: 3 Page 4 of I 1 , OFFICIAL INSPECTION FORM—NOT.FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: JuNtue Owner:.V'11/h/`6 Wa 44U Date of In pection` D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes N^�' V Bac}. of sewage into facility or system component due to overloaded or clogged SAS or cesspool _ V 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 '/2 day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number J 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. . Anyportion 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.] Ap.(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,the the system fails. The system owner should contact the Board of Health to determine what will be necessary to correctthe 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 — _ 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. 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: / Owner: lP� Date of pectin of Check if the following have been done.You must indicate"yes" or"no" as to each of the following: Yes No 1Z 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? j/ 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) I/ 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:. Yes no Existing information.For example, a plan.at the Board of Health. V _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15302(3)(b)] 5 Page 6 of 1 l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM-INFORMATION Property Address: Ot*-L Owner Date of Ins ect1on d"a FLOW CONDITIONS RESIDENTIAL V" Number of bedrooms(design):,--� Number of bedrooms,(actual): c DESIGN flow based on 310,CM 15.203 (for example: 1 I:0 gpd x 4 of bedrooms): Number of current residents: Does residence have a garbage grinder(yes or no) Is laundry on a separate sewage system (yes or no):_ f if yes separate inspection required] Laundry system inspected(yes or" Seasonal use: (yes or he Water meter readings le(last 2 years usage (gPd)): Sump pump(yes or no . � Last date of occupancy: COMMERCIAL/INDUSTRIAI/ - Type of establishment: Design flow(based on 310 CMR 15203): gpd Basis of design flow(s eats/person s/sgft,etc.); Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(.yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of inforrnation-p- n ,, -j,,/) Was system pumped as part of the nspection(yes or 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) _Tight tank _Attach a copyof the DEP approval Other(descr:ibe): Ap r ximate age of all components,date installed(if known)and source of information: Were:sewage odors detected when arriving at the site(yes or no):— 6 Page 7'of l 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM-INFORMATION(continued) Property Address: l Owner: Date of Ins ection: aQaa BUILDING SEWER(locate on site plan))/ Depth below grade: Materials of construction:_cast iron _40 PVC_other(explain): yl Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: j,✓ (locate on site plan) Depth below rade y Material of construction: Wncrete_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: Jz S'k X 5- Sludge depth: /a /' ;76. Distance from top of sludge to bottom of outlet tee.or baffle: Scum thickness: 21 y i1 Distance from to of scum to to of outlet tee or baffle: !r / P P f Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined,li��NIRB 0 � Comments(on pumping recomme ations, inlet and outlet tee or baffle condition, structural integrity, li uid levels s related to outlet invert, evidence of leakage,etc.): © Ad�/- / ,• GREASE TRA (locate on site plan) Depth below grade:_ 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: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 i Page 8 of 11 OFFIC][AL INSPECTION FORM—NOT FOR YOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM ]INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: Date of In pection , TIGHT or HOLDING TANK_,(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass__polyethylene other(explain): Dimensions: Capacity: gallons Design Flow:_ gallons/day Alarm present(yes or no): Alarm level:_ Alarm in working order(yes'or no): Date of last pumping: Comments(condition of alarm and float switches, etc.): DISTRIBUTION BOX: Le"(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert'/ u �J�`�-t Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover, any evidence of --1� tjt of,bQx,etc.): � f PUMP CHAMBER- (locate on site plan) Pumps in working order(yes or no)tchlap Alarms in working.order(.yes or no) o.mments(note condition f pump , cond' ' n of pump d appurtenances, etc_.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: Date of I s ection: J ,Q90 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: caching galleries,number: leaching trenches, number,length: •• c (o X o� 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, e O a49V i CESSPOOL(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 or no): Comments (note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation,etc.): . PRIVY• (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,.condition of vegetation,etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM.INFORMATION(continued) Property AddT•ess: , Owner: , Date of In ectio > p� 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 wherepublic water supply enters the building. i r I N_ 11 1 a . 10 i Page l 1 of 11 OFFICIAL INSPECTION FORM—.NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: ,� ow" '*,—// Owner: Date of I ectio 3��Qa SITE EXAM Slope Surface water Check cellar Shallow wells Estimated.depth to ground water 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:_ 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 elevationMa Z 11 Permit Number: Date: Completed by: HIGH.GROUND-WATER LEVEL COMPUTATION Site Location: .� � �5 Lot No. Owner: / Ze 0 Address: `e Contractor: �J�/, Address: S Notes: /�l�/��P6�✓�' �� /A� _ STEP 1 Measure depth to water table tonearest 1/10 ft. .............................................................................. .Date month/day/year STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: OAppropriate index well.................................. � •... OB Water-level range zone ...............................:..................... STEP 3 Using.monthly report "Current Water Resources Conditions" determine current depth to water level for index well ........................... � month/Year STEP 4 Using Table of Water-level Adjustments. for index well (STEP 2A), current depth to water level for index well (STEP 3), and water-level zone (STEP 26) determine water-level adjustment .......................................................................................... �pC STEP 5 Estimate depth to high water by subtracting the water- level adjustment(STEP 4) from measured depth.to water levelat site (STEP 1) ...........:...............................................:................ ............................... Figure 13:--Reproducible computation form. 15 I �� 73 i LJ I •� y d '1 t i!1 �r l �d93 os 1 c3 q e p(a C'e— Car for 5��.lporc,� CV4er comoAvvr4l"t") dr Iv 7d� E �Q X XJ� � ✓ Q Cy O M 0 C� o �V dJ d y Mrs. Mary Kerwin McKean 17 Hampshire Avenue Hyannis, MA 02601 January 20, 2000 Town of Barnstable Board of Health 367 Main Street Hyannis, MA 02601 I am writing to request relief from Condition (1) that was placed on my residence, 17 Hampshire Avenue, Hyannis, on September 14, 1998 by the Town of Barnstable Board of Health. This condition is described in a letter to the applicant, Dan Hynek, who was the former owner of the property. While the Board of Health was granting variances in order to upgrade the onsite sewerage system, Condition (1), was placed on the dwelling. Condition (1) states that no more than two bedrooms are authorized in the dwelling. Dens, study rooms, finished attics, sleeping lofts, and similar type rooms......... Town of Barnstable Building Inspector Richard Stevens visited the premises on January 7, 2000 and stated that in his opinion, the configuration of a room in the lower level that was existing in its present state would allow it to be considered a legal bedroom. The dwelling was erected in 1962, and the room in the lower level was constructed in that time period. When I bought the house, the basement configuration was as it is now, with the room under discussion existing. There is baseboard heating with a thermostat, adequate electric lighting, a closet, a separate full bathroom, and adequate egress to the outside, according to Mr. Stevens. Also, my property is located outside of the Zone of Nitrogen Contribution. The new Septic System installed in January, 1999 has 330 gallon per day capacity, adequate for a three bedroom dwelling, according to the Design prepared by Thomas McLellan, P.E. and dated 5/25/98. Title V Certificate was issued. The system functions very satisfactorily. This restriction to my full use and enjoyment of my home has and is continuing to be curtailed and to cause me considerable hardship. Therefore, I respectfully request your favorable decision. Sincerely, Ma�Ke in McKean n4 :J tME DATE t BARMAMZ E 59. 166 To*n of Barnstable REC. BY I AUG 6 1998 gi.E ,� oard of Health 3 7Nain Street,Hyannis MA 02601 Office: 508-790-6265 \ �•�` FAX: 508-790-6304 — Susan 0.Rask,R.S. Sumner Kauftnim,M.S.P.H. Ralph A.Murphy,M.D. VARIANCE REQUEST FORM LOCATION I ' Property Address: 17 f't M P s H J ff AVES N V AIN I S Assessor's Map and Parcel Number. 3 a 22 Size oftLot: I —Wetlands Within 300 Ft. Yes Subdivision Name: No 17 Business Name: APPLICANT CONTACT PERSON j _ �N®neja j �A N N ti Ale K Name: 0MA S Tk� M OIV51L Address: 854 ANW\tP_ 57 LowEUL MA Address: P•D , O0X. q63 (AIIES'( 0 tIVN]I t ✓f Phone: l 7 c�— rJ 3 ' 7�I l Phone: 990 ' -7110 ----FAX: FAX: VARIANCE FROM REGULATION(rant Reg.) REASON FOR VARIANCE(May attach if more space needed) 15.Z4B : Ajo Pwngvc L oc+a AQEA-- t,EL1-rI\/E -( SMAGC w-f w17-H 5L0pial_ _�5•ziz L� Atielt Yv y5•oaf Ta Po&rr. PHA H 1444 6-V-0vn10wA-(E2 I N r (-r iNOI.•1FtCQ. t3AcK- 6IAVr), c1C1S't°1NG. ►3.A7H2o0M IN 545FE►lr( `�� 15•Zlt c.EAcEd Al-tt ice 3 " tti55 THAN to' F-Oo/A f@PKI:N 115.111 : UEAG14 A1_eA tb 13t LgSSTNPN ?o' eQOM CIFLUrL tNA\-t.. Clfecklist(to be completed by office staff-person receiving variance request application) Four(4)copies of plan submitted(including septic system plans and/or restaurant floor plans) Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense(for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variances only) Variance request application fee collected(no fee rot iireguad ntodinwinn renemik pew&w vruianm renewals(same owrwAatm only),outside dining variance renewals(same ownerAeam only],and varianm to repair failed sewage disismi systems(only If no eapernlon to the building popaedn Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Susan G.Rask,R.S.,Chairman NOT APPROVED Sumner Kaufman,M.S.P.H. REASON FOR DISAPPROVAL Ralph A.Murphy,M.D. Q:/WP/VARIREQ ,. TOWN OF BARNSTABLE CETHET� OFFICE OF T HARW9T,ZL$ : BOARD OF HEALTH MA86 °o i639• `0m 367 MAIN STREET o MFY HYANNIS,MASS.02601 March 15, 2000 Mary McKean 17 Hampshire Avenue Hyannis, MA 02601 Dear Ms. McKean: Your request to remove Condition #1 from the variance letter dated September 14, 1998 which restricts your home at 17 Hampshire Avenue, Hyannis to two (2) bedrooms maximum, so that you could increase the number of bedrooms to three (3) is denied. Several variances from the State Environmental Code, Title V, were granted in September of 1998 in order to upgrade the septic system at this site. The septic system is located only 4.5 feet above the groundwater table, with no reserve area provided. According to 310 CMR 15.410 of the State Environmental Code, variances shall be granted only when, in the opinion of the approving authority: (a) The person requesting a variance has established that enforcement of the provision of 310 CMR 15.000 from which a variance is sought would be manifestly unjust, considering all the relevant facts and circumstances of the individual case, and (b) The person requesting a variance has established a level of environmental protection that is at least equivalent to that provided under 310 CMR 15.000 can be achieved without strict application of the provision of 310 CMR 15.000 from which a variance is sought. You failed to establish any manifest injustice and you did not establish that a level of environmental protection equivalent to that provided under 310 CMR 15.00 can be achieved without strict application of Condition #1. McKean A Therefore, your request to increase the number of bedrooms on this 9,900 square feet site to three bedrooms, is not granted. Sincerely yours, _ Susan G. Rask, R.S. Chairperson Board of Health Town of Barnstable SGR/bcs McKean J * ' Fee 5,10 No. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS IG ST 0ppYication for 33f 6pooal *potem CoJa' Y SUPERVISE FY IN WRITING THE SYSTEM WAS INSTALLED IN STRICT Application for a Permit to Construct( )Repair( )Upgrade+Abandon( ) ❑ Q TG]ftdftual Components Location Address or Lot No. J 7 'C""VV l Owner's Name,Address and Tel.No. Assessor's Map/Parcel 3 o q _� Installer's Name,Address,and Tel.No. �r � /` Designer's Name,Ad ress and Tel.No. Type of Building: Dwelling No.of Bedrooms ✓�' Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 33 D gallons per day. Calculated daily flow 3 c�)— gallons. Plan Date Number of sheets I Revision Date Title Size of Septic Tank I'-OD S -C 1 d(( ype of S.A.S. Description of Soil Ia� 5%A \ UY,;�A Nature of Repairs or Alterati [is(Answer when applicable) L-o P.,--- '' /C17�1• j cc vzcc c.�e w STG�-2� 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 a d not to place the system in operation until a Certifi- cate of Compliance has be y is \\ c Signed Application Approved by Date �d -9 Application Disapproved for the following reasons Permit No. F —' _ Date Issued �.� No. �', ^'.•c2 Fee -S THE COMMONWEA1TH bF MASSACHUSETTS Entered in computer: Yes PUB;LIC�HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0(ppYication for Mi-4 pool *pe;tem Cowaruction Permit Application for a Permit to Construct( )Repair( )Upgrade(-/j Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. I�'i - Owner's Name,Address and Tel.No. o Assessor's Map/Parcel Installer's Name,Address,and Tel.No. f Desi ner's Name,Ad ress and Tel.No. g I. . C^1 i•�� -.�--..-_�c�v r '"'��'-"'�'-� l-y"t f% 'a� �-� �Ci��'`[.�'��'i '�a��dl.�il. ( �,,. Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures gip` Design Flow 3 3 gallons per day. Calculated daily flow _3 gallons. Plan Date `l "c '�- Number of sheets Revision Date ff Title Size of Septic Tank 6D S 7-c I (�� Type of S.A.S. 'TV-Gyle- S Description of Soil I f 1 r S kl \` U n V Z C S ' f • f Nature of Repairs or Alterations(Answer when applicable) �:;n6�S"fi K1_-A A 1�`"`��1�,l�w l 5 7-1 '. 162 )). 0, l t ZIAv CJ -ry c, e �✓ w,STc-L r 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 a d�notto place the system in operation until a Certifi- cate of Compliance has bee ' y i �,yo�_ \ G,� Signed J"^^°' �� -v'" Date r Application Approved by Date Application Disapproved for the following reasons Permit No. / �-� 0 Date Issued tea'/- `7 ---------------------------------------- �l THE COMMONWEALTH OF MASSACHUSETTS f16 I BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System C nstructed( )Repaired( )Upgraded ,�) Abandoned( )by :,..t... at -ao_,t-lf has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No '" r ated v Installer Designer The issuanc o this e t shall not be construed as a guarantee that the syste -will fu otion as/�signe6 . Date - Inspector l -_ No.��--- —------------------ ---Fee i THE COMMONWEALTH OF MASSACHUSETTS r PUBLIC HEALTH DIVISION - BARNSTABLE,, MASSACHUSETTS Miopogaf by,5tem Construction Permit _ Permission is hereby granted to Construct( )Repair((( )Upgrade )Abandon ) System located at l-t N4�" ��Q_� 11 Lt n 1 i E r and as'described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. +�' Date: ��rl� Approved by TH E T0�♦� TOWN OF BARNSTABLE OFFICE OF Hsaa9TeHL i BOARD OF HEALTH i639' \em 0 MAX 367 MAIN STREET .E k. HYANNIS, MASS.02601 September 14, 1998 Dan Hynek 854 Andover Street Lowell, MA 01852 Dear Mr. Hynek: You are granted multiple variances to upgrade your onsite sewage disposal system located at 17 Hampshire Avenue, Hyannis. The variances granted are as follows: 310 CMR 15.248: To provide no future reserve area. 310 CMR 15.212: To construct a soil absorption system with only 4.5 feet vertical separation distance above the groundwater table. 310 CMR 15.211: To construct a leaching facility only fourteen(14) feet away from the foundation wall. These variances are granted with the following conditions: (1) No more than two bedrooms are authorized in the dwelling. Dens, study rooms, finished attics, sleeping lofts, and similar type rooms are considered bedrooms according to MA Department of Environmental Protection. (2) The designing engineer shall conduct a sieve analysis of the soil which is proposed to be used in the area of the proposed soil absorption system. (3) The engineer shall supervise the construction of the septic system and shall certify in writing to the Board that the system was installed in strict accordance with the submitted plans. These variances were granted because the existing septic system is "fluid" and is in need of replacement. The physical constraints of the lot make it impossible to construct a hynek I septic system which would meet every provision of the State Environmental Code, Title V. It is the opinion of this Board that the proposed septic system was designed to achieve maximum feasible compliance with the multitude of regulations in existence today. Sincerely yours, Susan & Rd, R.S. Chairman Board of Health Town of Barnstable cc: Thomas McClelland. hynek TOWN OF BARNSTABLE LOCATION j S�/'✓�'. Q'(1e SEWAGE # VILLAGE `�Ci'/i /^ 5 ASSESSOR'S MAP&LOT " INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY L_ �,�,o LEACHING FACILITY: (type) (size) X aC y'X-) ' i NO.OF BEDROOMS 3 i BUILDER OR OWNER PERMI TDATE:__ /��"/ —� COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility y Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) ll�� Feet Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) ,, Furnished by 001, c G 5 e- j t I 6 ; ay,� `'I jCy l 02/05/1999 16:24 5083987710 DEMAREST-MCLELLAN PAGE 01 ORMARRIBT MOLELLAN MMINCeP11NO February 5, 1999 Thomas McKean, R.S. Barnstable Health Agent 367 Main Street Hyannis, NA 02601 RE: Septic system construction inspections 17 Hampshire Avenue Hyannis, MA Dear Tom: On January 28 & 29, 1999 Demarest-McLellan Engineering inspected the construction of the septic system at the above referenced site. The system has been installed in strict accordance with the Site plan prepared by this office dated 5-25-98. As required in condition #2 of your variance approval letter we are having a sieve analysis performed and will be forwarding results to you as soon as they are available. If you have any questions or require any additional information please call me at 398-7710. Sincerely, Thomas M e lan, P.E. 24 School St. R0•Box 453 West Dennis,MA 02670 (508)398-7710 Town of Barnstable _ Department of Health, Safety, and Environmental Services Public Health Division P.O. Box 534, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health April 5, 1998 Daniel and Joanne Hyneck 854 Andover Street Lowell,MA 01852 ORDER TO COMPLY WITH 310 CMR 15.00,THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located at 17 Hampshire Avenue, Hyannis was inspected on January 9, 1998 by James D. Sears, a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00)due to the following: • A portion of the soil absorption system was below the high groundwater elevation You are directed to hire a licensed professional engineer(PE) to design a system that will bring the septic system in compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within twenty-one(2 1)days of your receipt of this letter. You are also directed to hire a licensed septic system installer to install the system components within forty-five(45)days of your receipt of this order. You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground,or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE BOARD OF HEALTH Thomas A.McKean,R.S., C.H.O. Agent of the Board of Health q/db/title5e.doc Town of Barnstable . Pa � h'Dep artment of Health Safety, and Environmental Services Public Health Division y MABB. f6Jg. � EDM�� 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Thotnee A.McKean,R8,CHO FAX: 509-790-6304 Ditedor of Public Heath TO: �g DATE: 2,L L O�.J Q.�� yam►n`(� CD1A,:5Z_ ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located at 1 -t(c7v,�DS�irQ..- fie& e �^kS was inspected on �nrl lgra by we smears q a Massachusetts lid used septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: �—. —tb- T), 5a,� Sor C i s. You are directed to hire a licensed professional engineer (PE) to design a system that will bring the septic system in compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within twenty-one(21) days of your receipt of this letter. You are also directed to hire a licensed septic system installer to install the system components within forty-five (45) days of your receipt of this order. You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health - quk.nnwemdunia�a� II COMMO'WEALTH OF MASSACHLSETTS c EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS I� DEPARTi�1ENT OF ENVIRONMENTAL PROTECTION ^� ONE WINTER STREET. BOSTON. MA 02108 617-292.5W � Title D COXE 350 MAIN STREET - BAN ecretan Governor F.WELD � � WEST YARMOUTH, MA Tara 6 1 9 V1D B. TRUHS Govcmor ^_ 508-775-2800 N hfA�TH�PlrAB� Co issioner ARGEO PAUL CELLUCCI Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION Gi PART A g CERTIFICATION MAP 309 PAR 022 PROPERTY ADDRESS: 17 Hampshire Ave, Hyannis ADDRESS OF OWNER: DATE OF INSPECTION: January 9, 1998 Daniel Hyneck NAME OF INSPECTOR : James D.Sears I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 9310 CMR 15.000) COMPANY NAME: A& B Canco MAILING ADDRESS: 350 Main Street, West Yarmouth, MA 02673 TELEPHONE NUMBER: (508)775-2800 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: PASSES CONDITIONALLY PASSES NEEDS FURTHER EVALUATION BY THE LOCAL APPROVING AUTHORITY X FAILS INSPECTORS SIGNATURE: , DATE: January 12, 1998 The system Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: A] SYSTEM PASSES: N/A I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B SYSTEM CONDITIONALLY PASSES: N/A One or more system components as.described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved b the Board of Health, will pass. Indicate yes, no, or not determined (Y, N, or NO). Describe basis of determination in all instances. If"not determined", explain why not) The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached) indicating that the tank was installed within twenty(20) years prior to the date of the inspection-, or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank is failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. Page 1 of 10 (revised 04/25/97) DEP on the World Wide Web:http://www.magnet.state.ma.un/d SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (CONTINUED) Property Address: 17 Hampshire Ave, Hyannis Owner: Hyneck, Daniel Date of Inspection: January 9, 1998 B]SYSTEM CONDITIONALLY PASSES(continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: N/A Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND 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 APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone 1 of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER (revised 04/25/97) Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 17 Hampshire Ave, Hyannis Owner: Hyneck, Daniel Date of Inspection: January 9, 1998 D] SYSTEM FAILS: You must indicate either"Yes" or"No" as to each of the following: X I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303.The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an over- loaded 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. N/A Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow N/A Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s) Number of times pumped X Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. N/A Any portion of a cesspool or privy is within 100 feet of surface water supply or tributary to a surface water supply. N/A Any portion of a cesspool or privy is within a Zone I of a public well. N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well. N/A Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E) LARGE SYSTEM FAILS: N/A You must indicate either"Yes" or"No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. I (revised 04/25/97) Page 3 of 10 • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 17 Hampshire Ave, Hyannis Owner: Hyneck, Daniel Date of Inspection: January 9, 1998 Check if the following have been done: You must indicate either"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 None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. X As built plans have been obtained and examined. Note if they are not available with N/A. X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout. X All system components, including the Soil Absorption System, have been located on the site. X The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: X The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal System. X Existing information. Ex. Plan at B.O.H. X Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable)[15.302(3)(b)] (revised 04/25/97) Page 4 of 10 f - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 17 Hampshire Ave, Hyannis Owner: Hyneck, Daniel Date of Inspection: January 9, 1998 FLOW CONDITIONS RESIDENTIAL: Design flow: 220 g.p.d./bedroom for S.A.S. Number of bedrooms: 2 Number of current residents: 2 Garbage grinder(yes or no): NO Laundry connected to system es or no): YES Seasonal use(yes or no) NO Water meter readings, if available(last two(2)year usage(gpd): 1995-96 93,000 1996-97 102,900 Sump Pump(yes or no): NO COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: gallons/day Grease trap present: (yes or no): Industrial Waste Holding Tank present: (yes or no) Non-sanitary waste discharged to the Title 5 system: (yes or no) Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: 95 AND 96 System pumped as part of inspection:(yes or no) NO If yes, volume pumped: gallons Reason for pumping TYPE OF SYSTEM X Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy . Shared system (yes or no) (if yes, attach previous inspection records, if any) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known)and source of information: 1986 PERMIT#86-95 Sewage odors detected when arriving at the site: (yes or no) NO (revised 04/25/97) Page 5 of 10 • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 17 Hampshire Ave, Hyannis Owner: Hyneck, Daniel Date of Inspection: January 9, 1998 BUILDING SEWER: N/A (Locate on site plan) Depth below grade: Material of construction cast iron 40 PVC other(explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK: X (Locate on site plan) Depth below grade: 3' Material of construction X concrete _ metal . _ Fiberglass _ Polyethylene _ other(explain) If tank is metal, list age Is age confirmed by Certificate of Compliance (Yes/No) Dimensions: 1,000 GALLON PRE CAST Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle: N/A Scum thickness: 1" 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 How dimensions were determined TAPE&ASBUILT NOTE; DID NOT OPEN OUTLET COVER 3' BELOW GRADE ROCK& ROCK HARD GROUND. INLET COVER RAISED Comments: (recommendation for pumping; condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) TANK AT WORKING LEVEL, INLET COVER 18" BELOW GRADE,TANK 3' BELOW GRADE. GREASE TRAP: N/A (locate on site plan) Depth below grade: 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: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (revised 04/25/97) Page 6 of 10 • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 17 Hampshire Ave, Hyannis Owner: Hyneck, Daniel Date of Inspection: January 9, 1998 TIGHT OR HOLDING TANK: N/A (Tank must be pumped prior to, or at time, of inspection) (Locate on site plan) Depth below grade: Material of construction _ concrete _ metal _ Fiberglass _ Polyethylene _ other(explain) Dimensions: Capacity: Design flow: gallons/day Alarm level: Alarm in working order _ Yes; _ No Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: X (locate on site plan) Depth of liquid level above outlet invert: 0 Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc,) D-BOX IS 16"X16"-42" BELOW GRADE, BOX IS CLEAN LEVEL AND SOLID. NO SOLID CARRY OVER FROM TANK, ONE LINE IN, ONE LINE OUT. PUMP CHAMBER: N/A (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order(Yes or No) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 04/25/97) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 17 Hampshire Ave, Hyannis Owner: Hyneck, Daniel Date of Inspection: January 9, 1998 SOIL ABSORPTION SYSTEM (SAS): X (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: o leaching pits, number: 1 leaching chambers, number: leaching galleries, number: leaching trenches, number, length: leaching fields, number, dimensions: overflow cesspool, number, alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) ONE 4' PRE CAST PIT, 14"WATER IN PIT. BOTTOM OF PIT IN GROUND WATER. PIT 36" BELOW GRADE, COVER 20" BELOW GRADE. CESSPOOLS: N/A (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(cesspool must be pumped.as part of inspection) Comments:: (note condition of soil, signs of hydraulic failure, , level of ponding, condition of vegetation, etc.) PRIVY: N/A (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 04/25/97) Page 8 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 17 Hampshire Ave, Hyannis Owner: Hyneck, Daniel Date of Inspection: January 9, 1998 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100(locate where public water supply comes into house) i 18' 0 I 0 F n, (revised 04/25/97) Page 9 of 10 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 17 Hampshire Ave, Hyannis Owner: Hyneck, Daniel Date of Inspection: January 9, 1998 Depth to groundwater 6.6 feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained fro Design Plans on record X Observation of Site(Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers Use USGS Data Describe in your own words how you established the High Groundwater Elevation. (Must be completed) NOTE; HAND DUG TEST HOLE HIT WATER AT 6.6" BOTTOM OF LEACHING T BELOW GRADE. (revised 04/25/97) Page 10 of 10 DATE a • ' lBSr .�rAIDIA KAK 1 j ATE �.� ' �' Toy n of Barnstable REC. By-�Z AUG s 1998 'oard of Health �. "rPoN TTABLE i 3� Main Street,Hyannis MA 02601 Ofce: 508-790.6265 r t�f �,j� Susan 0.Rask,R.S. FAX: 508-790-6304 Sumner KauBnan,MAP.H. Ralph A.Murphy,M.D. VARIANCE REQUEST FORM LOCATION Property Address: 17, Hm p S H I U AVE H U&IMS Assessor's Map and Parcel Number: 3 a ZZ Size of Lot: I , I M t Wetlands Within 300 Ft. Yes Subdivision Name: 1, No Business Name: APPLICANT CONTACT PERSON �+ AUG P e 0)i� N I��K Name: -r OMAS M (-UtU.AN P-E. �1�52 1owN'Address: ANWvtR 5-r L,6WELJ— MA Address: 'P.0 , 00X- q63 (AS'( bt A/AVl f Phone: 1�.�" i5 Phone: ��o FAX:` FAX: 3�b VARIANCE FROM REGULATION(List Rea.) REASON FOR VARIAN _F.(May attach If mores ace needed I5.z48 No OErS LejocQ AtfA-- t2eLA-rI\/EUj SMAtL w-( WIJ-H 5L0p1ti& 15.21z cep A'(O -(v 5E y-s`atioit; TaP06stt., voH4 H14-1 G�ovnfowA-P�rc ln� PZOUNn W MC 4 f3A c K- %A V-r? . �1C t S�►v G ,3,o7H QooM �n� �e�iy,�r�f _i5.2i► CEAc�A AAA- TO r3E; c SS -Mo/y 10 r (2-ROM i R0rCg(K WNF 0 A 15.2I t : LeAc1d 4ceA-1b 13e Le SS 7i4AN 20' PQOM CEI-UrL I\)jA0,. ��F (to be completed by office staff-person receiving variance request application) our(4)copies of plan submitted(including septic system plans and/or restaurant floor plans) � Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense(for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variances only) Variance request application fee collected(no tee for fireguard mwincation renewals,grease trap variance renewals tune orrnerAeasee only],«„side dining variance renewals(same ownerAessee only),and variances to repair filled sewage disposal sytu ns[only If no eapmsion to the building ptopoaedn Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Susan G.Rask,R.S.,Chairman NOT APPROVED ° Sumner Kaufman,M.S.P.H. REASON FOR DISAPPROVAL Ralph A.Murphy,M.D. Q:/WP/VARIREQ '-"'S'F'F'a4TiM'MF 'T9M M�.3'°9! t.uF�KsfH'n D�Akn� a+F�Ri•IT �R�;'�'�T''wP� w ...�. r. p f fg!". � � � ".`.•.. FYr ` �•. fsp��. '"+�+c+.:w.�:.,w.. rrs#F'sv#tr �'-.,i.^�..x: •ar .1°-3- a , �. .tx.,e K i t f i,�6 Y � rST.'- _ � .�> ;,.T.l'Y}: y. .... •• ; ..l ;F tg i+ t:' t t' i ti.�c a.�.`�' �.�aI yS�x't�'�n 1,}+<.f'ltft�'Z.�i k �°� °`S, _l"+,^r s.x?�?r*.L�y� .�..,•�n 4�4� f ` � "F , 'y • P,JS itl r SYY k -^ �••r3 t _ c m C. _ o •''�' �`' {�� t one.. ,S �.!..Y,.. c� �:�. ¢ + �)}tit '� ., � � N iF � ,� � �' r �N ` ` •'1.'^ SJ 1''� �i;l r .iy�I1w Ci9 p �et� at tag.'% ca el Sil 0 n t 961 �. 04 11 ® yl �6 I C•, 0 4 .,4 ' .� ? co !.i .� Via. �•,l • o ��. . -.� �� •' a`e►� g '�® ft � Ec :i ..® c•2e ��. •�e1�, C �aG' •"A '��Q F 'seat a l{ r Y c, •s^>q,3 r * "-e a G BB "�me aag� 6q :s w' °�, y ;r 0 - Pr !eJ N '�6,�'•.® (" ••:3'4S °- .294C •s�Va� ,a2 e�� i ' a 'J� F� v °m rb ar r c3 J .ga me Qy® .yQ� •2J dC �`� a h z I. C7 7 l r 4gs -2J,Bjt S a •J6 6 ,:�' Q `.' .,3 e3 ®t9 B� �. Qom Baas ag k, L7 v� �4. Absacs w° 463 r,cam m° II�� a4me4s •�JQC .:,ram 6k /,:i ?y? 61 • 'a3AC �,r aa� acr flab 3as ®) aaa 4V�, QE. 4 r AC 2 JO 42 Q ® w 39 j)r app oil,. U 4�4 r ipJ24 40C • °ta5 ` doffs �� c 9� •amp '�® `� m aEBI - r 'os „ aq eer { e -its. � �. l •`'oc(" e0' ®C dry 4 {t 9 O � �• s• Qa� �-y O � ® J�Ps� O f b�C' �S dt P4�- 3++ { ' :.� .6gt:., �_.( 'J R •�v/ (-,e. P?® .27� - ?oVa AC 9 1 e,t'JEt e�cC ?:' S• y)� qc i r� 4c Y. © a a c 7 b o Sa" � Z5- � � � log 2' .AD.& Y .ee'r Py II (� QptX rl� Z94C 27g 1v' ASS .90 as-• �" ® A,ff• Ad @p>® .9 < 234C a QjC3 88 dt3 $ D�� 4 eo°r c/'� `6`C 204[ 109 •-t . _ ,� �. � .� >'© sea. a• �' �✓�° irl. .i¢ :.w � ® PL e 7 51 t ' .,''.. - '. .-.-. .. Y �, .gyp Lt• �,, 78 Q 9® ;e (p4 _��'�a- i III 'Q ,o ! s 4"AerS34l®'11@ Cf9:� !F R•s".£9£ v 4 ��°� esa�c r=618 AVI .ClB��sf�JY xi. mo o rm YV- a .."rY ...+?ti.�,��}�,.�;ris�17'a �i, S C..-^F '.+. '"t. Tr_,^'•'n_ne--- is s,a .� +' '4k4;° z+�'Gi�Y.i.� ,...�u�.'ttc'sitis. i+w :.. ,.^ ?;^xF' '.R.:.!:��w•:•r..-n { Proper&Locadon: 161t1AMPSHIRLAVE C'✓.All W: Jxul UJ2/// k � Lq Other Xis: Bldg�/: 1 Card I of 1 Print Da.e.03/0511993 TIItGL T;1 escrzption o e ppraise a ue Assessed Va ue �'GUNGER,MI'&AEL II ,�s 301 16 HAMPSHIRE AVE RESEDNTL 1010 48,30 43,30 YANNIS,KA 02601 B,9RNSTABLE,MA ACCouni Tax Dist. 403 Land Ct# er."rop. #SR ''` Life Estate I EEL i 3�LCfl40 Roles: EEL 2 34-A GL66,01 i + w l.. _A r e Assessed Value , r. Code Assess2d Value Yr. Godc Assessed Palue UNDQUIST,BEATRICE C22173 3/15/84 U I A UNDQUIST,GUNNAR �C22173 Q UNDQU&ST,GUNNAR DTH CP-T C22170 U A Ot . , ®ta y I - ass signature acknowledges a vtstt y a aPa o ect®r or ssessor e—ar Awount Code Desci tpn on Number Amount comm.Mt. AFFNA .vVAL UE vd Appraised Bldg.Value(Card) 46,10€E Appraised Xl'(B)Value(Bldg) 2,200 Appraised®B(L)Value(Bldg) 0 ® Appraised Land Value(Bldg) 18,300 w, L Special Lanni Value ............`. Total Appraised Card Value ................ Total Appraised Parcel Value 65,600 Valuation Method: Cost/Market Valuation Net TotalpprUese ar`E a tee ernzt issue ate ype Description mount nsp• ate o omp• --Date oap orunents Dole r urpas esu t9/1 5fin XL t!.1+ ; t Liff se se escrtptton rie Frontage pt a nits nit rice actor C 1Gact®�7Vt Fug(�i j. o� J Zpecta nczng two. %it ce anst it ue INN-e arm 0.21 AL , . . ,U wf. 18,3ut ��„ ®iceN 121,45ri it � AProperty Location: 231 RE 63ESWAY HYANN IS NAP ID: 369/ 021/// Other ID: Bldg#: 1 Cart! 1 of 1 Print Date:08/05/1998 Tulpu. U ZTlia I LI GALL,GE Hescnpaon Code Appraised Value Assessed Value /oANDREDZZ1;JERRY 0 801 31 BEARSES WAY ESIDNTL I 1010 71,60 71,60 YANNIS,MA 02691 � BARN'STABLE,M ccoun zn e. Tax Dist. 400 Land Ct# 14034-A er.Prop. #SR �� Life Estate DL 1 �LOI 20 Notes: DL 2 / aAa , , Q tt r i SAL&FRIL& a4gq--- 9/15/w.-w 1 61,Uut Yr. Code Assessed Value yr. Gode Assessed Value Yr. Code Assessed Value LEARY, 8/13/8 Q I 58,80 IDREOZZI,BERRY C147491 2/17/9f Q I 65,00t 00 ota. n4,MoAa. 84, ota. 8-4,201 dis signareire acknowledges a Visit by H ara Collector or ssessor ear 7),pelDescription Amount Code Description Number Amount Comm. nt. Appraised Bldg.Value(Card) 69,300 Appraised XF(B)Value(Bldg) 2,300 Appraised OB(L)Value(Bldg) 0 at Appraised Land Value(Bldg) 21,300 4 Special Land Value 0 Total Appraised Card Value Total Appraised Parcel Value 92,900 Valuation Method: Cost/Market Valuation NetTotal Appraisedarce a ue BUILDINU IT RC Permit Issue Date lype Description Amount Insp.Date o Comp. Date Comp. Comments Date TD— CA rposelResult MUM ML Use Code Description Zone D Frontage Depth Units Unit Price 1. Factor S.I. G.Pactor Nblid. Adj. Motes-AdjlSpecial Pricing j ntt Price Land Value eng a ran, , o2c ar ats?.� I Otat Lanaa u operty oca on: S"n' UE —MAP-ID: 30 / 0 9 // Other ID: Bldg#: 1 Card 1 of 1 Print Date:08/05/1998 TOM- E12TL 7TE,b .-1R0 ,' Description Code Appraised Value Assessed Value 8 BRISTOL AVENUE SIDNTL 1010 51,50 51,50 801 YANNIS,MA 02601 BARNSTABLE,AdA _Account ZZLEHU Plan Ref. Tax Dist. 40� Land Ct# Per.Perop. -1 #SR 4 �I SION i � Life Estate DL 1 ]LOT 18 Notes: DL 2 14034A ota ,40 66,4U - qra vt r. Code Assessed Value Yr. Code ssesse a ue rr. Gode AssE-sed Value EARSE,KENNETH S&L1LA DREW C91917 5115183 Q 1 50,00 1 ota. ota. ota. 0T3 fats signature acknowledges a visit by a ata Collector or Assessor Year lypelVescription Aniount Code Description Number Amount Gomm.Int. Appraised Bldg.Value(Card) 49,500 Appraised XF(B)Value(Bldg) 2,O00 Appraised OB(L)Value(Bldg) 0 ota. Appraised Land Value(Bldg) 14,900 l Special Land Value I Total Appraised Card Value Total Appraised Parcel Value 66,400 Valuation Method: Cost/Market Valuation Net'fotal Appraisedarea a ue ern it iD Issue Date ype Description Amount Insp.Date o Comp. Date(onip, Comments Date ID Gd. PurposelResull ASh;(U117Tffl— B n se o e escptaon zone rotageept nits nit race actor . actor 77 a.. af. Nodes- J peeaa racng J. ntt race an Value ,m G." ( 1 Total cr d:P O a aPt a U , r _- Pi,epat'y 11Y i�VIP W: 309; 2 vl 1 . !13er ID: Bldg#. 1 C'crd 1 of 1 Pr nt Date.03/05/1993 T .IDU ;�'r' �OLL.i& s_ Description Code Apprmsed Value Assessed Value Sol siVA,a4lVIS,NIA 02601 BARNSTABLE, Account» 7zz 1sn` 1. 4 as Dist. 4C^e Land Ct# er.PFoP. t#SR Life Estate ,DJ—i Notes: viol � �.�� j sraR 2 apg7��Jy�gp�}[)'/•�;q gam' �7�g�-7 oFa � lil4d.1 t1T F,6YIfTL,BU.➢.T3��..�,�jti\�YWL1'd i'j �Yi fl �. '`a�L� ¢ � r .k d 1 � �Yjd i tom` C Yr. Code Assessed Value Yr. Gode Assessed Value Yr. Code Assessed VaLx i I—T cta. , ©t3 , ... •.r _.. iL yba visit a Data Collector oT sseSsor i Year yp escnptaon Amount code— Description Numoer Amount Comm.Int. i SUMMARY i Appraised Bldg.Value(Card) Appraised XF(B)Value(Bldg) o Special land Value Value (Bldg) A _® f Appraised band Value ld Total Appraised Card Value Total Appraised Parcel Value Valuation Method: Cost/Fliarket Valenti n NetlotalAppywsedftrcs a ue ermit ID ssue ate ype -scraptaon Amount Insp.Date Yo camp. Date amip -mments vote apos esu t EARBeSCnptaon..... c.; ,: .,..> �':-` .,..a,, •.,^ se Code zone rontage �pta raa� unit race actor factor J. ot77 es=ilaj pecea nc:ng a�. ni! nce ate;e I oral av a.0 '+ 1 CATION SEWAGE PERMIT N0. PILLAGE I I N S T A LLER'S NAME A ADDRESS j R UILDE R OR OWNER DA T E P ERMIT ISSUED DATE COMPLIANCE ISSUED I ' e PIJ 10. i i I I . LOCATION SEWAGE PERMIT NO. 112 Y I L L A G I 1 I N S T A LLER'S NAME & ADDRESS R U I L D E R OR OWNER DATE PERMIT ISSUED _ �, � � DATE COMPLIANCE ISSUED �-.2 - $ � i / o � c' vs No. Fms.....1 S.. ............ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH 1.vW... :...................OF.�..�.Jr.r?"Ie.. .......................................... Appliration for Dhipo i al Works Tomitrurtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ().) an Individual Sewage Disposal System at: 11 II nn ` ............ __.CtRI�1P.sx_lCSr4_..l5� t. lanniS-------------- ------------------•----------------------------------------........---- Location-Address /� r Lott No. - - l�l l�q. fsril _.. s�S�l.._. N.Ra�4 �.. • 1�0 L..&A.. Owne Addres I'A......................... W fs�yl�A ,v54__I�ldin__3r ,.....ls��_� _ riXd!td� ,a Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............. ..........................Expansion Attic ( ) Garbage Grinder ( ) P4 Other—Type of Building -_______•__-_._.•-•-___-.___ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ............................................. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank— xDisposal Trench_iqu�ocapacity......-_ gallons Length Total Lengthidth................. . Total leaching area---Depth-------sq.ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by................................ . ............................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water......................... (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.___-.____--___-•-______ a -•-•------••------------•-----•---•--•----•---•------•-----------••-•-------------------------------......................................................... 0 Description of Soil........................................................................................................................................................................ W ----------•-----------------•------••-•---------•------------------------------------------•-----------•-----•----------•-•-----....- ... ( r. V Nature of Repairs or Alterations—Answer when applicable_..�_4v0_r_aL. .' c.___��! Kt. secs ► P! � . cn�_c 1' And........................................................................................................................... Agreement: U The undersigned agrees to install the aforedescriribed Individual Sewage Disposal System in accordance with the provisions of iITA LE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the boar of health. Si ned 1 � L__- -- a_4_'S _...... ate Application Approved By........... . . __ .._•....__�_'=kS!'. ------------ --...__._. Dat Application Disapproved for the following reasons---------------••--......---•--------•------------------•------------------------•----•••--...••--•-------------- .........-•---•-----------------------•--------•-----•••-•-••--------------•-----------=----•--•-----......•-•••----•••----•-••••--•---••-----•--•----------------•-••----...............-••------------ Date PermitNo......................................................... Issued....................................................... Date No.`s. ---�._� FE.B.................:............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF tHEALTH ►._UV�`�.................OF......1 nrr�skc t ..� �...................................................... Appliration for Uiipos al Works Tonstrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair (�4) an Individual Sewage Disposal System at: .......... _ ._.. .................... .•--••..........------.....---------------------•--....._..-----•---------------•--.._......._.. Location-Address r .... ...........................••----•--...._..-_-. L N ......................... —,,,,,�,-„--owner }i 0 t �t tAddress 5...�.. ................ .a1f..►..... ..........--•-------..... F-I __....._ .............. ...... Installer Address Pq Q Type of Building Size Lot..... ....................Sq. feet Dwelling—No. of Bedrooms.............. ..........................Expansion Attic ( ) Garbage Grinder ( ) `4 Other—T e of Building No. of persons............................ Showers — Cafeteria G.1 Other fixtures -----•----•••--•-------•---•--• - - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 04 Septic Tank W Disposal Trench Nocapacity-_.---_-_W gallons LenghTotal Length Total leaching area-•Depth-_.---_sq._ft. W I Seepage Pit No---_---------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------- Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ........................................................................".................................................................................. 0 Description of Soil........................................................................................................................................................................ x U ..................••-••--•-'-•-'-•-'--'-"'--••---"......-----'-'.................•-'-_....._'•-•._.....••-•------•••••--•••-••-•-'------•'---•'•"'•-•-•'-'-'--'-•--••._.._..........._--"•..._.._••. W •-••-•-•••-•-------------------- -•-•-•••---•-•-•-•••-••--------------•-•---•-----•--._......••--•••----•--•-----•---------------••-•••......•----- ...................................- UNature of Repairs or Alterations—Answer when applicable._._Lovo __S'Pc ........... •-: ___� _ _.. � . •--'.__._......."•--....._.... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance,with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. _Signed__..r k`u -.............. `2-�:9-6, • Application Approved By.__.._.----•------..-`-•'''--='-� �`- ��--------- .._.......-•--�T•-•-•------------------------------------ -------------.�=_ ate Application Disapproved for the following reasons:................................................................................................................ --......-•-----'----••--'-'--•'---'--'...._...-••-'--•••-•-•••-••••--•-••-'--••"-'-"-'•-''-••-••••-'-•.••----'-'-'__.....•----••••----•------••'----------------•-•---•-----••----••--•--.....'-•----- Date PermitNo......................................................... Issued....................................................... Date ! THE COMMONWEALTH OF MASSACHUSETTS y N El! BOA�R'D� OF HEALTH L.ow�1....................OF.....! <.tti�t� sae ............................... ......................... Corrtifiratr of Tomplianrr THIS IS-TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by.................... ?� �_-� ?�.,i c� --•-----'--•-"'--......... ] ' 1 Installer . fr at-'-•--"--- 1 ;'- - .............. has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No........ :. =. ........... dated............... * _.------ ._.._._. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............................� 2- Y........................ Inspector....(_.h,.......•••..._....•--...•'--•••........................--......_....-' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF fHEALTH ^_ �6...... ......................OF .............[eK3l ............................................................... N......................:... FEE.......:............... Diopooal orko �onoaion �ernti Permission is hereby granted............1`'`'r?:l" 't..4..__ ::__�`_! _ ------"-------'.............................'--........................ to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at No........... I ! s :.t '`. Phn.r -(_6� .q, . -'. •••••--•------••--••--••-•-'•••-•-'--•--•-•-•................••-•••----•-••...._-•--•.--_.._ Street .._, . -� as shown on the application for Disposal Works Construction Permit No,-_: =::_.... } ADATE•--"'••" / '-----•-•---•......------•-----....... Board of Health FORM 1255 HOBBS & WARREN. INC., PUBLISHERS m L`cuS T EST HOLE LOGS - N R:QIIIRED vARIINcas TROY'rIrLE lira: NOTES: l I.SECTION 15248: NO ASSSIVE LEACHING AREA. 1.VERTICAL DATUM: ASSUMED FROM AD NGVD+ - S8 q t.sscrloN 16srE: sACH AREA ro BE 4s Asovs GRovNorArax ENGINEER TXOYAS McLELLAN,P.E. g�ttY 3.sacrloN tssv-('x isAca.nsA TO BE LM THAN w TROY PROPSRfr ttNss. 2. YDNICAPAL WATER IS AVAILABLE. N �E 4.SECTION 162"('J LEACH ACE' r0 Ba LESS THAN W FROM CELLAR WALL DATE: 5-21-BB PERCOLATION RATE: <2 YIN/IN 3.SCHEDULE 40-4"PVC PIPE TO BE USED THROUGHOUT SEPTIC SYSTEM. 9 ' .ALL PRECAST UNITS TO CONFORM WITH AASHTO H-10 KO y I (SEPTIC S7SlEY HIS BEEN:DESIGNED r0 YAXIWY FEASIBLE COYPL/INCl) 4 LOADING SPECIFICATIONS. t TX-1 TX-2 S.PIPE PITCH= 1/4" PER FOOT;(UNLESS NOTED OTHERWISE). pn 8en 6.FIRST Z'OF PIPE OUT OF D-BOX TO BE SIT LEVEL yQg ST � FILL ELsv FILL ELsv 7. THE SEPTIC SYSTEM HAS NOT BEEN DESIGNED TO ACCOMODATE THE 84' FINE SAND USE OF A GARBAGE DISPOSAL. 3sn SILT LOAM MIX 8.ALL CONSTRUCTION DETAILS ARE TO BE IN CONFORMANCE WITH THE LOCATION YAP fir LOA NoRr a STATE OF MASS. ENVIRONMENTAL CODE(TILE FIVE)AND LOCAL LOT 21 N , Stir LOAM as' ns HEALTH REGULATIONS. i mrR t/1 B oassRvsD 9. CONTRACTOR TO VERIFY LOCATIONS OF ALL UrILrT1aS PRIOR 8,900±S F. t ros 14! ELT 5/1 t.40 7B' GROUNDWATER t9S of c abut N TO CONSTRUCTION. ASSESSORS MAP: 22 E¢E "T 7 SAND 8. 0 0 rOp SOIL �D 10.GROUND COVER OVER ALL SEPTIC SYSTEM COMPONENTS NOT TO PARCEL- 22 E � 2.6'Y 7/e EXCEED 3.0'. FLOOD ZONE: v ENU EEp�� 156' ten 11 EXISTING LEACH PIT TO BE PUMPED AND FILLED WITH SAND A %g DAY r�E g�1t) 43.3 .OR REMOVED. FILL AND /� ) SYI I RE ES( pE��pYE. S �� USCS GROUNMATZR ADJUSTMENT. 12 WITHIN 5F OF UNSUITABLE ROPOSE LEACH TRENCHES IS To BE REMOVED AND A,L P igE�►y$E SEZE►=►ND 42 4 >.aLL An►-tso SONS:D. anlUsrYaNr:or _ REPLACED WITH CLEAN MEDIUM SAND. $ 1�+ kc oil =0 gd11 42 � 13.D-BOX TO BE HATER TESTED TO ENSURE LEVELNESS AND EQUAL FLOW. p051SOil � W� SEPTIC SYSTEM DESIGN 14IpANEX Co CONCRETE ADDITIVE OR CONBER IS TO BE WATER SEAL 56. MANUFACTURER WITH G Of 4 1 A 6'EZ WRAP IS ALSO REQUIRED FOR PUMP CHAMBER.. it FLOW ESTIMATE. (3 BEDROOM DESIGN,MINIMUM) W 40 1 0• ► \ a1\ -3-BEDROOMS AT 110CAL/DAY/BEDROOM-�830 GAL/DAY I Eg ao 39.4 I / po tiN ' \ ♦ SEPTIC TONE: BS r G \ ` -M GAL/DAP s 2 DAYS-"k CAL USE 1000_GALLON SEPTIC TANK (EXISTING) -cr \ i 1 f I LEACHING AREA 43 87� \ "'g-i E BEDS G \ USE 2 LEECH TRENCHES . ♦ t EyLI g ♦ _(26'z r a Z DEEP DEEP) t SIDE APE \ L� 26+4 2 s 2 120 SF .74 GAL DAY ♦ ♦ ' \ ♦ BOTTOM AREA 2W s 4'-104 SF (74)-77 CAL/DAY ♦♦ \ ` / tp'eEO ` ♦ ♦ 42 CAPACITY—166 CAL/DAY ♦ \ ♦♦ \ SpEtI ♦ s 2 TRENCHES-332 CAL/DAY —2'PEASTONE si \ ' J SEPTIC SYSTEM SECTION / -- 1 /3 4 r r pW $ i YC R SxE �DtE 01tiJ�YglEg�t1Y�s i 41 6-1/ ►WITHIN/Y or HASHED STONE D GRADE COVRR 0►sR PUMP 1G BE C�OpO Y, i / 43B WITHIN A'or rrxlsB GRADE4"PERFORATED Yp�g40 , FIRST FLOOR t PC9(PREs$VRR L711R) PVC PIPE *� O,oE . ELEV.a 3BS / (EXIST) -) �• Ao Z 3B.43 D-BOX 382E z 36D se' - - ELEV. ELEV. - � _ _ - � _CAL (aIIST.)) PUMP CHAMBER (6" OF ELEV. E �, _,_� ELEV. - SEPTIC TANK (1b Bd�ONlIRMED) (1000 CAL SEPTIC TANK) STONE 88' - - - �- - - - -BENCHMARK'AT UNDER (EXISTING) WITH MITERS SPY-4 (ftl AT DER 40 WOOD TJVN PDACEACK TO E INSTALLED 3813 TWO LEACH TRENCHES 45' sLEiATION-esf BISIYaM TEE SIZES:(TO BE CONFIRMED) (28's 4'x?DEEP) / INLET:6'UP,19 DOWN Ifir A N DWELLING POWERED FROM CIRCUIT RC PUMP SEPARATE ELEV. OUTLET:6'UP,14'DOWN '.\ gr R, DISTANCE Bar► EN (GAS DAPPLE AT ourl,ET TEE) oN�r�s►IrcH m Ba e¢j. (A°lvo uiaYBlo ejr,.r�N SWITCH ADJUSTZD GROUNDWATER ELEP-3/s BWTANCr FORCE-7115 LBS WRIGHT OF TAKE-&W LOS E K EXISTING CONTOUR: — -- -- SITE AND SEWAGE PLAN PROPOSED CONTOUR: .............................. � APPROVED BY. DATE. EXISTING SPOT ELEVATION: 25.5 1. LOCATION. PROPOSED SPOT ELEVATION:25 jf'F rasr HOLE: si�' t„oF 17 HAMPSHIRE AVENUE UTILITY POLL: -o- MdaL}. s` ` Falvca LINE: uvw � L R HYANNIS MA. HYDRANT: 9 Ho.SSW PREPARED FOR- RETAINING WALL ® °< rREE: J `'b A & B CANC01 DAN HYNEK I D RE EYAST-YeLELLIN ENGINEERING SCALE: fa 20' DATE: 5/25/98 DM ga-e59 (D28118) E4 SCHOOL STREET P.0 BOX 488 PHONE a FAX (6 398-fslo s otefo THOMAS YcLELLAN,P d. ✓OXN Z.DEYAREST✓R, P.L.S. REFERENCE. LAND COURT CASE 014034 A(SHEET 2) 1 a► ` LOCUS TEST HOLE LOGS NOTES. .t REQUIRED VARIANCES FROM TITLE TIVE: v, 1. VERTICAL DATUM: ASSUMED FROM QUAD (NGVD + -) A 1. SECTION t6248: No RESERVE LEACHING AREA ENGINEER: THOMAS McLELLAN, P.E. 2. MUNICAPAL WATER IS AVAILABLE. $I 2. SECTION 15.212: LEACH AREA TO BE 4.5' ABOVE GROUNDWATER PS S. SECTION 15.2H 0): LEACH AREA TO BE LESS THAN 10' FROM PROPERTY LINES. DATE: 15-21-98 3. SCHEDULE 40 - 4" PVC PIPE TO BE USED THROUGHOUT SEPTIC SYSTEM. 4. SECTION 15.2ff (r : LEACH AREA TO BE LESS THAN 20' FROM CELLAR HALL. N g E• � PERCOLATION RATE: < 2 MIN/IN 4. ALL PRECAST UNITS TO CONFORM WITH AASHTO H-10 1Q08 (SaPTtC SYSTEM HAS BEEN DESIGNED TO MAXIMUM FEASIBLE COMPLIANCE) LOADING SPECIFICATIONS. 5. PIPE PITCH 1f4" PER FOOT, (UNLESS NOTED OTHERWISE). TH-1 4f0 TH_2 ss0 6. FIRST 2' OF PIPE OUT OF D-BOX TO BE SET LEVEL. ELav ELEV 7. THE SEPTIC SYSTEM HAS NOT BEEN DESIGNED TO ACCOMODATE THE FILL Fi a SAND USE OF A GARBAGE DISPOSAL. Y 84" 34D SILT LOAM MIX 8. ALL CONSTRUCTION DETAILS ARE TO BE IN CONFORMANCE WITH THE A/B HORIZOx STATE OF MASS. ENVIRONMENTAL CODE (TITLE FIVE) AND LOCAL LOCATION MAP fzo" LOAMY SAND 8' sf ,�, SILT LOAM sf o ss HEALTH REGULATIONS. LOT 21 1 V rOYR 2/1 & OBSERVED 9. CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES PRIOR 9,900 ± S.F. pA� 144- 2sY 5/1 29.0 7e GROUNDWATER 29.5 TO CONSTRUCTION. 01 C HORIZON 10: GROUND COVER OVER ALL SEPTIC SYSTEM COMPONENTS NOT TO ASSESSORS MAP: 309 E 90E LOAMY SAND 84" OLD TOP SOIL 29A 2.5Y 7/6 EXCEED 317. PARCEL: 22 �i 11. EXISTING LEACH PIT TO BE PUMPED AND FILLED WITH SAND FLOOD ZONE: C E lv gEf -) 43. s fss" z8.o OR REMOVED. v xsof APPROX. 12- DEEP j2I �SIN) 43 f2. AL HIN 5U F PROPOSED LEACH TRENLE SOIL (FILL AND �HEs IS TO BE REMOVED AN g,E s vj8 T$Rf� r USGS GROUNDWATER ADJUSTMENT: E5 (A D�� 0�5Ip HELL: AIW-,.30, ZONE: D, ADJUSTMENT: Os' REPLACED WITH CLEAN MEDIUM! SAND. P S NGo TO 5y'f i i1) 42. 4 13. D-BOX TO BE WATER TESTED TO ENSURE LEVELNESS AND EQUAL FLOW. T � E AGg gaYR Ta 8gpt15 4z 14. PUMP CHAMBER IS TO BE WATER PROOFED BY MANUFACTURER WITH ,ry�LY yy1��[�' SEPTIC SYSTEM DESIGN IPANEX CONCRETE ADDITIVE OR CONSEAL 55: (� 0 W 1 A 6" EZ WRAP IS ALSO REQUIRED FOR PUMP CHAMBER. OF 41 1 Y►1� o' FLOW ESTIMATE: (3 BEDROOM DESIGN, MINIMUM) 8i�E 0'000 �► BEDROOMS AT 110 CAL/DAY/BEDROOM =330 CAL/DAY 40 �1 R w'd 39. 4 ' yY yIN� I SEPTIC TANK: s9 G 330 CAL/DAY x 2 DAYS = 660 GAL 6 / USE 1000 GALLON SEPTIC TANK (EXISTING) 38 43 1�0 - LEACHING AREA: , NG �p USE 2 LEACH TRENCHES 37 _ X15TI Y ,o , 36 \ \ \ T $ 1tiDeNG o \ 26' x 4 x x DEEP DEEP) \ 213 1, R �$ D�E F�°4so SIDE AREAS +4)2 x 2 - 120 SF (•74) 89 GAL/DAY \ \ ` Eye• BOTTOM AREA:; 26' z 4' = 104 SF (74) = 77 GAL/DAY \ \ CAPACITY =166 GAL/DAY iACY. 0 � � z 2 TRL'1JCIIL'S 332.GAL ✓DAY ,a ... BPI \ \ 2'" PEASTONE SEPTIC SYSTEM SECTION 3/4» - > 1/2' J \ GAy $R \ �,'Y WASHED STONE oo ► . ,� t000 � \ 1 COVERS WITHIN 12" OF o ti yp ti YO $xI,T1�T DN Gay pcpli�5T B�oN�11►yy / 4 f 43.6 - FINISHED cR.iva COVER tr OVER JUNUMP To Ba WITHIN B" OF FINISH GRADE. 4" PERFORATED t S$� SED A�a YVy / / 40 FIRST FLOOR41 ,2" PCv (PRESSURE LINE) PVC PIPE 5RY \ ^ ELEV: 38.5 1 0 f _-� s5 8 Z f 1 0 33.6 33.2 - ---2•---------- T ELEV.' 332 + -) ELEV. HOZJ 38.43 D-BOX 36.0 ' B (E%1ST.) ELEV. Df ELEV. \38.26 ELEV. 1000 GAL PUMP CHAMBER S N ELEV. 26' 38 - - To ST.) fOOO GAL SEPTIC TANK) STONE 37, _ - - / SEPTIC TANK ((TO BE CONFIRMED) WITH MYERS SRM-4 UNDER BENCHMARK AT (EXISTING) PUMP. PUMP ALARM (Tar AT INLET)) TWO LEACH TRENCHES 4.5' 38J3 38 - 40 WOOD STAKE UNDER PACKAGE TO BE INSTALLED (26' x 4' x 2' DEEP) sa _ - - - ELEVATION = ssa BASEMENT TEE SIZES: (TO BE CONFIRMED) IN DWELLING POWERED ELEV. 40 - INLET:'6" UP, 13" DOWN BY A CIRCUIT SEPARATE ELEV. OUTLET: 6" UP, 14" DOWN FROM THE PUMP ` POWER, DISTANCE BETWEEN (GAS BAFFLE AT OUTLET TEE) ON OFF<SWITCH To BE 8"). (DISTANCE BETWEEN ON SWITCH ADJUSTED GROUNDWATER ELEV.= 31.5 AND ALARM TO BE 12") BOUYANCY FORCE=7J75 LBS WEIGHT OF TANK =8,240 LBS KEY: SITE AND SEWAGE PLAN EXISTING CONTOUR: APPROVED BY: DATE: PROPOSED CONTOUR: .............................. - LOCATION: EXISTING SPOT ELEVATION: 25.5 r�° `=` PROPOSED SPOT ELEVATION: z5 ,,� ,�� µOFq 17 HAMPSHIRE AVENUE j TEST HOLE: HYANNI S, MA. UTILITY POLE: -0- CIVIL -� Z. FENCE LINE: . Its � N0.:36859 a PREPARED FOR HYDRANT: -� RETAINING WALL: DM , , A & B CANCO/ DAN HYNEK TREE; DEMAREST-McLELLAN ENGINEERING SCALE: 1"= 20" DATE: 5125 24 scaooL STREET P.O. Box 463 A ' WEST DS"rS, YAssACHUSZTTS 02670 ! REFERENCE: LAND COURT CASE 14034 (SHEET 2) DM # 2a-Qa_(D28F19) tHoxa Fax : (soa) ssa-77ra THOMAS MCLELLAN, P.E. JOHN Z. DEMAREST JR., P.L.S.