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0009 ISLAND AVENUE - Health
9 islan Avenue �---" -Hyannis ; --- A = 265 022 o e e o b pt DATE: oy PER: J~ 0 )dA88. REC. BY Town of Barnstable S DATE: S-P r6 Board of Health 367 Main Street,Hyannis MA 02601 Office: 508-862-4644 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,M.S.P.H. Ralph A.Murphy,M.D. VARIANCE REQUEST FORM LOCATION 11, Property Address: 9 71St.^"7 �V AAA kA ra SS flD e: C S al v ANa t�s LA"p Assessor's.Map and Parcel Number: 2(-5 ZOO 22_ Size of Lot: O o 98 ik e 2 cs Wetlands Within 300 Ft. Yes _2�,_ Business Name: , Ti No Subdivision Name: C APPLICANT'S NAME: 17Ay,9, 60.ki 1A1 L— Phone 3 - 230 • 1Z+ fo 7--1 Ca Did the owner of the propertrtyy authorize you to represent him or her? Yes K No ry ca 5 EE An-MNr—tlrFD 1»B+Tae Z�i Cnca PROPERTY OWNER'S NAME CONTACT PERSON -�, C Name: 1 t.L �—A M 1 L`( te.0 S? Name: E 2 S u ��v_ ►�. t� cn v ^ Qac.�s@t4 $ t_.t_�v�4t.�__ O tN Ge%Nr6RkN. Address: 575 A m^.L F!T �1 a QA0►5^0 0) CA• Address: P Q S3 cox 5 9 s t t t.t-L �f� o 26 SS Phone: 3%O- zt� 17g(o Phone: SO 9- <t?8_-_ l33�}q VARIANCE FROM REGULATION pst Reg.) REASON FOR VARIANCE(May attach if more space needed) 36OGM2�5.211 M%to -0e-M1CW's 5EPC1G'T�.ta,�c %S F."K�S'1NICr .>a16WIbf-1 si.Pb FruD Tb 6.T-APAK. tb' 1Za6?y Qsi> NQT Yb ZGLQC.A*M AcPP20X S" � in EVecrnQED . NATURE OF WORK: House Addition ❑ House Renovation ❑ Repair of Failed Septic System ❑ Checklist(to be completed by office staff-person receiving variance request application) Four(4)copies of the completed variance request form _ Four(4)copies of engineered plan submitted(e.g.septic system plans) _✓ Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) Signed letter stating that the property owner authorized you to represent him/her for this request 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 variance requests only) Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same owner/leasee only],outside dining variance renewals[same owner/lessee only],and variances to repair failed sewage disposal systems [only if no expansion to the building proposed]) 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 Rpr° 23 04 10:39a Hill 310-230-1046 p. 1 _ SULLIVAN ENG INC- PAGE 02 Town of Barnstable April 22, 2004 hoard of Health 200 Alain Street Hyannis, MA 02601 RE: 9 Island Drive, HYannisport David B. &Joan B. Hill, Trs./Hill Family Trust Dear Board of Health, As a trustee of the Hill Family Trust, please advised that Peter Sullivan or John O'Dea of Sullivan Engineering has my permission to represent me before Your board in, matters relating to a septic system design at my Property. Sills ly, /10 Hill COMMONWEALTH OF MASSACHUSETTS r EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION i Property Address: 9 Island Avenue ; Hyannis Port MA 02647 Owner's Name: David&Joan Hill Owner's Address: 575 Amalfi Drive Pacific Palisades CA 90727 Date of Inspection: November 30 2001 • I Name of Inspector:(Please Print) James M. Ford Company Name: James M. Ford Map:265 Lot: 022 � Mailing Address: P.O.Box 49 gi Osterville MA 02655-0049 Telephone Number: (508) 862-9400 it 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 urther Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: December 5. 2001 The system inspector shall sub ' 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. 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 6/15/2000 page 1 NARRATIVE TO ACCOMPANY BOARD OF HEALTH VARIANCE REQUEST for David B. & Joan B. Hill, Trs. 9 Island Drive, Hyannisport, Mass. Map 275 Parcel 022 The owner's are proposing some interior and exterior renovations to their existing home. There will be no increase in the number of bedrooms, therefore, there will be no increase in flow. The property is not located within a zone of contribution to a public water supply and the septic system passed a recent Title 5 inspection. There presently exists a set back from the building slab to the septic tank of approximately 10 feet. The improvements to the home will result in moving a wall such that the distance from the existing septic tank to the slab will be approximately 5 to 6 feet. Discussions with DEP indicate that the 10 foot set back requirement is for construction considerations only and does not effect the functionality of the septic system. Additionally, for this situation, 310CMR15.301(5) could imply that a variance may not be required since the system is existing and has recently passed an inspection. Regardless, we are requesting that the local Board of Health not require moving the tank to meet the present Title 5 set back requirement. . Per 310CMR15.412(4)(b) No Department Review is required and the Board can grant this relief. 22 '20 0.0 2k v ems, a ® IRS sq- r Wil, EM, VIRP /6 ��j•�•c+ ^ram 1 �j _ �. f.�\`�t1,, .•.. /fop iM AIM � e oil Sullivan Engineering Inc. 7 Parker Road Box 659 Osterville MA 02655 Peter Sullivan P.E. Mass. Registration No. 29733 Phone 42&3344 fax 42&3115 e-mail:PSullPE@aol.00m ABUTTER NOTIFICATION LETTER RE: Board of Health Public Hearing To Whom It May Concern: As a direct abutter of a proposed project, please be advised that a Variance Request has been filed with the Town of Barnstable Board of Health. The specific project information is as follows: Applicant : David &Joan Hill Trs for Hill Family Trust Project Location: 9 Island Ave. Hyannisport, Mass Assessor's Map and Parcel: Map 265 Parcel 022 Project Description: House renovations-applicant seeks relief from septic system set back requirement from slab Applicant's Agent: Peter Sullivan PE 7 Parker Road Osterville, MA 02655 Public Hearing: Location: Barnstable Town Hall 367 Main St., Hyannis 2nd Floor Conference Room Date: May 11, 2004 Time: 7:00 PM Plans and the application describing the proposed activity are on file at the Board of Health office 200 Main Street, Hyannis and at Peter Sullivan's office. Please call if you if you have any questions regarding this application. f SULLIVAN ENGINEERING INC. 7 PARKER ROAD/P O BOX 659 OSTERVILLE, MA 02655 Peter Sullivan P. E. Mass Registration No. 29733 psullpe@aol.com phone 508-428-3344 fax 508-428-3115 DIRECT ABUTTER LIST FOR MAP 265 PARCEL 022 FOR BOARD OF HEALTH VARIANCE HILL FAMILY TRUST 9 ISLAND AVENUE, HYANNIPSORT MAP /PARCEL OWNER NAME 265 15 &5 John G S Humphreys c/o Barry N Shanahan 359 Gorham Pond Road Goffstown, NH 03045 265 4 Susan W Humphreys 1825 Cutlass Cove Drive Vero Beach, FL 32963 265 28 Anne W Strachan, Tr. The 19 Island Ave. Realty Trust 380 Indian Harbor Road Vero Beach, FL 32960 265 30 Ronald E& Carol E Gwozdz 334 Boston Post Road Weston, MA 02493 �,�Lr tKik� �} a xI /4 ° 1•tyi' It f # � $ �K � µ,��.�[�.;ij: Q`�,_} �• ,�. �: may.. t }} a k , r � ��.1 � } � ,ram �� ��� � '���,_ `' � } •r• to � M `s 1 s v \ 4 • s re1e. t'L LT � L i fi!L - y � �Sa F�� � ••p ' ai F 8�r COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 9 Island Avenue Hyannis Port, MA 02647 Owner's Name: David&Joan Hill Owner's Address: _ 575 Amalfi Drive Pacific Palisades, CA 90727 Date of Inspection: November 30, 2001 Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford Map:265 Mailing Address: P.O. Box 49 Lot: 022 Osterville,MA 02655-0049 Telephone Number: _ (508) 862-9400 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 Need rther Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: December 5, 2001 The system inspector shall sub 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. Notes and Comments D ****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 6/15/2000 page 1 Page 2 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 9 Island Avenue Hyannis Port, MA Owner: David&Joan Hill Date of Inspection: November 30, 2001 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found an information which indicates that an of the failure criteria described in 310 CMR Y Y 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 replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: 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: 9 Island Avenue Hyannis Port, MA Owner: David&Joan Hill Date of Inspection: November 30, 2001 . 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 CNIR 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 a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria 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 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 9 Island Avenue Hyannis Port, AM Owner: David&Joan Hill Date of Inspection: November 30, 2001 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2 day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board'of Health to determine what will be necessary to correct the failure. E. Large System: 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: 9 Island Avenue Hyannis Port, AM Owner: David&Joan Hill Date of Inspection: November 30, 2001 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant, or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection ? ✓ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ _ Was the site inspected for signs of break out? ✓ Were all system components,excluding the SAS, located on site? ✓ Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction,dimensions,depth of liquid,depth of sludge and depth of scum ? ✓ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No ✓ Existing information. For example, a plan at the Board of Health. ✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)]. 5 I , Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 9 Island Avenue Hyannis Port, MA Owner: David&Joan Hill Date of Inspection: November 30, 2001 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 0 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system (yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): Yes Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Unknown COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): pd Basis of design flow(seats/persons/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 information: Pumped on Mar. 8100-per treatment plant Was system pumped as part of the inspection (yes or no): No If yes, volume pumped: Qallons--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 copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Apr. 8180-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 9 Island Avenue Hyannis Port, MA Owner: David&Joan Hill Date of Inspection: November 30, 2001 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron ✓ 40 PVC _other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 12" Material of construction: ✓ concrete _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: 1000 gal. Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 3" Distance from top of scum to top of outlet tee or baffle: 9" Distance from bottom of scum to bottom of outlet tee or baffle: 12" { How were dimensions determined: Measuring stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Cement tees were present. The liquid level was even with the outlet invert. There were no signs of leakage GREASE TRAP: None (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 Page 8 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 9 Island Avenue Hyannis Port, MA Owner: David&Joan Hill Date of Inspection: November 30, 2001 TIGHT or HOLDING TANK: None (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: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: -- Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box, etc.): The D-box was under a railroad tie walkway and unaccessible. PUMP CHAMBER: None (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.): 8 Page 9 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 9 Island Avenue _ _Hyannis Port, MA Owner: David&Joan Hill Date of Inspection: November 30, 2001 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 4'x 6'with 2'stone-per design plans leaching chambers,number: leaching galleries, number: leaching trenches, number, length: leaching fields, number, dimensions: overflow cesspool,number: Innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): The pit was dry. The scum line was 6"up from the bottom. There were no signs of failure. The bottom to grade was approximately 9.5. The cover was 10"below grade. CESSPOOLS: None (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: None (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.): r 9 Page 10 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 9 Island Avenue Hyannis Port, AM Owner: David&Joan Hill Date of Inspection: November 30, 2001 Map: 265 Lot: 022 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. t� �r0 3 ' A ' 1 Al - Lo 0 3 �3- 19, 83- 31• Lo y M E 10 Page I 1 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 9 Island Avenue Hyannis Port, AM Owner: David&Joan Hill Date of Inspection: November 30, 2001 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 elevation: The bottom of the leach pit to grade was approximately 9.5. Hand augered down 3.5'in the middle of the pit to 13'below grade, and no water was observed. There is no high,ground water adjustment for this site. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report. 11 GrA n J ,1 p 6ru��c�wit i e� o�Servc,� �\ C0ti1MONN -EALTH OF MASSACHt•SETTS EaECUTIVE OFFICE OF E?- %iRONNIENTAL AFFAIRS DEPART�IE�T OF ENVIRONMENTAL PROTECTI %��.t . • �, ArwONE WINTER STREET. BOSTON. NIA 02106 617 9:-f 00 V1'ILL1A�t F.V�Z:LD —k z?L'DY' O?E �9 s Govt:mC' ;.: , • �. ? IOWNOF 8 Se.�re 2: . ,. NFA(��E TTA4�'ID B STRL1✓� ARGEO PATUL CELLUCCI Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM .._%& PART A L g CERTIFICATION Property Addres,, Ck�S�q�,c� L 1Mt 15 "r Address of Owner. 1J�CJZAf�� Date of Inspection: 12`1(, :C1. (If different) ? - ^ Q�_. yYdC.�7tS�., Name of Inspector: ' 1 �0 1.c1't-eNov+ a- s N am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) 13035 Company Name:A:ffe m4-i'e E•+ rr'�^�•, 0" P ^ Mailing Address: Pep l3oxc e--3>-9�4 H /9-0 O-C4Lq Telephone Number: e-Se2 -;z CERTIFICATION STATEMEIT I cent. that I have pe•sonally inspected the sewage d!sposal systern at this address and tha: the information reported be!o%- is true. accurate and comolve a: o:the time cf inspectoo The rnspec-,:on %%as pe^ormed base- on my training and experience in the proper funmcn and maintenance of on-sae sewage disposa; systems. The ms em: Pay es _ Concuionaii% Passes Neeo_ Further Eya!u on By the Local Approving Authorrtti —J Inspector's Signature: _ _ Date: T:ie Sys:e^ Insred o• sha" submit a copy of this inspection reocr, to the Approving Authority within them (30) days of completing this inspection. If the system is a shared system o• hay a design floe of 10,000 gpd or greater, the inspector and the system owner shall submit the repo- to the appropriate regional office of the De;artment of Environmenta' Protecoor.. The orig:na! should be sent to the system owner and copes .-n, to the buyer, if applicable, and the aporoving authorim. INSPECT10% SUMMARY: Check A, B, C, or D: J AI SYSTEM PASSES: 1 have not found any information which indicates that the system violates any of the failure criteria as defined' in 310 C.MR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: BI 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. Indicate yes. no, or not determined (Y, N. or NDi. Describe basis of determination in"all instances. If'not determined',explain why not. _ The septic tank is metal, unless the owner or opeator has provided the system inspector with a copy of a Certificate of Compliance (attachedi 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 failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank w approved by the Board of Health, (revised 04125!97) Page 1 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM _.., PART A ''' t CERTIFICATION (continued) Property Addws: . N.;...;� Owner: � - � . _.. . :.. �� ..... . . _°, . , -�-�. ?�. .. Date of Inspection: 81 SYSTEM CONDITIONALLY PASSES tcontinjibd _ Sewage backup or breakout or high sta-ic water level observed in the distribution box is due to broken or obstructed pipes) or due to a broken, settled or uneven distribution box. The system will pass ' spection if(with approval of the Board of Healthi. Describe observations: broken pipe(s) are replaced obstruction is removed ; distribution box is levelled or replaced The system required pumping more than four times a year due to broken or strutted pipe(s).,The system will pass insaection if twith approval of the Board of Health): - broken pipets) are replaced obstruction. is removed _ C1 FURTHER EVALUATION 15 REQUIRED BY THE BOARD OF HEALTH: a Conditions exist which require furthe•evaluat)cn by the Board of Health " order to determine if the system is failing to protect the public health• safery and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES T AT THE SYSTEM 15 NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AN THE ENVIRONMENT: Cesspool or prn� is within 50 feet of a surface water, Cesspool or prn� is within 50 feet of a bordering veg sated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (A ' PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT P TEC75 THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soi. absorp on system (SAS) and the SAS is within 100 fee, to a surface water supply or tributary to a surface water supply The system has a septic tank and soil abs tion system and the SAS is within a Zone I of a public water supoty we!I. The system has a septic tank and soil ab orption system and the SAS is within 50 feet of a private water supply well. The systern has a septic tank and soil sorption system and the SAS is less thar. 100 feet but 50 feet or more from a private water supply well, unless a w !I water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from hat facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used toetermine distance (approximation not valid). 3) _ OTHER (revised 01'25/37) Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: D] SYSTEM FAILS: You must indicate either "Yes" or "►vo' as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 MR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what ill be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an overloaded or clogged 5 or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due t an overloaded or clogged SAS or cesspool. Static hquid levei in the distribution boa above outlet invert due to an overload or clogged SAS or cesspool. Lrouid depth in cesspool is less than 6" below invert or available volume is I s than 1/2 day floe. Recuired pumping more than 4 times in the last year NOT due to clogg or obstructeo pipes:. ~umber of times pumped Any portion of the 5o!I Absorption System, cesspool or priv,)• is belo the high groundwater elevation. Ant por:con o'a cesspool or privy is within 100 feet of a surface ater supply or tributan to a surface water supply. Any portion of a cesspoo' or prey is Aithin a Zone I of a pu rc well. An. pe^tor� o..,a cesspool or piny is within 50 feet of a pri -ate water supply well Any por,.or o, a cesspool or piny is less than 100 feet ut greater than 50 feet from a private water supply well with no acceptable water qualm analysis. If the well has bee analyzed to be acceptable, attach cop. of well water analysis for coliforn: bacteria volatile organic compounds, amm nia nitrogen and nitrate nitrogen. LARGE SYSTEM FAILS: 'rou must indicate ei:her "Yes' or "No" as to each of the followin : The folio":rig criteria aop+% to large systems in additio to the criteria above: The system se ves a facilitl with a design flow of 1 ,0.00 gpd or greater (Large System; and the system is a significant threat to public hea!th and safety and the environment be se one or more of the following conditions exist: Yes No . the system is within 400 feet of a s rface drinking water supply the system is within 200 feet of tributary to a surface drinking water supply the system is located in a nitr gen sensitive area (Interim Wellhead Protection Area - IWPA) or a mapped Zone II of a public water supply well) The owner or operator of any such system s all bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CN1R 5.00 and 6.00; lease consult the local regional office of the Department for further information. (revised 04/25/97) Page 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: C1 y5k,.� Owner:C'Wc%wo�j Date of Inspection: Check if the following have been done: You must indicate either "Yes" or "No"as to each of the following: Yes o -X Pumping information was provided by the owner, occupant, or Board of Health. _ None of the system components have been pumped for at least two weeks and the system has been receiving normal flowrates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. The facility or d%%elling was inspected for signs o-*sewage back-up. The system does not receive non-sanitary or industrial waste flow. The site %%as inspected for signs of breakout. All 5\stern components, excluding the Soil Aosorpuon System, have been located on the site. The septic tank manholes vYere uncovered. opened. and the interior of the septic tank was inspected for condition of barfies or tees. materiai. o• construction, dimensions, depth of liquid,.depth of sludge, depth of scum. _The size and location of the Soil .Absorption Svstern on the site has been determined based on. The facilm o\vne• ianc occupants. if dineren: trom o\,%•neri were provided with information on the proper maintenance of Sub-Surface Disposal Svsterr.. �} Existing information. Ex. Plan at B.O.H. _ Determined in the field !if an,. of the failure criteria related to Part C is at issue, approximation of distance is unacceptable (15.302.3i,b0 (revised 04/25/57) Page 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:Ck Owner: K3 *+.1 Date of Ihspect on: f 114, � V V'v FLOW CONDITIONS RESIDENTIAL: Design ilo%% ?6�;C) t.p. A-edroorr, for S.A.S Number of bedrooms 9.2? Number o-'current residents- Garbage g der (yes or noi: Laundry co-•-ected to system (yes or no!.—!A, Seasonal use tyes or no!: t-3 Water meter readings. if available (last two i21 year usage tgpo): Cn9m- yl 4-, V'S'�et/C�-- �VJ O k' . Sump Pump lees or no):� Last date o-occupancy S11o"Nv(t(,�StE�CJ COMMER6 AL'I NDUSTRIAL: Type of establishment Design fiow eahonsida,, Grease trap present rues or no_ Industrial \taste Holding Tani: present. ,ves or no_ ':on-sanitan waste discnargec to the T:;ie 5 system. iyes or no \later meter readings. if availabie Las,pa;e o; o cL;pancti OTHER: .De:cribe Last sate of occuoanc. GENERAL INFORMATION PUMPING RECORDS and source of inform�\att�n, System pumped as par, of inspection: Ives or no. N If yes, volume pumped gallons Reason for pumping TYPE OF SYSTEM Septic tank/distribution box'soil absorption system Singe cesspool Overflow cesspool Prno)• Shared system (yes or no) (if yes, attach previous inspection records, if any) I/A Technologv etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: Sewage odors detected when arriving at the site. (yes or no)N. (revised 04/25/9*7) page 5 of 20 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMAT10% (continued) Property Address: ti � Owner:Acl"Yq- Date of Inspection: L k `u� BUILDING SEWER: 1 (Locate on site plan) Depth below grade. Material of construction: _cast iron _40 PVC _other (explain' Distance from private water supply well or suction Ire Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK: (locate on site plan Depth below grade ►I Ntatenal of construction: -Xconcrete _meta _Fioerg,ass _Polyethylene _othertexplam If tank is metal. Its: age _ Is age confirmec o\ Ce•t;fica-,e of Compliance _(Yes.;No Dimensions 1oCbr1'P-\ Sludge depth 4% Distance from top o:�s!udee to bottom of outie: tee o, ba^;e �O�t Scum thickness s2— Distance from top of scum to top o' outle: tee or bate\� r Distance from bottom of scum to boom o,outlet a e, bane L How dimensions were determined Comments trecommendation for pumping. condition o� iniet and out et tees or baffles. depth of liquid level in relation o outlet inv rt, structural of leaka e, ) L integrity, evidence etc. GREASE TRAP: (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 o, baffle: Date of last pumping. Comments: (recommendation for pumping, condition of i!ilet and outlet tees or baffles. depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (revzoed 04!25:97) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Propem Address: TsL�vsc�( Owner: 4A � Date of Inspen: TIGHT OR HOLDING TANK: 'Tank must be pumped prior to, or at time, of inspections (locate on site plan, Depth below grade: Material of construction. _concrete _metal _Fiberglass _Polyethylene —other(explain) Dimensions: Capacin: galions Design flo" gal:ons-da, Alarm level Alarm in Nork:ng order_ Yes: _ No Date of previous pu:-aping Comments (condition of inlet tee. condition o- alarm and float switches, etc.) DISTRIBUTION BOX: - ,S ilocaze on site pia-. Depth of l:au:d le,,el aoove oune: rme^ tA1` Ov�t� SiN,�-� Comments- inote :i lleve! and distr:but+or. is eaua' evidence of solids carryover, evidence f leakage into or out of box, etc.) O PUMP CHAMBER:—OU (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 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM .PART C SYSTEM INFORMATION (continued) Propert? Addr-s`s_:Ja Owner: wt0 hf1 Date of Inspection:' SOIL ABSORPTION SYSTEM (SAS): (locate on site.plan, if possible, excala .on not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type. leaching pits. number._1 leaching chambers, number: leaching galleries, number. leaching trenches, number,length: I leaching fields, number, dirnensjons overflow cesspool, number Alternative system name of Techno)og,. Comments. inote condition of soil, signs of hydraulic failure, lever of pondrng, condition of vegetation, etc.) o- q ` ` ' Q f A- v N .1,o- , Cs¢-�T-�o.� a�- T�w�, a�-�r�s-tg�c%L W s CESSPOOLS: ?4.e.*►T1.0ry ra (locate on site plan Number and conftgura:,on Depth-top of liquid to inlet Inver, Depth of solids laye- Depth of scum layer. Dimensions of cesspool Materials of.construaior Indication of groundwate- inflow tcesspoo) must oe pumpec as par, of inspection} 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.) (revised 04/25/97) Page 8 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Propertv Ad ires-0i SSW c l Owner: Date of Inspection: 1 Depth to Groundwater+kS Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained irom Design Plans on record xObservation of Site (Abutting property. observation hole, basement sump etc.) Determine it from local conditions Cnec'K %+ah loca! Board o• nea!tr Chec:. Fii.N1A Maps Check pumping records Check local eacavato,s. installers lase LSCS !Da-.a r• Describe in voi, o%%-. %+oras r.o•.% .o..; estabh hed the High Groundwater Elevation. (Must be completed: .(reviled 04:2519-. Page 10 o1 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM 11FORMATION (continued) Propert} Address: "`' Y Owner. tlatpwo, Date of Inspection: tZ,�tc�,g1 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) � A L s Q 3 O Al - +bt al , �,� I ,bit pot - ,� A z- %5 , bz- `a5 A'5 - 11 , 63- 3 (reviled 04'25/57) Page 9 of 10 TOWN OF BARNSTABLE OP ��✓� LOCATION .1-SI�� �Vc- SEWAGE # VlIj AGE _ AISPOT ASSESSOR'S MAP & LOT GS� INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /On GA I LEACHING FACILITY: (type) iTy��� �I (size) NO.OF BEDROOMS 3 �,] BUILDER OR OWNER IJAw C� PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of 1 c g fagility) Feet Furnished by V0/ Q1,Sp �a 4 � � W � � � � O � � S � r` Q _� �� � �;.3r � .,.'r ` . W o, - �+ .' _ i j i �: �. ti '" LOCATION SEtIAGE PERMIT p0. 1 k 3 VILLAGE S&, .�� INSTA/LLER'S MA' ME !3 ADDRESS BUILDER OR OCypER e DATE PERRIIT ISSUED DAT. U;o'LIANCE ISSUED U�t \\� ��1 n �, .. , � �� . 4�r THE COMMONWEALTH OF MASSACHUSETTS . BOARO O� HEALTH NOISSlWWOO Town.-... OF...............Barnstable-------------------N011b/1213SN®O 31Ot/1SN�lbs "lO 1V _1t',::ddV. d 13,r al— Application is hereby made for a Permit to Construct T, ) or Repair ( ) an Individual Sewage Disposal System at: - Squaw _Island Ave,•----------------------••--•-• .......-••••Lot 39 . L.C.C. 13772 F William �°:at;°ao` o 5ar 73 Barnac�eLoed&d, Yarmouthport ApI�Gant ---•----•---•---•-•--••--•---•._Address W .---v ..................... -•--•--•••- ---••........................•-------•--••• a A�/�%�� Installer��• Address Type of Building Size Lot____.__27,000 Sq. feet Dwelling—No. of Bedrooms---______________3 ................Expansion Attic ( ) Garbage Grinder to ) '4 Other—T e of Building No. of persons____________________________ Showers — Cafeteria Other tures -------------------------------- - - W Design"Flow............................................gallons per person per day. Total daily flow......................._....................gallons. t rr t it t er WSeptic Tank—Liquid capacity,1000gallons Length----- __._ Width._4.__10__ Diameter________________ Depth_4__________- x Disposal Trench—No. ___.____: _.___ Width____________________ Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No......1............ Diameter_1011_._.._._. Depth below inlet.......41........ Total leaching,area_.2.627.__....sq. ft. Z Other Distribution box (X ) Dosing tank ( ) Percolation Test Results Performed by.CAp_e'_..OQd...S.11,rmey...Cr.Ql1_qultant�Uate._ y...2.3.4.... 979... `4a Test Pit No. 1-----�--------minutes per inch Depth of Test Pit_.12...____.___. Depth to ground water_______1Q_�_�?rr 4 _ Test Pit No. 2---_............minutes per inch Depth of Test Pit.................... Depth to ground water........................ ------_----------------------------------m--------•-••-------:.._..--•----t-•------•t------------------- --------------- •------- Q ----•-•------- -- ••-t-o•--_- 0 Description sa•nd_,....3e - 5_,•0...... --OF Mx med.----•• a • ••• _ 11. - _ As w coarse.._sand •_ ater @ 10�5'W -------•-• ••-•---•-•-•--••-•--•••• ROR� G VNature of Repairs or Alterations—Answer when applicable________ _____________________ ______________________________________ .F. EMYLM -------••-----••--••----------•----•--••----------•--•----•-•----•-•-•--•-••------•----------------•-•-•-•----•----..__.........-----•-•-•---•-•-•----------•----•-•-••---•-••--•-- _•-____...... Agreement: ,p�No.23 � The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accor the provisions of iIT E 5 of the State Sanitary Code— The undersigned further agrees not to place the s operation until a Certificate of Compliance has n •ssued by the boa4 of he.Yh. a �y� Signe _ ._ ..•• ••-•--• s ` ........ •••-- • ....-_ �� Date Application Approved By____________ __• --_ - ---_-um..Al ..................... V��:"l_ 7� /' Date Application Disapproved for the following reasons----------------------------•-------•----...-----------•---------------------------------------------..._.._.... n .�.•-----•--1.............. .....d --------------------•------------- /rf pry�Y / 9 ,j Date C �-(/l ,�-+ er No.... .........................•-----7•-- --_---- sued %/► 1�"a (�-� � )��G(,t ��?/+4AGC�����-��1� - ..._ � Date -'-V "------•------. No ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town .... ...OF...............Barnstable ......................... .......................................................................... Appliration for %qpoiial Workii Totwulartion Prrutit Application is hereby made for a Permit to Construct 0[ ) or Repair an Individual Sewage Disposal System at: uaw ..................................S...q1 6 5i! w,.d�.. Ave.. I .............. L.o...t.....3...9............L......C.......C..........1...3...7..7....2.....F Wi11ja tocatiSdIftar 73 BarnacTbL&a Yarmouth ...p...o...r.. tm .................................................................................................. . n�1'7,2i Address . ......... AddressInstaller Size Lot-------27.9.000..................Type of BuildingU Sq. feet .. 3 Dwelling—No.'of Bedpogowv............................................Expansion Attic Garbage Grinder �0 Other—Type of Bi�ilding ............................;-No. of persons...................,-------- Showers Cafeteria Otheres ...............................................................................�,F r5�" -----------------------330........................................ Design Flow..............................I.............gallons per person per day. Total dAily flow............................................gallons. Septic Tank—Liquid capacitylQQQ.gallon.s Length.....a.!_W! WidthJ+'.'_1.Q1' Diameter________________ Depthl.'Affi.... Disposal Trench—No.�................... Width........_........... Total Length,.-............... Total leaching area---_---------------sq. f t. Seepage Pit No..----1............ Diameter..!Q It......... Depth below inlet.......I........... Total leaching area..2,67.......sq. f t. Z Other Distribution box (X ) Dosing tank � ) Percolation Test Results Performed by.Q-aip 7 e---Co.d...%Arf 9Y..jQPA9i)A11k4!0!bate..&Y... f ' 7 Test Pit No. I.....Z--------minutesperinch Depth of Test Pit.-.12............ Depth to ground water.......1...0........6...... Test Pit No. 2................minutes per inch Depth of Test Pit___............._... Depth to ground water_.__._-__-_-___-._.-____ lack---1o'am'.0.,.5'..!3--------------------*......**----------------*---- ---------- • ;qed' brown sgpA 3 0 Description of Soil_jQ-Q --------------- brown .Ag .. sa 0 � MAd._.. " OF Mrs black 10M "..0-12.0 pK'�g4, ? -1....................... ............... ... ---------*----------------- coarse'"...sand..-*. ..---------Tat t...e'r'-,-'@"**...1...0.3.1 ...................................................... ............ ................................ .......................................................................... YERT —Answer when applicable........................................................................... ...... .; U Nature of Repairs or Alterations ...F. ................................................................................................................................................................................... -------4MYL Agreement: 11 ,p No.2 1 The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in actor ' T the provisions of TAITILE 5 of the State Sanitary Cqde—The undersig ed further agrees not to place the s, 5L un e slg ed further of r/ operation until a Certificate of Compliance has e issued by;th oar of health.Sg 1 1 ne .......... ... .......... .. .....................1-74, XV...... Date Application Approved By........... 40-A,44,0%.................... / , Date Application Disapproved for the following reasons:.................................................. ............................................................ ...........................................................7............................................................................................................................................ Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF .HEALTH .........OF.......... ..........r. ..&O. ................... (Infifiratr of Tomphaurr THIS IS TO CERTIFY, That he Individua Sew, e Disposal System constructed (4r-o-r-'Repaired by ..................... ...... V__�................ . ... .... ............................................ I tal� .fir at_ ................................... has been installed in actor,rnce with the provisions of T 5 of Tte State Sanitary Code as.described in the application for Disposal Workskonstruction Permit No._ --------V--- -- --------- dated_...' .............. THE ISSUANCE OF J:HIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM. WVILL FUNCTION SATISFACTORY. Japl.:.._../?��....................................... Ins ector........ ....................... ------------------------- .......... THE COMMONWEALTH OF MASSACHUSETTS BOARD .OF' HEALTH C7?) OF....... FEE.No......................... ........... utsposat orku. onoIrmtion Vamit Peefnission, is hereby granted.......... ........................................................................ to Con strt 1*or--!---e--P---- an IndiviZal enrage Disposal at No... ,, ' .................................. Street as shown on the application for Disposal W6 rks Construction�Perm* 0_i,07�___; Dated...Z:n° '......... ............ ............. ---- -- ............................. ;A04 Board of Health DATE__ . ............... .......................1...�.................... FORM 1255 HOBBS & WARREN, INC., PUBLISHERS TOWN OF BARNSTABLE LOCATION __i TS1-0, h L— SEWAGE # VILLAGE tJ%5 DoaT— ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY WOO LEACHING FACILITY: (type) (size) 1000�r�� NO.OF BEDROOMS 63 BUILDER OR OWNER -PErRMff DATE: I COMPLIANCE DATE: Separation Distance Between the: f Maximum Adjusted Groundwater Table and Bottom of Leaching Facility IS Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by w.Q'U 14 Ne® VN c a- a J lJJ � J q 0 s 06 i i IVA., I.. ti. 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BILL RESIDENCE ARCHITECTS n m o N y O O O �^ 9 9 pEL:(61 y MEET,CAMHRIDOH•MA-5764 9ISLAND AVENUH �{ H Z 0 Z O § 'I-IyANNISPORT,MA � THL:(617)334-S18R YAX:(617)R6&5769 N � o , I I` 1 4R I.j > > D m n Cm I� jo jo I I I �o 1m jo �o I I i pal II I II I j j V-0- 12'-0' V-0- 3'-4' I I I I I I I I I I I I I I I II I i I I _—_—_—_—_ _ FACEOFSTU - D ♦ —_ _—_ —_---_—_— —_—_—_—.�_—_—_—_—_—_ - --- ---------- I '•FACE OF SFUWD —- —j — - —�— -� —- ---------- ------ —j--------- — — d o FACE OF SFUD /1 _—_—_—_—_— _—_—.—_—_—_ _ ,I to m � El FE z I II I K m d <O I I CORNER OF S —_—_ a- _ �•, _ _ —_ ______ FOUNDATIONS OF SCUD FACE OF 5IUD F� `�• \�\yyb � I ��//BASEM NT _—_—_—_—_ �, 8 FIRST FLOOR ua ---------- ---- JI NER F I —_—_—_—_—_ _ COR O rn FOUNDATION O CE OF SPUD wl - �I 1 I7'I SFM€NT—_—_—_—_— ----_ .I R FIRST FLOOR _w UQ sl a e 2'-37/6 4 - I - 9'-II' EOWL LOlBI u 9 �z STUDACFt—--------- _ al a �,6 CORNER O 6 F0i5t FLOOR _ IN T OFOUNDAT bI I - I JId CORNEROF ttl a 4 \ I O � y-es-o•., I I e I I § a I - 'I i 2'-9' 3'-5 9/6'2'-M II/16- - 2'-9 3/4• 3'-8 1/2' 10'-I• 2'-4 V16' g I 2'-9 VV 15'-0 1/4' 5'-7 3/4' (TI -2 I/6- 15'-2 3/4' i 0 3 6 m g o 0 �I 0 o fo . j 4 0 h x, 0 DDDDD � Y �r M —N+ = O a HUL RESIDENCE IVAN BEREZNICKI ASSOCIATES,INC. N p ARCHITECTS ` Z T N r 4 9 ISLAND AVENUE TI IS- 9 WENDELL S7E8Er,CAr.>HwDOE,MA 02138 w - HYANNISPORT,MA t� IEL:(617)354-5188 FAX:(6M 868-5764 • �j 1. *OIL LOGS TA? . a / _ . _•�[Al7CM[ l0Ar1 r. II LlA� li YAft— . A I( l! 1 A `S• j Boa 3 S f1, • . ., I •0B*avy j w� ELEVATION SCHEDULE f�S-8Ui<-T � 4,:C I. DI T .,, ( M 1000 BOX I I'•r JO GAL ° 'LF. v� ° ' I rNV AT FOUNDATION L•T•�J I GAL. L -J '¢ �e.`.•• : PRECAST OR ~• � 01- 24" _..SST. I sa y3 ck V 10 MIN,.1 f SEPTIC _ ! ' ' I MIN ('o�� Ff,¢s) A 2 INV INTO SEPTIC TANK TANK �'•',e•� SEEPAGE _ • ' I �L�_ J • • �• ___ - • I 3 1 NV OUT OF SEPTIC TANK / Y' �_-�) - __J �4►' PIT Nam, Y✓j4rQ,Q r �c alEG, e,s 4 NV IINTo DISTRIBUTION x { ,�o - o B �� Tr,S/'9, Tos•' QF 2 0 MIN - ---,I . 5 INV OUT OF DISTRIBUTION BOX = l 12,7$ / FOUNDAT ti 1 % " WASHED STONE I I j Z Q /�+�� f"2'•/`j I 2 I 6 INV INTO SEEPAGE PIT 43, E 11.s�' �' E'Q �` r A-1 ''�a-S• ©` Sd 3 �'`� aL / \ FO�iuo 7 BOTTOM OF PIT 9�j 4 - PER C. RATE, _�4-�•» ,;, � .,••,'� ,��.� ' � j � / / f �/•. \ ELEVATION SKETCH � lo' --� _ SCAL F I TEST BY �', lam" OR CJi ���\ A TOWN INSPECTOR CIZ\ C BACKHOE OPERATOR L2t�ll�1 A_A[.�'c�__ _ J� O TEST MADE ON _ 12 L 3/'?;P / ,✓ / / % \x 1 (. E''>"t t�nA"C � aA►�.Y FL.x-y 00 • '� BC.O2.C�c��rt� X 11G �AI �DAY jF3� = "33� G4�C7 C.> ►�°. 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'; JJ •� I f ' r L.o C�'4 l!<J.�,e' 449,0 E� /9/, c /4 %�&o _T 33 ' 1G l it do 10 e-c .i.__. ` -" J ( w..• r. w + wr rr ..rurr.Ir.r .rr rr F. X \ \ \ w7 ': ��� v' ric^3 s �: F� To -r vE A/A 7•fa.v',0Q c ` P R 0 P 0 S E Q SITE PLAN i ; !y 1 1 \ e r`.� :• ?yG r1��2.� IGA� �ATcl�l� o 192� `'/" nm""2�' SEWAGE SYSTEM DESIGN \ � .., • .:' �, tee.,• .?,v s•/¢ "� \ \ � \ �/ =�%r.' .:.'.5�.:�,r IE'r/l?• �a�Z- �" /,w pP�/y p.v .HYt:?�.•�.v7 � �'-� � � - ,f✓ 3 r�-G'? - � �j � c _ s-�t ti ZSL,�^✓G .4'�IQl� : .,y 3 S yp,K/!.! O Syr f.;f.'• G' ` `' l •y r9� i � �I ./ G�''�� Y' �/ V j F �!7 ��f ..fir _. 'F .. .. �• ^ 9 (1 i • f• T y .�/`fF+,j�. .�'_'iLC 'H�A' , � � �' /7.•S � 1 Y / � ,yuo ftir. n�P or \ \ r•, /�.� 5'h%�•/.c'F L.!N: =2©�? 2 r 0O E s' /' ,/• '�} `j1� ssv.v^r .r W SCALE I - ."' :)U 1 19 �. Q O tf �.,c� _+/sic^ �-, 7_ h� ,�9♦ �')s ��yy ��r'^+�� F• /�yy [} �r� ,gyp ,r1 7-7 . - � . ✓.rw!Sr ry..:S��'r'f � / �""iG.�'�u � (J/7 �� w.�� '✓ t' .�.[.�5 � / / ,ems y. \ f .� \ ���K CAPE COD SURVEY CONSULTANT�� f t ROUTE 132 �•_._. Z)'n-rCjor�-6 A02 43 et ,yrAt�1!s ,iM+►sS J 7 `, �. ,�._�f lt}b�tcS R>~S"' �cl C'r'� D T G 6r2cSc��N • \ \ S 67 4j,00. I Water E I Edge of Traveled WoY \ _ _ _ 70. \ \ c 1�40` —n-10�(yulder p � \ 10 — Ij 111 �1 ` w � Zo13, �I Londsco a Tle Ret. Wa71 Back Patio 14 \ \ II — — PROPOSED �P�e �" EXISTING DRIVE — — __ ==__—i= TRELLIS \ SCALE: V = 20' — oy �=L PROPOSED 1 t �. I STEEL WIND PIPE SCREENS i �c'1,A.SS I Il11 by ya a5 \ Al to PROPOSED UPPER LEVEL 1 \ `4N DECK IMPROVEMENTS t I 13 ` Water® I lyO°� V T 3 NOT TO SCALE 14 15 S s\ ' Stone/Con \ 6>. 0 Polar o Hydrant `3 \ / 1 wa 00- ter N 17 — — — — Uogh� \\\ \\ r7 \ RAIN TO 8 K8'IDFIELOT I Edge of Troweled Ray D 20 \O \ \\ PRO POSED PROPOSED ti00 GAL 22— — a /\\ BIT. D \ T QW_ItD1 — _ \ \ \\ Conc. Bound DRYWELL W/1'OF p T.o,l/� ��' \ 7� \ Found STONE FOR ROOF p / / v \\ t \ \ \ \\\ pp °— ` � 13 --� � � � ' I l� Pwf g RaA Fence RUNOFF 3— — \ \ Landsco e \ \� 1 I \ u` Ret W�j I I l 0 — �` ' m &3 9rtck Pat/ \ � ` J I \� \ o 24 /-14 / �16, ` _—) \\ \I' to O \ BUO> SF.D O- a OUT Os anent Floor 4 — — �� ` ' 0 \ 15>'St.a4° 25 � Cone Pad/ (i �+'st F7 �14,7' — � 1 � T- C> `3 t{n9 \ A.G Unit w/WOpd F ed Dw Gov. =12r 4 \ Geroge under adl/ny , "�(Tnaer a� '1 119 Wand Am e / � l 1 \ � \ �cz C r- Bo Lower Levy Deck ♦ J/ / �✓ ► I - —9 s, Fou d \ tit /2%�f� jta \ \ 1 W1 U IS / Peer Le'W Deck / / / // / 1 10 rn Ret. won Deck ego // Frog p� / / // / / I'll t Cons Bound Found WORK /\ / ♦C� // /j �// /j �/j / / �c,� / / / r / �'t Z at Mj / / / / (� a•:.�' � •qa.n . go- Scope of Work ,ND 1. Relocate Bituminous Driveway as Shown. Add Drainage Improvements - =_ _ �,�• �� �� � F� 2. Build out Over Entry as Shown. 3. ModifyExisting Second Story. / \\1 f�_`!�� y 4. New Roof. , ' a_ - r # •; 5. ReplacelRepair all Outside Decking. Spacing to Remain the Same. p1 Lochs ' 6. Add Trellis and Wind Screens to Deck as Shown. � a f li'• / w w The property line information shown was compiled °°°' from available record information and does not represent an on the ground survey. LOCUS PLAN Scale: 1:12,000 The topography and detail shown was obtained Assessors Map 265 By conventional survey method on or between Parcel 022 12128101 and 01102/02. Directions: From Hyannis—Take Main Street to the West End Rotary and from the rotary take a right onto Scudder Ave. and follow to the end; Bear right onto Dale Ave. and follow to the end and then left The datum used is NGVD '29, a fixed mean onto Hawthorne and follow onto Squaw Island Drive which becomes Island Avenue; House is on the left sea level datum. #9. Title: PREPARED FOR: PREPARED BY-SITE PLAN DAVID B. & JOAN B. HILL Sullivan Engineering, Inc. CapeSury ? PROPOSED IMPROVEMENTS PO Box 659 `D HILL FAMILY TRUST 7 Parker Road Osterville, 575 AMALFI DRIVE MA 02655 Osterville MA 02655 AT 9 ISLAND AVENUE PACIF►C PALISADES, CA 90272 (508)428-3344 (508)428-3115 fax (508)420-3994 pesurvOcapec 5 fax PSulIPE6ao1.cam capesurvB�ap ecod.net SQUAW ISLAND 40 o Field. WHK/MCH. Draft: MDH 20 0 10 20 80 Date: March 22, 2002 Scale: _ Comp.: MDH Review: RLH 1 inch 20 feet Pro j. # C529 # DrawingC529G1.dwg i j 't I I j I I, f Utilty Pole 06* (typical) t I 'hw I 1 FogP Of T ' PROPOSED 2' WIDE 1 /A SIiOT DRAIN TO 1 1 !'X8' L. FIELD 1 \ ` ^, °h, �o FOR PROPOSED LANSCAPING �\ ` ' Q SEE PLAN BY RICK LAMB ASSOCIATESWater 1,1 FFM _ate - M NFB 14 r _ 1 � .S Stone/Conc. J �D ts�• / /a Pillar o Hydrant 16 - — Sl3QO , /. - \ / � �� 'S (SLA 17 - — — — I �PE�CRA 3 \ G I ' f AV — t l'E \ OO Edge of Traveled Way R O� "D -10 - - - - 19 Boulder C?O \ \ (typica �� \ hw ZO _._ X � � 1 / `� — � � - - - one Corltc __� -\ -I_ ohW� 21 — _ Bi \ 22 \� m SE /C SNG Conc: Bound O / \ \ YST M \ \ \ Found PROPOSED 600 GAL. / O / v \ / I \ \ I l ost Rail Fen p ❑— DRYWELL W 1' OF Londs �- \ t �\\� P & ce STONE FOR ROOF i RUNOFF / fTl \ ,lob PROPOSED PAT/O - / D Brick P ST ot✓ ONE S\ 24 �14 F �Z O oPR o SUIL C TRT Or_ Basemen L _- �� m ed CT/ON V. 14.joor 4 a / _ ��\��`1 1 Q Vv)Stooge / 25 Conc. Pad/ 9 Eirst Ftoo� ~ / / 1 I` - O \ ? .Booting \ A.C. Unit / Woo Existin /y \ / with Framed Owe//in c__ 22.T i o \ Gar,09e under B 10 Cori _ / I I I I IIH \ rt G / °•Wo/%Under Deck J I I I I I o_M #19 Island Ave. \ Z _ ---- _ n. I _ \ ,_. _ Rr'o, _ Lower_[ev i n_..,;, 1 1 \ _9 3 Found/ ,' ' SPAC//NG F t R A OUT l �/ /_ /J / / 1 y i N 15` = Tp REM S/DE DECK/NG l 0•1 \ \ ` o / THE SAME; 1 1 4 Upper Level Deck I \ _ 1 / Deck g\ocR RetLIS . Wo// Fi39 Pole \ / / '% /�/ Conc. Bound Found DIRECTIONS: FEMA ZONE B/ From Hyannis .— Take Main Street to the West End Rotary; Take a right onto Scudder Ave. and follow to the end; Bear right onto Dole Ave. and follow to the end; Take a left onto Hawthorne and follow onto Squaw Island Drive which become Island Ave.; House is on the left, #9. at 1 P c�1o� ZONE: F���� / - / / °�F<<"?S do i / . .s of ;1 RF-1 r,.. . , Area (min.) 43,560 SF / �'` Frontage (min) 20' / / / O _ o Width (min) 125' / Setbacks: b •q -_ �a Front 30' /�/ .( Side 15' 1 z i PN ti Rear 15' k i �x •� _> �$ OVERLAY DISTRICT: I AP — Aquifer Protection District rya As Shown on Plan Entitled LOCUS Revised Groundwater Protection t Overlay Districts" — April, 1993 �5 NOTES. �j tr •� - � wy��'e I 41,il 1.) The property line information shown was �i LOCUS PLAN FLOOD ZONE: Spa. i compiled from available record information. ( ) ( )Scale: 1" 2000' Zone V1 D el 22 , V16 el 15 �` ee 2.) The topographic information was obtained Community Panel No.. a � from on on the ground survey performed on ASSESSORS REF. #250001 0008 D � or between 12128101 and 01102102. J Map 265, Parcel 022 July 2, 1992 3.) The datum used is NGVD '29, a fixed mean +f Revision Modify Project Footprint 1041201041'7-5 sea level datum. Title: PREPARED FOR: PREPARED BY. S ite Plan . Sullivan En ineerin Inc. CapeSury David 3. & Joan Hill g g� Proposed Improvements Po eax s59 7 Parker Road !! (b A t 9 SC,' �Ua � S Island Roa�d//�� 0sterville, MA 02655 Osterville MA 02655 Barnstable, (Hyonnisport) MA (508)428-3344 (508)428-3115 fox (508)420-3994 (508)420-3995 fax 9 Island Avenue PSOPEOaol.com copesurv@copecod.net I Barnstable, (Hyannisport) MA 20 0 10 20 40 $o Field: WHK MDH Draft: MDH Date: Scale. Comp D Review. RLH March 22, 2002 1 inch — 20 feet Proj. # C529 Drawing # C529G1.dwg z1 I1 r