HomeMy WebLinkAbout0074 MASSACHUSETTS AVENUE - Health 74 MASSACHUSETTS AVE
HYANNIS
A= 287 -021 - 001
TOWN OF BARNSTABLE
LOCATION--9 ttAS 6Kkk 'isi i� Au c SEWAGE# JNQ$ 1—0 1 f
VILLAGE ASSESSOR'S MAP&PARCEL2r-0I-y0J
INSTALLER'S NAME&PHONE NO. .3.L C �a 15 7_71-d�-VII
SEPTIC TANK CAPACITY 9-t- ,
0
LEACHING FACILITY: (type) t-t -t�G¢�- (size) fib, JL!�•�3 K��
NO.OF BEDROOMS �o s �� �"�•
OWNER I AkO
PERMIT DATE:L- ` I COMPLIANCE DATE: 7
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility d— 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
No
f
No. Fee '
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Y�
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE MASSACHUSETTS
01ppliLation for Mispo8al *pstem Construrtion Permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) [Complete System ❑Individual Components
Location Address or Lot No. +��/',dSSCcCh vS �' Owner's Name,Address,and Tel.No.414-(mom•
1 Mn,'S r$ ArIS S i Mo laT66 Po l�m< 25089/
Assessor's Map/Parcel-n? p_ C0 o, ' -m_e AAA oalar
stalle 's Name Address,a 0 Tel.No. ��� a 8�0`6 Designer's Name,Address,and Tel.No SO$'
E�a^�o� u, itsk_y Rd' 06con ' c'n e-e.r i Y)5 R 3�t mum�'f'
Mdr-3 A oa(,4r$' 4 Oil,
o � o�!+ MaCo�s
Type of Building:
Dwelling No.of Bedrooms Lot Size/4�� sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) &(00 gpd Design flow provided (gC2 gpd
Plan Date WQJTIP�,�G, AUK Number of sheets I Revision Date �}
Title 77H?-.�Si n A 74 Massadjj, S 9�u� I" nig Qn-r�--1 M�
Size of Septic Tank
Description of Soil �p,gr� (j
Nature of Repairs or Alterations(Answer when applicable)14(0 C141b
S Rio
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maint—enance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environme ode and t to place the system in operation until a Certificate of
Compliance has been issued by this Board of He .
igned Date
Application Approved by Date ,- c -
Application Disapproved by Date
for the following reasons
Permit No. —0 ! Date Issued v
c if 1€,1
No.A J 1 Fee X�o
w z THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: t.� :Z.
°0. Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
2ppliration for`°Dispsal *pstem Construction Permit
Application for a Permit to Construct( ) Repair( ) Upgrade,( Abandon( ) ®Complete System El Individual Components
Location Address or Lot No. y a^ 1 Ate'
Ij �i25,� �,�; - ., Owner's Name,Address,and Tel.No.lvf'7"G39'G�9 V?
Assessor's Map/Parcela�ry aal(xl Sri. e c e -re-e , AAA 0a(9-s
Installer's Name,Address,and Tel.No. Soy- c g �Sq Xo Designer's Name,Address,and Tel.No.���'3( 2`V 5q
26441161t� C4r)5kakXiC-W117L-< V5Z-1 Las `r✓���' e.rEr,� d,ru 3cxpty-A S�Y
WA 0, �o, ,�rti � �:
. �c�, idyl A o-205
Type of Building:
i w x
Dwelling No.of Bedrooms Lot Size/6 - sq.ft. Garbage Grinder( )
Other Type of Building `` No.of Persons Showers( ) Cafeteria( )
Other Fixtures ' }�
Design Flow(min.required) to i-100 gpd Design flow provided (i(p ! gpd
Plan Date AbVq- nt .r )a, )G�-O Number of sheets Revision Date
Title 1 PH v -�S;1p P/t 0 A ALIP I1J P d114All,"",fh r 4--, M A i
Size of Septic Tank 14r.11l1+'a r'F•mon�•ctdJYPe of S.A.S.SW 1410
Description of Soil < c
Nature of Repairs or Alterations(Answer when applicabl-e)"(4l'0-1'7rM tT) f ,,�n M A100114 lr', A-k 1,• aj
a 1,,,1..4 k, S 111D 511,6&Z- A,.�J'r/iY,t�` A,,d, (4 A>;gk, p , i%.) ,rc .51) S C.X 19 S-,I Z) S4r n t u
Date last inspected: t ,'
Agreement: ✓
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental`Code and n t to place the system in operation until a Certificate of ,
Compliance has been issued by this B�ofHealth�ig en den d Date
Application Approved by �. ,�d. �� -«�.,, ,> Date
Application Disapproved by . •_ Date
for the following reasons -
w Permit No.
r-3,+-f--„�c/ Date Issued !���✓e�
- - - -_- - o - - - - ---------
THE COMMONWEALTH OF MASSACHUSETTS
` BARNSTABLE,MASSACHUSETTS ,-
Certifirate of Complianc>?
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded(A)
Abandoned byAr41
J /
at/?y A7�S,Sr eA1,,4 o YA 4w,A/t+y J rf Lyl ;,Ong�- has been constructed in accordance
with the provisions
��of,,//Title
/5 and the for Disposal System Construction Permit No dated
�
Installer�c�ar^'#t1/,.!'7. I fTC,411 J{4//yl (_ Designer
#bedrooms Approved design flows✓: -�., "1 gpd'
t
The issuance of this permit shall not be(construed as a guarantee that the system will nct�on,a ld igned.
Date (••it�� fJ / Inspector
- - - -- --- --- - -----•-- ------
For
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS
Misposal *pstem Construct Permit
Permission is hereby granted to Construct( ) Repair( ) Upgrade Abandon
System located at V /gll,r,4 S'So 1 fit^e- 477,,
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date of this permit.
Date :.Approved by
s
9.
FEB-23-2021 02:21 From: To:15087906304 Pa9e:1/1
Town of Barnstable
Inspectional Services
. ; Public Health Division
i enlwsraecs, 'a
es Thomas McKean,Director
o ° 200 Main Street,Hyannis,MA 02601
Office: 509-862-4644 Fax; 509-790-6304
Installer&Designer Certification Form
Date: A a-I Sewage Permit#! 20Q 1 -Dil Assessor's MaplParcel a8�e,121001
Designer: OU1 C(
Installer: L7or�o 1"m _dn, ug,,lrc
Address: . qbq go�f up Address: qS►�L-4ru 90
ygVmoU�l Po►�E , Mgt- �A ��UB
On J15 �� �7or Io . `°�Svt 'was issued a permit to install a
(date) (installer)
septic system at -714 M=aclhus(:N-S fW e,, based on a design drawn by
(address) "ah m s poyc
bQ,ltil . 0 M dated -2 5"a-0910
l (designer)
V I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank. Strip out (if required) was inspected and the soils
Were found satisfactory.
I certify that the septic system referenced above was installed with major changes (i,e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system)but in accordance with State&Local Regulations, Plan revision or
certified as-built by designer to follow. Strip out(if required)was inspected and the soils
were found satisfactory.
I certify Aat a Sys referenced above was constructed i sotfi i a� a with the to rms of
approva e�s(if applicable)
t"c /�'9'
o DANIELA. yG�
OJALA
CIVIL �''
(Insta11er's Signature) -G STE 4
TFcI sT E��V Ask'
(Designer's Signature) (Af Ix Designers Stamp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTI YCA'fE
Z.Aw,
OF COMPLIA CE WILLNOT BE ISSUED UNTIL BOTH THIS FORM.AND AS-
BU T CARD ARE RECEIVED BY THE BAR STABLE PUBLIC HEALTH DIVISION.
THANK YOU.
Xhouldepls\HISAUTMEWER connerASEPTIC10csigner Cerlif cadan Form Rov&14-13.000
afraY Town of Barnstable
Inspectional Services Department
r
r BA A`
MASS. Public Health Division
y
.
i639� �0
39 200 Main Street, Hyannis MA 02601
Office: 508-862-4644
FAX: 508-790-6304 Thomas A.McKean,CHO
CERTIFIED MAIL#7015 1730 0001 4987 7909
July 9, 2020
BERRY, ANDERS &ERIKA & BALJON, KRISTIN TR
3606 EDNOR ROAD
BALTIMORE, MD 21218
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5
The septic system located at 74 Massachusetts Ave, Hyannis, MA was inspected on
06/18/2020 by Patrick T. Sullivan, certified Title V Septic Inspector for the State of
Massachusetts.
The inspection of the septic system showed that the system "Fails" under the guidelines
of 1995 TITLE V (310 CMR 15.00) due to the following:
• The cesspool is structurally unsound.
You are ordered to repair or replace the septic system within sixty (60) days from the
date you receive this notification.
Failure to repair/replace the septic system within the deadline period will result in future
enforcement action.
PER ORDER F THE BOARD OF HEALTH
ins cKean, R.S., CHO
Agent of the Board of Health
Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\74 Massachusetts Ave Hyannis.doc
Town of Barnstable
BAMWABLL +'
1639. ,�� Inspectional Services Department
rED MA'S A
Public Health Division
200 Main Street, Hyannis MA 02601
Office: 508-862-4644
FAX: 508-790-6304 Thomas A.McKean,CHO
Feb 6, 2007
Rev. 4/26/19
DEADLINES TO REPAIR FAILED SYSTEMS
(Town Code §360-44 and Title V: 310 CMR 15.000)
An "x"marked in the ❑ is the failure criteria and associated repair deadline
60 DAY DEADLINE CRITERIA
❑ Discharge or ponding of effluent to the surface of the ground
❑ Pumping more than 4 times during the last year not due to clogged or obstructed
pipe.
❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool
C?SI uo l
Wtructurally unsound ,
ONE (1) YEAR DEADLINE CRITERIA
❑ Static liquid level in the distribution box is above the outlet invert due to an
overloaded or clogged SAS or cesspool
❑ A portion of the SAS,'cesspool, or privy is below the high groundwater elevation
❑ A portion of the cesspool is located within a Zone 1 to a public well
❑ A portion of the cesspool is located within 50 feet of a private water supply well
with no acceptable water quality analysis. (This system passes if the water analysis
indicates the well is free from pollution).
TWO (2) YEAR DEADLINE CRITERIA
❑ Single Cesspool
❑ Any "conditionally passed systems" (broken cover, relocation of a pipe, relocation
of a driveway due to H-10 components, etc)
❑ Leaching facility with standing liquid level at or above the invert pipe (per Town
Code §360-20 h)
OTHER
Repair deadline:
Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc
f
Commonwealth of Massachusetts
a0� - day e01
Title 5 Official Inspection Form c0
p
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments t
I
-,� 74 Massachusetts Ave. t I
Property Address
t
Ruth Anderson Berry Revocable Trust r t
Owner Owner's Name
information is H annis Port !f MA 02646 June 18, 2020
required for every y
page. City/Town State Zip Code Date of Inspection -
i
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. Inspector Information f g5gi---�-
filling out forms
on the computer,use only the tab Patrick T. Sullivan
key to move your Name of Inspector
cursor-do not Ready Rooter Excavating
use the return Company Name
key.
PO Box 89
Company Address
Forestdale MA 02644 _
Citylrown State Zip Code
508-509-0802 S112843
Telephone Number License Number
B. Certification
I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5
(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address
listed above; the information reported below is true, accurate and complete as of the time of my
inspection; and the inspection was performed based on my training and experience in the proper function
and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined
that the system:
1. 8 Passes
2. 0 Conditionally Passes
3. Needs Further Evaluation by the Local Approving Authority
4. Fails
June 24, 2020
Inspector's§gnature 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 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 form should be sent to the system owner and copies sent to
the buyer, if applicable, and the approving authority.
Please note: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.
t5insp.doc•rev.726/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
b Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
............e 74 Massachusetts Ave.
Property Address
Ruth Anderson Berry Revocable Trust
Owner Owner's Name
information is required for every Hyannis Port MA 02646 June 18, 2020
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary
Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6.
1) System Passes:
❑ 1 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:
2) 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, D)for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old* or a septic tank (whether metal or not) is structuraily
unsound, exhibits substantial infiltration or exfiltr ion or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a omplying septic tank as approved by the Board of
Health.
*A metal septic tank will pass inspection if is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is les than 20 years old is available.
❑ Y ❑ N ❑ ND (E plain below):
i
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18
r
c Commonwealth of Massachusetts
�.Ve Title 5 Official Inspection Form
I a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
9 P Y rY
74 Massachusetts Ave.
Property Address
Ruth Anderson Berry Revocable Trust
Owner Owner's Name
information is required for every Hyannis Port MA 02646 June 18, 2020
page. CitylTown State Zip Code Date of Inspection
C. Inspection Summary (cont.)
2) System Conditionally Passes (cont.):
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
❑ Observation of sewage backup or break t or high static water level in the distribution box due
to broken or obstructed pipe(s) or due t a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Bc rd of Health):
❑ broken pipe(s) are replace ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is lev ed 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):
3) Further Evaluation is Required by the Bo rd of Health:
❑ Conditions exist which require further valuation by the Board of Health in order to determine if
the system is failing to protect publi health, safety or the environment.
a. System will pass unless Bo d of Health determines in accordance with 310 CMR
16.303(1)(b)that the system i not functioning in a manner which will protect public health,
safety and the environment•
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
74 Massachusetts Ave.
Property Address
Ruth Anderson Berry Revocable Trust = _
Owner Owner's Name
information is Hyannis Port MA 02646 June 18, 2020
required for every y - -
page. Cityrrown State Zip Code Date of Inspection
C. Inspection Summary (cont.)
❑ 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
b. System will fail unless the Board of alth (and Public Water Supplier, if any)
determines that the system is functio 'ng in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank an soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply tributary to a surface water supply.
❑ The system has a septic tank nd SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic to and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic ank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water pply well**.
Method used to determin distance:
**This system passes if t well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicate absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, p ovided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
c. Other:
4) System Failure Criteria Applicable to All Systems:
You must indicate "Yes" or"No"to each of the following for all inspections:
Yes No
El ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
El ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
la Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
74 Massachusetts Ave. _
Property Address
Ruth Anderson Berry Revocable Trust
Owner Owner's Name
information is required for every Hyannis Port MA 02646 June 18, 2020
page. Cityrrown State Zip Code Date of Inspection
C. Inspection Summary (cont.)
4) System Failure Criteria Applicable to All Systems: (cont.)
Yes No
❑ ® 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 water supply
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 2000 gpd-
10,000 gpd.
® ❑ 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.
5) 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" es" or"no"to each of the following, in addition to the
questions in Section CA.
Yes No
❑ ❑ the system is yr in 400 feet of a surface drinking water supply
❑ ❑ the system i ithin 200 feet of a tributary to a surface drinking water supply
❑ ❑ the syste s located in a nitrogen sensitive area (interim Wellhead Protection
Area-I A) or a mapped Zone II of a public water supply well
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18
c� Commonwealth of Massachusetts
,p Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
74 Massachusetts Ave.
Property Address
Ruth Anderson Berry Revocable Trust
Owner Owner's Name
information is required for every Hyannis Port MA 02646 June 18, 2020
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
If you have answered "yes" to any question in Section C.5 the system is considered a significant
threat, or answered "yes"to any question in Section CA above the large system has failed. The
owner or operator of any large system considered a significant threat under Section C.5 or failed
under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner
should contact the appropriate regional office of the Department.
6. You must indicate "yes" or"no"for each of the following for all inspections:
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
® El 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)]
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18
Commonwealth of Massachusetts
rn Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
74 Massachusetts Ave.
Property Address
Ruth Anderson Berry Revocable Trust
Owner Owner's Name
information is required for every Hyannis Port MA 02646 June 18, 2020
page. City/Town State Zip Code Date of Inspection
D. System Information
1. Residential Flow Conditions:
Number of bedrooms (design): 4 Number of bedrooms(actual): 4
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 GPD
Description:
0
Number of current residents:
Does residence have a garbage grinder? ❑ Yes ® No
Does residence have a water treatment unit? ❑ Yes ® No
If yes, discharges to:
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system inspected? ❑ Yes ❑ No
Seasonal use? ❑ Yes ® No
Water meter readings, if available (last 2 years usage (gpd)): 2018= 86 GPS2019= 98 GPD
Detail:
Sump pump? ❑ Yes ® No
Summer 2019
Last date of occupancy:
Date
t5insp.doc-rev.7/2612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18
c Commonwealth of Massachusetts
�s Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
74 Massachusetts Ave.
Property Address
Ruth Anderson Berry Revocable Trust
Owner Owner's Name
information is required for every H annis Port MA 02646 June 18, 2020
y
page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
2. 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
Water treatment unit present? ❑ Yes ❑ No
If yes, discharges to:
Industrial waste holding tank presen . ❑ Yes ❑ No
Non-sanitary waste discharged to he Title 5 system? ❑ Yes ❑ No
Water meter readings, if availa e:
Last date of occupancy/use: Date
Other(describe below):
3. Pumping Records:
No records found
Source of information:
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18
Commonwealth of Massachusetts
lip Title 5 Official Inspection Form
I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
74 Massachusetts Ave.
Property Address
Ruth Anderson Berry Revocable Trust
Owner Owner's Name
information is Hyannis Port MA 02646 June 18, 2020
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
4. 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):
Converted cesspool
Approximate age of all components, date installed (if known) and source of information:
System installed over 50 years ago Age of home No file available at Health Dept.
Were sewage odors detected when arriving at the site? ❑ Yes ® No
5. Building Sewer(locate on site plan):
2
Depth below grade: feet
Material of construction:
❑ cast iron ❑40 PVC ® other(explain):
orangeburg
n/a
Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18
Commonwealth of Massachusetts
i= Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
74 Massachusetts Ave.
Property Address
Ruth Anderson Berry Revocable Trust
Owner Owner's Name
information is Hyannis Port MA 02646 June 18, 2020
required for every y
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
6. Septic Tank(locate on site plan):
Depth below grade: feet
i'
Material of construction:
❑ concrete ❑ metal ❑f fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age: Years
Is age confirmed by a Certificate Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions:
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle
Scum thickness
Distance from top of scum to top of outlet tee or baffle —
Distance from bottom of scum to bottom of outlet tee or baffle
How were dimensions determined?
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
74 Massachusetts Ave.
Property Address
Ruth Anderson Berry Revocable Trust
Owner Owner's Name
information is required for every Hyannis Port MA 02646 June 18, 2020
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
7. Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal fiberglass ❑ polyethylene El other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top outlet tee or baffle
Distance from bottom of scu o bottom of outlet tee or baffle
Date of last pumping: Date
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
8. Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
i
Dimensions:
Capacity: gallons
Design Flow: gallons per day
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
74 Massachusetts Ave.
Property Address
Ruth Anderson Berry Revocable Trust
Owner Owner's Name
information is required for every Hyannis Port MA 02646 June 18, 2020
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
8. Tight or Holding Tank(cont.)
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alar and float switches, etc.):
*Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
9. Distribution Box(if present must,be opened) (locate on site plan):
Depth of liquid level above outlet* vert
Comments (note if box is level nd distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or o of box, etc.):
1
j
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
I; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
c� 74 Massachusetts Ave.
Property Address
Ruth Anderson Berry Revocable Trust
Owner Owner's Name
information is
required for every Hyannis Port MA 02646 June 18, 2020
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
10. Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
Alarms in working order: ❑ Yes ❑ No*
Comments (note condition of pump amber, condition of pumps and appurtenances, etc.):
* If pumps or alarms are not in working order, system is a conditional pass.
11. Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Type:
❑ leaching pits number:
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
® overflow cesspool number: 1
❑ innovative/alternative system
Type/name of technology:
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18
c� Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
74 Massachusetts Ave.
Property Address
Ruth Anderson Berry Revocable Trust
Owner Owner's Name
information is required for every Hyannis Port MA 02646 June 18, 2020
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.) ,
11. Soil Absorption System (SAS) (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Overflow is made of concrete block. Dry at time of inspection.
12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration 1
Depth—top of liquid to inlet invert Dry.
4" I
Depth of solids layer
Depth of scum layer
4'x 4' below invert
Dimensions of cesspool
Materials of construction Concrete block
Indication of groundwater inflow ❑ Yes ® No
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Inlet and outlet lines are orangeburg, No tees in place. Cesspool dry at time of inspection. Not
structually sound. System needs to be replaced with new Title 5 Septic System.
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18
f
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1� 74 Massachusetts Ave.
Property Address
Ruth Anderson Berry Revocable Trust
Owner Owner's Name
information is required for every Hyannis Port MA 02646 June 18, 2020
page. Cityfrown State Zip Code Date of Inspection
D. System Information (cont.)
13. Privy (locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, sig s of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18
'. Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
74 Massachusetts Ave.
Property Address
Ruth Anderson Berry Revocable Trust
Owner Owner's Name
information is
required for every Hyannis Port MA 02646 June 18, 2020
page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
14. 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
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t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18
`C Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
74 Massachusetts Ave.
Property Address
Ruth Anderson Berry Revocable Trust
Owner Owner's Name
information is required for every Hyannis Port MA 02646 June 18, 2020
page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
15. Site Exam:
® Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow wells
Estimated depth to high ground water: >5
feet
Please indicate all methods used to determine the high ground water elevation:
❑ Obtained from system design plans on record
If checked, date of design plan reviewed: Date
❑ Observed site (abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health -explain:
❑ Checked with local excavators, installers-(attach documentation)
® Accessed USGS database-explain:
maps.massg is.state.ma.us/oliver.ph p
You must describe how you established the high ground water elevation:
Slope to West of property drops well below base of cesspool. Accessed local ground water contours
and topo mappng. No high ground water in area of system.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18
c � Commonwealth of Massachusetts
+� Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
74 Massachusetts Ave.
Property Address
Ruth Anderson Berry Revocable Trust
Owner Owner's Name
information is required for every Hyannis Port MA 02646 June 18, 2020
page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
Complete all applicable sections of this form inclusive of:
® A. Inspector Information: Complete all fields in this section.
® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked
® C. Inspection Summary:
1, 2, 3, or 5 completed,as appropriate
4(Failure Criteria) and 6 (Checklist) completed
® D. System Information:
For 8: Tight/Holding Tank—Pumping contract attached
For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached
For 15: Explanation of estimated depth to high groundwater included
r
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18
LE G E N D SYSTEM DESIGN: NOTES
-a
99- EXISTING CONTOUR GARBAGE DISPOSER IS NOT ALLOWED SYSTEM PROFILE ALL SYSTEM COMPONENTS SHALL BE 1. DATUM IS NAW 88
MARKED WITH MAGNETIC TAPE OR
= (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. 2. MUNICIPAL WATER IS EXISTING
ACCESS COVERS TO WITHIN 6" OF FIN. GRADE CONCRETE COVERS TO WITHIN 3" GRADE o
X 99 EXIST. SPOT ELEV. DESIGN FLOW: 6 BEDROOMS 011 O GPD 66O GPD ey o
-[99]- PROPOSED CONTOUR USE- A 660 GPD DESIGN FLOW TOF EL. 55.3' 2" PE OR GEOT 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT.
d
.
FABRIC
FILTER FABRIC OVER STONE
50.5 4. DESIGN LOADING FOR ALL PROPOSED PRECAST UNITS Smith
198.41 PROPOSED SPOT EL. SEPTIC TANK: 660 GPD (2) = 1320 MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 8.5
TH1 ..i: PRECAST H-10 WATERTEST D'BOX FOR LEVELNESS ® TO BE AASHO H-jQ s�o
USE A 2000 GAL. DUAL COMPARTMENT SEPTIC TANK BLOCKS OR SG�dJe.
RISERS (IYP.) , PRECAST RISERS 5. PIPE JOINTS TO BE MADE WATERTIGHT. O
TEST HOLE 2'0 47.99 4"0SCH40 PVC `
YY PIPES LEVEL' 1ST 2' COMPONENTS INVERT IN 44.67'
„ �ENDS
4 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH
2%'. SLOPE OF GROUND LEACHING: SIDES 45.5' 310 CMR 15.000 (TITLE 5.)
I},{
*49.8 10" 14" ,°JowoJs, < C oywo
(TYP.)
SIDES: 2 (50.5 + 12.83Z 2 (.74) = 188 GPD . 46 gl• TEE TEE TEE ° ° ° ° _ °
�> UTILITY POLE \4U 6' o o ° o ° o°O°o°°o°°o° ® ®®® ® ®®w °�°°O�°�
24" ,°°°°°°°°°°° o , o 0 0 ° °°°o°°°° 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO
BOTTOM 50.5 x 12.83 .74 = 479 GPD TEE GAS BAFFLE ,°°go o° °e ;0000g000g ® ®®® ® ®® ®® ;g°g°gogo BE USED FOR LOT LINE STAKING OR ANY OTHER
( ) ,
°°°°o°g° ® ®®® ® ® ®® ®® °°°°°°°°
PURPOSE.
FIRE HYDRANT 7 , °o°°°°°° o°°°°oo0 67. g
TOTAL: 901 S.F. 667 GPD GAS BAFFLE 45.94' 45
NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING > .. °o 0 0 42,
:o°00000° O (Vlll
-;:;;.. - _. .:• a• �':... ...: -•' _ L 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. o
° ° ° ° ° ° ° ° ° ° ° ° ° ° ° °<< o
°,00�0000,°,o,°,o o°,o,,,°0000°o00°oe°o,°,,o,Qo,°,°o_,°,o,°,°o°o°'o°° H-10'500 GAL. LEACHING CHAMBERS BY ACME PRECAST OR EQUAL
3/4"-1-1/2" DOUBLE WASHED STONE 4' MIN. 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED
USE (5) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) (5) UNITS REQUIRED Nantucket
ALL AROUND PRECAST STRUCTURES WITHOUT INSPECTION BY BOARD OF HEALTH AND
WITH 4' STONE AL AROUND 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 50.50' X 12.83' PERMISSION',OBTAINED FROM BOARD OF HEALTH. Sound
COMPACTION. (15.221 [21) h_
�' 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING
(12.6% SLOPE) (�2 % SLOPE) (�% SLOPE) DIGSAFE (1-`888-344-7233) AND VERIFYING THE
LEACHING LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES LOCUS MAP
FOUNDATION- 23' SEPTIC TANK 6' D' BOX 24' FACILITY 37.5' BOTTOM TH-1 PRIOR TO COMMENCEMENT OF WORK. SCALE 1"=2000't
NO GROUNDWATER FOUND
11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE
REMOVED BENEATH AND 5' AROUND THE PROPOSED ASSESSORS MAP 287 PARCEL 021001
MA LEACHING FACILITY.
APPROVED DATE BOARD, OF HEALTH
*THE INSTALLER SHALL VERIFY THE 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND LOCUS IS WITHIN FEMA FLOOD ZONE X
LOCATIONS OF ALL UTILITIES AND ALL REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. (AREA OF MINIMAL FLOOD HAZARD) AS
BUILDING SEWER OUTLETS AND SHOWN ON COMMUNITY PANEL #25001CO568J
ELEVATIONS PRIOR TO INSTALLING ANY DATED 7/16/2014
PORTION OF SEPTIC SYSTEM
TEST HOLE LOGS
ENGINEER: DANIEL E. GONSALVES, SE #13587
WITNESS: DAVID STANTON, RS (BARNSTABLE)
P V 8 OF 40 IN
T 5' OF S A OWN. 46 , DATE: 9/23/2020
TOP A V 5 TT AT PERC. RATE _ < 2 MIN/INCH
CLASS 1 SOILS P# 20-162
AP 87 ARCE 02100 ELEV. ELEV. t s ELEV. ELEV.
16,5 f O» Q 49.0' p" `�' 50.0' Op° 52.0' O" 4 52.5'
. tt5 A A A
a
I TI `r`�� LS LS LS
1 47 `19.0' r'> }P 12/1 1 OYR 3/2 10" 1 OYR 4/2 10» 1 OYR 4/2
GARAGE �� ��
� �, . _.. FILL. ,
- _- _ --- B -- -
- - -. - --
� LS LS
TH3 LS 36,E 47.0'
1 •c >� `� <\ \\ TH4 20„ 1OYR 5/8 47.3% 24" 1OYR 4/6 50.0° 20" 1OYR 4/6 50.8'
2 GRAVEL\\
\ D
PERC PERC
170) M/CS MS M/CS M/CS
EXISTING 4 \
DWELLING \\ \` _ 2.5Y 7/3 2.5Y 7/3 2.5Y 6/6 2.5Y 6/6
TOF - 55.3 \
Op 55 0
O
138 37.5 132 39.0' 132 41.0 132 41 .5
BENCHMARK
MAG NAIL SET : NO GROUNDWATER ENCOUNTERED NO GROUNDWATER ENCOUNTERED
Q EL. - 31.7'
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74 MASSACHUSETTS AVENUE
HYANNISPORT, MA
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PREPARED FOR
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lo�� DANIEL c��, ° DANIELA. 7
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No.40980 No.46502
o DATE: NOVEMBER 25, 2020
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> .,Y•v� I downcape.com
00WA) cafe engineering, inc.
civil engineers
�-f land surveyors
939 Main Street ( R to 6A)
DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675
LICE #20--210
20-210 BORTOLOTTI-SIMOLARDIS CORP.DWG