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HomeMy WebLinkAbout0233 MITCHELL'S WAY - Health 233 MITCHELLS WAY HYANNIS A 290 043 1 F �I <. �. �, •, _ �j , . . �, .. ---_-- ��� �i G j' �. oS . 7 (') ' . � o � , .. � � � a �. �- � �� � , rJ _ �.f w � � f r s 1 _` ..JJ � � � � � �' � c� �9 � 1 1 �• �� �. � -, c� � - � - � �. � � k � i ,� �: I I I - -1 I i I I I I I I I - - - - - - - - - - - - - - -� I - - - - - - - - - - - - - - - - — - - � I b I I UP UP LAUNDI;Y I I Ci' o •c ICDNEW DOOR 5'-2"FIN. I I D W ow I I ,ee WEArION I I wl J CL FIN. - II• III • rI - 'o°x3' ILL E.P.L _ ' .- •IIII III . w F -1 F -1 SHOWE I 1 Io 1 CWU L - -J i 'j) N 2X6 WALL u B I 1 4Z w J I I a LU C I I I I 3 a F- 2-11� I Z m m o I I U /Urie5 i I � I w I I —lCV I I I m = In N �W i w zQ 2,-6. Wa — - - - I I I L - - - - - - -.- - - - - - - - - - I I .N i i � A OWN OF BARNSTABLE LOCATION ^'►i` . SEWAGE # VILLAGE c ASSESSOR'S MAP& LOT .. _,:�J INSTALLER'S ,AME&PHONE NO. a , SEPTIC TANK CAFACrIT rQU g LEACHING FACILITY: (type) (size) ?3 v NO.OF BEDROOMS BUILDER OR OWNER PERMTTDA' h� 3� COMPLIANCE DATE: Separation Distance.Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and'Leaching Facility (If any wells exist on site,or within 200 feet of leaching facility) ¢ Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching faci ' ) Feet Furnished by AVr'arlb/�--.4 AWN Q � Iry Cl �- TO G r N. �' „ �✓ � �, i Fee io0 r THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MAS ACHUSETTS 01pprication for Migaal *pgtem Construction permit Application for a Permit to Construct Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 33 rn T'�Fl �-�—S �� Owner's Name,Address and Tel.No. J5`09 4 d 4p Assessor'sMap/Parcel 2e.3oj,A3 Q n Installer's Name,Address,and Tell.No. De gner's Name,Address and Tel.No. Q Zg e 33�tt l wl,S `J�c"" ���©� o[� !"i4t�\L E� ` O,4_0 05 eAlt l l_C� Type of Building: ,I Dwelling No.of Bedrooms J Lot Size t®,�0 sq.ft. Garbage Grinder A� ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow '03D gallons per day. Calculated daily flow -53 1 gallons. Plan Date E+l A 3 Number of sheets . Z Revision Date 0 ti4 tJ Title (di,ArV 0054FD E7PTIL .`yYST_GykA Size of Septic Tank ►5M &,4L-L-0► _ S Type of S.A.S. Description of Soil 2 N^b C) D f_l,Ctna Lc_ O^ 3 N A L.oAM r tw C s N-k c> 3"- 6" 8 iUUc SAr..D ►o"Ilf. s 8 16 gM-,eu& GAkXD go" kz.p" �L�ey �'�� c 3P.►Ut �.S1L2 .5� Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned,agrees to ens nstr 'on .nd paintenance of the afore described on-site sewage disposal system in accordance with the provi ' s of T' S of E to ental Code and not to place the system in operation until a Certifi- cate of Compliance has en iss y th' f th. _. Sig Date Application Approved b Date Application Disapproved for the following reas ns Permit No. Date Issued N. Fee BOO { THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: � -Yes" 'PUBLIC HEALTH DIVISION -TOWN OF.BARNSTABLE., MAS ACHUSETTS M± 01ppliCation for Mi000l *Paem Congtructton V ern�t AP11l cation for a Permit to Construct(K )Repair( )Upgrade( )Abandon( ) El Complete System El Individual Components Location Address or Lot No. Z 33 Ty—K Owner's Name,Address and.Tel.No. 1-kv�lu t,kts tM Ass �. Assessor's Map/Parcel 29o�g3 � , �16 Ap7 Installer's Name,Address,and Tel.No. De 'gner's Name,Address and Tel.No. 0 40 V1 /-1 p Type of Building: Dwelling No.of Bedrooms aJ Lot Size 10,-4W sq.ft. Garbage Grinder A10 Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 gallons per day. Calculated daily flow -53 1 gallons. Plan Date I A A 3 vq Number of sheets Z Revision Date �l0 t t Title 5t rr_ LfQ az ED '5Et�1 G 15-Y S71sm Size of Septic Tank ISM &Pv -L.0 t-A S Type of S.A.S. Description of Soil 2"-O ® D Z txA,,-kG- *At C R MkI-,A L O- 3 A LoAw r t ty G 3 15 t t N C 'SAU D I ON e- 5 Ads C 1r aetj F i to 55 SA kX D 2 5 1(�z 6-/q —ter Nature of Repairs or Alterations(Answer when applicable) ` 1 Date last inspected: Agreement: The undersigned agrees to enstue the nstr�tion drxtaintenance of the afore described on-site sewage disposal system in accordance with the provisi'l s F�b lts 5 of /e E ri oR//ental Code and not-to_place the system in operation until a Certifi- cate of Compliance has e n iss t d`by this Bo of He th. Siged `, - Date ..f APplication.Approved,:b. �' ! Date, . f •Application Disapproved for the"following reasons Y � 3x'; Permit No. Date Issued :'; ————————— ——————————————————————————— THE COMMONWEALTH OF MASSACHUSES -� BARNSTABLE, MASSACHUSET717S Certificate of Com0lianr THIS IS TO CER11EY,that the On-s'te Sewage Disposal„System Constructed(j` )Repaired( )Upgraded( ) ' Abandoned( )by at 2�J3 t'rr-t, F_L_L NJ iiYA,tA Ki k has been constructed in accordance with the pro ions of Title 5 and e for Disposal System Construction Permit No - 5_�dated Installer Designer The issuance of is pe it sha of be acd as a guarantee that the s ill functio as s gne Date a Inspect f ———— —————————————————————————— No. Yf Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Di000l 6pelem Conotructiotl 3permtt Permission is hereby granted to Construct O( )Repair( )Upgrade( )Abandon( ) System located at Z53 A I_rCf4 L^`.LL5 W&-t and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of th* M Date: I Approved by . t Sullivan Engineering Inc. 7 Parker Road Box 659 Osterville MA 02655 Peter Sullivan P.E . Mass. Registration No. 29733 428-3344 fax 428-3115 e-mail::1SullPE@aol.com May 4, 1999 Board of Health Town of Barnstable 367 Main Street Hyannis, MA 02601 RE: 233 Mitchell's Way, Hyannis, MA Map 290 Parcel 43 Dear Board of Health, Please find attached a Site Plan dated May 3, 1999, for the above referenced property. The lot is 10,560 SF and per part VIII Section B of your regulations, for Protection of Ground Water, the lot is not located within a zone of contribution as delineated by SEA Consultants, Inc. Map dated February 19, 1985. Further, it appears that the lot meets the test for 310CMR 15.005, Transition Rules Section 3 Isolated Lots. The proposed septic design for this lot complies with the latest version of Title 5 and given that there are no variances required, a permit can be issued over fhe counter. If you have any questions, please feel free to contact me. c Very truly yours, .,v Peter Sullivan PE Sullivan Engineering Inc. cc: Mark Lebeaux, M & R Realty Members of American Society of Civil Engineers, Boston Society of Civil Engineers wl-or`'. Z, .TH =1 EL. 201,2 M, r3' TH.2 CL, IS9.5 ORGANIC r s..,,•Y O ORGANIC: MATf=R1AL- G MA-TERAL , O LOAMY, FINE LOAM�I FINE ' A 3 SAND IOYR 3/1 SAND IOYR 3/1 , y s I=1NE -SAND FINE" SANp t3 I O Y R 5/8 -"D toy R .'5/6 Is VERY FIND I"1 VF-RY.FINC C, C1< SAND-2i'SYK 4- N SAND 2•sYR b/N ,, - HO' Hi VF[Zy FINE r He VER�I FINEPERK T �20 C.Z SAND'2,5YR, 5/H ,� C2 SAND Z.5YR SIM A " 120. s PERCO LAT ION"TEST CLASS I MATERIAL DATC 3/Ib99, OF PePT11: L18'' "No • P 937c/ ,.• SIN e':"LESS THAN°2-MiN:/INC1� ""'BY SULLIVAN ZN(r• I NC- N O.WATER CNCOUNT6D W ITNE$S D:M 1 ORAN D 1� T.O.6 ' PETER q SULLIVAN Cl IL, A a (so• Ind. r„al� woy) .�� I h s � 0.2d3•Z2 E a"syn,n.ne itBoP of gRB SO N 7 a C� S 48'10° 8.00' `ti11 Of Assessors Map 290 Parce143 ;.N Zoning RB o� F�ICHAM �yG ` 3 Setbacks a �? R Front 20 Side 10' LHEUREUX H " \Rear 10' No.34312 0 fST Z2 tlousa. 22 3' a a h $ +1 1 \ 10 s ��•�.`MIN , ' SePTIc O TANK The Proposed foundation shown hereon complies c-eox with the sideline set back requirements for the Town of Barnstable and is not located within the 100 year PRIMARY _ floodplain. O RessaRva �� stoo �I 100tSf I� �>9�_ -0 ? II 88.00' � � � ' ` N 7s48'10' WLI SITE PLAN '" PROPOSED SEPTIC SYSTEM Bernard Houand AT AIarY E. OW"a n�l/�oe v i 233 MITCHELLS WAY HYAN N IS, MASS. FOR =PLAN VIEW M81 R, REALTY Scale I�`= 30� SCALE:AS SHOWN DATE:MAY 3; 1999 SULLIVAN ENGINEERING INC. SHEET 1 Of+2 OSTERVILLE MA , :; �r y FG.200.0 s F.G.199.00 197.5 { 196.5 > 197.3 1500 Gallon 197,1 top El.1975 Septic Tank 1969 Bot.E1.194.5 . , • ::.: 196.7 x. .,,.,, •, Bedding as Per Title 5 10, •10' ' ,10, 10'. 12' . Bottom of Test Hole EI. jQ9.j No Ground Water. DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM Not to Scale .—Finish�Grade n DESIGN DATA Single Family-3 Bedroom Filter Compacted Fill With no Garbage Grinder J.. Fabric Daily Flow=llOx3=330 GPD' Septic Tank:330 GPD x 200%=6.60 GPD"` Pea Stone Use 1500 Gallon Septic Tank =v LEACHING AREA 330 GPD/0.74=446•SF Required Leaching A 3/4"-I I/2"/ Sidewall =2(12x25',2=148 S.F. a Chamber Double Washed Bottom Area= 12 x25 = 300 S.F. %-'e. Stone 448 S.F.Total Provided 4'-10' I I LEACHING CHAMBER DESIGN • . All Pipes to be Schedule 40. Use r 2-500 Gal.Leaching Chambers in 12'x 25'Washed Stone Field as Shown CROSS +SECTION OF CHAMBER NO •NOT TO.SCALE TES I.Water Supply ForThis.Louis Municipal Wotgr -'2 Location of Utilities Shown on This Plan Are Appr= � At Least 72 Hours Prior to Any Excavation For This. Project The ContractorShail Make The Required' ; ..: Notification to Dig Safe(1-800-322-4844) j 3 The Contractor is Required to Secure Appropriate: Permits From Town Agencies For Construction ne is�. Defined byTh' Plan. � _ 4. Install Risers as Required to Within.i2!�of Finished Grade. a c t S.AII Structures Buried Four Feet or More or Subject to Vehicular Traffic to be H-20 Loading. fi Septic System to be Installed in Accordance With 310 CMR 15.00 Latest Revision And The Townof Barnstable Board of Health Regulations 14Ae §° T Al I Piping to be Sch.40 PVC. PEJER lit SULLIVAN A 2�7.. . p33 '-- - CIVIL M a R Realty:, t 233 Mitchel ls Wa Hydlinis,' Mass y U SHEET2of 2." TH-I EL. 2.01.2 ORGANIC O. ORGANtC MATfiR1AL- G MA-TERAL O A LOAMY FINE A LOAMY FINE 3 SAmo toYR 3/1 . y, SAND IOYR 311 KINE SAND FINE SAND d IOYR 5/8 D IOYR 5/8 Il . VERY FIND vmj-zy,FINE CI SAND 2',6YR /b/'/ ,, CI SAND 2.5YR t%/ yo' 4 1 . PeRK TEST VERY FINE 49 C�- SAND ZgYR.5/y V ER`/ 1=1N E 4;l zo 120� C2. SAND 2.5YR 5/4 PERCOLATION TE5T CLASS 1 MATERIAL: DATE 3/I V/.9 a1 pEPT{1. 48'' No. P=937A4 LESS THAN- 2 BY SULLIVAN .ENtr. INC- NO WATER CNCOuNTED W►TNE$S'. D.M I GRAN D 1� T.O.B � tH OF Pd14 � PETER €; m SULLIVAN o NO.29 7 33 10' Nde— Publio woYI MUch(6,11 1 CIVIL site �� iop $/ tg,�_' •�"• of C.— S 48,10 8.00, rye .,, sl3/99 Assessors Map 290 Parcel 43 \ .V) Zoning RB Setbacks Front 20'.. Side to' Of �� \Rear•10 1 �04' R!CHARD so • ti LHEUREUX No.34312 QL pR � opoe 3 bit : W 2Z i 3 a s GIs lit � icd O O O � \ 2_c �, a SCPTIL \ O TANK The Proposed foundation shown hereon complies with the sideline set back requirements for the Town of Barnstable and is not located within the 100 year PRIMARY, floodplain. 10.560t 1 ���s�, ,p = .. . 88.00' � f I SITE PLAN N 76:4810" w i !HIr ,' PROPOSED SEPTIC SYSTEM _ Brnard Holland AT r wra;3i aaa 233 MITCHELLS WAY. HYANNIS, MASS. . , FOR PLAN-VIEW M& R< REALTY Scale: 1 SCALE: AS SHOWN ; DATE:MAY 3; 1999 SULLIVAN ENGINEERING INC: SHEET I Of 2 OSTERVILLE MA A ' FG.200.0 F.G.199.00 197.5 196.5 1973 1500 Gallon. 197.1 Top El.1975 Septic Tank 1969 Bot.E1.194.5 .:: 1963 Bedding as , Per Title 5.• 10, 10 10, 10 12' Bottom of Test Hole EI. No Ground Water DEVELOPED PROFILE.'OF PROPOSED SEPTIC SYSTEM Not to Scale Finish Grade^ ' DESIGN DATA Single Family-3 Bedroom Filter Fabric �_,Compaded FIII With no Garbage Grinder ;•' _ Daily Flow=110 x 3=330 GPD N 1/8-1/2° Septic Tank 330 GPD x 200%=6.60 GPD Poo Stone Use 1500 Gallon Septic Tank LEACHING AREA q '0 330 GPD/0.74=446'SF Required Leaching Sidewall =2(12'x �25)2=148 S.F. 3/4 -1 1/2 a Chamber Double Washed Bottom Area= 12'x25 = 300 S.F. Stone 448 S.F.Total Provided 4'-10' I LEACHING CHAMBERDESIGN le.0" I AI I Pipes to be Schedule 40. Use 2-500 Gal.Leaching Chambers ina 12'x 25'Washed Stone Field as Shown CROSS SECTION OF CHAMBER _ •NOT TO SCALE NOTES I.Water Supply ForThis Lot is Municipal Water 2 Location of Utilities Shown on This Plan Are Appro)L At Least 72 Hours Prior to Any Excavation ForThis. Project The Contractor Shall Make The Required Notification to Dig Safe(1-800-322-4844) t 3 The Contractor is Required to Secure Appropriate, Permits From Town Agencies For Construction Defined byThis Plan. w 4 Install Risers as Requiredto Within d'of . Finished Grade. 5.All Structures Buried Four Feet or More or Subject to Vehicular Traffic lobe H-20 Loading. 6. Septic System to be Installed in Accordance With 310 CMR 15.00 Latest Revision And The Townof ' Barnstable Board of Health Regulations T Al I Piping to be Sch.40 PVC. � pETI:R. ` L SULLIVAN I NO.29733 g CIVIL M 81 R Realty rtzi Q 233 Mitchells Way J Hyannis,Mass. . $f3�99 SHEET2of 2 OWN OF BARNSTABLE J �. LOCATION SEWAGE # VILLAGE ASSESSOR'S MAP& LOTS =G INSTALLER'S 4ME&PHONE NO. S Mick - ISEPTIC TANK CAPACITY LEACHING FACILITY: (type) ` (size) .5-4 y NO.OF BEDROOMS BUILDER OR OWNER © / U PERMITDAT�E: 3,� COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility.,(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching faci ' ) Feet Furnished byi /e/�j �,Ll fi'f4t1t i 914 YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates cost $30.00 for 4 years. A Business Certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L. - it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1st FL., 367 Main Street, H annis,.MA 02601 (TowV Hall and 200 Main Street Offices at the Licensing counter. �a DATE: ' . Fill in please: +- APPLICANT'S YOUR NAME: BUSINESS YOUR HOME A DRESS: Z-1;`8 i tic W6 G �o� ' S1 -22�� \S Z TELEPHONE # Home Telephone umber: NAME OF NEW BUSINESS L. t ZVro otft-Q, mh TYPE OF BUSINESS %Ar wLa vlr. . IS THIS A HOME OCCUPATION? YES NO 10-- Have,you been givemapip al froT the i Tg divisio ? ES NO c J ADDRESS OF BUSINESS 23 !V[���1n c s . ai MAP/PARCEL NUMBER 2 9 0 0 -1 _ When starting a new business there are several things you m st do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COM S NER'S OF ICE n This individ al h' s ert ir)tm f any permit require nts that pertain to this type of business. (<-F "` - MUST COMPLY WITH HOME OCCUPATION COMMENTS:- �!1 Aut prized tore RULES AND REGULATIONS. FAILURE TO COMPLY MAY RESUff IN FINES. 2. BOARD OF HEALTH This individual has be nformed of th er it re r en that pertain to thipa &WIM H ALL nzed Signature'' S MATERIALS REGULATI vmr COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: Hazar ous Materials Inventory Sheet Checklist to ���JJJJ Physical Street Address-Check database to ensure it exists Working Phone Number /Actual Amounts—(i.e.gas being used to fuel machines,thinner to dean brushes all count as hazardous materials) Storage Information—location of storage,how long is storage for? one,note that. �Hi"sposal Information—where and who? If none,note that. Applicant Signature—understand what is listed and noted. ,Applicant Initial—any questions,know who to ask. Vehicle Washing/Rinsing?—provide a vehicle washing policy and explain it—note that it was given. Attach the Business Certificate with your sign-off and comments. "The Inventory form should explain what the business consists of and the procedures they are doing. Notes need to be left to explain what you discussed with them Date: /ZZ/ o '�r' TOWN OF BARNSTABLE TOXIC AND HAZARDOUS, MATERIALS ON-SITE I VENTORY �I NAME OF BUSINESS: � t cud Li-ft froped,4 c,ti a Q fw el BUSINESS LOCATION: Z33 S INVENTORY MAILING ADDRESS: \4an tls r wcV ( Z(ao I TOTAL AMOUNT: TELEPHONE NUMBER: 00ir— — ZZ i I CONTACT PERSON: �'� - EMERGENCY CONTACT TELEPHO E NUMBER: 77`I—Z3 S-- (. 1 j7 MSDS ON SITE? TYPE OF BUSINESS: owl ro D INFORMATION/RECOMMENDATIONS: Fire District: y Waste Transportation: Last shipment of hazardous.waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum Antifreeze (for gasoline or coolant systems) Misc. Corrosive NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides NEW USED (insecticides, herbicides, rodenticides) 5 Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways &garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Misc. Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt & roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) NEW USED Any other products with "poison" labels - - —---Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor&furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): Laundry soil & stain removers (including bleach) Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS le COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF;ENVIRONMENTAL PROTECTION � 0 , TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS a °" SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM -PART°A s CERTIFICATION. Property Address: a3 !j 40 ^� Owner's Name: :ZvQhJ\ Owner's Address: Date of Inspection: Name of Inspector:(please print) SeaA^., S'a � Company Name: William E. Robinson Septic Service Mailing Address: P O Box 1089 Centerville, MA t Telephone Number: t 5081' 77 —8776 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the itif rmation r_portedt below is true,accurate and complete as of the time of the inspection.The inspection was performed based omruy training and experience in the proper function and maintenance of on site sewage disposal systeml am a DEP Fa approved system inspector pursuant to S tion 15340 of Title 5(310 CMR 15.000). The systetit: u' er, Passes' A: Conditionally Passes,, • - - co r . Needs Ftirther Evaluation by the Local Approving Autho 'ty Fails Inspector's Signature:. Date- alb/ -rt The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Neaith of 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 I , Yagc 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: a3--S M Owner. Dale of inspection: /1 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D Sys em Passes: �1 have not` d any information which indicates that any of the failure criteria des cribed in 310 CMR 5.303 or to 310 CMR"15.304 exist.Any failure criteria not evaluated arc indicated below. Comments: \ ti. B. System Cond�n�j ssc"J ='y `\11 y/' �f 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 meta:or not)is structurally unsound,exhibits substantial inf Itration or e41tration 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 replaccd 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 p4w(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is rtmoved ND explain: ` Page 3'of I I OFFICIAL INSPECTION`FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM `PART A CERTIFICATION(continued)•• Property Address: 3)3�� Owner: C� 1 E: VICk . Date of Inspection: C Further Evaluation is Required by the Board of Health:. Conditions exist which require fiuther evaluation by the of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(i)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that-the ' system is functioning in a manner that protects the'public health,safety and environment: " _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary'to a'surface water supply. w _ The system has a septic tank and SAS and the SAS is within a Zane I 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 frorda 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: r e 3 Page 4 of I t ' OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1'+C- 14 Li ��((S 0 ,v-.Y-.k 5 _ Owner: 6,VXC) Date of Inspection: aui=r D. System Failure Criteria applicable to all systems: You must indicate"ycs'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 b"below invert or available volume is less than%day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped Any portion of the SAS,cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100-feet of a surface water supply or tributary to a surface water supply. _ Any portion of a cesspool or privy is within a Zone I 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 umtcr supply well with no acceptable water quality analysis.lTbis 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 or 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.l (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: A A To be considered a large systeni 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 I 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 ommcr yr operator of arty 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 PARTB . . , . CHECKLIST Property Address: M+-k.'-\e(,5 ti ! Owner: 7:�_CVA4-) t Date of Inspection: 0 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: , Yes N� . 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? F ✓ 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?(1f they were not available note as N/A) f _ 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 baffl/es 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 CRR 15.302(3)(b)J - 4 FC� x Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Owner: SG1�f� G✓T`R ��:11. Date of Inspection: FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): —3 DESIGN flow based on 310 CMR 15103(for example: 110 gpd x it of bedrooms): 33.1 6 PO Qs,,,Aa ed Number of current residents: 0 Does residence have a garbage grinder(yes or no): A/0 Is laundry on a separate sewage system(yes or no): tw [if yes separate inspection required] Laundry system inspected(yes or no):4 Seasonal use:(yes or no): rlZo Water meter readings,if available(last 2 years usage(gpd)): 1 (.% +0 H)V j (0,SCL Sump pump(yes or no):-vo - Last date of occupancy: .20GZ ? COMMERCIAL/INDUSTRIAL Type of establishment: J Design flow(based on 310 CMR 15.203): gPd Basis of design flow(seats/persons/sgketc.): 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 INFOIMIATION Pumping Records Source of information: Was system pumped as pan of the inspection(yes or no): n.I;> If yes,volume pumped: gallons--Now was quantity pumped determined? Reason for pumping: TYPR OF SYSTEM ✓Se tic p tank,distribution box,soil absorption system _ cesspool Single of g Po Overflow cesspool --Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) ~_Innovative/Alternative technology.Attach a co of the current o eration and gY copy p 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: 15 h`l - Were sewage odors detected when arriving at the site(yes or nq): /'lJ 6 1'afc 7 l t 1 1 OFFICIAL INSI'1 C['ION I,0101—NOT FOlt'VOLUNTAItY ASSLSSNIL;NTS SUBSURFACESEIVAGE DISPOSAL SYSTEM INSI'L TION DORM PART C SYS' L11I INFORMATION(continues!) Property Address: a3'3 M� Dale a(Inspectlon: IJU1LUING SEWER(lucatc un silt pia,,) Dcptlr below grade: Materials of construction:_cast ilon'✓ 40 I've_older(Explain). Distancc from pris•alc a-alcr supply well or suction tut':_ Cunrrncnts(oil condition of juuits,v iurEiir6,evidence of leakage,cic.): SEPTIC TANK:Aucatc oil site an)cl M 1 Depth below grade: l Material of construction:_kullcrctc metal . fiberglass�uwlyctltylcne If tank is metal list age:_ is age cunftslaed•by a Ccilificale o certificate) f Conipliarrcc(yes or (attach,(aach a copy of Dimensions: ) Sludge depth: cj Distancc (roil►top of-sludgc tv burtvnt u(vutict lee or ba(Ilc: 3. i Smit Ihlckncss. L?cc Distancc from top of scum to tup of outlet Ice or baffle: i Distancc !torn builum of scum It'button,or outlet tee or battle: i lu%v ticcrc dimensions determined:l pe't t J'- CGS It rs Comments(oilpumping reeuuunenJatiuns,iritd and ouliei ice o_r'bafilc cutrditit,ta,muclutal inicbtily. liquid lei cis as r"c`ltmcJ to outlet inmi,evidence Qf leakage.etc.):. ©�i"tL�' �t till'(-fit;-� �G-•c� �'�' ltt�tisY - . GIIEA5ETIEAP..'V(( rate un site plan) Dcptlr bcluw grade:_ Material of construction:_cuuctctc stictai ` '`(tbcr�tass`)tolycthylcnc__outer (cr,plaal): Dimcusions: Scuts thickness: Distancc from top of scum to It'll of uuticl tcc or battle:_ Distancc Goal butioal of stun;to butlurn of outlet Ice or bafllc: Dalc of last pumping: Cununcnls(un pumping tccul"I"cndaliups,mlct and'uuticf tic ur ball c cunditw.-S,stlucilrral nttc6rily,liquid Ictcl, as related lu oullct inmi,cl-idcncc of IcakaFc, f • Page &of 11 OFFICIAL INSI'LCUON FORM—NOS' FOR VOLUNTARY ASSESSNJLNTS SUMUIVACE SEWAGE DISPOSAL SYSTEM INSPECTION 1;01(A1 PART C SYSTLA1 INFORMATION(cuniinued) Properly Address: Owner: Dille of inspection: TIGHT or HOLDING TANK: ✓' (taj tk must be puuyuJ at tirnc of insl,cction)(lucale oil site I,sit Ian) Dcpth below grade: Malcrial of construction:__coucrcic_metal_fiberglass_)rolyciliylcnc othci(explain). Dimensions: Capacity; i•ailwu Design Flow. • Alarm present(yes or no gallunslda y Alarm .level: Alann ur wuikin urdci Date of last pumping: b (y"cs ur uu): Cununenis(condition of alarm and float switches,etc.): DISTRIBUTION O UOa;_(if present must be opened locale-o)( n site plan) Dcpih of liquid level above owlet invert: r` Connnenls(note if box is level and distribwion to Darters edvai,an} evidence of;odds ca leakage inlu or oul f bux,cicJ: ,r}os•cr,any evidence of 44 SC .., L t- 7F•��Ivti� 1'UAII'CHAMBER: ,A1 y(,ucale on slit p{an) Pumps in working order(ycs or nu): Alarms in tvolking order(ycs or to). Conuireiils(late condition of pump chamber,t utditiuit of pumps and aPpuilcilantcs,etc.)_ Page 9 of 11 OFFICIAL INSPECTION-FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: R)'bO Date of Inspection: �� �g w SOIL ABSORPTION SYSTEM(SAS): k/ (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: innovative/altemative system Type/name of technology. Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): c`p rt CESSPOOLS:'vvIA(--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 4) (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page 10 of 1 l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYS TEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: R33 �L��'\4� Owner: 7VV ex ec it Date of Inspection:p ton• .� tr, F- . 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 welts within 100 feet.Locate where public water supply enters the building. K�Jsc-- /�' ; t3 t h 10 Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner. \ - Date.of Inspection: T' SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 3 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 S Observed site(abutting propertylobservation 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 descri how you established the high ground water elevation_ 11 Town of Barnstable Op THE Tp� o Regulatory Services ,,�,s,AB� Thomas F. Geiler, Director 9� b 9. ��� Public Health Division AlFO MA'I A Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 t REGARDING SEPTIC INSPECTIONS BY PRIVATE CONTRACTORS DISCLAIMER This septic system inspection report was.completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original or copy of the report; this Division does not warranty the functionality,of the septic system in the future nor does this Division agree with any technical observations and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would be listed on the "Disposal Works Construction Permit". If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection. Q:\SEPTIC\Disclaimer Private Septic Inspections.DOC HYANNIS FIRE DEPARTMENT 95 HIGH SCHOOL ROAD EXTENSION HYANNIS, MASS. 02601 Harold S. Srunelle w/. ` BUSINESS: 775-1300 • CHIEF SAwhe Oeteetma Save odivea � EMERGENCY: 911 FAX: 778-6448 To Town of Barnstable, Board of Health - T. McKean Town of Barnstable, Conservation Commission From ; Fire Prevention Bureau, Hyannis Fire Department Subject ; The installation of above ground storage tanks. Date 9/7/99 Persuant to the applicable sections. of 527 CMR Fire Prevention Regulations, this Department :has inspected the following location for above ground storage. ADDRESS 233 Mitchell's .Wa ' Hyannis cam? p OWNER/OCCUPANT John Hemphill PHONE SIZE OF TANK(S) (1) 275 Oval Steel / Basement COMMODITY STORED• : # 2 fuel oil PUMSF. FOR STORAGE Heating THIS INSTALLATION IS PRE-EX ING A REPLACEMENT NEW This installation complie does not comply with the required installation re u ation listed below. FIRE PREVENTION OFFICE For: HAROLD S.BRUNELLE,CHIEF HYANNIS FIRE DEPARTMENT ' ✓v