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HomeMy WebLinkAbout0287 MITCHELL'S WAY - Health 287 Mitchell's Way PF Hyannis F A = 290 052 f i e NW 'SONusvN NOJ LS �-Z �. a�ES� 'oN t CLL t Odn I i i 9 f A �r SINNVAH `3xVz 33INVr sZ: 00 TOWN OF BARNSTABLE 4000, LOCATION a�' c? 4 /r-C SEWAGE ASSESSOR'S MAP & LO'15'o - -3�� INSTALLER'S NAME&PHONE NOA&G I(-/ ass z S j CIO SEPTIC TANK CAPACITY l S O e LEACHING FACILITY: (type) Ws-"p CWW4 'Ste°`es (size)_,;>o x b x NO. OF BEDROOMS BUILDER OR OWNER PERMI I DATE: D 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 facility) Feet Furnished by f �1�' r _D No. c.V� —21(6 1 FmJ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Ztppfication for Mig�Upgrade( *pMem Construction Permit Application for a Permit to Construct( . )Repair( ) )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot Np. /r Owner's Name,Address and Tel.No. 02p p/r l-C'(C- r ��p 1PI0�l�l� es or's?Ma /Parcel IF Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations,(Answer when applicable) 14 C e -I i itSfnA Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued s Boar ealth. o ' Signed Date S 3 Application Approved by s Date 2v c7 Application Disapproved for the following reasons Permit No. 2 oo 3--2 2_`c Date Issued 2-0 0 3 y No. 2U _2 2 — },,..�.-•r� Fee J^ a i THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS Yes ZippYicat on for �Digpooat *pgtem Congtruction Permit Application for a Permit to Construct( . )Repair,(;/)Upgrade(' )Abandon( ), El Complete System 0 Individual Components Location Address or Lot Np,,,,,,, / Owner's Name,Address and Tel.No. 7 '� /2i. TC F /,fir 11647 p , ssessor's Map/Parcel ��+ D 1 '0{ k t S—�— Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 12 % l''.1 'Tac , dui'^ r " 2 7 SS 13 A- 27 r S' F..5' a Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) `Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures { Design Flow gallons per day. Calculated daily gallons. Plan Date l ' Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. i' Description of Soil I Nature of Repairs or AlterationsjAnswer when applicable) 5 UU an (c S w Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in'operation until a Certifi- cate of Compliance has been issued-}a 's Boaz o� ealth. _ 0 Signed FDate v 3 Application Approved by _ s SDate Application Disapproved for the following reasons Permit No. Date Issued S Zv t 1,03 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS w Certificate of Compliance < THIS,IS TO CERTIFY, that the On-site Sewage Disposal System Constructed ( )Repaired( Upgraded( ) q� Abandoned( )"by / rZ e �q S-r at 7 �X ,,T F' /—/-r has been construe d in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 7-M 3— 2 26 dated 5 20 03 Installer Designer The issuanc of his permit shall not be construed as a guarantee that the syste n as des'gned. a Date 0 3 Inspector I _ No. 2003 —2 2 Fee l.0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Migpogar *pgtem Congtruction Permit Permission is hereby granted to Construct( ,)Rep i ( )Upgrade( )Abandon( ) System located at 7 r T , Z ��1' k,,& 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: Constru tion ust be completed within three years of the date of this pe Date:_ 5�2o v3 Approved by TOWN OF BARNSTABLE LOCATIONS �'� c i c �� r SEWAGE #°2 D 42 a � VILLA ASSESSOR'S MAP & 1,012=20 INSTALLER'S NAME&PHONE NO.,0 G IV (fo s 7- C" LIE 22,S' r-7!9� SEPTIC TANK.CAPACITY l �� LEACHING FACILITY: (type) S-o® �ft�'"'S��S (siae)-;�o X r D x..2 NO,OF BEDROOMS BUILDER OR OWNER PERMITDATE: D 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 facility) Feet Furnished by =62 -2 .I � i S CONIMONWEALTH OF MASSACHUSETTS EYF.CUTIVE OFF]C�� OF ENVIRONMENTAL AFFAIRSCOP? DEPARTMENT Oh ENVIRONMENTAL PROTECTION d °W :LED INSPECTION TITLE s OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM _ PART A REC&EIVED CERTIFICATION -,perty Address: 287 MITCHELS WAY HYANNIS 02601 JAN 2 g 2003 ? -ner's Name: RICHARD PI,OTKIN TOWN OF BA t4STAE3LE s;,%ner's Address: BOX 490 HYANNIS MA.`02601 HEALTH DEFT. sate of Inspection: 1/6/03 game of Inspector: (please print) JOHN GRACI fi11AP ompany Name: SEPTIC INSPECTIONS -� Iailing Address: P.O. BOX 2119 TEAT ICKET, MA. 02536 PARCEL — 'LOT i clephone Number: 508-564-6813 FAX 508-564-7270 ..-_'ERTIFICATION STATEMENT certify that have personally in;pected the sewage.disposal�system at this address and that the information reported below is tie,accurate and complete as of the time of the inspection.The inspection was performed based on m) training and Terience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system uispector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes _ Condition J Passes _ Needs F�� er Evaluation by the Local Approving Authority X Fails I tlspector's Signature: P Date: 1%6/03 Ise system inspector shall subi t a copy of this inspection report to the Approving Authority(Board ol'1-lealth or DEP)within 0 days of completing this ins ' ction. If the system is a shared system or has a design flow of 10,000 gird or greater,the uispector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should he c it to the system owner and copies sent to the buyer, if applicable,and the approving authority. Dotes and Comments i HE SYSTEM FAII.S TITLE V INSPECTION.THE LEACH PIT WAS FULL AT THE TIME OF]HE INSPECTION. PIT _.;EEDS TO BE UP(4ADED '-,**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. • Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 287 MITCHELS WAY HYANNIS 02601 Owner: RICHARD PLOTKIN Date of Inspection: 1/6/03 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: THE SYSTEM FAILS TITLE V INSPECTION.THE LEACH PIT WAS FULL AT THE TIME OF THE INSPECTION.PIT NEEDS TO BE UPGRADED. 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. n/a 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: n/a n/a 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 wil i pass inspection if(with approval of Board of Health): 1 _ broken pipe(s)are replaced _ obstruction is removed t _ distribution box is leveled or replaced F ND explain: n/a n/a The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass,3, inspection if(with approval of the Board of Health): i _broken pipe(s)are replaced _obstruction is removed ND explain: n/a Page 3 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 287 MITCHELS WAY HYANNIS 02601 Owner: RICHARD PLOTKIN Date of Inspection: 1/6/03 C. Further Evaluation is Required by the Board of Health: _ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water. _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has aseptic 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 n/a "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: n/a r Page 4 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 287 MITCHELS WAY HYANNIS 02601 Owner: RICHARD PLOTKIN Date of Inspection: 1/6/03 D. System Failure Criteria applicable to all systems: You must indicate"yes" or"no"to each of the following for alLinspections: Yes No X _ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than ''/z day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped nLa. X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _ X Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X 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.] X _ (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: 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 X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X 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. A Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 287 MITCHELS WAY HYANNIS 02601 Owner: RICHARD PLOTKIN Date of Inspection: 1/6/03 Check if the following have been done.You must indicate "yes" or"no" as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks X _ Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection ? X Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up X _ Was the site inspected for signs of break out X _ Were all system components, excluding the SAS, located on site? X _ 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 ? X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? A The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no X Existing information. For example,a plan at the Board of Health. X _ 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 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 287 MITCHELS WAY HYANNIS 02601 Owner: RICHARD PLOTKIN Date of Inspection: 1/6/03 FLOW CONDITION_ S 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: 2 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): NO ciloI Water meter readings, if available(last 2 years usage(gpd#'tea G ':� Sump pump(yes or no): NO Last date of occupancy: n/a CO COMMERCIAL/INDUSTRIAL �� `�`a Type of establishment: n/a Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings, if available: n/a , Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: n/a Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: n/agallons--How was quantity pumped determined? n/a Reason for pumping: n/a TYPE OF SYSTEM X Septic tank, distribution box, soil absorption system _Single cesspool _Overflow cesspool. _Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _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): n/a Approximate age of all components, date installed(if known)and source of information: 1986 Were sewage odors detected when arriving at the site(yes or no); NO h Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 287 MITCHELS WAY HYANNIS 02601 Owner: RICHARD PLOTKIN Date of Inspection: 1/6/03 BUILDING SEWER(locate on site plan) Depth below grade: 12 Materials of construction:_cast iron X40 PVC_other(explain): n/a Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting, evidence of leakage,etc.): TOWN SEPTIC TANK: X(locate on site plan) Depth below grade: 6" Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a ifi ate of Compliance es or no : NO attach a co of certificate If tank is metal list age: n/a Is age confirmed by a Certificate p (y ) ( copy ) Dimensions: 1000 GALLONS" Sludge depth: 6" Distance from top of sludge to bottom of outlet tee or baffle: 28" Scum thickness: 4" Distance from top of scum to top of outlet tee or baffle: 0" Distance from bottom of scum to bottom of outlet tee or baffle: n/a How were dimensions determined: MEASURED Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): THE LIQUID LEVEL WAS OVER THE TEE IN THE SEPTIC TANK DUE TO HYDRAULIC FAILURE IN THE PIT.THE TANK IS STRUCTURALLY SOUND.RECOMMEND MAINTAINING SEPTIC SYSTEM'S EVERY TWO YEARS. GREASE TRAP: .(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): n/a 4 7 1 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 287 MITCHELS WAY HYANNIS 02601 Owner: RICHARD PLOTKIN Date of Inspection: 1/6/03 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX: _(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: n/a 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.): n/a PUMP CHAMBER: _(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a R Page 9 of 1 l OFFICIAL INSPECTION FORM-'NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 287 MITCHELS WAY HYANNIS 02601 Owner: RICHARD PLOTKIN Date of Inspection: 1/6/03 M(SAS): locate on site plan,excavation not required) SOIL ABSORPTION SYSTEM( ) X ( p q ) If SAS not located explain why: n/a Type 1000 GAL 6' X 6' leaching pits, number: 1 n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a innovative/alternative system Type/name of technology: n/a Comments(note condition of soil, signs of hydraulic failure,level of ponding, damp soil,condition of vegetation, etc.): THE LEACH PIT IS IN HYDRAULIC FAILURE.THE PIT WAS FULL AND THE LIQUID WAS OVER THE TEE IN THE SEPTIC TANK AT THE TIME OF THE INSPECTION. BOTTOM AT 7' CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: Wa Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.): n/a PRIVY: (locate on site plan) Materials of construction: n/a - Dimensions: n/a Depth of solids: n/a Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): n/a ' A PagellufII OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 287 MITCHELS WAY HYANNIS 02601 Owner: RICHARD PLOTKIN Date of inspection: 1/6/03 SITE EXAM _Slop _Surface water _Che, 1. cellar Shall+uw wells Estinu.( d depth to ground Nvater 10+feet used to determine the round water elevation:high g Please indicate(check)all methods s g � NO Obtained from system design plans on record- If checked,date of design plan reviewed: n/a YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Idealth-explain: n/a NO Checked with local excavators, installers-(attach documentation) NO Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: HAND AUGER- 10-F FT. e 10 of 1 I itl - OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) i'roperty Address: 287 MITCHELS WAY HYANNIS 02601 Owner: RI(--:HARD PLOTKIN )ate of Inspection: 1/6/03 ,:KETCH OF SEWAGE DISPOSAL SYSTEM Provide a sk,tch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmai r supply enters the building. public Ovate s !,ocate all wells within 100 feet. Locate where pub pp y g rc, q 13 A$ 0 Iy I� E R I i T f!Q. 0,c A.T I o WZ15 cl S E W A G E INSTA!LFs'S NAME ADDRESS 0 UILDE R OR OWNER SATE I- RmIT iSSUF0 ���-� � BATE C 0 M P L I A N C E ISSUED 1 .rl , s`� o S � I G THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............. WG o............OF....... 1w.....l.... Appliratiou for DispaiiFal Works Tantitrurtinu rruat Application is hereby made for a Permit to Construct (/—)"16r Repair ( ) an Individual Sewage Disposal System at: ai t i � ..LAC ",2,-Address _ -•._..-•---•-or Lot No. aOwner ................................Address...............��.�.car--...�7u -........-----------------....------- ------------ -----............---- Installer Address Type of Building Size ...Sq. feet Dwelling No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building No. of persons............................ Showers — Cafeteria a' Other fixtures ------------------------•------------------•------------------------------------------------------------•- d W Design Flow.................�5..................gallons per person per day. Total dai flow........... ....................gallons. WSeptic Tank—Liquid capacity.r .gallons 'Length._ -.�.... Width-__-jK._'!o.. Diameter._...r--._ Depth._..S.' _- x Disposal Trench—No. .................... Width.................... Total Length.........;.--- Total leaching area..................:.sq. ft. Seepage Pit No...........1------- Diameter....../4........ Depth below inlet--l.-.7_..... Total leaching area..tX60.._ Z Other Distribution box ( Dosin tank Percolation ( �� Percolation Test Results Performed by-f3'LGp.Eow_...... SdL7� T............ Date......71� _...__.... a { 11/07.�V2. Test Pit No. 1___�: ._.minutes per inch Dep h of'Tes Pit _._.__ Depth to ground water.. rs, Test Pit No. 2..... .�?!---minutes per inch Depth of Test Pit...... `'. Depth to round water,._ AZ . rx /.c/9.7�/z.._!�-IfE'�....�t=•T�l�i�l/f1.�...���?---.����'i!Y_ __..���!D :� �' O Description of Soil---- _--.�--- ----- W ---------------------10-h' '---- 12 -•------------------ b �zSC=�' L�1 � I nth �2/5�f jZ C din c�/ C 'N <<�1 �--W . t :_ ?S ..0 Nature of Repairs or Alteratio�,—Answer when appl�icable__. S /&0� - �c Agreement: c. b1 The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITI,,. 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance h b en issued by t e board of/healt g •• l In Signed �J ---•-•--- •--•�G Application Approved By............... ------...... ---•----•--•--....._...................._-•--•--•-•- .....-....------V. - ----- Date ------- Application Disapproved for the following reasons-..........................................-...................................................=................. .......-•-•---•--------------•---------•---------------•---.......---------------.........-•---------•----•-------------------------------•--------------------------------------•------•--•------------ - ... . Date PermitNo............. ---.............------..... Issued....................................................... Date t • No........... . JK1 V� Fssr? c .. i4 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH c�Gt)sSJ........I.....OF..........:-:........................ App irtt#inn for M-4vuiitt1 Work i Tongtrnrtiun Vamit Application is hereby made for a Permit to Construct *10*01- Repair ( ) an Individual Sewage Disposal System at: �17C l,1C t c Y'��,1 /8 ........... __. .... ._ ............................ .................................... ...-•-------........----•..........._..... Lo tion-Address or Lot No _ p downer Address Installer Address U Type of Building 2 Size Lot... t�'�pD...Sq. feet Dwelling-No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) a'4 Other—T e of Building No. of persons............................ Showers YP g ---------------------------- p ( ) = Cafeteria ( ) Otherfixtures ---- --------------------------------------•---.---•--•------------•---•---••---•-•••-•-•..._....--- ......--••-----••---....----------•- W Design Flow.................... ..................gallons per person}er day. Total daily flow..........Z2____....__.... galions. ' WSeptic Tank—Liquid capacity.A�Z./).gallons Length..&:4f_-_.. Width----._........ Diameter_.__=.... Depth_. __. x Disposal Trench—No. .................... Width.................... Total Length..................... Total leaching area..--.,...............sq. ft. � Seepage Pit No.......... .......... Diameter.__..gip_._..._. Depth below inlet...._._:..7....... Total leaching`area__-�._l'--........Sq-•ft- Z Other Distribution box ( Dosin tank Percolation Test Results . Performed by.�,GL_r, .C_j =---•-----• Date ifi�7 .vr Test Pit No. 1................minutes per inch .Depth of Test Pit---l9,d_,_:__ Depth to ground water..___.__.._..__._....._. f=, Test Pit No. 2....L'f ...minutes per inch Depth of Test Pit e��_:.. Depth to round water__ ... ./i? PS /.1117-t?l...C{�/F4-- ..........fo�t/U ........E _ v .. O Description of Soil ��i S c'..i fY-�- Jfrr crn�il/tr'' T� )?e* x' J roc c Tyr�v� _ _ .. .--- U ...............` � Q•... .� vr�f0/4 t f�i SO((t/ �Y� ----- n W J...— 'fir'" f s".._.r`r'r r� CG.L PyiJ Y✓1L°� '�i✓/> C_ IG1, t U Nature of Repairs or Alterations t—'Answer when applicable______._ .............................. ._ Y lam- f`L r -"j ._L I N i�✓ar/jZ C_ %i cYV l i(_ (/J VJt t i... '.......................----•-----a,._. --•----•--••......----•---••- . ---------------• ----•-•• -•--- ... - --•- Agreement: — b - - +ice cl l— ( f-rj r,>> f�/,�M I=�r N 1 r ili lr<,K< The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions,of _TlZ 5 of the State Sanitary Code— The undersigned further agrees not to place the system in P operation until jL Certificate of Compliance has been issued by the board of heal l ` Signe :-- .......__ Date Application Approved By.....-.................... ..____...:%l/Ft... . D ate, Application Disapproved for the following reasons:.....................................: -------------------------- c ti c .............................................. Date l Permit No...... ..S,.,:.............n... ---•••-•-•• Issue_ L - -•-- --•- ' Date a ` THE COMMONWEALTH,'OF'MASSACHUSETTS BOARD."'OF HEALTH .........OF..................................................................................... -, � �rr�gf irtt#r of f�lant�littnrr THIS I C.--TO CERTIFY, Thai the Individual Sewage Disposal System constructed ( ) or Repaired ( ) bY-------------------- -•--••..--............•-•-----........••-••-••----•..........------....•-•••-••••.._...••-••-•--...----•-•-••-•-•...........: �l t Installer 1p 'k., . .,/p n, -..--- - ----- ................................................. has been: installed in,accordance with th provisio 1s of TI L j of The State Sanitary Code s described in the application for Disposal Works Construction Permit No.___-_-•_-s ..��`_.__l!�- dated_...:�._._f.'.f.�'�.................. T14E ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM MILL FUNCTION SATISF CTORY. DATE...... .................•---- J y,�A --------••-_. Inspector ._.._•... • -----• --•----•-- ...................... THE COMMONWEALTH OF MASSACHUSETTS i'(_.- �' I ✓ f �������v 2 BOARD OF HEALTH ..........................................OF......---. IV No. .......1 FEE:.:.:, :��........ u . Permission is hereby granted••-• ------.....----•------------------------------------------•--......-----------.......-----.................---•--. to Constrict, ( ) or Repair ( ) an Individual Sewage Disposal System at No..--- ........ jfnn n n,5 ... -------•---------------------------------•-------••-•••••. -- 1 Street / as shown on the application for Disposal Works ConstructionViz______________________ Board of Health DATE........................................ . ---------------••--------•----- *, , FORM 1255 HOBBS & WARREN, INC., PUBLISHERS President: Member of: ROBERT BRUCE ELDREDGE,R.L.S. CAPE COD SOCIETY OF PROFESSIONAL ENGINEERS AND LAND SURVEYORS ELDREDGE ENGINEERING MASS.ASSOC.OF LAND SURVEYORS Associates: ' AND CIVIL ENGINEERS ALBERT A.MORSE,P.E.,R.L.S. COMPANY, INC. AMERICAN CONGRESS ON PHILIP WEINBERG,P.E.,R.L.S. SURVEYING AND MAPPING [J / AMERICAN SOCIETY FOR G,\E9CSEEZE� G/`E9LstEZER TESTING AND MATERIALS 712 MAIN STREET csuavEtjo2s �`•, r, �n9inEE'ts HYANNIS,MASS.02601 TEL.(617)775-2244 May 12 , 1986 Board of Health �^ Town Office 267 Main Street Hyannis, Ma. 02601 RE: Barnstable Holding Co. Inc., Lot 18, Mitchell's Way - Hyannis Job #86027 Gentlemen: A final inspection was made on May 8, 1986 and the results are as follows: DESIGN AS-BUILT Top oflFoundation Elev. 101 .0 Elev. 101 .41 Inv. at;Fbundation 98.0 11 98.2 Inv. at Septic Tank Inlet 97.25 98.0 Inv. at Septic Tank Outlet 97.0 97.7 Inv. at Distribution Box Inlet 96.83 97.6 Inv'. at Distribution Box Outlet " 96.67 " 97.4 Inv. at Leaching Pit 96.6 97.0 Bottom of Leaching Pit 93.0 92.8 The system appears to have been installed substantially in conformance to the minimum design standards specified in the sewerage `plans dated 8/10/85 and drawn by All Cape Survey Consultants, East Falmouth. Sincerely, ELDREDGE ENGINEERING CO., INC. Robert B. Eldredge, R. L. S. President RBE/lld C 'y� ASSESSORS MAP : IAO TEST HOLE LOGS NOTES: `L SrTe PARCEL : r.2 j 1) THE INSTALLATION MUST BE IN SUBSTANTIAL COMPLIANCE WITH FLOOD ZONE : C SOIL EVALUATOR : ) . I"IcyP ,�S CSE THIS PLAN, 1995 MASSACHUSETTS TITLE V & TOWN OF WITNESS : NOT REFERENCE : DATE : �vI KacD �_ BOARD OF HEALTH REGULATIONS. q DATE : NIA 2 Z-oXl �� 152 T "�� 2) THE INSTALLER SHALL VERIFY THE LOCATION OF UTILITIES, PERCOLATION 0 N R A E 2 SEWER INVERTS AND SEPTIC COMPONENTS PRIOR TO CLA-ss --L S0I1. (,7�g(L z v, y INSTALLATION. } TH- I FL. j,t2��, TH-2 3) THIS PLAN SHALL BE USED FOR SEPTIC SYSTEM INSTALLATION (^(JA-My ONLY, AND SHALL NOT BE USED FOR PROPERTY LINE Q,I S't0D On-� DETERMINATION. -I 53 n I 4) ALL PIPING TO BE 4" SCHEDULE 40 @ 1/8 "/ FOOT. (UNLESS g S IDy�-s� N SPECIFIED OTHERWISE) LOCATION MA�p-�S) A 5) THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A 10 GARBAGE DISPOSAL. m'f'D►uA4 7 6) SEPTIC TANKS AND DISTRIBUTION BOXES (WHEN INSTALLED) C SIN f� 2 /4 MUST BE PLACED ON A MECHANICALLY COMPACTED BASE OR ON A BASE OF 6"OF CRUSHED STONE. i 7) 6 K/sp" La,gcfj I:I rr 7d Be Fu M Peo,, C x-L viao Prc--Mw€l2 El!�Wq_C Exjsn (' Si0n�- 74+tiK To BE P-10n9-i� 50" aS StfVPJq- P-,F-KACF-- W/ l)-Svo CRt- S T_(/r- Re wlkip).. WeLLAIW-Z3o SEPTIC SYSTEM DESIGN l rb FLOW ESTIMATE - w1P5- W /� --o� /�RoPoSE0 LE�2t!ti1 - L� I� rr� lVu _ vet le-I<►-�c.�s �>�Nt-..I rTi,�_V_o,�_B�-�KsJ__�q�t�_.�p=----_ BEDROOMS AT 110 GAL/DAY/BEDROOM - 33U GAL/DAY "Few- rb`5e-SSORS P-gc.oR-AS SEPTIC 'TANK J�LGAL/DAY x 2 DAYS - 660 GAL USE I,� GALLON SEPT i C TANK - �ct4T/NCB - PEP ~ !1157 Tom- �CA"I L-�� SOIL AB:�ORPT I ON SYSTEM 5 U �GY� 4u.ot4 �'E-GCA f L E A C M ,4.N 8E2 S e,lOS 2•�� ETV ,ti30�Lx10ivz2l�J SIDE AREA: 32 z +- 10 Z x 2- BOTTOM AREA: 3oxio x o.?,/ = ZZZ.o L? �. aK was r A co rrec f-1 r (o ca`w .. -v-0, yo y pd XISr�N4 Sc�U (- +R-A� 3 l( 30 �' 0 '� �. Sae SEPTIC SYSTEM SECTION ©t Ti.F=Y3.73 �U F =EL q3 7�) a � �i Bc rv1�N r'0 wL ��— ��Cu/e S w ,n � T _/ 4 i of �_ yo of Q I -I^ , u,xc� ► E'`►s"'PITl� 10� 4-1 e /�' 3Rffc 3� Z - Gbc�c k&kt S16 e X: w7i,�8 �10'`` l�s7n � ry � o D-BOX _ — — — 4 1 F+/ SEPT I C TANK ' ' so. 68 6XI S 777 ; .�8 .6�8 Ili (mob v 6141 mM696L(.5 h/Ay �` iskod S' r1z S I New (, 5-00 I-- 30'1- >< /O t tj —I V 3 8, SN OF,{{gs SITE AND SEWAGE PLAN \ 0 EYER N LOCATION : 287 1 fTeP6LL5 WAY ` ��iJo. 1140 Il /STEV'�O SgN1TAR�PN PREPARED FOR : 1 g&H L1-'01L)ST4y6T0'1 'vy DARREN M. MEYER, R.S. SCALE : �(,�, ;� �N� C'v • 43 VINE STREET DATE Z{I17��56 DATE HEALTH AGENT �81B��02� 02332 , . ro INLET KNOCKOUT . / 4'--10„ L OUTLET y. 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UMBE�Q O� BEORODNI5 2 BE.�t/E �4 •SA N O SA,uJ �/ �6 1�x s �� SDP,4�•40/i'S 0 O z34CA',/L L PE/450rV.5 p�R BED.PoO,til Z- s 41 ��.s. �.s. 88`/8 v.s s: ,DA/L Y FLOW 1--Z f��'.PSO�/ .ems 76 x 4 y� �1E.4�t/ COA,QSE GRAit/UL.4� MA C � tL _ , ,v �.i.� 220 coo . 3�• 4. �E30A4R OL f�EAL TN v LEA G!- /!t/G IPEOU/REL7 /4'f (.vgTE2 F'F ly1.o LEACI-11AlG FJROI�/O�Ca -36G' c?o Ml�ST-BE /�1�7T/L/�D !�l/, =•� Tf�E r � .(/o H2 v 8 6 x v ' f/Zo I �vl /5 lIV57AL L ED ,eP, oR TO ICA/-CUL A 7/DNS P�RCO1-A71, t/ RATS �-�f9/N//�G�-/ . �ac/��iLL/rvc Fo,Q-rvs/-�Ecrrorv. �B15�'R!/AT/Dit/S B Y• 50770,NJ 5. 14107E0 AL.L a SYSTEM COWPOit/Eti/TS S/-/.4LZ- t3E A4 TE 725STFD :_7 /8� _ /NSTA LL ED /,�l/ .4C�O,QI�ANCE 1rt//Ty h POL�c�wT f�A�e�e.y ��LN$ERG 9't 1 11.68 IV14 55ACAl,'15,E77_S T/TL..E 17 S41t//TARY t� � Arv,0 LOCH?.'_ 4C/LES '` r yip f Y t �7` ._. __ __ •___X, / PRO�'JS�p DWELL/NGLOG4T/Orc./ Q `! I'ROPo5 i o ..SEWAGE .5 YS•T"E"LOCAT/Div /TCNF1. L -5 WAY _ 6 Tf//SLOT/5 "/w T,yE F�' Oon,�A/N T I /VI/T'C`�EL L IS l/(/�4y — /,v R E Z0 8 � � cARaACE cR �E �iL LET,� IIV57ALLED 0A1 THE Sl-15TEM. f-IIi9N/�/S 7,4 t3L-! , "A SS. �, T4P.1 Y0• -. � it , L�•G�i+i(p T•y/S L bT /S Gv/T�//�cl T.�E T�4sc/ D �.�,�" �. s , SCALe / _,3D . DATF : 8�/0�d'S O.QA vt//il/Git/O 5 _ o /`'� /OD•DO 9P�/STf�BLE Gl/AT�2 C'�f4[J�� 07 7-10A1 ;• ' ! J I co ORA WA.13K G Cl-/�ckE4 B y:/ 11015 1t/O. /���/L�D �D.e c3S/DTh� ie 5• A L L GA PE SVRVE Y C'OIV-5 714/V T JD -A✓.9,Y A L. , M,4 (Z- . '