HomeMy WebLinkAbout0042 OAK HILL ROAD - Health 42 Oakhill kd.,.Hyannis
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 42 Oak Hill Rd
Property Address
William Krenn
Owner Owner's Name
information is required for every Hyannis MA 02601 8-20-14
page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
A. General Information
1. Inspector:
Shawn Mcelroy
Name of Inspector
Upper Cape Septic Services
Company Name
P.O. Box 73
Company Address
E. Falmouth MA 02536
City/Town State Zip Code
1-508-495-0905 S13971
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5 (310 CMR 15.000).The system:
® Passes ❑ Conditionally Passes ❑ Fails
❑ Needs Further EAuation by the Local Approving Authority
8-20-14
t In or's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP.The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use.
t5ins•3113 Title 5 Official Inspection.F r r u urface Sewage Disposal System• ge 1 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 42 Oak Hill Rd
Property Address
William Krenn
Owner Owner's Name
information is required for every Hyannis MA 02601 8-20-14
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
® 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:
System is in good working order with no sign of failure.
B) System Conditionally Passes:
❑ One or more system components as described in the "Conditional Pass"section need to be
replaced or repaired. The system,.upon completion of the replacement or repair, as approved by
the Board of Health,will pass.
Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old" or the septic tank (whether metal or not) is structurally
unsound, exhibits substantial infiltration or 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.
❑. Y ❑ N ❑ ND (Explain below):
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
5
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 42 Oak Hill Rd
Property Address
William Krenn
Owner Owner's Name
information is required for every Hyannis MA 02601 8-20-14
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes (cont.):
❑ Observation of sewage.backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ The system required pumping more than 4times a year due to broken or obstructed pipe(s).The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
a 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
t5ins-3113 Title 5 Official-Inspection Fotm-Subsurface'Sewage Disposal System-Page 3 of 17
1
Commonwealth of Massachusetts
Title 5 Official inspection Form
_ Subsurface Sewage Disposal System form -Not for Voluntary Assessments
M 42 Oak Hill Rd
Property Address
William Krenn
Owner Owner's Name
information is required for every Hyannis MA 02601 8-20-14
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well".
Method used to determine distance:
** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less'than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate "Yes" or"No"to each of the following for all inspections:
Yes No
El ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
Static liquid level in the distribution box above outlet invert due to an overloaded
El ® or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than day flow
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
I
Commonwealth of Massachusetts
_ f Title 5 Official Inspection Form -
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
,M 42 Oak Hill Rd
Property Address
William Krenn
Owner Owner's Name
information is required for every Hyannis MA 02601 8-20-14
page. Cityfrown State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® Required pumping more than 4 times,in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
i
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
1 0,000g pd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303,therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ 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
El El the
— IWPA) or a mapped Zone II of a public water supply well
If you have answered "yes"to any question in Section E the system is considered a significant threat,
or answered "yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
42 ec
M Oak I
Property Address
William Krenn
Owner Owner's Name
information is required for every Hyannis MA 02601 8-20-14
page. City/Town State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate "yes" or"no" as to each of the following:
Yes No
❑ ® Pumping information was provided b the owner, occupant, or Board of Health
Y P
❑ ® Were any of the system components pumped out in the previous two weeks?
❑ ® Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions,depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): 3 Number of bedrooms (actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
m Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
,M 42 Oak Hill Rd
Property Address
William Krenn
Owner Owner's Name
information is required for every Hyannis MA 02601 8-20-14
page. City/Town State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents: 0
Does residence have a garbage grinder? ❑ Yes ® No
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)):
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: 8-2014Date
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203):
Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
t5ins•3M 3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 42 Oak Hill Rd
Property Address
William Krenn
Owner Owner's Name
information is required for every Hyannis MA 02601 8-20-14
page. CitylTown State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
General Information
Pumping Records:
Source of information: N/A
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology.Attach a copy of the current operation and
maintenance contract (to be obtained from system owner) and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank.Attach a copy of the DEP approval.
❑ Other(describe):
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17
Commonwealth of Massachusetts
_ W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�M 42 Oak Hill Rd
Property Address
William Krenn
Owner Owner's Name
information is required for every Hyannis MA 02601 8-20-14
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known) and source of information:
2007
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 24"feet
Material of construction:
❑ cast iron ® 40 PVC ❑ other(explain):
Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
Good condition.
I
Septic Tank(locate on site plan):
Depth below grade: 16"feet
I
Material of construction:
® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions:
1500 gal
Sludge depth:
12"
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
i4
42 Oak Hill Rd
Property Address
William Krenn
Owner Owner's Name
information is required for every Hyannis MA 02601 8-20-14
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle
20"
Scum thickness lit
Distance from top of scum to top of outlet tee or baffle Err
Distance from bottom of scum to bottom of outlet tee or baffle
15"
How were dimensions determined? Tape
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tank is in good condition with baffles installed and no sign of leakage.
Grease Trap (locate on site plan):
14
Depth below grade: feet
Material of construction:
concrete metal fiberglasspolyethylene other(explain):
❑ ❑ ❑ 9 ❑ ❑
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
t5ins-W3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17
i
. Commonwealth of Massachusetts
F Title 5 Official Inspection Form
Im o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
s 42 Oak Hill Rd
Property Address
William Krenn
Owner Owner's Name
information is required for every Hyannis MA 02601 8-20-14
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity:
gallons
Design Flow:
gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
*Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 42 Oak Hill Rd
Property Address
William Krenn
Owner Owner's Name
information is
required for every Hyannis MA 02601 8-20-14
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert 0
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
Good condition with water at working level and no sign of back-up from chambers.
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
Alarms in working order: ❑ Yes ❑ No*
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
* If pumps or alarms are not in working order, system is a conditional pass.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17
. Commonwealth of Massachusetts
F Title 5 Official Inspection Form
IR o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
,M s 42 Oak Hill Rd
Property Address
William Krenn
Owner Owner's Name
information is required for every Hyannis MA 02601 8-20-14
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
® leaching chambers number: 2-500's
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Leach chambers in good condition and empty at inspection with stain line at 3"off bottom of chamber.
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number.and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
t5ins•3113 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 13 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
42 Oak Hill Rd
Property Address
William Krenn
Owner Owner's Name
information is
required for every Hyannis MA 02601 8-20-14
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy (locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17
Commonwealth of Massachusetts
F Title 5 Official Inspection Form
a
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
42 Oak Hill Rd
Property Address
William Krenn
Owner Owner's Name
information is required for every Hyannis MA 02601 8-20-14
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
® hand-sketch in the area below
❑ drawing attached separately
.
_ r % .
30
36
Lv +f
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
c�M 42 Oak Hill Rd
Property Address
William Krenn
Owner Owner's Name
information is required for every Hyannis MA 02601 8-20-14
page. CitylTown State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
❑ Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow wells
Estimated depth to high ground water: 12'
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:
You must describe how you established the high ground water elevation:
Original design plans show no groundwater at 12'.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
Commonwealth of Massachusetts
m F Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�qM 42 Oak Hill Rd
Property Address
William Krenn
Owner Owner's Name
information is required for every Hyannis MA 02601 8-20-14
page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary: A, B, C, D, or E checked
® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed
® System Information—Estimated depth to high groundwater ,
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17
TOWN OF BARNSTABLE
LOCATION Yt� ,0,4 IL I' , I I 12 J SEWAGE# 417- `/rGo
WLLAGE ASSESSOR'S MAP&PARCEL
INSTALLERS NAME&PHONE NO. 4&')Lfl
SEPTIC TANK CAPACITY /SUf:
LEACHING FACILITY.(type) Q) SClca LC 1Y,U (size) / 3 X .S^
NO.OF BEDROOMS 3
OWNER 1Ur 111aPIA , �CtA tin
PERMIT DATE: 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 ,
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U THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Application for lhoo!ml *patent Con0truction Permit
Application for a.Permit to Construct( ) Repair( ) Upgrade(%/Abandon( ) L9.Complete System ❑Individual Components
Location Address or Lot No. -1'Z Owner's Name,Address,and Tel.No. W'06Z WK 4�re--t vl
Assessor's Map/Parcel �( 1���
-i WA
Installer's Name,Address,and Tel.
No. &jp4'f4AAhCk¢ L; 4 ei(j''Kf Designer's Name,Address and Tel.No. C`�(� �l j`14
Type of Building:
Dwelling No.of Bedrooms Lot Size 12 12T0 sq. ft. Garbage Grinder ( )
Other Type of Building S i I Y2 4 Lj No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) '3 3 n gpd Design flow provided 3 gpd
Plan Date Number of sheets Revision Date
Title Lo L
Size of Septic Tank ( !p0 Type of S.A.S.
Description of Soil
1
Nature of Repairs or Alterations(Answer when applicable) 11-Oo vt(04%A k C2, y j►� (,C,
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 Certificate of
Compliance has been issued by this Boar Health.
Signed Date 1 b/f c, J'-DO-7
Application Approved by Date )0-to — y 7'
Application Disapproved by: Date
for the following reasons
Permit No. d� �� — S� Date Issued �d (0
_ - - .. 4��r•r.-��"•-'��y..<�«t' fu.Fti ` ..,,. _. . .r. . . •l. -. r rw. .. 'v51+..,�^•,, ,-. ..�"�.-y`4~. ` •
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^ Q ✓
No. O` Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS- Yes
application for �h5pogal *patent Conoructiou Permit t
Application for a Permit to Construct O Repair O Upgrade(L)'/Abandon O 19"Complete System ❑Individual Components r
Location Address or Lot No. Gr Z o 4 k i4 r 1( Xj.4j Owner's Name,Address,and Tel.No. W.1 vl q
Ij Assessor's Map/Parcel
') Installer's Name,Address,and Tel.No. �Q''�`^�iCL� t!1�n1t✓P�/rj Designer's Name,Address and Tel.No.
94 ZY+wrt4 r�-C�+ 1
Type of Building:
_c II
Dwelling .i No.of Bedrooms Lot Size, l 2. t"2.$O ,a sq.ft. Garbage Grinder ( )
Other Type of Building s 4-3.n-- No.of Persons Showers Cafeteria
ttic
Other Fixtures`
Design Flow(min.required) 3 (7 gpd Design flow provided 35 " gpd I
Play Date ��� ZpQ Number of sheets Revision Date
} Title L ',, O k� y`
Size of Septic Tank ( 5 O� Type of S.A.S. S �" C�n( l.•L• w�s'Cz''
Description of Soil wW'1
i
Nature of Repairs or Alterations(Answer when applicable) t,5-00 5 `Tq'yt,t Y, (2 5bca 1►'s( c,(-,
Date last inspected:
Agreement:
i
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Boar f Health. -
Signed �' Date jc>�!0)
�T
Application Approved by Date )0 !0' y
Application Disapproved by: Date
for the following reasons
Permit No. 9 DD,:� S�- - - .Date Issued �U- (•� v _ _ .__, i
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded (V)
Abandoned( )by 64*,,4..!c+ �"k P✓I S-C
at u Z a At. Lts,t A_"A has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. a0 0'f-- 145 ro dated )O-ld
Installer ..A � ,/���t> Designer 4,aiO4 Z r 1,:x J 3 LX)Ll 1►-�,� �l
#bedrooms Approved design flow / gpd
I¢ The issuance of this permit shall not be construed as a guarantee that the system w"ll fu ction as de ned.� ;�f�
Date -- f l� � �osS Inspector %
j —————----,—jl ----—----- ---------- _---
i
No. D Fee 10-0
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS
r
I=i!gpo$a[ *p.5tem 'Con5tructionPermit
Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( Abandon ( )
System located at d 64,- uy k
1
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty
to comply with Title 5 and the following local provisions or special conditions.
Provided: Construction must be completed within three years of the date of this permit.
Date (�- i U- b Approved by j
. I
i S
oFz Ta,, Town of Barnstable
tiP� �s
Regulatory Services
• snaxsrns[.E. +
9 bL4s& Thomas F. Geiler,Director
qjA 039. �0
TFo �° Public Health Division
Thomas McKean, Director
200 Main Street,Hyannis,NIA 02601
Office: 508-862-4644 Fax: 508-790-6304
Designer Certification Form
w
Date:
Designer: !.; CI_ t� 't,�l ,_C� (,IN__�,,'
Address:
On " ��'�� (1 `;J - was issued a permit to insg_,ll a c
(date) —� (installer) p '
septic system at �,� L [z�`., A ! based on�a design I drew,
(address) kcL�•
dated 1b-�-�;�
+ . I certify that the septic system referenced above was installed substantially
according to the design.
I certify that the septic system referenced above was installed with changes but in
accordance with State & Local Regulations. Revision or certified as-built by
designer to follow.
OF bf�
0 RICHARDJAMES
GJ'
U BERTRAND co
f
NO
O 9.Q/STES
` t
SS
( esigner's Signature)
IOY,AL( amp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION.
CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS
FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE
PUBLIC HEALTH DIVISION. THANK YOU.
Q:Health/Septic/Designer Certification Form
No. 4W 5 Fee Cx+
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MAS$ACHUSETTS
Zipprttation for MigooaY ip�tent `�Cot� truce ott ernYft
Application for a Permit to Construct( )Repair( )Upgrade( )Abandon(;`j El Complete System I J Individual Components
Location Address or Lot No. Owner's Name;Address and Tel.No'y�,I
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. 6 a- q c t j 'a Designer's Name,Address and Tel.No.
Ate_)
Type of,Building:
Dwelling' No.of Bedrooms Lot Size sq.t.. Gaibage 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 TI pe of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) r
n `
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 bee ued by th' Boar of Heal h.
Si ed Date S
Application Approved b -Date 6 s
Application Disapproved for the following reasons
Permit No. ,r�w 0�7 Date Issued
s Fee C
No.
THE_COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE.MASSACHUSETTS
01pprication for Miopaal *p5tem Con!6truction Vomit
Application for a Permit to Construct( . )Repair( )Upgrade( )Abandon( H' O Complete System E14vidual Components
Location Address or Lot No. >;2 O Ow 's Name Address and el.No.
Assessor's Map/Parcela.' 4/0 Qg [J
Installer's Name,Ad ss,and T 3 6,a— —1 ct a Designer's Name,Address and Tel.No.
1
d'
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
r`*
Nature of Re airs or Alterations( nswer wheA app1' able)
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 bee� sstaed y t ' oard He th 6 /
Signed' Date 61151 -5 ,
Application Approved b Date
PP PP Y
Application Disapproved for the following reasons
Permit No. 00 5 Date Issued b I �.�
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
(Certificate of (Compliattce
THIS IS TO CE TIF?�, 11 t the On i Sewage Disposal System Constructed( )Repaired ( )Upgraded,( )
Abandot}ec ,( y
at Kam(, has been'construc ed 'n ac o dance
with the provision�jf 'tle 5 and th forpisposal System Construction Permit No.
Installer .V Designer
The issuance of this a�Ws, ll not be construed as a guarantee that the sy t m 1` tnction as desi ned.
Date 6 f r Inspector�e
�. _-_--_— - ---=-----------
No. � S s��� ————.—--_——Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
Migozal *pgtem Construction Permit
Permission is hereby grante jto nst ct( e atr�J�]Upgrade( Abandon
System located at (�1'C7t
I
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 m t be completed within three years of the d of of this per '
Date: V J)5 15 Approved
l
Town of Barnstable
NAM
nnzsenar,�,
��� Board of Health
200 Main Street, Hyannis MA 02601
Office: 508-862-4644 Susan G.Rask,R.S.
FAX: 508-790-6304 Sumner Kaufman,MS
Wayne Miller,M.D.
June 10, 2005
Mr.Robert Paolini
P.O. Box 66
Centerville, MA 02632
Dear Mr. Paolini, r
You are granted a one year extension on behalf of your client, William Krenn,to replace
or upgrade a single cesspool system connected to a clothes washing machine located at 42.
Oak Hill Road Hyannis. This extension is granted until July 1, 2006.
This extension is granted because the State has had some discussion of allowing filter(s)
for this type connection. Your application will be reviewed again in one year. At that
time, you should be prepared to present any cesspool pumping records, reports of any
overflows, any back-ups, or any other environmental or public health hazards associated
with this system.
Sincer ly yours,
Wayne iller, M.D., Chairman
Board o Health
I
DIME r�
Town of Barnstable
FAAY,,'� Board of Health
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Susan G.Rask,R.S.
FAX: 508-790-6304 Sumner Kaufman,MS
Wayne Miller,M.D.
June 10, 2005
Mr. Robert Paolini
P.O. Box 66
Centerville, MA 02632
Dear Mr. Paolini,
You are granted a one year extension on behalf of your client, William Krenn, to replace
or upgrade a single cesspool system connected to a clothes washing machine located at 42
Oak Hill Road Hyannis. This extension is granted until July 1, 2006.
This extension is granted because the State has had some discussion of allowing filter(s)
for this type connection. Your application will be reviewed again in one year. At that
time, you should be prepared to present any cesspool pumping records,reports of any
overflows, any back-ups, or any other environmental or public health hazards associated
with this system.
Sincer ly yours,
Wayne iller,M.D., Chairman
Board o Health
ly
DATE:
FEE: -n
BARNSTABM
REC. BY
Town of Barnstable sCHED.
Board of Health
200 Main Street,Hyannis MA 026.01
Office: 508-862-4644 usan �mi ' I
FAX: 508-790-6304 Sumneran,M.S.P.H.
Wayne A.Miller,M.D.
VARIANCE REQUEST FORM
LOCATION
Property Address: 43,
Assessor's Map and Parcel Number: y . Size of dt. .a �i P
^vim
Wetlands Within 300 Ft. Yes Business Name:
No Subdivision Name: %j t
QpPLICANT'S NAME: Ct<nPl;' '1,, C.Phone $-
Did the owner of the property.authorize you to represent him or her? . Yes X No CO
PROPE_M OWNER'S NAME CONTACT PEEN__ c7 rn
°° �� ll
Name:Wtll �1'Yl ��.11n Name: 9
Address: Address: PD, 50A t
Phone: Phone: $O 6 7 5
CE Ol ltE(i T (List Res.) FO (May attach if morg space needed)
��ON C
NATURE OF WORK House Addition ❑ ????? House Renovation ❑ Repair of Failed Septic System ❑
Checklist (to be completed by office staff-person receiving variance.request application)
Please submit copies in 4 separate completed sets.
_ Fouu(4)copies of the completed variance request form
_ Four(4)copies of engineered plan submitted(e.g.septic system plans)
_ Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans)
_ Signed letter stating that the property owner authorized you to represent him/her for this request
_ Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense.
(for Title V and/or local sewage regulation variances only)
Full menu submitted(for grease trap variance requests only)
C:\Documents and Settings\decollik\Local Settings\Temporary Internet Fi1es\OLK3\VARIREQ.DOC
I
u
61-41 69'h Lane
Middle Village, NY 11379
March 22, 2005
A..A
To the Town of Barnstable:
We are the owners of 42 Oak Hill Road, Hyannis, MA 02601.
F We give..Macomber & ;ion Inc:;the original inspectors of the septic
system, permission to represent us in filing a variance at your next
meeting regarding said cesspool system.
Thank you for your kind,consideration of this matter.
Sincerely,
G2�
William & Mary Ann Krenn
i
AiLrANL5
" �
.\ COMMONWEALTH OF MASSACHUSETTS
r EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
TITLE 5 �ik
r S w�
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY AS,�SMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION FAILED INSPECTION
Property Address: 42 Oakhill Road
Hyannis,Mass
Owner's Name: Barbara Gerkt-n
Owner's Address: Sam —
Date of Inspection: 29 01 --
RECEIVED
Name of Inspector: (please print) J P Macomber Jr
Company Name;Joseph P. macomber & Son Inc
Mailing Address: Box 66 ,1UL 5 2001
Centerville Ma 0 632
Telephone Number: TOWN OFBARNSTABLE
HEALTH DEPT.
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP
approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system:
;/—Zses
Conditionally Passes
^_ Needs Further Evaluation,by the Local Approving Authoriry
_ Fail
Inspectors Signatu?ubmit
/� Date:
The system inspector shaa copy of this inspection report to the Approving Authority(Board of Health or
DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000
gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving
authority.
Notes and Comments
****This report only describes conditions at the time of inspection and under the conditions of use at that
time.This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Title 5 Inspection Form 6/1,5/2000 page I
Paee 2 of I I '
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 42 Oakhill Road
Hyannis-;Mass-
Owner: Barbara Gerken
Date of Inspection: 6 29 01
Inspection Summary: Cbeck A,B,C,D or E/ALWAYS complete all of Section D
A. System Passe
have not foun any information which indicates that any of the failure criteria described in 310 CMR
15.303 or in 310 15.304 exist. Any failure criteria not evaluated are indicated below.
Comments:
None
B. System Conditionally Passes:
-Vb 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" lease
explain. p
.,d&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 exfilrration 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 sepric tank will pass inspection if it is structwally sound, not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
4!6 Observation of sewage backup or break out or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with
approval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
_ distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will
pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
_ obstruction is removed ,r-
ND explain:
2
r
f
' Page 3 of I I
OFFICIAL INSPECTION.FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 42 Oak Hill Road
Hyannis,Mass.
Owner: Barbara Gerken'
Date of lospectioo: 6/29/01
C. Further Evaluation is Required by the Board of Health:
O 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.
I. 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 envirooment:
NV Cesspool or privy is within 50 feet of a surface water
4 6 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:
4_ The system has se tic d soil absorption system (SAS) and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supply.
444UC The system has a tic tank nd SAS and the SAS is within a Zone I of a public water supply.
4Atj,CThe system has a septic nd SAS and the SAS is within 50 feet of a private water supply well.
�iJfrhe system has a c tic Pethcd
nd SAS and the SAS is less than 100 f et but 50 feet or more from a
private water suppl tell 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 rriggered. A copy of the analysis must be attached to this form.
3. Other:
This is a sewage system.There are two 6 'X8 ' block cesspools
in the rear. These handle the bathrooms only�T-ieftis a
6 'X8 ' block cesspool in the front yard. This handies the
grey water only.Laundry and kitchen.
3
Page 4 of I I
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 42 Oak Hill Road
Hyannis,Mass.
Owner: Barbara Gerken
Date of inspection: 6/29/01
D. System Failure Criteria applicable to all systems:
You must indicate 'yes"or"no" to each of the following for all inspections:
Yes No /
]!�4ackvp of sewage into facility or system component due to overloaded or clogged SAS or cesspool
ischarge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
�ii✓� - Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
�squid depth in cesspool is less than 6"below invert or available volume is less than 'A day Dow
equired pumping more than 4 times in the last year NOT to clogged or obstructed pipe(s). Number
- �of times pumped Q .
�y portion of the SAS, cesspool or privy is below high ground water elevation.
y portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
�,,water supply.
y portion of a cesspool or privy is within a Zone I of a public well.
�^y portion of a cesspool or privy is within 50 feet of a private water supply well.
A-'Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis. (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.)
_,oVO (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 now 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
_ �e system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(interim Wellhead Protection Area— IWPA)or a mapped
Zone II of a public water supply well
if you have answered "yes" to.any question in Section E the system is considered a significant threat, or answered
..yes" in Section D above the large system has failed.The owner or operator of any large system considered a
significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304. The system owner should contact the appropriate regional office of the Department.
4
Page 5 of I 1
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address:42 Oakhill Road
Hyannis,Mass.
Owner: Barbara Gerken
Date of Inspection:6 29 01
Check if the following have been done. You must indicate"yes"or"no" as to each of the following:
Yes No
Pumpine information was provided by the owner, occupant, or Board of Health
i/ 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,]&/Iuding the SAS, located on site ?
Were the e tic tank anholes 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 ?
Pl _ Was the facility owner(and occupants if different from owner)provided with information on the proper
maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has been determined based on:
Yes no
Existing information. For example, a plan at the Board of Health.
Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable) (310 CMR 15.302(3)(b))
I
5
I ,
Page 6 of 1 I
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Add ress:42 Oak Hill Road
Hyannis,Mass.
Owner:Barbara Geken
Date of Inspection: 6 29 01
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): ✓� Number of bedrooms(actual):
DESIGN flow based on 310 Cl 15.203 (for example: 110 gpd x# of bedrooms): x&1
Number of current residents:
Does residence have a garbage grinder(yes or no): As
Is laundry on a separate sewage system (yes or no):W'� (if yes separate inspection required)
Laundry system inspected (yes or no):Y&iC
Seasonal use: (yes or no):YfJ
Water meter readings, if available (last 2 years usage(gpd)): /' /.q.., z" 69 7; � 9.6 0.
Sump pump(yes or no): VO e��� — 'l�DQ'l 7? i •Q�f,�
Last date of occupancy:
COMM ERCLALJINDUSTRIAL
Type of establishment:
Design now(based on 310 CMR 15.203): z,l4 gpd
Basis of design flow(seats/persons/sgft,etc.): 41A
Grease trap present (yes or no): 0,10
Industrial waste holding tank present (yes or no):,j./d
Non-sanitary waste discharged to the Title 5 system (yes or no):A&,
Water meter readings, if available:
Last date of occupancy/use:
OTHER (describe):
GENERAL INFORMATION
Pumping Records
Source of information:
Was system pumped as part of the inspection(yes or no):
If yes, volume pumped: _gallons -- How was quantity pumped determined? �1d9
Reason for pumping:
TYPE OF SYSTEM
/Lb Septic tank, distribution box, soil absorption system
Single cesspoo&
Overflow cesspool
Privy
/L Shared system(yes or no)(if yes,attach previous inspection records, if any)
4,1 Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
4dl Tight tank M Attach a copy of the DEP approval
Other(describe):
Approximate age of all components, date installed (if known)and source of information:
/SOS�r
Were sewage odors detected when arriving at the site(yes or no):
6
'Page 7 of I I
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 42 Oak Hill Road
Hyannis,Mass,
Owner: Barbara Gerken
Date of Inspection:6/29/01
BUILDING SEWER (locate on site plan)
G-
Depth below grade: �r�'
Materials of construction: !/cast iron VA40 PVC other(explain):mdk�zA rq
Distance from private water supply well or suction line: /.O -
Comments(on condition of joints, venting, evidence of leakage,etc.):
Joints appear tight.No evidence of leakage _System is vented
through 'the house vent.
SEPTIC TANKtjdj locate on site plan)
Depth below grade: A
Material of construction:/pconcrete VAmetal,&�Afiberglass,(.LiQpoIyethylene
4M—other(explain)
If tank is metal list age: j2d Is age confirmed by a Certificate of Compliance (yes or no)* (attach a copy of
certificate)
Dimensions: 42
Sludge depth: �)
Distance from top of sludge to bottom of outlet tee or baffle: IV4
Scum thickness: _ M
Distance from top of scum to top of outlet tee or baffle: AM
Distance from bottom of scum to bottom of outlet tee or baffle: .fllf
How were dimensions determined: &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.):
SPp ti r tank is not p rPCPni The maul casspool and gray—Water
cesspool- cL0111-d be pumpedevery 2-3 years.
GREASE TRAPA4&(locate on site plan)
Depth below grade:4A
Material of construction:,4concrete4AmetaWAfiberglas�polyethylenelother
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:— dz/
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:—�6
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert, evidence of leakage, etc.):
Grease trap is not present
7
• Page 8 of 1 I
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 42 Oak Hill Road
Hyannis,Mass.
Ownersarbara Gerken
Date of Inspection: 6/2 9/01
TIGHT or HOLDING TANK41,01te—(tank must be pumped at time of inspect ion)(locate on site plan)
Depth below grade:4
Material of construction: t1 0 concrete metal 41,4 fiberglass A{* polyethylene,IA!L_other(explain):
who
Dimensions: 42A
Capacity: ,y/A gallons
Design Flow: 10 gallons/day
Alarm present (yes or no): _4L4
Alarm level: &A Alarm in working order(yes or no):
Date of last pumping: ,dZd
Comments(condition of alarm and float switches, etc.):
Tight or holding tanks are not present.
DISTRIBUTION BOX4&L(if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert:
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of
leakage into or out of box, etc.):
ni sg -ri hnt-i nn hnx is,—not presppnt
PUMP CHAMBERI. e-r-(locate on site plan)
Pumps in working order(yes or no):_AA
Alarms in working order(yes or no): _"
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
Pump chamber is not present.
' f
8
I
Page 9 of 1 1
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 42 Oak Hill Road
Hyannis,Mass.
Owner: Barbara Gerken
Date of Inspection: 6 29 01
SOIL ABSORPTION SYSTEM (SAS): Zoocate on site plan,excavation not required)
If SAS not located explain why:
'Located. System -consists of two 6 ' X8 ' Mock cesspools for
the septage_Overfl caw is dry and is stc)nerl nacker3 Proni- c-psic non
is for grey water only.
Type
leaching pits,number: d
A-)O leaching chambers, number:0
A-90 leaching galleries,number: 0
leaching trenches,number, length: �0
leaching fields,number, dimensions:
overflow cesspool, number: `
ND innovative/alternative system Type/name of technology: � '�
Comments (note condition of soil, signs of hydraulic failure, level of ponding,damp soil, condition of vegetation,
etc.):
Loamy boney sand to fine sand.No signs of hydraulic failure or
ponding. Soils are dry.Vegetation is ngrmal.
CESSPOOLSV---"(cesspool must be pumped as part inspection)(locate on site plan)
� � _
Number and configuration: �°�+ll1�lY' ��
Depth-top of liquid to inlet inv�`: is �~ �
Depth of solids layer: _
Depth of scum layer:r
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.):
Same as above
PRIVY,,f�(locate on site plan)
Materials of construction:
Dimensions: W14
Depth of solids: ill
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.):
Privy is not present
9
Page 10 of I 1
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 42 Oak Hill Road
myannisi
S.
Owner: Barbara Gerken
Date of Inspection:
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building.
Alt
ti
0
10
Page I 1 of 1 I
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 42 Oakhill Road
Hyannis,Mass.
Owner:Barbara Gerken
Date of Inspection: 6/29?01
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water 4; feet
Please indicate (check)all methods used to determine the high ground water elevation:
.,Obtained from system design plans on record - If checked, date of design plan reviewed:
Observed site(abutting propSem44,dbservation hole within ISO feet of SAS)
ecked with local Board of Health-explain:
T Checked with local excavators, installers- (attach documentation)
Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Map-Used water contoLrs
9 Mi l l Fs MnHel
1 /1ti / d
Il
i+*ar+.-rtrr'•-.•R-arn:+en•ntrrt/rnrtal'Tre>.Rrrr+et�errrrnTAa n�rR7J1+s'Str�llrt l�T �.�.��..-. r. .
IUHN OF Barnstable WARD OF HEALTH
`
1
0 SUIISURFACF SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION I
-•rn-T"".'a-T.Iti.�.�aTtT T.f11'R.'RIT�RIIe►Ia+rlrn:r.\7-'ivtR' wRwT-T�ww� �7 t�n1 •Trrr•Tr-�. �..A
-TYPE OR PRINT CI.EARLY-
P/IOPERTY INSPECTED
STREET ADDRESS 42 Oak Hill Road Hyannis,Mass.
ASSESSORS MAP, BLOCK AND PARCEL
OWNER' s NAME Barbara Gerken
PART D - CERTIFICATION
NAME OF INSPECTOR Joseph P. Macomber Jr..
COMPANY NAME Joseph P. Macomber V ion Inc
COMPANY ADDRESS Box 66 Centerville Ma 02632
Street Town or City State t(p
COMPANY TELEPHONE (508 ) 775 - 3338 FAX ( 508 ) 790- 1578
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposaj system at
this address and that the information reported is true , accurate , and
omplete as of the time of inspection , The inspection was performed and any
recommendations regarding upgrade , maintenance1 and repair are consistent
with my training and experience in the proper function and maintenance of on-
site sewage disposal systems ,
• n i II ;� I,
Check one ;
System: PASSED
The inspection which I have conducted has not found any information
which indicates that the system fails to adequately protect public
health or the environment as defined in 310 CMR 151303 . Any failure
criteria not evaluated are as stated in the FAILURE CRITERIA section of
this form ,
System FAILED*
The inspection which I have con tcted has found that the system fails to
Protect the public health and the environment in accordance with Title
5 , 310 CMR 16 , 303 , and as specifically noted on PART C - FAILURE
CRITERIA of this inspection form ,
Inspector Signature WDate
ne copy of this rtification must be provided to the OWNER, the BUYER
( where applicable ) and the BOARD OF HEALI'll.
* If the inspection PAILED, the owner or operator shall upgrade ' the eyetem
within one year of the date of the inspection , unless allowed or required
otherwise as provided in 3.10 CHR 16 , 306 ,
partd , doc
oFT"E Torf, Town of Barnstable �, �
ti
Regulatory Services 9�s ;� J
BARNSTABLE, * Thomas F. Geiler, Director
MASS.
°b 1639. Public Health Division 4-1 -tk- ®tom
ArF pia Thomas McKean,Director
200 Main Street,Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
William&Mary Ann Kren
6141 69th Lane
Middle Village,NY. 11379
NON-COMPLIANCE WITH STATE ENVIRONMENTAL CODE TITLE V.
The septic system owned by you located at 42 Oakhill Road Hyannis was inspected on, 6/29/2001
by Joseph Macomber a Massachusetts licensed septic inspector.
The inspection of your septic system showed.that your system has failed under the guidelines of
1995 TITLE 5 (310 CMR 15.00) due to the following:
Single cesspool
Our records show that the system has been in a failed state for more than two years:
You are ordered to hire a professional engineer or registered sanitarian to prepare a plan of
proposed replacement septic system component(s):: This plan is to be submitted to the Town of
Barnstable Public Health Division Office (Regulatory Services,200 Main Street,Hyannis),within
(90) days receipt of this letter. The plan will bring the septic system into compliance with 310 CMR
15.00, The State Environmental Code, Title V.
You are a lso o rdered t o u pgrade o r r eplace t he s eptic s ystem w ithin s ix months (180) days o f y our
receipt of this letter.
Any person aggrieved by any order issued by the local approval authority may appeal to any c ourt o f
competent jurisdiction as provided for by the laws of the Commonwealth. You have the option of
requesting an adjudicatory hearing pursuant to 310 CMR 15.422
Failure to comply with this order will automatically result in a public hearing scheduled before the Board
of Health.
ER T BOARD OF HEALTH
Thomas A. McKean,R.S.,
Agent of the Board of Health
CC: Board of Health
1/failed_septic_letten
Barnstable Assessing Search Results Page 1 of 2
1
Home: Departments:Assessors Division: Property Assessment Search Results
2 OAK
Owner:
KRENN,WILLIAM &MARY ANN property Sketch Legere!
Map/Parcel/Parcel Extension
248 /084/
Mailing Address
KRENN,WILLIAM &MARY ANN
6141 69TH LN
MIDDLE VILLAGE, NY. 11379
2005 Assessed Values:
.sue
Appraised Value Assessed Value
Building Value: $ 163,300 $ 163,300
Extra Features: $2,400 $2,400
Outbuildings: $0 $0
Land Value: $ 181,100 $ 181,100 Interactive Property Map: ap requires Plug in:
Totals:$346,800 $346,800 1 have visited the maps before �"R�zw ,
Show Me The Map .
April 2001 photos available
.dales History:
Owner: Sale Date Book/Page: Sale Price:
GERKEN,J HARRY JR& BARBARA M 10/15/1982 3584/262 $62,500
KRENN,WILLIAM& MARY ANN 10/1/2001 14287/310 $245,000
2005 REAL ESTATE Tax Information: Tax Rates: (per$1,000 of valuation)
Land Bank Tax $62.94 Town Fire District Rates Other F
$6.05 Barnstable-Residential $2.12 Land B.
Barnstable-Commercial $2.80
Hyannis FD Tax(Residential) $527.14 C.O.M.M.-All Classes $1.01
Cotuit FD-All Classes $1.28
Town Tax(Residential) $2,098.14 Hyannis-Residential $1.52
Hyannis-Commercial $2.39
W Barnstable-Residential $1.44
W Barnstable-Commercial $2.10
Total: $2,688.22 Due to rounding differences these values may vary
,http:Hvwww.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/A... 2/2/2005
Barnstable Assessing Search Results Page 2 of 2
Land and Building Information
Land Building
Lot Size(Acres) 0.28 Year Built 1961
Appraised Value $ 181,100 Living Area 1946
Assessed Value $ 181,100 Replacement Cost$201,587
Depreciation 19
Building Value 163,300
Construction Details
Style Cape Cod Interior Floors Hardwood
Model Residential Interior Walls Drywall
Grade Average Plus Heat Fuel Gas
Stories 1 1/2 Stories Heat Type Hot Water
Exterior Walls Wood.ShingleClapboard AC Type None
Roof Structure Gable/Hip Bedrooms 3 Bedrooms
Roof Cover Asph/F Gls/Cmp Bathrooms 1 1/2 Bathrms
Total Rooms 5 Rooms
Extra Building Features
Code Description . Units/SQ ft Appraised Value Assessed Value
FPL2 Fireplace 1 $2,400 $2,40.0
Property Sketch Legend
BAS First Floor, Living Area FST Utility Area(Finished Interior) UAT Attic Area(Unfinished)
BMT Basement Area(Unfinished) FTS Third Story Living Area(Finished) UHS Half Story(Unfinished)!
CAN Canopy FUS Second Story Living Area(Finished) UST Utility Area(Unfinished)
FAT Attic Area(Finished) GAR Garage UTQ Three Quarters Story(Unfinished)
FCP Carport GRN Greenhouse UUA Unfinished Utility Attic
FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story(Unfinished)
FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck
FOP Open or Screened in Porch TQS Three Quarters Story(Finished)
http://www.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/A... 2/2/2005
yl
Septic Inspection Information
DataEntry Date 9/12/2001 S�pt�c Inspect Pla
r-� -�
Assessors MaP 248 'Parcel,.
� 084 Loot..
B ess:
Numbers :` `
��� 42 Address:. Oakhill Road
f V Ilage H annis
3,,zlnspector;E Joseph Macomber
Inspect date 6/29/2001Y tam Statu"s F
Commegt Single Cesspool at rear for gray water not acceptable in
Barnstable Fail per order of Dave Stanton 9/16/02
Permit#- Repai ®at
NotificatioriDa a �Erigllnstaller
Re irDeadl ne Date
toWN.OF BARNSTABLE
FSSows MAC'
INSTALLER'S LER'S NAME Sc KI ONE AN4
SEIr AC 'X AN C.AI'AC1TX J'rC1 ez
LEACi1GACETTX . p�)
i 1EtN�ITDAU-1 r ; ._ y OIDOUANCEPF.'I'1.
Sapt�ntaost�Rt,tattqu l�t:t�rr�ert t�ao ;
I lV�axfinum� JusCcd C�tauisdw.a(a,- 'Meta tic
l3ouomgi'Lcttc;htn N�ir,iUty .-
ifaly t�'1tttc r Sgll�ly 141I.itiiCl f.Ca(;htteg aoeltty (a.61y*alls
a�.eitb a►<wi�ttn,�qR sect ai:laasEiir►�fstciUty)
,ctui c5it w&Wid acid UACIU9 F841 @y(Y.L'any alapd:s exile E'ee9,
ti�itlaiaa 3QQ fc a2 t lencliing 4itailsty C �
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';DLO-CAT ION SEWAGE PERMIT NO.
VILLAGE
Inc S°
1NS LLER'S NAME & ADDRESS
FloTt5 Alc.
Q u r n c Q OR OWNER
DATE PERMIT ISSUED
r
DATE COMPLIANCE ISSUED
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f, TOWN OF BARN T ID INSPECTION
�' dam. ,' '
I�:A~[10N 7 / SEWAGE # '•�
VIL`IAGE r , ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY415e?�
J
LEACHING FACILITY: (type) (size)
NO.OF BEDROOMS r,
BUILDER OR OWNER - +
PERMTTDATE: G 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) Fees.
Edge of Wetland and Lea ng Facility(If any we ds exist
within 300 feet 1 run f ' ty) Feet
Furnished o
4
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r=�r..s`
f �— , y4
E\�.
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No..............---------- FEa... 5,.99.........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Town............ -----OF......Barnstable
Appliratinn for Di ipoiial arks Ton.itrnrtion. Vamit
Application is herebymade for a Permit to Construct ( ) or Repair ( 7O an Individual Sewage Disposal
System at:
...toad ..__.... ----------------------- -------------------------------------------------------------------------------------------------
Location.Address or Lot No.
.................................................. .........................1.1Yanti .............................
w Joseph_ P. Macom°ber & Son inc . CentervVyle,..........................:......
Installer Address
Q Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms.............................. .............Expansion Attic ( ) Garbage Grinder ( )
per, Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
0.' Other fixtures -------------•--•••------------------------------•---- --._----------••------•--
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
fx Septic Tank—Liquid capacity------------gallons Length................ Width------------._.. Diameter---------------- Depth----------------
W Disposal Trench—No..................... Width-------------------- Total Length-------------------- Total leaching area..............._....sq. ft.
x
Seepage Pit No..................... Diameter-------------------- Depth below inlet..................... Total leaching area------------------sq. ft.
z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by-------------------------------------------------•----------•--••--•-•-•-- Date---------------------------------------
,� Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
�14 Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water.....-_.___-_-._-_-_---.
Ix ...........................................•.....-------•---------......................----....-•-•........................................---------------
O Description of Soil_.S_and__&-.Gr&Y! 1.------•-•-•----•----•--•--•---------••..............
V ---------------•----------•----••-•-------•----------------------------------------------•---•--•--•----•-•--•--------------
W
VNature of Repairs or Alterations—Answer when applicable___1-1000 -gallon--pit--_(overf PW)..______..
•----------------------------------•------------- ---..---------------------------------------------.-----_----•-----------------------•-----------------.------....---•-------------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
l the provisions of Article \I of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has e issued by the boa of al
�igne
_Date /
Application Approved By----- = - ----------------- -----/7,5 7-{�-----
Date
Application Disapproved for the following reasons-...........=-----------------------------------------------------------------------------------------------------
.................................•----•------------------•--•--------------•---------•-•--•--••--•----•-.
Date
PermitNo........................................................ Issued........................................................
Date
�_ -- -.------------------------------ ------------------- ------
y ............ FEE.... ..00
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
_Tour..............._OF--- --Barnstable
Appliration -fur Bi.ipuuttl Workii Tottutrurtiutt Vrrmft
Application is hereby made for a Permit to Construct ( ) or Repair ( 3 an Individual Sewage Disposal
System at:
1}2 0a', Hill Road
-----•------------------------------------------------------------------------------•---------
�7 Location.Address or Lot No.
d'rantiess Turaeon Jyann1.S
•---------------------•---------------•----•----.....----•---•-----•-............................ ............••---•-•---•---•-------•--------•-----------------.....•----•---•---•--------•-----•-.
Owner 2e
w jcs-pPh P. ;a.Cot won r tx Son Inc . Centers' lle,
,1 .----- . ........
Installer Address
Type of Building Size Lot_.-._.-___________________Sq. feet
U Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
per, Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
Otherfixtures ----------------------------------------------------------------------------- ------------
w Design Flow------........:.------------.--------.---- -gallons per person per day. Total daily flow...........................................-gallons.
9 Septic Tank—Liquid capacity--_-.--_-_gallons Length---------------- Width--------.---._.. Diameter..... ---------- Depth----------------
T Disposal Trench—No. .................... Width-------------------- Total Length-------------------- Total leaching area....................sq. ft.
x
Seepage Pit No--------------------- Diameter.................... Depth below inlet-------------------- Total leaching area--....._-_.--___--sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by----------................................................................ Date------------------------- -----•-------
Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water.. ---._-_-..--.-._._.
f4 Test Pit No. 2________________minutes per inch Depth of Test Pit-------------------- Depth to ground water--.---_.-_----_.--_-_...
a ------------------------- ---------------------------------------------------------------------•-----------------------------------•-----------------------
O Description of Soil---- ? ..:��::�r '° �
x
- ------------ -----------------------------------------------------------------------------------------------------------------------------------
U ------------------------------------- -----------------------------------------.................................................................... ----------...----. .............................
w
VNature of Repairs or Alterations—Answer when applicable..-._-�:'�� � .._ ;allon j3 .t --Oti't?I' 1G�t--)
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b-en. issued by the board'of health.
/. ) �J
Signed "<1--C e.. .------.....------.Gf�I ..Z'1. ---r---- ------
Date
Application Approved By------ ----- ` --/ ;-----------------• -----0
Date
Application Disapproved for the following reasons:.......................................................... ------------------------------- --•------
..._
...............••---------.----•------------------------•..............-------------------•------•--------•-------------------------------------------------------•------------------------------
Date
PermitNo............................ Issued..........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
........To=.n.................oF.:.....Barnstable
_. �rrtifirutr of Tantpliattrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( X)
by............. ss-rah...n. Macomber & Son, Inc..
-------------------------------------------------------- -'-----------------------------------------------...---------------------------------•-------.......
• Installer
at... = -"H-' ll Road, yang s Tur eon
---------------
has been installed in accordance with the provisions of Arc XIrpf The State Sanitary Code as described in the
application for Disposal Works Construction Permit No._�.. .................................. dated-------/-!,S`'-7`......................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNC N TISFACTORY. �
DATE ------------
... Inspector z: - -`,` '`
` THE COMMONWEALTH OF MASSAC SETTS
{
BOARD OF HEAK' H
7
Tc ............... Barnstable
oF.......B ,r
No............... FEE---- 5.00---•-
. � �i��u�ttl urk� C�utt�trttrtiuttVrrmit
Permission is hereby granted____jo"e--P.h P• Maeomber. & Son, 1 C .
--- ------•--------- ---• ............... ...............
to Construct ( ) or Repair ( X) an Individual Sewage Disposal System
at No---- '2 Oal,, 11 11 oaf,,-..H_,arm s...._...... - Turgeon
--------
Street
as shown on the application for Disposal Works Construction Perm' ----------- D d__.._f`, �"7_ ____________
DATE........ 7..- -•---------- ----------•........... card of a h
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS "'.s
I
SYSTEM PROFILE
TOP OF NOT TO SCALE
FOUNDATION FINISH GRADE FINISH GRADE OVER
EL. 78.2 EL. 77.1 FINISH GRADE OVER DISTRIBUTION BOX 75.5 '
SEPTIC TANK 76.2 FINISH GRADE
OVER TRENCHES 75.0
A _RISERS TO 6 Uf
h OF FINISH GRAD,
r PRECAST CONCRETE
,'-- _ 1 , o;o o. •b 500 GALLON DRYWELLS
3"MIN. °' RISERS TO 6"--�"' o'
MIN.SLOPE 1% OF FINISH GRADE OUTLET PIPE(S) LEVEL H-10 REINFORCED LOADING
13" g° .' MIN.SLOPE 1% o FOR 2'( MIN.1% SLOPE TRENCH LENGTH = 25'-011
BEYOND
MIN.I[I O DRYWELL LENGTH = 8'-6"
o ��0 13"MIN. 14,1 L
74.90 74.58 F6' UMP `'°' p p �L, o �L
_a• ' MIN. .1 \o:� �1 oa 1 ,1 q:o �®,:1 ,( �;oa ,�v,. '' I1 9:0'
PVC OR CAST IRON TEE 74.33 73.99 ` :i 1 p,o:( o0 73.82
1: rl 1 IOi � c^ 0" In 1 ,.;\ ^•. ';'
®= ' GAS BAFFLE �`01 (o , \o.lo r
�6- DISTRIBUTION BOX �bo' ^ b b,,., ., i ,
o^o °_ > MINIMUM INSIDE DIMENSION 12" 3/4"- 1-1/2" DOUBLE ,1500 GALLON w
o _4 OUTLET INVERTS 2 3/4"- 1-112" DOUBLE
5.4'BELOW INLET INVERT WASHED CRUSHED WASHED CRUSHED 4
°- PRECAST CONCRETE — MINIMUM CONCRETE WALL THICKNESS 2 STONE
o- :�- STONE
., o INSTALL ON COMPACTED LEVEL BASE
BSMT.FLR. :o_,;o�;�. 6 H-10 REINFORCED ,� NOTE: EXCAVATE TO =C= STRATUM IN ORDER TO BOTTOM OF TEST HOLE#1
ELEV. 70.7 - o� ;o; 1 - o .:
'r REMOVE ALL =A= & =Et= IMPERVIOUS MATERIAL
' 4� J� J'� WITHIN 5' OF THE SAS. REPLACE WITH CLEAN TRENCH SECTION
Fl�' • o \- i , ,l . :1 pi0 °•�`r. ®'gyp(.•/ '��\ �, .,•>\plr .'ar 0'' /'0 r '�0� ,A `,� r ',0'Q•:i '' :1
CLAY-FREE SAND
SEPTIC TANK
3110 F 1/8"- 1/2"
INSTALL ON COMPACTED LEVEL BASE
9" MIN. DOUBLE WASHED PEASTONE
-+ _— --- r'" :. -- 4" DIAM. 36" MAX. OR GEOTEXTILE FABRIC
u8
0 " table us
_ 6 " 6; o: 1 ,.o• r, oa o
• h&b t • w M tar. n. ,n.l, . 1
3/4"- 1-1/2" DOUBLE
• 4 " 1 5-2" WASHED CRUSHED
_ • i�• � �' `•sk
STONE
91e0 ,• • . NUMBER OF TRENCHES 1
:.. ,. OBSERVATION PIT NUMBER OF DRYWELLS 2
` • +. ffi� . P-11928
eat GENERAL NOTES: V.WARDEN S.E.
` " • ' '�
4 ASSUMED ,__. , .� x, „ ,
ole ` � � 1• ELEVATIONS IONS SN0'1iVi� ARE BASED ON SSu PL.r<C'OLXr r lOfv RATE:E. < 2 Mliv.niV
• 2. ALL PIPES IN THE SYSTEM MUST BE CAST IRON
WITNESSED BY: D.MIORANDI
`'�� OR SCHEDULE 40 FVC.
3. HEALTH AGENT/CAPE & ISLANDS ENGINEERING BARNSTABLE BOARD OF HEALTH
9 n
-�- • � • ••-: DATE:SEPT.27,2007
• t MUST BE NOTIFIED WHEN CONSTRUCTION IS EL.73.8 EL.75.o DESIGN DATA
• 9 • •• COMPLETE PRIOR TO BACKFILLING.
4. ANY CHANGES IN THIS PLAN MUST BE APPROVED THo
,#1 THoil
#2
BY CAPE & ISLANDS ENGINEERING AND THE BOARD =A= LOAM
OF HEALTH. 2.5 YR 3/3 NUMBER OF BEDROOMS 3
�
5. MATERIALS AND INSTALLATION SHALL BE IN 11 4" GARBAGE DISPOSAL NO•\ s COMPLIANCE WITH THE STATE SANITARY CODE
129f0'� [TITLE V] AND LOCAL APPLICABLE RULES AND =B= SANDY LOAM DAILY FLOW 330 GPD.
'y °sr REGULATIONS. 1OYR 5/6 SEPTIC TANK REQUIRED 1500 GAL.
6 \ 6. NORTH ARROW IS FROM RECORD PLANS AND IS SEPTIC TANK PROVIDED 1500 GAL.
/ \ NOT INTENDED FOR SOLAR ENERGY PURPOSES. 25" 35" LEACHING REQUIRED 330 GPD.
C7 \ 7. WATER SUPPLY. MUNICIPAL WATER SYSTEM.
O w \ 8. FLOOD ZONE [NON-HAZARD] SOIL ABSORPTION SYSTEM CALCULATIONS:
-------------
=C= MEDIUM SAND
10YR 7/4 SIDEWALL AREA = 152 SF.
;' 152 SF. X .74 G/SF. = 112 GPD.
C7 ^, 21 BOTTOM AREA = 329 SF.
pok 329 SF. X 0.74 G/SF. = 243 GPD.
c�,'4 ; e , 12�„ NO GROUNDWATER 120„ LEACHING PROVIDED = 355 GPD.
_'_ / LEGEND EL.63.8
q J , _,� 52 PROPOSED CONTOUR SEPTIC SYSTEM UPGRADE
HSE.N0.42 _ 00 o,
I6 O -' --1 �° o --- 52-- • EXISTING CONTOUR
LOT 7 �- 1 x�sExvE I i „\ ,,ti . PROPOSED SEWAGE DISPOSAL SYSTEM
12 28O SF. OBSERVATION PIT �••..• ,
o PREPARED FOR
_J a PA in
C'H.ARI F� ,Q
PUMP&REMOVE ❑ DISTRIBUTION BOX
NANiC Ri .� II H"& 1rLf3R A �1� 1L[ E �1�
161.10, CESSPOOLS ;° 28085
a HSE.NO. 42 OAK HILL RD.
s w N 87007'46"W o 070 IMI,i,���`'
HYANWIS,MASS.
SOIL ABSORPTION SYSTEM
o PLAN N0. 100407 SCALE: AS NOTED
z s�`;`°" '�`�'' FILE NO. 428BA DATE: OCT.4,2007
RESERVE RESERVE AREA o ti�
••HIC'HAxu••° SEPTIC FILE NO. 77 PCS FILE: oakhill
22.26 PIPE INVERT ELEVATION 'ANIL
"J'f'`3'1 CAPE&ISLAIVDSENGINEERING
0 0 0 „•e.. 800 FALMOUTH ROAD SUITE 301C
PLOT PLAN 248 84 7 42
SCALE: 1" -20' S 5 5 f .�> MASHPEE,MA 02649 (508)477-7272
MAP SEC PCL LOT HSE