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HomeMy WebLinkAbout0438 OAKLAND ROAD - Health 0 =43 8 Oakland Road Hyannis A= 272 - 103 5 h I� { u g i (I r Commonwealth of Massachusetts / /P ° IP3 Title 5 Official Inspection Form "- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments N 438 Oakland Road c Property Address r Madeline Taylor 1�a Owner Owner's Name information is Hyannis Ma 02601% 9/4/2015 required for every y r` page. City/Town State Zip Code Date of Inspection � ? M Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, ,j/L f3 use only the tab 1. Inspector: key to move your cursor-do not Sean M. Jones use the return Name of Inspector key. S.M.Jones Title V Septic Inspection Company.Name 74 Beldan Ln. Centerville Ma 02632 Cityfrown State Zip Code 774-248-4850 smjonestitle5@gmail.com SI4522 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 Evaluation by the Local Approving Authority L �� 9�/4/2O5 Inspector'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. o l<5 t5ins•3113 Title 5 Official Inspection Forth:Subsurface Sewage Dis sal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 438 Oakland Road Property Address Madeline Taylor Owner Owner's Name information is required for every Hyannis Ma 02601 9/4/2015 page. Cityrrown 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: The dwelling located at 438 Oakland Rd Hyannis is served by a Title V septic system consisting of a 1000 gallon septic tank, distribution box and 6 3050 Infiltrators. The system was found to be in proper working condition at the time of inspection. 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 438 Oakland Road Property Address Madeline Taylor Owner Owners Name information is required for every Hyannis Ma 02601 9/4/2015 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if i 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 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 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 t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Mf 438 Oakland Road Property Address Madeline Taylor Owner Owner's Name information is Hyannis Ma 02601 9/4/2015 required for every H y I page. Cityrrown 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 ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Affim Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M , 438 Oakland Road Property Address Madeline Taylor Owner Owner's Name information is Hyannis Ma 02601 9/4/2015 required for every H y ' page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No I ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for 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- ❑ ® 10,000gpd. ❑ ® 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 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. 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 M '( 438 Oakland Road Property Address Madeline Taylor Owner Owner's Name information is required for every Hyannis Ma 02601 9/4/2015 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 by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ 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 gpd t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 438 Oakland Road Property Address Madeline Taylor Owner Owner's Name information is Hyannis Ma 02601 9/4/2015 required for every y page. CityrFown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 4 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: current Date 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•3/13 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 438 Oakland Road Property Address Madeline Taylor Owner Owner's Name information is required for every Hyannis Ma 02601 , 9/4/2015 page. Cityrrown 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: 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 Offidal Inspection Forth:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 438 Oakland Road Property Address Madeline Taylor Owner Owner's Name_ information is required for every Hyannis Ma 02601 9/4/2015 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: system repaired 4/23/2008 per town records Were sewage odors detected when arriving at the site? ❑ Yes Z No Building Sewer(locate on site plan): Depth below grade: 1.5 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.): Joint were ok, no leaks, vented through the roof Septic Tank(locate on site plan): 101, Depth below grade: feet 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: 1000 gallons Sludge depth: 6" t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 438 Oakland Road Property Address Madeline Taylor Owner Owner's Nam_ _e_ information is required for every Hyannis Ma 02601 9/4/2015 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 3" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? opened covers, took measurements 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 does not need to be cleaned now but should be done soon and again every 2 years for proper maintenance. water level was even with outlet, tank was not leaking and was structurally sound. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , 438 Oakland Road Property Address Madeline Taylor Owner Owner's Name information is required for every Hyannis Ma 02601 9/4/2015 page. Citylrown 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 Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , 438 Oakland Road Property Address Madeline Taylor Owner Owner's Name information is required for every Hyannis Ma 02601 9/4/2015 page. Citylrown 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.): Distribution box was in good condition, no rot, water level was even with outlet invert. 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 438 Oakland Road Property Address Madeline Taylor Owner Owner's Name information is required for every Hyannis Ma 02601 9/4/2015 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 6 3050 Infiltrators ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The s.a.s. was inspected by running camera down vent into the chambers. The leaching facility was observed to have approx 3"of standing water with no signs of past hydraulic overloading. 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•3/13 Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M , 438 Oakland Road Property Address Madeline Taylor Owner Owner's Name information is required for every Hyannis Ma 02601 9/4/2015 page. CityTrown 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 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 438 Oakland Road Property Address Madeline Taylor Owner Owner's Name information is required for every Hyannis Ma 02601 9/4/2015 page. Cityrrown 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 _A - R I - — pq- 39 t5ins.3/13 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 y( 438 Oakland Road Property Address Madeline Taylor Owner Owner's Name information is required for every Hyannis Ma 02601 9/4/2015 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: Groundwater elevation was determined by accessing Town of Barnstable groundwater contour map. 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , 438 Oakland Road Property Address Madeline Taylor Owner Owner's Name information is required for every Hyannis Ma 02601 9/4/2015 page. Cityn'own 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 4 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 TOWN OF BARNSTABLE LOCATION T � ' � SEWAGE#4�20G ;Fy— /30 VILLAGE /`11114ANNIS, . ASSESSOR'S MAP&LOT INSTALLER'S &PHONE NO. 6IQG—WA1 EtZ `71 S'�aCO SEPTIC TANK CAPACITY OO TIr l�I,� 1 C3t6 15 A 1 LEACHING FACILITY:(type) -)Wrl[TVA(AZ 3?-Sb (size) �30pA 10f 1-a' NO.OF BEDROOMS A>w .T BUILDER OR OWNER AP P,-V— PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: ' Maximum Adjusted Groundwater Table and 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 i 1 w CP J � +t +� is t+ ♦ w -14cpI r j a�S - l° No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Zipplication for ;Di$po!6a1 6p6tem Con5trUCtion Permit Application for a Permit to Construct( ) Repair(✓) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No.i4 3% 00.1d(aw.t 12-4 Owner's Name,Address,and Tel.No. Assessor's Ma /Parcel r ,, Q, �<V p "1 l 0 3 l.�C�tZ 1 �V430o �:I a�l�i 2�l Installer's Name,Address,and Te.No. S'O$-775-'Z%$ O Designer's Name,Address and Tel.No.5 d 19 1,3(fZ f 2 4 Z Z 0Q UCfjAQ 5 +�C (�a�►eo I7ce�9i� (3usln�`e_ gal (,V1 e r1 �o 364 9%1 Type of Building: Dwelling No.of Bedrooms Lot Size 1 I°�� 725� sq.ft. Garbage Grinder (�) Other Type of Building I?4 o."� No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.rewired) Ito gpd Design flow provided 3 3 U gpd Plan Date 3�/!u 0q Number of sheets 2 Revision Date Title Size of Septic Tank loocl 49q` o._% Type of S.A.S. Description of Soil A- Z' 4.04-ys�j (' 7 Nature of Repairs or Alterations(Answer when applicable) l p Dv �� S p„+Z ,3��0 rr4 . .Z 4� S" on s"' I t 1 [7C�-3 N -(0 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 f Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issuedVbtis Board of h. Sig Date y / d C6 Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. j0�`�36 Date Issued / v 6 .�..-, wn�r...•.+ -,.".lF/. _. s.. �t' 1..:.._....•aY-.r • a••..^w�.n.-rim+r... _ . -vim• 'u...PA.a-.x,+riva�},wNn....v:W".'4:`.rr. �f'.T' R �..;...-...a.'Y.;'fir . r.h'++iv»-�V •r No. � Fee /DD THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Zipplication for Di5pogar bpgtem Cowaruction Permit Application for a Permit to Construct O Repair(Upgrade O Abandon O ❑ Complete System ❑Individual Components Location Address or Lot No.9 3% Oa Owner's Name,Address,and Tel.No. Assessor's Map/Parcel a 2 1 p 3 �bac�C", UV2dV 1, V 43 pc,,(i u.4a4 2ck Installer's Name,Address,and Tel.No.5 $`77 S-c-,?�G O Designer's Name,Address and Tel.N0.50 19/,34-Z/2`*Z Z. $� . U/ie��r�2. PQ• 60•1 ci`61 Fs�,d�,c�, Type of Building: Dwelling No.of Bedrooms Lot Size lam; 70- sq.ft. -Garbage Grinder ( ) Other Type of Building 2-A 4/owl No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) l/D gpd Design flow provided -3 3 U gpd Plan Date 'r/((n l os Number of sheets % Revision Date Title Size of Septic Tank /'(goo tee,(/a n Type of S.A.S. Description of Soil A C L.)c ,,,j ncc✓a G 1 Sct -, �_occun L1,A11 Nature of Repairs or Alterations(Answer when applicable) (95Q F4 t(ZJ -441AL/ t aiL 40)ti+0,a 309 0 H-Z 1�i�1n z `l �` S � OA 5"'"S 7 �ii5�a F�' '6�-C . O. i fInC1S 30'L-4 W1011Z' b 1 Dt� F 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 f Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued b�this Board of e'7th. / Si ra�d Date �'� 1 v C6 F Application Approved by� Date 7 1 v Application Disapproved by: Date for the following reasons. 13d i a a Permit No. > �. Y Date Issued /. .—— — ——————————=———————- - . . ---- — THE COMMONWEALTIV OF'1VMASSACHUSETTS R. BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (V) Upgraded ( ) Abandoned( )by iLf-, •F � CAl6c..c1--'0 />4'014 1?u(2As'1E , 4t'4 3-% f,L/1ci, cA has been constructed in accordance with the provisions of Title { //-d 5 and the for Disposal System Construction Permit No. —�3 d dated C( / pe 4staller c)I- 14. ei2- 46 A10 =/4�/,'Gt JtJ✓A4 'e Designer Pt0 f rti W1 c-/£ #bedrooms Approved design flow 7 T(5:7 gpd The issuance of this permit s/ha/ll•nnot be c'nnstrruu�ed as a guarantee that the system ill4cationas�desligned. Date 14 c Inspector No. �� U � ��J.'' ----------------------- Fee /OV ———— THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS 1=igpogal *pgtem Con5truction permit Permission.is hereby granted to Construct ( ) Repair (✓/) Upgrade ( ) Abandon ( ) System located at 443 5 <N-44l laviO ► c-{ 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: Constructl*ofymust be completed within three years of the da a of this erm't. Date NO1� Apprld by Town of Barnstable �y"WE � Regulatory Services Thomas F. Geiler,Director Public Health Division 030. Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 50878624644 Fax: 508-790-6304 Installer& Designer Certification Form Date: Z qJkSewage Permit# tom^130 Assessor's Map\Parcel Designer: . Iba2Qw1 l�s fM�t�I��L Installer: 240p,U,1 Z Address: iz�,®. B o i 9q I Address: 26-0 Ma-VIt S'�- On ` It ��32(DG_''$4Z, was issued a permit to install a (date) (installer) - septic system at IAA% ®cak��attnA 2ck based on a design drawn by (address) dated / (designer) ✓ 'I certifythat-the septic stem referenced above was installed substantially - p y s s bs antially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertic ation of any component of the septic system) but in accordance with State & s. Plan revision or certified as-built by designer to follow. w�ti DARREN. r) N No. 140 (Inst ller's Signature) aISTE �o SaAt l TAR% 06 (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNS BLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORNI AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form.!=267adoc rkzftld Town of Barnstable Barnstable Regulatory Services Department A&Anmdu j ,aRtvsra$Ue. M M Public Health Division i63� ,� m O 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO January 3, 2008 Barbara Urnick 438 Oakland Road Hyannis, MA 02601 i ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 The septic system located at 438 Oakland'Road,Hyannis MA was inspected on October 23,2007 by Michael Burnie, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system FAILED under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: Liquid depth in cesspool is less than 6"below invert or available volume is less then Y2 day flow. *Note: Please be aware that a system in this condition has the potential to backup, causing a failure that is required to be fixed within Sixty(60) days. You are ordered to repair or replace the septic system within Two (2)years from the date of this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health i Q:\SEPTIC\Letters Septic Inspection Failures\438 Oakland Road.doc Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M Inspection results must be submitted on this form. Inspection forms may not be altered in any way. A. General Information Important: When filling out 1. Property Information: _ t forms on the 438 OAKLAN D ROAD U\' o 'S computer, use ' only the tab key Property Address to move your BARBARA URNICK cursor-do not use the return Owners Name key. 438 OAKLAND ROAD 7.1I = Owner's Address ' HYANNIS MA `" 02601 City/Town State ° Zip Code -- (,rr Date of Inspection: 10-23-07 Date \3 2. Inspector: MICHAEL A. BURNIE Name of Inspector DAVID J. BURNIE &SONS SEPTIC SERVICES blue water holding corp. Company Name 105 FERNDOC ST UNIT A Company Address HYANNIS MA 02601 Cityrrown State Zip Code 508-775-0139 Telephone Number, B. Certification 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-(-31-0-OMR-1-5-.000).T-he-system -- — ---- -- ❑ Passes ❑ Conditionally Passes ® Fails`\` lr� OF�Mgss,,,,, El Needs urth al do by the Local Approving Authority MICHAEL'. r 10-26-07 = A. Inspector's Signature Date = - o 'er The system inspector shall submit a copy of this inspection report to the App(la�' .... ..fi.y Srd y of Health or DEP)within 30 days of completing this inspection. If the system is &4oreA 5p§t °or has a design flow of 10,000 gpd or greater, the inspector and the system owner sh910yubm?he 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. BARBARA URNICK.doc.03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System. _ Page 1 of 16 /1 y j t r Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System -Form M B. Certification (cont.) 438 OAKLAND ROAD Property Address HYANNIS MA 02601 City/Town State Zip Code BARBARA URNICK 10-23-07 Owner's Name Date of Inspection 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: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not -determined," please explain. ❑ The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: BARBARA URNICK.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 2 of 16 - C Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Certification (cont.) 438 OAKLAND ROAD Property Address HYANNIS MA 02601 City/Town State Zip Code BARBARA URNICK 10-23-07 Owner's Name Date of Inspection 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 ❑ obstruction is removed ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than.4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: 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 BARBARA URNICK.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 3 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form Q,M B. Certification (cont.) 438 OAKLAND ROAD Property Address HYANNIS MA 02601 Cityrrown State Zip Code BARBARA URNICK 10-23-07 Owner's Name Date of Inspection C) Further Evaluation is Required by the Board of Health (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 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: BARBARA URNICK.doc•0312006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Certification (cont.) 438 OAKLAN D ROAD Property Address HYANNIS MA 02601 City/Town State ZipCode BARBARA URNICK 10-23-07 Owner's Name Date of Inspection D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ® ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion,of a cesspool or privy is within 50 feet of a private water supply well. - -----❑------.Z Any-portion-of-a-cesspool-or-privy-is-less-than-1-00-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 of chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- . 10,000gpd. 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. BARBARA URNICK.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System. Page 5 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M Be Certification (cont.) 438 OAKLAND ROAD Property Address HYANNIS MA 02601 City/Town State Zip Code BARBARA URNICK 10-23-07 Owner's Name Date of Inspection 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 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. BARBARA URNICK.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 6 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. Checklist 438 OAKLAND ROAD Property Address HYANNIS MA 02601 City/Town State Zip Code BARBARA URNICK 10-23-07 Owner's Name Date of Inspection Check if the following have been done. You must indicate"yes" or"no" as to each of the following: YES NO ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, 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)] BARBARA URNICK.doc.03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System �-, Page 7 of 16: Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form 'M D. System Information 438 OAKLAND ROAD Property Address HYANNIS MA 02601 City/Town State Zip Code BARBARA URNICK 10-23-07 Owner's Name Date of Inspection Residential Flow Conditions: Number of bedrooms (design): unknown Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): UNKNOWN Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate.inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No GPD.6-1948 • Water meter readings, if available(last 2 years usage (gpd)): 005-194.6 GPD Sump pump? ❑ Yes ® No CURRENT Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: — --Design-flow-(based-on 31-0-CMR-1-5.203)= 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: Last date of occupancy/use: Date Other(describe): I BARBARA URNICK.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 8 of 16 Commonwealth of Massachusetts Title S Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M D. System Information (cont.) 438 OAKLAND ROAD Property Address HYANNIS MA 02601 City/Town State Zip Code BARBARA URNICK 10-23-07 Owner's Name Date of Inspection General Information Pumping Records: Source of information: SYSTEM WAS PUMPED IN 99,01,03,07 PER RECORDS DEPT. 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 15 YEARS + PER PERMIT DATED 12-29-92 Were sewage odors detected when arriving at the site? ❑ Yes ® No BARBARA URNICK.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System -ii Page 9 of 16 '� Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 438 OAKLAND ROAD Property Address HYANNIS MA 02601 City/Town State Zip Code BARBARA URNICK 10-23-07 Owner's Name Date of Inspection Building Sewer(locate on site plan): - .Depth below grade: 17"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.): Septic Tank(locate on site plan): 911 Depth below grade: feet 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: 1000 GALLONS 4,1 Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle Scum thickness lit Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? SLUDGE JUDGE BARBARA URNICK.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 10 of 16 /K--r Commonwealth of Massachusetts Title 5 Official Inspection For Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information cont. Y (cont.) 438 OAKLAND ROAD Property Address HYANNIS MA 02601 City/Town State Zip Code BARBARA URNICK 10-23-07 Owner's Name Date of inspection 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 (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recomme_nd_ations, 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): BARBARA URNICK.doc.03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 11 of 16 Commonwealth of Massachusetts a Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 438 OAKLAND ROAD Property Address HYANNIS MA 02601 City/Town State Zip Code BARBARA URNICK 10-23-07 Owner's Name Date of Inspection Tight or Holding Tank(cont.) 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 Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): THERE IS NO DISTRIBUTION BOX. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No BARBARA URNICK.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 12 of 16 f Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M D. System Information (cont.) 438 OAKLAND ROAD Property Address HYANNIS MA 02601 City/Town State Zip Code BARBARA URNICK 10-23-07 Owner's Name Date of Inspection Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 1-6X6 WITH 2' OF STONE ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑-- ---overflow-cesspool — - -- -number: - - — — — ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): THE LEACHING PIT WAS FULL AND IN A STATE OF FAILURE. BARBARA URNICK.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 13 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form ' M D. System Information (cont.) 438 OAKLAND ROAD Property Address HYANNIS MA 02601 Cityrrown State Zip Code BARBARA URNICK 10-23-07 Owner's Name Date of Inspection 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 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.): BARBARA URNICK.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 14 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M 5 y D. System Information (cont.) 438 OAKLAND ROAD Property Address HYANNIS MA 02601 City/Town State Zip Code BARBARA URNICK 10-23-07 Owner's Name 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. o Of ij ' 3 3 �G 3Y,�k BARBARA URNICK.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 15 of 16 Commonwealth of Massachusetts Title 5 Official, Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form ' M D. System Information (cont.) 438 OAKLAND ROAD Property Address HYANNIS MA 02601 City/Town State Zip Code BARBARA URNICK 10-23-07 Owner's Name Date of Inspection Site Exam: Slope Surface water � - Check cellar Shallow wells A"J Estimated depth to ground water: J41 ` 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: THE HEALTH DEPT. ADVISED US THAT GROUNDWATER IS APPROX. 30' DEEP. ❑ Checked with local excavators, installers-(attach documentation) Accessed-USGS-database—explain: — AIW 230 ZONE D 4-5 LEVEL 25.6 ADJUSTMENT=6.8' You must describe how you established the high ground water elevation: WE SPOKE TO THE BOARD OF HEALTH AND THEY ADVISED US THAT THE WATER TABLE IS APPROXIMATELY 30' BELOW GRADE. PLEASE SEE ATTACHED. BARBARA URNICK.doc-03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 16 of 16 I G 3 I I Y i Town of BAr.nstab le P# z Department of.Regulatory Services B14i Public Health Division Date_ $ j iesy �s 200 Main Street,Hyannis MA 02601 �lfD MAT' - ~ i •� � •� • I 1 Date S hedule - !Time Fee Pd: c d - 1 oil Suitability Assesshientjor Sewage Disposal Performed By: i s'6 Witnessed By i V'1oQ '►'`16K i LOCATION&GENERAL INFORMATION p ' Location Address . 0 �`I }� �Ok owner's Name �/To' R L�.iJ tSA/k I Address 439 OAKW O� Assessor's Map/P4rcel: 0-:7_�—fiO3, Engineer's Name" A beLfe'V_r NEWCONSIRU�#CION REPAIR r Telephone#y � t!,B' o+Z Land Use Slopes(%)'L�, Surface Stones S .� Distances from: Open Water Body �' ft Possible Wec Area �Z,y ft Drinking Watei Well t ft ' /� c-11 Drainage Way t✓y ft : Property,Line _ft Other ft ski SKETCH:(Street name,dimensions of lot,exact locations of tot holes&perc tests,locate wetlands in proximity t es) tom` EV S t'� t`' t•' lfo � ••� I • ti 1 • i i i I i • j I 1 ' i 14J 1 (g g j �CIGt'u� d Depth to Bedrock Parent material edlo tc. � I p Depth to Gibundwalar 1 Standing Water in Hole:" Weeping from Pit FACE Estimated§e isonal;fti Groundwater 1A i I*TERMINATION FOR SEASONAL HIGH WATICR TAELE Meths!Used: I. I Depth (1bperved standing in obs.hole: —_in. Depth to so11 MOtt"W, l:• Depth toiweeping from side of obs.hole: i in, Oroundwnter Adjuslinent Index Well# Reading Date Index Well level Act,factor ,,,,.,r,.- Adj.Groundwater Level,,,e PERCOLATION TEST Date z >�p Observation ( Time at 9" Hole# i Depth of Pere Time at b" (O Start Pre-soak Time.@ _ Time(9"•6") ..- --— End Pre-soakJj i Rate Min./Inch - �( Site Suitability Assosment Site Passed Site Failed: Additional Testing Needed(YIN) Original•,Public 1141th Division Observation Hole Data To Be Completed on Back—=--- ***If percolafiion test is to be conducted within 100' of wetland,you must first notify the Barnstable C4.#servation Division at least one(1)We6k prior to beginning. I DEEP OBSERVATION:HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Cher .Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistencv.%Gravel) 10 4 2., N (/YX r\ 1 ' \ I 7 �-l3Z DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture: Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistencv.%Gra I r '4 � p O DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil. Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Cons iste c %Oravel 4 , DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. nit Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes Within 500 year boundary No Yes i Within 100 year flood boundary No Yes �,... Depth of Naturally°Occurring Pervious Material Does at least four feet of naturally occurring per ` us material exist.in all areas observed throughout the ! � area proposed for the soil absorption system. eS If not,what is the depth of naturally occurring:pervious material? +, Certification' t ... I certify that on (date)I have passed the soil evaluator examination approved by the Departure nvir mental Protection and that the above analysis was,performed by me consistent with the required trat ' expertisd an ex p rience described in 3,10 CUR 15.017. �_- f Signature Date Q:\.SEPTIC\PERCFORM.DOC TOWN`OF BARNSTABLE LOCATION Y,3a l ., 1 SEWAGE # c i VILLAGE / ` ASSESSOR'S MAP & LOT j 7� - INSTALLER'S NAME PHONE NO. A & B CANCO 775-6264 .SEPTIC TANK CAPACITY LEACHING FACILITY:(type) /Q (size) NO. OF BEDROOMS PRIVATE WELL OR UBLIC ATBR BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No -, 6� ltz �- � � �.' -�� .- � .-�� ; , � r-_' c� s_ (V��j . . � �- Y �J VF THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH APPROVED TOWN OF BARNSTABLE Barnstable Conservation Department , ppliration for Mipoaa1 Works To Date _'"""' �P Application is hereby made for a Permit to Construct ( ) or Repair (w'T an Individual Sewage Disposal System at: L c tion-Address or Lot No. ...�� �. .-.�E1 5.. 1 �1............................................................... -••-----..................---........•.......................-...... owner Address a .............. ......C_0.h?'c0.........................................:....... ----i�p •' PlZltn _n Installer Addr ss d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms. ..............Expansion Attic ( ) Garbage Grinder ( ) aa Other—T e of Building ............... No. of persons............................ Showers —Type g -------------------------------------------P--�- ( ) — Cafeteria ( ) Otherfixtures ------------------ ----------------•---•---------------------•------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter.-._____--___- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. 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. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (s, Test Pit No. 2................minutes per inch Depth of.Test Pit---:................ Depth to ground water........................ ----------------------------------------•-------•----------.....--------------------•-•......._..--•........................................................ ODescription of Soil...............................................................................:.................................:...................................................... V ......---••----------------------•--•-----------...------------------------••---------•-•.....--------------------------------------••----------•...-----------••---•---.....------•----•--------------- ---------------- U Nature of Repairs or Alterations—Answer when ap livable. :.� .-.� )( ---- --- ------------ --- �- -- a Agreement: V i1 T The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Com la s been iss e y the board of health. /1'�23- �Signed ------ ---------------- ----- --------------------- .............................................. ------............................ Date Application Approved By -------.... ------ ..... :....... --�--------------__----------------------- ............................................. ��-�--'� Date Application Disapproved for the following reasons: ................................................--- ----------------------------------------_-----............................ ------------------------------ --------------- ----------------------------- --- -------------------------------------------------------- --- ------------------------------------ ------- -----................................... Permit No. g,V— .... Issued /� ,e �-- .............. tZ ..> ... �ce...........----...... -'---- i No.!e�ly FBB,3 o. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Applutt#iun for Disposal Works Coheir i_ n Application is hereby made for a Permit to Construct ( ) or Repair (✓1 an Individual Sewage Disposal System at: .!� R_Q A K L A N. __Z ---------------- Location-Address or Lot No. -Mt4ti L1QN31 CIS ........_----__.___—._..._..._._....._ owner-------------------.__.—__._.._ ------------___------------------------__. Address Installer Address Type of Building Size Lot----------__________--Sq. feet U Dwelling—No. of Bedrooms__%�_____________________________________•Expansion Attic ( ) Garbage Grinder ( ) Other—T a ype of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) QOther fixtures ------------------------------------------------------------------------------------------------------------------------------------- — W Design Flow-------------------------------------------gallons per person per day. Total daily flow-------------------------------------------gallons. WSeptic Tank—Liquid*capacity------------gallons Length---------------- Width---------------- Diameter----------------Depth------_------ x Disposal Trench—No--------------------- Width--------------------Total Length-------------------Total leaching area----------____-sq. ft. 3 Seepage Pit No--------------------- Diameter-------------------- Depth below inlet------------------- Total leaching area---------------sq. ft. z Other Distribution box ( ) Dosing tank ( ) `4 Percolation Test Results Performed by-------------------------------------------------------------------------- Date----------------------------------- 1 Test Pit No. 1________________minutes per inch Depth of Test Pit------------------- Depth to ground water_____--_________________ 44 Test Pit No. 2----------------minutes per inch Depth of.Test Pit___--____________-_ Depth to ground water-----__________----____ a ----------------------------------------------------------------------------------- - ODescription of Soil-------------------------------------------------------------------------------------------------------- ------------------------------------------------------------ W V ------------------------------------------ ---------------------------------------------- --------------------------------------------- ------------------------------- ---------_-_- -------------------------------------------------------------------------------------------=\----------�------=---------- ---- ------_— -_ - U Nature of Repairs or Alterations—Answer w en applicable? i_ __I hod ___A�t�R_��_r_,__ _ lC____ ------------- Agreement: U I The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a-Certificate of Com'liance as been issiE&- by the board of health. '15Signed ------------ ------ --�'-` ------------------------- -1'-"'------ tare Application Approved BY ----�------------------��e' --------------------------------------------- l'' Application Disapproved for the folloxuing reasons- --------------- ----------------------------------------------------------------------------------�-------------------- -----------------------------------------------=--------------------------------------------------- ------- Permit No. Issued-- �'' t� j / -,� � � ------------------ ------- ------------------------------------- -------- Dam THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Gertifirak of (.9om fiance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by------- �` '�a----------C-A N CQ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ at -----43-9---- fS. -h- ��'- -N-W--p o-alS has been installed in accordance with the provisions of TITLE 5 of The State Env' onmental Code as described in the application for Disposal Works Construction Permit No. --__-- c_. _ _ dated __��_-__eF�'_ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE -'-- - Q----- �� ----- Inspector - ------- = ------------------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No.. � Fes- 36. Eisposat Works Tonstrudiatt f rruttt Permission is hereby granted - - -------- ---------------------------------------------------------------------------------to Construct ( ) or Repair (j__),an Individual Sewage Disposal System at No------- —3ZR_—C�to l4_c,�4 t,a 1� — —,�� A !--N--------------------------------_------------------------------------ Street ------ r 0�i / / / - — 7 - _ as shown on the application for Disposal Works Construction Permit No.______:___t-y_______ Dated _ -----------. r1rF_�� - �---- B Q oard of Health DATE---- � /` - ' ------------- - t FORM 36508 HOBBS Q WARREN.INC..PUBLISHERS L 0 C A-T ION SEWAGE PERMIT NO• VILLAGE INSTALLER'S 'VA ME ADDRESS BUILDER OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED ���_ `�e "E` �., �: -- � / l � . // � � .. ��a' '� ��, !� No.......... »27� Fm$.........$... ...Q4... THE COMMONWEALTH.OF MASSACHUSETTS BOARD OF HEALTH ...........................T.Q)m...OF........�r table........................................................ Ap iratiou for Uiipus al. Works Tanstrurtinixt rumit Application is hereby made for a Permit to Construct ( ) or Repair (x) an Individual Sewage Disposal System at: 4,38._Oakland Rd:�..HY.a??Z?3S�.. ....02�Q ............... .................--------•-•-•---•--......-•---------•-----••-------------•------............-•--- Location-Address or Lot No. John Urnic. _............. .................. -._...._._..._._k 43$..9ak1.a�id._.Rd...,...4annj_&...MA.....0-2bQ1.............. •.------• ......... Owner Address aA & B Cesspool„Service......---•-••-•------••-•-----••-•--•-------•. Q?_601.... Installer Address Type of Building Size Lot............................Sq. feet �., Dwelling—No. of Bedrooms................3.........................Expansion Attic ( ) Garbage Grinder ( ) a p;, Other—Type of Building ............................'No, of persons.._....__.__...,.......... Showers — Cafeteria( ) ( ) aOther fixtures ............................................................ Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width,................... Total Length.....................Total leaching area .............sq. ft. 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. I................mmutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........._.............. a •------•--------------------•-••--•••••••-••--•-•-•--••------•--•••...._.........--••----------•-....-•-•-•--••••-•-•••-••-•••.............__.._....---•---•- 0 Description of Soil..........Sand..................................................................................................................................................... x W UNature of Repairs or Alterations—Answer when,applicable___...inatallatian...of.a--1,000-.gallon,_-pxe.-cast atone---Facked...lea.ch..pit---Co erflaw)..........................•-------------------------------------•-----------------------------•-----...--•---------•-----. Agreement: _ The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE , 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been.issued by the bo d/40 health. S' ned . . •Z�1..X. -..61nm....-.... Datp Application Approved By..... --------------------- -------.---_61-178Q--_----- Date Application Disapproved for the following reasons------------------- ---••----- •-•-•-----•-•-----•••-•--•-...•-------•--•----•----•----••••--•••--•-•••------ ...........-••••--•-----••---•-•---•-••---•----••---••-•-••--•••-••-•-•--------•--•-•........•--••--•••---•-----•--•--------••••-••--•-•---•--•••-•---••••••-•---------•-•----......................... Date Permit No......80---•-•-----•--•-•--•-•--------------------- Issued_............6AVA .......................... Date No.........80-.2 . '` F�s........ ... ...QA._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................T..Om. ...OF........:119,!=UW .S..._..--................................................ Application for Bilipnsttl Works Tonstrnrtinn anti# Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal System at: 4 -Qadand lid., - i :...NA....0�60. .. ............... .••••••---...-•---••--'•------•--••••••-•-..... .......................................... Location-Address - }}''� ��jj �por Lot No. p /� /�y d gain rJ'S'Ld.i ................ Y.. ..$SLR.1...3 YAMIJU.A'!d'A....M26101......:.....-- Owner y p I Address a A&--B._Gnaw-spoolAer ide.---•••-•..................................... A A�.dE t3��.`�'® '40.0u.. 1e9-.A&.....Q2fA�..... Installer Address Type of Building Size Lot............................Sq. feet aDwelling—No. of Bedrooms......::........ .........................Expansion Attic ( ) Garbage Grinder ( ) A4 Other—Type of Building ____-_-_---------------- No. of persons__---_-__-__---3---------- Showers ( ) — Cafeteria ( ) a' Other fixtures .................................................----.------------------=-----------•----------------------------------•--•-•-----------....--------- d w Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length---------------- Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. 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. I................minutes per inch Depth of Test Pit.................... Depth to'ground water--___-_-_____-__---__--- fi; Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ y Descriptionof Soil-------------•--........---......................----•-•..........-•---•---•----------------------------•---•--•-------------------------------........................ w U Nature of Repairs or Alterations—Answer when applicable------ 1i$ s$®ne..]?�6cked-- each.p $ (art�ea�f7 ox).. = Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board,j health. S' ned ✓° ..fj- - -?1r '- ?✓:'_ 6�17/8E).......... Application Approved By....: :. i � � �' 6/`r- _... Date Application Disapproved for the following reasons:................... .. --------------------------•----------•------------------------•---------. ----•---------••- -----------------------.................................._...---------------------.....----•-------••------------------•-------------- --------•------------------------•-----------------------....... 80- 6/a?/8o Permit No.............. .... Issued --------- ... Date 'Date-- ------•-----------^ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town.......O F...Barnstable w1rrtifiratr of fl omplianrr T I LLF� TO CEERTIFY Tha Individual Sewage Disposal System constructed ( ) or Re fired (X ) A C�sspteol Seai'ce, lshe�s ° erce o s, M�ysnn�l MA 0260l --law b ..................... --_-------•-------------------------• -------------- •.... --"••-__..... . 438 Oakland 9d,, Hya;mls, NA. 02601 -Ins diffin U rik at........................................................................................................... has been installed in accordance with the provisions of TIbLE 5-of The State Sanitary de s described in the application for Disposal Works Construction Permit No........ „_74—.:............. dated_._.- 7/-.---------_.................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST D A A GUARANTEE THAT THE SYSTEM WILL�, NCTION SAT F CTORY. w= DATE............... --•........................................ Inspector-- •---------- -=--------------'---............_...__......_........_....---- i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town Barnstable, 8C- ,2 tf ......................................OF..................................................................................... 5 No.................�.... FEE...........' ..... M goal Works Tnnstrnduan rrntit �. A & B Cesspool Service, 128 Bi.s Ps Terrace , Hyannis, MA 02601 Permission is hereby granted ----- ............... ------------------- -------•-••-------......_..............._._.. to ConVAt t��S�dR o ( a & jVuab j66jge Dj �Cern " at No .......................................--.............................................................- ------.......................................................................... eet 8 .- 6/17/80 as shown on the application for Disposal Works Construction it No .=_ ._.__�i____�_:. ated......:..........:........................ DATE. - 0C ...._.. Board of Health -- -------............ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS 0 Bk 21993 Ps18 -1mr1-26358 05-02-2007 d 012169:1- DECLARATION OF RESTRICTION We, John W. Urnick and Barbara A. Urnick, of 438 Oakland Road, Hyannis, Massachusetts 02601, being the owners of Lot 20, as shown on a plan of land recorded with the Barnstable County Registry of Deeds in Plan Book 206, Page 57 (the "Premises"), hereby impose the following restriction upon the Premises, which said restriction shall run with the land and be binding upon our successors and assigns thereto: The structure constructed or placed upon the Premises shall contain no more than three (3) bedrooms unless and until the Board of Health of the Town of Barnstable permits otherwise. Property Address: 438 Oakland Road, Hyannis, Massachusetts For title, see deed recorded with the Barnstable County Registry of Deeds in Book 18983, Page 148. WITNESS our hands and seals this Z~ day of.May, 2007. W. Urnick Barbara A. Urnick COMMONWEALTH OF MASSACHUSETTS Barnstable, ss. r On this Z, day of May, 2007, before me, the undersigned notary public, personally appeared John W. Urnick and Barbara A. Urnick, personally known to me to be the persons whose names are signed on the preceding or attached document, and acknowledged to me that they signed it voluntarily for its stated purpose. Philp Mlchaei Boudrew Notary Public ZMI , Commission Ex iras dams � Notary Public My Com p ery ry Commonwealth of Massachuselft My Commission Expires: EBARNSTABLE-C'OUNTY EDS E GISTER I STABLE REGISTRY OF DEEDS c� 'r ct: Z 7C L I O s• I 1 1 _S J dam-• � _ n Vv O rn� Q 'r ct; -S n �J ,r � r 'Covi 1, Cif' BARNS TABLE 2001 MAY -7 AM 8: 42 FA kl�R R ILLS v br"o,j t_ t-T :E LE-v,4-716 n1 ILJ/ \ R16#-7- -Et-6 VA-Ro ) r ffLr-v,A--nn,► t .r:xsc�:ar;:rgx�:Ma I:ivp,.:N�uy tiE;)izJ Home .. Improvcmentfovthe usc-ui Cep:zzi Home tmproVOMr±t :mplcye?s en.;su`..: _C±:;;s. A.n+,•Cne using Mese U K N 1 G IC /G rX a D A 7 rT o Al. - � `i' x`-irg concitioru, c.i iar:tlta!ebuikflrg SCALE:' _/ D° wsrwwmer: owwwnm iNa - -o_Crae:ings. Capizzi Hmrie - i owh: s-Crsibility for airyenda9 .c Use of the S I+AROIJ NI.A-lC/JE— _77ir- r:Cn mploy ese-subeor&3060ot _ Cariz-.i :cm('Imorrn+zmsnt - owwwwo Nu►revt ro,e �APi 2zi �/OME .MP.__ 7 D asy r/no a.omwa��r• ♦.. i I BRAWL gPAM- R".DQ 57 G.AP ` - Z' c'11C(p -lJILL-.' 67M P.f. 1 to ANG+h�R C'>OLT_PEfL GODS Q +� _ a co�_.x..IQ._.c.oNG. 04 o LoSe✓5 rn3Ec��zJ O I/ -ZIE L� I)k t PJ T30=, 51ze �`rlov " \9 Gks FIR= CO - I IGk�rT. Jays i y IrJ41)/,.4TiO,tJ _ ;CLooR Pcti nl I ao-o" k3o CLG 1-DUADA-nos) PLAW - GGAL��f —r l� 19 rLOaR.. POOP - ASP4AL.7 iTttr3 /S. FSL7- Ov.�2 PLY. �� a(k� /ZITJbt .1,e3_....k.U4- j+- L o t ax v. u L�J L �bF ¢ 41A, fl �N_ PnA,J kDVS IIFrG(. _ _ Ibc i tXI,ST. X f J�cJ _ 1 c)X Sal 2 ;n MA-rcy .FLo7. o2 L�vF� ;---} �x ti 3 f Tr 6 S08. i-LGO, &�A K. \1 l \ �6 L V E -I-, N A I I- x r- -- axlo v/ r =� -ANT..6 LI c�wL SP-ALc j d.-.ax6 y(LL 1 - I --- I BOTTbM /C L F T lA1.IN..DO_J ` CO .S_._GGN7U.. �_ 3f�"(cNC. coL. �,L t�D GvTAGLf 3D'c o` _....,.... �_. ' L...... .._.riAR�.E.y.WINnO (�/ZICt S f�NGllo�. f7dLr rf.E yI m R1f1.) HOv�E n GOD= GAP >d'�jOnK lD' GO/> V /Vdnt �/� .:.. ..... j..... .... ..._...FLD• - �� L,,Tt__ r.tf 51T')Al) E -PC�,�f.= - —, - - O.F I.A) -HOv5= rW &Kk .SLIV1EA, CG sow JLL �D077A-)6-' S All,-J, T--_tOiJ V/'-'vim CLjF '• D 1 D Y"' 7.T(i.t- 6 pA1L+p I xV 77E / �cd2�P) A LVA,/. itLLtiM. T2/tit 'fo q R o LEGEND ca o (IF MASs9 PROPOSED CONTOURUj Q = p k yo 9® PROPOSED SPOT GRADE �� �C DARREN M o S! d — 98 EXISTING CONTOUR A(p m N 0 Co + 96.52 EXISTING SPOT GRADE C E Cj o Q c S1E W— EXISTING WATER SERVICE DR _ = o U2 Q ---------- SANIR\�`� 0 600 0 ' \\ 60 - co---------- TA TEST PIT -------------- 00 ft E100 ES U p( N RO ar p Cq p MARKS o o s s Q \ \�� I_ O T 20 - PATH `\ 1nrGROUrvD aP,E�,Q = 15728 sf + - '\ LOCUS MAP N.T.S. ` SWIN4MING\ \ GENERAL NOTES:'\ POOL \ \ 1• ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL \ \ \ BOARD OF HEALTH AND THE DESIGN ENGINEER. \ 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE \ \ \ LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: \ \ \ t — 310 CMR 15.405 (1) (B): \ \ 1) UP TO A 1.5, FT. VARIANCE FROM 310 CMR 15.211 TO ALLOW \ EXISTING \ LEACHING TO BE UP TO 4.5 FT BELOW GRADE VS REQ'D 3 FT. (VENT PROVIDED) \• \ 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR 6' \ \ I TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE DWELLING DESIGN ENGINEER. 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN TOP OF FNDN \ - 6 74 o o ENGINEER BEFORE CONSTRUCTION CONTINUES. E L 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF \ / I \• THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 2 ft \ HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. / �3__- - --- // J 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY \ \ THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING Existing Leach Pit CONSTRUCTION. 10. EXISTING LEACH PIT TO BE PUMPED, CRUSHED AND REMOVED \ 1 a o I _� \ (See Note 10) 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION \ i o \� O \\ \ 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY / AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY r* 13. NO PRIVATE WELLS WITHIN 150 FT. OF PROPOSED LEACHING Sleeve Solids Line .14. ALL PIPING TO BE 4" SCH 40 0 1/8"/FT (UNLESS SPECIFIED OTHERWISE) 1 15. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW 59 ; - --__.-_--_r _ I l \{ (See Note 17/ FOR THE USE OF A GARBAGE GRINDER \ 1 35.00 rt - - - I _ \ 16. NO WETLANDS WITHIN 100 FT. OF PROPOSED LEACHING \ WATER \ \• 17. SLEEVE SOLIDS LINE ON 10 FEET EITHER SIDE OF WATER SERVICE. GATE \ _�� --_-- 59 EDGE OF PA\iEMEN T \ \` OAKL /z-\ ND ` PROPOSED SEPTIC SYSTEM UPGRADE PLAN 0 P\ / B E(\I r ' 4 OAK LAND ROAD, HYAN N D �� , I�/IA.RI � 38 0 IS, MA TOP OF WA41-EP GATE Prepared for: Urnick SURVEY REFERENCE: E L E VA T101\I , = 58. 72 MAP: 272 Engineering by: Surveying by: SCALE DRAWN JOB. NO. LOT.'103 DARRENM.MEYER,R.S. Eco—Tech Environments! 1"=20' DMM B A P.IV S T A B LI_ . G I S D.A TU M PLAN BOOK:18983 PLAN OF LAND BY DAVID H. GREEN — SURVEYOR Poaoxss� R (508) 364-0894 DATE: CHECKED SHEET N0. PLAN FA >48 EAST SANDWICH,MA 02537 I DATED: JULY 1966 508-362-2922 03/16/08 DMM 1 of 2 w I ti y � ELEV. TOP t vent required FOUNDATION (Existing) FINISH GRADE= 60.0-59.0 61.74-\A�F.G.EL: 60.0 F.G.EL: 59.76 F.G. EL: 59.3 MAINTAIN 2% MIN SLOPE OVER LEACHING AREA COVERS TO WITHIN 6 OF GRADE s" INSPECTION PORT W/IN 6" OF FINISH GRADE L = 100 ' 6" . _" 4" SCH 40 PVC L = 5' 10"I S= 1% 8 0 0 0 0 0 0 0 0 0 0 0 0 (MIN.) (MIN.) @ S= 1% (MIN.) TEE'S ARE TO BE 14" 4' scH 40 PVC INV.55.86 ° o G o ° o ° 0 0 0 0 0 • IN l INV.55.66 GAS J ` PROPOSED DB-3 EXISTING OUTLET ° ° ° ° ° ° ° BAFFLE H . 10 DISTRIBUTION BOX 30' INV. 58.11 EXISTING 1000 GALLON SEPTIC TANK G NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE INVERTS PRIOR TO CONSTRUCTION m•M F 9" MIN. 2) D-BOX SHALL BE SET LEVEL AND TRUE TO PER TI TLE 5 GRADE ON A MECHANICALL COMPACTED SIX OF MAss9 INCH CRUSHED STONE BASE, AS SPECIFIED IN BREAKOUT EL. = 55.5 310 CMR 15.221(2) INV. ELEV.=54.8 DARR N M. 3) REPLACE EXISTING 1,000 GALLON SEPTIC _ „ M TANK WITH 1500 GALLON SEPTIC TANK a� - '_MN. » aaa���SSE 24 30.5 N y IF FAILED, DAMAGED, OR UNDERSIZED. INVERT SEPTIC SYSTEM PROFILE 4) INSTALL INLET & OUTLET TEES AS REQUIRED C/ EO BOTTOM EL.= 52.8 50" 35" SANIT a� 08 r I _I 3.16 SEPARATION 5.0 FT. 120 N FI LTRATO R 3050 SPECIFICATIONS SOIL ABSORPTION SYSTEM (SECTION) BOTTOM OF TH-1 EL: 47.8 H H22O LOADING SOIL LOGS DESIGN CRITERIA -# 1Z©S-�g NUMBER OF BEDROOMS: 3 BEDROOOM DATE: DECEMBER 12, 2008 SOIL TEXTURAL CLASS: CLASS 1 (0.74 GPD/SF) SOIL EVALUATOR: DARREN MEYER, R.S., CSE DESIGN PERCOLATION RATE: <2 MIN/IN WITNESS: DONNA MIORANDI DAILY FLOW: 110•G.P.D. I HEALTH AGENT DESIGN FLOW: 330 G.P.D. GARBAGE GRINDER: NO (not designed for garbage grinder) INLET END Elev. TH-1 Depth L Elev. TH-2 Depth SEPTIC TANK: 330 gpd x 2 = 660 gpd USE EXIST. 1,000 GALLON SEPTIC TANK (OPEN) 59.25 0" 58.8 0' + ' A LOAMY SAND 1 A LOAMY SAND LEACHING AREA REQUIRED: (330) = 445.94 S.F. 10YR 3/2 10YR 3/2 .74 { 4.5'DM ACCESS PORT FOR INSPECTION. 58.75 B 6" � 58.3 B 6" USE THREE (3) INFILTRATOR 3050 UNITS (H20) WITH 2.91 FT. STONE �Y LOAMY SAND LOAMY SAND ON THE SIDES & 3.83 FT. STONE ON ENDS: 30' L x 10' W x 2'D 10YR 5/8 ; IOYR 5/8 BOTTOM AREA: 30 x 10 = 300 SF H 56.75 C1 30" 56.3 C1 30" SIDE AREA: (30 + 10) X 2 X 2 = 160 SF SANDY SANDY TOTAL SQUARE FEET PROVIDED = 460 vs.' 445.94 REQ'D LOAM LOAM ° t0YR8/1 10YR8/1 DESIGN FLOW PROVIDED: 0.74(460 S.F.) = 340.4 G.P.D. vs. 330 G.P.D. req'd ° ° ° 0 0 0 a 0 ° 55.25 C2 48 54.8 C2 48 PROPOSED SEPTIC SYSTEM UPGRADE PLAN INFILTRATOR 3050 MEDIUM PERC 054.0 MEDIUM 438 OAKLAND ROAD, HYANNIS, MA ck NOMINAL CHAMBER SPECIFICATIONS SAND SAND Prepared for: Urn LE 7.5Y 6/8 7.5Y 6/8 Engineering by: Surveying by: SCALE DRAWN JOB. N0. » „ 48.25 132" 47.g 132" DARRENM.MEYER,R.S. Eco-Tech Environmental N.T.S. DMM SIZE (W x H x L) 51 x 30 x 85.4 PD BOX 981 (508) 364-0894 WEIGHT 80.0 LBS. PERC RATE <2 MIN/IN. ("C" HORIZON) PERC RATE <2 MIN/IN. ("C" HORIZON) EaSTSANDWICH MA02537 DATE CHECKED SHEET NO. NO GROUNDWATER OBSERVED NO GROUNDWATER OBSERVED 50"62-2922 03/16/08 DMM 2 Of 2 I