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HomeMy WebLinkAbout0095 OAKVIEW TERRACE - Health �5 O kview Terrace Hyannis A= 268--292 TOWN OF BARNSTABLE V LOCATION q6 ®0.I �-Qr `t-'VILLAGE ASSESSOR'S MAP&PARCEL RqSTAtf-BR'S NAME&PHONE NO. Zkq v­yU_ 0( Oannkll qd&i'1'i�j SEPTIC TANK CAPACITY 000 LEACHING FACILITY:(type) (size) _O00 NO.OF BEDROOMS OWNER c,b r i PERMIT DATE: DATE: ��P S� 1 log 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 \.,.,.',.,.,•, 4.,. ,.\ \ \ 4 4 , ,.\ J i / i i f ? f r / ! • �' r r f r r f r r r / r .• �- ! f f f i i f J i f f f f f J - \ \ , \ r r f f f f ! f f ! r ! f r r f r f r f r f f • / / f f f f ' 25 f f f r r f r i f r J J f f f i f J i f 12 Jrr { ii { ! rI 27 39 v No. f'' Fee �pute�1D r: THE COMMONWEALTH OF MASSACHUSETTS Entered in corif PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTSJ Zipplication for Mif ponY *paem Con5tructiun Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. 65(*f c. Q(- ZA 13 2 i 5e Assessor's Map/Parcel Installer's Name,Address,and Tel.No. GA An, j cLg 9l)�t' fPi7« Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building T No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date ft 44 Number of sheets Revision Date Title Size of Septic Tank 1000 6,0-( g, 6"+ Type of S.A.S. Le✓�'1� Description of Soil Natur. f Repairs or Alterations(Answer when ap 1'ca(ble) Date last inspected: 1 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 Board of Health. Signed Date I� Application Approved by Date ( �— Application Disapproved by: Date for the following reasons Permit No. 0� Date Issued —C�� No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH BIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS .; 01pprica[On for Tigpogal *VWm Construction Permit ; Application for a Permit to Construct( ) Repair p ( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. G L A K V Qs J I c✓/AC A Owner's Name,Address,and Tel.No. (5/4 tr 6 F Assessor's Map/Parcel , Installer's Name,Address,and Tel.No. C gZ,,j',%6 P(�f/r;,t Designer's Name,Address and Tel.No. ( 2� �z yt-rq � Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder Other Type of Building �J:ti,�� r- w y No.of Persons Showers( ) Cafeteria'( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date 11 14 Number of sheets Revision Date Title Size of Septic Tank /000 CiIQ( 8,ke1 Type of S.A.S. I e✓I�'t� �i i Description of Soil r Natur of Repairs or Alterations(Answer when applicable) 141e: . 5 Iq.yt , 1~aR 9tae N N^ `1 o Date last inspected: Z Agreement: l(` The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in r 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 Board of Health. Signed Date b Z�c�C7 Application Approved by Date Application Disapproved by: V Date v for the following reasons 1 Permit No. o� Date Issued — ( r-0 pCet PQ THE COMMONWEALTH OF MASSACHUSETTS f BARNSTABLE, MASSACHUSETTS P Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (� ) Upgraded ( ) Abandoned( )by 6,4e d")I tk Q I-G(Q(, N C S at I ) U A-Lt u.t,<,, r/n4-.e / in I has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 100— 181, dated k-0(; Installer L t�dl e„t„1, � 'e%Qr t S s Designer_ ,)IA v #bedrooms 3 Approved design fl.yv A)k A- gpd The issuance of this pe it shall not be construed as a guarantee that the systemX11-1ton as desi,ed. Date � ��� Inspector (� No. 1 O°'1" Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS lwi.gpool 6poem C011gtruction Permit Permission is hereby granted to Construct ( ) Repair ( ( ) Up rade ( ) Abandon ( ) System located at 0 AL,v�,Gt.�1 and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction" ust be completed within three years of the date of this pc—nn"it Date J Approved by Town of Barnstable Barnstable Regulatory Services Department Mun1caft Public Health Division {) � 200 Main Street, Hyannis MA 02601 -2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#70081830000205006690 6/19/2009 Estate of Patricia Zabriskie 95 Oakview Terrace Hyannis, MA 02601 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 95 Oakview Terrace, Hyannis MA`was last inspected on May 1, 2009 by Patrick M. O'Connell, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Conditionally Passed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00). You are ordered to repair the septic system within two (2)years from the date you receive this notification. Failure to repair 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 95 Oakview Terrace Property Address Estate of Patricia Zabriskie Owner Owner's Name information is required for Hyannis MA 02601 May 1, 2009 every 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. n Important: A. General Information When filling out forms on the � �05 computer,use 1. Inspector: V only the tab key to move your Patrick M. O'Connell cursor-do not Name of Inspector use the return key. Septic Inspection Services Co. Company Name r� 189 Cammett Road Company Address Marstons Mills MA 02648 �nr» Cityfrown State Zip Code 508-428-1779 SI 12855 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. 1 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 May 1 2009 Ins ctofs Sign ure Date The sy�tem inspector shall submit a copy of this inspection report to the Approving Authority(Board of HeaP 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 re ort only describes conditions at the time of inspection and under the conditions of use at thattme.This inspection does not address how the system will perform in the future under the same or different conditions of use. I i I 09-73 Zabriskie.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 t i i Commonwealth of Massachusetts Title15 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 95 Oakvlew Terrace _ Property Address Estate of Patricia Zabriskie Owner Owner's Name information is MA 02601 May 1, 2009 required for Hyannis every page. City/Town I State Zip Code Date of Inspection B. Certi ication (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D i A) System'I Passes: ❑ 1 hyve 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. Comfits: i I t f f B) Systern Conditionally Passes: . ® One or more system components as described in the"Conditional Pass"section need to be rep aced 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 strL cturally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. SyE tern 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: Precast baffle in tank is missing, needs to be replaced with a PVC tee. .F ❑ 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): ❑ i broken pipe(s) are replaced i ❑ I obstruction is removed 09-73 Zabriskie.doc-08106 I Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 95 Oakview`Terrace Property Address Estate of Patricia Zabriskie — Owner Owner's Name information is required for Hyannis MA 02601 May 1, 2009 every page. City/Town State Zip Code Date of Inspection i B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ 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 t 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 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. 09-73 Zabriskie.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 95 Oakview Terrace Property Address Estate of Patricia Zabriskie Owner Owner's Name information is H annis MA 02601 May 1, 2009 required for y every page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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: 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_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. 09-73 Zabriskie.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 95 Oakview Terrace _ Property Address Estate of Patricia Zabriskie Owner Owner's Name information is required for y H annis MA 02601 May 1, 2009 - every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® 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. 09-73 Zabriskie.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 I Commonwealth of Massachusetts = Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 95 Clakview Terrace Property Address Estate of Patricia Zabriskie Owner Owner's Name information is required for Hyannis MA 02601 May 1 2009 every 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 inspeclied 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)) 09-73 Zabriskie.doc-08f06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 I' Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 95 Oakview Terrace Property Address Estate of Patricia Zabriskie Owner Owner's Name information is ann H is MA 02601 May 1, 2009 required for �— every page. City/Town State Zip Code Date of Inspection 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 0 Number of current residents: 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 Water meter readings, if available (last 2 years usage (gpd)): — Sump pump? ❑ Yes.® No Dec. 2008 Last date of occupancy: 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: Last date of occupancy/use: Date Other(describe): 09-73 Zabriskie.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 95 Oakview Terrace Property Address Estate of Patricia Zabriskie Owner Owner's Name information is y required for y H annis MA 02601 May 1, 2009 every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping.Records: Source of information: None 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: Compliance date: 11/13/80 Were sewage odors detected when arriving at the site? ❑ Yes ® No A { 09-73 Zabriskie.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 I - I . j w i l . Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 95 Oakview Terrace — Property Address Estate of Patricia Zabriskie — Owner Owner's Name information is Hyannis MA 02601 May 1 2009 required for State Zip Code Date of Inspection every page. Cityrrown D. System Information (cont.) Building Sewer(locate on site plan): 1' Depth below grade: 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): 1' 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 •------------------------------------------------------------------------------------------------- 8.5' long x 5.2'wide- 1000 gal. _ Dimensions: 2" Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle Trace 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 Measured How were dimensions determined? 09.73 Zabriskie.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 95 Oakview Terrace Property Address Estate of Patricia Zabriskie Owner Owner's Name information is Hyannis MA 02601 May 1, 2009 required for Y y every 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.): Liquid level was found at bottom of outlet invert, outlet baffle is missing. 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 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): 09-73 Zabriskie.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 i r Commonwealth of Massachusetts Title 5 Official Inspection Form R Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 95 Clakview Terrace Property Address Estate of Patricia Zabriskie — Owner Owner's Name information is Hyannis MA 02601 May 1 2009 required for - every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 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 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.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 09-73 Zabriskie.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments N 95 Oakview Terrace Property Address Estate of Patricia Zabriskie Owner Owner's Name information is Hyannis MA 02601 May 1, 2009 required for )/ every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 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: One 6x6 pit. ❑ leaching chambers number: El leaching galleries number: El 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.): Pit was empty at time of inspection, observed high stain line 2'from bottom of structure indicating pit has 4'of effective leaching 09-73 Zabriskie.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page Q of 15 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 95 Oakview Terrace Property Address Estate of Patricia Zabriskie Owner Owner's Name information is required for Hyannis MA 02601 May 1, 2009 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 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.): . t 09-73 Zabdskie.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form Not for Voluntary Assessments w., 95 Oakview Terrace -- Property Address Estate of Patricia Zabriskie — Owner Owner's Name information is Hyannis MA_ 02601 May 1 2009 required for ------- State Zip Code Date of Inspection every page. City/Town D. System Information (cont.) 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. Water Service \ \ ♦ \ \ ♦ ♦ \ \ \ \ \ \ \ Y Y \ Y \ \ \ Y 25 12 27 39 , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 95 Oakview Terrace Property Address Estate of Patricia Zabriskie Owner Owner's Name information is Hyannis MA 02601 May 1 2009 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells 20' Estimated depth to ground water: 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: USGS topo map and town GIS. You must describe how you established the high ground water elevation: Town groundwater contour map shows water below el 20 and topo map shows property at el. 40. 09-73 Zabriskie.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 L0CAT10 SEWAGE PERMIT NO. L,ot 471 Oakview Terrace 80-512 VLLAGE 'HYANNIS IIli�-STA LLER'S, NAME i ADDRESS James J. Driscoll 888 Old StaaP Rd- rpntPrvillP r B U I L D E R OR OWN ER CAPRICORN Hyannis DATE PERMIT ISSUED 9-16-80 DATE COMPLIANCE ISSUED 11-13-80 • 9 s C` ' t /a - No...._...... �:Z THE COMMONWEALTH.OF MASSACHUSETTS BOAR® OF HEALTH ro -�.----...OF....l/.AJ ......................... Allp iration for 11iipnsttl Works Tnnptrurtiun Errant Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Sy tem at• Loc t' n-Addr ss canertzo-- Address W ..... --..... .. :. ...............................................d ...... � Installer Address /` UType of Building Size Lot_.�c3j�f_ .-i.___..Sq. feet �-, Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) 1-.4 Other-- T e of Building No. of persons......... ................ Showers — Cafeteria a YP g P ( ) ( ) 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. 3 Seepage Pit No--------------------- Diameter.._......___._....... Depth below inlet.................... Total leaching area..........._......sq. ft. Z Other Distribution box ( ) Dosing C dam( Percolation Test Results Performed by..... .........c_)Z. .....)Zw.;..It..... Date.2./ ..._..................._.. minutes per inch Depth of Test Pit............•....... Depth to ground water........................Test Pit No. 1....�..... .. f=, Test Pit No. 2-_-'5-R..Z-1ninutes per inch Depth of Test Pit.................... Depth to ground water---..................... O f- .. r 1 .r.... r................................ Description of Soil ----- C = ®f / ._ � 1_l z ��� w x ----...----•---------•-----------------•--•--------------------------------------------------•--•-•---------------•----------••-------•---••---------•--------•------................................. U Nature of Repairs or Alterations—Answer when applicable-------------- ................................................................................ ...-•---•--------- ---------------------•_------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITi U 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 of health. ,. gned.... ------------- .....------.....----------------.--•--- ................. Date Application Approved By---- --- �c'.�// ! = •' 14 Date � = Date Application Disapproved for the following reasons-.............................................----------------------......................................... Date PermitNo................................................... .. Issued---.----�l ..�.�... ----------------------- Date N ..... Viz_ ` FEs .. ... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF 1 HEM TH .. r�-� . ApplirFation for DispooFal Works Tonitrur#inn Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Sy tem at L7 y /- Loc ` n-A dr s or N . _ , 1 .� . .1? . .... . .......f ?. `_'.. --��` .........--•............... w Owner q V Address a1r' _ ....... ...-•--•- ... �f Installer Address � l U Type of Building Size Lot..l:��.-,f41 Sq. feet �-, Dwelling gNo. of Bedrooms.•.....::.._;._; ..................Expansion Attic ( ) rbage Grinder ( ) Other—T a ype of Building ....:....................... No. ,of persons......... Showers G Cafeteria QOther fixtures -------------------- ............................•--------------------------------------------------------- Design Flow............................................gallons per perso ...._........... W n 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( C ~" Percolation Test Results Performed by..... .........c.�.l._... $...... Date..._.. .......................... a �� � l�S Test Pit No. I....4. -.minutes per inch Depth of Test Pit.................... Depth to ground water........................ (s, Test Pit No. 2..4m. iinutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 .." r - --- - . �O Description of Soi . •• f t� _____________ ......... l1 �A .. ................•--------- ----..... ------w UNature of Repairs or Alterations—Answer when applicable................................................................................................ -------------------••----•----•----•------------...------•------------------------•----............---------------------------------------...-••••••-•-•--- ...--•-•-•---••-•-••--•-.....•--••••-••-••. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TAITILS 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 of health. ned.. .::-1----- ----------------------------------- - ---------------- • :.. • J Datr Application Approved By------•-•--- ,{�' t .l. ... .. ........ .`l........................ Date ..... ...............••..............••..•••••.....----•-----Date Application Disapproved for the following reasons:.................................... ._.....__._... ..........................................•-----.......•••••-••...-•-.---•-•-•--•••-•-••-••--•••-•--...-••-•••-•-••-••-•••••••••••••------•--•----•--------...-•••••••-••--••---------•••-••---••--••••- Date Permit No..................... Issued•--•-...._........••----••- Date THE COMMONWEALTH OF MASSACHUSETTS ,..�- ---..BOARD OF .HEALTH Jai 1. ................OF..... .t � .,�(,. ....- ......... f9rdifirate of Tontplittnrr THI S TO CE hat the Ind; al Sewage D osal System constructed ( or Repaired ( ) by........ . - •- Installer at-- ar•-•4... ... �rC�LI....... ................... has been.installed in accordance with the provisions of T j f The State Sanitary C e as escr' edt in the application for Disposal Works Construction Permit No.- .._.�_Z? ........ dated.....- .....................................d.. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WALL FUNCTION SATISFACTORY. DATE.............. � ...::. � ................... Inspector------. THE COMMONWEALTH OF MASSACHUSETTS <��) BOARD F HEALTH �" ....... a ./( ....OF.......... I�- ....... :............. B • ._._ No.......... ......... FEE....................... . �io�roo�t o ko �onottr�ion rr/nti� Permission is hereby granted........ .::: .. to Constru .ty( or Repair ( ) a ndividual Sewage Visposal System . at No.... ...1.... .�! _1-(,1..... fl ,/ ydLJl ..r f. .......................................... Street„ ?- J�—��� as shown on the application for Disposal Works Construction Permif o... .___ ated...._.......................................... - ..1�/ ................. . ....- ...................... Board of Health DATE �_/�.�..€ Ct'�.�.......................••----- FORM 1255 HOBBS & WARREN. INC.. 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