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HomeMy WebLinkAbout0086 OLD STRAWBERRY HILL ROAD - Health i?- 6,0Id;Strawberry Bill Road Hyannis P A 249 125 i k dL� TOWN OF BARNSTABLE vt LOCATION 00 A) d6f212 lit// 12.1) SEWAGE # VILLAGE ,R, 5 ASSESSOR'S MAP & LOT y9/2 INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY 7.® /aoo �a� 7bgN�cS LEACHING FACILITY:(type) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No } .�,e j^ 2�/� '� _ COMMONWEALTH OF MASSAC14USETTS ExECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS > DEPARTMENT OF ENVIRONMENTAL PROTECTION p �gfiry a Z49 y�e �VIP1r _ .. PARCEL i Z� :n7 _ `Z ® _ TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address; 196 (9!d{ d w f /f;// N. 14- , Owner's Name: f I { a Owner's Address: v < <1.VL-ems_ s O !Date of Inspection: 0 < o Name of Inspector: l r9 0 _ Company Name* = �TagC. v> w co !Mailing Address• '� � �+ CD � v ,Telephone Number: .. a CERTIFICATION STATEMENT 'rn — I certify that I have personally inspected the sewage disposal system at this address and that the info tion reppoorted 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 n 15_w of Title 5(310 CMR 15.000� The syste to m: a� 'Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: t ��' .w Dater f3 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 shalt submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments� �` F 5�4 ****This report only describes conditions at the time of inspection and under the conditions of use at that time,This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Farm 6/15/2000 page 1 f Page 2 of 11 OFFICIAL,INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.,SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Owner: Date of Inspection: Inspection Summary: Check A,II,C,D or Is I ALWAYS complete all of Section D A• Syste Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CTMR 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: 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: Title 5 Inspection Form 6/15/2000 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Owner.• Date of Inspection: C. Further Evaluation is Required by the Board of Health: Conditions exist which require fiuther evaluation by the Board of Health in order to determine if the system t� is failing to protect public health,safety or the environment. �v 1. System will pass unless Board of Health determines in accordance with 310 CMR 15303(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. 1 " _ The system has a septic tank and SAS said 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's*.Method used to determine distance **This system passes if the well water analysis,performed at a AEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered A copy of the analysis must be attached to this form. 3. Other: Title 5 Inspection Form 6/15/2000 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Owner: Date of I ion: D. System Failure Criteria applicable to all systems: You mast indicate"yes"or"no"to each of the following for ail inspections: Yes No 'of sewage into facility or system component due to overloaded or clogged SAS or cesspool Dr a or ndin of effluent to the surface of the ground or surface waters due to an overloaded or � Po g �eiooggged SAS or cesspool c liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or 1 !red d depth in cesspool is less than 6"below invert or available volume is less than%day flow pumping more than 4 times in the last year NOT due to clogged or obstructed pips).Number s pled _ y portion of the SAS,cesspool or privy is below high ground water elevation. _ Any on of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface ��pF1Y Apyportion of a cesspool or privy is within a Zone 1 of a public well. �_ A�.y 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 conform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis most be attached to this form.] L(Yes/NO)The system fails.l have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails The s. ystem 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 most serve a facility with a design now of 10,000 gpd to 15,000 gPd- "or"no"to each of the following: You roust indicate either`des �$• (The following criteria apply to large systems in addition to the criteria above) yes no _ the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellbead Protection Area—IWPA)or a mapped Zone H 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 Deparlment' Title 5 Inspection Form 6/15/2000 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Owner: Date of Inspection: Check if the following have been done You must indicate"yes"or"no"as to each of the following: Yes o Pumping information was provided by the owner,occupant,or Board of Health +� o the stem eom onents umped out in the previous two weeks? Were an f P p .._ Y sy --L-Z Has die system received normal flows in the previous two week period ave 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) as the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out? ,L/ Were all system components;excluding the SAS,located on site? L/ Were the septic tank manholes amcovered,opened,and the interior of the tank inspected for the condition :;?: r tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes o _ xrsting information.For example,a plan at the Boatel of Health. eel in tiie field if an of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)1 Title 5 Inspection Form 6/1512000 5 f Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Owner: Date of Inspection FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): c) DESIGN flow used on 310 C 15,203(for example: 110 gpd x#of bedrooms): Number of current residents: Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system es or no):aQif yes separate inspection required) Laundry system inspected(,yes or no): Seasonal use:(yes or no): � � )�Zo©4. / ?3 � Water meter readings,if available(last 2 years usage(gpd ! Sump pump(yes or no): Last date of occupancy: k COMMERCIALANDUSTRUL Type of establishment: Design flow(based on 310 CM R 15103): god Basis of design flow(seatslpersonslsgftete.): Grease Crag present(yes or no):__._, Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no): p If yes,volume pumped: Ions--How was qu� um ed determined? Reason for pumping: + CtsccPpt �L:e 'r�tcu,a5� TYPE OF SYSTEM Septic tank,distribution box,soil absorption system Side cesspool verflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Altemative 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: Were sewage odors detected when arriving at the site(yes or ono):_ Title 5 Inspection Form 6/1Y2000 6 Page 7 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: Date of Inspection: 1R.I"ING SEWER(locate on site plan) Depth below grade:-�-L`-- Materials of construct►on:Est aon —'40 PVC_-.-other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): (locate on site plan) Depth below grade: Material_of constructio : concrete awtalberxlass._polyethylene If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: Sludge depth: ��M � Distance from top of sludge to bottom of outlet tee or baffle: _ Scum thickness: Z'Q_ f[ Distance from top of scum to top of outlet tee or baffle: `d Distance from bottom of scum to butt m f utIe a#Ilet d S U! � How were dimensions detemuned: " Comments(on pumping recommendations,inlet and out et tee or baffle con ition,structural integrity,liquid levels as re to outlet invert,evidence =1 ,etc.): t3�72 GREASE TRAP: {locate on site plan) Depth below grade:____ Zmensions; erial of construction: concrete metal--fiberglass--polyethylene other Scum thickness: Distance from top of scum to top of outlet tee orbaffle: Distance from bottom of scum to bottom of Outlet tee or baffle: Date of last pumping: liquid levels Comments(on pumpingbaffle recommendations,inlet and outlet tee or bae condition,structural integrity, q as related to outlet invert,evidence of leakage,etc.): Title 5 Inspection Form 6/15/2000 7 Page 8 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: Date of Inspection: 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_jmlyethylene other(explain): imensions:III . Capacity gallons Design Flow: _ gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): ,1 DISTRIBUTION BOX:_(if present must be opened)(kocate on site plan) P' 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.): PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Title 5 Inspection Form 6/15/2MO Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: Date of Inspection: SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: ate✓teaching pits,number: 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 Wure,level of ponding,damp soil,condition of vegetation, etc.); D f om , ,) } f � �►, i 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 Aids layer: , Depth of scum layer: It Dimensions of cesspool: _ Materials of construction: Indication of groundwater inflow(yes or no):JLO � Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of veg o —e-k PRIVY: (locate on site plan) PAterials of construction: imensions: Depth of solids:. Comments(note condition of soil,sagas of hydraulic failure,level of ponding,condition of vegetation,etc.): Tide 5 inspection Form 6/15l2000 9 Page 10 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner- 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. or I O - - o 2 �I rj c urvl .r . Tide 5 Inspection Form 6/15/2000 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: Date of Inspection: SITE EXAM Slope Surface water Check cellar. Shallow wells Estimated depth to ground water 12-f feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-if checked,date of design plan reviewed:- Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) r./t ccessed USGS database-explain: Xdek.9 mil/fo! M4'ek 2,cvf. You must describe how you established the high and water evation: 4 p b G Title 5 Inspection Form 6/15/2000 i I United States Geological Survey Observation Wells 4s a service to Cape officials, engineers and other interested parties,the Cape Cod Commission publishes monthly groundwater data gathered by its Water Resources Office. The water level measurements shown below are taken monthly from United States Geological Survey (USGS) observation wells and compiled during the last week of each month. They are published as soon as possible thereafter. Listed below are rune out of the 61 wells measured across Cape Cod by the Commission's Water Resources Office. These nine are employed as index wells to be used with Technical Bulletin 92-001 to predict high groundwater levels. For your convenience,we've also provided links to USGS national and state data. See the last c hin.;ae in the table and the footnotes below. To see what's happening in real time at a separate well in Brewster, visit the USGS site: (_SGS d14{,;:=00"! �C_14901..MA- For further information about any of the data or links on this page, please contact Hydrolop st Gabn61e Bel fit at the Lommission offices (508-362-3828). March 2004 Water Record Record Departure from USG SheN�4niber -= Location WellNo. Average" zlinlas t,,j I. :>(�s uataon,a Level* High* Monthly Overall wfiter-level daNhase) Barnstable 230 24.0 20.5 26.6 -1.0 -0.3 41..=956 7016 3 _1- Barnstable 24 24.4 20.5 28:6 -0.2 0.1 41 154070165()t,"j Brewster BMW 21 10.4 6.9 13.6 -0._ -0.1 ,1 _1 4 ?00'2 0 (� 2 1 � - i I Chatham CGV�T138 23.3 20.9 26.6 0.4 0.7 4 J 41 t.007001_1. 101. Mashpee MIW 29 8.4 5.fi 10.0 -0.4 0.2 4 l 52�!.�7.Q2 1.901 4 Sandwich SDW 47.2 45.9 48.2 -0.1 0.0 ,_; l ! ?02.11601_ Sandwich SDW 50.6 45.8 55.1 -0.6 -0.4 1 1_2.4 702. . Truro T5W 89 12.2 10.3 I3:0 -0.5 11 -0.1 11 4 2012(6 700450101_ LJW�efleet WNW 17 11.5 7.3 12:8 -1.4 -l.i 415'y 5 s-� I01 I Measurements are in feet below land surface. ttp://www.vsa.cape.com/-cccom/wefls.htm 5/2/2004 r - COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS ro ► rc, DEPARTMENT OF ENVIRONMENTAL PROTECTION , X ONE WINTER STREET,BOSTON MA 02108 (617)292-5500 4461 WILLIAM F.WELD `d° Tp COXE Q Governor pFe ARGEO PAUL CELLUCCI DAyVII3 B9�BTRUHS��` Lt. Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FO COII1°18°1OIIer PART A Z T CERTIFICATION Property Address: 86 Old Strawberry Hill Rd., Hyannis, MA Address of Owner: Date of Inspection: August 10, 1998 (If different) Name of Inspector: James M. Ford I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: James M. Ford Mailing Address: P.O. Box 49. Osterville, MA 02655-0049 Map: Telephone Number: (508)862-9400 Parcel: CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: ✓ Passes Conditionally Passes Needs Further Eval it n By the Local Approving.Authority ails Inspector's Signature: Date: August 11, 1998 .. - .. - T The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: A] SYSTEM PASSES: ✓ I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. 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. Indicate yes, no, or not determined(Y, N, or ND). Describe basis of determination in all instances. If"not determined",explain why.'. 'The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached) indicating that the tank was installed within twenty(20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04/25/97) Page 1 of 10 DEP on the World Wde Web httpJnwww.magnet.state.ma.us/dep Pnnted on Recycled Paper Y ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM •, PART A CERTIFICATION (continued) Property_Ad'dress:,e 86 Old Strawberry Hill Rd., Hyannis, MA 'Owner: Steve Stevens Date of Inspection: Augu'rt 10, 1998 B] SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than.four 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 Cl 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 the public health, safety and the environment.. 1) SYSTEM. WELL•PASS UNLESS:BOARD OF HEALTH__.DETERMINES. THAT THE SYSTEM IS. NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND 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 APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system(SAS) and the SAS is within.100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone 1.of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER , (revised 04/25/97) Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 86 Old Strawberry Hill Rd., Hyannis, MA Owner: Steve Stevens Date of Inspection: " August 10, 1998 i FLOW CONDITIONS RESIDENTIAL: Design flow: 440 g.p.d./bedroom for S.A.S. Number of bedrooms: 4 Number of current residents: 6 Garbage grinder(yes or no): No Laundry connected to system(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last two(2)year usage(gpd): 1997-105,000 gals.: 1996-129,000 gals. Sump Pump(yes or no): No Last date of occupancy: Currently occupied. COMMERCIAVINDUSTRIAL: Type of establishment: Design flow: gallons/day Grease trap present(yes or no): Industrial Waste Holding Tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: a,- GENERAL INFORMATION PUMPING RECORDS and source of information: Pumped in 1991 -per owner. System pumped as part of inspection(yes or no): No If yes, volume pumped: gallons 1`- 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) I/A Technology etc. Copy of up to date contract? Other W APPROXIMATE AGE of all components, date installed(if known) and source of information: Added pit on Oct. 3191. Sewage odors detected when arriving at the site(yes or no): No (revised 04/25/97) Page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 86 Old Strawberry Hill Rd., Hyannis, MA k Owner: Steve Stevens Date of Inspection: August 10, 1998 _ r BUILDING SEWER: (Locate on site plan) 4 i Depth below grade: Material of construction: _cast iron _40 PVC _other(explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK: None (locate on site plan) Depth below grade: Material of construction: _concrete _metal Fiberglass _Polyethylene _other(explain) If tank is metal, list age_ Is age confirmed by Certificate of Compliance_(Yes/No) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: 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: How dimensions were determined: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural'.. integrity, evidence of leakage, etc.) GREASE TRAP: None (locate on site plan) Depth below grade: 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: D ate of la t . ..,,. st pu__mping__: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural _ integrity, evidence of leakage, etc.) (revised 04/25/97) Page 6 of 10 i _ J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 86 Old Strawberry Hill Rd., Hyannis, MA Owner: Steve Stevens Date of Inspection: August 10, 1998 TIGHT OR HOLDING TANK: None (Tank must be pumped prior to, or 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/day Alarm level: Alarm in working order_Yes; _No Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: None (locate on site plan) ;3 •3,` Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) PUMP CHAMBER: None (locate on site plan) - Pumps in working order(Yes or No): - Alarms in working order(Yes or No): Comments: (note condition of pump chamber;condition of pumps and appurtenances, etc.) =" k► ?t"°' ' ;` , (revised 04/25/97) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) f Property Address: 86 Old Strawberry Hill Rd., Hyannis, MA Owner: Steve Stevens Date of Inspection: ,August 10, 1998 SOIL ABSORPTION SYSTEM(SAS): Yes (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number: leaching chambers, number: leaching galleries, number: leaching trenches, number, length: leaching fields, number, dimensions: overflow cesspool, number: 2 Alternative system: Name of Technology:, Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) The system had one cesspool and one pit for leaching The pit was added in Oct. 1991. The cesspool was full and the pit was one-half full. The bottom to grade was 9' - CESSPOOLS: Yes 4 (locate on site plan) Number and configuration: 1 (with 2 overflows) Depth-top of liquid to inlet invert:. 6" Depth of solids layer: 12" Depth of scum layer: 12" Dimensions of cesspool: 5' W x 6' T Materials of construction: Block Indication of groundwater: None inflow(cesspool must be pumped as part of inspection) Comments: (note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.) Grass covered the system Recommend pumping PRIVY: None (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.) (revised 04/25/97) Page 8 of 10 j • . v SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 86 Old Strawberry Hill Rd., Hyannis, MA Owner: Steve Stevens Date of Inspection: August 10, 1998 " • ` _' . '' "' - SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to at least two permanent references, landmarks or benchmarks. Locate all wells within 100' (Locate where public water supply comes into house). tis 37 _'.. 17 r; Cescl= IL cess?'c .,,._... �s—. _ .a ..� . ..�. .. .r.wq.• M1 r ..... .... . I -,. r �� h.�a t:�Air.,J i•Yf s -e , y i y.• e (. r (revised 04/25/97) Page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 86 Old Strawberry ryHill Rd. Hyannis, MA Owner: Steve Stevens Date of Inspection: August 10, 1998 Depth to Groundwater: feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on recofd Observation of Site(Abutting property,observation hole, basement sump etc.) Determine it from local conditions 1 Check with local Board of Health Check FEMA Maps Check records pumping Check local excavators, installers ✓ Use USGS Data Describe in your own words how you established the High Groundwater Elevation. rn,ust be completed) Using the Barnstable Water Contours map and U.S.G.S. Topographic Map, the maps are showing 25'to water at this location. �T This report has been prepared and the system inspected and passed as of August 10, 1998. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report. s (revised 04/25/97) Page 10 of 10 TOWN OF BARNSTABLE�� LOCATION 46 old`5;�a'a"114LI"JY)SEWAGE # �I ' VILLAGE ASSESSOR'S A�R6zAhQT INSTALLER'S NAME & PHONE NO. 78 LIND�iV ST. HYANNIS;- 0 1' SEPTIC TANK CAPACIT - - �o LEACHING FACILITYAty� (size) NO. OF BEDROOMS PRIVATE WELL Oil LIC WATE OWNER DATE PERMIT ISSUED: / Cl z Z-j/ DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No c� I t V / ti� \� �� `N` `^� V - ^v V^ V d V3 �� � � 4� Y� � � � � a �Z � ;_,��. � ,� � � � No.. Fxs �©............. C.:. THE COMMONWEALTH OF MASSACIJUSETTSQr' �, BOAR® OF HEALTM'`b1 p o v D 2 TOWN OF BARNST , - pphration for Mipma1 orki C Ting** 'u Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sje�"eosal System at., �'�.-�„�, v y P/�,r.c�-� �g .......... ..._.... . - ----- -......................... n Addresses� or j.o t✓o. .... `� - °' ..---...........-••--------•..... ----------- Oyvn� Add Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms---- ..Expansion Attic ( ) Garbage Grinder4 ( ) --------------•------ `4 Other—T e of Building ............................ No. of persons............................ Showers — Cafeteria Q' Other 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. 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........................ GL, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ •-- ODescription of Soil............ `a..�-�------------------------------------------------------------------------------------------------------------------ x VW --------------------------------------------------------------------------------------------------------------- --------•-- ••- Nature of Repairs or Alterations—Answer when appli e._______ ______ _ -____---.� -- ►..-G.. ed /� Agreement: 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 Compli nce ha been issued by the board of health. Si ne - - Date Application Approved By . �. Date Application Disapproved for the following reasons- ....................... ----------------------------------------------------------------------- -- ----- -- ---------- .---..--. - Date ------------- ----------------- PermitNo. � ------------- --- Issued -------------------------------------------------------------------- _. Date ..��� ao THE COMMONWEALTH OF MASSACHUSETTS t - BOARD, O.F. HEALTH TOWN OFBARNSTABLE,/— Application is hereby made for a Permit to Construct ( ) or Repair ((,/5""an Individual Sewage Disposal System at: ,! / ! �A,r F,/ a�/" —/Z S ... � Cam//U s��'c w d�i. ` I' 1.�.l.l v: -D,V Lo 7 0 - __ ....................................................... ............_.... ...... ......... L ocation-Address or Lot No. ------------ Owne Address W � ct. r y_ /�1C� C�r,�aS -7� i_y_ce`'._=a_.........................................................'J ..................................•--..........._..... � •• - ••.......... -••- Installer Address' S feet d Pq Type of Building z Size Lot............................ q. Dwelling—No. of Bedrooms...............!__..........................Ekpansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ ( ) — Cafeteria ( ) Other 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 ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water-.--_-_____----__---:_. w Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water............. .........7 a -- "-----_----- / ODescription of Soil = .....................;�-..-•--•-------------------------------------------------------•-------------------- -----------------......------ x U Nature ofRepairs or Alteraattiions—Answer when appliccable.__-_--� ..___ !�_`?`�._.C3 .�...._� L- . - T = /�/ �' ^�-,� e ! �1 - �li�.� f i. /t/{ram. z ....V -° Agreement: 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 Compliance has been issued by the board of health. t - -- Slgned ---....... ------. ................................. X Date Application Approved BY --........- ------------- --- .-- ---.... ---- o r t' %/ Date .---.. Application Disapproved for the following reasons: ...... ---------------------------------------------------------.................................... ------------- - -- ----------------------------------------------------------------------------- ----- --------------------- . Date PermitNo. a`�---------------------- Issued ------ .................................................. Date R� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Cer#iftra e of Graylinure THIS IS TO-CERZ"IFY, That�the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by - l W ----=�?�,�---------------- , .............. ---- r`�`-`"- - .. Installer 1 at ---:..------'` ..- t r - � �t C r. -------------- has been installed in accordance with the provisions of TITLE 5 �f The State jEnvironmental Code(as described in the application for Disposal Works Construction Permit No. -----7Z.....'71.$)--N-------. dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED,AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SA,T/I,S���TORY. � DATE.................................. .......... ----------------------------- Inspector ............................................................................................ /t I THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE NO K................ I FEE. ............ E.1iiplasa1 � ilan rrttt�# Permission is herebyanted_ t.` � :��^��?' ��•`- "--------------- ----------------•---------------•-------------••---•---.--.--____-___------- to Construct-{ ) or Repair �n�Indwidual�S wage Dl al System J 7 ,�/ at No. j 2.w2 Q • .� ���1 �'^� �: ,r/�Lt.CSi 11 d 1� •. Street -�U G as shown on the application for Disposal Works Construction Permit No'.g `—° ___ Dated------------ .......................... ........................................ ..`........----------------•--------•--•---•---------.....•--- DATE.............. --••-------------------•-------........ Board of Health p, FORM 36508 HOBBS A WARREN.INC..PUBLISHERS �. 1