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HomeMy WebLinkAbout0046 OLD TOWN ROAD - Health 46 Old Torn Road Hyannis ' A = 262 064 U O If u o fl a I i I 7 TOWN OFff STABLE LOCATION �h/ r )� SEWAGE # � VII,LAGE �-�-� CIr A�SSKEOr'S & LOINSTALLER'S NAME&PHONE NO. , ✓ SEPTIC TANK CAPACITY 1 LEACHING FACILITY: (type) Q ^>L��✓��� (size) NO.OF BEDROOMS c�, �►�4 "� t. BUILDER OR OWNER tt CGt ss� ~ PERMUDATE:��\�0`D� COMPLIANCE DATE: 3" 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 i 7 O a J i �J Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 46 OLDITOWN RD Property Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is HYANNISPORT MA 02601 10/11/07 required for State Zip Code Date of Inspection every page. Cityrrown Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your MICHAEL DEDECKO 1 y cursor-do not Name of Inspector use the return key. COMPASS REALTY DEV CORP Company Name P.O. BOX 2384 Company Address M MA 02649 ASHPEE City/Town State. Zip Code 508-221-5003 ' Telephone Number License Number C B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the •Q-) 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 or s'ke sewage disposal systems. I am a DEP approved system inspector pursuant to Section 1�.340fof Title 5(310 CMR 15.000). The system: I 1 ® Passes ❑ Conditionally Passes ❑ Fails Needs Further EvaluatiQn by the Local Approving Authority i 10/11/07 nspector's ignature 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. 28 GENERAL PATTON•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts Tithe 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w 46 OLD TOWN RD Property'Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is HYANIVIS MA 02601 10/11/07 required for State Zip Code Date of Inspection every page. Cityrrowh t B. Certification (cont.) 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: . i i l I . i I 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. i 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 i structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. I 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: i 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 28 GENERAL PATTON•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 Commonwealth of Massachusetts I Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments i „ 46 OLD TOWN RD Property'Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is required for HYANNIS MA 02601 10/11/07 every page. City/Town State Zip Code Date of Inspection i B. Certification (cont.) i B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced NDi Explain: i - i ❑ 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): I ❑ broken pipe(s) are replaced i ❑ obstruction is removed t • ND Explain: i f i 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. 28 GENERAL PATTON•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 OLD TOWN RD Property!Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is HYANN required for IS MA 02601 10/11/07 every page. City/Town State Zip Code Date of Inspection i B. Certification (cont.) i 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: i **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. I I 3.i Other: t i i. 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 El ® or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 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. 28 GENERAL PATTON•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments i ,M 46 OLD TOWN RD Property Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is required for HYANIVIS MA 02601 10/11/07 every page. Citylrown State Zip Code Date of Inspection I , B. Certification (cont.) I D) System Failure Criteria Applicable to All Systems (cont.): I Yes No t j ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. 1 ❑ ® 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.) I ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. f ❑ ® The system fails. I have determined that one or more of the above failure t 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. I yes No i �❑ ❑ 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 i❑ Elthe 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, oeanswered"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. 28 GENERAL PATTON-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments I 46 OLD TOWN RD Property!Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner'slNarne information is required for HYANNIS MA 02601 10/11/07 every page. Citylrown State Zip Code Date of Inspection c r i 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 I !❑ ® Were any of the system components pumped out in the previous two weeks? i ❑ ® 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? i - ® ❑ Were all system components, excluding the SAS, located on site? '® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank f inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? C 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)] f • S 28 GENERAL PATTON•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 i Commonwealth of Massachusetts Tittle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w 46 OLD TOWN RD Property Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's,Name information is required for HYANNIS MA 02601 10/11/07 every page. City/Town State Zip Code Date of Inspection i D. System Information i Residential Flow Conditions: i Number of bedrooms (design): 2 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No i Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No I Seasonal use? ❑ Yes ® No water meter readings, if available last 2 ears usage(gpd)): N/A. 9 ( Y 9 Sump pump? ❑ Yes ® No N/A 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 i 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): 28 GENERAL PATTON•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 46 OLD TOWN RD PropertyjAddress C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner'siName information is ( MA 02601 10/11/07 required for HYANNIS every page. Cityrrown State Zip Code Date of Inspection 1 D. System Information (cont.) I fGeneral Information Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No i If yes, volume pumped: gallons How was quantity pumped determined? I Reason for pumping: Type of System: ® Septic tank, distribution box,.soil absorption system j❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) O Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) I❑ Tight tank. Attach a copy.of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: i x 2004 t I Were sewage odors detected when arriving at the site? ❑ Yes ® No 28 GENERAL PATTON•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 46 OLD TOWN RD PropertyAddress C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's;Name information is MA 02601 10/11/07 required for HYANNIS State Zip Code Date of Inspection every page. Cityrrown I ' D. System Information (cont.) Building Sewer(locate on site plan): 2° Depth below grade: feet Material of construction: i ❑;cast iron ❑ 40 PVC ❑ other(explain): Distance from private water supply well or suction line. Town water P pp y feet Comments (on condition of joints, venting, evidence of leakage-, etc.): joints tight yes vented no sign of leakage. Septic Tank (locate on site plan): 1" Depth below grade: feet i Material of construction: i i ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) i i If tank is metal, list age: years I Isage confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No ------=---------------------------------------------------------------------------- 1 1 1500 GAL Dimensions: i 211 Sludge depth: t 32" 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 14" How were dimensions determined? MEASURED 26 GENERAL PATTON•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts Tithe 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 OLD TOWN RD PropertyAddress C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner'sName information is required for HYANNIS MA 02601 10/11/07 every page. City/Town State Zip Code Date of Inspection i i 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.): NO NEED TO PUMP,TEES INTACT,STRUCTUALLY SOUND,LIQUID EQUAL WITH OUTLET INVERT,NO LEAKAGE t I Grease Trap (locate on site plan): Depth below grade: feet I Material of construction: f4 r ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness i Distance from top of scum to top of outlet tee or baffle I Distance from bottom of scum to bottom of outlet tee or baffle i Date of last pumping: Date t Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 6 � P t 1. 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 El polyethylene ❑ other(explain): 28 GENERAL PATTON•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 OLD TOWN RD Property Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner'siName information is HYANNIS MA 02601 10/11/07 required for every page. City/Town State Zip Code Date of Inspection i D. System Information (cont.) Tight or Holding Tank(cont.) 1 Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No I Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): i I I *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No l Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert EQUAL WITH OUTLET INVERTS 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.): i DBOX IS LEVEL AND DISTRIBUTION EQUAL, YES SOLID CARRYOVER, NO LEAKAGE. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 28 GENERAL PATTON-08/06 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 46 OLDITOWN RD Property Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is HYANNISPORT MA 02601 10/11/07 required for State Zip Code Date of Inspection every page. cityrrowij t D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): i a Soil Absorption System (SAS) (locate on site plan, excavation not required): f If SAS not located, explain why: Type: I 0 leaching pits number: i 7 i leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: leaching fields number, dimensions: ❑ overflow cesspool number: '❑ innovative/alternative system r Type/name of technology: i Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): SOIL SAND/GRAVEL,NO SIGNS HYDRAULIC FAILURE , PONDING DRY, NO DAMP SOIL, VEGETATION NORMAL. 28 GENERAL PATTON•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 OLD TOWN RD Property!Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's'Name information is HYAN i MA 02601 10/11/07 required for every page. Cityrrow.n State Zip Code Date of Inspection i i D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration t Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction I Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): i i . t Privy (locate on site plan): Materials of construction: Dimensions I Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): I 28 GENERAL PATTON-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 46 OLD TOWN RD Property Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is HYANNIS MA 02601 10/11/07 required for State Zip Code Date of Inspection every page. Cityffowtl D. System Information (cont.) i 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. I . 2 r Z 1L\ 0 I tem-Pa e14of15 28 GENERAL PATTON�08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal Sys g f Commonwealth of Massachusetts . -Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments i 46 OLD,TOWN RD Property Address C/O TODAY REAL ESTATE DAVID HOLT 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is HYANNIS MA 02601 10/11/07 required for State Zip Code Date of Inspection every page. cityrrown i D. System Information (cont.) I Site Exam: i ®j Check Slope ®I Surface water ® Check cellar I a ❑; Shallow wells f 37.00' Estimated depth to ground water: feet Please indicate all methods used to determine the high ground water elevation: I Obtained from system design plans on record { If checked, date of design plan reviewed: Date 0 Observed site(abutting property/observation hole within 150 feet of SAS) 0 Checked with local Board of Health -explain: 0 Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: BARNSTABLE GIS You must describe how you established the high ground water elevation: BARNSTABLE GIS 28 GENERAL PATTON-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 I Town of Barnstable �p 1HE 1p� Regulatory Services BnRvSTnsLE ; Thomas F. Geiler,Director 116 39.A . •�� Public Health .Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within this report. In addition,by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the "Disposal Work Construction Permit". If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection. o Lr) m r=l u co u, S. T ul Postage $ a 3 7 A` ts'� C3 CoMed Fee o FEB hst2ari2005 0 Return Reciept Fee Here 0 (Endorsement Required) n �S Fee CO (Endorsement Re Restricted quired) /1'— �G+p� rI Total Postage&Fees $ _(' Ug r m O Sent To ff , .: .._ C -----------------------------•-- r- Street,Ap.No.; orPOBoxNo. � re e . r .., - CSae.Z + Tvt 4Unr , r M 0a63a PJ. Certified Mail Provides: o A m8iiing receipt (Bye e a)aooa eunr loose-od sd n A u que identifier for dour.mailpiece a A record of delivery kept by the Postal Service for two years Important Reminders:- e Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail® o CedifieduMall is nolavailable for any class of international mail. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. e For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for •a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required., �. e e For an additional fee,_,delivery may be restricted to the addressee or addressee's authorized'agent.Advise the clerk or mark the mailpiece with the endorsement'."Restricted Delivery". a If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. Internet access to delivery information is not available on mail addressed to APOs and FPOs. SECTIONENDER: COMPLETE THIS SECTION COMPLETE THIS ON DELIVERY ■ Complete items 1,2,and 3.Also complete atFire item 4 if Restricted Delivery is desired. ❑Acnt ■ Print your name and address on the reverse X ❑Addressee so that we can return the card to you. eceived�by ted Namp). C. ate of Delivery ■ Attach this card to the back of the mailpiece, �� ���\ ';2 or on the front if space permits. - D. Is delivery address different from iteeln 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑ No Poo rr ck t� cm-5-5 ',D 15 rVI'�► S�ree� 3. Service Type Ce' 'ervi ` m A Q.�6310 Certified Mail ❑ Express Mail i ❑ Registered ;&Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number (Transfer from service label) L� �7 0 0 3 16 8 0 0 0 0 4 5 4 5 8 19 5 0 PS Form 3811,August 2001 Domestic Return Receipt 102595-02-M-1540 UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No. G-10 • Sender: Please print your name, address, and ZIP+4 in this box • Public Health Division Town of Barnstable 200 Main St Hyannis,Massachusefts 02601 - I I I s I I i �4 Certified Mail#7003 1680 0004 5458 1950 Town of Barnstable , 1 Regulatory Services s #, Thomas F. Geiler,Director a Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 February 1, 2005 Patrick L. Cassidy 15 Irving Street Centerville,MA 02632 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II - MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND ARTICLE 51 OF THE TOWN RENTAL ORDINANCE. The property owned by you located at 46 Old Town Road, Hyannis, was inspected on February 1, 2005 by David Stanton R.S., Health Inspector for the Town of Barnstable, because of a complaint. The following violation of the State Sanitary Code was observed: 105 CMR 410.351: Owner's Installation and Maintenance Responsibilities. A leak in the heating system was observed in the oil service line between the fuel oil storage tank and the heating system. A puddle of oil was observed in the basement from this leak. You are directed to correct the violation listed above within twenty four (24) hours of your receipt of this notice by repairing or replacing the leaking fuel oil line. You may request a hearing before the Board of Health if written petition requesting same is received within ten(10) days after the date the order is served. Non-compliance will result in a fine of $100.00. Each day's failure to comply with an order shall constitute a separate violation. PER ORDER O E BOARD OF HEALTH E Thomas A. McKean,R.S. - Director of Public Health Town of Barnstable Q:Health/Order letters/Housing violations/46 Old Town rd.doc Health Complaints 22-Feb-05 Time: 7:45:00 PM Date: 1/31/2005 Complaint Number: 17913 Referred To: DAVID STANTON Taken By: DAVID STANTON Complaint Type: CHAPTER II HOUSING Article X Detail: UNSANITARY CONDITIONS Business Name: Number: 46 Street: Old Town Road Village: HYANNIS Assessors Map_Parcel: 267-064 Complainant's Name: Hyannis Fire-Capt. Farenkopf Address: Telephone Number: Complaint Description: They are out at 46 Old Town Road, Hyannis. They probably don't need anyone immediately, but wanted to check with a Health Inspector to see if we wanted to go out or wait until tomorrow. Tenant has a slow leaking fuel tank for heating system. Leak is near the fuel filter in the line. Hyannis Fire has cleaned up the with pads and speedy dry. They monitored the air, and it is not a fire hazard, would like BOH to do a follow up. Housing issue, Landlord Patrick Cassidy (508) 771-7864 (van go painting)was called by HY fire, but with no luck at this time. Tenant is Charlene Maloney (508) 771-3485 Actions Taken/Results: DS THOUGHT IT BEST TO WAIT UNTIL 2/1/05 AND TRY GO TO PROPERTY, AND GET A HOLD OF THE LANDLORD TO FIX. DS WENT TO SAID LOCATION ON 2/1/05 AND MET WITH CHARLENE. DS TOOK 3 PHOTOS, ON FILE. DS IS SENDING AN ORDER LETTER TO LANDLORD, PATRICK CASSIDY TO CORRECT THE VIOLATION. DS CALLED COMPLAINTANT ON 2/22/05, THE PROBLEM HAS BEEN CORRECTED. NO FURTHER ACTION REQUIRED. 1 Health Complaints 22-Feb-05 Investigation Date: 2/1/2005 Investigation Time: 2:20:00 PM 2 I • • f: load, Hyannis. Oil -in baemen . M° ^ 4 4 ,,,y•. n 3' 9. �� V a ,W ? 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J f c T No. 0 —o-2 3 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: �✓ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pplicatiou for Migogal *pztem Conotruction 3permit Application for a Permit to Construct( , )Repair( )Upgrade( )Abandon( ) Mcomplete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor'sMap/Parcela_qdph!5 Nor, ), 6%4 Ins er' Name,Address,and Tel.No. C Designer's Name,Address and Tel.No. 4� A—�78—fig' c� ,D 1 7 Mit ® Wes Pores I api Type of Building: PD�M1 d^ I n zGC .2&dip e� AsS�SI.'�y ��/b G�f �j Dwelling . No.of Bedrooms 2 Lot Size sq.i t. Garbage nnder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures l Design Flow gallons per day. Calculated daily flow QJ9' as gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank d17 S OJ-- cti Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer �when .applicable) �• (((///�//��� ■/� y� � 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 prod ions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has bee ' sued b this Bo o eal Signed Date Application Approved by � Date Application Disapproved for the following reasons Permit No. f1 r�l — 0 3 Date Issued t' No t; 4 THE COMMONWEALTH OF MASSACHUSETTS `Entered n computer: ✓✓ Yes PUBLIC�HEALTH`•DIVISION'-TOWN OF BARNSTABLEs MASSACHUSETTS ZRvAl-fcatidu for Mioogal *pgtem tongtruction Permit Application for a Permit to Construct( )Repair( )Upgrade(rX)Abandon( ) 1�0,11Complete System ,❑Individual Components Location Address or Lot No. L Owner's Name,Address and Tel.No. Assessor's Map/Pazcel` �P Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 4-1�- � -�78-Ja� Type ofBuilding: �a�aoMr d���( 76C 7fbG�/ppP� , fSPSt.'�y i�lb/G`/ Dwelling No.of Bedrooms 2 Lotize sq.ft. Gar ge Grinder( ) F Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow a! gallons. Plan Date Number of sheets / Revision Date Title *% mV L,A41z-rd Size of Septic Tank 1 d37 C AVV"-, Type of S.A.S. _=3,.Z,13✓c- C QW Description of Soil \ _4)\,A w�,a Yt-,t'� . tAA,,gC c,A.. Nature of Repairs or Alterations(Answer when applicable) r Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has beerNssued by this Boalcd-.of lilealthp. Signed 71.1 1 ; � Date f1 11 /.�l� A Application Approved by n"'. � Date 164 cl Application Disapproved for a following reasons Permit No.��2 n n Q- Q.> 3 Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE;'NIASSACHUSETTS Certif irate of Compliance } THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded( ) Abandoned( )by—AW AS 13p,011 C at r dr ,t)A r1t o4 kh,l fl.n l k)I I r f has been constructed in accordance with the provisions of Title.5 and the for Disposal System Construction Pe&'t No r)n�/ r1?3 dated I�1 0 t Installer d 01 f f D ' esigner The issuance yb system will this permit shall not be construed as a guarantee that the syste will function Its designed., Date 2,1 1"M r,L) Inspector n rr i 1 No. 7 0 U L/ — '1T .. . Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION . BARNSTABLEs MASSACHUSETTS Migpogal 6p5tem Congtruction Permit Permission is hereby granted to Construct( )Repair( )Upgrade.(Abandon( ) l System located ato and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction /must be completed within three years of the date of t�is'ppermit r Date: Approved by 1` nl >�_ �� J �- �� � .. v TOWN OF STABLE I LOCATION SEWAGE # v, ASSE 0 'S Ir & LOT1b7�O�y I VILLAGE INSTALLER'S NAME&PHONE NO. r� SEPTIC TANK CAPAC 1 LEACHING FACILITY: (type) (size) r NO.OF BEDROOMS-- BUILDER OR OWNER t PERNITTDATE: 1-\�O`�� COMPLIANCE DATE: 3 7 Separation Distance Between the: Feet Maximum Adjusted Groundwater Table tathe Bottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by gc� � � Date: TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: P L /`' BUSINESS LOCATION: k Le W I', MAILING ADDRESS: Mail To: ,,, TELEPHONE NUMBER: / - Board of Health S Town of Barnstable CONTACT PERSON: ko � (,. �c�`, r P.O. Box 534 EMERGENCY CONTACT TELEPHON NUMBER: 00S Hyannis, MA 02601 TYPEOFBUSINESS: 11 S'�ry1C �r� Does your firm store any of the toxic or hazardous materials listed below, either for sale or for you own use? - YES NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Quantity Antifreeze(for gasoline or coolant systems) Drain cleaners NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) Diesel fuel, kerosene, #2 heating oil NEW USED Other petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) Swimming pool chlorine Rustproofers Lye or caustic soda Car wash detergents Jewelry cleaners Car waxes and polishes Leather dyes Asphalt & roofing tar Fertilizers Paints, varnishes, stains, dyes PCB's Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint & varnish removers, deglossers Paint brush cleaners Any other products with "poison" labels (including chloroform, formaldehyde, Floor & furniture strippers hydrochloric acid, other acids) Metal polishes Laundry soil & stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): Spot removers & cleaning fluids i (dry cleaners) Other cleaning solvents Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Date: TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: L rS4(' a C11r ;✓1 BUSINESS LOCATION: MAILING ADDRESS: Mail To: TELEPHONE NUMBER: 08 7 71 S Board of Health Town of Barnstable CONTACT PERSON P.O. Box 534 EMERGENCY CONTACT.TELEPHONE NUMBER: S Oob (:76a G?3 (9 Hyannis, MA 02601 ' TYPE"OF BUSINESS: ,Does your firm store any of the.toxic or hazardous materials listed below, either for sale or for you own use?. YES NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed 'f envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: I' LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the.following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity - Quantity Antifreeze(for gasoline or coolant systems) Drain cleaners NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salt (Halite) Hydraulic;fluid (including brake fluid) Refrigerants �< Motor oils. . Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) _- Diesel fuel, kerosene,.#2 heating oil NEW USED Photochemicals (Developer)-Other petroleum products: grease, - ( p ) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink i Degreasers for.driveways & garages Wood preservatives.(creosote) Battery. acid (electrolyte) Swimming pool chlorine I Rustproofers Lye or caustic soda. Car.wash detergents Jewelry.cleaners -Car waxes and polishes Leather dyes Asphalt & roofing tar Fertilizers Paints, varnishes, stains, dyes PCB's Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint &varnish removers, deglossers Any other_products. with "poison" labels Paint brush cleaners . . .(including,chloroform, formaldehyde, Floor& furniture strippers hydrochloric acid, other acids) Metal polishes _ Laundry soil & stain removers Other products not9 listed which you feel ' (including bleach) may be toxic or hazardous (please list)': ' Spot removers & cleaning fluids 1. (dry cleaners) q Other cleaning solvents Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS ;. SAS SI�Ac,c, Rc BENCH MARK: TOP OF FND. �Co 75 LoilC, �`. LaGVS ELE.= 2 O. O MANHOLE COVERS TO EXTEND TO { - G• o' w pt WITHIN 6' OF FINISH GRADE '- t� 2 O � :► � �C11J6 A . � BAFFLE REQ'D I� o "' ' l •S 17. 30 N Evtl J �a "'ram 2X - - - 2" PEASTONE TOPPING 11 5� W 17.os DAL B. 1(*17` -- _ - ---_- - rcaN I(.c.70 _ _— CAP ENDS GENERAL NOTES: 14 1 —�� ram 3, z - _ - _ - -`�3/4 DOUBLE WASHED — ELEVATIONS SHOWN BASED ON U.S.G.S. DATUM. <. _ G. "Io4 C ����'� STONE ALL AROUND SYSTEM PIPE SHALL BE EITHER C.I. OR I L BAb m of s u SCHEDULE 40 P.V.C. ST°+�IC� I'8 — THE BOARD OF HEALTH SHALL BE NOTIFIED _"".,._20' MIN. 15 .5 A PRIOR TO BACKFILLING OF SEPTIC SYSTEM. 9'`3.��.. _ -7, 3 7 — SEPTIC SYSTEM STRUCTURAL COMPONENTS I > I SHALL BE CAPABLE OF WITHSIKNDING A SOIL TEST LOG PROPOSED SEPTIC SYSTEM Ee 7,S- „ w-+ H-10 LOADING. UNLESS SPECIFIED OTHERWISE SEPTIC SYSTEM UNDER DRIVEWAYS SHALL PERC RATE=< 2 MIN/INCH NO SCALE W$� ,severyy �7, /N F(C T,Gt��S C - COMPLY WITH A H-20 LOADING. DEPTHD ELEV.= �Q'S 3fl kJtT� 1 "S r' �� STti�£ S�Dfs �Z b THE DESIGN AND COMPONENTS OF THE SEPTIC D� ��� SYSTEM SHALL BE IN COMPLIANCE WITH THE A LOAMY SAND iDYR 1�5' 6P S,U�c ���5 STATE OF MASSACHUSETTS SANITARY CODE e LOAMY SAND IGYR 4/4 � n TITLE V. AND SHALL BE IN COMPLIANCE WITH Z'$ ."17_ # /•o . 0 t, S T04E `v 60 770 H THE LOCAL BOARD OF HEALTH RULES AND REGULATIONS. ct t+EDlutn salvo lamf 7- — THE CONTRACTOR SHALL BE RESPONSIBLE FOR LOCATION OF ALL UNDERGROUND UTILITIES AND 144' ♦a.00 + SHALL NOTIFY DIG - SAFE PRIOR TO M N P 2 7 � 7- (4 CONSTRUCTION. — NO GARBAGE GRINDER 4 W v, + f` © DESIGN CRITE IA. Gi4/ titc. S�D/KE �n�Se onlI . �N�. DESIGN FLOW �� LEGEND: (� 1 z4' S� r1 3 BEDROOMS AT 110 G.P.B. / DAY 330 G.P.D. EXISTING CONTOUR - --- -- .'� P ATER TEST HOLE t t. �,_ c x REQUIRED SEPTIC AN TSERVICE —VY--W— W GAS SERVICE —G—G SEPTIC TANK PROVIDED �" � t3, s�' DESIGN PERC RATE <2 MIN/INCH BENCH HARK SIZE OF REQ'D (SAS) AREA = 330/0.74 = 446 S.F. ir. 6 C` SIDEWALL (2)4(J .83 (�,1x: + 2 t.83)(�)= :`13' S.F a _ NAM f BOTTOM ( 3Cb,ts- _ $Q $ S.F. SIZE OF LEACHING FACILITY PROVIDED: S.F. + �'t Or:. S.F. '7`. S.F. NOTE: -- x _ � o _ GPD PRIOR TO INSTALLING THE NEW (SAS) THE . i' 1 r _ S a�e CONTRACTOR SHALL PUMPOUT ALL CESSPOOLS p:�< : ' EFFECTIVE DEPTH: 10"4,1 a. .AND BACK FILL WITH CLEAN MEDIUM SANG EFFECTIVE LENGTH: Qr`o s. S IF CESSPOOLS ARE ENCOUNTERED IN THE '(*' EFFECTIVE WIDTH: 04 Q.• (SAS) AREA THEY SHALL BE REMOVED v kOF4f4,9 JOHN P. 9�y HUNTER ENGINEERING ire HUNTER cGn 7 WEEKS POND DRIVE t f CIVIL FORESTDALE, MA 02644 r No.364450 Z (508) 477-8268 ig-IEP�� PROJECT: SEPTIC SYSTEM REPAIR ` saL FaR 4 As SHOWN b oc.O 7 0 tN rJ 1z0 I okr: MAP Z to 7/ LOT .G 4 Q,•J 115 . 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