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0023 PARK PLACE - Health
23 Park Place, Hyannis A= 286-010 e 1 i it I (4?3 1 16 L O CATION � �� SEWAG E PERMIT NO. re _VILLAGE INSTA LLER'S NAME & ADDRESS -- � � - , R U I L D E R OR OWN Eft 13 DATE PERMIT ISSUED �, � � DATE COMPLIANCE ISSUED _ �;� �� �� -gym 1 .{ � �..'.�. J , �lj I r. �' e �( �� ' �i I .�� �'� f y' NO...:. /7._ FEB.................... .... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........J---Q(P.a............OF...,.e -� !n ?�a ,--------....---------------------------- App iration for BigVniiZt1 Works Tontitrurtion Vamit Application is hereby made for a Permit to Construct (/r Repair ( ) an Individual Sewage Disposal System at ._ Lo ation-Address or t No. ...... Q6-A.... >�PV%!I..................................... .. Q....�6Lrt �_� ...... - . Owner y �A" ddress a .......... —��r�.S ................... spd ri< �.......b�T.�V ................ *------------- ._...... Installer Address Type of Building Size Lot............................Sq. feet aDwelling—No. of Bedrooms--6------------------------------------Expansion Attic ( ) Garbage Grinder P4 Other—Type of Building ............................ No. of persons-------.-------.------------ Showers ( ) — Cafeteria ( ) a Other fixtures .......................•---....... W Design Flow...........S�....................gallons per person per day. Total daily flow.-----&S ...........--...........gallons. W Septic Tank—Liquid capacity 0-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 ( ) aPercolation Test Results Performed by......................................................................... Date....................................... Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ L=, Test Pit No. 2................minutes per inch Depth of Test Pit--------_----.---- Depth to ground water........................ •--------------------------------------------------•-----•-------------.._...........--•-------•-.............................................................. ODescription of Soil........................................................................................................................................................................ x ----------------------------------------------------------------------------------------------------------------------------------------------------------'-=--------------------=---.................. V 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 iITIL' 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. ----------- ---------------------------•-- -•-----,r---- ----......__.._ Date Application Approved BY--- - -- ----'-...��� .................................................... f ' f Date Application Disapproved for the following reasons-........................................................`---................................................... .............................--------------•------------------------•-•-•-------•---------••------------.......----•---•-• -�---------•------------------------------------------------------- Date ''` 'Permit No----------_-------------------------------------------- Issued....................................................... Date sD................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................ ....................O F......................................"--.._..--..-..... Appliration for Uiipnsal Workri Cnnnitrur#ion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal System at: Location-Address or Lot No. ......................».......................................................................... ..........-•...................................................................................... Owner Address W . Installer Address Type of Building Size Lot............................Sq. feet .., Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) a`4 Other—T e of Building No. of persons....................... Showers YP g ---••---------------•------- P ----- ( ) — Cafeteria ( ) dOther fixtures ------------------------------------------------------...---------•-----------.....-----------------------•--------•-•------------••--._..........._.. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ W 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 ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground .water.._.....__......._...... (% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-.--.._____-____-I...___. P4 .............................................-............................................................................................................... 0 Description of Soil............ -----------------------------------------------------------------------------------------------------------------------------------------------------•--- U -------•----•----•-----•-----------------------•--....-•---------.........................................---•------------•--------•-------------•----•----•----••---•---------•--......-------------- W ----------------•------•--•------------••---•--------------......---•----------------•---•----•------------••--------------•-•-------•--------------------------••---•------...--•--•-------••...--•-- 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 TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed--------- ---------------••----------------------•--•--------.....---------•---•-•-- ................................ Date Application Approved By._1.4G�t_ Date Application Disapproved for the following reasons---------------------------------------------------•--------------•- ............................................ --••----•....................................•----•----------...-•------------------••--......-----........--------------..............................................................-................ Date _ PermitNo....................-..................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF................................................................................. T-wrrtifirFair of ToutpliFatta THIS IS TO CER IF That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by..................... .---- :.fit .....................•----•-- Install r at......................�'.....�........-1�...........- ."6.................-., ............_......._...----....._..............._......__......_..__.._..-- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No....... - ........... dated._"................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUgV AS A GUARANTEE THAT THE SYSTEM WI FU�yCTION SATISFACTORY. DATE..1� G.G.:d/................. Inspector I. ...------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...............:....................OF.....................................................................................No.....d1fAV. FEE.... t�o---•-•--..... Dispooal Workii T.1notratr#ion rrutit Permissionis hereby granted...........--�"�-•------•- ---------------------------------------------------------....--•-----....-----.........---•--- to Construct K),or Repair ) an Individual Sewage Disposal ystem atNo.........................-- ....... ---....o. _.......-- -- '--------•-•-•--------•--•-----------------•-------------•---•--------•.....•-•...... Street as shown on the application or Disposal Works Construction Permit Noo...........:W-_---_- Dated.......................................... DATE. -.11� Board of Health FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS Sullivan Engineering Inc. 7 Parker Road, P.O.,Box 659 Osterville,MA 02655 Peter Sullivan P.`E.Mass Registration No.29733 phone 508-428-3344 fax 508-428-9617 petergsullivanen m.com December 13, 2011 Health Division Town of Barnstable 200 Main Street Hyannis MA 02601 f Re: 23 Park Place H annisport Septic System Dear Health Division, The present owner wishes to increase the flow of the existing dwelling from 5 to_7 bedrooms. This property is not located within the Estuaries Overlay District or any Zone of Contribution to Public Water Supply: The existing septic system recently passed an Official Title 5 Inspection(copy attached). The original system was designed for 5 bedrooms with a garbage grinder and installed with a capacity of 1,098 gallons per day leaching and a 2,000 gallon septic tank (see attached). The garbage grinder is being removed by the contractor(see attached . letter from Rogers &Marney). Evaluating the required flow for 7 bedrooms with garbage grinder removed it follows: Required: 770 GPD for the leaching and 1,540 GPD.for the septic, Installed: 1,098 GPD for the leaching and 2,000 GPD septic tank, Conclusion: The existing septic system in the ground has the present capacity in handle the increase in flow. If you have any questions please feel free to call this office. eo,Dry truly your er 11ivan P Sullivan Engineering, Inc. cc: Rogers &Marney, Inc. 7 Members of American Society of Civil Engineers and Boston Society of Civil Engineers Section i � ommortatft of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 23 PARK PLACE Property Address LLOYD Owner Owner's Name information is required for HYANNIS PORT MA 11/15/11 every page. City/Town State Zip Code Date of Inspection Inepeetion re nits Mast be�SUbr�'i7i ea'on`this a inspei tion'ilvrms me�i nbt be''aitered'in any" way. Please see completeness checklist at the end of the form. Important:When filling out A. General Information � forms on the computer,use 1. Inspector: only the tab key to move your DOUGLAS A BROWN cursor-do not Name of Inspector use.the retum key. DOUGLAS A BROWN INC Company Name P.O. BOX 145 Company Address CENTERVILLE MA 02632 City/Town.. State Zip Code 508-4,20-4534 S29 Telephone Number License Number B. Certification 1 certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes 0 Conditionally Passes 0 Fails �j Needs Further Evaluation by the Local Approving Authority a 11/ ull Inspector'%Signature Date The system inspector sha(i 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. SULK t7 r Commonwealth—of:Massachuaetts._ rP Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 23 PARK PLACE Propertyf Address— LLOYD Owner Owner's Name information is HYANNIS PORT required for MA 11/15/11 every page. City/Town State Zi Code p Date of Inspection B. Ceirti;fication (cone.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: 'I.have.not found any information.whiih-indicate54hat any.of the.failure•;(it�(ia d scribed in 310 CNIR 15.303 or in 310 CMIR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: SYSTEM APPEARS.TO.HAVE HAD SEASONAL.OR LIMITED.USE, ONE LEACH PIT WAS OPENEDI•k iD U1�:AS-FOUNt�TO-SE DRY AT TIME C,�e= INSPECTi-ON Va°I-I-t=i--�fO--EVIDEt�iCE OF FAILURE B) Systenvi'londitionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. =A metal-septic-tank-w4li,pass inspection--if it-is-structurally sound not_-iaakang arrd-if-a Certificate-of- Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•09/08 Title 5 Official.Inspection Form;Subsurface Sewage DisposalSystem'•Page 2 of 17 cit3mmom, ` aft of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 23 PARK. PLACE y Pr3periy�,ddress- LLOYD Owner Owner's Name Informationeuirefor IS HYANNIS PORT MA required for 11/15/11 every page. City/Town State Zip Code Date of Inspection B. Certification (coli1t.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will ,pass inspection af:(�vit''� approval of Board of Hea!th). ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is'removed ❑ Y ❑ N ❑ ND (Explain below): distribution box is leveled or replaced ❑ Y ❑ N ❑, ND(Explaii i bCIOM): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the.system.is-failing.to.protect.public-.health,safety or.the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•09l08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 t \ Commonwealth-of Massachus Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 23 PARK PLACE Property-Addrt ss- LLOYD Owner Owner's Name informationeuirefor is HYANNIS PORT MA required for 11/15/11 every page. Cityrrown State Zip Code Date of Inspection B. Certfificatlion (cent.) 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 within100 fbet'o'f a-'Wrfauawater supply or-tributeYy tc�f`surfaee water supply: ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply: ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or r ore'ftdr t a private-water supplywelt�*_ 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 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Comm of Massachusetts rP Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 23 PARK PLACE Property Address LLOYD Owner Owner's Name information is HYANNIS PORT required for MA 11/15/11 every page. Cityrrown State Zip Code Date of Inspection B. Certi ca—fion (cunt.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ Any portion of the SAS, cesspool or privy is below high ground water elevation. ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a.surface water supply, ❑ ® 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. Z 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 hsystemC + in 400 feet F a 'Kin v water supply III the : I.,Yvi:hi.� v lee:Cs a surface dr isinii:� t:a:-a 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 �et.tion E the system is considered a;z:gnif:cane threat, r a h 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 510 OII R 15.304. The system owner should contact the appropriate regional office of the Department. i5inz.09P38 Tiff-.^^.rffi.Clel Inspec'tfion Form:Subsurface cexage Licnn<�I 5y Stet-,!Wage S of�7 I n Coil( mioni`ealth of i" U-33Oicilrusetia Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 23 PARK PLACE Property Address LLOYD Owner Owner's Name information'is HYANNIS PORT required for MA 11/15/11 every page. Cityrrown State Zip Code Date of Inspection 'Co" f"hecklist Check if the following have been done. You must indicate"yes" or..no" as to each of the following: Yes No Ili ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? On ❑ Was the bite 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: IF] ❑ Existinq 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(511 D. System Info of€on Residential Flow Conditions: Number of bedrooms (design): 1098 GPD Number of bedrooms(actual): 5 DESIGN flow based on 310 CMR 15 dr .203 (for example: 110 gpd x#of beooms): ingg GPD ._..._•nv,�t� Tito-5 f',m._iaj in:`,,eet-nn.Perm:_,�iici� aca fi:_wa.-_tig: .. i Sy m.Page L_.ni 17 r�'- ._ -a- -. \ Commonweafth of Massachusetts l9 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 23 PARK PLACE Property i;ddress LLOYD Owner Owner's Name information is required for HYANNIS PORT MA 11/15/11 every page. City/Town State Zip Code Date of Inspection D_ System information Description: DESIGN FLOW ACCORDING TO PLAN DATED OCT 15 1982 BY BAXTER NYE INC 1098 GPD 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)): SEE BELOW Detail: 2011 SO FAR=483 GPD 2010=666 GPD HOUSE HAS IRRIGATION SYSTEM, WATER COMPANY SAID WATER USAGE APPEARS TO BE HIGHEST IN THE SUMMER MONTHS Sump pump? ❑ Yes ❑ No 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: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 comrnonweaEth of M,iassachusetta Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r 23 PARK PLACE Property Address LLOYD Owner Owner's Name information is HYANNIS PORT� required for MA 11/15/11 every page. Clty/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: DEBARROS SEPTIC Was system pumped as part of the inspection? ® Yes '❑ No If yes, volume pumped: 2000 gallons How was quantity pumped determined? TANK TRUCK AND OFF SEPTIC PLAN Reason for pumping: MAINTENANCE 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 tie obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17. Commonwealth of Massachusetts rz Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 23 PARK PLACE Property Address LLOYD Owner Owner's Name information is required for HYANNIS PORT MA 11/15/11 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cant.) Approximate age of all components, date installed (if known) and source of information: SYSTEM APPEARS TO BE ORIGINAL FROM 1983 Were sewage odors detected when o arriving at t�1he site? ❑ Yes FJ NO Building Sewer(locate on site plan): Depth below grade: feet. Material of construction: ❑ cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (one condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): I Depth below grade: 2.5 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No' Dimensions: 2000 GALLON Sludge depth: LIGHT t5ms-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 it Cornitot`nii/ealth of Mlassachuse is Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 23 PARK PLACE Property Address LLOYD Owner Owner's Name information is HYANNIS PORT required for MA 11/15/11 every page. Cityrrown State Zip Code Date of Inspection D. ���� ��f�i atiO iP 'contl Septic Tank(cont.) 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 were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert; evidence of leakage;etc:). TANK WAS PUMPED AFTER INSPECTION FOR MAINTENANCE Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal E fiberglass ❑ polyethylene y ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to'bottom of outlet tee or baffle Date of last pumping: Date t5ins-09/08 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 1 0 of 17 Commonwealth of Rillassachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 23 PARK PLACE Properly Address LLOYD Owner Owner's Name information is HYANNIS PORT required for MA 11/15/11 every page. City/Town State Zip Code Date of Inspection D. System In6ort-nation (cone.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to Outlet invert,evidence of leakage,etc,); Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene, ❑ other(explain): Dimensions: Capacity: gallons- Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑t Yes ❑ No t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 l Commonwealth of Massachusetts �p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 23 PARK PLACE Property Address LLOYD Owner Owner's Name information is HYANNIS•PORT required for MA 11/15/11 every page. City/Town State Zip Code Date of Inspection ®_ Sy5teni hiforfeiBtion l'cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Oil 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 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: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 %ommonwealith of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 23 PARK PLACE Property Address LLOYD Owner Owner's Name information is required for HYANNI PO RT MA 11/15/11 eve ry page. Ct rro wn State Zip Code Date of Inspection D. System Inforinnafion (coat.) Type: ® leaching pits number: 2 leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: gY: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation;etc.-. ONE PIT WAS OPENED AND WAS FOUND TO BE DRY AT TIME OF INSPECTION WITH NO SIGNS OF FAILURE, INTERIOR OF PIT WAS CLEAN AND IN GOOD CONDITION WITH RISER IN PLACE Cesspools (cesspool must'be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Masssuirruserts Q Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 23 PARK PLACE Property Address LLOYD Owner Owner's Name information is HYANNIS PORT required for MA 11/15/11 every page. Citylrown State Zip Code Date of Inspection �_ System a f��m- atio� (con!.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.-I: Privyi(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.): wins•03;OS Trie 5 CYcial;nS Don Pemi:Subsurface awn e Pe 9e Cisposai System•Page:4 04 17 ti Common, wealth of Massachusetts �p Title 5 Official Inspection Form Subsurface Sewage _g Disposal System Form p y Not for Voluntary Assessments 23 PARK PLACE ✓` Property Address LLOYD Owner Owner's Name informationefire o is HYANNIS PORT MA required for 11 every page. City/Town 11 State Zip Code Datea o of f Inspection D. System information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: I.] hand-sketch in the area below Z drawing attached separately 1 l I. I Kinc. 4!i`T T G finial Incnecibon Form subz urfaro sewage f'licrwrcal&IC+em.Fane i5 of 17 y Coi'ii'morinwealth of Massachusetts a� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 23 PARK PLACE Froperby i;ddress LLOYD Owner Owner's Name information is required for HYANNIS PORT MA 11/15/11. every page. City/Town State Zip Code Date of Inspection D. System Information (con;.) Site Exam: ® Check Slope ffica - El Sur r�ce water ® Check cellar ® Shallow wells Estimated depth to high around water: GREATER THAN 4' FROM BOTTOM feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of 1 1/1 rj/1 1 design plan revieaved: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with ilocal Board of Health-explain: Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: DESIGN PLAN Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09ro8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 • '� Commonwealth of Maaaachuaerw P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 23 PARK PLACE Property Address LLOYD Owner Owner's Name information is HYANNIS.PORT required for MA 11/15/11 every page. City/Town State Zip Code Date of Inspection E= Report Completeness Cfheckfist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed S'.'StGCi i Ir$GrmatiG,i—9- v i�t d depth to It i groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file 15;ns•C4%O8 TRie 5 Offisclal lnspaciia}Form:Subsurface Sew-aye Cisposs:Syair n•Page' 01 17 Assessing As-Built Cards Page 1 of 1 LO CA ION,_ SIW2 A'C E PERMIT NO: � INSTA LLE'S NAME D ADDRESS so OIL 6 U I L D E 0 ON OWNER CL DATE FERFAIT I S S V F D "L -- DATE C D M P L I A N C E ISSUED c I I 3 4 http://town.bamstable.ma.us/Assessing/HMdisplay.asp?mappar=286010&seq=1 11/16/2011 Lloyd Residence 23� Park Place Hyannisport, Massachusetts _. Construction Drawings , Issued for Permit 11/21/12 LDa ARCHITECTURE E INTERIORS 222 Third St.Spite 3212 tel:617-621-1455 C—bddge,MA 02142 fax:617-621-1477 www1Da-ArchitecLS.com SYMBOLS KEY ABBREVIATIONS DRAWING LIST � o . � � ��¢ � .uuu uuulxuu xn xo„osws fAVEASHEET � /u� eo•w ow orwsne G10E INDEX SHEET ® w<s[xsrvcs xsr[xEx[E s vao, 0:DD BASEMENT OEMOIIiION PIAN w r _ - Aol USEMENiWF U _ AIm USE MEW REFLLECTED CEILWG PUN k ® wgoct: xLr[aExcE <r cswulcnE rwn rtn�000 oa v� A1w EASEMENTIWERIOR ELEVATIONS �.. A .. v . � � - esw cuEaMKE ox x xaurulawlwc ; • - - _ - src soonxG smocr sT--Tl— - cvsuuw 1 I'll r.rru rnoovE _ `. .. - �.• . a t vow, IT ... •� .` -'# ' ! •. �. A. wr wrtxsm - !. w vssufvwruw f A. uAsoxm nr s .. .. ,A ,�'r •ro ozunxc � cn N DOOR SCHEDULE BUILDING CODE a' d Ar ' - . � �r rvcFl e1 c.s.mrNo ,uwcaos s,.,E wsuwcmE T c 4 r I" a'2 ..e o,ra r n olm .mac 4 '; • da ... - _ .srce+rf ...vo.w�rni�au.mm un GENERAL NOTES CHECKED: D INFORMATION SHEET G100 ..... .......--- ------- -------------------------- --- ---- ---- -..._ i .i•-, - '11 ------------------------- i g a � P E a ----- ------- s _x.. Ip ' t � w Lloyd Residence CD - 4 LDaao Pae Q S 23 Park Place ARCHITECTURE&INTERIORS Hyannisport,Massachusetts f k i m- -77 s DR Ellm �� a �p €, s E ®D. i HIE s R 2 i -x R� m j J D m m �Nils Lloyd Residence, LDa Q 23 park Place ARCHITECTURE&INTERIORS Hyannispod,Massachusetts r. LIGHT/POWER SCHEDULE: o W �� w qp 0. _ {. .. I ' s db — . o N� m x m, � � _ — I I I I I ROPt�OR9ox I d m 777 ..-- --- — - r 11 J N _ � -- I« BASEMENT REEIECTEO CEILING PLAN A101 1 a d . e - e t T 4 9 f i' EE:11 i J L�-- WH 1 I I r \ l • I 1 \ n E� -x� h! \ 1 gig r I \ �� /\ • IS / ` � it gg � mmmC9�O� 3 1 a� • M '�£g� 3 t y �3 3 3 m �cNB Lloyd Residence � Aye N n a s= awe6 LDa Q N 23 Park Place - ARCHITECTURE&INTERIORS Hyannispotl,Massachusetts RO GERS&MARNEY,INc. BUILDERS December 10, 2012 TO: Donna Z. Miorandi Health Inspector Town of Barnstable Public Health Division RE: Lloyd Residence 23 Park P-lace, Hyannisport, MA Donna, Per your request and based on our discussion concerning the Lloyd Residence septic it(s), 0 I am furnishing the following letter: In May of 2012, Rogers and Marney Builders, Inc. completed the conversion projectgof the garage O at 23 Park Place.Two permitted bedrooms were added above the garage as called &Vin permitted plan from November 2011.As stipulated in the permit,the two bedrooms were allowe#d to be added to the existing septic system under the condition the garbage disposal would be removed from t mam house kitchen. Rogers and Marney Builders, Inc. has removed the garbage disposal. i Thank you for your assistance on this matter. If you have any further questions or concerns please contact me at 508-428-6106. ' rn Sincerely, Michael Curley * r-C4 Rogers and Marney Build rs, Inc. Building Quality Homes Since 1968 • rogersandmarneybuilders.com Post Office Box 310, Osterville,MA 02655 • tel 508.428.6106 9 fax 508.420.3550 24'.U't LEGEND: .. ' 24'-(r= , 0 EXISTING WALLS - L__ CONSTRUCTION TO BE REMOVED 9' J NEW CONSTRUCTION I I I I I OUTLINE OF I ©SMOKE DETECTOR DN. I I I I I ABOVE I ©CARBON MONOXIDE DETECTOR EXIST. I—I—I � I I ®HEAT DETECTOR DECK UP - HVAc b EXIST. EXIST. b `D CLOSET W W I ) 1 O K g g ELECTRIC 1 PANEL I I lY t E PELLA - PELLA a ® r ID DOUBLE DOUBLE rO CASEMENT 1 CASEMENT TO MATCH m TO MATCH I WINDOW w G WINDOW y m BELOW - H BELOW q w I W NEW 'ro 1 I ALIGN NEW WINDOWS LIVING W/UNITS BELOW (VAULTED CFJU..-) VERIFY DIMENSIONS 1 IN THE FIELD 124T 2-3 2-T T-4' I NEW ' N WETBAR 4'-0' U.C.REF. ' I I \ ENCLOSE T—— P.T.6 x 6 POSTS W/CASING I REAMOD. .EXIST COVERED POST IN ovv SINK —i———j PELLA� b Lr ON 12 DIA.CONC.SONOTUBE5824-DIA b BIGFOOT FOOTINGS TO 4'D-BELOW GRADE. RAGE WALK b b ID WALL x CASEMENT b o b -S b I USE SIMPSON SS ABU 66 POST BASE 8 ' b § 0. N _ ;� I N. I tl _ A I ssscsPosrCAP q ,n A3 �1 -- I 3 H A3 3D x66 i 15-xs 3 W 3 z DN 1 z 1'6-x STAC --- � p , ® M L——— 1'G x 2c z sc O ID 2'SxBE 2'Gx6'S I - PELLA 10'-10' j-1- g-g PELLA 1 DOUBLE DOUBLE CASEMENT I CASEMENT TO MATCH NEW TO MATCH - aq WINDOW WINDOW y t BELOW BEDRO M#1s BELOW W (VAULTED CEIUU G) © CL OS., © NEW BEDROOM#2 - I 1 VAULTED CEILING) UP 20'x 65 to e x 1 b N Q CLOS. NEXIST. EXIST. EXIST. EXIST. FIRST FLOOR PLAN SECOND FLOOR PLAN . TIE DESIGNER SHALL BE N'REDWF T SCALE COTUIT BAY DESIGN LLC NEW REMODELING FOR. IDON DORDLSSSPMORTEFODAVGN DRAWING NO.: TIES=DRAW Rte$R'GOR TO9TMi CF 43 BREWSTER ROAD `°LBE RESPO "��L°"�CN`E"7`�° 1/411= 11-01' IN T ES RESPONSIBLE FOR THE OCTIO N! IN THESE DRAYf.NS)S IFCJNSLAUC'iTON MASHPEE ,MA. 02649 LLOYD RESIDENCE =IGNECESVATHOUTNSORCMTHE OESIGEDR W ANY ERRORS OR CMISSOfS lAl PH. 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