HomeMy WebLinkAbout0032 SIXTH AVENUE (HYANNIS) - Health 32 Sixth Ave
Hyannis
A=246- 135
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CNS 1 0Q•00, CORNERBOAROS I N
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PROPOS�'D
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ADDITION I u
ADDITION TO BE SUPPORTED S
BY 6 SONO TUBES AND
SLIGHTLY CANTILEVERED I
AS INICATED
PARCEL 136 i
A BUILT PL OF
L0CAT0N.•
I 'Hearn, P.L. S , R. S. #32 SIXTH .4 MVUE
14 Swan River Plaza, Unit 2 NEST HY4NNISPORT, A4. J -
Dennis, jVa. 02660 4SSZSSORS jVAP 246 PARCZZ 135.
JOB NO.: 1161 R s-
:- JONATHAN TYLER
+11 OF BARNSTABLE BUILDING INSPECTOR
=ST OF MY INFORMATION, KNOWLEDGE \�P`� GF P�q'S.�(7. °A JAN 1, 2011
Sir,UCTURES SHOWN ON THIS PLAN =s RI HARD 5
7D ON THE GROUND AS INDICATED J. 1 CLIENT. TYLER
-?E LOCATED IN FLOOD ZONE C PER O'HFARN L
NO. SCALE.- �.
RATE MAP DATED AUGUST 19, 1985 U ,o 1 IN = 30 FT '
FJSGISi��J".'
/ONAL LAND%' OR. BY. R. OH S
=_ 4ENAL LAND SURVEYOR SHEET 1 OF 1
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliratinn for Di-tipwial Work.6 Tomitrnr#inn Prrini#
Application is hereby made for a Permit to Construct ( ) or Repair X) an Individual Sewage Disposal
System at
..... �^...4-re--------.................................................. -----•---•--------------------------------...._----- ---...---...-----------.....------------•.
c L cation-Address or Lot No.
l W —1
W �Q� - owner /"►"°�
V ../ ✓A/ �7 ..L.Ye_s.s._-•.._.-.•
Installer Address
UType of Building Size Lot............................Sq. feet
►� Dwelling—No. of Bedrooms_-__-____--3-----------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type
of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
dOther fixtures --------------- --------------------------------------------------------------------------------------------------------------------=--------------
W Design Flow........110.............................gallons per person per day. Total daily flow--------------------------------------------gallons.
WSeptic Tank—Liquid capacityl`t ___gallons Length---------------- Width---------------- Diameter---------------- Depth................
x Disposal Trench—No. .................... Width-------------------- Total Length Total Total leaching area....................sq. ft.
3 Seepage Pit No.___-.r_------------ Diameter-----C!----------- Depth below inlet_.._1�_.__....__.. Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
a
a Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water-.-___._._______-.-__._.
44 Test Pit No. 2................minutes per inch Depth of Test Pit--------_........... Depth to ground water........................
a --
.DescriPtion of Soil..___. :-d.c-----------•------•-•-----....---••••-----•-•-•---•••--------------------••••- -----. -•------.--------••---•--••......._...---x 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 Environmental ode—The undersigned further agrees not to place the
system in operation until a Certificate of CoEliancea ben ssu d by the b ar f health. q(Signe . � ---5 .-l..-r
Dace
Application Approved By ............... .. .............----------------------------- /..:� ..D.�..�..-. Y
Application Disapproved for the following reasons: .. ..... ............................................................................. .......... .................
....... ..................................... .......... ...................................................................................................................................... ------------
*---------
--------.........
Dace -
Permit No. P'
- 7 a--7 .. Issued - --
Dace
135
No.... y- - 7
Fps.......,..
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE_
Apphratiou for Uinpwml Works C�a��t r r#inn, Pratt#;
Application is hereby made for a Permit to Construct ( ) or Repair ) an Individual Sewage(Disposal
System at: C
r Location-Address or Lot No.,
r Owner d es -
----- ----- ------------- -- es---------------------------------------------
Yr_� Installer Address
d Type of Building Size Lot............................Sq. feet
" U Dwelling—No. of Bedrooms------------ --.__Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ---------------------------- No. of persons........................... Showers ( ) Cafeteria ( )
04 Other fixtures ------•-------• ------------------------------------------• '-----
--
w Design Flow........110..............................gallons per person per day. Total daily flow........................................ gallons.
R; �',r.Septic-:.T`nk—Liquid capacity!,!? ___gallons Length_.............. Width---------------- Diameter................ Depth................
Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage P`;t No._-___-_._.._---_-_ Diameter_____ ___________ Depth below inlet....
Total leaching area..........._..____sq. ft.
z Other Distribution box ( ) Dosing tank ( )
-._Percolat n Test Results Performed by.......................................................................... Date......................................
Test Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................
(i, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
W
DDescription of Soil....... -•----••••--•-•--••••••-••-•----•--•-•--•--•-•-•••..................•-----•--•.....•--•--••---•------•......-•------•---------...........-•--- .
W -------------------------------------------•------...--------------------------------------------------------------------------------------------"------------------------------------.......•••..---•-•
UNature of Repairs or Alterations=Answer when applicable................................................................................................
..•. -•-•-••-•-----••-•--•••--••----•---•......-•-• • .--•--•---------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
__the provisions of TITLE 5 of the State Environmental ode—The undersigned further agrees not to place the
,the
in operation until a Certificate.of Co liance ha ben ssu d by the b ar f health.
Signed ---- _.. t.. - ......-
s All
Dare
Application Approved By ...- _./... - t !n_. �
----- -- ^ ---'.....................................-......---.................................--- A .,- Dare��
Application Disapproved for the following rearonr- - ------------------__---.....-------------......----------------------------------------------- --..._.. ------------
........................................`--------------..-....-------------------------- ..........------------------------- - ---
-7 _ Dare
Permit No. �I'� /...r--7..... - Issued .............1--0�---- - -gLf
...... ... ..........
Date
THE COMMONWEALTH OF MASSACHUSETTS ~
BOARD OF HEALTH
TOWN OF BARNSTABLE
Cer#ifira e of Compliance
THIS IS CERTIFY, hat the Individual Sewage Disposal System constructed ( ) or Repaired (V )
bY "
--------------------_.. Q . Co...1 - - -
`�/�� Inxcrl ler
at ��
has been installed in accordance with the provisions of TITLE 5 The State Environmental Code as described in
the application for Disposal Works Construction Permit No. .__. -----___79-7 . dated 1..�--.�.'� - °� ...
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUN CTIO TI S.F-A TfORY.
G ,.DATE -1 -7- - J.. --------,------ Ins ect6��'
..--... .-...
----------:------------------------ -------------
THE COMMONWEALTH"OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
FEs .........--
Btopoottl Worb .Towitrudion VarAft
Permission is hereby granted.............. = =-----0-I'-5. ;6A)..........................i.... ..•--�
to Construct ( )for Repair (X) an Individual Sewage Disposal'System �
at No.----•---------------7 �,r �"� _� ........----•---- '- ��
as shown on the application for Disposal Works Construction Permit Street
--;_ .2-_ Dated.._..��................N_
...................................A`......11.......................................................
� �`� ���••--_-••-•-•-•-•••---- Board of Health
1\\ DATE..................... ---------•- --••--•,--
f
FORM 38508 HOBBS 8r WARREN.INC..PUBLISHERS
1
Town of Barnstable P# Z,2.5_.3j�
Departiment of Regulatory Services
> aTABM : Public Health Division Date �3
>,
�p 1639.6 200 Main Street,Hyannis MA 02601
rED MA't
Date Scheduled 1A Time�� Fee Pd. ®U
Soil Suitability Assessment for Sewage D'sposal
' �. 1
Performed By: i L ps
Witnessed By: �l
LOCATION& GENERAL INFORMATJON
Location Address 61�3 e-,i X.-I.I,-- 'c Owner's Name ,.JJ C,V)n j
4Y
Addressco7W h it_), V A Z 51)
Assessor's Map/Parcel: :-.( y / O L, Engineer's Name Caw-r►7 2.rn Sh ei,
NEW CONSTRUCTION REPAIR Telephone#
Land Use _ 151 tier-,GP Slopes(%) 5 C1 _ Surface Stones N'
Distances from: Open Water Body ft Possible Wet Area 1ft Drinking Water Well N/�4 ft
Drainage Way Ak Property Line ! a / ft Other �Il/} ✓ ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes)
TPZ
Z
2'
of < t `,1
ux
s X
Parent material(geolo(geologic) OuT � Depth to Bedrock IJ Nth.,
Depth to Groundwater. Standing Water in Hole: ` I(S Weeping from Pit Face
Estimated Seasonal High Groundwater 9
DETERARNATION FOR SEASONAL HIGH WATER TABLE
Method Used:
j Depth Observed s nding in obs.hole: - 1 vZ0 �t in, Depth to soil mottl0h: /J1'a in.
Depth to weeping from side of o s.hole: 1 oLl1 )Iin, Groundwater Adjustment o. ft.
Index Well#IA-1A Reading Date: t 1 109 Index Well level Adj,factor m- Adj.Groundwater Level_121Wr6l'cc }q
't3i:S
PERCOLATION TEST Date— Time.,,,_,., �
Observation
Hole# Time at 9" A.
0,4-
Depth of Perc �' �` Time at 6"
Start Pre-soak Time @ Time(9"-6")
End Pre-soak 1 Lf2`J-
ra
Rate Min./Inch _ 1
Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N)
Original:.Public Health Division Observation Hole Data To Be Completed on,Back-----------
***If percolation test is to be conducted within 100' of wetland,you must first notify the.
Barnstable Conservation Division at least one (1) week prior to beginning.
Q:\SEPTICIPERCFORM.DOC '
DEEP.OBSERVATION HOLE LOG Hole#—j—
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling '(Structure,Stones;Boulders.
Consistency,% ravel
o Q /J/
5 C. Lfl S1�
® -�aD M 8.5 Y 7-
DEEP OBSERVATION HOLE LOG Hole# _
Depth from Soil Horizon Sbil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency,% ravel
• ��y'� 10��31 N�� �"'
l,ao
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency.%Gravel
;,ram
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Sail Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency,
Flood Insurance Rate Man:
Above 5.00 year flood boundary No_ Yes
Within 500 year boundary No= Yes
Within 100 year flood boundary No Yes
Depth of Naturally Occurrin>;Pervious Material
Does at least four feet of naturally occurring pervious material exist in,all areas observed throughout the
area proposed for the soil absorption system?
If not,what is the depth of naturally occurring pervious material?
Certification
I certify that on 1 (date)I have passed the soil evaluator examination approved by the
Department of Environmental Protection and that the above analysis was performed by me consistent with .
the required trai ' g, r se n xperience described in 310 CMR,15.017.
Signature Date A C)
Q:\S.EPTIC�PERCFORM.DOC
Date:
TOWN OF BARNSTABLE
TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY
NAME OF BUSINESS: l 0 P J ®I
BUSINESS LOCATION: d,,S 1�el-e- INVENTORY
MAILING ADDRESS: ��� 7/d ('� �GCvt .�C �%l!�` D�G3� TOTAL AMOUNT-
TELEPHONE NUMBER: �r'2eW` 4A
CONTACT PERSON:_,, �`�- / Gae
EMERGENCY CONTACT TELEPHONE BER:
�77�`� 7�� MSDS ON SITE?
TYPE OF BUSINESS: 66,01 /IGIG I� zG"
INFORMATION/RECOMMENDATIONS: Fire District:
Waste Transportation: Last shipment of hazardous waste:
Name of Hauler: Destination:
Waste Product: Licensed? Yes No
NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use,
storage and disposal of 111 gallons or more a month requires a license from the Public Health Division.
LIST OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health and the Public Health Division have determined that the following products exhibit toxic
or hazardous characteristics and must be registered regardless of volume.
Observed/Maximum Observed/Maximum
Antifreeze (for gasoline or coolant systems) Misc. Corrosive
NEW USED Cesspool cleaners
Automatic transmission fluid Disinfectants
Engine and radiator flushes Road Salts (Halite)
Hydraulic fluid (including brake fluid) Refrigerants
- Motor Oils- Pesticides -NEW USED (insecticides, herbicides, rodenticides)
Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers)
Diesel Fuel, kerosene, #2 heating oil NEW USED
Misc. petroleum products: grease, Photochemicals (Developer)
lubricants, gear oil NEW USED
Degreasers for engines and metal Printing ink
Degreasers for driveways &garages Wood preservatives (creosote)
Caulk/Grout Swimming pool chlorine
Battery acid (electrolyte)/Batteries Lye or caustic soda
Rustproofers Misc. Combustible
Car wash detergents Leather dyes
Car waxes and polishes Fertilizers
Asphalt & roofing tar PCB's
Paints, varnishes, stains, dyes Other chlorinated hydrocarbons,
Lacquer thinners (inc. carbon tetrachloride)
NEW USED Any other products with "poison" labels
Paint &varnish removers, deglossers (including chloroform, formaldehyde,
Misc. Flammables hydrochloric acid, other acids)
Floor &furniture strippers Other products not listed which you feel
Metal polishes may be toxic or hazardous (please list):
Laundry soil & stain removers
(including bleach) �/41)_ 1 4"421W
Spot removers &cleaning fluids
(dry cleaners)
Other cleaning solvents
Bug and tar removers
Windshield wash
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS
NO TES
1.) THIS PLAN IS VALID ONLY IF IT IS STAMPED AND SIGNED
IN RED. THIS OFFICE ASSUMES NO RESPONSIBILITY FOR
INFORMATION CONTAINED ON COPIES WHICH DO NOT HAVE N
ORIGINAL STAMPS AND SIGNATURES IN RED.
2.)ZONING DISTRICT RS
W E
S
CB
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' PARCEL 194
o PARCEL 134 I
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14.9ft 100.00'
CB
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27.Oft
o - wog by o
o V o
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47.Oft o
1.8ft18.3ft
16.0'
10 FTREQUIRED
SIOELINE
-
SETBACK
cNs 100.DO' 9.srr 6.5ft
o CB PROPOSEI> I
AI�I�ITION ' W
FOUNDA TION FOR ADDITION I cr
cr-
TO BE SET 10.25 FT FROM �
LOT LINE, ADDITION TO BE
CANTILEVERED I
PARCEL 136
AS - BUILT PL OT PLAN
R J.� O'Hearn, P.L. ,S., - R. S. LOC#3,2 SIXTff AMME
35 Route 134, Swan River Plaza, Unit 2 WEST HYANNISPORT, ff,4.
South Dennis, Ala. 02660 ASSESSORS AMP 246 PARCEL 135
I CERTIFY TO JONA THAN TYLER JOB NO.: 1161R
AND TO THE TOWN OF BARNSTABLE BUILDING INSPECTOR �P�(N OF lLlgss9 v�
THAT TO THE BEST OF MY INFORMA770N, KNOWLEDGE c DAIS
AND BELIEF, THE STRUCTURES SHOWN ON THIS PLAN o� RtCJ. �n OCT. 16, 2010
HAS BEEN LOCATED ON THE GROUND AS INDICATED o J. y MEW'
AND THAT IT IS LOCATED IN FLOOD ZONE C PER O.2787 TYLER
" ld0.27871 �
FLOOD INSURANCE RATE MAP DATED AUGUST 19, 1985 Q q SCALE 1 IN = 30 FT
S�ONAL LAND SJ
DR. BY.• R. OH
1EA
Z /a EG. PROF S IONAL LAND SURVEYOR
SHEET 1 OF 1
i
-
On the above date, I inspected `the septic system at the above address.
This system consists of the following:
1 . 2-block cesspools . 51x4' S
Based on my inspection, I certify the following conditions:
1 . This is not a title five septic system.
2. This is a sewage sytem with the holding capacity of
800-1000 galloons . The water level is within 140 of
the invert pipe. System is operating at 709 of capacity.
® . G
SIGNATURE: ,.
Name: Joseph P. Macomber Jr.
Company:J.P.Macomber & Son Inc.
P Y•-------------------
Address:
Centerville ,Mass , 02632
P h o n e: p8_22 -_33a-------
THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY
N�Ea�
---
JOSEPH `P. MACOMBER & SON, INC.
Tanks-Cesspools-Leachfields
Pumped & Installed ®�c
Town Sewer Connections �e
P.O. Box 66 Centerville, MA 02632-0066
.775.3338 775-6412 � �
JOSEPH P. MACOMBER & SON, INC.
P.O.BOX 66
CENTERVILLE.MA 02632-0066
775-3338 775-6412
recommendations .
1 . The sewage system should be pumped annually.
2. The sewage system should function properly on a seasonal basis.
3. Year round occupancy is quetstionable .
4. System is small.and elderly.
5. For year round use . It should be considered to have a septic system
installed.
6. The present system is a sewage system. That consists of two 51x4'
block cesspools . The present system design barely meets the 330
gallon per day requirement of a three bedroom house.
I
Per•
II
For; J.P.Macomber & lion Inc
I
Commonwealth of Massachusetts
Executive Office of Environmental Affairs .
Department of
Environmental Protection
William F.Weld
aWIt110t Y .
Trudy Coxe e'
Ow 1,y,EOEA
Davld B.Struhs
Cortwnlu10n4t
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Property Address: 105 6th Ave Rest Hyannisport Address of Owner: 1 Pleasant Street
Date of Inspection:11 /28/9 5
(If different)
Name of lnspector:Joseph P-Macom$er Jr.
Company Name Address and Telephone Num er:
.P.Macom�er & Son Inc. Box 66 Centerville ,Mass . 02632 508-775-3338
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:
ZPasses
_ Conditionally Passes
_ Needs Further Evaluation By:the Local Approving Authority
_ Fails
Inspector's Signature: ' Date:
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:
have not found any information which;ndicates that the system violates any of the failure criteria as defined in 310 CMR 15.303.
Any failure criteria not evaluated are indicated below.
81 SYSTEM CONDITIONALLY PASSES:
A16 One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair,
passes inspection.
Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not)
The septic tank is metal, 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 8/15/95) 1
One Winter Street 9 Boston,Massachusetts 02108 • FAX(617)556-1049 9 Telephone (617)292.5500
T +.
u„ rim,;y.�. .a`rs�:.o:: s k•.." „y; a ..,, ..:.r - .. .. ... .. •• .. +. . r '.
SUBSURFACE SEWAGE DISPOSAL' SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
roperty Add 106 6th Ave West Hyannisport,Mass .
ress:
-
wner. y..
+.R
a.
ate of Inspection 11 /28/95 1 ;
4 ,r.y:s. Y :rise. f 1— 1p_ y. ,• ,•y" '
J SYSTEM CONDITIONALLY PASSES (continued) obstructed
.,n Sewage backup or breakout or high static water level observed in the distribution box is d brokenue to or.
�f 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):
broken pipe(s) are replaced
obstruction is removed'-~- - ->.r,. +,:, ,, —, .
distribution,box:,is levelled.or replaced
y
B
jl;'z"system required pumping more tiian`(our 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 replace
obstruction is removed
C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH
1J Conditions exist which require further evaluation by the Board of Health in order to determine if the system Is falling to protect the
'public health;safety iri&the environment.
IS
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES
AND THE THE SYSTEM
ENT:O7 FUNCTIONING IN A MANNER
WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY
&6 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°-F•AIL=`UNLESS'THE BOARD°ONE THAT E PRALTH OTECT T THE PUBLIC HEALTH AND
:FUB -WATER SUPPLIER,�Jf APPROPRIATEY DETERMINES THAT
THE SYSTEM IS FUNCTIONING IN A MAN
SAFETY AND THE
EnVIRONMENT:
The wstem nas a woo. Wilk inj wil db� i urpliull syilely, and \tiithin 100 feel to a $UrfaLl° �+.ater $lippi�' Cr tr:vuta � tC a
surface water supply.
/ The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well.
/ The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well,
t The systen•, has a septic tank and soil absorption system.and 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 or
compounds indicates that.the.well is
flee'from"pollufion'yfrorTi that facility andthe presence oPammonia nitrogen and nitrate nitrogen is equal to or less than 5
ppm.
DJ SYSTEM FAILS:
N U I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis
for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct
the failure.
Backup of sewage into facility or system component due to an overloaded or clogged.SAS,or,cesspool. .
._'!.�.yev .r.'ih' } {.w'1.35.P'•e.r• :. _ i
Discharge or ponding of effluent to the surface of the ground.or surface waters due to an overloaded or clogged SAS or
cesspool.
2
treviseo 8/15/95)
JVOJVnfn\.[ J[rrnV[ u1Jf VJnc JIJIc""/YI 11•Jf C�.IIVI� IVNr1 •,
PART A
CERTIFICATION (continued)
Property Address: 105 6th Ave West Hyannisport,Mass'.
Owner: Leg D Marco
Date of Inspection 1./ 28�95
D] SYSTEM FAILS (continued):
Qf� Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
jLQ 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
�fff '%ny portion of the Soil Absorption Systenq cesspool or privy is below the high groundwater elevation.
Any portion of a 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 I of.a public well.
�l Any portion of a cesspool or privy is within 50 feet of a private water supply well.
1 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
E] LARGE SYSTEM FAILS:
The following criteria apply to large systems in addition to the criteria above:
The design flow of system is 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety
and the environment because one or more of the following conditions exist:
BA the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area (IWPA) or a mapped Zone II of a
public water supply well;
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(revised 8/15/95) 3
F
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address:105 6th Ave West Hyanni'sport,Mass .
Owner.
Leo DeMarco
Date of Inspection: 11 2 8/9 5
Check if the following have been done:
-�Pumping information was requested of the owner, occupant, and Board of Health.
None or the system components have been pumped for at least two weeks and the system has been receiving normal flow rates
during that period. Large volumes of water have not been introduced into the system recently or as pan of this inspection.
/l(Q As built plans have been obtained and examined. Note if they are not available with N/A.
The facility or dwelling was inspected for signs of sewage back-up.
The system does not receive non-sanitary or industrial waste flow
ZThe site was inspected for signs of breakout.
2All system components,*Kluding the Soil Absorption System, have been located on the site.
The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of-baffles or
Ma
tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum.
- The size and location of the Soil Absorption System on the site has been determined based on existing information or
haproximated by non-intrusive methods.
e facility ov.ne; and occupants, if different from owner) were provided with information on the proper maintenance of Sub-
Surface Disposal System.
(revised 6/15/95) 4
I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 105 6th Ave West Hyannisport,Mass .
Owner: Leo DeMarco
Date of Inspection: 11 /2 8/9 5
F40W CONDITIONS
RESIDENTIAL:
Design w: 'M3n Rall, ns ��-
Number of bedrooms:
Number of current residents: r
Garbage grinder(yes or no):A1
Laundry connected to system (yes or no):'s
Seasonal use (yes or no): §
Water meter readings, if available:' iXTG4i 1° F9CCouc I Y0Z? !2,6 N-/u&lilCl7V ,
Lasu elate of occupancy:
COMMERCIAUINDUSTRIAL:
Type of establishment: Al
Design flow: A allons/day
Grease trap present: (yes or no)bp p
Industrial Waste Holding Tank present: (yes or no)
n-sanitary waste discharged to the Title 5 system: (yes or no)A)A
,water meter readings, if available:
Last date of occupancy:A,!—
OTHER: (Describe) AM
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS' d source oj i formation:
System pumped as pan of inspection: (yes or no) E7.1
If yes, volume pumped. . R�1406 allons
Reason for pumping: ULleA).4 L150,
TYPE OF SYSTEM
Septic tank/distribution box/soil absorption system
Single cesspools
Overflow cesspool
AJD Privy
1 1 Shared system (ye or o) (if yes, attach pre ious inspect' n records, if any)
(if(explain) ,
APPROXIMATE AGE of all components, date installed (if known) and source of information: 3V2/41LS
rage odors detected when arriving at the site: (yes or no)
(revised 8/15/95) S
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 105 6th Ave West Hyannisport,Mass .
Owner: Leo DeMarco
Date of Inspection: 11 /2 g/9 5
SEPTIC TANK:A4 ,.
(locate on site plan)
Depth below grade:&9914
Material of constructiio concrete _metal _FRP—other(explain)
Dimensions:
Sludge depth: VA
Distance from top of sludge to bottom of outlet tee or baffler .
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: fvn
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.) AtoiVe-
GREASE TRAP;&&)C'
(locate on site plan)
Depth below grader
Material of construction:41concrete _metal _FRP_other(explain)
AA
Dimensions:
Scum thickness: AA
Distance from top of scum to top of outlet tee or baffler
Distance from bottom of From in bottom or outlet tee or bafue:_LL
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.) t
(revised 8/15/95) 6
SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 105 6th Ave West HyannisportMass .
Owner: Leo DeMarco
Date of Inspection: 11 /2 8/g 5
TIGHT OR HOLDING TANK:Ahwkl
(locate on site plan)
Depth below grade:
Material of constructionilAtoncrete_metal _FRP—other(explain)
Allf
A
Dimensions: /G
Capacity: allons
Design flow: allons/day
Alarm level: N
Comments:
(condition of inlet tee, condition of alarm and float switches, etc.)
DISTRIBUTION BOX:&yt;4�
(locate on site plan)
Depth of liquid level above outlet invert:-. „*-- '
Comments:
(note if level and distributwi. i, equal, evidence of solids carryover, evidence of leakage into or out of box, etc.)
PUMP CHAMBER:A'�A/z
(locate on site plan)
Pumps in working order:(yes or no)dje—
Comments:.
(note condition of pump chamber, condition of pumps and appurtenances, etc.)
dN e�
I
a
(revised 8/15/9$) 7
-- SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Add ress: 105 6th Ave West Hyanni sport,Mass .
Owner: Leo DeMarco
Date of Inspection:1 1/2 8/9 5
SOIL ABSORPTION SYSTEM(SAS): 2e
(locate on site plan, if possible; excavation not required, but m of be approximated by non-intrusive methods)
if not determined to be present, explain:
Type: ,
leaching pits, number:
leaching chambers, number:
leaching galleries, number: CJ
leaching.trenches, number,length:
leaching fields, number, dimensions:
overflow cesspool, numbei:
Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.)
AV A)
CL,,,OOLS: S
(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: C
Indication of groundwater: nn / /�
infl w (cess ool must be pump as part of inspection) r' - C'L� 1�S
,�t!' �' � ��� � .0 v• a , � sue•
Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
PRIVY:
(locate on site plan)
Materials of construction: �� Dimensions:
Depth of solids:
Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
(revised 6115195) 8
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION.(continued)
Property Address: 105 6th Ave West Hyannisport,Mass .
Owner: . Leo DeMarco
Date of Inspection: 11 /2 g/9 5
SKETCH OF SEWAGE DISPOSAL SYSTEM: ••
Include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100'
Town Water. Fixtured rate .
1
A vC
DEPTHJO GROUNDWATER
Depth to groundwater:,4q r_+feet
nthod of getermination or approximatiop: _ TDqtaljed. systems on this street.
Existing property on Knoll Gesspoois were pumped no signs off' water
_intrusion. --,-°�
(revised 8/15/95) 9
. R�1T1T-Rt•T�Ti�iTlTTSRT'S.T�TrS'TTRT.�T::'S'1T!TTT:ZTt�.�ITTT�'L1�TCT..� .� ... ... .. . �.. . �.. - .II.TTI_�g+�T:i'T�r�.TT.TT.i'-•'p
� 'I.OWN OF Barnstable BOARD OF HEALTH
SUnSURFACR SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION
F•••s:•ter•:-e'T--.lea-.-T.rnn•r.:rrs�r.—Tr.— :"r.r—•T•-s.---......... rpm.—.........crr..rs,r:r"rss�srasr..... a-rsresrm Rrerrrrs-- ... rT r.
-TYPE OR PRINT CI,EARLY-
PROPERTY INSPECTED
. STREET ADDRESS 105 6th Ave West H_yannisport.Mass .
ASSESSORS MAP, BLOCK ANJ) PARCEL
OWNER' s NAME Leo DeMarcb
PART D - CERTIFICATION .r
NAME OF INSPECTOR Joseph P.Macomber Jr.
COMPANY NAME J.P.Macomber & Son Inc.
COMPANY ADDRESS Box 66, Centerville,Mass , 02632
Street Town or City Stat• LIP
COMPANY TELEPHONE ( 508 ) 775 3338 FAX ( 790 ) 1578 - 508
t
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at
this address and that the information reported is true , accurate, and
complete as of the time of :inspection . The inspection was performed and any
recommendations regarding upgrade , maintenance , and repair are consistent
with my training and experience in the proper function and maintenance of on-
site sewage disposal systems .
Check one:
ysteui PASSED
The inspection which I have conducted has not found any information
which indicates that the system fails to adequately protect public
health or the environment as defined in 310 CMR 16 . 303 . Any failure
criteria not evaluated are as stated in the FAILURE CRITERIA section of
this form.
System FAILED*
The inspection which I have conducted has found that the system fails to
protect the public health and the environment in accordance with 'title
6 , 3.10 CMR 15 . 303 , and as specifically noted on PART C - FAILURE
CRITERIA of this inspection form .
Inspector Signature v"� ,Z 11 2
Date _ / 9/95
p
One co.py of this certification must be provided to the OWNER, the BUYER
( where applicable ) and the BOARD OF HEALTH.
* 1`f the inspection FAILED,, the owner or"" perator shall upgrade ' the ayatem
within one year of the date of the inspection, unless allowed or required
otherwise as provided in 310 CDfR' 15 . 305 .
L
THE COMMONWEALTH OF MASSACHUSETTS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
e+
BE IT KNOWN THAT
Joseph P. Macomber, Jr.
Has satisfied the Department's qualifications as required and is hereby
authorized to use the title
CERTIFIED TITLE 5 SYSTEM INSPECTOR
as provided in 310 CMR 15.340 and Section 13 of Chapter 21A of the
General Laws. Issued by The Department of Environmental Protection.
.June 8, 1995
Acting Director of the ' ion of Water Pollution Control
TOWN OF BIA�RNSTABLE
LOCATION UOU'A 3� S �X-�� AJ-t SEWAGE #
VILLAGE We54 ASSESSOR'S MAP & LOT;2"
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY
LEACHING F-ACILITY:(type) �eA& Qi (size)
NO. OF BEDROOMS 3 PRIVATE WELL O PUBLIC WATER
BUILDER O WNER �� t,'►e4 �,e(
DATE PERMIT ISSUED: I Z.
DATE COMPLIANCE ISSUED: ^ l
VARIANCE GRANTED: Yes No
:11
1 s s �`
s � �
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ASSESSOR' M P NO. Z (�� PARCEL �� S
L0 €. Agl '47, SEWAGE QPERMIT
VILLAGE
INSTALLER'S NAME i ADDRESS:
4 U I L D E R 0 OWNER
_,)4
DATE PERMIT ISSUED
DAT E COMPLI'ANCE ISSUED
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• � �` Architect.
85 River Wew lene..Cen4.Wlle Mamachumaa O2M •Tekphane")790d910.� .
Plans and Elevahoris' AlImrooIn Addirion L1
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32 6'"Avenue,Hyawn Sport,MA.
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_rANv...tou�5f Architect
GONG .Telephone(508)790.071A.
85 Rher view L•ne• Centerville.Me hu tb 02632
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Sections and Details
Sunroom Addition A2
32 6"Avenue,Hyannisport MA
- _ A6 uotl:D ie-28-io A¢4'
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