HomeMy WebLinkAbout0039 SKATING RINK ROAD - Health 39 Skating Rink Road
A= 291 - 177
Hyannis
No. d _ 3 7q Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
Nplitation for Misposal *pstrm Construction permit
Application for a Permit to Construct( ) Repair(1,f Upgrade( ) Abandon( ) ❑Complete System Individual Components
Location Address or Lot No.3 Q X,44;!!%A16r AAANe X,0 Owner's Name,Address,and Tel.No. r
Assessor's Map/Parcel .a 9,/ /�� -V �� �� � -;;; ;7_f- �� 7
Installer's Name,Address,and Tel.No. Designer's N e,Address,and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building gt:�T, e' P- No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) 4X � e� �� C'
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 Certificate of
Compliance has been issued by this Board o alth. — a
Sig Date
Application Approved by Date ( 0 i—(
Application Disapproved by Date
for the following reasons
Permit No. d&_ 7� Date Issued
No. d 7 3 / t Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC=HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
Zipplication for Bisposal .pstem Construction Hermit i
Application for a Permit to Construct( ) Repair(jK Upgrade( ) Abandon( ) ❑Complete System ZjIndividual Components
Location Address or Lot No3 9 r('44;9/y'6: Akw*Oep Owner's Name,Address,and Tel.No.
Assessor'sMap/Parcel ,1 91 /)
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
r
` Type of Building:
Dwelling, No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building q .P• No.of Persons Showers( ) Cafeteria( )
- Other Fixtures \ �!
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
w
Nature of Repairs or Alterations(Answer when applicable)
i
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 Certificate of
Compliance has been issued by this Board o alth.
Sig ACT Date
i
Application Approved by Date �U— i_r V 1
Application Disapproved by Date
for the following reasons
Permit No. d ,l C�- 7� Date Issued
TH E COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(� Upgraded( )
Abandoned( )by�� c��O�`y/� Y44.,GI>fi v'O-
at .3'9 �i�/�T/!°'a� ��''� !� has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. -3 7 9 dated 10 _ IV
Installer,j�� ,�i1�0�`y/t Designer 4�''�
#bedrooms N Approved design-flow� i gpd /
The issuance of this permit
/sh)alll ootf be onstrued as a guarantee that the system will function as`designedI A (r ( q
Date Inspector i� ZA
No. �O (�` Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Nsposal bpstem Construction Permit
Permission is hereby granted to Construct( ) Repair( A,< Upgrade( ) Abandon( )
System located at9
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Constructioh must be completed within three years of the date of this permit. q r
Date j L) �I�� Approved by �rVti i
Commonwealth of Massachusetts
a Title 5 Official Inspection Form
4 _,.
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
®4 Jp 39 Skating Rink Road
Property Address
Timothy Egan Nodoor
Owner Owner's Name
information is required for every Hyannis MA 02601 October 8, 2014
page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When filling out forms A. General Information
Ion the computer, �q
use only the tab 1. Inspector: I D
key to move your
cursor-do not David B. Mason
use the return Name of Inspector
key.
David B. Mason
Q Company Name
4 Glacier Path
Company Address
East Sandwich MA 02537
City/Town State Zip Code
508-367-1617 S1287
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
c:s 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 $(310 CMR 15.000). The system:
0- _
Eon=-`
tx ._Passes ❑ Conditionally Passes ❑ Fails
'.Needs Further Evaluation by the Local Approving Authority
C,7 C Cj
• October 8, 2014
Inspector's Signature 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.
t5ins•3/13 Title 5 OTsp. orm:Subsurface Se age Disposal System•Page 1 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
,i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M ems; 39 Skating Rink Road
Property Address
Timothy Egan
Owner Owner's Name
information is required for every Hyannis MA 02601 October 8, 2014
page. Cityrrown State Zip Code Date of Inspection
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:
The observations noted in this report represent the condition of the system only on this date of
inspection and the information contained herein does not guarantee the continued operation of the
system.
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.
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 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.
❑ Y ❑ N ❑ ND (Explain below):
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17
Commonwealth of Massachusetts
_ Title 5 Official Inspection Form
�� --- - Subsurface Sewage Disposal System Form Not for Voluntary Assessments
®4 39 Skating Rink Road
Property Address
Timothy Egan
Owner Owner's Name
information is required for every Hyannis MA 02601 October 8, 2014
_
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
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 if(with approval of Board of Health):
❑ 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 (Explain below):
As a part of inspection the D-Box was found to be deteriorated and was replaced with a new H-20 D-
Box.
❑ 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
Commonwealth of Massachusetts
r� Title 5 Official Inspection Form
m� - .1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
39 Skating Rink Road
Property Address
Timothy Egan
Owner Owner's Name
information is required for every Hyannis MA 02601 October 8,2014
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
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.
❑ The system has,a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well".
Method used to determine distance:
**This system passes if the well water analysis, performed at a DEP certified laboratory, for 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 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 '/2 day flow
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
Commonwealth of Massachusetts
a Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
39 Skating Rink Road
Property Address
Timothy Egan
Owner Owner's Name
information is required for every H annis MA 02601 October 8, 2014
Y
page. CityTTown State Zip Code Date of Inspection
B. Certification (cont.)
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.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area—1WPA)or a mapped Zone 11 of a public water supply well
If you have answered "yes"to any question in Section E the system is considered a significant threat,
or answered "yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
39 Skating Rink Road
Property Address
Timothy Egan
Owner Owner's Name
information is required for every Hyannis MA 02601 October 8, 2014
page. City/Town State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes" or"no" as to each of the following:
Yes No
Z ❑ 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?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
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
r
l5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17
Commonwealth of Massachusetts
a ITitle 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
39 Skating Rink Road
4s
Property Address
Timothy Egan
Owner Owner's Name
information is required for every Hyannis MA 02601 October 8, 2014
page. City/Town State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents: 0
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? (Include laundry system inspection
information in this report.) El Yes ® No
Laundry system inspected? ❑ Yes ® No
Seasonaluse? ❑ Yes ® No
Water meter readings, if available (last 2 years usage (gpd)): Yes
Detail:
2013; 20,944 gallons and 2012; 42,636 gallons.
Sump pump? ❑ Yes ® No
Last date of occupancy: UnknownDate
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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17
Commonwealth of Massachusetts
M Title 5 Official Inspection Form
D, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1.•
4-/ 39 Skating Rink Road
Property Address
Timothy Egan
Owner Owner's Name
information is required for every Hyannis MA 02601 October 8, 2014
page. City/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: Board of Health
Was system pumped as part of the inspection? ❑ Yes ❑ No
If yes, volume pumped:
gallons
How was quantity pumped determined?
Reason for pumping:
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner) 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•3/13 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 8 of 17
Commonwealth of Massachusetts
l- _ r Title 5 Official Inspection Form
R+ li Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
39 Skating Rink Road
Property Address
Timothy Egan
Owner Owner's Name
information is required for every Hyannis MA 02601 October 8, 2014
page. CityrFown State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known) and source of information:
1985
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 3
feet
Material of construction:
❑ cast iron ®40 PVC ❑ other(explain):
Distance from private water supply well or suction line: 10+feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
Septic Tank (locate on site plan):
Depth below grade: 2
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: 1000 Typical
Sludge depth: 2„
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17
Commonwealth of Massachusetts
_ Title 5 Official Inspection Form.
a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
gt 39 Skating Rink Road
�...r
Property Address
Timothy Egan
Owner Owner's Name
information is required for every Hyannis MA 02601 October 8, 2014
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle
47"
V
Scum thickness
Distance from top of scum to top of outlet tee or baffle
3"
Distance from bottom of scum to bottom of outlet tee or baffle
16"
How were dimensions determined? Scour Stick
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Effluent level with outlet invert.
Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
39 Skating Rink Road
Property Address
Timothy Egan
Owner Owner's Name
information is required for every Hyannis MA 02601 October 8, 2014
page. CityrFown State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
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? ❑ Yes ❑ No
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
Commonwealth of Massachusetts
_ . r Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
39 Skating Rink Road
M ..byre
Property Address
Timothy Egan
Owner Owner's Name
information is required for every Hyannis MA 02601 October 8, 2014
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert Effluent level with outlet invert
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
D-box is a brand new H-20
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.):
* If pumps or alarms are not in working order, system is a conditional pass.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
Commonwealth of Massachusetts
a} Title 5 Official Inspection Form.
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�11 39 Skating Rink Road
Property Address
Timothy Egan
Owner Owner's Name
information is required for every Hyannis MA 02601 October 8, 2014
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
❑ leaching chambers number:
® leaching galleries number: 3
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
Unknown
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Leaching is 3 flowdiffusors with 3 feet of stone around. Based on original design computations the
leaching is designed to accommodate 492 gallons per day. The existing system as approved by the
Health Department can accommodate an increase in bedrooms. No effluent standing in leaching nor
any indication of staining. Bottom of leaching is clean sand.
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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
Commonwealth of Massachusetts
a} Title 5 Official Inspection Form
F� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
39 Skating Rink Road
L..J
Property Address
Timothy Egan
Owner Owner's Name
information is required for every Hyannis MA 02601 October 8, 2014
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
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.):
F
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17
Commonwealth of Massachusetts
�� -- . .
r# Title 5 Official Inspection Form
_ JC Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
39 Skating Rink Road
Property Address
Timothy Egan
Owner Owner's Name
information is required for every Hyannis MA 02601 October 8, 2014
-
page. CityTTown State Zip Code Date of 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:
❑ hand-sketch in the area below
® drawing attached separately
t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
Commonwealth of Massachusetts
a _ Title 5 Official Inspection Form
=� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
° ®4s� 39 Skating Rink Road
�...r
Property Address
Timothy Egan
Owner Owner's Name
information is required for every Hyannis MA 02601 October 8, 2014
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
® Check Slope
® Surface water
® Check cellar
❑ Shallow wells
Estimated depth to high ground water: 14'
feet
Please indicate all methods used to determine the high ground water elevation:
❑ Obtained from system design plans on record
If checked, date of design plan reviewed: Date
® Observed site (abutting property/observation hole within 150 feet of SAS)
® Checked with local Board of Health -explain:
Groundwater Contour Map
❑ Checked with local excavators, installers- (attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Groundwater Contour Map
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17
Commonwealth of Massachusetts
a Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
y' 39 Skating Rink Road
Property Address
Timothy Egan
Owner Owner's Name
information is required for every Hyannis MA 02601 October 8, 2014
page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary: A, B, C, D, or E checked
® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed
® System Information— Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
Assessing As-Built Cards Page 1 of 2
L 0 CA TIONN S E 3YiTi ?i ;m;T iJ D.
VILLAGE —
IM5TALLER'S NAME A ADaaITS -
2UILaER o OWNER
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DATE FIERMIT ISSUED Ts
DATE C 0 M P L I A N C 1 ► S SUED
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WILLACE
114STALLER'S I AW, E A ADDRESS �
1�-o Al e S
5 U I L D x R on ownEg
DkTE PERMIT ISSUED
DATE COMPLIANCE ISSVED
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THE COMMONWEALTH OF MASSACHUSETTS
1 BOARD OF HEALTH �,..
ow. ?......._.. OF...... .......................................
Appliration for Dispnsttl Works Tnnstrnrtiun ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
ocation-Address or Lot No.
......GU2 At!_'.�.1d_.... .._....u?6cfdl .................................... Sd�d �1C ....... 4! !a?1 F1 ...................
w er Ad ss
r _... ,..
Installer Address
d Type of Building Size Lot_13_I_______________Sq. feet
V Dwelling—No. of Bedrooms_________________._.____._.___.____._._Expansion Attic ( ) Garbage Grinder ( )
pa, Other—Type of Building ____________________________ No. of persons____-_______________________ Showers ( ) — Cafeteria ( )
Q' Other fixtures -•--------------•----------••-••--•------•••----•••---.••••-•--••-• --
W Design Flow................s, ....................gallons per person pear day. Total dajly flow--------Z ........................
g�llorts.
WSeptic Tank—Liquid capacity,/lW__gallons Length.&:_K'"_. Width._5--t�.`__ Diameter________________ Depth'__-__.c5......
x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft.
3 Seepage Pit No....................... Diameter...../ �___.__ Depth below inlet---�%r....... Total leaching area_ ......sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.___...6< .'g�`�k �=� i ............ Date_____yf ...........
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........................
a --------------•------------••------__._...•----••-___.____...__......-----------------...._......---.........................................................
O Description of Soil-----.�:ai......ZP,:ff.;S024...-------------J6=P -----•- ...................................
W
V
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 ilTlL- 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
oper o until a Qate of Compliance has been is ed by the b rd of health.
Signed ---------------------------------••-----••-- -•---- -
PPlication Approved BY -
a �
Date
Application Disapproved for the following reasons:--•----•••----••--•.....----•--•---------•-------•••--•-•--•--•-------------•----•--------___..-•-•--...._-•----
........-•-•--•-•-------•................•--------•----•----•--•-•----.....--------------.......-•------------•---------•-------------•-----•--•-----•-------------------._..----•---•---•--•-------=---
Date
PermitNo.........................................................�� Issued.......................................................
Date
-I t
L . ,
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
70.VQ-A)...................OF.....
� !`%2 5/. -......_...
ApplirFation for Disposal Works Tontrurtion Vprrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
........... ...- .._..J .....�....... -
ocation Address r Lot No.
_ owner 1 Xa Ad ess
Installer Address
Type of Building Size Lot___, -------Sq. feet
I—. Dwelling—No. of Bedrooms.................`_.___
a .....................Expansion Attic ( ) Gart�age Grinder ( )
a`4 Other—T e of Building __.____ No, of ersons____________________________ Showers
YP g -----•-------•------• P ( ) — Cafeteria ( )
dOther fixtures _..-•---•------------•----•••-•------------•----•---•-.-•••-----•-•-••----•--•-----••---
W Design Flow................ per person pqr day. Total daily flow_______ _.-______..____.________gallons.
r �.
Septic Tank—Liquid capacity/Zr—O.-gallons Length ea:iK...... Width_Y_-&__.__. Diameter________________ Depth-l�___A__.__-
W Disposal Trench—No_ ____________________ Width_................. Total Length.................... Total leaching area........._..........sq. ft.
Seepage Pit No-------.l_________ Diameter____ 0.1._.____ Depth below inlet__e�.....__ Total leaching area_j5�l._1`'_'_------sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by-___r' ��f ____.. .. v` '
------------- Date Test Pit No. 1...<_�_minutes per inch Depth of Test Pit____________________ Depth to ground water.__5�6_---________-_-
fL4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-----_..................
P4 •••-••-•-•--------- ------------•-•-•--•-----•------••--•---•--•-••---------•---.........•---------•----.....-----••--......__••-------•......---•-•---__-•--
O Description of Soil. C� U! =,�Z!...........................9'6 .�>. ���IA,- - '� ?,
U -----------------------
_
W
VNature 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 rued by the b and of health.
Signed------- ���1c:�..�,._.S - �'�� -----•-
Application Approved BY - - ��_ � ' .; 4.(((,/ --------------------•--. -•------ / V
�-•'.. __-----
at
ate
Application Disapproved for the following reasons:-•--------•-•--•---•-------•----•-------•-•---•-•--•---•---------------------------------------•-•••............
----•...............................................••••••-•-•-----•---••--••---------•-•--•------•••-•-•--••-•--•------•-----•---•--•-••-••-••-•--•------•-•-•••--••------•--••-------••••-••--•-------
Date
Permit No........... :.... .........!.....:`----------.... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS _
BOARD OF HEALTH
r i,)r r✓U rL
Tnrtifirate of Toms liFanrr
TIIS� IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( , ) or Repaired
by. ICE a n d-_..i _=-
�.
_ Installer
""'
at.--------- -1----•--'f',---•--�.......----��-= �-...1_'-=�----=--_�n\ -•---•....~'-• -..._�- i;CY`-�:----------•--••---•..............J..•�......•.. -1
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......<_"r-_.......(_?_� ........... dated----------- ...__.__.__..;
THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CO TRUE® AS A GUARANTEE THAT THE
6-D
SYSTEM WIL& *Nfl�r SATISFACTORY.
$��bb
g DATE ......--••-•-----__--••••--•-•.._... Inspector--_-•-
THE COMMONWEALTH OF MASSACHUSETTS -- - 2
BOARD OF HEALTH
r,
F�
i.
s-
.................OF...... `' ^r' - .................................. :.
No ................. FEE FEE..__. .........
Dis pos al orkn Tontratrtion rrntit 4_
- �ti % u� -
Cj,:�� ' -^- �.=' -•-----------------------------••--•-------••_.__••---•-• ..._...--r-•-.................�`�;Permission is hereby granted-Q
to Construct,.( ) or Repair ( ) an Individual Sewage Disposal System
~'
`J Street �
as shown on the application for Disposal Works Construction Permit No.._,?=:_____...')___ Dated_____ _ ..5'.r`__:.......
_�5�f�~
I �
............................................. `' =_ms• . z<
---- -----------.............
t Board of Health
DATE..................s ---- z. ?.......•-------••--------.
FORM 1255 �'A. M. SULKIN, INC., BOSTON
S '
sf/e - i of Z
30)
-- 30,
37
1 LoT Ole
Zol
[or >y NoEsc isn^'� r
Fj�lt"DIP4
Ro' W1714
3 17'
-
�lsr
s�rync l / eox
3,11
LOCATION
SCALE . . o DATE
PLAN REFERENCE
P`ZH 0i B4oG4G 8 L,�./a Cov 2 7- . . . .
EDJJ RDal
9�yG�^ /�LA'n/ ✓�0.3'� ~ .SyE�'9- �r . . . . .
J
KELLEY
o No. 26100 ,o
Ess'�fCIS1ER��
�o�AL LA«�S i CERTIFY THAT THE
SHOWN ON THIS PLAN IS LOCATED ON THE GROUND
AS SHOWN HEREON AND THAT IT CONFORMS TO THE
SETBACK REQUIREMENTS OF THE TOWN OF
WHEN CONSTRUCTED.
DATE . . . . . . . . .. .
WiGL�A� .4' SW/FT - P&T/77a,ve-;e REGISTERED LAND SURVEYOR
38. ✓e
TOP OF FOUNDATION
CONCRETE COVER
�;: CONCRETE COVERS
4,82" 4"CAST IRON "
OR SCHEDULE432 MAX. 12"MAX.
P.V.C. PIPE 4"SCHEDULE 40 PVC.(ONLY) �.�
PITCH 1/4"PER. PIPE- MIN. tE�icsl
PITCH 1/4"PER.FT. 7Z6wuv
PRECAST
o'. INVERT . bvir"
EL..3�,68„ 3 few_ DiGFvso¢5
SEPTIC TANK INVERT INVERT
EL. /,30: BIOX 30,.S8 • .• �i soQs �; t;3 eE4�,)
, o INVERT .
GAL. INVERT INVERT ; ' �,o N :is 3/4��TO I V2
EL3o:7S
i EL3 4.. WASHED
STONE
DIA--►-� 7
PROFI LE OF GROUND WATER TABLE
SEWAGE DISPOSAL SYSTEM uscs lv,cN
6llou.�v-WAT�,TG
NO SCALE
P-4353
�TNs
SOIL ' LOG c�.,T�c WITNESSED BY :
DATE!- f?� !Bi98STIME.��,'Ob '> :TAh'�j. �"/�'v BOARD OF HEALTH
TEST HOLE I TEST HOLE 2 .. . ENGINEER
ELEV. . 3o•¢O ELEV. ,3Z.¢o,
w ,Nri Woop&," or
z¢" Swe_so.� DESIGN DATA :
36" Su8-.SoiC,
�v Z7'�o A*a NUMBER OF BEDROOMS
0 7t"wirw S&2.u.4o TOTAL ESTIMATED FLOW . . Z?� , ..GALLONS/DAY
so•,d- ea" caav,77�
�ivrs E'Z.ZA4o BOTTOM LEACHING AREA 300 , SO.FT. /PIT/CPA,
96" wara�c. �0 � SIDE LEACHING AREA . . . 80. . . SQ.FT./ PIT/zoo CAD
e2.ZZ-96 °
W47arAz 4a GARBAGE DISPOSAL (50% AREA INCREASE)
Cow E TOTAL LEACHING AREA ,38a SQ.FT
SAID TinJ TWo
' /o„ �,Zo.gv PERCOLATION RATE . . . .LOSS. . . . MIN/INCH
LEACHING AREA PER PERCOLATION RATE.Soo SQ.FT./C.R
14"-WATER ENCOUNTERED 3 `lok�-1�/F/wsoe.S W�T,S/NUMBER OF LEACHING PITS . . . . .
Tl.ec- F T U,�sra.✓�o.� ,9-1.G: siD�s
APPROVED . ,. , , ; .". , , , BOARD OF HEALTH • • • • • . .
DATE . ,,. . . . . . . . . . . .
AGENT OR INSPECTOR
EDWA�(
Lis .rs
. ', • LvT . . , 'ELLEY v o.
S/CR-TING' �/.VirC /ZuAD• •�+ 0. 26100
EC►S1�R 1sT0'
PETITIONER
>c
Completed by
HIGH GROUND-WATER LEVEL COMPUTATION
Site Location: SeA7/A/G .e/N/LZ%YD Lot *No.
Own er• h//!.�/ SW�rT Address:^
Contractor: Address:
Notes.-
STEP 1 Measure depth to water table
to nearest 1/10 ft. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
date
STEP 2 Using Water-Level Range Zone
and Index Well Map locate .
site and determine:
A) Appropriate ind
ex wellA�w -Z3d - _
B) Water-level range zone . . . . . . . . - - 3 r¢ �
STEP 3 Using monthly report"Current
Water Resources Conditions"
determine current depth to
water level for index well 3/8,T
mo yr
STEP 4 Using Table of Water-level
Adjustments for index well
STEP 2A , current depth to
water level for index well
(STEP 3) , and water-level
zone (STEP 213) determine 3. 0
water-level adjustment . . . . . . . . . . . . . . .
STEP $ Estimate depth, to high water
by subtracting the water-
: level adjustment (STEP A)
from measured ,depth to water ,�o
level at site (STEP l) . .
I
Figure 3
_ J
_ • b .. �.`` -may,.,.^—--... _ � i `
L ,
EDWARD E. KELLEY
REG. LAND SURVEYOR
CUMMAQUID9 MASS.
02637
TEL : (617 ) 362-2266
March 3 , 1986
Town of Barnstable
Board of Health
Hyannis,Mass.
Ref:Lot Skating Rink Road H annis
85_4,22
#5 g � y
The sewage system was installed in accordance with the approved .
plan as far as location is concerned and theelevations of the
leach trench conforms to the approved plans. The slope of the
pipe from the septic tank to the distribution is great-- enough
so as to require a tee in the distribution.
�P F
cy
R i Red Pr.ofpss `ari
�+nrt�m�a Land S,urveor7'
CompleIed by
HIGH GROUND-WATER LEVEL COMPUTATION
• x:
[Site Locat ion: SeAT/AIC RIAllG Z10T) /-/YAN�//S' Lot 'No. *'
Owner: Address:
Contractor: Address:
------------
Notes:
STEP 1 Measure depth to water table
to nearest 1/10 ft. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ¢ date
8 a
datee
STEP 2 Using (dater-Level Range Zone
and Index Well Map locate .
site and. determine:
A) Appropriate index well . . . ,
B) Water-level range Zone .?. ..! . . . . . . 3`¢
STEP 3 Using monthly report"Current
Water Resources Conditions"
determine current depth to
water level for index well . . . . . 3/Rr
mo yr ,
STEP � ' Using Table of Water-level
Adjustments for index well
STEP 2A , current depth to
water level for index well
(STEP 3) , and water-Level
zone (STEP 2B) determine 3. O
water-level adjustment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . '
STEP 5 Estinate depth to high water
by subtracting the water-
level adjustment (STEP 4)
from measured ,depth to water. �o
level at site (STEP 1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . .
Figure 3
• k