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Home My WebLink About0074 STUDLEY ROAD - Health A Studley Ro.vz,�, Hyannis r No. Fee 2 S THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 0[ppliLation for Bisposal ,4pstpm Co�stCu �101� Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon(X) Complete System ❑Individual Components Location Address or Lot No. 7 l $'"TUp u, 'Y R() Owner's Name,Address,and Tel.No. hF 14+0 XJ IS �l Cl4ek b �Y-,•ar-rN�nl Mi:k VJ Z Assessor's Map/Parcel Q i00 LJQ WLf T 1EZf7t C.T Installer's Name,Address,and Tel. o. 50J5 �`i'] —�$-1� Designer's Name,Address,and Tel.No. CAVGle_XbE �Tt�$��S (,L<_- 1 Type of Building: Dwelling No.of Bedrooms Lot Size ?b t- sq.ft. Garbage Grinder( ) Other Type of Building 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) /40AP aoai 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 of Health. S' ne Date 1 '" (�-av (3 Application Approved by Date L ? Application Disapproved by Date for the following reasons l Permit No, 2.0'1.3 Date Issued / /—I2 '�3 2 �No. .� �. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS es 01pplication for Dispo8AY 6pstetn Construction 3permit Application for a Permit to Construct( ) Repair( ) Upgrade(, ) Abandon ) ,[Comp omplete System ❑Individual Components Location Address or Lot No.r7� STUD G4t� {?(� Owner's Name,Address,and Tel.No. N`(r4dKJIS1Gt�oER7 .%I t�4TN�. 1 lti��Wlt. Assessor's Map/Parcel 1 Installer's Name,Address,and Te-1 T4.5 S-411 .-1Z a"i"I Designer's Name,Address,and Tel.No. � C Ao FW eY 1-sp-FlLlsts Lc,c 4A i Type of Building: Dwelling No.of Bedrooms Lot Size —9�4'7(.± sq.ft. Garbage Grinder( ) Other Type of Building jkl . No.of Persons) Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required)- gpd Design flow provided 1 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) & Non Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in sr' 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 of Health. Sizned,, Date I�L A0 (:21 Application Approved by Date Application Disapproved by Date for the following reasons Permit No. V/ o Date Issued I -------------------------- ----- TH E COMMONWEALTH OF MASSACHUSETTS 1 / BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned(�()by C 17�(�!�� -;,&) �Q I SES 4,�C at /` �a ��4Y".!� has been constructed in accordance —T with the provisions of Title 5 and the for Disposal System Construction Permit No. .0 1 1I0 dated Installer �' 1( U � —44-C! Designer NI IA #bedrooms A 7 I,4—. Approved design flow 1✓ f� gpd The issuance of this permit shall/not be construed as a guarantee that the system wil fu ct on.as�jdesigned. Date // Inspector /�'�'1 . , �u�t lR /. ' p y ._ — . u f r � / No. r ( —�-1 SIG Fee THE COMMONWEALTH OF MASSACHUSETTS ' PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Disposal �pstettt (Construction hermit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon(x) System located at YAOMS 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:Construction must be completed within three years of the date of this permit Date Approved by I / 1 l �J v •" - AsBuilt �. Page 1 of 1 LOCATION N .5 `k ley SEWAGE N VILLAGE 1411460 T404 ASSESSOR'S MAP&LOT U6 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY IC06 GK I LEACHING FACILITY: (type) OX/0 f" (size) NO.OF BEDROOMS c3 BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any weUs exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet (leaching ff Ri 1 Feet Furnished by sl �'"'t / �E//" a ao 1>•-C-gyp' (�-L- 7 ' t http://issgl2/intranet/propdata/prebuilt.aspx?mappar=306012&seq=1 11/12/2013 ' Town of Barnstable Barnstable ,*'THE ram, Regulatory Services Department U�ftaicaC'j 3ARNSfABM , " ,�� Public Health Division m ---200-Main Street, Hyannis MA 02601---- - -- -- - 2007- -- -- Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7012-1010-0000-2848 -1391 March 28, 2013 RICHARD & KATHLEEN KARWIC 100 LANTERN LANE IMPORTANT NOTICE WETHERSFIELD, CT 06109 Map & Parcel: 306- 012 The Department of Public Works informed us that public sewer lines are now available in your neighborhood. According to our records, your property has a septic system. This letter directs you to connect your dwelling, at 74 Studley Road, Hyannis, MA, to public sewer on or before 4/30/2015. The old septic system must be either removed or filled in due to future safety concerns. This may be done by the same contractor who connects you to the sewer. Septic Abandonment Permits ($ 25) are issued at the Public Health Division, 200 Main Street, Hyannis. Failure to comply with this Board of Health Order may result in a complaint against you, in a court of law. For additional information pertaining to the sewer connection, please see the reverse side of this page. PER ORDER O BOARD OF HEALTH L Th A. cKean, R.S., C.H.O. Agent of the Board of Health Cc: Barbara Childs,WPC/Roger Parsons, Town Engineering, DPW Enc. QASEwER connect\Lettets Stewart Creek Sewer Connects\MAILING LetA Sewer 2Pgs Merged 3-28-13 Yr2015.doc - ---- --- --..---_----Public Health-Division------ -- --- --- — ------ ------------March 28, 2013 ADDITIONAL INFORMATION AND REMINDERS FROM OTHER DIVISIONS: SAVINGS AVAILABLE/GRINDER PUMP: A reminder to those of you who need a grinder pump for your connection: Department of Public Works (DPW) sent you a letter in December 2012 stating the town, for a limited time of two years, only from the receipt of the DPW letter, would provide you with the pump at no charge. (This can save you thousands of dollars.) Please note: You must pay the installation cost through your own contractor. Please make your contractor aware of this, if interested. Also be aware: this is a shorter deadline than the Public Health Division's deadline on the reverse side of this page. SAVINGS AVAILABLE/PERMIT FEE: The Town offers a waiver of the residential sewer connection fee of $420.00 for those properties that connect within two years of the receipt of the DPW December 2012 letter. LOANS: For loan(s) available, please see the enclosed brochure, or see the town website: http://www.town.barnstable.ma.us/cdb7 (under the"CDBG Programs", see "Sewer Connection Loan Program). For loan specific questions, you may contact Kathleen Girouard, Growth Management, at 508-862-4702. CONTRACTORS: Information on Licensed Sewer Installers is available on our web site at www.town.bamstable.ina.us/PublicWorksTech/sewerinstallers. Contractors, approved to perform sewer connection work in the Town of Barnstable must obtain and file a Sewer Connection Permit with DPW-Water Pollution Control Division, 617 Bearse's Way, Hyannis—contractors,please call Dave Anderson at(508) 790-6244. FOR ANY QUESTIONS/ASSISTANCE:_ Len Gobeil at the Town Manager's Office is available to provide you with direction you may need in reference to the Stewart Creek Sewer Connections. You may contact him at 508-862-4701. QASEWER connecALetters Stewart Creek Sewer ConnectsNAIL.ING LetA Sewer 2Pgs Merged 3-28-13 Yr2015.doc Town of Barnstable oFtHe, Regulatory Services Bar nstable Thomas F. Geiler, Director MAmenaacitr snxtvsTnsLE, Public Health Division 9 MASS. Thomas McKean, Director 2ce7 �Ar i639' A`0 200 Main Street fD MA'S Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 November 14, 2008 S Mr. Larry Morin 74 Studley Road Hyannis, Massachusetts 02601 Re: 74 Studley Road Hyannis,MA Dear Mr.Morin: In regards to the April 1, 2008, inspection report for 74 Studley Road,which was reviewed by Thomas McKean and was determined,based on the notes on the report, that the system ap sses. The fact that the leach field is five feet off the slab foundation is a preexisting condition and is not one of the failure criteria under Title V, 310 CMR 15.303: Systems Failing to Protect Public Health and Safety and.the Environment. Very truly yo s, C omas McKe , R.S., CHO Director of Public Health $.f gAmorin.74 studleyroad.hy.I LI4.08.doc t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Studley Rd Property Address Larry Morin 1 Owner Owner's Name information formation is H anni rt squired for Y � MA 02601 4-1-08 every page. Cityfrown State Zip Code Date of Inspection S. Inspection results must be submitted on this form.Inspection forms may not be altered in any way. A. General information 1. inspector: Shawn Mcelroy Name of inspector Shawn Mcelroy Enterprises Company Name 29 Atwater Dr Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 - S13971 Telephone Number License Number Be Certification 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 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 6(310 CMR 15.000).The system: ❑ Passes ❑ Conditionatty Passes ❑ Fails ; ® Needs Further Evaluation by the Local Approving Authority 4-1-08 Inspector's Signature Date v` k The system inspector shall submit a copy of this inspection report to the Approving Authority'(8oartl of Health or DEP)within 30 days of completing this inspection. If the system is a shared system 6,rr has a design flow of 10,000 gpd or greater,the inspector and the system owner sh it submit1he r- report to the appropriate regional office of the DEP.The original should be,sent to a 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. F�� ter e�f4 � f. s.. ;5y �f:r 1�ctc�/ � e%l 55 ' �� ,./C"I tcii k ayLe �/75 r ►'� gaezl w.e, A A <S:G;IJI e r-4 � J t5insp•08f06 Tide 5(facial bmWcbme Form:Subsurface Sea+aw D"sposai System-Page t of 15 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Studley Rd Property Address Larry Morin Owner Owner's Flame information is required for Hy �annis rt MA 02601 4-1-08 every page. City/Town 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: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Answer yes, no or not determined (Y, N, ND) in the❑for the following statements. If'not determined," please explain. ❑ The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s) are replaced ❑ obstruction is removed t5insp•08= Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Studley Rd Property Address Larry Morin Owner Owner's Name information is required for Hy p annis ort MA 02601 4-1-08 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cunt): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ® Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. t5insp-0a/06 Title 5 official Inspection Forth:Subsurface Sewage Disposal System-Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments, 74 Studley Rd Property Address Larry Morin Owner Owner's Name information is required for Hyannis port po rt MA 02601 4-1-08 every page. CitylTow n State Zip Code Date of Inspection i B. Certification (cunt.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well*". Method used to determine distance: **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: Leach fileld is within 5'of slab foundation. 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 overioaded 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 'h day flow ` • ❑ ® Required pumping more than 4 times in the last year NO. T due to dogged 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. t5insp•O8106 Tdle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Studley Rd Property Address Larry Morin Owner Owner's Name information is required for Hy p annis ort MA 02601 4-1-08 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cunt.): Yes No ❑ ® 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. 1 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—IWPA)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. t5insp-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Studley Rd Property Address Larry Morin Owner Owner's Name information is required for Hy p annis ort MA 02601 4-1-08 every page. Cityrrown 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 ® ❑ 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? El ® 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(f any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp-08f06 Tile 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 6 of 15 1 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 74 Studley Rd Property Address Larry Morin Owner Owner's Name information is required for y P H annis ort MA 02601 4-1-08 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 3 Number of current residents: 1 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)): Sump pump? ❑ Yes ® No Last date of occupancy: 4-1-08Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day Y(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: Last date of occupancy/use: Date Other(describe): t5insp-08/06 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Studley Rd Property Address Larry Morin Owner Owner's Name information is required for Hy �annis rt MA 02601 4-1-08 every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) General Information Pumping Records: Source of information: Owner pump 2 yrs ago. Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? 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 be obtained from system owner) ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): i Approximate age of all components,date installed (if known)and source of information: 1970's Were sewage odors detected when arriving at the site? ❑ Yes ® No t5insp-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Studley Rd Property Address Larry Morin Owner Owner's Name information is required for Hy �annis rt MA 02601 4-1-08 every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Building Sewer(locate on site plan): Depth below grade: 18"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints,venting,evidence of leakage,etc.): Septic Tank(locate on site plan): Depth below grade: 12"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 Gal Sludge depth: 6" Distance from top of sludge to bottom of outlet tee or baffle 26" Scum thickness 0 Distance from top of scum to top of outlet tee or baffle 611 Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? Tape t5insp-08/06 Trite 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , 74 Studley Rd Property Address Larry Morin Owner Owner's Name information is required for HY �annis rt MA 02601 4-1-08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments on pumping recommendations inlet and outlet tee or baffle condition structural integrity, ( P P 9 9 Y, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank in good condition with all baffles in place. 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 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): t5insp-08/06 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM , 74 Studley Rd Property Address Larry Morin Owner Owner's Name information is required for Hyannis port p ort MA 02601 4-1-08 every page. City(rown State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) 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 Distribution Box(if present must be opened) pocate on site plan): Depth of liquid level above outlet invert N/A 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 t5insp•08/06 Trtte 5 Ofriciai Inspection Form:Subsurface Sewage Deposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Studley Rd Property Address Larry Morin Owner Owner's Name information is required for Hy p annis ort MA 02601 4-1-08 every page. City/Town State Zip Code Date of Inspection I D. System Information (cunt.) 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: Type: ❑ leaching pits number ❑ leaching chambers number: ❑ leaching galleries number. ❑ leaching trenches number,length: ® leaching fields number,dimensions: i-30'x10'x2' ❑ overflow cesspool number: ❑ innovative/afternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach field size is estimated by probe. In good condition with no sign of back up or break out. t5insp-08M Title 5 Official tnspechm Form:Subsurface Sewage Dsposal System-Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 74 Studley Rd Property Address Larry Morin Owner Owner's Name information is required for Y P H annis ort MA 02601 4-1-08 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) 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 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.): t5insp-08106 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 13 of 15 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Studley St Property Address Larry Morin Owner Owner's Blame information is Hyannisport MA 02601 4-1-08 required for every page. Citytrown - state Zip Code Date of Inspection D. System Information (cc)nt.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. f R 6 t kc- -19-�23' a� 1 i a ' t t5insp-oa(W TdL-5 OtficiW h<specWn Form:Suhsudace Swrige Disposal System•Page 14 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , 74 Studley Rd Property Address Larry Morin Owner Owner's Name information is H anniS Ort required for Y P MA 02601 4-1-08 every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope L❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to ground water: 9.9' 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: ® Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: You must describe how you established the high ground water elevation: Town contour map at town hall shows a spot elevation at 9.9'. t5insp-011106 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 15 of 15 Town of Barnstable OF 1HE TOE, Regulatory Services BARNSTABM : Thomas F. Geiler, Director alEo 3 Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 t ' Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within this report. In addition,by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the"Disposal Work Construction Permit". If you should have any questions regarding this report,please contact the certified Septic System Inspector who conducted the inspection. COMMONWEALTH OF MASSACHUSETTS e. EXECUTIVE"0FFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION � S r w ti y` TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A t . CERTIFICATION Property Address: 74 STUDLEY RD HYANNIS,MA 02601 Owner's Name: ROBIN HUNTER Owner's Address: 74 STUDLEY RD HYANNIS,MA 02601 Date of Inspection: 10/31/00 ' r/i�� f Name of Inspector: (please print) JOHN GRACI NO V 2 9 2 Company Name: SEPTIC INSPECTIONS 2oQ� Mailing Address: P.O.BOX 2119 TEATICKET,MA.02536 a" wsr ��,' Telephone Number: 508-564-6813 FAX 508-564-7270 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 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 15340 of Title 5(310 CMR 15.000). The system: X Passes r; _ Conditionally Passes _ Needs Furt r valuation by the Local Approving Authority Fails Inspector's Signature: Date: 10/31/00 The system inspector shall submit 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 now 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 itbe buyer,if applicable,and the approving authority. Notes and Comments THE SYSTEM PASSES TITLE V INPECTION. RECOMMEND PUMPING THE EVERY ONE TO TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. ****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. iF?, Title 5 Inspection Form 6/15/2000 011 Paae 1 of 11 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 74 STUDLEY RD{'HYANNIS,MA 02601 Owner: ROBIN HUNTER Date of Inspection: 10/31/00 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X 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 SYSTEM PASSES TITLE V INPECTION.RECOMMEND PUMPING THE EVERY ONE TO TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. 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 replacemenit{or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(YXND)in the for the following statements.If"not determined"please explain. n/a The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: n/a Observation of sewage backup or breaklout or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): _ broken pipe(s)are replaced _ obstruction is'removed _ distribution box is leveled or replaced ND explain: a k� n/a The system required pumpingi�more'Ahan 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the iotArd of Health): _broken pipe(s)are replaced _obstruction is removed 13-� ND explain: it Page 3 of 11 ` OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ` PART A CERTIFICATION(continued) ,j Property Address: 74 STUDLEY RD HYANNIS,MA 02601 Owner: ROBIN HUNTER Date of Inspection: 10/31/00 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: A ' _ 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 :{I 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 n/a "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: i r n/a P 1 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) ' Property Address: 74 STUDLEY RD HYANNIS,MA 02601 Owner: ROBIN HUNTER Date of Inspection: 10/31/00 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all-inspections: Yes No _ X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding.of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than '/z day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped 10/12/00. X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _ X Any portion of a cesspool or privy is within a Zone 1 of a public well. _ X Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ X 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] (Yes/No)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. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no _ X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped .Zone 11 of a public water supply well s �} If you have answered"yes"fo'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. Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A . ,;+CERTIFICATION(continued) Property Address: 74 STUDLEY RD HYANNIS,MA 02601 Owner: ROBIN HUNTER Date of Inspection: 10/31/00 Check if the following have been done.You must indicate "yes"or"no"as to each of the following: Yes No X _ Pumping information was provided.by the owner,occupant,or Board of Health X _ Were any of the system components pumped out in the previous two weeks? X Has the system received normal flows in the previous two week period? X _ Have large volumes of water,been introduced to the system recently or as part of this inspection? X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? 1 X _ Was the site inspected for signs of break out? X _ Were all system components,excluding the SAS, located on site? X t_ 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: Yes no ; X _ Existing information.For example,a plan at the Board of Health. X _ 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(3)(b)] y i 1• 5 , f1 Page 6 of I I ' R OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 74 STUDLEY'RD HYANNIS,MA 02601 Owner: ROBIN HUNTER !" Date of Inspection: 10/31/00 14,Fd FLOW CONDITIONS RESIDENTIAL V. Number of bedrooms(design):3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203,(for example: 110 gpd x#of bedrooms): 110 Number of current residents:2 Does residence have a garbage grinder(yes,w no): NO Is laundry on a separate sewage system(yes;or no):NO [if yes separate inspection required] Laundry system inspected(yes or no):NO, 11 Seasonal use:(yes or no):NO Water meter readings,if available(last 2 years usage(gpd)): n/a Sump pump(yes or no): NO Last date of occupancy:n/a COMMERCIALANDUSTRIAL Type of establishment: n/a Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no):NO Industrial waste holding tank present'(yes or no): NO Non-sanitary waste discharged to the,title 5 system(yes or no): NO Water meter readings,if available: n/a Last date of occupancy/use: n/a tt• f<ff It I OTHER(describe): n/a f It GENERAL INFORMATION Pumping Records Source of information: 10/12/00 Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: n/agallons--How was quantity pumped determined?n/a Reason for pumping: n/a TYPE OF SYSTEM X 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) sc _Tight tank Attach a copy of the DEP approval Other(describe): n/a Approximate age of all components,date installed(if known)and source of information: 1975 j' f Were sewage odors detected when arriving at the site(yes or no): NO l-. Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C a SYSTEM INFORMATION(continued) Property Address: 74 STUDLEY RD HYANNIS,MA 02601 Owner: ROBIN HUNTER r Date of Inspection: 10/31/00 BUILDING SEWER(locate on site plan) Depth below grade: 18" Materials of construction:_cast iron X40 PVC_other(explain): n/a Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): THERE IS TOWN WATER SEPTIC TANK: X(locate on site plan) Depth below grade: 12" Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age co►f firmed by a Certificate of Compliance(yes or no):NO(attach a copy of certificate) Dimensions: 1000G L 8'6" H 5'7" We' 10"" Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle:33" Scum thickness:0" ' Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom idoutlet tee or baffle: n/a How were dimensions determined: MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): THE SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING THE SYSTEM EVERY ONE TO TWO YEARS. GREASE TRAP:_(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a i,z Distance from top of scum to top of outlet tee or baffle: n/a. Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a .Ile Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related ik to outlet invert,evidence of leakage,etc : n/a 4 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C a SYSTEM INFORMATION(continued) Property Address: 74 STUDLEY RD HYANNIS,MA 02601 Owner: ROBIN HUNTER Date of Inspection: 10/31/00 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons , Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level:N/A Alarm in working order(yes or no):NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX:X(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert LEVEL WITH BOTTOM OF PIPE 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.): THE DISTRIBUTION BOX IS'STRUCTURALLY SOUND. PUMP CHAMBER:_(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a �4c i 10 `I1 ! k Page 9 of 11 • OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 74 STUDLEY RD HYANNIS,MA 02601 Owner: ROBIN HUNTER Date of Inspection: 10/31/00 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type n/a leaching pits, number: nla n/a leaching chambers, number: n/a n/a leaching galleries, number: nla n/a leaching trenches, number, length: n/a 1 leaching fields, number: LEACH FIELD n/a overflow cesspool, number: n/a n/a i, innovative/alternative system Type/name of technology: nla Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): THE LEACH FIELD APPEARS TO BE FUNCTIONING PROPERLY,THE SYSTEM SHOWS NO SIGNS OF FAILURE. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) �x Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) Materials of construction: n/a �,l Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a R N � CCy� y a Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 74 STUDLEY RD HYANNIS,MA 02601 Owner: ROBIN HUNTER. Date of Inspection: 10/31/00 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. 4 C pD�T p . D L Q AN kP N 1° P Cq 31 C5 y3� �c 4� Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM I ^ PART C SYSTEM INFORMATION(continued) Property Address: 74 STUDLEY RD HYANNIS,MA 02601 Owner: ROBIN HUNTER Date of Inspection: 10/31/00 SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 10+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-If checked,date of design plan reviewed: NO Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: NO Checked with local excavators, installers-(attach documentation) YES Accessed USGS databaseexplain: You must describe how you establishe&the high ground water elevation: USGS MAPS AND CHARTS-10+FEET 1�+ �i r No......................... THE COMMONWEAL Hy OF MASSACHUSETTS BOAR® OF HEALTH ................T own..............OF....Barns table... Appliration for R-4p ii al Workii Tomitrairtinn rvrmit Application ' hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Sys at t'�i- H anni s MA ......Z_ ...... .. ...� . --------- ..............�-----............----••------------•---------..................-•-... Location-Ad ess or Lot No. Capricorn Realt r••Trust __ 765 Falmouth Road.,... Hyannis................................ Owner•- Owner Address W Steve Lebel Installer Address dType of Building Size Lot............................Sq. feet V Dwelling No. of Bedrooms......... Expansion Attic Garbage Grinder pa., Other—Type of Building _-Ranch........... No. of persons............................ Showers (2 ) — Cafeteria ( ) Other fixtures -------------------------------- - W Design Flow............5.5...........................gallons per person per day. .Total daily flow........330...........................gallons. WSeptic Tank—Liquid capacityl.DQQgallons Length__8_'.6..._. Width..4.-'1D_'.` Diameter________________ Depth..5.!8."...` x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area-__--__...........sq. ft. Seepage Pit No.................... Diameter........6_.__..... Depth below inlet....6............ Total leaching area..2.............sq. ft. Z Other Distribution box ( ) Dosing tank ( ) • Percolation Test Results Performed by._Eldxe.dg8.-F�TlgirieY'r 1T1g............. Date------..11-2.... -81 .....5......_............. a Test Pit No. ..minutes per inch Depth of Test Pit------ Depth to ground water.none encounter- -------------- e d _Test.Pit No. 2...4/A....minutes per inch Depth of Test Pit...N/A....,... Depth to ground water____N/A........... --- •. -- -• ••----.------. ----•--- ......----•------------------------------------------ ---•-------------------- •......... DescriptionofSoil 0.'_-2_'..... LOam..&..TOpSO11. U., . .---------------•-------••-----•-----------•-•2- -..-� ------Medium__Yellow__Sand----------------•---------------------------------------•--•----------------- 1_0.'_- .2- Med.....Whzte Sand/ txaCe 9f Gravel/no•.water-,at 12 ' 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 TITI,;a. 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 y the board of h h. Signed.....Z-......... DaApplication Approved By.._....._�____ �;�1... ��e ��/��/..._........ ...................•.... . ---- Date Application Disapproved for the following reasons----------------•----------------------------------------------•---------------------.......................... -•-•--•-•••-•-----•--•--•----•••••-••----....•-•---•-•-•-.....-•--•---••-••--.._..--••----------•-.......I.•-----•---•-----•-------•--------•----•----------••--------•--•----------•------••-••--------- Date PermitNo......................................................... Issued........................................................ Date No......................... �� Fps..... ... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �. . ,. ., ,l Appliration for Disposal Works Construrtion ermit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ......................................„..•.-'=.:.......c._.:..nc:..�........................ ..........................` A........:------•--•-------•---------------............................ Location-Addss or Lot No. ....J^ !i^l_Pf]�'`i'1 :C3. nr Y'1,1 't� �.) •'t�.��'n11.'l� on ilk -'=�r`: n :�'.........~ =....._................................ ....................... ... --._........ ...._......... .. ..... Owner Address Y.., Installer Address Type oft,Building Size Lot............................Sq. feet Dweling—No. of Bedrooms....... ..................................Expansion Attic ( ) Garbage Grinder ( ) ^�..........._ No. of persons............................ Showers 2 — Cafeteria p.l � Other—Type of Building ..:............ p ( ) ( ) a Other fixtures ................................ . W Design Flow............5.5...........................gallons per person per day. Total daily flow........3..0._......................__.gallons. OG Septic Tank—Liquid capacity.1000•gallons Length._8'6...... Width._4.'.1Q'.' Diameter................ Depth..'. ...... Disposal Trench—No. .................... Width.................... Total Length................. Total leaching area.__._.........___...sq. ft. Seepage Pit No................... Diameter........ ..'_...... Depth below inlet..... :........... Total leaching area..266.......sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '- Percolation Test Results Performed by..:._:_r!?''n:'...:......:".::'*:!...."y. ::............... Date.....117:2-5-8�--•-•-_----. a _ ,� Test Pit No. 1��-_.2.i.Q..minutes per inch Depth of Test Pit..... 2.......... Depth to ground water.nQp ... nCOunted GL, Test Pit No. 2__11V-A.....minutes per, inch Depth of Test Pit...N/A........ Depth to ground water....N,A........... P4 ---••----••••---•-----•••......•-----••....•-•-...._....•-••--••--•..............•-...-------•--------•--•-----•--•-•--------•-........_..._......------•--- Description of Soil n---2 L'g3m -'USo-ll v 2.'.-10..`_..:....:Med u.m---Yellow_-$and..----- ----- --- - -------- ----- -....................................--------- -- - -- W -------------------------------------------1.Q.'_--1-a --------.iY7es�.....'�7h 5 xac�/ rac_ :s'...of..Gxavel/no.Water'--at--12 , 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 IT r:i^. p 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 oard of i .kth. Signed .... �...�,+ ---• - :--•--- i.f. ,� Da e Application Approved BY --� f=. >___1�—-- - ----. -- z�31 �` Date Application Disapproved for the following reasons:..................................... .......................................................................... ..........................•-----------------•------------......---•-•---•----_._.........----•-............-•--•••••-•--•--•-•-••_.....------•-----•--•••-••----••••---•--•-••••---------•-•.•......••--- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.......*............................................................................... %rrtifirate of Tontplianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) J_GEV0 bY-•----• ----------------------------------•---------•--._...-----------`•----------------------.........-----------------•-----•-•---•-•-•-------------......-•---...-•-•--........... Insta at.-•-------•..........49:.S'- - �te ........ s--------------------------------------------- has been installed,in accordance wlti provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No...._9/r.7.77............. dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISF CTO Y. DATE..................................... :�:. .` --.. Inspector...-----•-•----�-.:t.2-. .�' ....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Yl No. .....7p 3 s ..1... FEE... Disposal Works Oonotrnrtion 3phrmit Permission is hereby granted -.eve ;�o3+- ----------------------------------- to Construct (i ) or Repair ( ) Individu Sewage Disposal System at No.- y �. , ' .. ' .-- Street as shown on the application for Disposal Works Construction Permit No..................... Dated......._.................................. ! ...................................................... Board of Health DATE................................................................................. FORM 1255 HOBBS & WARREN, INC., PUBLISHERS 14 0 'k o 11 a 47 tcD,oZ(o 5,� p �h� tti 1 N _ o e b r t ��N OF M4 Of Mgs;,9c\ o LBE T. I o� JOHN dN I o MORS E ^�' ERIITIM No.10951, r ,p ev � ,- ` \ �� Q/8TO pQ` ` uFFSSIONA�� - �ND SUR�� i r. LEGEND I . EXISTING sPOT ELEVATION Ox CERTIFIED PLOT PLAN EXISTING CONTOUR ---� 0 --- tiE� ,L 4 T' 2_4` FINISHED SPOT. ELEVATION Dig FINISHED CONTOUR - 0 HYAN N /s . IN , } APPROVED s BOARD OF. HEALTH ` t DATE AGENT SCALE, =7rJ' DATE= /2—z3--g/ 'r a L D RED GE. £NG/NEER/NG CQ m v CLIENT FFANt 0 I CERTIFY .THAT THE PROPOSED . EGISTERE REGISTERED JOB N0. B� BUILDING SHOWN ON THIS PLAN CIVIL LAND DR-BY, /� CONFORMS TO THE ZONING LAWS ENGINEER URVEY R ' ---- OF BARNSTA LE, MASS.. 7I2 MAIN STREET. CH. BY, .,jA.r H YA N N IS, MASS.. 12 ti4 g� ems_' ' SHEET.., OF Yz' DATE G. LAND SURVEYOR s c , _ 4 a� Vi x4 A{ � q is j nh' �'{ '.i A., ,_......._.. .,......•..., v -.... _ (� r .. it i� a:r �u �,� r .' /�� r tis !'O�: Mgt.° "a, �. `l 4� �C, l!P •.a ff `tFk '�t� �r sit 9 j �` �'��' ss''S .'�,�jti uCwj �. 9 d - �• ly,, � s!p' , yP„ �� '<. '� � '6, `+.. �S'c. Je ..,•�. � •`- '' pip �'�. +e+r•�� fi r l 1 .� k •\+IY ` +"` �'\'' 'b ''V _n',it '�. Z tot • � 1 ,L �`.:•�e � � � � � � � tp d°y�`i. �"q`I- e�, p�. 'Vj � � Ji rlsaa a�+°�`iy� r I: 't O I f a➢� i w. �, ` j `t , • T , S;CSv-•�i-...x:. ......rr.-,._�..ns.....�<.Q:._.._.a.b.u,,-za_.ws.-:-:::s a...a.-x...ua&;..,.s.-.x:, ,. .,..0 a_:.. ,., .. ..� .. .. ,. ....d.x,.,;ary....�..1..s� t _ �—- FTHE No.T �o Oho OFFICE. OF THE BOARD OF HEALTH OF THE o VABHSTABLE, TOWN OF BARNSTABLE, MASS. y MASS. �pA 1639. `�� ! ! -------------------- 4 rFD MAY � F-WAGE DISPOSAL PERMIT ��a Permission is granted to ____ 0701—______ _____ -_ -- ------------- to construct Up remises of Sketch --------- ton.--------- A4----------------- ------------- In the vill4e of 75 or more eet from any source of water supply 20 feet from building 10 feet from property line -_-- —� - —,--~ Health Officer. it N . , T"E'T°�°� 'OWN OF BARNSTABLE BARNSTABLE, i ° 39- ale BUILDING INSPECTOR �o Mar APPLICATION FOR PERMIT TO ............ .............. ..................t-9.. .... :. I................................. ` F `TYPE OF CONSTRUCTION �/1,1 V ............ TO THE INSPECTOR OF BUILDINGS: i _The undersigned hereby applies for a permit according to the fo wing information: Location ........ .. - ...........� d .T.,Z�+ ��r�?.. . Proposed Use �:......... y........................................................................................... Zoning District ......................Fire District ............................................ Name of Owner ... .. 4 . .L?tl�l,� '' — /L �� Name of Builder .... . ............mil....... rfl.S.......Address :"......... Name of Architect .......................Address Number of Rooms ............... Foundation40 49 Exterior .........., LJ, ........... ............Roofing ........Jv. .,-V-9X,- Floors /.:�z �� ..........l�leG?E.a�.:"�....,Q/�r�.�..........................Interior ........... l ................. Heating .. . , , o��n ... ..... ......... Plumbing Fireplace .......... %� Approximate Cost ......................................... �a-......r 1.v+........................., Difinitive Plan Approved by Planning Board ________________________________19________. Diagram of Lot and Building with Dimensions i r 40 (A eb �y 1 hereby agree to conform to all the Rules and Regulations of the 4Townofrnstable arding a above construction. Name ..... 1 %moo G � THET� TOWN OF BAR.NSTABLE BABBSTABLE, 0 ;pYa`� BUILDING INSPECTOR b APPLICATION FOR PERMIT TO .."". 1.,11jA.. ........... `t`/. I..� S.4�I.. "'°'................................................... TYPE OF CONSTRUCTION ......... . � ........ .faf> ...... 1�!Z'°0 ................................... TO THE INSPECTOR OF BUILDINGS: The undersi ped--he�p�l' s for a permit according to the following information: ... ~ Location .. .. .....� ... ProposedUse,p �. . .tr ................................................................................................ ZoningDistrict ........................................................................Fire District .............................................................................. .._ w Name of Owner ... .OUP .u��.....A!. �IF.�iSr�'t...........Address ...Syf.��:..�: ..1.'....�A�.�...� �.1,�Afl.. . Name of Builder �i rQ�N.... ... .�........ .4�::.......Address !� 0A-aws';�.. �. ... Name of Architect ..... .... ...........Address ...!7":................... ...........................Z44.4 ...................................... ........... y� �i .. ..�. i 1.\:' y� L Number of Rooms .... .. .. ��,li�......Foundation ......��............ '�. .. Exlerior .°.`' o' kf. ...........................Roofing .....000 .:? ie`:24. ............................................... Floors ... .................... ..........Interior .... .. . . .s Heating ✓..... �r "r "!K�a. .. .."� ��! ...Plumbing ....C�,�?�('.� 1 ......Z.2.... :./.. ......... ?%-Fireplace ..... /.4I0- .�.w )9C�4 h..J ......................Approximate Cost ....... a�. r.. .k ......................... Difinitive Plan Approved by Planning Board -----------______------------19________ . Diagram of Lot and Building with Dimensions FT, I I i v rq I I j 7T� --, , I hereby agree to conform to all the Rules and Regulations of the Tow o Barnsta le regard' g e above construction. Name .. ..... .. ..+ ............... ....... , , �. s I - I � �i� �; i i i I �!'i � i �.�.�_� :_ o � - �'�c �.. ®' l 4 '� ' ? ^ .�'i�t � `I'`1 r �. rd ��'` � . �' �x 9 'k • �� i .� � � 111 f � � LOCATION � �°Y � � SEWAGE# VILLAGE S ASSESSOR'S MAP& LOT OG 0l-2 - i INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY JOC3� 6"C LEACHING FACULITY: (type) JOX/0/,), ES f (size) NO.OF BEDROOMS j BUILDER OR OWNER PERMITDATE: COMA .LIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the B&d of Leaching Facility Feet Private Water Supply Well and Leaching Facility 1(If any wells exist on site or within 200 feet of leaching facility) 1. Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching;f1lity) Feet Furnished r _ _ _, .. ,� , ;�� .. � 6 ^. � � , ?. �n W C (A i� C� v o � �1 W .. fi ,. '•r, .. TOWN 0 B STABLE JC q, 5 A7110N� SEWAGE # VILLAGE ASSESSOR'S MA LOT) ' INSTidiLER'S NAME PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) L NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Fumished by 9 «� Not Ag 6A ;® CA c 1f3� 4 ; g a � r �� - i 1 TOWN OF�BARNSTABLE ION SEWAGE# VII,LAGE ASSESSOR'S MAP&LOT I. SEP71C NSTALLER'S NAME&PHONE NO. TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by r c