HomeMy WebLinkAbout0047 SUFFOLK AVENUE - Health A7-S—Li olk Avenue
Hyannis
A=291 -- 123
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TOWN OF BARNSTABLE
LOCATION 12/2 �y LC o% A y,E SEWAGE #2-609 JF2/
V2-.LAGE /4/,4 n/IV /S ASSESSOR'S MAP& LOT221 -/i,23
INSTALLER'S NAME&PHONE NO.,Rk-z.A' e'-,4 L,0 7 7 /
SEPTIC TANK CAPACITY
6,7xidxa..
LEACHING FACILITY: (type) y A e- S O (size) i D aC a
NO.OF BEDROOMS S
BUILDER OR OWNER 214
PERMITDATE: S COMPLIANCE DATE: /j
Separation Distance Between the: _ c
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility S 7 Feet
Private Water Supply Well and Leaching Facility (If any wells exist A/
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
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TOWN OF BARNSTABLE
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I. .ATION SEWAGE #
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a:�:,LAGE ASSESSOR'S MAP & LOT
INSTALLER'S N &PHONE NO.
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SEPTIC TANK CAPACITY
LEACHING FACILrrY: (type) ize)
NO. OF BEDROO
BUILDER O OWNER
PERMTTDATE: 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 I wetlands exist
within 300 feet of leaching facility) - I Feet
Furnished by
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Commonwealth of Massachusetts
. Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
M 47 Suffolk Ave
Property Address
BARRY, MARIA T
Owner Owner's Name
information is required for every Hyannis Ma 02601 2/22/2014
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 A. General Information
filling out forms
on the computer,
use only the tab 1. Inspector:
key to move your vp
cursor-do not Sean M. Jones
use the return Name of Inspector
key.
S.M.Jones Title V Septic Inspection
Company Name
74 Beldan Ln.
Centerville Ma 02632
City/Town State Zip Code
774-248-4850 smjonestitle5@gmail.com S14522
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and thhe O
information reported below is true, accurate and complete as of the time of the intpection. Tire ins��tion
was performed based on my training and experience in the proper function and,.' ntenanceaf on to
sewage disposal systems. I am a DEP approved system inspector pursuant to Section P6.340 V
Title 5(310 CMR 15.000).The system: _r t
® Passes ❑ Conditionally Passes ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
2/22/2014
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.
3 �
t5ins-3/13 Title 5 ici spection Form:Subsurface Sewage Disposal System-Page 1 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
47 Suffolk Ave
Property Address
BARRY, MARIA T
Owner Owners Name
information is required for every Hyannis Ma 02601 2/22/2014
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:
The dwelling located at 47 Suffolk Ave Hyannis is served by a Title V septic system consisting of a
1500 gallon septic tank, distribution box and 7 3050 Infiltrators. The system was found to be in
groper working condition at the time of inspection.
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.
. ,r
❑ Y. ❑. N ❑ ND (Explain below):
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
f
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
�M 47 Suffolk Ave
Property Address
BARRY, MARIA T
Owner Owner's Name
information is required for every Hyannis Ma 02601 2/22/2014
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):
❑ 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.
t 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
;M 47 Suffolk Ave
Property Address
BARRY, MARIA T
Owner Owner's Name
information is required for every Hyannis Ma 02601 2/22/2014
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
El ® 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 Y2 day flow
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
I
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
wM 47 Suffolk Ave
Property Address
BARRY, MARIA T
Owner Owner's Name-
information is required for every Hyannis Ma 02601 2/22/2014
page. Citylrown 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 16,000 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 II of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant threat,
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
47 Suffolk Ave
Property Address
BARRY, MARIA T
Owner Owner's Name
information is required for every Hyannis Ma 02601 2/22/2014
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?
❑ ® 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): 5 Number of bedrooms(actual): 5
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 611.31 gpd
provided
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17
r
�. Commonwealth of Massachusetts
w Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
Gib 47 Suffolk Ave
Property Address
BARRY, MARIA T
Owner Owner's Name
information is required for every Hyannis Ma 02601 2/22/2014
page. CitylTown State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents: 3
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system inspected? ❑ Yes ® No
Seasonal use? ❑ Yes ® No
Water meter readings, if available (last 2 years usage (gpd)):
Detail:
2012= 71,000 total = 195 gpd 2013=28,000 total = 77 gpd
Sump pump? ❑ Yes ® No
Last date of occupancy: current
Date
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203):
Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No s
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
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
47 Suffolk Ave
Property Address
BARRY, MARIA T
Owner Owner's Name
information is required for every Hyannis Ma 02601 2/22/2014
page. Citylrown 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:
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
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
47 Suffolk Ave
Property Address
BARRY, MARIA T
Owner Owner's Name
information is required for every Hyannis Ma 02601 2/22/2014
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:
system installed 6/2008 per town records
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 1
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.):
Joint were ok, no leaks, vented through the roof
Septic Tank(locate on site plan):
Depth below grade: .5
feet
Material of construction:
® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 1500 gallons
Sludge depth:
-6"
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
°M 5 47 Suffolk Ave
Property Address
BARRY, MARIA T
Owner Owner's Name
information is required for every Hyannis Ma 02601 2/22/2014
page. Cityrrown 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
3"
Y
Scum thickness
Distance from top of scum to top of outlet tee or baffle
6"
Distance from bottom of scum to bottom of outlet tee or baffle
10"
How were dimensions determined? opened covers, took
measurements
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tank does not need to be cleaned now but should be done soon and again every 2 years for proper
maintenance. water level was even with outlet, tank was not leaking and was structurally sound.
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 Offidal Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
47 Suffolk Ave
Property Address
BARRY, MARIA T
Owner Owner's Name
information is required for every Hyannis Ma 02601 2/22/2014
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,
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 El,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
Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
°M 47 Suffolk Ave
Property Address
BARRY, MARIA T
Owner Owner's Name
information is required for every Hyannis Ma 02601 2/22/2014
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
0"
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.):
Distribution box was in good condition, no rot, water level was even with outlet inverts. Cover is on a
riser
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
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
°M 47 Suffolk Ave
Property Address
BARRY, MARIA T
Owner Owner's Name
information is required for every Hyannis Ma 02601 2/22/2014
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
® leaching chambers number: 7x3050
Infiltrators
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ 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.):
s.a.s. was video inspected from distribution box and was observed to have only a few inches of
standing water with no sign of past hydraulic overloading.
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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 47 Suffolk Ave
Property Address
BARRY, MARIA T
Owner Owner's Name
information is required for every Hyannis Ma 02601 2/22/2014
page. Cityrrown 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.):
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
M 47 Suffolk Ave
Property Address
BARRY, MARIA T
Owner Owner's Name
information is required for every Hyannis Ma 02601 2/22/2014
page. CityrFown 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
Z t
7
A-3
r+ Y 2 7.S
t5ins-3/13 Title 5 Official Inspection forth:Subsurface Sewage Disposal System-Page 15 of 17
Commonwealth of Massachusetts
F Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
;M 47 Suffolk Ave
Property Address
BARRY, MARIA T
Owner Owner's Name
information is required for every Hyannis Ma 02601 2/22/2014
page. Cityrrown 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: 12'+
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: 5/5/08
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:
1)Groundwater elevation was determined by accessing Town of Barnstable groundwater contour
map.
2) design plan indicates that no groundwater was observed at 126"and system is designed to have a
seperation of 5'+ between bottom of s.a.s. and adjusted groundwater elevation.
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
Title 5 Official Inspection Form
a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
47 Suffolk Ave
Property Address
BARRY, MARIA T
Owner Owner's Name
information is required for every Hyannis Ma 02601 2/22/2014
page. Cityrrown 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
I
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form • Not for Voluntary Assessments
Lf7 SfAf�1� � V�
Property Address
Owner Owner's Name
information is �hfs A4 Oo�6 0
required for --— —
every page. City/Town State Zip Code Date of I spec on
Inspection results must be4ubmitted 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 A. General Information
I l
forms;on the
computer,use 1. Inspector:
only the tab key
to move your T v� a✓
cursor-do not Name of Inspector
use the return
key. . ' j( yl D I Ffi
Company Name
l1lli4U — 1�0o dO"4
Company Address
'e-As�4 C.k"_ AM na 6 ��
City/Town State Zip Code
6�?) / —
Telephone Number License Number
B. 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 5 (310 CMR 15.000). The system:
Passes ❑ Conditionally Passes ❑ rails
❑ Needs Further Evaluation by the Local Approving Authority < ;'
Inspecto's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving AuflporitK,Poard
of Health or DEP) within 30 (Jays 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.
Si
15ins-09/08 Title 5 Official Inspection Form:Subsurface ge Disposal System•Page 1 of 17
Commonwealth of Massachusetts
Title 5 Officrall Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
UV
LO SLf'(o/ll "-4y-e-
Property Address
011 e 6�s
Owner Owner's Name
information is /�J� �a 6 O �� rAv
required for A�hl1 _ /
every page. Cityfrown State Zip Code Date 6f Insp Lion
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/ always complete all of Section D
A) System asses:
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: 1
r �H�d— o+�o/^G l� le � /HvGrJ�.
D w Ile, IL 10 kle l-� N� o� �, s f-� ' �► 11 H.��r✓
o
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):
15ins-09108
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
SIA IqO
IV ---
Property Address Q
Owner Owner's Name
information is Al q IS _ /"'/ �02�00 �S 0
everrequired f page.
City/Town own — State Zip Code Date of Ins ecti
every
Be Certification (Cont.)
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($) 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):
❑ 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
Isms-09l08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17
Commonwealth of Mafssachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
Property Address
Owner Owner's Name
information is ,J
required for q H''>
every page. Citylrown State Zip Code Date of Inspec on
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 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
❑ Q/' 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 B" below invert or available volume is less
than 1/2 day flow
t&ns•o4roe
Title 5 Official Inspection Form:Subsurface sewage Disposal system•Page 4 of 17
Commonwealth of Massachusetts
Title 5 Officia, Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
Property Address
Ae 1/'I 41 V, "f- �-e
Owner Owner's Name
information is �q(,7 6i h h 0 t3 6 0/
required for —
every page. Cityrrown _ State Zip Code Date 9f Inspection
B. Certification (cost.)
Yes No /
Required pumping more than 4 times in the last year NOT due to clogged or
u 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.
❑ Q"" Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ 2 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.]
❑ 2111,— 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
El D the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area IWPA)or a mapped Zone II of a public water supply well
If you have answered "yes" to any question in 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•09f08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
Commonwealth of Mas<.>�achusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form •Not for Voluntary Assessments
Property Address
Owner Owner's Name /
information is
required for � a✓►n tl_ 2d 6 0 / /6- /o
every page. City/rown State Zip Code Date df lnspgction
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?
❑ 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?
L� ❑ Was the site inspected for signs of break out?
L�' ❑ Were all system components, excluding the SAS, located on site?
Lam' ❑ 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:
L�" ❑ 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): ` Number of bedrooms (actual):
DESIGN flow based on 310 C:MR 15.203 (for example: 110 gpd x #of bedrooms): J��
15ins•ogroe
Tine 5 Officiai inspection Form:subsurface sewage oisposat system•Page 6 o(17
Commonwealth of Massachusetts
Title 5 Officfavl Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�
Itr ��-
y
Property Address �S-S
Owner Owner's Name
information is
required for G ✓i —
every page. City/Town State Zip Code Date of I specbon
D. System Information
Description: 0 [,00 G M0.1 S P,oTI C
O
Number of current residents:
Does residence have a garbage grinder? ❑ Yes E No
Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes Er"No
Laundry system inspected? ❑ Yes B No
Seasonal use? ❑ Yes No
Water meter readings, if available (last 2 years usage (gpd)):
Detail:
Sump pump? ❑ Yet No
Last date of occupancy: Date
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow (based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow (seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available: ---
15ins•09f0e
Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17
i
Commonwealth of Mass-achusetts
Title 5 Officici l Inspection Form
Subsurface Sewage Disposal System Form • Not for Voluntary Assessments
Property Address
1�1-ee4
i-e
Owner Owner's Name
information is
required for G✓i✓� t _ zQS11,V
every page. Cityfrown° State Zip Code Date ofinspeii5tion
D. System Information (cont.)
Last date of occupancy/use:
Date
Other(describe below):
General Information
op0o 'g.S�r
Pumping Records: v�
Source of information:
Was system pumped as pail of the inspection?
❑ Yes 4a o
If yes, volume pumped:
gallons
How was quantity pumped determined?
Reason for pumping:
Type of Sy
Septic tank, distribution box, soil absorption system
❑ Single cesspool
11 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):
t5lns-09/oe
Title 5 Official Inspection Form:Subsurface Sewage Disposal System•page 8 of 17
Commonwealth of Massachusetts
Title 5 OfficillZil Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
Property Address
Owner Owner's Name / /
information is ,C� _ Oc�6 01 11115110
required for ✓✓
every page. Cityrrown State Zip Code Date Ins coon
D. System Information (cont.)
Approximate age of all components, date installed (if known) and source of info tion:
a00� -- /,mot f- /9} — ,t� L
Were sewage odors detected when arriving at the site? ❑ Yes No
Building Sewer(locate on site plan):
Depth below grade: /
feet
Mated of construction: /
cast iron 410 PVC ❑ other (explain):
�Q
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: feet
7Marterial f 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: X n
Sludge depth: _
t5ins-og/o8
Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Mssachusetts
Awm Title 5 0 fficical Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
Property Address
Owner Owners Name
information is a N nos' 04601
required for — _
every page. Cityfrown 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 fo
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle �— /
How were dimensions determined?
Ilk- A owc1n.,
C71-
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
N 1^'1 f II ,,,, -- //
4�s
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-09M
Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
r
Commonwealth of Massachusetts
Title 5 Offid,hl Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
Property Address
Owner Owner's Name '
information is a 0 6,0
required for _ �''1_
every page. City/Town State Zip Code Date of/inspe6tion
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•Ofte
Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 11 of 17
Commonwealth of Masuchusetts
Title 5 Official Inspection Form
Subsurface Sewage Dispdsal System Form - Not for Voluntary Assessments
Property Address
✓ -Sses-
Owner Owner's Name
information is q Oki 1- vc 2 /(o 0[ // /5 �
required for _ _
every page. Cityrrown State Zip Code Date of inspfiction
D. System Information (cont.)
Distribution Box (if present must be opened) (locate on si plan):
Depth of liquid level above outlet invert �e
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.):
�o/r dam'
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No
Alarms in working order: ❑ Yes ❑ No
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
15ins-09M
Title 5 Official Inspection Form:Subsurface Sewage Disposal Sysiem.page 12 of 17
s
Commonwealth of Ma :sachusetts's
WALM
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form • Not for Voluntary Assessments
Property Address
Owner Owner's Name
information is Qa 6 0
required for G��/S _ �''L
every page. Cityfrown State Zip Code Date Ins ction
D. Syste nformation (cont.)
Type: 2 Jj h T/ l/-/'G �0/-:r w, -7 V n-e— _
❑ leaching pits number:
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovativelalternative system
Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
14 v/ SO I C4-;1-7 /
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
15ins•09M
ride 5 Official inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
Commonwealth of Ma sachusetts
I �
Title 5 Offici it Inspection Form
Subsurface Sewage Disposat System Form - Not for Voluntary Assessments
Property Address
Owner Owner's Name
information is All OV 6 0
required for `71�✓)��s
every page. City/Town 01 State Zip Code Date offInspOction
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.):
(Sins•o"
Title 5 Official Inspection Form:Subsurface Sewage Disposai system,page 14 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1� l CSu
Property Address
Owner Ovmer s Name ✓�v�r f0.)60�,}(-
information is //��l j
required for a ` S /a every page. Ctty/Town State Zip Code Date of I
pe '
D. System Information (cont.)
Site Exam:
❑ Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow welts
Estimated depth to high ground water: �pC.V
feet
P;77
' to all methods used to determine the high ground water elevation:
btained from;system design plans on record
If checked, date of design plain 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:
L4,5- YL-in, le,
� s S ZV e �� r
l061t4 4�1
V4, y4(C cks-
G r-1 V11 ZA
4:--z
Before filing this Inspection Report, please see Report Completeness Checklist on page.
1&ns-OW08 next P 9
Title 5 Official Inspection Form:Subsurface Sewage D sposal System•Page 16 of 17
Commonwealth of Massachusetts
Title 5 Offici l Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
Property Addrej7,-,,
ss
Owner Owner's Name
information is ,(�
k1pi ---
required for y)(�/ // Od60
every page. City/Town State Zip Code Date o I ection
E. Report Completeness Checklist
Inspection Summary:A, B, C, D, or E checked
Inspection Summary D ((System Failure Criteria Applicable to All Systems)completed
S em Information—Estimated depth to high groundwater
Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
(Sins-09M
Title 5 official Inspection Form:Subsurface Sewage Disposal System-page 17 of 17
Commonwealth of Massachusetts
,p Title 5 Officii Inspection Form
Subsurface Sewage Dispoal System Form - Not for Voluntary Assessments
�
Property Address I
Owner Owner's Name
information is
required for /s Z— 6 0
every page. CirylTown _ State Zip Code Date of Injection
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
7publwher
ic water supply enters the building. Check one of the boxes below:
hand-sketch in the area below
❑ drawing attached separately
c.
a
r
14.),
L/o, 3
IS014
15ins•09M
Title 5 Official Inspection Form:Subsurface sewage Disposal system-Page 15 of 17
I
Torn of Barnstable
�THE
.Regulatory Services
Thomas F. Geiler, Director
URN87ABLL
9�a `; Public Health Division
Thomas McKean- _ , Director
200 :Main Street, Hyannis, NIA 02601
Office: 503-362-46 44.
Fax: 503-790-6304
Installer & Desianer Certification Forin
Date: lg� Sewage Permit# Assessor's tNlaplParcel Z41 �27J
Designer:
i Installer: A)le_ C-
address:
b19X qV _ Address:
On 5—vis-Nr
(date) was issued a permit to install a
i installerl
septic system at 5V P(Q(K. 1211EAl UC-, based on a design drawn by
('address)
died
(designer)
f certify that the septic system referenced above was installed substantially according to
the design, which may% include minor approved changes such as ;t t era I re?ocat:on of the
distribution box and,or septic tank. Z�4 lNa
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation Of the SAS or an,, vertical relocation o`-any component
of the septic system) but in accordance with State & Local Regulations. Plan revision or
certified as-built by designer to follow.
OF
o D RR N ✓+
(Installer.'s _atut' E
1140 ,
0
SgNITAOa Q�
(Designer's Signarttre) (Affix Designer's Stamp Here)
PLEASE RETURN TO BA STABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF
C011VIPLIANCE w71 L NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE
RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU.
rya 17
POO {
A 33 Fbe, ry
�.w
30.E
G (051f
Al'� N A
k00/Yj STD a��>
3���► 9rH
F,�oNr
74
40•�
J
Cot
Sr
J1
i
V
.�
f
A
VI S
I
�oF Ero Town of Barnstable
Barnstable
Board of Health AS-f,edcaCf
,1 RARNSTAULE,� ,
Ass. o, 200 Main StreetY Hyannis MA 02601
9�00
w 9
�0 039.
9.a.
2007
Office: 508-862-4644 Wayne Miller,M.D.
FAX: 508-790-6304 Paul Canniff,D.M.D.
Junichi Sawayanagi
March 31, 2008
Jamison DaSilva
47 Suffolk Avenue
Hyannis, MA 02601
RE: Variance Request Denial / 47 Suffolk Avenue, Hyannis A= 291 - 123
Dear Mr. DaSilva:
Your request to increase the number of bedrooms at your property from four to
six at 47 Suffolk Avenue, Hyannis, was not granted.
The request was denied because there are two illegal bedrooms in the lower
level. These bedrooms do not have a second means of emergency egress.
Also, the existing driveway is 30 feet wide which is ten feet too wide.
You must comply with the occupancy's restriction on the size of the parking area
which is a driveway of 20 feet and no more than 25% of the front yard area.
Chapter 59 Comprehensive Occupancy: The maximum number of motor
vehicles that are permitted to be parked overnight; other than in a
building, at any residential dwelling shall be equal to two motor
vehicles for the first bedroom in a residential dwelling and one
motor vehicle per bedroom thereafter.
Your failed septic system must be repaired on or before June 19, 2008.
Sincerely yours,
WaynqLViller M.D.
Chairman
Note: If the Building Division approves a second kitchen within this dwelling, a
double-compartment septic tank shall be installed.
Q:\WPFILES\47 SUFFOLK AVE Hy Mar2008.doc
l-
No. O—V
THE COMMONWEALTH OF MASSACHUSETT$`~f Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Zip plication for 3Di!6pOga1 *p!gtem Conotrurtton Vermtt
Application for a Permit to Construct( ) Repair( ) Upgrade( Abandon( ) ❑ Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address,and Tel.No.
�7 Svr"C-,le 4 � Ysj.v�v.S' D,-5, �vA
Assessor's Map/Parcel S
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
� 7 3,F
Type of Building: `
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder (
Other Type of Building No.of Persons Showers( ... ) Cafeteria( )
Other Fixtures
Design Flow(min.required) S , ® gpd Design flow provided -3 gpd
Plan Date l� 2 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 applicab
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 lace the system in operation until a Certificate of
Compliance has been issued by this B.ar f Health. /
Signed Date D a
Application Approved by Date ^-0 V
Application Disapproved by: Date
for the following reasons
Permit No. ;?-0 o w O Date Issued S s
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i Y,
/
to ;`�S� P`aV ,,� ( Fee
THE COMMONWEALTH OF M SACHUSETTS`�Entered in computer:
PUBLIC HEALTHDIVISION - TOWN OBARNSTABLE, MASSACHUSETTS Yes
F�-
ip' lication for' aigoz,aY iptten� Cor� truction . ernYit
Application for a Permit to Construct( ). Repair( Upgrade(L)X Abandon O ❑Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address,and Tel.No.
�7
sa c y A �• Al.s
Assessor's Map/Parcel S G4 .y h
' Installer's Name,Address,and Tel.No. Designer's ame,Address and Tel.No.
02
,Type of Building:
Dwelling No.of Bedrooms Lot Size sq. ft.` 'Garbage Grinder Al/
Other Type of Building /Z s No.of Persons Showers( ) Cafeteria(. )
Other Fixtures
Design Flow(min.required) S D gpd Design flow provided e55 3 gpd
Plan Date f ,/® Number of sheets Revision Date
Title
N.Size of Septic Tank Type of S.A.S.
Description of Soil r
Nature of Repairs or Alterations(Answer when applicab
_ ll.
j.t
Date last inspected: i
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
4accordance witht the provisions of Title 5 of the.Environmental Code and nott_place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signed���' l_.--' Date -Al
Application Approved by"4 �Q
! �--� P� Date S- 0
Application Disapproved by: Date
- for the following-reasons
Permit No. .2-0 D O Date Issued
--------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded
Abandoned( )by /0/L e /-.(
at 15/ % Sv i`f o 44- 19 d E has been co�/nstructeed� in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. oZ O d 0— 191 dated
Installer �iZ e�� _ Designer 2 ?G�- /�7 i-y. .2
t
#bedrooms Approved design flow /�, 3/ gpd
The issuance of this permit shall not be
construed as a guarantee that the system//�I Nri(\
as designed.
Dated // C` / Inspector°__
————————————————— —— _———
No. m` 0 t v� Fee /b G
THE COMMONWEALTH OF MASSACHUSETTS -
PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS
'Wi5pool 6p5tem Construction Permit
Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( Abandon ( )
System located at
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty
to comply with Title S and the following local provisions or special conditions.
Provided: Construction gust be completed within three years of the date of t,'
Date 7 ` o 10
Approved by
� 1
Town of Barnstable
�p1HE Regulatory Services
Thomas F. Geiler, Director
ftARNBTABLE.
��� Public Health Division
\'F-639. Thomas McKean, Director
200 :Main Street, Hyannis, MA 02601
Off-ice: 503-362-464-1 Fax: 503-790-6204
Installer & Designer Certification Form
Date: 4P MO% Sewage Permit#�6��`�Assessor's ivlap\Parcel
Designer: Dkp-pcm m;V Installer: /-)/t
Address: P� �vT M :address: .209 —2
W VA4 hA 02-5-39 A
On � � � _ &C,14 6/4ST was issued a permit to install a
(date) r/ r (installer)
septic syst ^em at `F 1 5V l'(-OLr— R:VEI\ Ui based on a desian drawn by
(address)
'CJ� s•5.08
��-dated
(designer)
I certify that the septic system referenced above was installed substantially according to
the design. which may include minor approved charges such as lateral relocation o'the
distribution box ancL or septic tank. Z�A llNfK. lvv�bcf�)
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or am; vertical relocation of any component
or the septic system) but in accordance with State & Local Regulations. Plan revision or
certified as-built by designer to follow.
J v 10 OF MAssq�y
o D RR N ✓>
E
(Installer's S,g>iatu, N 1140
0
6 '�FG/STE�`0 t7 6
b S4NITAR�P� 06P
(Designer's Signature) (Affix Designer's Stamp Here)
PLEASE RETURN TO BA , STABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF
COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE
RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU.
Q: Heal th/Seprie%Designer Certification Form 3-26-4.1doc
NOTE TO FILE
47 SUFFOLK AVENUE, HYANNIS
f
• The Building Division issued a letter May 8, 2006—illegal apartment, being used
as multi-family.
• The BuildingDivision issued an Exit Order—Ordered to immediately discontinue ey
the use of the cellar/basement area for sleeping.
• The Building Division will attempt to inspect prior to the Board of Health
Meeting on March 11, 2008.
1
Town of Barnstable
°Ft"E r°'y Regulatory Services
Thomas F. Geiler, Director
HARNSPABLE.
MASS. g Building Division
1639. �0
ATFo �p Thomas Perry, CBO, Building Commissioner
200 Main Street, Hyannis, MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXIT ORDER
DATE:
LOCATION:
UNDER THE PROVISIONS OF 780 CMR, THE STATE BUILDING CODE,
SECTION 3400.5.1, YOU ARE HEREBY ORDERED TO IMMEDIATELY
DISCONTINUE THE USE OF THE CELLAR/BASEMENT AREA FOR SLEEPING
PURPOSES.
LOCAL INSPECTOR
SIGNATURE OF RECIPIENT
ODEM DE SAIDA
DATA: 3l
/0 7
LOCALIDADE:
DE ACORDO COM 0 PROVISORIO 780 CMR, CODIGO DE CONSTRUCAO DO
ESTADO, PARAGRAFO 3400.5.1, VOCE ESTA ORDENADO DE DEIXAR DE
USAR, IMEDIATAMENTE, A AREA DO PORAOBASEMENT PARA O
PROPOSITO DE DORMIR.
INSPETOR LOCAL
A8SINATURA DO RECIPIENTE
pF1HE roy, Town of Barnstable
Regulatory Services
a'' ASS.M Thomas F.Geiler,Director
y Mass. �
`�AtEo;9.�a Building Division
Thomas Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4024 Fax: 508-790-6230
May 8, 2006
Mr. Jamerson Dasilva
47 Suffolk Avenue
Hyannis, Ma. 02601
Re: Illegal Apartment47 Suffolk Avenue Hyannis, Ma. 02601
Map 291 Parcel 123
Dear Property Owner:
Our records indicate that your house at the above-referenced location is currently being
used as a multi-family home,which is contrary to Barnstable Zoning Ordinances.
Violation of zoning ordinances is a misdemeanor, conviction for which results in a
criminal record.
You must contact this office within 14 days to either:
• Apply for a building permit to restore the property to a one-family home
• Apply to the Amnesty Program
• Prove that this is a legal multi-family home.
Please contact this office immediately to tell us what direction you wish to take.
Sincerel
Lina Edson
Amnesty Program
Zoning Officer
Building Department
gfonns:zoning3
:a
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j DATE:
IMC.BY
t e634
Town of Barnstable
A
Bt:HED. DATE:
Board of Health
i
200 Main Street,Hyannis MA 02601
6ffice: 508-962-4644 Susan 0.Reek,R.B.
FAX: SOB-790-6304 Samaar Kaufman,M.S,P.H.
Wayne A.MMer.M.D.
I
i
AppUcation to Construct or Elipand to Six or More Bedrooms.
I
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y o ress: OFFOLK A!��f� HYA-nJ0)S Propo Add
{
Asses or's Map and Parcel Number: L 7., Size of Lot.. b®t> f--T I
Wetlands Within 300 Ft. Yes Business Name: tq .!�
No—,T7 Subdivision Name: A
Am CANT' /A ° E RSPhone S 09
Did the owner of the property authorize you to represent him or her? Yee K No
PROP WI+T1✓A' �Q�'1f ACT PER4QSj
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�/� ► ,-�
I+taute: S®iJ J�9 7 Name: I)Q RP PA
Addre s• 1-,-/7 A- AIL; Ps Q:
Address:
F �
Phone: v 7 i' t7 C� / 3 y Phone: �� 1 e 1�'o A OZ53
in Ca
Cho
,at -
CO
Please agbnnk Copies in 4 separate cornpteted soft
!� Four(4)copies of this application form CO
Four(4)copies of engineered plan submitted(e.g.septic system plans) Gn M
Four 4 copies of labeled dimensional floor plans submitted(e. .house plane)
Ost App icatioa FormaNSixeedracnForm.dcc
Town of Barnstable
of THE 1p�
Board of Health
"• '" NAS& 200 Main Street - Hyannis MA 02601
9� 1639.
ptED H1p'f A
Agreement to Extend Time Limit
for Acting Upon a
Variance Request
In the Matter of a variance request form received on
the Petitioner(s),
regarding the property at L l .7 1)� -
the petitioner(s)and the Board of Health agree that the Board of Health has until 20
(insert date)to act upon the Petitioners'completed application for a variance.
In executing this Agreement, the Petitioner(s) hereto specifically waive any claim for a constructive
grant of relief based upon time limits applicable prior to the execution of this Agreement.
Petitioner(s): %` Board of Health:
Signature:' `� �Petitioners
Signaturp�-"�"etitioner(s)or ores ntative c� ' Chairman
,i
Print: Print: Wayne Miller, M.D.
Date: Date:
Address of Petitioner(s)or Petitioner's Representative
Town of Barnstable
Board of Health
Public Health Division
200 Main Street
Hyannis, MA 02601
Phone: (508) 862-4644
Fax: (508) 790-6304
file q:extend.doc
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a 84 Rolling Hitch Road
x Centerville, MA 02632
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January 11, 2008
f Mr. Thomas McKean
Director, Board of Health
200 Main Street
Hyannis, MA 02601 ='=
RE: Request for 6 bedroom permit at-47 Suffolk Ave,Hyannis CAN
Owner: Jamison DaSilva c
Dear Tom and Board of Health: rx'.
try r--
We have become aware of the-request of Mr. DaSilva to obtain permitting fora 6 bedroomm
home at 47 Suffolk Ave,Hyannis.
We have been abutters of that house since 1965. It was built as a 3 bedroom home in the early
1960's and has been maintained as such until Mr. DaSilva purchased the house. Since that time
the house has been turned into a boarding house! There has been a constant stream of tenants,
more than the allowed number of vehicles and removal of trees since that time. We. left the
neighborhood and our house is currently on the market due to the inconsideration of Mr.
DaSilva and others in the.neighborhood who have added to the depreciation of other homes
which long time owners had maintained with pride.
We believe that Mr. DaSilva;cut into the foundation and installed a new door and window next
to the garage — without a proper permit from the Town - so that people who lived in the
basement could have access to that level. Also noted was lots of late night construction projects
out on the deck making partitions for use inside for which, we believe, there were no permits
granted.
On one occasion we observed a truck dumping dirt in the backyard and being leveled and when
I spoke with Mr. DaSilva and asked what was going on, he replied that there was a low spot in
the yard and he was filling it in!!!! We knew that the cesspool was located there and it had
obviously overflowed!!
We have called the various Town boards over the past few years with complaints but never
heard back with any action taken.
This letter will serve as our objection to allowing Mr. DaSilva to receive permitting to add any
bedrooms in this house. This neighborhood has been in steady decline over the past few years
due to people who have purchased homes with walk-out basements to create rental income to
- assist them in paying for their mortgages. PLEASE DECLINE THIS REQUEST:
Sincerely; � ..
William and Myrna Elkins
FEB.19.2008 12:02PM BARNSTABLE BOARD OF HEALTH NO.757 P.2i3
'own of Barnstable
Board of Health
200 Main Street-Hyannis MA 02601
Agreement to Extend Time Limit
for Acting Upon a
Variance Request
In the Matter of a variance request form received on Z6 A 1 q
the Petitioner(s), PiRM6XRAl.- /ems
regarding the property at
the petltioner(s)and the Board of Health agree that the Board of Health ntil p
Cnsert date)to act upon the Pelltioners'completed application for a variance.
In executing this Agreement,the Petitioners)hereto specifically waive any claim for a constructive
grant of relief based upon time limits applicable prior to the execution of this Agreement.
Petition , Board of Health:
Signetu ` Signature:
t oner(a)or Petfonees epreaen Chairman
Print• � ' Print; Wayne Miller, M.D.
Date: ` date'
e
Address of Petition'er(s)or Pet fiam s Representative
® � � Town of Barnstable
L. S�� f Board of Health
Public Health Division
Zg 200 Main Street
Hyannis, MA 02601
Phone: (508)882.4644
Fax: (508)790.6304
rse q:axtend.doo
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.Gown of B i rnstable. r#
,►tE •
Department of.Regulatory Services
-- , Public Health Division. , DateWAS
_ D
IL tee$ 200 Main Street,Hyannis MA702601
�, , i l!n 1
! Time 1 Fee Pd.
. Date Scheduled •I , --J---- •
!
Foil Suitability Assessment for Sewage osal
o D �Performed By: l �-y{ =� �T_ Witnessed By: j
LOCATION& GENERAL INFORMATION
Location Address'. Lt 7 S o F Fo L V_ A-�e ; Owner's Name jArA4 Cr j,0#J A+S ttL VA.
YAddress
S1jr_r_0� ,
Assessor's Map/P4rcel: 19 ! j I Engineer's Name ��/�(Lia-P✓�1 Zir
NEW-CONSIRU�'I'ION REPAIR _ r Telephone#
/wA t OJ I ,
Land Use ReSc`" �' p ( ) / 5uifaceStones ,y 011e:. .
Slo es g'o
Distances from: Open Water Body 5OO ft 'Possible Wet Area>ZOO ft Drinking Water Well Z°U ft p ��
I �
Drainage Way T �� ft Property Line y t O ft Other ft 1�
i
SKETCH:($treet name,dimensioos'of lot,exact locations of 4#holes&perc tests,locate wetlands in proximity to holes)
✓'o • b�eC� Srf Q 1�
plam dq� l
• I
I
Parent material(geologic) a ur^-� «a OLA ' Depth,to Bedrock
Alld
L_
Depth to Groundwaier. Standing Water in Hole:_ i r Weeping from Pit Face
. 1� r
Estimated Seasonal il#igh Groundwater
DtT- ERMIN TION FOR SEASONAL HIGH WATER TA19LE
Method Used: !
Motow
Depth Cib�served standing in obs.hole: _in. Depth to Sgll Adjust ln,
Depth toiweeping from side of obs.hole: I in, Groundwater AdJuBtmept tt
Index Well#� Reading Date: IndexWelllevtl '" - - Ar�:faetor.,.._-� A�.dB7unSwatePleVel.,,,m
l
PERCOLATION:TEST Dat Tlt>S"
Observation 1 � Time at 9"
Hole# _L_ '�." ..
&Q t/ 0.
Time at 6"
Depth of Perc 0.
Start Pre-soak Time.@ l _ 22
I Time(9"-6")
End Pre-soak
L•2 r�� ���ti . i
Rate Min./Inch
Site Suitability Assessment: Site Passed Site Failed; Additional Testing Needed(YM)
Original:.Public Health Division Observation Hole Data To Be Completed on Back--- ---
i
***If percola#pn test is to be conducted within 100' of wetland,,•you must first notify the
'Q._"cf ahlP C'_duiservation Division at least one(1)we&prior to beginning.
DEEP OBSERVATION HOLE LOG Hole# '1
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
onsistenc 9'o Gravel
L6 AM. A+J b l 1 1 2. A del ass
u
30` 72`' a�5 oase ,r am
77 3�`' a,sY ��� �t !,
17-7
DEEP OBSERVATION HOLE LOG Hole# 2
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
_ Consistency,_%Gravell _
0`t- to" A Lo kvq S 01 V AJIA mossll�
1041-3D" LO 10 9,('1q
O'�7Z G 2•'� (alq loobe ruk to lK'
7Zt 1371, ` ''G 2 S 7/ �t it
� � 7
DEEP OBSERVATION HOLE LOG Hole#_
f, Depth from Soil Horizon Soil Texture Soil Color Soil Other
r! Surface(in.) (USDA) (Munsell). Mottling (Structure,Stones,Boulders.
'a . onsistenc '%Gravel
LoAmoA140 4 z /� /1/►aSS,tItiP �cutp.
DEEP OBSERVATION HOLE LOG Hole#_
Depth from Soil Horizon Soil Texture Soil Color Ul Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
ns stency, Qmvgl)
S I b � cz
Flood Insurance Rate Man:
Above 500 year flood boundary No�v Yes _.
Within 500 year boundary No X Yes
Within 100 year flood boundary No X Yes;,
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious material exist,in all areas observed throughout the
area proposed for the soil absorption system? 2S
If not,what is the depth of naturally occurring per 'ous material? '
Certification A I,Q
I certify that on. 0 .l A (date)I have passed the soil evaluator examination approved by the
Department of Environmental Protection and that the above analysis was performed by me consistent with.
the require tra i ,expertise nd exp rience described in 3,10 CMR'15.017.
Signature Date,ltL2 do?
Q:\,SEPTICVERCFORM.DOC
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77-71
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McKean, Thomas
From: McKean, Thomas
Sent: Wednesday, September 22, 2004 9:18 AM
To: Geiler, Tom
Subject: HEALTH REPORT OF BIRST INSPECTIONS/SEVEN PROPERTIES-Sept. 21, 2004
The following properties were visited on September 21, 2004:
- 5 George Street- Refuse violations observed, holes observed in siding of dwelling, $100 ticket citation issued
9/21/04 to owner,Winona Kostic, order letter to be prepared today,follow-up Monday Sept. 27, 2004
- 27 George Street, 4 health violations observed including illegal basement bedrooms without second means of
egress, insufficient number of smoke detectors,4-$100 ticket citations mailed 9/22/04 to owner, Hermes Santa
Rosa, order letter to be prepared today
- 47 Suffolk Ave. , no housing violations observed, verbally ordered owner to remove carpeting and construction
materials from rear yard,will follow-up on Monday September 27, 2004
- 88 Compass Circle, nobody onsite to allow inspectors inside for an inspection, history of violations regarding illegal
finished basement bedrooms according to BLDG, reinspection needs to be scheduled, rubbish violation observed,
$100 ticket citation mailed 9/22/04 to Vilson Rubio.
- 184 Compass Circle, refuse violations observed, $100 ticket citation handed to Lynda Lamb 9/121/04.
- 63 LaFrance Avenue, nobody onsite to allow inspectors inside, no violations observed outdoors, attempted to call
owner this morning to set-up meeting appt., left message on her answering machine (508 775-6527)
- 118 Wagon Lane , 3 violations observed including illegal basement bedrooms without second means of egress, 3=
$100 ticket citations mailed 9/22/04 to owner Israel DaSilva & Lea SM, order letter to be prepared today
1 i
-700 a l 000 00 oLl
Town of Barnstable
F1HE Tp�
do Department of Health, Safety, and Environmental Services
,, ,,CAB Public Health Division
367 Main Street,Hyannis MA 02601
ArED MA'S A
Office: 508-79U-6265 Thomas A.McKean
FAX: 508-775-3344 Director of Public Health
September 23,2004
Mr.Carvalho Aluizio
47 Suffolk Ave.
Hyannis,MA 02601
NOTICE TO ABATE VIOLATIONS OF THE STATE SANITARY CODE,CHAPTER 2, 105 CMR
410.00, THE STATE ENVIRONMENTAL CODE, TITLE 5 AND THE TOWN OF_BARNSTABLE
RENTAL ORDINANCE,ARTICLE 51
The property owned by you located at 47 Suffolk Avenue, Hyannis,'MA was inspected on September 21,
2004 at 10:58 a.m. by Thomas McKean, Health Agent for the Town of Barnstable. Also present were
Thomas Perry Building Commissioner,Eric Hubler of Hyannis Fire Department, Sergeant Sweeney of the
Police Department and Thomas Geiler, Director of Regulatory Services. The following violations of the
State Sanitary Code, 105 CMR 410.00, and of the Town of Barnstable Rental Ordinance, Article 51 were
observed:
105 CMR 410.602: Large pile of items including abandoned carpeting, and other debris on the ground
behind the dwelling.
You are ordered to remove all refuse,rubbish,and debris within seven(7)days of your receipt of this
letter.
You may request a hearing before the Board of Health if written petition requesting same is received within
seven(7)days after the date the order is.served.
Non-compliance will result in the issuance of non-criminal ticket citations of$100.00 each. Each day's
failure to comply with an order shall constitute a separate violation.
PER ORDER OF T BOARD OF HEALTH
Thoma McKean
Director of Public Health
l
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COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
Qle
h
ti
t
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 47 SUFFOLK AVE HYANNIS,MA 02601 M123 P291
Owner's Name: PASS
Owner's Address: 47 SUFFOLK AVE HYANNIS,MA 02601
Date of Inspection: 10/6/03
Name of Inspector: (please print) JOHN GRACI,INC.
Company Name: SEPTIC INSPECTIONS
Mailing Address: P.O. BOX 2119 TEATICKET, MA.02536
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 15.340 of Title 5(310 CMR 15.000). The system:
X Passes
_ Conditiony/lyses_ Needs Fuluation by the Local Approving Authority
Fails
Inspector's Signature: Date: 10/6/03
The system inspector shall submit a py of this inspection report to the Approving Authority(Board of Health or DEP)within
30 days of completing this inspectoo . 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.
Notes and Comments
THE SYSTEM PASSES TITLE V INSPECTION. RECOMMEND PUMPING EVERY ONE TO TWO YEARS TO
PROLONG THE SYSTEM'S USEFUL 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.
Title S lncnartion Form 6/1 5/ 00f) 1
Page 2 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 47 SUFFOLK AVE HYANNIS,MA 02601 M123 P291
Owner: PASS
Date of Inspection: 10/6/03
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 INSPECTION.RECOMMEND PUMPING EVERY ONE TO TWO YEARS TO
PROLONG THE SYSTEM'S USEFUL 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 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.
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
n/a 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
_ distribution box is leveled or replaced
ND explain: n/a
n/a 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: n/a
Page 3.of I 1
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 47 SUFFOLK AVE HYANNIS,MA 02601 M123 P291
Owner: PASS
Date of Inspection: 10/6/03
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.
_ 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:
n/a
Page 4 of 11
Qb
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 47 SUFFOLK AVE HYANNIS,MA 02601 M123 P291
Owner: PASS
Date of Inspection: 10/6/03
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 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 SYSTEM WAS PUMPED ON SEPT. 11 BY HICKEY.
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.]
NO (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—I WPA)or a mapped
Zone II of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant threat,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.
4
Page 5 of I I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 47 SUFFOLK AVE HYANNIS, MA 02601 M123 P291
Owner: PASS
Date of Inspection: 10/6/03
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
X _ Was the site inspected for signs of break out'?
X _ Were all system components,excluding the SAS, located on site'?
X _ 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?
X _ 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)]
5
Page 6 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 47 SUFFOLK AVE HYANNIS,MA 02601 M123 P291
Owner: PASS
Date of Inspection: 10/6/03
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 0 Number of bedrooms(actual): 4
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440
Number of current residents: 2
Does residence have a garbage grinder(yes or 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
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
COMMERCIAL/INDUSTRIAL
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
OTHER(describe): n/a
GENERAL INFORMATION
Pumping Records
Source of information: SYSTEM WAS PUMPED ON SEPT. 11 BY HICKEY
Was system pumped as part of the inspection(yes or no): NO
If yes,volume pumped: Gallons--How was quantity pumped determined? n/a
Reason for pumping:
TYPE OF SYSTEM
_Septic tank,distribution box,soil absorption system
X Single cesspool
X 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): n/a
Approximate age of all components,date installed(if known)and source of information:
40 YEARS PER AGENT
Were sewage odors detected when arriving at the site(yes or no): NO
Page 7 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 47 SUFFOLK AVE HYANNIS, MA 02601 M123 P291
Owner: PASS
Date of Inspection: 10/6/03
BUILDING SEWER(locate on site plan)
Depth below grade: 18"
Materials of construction:_cast iron _40 PVC Xother(explain): ORANGEBURG
Distance from private water supply well or suction line: n/a
Comments(on condition of joints,venting,evidence of leakage,etc.):
TOWN WATER
SEPTIC TANK: (locate on site plan)
Depth below grade: n/a
Material of construction:_concrete_metal_fiberglass_polyethylene other(explain)n/a
If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate)
Dimensions: n/a
Sludge depth: n/a
Distance from top of sludge to bottom of outlet tee or baffle: n/a
Scum thickness: n/a
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
How were dimensions determined: n/a
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related
to outlet invert, evidence of leakage,etc.):
n/a
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
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
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related
to outlet invert,evidence of leakage, etc.):
n/a
Page 8 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 47 SUFFOLK AVE HYANNIS,MA 02601 M123 P291
Owner: PASS
Date of Inspection: 10/6/03
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:_(if present must be opened)(locate 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.):
NONE
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
R
7
Page 9.of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 47 SUFFOLK AVE HYANNIS, MA 02601 M123 P291
Owner: PASS
Date of Inspection: 10/6/03
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: n/a
n/a leaching chambers, number: n/a
n/a leaching galleries, number: n/a
n/a leaching trenches, number, length: n/a
n/a leaching fields, number: n/a
6' X 6' BLOCK overflow cesspool, number:
n/a innovative/alternative system
Type/name of technology: n/a
Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.):
OVERFLOW IS STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.THE PIT WAS EMPTY AND HAS
NOT HAD MORE THAN TIN IT.BOTTOM IS AT 10' 6"-OVERFLOW SHOWED NO SIGNS OF FAILURE AT
TIME OF INSPECTION.
CESSPOOLS: X(cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration: 1
Depth—top of liquid to inlet invert: 4"
Depth of solids layer: 0"
Depth of scum layer: 0"
Dimensions of cesspool: 6' X 6"'
Materials of construction: BLOCK
Indication of groundwater inflow(yes or no): NO
Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
MAIN CESSPOOL AND ALL COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING
PROPERLY.RECOMMEND PUMPING EVERY ONE TO TWO YEARS TO PROLONG THE SYSTEM'S USEFUL
LIFE.
PRIVY: (locate on site plan)
Materials of construction: n/a
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
I
4
Page 10 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 47 SUFFOLK AVE HYANNIS, MA 02601 M123 P291
Owner: PASS
Date of Inspection: 10/6/03
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.
l�
�eCIL-
AA 0
AP ��
PA
6 10
in
r
rage j,1 of 1 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 47 SUFFOLK AVE HYANNIS,MA 02601 M123 P291
Owner: PASS
Date of Inspection: 10/6/03
SITE EXAM
_Slope
_Surface water
_Check cellar
_Shallow wells
Estimated depth to ground water 12+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: n/a
YES Observed site(abutting property/observation hole within 150 feet of SAS)
NO Checked with local Board of Health-explain: n/a
NO Checked with local excavators, installers-(attach documentation)
NO Accessed USGS database-explain: n/a
You must describe how you established the high ground water elevation:
GROUNDWATER WAS DETERMINED BY HAND AUGER-NO WATER AT 12'
Date:
TOWN O BARNSTABLE
TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY
NAME OF BUSINESS:
BUSINESS LOCATION: �l� SUF'r0J'6Z I�IF�%ENTORY
MAILING ADDRESS: TOTAL AM06T-
TELEPHONE NUMBER:
CONTACT PERSON: MAA6-AspN .A-Si zjL/A IjIV iS1 7�4
EMERGENCY CONTACT TELEPHONE NUMBER: qo`,,f'— MSDS ON SITE?
TYPE OF BUSINESS: �ANQ&W"G + fAIPJ'S 11' '
INFORMATION/RECOMMENDATIONS: Fire District:
Waste Transportation: Last shipment of hazardous.waste:
Name of Hauler_ __ Destination:
Waste Product: Licensed? Yes No
NOTE: Under the provisions of Ch. 111, Section 31 , of the General Laws of MA, hazardous materials use,
storage and disposal of 111 gallons or more a month requires a license from the Public Health Division.
LIST OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health and the Public Health Division have determined that the following products exhibit toxic
or hazardous characteristics and must be registered regardless of volume.
Observed/Maximum Observed/Maximum
Antifreeze (for gasoline or coolant systems) Misc. Corrosive
NEW USED Cesspool cleaners
Automatic transmission fluid Disinfectants
Engine and radiator flushes Road Salts (Halite)
Hydraulic fluid (including brake fluid) Refrigerants
Motor.0ils Pesticides
NEW USED (insecticides, herbicides, rodenticides)
Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers)
Diesel Fuel, kerosene, #2 heating oil NEW USED
Misc. petroleum products: grease, v Photochemicals (Developer)
lubricants, gear oil NEW USED
Degreasers for engines and metal Printing ink
Degreasers for driveways &garages Wood preservatives (creosote)
Caulk/Grout Swimming pool chlorine
Battery acid (electrolyte)/Batteries V Lye or caustic soda
Rustproofers Misc. Combustible
Car wash detergents Leather dyes
Car waxes and polishes Fertilizers
Asphalt & roofing tar PCB's
Paints, varnishes, stains, dyes \ Other chlorinated hydrocarbons,
Lacquer thinners v (inc. carbon tetrachloride)
NEW USED Any other products with "poison" labels
Paint &varnish removers, deglossers (including chloroform, formaldehyde,
Misc. Flammables hydrochloric acid, other acids)
Floor& furniture strippers Other products not listed which you feel
Metal polishes may be toxic or hazardous (please list):
Laundry soil & stain removers
(including bleach)
Spot removers &cleaning fluids
(dry cleaners)
Other cleaning solvents
Bug and tar removers
Windshield wash
WHITE COPY-HEA\DEPARNT/CANARY COPY-BUSINESS
• •. d �'..'y ,1. `k M ,ti. +;' vr.... '+••,..+- t� _ r ... :v- ..
r Date:
TOWN OFF BARNSTABLE
TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY
NAME OF BUSINESS: �� M A205 01011 6 f�9/�I N C, ''''
BUSINESS LOCATION: y 7 .�i�fr J4 4 W ► µq AAJN i S Mq fl�001F". 1N,VENTORY
MAILING ADDRESS: AM 15 TOTAL AMOUNT:
TELEPHONE NUMBER: �~0l,,3r
CONTACT PERSON: �JM&Y 5orJ '0A51 WA " i"Zw���
cb
EMERGENCY CONTACT TELEPHONE NUMBER: ` j q- 53— `�� MSDS ON SITE?
TYPE OF BUSINESS: , AK19&CA(PtNG + fAtyjT 1 PJC--
INFORMATION/RECOMMENDATIONS: Fire District:
Waste Transportation: Last shipment of hazardous,waste:
Name of Hauler: Destination:
r
Waste Product: Licensed? Yes No
NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use,
storage and disposal of 111 gallons or more a month requires a license from the Public Health Division.
LIST OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health and the Public Health Division have determined that the following products exhibit,toxic
or hazardous .characteristics and must be registered regardless of volume. `
,k Observed/Maximum Observed/Maximum
Antifreeze (for gasoline or coolant systems) Misc. Corrosive
NEW USED Cesspool cleaners
Automatic transmission fluid Disinfectants
Engine and radiator flushes Road Salts (Halite)
Hydraulic fluid (including brake fluid) Refrigerants
Motor Oils Pesticides
I NEW USED (insecticides, herbicides, rodenticldes)
Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers)
Diesel Fuel, kerosene, #2 heating oil NEW USED
Misc. petroleum products: grease, l " Photochemicals (Developer)
'lubricants, gear oil 1qj� ; NEW USED `
Degreasers for engines and metal I Printing ink
Degreasers for driveways & garages Wood preservatives (creosote)
Caulk/Grout Swimming pool chlorine
Battery acid (electrolyte)/Batteries Lye or caustic soda
Rustproofers Misc. Combustible
Car wash detergents Leather dyes
Car waxes and polishes Fertilizers
Asphalt & roofing tar �� PCB's
Paints, varnishes stains, dyes Other chlorinated hydrocarbons
Lacquerthinners; -°` "(inc: carbon tetrachloride)
NEW USED
Any other products with "poison" labels
Paint & varnish removers, deglossers (including chloroform, formaldehyde,
Misc. Flammables hydrochloric acid, other acids)
Floor &furniture strippers Other products not listed which you feel
Metal polishes may be toxic or hazardous (please list):
Laundry soil & stain removers
(including bleach')'
{
Spot removers & cleaning fluids
(dry cleaners)
Other cleaning solvents \
Bug and tar removers
Windshield wash
WHITE COPY-HEALTH DEPARTM94T/CANARY COPY-BUSINESS
klu
t 19.45 ft _ LEGEND
1' PROPOSED CONTOUR
�� 'f9 ® PROPOSED SPOT GRADE- 2 S Wq L
' R N —— 98 —- EXISTING CONTOUR u ¢ MARY ALI i�YARO
} G
R N � 1
No. 1140 + 96.52 EXISTING SPOT GRADE o
' G� GEORG I I
5 ft. Soil Removal W— EXISTING WATER SERVICE a iBRISZOtS�.
(see note 18) SgNITARlp� TEST PIT 'R
9.45 ft.
ST? ti o tJ�NTYS T �o
Ll' CIO SKA R10K �' o
RD ;
Existing Cesspools ti &Z ?'o CONNEN1a49 VER
(See Note 10)
34 # BENCH M A R K LOCUS .MAP N.T.S.
TOP OFDRAIN GRATE
�er _ ELEVATION = 32. 79GENERAL NOTES:
2.91 �70 i �,ju(k? BARNSTABLE GIS DATUM 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL
i t ` Sy`0 ^00 it BOARD OF HEALTH AND THE DESIGN ENGINEER.
2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS
OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE
o _� I Y LOCAL RULES AND REGULATIONS.
3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR
�o TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE
j \ C 20 DESIGN ENGINEER.
4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING
/
THi4�� \ \\ Qo ?'kO�H 90 .- 8S / FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN
CVzlfC ENGINEER BEFORE CONSTRUCTION CONTINUES.
_� \ \ F x 32t�E2S I 5. ALL ELEVATIONS BASED ON ASSUMED DATUM.
Y 3' I . P / v 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF
�� 7 /' — \ THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF
TH`-3 / 0 ff OPI�'Elvq y it --� 7, WAFTERH FOR SUPPLYROPER PROVIDEDPECTIONS BY TOWN WATING ER SERVICE.
CONSTRUCTION.
CE
8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED
/ \� TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR.
/ 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY
v 1 it \•�\ �� �/ �\ THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING
v
j / \ CONSTRUCTION.
10 ft. l jj/i � �� _ �i^T 1 \ l z 10. EXISTING CESSPOOLS TO BE PUMPED, CRUSHED AND REMOVED
T —2 / —E``!� �lo \� 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION
LEACHING DETAIL !TH-1 /� /�\ f 1 '�E I -_O 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY
(not to scale) Q / // O AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY
U) Z
•r �� ! Ur j y O 1 I,
i� 14. ALL PIPING TO BE 4" SCH 40 ® 1/8"/FT (UNLESS SPECIFIED OTHERWISE)
15. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW
FOR THE USE OF A GARBAGE GRINDER
I J j O ii \ j 34 Q 16. NO WETLANDS WITHIN 100 FT. OF PROPOSED LEACHING
17. PROPERTY IS NOT LOCATED IN A ZONE OF CONTRIBUTION.
O 18. POTENTIAL REMOVAL OF ALL UNSUITABLE SOILS 5 FT. AROUND LEACHING TO
�Ij _:D TOP OF C1 LAYER AND REPLACE WITH CLEAN MEDIUM SAND.
�/� C) / 19. PLACE 40 ml POLY LINER AS SHOWN FROM EL 34.0 TO EL 30.0 TO PREVENT BREAKOUT
38 , , i i 36 cu
oo L_O T 2 i
T, ARLA = o.oo f i/ PROPOSED SEPTIC SYSTEM UPGRADE PLAN
47 SUFFOLK AVENUE, HYANNIS, MA
\ Prepared for: DaSilva
\ J MAP.- 291 DRAWN DATE:
-^; Engineering by: Surveying by: SCALE
SURVEY REFERENCE: LOT. 123 DARRENM.MEYER,R.S. Eco—Tech hbv&onmentel 1"=20' DMM 1 1/28/07
PLAN OF LAND BY WHITNEY & BASSETT, ENGINEERS i } LCP#.• 177734 PO BOX9B1 (508) 364-0894
E4srsANDW1CH,MA02537 REV. DATE: CHECKED SHEET NO.
DATED: DECEMBER 1958
"-362-2922 05/05/08 DMM 1 of 2
I
ELEV. TOP
FOUNDATION
(Existing)
FINISH GRADE= 37.50-37.0
41.01 F.G.EL: 37.0 F.G.EL 37.0 F.G. EL: 37.0
MAINTAIN 2% MIN SLOPE OVER LEACHING AREA
i
COVERS TO WITHIN 6 OF GRADE 6" INSPECTION PORT
X
�. L - 51 d ,, W/IN 6" OF FINISH GRADE
,•
' 6" • _ 4" SCH 40 PVC L = 40'
•. O O O O O O O O O O O O
_ 10"I S= 1% (MIN.) a 6
A: (MIN.) TEE'S ARE TO BE 14' 0 S= 1% (MIN.)
:. 4" SCH 40 PVC INV.35.OI
INV.35.25 O G V G G V C C G C G V
INV.34.80
GAS t PROPOSED DB-3
EXISTING OUTLET BAFFLE
INV. 37.76 •: H-10 DISTRIBUTION BOX I ;'6.7'/9.45'
INV. 35.5 PROPOSED 1,500 GALLON SEPTIC TANK
NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING FXM?r r 9" MIN.
PIPE INVERTS PRIOR TO CONSTRUCTION say PER TI TLE 5
2) SEPTIC TANK AND D-BOX SHALL BE SET LEVEL
AND TRUE TO GRADE ON A MECHANICALLY BREAKOUT EL. = 34.50
COMPACTED SIX INCH CRUSHED STONE BASE,
DARR�N ys AS SPECIFIED IN 310 CMR 15.221(2) INV. ELEV.= 34.0
�c ME 3) INSTALL INLET & OUTLET TEES AS REQUIRED DW&E��'S f 24" 30.5"
�Fd0: �14U "' INVERT 1
REcisrEt�°� SEPTIC SYSTEM PROFILE BOTTOM EL.- 32.0 L_3s 50" 35" -�
�NITAR�a
SEPARATION 5.98 FT. I �20" _
0 BOTTOM OF TH-1 EL: 26.02 SOIL ABSORPTION SYSTEM (SECTION)
SOIL LOGS P#: 11992 " DESIGN CRITERIA
NUMBER OF BEDROOMS: 5 BEDROOOMS
DATE: NOVEMBER 2, 2007 SOIL TEXTURAL CLASS: CLASS 1 (0.74 GPD/SF)
DESIGN PERCOLATION RATE: <2 MIN/IN
SOIL EVALUATOR: DARREN MEYER, R.S., CSE DAILY FLOW: 110 G.P.D. DESIGN FLOW: 550 G.P.D.
WITNESS: DONNA MIORANDI, BARNS. BOH GARBAGE GRINDER: NO (not designed for garbage grinder)
r M1 SEPTIC TANK: 660 gpd x 2 = 1,320 gpd USE PROP. 1,500 GALLON SEPTIC TANK
Elev. TH-1 Depth Elev. TH-2 Depth Elev. TH-3 Depth Elev. TH-4 Depth LEACHING AREA REQUIRED: (550) = 743.24 S.F.
37.62 A 0" 37.52 A 0" 37.21 0" 37.05 p" .74
LOAMY SAND LOAMY SAND A LOAMY SAND A LOAMY..� 10YR 4/2 10YR 4/2 10YR 4/2 ? 1OYR 4/2ND USE SEVEN (7) INFILTRATOR 3050 UNITS IN THE CONFIGURATION SHOWN .
36.79 10" 36.69 10" 36.54 8" 36.38 8" ONE TRENCH OF (1) 3050-S WITH 1' STONE ON ENDS AND 2.91 STONE ON SIDES
B LOAMY SAND B LOAMY SAND B LOAMY SAND B LOAMY SAND ONE TRENCH OF (6) 3050'S WITH 1' STONE ON ENDS AND 2.91 STONE ON SIDES
10YR 6/4 10YR 6/4 10YR 6/4 10YR 6/4 BOTTOM AREA: 46.7 x 10 + 9.45 x 10 = 561.5 SF
35.12 30" 35.02 30"
Cl Ct SIDE AREA: (46.7 + 10 + 36.7 + 9.45 + 10 + 19.45) X 2 = 264.6 SF
MEDIUM SAND MEDIUM SAND 34.21 36" 34.05 36 TOTAL SQUARE FEET PROVIDED = 826.104 vs. 743.24 REQ'D
2.5 Y 6/4 2.5 Y 6/4 C1 C1 DESIGN FLOW PROVIDED: 0.74(826.10 S.F.) = 611.31 G.P.D. vs. 550 G.P.D. req'd
PERC 032.62 MEDIUM
6/4NE PERC ®49.09 MEDIUM SAN
2
2.5 Y6/4 PROPOSED SEPTIC SYSTEM UPGRADE PLAN
31.62 72" 31.52 72" '
C2 MEDIUM C2 MEDIUM - 47 SUFFOLK AVENUE, HYANNIS, MA
SAND SAND 2.5 Y 7/4 2.5 Y 7/4 Prepared for: DaSilva
Engineering by: Surveying by: SCALE DRAWN DATE
26.12 1 138" 26.02 138" 26.71 126" 26.55 126" DARRENM.MEYER,R.S. Eco-Tech Rnvironmentei N.T.S. DMM 1 1/28/07
PERC RATE <2 MIN/IN. ("Cl" HORIZON) PERC RATE <2 MIN IN. Po BOX saf (508) 364-0894REV. DATE:
NO GROUNDWATER OBSERVED NO GROUNDWATE COBSERVED N) a5o"s2-2922 cH ntiaozss� 5/05/08 CH DMM SHEET
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