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0023 SYCAMORE STREET - Health
yci i.rl:2 ..7'M"" < 4... di a. o v�:6 rr +j r Hyannis' �F04� ° v c o a o K r TOWN OF BARNSTABLE LOCATION C V1 D 1'Z.F 5(P. SEWAGE# -VILLAGE q h h►kS ASSESSOR'S MAP&PARCEL E INSTALLERS NAME&PHONE NO. F� SEPTIC TANK CAPACITY a o LEACHING FACILITY:(type) ' �O G C b414h W-S'(size) NO.OF BEDROOMS OWNER PERMIT DATE: I I/ 7,111 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY L r � i P 9� a p -c .c i C S. No. G�Il p Fee T!�€-COMMONWEALTH OF MASSACHUS,ETTS. Entered in computer:_ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLt—MASSACHUSETTS Zlpplira iO4 for disposal *pst>ent Construction hermit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. a 3 S`aG rt n1 f/i'� Owner's Name,Address,and Tel.No. 7 t 71 2 y r)9 Assessor's Map/Parcel 310 Q 4 ��`�9 n n, S 14 'G V I c(_ S'.J am ) /9,1 Pt o k P I'P) Installer's Name,Address,and Tel.No. Ect d(03('� Designer's Name,Address and Tel.No. $og- 7-2 S 7 00- Z 116c, afvl�-r-s C c„Sj 1,20"1C4 C9 PJ� nd r 0 o 9-e 12g- Type of Building: J VV 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) 330 gpd Design flow provided gpd Plan - Date VaV• t-t a Number of sheets Revision Date Title Size of Septic Tank ISop Type of S.A.S. a ' SoD S,4 1 nr� c�,,icj L-f Description of Soil Se?Se j Lq Nature of Repairs or Alterations(Answer when applicable) SP P DpS,,�^�1 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of " Compliance has been issued by this Board o 2/1 lth.tgn Date 1/ Application Approved by Date l 7 Application Disapproved by Date for the following reasons Permit No. // Date Issued No. rlCJ�� �7C i,� i Fee :TEE COMMONWEALTH OF MASSACHUSETTS' Entered in computer. PUBLIC HEALTH (VISION -TOWN OF BARNSTABLE-, RlI—A--SSACHUSETTS _ applidbift4 misposal *stern Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. a 3 S�C 5 rh Ury{ S Owner's Name,Address,and Tel.No. 7 1 - 7 I a tiCC 1 Assessor's Map/Parcel O ( f" V 1 Lt" ) 4rinei- Installer's Name,Address,and Tel.No. Set'�(oa (� 7 Designer's Name,Address,and Tel.No. S oFr 77,s— S 7 GCi � IIiS �rc(lrr'S Cc�S� IZcn�l(/) C9 ►'�' IIyL n -ks g- Type of Building: JVU- C7, 6 Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) ll i Other Type of Building No.of Persons Showers( ) Cafeteria Other Fixtures a Design Flow(min.required) 33p gpd Design flow provided gpd 1 Plan Date Number of sheets ) Revision Date Title i Size of Septic Tank Isom Type of S.A.S. .1 - Description of Soil SP P S L,cd t Nature of Repairs or Alterations(Answer when applicable) SP P sw,6 ,),•C,C;rej d t Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in 1,accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Date Application Approved by Date / Application Disapproved by Date for the following reasons �I 3�'1 Permit No. �.- Date Issued i 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 , <d Ig 1Cc in }. at has been constructed in accordance with the provisions of Title"5 and the�for Disposal System Construction Permit No-Z&_-323dated Installer 1=I I,S fa 1'l ad Cc�S). Designer 12, <� Cc fL//1 S i #bedrooms Approved design flow 2�C-1 gpd i The issuance of this permit shall not Pe construed as a guarantee that the systemv�iTCfilctio esigned. Date //' ad/ I Inspector --------------------------------------------------------------------------------------------------------------------------------------- No. -- 3P Fee / P THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Misposai &pstem Construction Permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) System located at e ��� <9'`i o ry 57 htti,, M � . f i+-i 9 and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to cd..mply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this pe it. I Date �� / 1 Approved by� I i Town of Barnstable P#_ Z . oFTME'tiryl, Departinent of Regulatory Services J Public Health Division MAMSDate 200 Main Street,Hyannis MA 02601 Date Scheduled A/� — Time—-� Fee Pd. Soil Suitability Assessment for S e Disposal Performed By. B �' L_L �, Witnessed By: / -Si &GENERALT-TIIFCjj IA:Tr0N - ---- -- - Location Address 2-3 S CA 94 a Name Y mares Stp F ''r Rna�t r,uo I-E�R nrl i 5 -Address . l4 for yST Assessor's Map/Parcel: 7jj DjDg 8 En 'neer's Name W-41 A n n i ,VI�pA 0245 NEW CONSTRUCTION REPAIR Telephone# 50 8—7 7 j—970 U Land Use ,*I/g i-D Slopes(%) (J" [O°7 Surface Stones n0 Distances from: Open Water Body ft Possible Wet Area A g . Drinking Water Well _ft Drainage Way ft Property Line �ft Other r- ft SKETCH:(Street name,dimensions of lot,exact locations of test holes& rc tests,l ate wetlands in proximity to holes) IV (Tt — _ Parent material(geologic) Depth to Bedrock 34 Depth to Groundwater. Standing Water in Hole: 7}7(�. ' �(-- Weeping from Pit Rnee � n i7Pi Estimated Seasonal High Groundwater ut. /� :�1 ( (�1�9 P�f}yL ul pV,0 us I'AZ,, Tewv � DETERMINATION FOR SEASONALHIGH WATER TABLE pt Method Used — (9w1 6J('�1 �j �L, . ON TC9rnlgJ Depth Observed standing in obs.hole: In. Depth to Soll mottles: in. Depth to weeping from side of a s.hole: In. tDro th to soil Ad usttnent in Index Well# •9/ l3(Reading Date: (o Index Well level Adj.factor Adj.Oroundwnter Level � D _IIF. ' PERCOLATION TEST . buts j'lYme D, Location Address ^L 3 SYCA Mctiv *V-6 Name .1. Si.S"ti 1 rr I 1;J0 14� Anni aS Address . l� �At/lor 5T Assessor's Map/Parcel: 31(� C72+ ��iT� Engineer's Name �' R J: CA.C>tu.J-v NEW CONSTRUCTION REPAIR Telephone# 53 5v 8—7 7S —q,7®o Land Use- YR y'A Slopes(%) U— �O`� Surface Stones �D Distances from: Open Water Body /v 14 ft Possible Wet-Area /Lv lq ft Drinking Water Well �ft Drainage Way ft Property Line Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes& rc tests,IwIte wetlands in proximity to holes) Q b 4P` N s y o9 mare �ST- Z ,�l .41 (•Z�f Parent material(geologic) Depth to Bedrock /v l ` Depth to Groundwater. Standing Water in Hole: �h M Weeping from Pit Face___ n new �J r Estimated Seasonal High Groundwater ul. � : t (�1�9 ELA21 1112 V. 4ug ( C9 W"U t DETERMINATION FOR SEASONAL HIGH-WATER TABLE p� Method Used: ( W 6�I 1 2 3 t et, O N C>w pU m a 7� e t/47/) Depth Observed standing in obs.hole: in, Depth to soil mottles: "6 r� Depth to wceping from side of o s.hole: in, Oroundwater Adjustment ft. Index Well# G D heading Date: Index Well level Adj.factor Adj.Groundwater level,, , J PERCOLATION TEST butt: /Tim" M Observation Hole# Z Time lit 9" ^ ), Depth of Penc Time at G" ' Start Pre-soak Time ZQ9,110 Time(9"-V) End Pre-soak �Zt� VJ 0,0� 7/kl Zml Rate Min./Inch le� Site.Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) !V -- Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the, Barnstable Conservation Division at least one(1) week prior to beginning. Q:\SEPTIC\PERCFORM.DOC DEEP-OBSERVATION HOLE LOG Hole# 2 Depth from Soil Horizon Soil Texture Sdil Color Soil- Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency.% ravel P �i C �.C, / 2 5 s f 2 e , ' . 2,S 6 - , DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsi tency.%Gravel n 1-2/ 72►►-� 7 2, D A� Flood Insurance Rate Map: --- Above 500 year flood boundary No Within 500 year boundary' No= Yes Within 100 year flood boundary No; 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 absorptibn system? If not,what is the depth of naturally occurring pervious malarial? Certification I certify that on Ne V �3(date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required experti nd experience described in 310 CMR 15.017. Signature Date Q:\SElyn0PERCFORM.DOC i Town of Barnstable �p tHE T °'tip Regulatory Services, Thomas F. Geiler, Director BARNSTABLE, MASS. s6 Public.Health Division 0� AIFOMP�p Thomas 0McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: Designer: �JC,.A.D 1I I Installer: E l l 1 S brOS .Address: (}, to Address: 2 G-Ni 4(-r pr t Sa RBI 0 2.�075 On 6ar ,r, CuNS�was issued a permit to install a (date) (installer) f ' tt rih1S septic system at 2 ��j AYY1� ' s� ,, based on a design drawn by n (address) l: 1L6/4--C S dated (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the L ' distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. H 0"an6 A9gss� staller's Signature) ) RONALD JAMES m } CADILLAC -' 1060�a Is'I qn, P. (Designer s S rgn e) (Affix Mip Here) PLEASE RETURN TO BARNSTABLE 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: Health/Septic/Designer Certification Forrn I � t GF SME 1p� Town of Barnstable Barnstable AMm Regulatory Services Department edcaC j ' BARNSTABLE. 639. ,�� Public Health Division Area"`A+a 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.OMcKean,CHO' CERTIFIED MAIL # 7011 0470 0001 4525 5426 920 October 20 2011 78 V Mr. Anthony Pino 14 Taylor Street Waltham, MA 02453 `}� c ,V Fel YOU ARE SCHEDULED TO APPEAR BEFORE THE BOARD on Tuesday, November 81h 2011 at 3 prri in the Town Hall, Hearing Room, 2nd Floor 367 Main Street, Hyannis, MA due to your failure to repair or replace the failed septic system at 23 Sycamore Street, Hyannis, MA. The State Environmental Code Title V requires all failed septic systems to be repaired or replaced within two years. The Town of Barnstable Board of Health has more stringent Cow, ap/, deadlines dependent upon the type of failure identified. In this case, the septic system 1/' has been in failure beyond the established deadline. .4 :7 You will be given the opportunity to testify, present witnesses, documentary evidence, and other official information regarding this case. PER ORDER OF THE BOARD OF HEALTH • z" c Wayne Miller, M.D. Chairman Q:\SEPTIC\Letters Septic Inspection Failures\23 Sycamore St Hy BOH Oct201 Ldoc SOUTH COASTAL COUNTIES LEGAL SERVICES, INC. Hyannis Law Office TEL (774) 488-5940 • (800) 244-9023 460 West Main Street FAX(508) 790-3955 Hyannis, MA 02601-3653 ryox@sccls.org November 20, 2019 Q; Town of Barnstable a /o Inspectional Services Department Public Health Division 200 Main Street Hyannis, MA 02601 Re: Ms. Kimberly Robinson, 23 Sycamore Street, Hyannis, MA 02601 Dear Health Inspector, South Coastal Counties Legal Services, Inc. is representing Ms. Kimberly Robinson in a summary process action regarding her tenancy at 33 Sycamore Street, Hyannis, MA,,02601. She has advised us that she has reported sanitary code violations at her apartment to your department. Her landlord is Anthony Pino. Please forward certified copies of all documents, letters and health inspection reports conducted at the 33 Sycamore Street residence since the beginning of Ms. Robinson's tenancy, December 15, 2016 to the present. Please send the requested certified documents, letters and health inspection reports to.me at the above address. Please contact me if there is a fee required to be paid to receive the requested documents. Thank you for your anticipated cooperation in this matter. Very truly yours, _Raymond A. Yox Attorney at Law RAY South Coastal Counties Legal Services is funded by individuals,corporations,municipkities,foundations,and the following partners: s United TT cc elder �<r r- !'®La�JC SerVt�eS ' ` ' Coastllne Way Massachusetts Legal Assistance Corporation . 2/4/2020 Citizen Web Request ,,ie o NI MAIN. Citizen Request Management Request ID: 70296 Created: 10/10/2019 3:18:54 PM Status: Closed Assigned To: Parziale, Jim Health Department Anonymous: No Category: Chapter II : Housing Q Substandard E.C. Date: 10/25/2019 Created By: Crocker, Sharon Citations: Health Department Time Worked: 2.00 Response Time: 8.00 Request Location: Parcel Number: Map: 000 Block: 000 Lot: 000 Request: Property is a rental and is not registered. Single house. Tenant has had issues since moving in Jan 2017. Her Sec.8 Housing Office (Ya rm)identified in their Jan 2017 inspection that the Boiler needed repair and this has never been fixed. The Gas Co had come out to light pilot and determined it needed to be cleaned and serviced before it was safe for them to light pilot. Without boiler, they were using fireplace for heat, flue is broken and LL said can't use until he fixes. Landlords come and go into property without permission or proper notice and are storing things in basement. They have been to Court. Court told Landlord to move his-items out but has not been done. Request Work History: Entered on 10/16/2019 4:00:44 PM left message with occupant but have not heard back. called again but could not hear her on her phone. called owner who said he has a service for boiler scheduled for 10/31. Entered on 10/23/2019 8:03:02 AM boiler works but the pilot blows out frequently. house still has heat service will fix pilot issue according to owner. Entered on 12/3/2019 3:05:10 PM boiler was serviced as scheduled and had a few minor repairs made to it. spoke with occupant and boiler has been working fine since. owner asked for a little extra time to register due to busy schedule this time of year. will continue to monitor to make sure property gets registered. https://itsgldb.town.barnstable.ma.us/CitizenRequest/WRequestPrintPub.aspx?ID=70296 1/2 Town of Barnstable P#_ 1-3 gyp' Department of Regulatory Services Public Health Division Date i63¢ '20.0 Main Street,Hyannis MA 02601 Date Scheduled' � / Jf / Time Fee Pd. Soil Suitability Assessmentfor S e Disposal Performed•By:�_Io /�-A (_L �, Witnessed By: LOCATION & GENERAL INFORMATION Location Address 23 S cA Butn.►re Name 1�p � T1'IbY� S-r'o . --// i���-A11 d 1'/,V p - 14! a n n 1-5 Address l� t A.1 16 r- S-r Assessor's Map/Parcel: :31 o tA/41� inj i MA 0245-3 ' Engineer's Name R J.>CA IN Ll_)9� NEW CONSTRUCTION REPAIR Telephone#. 5d 8—7 7S—VO U Land Use Slopes(g'o) U Surface Stones /0 if Distances from: Open Water Body V 4 ft Possible Wet Area LV A ft .'Drinking Water Well �ft u, / Drainage Way_ 411A ft Property Line !0/ ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes& re tests,1 ate wetlands in proximity to holes) NO 3 4729 N� 5yc/iTy -are S1 7 � _ Parent material(geologic) Depth to Bedrock Depth to Groundwater. Standing Water in Hole: �t2 6P Weeping from Pit Fnce__ ! LA M!t, Estimated Seasonal High Groundwater Et /f) :"G r B 1J FIA , pa t/4u� Ls" DETERAUNATION FOR SEASONAL HIG WATER TABLE p Method Used: &J 23 r ,S ` .�,i O AJ W uJAJ hly 5fe [A-0 Depth Observed standing in obs.hole: In. Depth to soil mottles: in, Depth to weeping from side of o s.hole: In, GroundwateLr Ad ustment ft. Index Well 2# QReading Date: W2 Index Well level AdJ,factor._( Adj.CiroundwaterLevel,.� D I j M Observation PERCOLATION TEST . Dittof9F/ hne p r Hole# Z Time at 0" N Depth of Pere --I-r)— Time at G" � Start Pre-soak Time @ 19 Time(9",6") End Pre-soak ff20 'G l9/ULC 7 r Rate MinJlnch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you musffirst notify the. Barnstable'Conservation Division at least one (1) week prior to beginning. Q:\.S EPTIWERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Sdil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. " Consistency.%'Gravel D /2�� / •Qr. 1.9rt� /l' 3 rlo 7?'�/30 Z e .1 2,5 6 DEEP OBSERVATION HOLE LOG - H01e# 7— Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) ! (USDA) (Munsell) Mottling. (Structure,Stones,Boulders. Consistency,% el Tz/ C/ G, 2� s DEEP OBSERVATION HOLE LOG Hole# - - Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,9 Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Sol] Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, 01mveI Flood Insurance Rate Above 500 year flood boundary"^No_ Yes_k:!:� ' Within 500 year boundary' Nc= Yes Within 100 year flood boundary No 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 absorptibn system? — If not,what is the depth of naturally occurring pervious material? Certification qq� I certify that on ��/0 v (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required t experti nd experience described in 310 CMR 15.017. Signature Date Q:\SEPrWPERCFORM.DOC i I I � T �r 1 t � " C N 7 I ' J L 1 � Q V r� v� I \ 7 4• c� Barnstable Town of Barnstable "`` KV Regulatory Services DepartmentA&A"'' aC BARNSPABLE, 9 MASS. A $, .639. Public Health Division m DM a 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL # 7011 0470 0001 4525 5426 October 20 2011 Mr. Anthony Pino 14 Taylor Street Waltham, MA 02453 YOU ARE SCHEDULED TO APPEAR BEFORE THE BOARD on Tuesday, November lst 2011 at 3 prn in the Town Hall,-Hearing Room, 2nd Floor 367 Main Street, Hyannis, MA due to your failure to repair or replace the failed septic system at 23 Sycamore Street, Hyannis, MA. The State Environmental Code Title V requires all failed septic systems to be repaired or replaced within two years. The Town of Barnstable Board of Health has more stringent deadlines dependent upon the type of failure identified. In this case, the septic system has been in failure beyond the established deadline. You will be given the opportunity to testify, present witnesses, documentary evidence, and other official information regarding this case. PER ORDER OF THE BOARD OF HEALTH Wayne Miller, M.D. Chairman r� Q:\SEPTIC\Letters Septic Inspection Failures\23 Sycamore St Hy BOH Oct2011.doc r ,l �t Barnstable SHE Town of Barnstable T°�� Board of Health j�1e'�j ' BARNSTABLE, ' MASS. 200 Main Street Hyannis MA 02601 q, i639. Y °Tf0 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi CERTIFIED MAIL # 7011 0470 0001 4525 5358 September 30, 2011 FIDC Receiver INDYMAC Bank, FSB c/o Mark Bruce P.O.,Box 8265 Wichita Falls, TX 76301 YOU ARE SCHEDULED TO APPEAR BEFORE THE BOARD OF HEALTH on Tuesday, October 11, 2011 at 3pm in the Town Hall, Hearing Room, 2nd Floor, 367 Main Street, Hyannis, MA due to your failure to repair or replace the failed septic system at 23 Sycamore Street, Hyannis, MA 02601 • The State Environmental Code Title V requires all failed septic systems to,be repaired or replaced within two years. The Town of Barnstable Board of Health has more Stringent deadlines dependent upon the type of failure identified. In this case, the septic system has been in failure beyond the established deadline. You will be given the opportunity to testify, present witnesses, documentary evidence, and other official information regarding this case. PER ORDER OF THE BOARD OF HEALTH Wayne Miller, M.D. Chairman Q:\SEPTIC\Letters Septic Inspection Failures\You are Scheduled.doc t i PROPOSAL 11062 ELLIS BROTHERS • CONST. CO. PAGE OF P.O. Box 59 23 Enterprise Road YARMOUTH PORT, MA-02675 508-362-6237 PHONE DATE TO: ANTHONY PINO 781-718-2420 10/31/2011 14 TAYLOR STREET JOB NAME/LOCATION WALTHAM MA 02453-5252 ANTHONY PINO 23 SYCAMORE STREET HYANNIS,MA JOB NUMBER JOB PHONE 11-062 781-894-9030 We hereby submit specifications and estimates for: PRICE TO INSTALL TITLE 5 SEPTIC SYSTEM AT 23 SYCAMORE STREET, HYANNIS,MA AS DESIGNED BY RONALD J. CADILLAC, PLS,RS,P.C. , P.O. BOX 258, WEST YARMOUTH, MA 02641, PHONE NUMBER 508-775-9700, DATED 10/07/2011, JOB NUMBER FB26/54 SB12/45 AND THE APPROVAL OF THE BARNSTABLE HEALTH DEPARTMENT. 4,760.00 NOTE SEPTIC TANK IS 1500 GALLONS. SEPTIC TANK IS NOT H-20 AND A BARRICADE IS REQUIRED FOR PARKING AREA. 100.00 ALL IRRIGATION SYSTEMS, PLANT GROWTH, UNDERGROUND UTILITIES, CHANGES ON UMBING ON INSIDE OF HOME IF NEEDED, CHANGES NEEDED ON ELECTRIC SYSTEMS TO LNG UP TO CODE ON INSIDE OF HOME, COST FOR CHANGES ON SEPTIC DESIGN AND GINEERS FEES AREA OWNERS RESPONSIBILITY. PERMIT TO INSTALL SEPTIC SYSTEM. WITH ACCEPTANCE OF PROPOSAL PLEASE PROVIDE A FLOOR PLAN OF HOME . ( HAND MADE IS OK) FOR PERMIT WITH BARNSTABLE HEALTH DEPARTMENT. ANY QUESTION CALL REID AT 508-362-6237 BILLING ADDRESS r . NAME 41 / Y G ADDRESS'f U 7;1 1iZc)yel s/; �U✓�6 `'��C?; �,1 , d ys.� PHONE NUMBER /�'I-�I F 9.L,'1z D Service You Can Trust We Propose hereby to furnish material and labor—complete in accordance with the above specifications,for the sum of: Four Thousand Eight Hundred Sixty and 00/100. Dollars dollars($ 4, 860.00 )• Payment to be made as follows: ONE HALF DEPOSIT AND ONE HALF DUE DAY WORK IS COMPLETED. All material is guaranteed to be as specified.All work to be completed in a professional manner according to standard practices.Any alteration or deviation from above specifications Authorized involving extra costs will be executed only upon written orders,and will become an extra Signature f t L charge over and above the estimate.Ail agreements contingent upon strikes,accidents or delays beyond our control.Owner to carry fire,tomado,and other necessary insurance.Our Note:This proposal may be ware fully covered by Worker insurance. s Compensation insunce. withdrawn by us if not accepted within 45 days. A eptance of Proposal—The above prices,specifications and con- ditions are satisfactory and are hereby accepted.You are authorized to do the work as �/��/ specified.Payment will be made as outlined above. Signature Signature Date of Acceptance: SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signat e item 4 if Restricted Delivery is desired. �� X ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. eceived b (P' red Name) C. Da o Deliv ry ■ Attach this card to the back of the mailpiece; or,on the front if space permits. U�� � D. Is delivery address different b6m Rem 11 LJ Yes 1. Article Addressed to: e� If YES,enter delivery address below: ❑No Mr' &Mrs. David Cunningham _y 48`16 Quebec,N.W. t-�s R° Washington, DC 20018 ; 3: Service Type 't 0 certffied Mail ❑Express Mail ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number 70]r]i 0470 oaal 4525 5'419 C• (Transfer from service labeq 6.PS Form 3811,February 2004 t r? Domestic Return Receipt. 102595-02-M-1sao UNITED STATES POSTAL SERVICE First-Class Mai]PaId Postage&FeeUSPS Permit No.G-1 • Sender: Please print your name, address, and ZIP+4 in this box • Town of Barnstable Public Health Division d 200 Main Street Hyannis, MA 02601 I i SHE Town of Barnstable Barnstable Op TOw Regulatory Services Department WfteicaQW BAtNSfAULE, 1 9� "639: a, Public Health Division m AjFt)MAt A 200 Main Street, Hyannis MA 02601 2007 Office: 508-8624644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL # 7011 0470 0001 4525 5426 October 20 2011 Mr. Anthony Pino 14 Taylor Street Waltham, MA 02453 YOU ARE SCHEDULED TO APPEAR BEFORE THE BOARD on Tuesday, November 1"2011 at 3 pm in the Town Hall, Hearing Room, 2n8 Floor 367 Main Street, Hyannis, MA due to your failure to repair or replace the failed septic system at 23 Sycamore Street, Hyannis, MA. The State Environmental Code Title V requires all failed septic systems to be repaired or replaced within two years. The Town of Barnstable Board of Health has more stringent deadlines dependent upon the type of failure identified. In this case, the septic system has been in failure beyond the established deadline. You will be given the opportunity to testify, present witnesses, documentary evidence, and other official information regarding this case. PER ORDER OF THE BOARD OF HEALTH Wayne Miller, M.D. Chairman QASEPTICU.etters Septic Inspection Failures\23 Sycamore St Hy BOH Oct201 Ldoc Town of Barnstable Barn , THE l .� Regulatory Services Department AN-AmedCeCilv * saxtvsraBM b 9 ,�� Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geller,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 70062150000210418061 4/15/2009 INDY MAC Bank c/o David Holt, Today Real Estate 1533 Falmouth Road Centerville, MA 02632. ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 23 Sycamore Street Hyannis,MA was last inspected on October 1, 2008,by Shawn McElroy, a certified septic inspector for the State of Massachusetts. l The inspection of the septic system showed that the system "Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Backup of sewage into facility or system component due to an overloaded or clogged SAS. • Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS. You are ordered to repair or replace the septic system within Sixty(60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures\23 Sycamore Street.doc Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 23 Sycamore St Property Address INDY MAC Bank- (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Hyannis MA 02601 10-1-08 every 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. A. General Information 31 o' a48 1. Inspector: Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name 29 Atwater Dr Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number 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 ® Fails ❑ Needs Further E aluation by the Local Approving Authority �. CD 10-1-08 Q �` Inspector's Signature Date N The system inspector shall submit a copy of this inspection report to the App q ing AuMrity C,00ard of Health or DEP) within 30 days of completing this inspection. If the system Is shared syste,[p or has a design flow of 10,000 gpd or greater,the inspector and the system owne shall s tUmit the report to the appropriate regional office of the DEP.The original should be sent to the stem Wyvner 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. t5insp•03/08 -Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w 23 Sycamore St Property Address INDY MAC Bank (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Hyannis MA 02601 10-1-08 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Answer yes, no or not determinedd(Y, N, ND)in the ❑ for the following statements. If"not determined,"please explain. ❑ The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due ' to broken or obstruc�_ed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed t5insp-03/08 Title 5 Official Inspectlon Form:Subsurface Sewage Disposal System-Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for.Voluntary Assessments 23 Sycamore St Property Address INDY MAC Bank_ (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Hyannis MA 02601 10-1-08 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): f , ❑ , distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR J 15.303(1)(b)that the system is not functioning in a mannerwhich will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. t5insp-03108 Me 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 15 r , l Commonwealth of Massachusetts Title 5 Official Inspection Form i a Subsurface Sewage Disposal System Forth -Not for Voluntary Assessments 23 Sycamore St Property Address INDY MAC Bank_ (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Hyannis MA 02601 ' .10-1-08 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank.and SAS and the,SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: *" This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria.Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6"below invert or available volume is less than day flow ❑ ® 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. El ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. t5insp•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts , Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 23 Sycamore St Property Address INDY MAC Bank_ (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Hyannis MA 02601 10-1-08 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ` ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ 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.) The system is a cesspool serving a facility with a design flow of 2000gpd- ❑ ® 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ` ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—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 CM 15.304. The system owner should contact the appropriate regional office of the Department. t5insp•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection. Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 23 Sycamore St Property Address INDY MAC Bank_ (Contact,David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Hyannis MA 02601 10-1-08 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ❑ ® 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)] t5insp•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 23 Sycamore St Property Address INDY MAC Bank_ -(Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Hyannis MA 02601 10-1-08 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x #of bedrooms): 330 Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 908IGPD 9 ( Y 9 (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: 7-08 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: Last date of occupancy/use: Date Other(describe): t5insp•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 ^I t Commonwealth of Massachusetts Title .5 Official Inspection Form s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 23 Sycamore St Property Address INDY MAC Bank_ (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Hyannis MA 02601 10-1-08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: N/A ' 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): Approximate age of all components, date installed (if known) and source of information: 2004 Were sewage odors detected when arriving at the site? ❑ Yes ® No t5insp•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 23 Sycamore St Property Address INDY MAC Bank- (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Hyannis MA 02601 10-1-08 -- every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 14 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.): Good condition. Septic Tank(locate on site plan): 8" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 1000 Gal i Sludge depth: 20" Distance from top of sludge to bottom of outlet tee or baffle 12" Scum thickness 12 3" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 5 How were dimensions determined? Tape t5lnsp-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15 - 1 'Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 23 Sycamore St Property Address INDY MAC Bank_ (Contact;David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Hyannis MA 02601 10-1-08 every page. City/Town State Zip Code Date of Ir:spection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or,baffie condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Septic tank in good with!baffles in place. Recommended pumping to remove solids. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain): Dimensions: , Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, . liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): t5insp.03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 23 Sycamore St Property Address INDY MAC Bank_ (Contact David Holt @ Today Real Estate 1-80M66-2448) Owner Owner's Name information is required for Hyannis MA 02601 10-1-08 � every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) _ •. r Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): » *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box (if present must be opened) (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.): Box in good condition with stain lines above inlet invert. Pump Chamber(locate on site plan): Pumps in working order: F ❑ Yes ® No Alarms in working order: ❑ Yes ® No t5lnsp•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 23 Sycamore St Property Address INDY MAC Bank_ (Contact David Holt@ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Hyannis , MA 02601 10-1-08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Pump chamber was opened and evaluated, but due to power being turned off, pump and alarm were not checked. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 2-500's ❑ leaching galleries number: ❑ Teaching 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.): ` " Leach chambers had clear signs of being filled beyond capacity with stain lines in risers. t5insp•03/08 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 23 Sycamore St Property Address INDY MAC Bank_ (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Hyannis MA 02601 10-1-08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) , 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 i Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts Title 5 Official, Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 23 Sycamore St Property Address INDY MAC Bank. (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Hyannis MA 02601 10-1-08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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. _vb O t w ck OD t5insp•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 23 Sycamore St Property Address INDY MAC Bank_ (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for Hyannis MA 02601 10-1-08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 15 i feet Please indicate all methods used to determine the high ground water elevation: I ® Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers- (attach documentation) ® Accessed USGS database-explain: You must describe how you established the high ground water elevation: Original design plans show no groundwater at 10'. t5lnsp•03/08 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 15 of 15 TOWN OF BARNSTABLE LOCATION, /�i� "+ n S✓ SEWAGE # 1..y 0 VILLAGE 1`t//X��Ni S ASSESSOR'S MAP & LOT- . INSTALLER'S NAME&PHONE NO. 1/! AJ �� �✓s> �� C SEPTIC TANK CAPACITY "�S a P 5 7- LEACHING FACILITY: (type) rq�)S'o eC40 (size)-2.5,1(i 3 ,NO. OF BEDROOMS 3— BUILDER OR OWNER 9 n/ PERMITDATE: t> COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by � -�, � �� � � �a _! . G.; "' r � . � t . .` �'J '. 'i '• _ � r ' � .. Q e\ _ � -�� . � � � .,_. :. ® � W � i �, n �, � � � ,� � \ � w � �, � � _ , . _ . . l6`CATION 1� S E W A G E PERMIT NO. CD VILLAGE , g ',l,v . n 2-6 1 { INSTALLER'S NAME & ADDRESS J..CRAIG MEDEIR--OS !eSo rix an G U I L D E R OWNER yclints, !V q= 775-0820 �s�7 J /cam pos oNA , DATE . . PERMI.T .ISSUED a DATE 'COMPLIANCE ISSUEDJI O _ � � _ . rt � _ �. .v �` 9 ' o \ � �ie1� , . � � .�� ��� X �o � � _ , ` � i t 11 may)i No. � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: �L Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZIppYication for �Bigpotal *p5tem Con.5truction Permit Application for a Permit to Construct( )Repair( Upgrade Abandon( ) O Complete System D Individual Components Location Ama //ss or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel, / D o '5� r / y Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. � 2Gf/ c"ori5.7 .p44/119i,/ � t=yC"L � 36- Type of Building: �! � nNt�t/c� Dwelling No.of Bedrooms S sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures c Design Flow 7 ' d gallons per day. Calculated daily flow 5 9 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /D 63:1 d /=' -.S T, Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when a plicable) ��/�"1� ��/ /3 "y J'= Z G� D X 5 c� d C' i9 y°iul y 2-5- 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 nd not to place the system in operation until a Certifi- cate of Compliance has been issued Yy this B oajP of Hea Signed, - A Date 7 Yx4//D Application Approved b Date v Application Disapproved for the following reasons Permit No. 0 _ Date Issued y U L 140. d�u L'- I (I ! Fee / - (. / �'`. l THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: . � •�.., �.F........:�, Yes T ; PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 01pplication for Mitpozaf *poteltt Con.5truction Permit Application for a Permit to Construct( )Repair( Upgrade( )Abandon( ) ❑C�plete System ❑Individual Components Location Address or Lot No. Owner wne 's Name,Address and Tel.No. ,23 -S yc A rh d 2 /nN� s �� 6► f:11� ,�/V . / Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: a /YOM/I�f bide h^�^ ✓��✓� Dwelling No.of Bedrooms 3 L-ot Size`~— sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow y gallons per day. Calculated daily flow 3 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /O02r> i� y • 5, % y Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when a plicable) � ii� O X "�? 5 vd c' .Ashlti luS Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certify- cafe of Compliance has been issued, y this Boar of Health. / I i /D li Signed / Date Application Approved by /1r �.. Date Application Disapproved for the following reasons Permit No. a U�L�" I,�� Date Issued L 2 U ------------------------------------------ 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 "/o 2- e { at �z 3 Sy /y ' 02 F has been construct d try accordance with the provisions of Title 5 and the for Disposal System Construction Perrmtt,�o. 0 Od " l dated . '310 Installer A 2 e /-,e Designer 0"I /t E 'i The issuance of this p rmit shah not be construed as a guarantee that the�syste u i�t "s designed. M20 l t• Date 9 �J Inspector'_Sc -�.a_ 1 --------------------------- --No. o11oL/.'4 / Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Migo$ar *p$tem Cow5truction Permit Permission is hereby granted to Construct( )Repair( Upgrade( )Abandon( �) System located at 3 S,/ �9 `' O 2 it S7 //7;/ ,y v i j and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction, ust be completed within three years of the date of th' )erm' Date:_ 0 �� Oil Approved by /�?J-- l . Town of Barnstable yP�°Estee rgy�o� Regulatory Services Thomas F.Geiler,Director UAS& Public Health Division i6j. `0 ArmA Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office:.508-862-4644 Fax: 508-790-6304 Installer &Designer Certification Form Date: a 2004 Designer: A-P-42-E "GR Installer: Address: . Address: On was issued a permit to install a (date) (installer) septic system at based on a design drawn by , AA �nn (address) 'vt AF- eg �dS- dated A' v► Cj (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State& Local e .ons. Plan revision or certified as-built by designer to follow. �H of �. ^ass DARRE yGs o� M. f� Y (Installer's ignature) 40 10 64NITAR\Pa 1� v (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARN TABLE 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:Health/Septic/Designer-Certification Form _ TOWN OF BARNSTABLE LOCATION �� C"e '''°/L� ✓ SEWAGE # -�L®0 VILLAGE �T}'A�"'�3 ASSESSOR'S MAP & LO e' 47 INSTALLER'S NAME&PHONE NO. 4 A--W 6' SEPTIC TANK CAPACITY b a 5 T J /� a o LEACHING FACII.ITY: (type)C�So®C'4'�,•.LENS .(size) k !I- NO.OF BEDRODMS BUILDER.OR OWNER ' �'9 �✓ �/� '�� PERMIT DATE: COMPLIANCE DATE: Separation Distance Bet e: Maximum Adjusted Groundwater-Table to the Bottom of Leaching Facility - Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist >within 300 feet of leaching facility) Feet - I Furnished by 3-1 ?7P G � G i + FAILED INSPECTION COMMONWEALTH OF MASSACHUSETTSCOP EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS Z F DEPARTMENT OF ENVIRONMENTAL PROTECT.ION REC�EHoVED w JAN 0 8 2003 p1M Syev TOWN OF BARNSTABLE HEALTH DEPT. TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION �Zlol � Property Address: 23 SYCAMORE ST HYANNIS,MA 02601 Owner's Name: FRANK FLYNN Owner's Address: 42 FARMSIDE DRIVE PEMBROKE,MA 02359 1 Date of Inspection: 11/29/02 MAP PARCEL Name of Inspector: (please print) JOHN GRACI LOT 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: _ Passes _ Conditionally Passes _ Needs Fu Evaluation by the Local Approving Authority X Fails Inspector's Signature: Date: 11/29/02 The system inspector shall submi a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspe ion. 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 SYSTEM FAILED TITLE V INSPECTION. LIQUID LEVEL IN D-BOX IS FULL OVER PIPES.THE PIT HAS NO EFFECTIVE LEACHING LEFT. ****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 5 1ncnp.rtinn Fnrm h/l 5/?f160 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 23 SYCAMORE ST HYANNIS,MA 02601 Owner: FRANK FLYNN Date of Inspection: 11/29/02 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: SYSTEM FAILED TITLE V INSPECTION. LIQUID LEVEL IN D-BOX IS FULL OVER PIPES.THE PIT HAS NO EFFECTIVE LEACHING LEFT. 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 i Page 3 of I 1 I : OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 23 SYCAMORE ST HYANNIS,MA 02601 Owner: FRANK FLYNN Date of Inspection: 11/29/02 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 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 23 SYCAMORE ST HYANNIS,MA 02601 Owner: FRANK FLYNN Date of Inspection: 11/29/02 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 nLa. _ 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.] X _ (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no _ X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply _ X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 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. a Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 23 SYCAMORE ST HYANNIS,MA 02601 Owner: FRANK FLYNN Date of Inspection: 11/29/02 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)] d. S Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 23 SYCAMORE ST'HYANNIS,MA 02601 Owner: FRANK FLYNN Date of Inspection: 11/29/02 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents:3 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 ears usage d ( Y g (gP ))�*� (�� -- �Sp� Sump pump(yes or no): NO Last date of occupancy: n/a 0� 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: n/a Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: n/agallons--How was quantity pumped determined?n/a Reason for pumping: n/a TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _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: 1983 BY OWNER Were sewage odors detected when arriving at the site(yes or no): NO F Page 7 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 23 SYCAMORE ST HYANNIS,MA 02601 Owner: FRANK FLYNN Date of Inspection: 11/29/02 BUILDING SEWER(locate on site plan) Depth below grade: 14" Materials of construction:_cast iron —40 PVC other(explain): n/a Distance from private water supply well or suction line: n/a Comments(on condition of joints, venting,evidence of leakage,etc.): TOWN WATER SEPTIC TANK: X(locate on site plan) Depth below grade: 8" Material of construction: Xconcrete_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: 1000 GALLONS" Sludge depth:3" Distance from top of sludge to bottom of outlet tee or baffle: 31" Scum thickness: 2" 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: 16" How were dimensions determined: MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. 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 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 23 SYCAMORE ST HYANNIS,MA 02601 Owner: FRANK FLYNN Date of Inspection: 11/29/02 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX:'X(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: OVER PIPES 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.): LIQUID LEVEL IN D-BOX IS OVER PIPES. 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 i Pale 9 of I OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 23 SYCAMORE ST HYANNIS, MA 02601 Owner: FRANK FLYNN Date of Inspection: 11/29/02 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: 0 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 n/a overflow cesspool, number: n/a n/a innovative/alternative system Type/name of technology: n/a Comments(note condition of soil,signs of hydraulic failure, level of pording,.damp soil,condition of vegetation,etc.): THE LEACHING COMPONENT WAS NOT EXPOSED DUE TO SATURATION OF SYSTEM- LIQUID LEVEL IS OVER PIPE IN D-BOX- LEACHING COMPONENT IS PAST THE EFFECTIVE DEPTH OF LEACHING. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure, level of pondinc,condition of vegetation,etc.): n/a 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 Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 23 SYCAMORE ST HYANNIS,MA 02601 Owner: FRANK FLYNN Date of Inspection: 11/29/02 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. o A AA 1) 161 10 Page I 1 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 23 SYCAMORE ST HYANNIS,MA 02601 Owner: FRANK FLYNN Date of Inspection: 11/29/02 SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 10+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-If checked,date of design plan reviewed: 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: HAND AUGER- 10+FT. rr� - �0 TOWN OF BARNSTABLE LOCATION ����� ��� SEWAGE # /t ASSESSOR'S MAP&LOT VILAGL-469 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 6 C l LEACUING-FACII.TTY: {type) Ixao, �IS ' (size) O -� NO.OFBEDROOMS r BUILDER OR OWNER. PERMITDATE: - COMPLIANCE DATE: 1 Separation Distance Between tbe: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility -- Feet private Water Supply Well and Leaching Facility Of any wells exist on site or Mthin 200 feet of leaching fwWty) ]Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet/°f leachtir, Tacit--nf Feet Furnished by��k�,���/1����I���P�'�-��'c n • s n ti o ® Ri r - ? w .. H � Po d . =� 4w ASSESSORS MAP : �jl a b..d = TESL -;OLD LOGS NOTES: x PARCEL : C> � i) THE INSTALLATION MUST BE IN SUBSTANTIAL COMPLIANCE WITH Ulu- _ Fn � � FLOOD ZONE;: Noll t(AyA-PC) SO L EVALUATOR . �..J�' �"����-✓, R.S. �Cs L=' THIS PLAN, 1995 MASSACI-IUSETTS TITLE V & TOWN OF A °o! , W I TNE55 : (�� t.G U} (� bf� � 1,f BOARD Oi'HEALTH REGULATIONS. lY NNI REFERENCE : IL. `� , t.> ,� ! '` 9W DATE : r� ru--H ! tO4 rs "° " "1 I G� PERCOLATION RATE : 1�1 z) THE INSTALLER SHALL VERIFY THE LOCATION OF UTILITIES, W P"- �I I - ItJL1I SEWER INVERTS AND SEPTIC COMPONENTS PRIOR TO u Q a i!�,� CLASS T. S a(r4.-S r--►n INSTALLATION. - o.��(g���y N'. ' '' TH- I L.` TH-2 3) THIS PLAN SHALL BE USED FOR SEPTIC SYSTEM INSTALLATION y " a, _ �3 ONLY AND SHALL NOT BE USED FOR PROPERTY LINE ` �61TW ' iy DETERMINATION. ERMINATION. •, �� ��� 4) ALL PIPING TO BE 4" SCHEDULE 40 @ I/8 "/ FOOT. (UNLESS I S SPECIFIED O rhTR.xJ'ISE) LOCATION NIA ��� I �� 5 r �, i t 5) THE DESIGN OF TI qS SYSTEM DOES NOT ALLOW FOR THE USE OF A GARB A _ �. •. 32 �j -LS- �2 .25 ' � � \ � AGE DISPOSAL. ----- ,r� I I� 6) SEPTIC TANKS AND DISTRIBUTION BOXES (WHEN INSTALLED) i MUST.BE PLACED ON/A MECHANICALLY COMPACTED BASE OR ON ' ;S A BASE OF 6"'OF��tUS)��D STONE. 38 : sy 3�• NO tAJ oil SEPTIC S v S-'"E M DESIGN �) _,��;�._�.��►��_ _tom' _�iza�os��-. IT FLOW E S 3 I MATE ID o F � f 11� 2 '3Ebj�0oMS.-ft� _�r��M��__'rb__��. .�•�✓1��1'� - BED QOOMS AT GAL/DAY/BEDROOM - GAL/DAY >E i_>r C�G�AA,5 1/J &�-L c AA-f 1J?- SEPT I C •TANK ql� 3SO GAIJDAY x 2 DAYS � 'b GAL USE I �;�GALLON SEPT I C TANK N SOIL AB. Or�P , !Ors SYSTEM CMr�Nr,�. 5A STO tJe 0n1 11". 51DE5 (25 I x 13`wx2� ) - SIDE AREA 'ZX 0,7 � = tIZ `l? �a BOTTOIr ARIfA: a AE r 3S 2 IS �PZ � � y� SEPT I C SYSTEM SECT I ON (Acvj4-� (v'a�4 K2' GA,s BP FH�E 1'° Dou te W 5 ed o Box i S o r------v GAL = 2) �0 SEPTIC TANK 3s kvtly-s� - 32' ! CKrSTrti?G� 74 IY2. 1�Uubl� wasne.4 �s o 00 Fum to 7 -7o7T&m of TCST qo[-F— a�MAss ate_E E��,G �o,�; �, : 3�•5� I S I TE AND SEWAGE PLAN 2s ° I - ------ L 0 CA T I 0 N : 9�511 PUS 6l 5T, SroNe 8 42 -r t ,� _76 3 PUM 7S?.SG.__Zoe. L6 2t-4° v" I'- ��iM 1� C IaRM�i��_ G.� FkG�v,�� W,4 T� .. . N7' �-___.. I v � V�r �:, r�!c�L � -�r✓v��_C�,v ivc PREPARED FOR :R .sAN 0�- _ � 7���. Se� RA'I __Gl�l.v►.t._F VJv.I',_ ------ __. _._ __ DARREN M. E E SCALE : / ,_30� 4-3DATE :� E-T S� VINE sTI�E�. l PI.�rJ v >✓ t,-Acijn> Fby �{ .(� e tjF., R-L C �:CBU Y, MA, 02332 4y = I�t�,D DATE HEALTH AGENT (731) 535-0293 C�27-1�/�Q 4S soILT Mai 18 2 �- JOB NO. 811y-02 N 0 t E` Piho3.dwg Rte �8 'Q 11. LOCUS IS A.M, 310, PARCEL 048. F626/54 S812/45 fe28 2. ELEVATIONS SHOWN ARE TOWN GISf1'. w ESTIMATED GROUNDWATER(AIW 230, ZONE D) =23't(6/92) + 6.4'=29.4t TOWN GIS 3. LOCUS IS IN FLOOD ZONE C ON FIRM DATED AUGUST 19, 19s5: r 4. ALL PIPES TO BE 4" SCH 40, AND PITCHED AT 1/4" PER FOOT. (UNLESS NOTED) e LOCUS ELEVATIONS ARE TOWN GIS± 1 SO MAX. HIGH GROUND WATER= 30.4f 5. MUNICIPAL WATER IS AVAILABLE. LOTS WITHIN 100 ARE ON TOWN WATER. 6. COMPONENTS TO BE AASHTO H-10, UNLESS NOTED. v, �0 0 7. INLET TEE TO PROJECT DOWN 13", OUTLET TEE DOWN 14". •- 8. IF TWO OR MORE LINES, WATER TEST D-BOX FOR EQUAL FLOW D'-BOX EXIT PIPES TO BE LEVEL FOR FIRST TWO FEET. CL 9. DEPTH OF COMPONENTS NOT TO EXCEED' 3', OR VENTING MUST BE PROVIDED.. NOT TO u7 COVERS BUILD COVERS TO GRADE--1 ON TANK AND, 1 OVER PUMP. (OTHER COVERS 6" BELOW) SCALE 10. STONE TO BE DOUBLE WASHED 3/4 TO 1 1/2" WITH 2" MIN. 1/8 TO 1/2" PEA STONE ON TOP. LOCATION MAP 11. IF UNSUITABLE SOILS, OR SOILS DIFFERING FROM THE SOIL LOG ARE FOUND, m CONTACT THE BOARD OF HEALTH, OR R.J. CADILLAC. 12. IF AN OVERDID IS CALLED FOR BELOW, FILL MATERIAL FOR 5' AROUND AND UNDER LEACHING I'S TO DE CLEAN GRANULAR SANE? MEETING SPECIFICATIONS OF 310 CMR 15,255(3). 13. BUMP AND FILL ANY EXISTING CESSPOOLS. REMOVE ANY CLOGGED SOIL, BLOCK, AND STONE IN LEACH AREA, AND DISPOSE OF AS DIRECTED BY HEALTH AGENT. N/F 14. ALL CONSTRUCTION TO MEET TITLE 5 AND LOCAL REGULATIONS. FARIA TEST HOLE 1 TEST HOLE DATE: September 22, 2011 PERFORMED BY: Ron Cadillac, Soil Evaluator D O 44 DEPTH (inches) ELEv.( 1. N/F WITNESSED BY: Donald Desmarais, IRS A layer 10yr 3/3 1 PERC RATE: <2'-00"/inch (C layer) 12„ foamy sand AGUTAR SOIL SURVEY(1993): Urban land SLIGHT GRADE CHANGES GEOLOGIC MAP(1966): Barnstable plain deposits B layer loyr 5/8 ARE PROPOSED sandy Idam COVER TO GRADE Invert 33.60± 2--500 GAL. DRY WELLS 24" 39.4 BENCH MARK—TOP, BACK & CENTER secured SEPTIC TANf�=35.0� TOWN GI5f1' (secured) SET 4' APART c1 layer 2.5y 5/6 Use Ras Baffle Invert 41.00 med. coarse CONSTRUCTION NOS: Effluent Filter Proposed 40.0=Top Unit loamy sand 9" min. Cover p 20% gravel 1. SEPTIC TANK NOT H-20 _ _�___ �_ __� _ see detail 39.6=Top Peostone/ 72„ PROVIDE BARRICADE. I — Filter Cloth 35.4 ~� 1500 Gal.. I S=Varies C2 layer 2.5 6/4 2. USE CAUTION AND CORRECT x 42,17 I I I d y PROCEDURES TO REPLACE PUMP f42\ I EXIST. H-10 I I P I _�__�_- medium sand N CONFINED SPACE. 4? f Septic _Tanks -"' r� 10% gravel •. Bottom � Tea Sanitary � 24 N /�F x 41,78 » 41.47 41.85 6" Stone or compact Invert 41.17 Invert 39.20 \�37.2 132 no water 30.4 MACLELLAN Propose Proposed i 6.8' Bottom x 37.56 x 41.60 N /F 1 ,I 1 N i 4 L�LJ `15 x 3 ,644 75 CARVER 157 I I roY 115' Bottom TH1=3o.4t TEST HOLE 2 3 ,1 I SEEC11ON SCHEDULE < ESTIMATED HIGH GROUNDWATER-30.4t BENCH MARK--TOP OF SPIKE SET DESIGN DATA (D DEPTH (inches) ELEV.(feet) DOWN MARK--TOP 39 ASSIGNED � 5,740±S.F.� 41,89 CALL R.J. CADILLAC TO ) 19' OFF HOUSE CORNER ON RANGE LINE �'� �IMT 'INSPECT PRIOR TO BACKFILL. y Yr / ( ) STON ""�-� BEDROOMS: 3 0 Ala layer 10 3 3 41.8 PAR NG GARBAGE GRINDER: No 8» loamy sand x 36,67 ' 37,6 38.68 LEACH AREA 36.80�� 6J1 `\ 40 REQUIRED CAPACITY: 330 GPD B Iayery10yr 5/8 . ' o USE 2 DRY WELLS SET 4 APART WITH Viand Imam � EXISTING SEPTIC TANK: 1500 GAL. „ 4' OF STONE °.ALL AROUND TO MAKE 24 BOTTOM LEACHING AREA: 377 SF 39.8 N/F 38• r- 40,76\ °o c+ A 13' X 29' X 2' DEEP LEACH AREA. �,. i 3�,7�------ , [(29 X 13 )] a C1 layer 2 5y 5/6 cC BOOTH 32 i/ 3713 / \�� SIDE LEACHING AREA: 168 SF 4$'ia oamycsande JOHNSON 42,13' / ................................. - o , ........................ ' 0,38 39.19 3 �3g � �,.�' 42.09 [2(13 + 29 ) X 2 DEEP)] % grave 72 35.8 DESIGN CAPACITY: 403 GPD 9.64// 4 S [(377 SF + 16$ SF) X .74 GPD/SF] C2 layer 25y 6/4 * 39 63 Ca i I 30 AL. medium sand EXISTING 4¢ 219 PUMP CHAMBER STORAGE CAPACITY: 3 G 10% gravel H 1,� 4 i�1,01 / 0 HOUSESYCA i 41,98RE DOSES PER DAY: > 4 'TH 2\��x 4`//r�<-- x 41,59 - ,44 �J� 4 ,3 �4a, no water i 1.8� �' r �i i ---- NO. 23 ST 132 3O'.$ i �i 44,25 �' i Exist. ;.: •:: 42�4- �.--•+�4 ,3 i , o JB, ALARM & PUMP NOTES EXISTING 1000 GALLON a /F i Deck / i�ti 1, ALARM TO BE WIRED BY ELECTRICIAN ON _` ° �� x 4 ` ' H-�20 RUMP CHAMBER AN N AN TU ON I 0 3 l :: :::::::::: ........:::::` SEPARATE CIRCUIT FROM PUMP. COV'R TO GRADE ii '44,72 \xx 9 i \ a /�L-J i *-429 G 42,4z /i S Pseeured) 2: ELEC TRICAL WORK TO BE INSPECTED BY J._---J I 111 1 `-- -._._-K 42,76 i WIRING INSPECTOR. `� ,� 3,16 i 4258 3. ALARM TO BE LOCATED IN HOUSE. DRILL 3/8" WEEP/VENT HOLE 44.29 ��' rla� ` ,� 42,F 3 _ __._- 43,23 4. LINE �• PUMP TO BE CAPABLE OF PASSING Re�ommond Floats 2" 44.02 EXIST-. LEACHING PER STONE �� ` 1-t/4�' SOLIDS AND INSTALLED IN STRICT replaceable from top :. ::` CONFORMANCE WITH MANUFACTURER'S ST, i AS--BUILT PARKING x 42,80 �F 5 SPECIFICATIONS. R SHED x 43.23 ► Quick Disconnect/ N 33.55± larm 32 Union USE NEW MEYER MW50, 1/2 HP PUMP, O 44.14 I EQUIVALENT. Invert On 26» 4,47 , plFiR 6. TO PROVIDE FOR EASY AND SAFE Off 21" Check Valve i ..,..,..:. ^��^ �---4.4-8�--------�..-4�_4.��3.44.__ � MA NTENANCE OF PUMP: -PROVIDE UNION/DISCONNECT IN 2" PVC P — - �3��--------------- 43,01 LINE AT TOP PUMP CHAMBER SO P TAN 174 1 O' CAN BE REMOVED FROM TOP OF K. 29.0 N/F 'r 83'22'4 -RECOMMEND FLOATS BE ATTACHED TO 2`' 43,19 PUMP (LINE SO FLOATS CAN 6E ADJUSTED Bottom GORDON OUTSIDE CHAMBER. N/F SHE DSTRADDLES PROPERTY LINE RIVERVIEW SCHOOL INC. BENCH MARK--TOP OF WOOD STAKE=45.00 TOWN GISf1' SITE PLAN THIS PLAN IS A VALID COPY ONLY IF IT BEARS FOR AN DRIGI L RED STAMP AND SIGNATURE. ANTHONY PING LE GEND ����H�'`hti RONALD �N LOT 15, 23 SYCAMORE ST. , HYANNIS, MA 11114 c� o` TH 1 TEST HOLE LOCATION, NUMBER s CADILLACM JAMES CADILLAC # 1060 #357 �, / �� W WATER LINE MARKINGS �. 79 N 0 V EM BER 4 2011 SCALE. 1 -- 20 E OVERHEAD ELECTRIC WIRES (IF SHOWN) �� � ° �" °� o� G_�_ GAS LINE MARKINGS S�NITaR% 8S, `0I taxi x 9.5 x 4.3.0 EXISTING & PROPOSED ELEVATIONS ('X' MARKS POINT) /--�6--'-�- EXISTING CONTOUR , RONALD J. CADILLAC, PLS, IRS, P.G. PROPOSED CONTOUR PROFESSIONAL LAND SURVEYOR & REGISTERED SANITARIAN UTILITY POLE (IF SHOWN) P.O. BOX 258 ® EXISTING DRAINAGE CATCH BASIN WEST YARMOUTH, MA 02673 X FENCE (IF SHOWN, NOT ALL SHOWN) (508) 775 9700 0 TREE (IF SHOWN, NOT ALL SHOWN) HEALTH AGENT APPROVAL DATE "`C 2011 BY R.J. CADILLAC PAGE 1 OF 1 No..��"�."j'.. F:ms.... ........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............OF......................................................................................... Allp iratiou for Dinpotia1 lgorkii Tontrnrfiun V(ami# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: d%^ t Location-Address r or Lot No. Address ....--•-•-•--•.............................................. .•----.....----•-..............--••--............................-= Installer Address Q Type of Building Expansion Attic ( ) Garbage Sq. feet Size Lot................ U Dwelling—No. of Bedrooms............................. Grinder ) '_l Other—T e of Building No. of persons............................ Showers ( ) — Cafeteria ( ) QIYP g ---------------•------------ QOth t, res ---•-•-••------ -------•-----•-•....--•---------.....-----•------------•-•-•---•-----...-•--•------------•-----•......------------•.........._...---- WDesign Flow..........................................gallons per person per day. Total daily flow..:.........................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter--.............. Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......... .......... Diameter.........---........ Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) PercolationTest Results Performed by...................................................................----... Date........................................ aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water......................... Test Pit No. 2................minutes per inch Depth of Test Pit.....-.............. Depth to ground water........................ cx -•--•---•------------------•-•-•-----------•-•--------------•••....-•---..........._......-•-.........---------•-...--••----•-•-•---•-......----•..........-. ODescription of Soil..........................................................................:............................................................................................ U ---------------- •------------------- •----------------------- --------------- ------------------------------------------------- •------------.._..---•--------•------- -------------------------.----- W ••----•-------------------------•---•-------•-------•--•----....--------••-•---•-•---••---............................................................................................................ U Nature of Repairs or Alterations—Answer when applicable................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has /been issue{i the,board of health. ------------- r � f D Application Approved � °_;_7.._._... ••�f.�® �'-------- PP PPY - -----y 1��„ Date Application Dissa proved`f/or-'the following reasons---------------------•----------•----------------------------------------------------------------------........._ f f.._..... --------------------------- •---------------------------------------------- •-------- ........-•-------•--••-------------•---. Date PermitNo....................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HE LT .........................OF..... .......................... Tntifiratr of Tompliatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (Y) or Repaired ( ) by ...•-..- --••�•..................... A. •••..... .... - _..-.../........----.......------........---•-•------...-•-------•-----•••. �.f . .Installer '�Jl .. .... ''mod J -- at........... ....• •-/ 'r° !.--- - - '------- •- -----------------------..--.-----•---------------- has been installed in ac p���o��rdff nce with the provisions of T�; gf T State Sanitary Cod as ascribed in the application for Disposal Vorks Construction Permit No.. -----•--------------------------------- dated� _..- ©/- a�" -------.----------- THE ISS11 NCE OF THIS CERTIFICATE SHALT. NOT BE CONSTR D AS A GUARANTEE THAT THE SYSTEM W"e NCTION SATISFACTORY. Ile DATE... ....................................................... Inspector ........................................... THE COMMONWEALTH OF MASSACHUSETTS BOAR OF HE LJki ...//l?ft............................ ... ............................................ FEE1.0................ Disposal Workn T-1ontrion "anti# Permissionis',herebyr granted.............................................................................................................................................. to cork tr ) or Repair ( ) an Individual Sewage Disposal System at No ,......:-/.........................! � .................4:--•---••--------------- ------ �. Street - Street � as shown on the ap i tion for Disposal Works Construction Permit No---- --- -------- Dated/, __?.................................. .............................. ---- ----------•----•--••-----•--------------------------••......_...._ /O Board of Health DATE ��-----•-----------•----------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS ao w i i}-I J =GY Y ,RBERT Q: f� !. CA Na 29874�� �NU SUR�� Ijl �_ y ice.• � . ..'r �: ii l bp 26 IL v ♦ � CV V �X�.1Nri��1 11CH, , d% r F,.J 4- . _ /4 L o,ti - 5o�p� N/F .JAN& LEGEND �'� CERTIFIED PLOT PLAN EXISTING SPOT ELEVATION Ox0 �� °FjMss EXISTING CONTOUR --- 0 -- �a,� FINISHED SPOT ELEVATION [ A. FINISHED CONTOUR 0 kS1= IP! Plo.10951�4 APPROVED , BOARD OF HEALTH Age GfvfE-: C' '_ kl VAS L. ,bl SS* ONP- DATE AGENT SCALES �'n;, �. U DATE j'-rz •s f �r_.. LDR'EDCE ENGINEERING CQ IN /Fz-1 � •� CLI�NT� 1 CERTIFY- THAT THE PROPOSED 2 1 S6 BUILDING SHOWN ON THIS PLAN EGISTERE FtEtii3TEftED JOB NO. CIVIL LAND CONFORMS TO THE ZONING LAWS DR.BY, ,/s i J %ENGINEER SURVEYOR OF BARNSTAB E , IAS3. 712 MAIN STREET CM. 8Y H Y:A N N I S, M A S S. SHEET OF, DATE �_HEG:: LAND SURVEYOR , J. 3: 20: FT. M/N. /YOTL� /F E/TNER T.r,rE SEPT/C TAN K Or? t ,—EACY//VG ?/T ARE MORE T/Y.q."/ /2"BEJ-0.4V /p /eT-M/N. ::rRAOE� fa 24'O/AM ETER CONCRETE COVER SNALL gF.B,40tJG.y7- TO GRADE. C.-;,v EXTRA. CONC/?CTE 4�PVC. O/P1r hE,4VY CAST /RO/Y COVER SI-1,4 0—= USED �C"vt q a f- COVERS M/N. P/TCN /F/N DR/YEiNA y ►•. �B ,PER FT. CO/YCRE TE CO VER CLEAN S'A/V O _ &ACJC,=/L L. o ..'e'4-CAST- oF Q M lTC�I , GAL. 1 • . . . � e . N. a_ 4 AS F H O. TLC S . . o YY NE D I ST, J • . • s "P �e>? PT/C TANK 1 c 5E_ BMX • e t• • 1 •EFFECT/VE • ,y o i•VA3WED STaNE 0 e e k o = 7 v . e. . • • • • • . . . d, P PREG45 T SEEPAGE P T D / r . . e o R UV 61 !Nt/Bl�?' CLE✓ T/ N _ rr c.���-- l - S'��� ,L l' c-LC- may, z P INVERT:AT°O!J/LD/NG 9,6:s FT.. 6 FT T T o E UL.4 !ON 9�. 1 FT O/A1►9. C�S E A8 INLET 'SEPT/.0 Ti4NK fT � �,I 1" S S z �' OUTLET SEPT/C TANK FT _ / /G 9 5,6 GROUND WATER TABLE ! t " /NLET O STR 8 T. 80X � SECT/ON-OF OCITLt7D/STRJBtl7/ON BOX /N< r cr.vc!/inrG•O/T. Fr, SEZVAGE SPASA L SYSTEJ�! , P/T TABUL LEACH//VG AT/D/V ¢ C/MENS/ON A. 3 FT. DES/G/V CR/TER/•4 Ns o G 8 Ft. D/.•fE / N NUMBER OF BEDROOMS 3 D/MENS/ON C 4 FT /11/Al• - G�RQAGED/SPO.SAL.lJN/r Al SO/L LOG TOTAL-E.3T/MA`TED FLOW. 3'3 O 0.44./0AY . SO/L TEST A/ SO/L 7E'S72' SO/1. TEST MUMBER of teWAc/ltNG P/TS_1_S fELtK 9�3 �-ELFY., 9 •0 PATE OF SO/L TEST SIDE LEACH/NG PER"P/T Sf.� FT. _ Z RESULTS IV/TNESSFD BYE RC -7r �2r� BOTTOM LE�ICH/NG PER P/T 7{ 34.. pT.. J ra.� r z .k PCRCGLAT/ON RATE,*l L4E:ss M/N INCK TOTAL 'LEACH//YG AREA 2� �� SQ. FT., s r _� gf" AENCOLA7^/oA/RATE�6E2 � `�^J/ylN.�INGN RESgR1iEGEftC'N/N6AREA "�-'-' SQ. FT. "~ Ci9 z v L) - ,o', •� '....�,' .�, ��� Sot L. i r_ST r.S`' f•' - 1 3 3 `.� { •� Nay �, a Al •.�R���� i �1y f T/S ';✓ .pill N A �` b l :Li ':`�� 'Al A."', t ' EWSA \v MORSE NQ Y9874 x t J v _ o t� LD E KEDGE EIVGI A/EER/NG N . F �o. 1�951•p C� � C G�STflekLLJI I I LI .. !' . '? 7/2 MA/N ST. , HYf)rt/Al/S; MASS. 0 < p 1� ,P' d Np JA' ��'%/�' 0 /YO GROUND 1�Mi4TCR ENCOUNTER60'.„ CL/EN T.`R,tc7_�v �Py� G1 G/e 1 U�VO 1-�/ATER AT ELEv _ .JOB NO; S �. t ti E� SHEET�OF �--