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HomeMy WebLinkAbout0004 WACHUSETT AVENUE - Health 4-Wachusett Aver , Hyannis , A,= 287-='051 ° t ° ° o J "d � V•L Bk 29538 P:o 5l *14 620 03-28-2e e 1 6 a 01 a 45� NOTICE: The Town of Barnstable recommends that the applicant seek legal advice to prepare a properly worded deed restriction document. DEED RESTRICTION WHEREAS, (Lng .1 oL e. & I-oy-1 -S. p2� of (owne's name) v� p MA ddress) is the owner of 1� "-ko /Q,. located (address) at yniq MA (hereinafter referred to as nd being sW n on a plan entitled "Subdivision of Land in a a C A, Property of et al, duly recorded in Barnstable County Registry of Deeds in Plan Book ILI 5 , Page �S ; Or on Land Court Plan Number WHEREAS, A 'E. + L15f, :S. �L4r'5 as the owner of said lot has (owner's name) agreed with the Town of Barnstable Board of Health to a restriction as to the number of bedrooms which can be included in any home built on said lot as a pre-condition to obtaining a disposal works construction permit in compliance with 310 CMR 15.000 State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage; WHEREAS, the Town of Barnstable Board of Health, as a pre-condition to granting a disposal works construction permit for a septic system in compliance with 310 CMR 15.200, State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage, and authorizing the issuance of a building permit for the construction of a single family home on this property, is requiring that the agreement for the restriction on the number of bedrooms in any house constructed on the lot be put on record with the Barnstable County Registry of Deeds by recording this document, C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\2PIOIDHR\DEED Restrict Sample.DOC NOW, THEREFORE, �}-L P does hereby place the (owner's name) following restriction on his above-referenced land in accordance with his agreement with the Town of Barnstable Board of Health, which restriction shall run with the land and be binding upon all successors in title: 1. N Aloe, H-U.&vinkS F`e may have constructed (address) upon the lot a house containing no more than OUP ( �}) bedrooms. agrees that this shalt be permanent deed (owner's name) restriction affecting located on MA, and being shown on the plan recorded in Plan Bookjg5 , Paged . Or on Land Court Plan For title of 1-44 see the following deed: Book jj�3 , Page !%22 . Or Land Court Certificate of Title Number Executed as a sealed instrument ��v day of Owner's sign e Own(Rs's signature Owner's signature COMMONWEALTH OF MASSACHUSETTS WHITNEY VAIL BODURTHA , ss = NOTARY PUBLIC 33 20 � � _L/ f Commonwealth of Massachuselfs ` � I My Commission Expires December 25, 2020 Then p rsonally pared the above amed known to me to be the person who executed the foregoing instrument and acknowledged the same to be free act and deed, before me, VaAj Notary .7 Public BARNSTABLE REGISTRY OF DEEW commission expires: John F. Meade, Register (date) C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\2PIOIDHR\DEED Restrict Sample.DOC TOWN OF BARNSTABLE Ld ,. LOCATION `T W610 u's e- SEWAGE# oZO ( 3-7 O " VILLAGE# j ASSESSOR'S MAP&PARCEL d$Z I INSTALLER'S NAME&PHONE NO. ��p��''r�`tz L�' e_v�priSe�S SEPTIC TANK CAPACITY 15-00 Gat LEACHING FACILITY:(type�� );5GEC I c /- n1t size) foZ r NO.OF BEDROOMS 1� OWNER 7erc G2 vw rt -PERMIT DATE: (0 s,2(o vZ O! S COMPLIANCE DATE: /�d Separation Distance Between the: � Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility EAC JA t l feru( 4 'feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) zi/A Feet. Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHEDBY (f4®6coo& &)T64W fSGs I Y � A I Wrrc:hvbe� �e �r � tJD } S � ard :ZoF 2 � II TOWN OF BARNSTABLE `t �— LOCATION WACM U 50T-'f A Y C SEWAGE# `1 VILLAGE •4 VANM 1 S ASSESSOR'S MAP-&PARCEL A8 5 i INSTALLER'S NAME&PHONE NO.�A'P&W IDL riERrRI.5ES SEPTIC TANK CAPACITY 1 500 G-zA -LLDM ( H-.10 LEACHING FACILITY:(type)(4)5 oo EAL C.4144 KBEtS (size) I NO.OF BEDROOMS 5 _ OWNER NA001Y STCly.42T I4E.4THEAL is rl PERMIT DATE: COMPLIANCE DATE: I s 021 -o101(p Separation Distance Between the: NO GW Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility ht lcO01'JTe .off I`kFeet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) N/A Feet Edge of Wetland and Leaching Facility(If any wetlands exist within ) 300 feet of leaching facility) Feet FURNISHED BY (2 AP 6t.Jt-D E &- TG-P9-ASCS l.LC- 13,3 23` C- a - p- l�7 _ as as 4 n-9 - A°,2 ' �- _ate E-� _ 4.�� � C-!o ' Q.3 � - -7 - 13 .i -� = 3at= ' C —cl = 5(.3 C— cc� tic,r� 2 °� 2 No. / /V —,MD Fee /10 THE COMMONWEALTH DF MASSACHUSETTS Entered in eompnter: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS fIPhration for MispDsal 6pstrm Construction 3permIt Application for a Permit to Construct( ) Repair(Xl Upgrade( ) Abandon( ) [Complete System ❑Individual Components Location Address or Lot No. 1f WAda AJF_ Owner's Name,Address,and Tel.No. N#%aJe-%L TreW4P-rr Assessor's Map/Parcel 927 P 51 43 PA;k'S RLA05 554OWC l41(A-S aJ-7" I a,r's Name,Address,and Tel.No.�()$-4'' 1j—2%7 7 Designer's Name,Address,and Tel.No. �24T� 6w D ;st LA q<— XAX— d. CZ 57 S Type of Building: Dwelling No.of Bedrooms 5 Lot Size %-2 i'7®9 *sq.ft. Garbage Grinder( ) Other Type of Building 6tG S[Dl: T[ No.of Persons Showers( ) Cafeteria( ) Other Fixtures o Design Flow(min.required) FJ 50 gpd Design flow provided c gpd Plan Date (jC T ' 0I s Number of sheets Revision Date Title * 1A1AC 0ScrTT AV25* Size of Septic Tank 641, 61-Aj�N Type of S.A.S. (14) 500 &V 4 aGj Description of Soil Nature of Repairs or Alterations(Answer when applicable) WS-*L Ll 15,20 Cat. (a-)t®,5;1yr cc. low 1, Y ' 01= C - Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Heal S' e Date 10 Application Approved by Date ;Oo�c�ro 5 Application Disapproved by Date for the following reasons Permit No. rDa/5 Date Issued No.obls -3 Fee �Q THE COMMONV EFAL OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION . TOWN�OF BARNSTABLE, MASSACHUSETTS Yes J Zipplication for Disposal *pstem Construction permit Application for a Permit to Construct( ) Repair(( Upgrade( ) Abandon( ) Complete System ❑Individual Components Location Address or Lot No. ,+ WACFIa- rrAvE Owner's Name,Address,and Tel.No. of N�,Nc�t Sr�c�r�tt�r Assessor'sMap/Parcel 227 b51 4a J>„q:04` QLAC35 54O'MT ki1,LLS 63T Installer's Name,Address,and Tel.No.50% Designer's Name,Address,and Tel.No. S62-' 73-O.377 G` 4P6ca)cUr,- e T-e3aAlGL=i (yc_ '?<- XAIC. 153 "R t coo sT dtt�A 1EC� oZ� � tkoJ W Type of Building: Dwelling No.of Bedrooms cj Lot Size /a 1?®9 t sq.ft. Garbage Grinder( ) Other Type of Building JZG S 1 DL�?t 1 r4k,, No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �'s(� gpd Design flow provided S(011 ( gpd Plan Date Oc-r 77 V0�0 1 Number of sheets I Revision Date Title 414 WSWU$m—� AV Size of Septic Tank /� �(f4-Al Type of S.A.S. � � SOO &OL.& .101 Description of Soil MaILCAf Nature of Repairs or Alterations(Answer when applicable) :WSTA(LL. 1 $0a In �14->0)5GEr(G- '�)k TD lip h -ba)!C Ta 4) Son 66 Ldrj 6Y-a OO Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. g d Date �(���-rc -,X0t T Si Application Approved by Date Application Disapproved by Date for the following reasons - Permit No. Date Issued c�lp --------------------------------------------------------------------------------------------------------------------------------------- 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 CAP6W(P6 6X)Ta5M4P4rs&-r L j c- at 4 WAC-Husc t AVE pt6&-T' has been constructed in accordance ) with the provisions of Title 5 and the for Disposal Syste`rn Construction Permit No�'15 3w !dated 6 � ) -5--. Installer C4PEW106 r�ic�T�ncA�t L.(�G Designer TG #bedrooms S _ Approved design flow t, S O gpd 11 The issuance of this permit shall not be construed as a guarantee that the system will ctioln as designed. Date 0 Inspector of_ I p U --------------------------------'--------------------------------------------------------------------------------------------------------- No. I '"` / y. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair( X Upgrade( ) Abandon( ) System located at T W/� Cti(1S UL ("i1�r4YJ�!< and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be mpleted ithin three years of the date of this permit. ' Date � / Approved by 3 1100101/22/2016 08 :52 5082730367 94497 P. 001/001 % ■ ■ Town of Barnstable Regulatory Services S� Thomas F. Geiler,Director NAMOrA&Z : Public Health Division MA86. ,�nMp►`� Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790.6304 Date: Sewage Permit# ` cals "�-70 Assessor's Map/Parcel Installer& Designer Certification Form Designer: SC ee- f)Oj , TnC. Installer: C�ew�cbe �nEer?rises Address: L95'1 CrcanbecrT4d[ti�nwT_ Address: 15'a-Comm erLr'6 roil watc�nc•� rJA 02S36 �IuslnpC% )1A oz.Gy 9 SuE•273'•0377 On Capc,,J.- t_ &Y)Vcre,iR-S was issued a permit to install a (date) (installer) septic system at W wAcbo S ?_.'A vtiu based on a design drawn by (address) 1 C En5toe.e-ct05 , TAG dated 6ctok 7 20r.5 (designer) v 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. Stripout (if required) was inspected and the soils were found satisfactory. 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. Stripout(if required) ected and the soils were found satisfactory. t JOHN L. r CMURCMILL ( st ler's Sign re) mG �160 esigner s Signature (Affix De g Here) P ASE RETURN TO ARNSTABLE PUBLIC AL DIVISION. CERTIFICAT OF COMPLIANCE WILL NOT BE ISSUED UNT BO T FO AS- BUILT CARD ARE RECEIVED BY THE BARNSIA13 ,PUBLIC HEALTH DIVISION. THANK YOU. gAofike fannsWesignercertification form-doe 5 D-BOX= 39.5'f---. _-----_._-__---�-_-__.�_---- ------ y REMOVABLE WATER-TIGHT COVER OVER I 'ANK EL.= RISER TO WITHIN 6"OF FINISHED GRADE I 4"SCHEDULE 40 PVC ' 5" DIA, OUTLETS MIN SLOPE 1% 4.3'MAX. 0 SEE NOTE 22 1 33*ce 70' SEE I I� f L=26'± PROVIDE WATERTIGHT 1 I 4"PVC IN FROM JOINTS(TYP.)SEPTIC TANK 4" PVC OUT TOLEACHING FACILITY 12" 34.17 MIN. 34.00' j 2' 0 6"CRUSHED STONE OVER MECHANICALLY o0 COMPACTED BASE :RED 5 i 4.0' . OUTLET DISTRIBUTION BOX f TO BE INSTALLED ON A LEVEL STABLE BASE. FIRST TWO FEET OF OUTLET PIPES TO BE LAID LEVEL. 31 .70' CROSS SECTION VIEW ' TYF - 0 DISTRIBUTION BOX DETAIL NOT TO SCALE MAP 287 PROPOSED INSPECTION PORT PARCEL 50 PROPOSED 4" PVC VENT PIPE; EXACT LOCATION PER OWNER S880 48'00"E 93.60' co SUB LINE co d ci d Eo X w ate-- W 22' PR. -� 6.7' e EX. O PROPOSED N.. >o� GARAGE TP 1 - z. 16'x 22' 39x4' 0 U i0.1' (6 6.7' �. PR. SED H-20 ° EXISTING GARAGE tUTION BOX = . - � 5.0' (TO BE REMOVED) No. Ab Fee �� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01ppfitation for Disposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair(A) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 4 "dt4 u scrT A%JF Owner's Name,Address,and Tel.No. t-W"5 tJA-Pt4 S-rGCJ 4P__ - Assessor's Map/Parcel a g Z ()t 0 1— l., L,G St LU tD— JT Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No: Type of Building: Dwelling No.of Bedrooms Lot Size ,29 4QLK s+oe Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. S' ed Date P rr__ Application Approved by - Date tP C Application Disapproved by Date for the following reasons Permit No. Date Issued b AI No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 0[pplication for bisposal *pstrm Construction Permit Application for a Permit to Construct( ) Repair(A) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 4 K1Ad US<5--T AV& Ow er's Name,Address,and Tel.No. A MY�I► tv�ItNc.�{ ST��.eu41zT Assessor's Map/Parcel a a 7 Q 5 4 f3RgC—Z_%4 (fit 0 T' L I (—G Sl W tu- e,Address,and T 1.No. Designer's Name,Address,and Tel.No. InstalIK's Nam 153 A4(£APPLe TI pe of Building: Dwelling No.-of Bedrooms Lot Size 9 Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures ' It ,... Design Flow(min.required) gpd Des'gn,flow,.provided f gpd Plan Date Number of sheets, ' Revision Date Title ~~ Size of Septic Tank Type of S.A.S. t Description of Soil i s ti Nature of Repairs or Alterations(Answer when applicable) N �ry F 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 t; Compliance has been issued by this Board of Heal _ S'gned Date M Application Approved by - _ _ n Date - Application Disapproved by Date for the following reasons Permit No. Date Issued ` --.--------- ----.---- .,-..-.-: . - _- - :- -;_._._._._: _-- -- -- - - - -> - ..._ ._ 7 THE COMMONWEALTH OF MASSACHUSETTS- / BARNSTABLE,MASSACHUSETTS Compliance Certificate of C THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded( ) Abandoned( )by C 6 APQ0 6V7&404 r Lt'5— at 4 /N f4 64 u5[`�'T k U fC t4'1#4N AB_5 has been constructed in accordance with the provisions of Title-5-and the for Disposal System Construction Permit No:__�(_' 3 CXy ]dated � �3 Installer 0_An6kX D t' (,L�- Designer #bedrooms Approved design flow, r-\ gpd The issuance of this permit shall o/fbe construed as a guarantee that the system will��fun ion as est ned. Date Z7 4� , Inspector ti... No. Jo/� 3 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS ]Disposal *psttem Construction Vermit, Permission is hereby granted to Construct( ) Repair( X) Upgrade( ) Abandon( ) System located at 0 W A-C4 L)5 ET 7 ` V6 W FAQ O(s and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction mus be co pleted within three years of the date of this permit. �--- Date V Approved by { r �ttta Town of Barnstable P#. Departliueut of Regulatory Services Public Health Division M„�• Date �A t43p 1 200 Main Street,Hyannis MA 02601 r , • rflJ MA'1 A Date Scheduled l Time��r'' Fee Pd. �. X Soil Suitability Assessment for Sewage Disposal Performed By:, tJlbl'_4Ar1_ 91MEnirv_t� CSE a 451'1' Witnessed By: LOCATION& GENERAL INFORMATION Location Address Owner's Name MWVY S'T[-ftAM T' i�i/fFC i ilS�-r T Avg / H yid!!S Address tr 15 Y ©T• L.Vr-r e,E 5 l C.V=-p— Assessor's Map/Parcel: a�/ 1 Engineer's Name L,%j4& NEW CONSTRUCTION REPAIR Telephone Land Use 'ZE,SIO.CAJs14I AUgeAII,J Slopes(9'n) 3-91 Surface Stones . A/A Distances from: Open Water Body >ISG ft Possible Wet Area 110 ft Drinking Water Well >f56 ft Z. Dralnago Way 7 ip ft Property Line g I a ft Other ft SIMETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity, to holes) Sire- a k+ac cl- e(a✓t Nmuroca.er sc nvo Parent material(geologic) �C6�cer�ngtr p�PoSrt S Depth to Bedrock Depth to Groundwater. Standing Water in Hole: Weeping 1i'om Pit Fnee Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL•HIGH WATER TABLE Method Used: DRQcV 6twpwoigyj Depth Observed standing in obs.hole: 7 s ib. Depth to soil 1TIUtt1@5: Depth to weeping from side of obs.hole: Ilt' Index Well Y _ _ bL Groundwater Adjustment ft. Reading Date: Index Well levol Adj,f actor A Q,pixsundwtiter 1xvri _ PERCOLATION TEST Dote gA-J Tiara �l A Observation Hole# ' p Tinto at 4" "- Depth of Pere Time at G" Start Pre-soak Time Q _ Time(9"-6") End Pre-soak See Si eV e_ n i'1 n Q( 5 �z. 5.� �2 Rate Mih-fluch 7— Site Suitability Assessment: Site Passed_ Vr�S_ Site Failed: g Additional Testing Needed(Y/N) Original: Public Health Division r 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:\S EPTIC\PERCFORM.DOC V5 DEEP.OBSERVATION MOLE LOG hole Depth from Soil Horizon Soil Texture Sdil Color Soil• Other Surface(in.) (USDA) (Munsell) Mottling (Stnucture,Stones;Boulders. oneiotency,%aravell 3a. l3 COgNty S:tn/0 ftD-ye- 5'g -tom" c-I sat LMm -Z.sy tm - 1��� C-2 iMEaum DEEP OBSERVATION HOLE LOG Dole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) DEEP OBSERVATION BOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(iu.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Q DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders, Consistency. s Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes ✓__ Within 500 year boundary No Yes Within 100 year flood boundary No. Depth of Ngturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of haturally occurring pervious material? -- - Certification I certify that on. �D Z �9 (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 training,expertise and experie described in 10 CMR 15.017. Signature — Date 16-/E IV V 6 Q:\SHPTIC\PERCPORM.DOC �a Town of Barnstable . rnstable , , fl Regulatory Services Department p • &%Rrr8'rABM * D "'"W 639. Public Health Division on m 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7014 1200 0001 0358 5906 October 15, 2015 Nancy P. Stewart %Nancy P Stewart& Heather Finan 43 Park Place, Short Hills NJ 07078 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 4 Wachusett Avenue, Hyannis,MA was last inspected on August 7 2015, by James Ford, a certified septic inspector for the State of Massachusetts. 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: • Single cesspools automatically fail in the Town of Barnstable. You are ordered to repair or replace the septic system within two (2)years from the date you receive this notification. Failure to repair/replace the se tics stem within the deadline period will result in future p Y enforcement action. PE R OF T E BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTICS\Letters Septic Inspection Failures or Future Eval\4 Wachusett Ave Hy Port Oct 2015 Parcel Detail Page 1 of 4 C OF ta3 ?31 , MAY', r ._ - a Logged In As: Parcel Detail Tuesday,Ockober 13 2015 Parcel Lookup Parcellnfo _ Owner Info Owner;STEWART, NANCY P Co-Owner %STEWART, NANCY P&FINAN, HEATHE� Streetl aTERENCE ' Street2 eZ PARK PLACE ---"-. City SHORT HILLS ( State Zip 07078 ­ Country Land Info Acres 10.30l use aSingle Fam MDL-01 zoning Nghbd g0116 � Topography Level � i Road Paved Utilities Public Water,Gas,Septic� �� Location Construction Info Building 1 of 1 Buat 8954 I sRu°t�Gable/Hip wall Wood Shingle l Living 12204 1 Roof IAsph/F GIs/Cmp, AC"None Area 9 Cover Type Int Bed' Style IfConventional J wall:Plastered Rooms 15 Bedrooms Model Residential f Floor'Pine/Soft Wood f Rooms V4 Full-0 Half� rj'' � Grade Average Plus I Heat'Hot Air � Total"g Rooms p ' R Type Rooms Heat Found- stories 1/2 Stories FUeI ,Gas Li ation JBlk/Pour Ftgs j � Gross 3198 � - Area Permit History Issue Date Purpose I Permit# Amount I Insp Date I Comments Visit History _. Date Who Purpose 8/24/2015 12:00:00 AM Anne Leonelli In Office Review 8/23/2012 12:00:00 AM Jeff Rudziak In Office Review 12/19/2000 12:00:00 AM Paul Talbot Meas/Listed-Interior Access Sales_History Line Sale Date Owner Book/Page Sale Price 1 8/15/1986 STEWART, NANCY P P0832EF $1 http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=21644 10/13/2015 ��TFIE Tp� Town of Barnstable • r + 3ARN3fAHLE, � pMASS ,.� " Regulatory Services Department rEa rna'� Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-8U-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 7/6/15 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4,times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑Any portion of the cesspool within a Zone 1 to a public well ❑ Any.portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes.if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA y Single Cesspool ❑ Any"conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑.Leaching pit or cesspool with high liquid level, <12"below inlet(per Town Code §360-9.1) OTHER Repair deadline: Q:ISEPTICIDEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts /yp �g 7 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4 Wachusett Avenue Property Address '^•3 Nancy Stewart , Owner Owner's Name / information is ✓/ required for every Hyannisport MA 1;ai 02647 8/7/15 g: page. City/Town State ZipCode Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any 1 a way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, 6/# use only the tab 1. Inspector: key to move your cursor-do not James Ford use the return key. Name of Inspector ,� Company Name P.O. Box 49 Company Address Osterville MA City/Town 02655 Zip Code 508-862-9400 State S12482 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 Furthe valuation by the Local Approving Authority 8/10/15 Insp tor's Signature Date Th s stem inspector shall submit a copy of this inspection report to the Approving Authority(Board of Ith or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable, and the approving authority. ""This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. i 15ins•3/13 vs Title 5 Official Inspection Form:Subsurface Sewage Disposal ys m•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a,•''� 4 Wachusett Avenue Property Address Nancy Stewart Owner Owners Name information is required for every Hyannisport MA 02647 8/7/15 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): 15ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17I� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4 Wachusett Avenue Property Address Nancy Stewart Owner Owners Name information is required for every HYannisport MA 02647 page. City/Town 8/7/15 State Zip Code Date of Inspection B. Certification cont. ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed i e s p p ( )or due to a broken, settled or uneven distribution box. Sy stem well pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND below (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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh ISins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Volu ntary Ass essments y .,,a •'•• 4 Wachusett Avenue Property Address Nancy Stewart Owner Owner's Name information is required for every Hyannisport MA 02647 8/7/15 page. Cltyrrown State ZipCode Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: The House has 3 single cesspools. Single cesspools fail in the Town of Barnstable 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 1Y2 day flow l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M A 4 Wachusett Avenue Property Address Nancy Stewart Owner Owners Name information is required for every Hyannisport MA 02647 page. City/Town 8/7/15 State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— 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. 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4 Wachusett Avenue Property Address Nancy Stewart Owner Owners Name information is required for every Hyannisport MA 02647 page. City/Town 8/7/15 C. Checklist State Zip Code Date of Inspection Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil.Absorption System (SAS) on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms n/a S— 5 (design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 15ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4 Wachusett Avenue Property Address Nancy Stewart Owner Owners Name information is required for every Hyannisport MA page. CltylTown 02647 8/7/15 State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? Include laundry Y ( d y system inspection information in this report.)P ) ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): unavailable Detail Sump pump? ❑ Yes ® No Last date of occupancy: unknown 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: l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 7 of 17 Commonwealth of Massachusetts IREW Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a 4 Wachusett Avenue Property Address Nancy Stewart Owner Owner's Name information is required for every Hyannisport MA 02647 page. City/Town ZipCode 8/7/15 State of Inspection D. System Information (cont.) Date Last date of occupancy/use: Date Other(describe below): i General Information Pumping Records: Source of information: unknown 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): 3 single cesspools t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °. 4 Wachusett Avenue Property Address Nancy Stewart Owner Owners Name information is required for every Hyannisport MA 02647 City/Town 8/7/15 page. State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: stem installed -original system -date unknow Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other ) (ex lain : P Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene Y ❑ other(explain) �I If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: 151ns•N13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a,•• `t 4 Wachusett Avenue Property Address Nancy Stewart Owner Owner's Name information is required for eve ryH annis ort MA 02647 8/7/15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease Trap (locate on site plan): Depth below grade: n/a 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 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4 Wachusett Avenue Property Address Nancy Stewart Owner Owner's Name information is required for every Hyannisport MA City/Town 02647 8/7/15 page. State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass 9 ❑ polyethylene El other(explain): N/a 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 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4 Wachusett Avenue Property Address Nancy Stewart Owner Owner's Name information is required for every Hyannisport MA 02647 8/7/15 page. City/Town State ZipCode Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments (note if box is Level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 12 of 17 Commonwealth of Massachusetts t Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4 Wachusett Avenue Property Address Nancy Stewart Owner Owner's Name information is required for every Hyannisport MA 02647 page. City/Town 8/7/15 State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration 3 -singles Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool 6'w x7't x10' bottom to grade Materials of construction stone Indication of groundwater inflow ❑ Yes ® No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection For Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4 Wachusett Avenue Property Address Nancy Stewart Owner Owner's Name information is required for every Hyannisport MA 02647 8/7/15 page. City/Town State ZipCode Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/a l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ments 4 Wachusett Avenue Property Address Nancy Stewart Owner Owners Name information is required for every Hyannisport MA 02647 page. Cltylrown 8/7/15 State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately d 18 ' 17 Q � X J 3 ao b 10' i 15ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 15 of 17 Commonwealth of Massachusetts " u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4 Wachusett Avenue Property Address Nancy Stewart Owner Owners Name information is required for every Hyannisport MA 02647 page. City/Town 8/7/15 on State Zip-Code Date of Inspecti D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 20'+1- feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: _ Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health - explain: Topo and water contours map ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 a Commonwealth of Massachusetts '-, - Title• 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4 Wachusett Avenue Property Address Nancy Stewart Owner Owner's Name information is required for every Hyannisport MA 02647 8/7/15 page. City/Town State ZipCode Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 FINISH GRADE OVER D-BOX- 39.5�t PROP. VENT WITH CHARCOAL FILTER TO ABOVE GRADE q^ �- TOP OF FOUNDATION = 38.3 f N RISER FINISH GRADE OVER CHAMBERS= 39,4� - 40,7� 3/4"TO 1-1/2" DOUBLE WASHED GENERAL NOTES PROVIDE EXTENSION S REMOVABLE WATER-TIGHT COVER OVER SLOPE @ 2/o MIN. OVER SYSTEM WITH COVER OVER INLET& FINISH GRADE OVER TANK EL.= STONE TO CROWN OF PIPE 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION FINISHED GRADE OUTLET TO WITHIN 6"OF F.G. MIN SLOPE 1 /o BOX T F.G. NOTE 21 � CODE AND ANY APPLICABLE LOCAL RULES. RISER TO WITHIN 6 OF FINISHED GRADE 39.8' MAX. 4 SCHEDULE 40 PVC INSPECTION PORT WITH ACCESS METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL �- @ FOUNDATION= VARIES 5' DIA. OUTLET(S) ° O O G (S O ) 2 OF 1/8 TO X DOUBLE WASHED STONE OR GEOTEXTILE FILTER FABRIC 20"MIN.ACCESS - __. __ 2, ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE COVER(3 TYP.) SEE NOTE 22 1 , PLACE RISERS ON ALL + DESIGN ENGINEER. PROP. SCH. 40 4.3' MAX. TOP OF SAS=34.70 CHAMBERS WITH PROP. SCH. 40 6.0 MAX. 1 3. 4 SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL PVC SEWER PVC SEWER SEE NOTE 22 33.70' SEE NOTE 22 INLET PIPES TO 6"OF SYSTEM UNLESS OTHERWISE NOTED. BREAKOUT EL= 34.20 FINISHED GRADE 6�3„ 2" DROP MIN. 9„ MIN.SLOPE@1% 3" DROP MAX. 3 L-32'± 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN MIN.SLOPE@1% PROVIDE WATERTIGHT o a ELEVATION = 34.20' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A _ 13" 4" PVC IN FROM JOINTS (TYP.) o � o 35 14" 34.50' SEPTIC TANK 4" PVC OUT TO Q o o Q o THE LINER S NOT LESS THAN HE BREAKOUT ELEVATION. ET FROM S.A.S. AND THE TOP OF B=34, O LEACHING FACILITY o0 0 0 0 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. C=36.L oo 00 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. 48" OUTLET TEE 34.17 MIN. 34.0012 00 © � 0 0 � � o0 34.75' o0 00 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK GAS BAFFLE 6" CRUSHED STONE o °o°o o o FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS OVER MECHANICALLY o _ NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH 10.1' OFFSET TO FND COMPACTED BASE I AND DESIGN ENGINEER. TEES TO BE CENTERED ` 5 UTLET DISTRIBUTION BOX 4.0' 8 5' (�rp) 4.0' 4 0' __ 4 83' 4'0' 8, ELEVATIONS ARE BASED ON APPROXIMATE M.S.L. DATUM. ELEVATION OF 40.00' 6 CRUSHED STONE DIRECTLY UNDER RISERS TO BE INSTA LED ON A LEVEL STABLE 42.0' (TYP.) ESTABLISHED ON THE CORNER OF A CONCRETE PAD AS SHOWN ON PLAN. OVER MECHANICALLY COMPACTED BASE C C C BASE. FIRS TWO FEET. OUTLET , GROUND WATER ELEV.= < 26.40' 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION IPES TO LAID LEVEL. 31 •70 12.83' PROPOSED 1 ,500 GALLON CONCRETE SEPTIC TANK THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT ' ' ' " ' " Dimensions per Wiggin 4-500 GALLON CHAMBERS 5' MIN. 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES LENGTH 10 -8 WIDTH 5 -10 DEPTH 6 -2 ( � CROSS SECTION VIEW CHAMBER END VIEW *CON i NAui Ui< i U VLKW r L,\16 i HAO � Precast Corp.,Pocasset,MA) �g i t TYPICAL CHAMBER PROFILE �g { TO THE DESIGN ENGINEER. ELEVATION PRIOR TO ANY WORK & �"'�- i s IC I R�i L- H-20 DI i c,,, L3 UTI�i i I`.),,X DETAIL H-20 CHAMBER DETAILS 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONCRETE STRUCTURES SHALL BE MADE NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE NOT TO SCALE NOT TO SCALE - --- _ _ WATERTIGHT. REMOVE UNSUITABLE MATERIAL "-EST PIT DATA r �i'.' {.� t+ �' ' k 0 E 1 PIT 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING DOWN TO C-2 SOIL& REPLACE w/ - I' ° /r CLEAN SAND PER 310 CMR 255(3) .ilk *'�iy* - ' �`�. 4S` `�' <j( PERC NO. 14819 REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM MAP 287 'I: . .,; h �'._ 4 ' APPROPRIATE_y�LTHO -- _ INSPECTOR: David W. Stanton, RS - - -'M PROPOSED(4) 500 GALLON PARCEL 50 .:•�w . !� r: 4 --- !- I � _ 12 ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UN-20 LEACHING CHAMBERS * ��ti �q t� a y Michael Pimentel, EIT, CSVEVALUATOR:/ ` PROPOSED INSPECTION PORT .;'•, ' ,� "' i ) I) '� I ' • ', LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CAS S88° 51'00"E �; ! I ;�( ` s :� .j� C.S.E. APPROVAL DATE: Oct. 1999 THEY SHALL WITHSTAND H-20 LOADING. «M5 ♦ !fl-ice 4��* �I�� j M A •. DATE: September I ber 16, 2015 � 1 41 100.09 w 7�I�1 C 2 � f -� � �� i ` �� 13. DO SHALL BE FREE OF ALL DIRT, DUST AND FINES. - i J -- J �L. 101 C• C b huS LINE __ PROPOSED 4" PVC VENT PIPE, I ti ' . - �`' 1• TEST PIT#: 1 ti-� �`� �a 14. WHERE REQUIRED CONTRACTOR SHALL REMOVE ALL LOAM SUBSOIL AND UNSUITABLE EXACT LOCATION PER OWNER I � ELEV TOP = 39A0' MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. ,C. 4) 42.0 5) I V - �, ELEV WATER= <26.40' REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). -- - �- . / -;� __ ------ - � _ ��- ;, -,_ I .:,},•. � � :-. PERC RATE _ � ..f .� M •,. � - 4• .' see sieve results below 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN ° C'EA � 108"- 156„ 1 DEPTH OF SIEVE _ RCC SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. CC G O O ca � '' „� � �� ...r 16. PROPOSED PROJECT IS LOCATED WITHIN: lit TEXTURAL CLASS: 1 In ASSESSOR'S MAP 287 PARCEL 51 c� r- _ % TP 2 TP 1 z m n , I / _ 39x4� 39x4' - °p EXISTING �'•° P �� '9 �r - OWNER OF RECORD: NANCY P. STEWART o- UI GARAGE ., t' 73) . '- # -� � " � - 01. HEATHER FINAN &TERENCE FINAN �� m I 10.0' (6 f"� , r" ,` f=' �'►� k^-j� :- :�'I�� ,+ 12 Fill ADDRESS: 43 PARK PLACE O f r 1J , QJ• {� 38.40 ' + SHORT HILLS, NJ 07078 Im- D D -- PROPOSED H-20 --. a C-1 ? ►� �^ }1_ _ B Y y < L 10Yr 5/8 d FEMA FLOOD ZONE X m DISTRIBUTION BOX °� ' f�i _;� , .. hfd� _ m 1.. i n!� et . ,- LOCUS 36 C Z m I ����\\� �� u +��` ,q � . � 36.40' COMMUNITY PANEL# 25001 C0568J mz 17, DEED REFERENCE: BOOK 29089, PAGE 213 41 Benchmark !D ``•, It 118. PLAN REFERENCES: 1. PLAN BOOK 38, PG. 47 .Oi 3 \� �' ,� . Silt Loam 2. PLAN BOOK 40, PG. 67 / Concrete Corner ' C-1 2,5Y 6/6 As --__ GAS Elev. =40.00' 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. GAS A rox. M.S.L. PP - �' GAS GAS -_ 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY PROPOSED H-20 1,500 _ '1 �r. �. 4. FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY GALLON SEPTIC TANK / _ GA �!' }. 108" 30.40' FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. PROPOSED LONG :+�-� 90° SWEEPING 21. A 4" PERFORATED SCH. 40 PVC PIPE SHALL BE PLACED IN A VERTICAL POSITION TO A tk 2) BEND (TYP OF 3) DEPTH OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3" OF FINISH GRADE. A .- 1) __ p/HiW - - � Medium Sand / U/H/W LOCUS PLAN C-2 2.5Y 6/6 REMOVABLE THREADED CAP SHALL BE PLACED ON THE TOP TO ALLOW FOR INSPECTIONS. / iH 1" C-2 -INV.=35.8'_ 22. IN ACCORDANCE WITH 310 CMR 15.401 -15.405,THE FOLLOWING LOCAL UPGRADE U/H/W ❑/H/W / !-EXISTING CESSPOOL TO BE INV.(B)=34.9'± PUMPED, FILLED w/CLEAN SCALE: 1"= 1000' APPROVALS ARE REQUESTED FROM 310 CMR 15.221(7): / I 156 26.40 (1.) A 3.00 WAIVER (3.00 -6.00') FOR THE MAXIMUM COVER OVER THE LEACHING SYSTEM. U.P. 19/61 10.6' SAND & ABANDONED I I "` ! CP �/ No Mottling, Standing or Weeping Observed (2.) A 1.30'WAIVER (3.00'-4.30') FOR THE MAXIMUM COVER OVER THE DISTRIBUTION BOX. / (3.) A 0.70'WAIVER (3.00' -3.70') FOR THE MAXIMUM COVER OVER THE SEPTIC TANK. I Q N - DESIGN DATA TEST PIT DATA / I PROPOSED PERC NO. 14819 LEGEND 11 CLEAN-OUT r) �r INV.=34 < (TYP OF 7) o INSPECTOR: David W. Stanton, RS z INV.(B)=36.2'_+. � NUMBER OF BEDROOMS 5 EVALUATOR: Michael Pimentel, EIT, CSE ' EXISTING CONTOUR / I C-1 INV.=36.4'± MAP 287 DESIGN FLOW 110 GAUDAY/BEDROOM C.S.E. APPROVAL DATE: Oct. 1999 r� PROPOSED CONTOUR c=r> TOTAL DESIGN FLOW 550 GAUDAY DATE: September 16, 2015 PARCEL 52 -- - t EXISTING OVERHEAD UTILITIES EXISTING CESSPOOL TO BE PU PED & � _ REMOVED IN ACCORDANCE ���TITLE 5 DESIGN FLOW X 200 % - 1,100 GAUDAY TEST PIT#: EXISTING ELEV TOP = 39.40' EXISTING GAS LINE USE PROPOSED 1,500 GALLON SEPTIC TANK / I 5-BEDROOM ELEV WATER= <26.40' I DWELLING EXISTING WATER LINE 0/ TOF = 38.3'± PERC RATE _ TEST PIT LOCATION "' DEPTH OF SIEVE _ Z INSTALL 4 - 500 GALLON LEACHING CHAMBERS O O O PROPOSED 1,500 GALLON H-20 SEPTIC TANK TEXTURAL CLASS: 1 o / SIDEWALL CAPACITY EXISTING CLEAN OUT -'- EXISTING CESSPOOL (LENGTH +WIDTH) (2 SIDES) (2' HIGH) (0.74 GPD/S.F.) = GAUDAY (42.0'+ 12.83' 2( ) (2' ) ( 0.74 GPD/S.F.) = 162.3 GAL/DAY 0" 39.40' Fill PROPOSED 4" SOLID SCHEDULE 40 PVC PIPE i 12„ / \ 3 38.40' q INV. BOTTOM CAPACITY ❑ PROPOSED H-20 DISTRIBUTION BOX ( � - - � B Loamy Sand INV.(A)=35.8'± 3 (LENGTH x WIDTH) (0.74 GPD/S.F.) = GAUDAY 10Yr 5/8 (42.0' x 12.83') (0.74 GPD/S.F.) = 398.8 GAL/DAY 36" 36.40' PROPOSED H-20 500 GALLON LEACHING CHAMBER CP 3 REV. DATE BY APP'D. DESCRIPTION MAP 287 TOTALS: I Silt Loam PROPOSED SEPTIC SYSTEM UPGRADE PARCEL 51 TOTAL NUMBER OF CHAMBERS 4 C-1 2,5Y 6/6 ' 12,709 S.F.± TOTAL LEACHING AREA 758.2 SQ.FT. PREPARED FOR: APPROXIMATE LOCATION OF EXISTING / I TOTAL LEACHING CAPACITY 561.1 GAL./DAY CAPEWIDE ENTERPRISES CESSPOOL TO BE PUMPED, FILLED w/ 3 CLEAN SAND & ABANDONED (NOT FOUND AT TIME OF SURVEY) ��° SIEVE ANALYSIS RESULTS 108" 30.40' LOCATED AT � 3 SWING-TIES (Soil sample taken from C-2 soil in TP1) C 2 Medium Sand I 4 WACHUSETT AVENUE j 3 SAND 91.4% 2.5Y6/6 HYANNIS, MA 02601 NOTES: DESCRIPTION HCA HC-2 GC-1 SILT 5.2% I -- CLAY 3.4% MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE TANK INLET COVER (1) 16.2' 31.8' 156" 26.40' SCALE: 1 INCH = 10 FT. DATE: OCTOBER 7, 2015 1.) MAGNETIC PER TITLE 5 ALTERNATIVE TO No Mottling, Standing or Weeping Observed U►►1JI 0 5 10 20 40 FEET OF EACH SEPTIC SYSTEM COMPONENT. \ N86°08'00"W 13.1' 23.9' - c _ i / TANK OUTLET COVER (2) PERCOLATION TESTING GUIDANCE r{off. 51.89 _ -- -- ��+ PREPARED BY: 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF s - 50.6' -- 62.9' FOR SYSTEM UPGRADES JOHNL. .1C ENGINEERING INC. CHAMBER CORNER (3) (EFFECTIVE DATE: MAY 3, 2006) ��, CHUR H! THE PROPOSED LEACHING FACILITY TO ENSURE CONSISTENCY WITH __� WACHUSETT AVENUE 63.2' 66.2' UNDER POLICY BRP/DWM/PeP-P00-4: IV E 2854 CRANBERRY HIGHWAY TEST PIT DATA SHOWN ON THIS PLAN. REPORT TO ENGINEER AND LOCAL (PUBLIC-50'WIDE LAYOUT CHAMBER CORNER(4) -- BOARD OF HEALTH IF SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. ) SOIL TYPE: "UNCOMPACTED" 0. CHAMBER CORNER (5) 68.2' -- 30.6' EFFLUENT LOADING RATE FOR �i�. F�� EAST WAREHAM, MA 02538 3.) ENTIRE PROPERTY IS NOT LOCATED WITHIN A DEP APPROVED ZONE 2 SITE PLAN- CHAMBER CORNER (6) 56.8 22.5 CLASS 1, >85% SAND= 0.74 GDP/SF 508.273.0377 -- � OR ESTUARINE WATERHSED. SCALE: 1" = 10' ASSUMED PERC RATE <2 mpi ! �) Drawn By: BSM Designed By:MCP Checked By:JLC JOB No.3243 ------- - --- - - --- - _ _ - -- -- ---- _ i -- - - --- - -- - -