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HomeMy WebLinkAbout0069 WASHINGTON AVENUE - Health A1160 69 Washington- ' Hyannis pne- A= 287-085 1 a TOWN OF BARNSTABLE LOCATION ln*� N At)f SEWAGE# S--2,7(e VILLAGE ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. L& A ro orJ Tex SEPTIC TANK CAPACITY o1_eC? , LEACHING FACILITY:(type.) 6eZ (size) 4 b X 25 NO.OF BEDROOMS OWNER pfifarj 7 PERMIT DATE: 8_10 - IT 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 I,L- FURNISHED BY0O��(e),M a) C% C'% �.y� �.i w c_� _c`i• _=i J f; Commonwealth of Massachusetts 47- " ORE- w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments TJ tea, 69 Washington Ave Property Address 47 Celentano Owner Owner's Name s' information is H annis Port MA 02647 3-8-18 F. required for y f,„? 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. Please see completeness checklist at the end of the form. Whe n filling out n Important: Whe A. General Informatio ' �� i�•9 r� forms on the computer,use 1. Inspector: only the tab key to move your DOUGLAS A BROWN cursor-do not Name of Inspector use the return key. D.A.BROWN INC Company Name P.O. BOX 145 Company Address CENTERVILLE MA. 02632 fe°0" Cityrrown State Zip Code 508-420-4534 S14297 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 Evaluation by the Local Approving Authority 3-8-18 Inspector's ignature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 69 Washington Ave Property.Address Celentano Owner Owners Name information is required for Hyannis Port MA 02647 3-8-18 every 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: System has seen little to no use since installed in 2015. System meets all passing requirements. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 69 Washington Ave Property Address Celentano Owner Owner's Name information is required for Hyannis Port MA 02647 3-8-18 _ every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 69 Washington Ave Property.Address Celentano Owner Owner's Name information is required for Hyannis Port MA 02647 3-8-18 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment:. ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: III 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 t5ins-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 69 Washington Ave Property.Address Celentano Owner Owner's Name information is required for Hyannis Port MA 02647 3-8-18 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No El ® 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. t5ins•3113 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 69 Washington Ave Property.Address Celentano Owner Owner's Name information is required for Hyannis Port MA 02647 3-8-18 every page. City(rown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 8 Number of bedrooms(actual): 8 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 880 t5ins•3113 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 69 Washington Ave Property Address Celentano Owner Owner's Name information is required for Hyannis Port MA 02647 3-8-18 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: System consists of a 2000 gallon septic tank d-box and a 48x25 ft field s.a.s Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ❑ No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ❑ No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ❑ No Water meter readings, if available(last 2 years usage (gpd)): Detail: system has seen little to no usage since it was installed in 2015. 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: t5ins-3f13 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 69 Washington Ave Property Address Celentano Owner Owner's Name information is required for Hyannis Port MA 02647 3-8-18 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: unknown Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M ,•'°r 69 Washington Ave Property.Address Celentano Owner Owner's Name information is required for Hyannis Port MA 02647 3-8-18 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: System was installed in August of 2015. 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(explain): Distance from private water supply well or suction liner feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 2 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 2000 gallon Sludge depth: 0 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M ,. 69 Washington Ave Property.Address Celentano Owner Owners Name information is required for Hyannis Port MA 02647 3-8-18 every 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 0 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle II 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.): No need for pumping at thistime. I recommend pumping every 2-3 yrs once the house is occupied. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal El fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 69 Washington Ave Property Address Celentano Owner Owner's Name information is Y required for Hyannis Port MA 02647 3-8-18 every page. Citylrown 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.): i Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 69 Washington Ave Property.Address Celentano Owner Owner's Name information is required for Hyannis Port MA 02647 3-8-18 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Oil 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 looks fine with no signs of leakage. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 69 Washington Ave Property Address Celentano Owner Owner's Name information is required for Hyannis Port MA 02647 3-8-18 every page. Cityrrown 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: 1 /.48x25 ❑ 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.): No signs of failure at this time. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 69 Washington Ave Property Address Celentano Owner Owner's Name information is required for Hyannis Port MA 02647 3-8-18 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 69 Washington Ave Property Address. Celentano Owner Owner's Name information is required for Hyannis Port MA 02647 3-8-18 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent,reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters.the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form .-Not for Voluntary Assessments M ,•''p 69 Washington Ave Property Address Celentano Owner Owner's Name information is required for Hyannis Port MA 02647 3-8-18 every page. Cityfrown 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: 5+ 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: 3-2018 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: design plan Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts 11F UTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 69 Washington Ave Property Address Celentano Owner Owner's Name information is required for Hyannis Port MA 02647 3-8-18 every page. CitylTown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Assessing As-Built Cards Page 1 of 2 TOWN OF BARNSTABLE LOCATION line--'106C"1 Av le SEWAGE* AQ S-27(; , VILLAGE N Ni ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO: _oo L,, A SEPTIC TANK CAPACITY Ad O r� LEACHING FACILITY.(type) (siie) Qj X 2S NO.OF BEDROOMS OWNER PERMIT-DATE; COMPLIANCE DATE: P)40�-/_Sr Separation Distance:Between the- MaximumAdjusted GroundwateTablg to the Bottom of Leaching Facility Feet Private Water Supply We11 and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility Of any wetlands exist within' 30.0 feet of leaching.facility) Feet II. FURNISHED BY 1 0 }E�(fr1�U IN) _. I' A 1,4 11I Our-Z7 3. A. H`'S3 P o�; l z-,� A .3—2 ' r y, r http://www.townofbamstable.us/Assessing/HMdisplay.asp?mappar=287085&seq=1 3/29/2018 f x Town of Barnstable .� ' .� Regulatory Services Richard V. Scali, Interim Director MMSTABM M^S& Public Health Division 16.39. Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 Installer &Designer Certification Form Date: Sewage Permit# 10I5'-,A 7(5 Assessor's Map\Parcel C - Designer: �.le e � �� ,}fl, Installer: c �Co� -�ezg.t,n1.�-ram Address: Pb 610/- 3-.,"1 Address: On —((`�� ', . as issued a permit to install a (date) (installer septic system at (OR W a, k►n t-,1 f. . based on a design drawn by address) lqc. dated `111411 )2ev / (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. Strip out (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. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed ce with the terms of the I\A approval letters (if applicable) N eF a,�ss�c LINDA J. yG� o PIN staller's Signature) CI IL orsTEa`` �wt �+aouq !a (Designers Signature) (Affix Des? p 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:\Septic\Designer Certification Form Rev 8-14-13.doc A� r' February 18, 2016 Mr. Steve Jenney Oceanside Restoration 217 Thornton Drive Hyannis, MA 02601 Dear Mr. Jenney: Per your request, I am confirming that the property located at 69 Washington Avenue, Hyannis, known as Assessor's Map 287, Parcel 085 now has a new Title V compliant septic system which was installed by Doug Brown on August 13 of 2015. Previous to the installation of the new septic system the property had single cesspools which are automatic failures in this town, being the Town of Barnstable. Due to an automatic failure the property would not be able to have any approved sign-offs for building permits. To reiterate, the Health Department cannot sign-off on any building permits for a property that has single cesspools. Any further questions please feel free to call this office at 508-862-4644. Si erely, m p Donna Z. Miorandi, S. Town of Barnstable Health Inspector Sent via e-mail to : steve.j@oceansideinc.com I Health Master Detail Page 1 of 1 v �'S+_ � .,rnMm... +�."CSLJfJ2�H�i'L v#n�A'w �' _ /�a � i � •� '�' Logged In As: TOWN\miorandd Health Master Detail Wednesday, February 17 2016 Application Center Parcel Lookup Selection Items Parcel Septic Perc Well Fuel Tank Parcel: 287-085 Location: 69 WASHINGTON AVENUE, HYANNIS Owner: CELENTANO, ROSARIO D& ROSETTA M TRS Business name: I Business phone: Rental property: ❑ Deed restricted: ❑ Number of bedrooms : �0 Contaminant released: ❑ Fuel storage tank permit: ❑ 'Save Parcel Changes ,roJ �Return7to Lookup _ r. Parcel Info Parcel ID: 287-085 Developer lot:EASTERLY 1/2 OF LOT 35 Location:69 WASHINGTON AVENUE Primary frontage:180 Secondary road: Secondary frontage: Village:HYANNIS Fire district:HYANNIS Town sewer exists at this address:No Road index:1785 Asbuilt Septic Scan: 287085_1 Interactive map AP (Aquifer Protection Overlay Town zone of contribution:District) State zone of contribution:OUT Owner Info Owner: CELENTANO, ROSARIO D & Co-Owner:CELENTANO HYANNIS PORT ROSETTA M TRS REALTY TRUST Streetl:P 0 BOX 333 Street2: City:HYANNIS PORT State:MA Zip: 02647 Country: Deed date: 1/14/2000 Deed reference: 12780/316 Land Info Acres: 0.39 Use: Single Fam MDL-01 Zoning:RF-1 Neighborhood: 0121 Topography:Level Road:Paved Utilities:Public Water,Gas,Septic Location:Excel View Construction Info Building No ear BuiltlGross Area Living Area Bedrooms Bathrooms 1 1876 6434 3462 8 Bedrooms Full-0 Half Buildings value:$216,600.00 Extra features: $63,100.00 Land value: $1,728,600.00 http://issgl2/intranet/healthMaster/HealthMasterDetail.aspx?ID=287085 2/17/2016 Health Master Detail Page 1 of 1 Logged In As: TOWN\nniorandd Health Master Detail Wednesday,February 17 2016 Application Center Parcel Lookup Selection Items Parcel I Septic Perc I Well I Fuel Tank Parcel: 287-085 Location:69 WASHINGTON AVENUE,HYANNIS Owner:CELENTANO,ROSARIO D&ROSETTA M TRS Septic 1,8/13/2015 New Septic Permit number: 12015 276 Permit type: Repair Complete system: Issue date : 8/13/2015 IEN Complete date : 8/25/2015 l Septic tank size: 2000 Type/Size of SAS. field 48 x 25'x 1 Installer:I Brown,Douglas A.,D.A.Brown _ _�' Card on file: ❑ I/A service type: Select service V Innovative/Alternative Technology type: Select IA type Variance date : tj?Abandon complete date : -!i Abandon permit number: . .,. Repair deadline date : ��,, Repair notification date : F7777 t1 Keyword: Comments: 8 bedrooms existing i; r elete Septic' New Inspection.. Number Inspection Date Inspector Result 0 , Select Inspector _ Q Select result Received Date Comments 2/1 712 0 1 6 ........................ ' Save Septic CChanges � Return to Lookup—'� f http://issgl2/intranet/healthMaster/HealthMasterDetail.aspx?ID=287085 2/17/2016 y 1]1\ No. �' Fee Vv ' THE COMMONWEALTH OF MASSACHUSETTS Entered incom uter: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01ppIitation for Disposal *pstem Construction Permit Application for a Permit to Construct( ) Repair(Upgrade Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 6A! 0 G Owner's Name,Address,and Tel.No. 4 y cma- s ` Assessor's Map/Parcel ��1j 7 1 �tC��0 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 0 -400 _7/sl 0eec-"_),6 cc'e Type of Building: Dwelling No.of Bedrooms E3 Lot Size 39[AC�sq.ft. Garbage Grinder( ) Other Type of Building lree No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date 7-f!1°-1,T- Number of sheets f Revision Date 2 Title \\ Size of Septic Tank (x) 3r,,3 Type of S.A.S. L Description of Soil Nature of Repairs or Alterations(Answer when applicable)NI A-) X Gt !kC7 w— 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 and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. S' �—. Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued Fee V� T THE COMMONWEALTH OF MASSACHUSETTS Entered in corn uter: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pplicatlon for Misposal *pstem (tonstrUctlon Permit Application for a Permit to Construct( ) Repair(PI Upgrade( ) .Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 61 W4 5 Owner's Name,Address,and Tel.No. H yu'ai5 M+` Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 1)E,)Slab A '�jlow&) 17^ic 1 50S3<900 -WS Se Type of Building: P. s Dwelling No.of Bedrooms Lot Size 9/Cye!b sq.ft. Garbage Grinder( ) Other Type of Building t, No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided F3 5 13 gpd Plan } Date Number of sheets Revision Date 2 1 r. Title Size of Septic Tank `d C? GI Cd� UrJ - Type of S.A.S. G . Description of Soil a Nature of Repairs or Alterations(Answer when applicable NS �( 1-Sx ns 0 W,- Sepk-1 c Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance ofthe 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. _ t Sin d, Date 1 Application Approved by ' Date Application Disapproved by Date for the following reasons Permit No. 76 Date Issued ---------------------------------------- ---------------------------- ------------------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( )✓ Upgraded( ) Abandoned( )by i ,G S (d vv C at IAJ, �,', has been constructed in accordance with the provisions of Title 5 an the for Disposal Syste Construction Permit No. 2-0 O -)7 dated Installer 1 O:,.�C-5 f\ \`7!C!P / N C Designer ©C�o.o C,c7 P S���e ►C #bedrooms 13 Approved design flow NAM and The issuance of t is perrift shall not be construed as a guarantee that the system will fi ctiyas des' ned. Date Inspector --------------------------------------------------------------------------------------------------------------------------------------- -- No. 76 Fee'- d d THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal *p8tetl�.(Construction 3permlt Permission is hereby granted to Construct( ) Repair(,/) Upgrade( ) Abandon( ) System located at A n e H Y a s,j%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 must be completed within three years of the date of this permit Date -10-t ls-- Approved by QLW,.4 S r Citizen Web Request Page 1 of 2 Tp�� �t „-- q, =t �` ,^ 1r ..e;>; Citizen Request Management Request ID: 48264 Created: 2/18/2014 10:02:62 AM Miorandi, Donna - Status: Closed Assigned To: Health Office Chapter 326 : Fuel and Anonymous: No Category: Chemical Storage Tanks E.C. Date: 3/4/2014 Created By: Wadlington, Ellen Citations: Health Office Time Worked: 16.00 Response Time: 0.50 Request Location: 69 WASHINGTON AVENUE Hyannis, Ma 02601 Parcel Number: Map: 287 Block: 085 Lot: 000 Request: Basement flooded, oil tank floating. Incident occurred on 02/15/2014 at approximately 12:30 PM Request Work History: Entered on 2/18/2014 4:30:57 PM Last modified on 3/11/2014 8:28:39 AM DZM reponded to a Hyannis Fire Dept. call on Sat. 12/15/14 at 12:30 pm. Call was for a water leak. Upon arrival basement(Cape Cod)was full of water and there was a strong smell of oil. There was a double walled oil tank floating in basement and had it's connections, piping thru basement and fill pipe)were free floating.The stairs in basement were also floating (spring loaded) but floating. DZM took pictures and Hyannis Fire Dept. has even better of the oil floating at top and the new red staining from oil on steps. Hyannis Water Dept.was on the scene to shut off the water main to house and DEP was called. 2/20/14-Global Remediation , Heather Atwood, of Taunton, MA has been hired to do the clean-up. A frac truck is on site where they have pumped 6000 gallons of a oil and water mix. It is being tested.Joe Salvetti, is the LSP and waiting to hear about borings being done at the house.The water in the frac truck has come back"bad" according to Heather Atwood. DZM has taken many pictures. Ocean Side was doing the structural clean-up. Oil Express was the company delivering the oil. 12/6/13-137 gal;12/26/13-175 gal; 1/20/14 150 gal and another delivery after that that there is no record of. Mark Jablonsky was the contact person at DEP and the RTN number is 4-24994.The power of attorney for the property is .the daughter who lives in Main-her name is Rickie Cellentano-207-542-7810 and 207-236-4003. Pictures were taken and will be in street file as well as in the I drive folder. r http://issgl2/lntemalWRS/WRequestPrintPub.aspx?ID=48264 11/10/2014 February.23, 2015 � Town Council C�� S Town of Barnstable s; 367 Main Street, Imo, Hyannis, MA 02601 i u� Re:` Phase I Initial Site Investigation &Tier I Classification Report Residential Property _4 669,Washington Avenue 'Hyannis Port,-Massachusetts 02601 r.Awa DEP Release Tracking Number(RTN) 4-24994 FST Ref. No. GH-005 To the Town.Council: On behalf of Celentano Hyannis Port Realty Trust and in accordance with the public notification requirements of the Commonwealth of Massachusetts Department of Environmental Protection (DEP) Bureau of Waste Site Cleanup (BWSC) Massachusetts Contingency Plan 310 C.MR 40.1403 and 40.0510(3)(a)(3), this letter serves to notify you as chief municipal officers for the Town of Barnstable, of the submittal and availability of a Phase I Initial Site Investigation & Tier l Classification Report in connection with remedial actions being conducted in response. to a reportable-release of No. 2 fuel oil from a 275-gallon aboveground storage tank located.within the basement of the residence located at 69 Washington Avenue in Hyannis Port; Massachusetts. A copy of the Disposal Site Map, Legal Notice and Conclusions Section of the Phase I submittal is attached. This Disposal Site has been tier classified as a Tier I Disposal Site in accordance with 310 CMR 40.0500 of the Massachusetts Contingency Plan. Pursuant to 310 CMR. 40.1403(6)(b), this letter serves as notification that the attached legal notice is .scheduled for.publication in The Barnstable Patriot on Friday, February 27, 2015. The Phase I Initial Site Investigation & Tier l Classification Report was submitted electronically to DEP and. is available for review by going to the DEP website http://public.dep.state.ma.us/SearchableSites2/Search.aspx then entering the Site's RTN_4- 24994, next click on the "Search button, and then click on "Files" on the right hand side of the next page. Should you have any questions regarding this matter, please do not hesitate to call. Sincerely, Fay, Spofford and Thorndike .'Joseph P...Salvetti,.LSP Andrew Eckhardt Associate Environmental Project Manager cc: Celentano Hyannis Port Realty Trust,69 Washington Avenue, Hyannis Port,MA 02601 Barnstable Public Health Division,200 Main Street, Hyannis,MA 02601 400 Crown Colony Dr.,Suite zoo FAY, SPOFFORD &THORNDIKE Oulincy,:MA o2i69 T:_627 786-796o Offices in:Massachusetts,New Hampshire,Maine, F:6i 86 62 77 79 Connecticut and-New York www.fstinc.com i W-2 I89.57] O w a BULKHEAD p O O i a3 FIRST FLOOR SUMP SB-7 ENTRANCE 01 MW 1 1.5•.DRAIN LINE _ - \ I QHA44 CAPE COD CELLAR LOOR DRAIN \\ I �g PORCH I I ..................... CH-,pp I 9(0-3*'.6r •\ �`� ` I APPROXIMATE SOIL I EXCAVATION BOUNDARY F E / 5 (OUTSIDE) 5-51 0-10 (CRACK IN FLOOR -16 6.6•/.B O \� I GRGUN 7ER QHA-45 IMN ' C3.0 H7 IN, S\\ I FLOW D/R WCR .GARAGE / i \ 11 i *69.561 oN L EAR FLOOR '., \ 5 CRAWLWL SPACE � H17 N] S-2B I I w (OS 1.7)� `�(,(0��•8 _ \I(pa-/. A � y I O HA-46 \ I APPROX.W FEET TO o ����� IYANOUGH AVE s1G sd4 6 l 2.2) p S-1z szs oan I Gsze ` S-20 Os-23 04 (Da•/6.4) szo `saws` 0 p L__________________________ 30 $-27 MW-5 8-21 S33 QSJ5 / / y MW4 I `QS-22 5-36/ 169.47f I BENEATH HOME `�-3 i SOIL VOLUME CALCULATION: V -4 FT OF SOIL REMOVED=139 CU YD. �MWa �►'e9.561. -g FT OF SOIL REMOVED=206 CU YD. _ SOURCE: APPROX.PROPERTY LINE FAY,SPOFFORD ec"I'HORNDIKE, LEGEND FST ENS CROW PLANNERSON �SU:TE 22 0 S&] -SOIL BORING LOCATION WINCT,MASSACHUSETTS Ot169 FST FlELD 09SERVA77ONS S-5 Q -SOIL SAMPLING LOCATION HA450 -HAND AUGERED SOIL SAMPLING LOCATION FIGURE 2 REVISIONS nTLE: (06-/2.2) -SAMPLE DEPTH/PID RESULTS DISPOSAL SITE MAP MW-1* -MONRORING WELL LOCATION NO. DATE DESCRIPTION 69 WASHINGTON AVENUE EDITEDEDr. DKT. 189.601 -GROUNDWATER ELEVATION(041241M14) HYANNISPORT,MASSACHUSETTS DATE: PL7fz2olw PREPARED FOR: DWG SCALE: 1�< IO' •.� /- -AREA TO BE EXCAVATED(UP TO 4 FEET TO BE REMOVED) JOHN CELENTANO PROJECT NUMBER: 69 WASHINGTON AVENUE GH-005/1600.001 -AREA TO BE EXCAVATED(UP TO 6 FEET TO BE REMOVED) HYANNISPORT,MASSACHUSETTS R G1D C9,f tlWOM 9RLAP.DM9 SHEET NO: 1 OF 1 r 12.0 CONCLUSIONS On behalf of Celentano Hyannis Port Realty Trust, FST has prepared this Phase 1 & Tier Classification Report in connection with a release of an unknown quantity of oil and/or hazardous material (OHM) from a former underground storage tank at 69 Washington Avenue, Hyannis Port, Massachusetts (the Site). Pursuant to 310 CMR 40.0483(1)(h), of the Massachusetts Department of Environmental Protection (DEP) Massachusetts Contingency Plan (MCP) our findings and conclusions are discussed below: • The Site is a currently vacant residential property located in a residential zoned area of Hyannis Port, Massachusetts. • The Site has been impacted by a release of an unknown quantity of No. 2 fuel oil. The source of the release was a 275-gallon No. 2 fuel oil AST which leaked as the result of flooding within the basement of the residence. • The DEP was notified on February 15, 2014 and subsequently assigned RTN 4- 24994 respectively to the notification. • IRA assessment and remedial actions performed to date include, dewatering of oil impacted flood water, soil boring advancement, monitoring well installation, soil and groundwater laboratory analysis, groundwater elevation survey and excavation of petroleum impacted soil at the exterior of the Site building. • Groundwater samples collected from monitoring wells located immediately down, cross and up gradient of the release show petroleum analytes to be below applicable MADEP Method 1 GW-1/2/3 standards. • Comprehensive Response Actions are still necessary at the Site. Laboratory analysis indicates that residual petroleum impacted soil, at concentrations above DEP Method 1 S-1/2/3 GW-1/2/3 Soil Standards, currently exists beneath the footprint of the Site building. Excavation and off-Site disposal of these soils are anticipated to commence following additional shoring of the Site building. • The Site residence is currently vacant and therefore there is no current exposure to any potential vapor intrusion pathway. Following anticipated future excavation of soil impacted soil beneath the residence and/or occupancy, FST will conduct a vapor intrusion assessment. • Based upon information obtained from the Barnstable Board of Health, no abutting properties within 500 feet of the Site have a private water supply well. • The Site meets the Tier I Inclusionary Criteria listed in 310 CMR 40.0520(2)(d) of the MCP one or more response actions are required as part of an Immediate Response Action to eliminate or mitigate a Critical Exposure Pathway pursuant to 310 CMR 40.0414(3) therefore, the Site is classified as Tier I. 12-1 rRn, �E anxB.sFxuT:Imm�B �oB.�,'°o° cN•�M E0.EFUSEp WmS0lxBm nF rxROWl6ef � '� ,4�A•��le� . • nEa�n MxWoxnV,Kx• ACEbauBMBxES r mBEPEPoBIrm Bee-06F.1 BEPNPBEnnBArM 0.EaipxFEYnipBraVm w5M /tri1Gi®PISR ' RWA6 TBREMNH air `• t; OFlnef mFAtE /At • ® ® Q$7 II RIRIE • BBB) „H'a vs•DaxnA - ------------ eu�BSrF➢s ._.— h �`5 ciEUAin.Enm° zNEE xuv vvencBFnm+n - Exiz,wo � �Fmrnc - k Em.wnix�Ea - rcxIEE114 .0 a.wxorm dam 7 1 qua, �0 F,ABEB SECTION ELEVATIONATLMNO BOON } � Ru,zrERm eepvmm�wrx R°isE°�raax1zroBEvcro«ro �ExmvErmurmx siEuzi�' � �� t!1 Porch Details __ - ux�Er wwsxwmEesse vBer vmaoemme;mrtei s.mm B:rxvvsmw ariro tk'-r-o' -- �oxTmaFA.a r:� �ivn*nxwxnm rov �roE�Bixsreumm wawnwmwa Nn �civncPnitEnx. �Z Washingten Avenue Side i� x/B,BB.smeEBnmt F urx�wrpamwmx Wr�FffirgB —_—_—__.—_—.--_._L'IFAfSTW:R_.—.—_—_—_______— - Cwnxx Yellow House -- cnRtlFAenwn CUFewims 69 WasBinBton Avenue FnuR nEWue Nvenno Port,NneacBusetb Nm,uA'wNsstsd • - I,r1er auRSEt yc•4'WZ,,i 2 Washin ton Avenue Side-Inside Porch Rail xu�w�xs,F,mBsuRe ,'' ' va•-r-o• vaEs�.xB,EBw�B �a m—wnnaBwvm- BaiBeBwsE _ a.rFnweBBewBB.nos • CYU QNN4®.�. • «BaxrmwonB mi»me coBBlroclroe e SpoFu.s: - Erterior Elevations ` Gera a Side - A2.1 ` I I i I I I 3 I _ I . I R - I r4�llf» sMCFk I ��,°»�ro mwtrxlrtrv� s«wstem9sws*°w�rx MrIlm j j j j (1 Backyard ISideyaJ Side j urn» - cNX3.91TJ.A°» s+umoracwres mw9sowrwe ,mwcoarna.,xr.» --------------------------------------- � w�iwEsrwn Yellow House 01D ® ® r0u»nEcuwr 69 VJac"inyrn(us -�� hF°oN5F51sJ MWmi Port.Mss"C�uaeth ItYN,LL� Back and(Sideyardl Side-Inside Porch RailingH_ tj iWA ------ ----- °x» - e fan slams 4 M ya• - Exterior Elevations vd- Washington Avenue Side A2.2 r-o cz s`9y R E ! 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I i 1 i I I 1 i I i I I I I I I o-- I -- —�1 '------ 4 1--._--_—. Dd— r, i 8 arc�,w eau DUDiL! CC Dw rm' 'iwoaaui Meil rmvmox ' Maetar 8edraom w c`ommmD Bed® , • D+ED.'VnRNi1LM. ' IMeY Wu1.41DCLN' I iI Badrw io a °E°DAED p-- i------- i-- --=--- ------ i ------- i - -------- i Q-- 1 ---� — --_ -- — -------L ---- Yellow House ro I I I 89Wa°ePq A— I i i I I J I i i i r r CM SIMI=® mow:°ro nme. n - MON 1018 1/b•1'd• Second level Pia. Town of Barnstable P� � 75�! ilia Department of Re:gulato • �'•� �, ry Services • >s Public Health Dilvislion pace . .1elp. 200 Main Street,Hyannis MA 02601 Date Scheduled / Time ° :'yip• Fee Pd. • Soil Suitability AssesSment for Sew ' e s osal Performed-By:. 6JA 121 jf0 Witnessed By: ` �✓ n LOCATION&GENERAL T•INFORMATIONLa//cation Add-a- (D� Owner'a Name ;�---- ' + Add 11414 o �'? Assessor's Map/Parcel: " 2$�� 1 7 ��� .> Engineer's Name NEW CONSTRUCTION REPAIR v k... �'1 � �i { Telephone It >0 � Z-7 q � -,V- ' Land Uae•_ _ 5lopca(%)_��.•I� Surface Stones Distanceb from: Open Water Body ( (t :possible Wet-Area `• T T fl I ft DrinkingWatcrWell Drttlhage Way ft Property Line V , R Oil ter ft S1 +TCH:(Street name,dimensions of lot,exact locations of teat holes&perc tests,locate wetlands 1n proxinilt to holes) (nJ A 5 16„6V .fjo i y 71' r Parent material(geologic) kD I o ►�.� >2��r Depth to Redroek Depth to Groundwater. Standing Water In Hoe: N r� • l Weepingfi'otn PltFnce A14 . Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL-RI GH WATER TABLE Method Used: Depth Observed standing In obs.hole: _ De�th to weeping frorn side of oba.hole: to Deptll to soli mottles. Itl. Index Well fr In, Orntindwater,A4justment fit, Reading Dato:_ Index Well leYol�, �� -.•_• • • - AcU,fltctor„7— p`U:pt•nundwtitcr Levgl,,,,_, PERCOLATION TEST nata 'rt>uri Observation 3 Hole fk _ • �-- - - Time at Depth of Pere Time at G Start Pro-soak Time Q End Pro-soak 00 L Z Rate Min./Iuch �Zrn Site Suitability Assessment: Site Passed -Site Failed: — Addldonnl Testing Needed(Y/N) • C! 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 notif y the Barnstable Conse>}vation Division at least one(1)weel[prior to beginning. Q:\S EPTIC\PERCFORM.DOC • r.• ' y . DEEP.OBSERVATION HOLE LOG Hole# Deptli from Soil Horizon Soil Texture Shcl Color Soil• Other ' Surface(in. (USDA) (Munsell) Mottling (Stnucture,Stones;Boulders. nsietency,y6'aravell • �i — ` f Jv �S� t�D' �V2 3 2 ' Z7 q C r MJ- 5,9 t0�R. )� , f C 2 d/ .f. 1 Q'i1 4 `� DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soll Texture Soil Color Soil Other. Surface(in) (USDA) (Munsell) Mottling (Structure,Stoncs,Boulders. Consistenry.qfi OraVol) 1f3 °ft 3 2 r"`tA!-LCi� 77 9 ldy DEEP OBSERVATION HOLE LOG Hole# ) Depth froi I Soil Horizon Soil Texture Soil Color Soil Olhcr Surface(i ) (USDA) (Munscll) Mottling (Structure,Stoncs,Boulders. Conslatcney,%G C i ez!,. 1 0yk DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Boll Other Surface(n.) (USDA) (Munsell) Mottling (Structure,Slopes:Boulders. Consistencv. y i • i Flood. nsurance Rate Ma Above 500 year flood boundary No Yes Wltlrin 500 year boundaryNo 1 Yes ' Within 100 year flood boundary No. De nth of Naturafly Occurring Pervious Material Does it least-four fact of naturally occurring PC us tpatarial exist in all areas obgorved thrpughout the area p oposed for the soil absorptibn system? If not,what is the depth of naturally occurring per ous mal'oriall Certi cation I'card that on. � (date)I have passed the soil evaluator examination approved by the Depa tment of E ironmental Protection and that the. above analysis was performed by me consistent with . there uired tral ng,expertise and experience described in�10 CMR 15.017. Signs Date QAS.11 0-PBRCPORM.DOC I i Massachusetts Department of Environmental Protection --� Bureau of Resource Protection. j- Well Completion Reports 1 Well Driller Please specify work performed: Address at well location: " New Well Street Number: Street Name: 69 WASHINGTON Please specify well type: Building Lot#: 'Assessor's Map#: Monitoring Assessor's Lot#: ZIP Code: Number Of Wells: City/Town: Well Location BARNSTABLE In public right-of-way: GPS (GPS for the deepest well) G Yes t: No 'North: West: 41.37978 70.18079 Subdivision/Property/Description: Mailing Address: EJ click here if same as well location addres Property Owner: Street Number: Street Name: 1 ROBERTS ROAD City/Town: State: Engineering Firm: PLYMOUTH MASSACHUSETTS777 FST ZIP Code: 02360 Board of health permit obtained: G Yes (07)Not Required Permit Number: Date Issued: r _ Y ; Y Massachusetts Department of Environmental Protection Bureau of Resource Protection—Well Driller Program tWell Completion Reports(Monitoring) Well Driller - Monitoring Form DRILLING METHOD Overburden (Direct Push I Bedrock Choose Bedrock— WELL LOG OVERBURDEN LITHOLOGY From To(ft) Code Color Comment Drop in drill Extra fast or Loss or addition of (ft) stem slow drill rate fluid 0 20 Silty Sand And Gravel I iBrown 0 YES r NO r Fast C Slow 0 Loss r Addition PERMIT INFORMATION DEP 21 E RTN# DEP Groundwater Discharge# " ADDITIONAL WELL INFORMATION Developed ri Yes 61 No Are these wells nested? r.Yes r'No Surface Seal Type Cement Area of group(sq.ft) Total Well Depth 20 Depth to Bedrock CASING r Is Casing above ground. From To Type Thickness Diameter 0 10 (Polyvinyl Chloride Schedule 40 2 SCREEN(r No Screer� From To Type Slot Size Diameter 10 20 ISlotted PVC 1 2 WATER-BEARING ZONES Yield From To (gpm) k ANNULAR SEAL/FILTER PACK Water From To Material 1 Weight Material 2 Weight (gal) Batches Method Of Placement 0 8 , Native Material ---Choose Material--- Gravity g 9 Bentonite Chips/Pellets ---Choose Material--- Gravity 9 20 Sand ---Choose Material--- Gravity WATER LEVEL Date Measured Static Depth BGS (ft) Flowing Rate (gpm) 4/23/2014 12 , 9` Massachusetts Department of Environmental Protection Bureau of Resource Protection—Well Driller Program Well Completion Reports(Monitoring) COMMENTS r WELL DRILLERS STATEMENT This well was drilled or altered under my direct supervision,according to the applicable rules and regulations,and this report is complete and accurate to the best of my knowledge. Monitoring[M] Supervising Driller Signature NEWSHA Driller MATTHEW KELLY Registration# 606 PETER,W TECHNICAL DRILLING Date Job Complete Firm SERVICES,INC. Rig Permit# '66 4/23/2014 ' NOTE:Well Completion Reports must be filed by the registered well driller within 30 days of well completion. ' f 48' H ann15, TOP OF FOUNDATION 24"diameter contrcte covers EL=19.6 rarsecl to wtha 6"to fimsJr grade E LOW P ONO`F I LE MA (ores noted) 5',��/ ova/ >=dge Hill Rd s=.., NOT TO SCALE (5-Atte#2 ^ x �- fL=/7.0+ fL�/6.5.t- /70_ , •, � � fl /4.5_ EL=/3.9(\ ,� � � � . o LOCUS Rx 777 Wa5hinelton Ave 944n-36°Max co y ° ------ ---- r ,: /5.4 � � � M K t � D /3.5+ _ ° Wachu5ett Ave m _ g i 2'LAYfR OF//B"- 1/2"STONE 4" N �-5 l4.25 l4.00 !2./7 / .GYM 2 /O./6J a INmg Ave iv 10.40 -4'- 1-1/2'ST0NE ° 3 t z 9.40 9./C Leas Lllafile Nantucket Sound Longest Run 52 13' 48' 2000 GALLON (fJ-20 Rated) 25.0'X 48.0'X 1.7 inspection Pares(See N©te#�f) 5fPT/C TANK D-BOX LEACHING FIELD fL=3.5{Bottom of Test Ho% SITE LOCUS NOT TO SCALE PLAN VIE I E J�/ 40 mil. tfOtrGner(see Note,#23) CO N ST R,U CT I O N NOTES V V v I .) Aasessor's Map 287 Parcel 85 SCALE: I" = 10' 2.) Deed Book 12780 Page 3 I G 1.)ALL WORK SHALL CONFORM TO THE STATE ENVIRONMENTAL CODE,TITLE 5 (3 10 CMR 1 5.000):STANDARD 3.) Plan Book I I I Page 30 REQUIREMENTS FOR THE SITING, CONSTRUCTION, INSPECTION,UPGRADE,AND EXPANSION OF ON-SITE BENCHMARK 4•) This property Is not in a Zone II of a Public SEWAGE TREATMENT AND DISPOSAL SYSTEMS AND FOR THE TRANSPORT AND DISPOSAL OF SEPTAGE,AND THE g 30 8 Y c�5 n Water Supply 1 J /g to n Gas Valve Rim ) LOCAL BOARD OF HEALTH REGULATIONS. Pole Electric \ 6 I E.77 16 15.91 J AVe n Ue EL=14.45 (A55umed Datum) 5. Flood Zone: C, X, A� cm Box 2.) ANY SEPTIC SYSTEM COMPONENT INSTALLED IN A LOCATION WHERE THERE IS POTENTIAL FOR VEHICLES OR ° �'Utihty 60 HEAVY EQUIPMENT TO PASS OVER IT SHALL BE DESIGNED TO WITHSTAND AN H-20 LOADING. IF UNDER AN , . Pole IMPERVIOUS SURFACE, SYSTEM SHALL BE VENTED TO THE ATMOSPHERE. �,' _. -- `"`�-r 14 e LEGEND -`" 13.9 3.)TO MINIMIZE UNEVEN 5ETfLING, SEPTIC TANKS SHALL BE INSTALLED ON A STABLE ` Hedges Ga5 Valve Water Valve MECHANICALLY-COMPACTED BASE ON 51X INCHES OF CRUSHED STONE. ,� _ 7^ii Stop Sign° ,2.G Om EXISTING SPOT GRADE o � _ 2.40 a 24x5 PROP05ED SPOT GRADE 4.) COVERS OVER THE INLET AND OUTLET TEES OF THE SEPTIC TANK,THE DISTRIBUTION BOX,AND THE SOIL u Cn fi ' - _ ABSORPTION SYSTEM SHALL BE RAISED TO WITHIN G"OF FINAL GRADE. LEACHING FIELDS,TRENCHES,AND ^� cp - , _ d - - z''-� EXISTING CONTOUR a! > _ 0 3 24- PROPOSED CONTOUR OTHER SOIL ABSORPTION SYSTEMS WITHOUT ACCESS MANHOLES SHALL HAVE AT LEAST ONE(1)INSPECTION m L I PORT CON515TING OF PERFORATED 4"PVC PIPE PLACED VERTICALLYTO THE BOTTOM OF THE SOIL °N 8 a / , / m w WATER SERVICE LINE ABSORPTION SYSTEM WITH A CAP, TIED WITH MAGNETIC MARKING TAPE,ACCESSIBI r-TO WITHIN 3"OF FINAL ° Parcel (55 ' 1h - 40md.HDREbner o z 6.6 �w M o OVERHEAD UTILITY LI NE5 27.0' �: ' (See Note#23) U UNDERGROUND UTILITY LINES GRADE, Area=0.39 Acres± � � ,.�� �� , 5.) PIPING SHALL CONSI5T OF 4"SCHEDULE 40 PVC OR EQUIVALENT. PIPE SHALL BE LAID ON A MINIMUM E p x J / G GA5 SERVICE LINE CONTINUOUS GRADE OF NOT LE55 THAN 2%FROM THE BUILDING TO THE SEPTIC TANK,AND NOT LESS THAN +1 JS 18 p- / //0 5' / zo /` /�✓ EDGE Of CLEARING I% OTHERWISE. C) ° e A° 4 / O' / TIP PENCE i iii ii i� r / i�i G.) DISTRIBUTION LINES FOR THE 501E ABSORPTION SYSTEM SHALL BE 4"DIAMETER SCHEDULE 40 PVC(OR { 0 TEST HOLE LOCATION EQUIVALENT) LAID AT 0.005 FT/FT. UNLE55 OTHERWISE NOTED. LINES SHALL BE CAPPED AT END OR AS NOTED. °° j r � 5T 5EPTIC TANK DB D15TRIBUTION gOX 7.) LINES FROM THE D15TRIBUTION BOX TO BE LEVEL FOR THE FIRST TWO(2)FEET BEFORE PITCHING TO THE / SAS 5OI L AB50RPTI ON SYSTEM SOIL ABSORPTION SYSTEM. DISTRIBUTION BOX SHALL BE WATER TESTED TO A55UU EVEN DISTRIBUTION. / Existing 8 bedroom Dwellin �� � � _ 5 �/Remove/ i Gara e Top of Foundation EL=!9,69 / �r', / �,f (See NRemow J 5.)GROUT TO BE USED AT ALL POINTS WHERE PIPES ENTER OR LEAVE ALL CONCRETE STRUCTURES IN ORDER / g Top of Slab EL-12,4+ / TO PROVIDE A WATERTIGHT SEAL. / / ' = INSPECTION4y�� SPECTION NOTE: 9.) HEAVY EQUIPMENT SHALL NOT BE ALLOWED TO OPERATE OVER THE LIMITS OF THE-SEWAGE DISPOSAL FIELD / / 20'mn DURING THE COURSE OF CONSTRUCTION OF THE SYSTEM. - PRIOR TO FINAL INSPECTION BY THE ENGINEER,SYSTEM In / % (� NEEDS TO BE COMPLETE INCLUDING BUILDUP FOR COVERS. 10.) IN ACCORDANCE WITH 3 10 CMR 15.22 J,ALL SYSTEM COMPONENTS SHALL BE MARKED WITH MAGNETIC a MARKJNG TAPE. , I G / C) 1 1.)THERE ARE NO KNOWN WELLS WITHIN I00'OF THE PROPOSED SOIL ABSORPTION SYSTEM. { / r f !� f dy3 r� SYSTEM DESIGN CALCULATIONS z.5 _a.4o -.. SEWAGEDLIGN fZ,OW REQUIREDD•B BL"7aROOM DWELL/NG 12.) FROM THE DATE OF THE INSTALLATION OF THE 501L ABSORPTION SYSTEM UNTIL RECEIPT OF THE \� / Flag / B CERTIFICATE OF COMPLIANCE,THE PERIMETER SHALL BE STAKED AND FLAGGED TO PREVENT USE OF THE AREA f-ting Cesspools(potenful/y3) �p Pole / / I //0GPD/BEDROOM="GPD REQUIRED THAT MAY CAUSE DAMAGE TO THE SYSTEM. to be Abandoned(see Note f22) _ Boulders 5EWAGfDES/GNfLOWPR'Ol//DED: 0NE25 X4B x/.0'LEACf1 f/ELD 13.) THE DESIGNER WILL NOT BE RESPONSIBLE FOR THE 5Y5TEM AS DESIGNED UNLP55 CONSTRUCTED AS 8 �' - ;� - •� haybalrs 14.7 / / -�I h f/t=((880/0.74)= //B9.2S.FREQU/RfD(/21Xy5.J' PROI/IDED) SHOWN ON PLAN. ANY CHANGES SHALL BE APPROVED IN WRITING BY THE DESIGNER. ( p " 145'-i '� t , 1 T E PLAN 16 Hedges _� z� �f-/ l 8BB GPD PROVID,50 s WO GPD ReQUJRED 14.)THE BOARD OF HEALTH REQUIRES INSPECTION OF ALL CONSTRUCTION BY AN AGENT OF THE BOARD OF -... --- HEALTH AND THE DESIGNER. THE DESIGNER SHALL CERTIFY IN WRITING THAT THE SEWAGE DISPOSAL SYSTEM I 0 5EP77C TANK CAPAClTYREQUIRED- BBO GPDX200%_ /790 GPD REQUIRED WAS INSTALLED IN ACCORDANCE WITH THE TERMS OF THE PERMIT AND THE APPROVED PLANS. 48 HOURS SCALE: I" = 20' G 1 ADVANCE NOTICE 15 REQUESTED. d Zo j SEPTIC TANK CAPAC/TYPROI//DED 2000 GALLON SEPTIC TANK \oo on X ,►... 15.) LOCATION OF UTILITIES 1-9 APPROXIMATE!AND CONTRACTOR SHALL BE RESPONSIBLE FOR DETERMINING F �\oo Z e I O 8.70 A GARBAGED/5POSAL 15 NOT PERMITTED WITH TH/5 DE51GNfLOW THE LOCATION OF ALL UNDERGROUND AND OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF ANY WORK. THIS INCLUDES, BUT 15 NOT LIMITED TO, REQUESTS TO DIGSAFE,ANY PRIVATE UTILITY COMPANIES,AND THE j� o� fib, LOCAL WATER DEPARTMENT. TEST HOLE LOGS oo �,00 I G.)CONTRACTOR SHALL VERIFY THAT ALL WA5TELINE5 ARE CONNECTED BY WATER TESTING WITHIN THE Test Hole#I (EL=14.8±) Test Hole#3 (EL=13.5±) DWELLING PRIOR TO INSTALLATION OF ANY SEPTIC COMPONENTS. Depth Layer Soil Cla55 Sod Color Comments Depth Layer Soil Class Soil Color Comments 17.)CONTRACTOR SHALL VERIFY EXISTING INVERT ELEVATIONS PRIOR TO INSTALLATION OF ANY SEPTIC SYSTEM REVISION 8/12/15: Changed Elevation of end of 5A5,Sod Removal Depth COMPONENTS. 0"-7" A Fine Sandy Loam I OYR 3/2 0"-20" A Fine Sandy Loam 10YK 3/2 7"-27" B Medium Sandy Loam I OYR 5/G 20"-37" B Medium Sandy Loam I OYR 5/G 18.) INSTRUMENT SURVEY CONDUCTED FOR PROPOSED WORK ONLY. SITE PLAN SHALL NOT BE USED FOR 27"-98" C I Medium Loamy Sand 1 OYR GIG 37"-120" C 1 Medium-Coarse Sand I OYR G14 Perc @ G4" Prepared for: STAKING, OR ANY OTHER PURPOSES. 98"-146" C2 Medwm-Coarse Sand I OYR G14 19.)THIS PLAN DOES NOT CERTIFY, Celentano GUARANTEE OR WARRANTY COMPLIANCE WITH DEEDED OR ZONING P.O. Box 333, Hyannis Port, MA 02G47 BYLAWS, SPECIFICALLY, BUT NOT LIMITED TO, SIDELINE SETBACKS AND BUILDING HEIGHT RESTRICTIONS. Test Hole#2 (EL=14.G±) �ZKS OWNER 15 RESPONSIBLE FOR OBTAINING SUCH A DETERMINATION FROM THE APPROPRIATE AUTHORITY. I CERTIFY THAT I AM CURRENTLY APPROVED BY THE DEPARTMENT OF 2d�� Depth Layer Sod Class Sod Color Comments ENVIRONMENTAL PROTECTION PURSUANT TO 310 CMR 15.017 TO �4 LINDAJ, Proposed Sewage D15po5al 5y5tem 20.)TEST HOLES COMPLETED PER STATE ENVIRONMENTAL CODE,TITLE 5, SOILS CAN BE VARIABLE AND TEST CONDUCT 501L EVALUATIONS AND THAT THE 501L ANALYSIS HAS BEEN c Pf ^' G9 WaShington Ave., Hyannis, MA HOLE DATA 15 NO GUARANTEE OF SOIL CONDITIONS IN OTHER AREAS. IF SOILS DIFFER FROM THOSE SHOWN 0"-5" A Fine Sandy Loam 1 OYR 3/2 PERFORMED BY ME CONSISTENT WITH THE REQUIRED TRAINING, ul IN THE 501L5 LOGS, DESIGN ENGINEER IS TO INSPECT THE SOILS PRIOR TO PROCEEDING WITH INSTALLATION 5"-35" B Medium Sandy Loam I OYR 5/G EXPERTISE, AND EXPERIENCE DESCRIBED IN 310 CMR 15.017. I v OF ANY SEPTIC COMPONENTS. 35"-85" C I Medium Loamy Sand I OYR GIG FURTHER CERTIFY THAT THE RE5ULT5 OF MY 501L EVALUATION AS r Prepared by: 85"-144" C2 Medium-Coarse Sand I0YRG14 INDICATED ON THE ATTACHED SOIL EVALUATION FORM, ARE ACCURATE Fo RrG 2 1.) SOIL REMOVAL: ALL TOPSOIL("A"LAYER)AND SUBSOIL("B"LAYER)SHALL BE REMOVED FOR A DISTANCE AND IN ACCORD NCE WITH 31 O CMR 1 5.100 THROUGH 1 5.107 OF FIVE(5)FEET LATERALLY FROM THE SOIL ABSORPTION SYSTEM DOWN TO THE CLEAN SAND LAYER �.sJdINAL (EL=G.G±). AREA TO BE BACKFILLED WITH CLEAN SAND AND COMPACTED TO MINIMIZE SETTLING. �- DATE OF TESTING: 07/08/15 22.)EXISTING SEPTIC COMPONENTS TO BE LOCATED, PUMPED DRY, FILLED WITH CLEAN SAND AND ABANDONED SOIL EVALUATOR: LINDA J. PINTO, P.E., OCEANSIDE SEPTIC, INC. IN PLACE. AREA TO BE COMPACTED TO MINIMIZE 5E77LING. BOARD OF HEALTH AGENT: DAVID STANTON, 13ARN5TABLE HEALTH DEPARTMENT Linda J. Pinto, Certified Soil Evaluator PERCOLATION RATE: LESS THAN 2 MIN/INCH IN "C" LAYER 23.) INSTALL A 40 and HDPE LINER FOR BREAKOUT FROM EL 10.9± TO EL G.9± AS SHOWN ON PLAN(SEE PLAN 0 20 40 GO VIEW). NO GROUNDWATER ENCOUNTERED EP,iG9E_Etl€6N6 fl6i/1Si0N SCALE 1 "=20 P.O.Box201, Brewster,MR 02631 Phone:(508)896-1513 C:\Ocean5ide\05-Wa5hington\05-Wa5hington-5D5 Pian.dwg Date:07/14/15 Sca1e:As Shown By: LJP Check:MLA Project No.OS l 5 161