HomeMy WebLinkAbout0109 WOODLAND AVENUE - Health 109 W&ottand Avenue I
Hyannis.. ..P
A _. 269_ 006003
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TOWN OF BARNSTABLE
LOCATION 109 (Jpnd_1an(4 AVE SEWAGE# ZOIS- 3qO
VILLAGE ASSESSOR'S MAP&PARCEL
r4NSTALLER'S NAME&PHONE NO. Q 6XCayaA►o�J q*11 • OG53
SEPTIC TANK CAPACITY 1O00
LEACHING FACILITY: (type) 5t)0sp ) LC t 3) (size) 13 x 33 x 7-
'NO.OF BEDROOMS q
OWNER '
PERMIT DATE: . /Oi2 IS COMPLIANCE DATE: 40
Tr
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
i
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching.facility) Feet
Edge of Wetland and Leaching Facility.(If any wetlands exist within
300 feet of leaching facility) Feet
FURNISHED BY
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14,
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WN OF ARNSTABLE
l A710N; SEWAGE #
VILLAGE ASSESSOR'S MAP & LO
INSTALLER'S NAME AONE NO.
SEPTIC TANK CAPACITY 0 o
LEACHING FACILITY: (type) CL) (size) l Q Q V
NO.OF BEDROOMS
BUILDER OR OWNER
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) - Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by 2 1 0— O c�
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No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in corn uteri
Yes
PUBLIC HEALTH DIVISION - TOWN Of BARNSTABLE, MASSACHUSETTS
31 Iitation for i�l�l � BpOSaY 6psteUt Construction permit
Application for a Permit to Construct( ) Repair V Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
ocat�ionAddress or Lot No. I pck wooako.n6- Pave- Owner's Name,Address,and Tel.No.
ss°�sso�Map/Parcel `A am i S o.• M;C.h0,C I tf%0.0
Ins
taller's s Name,Address,and Tel.No. SO$ Designer's Name,,�ddress,and Tel.No.
s*8 cxcAv 1y-rcaSc,rr4 W RmUa) ue4 ASSOC10. C S'
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) q W 0 gpd Design flow provided y 4 g gpd
Plan Date D {' I S Number of sheets 'Z. Revision Date
Title
Size of Septic Tank Type of S.A.S. Top 9m) I.C (3)
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) .,O BOX - LLac�i19 C.�gw�.�
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.
Date
Application Approved by 0Date
Application Disapproved by Date
for the following reasons
s
Permit No. Date Issued
a +
Fee
r �0o. 0 .,41l�' 1 OP
THE COMMONWEALTH OF MASSACHUSETTS Entered in coraker: #
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
4pYication for Disposal fpstem Construction Permit
Application for a Permit to Construct( ) Repair(X Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
ocat� ddress or Lot No. `O� (,,)oodlar.ct Nve- Owner's Name,Address,and Tel.No.
�' M;jiCXCl C,�cn0.O
( � ssesso Map/Parcel o nr,,s M o • p 9 wonot ig n V E
Installer's Name,Address,and Tel.No. SO$ '491. OGS Designer's Name,Addr ss,and Tel.No.
SZ-3 rAcAv )q?ZaSzrr`1 LYO Rra-W01 vl-► ASSOci0.MM S
Type of Building: 1
Dwelling No.of Bedrooms '7 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) q q 0 gpd Design flow provided 'y y 3 gpd ,
Plan Date 10.11.11.5 Number of sheets 2 Revision Date
Title A J"
Size of Septic Tank s/000 Type of S.A.S. T0C) L.C
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) Z SOX • (��a c 1, 1 C�a nn5
Date last inspected:
X t
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.
Date 0•/Z S--
Application Approved by O Date D
r� Application Disapproved by Date
for the following reasons
100
Permit No. 0.,/ Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(t/j Upgraded( )
Abandoned(/ )by 3 -�-a G XC G VoA�0
at O 9 Woodboa AvChas been cons ucted�in a4? ed
e
with the provisions of Title 5 and the for Disposal System Construction Permit N . /
Installer 3�'/B CX Cok Vy,�t O.J Designer V N A SOC t c,4'_$
#bedrooms "7 Approved desiow y y gpd
The issuance of this �rmit shallot be construed as a guarantee that the system wi fun� �ti as designe .
Date I ( � Inspector v ' \�
-4No. ( Fee 4�2n --
THE COMMONWEALTH OF MASSACHUSETTS��o 1 `'
PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS
Disposal 6pstem Construction Permit
Permission is hereby granted to Construct( ) Repair(1 pgrad ( .`Abandon( )
System located at 09 Wood o o Ot A L/C J
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:Construc on st be mpleted within three years of the date of this permit.
Date Approved by
r
Town of Barnstable
Regulatory Services
Thomas F.Geiler,Director
SWIM Public health Division
+ Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer&Designer Certification Form
Dater Sewage Permit# ;:Z&i4r- Assessor's Map\Parcel -Z 6 9
Designer: U� It s&tl�l�3 Installer:
Address: �� � �%vim' Address:
On 16 -�� �\ !//���� as issued a permit to install a
(date) (installer)
septic system at /,v / ��6LG1 based on a design drawn by
l/,! (address)
dated //Z)(designer)
�I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
Of the septic system)but in accordance with State&Local Regulations. Plan revision or
certified as-built by designer to follow.
VU
V(1,N HOME
(Installer's Signature) #1068
( esigner's Signature) (Affix Designer's Stamp 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:HealtblSeptic/Designer Certification Form 3-26-04.doc
r
�t Town of Barnstable •: -Barnstable
Regulatory Services Department ""nMft
Cb
" ` ' Public Health Division D
lb;q
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 #7012 1200 0001 0358 5845
September 22, 2015
Michael Genao
109 Woodland Avenue
Hyannis, MA 02601
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,Title S.
The septic system located at 109 Woodland Avenue, Hyannis,MA,was last inspected
on 8/24/2015 by Brett Hickey, a certified septic inspector for the State of Massachusetts.
The inspection of the septic system showed that the system"Fails"under the guidelines.
of the 1995 TITLE 5 (310 CMR 15.00) due to the following:
• Leaching pit or cesspool with high liquid level, <12" below inlet (per Town
Code 360-9.1)
You are ordered to repair or replace the septic system within tow (2)years from the date
you receive this notification.
Failure to repair/replace the septic system with in the deadline period will result in future
enforcement action.
PER ORDE HE BO OF HEALTH Q�>
0
ean, CHO
Agent of the Board of Health ,.,,
Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\109 Woodland Ave Hy Sept 2015.doc
f
Parcel Detail Page 1 of 3
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Logged In As: Parcel Detail Monday,September 21 2015
Parcel Lookup
Parcel Info
Parcel ID9-061 003 �� Developeer
26 LOT 3l
Location F09 WOODLAND AVENUE I Pri Frontage � � � _I
Sec Road l .� Sec
! Frontage
Village HYANNis Fire District JHYANNIS
Town sewer exists at this address No Road Index F1872 I
Asbuilt Septic Scan: Interactive
269061003_1 Map
z
Owner
Owner;GENAO, MICHAELJ __..___....._.._...._.V �-� �) Co-Owner��^��
Streetl 109 WOODLAND AVENUE Street2
City 4HYANNIS ( State MA zip F2601 Country f
Land Info
Acres .33 _ Use
Single Fam MDL-01 � zoning IRB Nghbd 0104
Topography ,Level I Road rPaved
Utilities;Public Water,Gas,Septic I Location F� .� ��1
Construction Info
Building 1 of 1
Year Roof - .�.."` Ext"."."""""."_..,"
Built 1987 I struct Gable/Hip I Wall Wood on Sheath
Living 440 Roof Asph/F GIs/Cmp I AC
ne �
Area. Cover" Type
Int Bed
Style d W
�C�ape Co all .'Plastered ( Rooms 3 Bedrooms °;10W K
Int Bath
Model FResidential Floor Carpet � l Rooms l Full-0 Half s
BAS
Bmv�
Grade Average Type Hot Water ( Rooms5 Rooms �a FHsI
1 1/2Stories. _ _�
�Heat Found
Stories
Fuel i011 ation Poure CoConc. —_ — nog,
Gross
Area 13124
Permit History
http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=19707 9/21/2015
Town of Barnstable
s r
+ IARNSfABLE,
9 Regulatory Services Department
Public Health Division
200 Main Street, Hyannis MA 02601
Office: 508-8624644 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 privhte 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
❑ Single Cesspool
Ei Any"conditionally passed systems" (broken cover,relocation of a pipe, relocation
of a driveway due to H-10 components, etc)
Xeaching pit or cesspool with high liquid level, <12"below inlet(per Town Code.
§360-9.1)
OTHER
Repair deadline:
Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc
t
Commonwealth of Massachusetts - ,/
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
I"r"I
109 Woodland Ave
Property Address
Michael Genao
Owner Owner's Name
information is =
required for every Hyannis Ma 02601 8-24-15
page. City/Town State Zip Code Date of Inspection i-.a
I;wr'1
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When filling out forms A. General Information
on the computer,
use only the tab 1. Inspector:
key to move your
cursor-do not Brett Hickey
use the return Name of Inspector
key.
Excavation
Company
� Company Name
14 Teaberry Lane
Company Address
ICI Sandwich Ma. 02644
City/Town State Zip Code
(508)477-0653 S113747
Telephone Number License Number
B. Certification
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 F her Evaluati by the Local Approving Authority
8-24-15
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.
�,96�d VS
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 109 Woodland Ave
Property Address
Michael Genao
Owner Owner's Name
information is
required for every Hyannis Ma 02601 8-24-15
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):
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
109 Woodland Ave
Property Address
Michael Genao
Owner Owner's Name
information is required for every Hyannis Ma 02601 8-24-15
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes (cont.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
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
w W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
,M 109 Woodland Ave
Property Address
Michael Genao
Owner Owner's Name
information is
required for Hyannis Ma 02601 8-24-15
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well".
Method used to determine distance:
**This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate"Yes" or"No" to each of the following for all inspections:
Yes No
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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
'wM 109 Woodland Ave
Property Address
Michael Genao
Owner Owner's Name
information is required for every Hyannis Ma 02601 8-24-15
page. Cityrrown 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.
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
109 Woodland Ave
Property Address
Michael Genao
Owner Owner's Name
information is
required for every Hyannis Ma 02601 8-24-15
page. CityrTown 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): 4 Number of bedrooms (actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17
Commonwealth of Massachusetts
o- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
wM 109 Woodland Ave
Property Address
Michael Genao
Owner Owner's Name
information is required for every Hyannis Ma 02601 8-24-15
page. CityrFown State Zip Code Date of Inspection
D. System Information
Description:
l
Number of current residents: 2
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? (include laundry system inspection
information in this report.) El Yes ® No
Laundry system inspected? ❑ Yes ® No
Seasonal use? ❑ Yes ® No
Water meter readings, if available (last 2 years usage (gpd)): see below
Detail:
2014- 113,696gallons 2013- 136,136gallons
Sump pump? ❑ Yes ® No
Last date of occupancy: current
Date
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
Lt5ms Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17
�. Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
109 Woodland Ave
Property Address
Michael Genao
Owner Owner's Name
information is
required for every Hyannis Ma 02601 8-24-15
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
General Information
Pumping Records:
Source of information: owner- last pumped 4-5years ago
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 109 Woodland Ave
Property Address
Michael Genao
Owner Owner's Name
information is required for every Hyannis Ma 02601 8-24-15
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:
1994
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
2'
Depth below grade: feet
Material of construction:
❑ cast iron ® 40 PVC ❑ other(explain):
Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
At time of inspection building sewer appeared to be in good working order with no sign of leakage.
Septic Tank(locate on site plan):
1'
Depth below grade: feet
Material of construction:
® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age:
years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 1000 gallon
Sludge depth:
12"
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
F u Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
109 Woodland Ave
Property Address
Michael Genao
Owner Owner's Name
information is
required for every Hyannis Ma 02601 8-24-15
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
24"
Scum thickness 6
Distance from top of scum to top of outlet tee or baffle
6"
Distance from bottom of scum to bottom of outlet tee or baffle
11"
How were dimensions determined? measured
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
At time of inspection septic tank appeared to be in working order. Tank is in need of pumping for
maintenance.
Grease Trap(locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
109 Woodland Ave
Property Address
Michael Genao
Owner Owner's Name
information is
required for every Hyannis Ma 02601 8-24-15
page. CityTTown State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ 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-3113 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
109 Woodland Ave
Property Address
Michael Genao
Owner Owner's Name
information is required for every Hyannis Ma 02601 8-24-15
page. City/Town State Zip Code Date of inspection
D. System Information (cont.)
Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert 0
Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
At time of inspection d-box was in poor condition with carry over present.
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:
I
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
4�M , 109 Woodland Ave
Property Address
Michael Genao
Owner Owner's Name
information is
required for Hyannis Ma 02601 8-24-15
page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
Type:
® leaching pits number: 2 6'x6'
❑ 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.):
At time of inspection leach pit#1 was full over inlet pipe. Leach pit#2 had standing water 2' below
invert but had staining over top row of leaching holes showing pit has been backed up. Leaching will
need to be replaced.
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
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 109 Woodland Ave
Property Address
Michael Genao
Owner Owner's Name
information is
required for every Hyannis Ma 02601 8-24-15
page. City/Town 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
r
{
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
109 Woodland Ave
Property Address
Michael Genao
Owner Owner's Name
information is required for every Hyannis Ma 02601 8-24-15
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
rv� �U4odl�nd. itvc� .e i
�o!\
y \
b 1�1
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
Commonwealth of Massachusetts
w W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
,M yV•y'�. 109 Woodland Ave
Property Address
Michael Genao
Owner Owner's Name
information is
required for every Hyannis Ma 02601 8-24-15
page. CityTTown 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: No Gw 12'
feet
Please indicate all methods used to determine the high ground water elevation:
® Obtained from system design plans on record
If checked, date of design plan reviewed: permit dated 12-23-94Date
❑ 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:
Permit on file at BOH.
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
r a:
Commonwealth of Massachusetts
w - Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
109 Woodland Ave
Property Address
Michael Genao
Owner Owner's Name
information is
required for every Hyannis Ma 02601 8-24-15
page. Cityrrown State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary: A, B, C, D, or E checked
® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed
® System Information— Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
Town of BAmstable. P#1 �
°F Department of Regulatory Services
g Public Heal Division Date
200 Main Street.H�nnis MA 02601
J.
Date Scheduled ' Fee Pd.
. Time Lkq
•�� � ,��
Foil Suitability Assessment for Sewa a Disposal X�
Performed Br. /SS�I C/ll� I Witnessed By: \
LOCATION&GEN]E&L INFORMATION/ '
Location Address'. 6 f �/ff �Q�� /s��( Owner's Name w1e k-eel/ �e��e
S, /r Address
Assessor's Mapmw-cl: ,74� j / ��6i' Engineer's Name
NEW CONSTRUftON REPAIR Telephone
Land Use S i�/7 Slopes(%) ! fo e9 Surface Stones
Distances from: Open Water Body R Possible we i Ara ft Drinking Water Well ft
Drainage Way ft. Property Lin' ._3, 0 ft Other ft
SKETCH:(uftrcet name,dimeosiods of lot,exact locations of tot holes&pen;tests,locate wetlands in proximity to holes)
/o �,97L_C1 'T.
N\
4- --- - _ -
1101P
Parent material(geologic) ���
S"I ' • Depth to 9edroek
Depth to Groundwatdr: Blending Water In ftm Pit Face in Role:* ,
Estimated Seasonal illigh Groundwater —
�
D ERMIN TION FOR SEASONAL HIGH WATER TA.8LE
Method Used:
)n. Depth to call mottles: In.
Depth obperved standing�in obs.hole .B.
Depth tolweeping from side of obs.hole: I in. j.01001' Adjustment
� A ,thctor,,.,._.,�.A�.draundwaterLev�al.,,._,
Index Well#� Reading Date: Index Well level --
PERCOLATION TEST Dille a " ' ��
FOb I Tune at 9"
Time at a__� (_0C� jy(/' ' )e-lfg5d-e
Rate MinAnch /yV_1 V /
Site Suitability AssepsmenG Site Passed_.___.
Site Failed; Additional Testing Needed(YIN)
Ori ginub.Public H41th Division Observation Hole Data To Be Completed on Back---
***If percola ion test is to be conducted within 100' of wetland b You must first notify the
Barnstable C i'servation Division at least one(1)week pri01'to eginning• S
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil ' Other
Surface(in.) (USDA) (Mlmsell) Mottling (Sawwl%SWne51 Boulders.
Consistency,%Gravel)
Olt
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
//
ld
7. 7
DEEP OBSERVATION HOLE LOG Hole#
Depth from' Soil Horizon Soil Texture Soil Color Soil Other
Surface(in,) (USDA) (Munsell) Mouling (Structure,Stones,Boulders.
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color $oil ,Other
Surface(in.) (USDA) (Munsell) Mottling (Structure.Stones.Boulders.
Flood Insurance Rate Man:
Above 500 year flood boundary No— Yes s.Z
Within 500 year boundary No-,Z' Yes
Within 100 year flood boundary Nolz Yes
Death of Naturally Occurring Pervious Material
Does at least four feet of oatumlly occurring pervioys material exist.in all areas observed throughout the
area proposed for the soil absorption system? V-1
If not,what is the depth of naturally occurring pervious material?
Certification,
I certify that on (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,e ' e and ex 'once described in 3.10 ClviR 15.017.
Signature Date ����
4.
` b....^. 4 .:..
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
;M 109 Woodland Avenue
Property Address
Francisco Conceicao
Owner Owner's Name
information is Hyannis MA 02601 April 18 2009
required for Y p ,
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.
I mportant:When filling out A. General Information
^
forms on the J'
computer,use 1. Inspector:
only the tab key
to move your David D. Coughanowr
cursor-do not Name of Inspector
use the return
key. Eco-Tech Environmental
Company Name
43 Triangle Circle
Company Address
Sandwich MA 02563
Cityrrown State Zip Code
508 364 0894 1328
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
144 • �`—� April 18, 2009
Inspector's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time. This inspection does not address how the system will perform in the future under
the same or different conditions of use. LA
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Pa If 17
r
x" Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�M 109 Woodland Avenue
Property Address
Francisco Conceicao
Owner Owner's Name
information is Hyannis MA 02601
required for y April 18, 2009
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:
® 1 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:
Inspector's Note==> A septic system is deemed to pass this Real Estate Transfer Inspection if it
does not trigger any of the failure criteria listed below. The septic system has been evaluated
according to the conditions observed on the day it was inspected. No estimate or guarantee of
system longevity is made or implied by a passing determination.
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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�M 109 Woodland Avenue
Property Address
Francisco Conceicao
Owner Owner's Name
information is Hyannis MA 02601 April 18 2009 required for H Y pi
every page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
B) System Conditionally Passes (cont.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
Commonwealth of Massachusetts
w W Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
109 Woodland Avenue
Property Address
Francisco Conceicao
Owner Owners Name
information is Hyannis MA 02601 Aril 18, 2009
required for y p
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 coliform
bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be
attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate"Yes" or"No"to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than '/z day flow
t5ins•09/08 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
GM , 109 Woodland Avenue
Property Address
Francisco Conceicao
Owner Owner's Name
information is Hyannis MA 02601 April 18 required for y p �il , 2009
every page. City/Town 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.
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
ge
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
109 Woodland Avenue
Property Address
Francisco Conceicao
Owner Owner's Name
information is Hyannis MA 02601 Aril 18, 2009
required for Y P
every page. Cityrrown State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes" or"no"as to each of the following:
Yes No
® ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ ® 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): 4 Number of bedrooms (actual): 3-4
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 gpd
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
109 Woodland Avenue
Property Address
Francisco Conceicao
Owner Owner's Name
information is Hyannis MA 02601
required for y April 18, 2009
every page. Cityrrown State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents: 3
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No
Laundry system inspected? ❑ Yes ❑ No
Seasonal use? ❑ Yes ® No
Water meter readings, if available (last 2 years usage (gpd)): 302 gpd
Detail:
2007-2008
Sump pump? ❑ Yes ® No
Last date of occupancy: current
Date
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
t5ins-09108 Title 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
M 109 Woodland Avenue
Property Address
Francisco Conceicao
Owner Owner's Name
information is Hyannis MA 02601 April 18 2009
required for y p
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
General Information
Pumping Records:
Source of information:
Was system pumped as part of the inspection? ❑ Yes ® No
If yes,volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner) and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
t5ins-09108 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 109 Woodland Avenue
Property Address
Francisco Conceicao
Owner Owner's Name
information is Hyannis MA 02601 Aril 18 2009
required for Y P
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known) and source of information:
Age: 14+ years. Certificate of compliance for repair issued 12/28/94 (Permit#94-744)
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 2feet
Material of construction:
❑ cast iron ® 40 PVC ❑ other(explain):
Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
No evidence of leakage or backup into dwelling was observed.
Septic Tank(locate on site plan):
Depth below grade: 1
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:
8.5 ft x 5 ft x 5 ft(1000 gallon)
Sludge depth:
6 in
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�M 109 Woodland Avenue
Property Address
Francisco Conceicao
Owner Owner's Name
information is Hyannis MA 02601 Aril 18, 2009
required for Y p
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank (cont.)
Distance from top of sludge to bottom of outlet tee or baffle 28 in
Scum thickness 4
Distance from top of scum to top of outlet tee or baffle 8 in
Distance from bottom of scum to bottom of outlet tee or baffle 12 in
How were dimensions determined? Design Plan
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Pumping not required at this time but maintenance pumping is recommended within and every two
years. Tank and tees appear structurally sound and functioning as intended. No evidence of leakage
in or out was observed.
Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
Commonwealth of Massachusetts
w Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
°M 109 Woodland Avenue
Property Address
Francisco Conceicao
Owner Owner's Name
information is Hyannis MA 02601 April 18 2009
required for y p
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ 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.):
f
*Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
t5ins•09/08 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
109 Woodland Avenue
Property Address
Francisco Conceicao
Owner Owner's Name
information is required for y H annis MA 02601 April 18 2009
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 at 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.):
D-box appears structurally sound with no evidence of leakage in or out. Few solids in sump. A bucket
of water was poured into the distribution box and was observed to pass through in a rapid and
unobstructed manner, and could be heard splashing down loudly into both leach pits. No staining
above the operating level of the D-box was observed.
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No
Alarms in working order: ❑ Yes ❑ No
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17
i
9
Commonwealth of Massachusetts
w Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
109 Woodland Avenue
Property Address
Francisco Conceicao
Owner Owner's Name
information is Hyannis MA 02601 Aril 18 2009
required for y p ,
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Type:
® leaching pits number: 2
❑ 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.):
Soils above leaching pits appeared unsaturated. No evidence of surface ponding, breakout, lush
vegetation, or other evidence of hydraulic failure was observed. A bucket of water was poured into
the distribution box and was observed to pass through in a rapid and unobstructed manner, and could
be heard splashing down loudly into the leach pits.
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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
109 Woodland Avenue
Property Address
Francisco Conceicao
Owner Owner's Name
information is Hyannis MA 02601 Aril 18 2009
required for y p
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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
wM 109 Woodland Avenue
Property Address
Francisco Conceicao
Owner Owner's Name
information is
required for Hyannis _ - MA 02601 April 18, 2009
every page. City/Town 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
LEACH
O PIT LOCATIONS
4
LE ITH A B
D-BOX30 1 22 FL 24 FL
2 26 FL 28 FL
SEPTIC 2a 3 33 FL 32 FL
TANK o 4 55 Ft:. 49 FL
5 54 FL 28 FL
A g
EXISTING
DWELLING
# 109
NOT TO SCALE
WOODLAND AVENUE
t5ins-09/08 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
w 109 Woodland Avenue
Property Address
Francisco Conceicao
Owner Owner's Name
information is required for y H annis MA 02601 April 18 2009
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
❑ Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow wells
Estimated depth to high ground water: 12+
feet
Please indicate all methods used to determine the high ground water elevation:
® Obtained from system design plans on record
If checked, date of design plan reviewed: 12/23/94
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:
Approved design plan on file with the Board of Health shows bottom of system to be 4 feet above the
bottom of a witnessed test pit in which no water was encountered.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
109 Woodland Avenue
M
Property Address
Francisco Conceicao
Owner Owner's Name
information is Hyannis MA 02601 Aril 18 2009
required for y P
every page. Cityrrown State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary: A, B, C, D, or E checked
® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed
® System Information— Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17
SEWAGE INSPECTIONS
L CA7716N , G � .✓/� Ale—, DATE
V-ILLAGE ASSESSOR'S MAP & LOT
-INSF?FCTOR
e
SEPTIC TANK CAPACITY /G
LEACHING FACILITY: /'�r� (size)
NO. OF BEDROOMS
BUILDER OR OWNER
OWNER
MAILING ADDRESS
. O
Cgu
��
LA
�� �� �\-3
DATE:9/18/02
PROPERTY ADDRESS: 109-Woodland-Ave
--- -------- ----------
Hyannis,Mass.
------------------------
02601
------------------------
On the above date, I inspected the septic system at the above address.
This system consists of the following:
REC:EE
1 . 1 -1000 gallon septic tank.
2. 1 -Distribution box.
3. 2-600 gallon precast leaching pits. ( 1 2 ' X4 ' ) FSEP F BARNSTABLE
Based on m ins ection I certif the followin T�WHE�AL
Y p Y g conditions:
4 . This is a title five septic system. ( 78 Code ),
5. The septic system is in proper working order
at the present time. 11-7 -7 2)
6. Waste water is 34 ' below the invert pipe of pit #2
Pit #1 one is dry-No visible stain lines on pit #2
SIGNATUR
Name :- J .- P . -Macomber-Jr .
-- -- ------- -------
COrTlpany : Joseeh PJ_ Macomber & Son, Inc .
Address :__BQx _E_Ez__-__-_---__
-_Qen-t-erY-i—L e,_ba--n632-0066
Phone: 508-775- 3338
THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY
JOSEPH P. MACOMBER & SON, INC.
Tan ks-Cesspools-Leachflelds
Pumped & Installed
Town Sewer Connectlons
P.O. Box 66 Centerville, MA 02632.0066
775.3338 775.6412
COMMONWEALTH OF MASSACHUSETTS
r EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
TITLE 5
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 109 Woodland Ave
Hyannis,Mass .
Owner's Name:Viviane Da' Silva
Owner's Address: Same
Date of Inspection:9 1 8 0
Name of Inspector: (please print) Joseph P.Macomber Jr.
Companv Name: J_P-Macomber & Son Inc.
Mailing Address: Finx hh
r®x,ber17i11P.Mass _ 02632
Telephone Number: 598 77g 3338
CERTIFICATION STATEMENT
I ceriii'y 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. 1 am a DEP
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:
/Passes
_ Conditionally Passes
Needs Funher Evaluation by the Local Approving Authority
Fails
Inspector's Signature: i Date:
The system inspector shal bmit 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.
Notes and Comments
•'•'This report only describes conditions at the time of inspection and under the conditions of use at that
time. This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Title 5 Inspection Form 6/15/2000 page I
Nee
. e _ ofll
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 1 09 Woodland Ave
Hyannis,Mass.
Owner: Viviane Da Silva
Date of Inspection: 9 1 8 0 2
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A4stem Passes:
1 have not found an�4exist.
�Anny
hich indicates that any of the failure criteria described in 310 CMR
15.303 or in 310 ailure criteria not evaluated are indicated below.
Comments:
The septic system is in proper working order at the
present time-
B. System Conditionally Passes:
One or more system components as described in the"Conditional Pass" section need to be replaced or
repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass.
Answer yes, no or not determined (Y,N,ND) in the for the following statements. If"not determined" please
explain.
.a The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the
existing tank is replaced with a complying septic tank as approved by the Board of Health.
'A metal sepric tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
4b Observation of sewage backup or break out or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with
approval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will
pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
2
Page 3 of I 1
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 109 Woodland Ave
Hyannis,Mass.
Owner: Viviane Da' Silva
Date of Inspection: 9/1 8/0 2
C. Further Evaluation is Required by the Board of Health:
A> 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:
Ab Cesspool or privy is within 50 feet of a surface water
.{ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the
system is functioning in a manner that protects the public health, safety and environment:
�6 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.
AAJ The system has a septic tank and SAS.and the SAS is within a Zone I of a public water supple.
• A6� 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 Q0 feet b 50 feet or more from a
private water supple well". Method used to determine distance �
"This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other
failure criteria are triggered. A copy of the analysis must be attached to this form.
3. Other:
&Yet
3
f -
Paee 4 of I I
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 109 woodland Ave
Hyannis,Mass.
Ownerviviane Da' Silva
Date of Inspection:911 8/02
D. System Failure Criteria applicable to all systems:
You must indicate "yes" or "no" to each of the following for all inspections:
Yes 'N'o
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
cesspooli ,5
quid depth inz is Less than 6" belo '/
invert or available volume is less than , day flow
R tssprxil equired pumping more than 4 times in the last year NOT due to clogged or obstructed pipe($). Number
of times pumped D .
,,An,v 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.
�/ y portion of a cesspool or privy is within a Zone I of a public well.
_ 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 Irom a private water
supply well with no acceptable water qualiry analysis. jTbis system passes if the well water analysis,
perl',lrmed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria
are triggered. A copy of the analysis must be attached to this forma
_ (Yes.'No) The system fails. I have determined that one or more of the above failure criteria exist as
described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of
Health to determine what will be necessary to correct the failure.
E. Large Systems:
To be considered a large system the system must serve a facility with a design now of 10,000 gpd to 15,000
gpd•
You must indicate either"yes" or"no" to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
des no
_ lthe system is within 400 feet of a surface drinking water supply
!✓ th system is within 200 feet of a tributary to a surface drinking water supply
4' the system is located in a nitro en sensitive area Interim Wellhead Protection —
_ Y g (_ o on Area IWPA) or a mapped
Zone 11 of a public water supply well
If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered
eves" 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 3 10 CMR
1 5.304. The system owner should contact the appropriate regional office of the Department.
4
i
Page 5 of I I
O FFICIA-L INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Properry Address: 1 09 Woody anc3 AvP
Hyanni s..,M���
Owner: Viviane na 'Si Iva
Date of lospectioo:9�118402
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
zV'ere any of the system components pumped out in the previous rwo weeks
Has the system received normal (lows in the previous two week period .
_ _ Have large volumes of water been introduced to the system recently or as part of this inspection ?
_ 4/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
l Were all system components,.e*cluding the SAS, located on site .
J se Were the tic tank manholes uncovered, opened, and the interior of the tank inspected for the condition
d — P
of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum
. Was the facility owner(and occupants if different from owner) provided with information on the proper
maintenance of subsurface sewage disposal systems ?
The size and location of the Soil Absorption System (SAS) on the site has been determined based on.
Yes no
_ Existing information. For example, a plan at the Board of Health.
Determined in the field (if any of the failure criteria related to Pan C is at issue approximation of disiznce
is unacceptable) (310 CMR 1 5.302(3)(b))
5
Page 6 of 1 1
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 1 09 Woodland Ave
HYannis,Mass.
Owner:Viviane Da ' Silva
Date of Inspection: 8/1 8/0 2
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): !� Number of bedrooms(actual):
DESIGN flow based on 310 CMR15.203 (for example: 110 gpd x # of bedrooms): X)v c,5JV ex(-d
Number of current residents:
Does residence have a garbage grinder(yes or no): .z9
Is laundry on a separate sewage system (yes or no):� [if yes separate inspection required]
Laundry system inspected (yes or no):
Seasonal use: (yes or no):_O
Water meter readings, if available (last 2 years usage(gpd))2 0 0 0—4 5, 000 gal lons=1 23. 29 GPD
Sump pump(yes or no): /N 2001 —73, 500 gallons=201 . 37 GPD
Last date of occupancy:
COMMERCIAL4"USTRIAL
Type of establishment: d'?V
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/s ft,etc.):�—
Grease trap present(yes or no):�
Industrial waste holding tank present(yes or no):AO
Non-sanitary waste discharged to the Title 5 system (yes or no): 27
Water meter readings, if available: /p/
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information:
Was system pumped as part of the inspection(yes or no): O
If yes, volume pumped: ® gallons-- How was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM
ZSeptic tank,distribution box,soil absorption system
4Z Single cesspool
/ Overflow cesspool
Privy
m Shared system(yes or no)(if yes, attach previous inspection records, if any)
nnovative/Altemative technology. Attach a copy of the current operation and maintenance contract(to be
obt teed from system owner)
jg
Tight tank 2�a Attach a copy of the DEP approval
41/bOther(describe): 2b
Approxi ate age of all compo ents, ate installed (if known) and source of information:
Were sewage odors detected when arriving at the site(yes or no):
6.
Page 7 of 1 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 109 Woodland Ave
Hyannis,Mass.
Owner:Viviane Da ' Silva
Date of Inspection: 9/1 8/0 2
BUILDING SEWER (locate on site plan)
Depth below grade: 1
Materials of construction: �ast iron _.//40 PVC4�b other(explain):
Distance from private water supply well or suction line:
Comments(on condition ofjoints, venting, evidence of leakage, etc.):
The joints appear tight-No PvidPnr-P of leakage The system is
vented throug the house vents.
SEPTIC TANK: (locate on site plan)
<<
Depth below grade:
Material of construction: Z✓concrete '> metal fiberglasspolyethylene
%L�Dther(explain) 40
If tank is metal list age:, Is age confirmed by a Certificate of Compliance(yes or no):44 (attach a copy of
certificate)Dime
Dimensions:
Sludge depth.
Distance from top 2 fudge to bottom of outlet tee or baffle:X4 .ft!.
Scum thickness: .�
Distance from top of scum to top of outlet tee or baffle��ZV—
Distance from bottom of scum to bottom 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.):
Pump the septic tank aver_= ?-3—=pars Inlet & autl®t tares are
in place-The tank is stlacturally Sound and- 6hews ne eyidetree—ez
leakage.Liquid level at the outlet invert is 51 "
GREASE TRAP, d!4locate on site plan)
Depth below grade:XN
Material of construction:. lJconcretemetafiberglas,,;,�olyethyleneXo�other
(explain):
Dimensions: 101
Scum thickness:
Distance from top of scum to top of outlet tee or baffle: 4�?_
Distance from bottom of scum to bottom of outlet tee or baffle: _
Date of last pumping: _
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert, evidence of leakage, etc.):
S,rease Iran i c not present
7
I
Page 8 of I I
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 109 Woodland Ave
Hvannis,Mass.
Owner: 17i-,7iAnP Da ' Si Iv
Date of lospectioo: 911 R/02
TIGHT or HOLDING TANKe• WO-(tank must be pumped at time of inspection)(locate on site plan)
Depth below grade: /0
Material of construction: Aaconcrve ,�� metal fiberglass jpolyethylcnefM other(cxplain):
Dimensions
Capacity: gallons
Design Flo'A gallons/day
Alarm present (yes or no):
Alarm level: -_..d/A Alarm in working order(yes or no):
Date of last pumping: A
Comments (condition of alarm and float switches, etc.):
Tight or hol ing an s are
DISTRIBUTION BOX: J/of'present must be opened)(locate on site plan)
Depth of liquid level above outlet inven: _Ae
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of
leakage into or out of box, etc.):
Distribution box has two laterals.No evidence of solids carry over.
No evidence of lea age in o or
PUMP CHA:MBe RAJ;
locate on site plan)
Pumps in working order (yes or no): 41�
Alarms in working order(yes or no):�
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
Pump chamber is not present.
8
Page 9 of I I
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 109 Woodland Ave
Hyannis,Mass.
Owner:Viviane Da' Silva
Date of lnspectioa: 9/1 8/02
SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, excavation not required)
2-600 gallon precast leaching pits ( 12 ' X/ 4 ' )
If SAS not located explain why:
Located: See page 10
Type
leaching pits, number:2"
/1Z leaching chambers, number: 4
ItM leaching galleries, number: _Q
leaching trenches, number, length:
A,?& leaching fields, number, dimensions: _n
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.)
Loamy sand to medium fine sand.No signs of hydraulic failure
or ponding. Soils are dry. Vegetation is normal.Wates wa er in pit
is 0" . #2 pit waste water is 34" below the invert pipe.
CESSPOOLSf,�Le,(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 laver _
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow(yes or no):
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.):
Cess�n��l � ar _ Lot present
PRIVY(locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
m Coments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.):
Privy is not present.
9
piv 10 0( 11
0FFICL- INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL, SYSTEM INSPECTION FOR.N+
PART C
SYSTEM INPOR_I` CATION (conlinvc0)
P(CP,rr� Aoof(,) 109 Woodland Ave
Hyan�
0^0rr.V nis,Mass.
_iviane DaTSi vT a
0l1r 0r 'OI9 l,00: 9/18/02
SKITCH OP SCWACC DISPOSAL SYSTEM
Ao. or I Ilmh o(,nr 1(MI(r 0iiPolrl Iyllcm IncjVdVg IIc1 10 11 IcIN rwo wmintnl tcfcrcncc ILACinUR, o
> rrrrnvY, lour lu `+rn, . ,,r,n 100 (ccl. Lo<rrc wncrc Pv"c wcicc IvPPIy cnlcrl inc Dviloinj
fOq WooA�A Ave-A e llyann�s
2,{,
P2
� a1
10
Page 1 1 of 1 1
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 1 09 Woodland Ave
Owner:Viviane a Si va
Date of Inspection: 0 2
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water feet
Please indicate (check)all methods used to determine the high ground water elevation:
NO Obtained from system design plans on record -If checked,date of design plan reviewed: NA
YES Observed site(abutting property/observation hole within ISO feet of SAS)
NO Checked with local Board of Health-explain: NA
YFS Checked with local excavators, installers-(attach documentation)
YFS Accessed USGS database-explain:ht -p- f f-awn-harnstable.ma.us.
You must describe how you established the high ground water elevation:
sed: Gahrety & Miller Model 12/16/94 Ground water elevations abve sea level.
sed: USES- Observation well data.June 1992
sed: USES- Te _hni .al bill tin 9 .-000-02 Plate#2 January 1992-Annual ranges
nor 7�r`�b u�rPlesza t-inn s
Leaching d!
Pit 'eet
At
Groundwate �t=eet Below Bottom o �tiridwatc�sAdlustment I.&ftper Fnm ethod
, efore, the vertical separation distance between the bottom
of the leaching pit and the adjusted groundwater table is
feet.
11
u
'1
y:+nrnn,-nrs—.�-.r'rr.-m.•nmrv-rr.xsr'r.m..r:•.�,-.-+-orr:•na-t.r-mr.v..a-vrrcr.mn
TOWN OF Barnstable BOARD OF HEALTH
SUBSURFACR SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D .- CERTIFICATION I
....T,•••••T". •.•. -T.li�^�'T.T..^..fl•If:ITi Tt�TTfT S'T.T.T'r'•i TSTTTY 11T19-TRRT.F4Tf T7 . TTf 111TRTRTiTPT /,TT'1'TPTT.•.�.r l•T-'T•1. .-..
-TYPE OR PRINT CI.EARLY-
PROPERTY INSPECTED
STREET ADDRESS 109 Woodland Ave H annis Mass.
ASSESSORS MAP , BLOCK AND PARCEL # 269 003
OWNER' s NAME Viviane Da' Silva
PART D - CERTIFICATION i
NAME OF INSPECTOR Joseph P.Macomber Jr.
COMPANY NAMEJ.P.Macomber & Son Inc.--e '
COMPANY ADDRESS Box 66 Centerville,Mass. 02632
Street Town or City State LIP
COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX ( 508 1 790 - 1578
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposaj system at
Oecoininendat' ions
his address and that the information reported is true , accurate , and
omplete as of the time of .inspection . The inspection was performed and any
regarding upgrade , maintenance , and repair are consistent
with my training and experience in the proper function and maintenance of on-
site sewage disposal systems .
Che� one :
System PASSED
The inspection which I have conducted has not found any information
which indicates that the system fails to adequately protect public
health or, the environment as defined in 310 CMR 15 . 303 . Any failure
criteria not evaluated are as stated in the FAILURE CRITERIA section of
this form .
System FAILED*
The inspection which I have con rcted has found that the system fails to
Protect the jiublic health and the environment in accordance with Title
5 , 310 CMR 15 . 303 , and as specifically noted on PART C - FAILURE
CRITERIA of this inspecti ;4nm .
Inspector Signatu Date
copy of this certification must be provided to the OWNER, the BUYER
One
where applicable ) and the BOARD OF HEALT'll.
* If the inspection FAILED , the owner or operator shall upgrade the system
within one year of the date of the inspection , unless allowed or required
otherwise as provided in 3.10 CMR 15 . 305 .
partd .doc
OpIHE Tp� DATE:
FEE: t(j�
BABNSfABL.E.
MASS.
9� i6g9. REC. BY
;,,Town of Barnstable /
d� SCHED. DATE: 3lZo Ztrvv
RELEIVEO Board of Health.
F E B 2 4 2000 ^?667 Main Street, Hyannis MA 02601
Office: 508-86Z-4644 TOWN OFBARNSTABtg ip� )
yE". DEPT. Susan G.Rask,R.S.
FAX: 508-790=6 iO4i Sumner Kaufman,M.S.P.H.
Ralph A.Murphy,M.D.
VARIANCE REQUEST FORM
LOCATION ) � ''Il
Property Address: l o ll Q)Dt� r M n i/1 JC d , QjG1�j n L*5 rn A 6160 1
Assessor's Map and Parcel Number: a 6(1' Size of Lot:
Wetlands Within 300 Ft. Yes Business Name:
No Subdivision Name:
APPLICANT'S NAME: Phone
Did the owner of the property authorize you to represent him or her? Yes No
PROPERTY OWNER'S NAME CONTACT PERSON
Name: m m p .�4'1 Y���S Name: ?'C4�PI CN �,U �`P;r� v---1 r--o)
Address: joic la'i?d k ��(_:�t }, Address: , ) f,dtf / I7W�1 , L. fgln?l9wl ,��'!
dL6U1 d7 S"s
Phone: Phone:
VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more pace needed)
i o c � r2 Z �t�rr ��Q� d< r 6 r-cn�s cl #
gf t iY l•- Rtt �yU .t r e .d 1 h iqqq.
u 1--7NN re ,,oej
Y 161 12u, is t
Checklist(to Si completed by office staff-person receiving variance request application)
i/ Four(4)copies of engineered plan submitted(e.g.septic system plans)
Four(4)copies of floor plan submitted(e.g. house plans or restaurant kitchen plans)
✓ Signed letter stating that the property owner authorized you to represent him/her for this request J?,/" 1 I
✓ Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting 1'�J�..�•�
date at applicant's expense(for Title V and/or local sewage regulation variances only)
Full menu submitted(for grease trap variance requests only)
✓ Variance request application fee collected(no fee for lifeguard modification renewals.grease trap varimcc renewals(same owner/leasee only),outside
dining variance renewals(same ownedleasee only).and variances to repair Failed sewage disposal systems(only if no expansion to the building proposed))
✓ Variance request submitted at least 15 days prior to meeting date
VARIANCE APPROVED Susan G. Rask, R.S., Chairman
NOT APPROVED Sumner Kaufman, M.S.P.H.
REASON FOR DISAPPROVAL Ralph A.Murphy, M.D.
Q:/WP/VARIREQ
McKean Thomas
From: Maloney Kathy
To: McKean Thomas
Subject: 109 Woodand
Date: Monday, March 20., 2000 8:45AM
I just gave Dale a copy of the only permit info we have for this address.
O
Page 1
DFTHE TTp� DATE:
O
FEE:
+ iARNSPABLE :
-
1679• �0 REC. BY
Town of Barnstable
SCHED. DATE:
Board of Health
7 Main Street, Hyannis MA 02601
Office: 508-862-4644 ?��� Susan G.Rask,R.S.
FAX: 508-790-6304 Sumner Kaufinan,M.S.P.H.
Ralph A.Murphy,M.D.
VARIANCE REQUEST FORM
LOCATION._:
Property Address: D I/V ODltt .t, Av�j�,t,(� � /�i4 co (J
Assessor's Map and Parcel Number: Size of Lot: 11 3 15
Wetlands Within 300 Ft. Yes Business Name:
No_ X Subdivision Name:
APPLICANT'S NAME: J�J� /' l�' t-,�}/ 1 S Phone ( jog ) �8 " 10J �p
Did the owner of the property authorize you to represent h o her? Yes k-� No
PROPERTY OWNER'S NAME CONTACT PERSON
S
Name: �J(� Z . �,� r U S Name: �L '
Address: I O� VVDUG(La nd A(ZP•r I49 A Address: Jo 9 m ai'n S 1, . l eti k(vt/le7 IV A
1
Phone: > (D d �p Phone: (SOff/l 7-I Qr>— 4 o s(o
VARIANCE FROM REGULATION(List Res.) REASON FOR VARIANCE(May attach if more space needed)
310 CM ?, 15 , a ►4 Ae r'ooMs czdd--ed AV je�-le yl;p�
6a i-n Sha51 u Zat�1 s bill/tSPc Ofl w e r w o f o�i o
�PS�r� r.l1 Resk-I'rrh6eN C�Ja nd�
Chr cklist(to be completed by office staff-person receiving variance request application)
Four(4)copies of engineered plan submitted(e.g.septic system plans)
V Four(4)copies"of floor plan submitted(e.g. house plans or restaurant kitchen plans)
Signed letter stating that the property owner authorized you to represent him/her for this request
Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting
date at applicant's expense(for Title V and/or local sewage regulation variances only)
Full menu submitted(for grease trap variance requests only)
Variance request application fee Collected(no fee for lifeguard modification renewals,grease trap variance renewals[same owner/leasee only],outside
dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems[only if no expansion to the building proposed]) .
Variance request submitted at least 15 days prior to meeting date
VARIANCE APPROVED Susan G. Rask, R.S., Chairman
NOT APPROVED Sumner Kaufman,M.S.P.H.
REASON FOR DISAPPROVAL Ralph A. Murphy,M.D.
Q:/WP/VARIREQ
yob BY ,, Qr-� 61, ��,. Lo v� i ✓�,�,,,Q;, ..Q�,�,S�
V" l
August 2,2000
Board of Health
367 Main Street
Hyannis,MA 02601
RE: James S. Childs- Septic Variance
109 Woodland Avenue, Hyannis,MA 02601
Dear Members of The Board of Health:
I would like Kristin Ryan to represent me for the variance request.This is for my
property located at 109 Woodland Avenue,Hyannis, MA 02601.The request is for a
variance from 310 CMR 15.214 and Barnstable Bylaw Part VI I lA Section 8.00. The
reason for the variance is because bedrooms were added by the previous owner without
knowledge of the restriction.The restriction was not enforced at time of permitting.
Thank you for your time on this matter.
erely, ry/o
James S. Childs
December 4, 1986
sirs. 1.4ariane Kruegar
85 Woodland Avenue
Hyannis, Ma 02601
Dear :ti1rs. Kruegar:
You are granted a variance from the hoard of ;Jealth Interin, ground
Water Protection Regul<ar,ion limiting, daily sewage flnws to 330 gallons
per acre; to install an on-site sewage Disposal System on Lot 3, Woodland
Avenue, tivannis, with c; foilowinP_ conditions:
(1) The desi`,ning -'rl`7i.ne r ;nust sucervise :onstr',cti.on :)f t'ne
Sewage Lispos`i Systef". m(i (.unit) in 'Nritinu t;l:3t iiis design nas een
complied with prior to issuance of a Certificate of Compiiance or
Occupancy Permit.
(2) The d-welling cannor have ;Wore than csvo 5e;lr6o ;s or exceed five
(5) rocins in entirety,
(3) A garbacle ;;rimier is not aut:':ori_-ed.
(4) It should be recorded on the Hill of Sale chat the inn-Site Sewage
Diposal System must be pumped every three (3) years and written
certification submitted to the Board of Health.
(5) Variance expires January 1, 1988.
This variance is granted because the area is almost fully developed with
few remaining vacant lots. The dwelling is restricted to two bedrooms
with a projected Title 5 Sewage Flow Estimate of 220 gallons per day.
Cape Cod Planning and Economtc Development estimate average dwelling
set,va,ge fie,,, rates as 1165 ;;er clay based on an average occupea,nc-;
of three persons. The lot size is approximately 1/3 of an acre.^
It is the opinion of the. Board chat the insralla.cion of a Sewage Disposal
System on this lot will not significantly effect the problems associated
with the ground water in this arain. The Board strongly recommends Town
sewer for the area.
Very ruly urs,
Ro ert L. Childs, Chairman
BOARD OF HEALTH
TOWN OF BARNSTABLE
JMK/bs
i
No. ...._.
• THE COMMONWEALTH OF MASSACHUSET, S� t
BOARD OF HEALTHP)l7!,/NCi1 '-gin;
[.( . ..................oF............ c ro PLAN TA<<CD lN'
�� ... tKc'............................... - QTalCt
Applirtttioit for 3DioVooal luorkli Town urtiott Permit
Application is hereby made for a Permit to Construct (K) or Repair (. _) an hndiviclual Sewage Disposal
Syste n at:
Z-07-3
......................_.................... -. .............. ......... � ,s ................
!^ Loeatinn- dress p Lot No.
..... ................••....... /---•` �.--�1.ni�t/i--P c_✓.....(_�.k..... s°.:..:.� �-r✓
Owner / Address
W
a ••-•..............................................................................................
Installer Address
Type of Building Size Lo ...�.� ...Sq. feet
Dwelling— No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
p.l Other—Type of Building No. of persons............................ Showers ( ) — Cafeteria ( )
114 Other fixtures .........................................:..............
W Design Flow-------- ................._--_--gallons per person per dy. Total daily flow.............................
...............gallops.
WSeptic Tank—Liquid capacity../A!9gallons Length.lr-.-.G'___. Widtl�..7� /--�... Diameter................ Depth._.5.-.-•'7
x Disposal Trench-- No. ............:....... Width
v........ ....._... Total Length...........I........ Total leaching area.................... ft.
3 Seepage Pit No........../.. .:-. 1 g y! '. q.
.___.. l�taineter-. G'..... Depth below inlet.................. Total leaching area ......7....s ft. I
Z Other Distribution box (x) Dosing tank ( )
Percolation Test Results? Performed by.....................�.�....... Sv/1rp Date......9.(.-1� _........
H Test Pit No. 1........?__....minutes er inch Depth of Pest Pit.. y. ..P 1 Dept i to ground water.....1?�t>..... Z
w Test Pit No. 2....... per inch Depth of Test Pit.../ ....... Depth to ground water......0....-�.zU
ll,'
p n ................
................... y---.._....- ............_...:....-........._..-......
Desch tton of Sotl.. .--••-� 1 ... �?! ,3 0.-..-../.Yy...-.......G...._...... %... i rC'....., .lg��
x iN��.•••• ° ale S u -----.. . .. ,. . - ---- ......Q-'•"---3�.............. �--.�..s���.�o�.�......,�6.....-..icy........
S9r'1�........w...l. -._.....�o... 13 J.['5................................ .... ................ ...................
U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
.................................................................................................................................................................•---............---........._....._....
Agreement:
The undersigned agrees to install the afor edescribed Individual Sewage Disposal System in accordance with
T .-,
the provisions of TILT
LE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in'
operation until a Certificated Compliance has been issued by the board of Health.
.;Signed.-----------••••..... ....
Date
Application Approved By... �. ... ._._4 .1__
•�' Date
Application Disapproved for the following r coons:..:..................
...............................••--.............._._....--•-----..._..._............-•---......._........---......._............-•------......_...---------•--..........--••--
Dale
PermitNo........................................................ Issued_.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF...........................
..........................................................
Tertif irate of Tum.plinary
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( )
by.................................................................
................
.. l ie.---------------•-----._----------•----------•---.--•-
at ..__...r�....._...L�--�: ..
has been installed in accordance with the provisions of TITLE 5 0� jhe tate Sanitary Cod as described 'i the
application for Disposal Works Construction Permit N ..---(••�...... •-_-_- d ted......I- ............. .
. .....
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE
SYSTEM WILL FUNCTION SATISFACTORY.
��
A&�essor's map and lot number Q 0-3
CA
Sewage Permit number3
�
� SYSTEM ARtISt
e �':ti �"�� 8 CFTHE
...........................' :. LEo i
M CO
House number .... P�gN
..............
AA
.../..5'.............. IJ c r` ��yy,p ® WIY S�u�EI VIr7®N Z BARXS*
IyIEN' 'q` CODE,q 7 MAaa
TOWN T®PAIN RECU ,� AY
o M
OF BARNSTABLqTioNS -
D�UILDING INSPECTOR
, .
APPLICATION FOR PERMIT TO . ��: •
I
TYPE OF CONSTRUCTION �
t&�O •••
.........19
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location ...�:.�... , .1 �)C
Proposed Use r
....................................
Zoning
District ....................................... ............................Fire District ....................................
Name of Owner ........ '11 / T
..... .....................Address ...... 3 L• � �
Name of Builder
9...;. .. .fl?�.. .....�.R-� .....Address ......
�2i
Name of Architect ........•r. !��v�"..c�Yv �i�,�•„
"••••••...............Address ....... ...
Number of Rooms �••••���••"""""""""............... ................................................Foundation
Exlerior ....lf..l ..................... ...............
.................................................... ......Roofin ...... ..
.............
Floors ...�� ,,,,tt.... ............................
..l..'�'..G-.............
...........................Interior ......... ..
Heating ,,,,•,.����,
............................................................Plumbing ,,;,,,•••,. ('
... :' .......r�................................
Fireplace f'�: ••••••••••-
.....Approximate Cost ..... � . v
Definitive Plan Approved>by Planning Board 1 -_-_ f�
19Y" Area q
Diagram .of Lot and Building with Dimensions
Fee .............
SUBJECT TO APPROVAL OF BOARD OF HEALTH
/d Xiz j) t✓�,�
0
Z
Ida
/ ZO
1� o
f
y ,
McKean Thomas
From: Maloney Kathy
To: McKean Thomas
Subject: 109 Woodand
Date: Monday, March 20, 2000 8:45AM
I just gave Dale a copy of the only permit info we have for this address.
O
Page 1
Property Location: 109 WOODLAND AVE HY AIAP ID: 269/061/003//
Vision ID:19707 Other ID: Bldg#: 1 Card 1 of 1 Print Date: 03/20/2000
C�U
Element h. Description onernercra ata Elements
y e ype ape .oc enrent r. Description
"ode] [1.4
esk'e!" i ea
rade game Type —1
aths/Plumbing
tones 1 Story rv/Finccupancy eiling/Wall
ooms/Prins
xterior Wall 1 13 re-Fab Wood /o Common Wall 10
2 Nall Height
Roof Structure 03 able/flip
Roof Cover 03 sph/FGIs/Cmp 10 1
Interior Wall 1 3 Plastered AS
2 enrent ;; o e Description actor BM
interior Floor 1 14 arpet omp ex
2 iFloor Adj
Unit Location
8 -
eating Fuel 4 lectric
Heating Type 9 Typical Number of Units
C 7 None Number of Levels
/o Ownership 4 2
Bedrooms 2 2 Bedrooms
B7throoms 2 Bathrooms VALVAMIT
0 2 Full Unadj.Base Rate
Total Rooms Rooms Size Adj.Factor 1.13842
Grade(Q)Index 0.99
ath Type Adj.Base Rate 54.10
Kitchen Style Bldg.Value New 76,606
Year Built 1987 40
ff.Year Built 1988
rml Physcl Dep
�uncnl Obslnc
-con Obslnc
pecl.Cord.Code
Code escrr iron r— enta a pecl Cord%
erc verall%Good. 1
Single Fam iuu
eprec.Bldg Value 9,700
DIN
A ...;
(-Ode Description LIB Units Unit Price Yr. Dp Rt %Cnd Apr. Value
'A S11
f, -
Code Description Living Area Uross Area Eff. Area .nit Cost n eprec. a ue '
Mrs oor
EAU Attic,Expansion,Unfinished 0 960 240 13.53 12,984
UBM Basement,Unfinished 0 960 192 10.82 10,387
WDK Wood Deck 0 244 24 5.32 1,298
i
I
t. Gross LivlLease Area 97MI 3,1241g a ;
04/05/2000 15:11 5084570446 0 REGAN PAGE 02
OREGAN & O'REGAN
Attorneys At Law
31 Teaticket Highway,No.7
E.Falmouth,MA 02536
PM&k T.O'Regan it.,J.D.,M.BA
s 1 KOM(508)457.4542
COMM C.O'Regen,J.D.,R.N. � ,"� Fax;(508)457-0446
S �
April 4,2000 y. T °Bg9 00
CFpT�gze
Board of Health
Town of Barnstable -
367 Main Street
Hyannis,MA 02601
VIA FAX: 1508-790-6304
R£: James S. Childs - Septic Variance
109 Woodland Avenue, Hyannis,MA 02601
Dear Members of The Board of Health:
This letter is to inform you that my client,Mr.James S,Childs,is requesting that his applica-
tion for a Variance from 310 CMR 15.214 and Barnstable Bylaw Part VII1A Section 8.00 be
withdrawn without prejudice. I informed Mr. Glen Harrington via telephone of this re-
quest earlier today.
If there are any problems or I need to do anything further,do not hesitate to contact me. I
am assuming unless informed otherwise,there will be no need to attend the Continued Hear-
ing scheduled for Monday, April 10, 2000 at 10:0 a.m..
Thank you for your consideration in this matter.
Very,
Y vows,
Patrick T. O'Regan Jr.
Cc; Mr. James S. Childs
04/05/2000 15:11 5084570446 0 REGAN PAGE 01
VREGAN & WREGAN
t A"ORNK"AT 1.AW
31 TRATICUT 1110"WAY,W).7
"arr TALMOMOO MA 025M
'lbWww (M 4574M Fax(SOB)4374MG
rATRKX T.WNUAN.JR.,1.b.,M.B.A.
MRDU C.WUGAN,J.D.,R.N.
FAX MISSION SKKLT
Nta�R or rA�a.e1�corer
We are trannnlidul rrew(544)45744*
DATE: 6/1M
/
-77
DEUVER TOs ZP
COMPANYlFU M1 Am" ► al'IA
FAX NOs_�"
FROM:
RD
w
J •
MifSSACEt
If you do Not receive all this transmission,please contact us as soon as possible
at(W$)457 4542.
Conlidentiatity notice: This fae► milie mesasge and any accompanying documents
contain legally privileged and confidential Information intended only for the use of the
individual or eutitity named above. If you are not the intended recipient or an agent for
the named rec0itent,you are Hereby notified that any disclosure,dissemination,
distribution or copying of The htforu>atiou contained in this transmission is strictly
prohibited. if you have received this infonnation.contained in this transmission in error,
please hunlediately notify us by conect telephone call and retuni the origian transrnissiar
to us at our expense at the above address via the United States Postal Service. hank
you.
COMMONWEALTH OF MASACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE WINTER STREET BOSTON MA 02108(617)292-3500
TRUDY CORE
Secretary
ARGEO PAUL CELLUCCI DAVID B.STRUHS
Govemor Commissioner
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Property Address: 109 WOODLAND AV. HYANNIS, MA 02601 O�n
Name of Owner CHILDS
Address of Owner: 109 WOODLAND AV. HYANNIS,MA 02601
Date of Inspection: 2I22I00
Name of Inspector: JOHN GRACI
I am a DEP approved system Inspector pursuant to Section 15.340 of Tide 5(310 CMR 15.000)
Company Name: TITLE V SEPTIC INSPECTIONS
Mailing Address: P.O.BOX 2119 TEATICKET MA.02636
Telephone Number: 608-664.6813
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information report!�belowtis'—true;accurate
and complete as of the time of inspection.The Inspection was performed based on my training and experience In,tth*proper function and \
maintenance of on-site sewage disposal systems.The system: °
c!.y
X Passes
_ Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
Fails
eo
Inspector's Signature: Date:3W&
The System Inspector shall s mit a copy of this Inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of
completing this inspection.If the system is a shared system or has a design now of 10,000 gpd or greater,the Inspector and the system owner
P 9
shall submit the report to the appropriate regional office of the Department of Environmental Protection.The original should be sent to the
system owner and copies sent to the buyer,if applicable,and the approving authority.
NOTES AND COMMENTS
"The inspection is based on criteria defined in Title V code 310 CMR 15.303.My findings are of how the system Is performing at the time of inspection.My
inspection does not imply any warranty or guarantee of the longevity of the septic system and any of its component's useful life:"
THE SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING THE SYSTEM EVERY TWO YEARS FOR PROPER MAINTENANCE.
revised 912/98 Page 1 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 109 WOODLAND AV. HYANNIS, MA 02601
Name of Owner CHILDS
Date of Inspection: 2122100
INSPECTION SUMMARY: Check A, B, C, or D:
A. SYSTEM PASSES:
X I have not found any Information which Indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated
are Indicated below.
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.
Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination In all Instances.If"not determined",explain why not.
n1a The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance
attached)Indicating that the tank was Installed within twenty(20)years prior to the date of the Inspection;or the septic tank,
whether or not metal,Is cracked,structurally unsound,shows substantial infiltration or exriltration,or tank failure is imminent.The
system will pass inspection If the existing septic tank is replaced with a complying septic tank as approved by the Board of Health.
Wa Sewage backup or breakout or high static water level observed in the distribution box Is due to broken or obstructed pipe(s)or due
to a broken,settled or uneven distribution box.The system will pass Inspection If(with approval of the Board of Health).
_broken pipe(s)are replaced
_obstruction Is removed
_distribution box is levelled or replaced
n1a The system required pumping more than four times a year due to broken or obstructed pipe(s).The system will pass inspection if
(with approval of the Board of Heath):
_broken pipe(s)are replaced
obstruction is removed
revised 9/2198 Page 2 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 109 WOODLAND AV. HYANNIS, MA 02601
Name of Owner CHILDS
Date of Inspection: 2122100
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 the public health,safety
and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 16.303(1)(b)THAT THE SYSTEM IS
NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
_ Cesspool or privy is within 50 feet of surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER.IF ANY)DETERMINES THAT THE SYSTEM IS
FUNC
TIONING IN A MAN
NER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well,
The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a
private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the
well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less
than 5 ppm,Method used to determine distance a&(approximation not valid).
3) OTHER
n/a
revised 9/2/98 Page 3 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 109 WOODLAND AV. HYANNIS, MA 02601
Name of Owner CHILDS
Date of Inspection: V22100
D. SYSTEM FAILS:
You must indicate either"Yes"or"No"to each of the following:
i have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is
identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure.
Yes No
X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool.
X Static liquid level in the distribution box above outlet Invert due to an overloaded or clogged SAS or cesspool.
X Liquid depth in cesspool Is less than 6"below Invert or available volume is less than 1/2 day flow,
X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped Q.
X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation.
- X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
X Any portion of a cesspool or privy is within a Zone I of a public well.
X Any portion of a cesspool or privy is within 50 feet of a private water supply well,
X Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality
analysis.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,
ammonia nitrogen and nitrate nitrogen.
E. LARGE SYSTEM FAILS:
You must indicate either"Yes"or."No"to each of the following:
The following criteria apply to large systems In addition to the criteria above:
The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and
safety and the environment because one or more of the following conditions exist:
Yes No
- X the system is within 400 feet of a surface drinking water supply
X the system is within 200 feet of a tributary to a surface drinking water supply
- X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well)
The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the
Department for further information.
revised 9/2/98 Page 4 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 109 WOODLAND AV. HYANNIS, MA 02601
Name of Owner: CHILDS
Date of Inspection: 2/22/00
Check if the following have been done:You must indicate either"Yes"or",No"as to each of the following:
Yes No
X - Pumping information was provided by the owner,occupant,or Board of Health.
X - None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period.
Large volumes of water have not been introduced Into the system recently or as part of this inspection.
X - As built plans have been obtained and examined.Note if they are not available with N/A.
X _ The facility or dwelling was Inspected for signs of sewage back-up.
X _ The system does not receive non-sanitary or industrial waste flow.
X _ The site was inspected for signs of breakout.
X _ All system components,excluding the Soil Absorption System,have been located on the site.
X _ The septic tank manholes were uncovered,opened,and the Interior of the septic tank was Inspected for condition of baffles or tees,material of
construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been
determined based on:
X Existing Information,For example,Plan at B4O,H,
X - Determined in the field(if any of the failure criteria related to Part C Is at Issue,approximation of distance is unacceptable)1 5.302(3)(b))
X - The facility owner(and occupants,if different from owner)were provided with Information on the proper maintenance of SubSurface Disposal
Systems.
revised 9/2/98 Page 5 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 109 WOODLAND AV. HYANNIS, MA 02601
Name of Owner CHILDS
Date of Inspection: 2/22100
FLOW CONDITIONS
RESIDENTIAL:
Design flow: 110,g.p.d./bedroom
Number of bedrooms(design): 4 Number of bedrooms(actual):
Total DESIGN flow: 440 gpd
Number of current residents:3
Garbage grinder(yes or no):NO
Laundry(separate system)(yes or no): NO If yes,separate Inspection required
Laundry system Inspected(yes or no): NO
Seasonal use(yes or no): NO
Water meter readings,if available(last two year's usage): n/a gpd
Sump Pump(yes or no): NO
Last date of occupancy: n/a
CO M M ERCIAL/i NDUSTRIAL
Type of establishment: n/a
Design flow: n/a gpd(Based on 15.203)
Basis of design flow:n/a
Grease trap present:(yes or no): NO
Industrial Waste Holding Tank present:(yes or no): NO
Non-sanitary waste discharged to the Title 5 system:(yes or no):NO
Water meter readings.If available: n/a
Last date of occupancy:n/a
OTHER: (Describe)
n/a
GENERAL INFORMATION
PUMPING RECORDS and source of information:
n/a
System pumped as part of inspection:(yes or no):NO
If yes,volume pumped n/a gallons
Reason for pumping:n/a
TYPE OF SYSTEM
X Septic tank/distribution box/soil absorption system
_ Single cesspool
_ Overflow cesspool
_ Privy
_ Shared system(yes or no)(if yes.attach previous Inspection records,If any)
I/A Technology etc.Attach copy of up to date operation and maintenance contract
Tight Tank Copy of DEP Approval,
Other:n/a
APPROXIMATE AGE of all components,date installed(if known)and source of information:
1994 PERMIT 94-744
Sewage odors detected when arriving at the site:(yes or no): NO
revised 9/2/98 Page 6 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 109 WOODLAND AV. HYANNIS, MA 02601
Name of Owner CHILDS
Date of Inspection: 2/22/00
BUILDING SEWER:X
(Locate on site plan)
Depth below grade: 18"
Material of construction: _ cast Iron X 40 Pvc _ other(explain)
Distance from private water supply well or suction line: n/a
Diameter: 4"
Comments: (condition of joints,venting,evidence of leakage,etc.)
THE SYSTEM HAS TOWN WATER.
SEPTIC TANK: X
(locate on site plan)
Depth below grade: 12"
Material of construction: X concrete_ metal_ Fiberglass_ Polyethylene_ other
explain: n/a
If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): NO
Age: n/a
Dimensions: L 8'6"H 5'7"W 4'10""
Sludge depth: 1"
Distance from top of sludge to bottom of outlet tee or baffle: 33"
Scum thickness: 0"
Distance from top of scum to top of outlet tee or baffle: 6"
Distance from bottom of scum to bottom of outlet tee or baffle: n/a
How dimensions were determined: MEASURED
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage,
etc.)
SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE
SYSTEM'S USEFULL LIFE.
GREASE TRAP: _
(locate on site plan)
Depth below grade: n/a
Material of construction: _concrete_ metal^ Fiberglass _ Polyethylene_other
Explain: n/a
Dimensions:n/a
Scum thickness: n/a
Distance from top of scum to top of outlet tee or baffle: n/a
Distance from bottom of scum to bottom of outlet tee or baffle n/a
Date of last pumping: n/a
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage,
etc.)
n/a .
revised 9/2/98 Page 7 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 109 WOODLAND AV. HYANNIS, MA 02601
Name of Owner CHILDS
Date of Inspection: 2/22/00
TIGHT OR HOLDING TANK: _ (Tank must be pumped prior to,or at time of,inspection)
(locate on site plan)
Depth below grade: n/a
Material of construction: _concrete_ metal_Fiberglass _Polyethylene _other
Explain: n1a
Dimensions: n1a
Capacity: n/a gallons
Design(low: n/a gallons/day
Alarm present: NO
Alarm level:N/A Alarm in working order:NO
Date of previous pumping: n/a
Comments:
(condition of Inlet tee,condition of alarm and float switches,etc.)
n/a
DISTRIBUTION BOX:X
(locate on site plan)
Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE
Comments:
(note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.)
THE DISTRIBUTION BOX IS STRUCTURALLY SOUND.
PUMP CHAMBER: _
(locate on site plan)
Pumps in working order:(Yes or No): NO
Alarms in working order(Yes or No): NO
Comments:
(note condition of pump chamber,condition of pumps and appurtenances.etc.)
n1a
revised 9/2198 Page 8 of 11
I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 109 WOODLAND AV. HYANNIS, MA 02601
Name of Owner CHILDS
Date of Inspection: 2/22/00
SOIL ABSORPTION SYSTEM(SAS): X
(locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods)
If not located,explain:
n/a
Type:
leaching pits,number:(2)1000 GAL 6 X 6'
leaching chambers,number: (n/a)n/a
leaching galleries,number: (n/a)n/a
leaching trenches,number,length: (n/a)n/a
leaching fields,number,dimensions: (n/a)n/a
overflow cesspool,number: (n/a)n/a
Alternative system: n/a
Name of Technology: n/a
Comments:
(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.)
THE LEACH PITS APPEARS TO BE FUNCTIONING PROPERLY.SYSTEM SHOWS NO SIGNS OF FAILURE.
CESSPOOLS: _
(locate on site plan)
Number and configuration: n/a
Depth-top of liquid to inlet invert: n/a
Depth of solids layer: n/a
Depth of scum layer. n/a
Dimensions of cesspool: n/a
Materials of construction: n/a
Indication of groundwater: n/a Inflow(cesspool must be pumped as part of inspection)NO
Comments:
(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
n/a
PRIVY:
(locate on site plan)
Materials of construction: n/a Dimensions: n/a
Depth of solids: n/a
Comments:
(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
n/a
revised 9/2198 Page 9 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 109 WOODLAND AV. HYANNIS, MA 02601
Name of Owner CHILDS
Date of Inspection: 2/22100
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent reference landmarks or benchmarks
locate all wells within 100'(Locate where public water supply comes Into house)
D
d n
Ac y�
a� II AD �s
�a
0 gc 5
5D Sy
revised 9/2/98 Page 10 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 109 WOODLAND AV. HYANNIS, MA 02601
Name of Owner CHILDS
Date of Inspection: V22100
NRCS Report name: n/a
Soil Type: n/a
Typical depth to groundwater: n/a
USGS Date website visited: n/a
Observation Wells checked: NO
Groundwater depth: Shallow_ Moderate_ Deep_
SITE EXAM _ Slope
_ Surface water
_ Check Cellar
Shallow wells
Estimated Depth to Groundwater 12 Feet n/a
Please indicate all the methods used to determine High Groundwater Elevation:
_ Obtained from Design Plans on record
_ Observed Site(Abutting property,observation hole,basement sump etc.)
Determined from local conditions
Checked with local Board of health
_ Checked FEMA Maps
Checked pumping records
Checked local excavators,installers
X Used USGS Data "
Describe how you established the High Groundwater Elevation.(Must be completed)
USGS MAPS AND CHARTS-12+FEET
age 11 of 11
revised 9/2/98 P _ .
I
FEB-08-2000 07:37 LEIGH ANN SHIPMAN 508+420+0469 P.04i06
y BP0687-0279 95-05-30 264 #025057
I, DAVID C. AYMS of 159 Asa Meigs Road, Marstons Millet MA
02640
in consideration of NINETY THOUSAND and 001100 ($90,000.00)
DOLLARS paid
greht to JAMBS S. CBYLDS of 109 woodland Avenue, Hyannis,
Barnstable County, Massachusetts
WITH QUI2'CLAXK COVENANTS
The land in the village of Hyannis, Town and County of
Barnstable, Massachusetts together with any buildings thereon
bounded and described as followas
EASTERLY by Woodland Avenue, as shown on hereinafter
mentioned plan, one hundred and 00/100 (100.00)
SOUTHERLY by Lot 2, as shown on said plant one hundred
thirty-five and 73/100 1135,73) feet;
WESTERLY by a portion of land no
w w or formerly of Richard
• W. and Nancy R. Griffith, as shown on said plan,
one hundred six and 97/100 (106.97) feet; and
NORTHERLY by a portion of land now or formerly of Rath H.
Schuman, as shown on said plant one hundred
thirty-eight and 62/100 (130,62) FEET.
Containing 14,179 square feet, and being shown as L4" on
plan entitled "plan of Land in Hyannis, Barnstable, Mass. for
Mairanne L. Krueger; Dates Feb. 18, 1076 Scales I" ow 40,
Charles N. savory, Inc, Registered Civil Engineers & Land
Survdulyerecorded ws 712 ith hn Barnstable Count Registry
which f said plan in
Book 393, Page 72. Y R gietry of Deeds in plan
Said premises are conveyed subject to an easement reoorded
with Barnstable Deeds in Book 6890 Page 177, and subject to a
taking recorded with said Deeds in 'Book 780, Page 219, insofar
as the same are now in force and applicable.
Also, subject to and with the benefit of all rights,
restrictions, reservations,
effect. appurtenances, rights of way and
easements of record insofar as the acme are now, in force and
For title see deed recorded in Book 9492, Page 320.
EXECUTED AS A 58ALED INSTRUMENT this 30th day of May, 1995.
,ocz - .A
av . Ayres
ti
FEB-08-2000 07:37 LEIGH ANN SHIPMAN 508+420+0469 P.05/06
. BPi09697-0280 95-05-30 2154 N02585?
COMMONwSUTH OF MUSACRUS8TT8
BWSTABLB, 88 May 30, 1995
Then personally appeared the above named Davi C. Ayres
and acknowledged the foregoing inst nt4gew,
free act
and deed, before me,
Noe Qp
MY osiaai
iWaS k
V
AtiN�r
HAY r 2 U 5.
^y c:, 1;�ia►1,i,:..._,... i.
�y�•:
• SASH
3u?.
17A1A000 ,�q; •.
EXr�tC ?'AX.�d
MOL
JO
8ARN8TAB1.�REQIS'tRY OF
t
Date March 2 , 2000
Town of Barnstable
367 Main Street
Hyannis, MA 02601
Dear Town of Barnstable
I am writing to inform you of our request for variances from the State Environmental
Code Title V, and from local Board of Health Regulations in regards to our new septic
system which will be installed at 109 woodland Avenue, Hyannis, MA 02601
We are requesting a variance from 310 CMR 15 . 214 and
Town of Barnstable By-Law Article 47 , Part VIII , Section 8 .
Tmesrdayz Monday, March 20, 2000
The Board of Health meeting will be held on R&y ,X1999 at
10 : 30 a.ap."yn., or as soon thereafter as practicable at the Second Floor Conference Room,
New Town Hall, 367 Main Street, Hyannis, MA.
The letter is to serve as an official notification to abuttor(s).
Sincerely ours,
Name----Patrick T.- O' Regan. Jr. _.
Attorneyyfor James S. Childs
Q:health\wpfiles\abbutor l
FEB-08-2000 TUE 03:49 PM FAX NO. 9787205761 P. 04
SKETCHIAREA TABLE ADDEND—
55109W00
]wm,,,,,y1 c•Ic,j,t Ch i ids
h•,IwifyAckhe" 109 Woodland Avenue
(icy fl rannl5 c•,lumv 13z notable s, ,c MA
-- ifn c,KID• 02601
I�ntice Salem Five Mortgage Corporation ~ —
I Di rrensi ons are Approxi lmte
Roolra are not to Seal e
rB4ed
room chef) %•;�
tJ- _
First Floor Layout
r oom Li vi i)g
Roora
Bedroom Be(Irot)in
C C Second Floor Layout
SCAIX; t inch�49 rcal
AREA NAME OF AREA Sq. Ft. TOTALS Gross Living Area
Calculations
(71AI (:nhlIloe, W2.w u
(;?Az R,•cond I lam x 3x tul 91200
A111114 534.011 II,t1t) x
POR park � 38,r)q S32.rrq
I,ii lul IV6.tH> 't
J
TOWN OF 13ARNSTABLE
L®CAMON�G�7 ey,06
VILLAGE n ASSESSOR'S MAP Q LO'I'��/.
INSTALLER'S NAME $ FHONE N
SEPTIC TANK CAPACITY
LEACd3IPdG FACILIZ'Y:(type) S �(s ze) y /0
NO. OF SEDROOMS PIUV,ATE WE L Olt p1�HL1C SAT~E
BUILDER di
DATE PEXMIT ISSUED: ol
DATE COMPLIANCE ISSUE-
•�"�
VARIANCE GRANTEI i Year— N-0
eaj- P .doer
U,
i
TOWN OF BARNSTABLE
LGCA.10N /6 ' 'AS&04A-J0 19-JF- SEWAGE # 9!y'7yy
VILLAGE �4�y+t/CS ASSESSOR'S MAP & LOT�9-06 607
INSTALLER'S NAME & PHONE NO. 'I?CvVry c-o`r)-7
SEPTIC TANK CAPACITY 169.-S
LEACHING FACILITY:(type) �/TS o� (sue)
NO. OF BEDROOMS PRIVATE WELL PUBLIC WATER'
BUILDER O OWNER
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED: ,�`� -�. c1 ! ut
VARIANCE GRANTED: Yes No j'
�'
�--�
• J
.�o � � .
,, �' .��
� �
�� ��
0
c1 c oo3
No....7. ::..l.. t� Fss...............��...............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
App iratiun for Uiripmml Works Tnnutrnrtiinn ramit
Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal
System at: r�
�d../--------------------QQ�.- �_-•----......-----�........... --•-=��-�-6� •--•--......----•---.....---•--•--•--.......................----
........
+�1
catiop td dre•ss . r ol Ld dotr eN
� �.... .........:.:... � ... G .... sso
ezoUo j,
� Ownr6 77t e �� ti Z
---•............................ t ---•-- - .rS�=.............. n -----'•. ./------------------------------------------------
Installer
4
A
U Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms.-.--.-.--- ---------------
--------------Expansion Attic ( ) Garbage Grinder
`14 Other—Type of Building No. of persons............................ Showers
a yP g ---------------------------- P ( ) — Cafeteria ( )
dOther fixtures ----------------------------------------------•--------------•---•---•----------------- ---------------..-....-..-.-....------..-•------••-•---------
W Design Flow---------------S7257 -----------------gallons per person per day. Total daily flow.............L1Ya....................gallons.
WSeptic Tank—Liquid capacity./.?-.gallons Length................ Width................ Diameter......--........ Depth....----.--.....
x Disposal Trench—No. .................... Width-------------------- Total Length-------------- Total leaching area....................sq. ft.
Seepage Pit No....�-........ Diameter...../ :----- Depth below inlet.....1�._....... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
1
,-� Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water........................
fT4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.............---........
W •-•••...-•-•-----------•----••--•-•-••••--•••-•--••-••••--------•••-•••-•-•-•-••......----•-.....•--........................................................
0 Description of Soil.........................................................................................................................................................................
--------------- ------------------------------------------------------------------------------------------------------------------------------ ---•-- •-
U Nature of Repairs Alterations— nswer when applicable..... A-..... .......-
---0---- ---.. .�"-!.�..............
lrs7��.. . .----• Ga0
Agreement: cS' r�c: - -r�rcL Ala G. cop i r r
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance s b en iss he board of health.
Signed ............ '
Application Approved By . ... ,c...........
.......................................... .............................. ..... 01.-
JDate
Application Disapproved for the following reasons: ..... ........................ ............... . .................................. ............. .................
.. ........................................... . .... ................................................................................................. .......................................
Permit No. .. .:- tf�/..................... Issued ........................................................Da[e....
Dare
FInc..... G. .......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
t
Appliratiun for Di-rivuiittl Works Tunitrnr#iun rami#
Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal
System at:
..... �_5.............................................................C.✓.160� . D .4,/� --... ..... �r-S•-•---•-••....................•-------'-
/
...................... /* Loca .�i-Address ��Q �-f...�:�......-,�...... Lot No.
Owner. _ Address
......._..-•- ............................................7(,S ........................... .....��•.... .------
t"� Installer Address
Q S Type of Building Size Lot........................... q. feet
Dwelling— No. of Bedrooms.____._....��...........................Expansion Attic ( ) Garbage Grinder -� —)"nJ 6
`, Other—Type of Building No. of persons____________________________ Showers — Cafeteria
dOther fixtures ----------------------------------------------------------------------------------- --- ----•--•-•------••--•••-••••••-------•------••••......-•••••.
W Design Flaw----------------5. .................gallons per person per day. Total daily flow.._...._.___�yP......._......._..._gallons.
WSeptic Tank—Liquid capacity/'_'..gallons Length---------------- Width---------------- Diameter..............-. Depth................
x Disposal Trench—No. .................... Width.................... Total Length-------------- Total leaching area....................sq. ft.
Seepage Pit No....�-.-------- Diameter-----Z-4 t....._ Depth below inlet-----�._j..._. Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation-Test Results Performed by.......................................................................... Date........................................
Test Pit No. I................minutes per inch Depth of Test Pit:................... Depth to ground water........................
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P4 -----------------------------------------------------------------------------•-•-----------.....---.........................................................
0 Description of Soil-•---------------------------------------------- .......................------------------------------------------------------•------------------------•••-•.......----
x
c.,
W ---•••-------------- -----------------------------------------------------------------•-•----------------------------------....---------
U Nature of Repairs or Alterations—Answer when applicable._-__ ...._
--
UP -------- -------�-----------v------------::
.........................................................`' ` 7/7,V l � �t 1 _ -h is•. /G
Agreement. S' d>r� C- ?4-�c.L 1-1+-j 0 , GU�a� ;�/ ---
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in a&ordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance/h. s b en iss e11 b,0 e board of health.
Signed ----------- ,�� ------ 1. �9�................... .............. Date ....
Application.Approved By ................ ...e ---------------------- ------------......
Date
Application Disapproved for the following reafonf: . .... ......... ....................--...................... ... ........................
................... ...........................:...................................................................................................
Da
Permit No. -----. V----------7.y.----------- ---------- Issued .............................
.......................................
Dare
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
CErtificatrE of Compliance
THIS IS TO CERTI�Yat the Individual Sewage Disposal System constructed ( ) or Repaired ( �)
by .... -------------- -------------------- li✓ 1r -c" ... �llriJ..S-T-/LV
................ ....... . ................. ....
Ins to Ile
Gv oo D c w,, ..4.........�4�U. .....,�..../ /a- -v.t:-----------------------------------------
at .....
�� ---- ------------ - ------- -------
has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. ... L..-....7--1j/. ....... dated ...............................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE--------------------------- .. -. ..: ..:._ . _/.... ......... .......... Inspector .............................. .._ ..... -----------
——————— —�-------------_____.,___,_,--,----------------------------------------
c7�, G'o3 THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
��l -� TOWN OF BARNSTABLEa �.
No.... . -----Vy FEE........................
Permission is hereby granted ........................ ��LT«v+J
to Construct ( ) or Repair (.--
,,)--an Individual Sewage Disposal SysterrL
atNo....................................................1 0--9... •---6AIa!4L._-8---... _ �fJn`.-5--------------------
street yy��
as shown on the application for Disposal Works Construction Permit No..!_j�'.. :Y__ Dated---..,le .`.. - .'-.. L:!....
...................................-
/ Board of Health
DATE--------F �' - �-�' ----•------------------------------•----
FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS
FEB-08-2000 TUE 03:49 P.M FAX K0. 9787205751 P. 04
-=' SKETCH/AREA TABLE ADDEND
55109W00
`]
l4•i1,IlyrkQircwl 109 Woodland Avenue
rlh Ilyannis r•l„np• 13ar,nstablQ
5ruk MA XiP r,Kr,• 02601
I,,•nder Salem Pive 'Mortgage Corporation
--------------
Di mensi ons are Approxi Imte
;, r.�6,d,,;•,7 x Rooms are not to Scal e
Bedroom C X".1
-cj"n
d y3
Fi r 9 t Fi oor Layout
6edr oorn— C Li �i Ili
Roora
G
Bedroom Bedroom
C C Second Floor Layout
AREA NAME OF AREA Sq. Ft. TOTALS Gross Living Area
Calculations
(71AI (nsll.hm
91?.an
WA2 3,znml l Lw, 51?nq 14 (it) x !R 0U 912(K1
1'l4 fill 16.1x)
i
"'A,Ya++xy^•b-'is° iz e .. L ,a,,� •�e J 4 - 3 ^t` 2 �' a h. 4l', dt -.R'::-t T'- ,.r $� a
IRM
Fx - a 'x i:h { T"+' Y u '7"R} 4. i'a3 . : ¢ '..Y 4...• ,.,,5 v_..4 ' ,'k-y„x"^m.,'t G, !hy'e}a P` }" ad'^ "?r` Sl'.s. w is! ... �k }.__ ,�, `}
x d s ' -' r ry v t •.. h, a, f.- a '" { ai ar S .e7` `..z^, w,fi. u y- t ct'
y
-+...,3'•'
'•1 4 t -
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ry
e
w December:4, 1986
-
m.
r
Mrs.-Mariane Kruegar, F .
s
85 Woodl'and Avenue= —
y Hyannis,"Ma 02601 r
_- Dear Mrs. Kruegar:
You are ranted a variance.; from the' Board of'.Health. Interim Ground
Water Protection Regulation: limiting daily sewage flows to 330 .gallons, _
r acre;-to install'an on-site�sewa Dis sal S stem on. Lot, -.Woodland.---,--..
- Pe 8e� Po y � ,d
Avenue, Hyannis,.with the following conditions: a
(1) The designing engineer must supervise construction of the on site.
Sewage---Disposal System and certify in writing_.that-_his _design has_ been
complied. with prior to issuance of a Certificate of Compliance or _ s
z
Occupancy Permit. _
(2) The dwelling cannot have more than two bedrooms or exceed five
(5) rooms in entirety....
(3) A garbage grinder is not authorized.
(4) It should -be recorded on: the Bill of Sale that the On Site Sewage z
Diposal :System'' must, be ,_ um d "'ever three ,.t(3) ; ears and awritten; �' "
certffic�ttion submitted to the-Board of Health.
(5) Variance expires January 1, 1988: = �r, :
This variance is granted because the area is almost fully developed with
few remaining vacant lots. The dwelling is restricted to two bedrooms
with a projected Title 5 Sewage Flow Estimate of 220 gallons per flay.
Cape. Cod Planning and. Economic Development estimate-average dwelling
sewage flow rates as 165 gallons per day based on an average occupancy
of three persons. The lot size is approximately 1/3 of an acre.
It is the opinion of the Board that. the installation of a. Sewage Disposal rg
System on this lot will not significantly effect the problems associated
with the ground water in this area. The Board strongly recommends Town
sewer for the area. `
Very rul urs,
Ro ert L. Childs, Chairman
BOARD-OF HBALTH:
TOWN OF BARNSTABLE n
JMK/bs _: -f
December.4,"'1986
Mrs. L14riane,.Kruegat
85 'Woodland'Avenue,
�iyannis,Ila '02601
DeaOlrs:.Kruegar.. .. v`
You are 'granted a, =variance,,.from 'the- Board ofiealth Interim Ground
Water _Protection R_ egulation, limiting daily sewage flows to 330'_0allons
per ;acre;:to in tin.06-site sewage Disposal•System°on Lot.,'5,'.Woodland.
Avenue,''ii Vann is, with the following conditions:
(1). .The designing engineer Tnust ,supervise_ construction of. the' 0 -site
Sewage -.Disposal Systeni and certify. -in writing that his -design ,has- been
complied with ' prior. to "issuance of a Certificate •of Cianipliance 'or-
Occupancy Permit:
(2) 'The .dwelling cannot have mare than. two-.bedrooms or-exceed five
(5)-rooms in entirety;
(3)" A garbage grinder is,not authorized.
(4j It 'should be tecorded'`on, the Bill of Sale'that• the On-Site..Sewage
Dipbsal System; thust bye " pdinped every. three, (3). years and' 'written
certification submitted .to the Board-of Health.
(5) Variance expires Januniy,1,. 1988 _
This variance' is:granted because the:area is almost. fully,developed withs
few remaining vacant 'lots. "_,The, dwelling Is restrtGted Ao' two bedrooms
with. a'projected Title•.5•Sewage-Flow Estimate -.of.,220 gallons-per.. day.
Cape Cod Plapning and Economic Development estimate average dwe. ng
sewage-,flow rates aB`165 gallons per day based on an-average occupancy
of'three persons. Ttie'lot,size is approximately,1/3"of an acre..
-It to. the opinion' of the Board :that the installation ,of a Sewage Disposal
System on thin lot• will not ,significantly effect the problems 'associated
With the ground. water in this area.- The.Board.strongly_recommende'.Town•
sewer-fog..thearea.
Very rul urs,
/
Ro :ert `L. C.hilds,`Chaliman.
BOARD'OF HEALTH
TOWN OF BARNSTABirB
J MK/ba
"q -ht,
-Nk-, -t-t A. y , -1 -, .j,!�. 5V ';,;.Z
,45,11
,q.. x .
41
Z
Decem
ber 4, 1986
Mrs.-Mariine Krueg4r"
85 Woodland--Avenue
Hyannis- Ka 02601
zlt ZZlr�4�,7a,
Dear Mrs. Kruegar:
e You `gran
ted_d 'a. variance, from 'the' Board of Health Interim Ground,
Water Protection Regulation- limiting daily sewage flows to '330 -gallons
per acre,;.to install an on-site sewage :Disposal System on.10 3,t. :.Woodland
Avenue, Hyannis,,with the following conditions:
(1) The designing engineer must supervise construction of the, .on-site-,
Sewage Disposal System and certify. In writing- that- his .design hii, been.t,.
complied with prior to issuance of a Certificate of Compjiance or
Occupancy Permit. ------
(2) The dwelling cannot have more than two bedrooms or exceed five
(5) rooms in entirety..
(3) A garbage grinder is not authorized.
(4) It-.should-'be. recorded on the Bill of Sale that the On Site Sewage
-:.Di � -.System -Must, be umo6d-,.-6verypoff l _-
certification submitted td the.Board of Hea th.
W.
(5)- Variance expires January 1, 1988:
This variance Is:granted because the area is almost fully developed with
few remaining vacant lots. The dwelling is restricted to two bedrooms
with a projected Title 5 Sewage Flow Estimate of 220 gallons per- day.
Cape Cod Planning and Economic Development estimate average dwelling
sewage flow rates as 165 gallons per day based on an average occupancy
of three persons. The lot size is approximately 1/3 of an acre.
It is the opinion of the Board that the installation of a Sewage Disposal
System on this lot will not significantly effect the problems. associated
with the ground-water in this area. The Board strongly recommends-Town
sewer for the area.
V e I ur s.ru'Ro r PertL.�C_htlds, Chairman
BOARD OF HEALTH,-
TOWN OF BARNSTABLE
JMK/bs
r
November 20, 1986
Iris. Mariane Krueger
:85 Woodland Avenue
Hyannis,Ma 02601
Dear,Ms: Krueger: r.
The Board"of Health reviewed: your variance",request.,fors'Lot 3' Woodland
Avenue, Hyannis, at it's meeting November 18 1986.
We would 1,ike additional into prior to making a final decision. ,
We would• appreciate ,your meeting. with us at:4:45 PAL on December
2, 1986, in:the'Hoard of Health office:
Very,t y urs,
Ann baugh, Acting Chairman
:BAR BLB'BOARD OF HBALTH
AJ:B/b