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0322 YARMOUTH ROAD - Health
322 Yarmouth Road Hyannis P a .. -A = 344 019 , C�lrn M4� t EA Survey, Inc. Business: (508) 888-3619 P.O. Box 1729 Cell: (508) 527-3600 Sandwich, MA 02563 email: eas.survey@yahoo.com January 19, 2018 RE: 322 Yarmouth Road, Hyannis, Mass. Septic repair To whom it may concern In order for the septic system to be repaired at#322 Yarmouth Road, the following variances are required under 310 CMR, Sec 15.405. 1.) To allow the leaching trenches to be 5.2' from the existing foundation in lieu of 20'.A 15' variance is requested. 2.) To allow the leaching trenches to be 2' from the side property line in lieu of 10'. A 8' varaince is requested. 3.). To allow the leaching trenches to be 4.5' from the rear lot line in lieu of 10' a 5.5' variance is requested. A meeting with the Board of Health is scheduled for Tuesday February 27th at 3 pm in Barnstable Town Hall at 367 Main Street, Hyannis. Plans are available for review at the Barnstable Board of Health. If I can be of any further assistance in this matter please contact me at 508-527-3600 Sinc Edward a. Stone. PL Date Town of Barnsiable P Department of Regulatory Services M, Public Health Division 7 ,,,,,�, Date rm�v 200 Main Street,Hyannis MA 02601 0 • rrn n�� . Date Scheduled T— Tima�_ Fee Pd._ a. Soil Suitability Assessment for Sedvg ge Disposal "� Performed-By: Witnessed By: LOCATION&.GENERAL INFORMA I Location Address Z Off! �U Owner's Name cL?7 Vf f DZIU� Address Assessor's Map/Parcel: Engineer's Name �S< NEW C0NSTRUM0N REPAIR - Tcla hbne# — / t - -3lr !/ C Innd Use Slopes(%) / 6 Surface Stones Distances flvm: Open Water Body AW ft Possible Wot,Area �"' ft Drinking Water Wcll ft Drainage Way. Iy/? ft Property ne ZU / ft Other 6� ft �JJ SKETCH[(Street name,dimensions of lot,exact locations of test holes& era tests,locate wetlands-inproximity, roximl to e • � P tY holes) T4 i 15, .T Parent material(geologic) LET C9�Y�t' Depth to Bedrock,,, , Depth to Groundwater. Standing Water In Halo: p Weeping fl otn Pit Fnca Estimated Seasonal High Groundwater '-7` Z/ DETERMINATION FOR SEASONAL'HIGH WATER TABLE Method Used: , Depth Observed standing in obs.hole: �7 In, Depth to sell mottles., Dclith to Wcping from side of obs. ole: In, Groundwater A uethtent ft. Index Well-# Reading Date; Index NVoll level Adj�fhctc Adj:drnun water•Leval PERCOLATION TEST Deie!2 t¢ Time �d�M Observation Hole# � Time at 9" Depth of Pdro fe!!�o Time at 6" Start Pro-soak Time @ Time(91, End Pro-soak > Rate Min.Anch Site Suitability Assessment; Sltd Passed �l Sity Failed: Additional Testing Needed(YIN) v Original: Pubic Health Division Observation Hole Data To Be Completed on Back ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conselrvation Division at least one(1)week prior to beginning. Q:\SBPfIC\PBRCPORM.DOC DEEP.OBSERVATION HOLE LOG Hole# X '� Depth from Sol Horizon Soil Texture Sdil Color Soil. Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. o islelme m-'aravel) 413 le r Ate' C / cv 154 Nm DEEP OBSERVATION HOLY+ LOG Hole# Depth from Sall Horizon Soil Texture Sall Color Soil Other Surface(in.) (USDA) (Munsell). Mottling (Structure,Stones,Boulders, Ole' 5 v se, , iol 7/4 !, ,2 -vo 'v p'x gW— G6✓h .O!%B DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Taxture Soil Color Soil ' Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders, DEEP OBSERVATION HOLE LOG Hole# Depth from Sall Horizon Sall Texture Sall Color Sall Other Surface(In.) (USDA) (Munsell) Mottling (Structure,Scopes;Boulders, Consistency, Onlyll) Flood Insurance Rate Man Above 500 year Mood boundary No— Yes ;vl� Within 500 yrAr boundary No_ Yes Within 100 year flood boundary No,,— ., Yes,,,_... pepth of Naturally Occurrine Pervious Material Does at least four feet of naturally occurring pervious mtiterial exist in all areas observed thrpughout the area proposed for the soil absorption system? 5 If not,what is the depth of naturally occurring peivious materlal? CerN---.�°T I certify that o ✓ S (date)I have passed the soil evaluator examination approved by the Department of vlronmental Protection and that the above analysis was performed by me consistent with . the required traini xperds ea rlence described in 410 CMR 15.017. Datb Signature Q;15EPT1CWBRCPORM.DOC TOWN OF BARNSTABLE LOCATION' SEWAGE# z6 r8 - 3616 VILLAGE 14YA o W(5 ASSESSOR'S MAP&PARCEL 1-2-44 -o 9 INSTALLER'S NAME&PHONE NO. � �r�Di��Os 608- ZD 9't38 , SEPTIC TANK CAPACITY(IAtu) LEACHING FACILITY. (type)(Y-��RkuCl{�S Zx3�2x3�(size) `�77 p I NO.OF BEDROOMS OWNERw � / t PERMIT DATE: It-ZS— S COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet _Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) itf 4 Feet FURNISHED BY � N a O-Z 7.t.2' A-3�o.b g-3 Za,g, Q, ld.D' Ll-S L S-2' . 1 �� 3xlf�' a, .� aPl� nj�' No. aA) l --- Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZippliCation for Disposal *pstrm Construction Permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 60/ O� e,Ad¢re s Y3 02 sGTy ' e 221�1C Assessor's Map/Parcel Z eSS S6A¢¢¢ �/ Installer's Name,Address,and Tel.No. 8� 4 9�3t� Designer's Name Address,and el.No.a�- �/C' A7 E T24/l� /�,D�/f xy�ctr o zG4B T�V� /7 �S Ocr/rc�y a 2 sc Type of Building: Dwelling No.of Bedrooms n.� Lot Size s,D 1/ sq.ft. Garbage Grinder( ) Other Type of Building � i No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 � gpd Design flow provided 5_7 tF gpd Plan Date /' l s— /10 Number of sheets 3 Revision Date Title �� ��t�/,¢6E ��'¢i P q N Size of Septic Tank /JrDO, Type of S.A.S. Tf2 I"-�P , d7 "r s Description of Soil AgOU6"cs�an/0 J�5,_Oge ✓Uo 020"Oft- i�ad�t-�ir'od m Nature of Repairs or Alterations(Answer when applicable) TC / l�3rlJlJ C5, r ,/ 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. Signed Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No.�� Date Issued t �� ------------------------- --- --- - - a • � n� F it • � _Lx' i n - �. . Entered in;com i{ 'TiHE�COMMONW..EALTH'OF;,MA$SACHUSETTS V_"�r PU: C�HEALTH MUM MA:T�Q N OF B�ARNS�T►ABUE;{IIAASSACHU,SETTS °" IputaltiorrforlS�IDdY' ipStEllt'�OttSULtIOtt, EL'Irt v A hcation,for a p, Re air U r r— V _ p _ - _ ermit to,?Co trust( )" . p .( pg ade( ), �band6 n El Complete,System _ ,�FIndiy_dual'tCo>nponents 'LOcahAd`diessyour Loth_101 ,j���+� "�� f er's,Name;,Address;and Tel No "� =?�f4�? ` rAsssessorgsiMap/P,arcel �Ins'taller s Name; ddress;nd Tel:No T �� `, Designer saNani6 Address,and Tel No: K •� Y �JV 42-1 ^/- "e'd< T i?i1 ram�lr Typesgf Baling;_ - Dwellin" No pf Bedrooms"g, ?.- .. L'ot4Size, ._ sq:'ft, Garbage Grinder'( �, Other, TyPeaofaBu ding�� 1 i 1�T�'/.C.No�q e�sons+ Showers^('., ) Cafetena,(. • Oiher;.Fizhues — De'signtFro`w(min.required] .c} gpd ;Design flowiprovided td •r P;18�X Date, - �` �'3 1 ' 5 Number of sheets9 .3 J Revision;Date. -�_ 4 Title; S' j Size of$-ftic Tank: Type of StA S. T� r -Elm ,D-escnphowOESoil -7 I-'dn. /e l.Yl Lyi��r,Y^Ca1r7,r.4— a✓o i NaturedofaRepe rs orAlterahons7(Answer w,,tien applkdble); /J rr l� �� �r �` �;._. /`7 'l/_ t' +� ' 1 u�•-- � '�{ .�r•`./,'S. ' C`�' •J �/ G •:L'uf_Y! J� j� .0 1,. G�f� a1� Date las��iii"ss ecte ;r- Agrcewent, gn gre theticonstruchon and maintenance o - µ ag p sy m m The undersi ed a es to ensure t _ of Title 5 of{_e�Env�ronaiental Code,and not�to place lttoe syst mbin operation urftil a Cerhfi_sate of accordance withe,prowsions th zt" P - y • ;�'@om lia`nce hasbeen,issued bythis`Board ofrHealfh. � S'igned, . . Date, T _ �PPlication App�oved by • ]Date, ra AppLcation Disapp eby,' Date owing reasons rfor the foil _ L P,ennit No ����� . Date`Issued r � — - Y O?t� r THE COMMONWEALTH OF MASSACHUSETTS q, - �B` STABLE,1VIASSACH�USETTS' _ Cierhfica�te��of��on�•��'�arite, }�ti•, 'THIS,IS�T6,uogFY,'tlatiie,6hstteSewageDi§posahsystemConstructed,(; ); Repaired(r�)M- Upgraded:(; • r 'a bandoned f �11_ �� a �1* 1�.U,T7{ � .i r n�d�I S' ://,,p c vs/'has been consiructed Wacco dance. a. wit�li the�provi nsiof TitlIP- r�e�5�and;th'e for D'sposal'System;Construction Penriit IVo 0 dated; 4 P�Iti9taller-_.;s7&� 5 /'h �.•:N.r gi'/, 5, Designer_ ''r%C�.--'l�r..s u•�,^'.: a�. ~�.•,,r n .�r•y rr J,r #`rbedrootns� ' ---- - - _ _ _ Approved;design flow 1 The issuance of thi'sapermit_ hall not. acohs_ttued as a guarantee¢that,tlie system w _ --c e e r 'Date -F No r ljj Fee PiJBL%IC;HE' ,,COMIVIONrWEA 111 OF�NIASSACHUSETTS _ wTIIIDIVISIUN .B�'_� s + 5�a�ABLE,NIASSAC SE T T,S 'Opstr ,C,onstrutaotr errn t qn �, Perinissionns;hereby;granted;to:Construct(' ); Repair('�('°) # Upgrade,(' ) Abandon( ) sS?ystemrlocateda: ,3 2' :a ` ` din.the above A licationLforkDis;osal,S stem Construction PermR. The applicant reco zed:his• end'�as descnbed `- .�, - W - T`t1e�5aand�the fohowuig,local•p ovi`sions^orspecialrcond hods. . ., � - /her=du ,to comply with•, MrovidedXongiruction rnusvbescompleteddwittiin;three�/ears,of the date�of'tliis;;permit. �-* - - - -T--• •� a Tate; - r i4ippcoyed by - 1 Town of Barnstable Barnstabie P�°p THE Board of Healthac nARN. ABLE. • ASS. 01 200 Main Street, Hyannis MA 02601 = -- 039. 9 \o°�D MAC LUO 7 Office: 508-862-4644 Paul J.Canniff,D.M.D FAX: 508-790-6304 Donald A.Guadagnoli,M.D. JunichiSawayanagi March 5, 2018 Mr. Edward A. Stone P.O. Box 1729 Sandwich, MA 02563 RE: 322 Yarmouth Road, Hyannis A= 344-019 Dear Mr. Stone, You are granted variances on behalf of your client, Sew Realty Trust, Wayne Sullivan trustee, to construct a replacement onsite sewage disposal system at 322 Yarmouth Road, Hyannis. The variances granted are as follows: 310 CMR 15. 405: To install the soil absorption system with 4.5 feet away from the rear property line, in lieu of the ten (10)feet separation distance required. 310 CMR 15. 405: To install the soil absorption system with 2 feet away from the side property line, in lieu of the ten (10)feet separation distance required. 310 CMR 15. 405: To install the soil absorption system with 5.2 feet away from the foundation wall, in lie} of the twenty (20)feet separation distance required. This variance is granted with the following conditions: (1) .The existing leaching facility appears to be located on the adjacent land to the north of this property.(on the Pine Harbor parcel). The,applicant and/or the designer (registered sanitarian) shall directly communicate and Work 'with the neighbor to ensure the existing leaching facility is properly abandoned, in accordance with Title V standards and local requirements. -- /2) The designer(registered sanitarian) shall submit the required percolation test form. (3) The designer (registered sanitarian) shall revise the plans to show the variance request code numbers. (4) No more than five (5) bedrooms are authorized within the dwelling served by this septic system. Dens, study rooms, offices, finished attics, sleeping lofts, and similar-type rooms are considered "bedrooms"according to the MA Department of Environmental Protection. (5) The septic system shall be installed in strict accordance with the revised engineered plans. (6) The designer (registered sanitarian) shall supervise the construction of the onsite sewage disposal system and shall certify in writing to the Board of Health that the system was installed in substantial compliance with the revised. Q:\WPFILES\Stone 322 Yarmouth Road Sullivan 2018.docx The proposed system was designed to replace the failed system. These variances are granted because the proposed plan appears to meet the maximum feasible design standards contained within the State Environmental Code, Title 5 and local Health Regulations. Sincerely your u KIMNn D �W b Chairman Q:\WPFILES\Stone 322 Yarmouth Road Sullivan 2018.docx Stone 322 Yarmouth Road Sullivan 2018.doex d e � r�ra .2 � C3x11`x�ix �7 /� , r �� 3 - '��r/ C�if`" vv✓'.��CP/ C`dde--H S f P 1 i IMETp� DATE: ( C FEE: L.— * BAMRrABLE, MAS& g i ppliVI 1639• ♦0 REC.BY: V L Town of Barnstable SCHED.DAT ' 7 4 Board of Health ` 6'1 200 Main Street, Hyannis MA 02601 Office: 508-8624644 Paul J.Canniff,D.M.D. FAX: 508-790-6304 Junichi Sawayana D.gi Donald A.Guadagnoli,M. a Alternate:Cecile Sullivan,RN,MSN RI VAANCE REQUEST FORM LOCATION (/ ,,/ Property Address: _ �Zz �. �I j� 0/� J/Y'y A N1� �ZG e1 Assessor's Map and Parcel Number: ¢ Size of Lot: , Q Wetlands Within 300 Ft. Yes Business Name:., 4 No Subdivision Name: itIZ19 APPLICANT'S NAME: �� �- • .555&r Phone me s27^ S 0,0 `Did the owner of the property authorize you to represent him or her? Yes No PROPERTY OWNER'S—NAME41,1& CONTACT PERSON ,Name: �'�CL/ �U Name: �O�ri*/20 U/'J t Address: 3�310 Address: 70 Phone: � yot/ sC '4�,c Sit- Phone: :5214/0 All l Z)2� EMAIL: s 5 v ti{ a Ga'� VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if re sp a eeded) �)/U ' , U >< /S >"r, NATURE OF WORK: House Addition LJ House Renovation Ll Repair of Failed Septic System / Checklist (to be completed by office staff-person receiving variance request application) Please submit copies in 5 separate,collated packets. Five(5)copies of the completed variance request form Five(5)copies of engineered plan submitted(e.g.septic system plans) Five(5)copies of MA DEP approval letter for I/A septic systems only. 1 Five(5)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) A completed seven(7)page checklist confirming review of engineered septic system plan by submitting engineer or registered sanitarian Signed letter stating that the property or business 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—Five(5)copies of full menu submitted(for grease trap variance requests only). $95.00 variance request application fee collected (No fee for lifeguard modification renewals , grease trap variance renewals [same owner/lessee only],outside dining variance renewals[same owner/lessee 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, Paul J.Canniff,Chairman NOT APPROVED Junichi Sawayanagi REASON FOR DISAPPROVAL Donald A.Guadagnoli,M.D. Q:\Application Forms\VARIREQ Rev APR2017.DOC O •. • O m -q Certified Mail Fee 3 .45 0$$4 rU $ - �I� ul Extra Services&Fees(check bq$add fee I I late) ❑Return Receipt(nerdcopY) $ � O ❑Return Receipt(electronic) $ $0 I.i+.rat�� Postmark. O ❑Certified Mall Restricted Delivery $ .Q.AM . Here C3 ❑Adult Signature Required $ _ O ❑Adult Signature ResMcted Delivery$ O Postage' r- Total Postage and Fees ta1J??J2il�g nj $ $6.70 sentsU11-JAl a f PAT7A&E ------------- - ---- ------- -- ----- Stceet an t.No.,or O Box No. r`- )ty s �?�� 1�1.e?�1C T --------------- AJA/IS I4-A ���a / Certified Mail service provides the following benefits: re A receipt(this portion of the Certified Mail label): for an electronic return receipt,see a retail e A unique identifier for your mailpiece. associate for assistance.To receive a duplicate ■Electronic verification of delivery or attempted return receipt for no additional fee,present this delivery. USPS®-postmarked Certified Mail receipttpthe ■A record of delivery(including the recipient's retail associate. signature)that is retained by the Postal Service' Restricted delivery service,which provides for a specified period. delivery to the addressee specified by name,or to the addressee's authorized agent. Important Reminders. Adult signature service,which requires the •You may purchase Certified Mail service with signee to be at least 21 years of age(not First-Class MailO,First-Class Package Servtcsf,' available at retail). t' or Priority Mail®service' i Adult signature restricted delivery service,which • •Certified Mail service is hot avabable for requires the signee to be at least 21 years of age international mail. -r`^ and provides delivery to the addressee specified ■Insurance coverage is notavailable for purchase ` by name,or to the addressee's authorized agent With Certified Mail service.However,the purchase (not available at retail). of Certified Mail service does not change the ■To ensure that your Certified Mail receipt is insurance coverage automatically included with accepted as legal proof of mailing,it should bear a certain Priority Mail items. USPS postmark.If you would like a postmark on? •For an additional fee,and with a proper this Certified Mail receipt,please present your ' endorsement on the mailpiece,you may request Certified Mail item at a Post Office'for the following services: postmarking.if you don't need a postmark on this -Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece. electronic version.For a hardcopy return receipt, complete PS Form 3811,Domestic Return Receipt attach PS Form 3811 to your mailpiece; IMPORTANT:save this recelpt for your records. PS Form 38OO,April 2015(Reverse)PSN 7530-02-000-9047 •, news& r--91 m —0 C r-I Certified Mail Fee er r Ln $3.45 0664 iu $ n mac. (13 Ln Extm Services&Fees(checkbmy add fee a epprpp- ) ❑Return Receipt(hardoopy) $ 177 11 11 +� [] ❑Return Receipt(electronic) $ VI-1 t11 Postmark O ❑Certified Mail Restricted Delivery $ $fl i�1I 1 Here 0 .[]Adult Signature Required $ Nam_ C7 ❑Adu@ Signature Restricted Delivery$ Postage0.50 r-q Total Postage and !11,�22/2018 Fp�iss S IXie M o ie EA c 7y - ?--- I- C3rq etand-t.- Pa Box No:- r`- ?-SE - -- �'ty t V-4- PRISM I n26 S .. Certified Mail service provides the following benefits: a A receipt(this portion of the Certified Mail label). ,for an electronic return receipt,see a retail ■A unique identifier for your mailpiece. associate for assistance.To receive a duplicate ■Electronic verification of delivery or attempted return receipt for no additional fee,present this delivery. USPS®-postmarked Certified Mail receipt tg the ■A record of delivery(including the recipient's retail associate. S signature)that is retained by the Postal Service- Restricted delivery service,which provides for a specified period. delivery to the addressee specified by name,or to the addressee's authorized agent. Important Reminders. Adult signature service,which requires the ■You may purchase Certified Mail service with signee to be at least 21 years of age(not First-Class Mail®,First-Class Package Serving®, available at retail). r or Priority Mails service. Adult signature restricted delivery service,which n Certified Mail service is notavaifble for requires the signee to be at least 21 years of age international mail. -I and provides delivery to the addressee specified ■Insurance coverage is notavailable for purchase, by name,or to the addressee's authorized agent with Certified Mail service.However,the purchase (not available at retail). of Certified Mail service does not change the To ensure that your Certified Mail receipt is insurance coverage automatirally.induded with. accepted as legal proof of mailing,it should bear a certain Priority Mail items. USPS postmark.If you would like a postmark on ®For an additional fee,and with a proper this Certified Mail receipt,please present your endorsement on the mailpiece,you may request Certified Mail item at a Post Office'for the fol!owing services: postmarking.if you don't need a postmark on this -Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece. electronic version.For a hardcopy return receipt, complete PS Form 3811,Domestic Retum, Receipt;attach PS Form 3811 to your mailpiece; IMPORTAN.Save this recelpt for your records. PS Form 3800,April 2015(Reverse)PSN 7530-02-000.9047 ru m -0 .HY I FFVVIA rlCertified Mail Fee 3.45 0$64 fU $ 03 � Extra Services&Fees(check box,add fee aTI, [I Return Receipt(hardtop» $p ❑ReturnReceipt(electronic) $ $II Postmark C3 ❑Certified Mail Restricted Delivery $ . d. l � Here O ❑Adult Signature Required $ r3 ❑Adult Signature Restricted Delivery$ . I3 Postage $I:1,ill ti Total Postage and Fees j+1/iry/y111°, .� Sent, 849 .?/��7L7`.6. . WY AT6 _ ra [,_ _ - _: ST2EC it 14 r - - :rr t it r.k•k, Certified Mail service provides the following benefits: ■A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail ■A ynique identifier for your mailpiece. associate for assistance.To receive a duplicate ■Electronic verification of delivery or attempted return receipt for no additional fee,present this delivery. USPS®-postmarked Certified Mail receipt"a ■A record of delivery(Including the recipient's retail associate. I ,j signature)that Is retained by the Postal Service' Restricted delivery service,which provides " for a specified period. delivery to the addressee specified by name,or. to the addressee's authorized agent Important Reminders. Adult signature service,which requires the ■You may purchase Certified Mail service with signee to be at least 21 years of age(not First-Class Mail®,First-Class Package Service available at retail). or Priority Mail®service. . - ■Certified Mail service is notavailaVe for '+' Adult signature restricted delivery service,which' requires the signee to be at least 21 years of age International mail. and provides delivery to the addressee specified Y ■Insurance coverage is notavailable for purchase by name,or to the addressee's authorized agent with Certified Mail service.However,the purchase (not available at retail). of Certified Mail service does not change the ■To ensure that your Certified Mail receipt is insurance coverage automatically included with accepted as legal proof of mailing,it should bear a . certain Priority Mail items. USPS postmark.,if you would like a postmark on ■For an additional fee,and witha proper this Certified Mail receipt,please present your " endorsement on the mailpiece,you may request Certified Mail item at a Post Office'for the following services: postmarking.if you don't need a postmark on this -Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece. electronic version.For a hardcopy return receipt, complete PS Form 3811,Domestic Return Receipt,'attach PS Form 3811 to your mailpiece; IMPORTANT.Save this receipt for your records. PS Form 3800,April 2015(Reverse)PSN 7530-02-000-9047 EAS survey, Inc. Business:(508)888-3619 PO. Box 1729 Cell: (508)527-3600 .Sandwich, AL4 02563 email: eas.survey@yaboo.com yahoo.com Januaiy 1.9,2018 RE: 322 Yarmouth Road,Hyannis, Mass. Septic repair To whom it may concern ` w In order for the septic system to be repaired at#322 Yarmouth Road, the Mowing variances are required under 310 CMR,Sec 15.405. 1.) To allow the leaching trenches to be 5.2' from the existing foundation in lieu of 20'.A 15' variance is requested. 2.) To allow the leaching trenches to be 2' from the side property tine in lieu of 10'. A 8' varannce is requested. 3.) To allow die leaching trenches to be 4.5' from the rear lot line in lieu of 10' a 5.5' variance is requested. A meeting with the Board of Health is scheduled for Tuesday February 27th at 3 pm in Barnstable Town HaR at 367 Main Street,Hyannis.Plans are available for review at the Barnstable Board of Health. If I can be of any further assistance in this matter please contact me at 508-527-3600 Sin y w Edward a. Stone.W '. Date McKean, Thomas From: McKean, Thomas Sent: Friday, February 23, 2018 3:13 PM To: 'ees.survey@yahoo.com' Subject: 322 Yarmouth Road/ Proposed Septic System Good Afternoon, Health Inspector David Stanton reviewed the proposed project and there are five issues that must be addressed as follows: - The existing SAS appears to be on the neighbor's property. Please show the actual location of the existing SAS. - Have you contacted the neighbor to determine when and how it will be abandoned on his property? Do you have the neighbor's permission to abandon the septic system on his property? - Please provide a complete listing of the variances requested along with the regulation code numbers(e.g. 310 CMR 15.405) on the engineering plan. - The SAS profile is sized at 3' X 2' X;2"sX 3T How is this possible? - No percolation test form submitted.. 1 AsBuilt Page 1 of 1 TOWN OF BARNSTA13LE _ATION SEWAGE# VII.I:1t;;E S ASSESSOR'S MAP&LOT 'S 4y n INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY ISOI> � J V LEACHING FACILITY: (type) I <.\a NO.OF BEDROOMS��,,''����_ `- BUILDER OR OWNER _�f`yr•�, PERMrf DATE: 3 n 11_COMPLIANCE DATE:,/ 1 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 ° 13 � SOU C http://issgl2/intranet/propdata/prebuilt.aspx?mappar=344019&seq=l 2/16/2018 r December,161h,2017 EAS. Survey,Inc.P.O.Box 1729 Sandwich,MA 02563 RE: 322 Yarmouth Rd.,Hyannis,MA Dear Mr.Stone, Please be advised, E.A.S.Survey,Inc., Edward A.Stone,and or David Flaherty are authorized to represent SEW Realty Trust at Town of Barnstable Board of Health meetings, hearings,regarding the above property. Please feel free to contact me,if I can be of any further assistance in this matter Best regards, W ne E.Sullivan,trustee Town of Barnstable �VE Regulatory Services ti Richard V. Scali,Director B"R'ASS.M ` Public Health Division 163T9. 61��� Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 Date: Z- 3" Sewage Permit#2C>(8-3" Assessor's Map/Parcel 344-0 1 9 Installer& Designer Certification Form Designer: Cd,S -,5Je-V�5-`t°T�L Installer• F '�d►z�oS Address: f7 «Z�2 Address: c57 r (19 _" �VLtJIC-1A � �UZ.SCo3 ��S i�lq 1LGis ���a 15�0- z - 3�00 �4Zd-9�313 On 11 - 7-0-1 g __4W&M5 `aGf?t(� was issued a permit to install a (date) (installer) septic system at �jZZ �ACOWW, 44Yti�Pi S based on a design drawn by (address) I `PA\A 9_1;� ('-U Pis'R��dated 1-t5-18e"l/ (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. Stripout (if required) was inspected and the soils «-ere found satisfactory. I certiA, that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Stripout (if required) was inspected and the soils «•ere found satisfactory. I certify that the system referenced above was constructed in compl ance with the terms of the I/A approval letters(if applicable). w �. ` i€E tTY,JR. Qi aller's Signature) NO, 1211 � o /BTEVL �PITOM- (Designer's Signature)0 (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. gAoffice fonnsidesignercertification form.doc December.le,2017 E.AS. Survey,Int P.O.Box 1729 Sandv*k MA OM RE: 322 Yarmouth Rd.,HyanrO4 MA • Dear Mr.Stone, Please be advbed, E.A.S.Survey,Wc., Edward A.St eM and or DwM Ilatwty are auft*ed to represent SEW Realty Trust at Town of Barnstable Board of Heaith meeUres, hearinss,regarding the Am property. Pieria feel free to contact me,if i can be of any further assistance in this matter Best regards, W e E.Suptvan,trustee YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates(cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. � � ► _ DATE: Fill in please: ��� ,' APPLICANT'S YOUR NAME/S: _ Q. QL)-MO. BUSINESS YOUR HOME ADDRESS: ' TELEPHONE # Home Telephone Number ` NAME OF CORPORATION: NAME OF NEW BUSINESSTYPE OF BUSINESS rL U C (U IS THIS A HOME OCCUPATION? YES NO ADDRESS OF BUSINESS 2i ET MAP/PARCEL NUMBER —Orl [Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Ln Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. &Main Street) to m e sure you have the appropriate permits and licenses required to legally operate your business in this town:'' 1. BUILDING COM IS 10 R'S OFF E MUST COMELY WITH HOME OCCUPATION This individu I h e i or e o a pe mit re ui ements that pertain to this pe of business. RULES AND REGULATIONS. FAILURE TO 6OMPLY MAY RESULT IN FINES. Aut r ad Sign tur EN S: r 2. BOAR O EALTH This individual has been informe o e per it r quirements that pertain to this type of business. MUST COMPLY WITH ALL Authoriz d Sign * / _ HAZARDOUS MATERIALS REGU.LAT16 S. COMMENTS: 3. CONSUMER AFFAIRS [LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: DATE: FEE.: + RARNUMBLE. Khm 45 REC.BY: Town of Barnstable SCHED.DATE:. Board of Health 200 Main Street,Hyannis MA 02601 Office: 508-862-4644 Paul J.Cannift D.M.D. FAX: 508-790-6304 Junichi Sawayanagi Donald A.Guadagnoli,M.D. Alternate:Cecile Sullivan,RN,MSN VARIANCE REQUEST FORM LOCATION Property Address: � z �� B /J 1/���15 F yLAG�� Assessor's Map and Parcel Number: —' 4 Size of Lot: , 9 f Sl= Wetlands Within 300 Ft. Yes Business Name: d/ 4 No Subdivision Name: it/ 4 .APPLICANT'S NAME: 1- • .53C*r Phone 3?W — sZ7 3(-oa Did the owner of the property authorize you to represent him or her? Yes No ]PROPERTY OWNER'S NAME CONTACT PERSON Name: MjiQy Name: w W A Address:. �' 3U314 Address: � . l 72 Phone: ,� � WE � s� Phone: N A11(e44 Z)z G EMAIL.: s vr%v GoX1 VARIANCE FROM R—E7G—,U,LATION(List Reg) REAS FOR VARIANCE(May attach if re sp eeded) ,�tr) NATURE OF WORK: House Addition U House Renovation U Repair of Failed Septic System Check t (to be completed by office staff-person receiving variance request application) Please submit copies in S separate,collated packets Five(5)copies of the completed variance request form Five(5)copies of engineered plan submitted(e.g.septic system plans) Five(5)copies of MA DEP approval letter for I/A septic systems only. Five(5)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) A completed seven(7)page checklist confirming review of engineered septic system plan by submitting engineer or registered sanitarian Signed letter stating that the property or business 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—Five(5)copies of full menu submitted(for grease trap variance requests only). $95.00 variance request application fee collected (No fee for lifeguard modification renewals , grease trap variance renewals [same owner/lessee only],outside dining variance renewals[same owner/lessee 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 Paul J.Canna Chairman NOT APPROVED Junichi Sawayanagi REASON FOR DISAPPROVAL Donald A.Guadagnoli,M.D. Qp\Application Forms\VARIREO Rev APR2017.DOC t 4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 322 Yarmouth Road Property Address Country Wide Bank Owner Owner's Name information is required for Hyannis MA 02601 5/11/09 every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important:When filling out A. General Information forms on the _ computer,use 1. Inspector: only the tab key to move your Michael Kellett cursor-do not Name of Inspector use the return key. Aardvark Environmental Inspection Company Name P.O. Box 896 Company Address East Dennis MA 02641 " �1 Cityrrown State C Zip Code�y 508-385-7608 S13742 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 16.340 of Title 5(310 CMR 16.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority !I 05/11/09 InspectoPs 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. f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �< 322 Yarmouth Road Property Address Country Wide Bank Owner Owner's Name information is required for Hyannis MA 02601 5/11/09 every page. City/Town State Zip Code Date of inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Answer yes, no or not determined (Y, N, ND) in the ❑for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. 'A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or 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 Commonwealth of Massachusetts Title 5 Official Inspection. Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments SY 322 Yarmouth Road Property Address Country Wide Bank Owner Owner's Name information is required for Hyannis MA 02601 5/11/09 every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any) determines that the system is functioning In a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 322 Yarmouth Road Property Address Country Wide Bank Owner Owner's Name information is required for Hyannis MA 02601 5/11/09 every page. City/Town State Zip Code Date of inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health(cunt.): ❑ 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 boz above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 322 Yarmouth Road Property address Country Wide Bank Owner Owners Name information is required for H annis MA 02601 5/11/09 y every page. City/rown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems(cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® 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 ❑ O the system is located in a nitrogen sensitive area(Interim Wellhead Protection 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"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. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments l 322 Yarmouth Road Property Address Country Wide Bank Owner Owner's Name requinform r don is for Y H annis MA 02601 5/11/09 required every page. Cityfrown 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? ❑ 0 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. ® 0 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)] Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 322 Yarmouth Road Property Address Country Wide Bank Owner Owner's Name information is required for Hyannis MA 02601 5/11/09 every page. City1rown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): 5 Number of bedrooms(actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No m? i r inspection required] Is laundry on a separate sewage system?[f yes separate nspect on equ dj El Yes ® No Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: 08/08 Date Commerciallindustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 322 Yarmouth Road Property Address Country Wide Bank Owner Owner's Name information is y required for Hyannis MA 02601 5111/09 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): n information:Approximate age of all components, date installed(if known)and source of i nf o ation: 9/30/97 per BOH Were sewage odors detected when arriving at the site? ❑ Yes ® No Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments yr o 322 Yarmouth Road Property Address Country Wide Bank Owner Owner's Name information is Y required for Hyannis MA 02601 5/11/09 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 2.1 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): _ Depth below grade: 1.4 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) If tank is metal, fist age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No ------------------- ------------------------------------------------------------------------------------------------------ Dimensions: 1500 gal 311 Sludge depth. ` Distance from top of sludge to bottom of outlet tee or baffle 29" Scum thickness 2„ 611 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? Measured Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 322 Yarmouth Road Property Address Country Wide Bank Owner Owner's Name information is required for Hyannis MA 02601 5/11/09 every page. Cityfrown 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.): The tank was sound and tight with liquid at outlet invert. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade:, Material of construction: 0 concrete ❑ metal ❑fiberglass 0 polyethylene ❑ other(explain): Commonwealth of Massachusetts up Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 322 Yarmouth Road Property Address Country Wide Bank Owner Owner's Name information is required for Hyannis MA 02601 5/11109 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert even 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.): The box was level and tight with no sign of carry over. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 322 Yarmouth Road Property Address Country Wide Bank Owner Owner's Name information is required for Hyannis MA 02601 5111/09 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) 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: Type: ❑ leaching pits number: ® leaching chambers number: 7 ❑ 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.): The system has seven infiltrators in a 44'xl 1'field of stone. There was no sign of ponding or failure. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments `t 322 Yarmouth Road Property Address Country Wide Bank Owner Owner's Name information is required for Hyannis MA 02601 5/11/09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Commonwealth of Massachusetts Officia) ansperficin Farm Substurface Sewage Disposal System Form-Not for Voluntary Assessments 7c i �'XIM"WM(atftr. 9aasl. ! Properb,y Address Counti€ry Wide Bank i Owner Owner's.:•Name information is Ham its MA 02601 5/11/09 required for _ am every page. Cityrro�,wn State Zip Code Date of Inspection; , D. Ssystem Information (cont.) S1 ketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system!including ties tc)>at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. i 1 I i I I i - j i Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �t 322 Yarmouth Road Property Address Country Wide Bank Owner Owner's Name information is required for Hyannis MA 02601 5/11/09 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: 20.0 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: You must describe how you established the high ground water elevation: USGS maps show an elevation of over 20.0 feet. i 7 04dc ` COMMONWEALTH OF MASSACHUSETTS � EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS d DEPARTMENT OF ENVIRONMENTAL PROTECTION RECEIVED 5y David B. Mason,RS,Certified Title V Inspector,508-833-2177 OCT 1 5 2004 TOWN®E BAENSTABLE HEALTH DEPT, TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION AA, MAP :�, ..,.,. . Property Address:322 Yarmouth Road,BWrnst"le,MA PARCEL - Q09 Owner's: Sylvia Ny 1-4 N N LS Owner's Address:P.O.Bog 1342,Hyannis,MA Date of Inspection: September 27, 2004 Name of Inspector: (please print)David B.Mason Company Name:—N.A. Mailing Address: 4.Glacier Path East Sandwich,MA 02537 Telephone Number:508-833-2177 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: X Passes Conditionally Passes _ Needs Further Evaluation by the Local Approving Authority Fails 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. Notes and Comments:System as inspected appears to have operated based on occupancy level. Increase in occupancy may cause hydraulic failure. The information as identified represents only the condition of the system on September 27,2004 at 12:00 PM. ****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. Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:322 Yarmouth Road Owner: Sylvia Date of Inspection: September 27,2004 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _X_ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CUR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or 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 (THIS IS REQUIRED TO BE COMPLETED) _. 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: Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:322 Yarmouth Road Owner: Sylvia Date of Inspection: September 27,2004 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)(0)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**.Method used to determine distance **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: The primary cesspool is not a typical configuration for a cesspool. It appears to be a pipe cylinder with an inlet pipe and outlet pipe with tee connected to a pre-cast 4'deepx6'diameter leach pit with stone. Permit on file with the BOH for the pre-cast leach pit. OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL, SYSTEM INSPECTION FOMM PART A Page 4 of 11 CERTIFICATION(continued) Property Address:322 Yarmouth Road Owner: Sylvia Date of Inspection:September 27,2004 D. System Failure Criteria applicable to all systems: You must indicate`yes"or"no"to each of the following for all inspections: Yes No _X_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _X_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _X_ Liquid depth in cesspool is less than 6"below invert or available volume is less than '/Z 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 _X_ Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. _X Any portion of a cesspool or privy is within 50 feet of a private water supply well. —X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] No (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no 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 U 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. Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:322 Yarmouth Road Owner: Sylvia Date of Inspection: September 27, 2004 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health X _ Were any of the system components pumped out in the previous two weeks? X Has the system received normal flows in the previous two week period? _X Have large volumes of water been introduced to the system recently or as part of this inspection? X Were as built plans of the system obtained and examined?(If they were not available note as N/A) _X _ Was the facility or dwelling inspected for signs of sewage back up? X Was the site inspected for signs of break out? _X _ Were all system components,excluding the SAS,located on site. _X _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _X_ _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no X _ Existing information.For example,a plan at the Board of Health. X_ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)]_ Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:322 Yarmouth Road Owner: Sylvia Date of Inspection: September 27,2004 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):4(per assessors records Number of bedrooms(actual):4 DESIGN flow based on 310 CUR 15.203 (for example: 110 gpd x#of bedrooms): (440 gpd capacity) Number of current residents:_0 Does residence have a garbage grinder(yes or no):NO(Not Allowed) Is laundry on a separate sewage system(yes or no):NO [if yes separate inspection required]Per owner Laundry system inspected(yes or no): NA Seasonal use: (yes or no):NO Water meter readings,if available(last 2 years usage(gpd)): 2003:69,000 gal. 2002;66,000ga1. Sump pump(yes or no):No Last date of occupancy: (current) COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgketc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no):_ Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information:Barnstable Water Pollution Control Was system pumped as part of the inspection(yes or no): No If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: No information back to 1998 for pumping records TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system(6'pit with 2' stone) _Single cesspool Overflow cesspool Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known)and source of information:Approx. 1985 Were sewage odors detected when arriving at the site(yes or no):NO OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C i SYSTEM INFORMATION(continued) Property Address:322 Yarmouth Road Owner: Sylvia Date of Inspection: September 27,2004 BUILDING SEWER(locate on site plan) Depth below grade:Approximate; 14 Inches Materials of construction:_cast iron _X_40 PVC_other(explain): Distance from private water supply well or suction line:_NA Comments(on condition of joints,venting,evidence of leakage,etc.): Appears in good condition. No evident leakage. SEPTIC TANK: N.A.(locate on site plan) Depth below grade: 14" Material of construction:X_concrete_metal_fiberglass_polyethylene_other(explain)_ If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: Typical 1500 gallon tank Sludge depth: 6" Distance from top of sludge to bottom of outlet tee or baffle: 14" Scum thickness:2.5 inches Distance from top of scum to top of outlet tee or baffle: 15" Distance from bottom of scum to bottom of outlet tee or baffle: 12.5" How were dimensions determined: Actual measurements with tape and scour stick. Condition of tank(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.) Recommend maintenance pumping,tank appears in operating condition.,PVC tees in good condition,Effluent level with outlet tee. GREASE TRAP: N.A. Depth below grade:_ 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: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 322 Yarmouth Road Owner: Sylvia Date of Inspection: September 27,2004 TIGHT or HOLDING TANK:—N.A.—(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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX:_X (if present must be opened)(locate on site plan) Depth of liquid level even with outlet invert:liquid level even with outlet pipe 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.): no indication of solids carryover. Slight build up of pink scum. Tank 23 inches below grade. PUMP CHAMBER:_(locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS Page 9 of 11 PART C SYSTEM INFORMATION(continued) Property Address:322 Yarmouth Road Owner: Sylvia Date of Inspection: September 27,2004 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: Type X leaching pits,number(1)6'wide x 6' deep w/approx.2' of stone around _leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions_ overflow cesspool,number: innovativelalternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.). soil in area of pit was not saturated,no ponding evident,no indication of surface ponding due to hydraulic failure,no excessive growth of vegetation. 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 or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: N.A._(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.):. OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:322 Yarmouth Road Owner: Sylvia Date of Inspection: Septmeber 27,2004 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. v\ DF O x � � OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS Barnstable Assessing Search Results Pagel of 2 OIL P q! ii fit, Y '; � `..ter✓ ,all + Home: Departments: Assessors Division: Property Assessment Search Results - - -s= 322 YA J Owner: Property Sketch Legend SYLVIA, PETER J Map/Parcel/Parcel Extension 344 /019/ ` Mailing Address SYLVIA, PETER J P O BOX 1342 HYANNIS, MA.02601 2005 Assessed Values: Appraised Value Assessed Value 1 � _ Building Value: $ 110,200 $ 110,200 Extra Features: $7,600 $7,600 Outbuildings: $0 $0 Land Value: $90,900 $90,900 Interactive Property Map: ap requires Plug in: i :s 05 Totals:$208,700 $208,700 1 have visited the maps before , Show Me The Map «, r. April 2001 photos available -- Sales History: Owner: Sale Date Book/Page: Sale Price: SYLVIA, PETER J 9/29/1997 10976/311 ` $64,000 THE DIME SAVINGS BANK OF NEW YORK FSB 7/28/1997 10870/215 $50,100 MERRY, EDWARD L 8/15/1987 5904/228 $134,000 PATEL, DILIP K&BHAVINI D 1/15/1987 5531/329 $99,500 BABCOCK, MILTON&ANN 3270/42 $0 PATEL, DILIP CONFIRM 5904/226 $0 Tax Information: Tax information is currently not available for this parcel http://www.town.bamstable.ma.us/t.../displayparce103.asp?mappar=344019&SearchBy=Addres 10/7/04 ,off e e �\ COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENxIRONMENTAL AFF DEPARTMENT OF EN IRONMENTAL PRO Tf "'cO 1. � ONE W1N7ER. STREET. BOSTO,. NIA 0:1C!S 617-:9:-5:00 trA O,c 19 h�lTyoFNsj�� 9 WILLI.AN'F.W'ELD D CO\T Govemc• ti Secrelar% ARGEO PAUL CELLLYCI D.AVID B.STRLHS Lt.Govemor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commission, PART A ,Q CERTIFICATION Property Address: 3�- «•.--tip " "'`�- Address of Ownepl /p, � O'L �K Date of Inspection: O� l6/ (if different) (o Name of Inspector: I am a DEP ap/proved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.00b� t- -1� Company Name: En P"N'r''c2ot w e,&,i, II-e_l S. yfttivnou +,`� U2i,(.•ti-". Mailing Address: Rp Acnx e 3Z!f Hf1S'a4e-0— H/'}© 26'4-q Telephone Number: C 5"e;f) /L/- ZO CERTIFICATION STATEMENT I cer if that I have personally inspected the sewaee disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspec,ia-. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage d!sposa� systems. The system: Passes _ Conci!oonaiiv Passes Neeas Furthe• E !• anon v the Local Approving Authorm a � Inspector's Signat Date: ri1 . The Svsterr Inspector shall submit a copy of this inspection report to the Approving Authority, within thirty (30) days of completing this inspection. If the system is a shared system o, has a design flow of 10,000 god or greater, the inspector and the system owner 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 authorih. INSPECTION SUMMARY: Check A, B, C, Or D: A] SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: 5 3re, SZQA- e,' . N_." vom_ `z.p\._L:.� qx '�4. . IS oft i" -?VC_ pt Pc Q�ivNc••S 1',v?ey 0. VLi%VV\ B] SYSTEM CONDITIONALLY PASSES: Gov a4, b� 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. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (anachedi 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 exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revived 04/25/97) Page 1 of 10 DEP on the wontl wine weo htm.rrwww magnet state ma.us/oec . `' /► SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 4 PART A CERTIFICATION (continued) r Property,Address: 3ZA cc,.__o rCH /�-t +�•�,.�, F � y Owner: J�i''nQ��l�c�"CIA f - Date of�spedion;�,'' t �6 B] SYSTEM CONDITIONALLY,PASSES tcontinu"d Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipets) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced 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 Health): — broken pipets) are replaced obstruction is removed 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, safe(\•and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or priv% is within 50 feet of a surface water Cesspool or prn- 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 APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER 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 to 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 supn'v 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 (approximation not valid). 3) OTHER (revised 04/25/97) Page 2 of 10 CI r' a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIO's FORM PART A I CERTIFICATION (continued) Property Address: ,j2�_. Gam,/. -C (�, �, yC< u Gc.-- Owner: % t .� � Date of nT spection: DJ SYSTEM FAILS: You must indicate either "Yes" or *'No' as to-each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The bans 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 Backup of sewage into facility or system component due to an 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 levei in the distribution boa 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 1/2 day flov:. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe'.s:. Number of times pumped _. Any portion o'the Soil Absorption Svstem, cesspool or privy is below the high groundwater elevation An,, portion of a cesspool or privy is within 100 feet of a surface water supph, or tributar to a surface water supply. Ant portion of a cesspoo' or prr,), is within a Zone I of a public well. Am por�ron e`a cesspool or pri,.ti• is within 50 feet of a private water supple well Any por;.or: of a cesspool or prr\-• is less than 100 feet but greater than 50 feet from a private water supply well with no acceotabie water qualm` analysis, If the well has been analyzed to be acceptable, attach copy of well water analysis for coliiorm bacteria. volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E) LARGE SYSTEM FAILS: You must indicate either "Yes' or "No" as to each of the following: The ioliow;ng crrter;a appi, to large systems in addition to the criteria above: The system serves a facilm 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 . 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04/15/97) Page 3 of 10 r � SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:3� `� �—°' RC4 - Owner: � it.� e cr. " Date of;2pect'icin: ll/y-- Check if the following have been done: You must indicate either "Yes" or "No"as to each of the following: Yes No Pumping information was provided by the owner, occupant, or Board of Health. 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 pan of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. IL _ The fac:li-, or dwelling �. as inspected for signs of sewage back-up. _ The system does not receive non-sanitary or industrial waste flow. The site \,+as inspected for signs of breakout. All systerr components, excluding the Soil .Absorption System, have been located on the site. `o The septic tank rnanhoies were uncovered, opened. and the interior of the septic tank was inspected for condition of baffies or tees, matera! o' construction, dimensions, depth of liquid, depth of sludge, depth of scum. —The size and location of the Soil Absorption Svstem on the site has been determined based on: The facilm o%%ne, iano occupants. if difieren: from owner were provided with information on the proper maintenance of Sub-Suriace Disposal Svstem. Existing information. Ex. Plan at B.O.H. _ Determined in the field of an, of the failure criteria related to Pan C is at issue, approximation of distance is unacceptabie [I5.302.3t;b!? (revised 04/25/97) Page 4 of 10 t i J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Propem Address:,3� lee4,--- v C/t 2Owner /f Date of nspeciiotnt:'� FLOW CONDITIONS RESIDENTIAL- Design flow" �-9 P.d.. 'room for S.A.S Number of bedrooms. Number o`current residents_Q - Garbage g•. der (yes or no�: K)n Laundry co-•^ected to system (yes or no) S Seasonal use tyes or no:_:jo Water meter readings, if available (last two i2i year usage (gpd): K34D t haz Ingo.iu �ac�ao �a� �- Sump Pump (ves or no):_& Last date o`occupancv 7�VNT%., QV_16v V0 COMMERCI AUINDUSTRIAL: Type of establishment. Design fio�% ¢alions/da\ Grease trap present. ryes or no'_ Industrial Taste Holding Tani; present. Ives or no 'ion-sanitan waste dscnarged to the T!tie 5 system: ,ves or no_ 1Nater meter readings, if availabie Last date o: o c;:Panc. OTHER: Describe Last date of occuoanc. GENERAL INFORMATION PUMPING RECORDS and source of information. NIA . System pumped as par, of inspection. (ves or no._ If yes, volume pumped gallons Reason for pumping TYPE OF SYSTEM Septic tankfdistri�uuon box/soil absorption system Single cesspool ip" Overflow cesspool Pro.), Shared system (yes or no) (if yes, attach previous inspection records, if any) I/A Technology etc. Copy of up to date contract? Other PROXIMATE AGE of all components, date installed (if known) and source of information: JI;Uou S,-S iz LS y Q-Q fit.+ &j5-01,C cw q N'► . Sewage odors detected when arriving at the site. (yes or no) NO (revised 04/25/97) Page S of 10 L _ i r SUBSURFACE SEVVAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner:2spection j ' � Date of 0 E BUILDING SEWER: (Locate on site plan) Depth below grade: Material of construction: _cast iron _40 PVC _other (explain) Distance from private water supply well or suction li-t Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK: N� (locate on site plan Depth below grade material of construction: _concrete _meta' _Fiberglass _Polyethylene _ethertexplaiw If tank is metal, list age — Is age confirmed b\ Cen;ficate of Compliance _(Yes..No Dimensions Sludge depth Disiance from top o: sludge to bottom of outlet tee or ba^:e Scum thickness: Distance from top of scum to top of outlet tee or bade Distance from bottom of scum to bottom of outlet tee or bare. How dimensions were determined Comments: (recommendation for pumping, condition or inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) GREASE TRAP: (locate on site plan) Depth below grade: 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: 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.) (revised 04/25:9-,) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) . � m � Prope Address: ' ON ner:�P Date of spection: TIGHT OR HOLDING `TANK: 11)() Tank must be pumped prior to, or at time, of inspection) (locate on site plan; Depth below grade: Material of construction. _concrete _metal _Fiberglass _Polyethylene —other(explain) Dimensions: Capacm: galions Design flow. gahons,da� Alarm level Alarm in „orking order_ Yes: _ No Date of previous pumping Comments (condition of inlet tee. condition, of alarm and float switches, etc.) DISTRIBUTION BOX:�t� (locate on site pian Depth of liquid leve! aoo,e outie: ime Comments mote if level and distribution is eoua', evidence of solids carryover, evidence of leakage into or out of box, etc.) PUMP CHAMBER: lVf� (locate on site plan. Pumps in working order: (Yes or No` Alarms in working order (Yes or No, Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 04/25/97) page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION N F FORMATION (continued) Property Address: Owner: Date of>ection:O SOIL ABSORPTION SYSTEM (SAS):__ (locate on site plan, if possible, exca�at(on not required, but may be approximated by non-intrusive methods( If not determined to be present, explain: Type: ...... . leaching pits, number. leaching chambers, number: leaching galleries, number: leaching trenches, number,iength: leaching fields, number, dimensions. overflow cesspool, number Alternative system Name of Technology: Comments: . (note condition of soil, signs of hydraulic failure, level of ponding,, con on of vegetation, et4) , 1-4 ��. 2%k 0R*,Cat.ON- �L�.C-aC�uT Pt�T�vti C. Z fv y�i��.a.1�S •..�Q G11[r v Imo. �l� �� A5!>+ —1:ihe CESSPOOLS: ca(lote on site an Number and coniigura:�Cn, Depth-top of liquid to inlet Inver, Depth of solids layer h ft Depth of scum layer. 23" Dimensions of cesspool Materials of construction ce y—jot - Indication of groundwater w�i inflow tcesspool must be pumped as par, of inspection} Ih(% Comments: (note condition of soil, signs of hydraulic failure, level of ponding, conditi n cqf ve�etati , r �t PRIVY: (locate o 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.) (revised 04/25/97) .�r 47 Page 8 of 10 M SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C �/fSYSTTEEM INFORMATION (continued) Property Address:.] �(�(. P - ice Owner. � Date of I elcton: C5 .51 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reierences landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) - 3z Y '� U v9.� C.c.a�,JZv.•�•� j� i (revised 04!25/57) page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property 2p!ction: ress: " �Q.��--c� v( �' �y�t w u-� Owner: /�„_� ,/ Date of Iu w u ep;w//cl 73 Depth to Groundwater _IOFeet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of Site (Abutting property(obsenat�on ho , basement sump etc.) Determine it from local conditions Cnec'K with local Board o• neaith Checi FE.1,AA Maps Check pumping records Check local excavators. installers lase L SGS Daza r• Describe in vour.ow.n %%oros no%% you established the High Groundwater Elevation. (Must be completed; A t(L i �.T tAT r lzsv-,med 04,25 19'. Page 10 of 10 TOWN OF BARNSTABLE t/ PqTION \l c..� '�. SEWAGE # ?- S ASSESSOR'S MAP & LOT ` IN'IN,�ALI,ER'S NAME&PHONE SEPTIC TANK CAPACITY K Ou e o E LEACHING FACIL=: type( ) V\,���� (size) qV 7eII tc NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: _T� � "1 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 �' -�'� �. . �.� Z.�,, ,; . ,�=� �� . � ��.�. �� 6�' �� c ' _ � t„ �, �. �-; \!\\\�'' ty J�/ �\``� .^� I, � � .. �.- �. v y! .. � .� No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIpphration for �Dtgaal *pgtem Con5trurtion i3ermit Application for a Permit to Construct( )Repair(�i)Upgrade( )Abandon( ) Complete System ❑Individual Components Location Address or Lot No. '3 D-Y c v.oNt A-b\ V-00-10 Owner's Name,Address and Tel.No. Assessor's Map/Parcel y�l�j Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ?.,C> bcx.%c� Type of Building: r Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) ' Other Type of Building o.of Persons Showers( ) Cafeteria( ) Other Fixtures �o Design Flow y gallons per day. Calculated daily flow S-1.13-0 gallons. Plan Date Number of sheets Revision Date Title j6C Size of Septic Tank Type of S.A.S. Description of Soil i Nature of Repairs or Alterations(Answer when applicable) ':t=fn�n4 G"Cd-D 0il• ram. r' Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code nd not to place the system in operation until a Certifi- cate of Compliance has been issue o C� M�' Signed Date isL 717 Application Approved by Date Application Disapproved for a fol ing reasons r\ Permit No. 7 ���/ Issued No. Y 17' Fee i THE COMMONWEALTH OF MASSACHUSETTS Entered in compute��r: es PUBLIC HEALTH--DIVISION -TOWN—OF BARNSTABLE., MASSACHUSETTS Yes r 0pprication for'Mi*.ga1-* `otgm ConotrA ton permit Application for a Permil,to Construct( )Repair(V1`Upgrade( � )Abandon( ) Complete System El Individual Components ' Location Address or Lot No. 3 a._y c v Moth 12t*0 Owner's Name,Address and Tel.No. Assessor's Map/Parcel In � �1't ' Sy VAO '-i #' Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Z�p.,e of Building: y. Dwelling No.of Bedrooms j Lot Size sq.ft. Garbage Grinder( ) Other Type of Building a o.of Persons Showers( ) Cafeteria Other Fixtures Design Flow gallons per day. Calculated daily flow as gallons. Plan Date Number of sheets , <.Revision Date Title Size of Septic Tank PS) !�t4 '`Type of S.A.S. L?9r4ck,> — vYv.. n Description"of Soil 1 �J Nature of Repairs or Alterations(Answer when applicable �1?0 r'V-x y 1 X Date last inspected: Agreement:The undersigned agrees to ensure the,construction and maintenance of the afore described�°on-site sewage disposal syste,m ' in accordance with the provisions of Title of the Environmentat'Code nd not to place thef system in operation until a Certifi r -�cate of Compliance has been�issue '. d of h: „f _ Signed ��?. W�t Ga Date ' f ; Application Approved by � Tn ,�.___ .. '. Date & Application Disapproved' e- ing reasons, Permit No. Date Issued -- ————E — THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS t Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( pgraded( ), Abandoned( by at o c� r It, has been constructed in.,accordance with the provisions of de 5 and the for Disposal System Construction Permit No. �~� dated Installer �(Y�`�""k" 't-ln :C- Designer The issuance of this permit shall not be construed as a guarantee that the system will functio i as designed. Date e~L - Gl � Inspector �! 1 CJl.4 ` --� --------------.--.----------- -- No. -"i Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION — BARNSTABLE., MASSACHUSETTS Ztopogal *pgtem ongtruction Permit -� Permission is hereby granted to Construct( )Repair( Upgra e( )Abandon( ) System located at 2 a J and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date: / Q f 7 Approved by NOTICE: This Form is (o I)c Itsetl for file Repair of Failed • • •�'r Septic Systems Only CI?It'I'IFICA•I'ION OF SKETCH AND APPLICATION FUR A DISPOSAL 1YUli',I�S (;UNS'!-IZU(;'I IUN I'I;li'.11]Il' 11Y1'1'IIUU'1' UESIGNEU PLAN hereby certify that the application for disposal works construction permit signed by me dated concerning the property located at w� �/���"`� / -s, meets all of the following criteria: t/• There are no wetlands within Soo feet of the proposed septic system +i• Thcrc are no private was within 1 So feel of the proposed septic system ✓. The observed groundwater table is 14 feet or greater below the bottom of the leaching facility Thcrc is no increase in now and/or change in use proposed ✓• There are no variances requested or needed. SIGNED: DATE: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER Allach a sketch plan of the proposed system. Also if the licensed Installer posesses a certified plot plan, this plan should be submittcdl. e e I ___ - --- � - -- - -J TOWN OF BARNSTABLE j LOCATION V c..�Mn h+. J SEWAGE# ,`.•..,:.• .VII. AS SESSOR'S S MAP LOT: �; INSTALIR'S NAME&PHONE N0. SEPTIC I'TANK CAPACITY TS Ol7 � �LEACHINO FACILITY: (type) �7h:Tj (size)) yVK11112' NO.OP h>rDROOMS i � BUILDER,QR OWNER . 1��Trr'�i Iiye� i i PERMITDATE:T� n .�J COMPLIANCE DATE: 1 ,2 .. Separation Mistance Between the: Maximi. Adjusted Groundwater'Table.and Bottom of Leaching Facility.. Feet j Private:Water Supply Well and Leaching Facility (If an wells exist Y . on site nor within 200 feet of leaching facility) Feet Edge of; itland and Leaching Facility(If any wetlands exist ' within 300 feet of leaching facility) Feet j Furnished ky . - - I 17) 015 06 t O . l 'eA•T-10N SEWAGE PERMIT NO. AW 3 .�. VILLAGE INeTLLER'S NAME i ADDRESS gel &�& t OR OWN ER DATE Pit RMIT ISSUED DATE COMPLIANCE ISSUED _( --� 3 l;• ti /^T ��G,� '� (� y ,•1n�► a .+ 1.r �I ' �. J a �� 4 � , w �iL�. '`* �r No..............._..... Fps............. ............... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ...----- -- ............ .............OF...................................... ------------------------------------....._........ App iru#ion for Bigpviia1 Warks Tiantitrurtiutt Prrutit Application is hereby made for a Per it to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: - - ----- • .... ..... .......................... ..•--------------•..............••-••-----------------•••----------------....................----- catio Addre or Lot No. ...... .......... . .........�-...............••••.. ----•-----------......-••-----•---•..................--------••--------........................... Owner Address a --------•-•-•----- . .................................................... ...........•-•-••............-- --••••••••••------•-------••••............. Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building ............... No. of persons....._.._._.............____ Showers — Cafeteria Q' Other fixtures .................................. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width--_----------- Diameter---------------- Depth................ x Disposal Trench—No..................... Width..........._........ Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit-------------------. Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ------------------------------------------••------•----------------------------..........---••-•----......................................................... C) Description of Soil......G'/ti...... x W -- --- --- --- UNature of Repairs or Alterations—Answer when applicable_______________ ________________ __________ I....� ... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT1E 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by tl board of h g .'C. ---- ------ --------------------- ---- - Application Approved By. __.. ,__. Date Application Disappro f or he following reasons:.............................................................................................................. -------------•••••.....•--•--•••-••----•-----•----•-•---••-••---•---••-•.....•---•-.....••-•••-----•----•••----•----•--••••-•-••--••--•••--•----•--------------•--•--••--•-----•----------••---••---•--- Date PermitNo.......................................................... Issued....................................................... Date t.-2,N� ......... .................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...................."..........--.---......O F..........--.................--........-----------.......--...._........._-......._....... Appliration for Uiiposal orkg Tongtrn.rtion rrmit Application is hereby made for a Per it to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ation ddres or Lot No. Owner Address W -------------- ......... a ._... Installer Address Type of Building Size Lot............................Sq. feet �.. Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) WOther—Type of Building ............................ No. of persons............................ Showers ( } — Cafeteria ( ) Otherfixtures .........--•----•-------•-••-•-------------•-•----•-•--•--•-••--........--•••-......--- ............................................................. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter._.____-.____-_• Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ ,.� Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -------••-------------------------------------•------------........------...._.......---------_...._......................................................... 0 Description of Soil-........................................•--•-•-------•-•--------------•--••------------------------------------------------------------------•------•-•---•-- - W -------------------------------------------------------------------------------------------••-••-•• --•••-- 4� --• --•...... U Nature of Repairs or Alterations—Answer when applicable. .` -•-----••--------------------------------------------------------------------------••---._..........----•-------•---------------•-•---•-•-----••...••----•••••------•---••---••----••-•---...--•--••---. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary.Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of he lth. `igned............ --- ...... ......................... ------ Application ApprovedZBy... --•-•%� -------------------------•-•--------------------------...----•-- ----__.Y E `..--. .-- Date Application Disappro following reasons--------------------------------------------------------•------------------------••--•-----. -----••....---•••-- -•-•-•-•------•------------------•---•--......---------------•--------------•-•----------....------•....... Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Vr if iratr of f�ompliiinrr f T - �� LFy, a't the'1ndiv. al S f ge Disposal System constructed ( ) or Repaired ( by......... -----------------------------------------------------------------------------•---•--...•-- - >ac s alle at :C'- ------ -- ---------- -------------------------------------------------------------------- -- ------------f The State Sanitary Code a de- in the has been installed idance with the rovisions of TI L� 5P 'application for Dislorks Construction Permit No-----„ .:": .................... dated_.-._._ .-�......� ._.._......._._._._.... THE ISSUANCE OF THIS`.CERTIFICATE SHALL NOT BE CONSTRUE® S A GUARANTEE THAT THE SYSTEM WIL FUN. 2ON SATISFACTORY. DATE.---- �L? ....-•-•...............•-•--------••-•----..._.. Inspector.- ------•--..•.....------------..........---•------••--•---•----•---•--. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 2 ...................OF..................................................................................... No. .............: . . FEE........................ i nto rrkii TAiitrnrtion an it Permission is hereby granted... ---------------------------------- •---------------------- •............ ............ to Construct ( ) or Re r ( div ual ewage Disposal System atNo..........3- ..41....... -- ----...-•---......-------------------------------...------------------....--- ' Street g as shown on the application for Disposal Works Construction Permit No.................... D"" `--.•••- �- s7 p •- Boayfl of Health C% OG FORM 1255 HOBBS & WARREN. INC., PUBLISHERS _ _ _ � - - _ _ �,y� - - - -- ���;v d" ��- - - 1�-� '� `� - _. i�G - - --- - _ - - - _ _ - - I � � r � i ; i i r � ► { j { I { � 1 I i 4 I i { f { I , a I I I ! It • — _ _ EXISTING S.A.S. (3) NEW- LOCUS DATA o � o N/F ABANDONEDITLER5�� LEACHING TRENCHES 0 w "'s ��1` PINE NEW 40 MIL \ �' wI ' w _ HARBOR POLY LINER _ —36 Of CURRENT OWNER SEW REALTY TRUST Q \ 3 OFF S.A.S. WAYNE SULLIVAN 2 a s 66'51'36" E 100.00' 36.6 I— o G --� G�✓ \ 2.0 PLAN REFERENCE NO RECORD PLAN O• o' o I 1 G \ 2 p' DEED REFERENCE w 23775-102 1 I 20.6' � to HYDRANT ` ;, 5 2 4 _ 3 ZONING DISTRICT B 8.0' o.0 3.0' >_ \ 7.8' X FLOOD ZONE "X" I o* el or 36.3 ? .3' ASSESSORS MAP 344 J D.T.H.. #1 B J / X o PARCEL 019 I Q I O o 6• OVERLAY DISTRICT ZONE II / WP o N to ,\ i\ i X 3 LOT AREA 5,011 t S.F. \ ' EXISTING �o \ '� M D.T.H. #2 2 STORY 36\ _ \4.8' .o 5 BEDROOM co SITE & SEWAGE DWELLING 22 ASBUILT REPAIR PLAN -°"P OHP\ \� 1 / z ED E OF LEACH #J22 PAVEMENT OBS PIT \ 4 \ d. YARMOUTH ROAD (TYP) I \ A 5 CESSPOOL IN 10.8, 6.3' 6 HYANNIS, MASS \�� � 194' t71 EDGE OF PAV MEME EN 2. DATE: JANUARY 15, 2018 1 0 7 0 ` 2•9 CHICKEN COOP 2018 \ ON STILTS REV: MARCH 26, II PARCEL 19 REV: DECEMBER 10, 2018 5,011f S.F. RELOCATED W gg.00 BENCHMARK ON SITE OWNER/APPLICANT: 1 SURVEY \ N 77'0437 OF is , SURVEY MARK / EXISTING 1,500 ELEV=35.37 SEW REALTY TRUST MARK �\ ���' S.T. REMAINS {\ � EDWARD WAYN E SULLIVAN TR. EXISTING PRECAST LEACHING PIT, A — _ 18-0100 P. O. BOX 3036 \� D-BOX AND CESSPOOL PUMPED, s �� To E �3 CRUSHED AND REMOVED FROM SITE .28 80 NEW BERN , NC. 28564 N ACCORDANCE WITH TITLE 5. tc � � TIE DATA SHEET 1 OF 3 �� ` - A B PREPARED BY: � � C �� IN TANK-1 20.4 26.0 \ ti ` \' y OUT TANK-2 25.7' 21.2' E A S SURVEY, INC. 0 10 15 20 \ / D-BOX-3 40.0' 20.8' P. O. BOX 1729 OBS-4 18.8 SANDWICH , MA 02563 GRAPHIC SCALE: N F f OBS-5 15.2' 28.0' CELL (508 527-3600 1 INCH = 10 FEET HYANNIS } �\ ��� J OBS-6 24.4' 33.8' WATER CO. EAS.SURVEY@YAHOO.COM �� �� AS-BUILT SYSTEM PROFILE SYSTEM DESIGN OBSERVATION PORT(S) RAISED TO WITHIN 3" TCF = 37.92 RIM RIM OF FINISH GRADE DESIGN FLOW ELEV. 36.17 ELEV. 36.17 FINISH GRADE `• / MAGNETIC TAPE FINISH GRADE 5 BEDROOMS AT 1 GPB/0 512 GPD ::•/ � ELEV. 36.3 �7 ELEV. 36.2 o //C�� /� .02 //,� REQUIRED SEPTIC TANK TOP .! /�� �///ate �l�/ �� ��//��/•�� /��///ate / � 1' MIN.-3' MAX. COVER 550 x_2 = 1.1 00 GAL. A. 4" PVC SCH 40 15'®S=0.03 TOP ELEV�33.30 SEPTIC -- ----- 4" PVC SCH 40 16'®S=0.025 FILTER CLOTH SEPTIC TANK PROVIDED = _1500 _GAL. •EXISTING INV.= 2 MIN-MAX NEW �,• INV. REMAINS INV.= K O O O O 37'®5=0.005 O O O O o 40 MIL POLY LINER SIZE OF LEACHING FACILITY REQUIRED 31.3 34.00 10"TEE 14"TEE p p p O p O p O p 0 00 p 0 0 0 0 0 O O O O� EXIST. 33.74 6"nDB6 00000000000000000 0000 N TOP = 33.0 5'-7" EXIST. . BOTTOM 30.0 DESIGN PERC RATE <2MIN./INCH GAS BAFFLE 6 4'-6 1/ �j (3)�3'x2'x2'x37' LEACHING TRENCHES LONG TERM APPL. RATE-9•74_GPD/S.F. 2 4'-1" LIQUID LEVEL H- V 32.53 INV. `� INV.=32.73 0 w SIZE OF LEACHING SYSTEM PROVIDED: DATUM: L cr IN V 30.53 0 0 0 o C o FILTER 00 0 550 - 0.74 SF/GPD = ._11A S.F. MIN. REQ. VERTICAL DATUM: EXISTING 1,500 GALLON CLOTH 23.7 USING (3) 3' WIDE, 2' HIGH, 37' LONG MSLt / BARNSTABLE GIS. SEPTIC TANK T 00 00 00 00 0 BENCH MARK USED: 000000000 3/4" - 1 1 2" LEACHING TRENCHES 2.0' 000000000 SURVEY MARKER 000000000 DOUBLE WASHED 2'+2'+3' x 37' = 259 S.F. ELEVATION 35.37 CONSTRUCTION NOTES: l000000000 STONE 259 S.F. x 3 TRENCHES = 777 S.F. 18-0100 3.0' 1. CONTRACTORS / INSTALLERS SHALL VERIFY GRADES AND 777 G/SF 575 GPD SITE 8c SEWAGE ELEVATIONS AND SITE CONDITIONS PRIOR TO COMMENCING SIDE VIEW 575 GPPDD PROV OV > 550 GPD REQ. = 25 GPD RES. WORK ON THE SITE. NO (GARBAGE DISPOSAL / GRINDER ALLOWED) 2. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE A S B U I L T/REPAIR PLAN WITH DEEDED OR ZONING REGULATIONS. OWNER / APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. P 1 5536 #J22 3. VEHICULAR TRAFFIC, PARKING OF VEHICLES AND PLACING MATERIALS OVER THE SEPTIC TANK, DISTRIBUTION BOX AND D.T.H. #1 ib D.T.H. #2 ib YARMOUTH ROAD S.A.S. AREA IS PROHIBITED DEPARIFY TMENTAOFI AM CURRENTLY APPROVED ENVIRONMENTAL PROTECTIONBTOTHE DATE: 12/14/17 DATE: 12/14/17 GROUND ELEV• 34.7 GROUND ELEV. 34.2 GENERAL NOTES: CONDUCT SOIL EVALUATIONS AND THAT THE RESULTS NO GROUNDWATER NO GROUNDWATER IN 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. OF MY SOIL EVALUATION ARE ACCURATE AND IN TITLE V AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS . ACCORD WI A31OMR�F.1 THROUGH 15.107. A A HYANNIS, MASSFOR SUBSURFACE DISPOSAL OF SEWERAGE. LOAMY SAND LOAMY SAND 2. AT LEAST ONE ACCESS POINT OVER TANK TEES SHALL BE _ 10YR 4 3 10YR 4/3 DATE: JANUARY 15, 2018 ACCESSIBLE WITHIN 3" OF FINISH GRADE, WITH ANY REMAINING _ / 6" 4" REV: MARCH 26, 2018 ACCESS PORTS BROUGHT TO WITHIN 12" OF FINISH GRADE. EDWARD A. STONE, CERTIFIED SOIL EVALUATOR B B 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE LOAMY SAND LOAMY SAND REV: DECEMBER 10, 2018 CAPABLE OF WITHSTANDING H-10 LOADING UNLESS 7.5YR 5/6 7.5YR 5/6 OTHERWISE SPECIFIED. '11 „ OWNER/APPLICANT: 4. THE EXCAVATION CONTRACTOR SHALL VERIFY THE LOCATION 1� TMOF EL. = 33.2 18 EL. = 32.9 16" OF ALL UTILITIES PRIOR TO ANY EXCAVATION. INDICATES DEEP SEW REALTY TRUST 5. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE DA TH #1 TEST HOLE OR WITHIN 6" OF GRADE SHALL BE MORTARED IN PLACE. chi F H ,J C-1 48" C-1 WA YN E SULLIVAN TR. 6. FINISH GRADE SHALL HAVE A MINIMUM OF 0.02 FEET PER o. 1 11 COARSE SAND COARSE SAND FOOT OVER THE S.A.S. AND DISTRIBUTION BOX. INDICATES P.O. BOX 3036 7. SEPTIC TANK SANITARY TEE'S SHALL BE CONSTRUCTED OF P-1 48" PERC TEST 11O GRAVEL 110 GRAVEL SCHEDULE 40 PVC AND SHALL EXTEND A MINIMUM OF 6" ABOVE TE 10YR 5/6 84„ 10YR 5/6 86" NEW B E R N, NC. 28564 THE FLOW LINE AND SHALL BE ON THE CENTERLINE AND SArwrnR�PN NO MOTTLING C-2 C-2 LOCATED DIRECTLY UNDER THE CLEAN OUT MANHOLES. i NO WEEPING MED. SAND MED. SAND SHEET 2 OF 3 8. THE INLET PIPE INVERT ELEVATION SHALL BE NO LESS THAN j Iz �0 �0 2.5Y 7/4 2.5Y 7/4 2 INCHES NOR MORE THAN 3 INCHES ABOVE THE INVERT 126" INDICATES ADJ. GROUNDWATER ELEVATION OF THE OUTLET PIPE. t NO G.WATER NO G.WATER PREPARED BY: 9. THE SEPTIC TANK SHALL HAVE A MINIMUM COVER OF 9 INCHES NO OBS. GROUNDWATER EL. = 24.7 120" EL. = 23.7 126" 10. THE OUTLET SANITARY TEE SHALL BE EQUIPPED WITH A GAS 1 E A S SURVEY INC. BAFFLE, 4 INCHES IN DIAMETER AND CONSTRUCTED OF 4" PVC B.O.H. 11. ALL PIPES SHALL BE SCHEDULE 40 PVC SEWER PIPE AND NO OBSERVED GROUNDWATER DON DESMARAIS P. O. B O\/ 2 9 SHALL BE SLOPED 1/4 INCH PER FOOT MIN. EXCEPT FOR THE DEPTH TO BOTTOM OF HOLE 10.5' SOILED VALUATO STONE R /� FIRST TWO FEET OUT OF THE DISTRIBUTION BOX WHICH SHALL SANDWICH M A 02563 BE LEVEL ( VARIANCES APPROVED BACKHOE OPERATOR. 12. CHANGES OR REVISIONS TO SEPTIC DESIGN REQUIRE NOTIFICATION ELLIS BROTHERS TO EAS SURVEY INC. FOR B.O.H. AND DESIGN ENGINEERS REVIEW �I SEE PAGE 3 SOIL TYPE: -_ CELL (508) 527-3600 AND APPROVAL. PERC RATE: <5 MIN. PER INCH ASSUMED EAS.SURVEY©YAHOO.COM 13. MAGNETIC TAPE ON ALL COMPONENTS. i LOADING RATE: 0.74 GAL/SF/MIN I; . i a 0 VARIANCES APPROVED �oQ J m � a 310CMR: 15.405 o LOCUS�oJ I a a TO ALLOW THE LEACHING TRENCHES TO BE 5.2 FROM THE EXISTING FOUNDATION I x N m r IN LIEU OF 20'. A 15' VARIANCE IS REQUESTED. EAVE EAVE a 0 op O `o 31OCMR: 15.405 BEDROOM#4 Q > TO ALLOW THE LEACHING TRENCHES TO BE 2' FROM THE SIDE PROPERTY LINE 11.5'x15' o 0 IN LIEU OF 10'. AN 8' VARIANCE IS REQUESTED. 28 310CMR: 15.405 HALL BEDROOM#3 TO ALLOW THE LEACHING TRENCHES TO BE 4.5' FROM THE REAR LOT LINE IBEDROOM#5 11.5'x11.5' LOCUS MAP 17'x19' NOT TO SCALE: IN LIEU OF 10'. A 5.5' VARIANCE IS REQUESTED. SITE RESTRICTION BATH THE LOCUS PROPERTY IS LIMITED TO A MAXIMUM OF 5 BEDROOMS ON AN EAVE ROOM EAVE ON-SITE SEPTIC SYSTEM. 5'x12' 18-0100 OF SITE & SEWAGE THE DESIGNER (REGISTERED EDWARD A S B U I LT/REPAIR PLAN SANITARIAN) SHALL SUPERVISE THE A CONSTRUCTION OF THE ONSITE S NE H ) #32'2' SEWAGE DISPOSAL SYSTEM AND SHALL No 898000 CERTIFY IN WRITING TO THE BOARD OF YARMOU TH ROAD HEALTH THAT THE SYSTEM WAS INSTALLED IN SUBSTANTIAL �. IN COMPLIANCE WITH THE REVISED PLANS. 2 HYANNIS, MASS DATE: JANUARY 15, 2018 REV: MARCH 26, 2018 I HEREBY CERTIFY THAT THIS SEPTIC BEDROOM#1 BEDROOM#2 REV: DECEMBER 10, 2018 SYSTEM HAS BEEN INSTALLED IN LIVING 11'x11.5' 11.5'x12' ROOM OWNER APPLICANT: ACCORDANCE WITH THE PLANS 13.5 APPROVED BY THE BARNSTABLE x15 SEW REALTY TRUST BOARD OF HEALTH AND REVISED WAY N E SULLIVAN TR. MARCH 26, 2018. BATH P.O. BOX 3036 I ROOM 8.x9. NEW BERN, NC. 28564 OF D A DINING KITCHEN SHEET 3 OF 3 FLAHERTY,JR. ( ROOM 10.5'x11.5' No. 1211 } 11.5'x13.5' PREPARED BY: N/STE EAS SURVEY, INC. SAN�TAR�PN 0 10 15 20 P. O. BOX 1729 C SANDWICH , MA 02563 - ----- --=----- - �2�0 �� j GRAPHIC SCALE: DAVID D. FLAHERTY,JR. R DA E i 1 INCH = 10 FEET CELL (508) 527-3600 EAS.SURVEY©YAHOO.COM 1