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HomeMy WebLinkAbout0074 MELBOURNE ROAD - Health 4 MELBOURNE RD, HYANNIS A=268-231 o v 0,F THE A �BARNSrABLE, Town of Barnstable i639. �0 rFv►��°i Regulatory Services Barnstable Thomas F. Geiler, Director ;mericaCity Public Health Division Thomas McKean,Director zinc» 200 Main Street Hyannis, MA 02601 .Office: 508-862-4644 Fax: 508-790-6304 August 17, 2010 T o whom it may concern: Based on the Title V inspection reports of Douglas A Brown and Peter McEntee along with my own observations, the septic system located at 74 Melbourne Rd., Hyannis PASSES. I found no evidence to support the inspection report done on 6/24/2010. Feel free to contact me if there are any other questions. Donald Desmarais, R.S. of ASH MgSS Health Inspector J a -�q�y� Town of Barnstable ON D v DE MA AIS _J. � \P n/STFRED SPN��P� i Q:\Show Cause\Comfort inn drowning.doc Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 MELBOURNE RD Property Address Owner Owners Name information is required for HYANNIS , MA 02601 8/14/10 every page. City/Town State Zip Code Date:of Inspection Inspection results.must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. When filling A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your PETER McENTEE cursor-do not use the return Name of Inspector key. ENGINEERING WORKS Company Name 12 WEST CROSSFIELD RD Company Address F ALE MA 02644 City/Towny[Town State Zip Code 508-477-5313 ,A, acs Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 16.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 8/14/10 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 1 of 17 i raft_ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 MELBOURNE RD Property Address Owner Owner's Name information is required for HYANNIS MA 02601 8/14/10 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: I OBSERVED THE STONE EXCAVATED FROM THE S.A.S AND THE SOIL AUGERED FROM THE BOTTOM OF THE LEACHING CHAMBERS AND FOUND NO SIGNS OF HYDRAULIC FAILURE, THE STONE WAS CLEAN AND THE SOIL WAS CLEAN SAND WITH TH EXCEPTION OF THE BIOLOGICAL MAT AT THE BOTTOM B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 J Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments •'` 74 MELBOURNE RD Property Address Owner Owner's Name information is HYANNIS required for MA 02601 8/14/10 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•(KJlOS Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 74 MELBOURNE RD Property Address Owner Owners Name information is HYANNIS required for MA 02601 8/14/10 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: '* This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than%day flow t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 't 74 MELBOURNE RD Property Address Owner Owner's Name information is HYANNIS required for MA 02601 8/14/10 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments t 74 MELBOURNE RD Property Address Owner Owner's Name information is HYANNIS required for MA 02601 8/14/10 every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(if they were not available note as N/A ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ❑ ® Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 t5ins-09108 Title 5 Officiaf Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 MELBOURNE RD Property Address Owner Owners Name information is HYANNIS required for MA 02601 8114/10 every page. Cityfrown State ZipCode Date of Inspection D. System Information Description: ACCORDING TO AS-BUILT CARD SYSTEM CONSISTS OF A 1000 GALLON SEPTIC TANK D- BOX AND 2 500 GALLON CHAMBERS WITH STONE Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage(gpd)): 08-263/09-12 Detail 2008-96000 2009-4500 Sump pump? ❑ Yes ® No Last date of occupancy: UNKNOWN Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y� 74 MELBOURNE RD Property Address Owner Owner's Name information is HYANNIS required for MA 02601 8/14/10 every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Last date of occupancy/use: 2009 Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was,quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•09= Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 MELBOURNE RD Property Address Owner Owner's Name information is HYANNIS required for MA 02601 8/14/10 every page. Cltyfrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: S.A.S INSTALLED AUG OF 2001 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: .75 feet Material of construction: Z.concrete ❑ metal ❑fiberglass ❑ polyethylene y El other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 GALLON OFF AS-BUILT Sludge depth: VARYING t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r` 74 MELBOURNE RD Property Address Owner Owner's Name information is HYANNIS re uired for MA 02601 8/14/10 every page. CityTrown State Zip Code Date of Inspection D. System Information (cunt.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): TANK COULD USE PUMPING AT THIS TIME Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 74 MELBOURNE RD Property Address Owner Owner's Name information is required for HYANNIS MA 02601 8/14/10 every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: , ❑concrete ❑ metal ❑fiberglass ❑ polyethylene El other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•09/68 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments �( 74 MELBOURNE RD Property Address Owner Owners Name information is HYANNIS required for MA 02601 8/14/10 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cunt.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): BOX LEVEL NO LEAKAGE APPEARS TO BE H-20 SOME CORROSION ON TOP EDGE SPEED LEVELS IN PLACE Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 74 MELBOURNE RD Property Address Owner Owner's Name information is HYANNIS required for MA 02601 every page. City/Town 14/10 State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 2 ❑ 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.): CHAMBERS DRY AT THIS TIME OBSERVED EXCAVATED STONE FROM S.A.S NO EVIDENCE OF FAILURE OBSERVED SAND FROM BOTTOM OF CHAMBERS ALSO NO SIGNS OF FAILURE 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 i Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments '~ 74 MELBOURNE RD Property Address Owner Owner's Name information is HYAN N IS required for MA 02601 8/14/10 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 MELBOURNE RD Property Address Owner Owner's Name information is HYANNIS required for MA 02601 8/14/10 every page. Ctty/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 74 MELBOURNE RD Property Address Owner Owner's Name information is HYANNIS required for MA 02601 8/14/10 every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: GREATER THAN 5 FT 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: SEPTIC#2001407 TEST HOLE DONE PRIOR TO INSTALL Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 MELBOURNE RD Property Address Owner Owner's Name information is HYANNIS required for MA 02601 8/14/10 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D;or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 New Page 1 Page 1 of 1 TOWN OF BARNSTA13LE /OCATION �G!/`/ /� ZOO. Y �/I 1 SEWAGE VILLAGE_ /SSW 4els ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. �/'T�Ld�`IGm��T. ?7/,¢-7ff SEPTIC TANK CAPACITY AMe y�.tlg7`ig4 LEACHING FACIL-rry: (type) 'raw 4d1/4it (size) JU'-'rd-G NO.OF BEDROOMS__ BUILDER OR OWNER JTe , ,a ° PER2vIITDATE: �I ZIIP/ .,_.COMPLIANCE DATE: 01 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 . DeSK Z0 q://Www.town.bamstable.ma.us/assessing/2010/HMdisplay.asp?mappat=26823.1&seq=1 8/16/2010 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 74 MELBOURNE RD Property Address FEDERAL HOME LOAN MGMT Owner Owner's Name information is HYANNIS required for MA 02601 8/7/10 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out A, General Information forms on the computer,use 1. Inspector: only the tab key to move your DOUGLAS A BROWN cursor-do not Name of Inspector use the return key. DOUGLAS A BROWN INC "�—`I Company Name P.O. BOX 145 A At Company Address CENTERVILLE MA 02632 City/Town State Zip Code 508-400-7159 S14297 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority �. 8/7/10 Inspecto Ignatu Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•09iD8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 74 MELBOURNE RD Property Address FEDERAL HOME LOAN MGMT Owner Owner's Name information is HYANNIS required for MA 02601 8/7/10 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: I EXCAVATED INTO THE STONE AROUND THE 500 GALLON CHAMBERS AND FOUND CLEAN STONE WITH NO SIGNS OF HYDRAULIC FAILURE B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 years old"or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins•09M Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 74 MELBOURNE RD Property Address FEDERAL HOME LOAN MGMT Owner Owner's Name information is HYANNIS required for MA 02601 8/7/10 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ 'N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•09= Me 5 Offnel.Inspection.Foim-Subsurface.SewageDisposal System.•Pagalaf.17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 74 MELBOURNE RD Property Address FEDERAL HOME LOAN MGMT Owner Owner's Name information is HYANNIS required for MA 02601 8/7/10 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: "*This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or dogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or dogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6"below invert or available volume is less than Y2 day flow t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 74 MELBOURNE RD Properly Address FEDERAL HOME LOAN MGMT Owner Owner's Name information is required for HYANNIS MA 02601 8/7/10 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipes . Number of times pumped: O P P ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than,50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems,you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered'yes"to any question in Section E the system is considered a significant threat, or answered`yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. t5ms-09= Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 74 MELBOURNE RD Properly Address FEDERAL HOME LOAN MGMT Owner Owner's Name information is HYANNIS required for MA 02601 8/7/10 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ❑ ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 t5ins•09M Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 74 MELBOURNE RD Property Address FEDERAL HOME LOAN MGMT Owner Owner's Name information is HYANNIS required for MA 02601 8/7/10 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: ACCORDING TO DESIGN PLAN SYSTEM CONSISTS OF A 1000 GALLON SEPTIC TANK D-BOX AND 2 500 GALLON CHAMBERS Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ❑ No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ❑ No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): Detail: HOUSE VACANT n Q Sr)C? (Z ���Dey Sump pump? ❑ Yes ® No Last date of occupancy: 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: t5ins•09N8 Title 5 Official Inspection Form:Subsurface Selvage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 74 MELBOURNE RD Property Address FEDERAL HOME LOAN MGMT Owner Owner's Name information is HYANNIS required for MA 02601 8/7/10 every page. Cltyrrown State Zip Code Date of Inspection D. System Information (cunt.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system(yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•09/O8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r 74 MELBOURNE RD Property Address FEDERAL HOME LOAN MGMT Owner Owner's Name information is HYANNIS required for MA 02601 8/7/10 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed(if known)and source of information: S.A.S INSTALLED IN AUGUST OF 2001 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑cast iron ❑40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints,venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) 1000 GALLON If tank is metal, list age: • years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: t5ins•09)08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 74 MELBOURNE RD Property Address FEDERAL HOME LOAN MGMT Owner Owner's Name information is HYANNIS required for MA 02601 8/7/10 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): TANK LOOKS FINE AT THIS TIME Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•09108 Title 5 Official Insp ection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts 99Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 74 MELBOURNE RD Property Address FEDERAL HOME LOAN MGMT Owner Owner's Name information is HYANNIS required for MA 02601 8/7/10 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 74 MELBOURNE RD Property Address FEDERAL HOME LOAN MGMT Owner Owner's Name information is HYANNIS required for MA 02601 8/7/10 every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): BOX LEVEL NO LEAKAGE Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09A78 Title 5 Official Insp ection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ° 74 MELBOURNE RD Property Address FEDERAL HOME LOAN MGMT Owner Owner's Name information is HYANNIS required for MA 02601 8/7/10 every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Type: ❑ leaching pits number: ® leaching chambers number: 2 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology: Comments(note condition of soil,signs of-hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): I EXCAVATED INTO THE STONE AROUND THE CHAMBERS AND FOUND CLEAN STONE WITH NO SIGNS OF FAILURE CHAMBERS ARE DRY AT THIS TIME Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No 't5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 74 MELBOURNE RD Property Address FEDERAL HOME LOAN MGMT Owner Owner's Name information is HYANNIS required for MA 02601 8/7/10 every page. Cltyrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): t5ins•09iD8 Title 5 Official Insp ection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments J°r 74 MELBOURNE RD Property Address FEDERAL HOME LOAN MGMT Owner Owner's Name information is HYANNIS required for MA 02601 8/7/10 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins•09io8 Title 5 Otricial Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 'y< 74 MELBOURNE RD Property Address FEDERAL HOME LOAN MGMT Owner Owner's Name information is HYANNIS required for MA 02601 8/7/10 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: 5+ feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 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: OFF DESIGN PLANS Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09f08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 I� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '• 74 MELBOURNE RD Property Address FEDERAL HOME LOAN MGMT Owner Owner's Name inrmaton is HYANNIS requiredfor MA 02601 8/7/10 every page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-09A8 Title 5 Official Inspectbn Form:Subsurface Sewage Disposal System•Page 17 of 17 New Page 1 Page 1 of 1 TOWN OF BARNSTABLE r OCATION Y /�'d e ,(7®G!/'II� �Jl• SAGE `y7 VILLA /S��1LI n/lls ASSESSOR'S MAP&LOT �S,Z INSTALLER'S NAME&PHONE NO. SEP7IC TANK CAPACITY LEACHING FACEL'r Y: (type) fOB 4e'ajL {size) NO.OF BEDROOMS BUILDER OR OWNER f//Tt PE INIITDATE:- �i Z//�/ COMPLIANCE DATE:—_9' G — O/ 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 . ` !3 Af- fz .4- y ttp://www.town.bamstable.ma.us/assessing/2010/PIMdisplay.asp?mappar=268231&seq=1 8/12/2010 T l Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 74 Melbourne Rd. Property Address Owner of Record Owner Owner's Name information is Hyannis Ma. 02601 6/24/2010 required for y - every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out I forms on the computer, use 1. Inspector: only the tab key to move your Robert Paoliri cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC. Company Name t� P.O.Box 763 Company Address Centerville Ma. 02632 City/Town State Zip Code P (508)428-4028 S14454 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority a 6/24/2010 Ins ctor's Sig ure Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to.the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. LA� Df t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Q sposal Syste •Pa e 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 74 Melbourne Rd. Property Address Owner of Record Owner Owner's Name information is required for Hyannis Ma. 02601 6/24/2010 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will,pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M a 74 Melbourne Rd. Property Address Owner of Record Owner Owner's Name information is required for Hyannis Ma. 02601 6/24/2010 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cunt.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system-is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official .Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Melbourne Rd. Property Address Owner of Record Owner Owner's Name information is required for Hyannis Ma. 02601 6/24/2010 every page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method) used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ® ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow l5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 74 Melbourne Rd. Property Address Owner of Record Owner Owner's Name information is required for Hyannis Ma. 02601 6/24/2010 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply El the system is located in a nitrogen sensitive area (Interim Wellhead Protection ❑ Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 74 Melbourne Rd. Property Address Owner of Record Owner Owner's Name information is required for Hyannis Ma. 02601 6/24/2010 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 74 Melbourne Rd. Property Address Owner of Reccrd Owner Owner's Name information is Y required for Hyannis Ma. 02601 6/24/2010 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2008:96,000 g ( y g (gp )) 2009:4500 Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Unknown Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow'(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 74 Melbourne Rd. Property Address Owner of Record Owner Owner's Name information is required for Hyannis Ma. 02601 6/24/2010 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 74 Melbourne Rd. Property Address Owner of Record Owner Owner's Name information is required for Hyannis Ma. 02601 6/24/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 2001 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 16"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented through the house vents. Septic Tank (locate on site plan): Depth below grade: 14"feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallon Sludge depth: 5" t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M °v 74 Melbourne Rd. Property Address Owner of Record Owner Owner's Name information is required for Hyannis Ma. 02601 6/24/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 27" Scum'thickness 5" Distance from top of scum to top of outlet tee or baffle 3" 911 Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump tank every two years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears structurallt sound. 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 l5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 74 Melbourne Rd: Property Address Owner of Record Owner Owner's Name information is required for Hyannis Ma. 02601 6/24/2010 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.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): i Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 74 Melbourne Rd. Property Address Owner of Record Owner Owner's Name information is required for Hyannis Ma. 02601 6/24/2010 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert No Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any . evidence of leakage into or out of box, etc.): Box is level.Box has two outlet laterals.Evidence of solids carryover.No evidence of leakage. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 74 Melbourne Rd. Property Address Owner of Record Owner Owner's Name information is required for Hyannis Ma. 02601 6/24/2010 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 2 ❑ 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.): Sandy soil.System shows signs of hydraulic failure.Chambers were dry at time of inspection.Stain lines observed above invert. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication,of groundwater inflow ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 74 Melbourne Rd. Property Address Owner of Record Owner Owner's Name information is required for Hyannis Ma. 02601 6/24/2010 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): I f t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ` 74 Melbourne Rd. Property Address Owner of Record Owner Owner's Name Information is required for Hyannis Ma. 02601 6/24/2010 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ❑ drawing attached separately ... .. ..:y - _ - . 9 DecK 'Z° ,4-y > z Lj_ , 3 37 t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 74 Melbourne Rd. Property Address Owner of Record Owner Owner's Name information is required for Hyannis Ma. 02601 6/24/2010 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: Bottom of LC 12' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: As-built ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: USED:USGS Observation Well Data.USED: Technical Bulletin 92-0001 plate#2 annual ranges of groundwater elevations. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 74 Melbourne Rd. Property Address Owner of Record Owner Owner's Name information is required for Hyannis Ma. 02601 6/24/2010 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Derr1-0 1 I 'll r , TOWN OF BARNST ABLE4. LOCATION l �/,(7l,Ll/`/k� /�/� S AGE # VILLAGE ova 4713 ASSESSORS MAP &LOT INSTALLER'S NAME&PHONE N0. /TDL® G� ST. Z71- ¢3p� SEPTIC'TAN CAPACITY /ODO:., XI�`ix g 1 LEACHING'FACILITY:.(type0-47 (size) ,laZ,y.a1r� NO.OF BEDROoms PERMITDATE OM D :_�T �//G% CPLaN% ATE G o _ Se;paratioti Distance Between the: Ivlaumtim Adjusxed Gioundwatec.Table.and B.ottoth pf Leaching Facility Feet _ ; Private.Water Su 1 Well and L achun' Facili If` s east +: PP Y'. S tY ( any-WeillNt> on site.nr within 200 feet of leaching facility) Feet Edge of Wedand:and Leaching Faeiltty(Lf any wetiands.eiist within 300 feet of leaching€ability) Feet k M1 Fiunistied.by :;, r p , d. .I .. 1 4 k Y i �14 A I �9 3 3� l ati Y • °Ft r Town of Barnstable Regulatory Services *vQ�anRMASS. E Thomas F.Geiler,Director� ,fig' Public Health Division Thomas McKean,Director 367 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 March 28, 2001 Frank&Dorothy Stewart 74 Melbourne Road Hyannis,MA 02601 NOTICE TO ABATE VIOLATIONS OF 310 CMR: 15.00 THE STATE ENVIRONMENTAL CODE TITLE V: ME41[MUM REQUIREMENTS FOR THE SUBSURFACE DISPOSAL OF SANITARY SEWAGE, AND 105 CMR 410.00 STATE SANITARY CODE H - MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION. The property owned by you located at 74 Melbourne Road, Hyannis, listed as Parcel 231 on Assessor's Map 268 was inspected on March 16, 2001 by Glen Harrington, R. S., Health Inspector for the Town of Barnstable, because of a complaint. The following violation of 310 CMR 15.00, the State Environmental Code, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage and 105 CMR 410.00 State Sanitary Code II - Minimum Standards of Fitness for Human Habitation was observed: REGULATION 310 CMR 15.02 (207)AND 105 CMR 410.300: Overflowing sewage onto the ground. This violation is a serious public health hazard. 1) You are directed to hire a licensed septage hauler to pump the overflowing cesspool within twenty-your(24) hours of receipt of this letter. 2) You are also directed to keep the on-site sewage disposal system pumped as many times as necessary to keep from overflowing onto the ground. 3) You are further directed to contact and hire a licensed Disposal Works Installer withinseven (7) days of receipt of this letter in order to repair this system or.connect to town sewer. You may request a hearing before the Board of Health if written petition requesting same is received within seven (7) days after the date the order is served. Non-compliance could result in a fine of up to $500.00. Each day's failure to comply with an order shall constitute a separate violation. R OF T BOARD OF HEALTH Thomas A. McKean Director of Public Health THE COMMONWEALTH OF MASSACHUSETTS �6 TOWN OF BARNSTABLE BOARD OF HEALTH NOTICE TO ABATE A NU/JIISANCE 2000 00 As ownpant of 7 �2 �av�ge ,ctti, you are hereby notified to remedy the conditions named below within 24 hours of the service of this notice, according to Massachusetts General Laws,Chapter III,Section 123: 3/0 21^21,5— - Sic -eL�W� 0�1e-"'4ze m6 r,e J.T g, Y SIC) If at the expiration of time allowed these conditions have not been remedied, such further action will be taken as the law requires and a fine of$40.00 per day may be charged. (Hazardous Waste$75.00). By Order of the Board of Health ' Inspector MINOR /i �C@!dam 268231 V 1� 001723 LOT 33 �, z 0.23 � •,r, Gt1r fit.. STEWART,FRANK P&DOROTHY 101 rr -- 74 MELBOURNE RD c z IYANNIS I MA 02601 a z 00-0000-000 m"I'Mm Ell uagf STEWART,FRANK P&DOROTHY _ . [ 0987 5930/042 ° 000041900 iCd 000072500 »0000000000 a < �� 74 MELBOURNE ROAD 1015 0100 a t.� j� c I SOL Y TOWN OF BARN/STABLEt LQCATION l �l.f7�1.�/'/!e� /�/c• SAGE # VILL/'sGE ASSESSOR'S MAP & LOT ,INSTALLER'S NAME&PHONE N0. /7�� G�7�T. SEPTIC TANK CAPACITY ��®D �i�I�`%�l9 LEACHING FACILITY: (type) f0® ledll— le-OZ1 1T (size) NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: C It Z, U/ COMPLLANCE 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 0 ca CA N o � N � •1 w �" '� 2ov —z3I !L No. �/— - 7 7 Fee computer: THE COMMONWEALTH OF MASSACHUSETTS Entered in com p Yes / PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Application for Migpogat *pgtem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade(V)Abandon( ) ❑Complete System Idividual Components Location Address or Lot No. Z Owner's Name,Address and Tel.No. Assessor's Map/Parcel 11V1a,111 (- Installer's Name,Address,and Tel.No. / Designer's Name,Address and Tel.No. -7 7Z-�3 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(,�(/o Other Type of Building 21h No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow ,731� gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. d® '4101 45 - ,Q e4s Description of Soil / •S 7 Z Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued this Bo ofjjealth. Signed Date O // Application Approved by Date ! Zt 0 I Application Disapproved for the following reaso s Permit No. 240 l _LIO 1 Date Issued 4�v Z/—D / a_�_ Fee � a s Entered in com uter: .. .r•, THE COMMONWEALTH OF MASSACHUSETTS p .f Yes _ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ✓ "y 0[ppYication for �Mioogal *raem Congtruction Permit Application for a Permit to Construct )Repair(air )Upgrade rade V Abandon ❑Com lete System [dividual Components PP ( P ( Pg ( ) ( ) P Y P Location Address or Lot No. 7 q -,f1e 1Avfwe set Owner's Name,Address and Tel.No. Assessor's Map/Parcel �/laye/65 Installer's Name,Address,and Tel..No. ' rAl/ Designer's Name,Address and Tel.No. J�f Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder(�l� Other Type of Building ���S/ t°�lC� No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow J?� gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /Ddl� �l/� �il'/9>`%�9 Type of S.A.S. 7 " 5W Description of Soil Z S Z�XZ Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issuedhv this Board of Health. Signed , Date Application Approved by . Date G/Z��O 1 Application Disapproved for the following reaso s Permit No. -U0 I '" YD Date Issued 4� O ---------- . THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance f THIS IS TO CERTIFY, that the 9n-site Sew% a Disposal System Constructed( )Repaired( )Upgraded(t/) Abandoned( )by at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 7(1 —�0 1 dated Installer Designer Ile The issuance of this pe it s all not be construed as a guarantee that the sys ill nc o. as desi ed�/� Date �v�� Inspectorr if _ No. zwz _/v� -----------_-------- fiCJ D ���/ Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS ligpogat *pgtem Congtruction Permit 11 Permission is hereby granted to Construct )Repair( )Upgrade(V)Abandon( ) System located at �� � �Du/�f1 e ` 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: Constructio9n�ust be completed within three years of the date of this it. Date: % Z�/ _ Approved by c` Cal L G Fp>2 ��=J T ffiG E /;11-16 L 7a G7,�rsT G7�D� �( NOTICE: This Fora Is To.Be'Used For the Repair Of Failed Septic Systems.Only. - QW-RTQCAU0N OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONMUCTION PERMIT(WITHOU-'DESIGNTED PLANS) k/Jer r 7. AV/A041f1hereby certify tha,- the application for isoosal works cor?suuctlon Der= signed by me da-ten ��U'/ concerncnz tSe properl-y Io=ed:at �fe/le4e'lfle 161 all,7�5 meets all.of the raIlOwuls �LerIG.. /-a-Z ; Cd Srs=S collne=ied to a rtsi'-ncal�-4eil'no ni ,..: �- L_OJ Y, _IIe: no corumt C.al Or busiZ- ., es RZ :he Q"riC i n_Q. /7-ac �— soil,S C 2au1 25 CLc, I iIlQ the is .e s ZIIaTl or eiL :O. ZLuuz=- v-`mc: ae._are no W,-dmds wi-;*t100 =-_.of 1ze �mpes:�szodc::sT= _ae_e are no�iTxale aces wit En.1=0 :of ae oro-c-csed seonc 7 a= is no in= - t jr-flow d/or c:=,e L:se oropes_ed-. `r- 42-e:'xrrom-cf II _ _ IIO Y^a2':?�C�.S�11Sce`.1 OI Am^e'� the proxse3 ieac�ing a�:iity will not be-jo=ttdo less trT*l five:,-:above the :�.a;:mum ad]tst�.,�ouad�ate:able e?_ration (Adjus tae mound aate:.table.us' I :rilnptor /Tf-the =hod when applicable]. S.1 C.'7,U be locI°d with.ZSo Iee:of eiY vea_:2Ie�YJe IaIlds, [he boCICIi!CI Lyle nIDLQse leaching facility-,�U not oc loca d less than IoLreen(14) above the rz:;;�-num adn5t°a 4roundaate:table el--adon, Pie=complete the foiloWinb A) Top of Ground S*:riaro=Inarion(lam GIS information) B) G W.Snadon ZF -the �n� l;n G.W.'Adj=Lmeat. 2 °.3 = Z DIFE NCr 3 N A and 3 �° U SIGN-D : DAM [SK--tch proposed pLan.of svX=on oa�J. 1 � Joe ® 6 oil mel heame ro', 111 CAT ION SEW-AGE PERMIT NO. VILLAGE INSTA LLER'S NAME & ADDRESS B U It DE R OR OWNER a DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED '-,� T I� � A IR A Cj Oro t f A THE COMMONWEALTH OF MASSACHUSETTS BOARD I-DEALT --....OF........ .......:.......................... ......---------......------- Appliration -for Di!ipoottl Workfi Tonfitrnrtion Vrrntit Application is hereby"made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: 409 Locati n•Address or Lot No. -- 9�. ----- �1� .7-....... ......•------ X .ram...---= W ow r Address - '•' ` --•---•------------------- --•-•-••--• /`_•'_._.........__._._ate.. a Installer Address U Type of Building //Tj ya Size Lot_______lo _ ---Sq. feet Dwelling—No. of Bedrooms______........___________________________Expansion Attic ( Garbage Grinder •{74 aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) d, Other fixtures _ __--_ _ W Design Flow__________Is- :_ __41.=_:g<-ttl ns per person per day. Total daily flow._..__________________________gallons. WSeptic Tank—Liquid capacity/d_v—fallons Length---------------- Width................ Diameter__._......----- Depth_-______-_.-. x Disposal Trench—No-------------------- _ W' th___________________ Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No./___e$_<f-----_ M eter____________________ Depth below inlet____________________ Total leaching area------------------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) —di .�✓Ic 2 y 3` 7.7- aPercolation Test Results Performed bY---------------........................................................... Date---------------------------------------- Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water--____-_-____-___-__---- fi Test Pit No. 2................minutes per inch Depth, of Test Pit-------------------- Depth to ground water-_-_--___-__-____----- Descrt tiot) of Soil -` - W�� - P -----1 `t 414 ----------- U r W ', L — . _ `fit -- d UNature of Repairs or Alteration —Answer when ap livable._ _:..._-_- r / �.� r -------------------------------------- Agreement: — �^ . The undersigned agrees to install the aforedescribed Individual Sewage Disposal System to accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance ha .been issued b the board of health. Y _ Sim ------••--• --------------------• -----�- �f`------ -- ------ --- _ . _ r- — ' Date .. Application Approved BY ... �� °"� ---------- ------ ----_.._ ._' �.. �� Date Application Disapproved for the following reasons____________________________________________________________________________________________ ___________________ ......................................................--------------...............--•------------------------------------------------------------------------------------------------------------------ Date Permit.No.......................................................... Issued........... --------------- ........................... Date No......2 ........... Fus.......................... .... THE COMMONWEALTH OF MASSACHUSETTS BOARD 9F HEALTH .'..............OF....... ... ....... Appliration -for 'Uiipo-qttl Works Tonstrurtion Vrru it Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: I Pl E._ .. � s//!!/ Location-Address *---. or Lot No. ................... . ---r/1 ` o / r---�'---------------5 a O Address✓� .4-mo ... ---•--•-----/Ks Installer Address Type of Building Size Lot...... a..t..'".'�....Sq. feet U Dwelling—No. of Bedrooms.__._---_..Z ........................Expansion Attic ( Garbage Grinder T I per, Other—Type of Building ____________________________ No. of persons.--------------------------- Showers ( ) — Cafeteria ( ) Q' Other fixtures ........................ -----------------------------•-------------------._--- -- ------------••-•----.---_---- W Design Flow--------- _.. :...�. .._"g�rll ns per person per day. Total daily flow_____C7�-�__-.-_____-_-_-_-_-_-gallons. Septic T,-nk—Liquid capacity/ff_Wgallons Length---------------- Width----....__- _-- Diameter________________ Depth____--_.--.-.:. xDisposal Trench—No_ ____________________ Width-------------------- Total Length-------------------- Total leaching area--------------------sq. ft. .5fn C sue: _ PC Seepage Pit No./---. X?-_.__ Dtatnceter._______.___•------- Depth below inlet--__•_____•-__-_._. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) AC/)�- ,2 - 3- 7 7 Percolation Test Results Performed by------ - ----•- Date--------------------------------------- HTest Pit No. I----------------minutes per inch Depth of Test Pit.--------•.__....... Depth to ground water..._.__.___.-__.._.-___. rXq Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water------------------------ --- •• ' ` "= G -------------- ------------ --- ----------- -------- Descriptiop of Soils G x , �- "- - �--w�-------- - - W -----------`� f.< �' ----------------------------------------- f U of Repairs or Alterations—Answer wh alp licable.----------------- Nature .. ��t--- =------------------------------------ -y�------��:�-�.L--;�-•---�J-- { -- - -v:-- st-�-Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance hakbeen issued b�the board of health. Sign .''^'r t�•�'F' �1�'u-� - 2 ---._...-•-......-•-- -•---_----------- ------------- 77 ! . _ Date Application Approved By...... ---- !!. GvLt C ... ---- -------�---`--- .............•------------......-----------.........................Date--------••-••- Application Disapproved for the following reasons:...................... --•.............••-••-•-•••......•-•------•-•-------•-------•••--------------•---•-••-••-••-••---------......._..--------......._•-•-••--••-•---•--..----••-•--------------.-_._...•••---------------•••- Date PermitNo......................................................... Issued......................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH j- 1...........OF......... 'r// /� �-....................... TT' Qrrtif irate of V01,11utphattre T S T C TIFY, That the Individual Sewage Disposal System constructed (�r Repaired ( ) byf 1r.................................Ins f at : � has been installed in accordance with the provisions of : XI of The State Sanita v Code as de ribe n he application for Disposal Works Construction Permit No______________t-_-( :_._.___________ dated...._....__ _r _._.. THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATEInspector.............................................................. THE COMMONWEALTH OF MASSACHUSETTS ;;r;, 77 BOARD OF HEALTH ......... ... - ..:.......... F . �angtrurtion Vrrmit - -lo ....................... Per on is eeby granted---`----- _--------------- t � � �q a n tvi �air1 e s Osal S ste' atNo....................................................................................................... - --------- .--- v •�---•---------•-------------- stree as shown on the application for Disposal Works Constr Per !V Jo. -. ----___--__-_- Dated.......................................... L/�� � Board of alth DATE.............................. ------------------------------------------------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS � ,t i t { • F f I' t .� � 7 f ._ ►�� � ` � 4.: ... in L Tj v �. � cs fin` c �► Z� .n rl 41 S'' Vk16V•# ; d nrt c V" =1 �. a 1 � � -- � _ ---- AS - LU = 93«1 2 - 0 ° SIEPTY, P IT C,8 CA9 �t��0 f r 84,8 19, �sv"ev �S$.f� Der. 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