HomeMy WebLinkAbout0157 MELBOURNE ROAD - Health 157 Melbourne Road
Hyannis P
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COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS .
I ®� DEPARTME
NT OF ENVIRONMENTAL PROTECTION
2l0`� t 1 ) 4-1
MAP _.�..,..
PARCEL 1 6 Z
LOT
TITLE 5
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 157 Melbourne Road
yannispor .
Owner's Name: Richard Sparks � :�
Owner's Address:
3
Date of Inspection: / " /
Name of Inspector:(please print) Wi 11 i am E_ • Robinson Sr. ,.. pS•
Company Name: William E. Robinson Septic Service
Mailing Address: P O Box 1 089
Centerville, MA
Telephone Number: (5081 775-8776
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP
approved system inspector pursuant to Sect' 15.340 of Title 5(310 CMR 15.000). The system:
asses
? Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signature: Zo„t Date:l�—/�0 3
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Heatth 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 ent to the buyer,if applicable,and the approxing
authority.
Notes and Comments
****This report only describes conditions at the time of inspection and under the conditions of use at that
time.This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Title 5 Inspection Form 6/15/2000 page I
Page 2 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 157 Melbourne Road
HVannisport
Owner.. Rirhard Spark
Date of Inspection:
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. Sy m Passes:
y 1 have not found any information which
ch 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. yytem Conditionally Passes:
One or more system components as described in the"Conditional Pass"section need to be replaced or
repair d.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass.
Answ yes,no or not determined(Y,N,ND)in the for the following statements.If"`not determined"please
expla" .
e septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally
torso d,exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the
exist' Ig tank is replaced with a complying septic tank as approved by the Board of Health.
•A m tal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance
indic in
that the tank is less than 20 years old is available.
ND plain:
Observation of sewage backup or break out or Idgh static water level in the distribution box due to broken or
ob cted pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with
appro al of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
Th system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will
pass inspe "on if(wtth approval of the Board of Health):
broken pipe(s)are replaced
obstruction is n mtared
ND explain
Page 3 of l I
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 157 M lho erne Road
Hyannisport
Owner: Richard Spark.
Date of Inspection:
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 failitf to protect public health,safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the
system is not functioning in a manner which will protect public health,safety and the environment:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the
system is functioning in a manner that protects the public health,safety and environment:
The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supply.
The system has a septic tank and SAS and the SAS is within a Zone I 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 frond a
private water supply well'• Method used to determine distance
"This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other
failure criteria are triggered.A copy of the analysis must be attached to this form.
3. Other:
3
Page 4 of 1 I
J
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 157 Melbourne Rnad
Hyannis port
Owner: Richard Sparks
Date of Inspection:
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
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 I 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 Let Gonr a private water
supply well with no acceptable water quality analysis. (This system passes if the well water analysis,
performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria
are triggered.A copy of the analysis must be attached to this form.]
(Yes/No)The system fails.I have determined that one or more of.the above failure criteria exist as
described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of
Health to determine what will be necessary to correct the failure.
E: Large Systems:
To be considered a large system the system must serve a faci!ity with a design now of 10,000 gpd to 15,000
gpd•
You must indicate either"yes"or"no"to each of the following:
(`nte following criteria apply to large systems in addition to the criteria above)
yes no
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped
Zone 11 of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered
"yes"in Section D above the large system has failed.The u%mcr or operator of arty large system considered a
u
significant threat under Section E or fatted 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.
4
Page 5 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: a 5;� 4o l r.,,,,,,-„o Road
Owner: s
Date of Inspect on: 1
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
t//Were any of the system components pumped out in the previous two weeks 7
r/ 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?
v — 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: .
Yes -no
!/ Existing information.For example,a plan at the Board of Health.
Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable)[310 CMR 15.302(3)(b))
i
5
Page 6 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 157 M _lho urnP Road
Hyannisport
Owner: Richard Sparks
Date of Inspection: - i 7 —6-3
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design):., Number of bedrooms(actual): 3 O
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 3
Number of current residents: A-,,.&
Does residence have a garbage gander(yes or no): A 0
Is laundry on a separate sewage system(yes or no):�Lo [if yes separate inspection required)
Laundry system inspected(yes or no):L49
Seasonal use:(yes or no):W
Water meter readings, if available(last 2 years usage(gpd)): 9/0 2 th ru 9/0 3 4 9, 5 0 0 a 9
Sump pump(yes or no): 4�"9 9/01 thru 9/0 2 47, 250
Last date of occupancy: ,� ,Q 63
COMMER IAL/INDUSTRIAL
Type of esta lishment:
Design flow(based on 310 CMR 15.203): gpd
Basis of de gn flow(seats/persons/sgft,etc.):
Grease trap resent(yes or no):_
Industrial laste holding tank present(yes or no):_
Non-sani wreaste discharged to the Title 5 system(yes or no):_
Water mePer adings,if available:
Last date f occupancy/use:
OTHE (describe):
GENERAL INFORMATION
Pumping Records
Source of information: 1
Was system pumped as part of the inspection(yes or no):_
If yes,volume pumped:_gallons--How was quantity pumped determined?
Reason for pumping: A,I iC L U
TYP F 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)
_ to be
Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract
obtained from system owner)
_Tight tank *—Attach a copy of the DEP approval
_Other(describe):
Approximate age of all components,date installed(if known)and source of information:
6�,d
Were sewage odors detected when arriving at the site(yes or no): v
6
Page 7 of 1 I
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 157 M -lhrnjrne Road
_Hyanni -port
Owner: Rjrhard Spa ks
Date of Inspection:
BUILDING QrWER(locate on site plan)
Depth below ade:
Materials of co struction:_cast iron —40 PVC_other(explain).
Distance Gom rivate water supply well or suction line:
Comments(on condition of joints,venting,evidence of leakage,etc.):
SEPTIC ✓TANK:_(locate on site plan)
Depth below grade: ]U r Xconcretc
Material of construction: —metal—fiberglass—polyethylene
_other(explain)
If tank is metal list age:— Is age confirmed-by a Certificate of Compliance(yes or no):—(attach a copy of
certificate)
Dimensions:
Sludge depth:
Distance Gom 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 tlet tee or baffle: /-I
How were dimensions determined:
Comments(on pumping recommendations,inlet and outlet tee or baffle conditicn,structural integrity,liquid levels
as related to outlet invert,evidence of Ieaka ,etc.):
1600
G SE TRAP: locate on site I
_( pan)
Depth below grade:—
Mazer al of construction:_concrete metal fiberglass—polyethylene—other
(cxpl ): —metal
slops:
Scum thickness:
Dis ce Gom top of scum to top of outlet tee or baffle:
Dis nce from bottom of scum to bottom of outlet tee or baffle:
Dal of last pumping:
Co ents(on pumping recommendations,inlet and outlet tce or baffle condition,structural integrity, liquid levels
as lelatcd to ouQet invert,evidence of leakage,etc.):
7
Page 8 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 157 Me1 bourne Road
H}LAnni.�sT nrt
Owner: Rj-c ,a rd
Date of Inspection: �e l—
TIGHT or H WING TANK: (tank must be pumped at time of inspection)(locate on site plan)
Depth below gra e:
Material of const ction: concrete metal fiberglass__polyethylene other(explain):
Dimensions:
Capacity: gallons
Design Flow. gallons/day
Alarm present(ye or no):
Alarm level: Alarm in working order(yes or no):
Date of last pump g:
Comments(con d lion of alarm and float switches,etc.):
DISTRIBUTION BOX: /(if
resent must be opened)(locate on site plan)
Depth of liquid level above outlet invert: D
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of
leakage into or out of box,etc.):
PUMP CHAMBE (locate on site plan)
Pumps in workin order(yes or no):
Alarms in worki g order(yes or no):
Comments(no condition of pump chamber,condition of pumps and appurtenances,etc.):
8
Page 9 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 1 57 Melbolirm- Road
II.�a.nn i s Fart
Owner: s
Date of Inspection: -� 3
SOIL ABSORPTION SYSTEM(SAS): V (locate on site plan,excavation not required)
If SAS not located explain why:
Type
a hing pits,number:_
leaching chambers,number:
leaching galleries,number:
leaching trenches,number,length:
leaching fields,number,dimensions:
overflow cesspool,number:
innovative/alternative system Type/name of technology:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,
etc.):
17a9 ez 1<
CESSPOOLS: (cesspo 1 must be pumped as part of inspect ion)(]ocate on site plan)
Number and configuration•
Depth—top of liquid to ' et invert:
Depth of solids layer:
Depth of scum layer.
Dimensions of cessp ol:
Materials of cons ction:
Indication of gro dwater inflow(yes or no):
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
PRIW: (lo ate on site plan)
Materials of co traction: _
Dimensions:
Depth of soli
Comments( ote condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
9
Page 10 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 157 Melbourne Road
Hyannispnrt
Owner: R i r-h a rrl Rpa rks
Date of Inspection:-,L1^/7- D 3
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building.
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10
Page 11 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 157 Melbourne Road
Hvannisport
Owner. Richard SparkG
Date of Inspection:
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water�feet
Please indicate(check)all methods used to determine the high ground water elevation:
yrl,.,.s
fined from system design plans on record-if checked,date of design plan reviewed:
rved site(abutting property/observation hole within ISO feet of SAS)
cked with local Board of Health-explain: y 5
Checked with local excavators,installers-(attach documentation)
Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
� 1 15 n.9 S �20u2
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TOWN OF BARNSTA.BLE (, J
LOCATION i l f PLO d J >a- x L: ul SEWAGE #
n .—
VILLAGE �c) � �w 1 ff ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. cab e,- d— 7 7 �""� '� 1
SEPTIC TANK CAPACITY 16
LEACHING FACILITY: (type) 3 122,6 4.S• (size)d-3 6--
NO.OF BEDROOMS In
BUILDER OR OWNER Sj9`JA < S
PERMTTDATE: '� �- COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility, (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
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No. Fee $5�0 .0 0
THE COMMONIIVE?ALTH OF MA/SACHUSETTS
Entered in computer: V
Yes
.PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
01pprication for �Di.5paaf *pgtem Conttrurtton permit
Application for a Permit to Construct( )Repair( x)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 1 5 7 Melbourne Rd Owner's Name,Address and Tel.No. 781 —3 9 5—5 5 7 0
sse sor's /Parcel Hyannisport, MA Richard . Spanks 200 Mystic Ave
Medford MA 02155
Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No.
W E Robinson Septic Service
PO Box 1089 , Centerville,MA 02632
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder�10)
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil sand
Nature of Repairs or Alterations(Answer when applicable) Title 5 Leaching system
consisting of D—Box, and 3 H2.0 stonepacked maximizers.
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 by t ' Bo of Health
Signed Date
Application Approved b Date
Application Disapproved for the following reasons
Permit No. F Date Issued ' `
VACHUSETTS
No. 4. ` Fee 50.00O EA
THE COMMNWLTHOFMA Entered in computer:
Yes
PUBLIC HEALTH DIVISION —TOWN OF BARNSTABLES MASSACHUSETTS
01ppYication for Mgozal *p5tem Construction Permit '
Application for a Permit to Construct( )Repair( x)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 157 Melbourne Rd Owner's Name,Address and Tel.No. 7 81 —3 9 5—5 5 7 0
Assessor's Map/Parcel Hyannisport, MA Richard Pparks 200 Mystic Ave
Medford, MA 02155
Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No.
W E Robinson Septic Service
PO Box 1089, Centerville,MA 02632
Type of Building:
Dwelling No. of Bedrooms 3 Lot Size sq. ft. Garbage Grinder(no)
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures y 4 f
v
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of'Soil sand
Nature of Repairs or Alterations(Answer when applicable) Title 5 Leaching aystem
consisting of D-Box, and 3 H2O stonepacked maximizers.
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 by thi 5. oSOoff Health.
Signed Date Q
Application Approved by /' Datea ��
Application Disapproved for the following reasons
Permit No. A Date Iss
----.—---------- ---
JHE CQMMONWEALTH OF MASSACHUSETTS
Sparks �� i j,w/`,,�AA. , MASSACHUSETTS _ s
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( X )Upgraded( )
Abandoned( )by 4
at 157 Melbourne Rd, Hyannisport has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. 9 — dated �7—7�--F
Installer W E Robinson Septic Service Designer
The issuance of th ermit hall no be construed as a guarantee that the system w' f ncnc-ti�on as designed.
Date i Inspector ,`�
k
No. r l Fee$5 0.0 0
THE COMMONWEALTH OF MASSACHUSETTiS
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
Sparks 'Wi5po.5al *pztem Conotruction Permit
Permission is hereby granted to Construct( )Repair(XX)Upgrade( )Abandon
System located at 157 Melbourne Rd
Hyannisport, MA '
Installer: W E Robinson Septic Service
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date of this eflnit. .F
Date: ." Approved by �� ,
_y N — ¢4_
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NOTICE: This Form I9.Tolle Used For the Repair Of Failed;
Septic Systems Only.
CERTIFICATION OF SKETCH AND APPLICATION FOR A
DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT
ENGINEERED PLANS)
I, William E. Robinson, Sr. ,hereby certify that the application for disposal works
construction permit signed by me dated concerning the
property located at 157 Melborne Street, Hyannisport, meets all of the
following criteria:
* There are no wetlands within 100 feet of the proposed leaching facility.
* There are no private wells within 150 feet of the proposed septic system.
* There is no increase in flow and/or change in use proposed.
* There are no variances requested or needed.
* If the proposed leaching facility will be located with 250 feet of any wetlands,the bottom of the
proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted
groundwater table elevation.
Please complete the following:
A)Top of Ground Elevation(according to the Engineering Division G.I.S. map) o
B)Observed Groundwater Table Evaluation(according toHealth Division well map)—F
SIGNED:w DATE
LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER 20-1998
(Attach a sketch plan of the proposed system. Also if the licensed-installer posesses a certified plot plan,
this plan/should be submitted).,
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TOWN OF BARNSTABLE `J
LOCATION ! SEWAGE # f t� r 'Y J
VILLAGE ASSESSOR'S MAP & LOT 6 1 - A",
INSTALLER'S NAME&PHONE NO. c�� : e-s 1 7 5 ` ''7
SEPTIC TANK CAPACITY 16 6---0
LEACHING FACILITY: (type) (size) /i o f 6 -
NO.OF BEDROOMS
BUILDER OR OWNER aA I< S
PERMIT DATE: % 01-1 g COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
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. Z 203 499 090
US Postal Service
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Return Receipt Showing to
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COP TOTAL Postage&Fees
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Stick postage stamps to article to cover First-Class postage,certified mail fee,and
charges for any selected optional services(See front).
1. If you want this receipt postmarked, stick the gummed stub to the right of the return
address leaving the receipt attached, and present the article at a,post office service m
window or hand it to your rural carrier(no extra charge).
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i
P011c Heath Division
Town of Barnstable
P 0 Box 534
Hyannis, Massachusetts 02601
Town of Barnstable
CF THE
Department of Health,Safety, and Environmental Services
BARNSTABM
6 ,0r Public Health Division - ,�,e(
1F0�"P�A P.O. Box 534,Hyannis MA 02601 t
Office: 508-862-4644 Thomas A.McKean,RS,CHO
FAX: 508-790-6304 Director of Public Health
i June 15, 1998
Richard Sparks
200 Mistic Ave.
Medford,MA 02155
NOTICE TO ABATE VIOLATIONS OF 310 CMR: 15.00 THE STATE
ENVIRONMENTAL CODE TITLE V: 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.
The property owned by you located at 157 Melbourne Road, listed as Parcel 267 on Assessor's
Map 162 was inspected on May 11, 1998 by Jerry Dunning, 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-four(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 within seven
(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.
PER ORDER OF THE BOARD OF HEALTH
i
Thomas A.McKean
Director of Public Health
I
1
I
F ,
t
t
;:00 (A., ,e
NOTICE TO ABATE VIOLATIONS OF 310 CMR: 15.00 THE STATE
ENVIRONMENTAL CODE TITLE V: 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.
;i
The property 'owned by you located at /v5- 71 W cr-c=•-rs,
listed as Parcelg 6 7 on Assessor's Map 161, was inspected on
5'-11_99 , 199 , byk7le " e a o� , Health Inspector
for the Town of Barnstabecaus a complaint. The
following violations 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 were 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.
t
1) You are directed to hire a licensed septage hauler to
pump the overflowing cesspool within twenty-four (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 within seven (7) days of receipt of
this letter in order to repair the system.
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.
PER ORDER OF THE BOARD OF HEALTH
Thomas A. McKean
Director of Public Health
v i
Health Complaints ,
10-Jun-98 ^�"
Time: 1:20:00 PM Date: 6/10/98 Complaint Number: 1380
Referred To: JEROME DUNNING Taken By: EDWARD BARRY
Complaint Type: TITLE V SEWAGE
Article X Detail: UNSANITARY CONDITIONS
Business Name: TENANT
Number: 157 Street: MELBOURNE RD
Village: HYANNIS Assessors Map_Parcel:
1
PAR ] Real Estate System - General Property Inquiry] Help [ ]
Parcel Id: 267 162- - Account No: 169793 Parent :
Location: 157 MELBOURNE RD Neighborhood: 55BC Fire Dist : HY
Devel Lot : 57 Lot Size: .23 Acres
Current Own: SPARKS, RICHARD E State Class : 101
200 MISTIC AVE No. Bldgs : 1 Area: 1008
Year Added:
MEDFORD MA 2155
Deed Date : Reference : 1919/11
January 1st : SPARKS, RICHARD E Deed MMDD: 0000 Deed Ref : 1919/11
Comments :
Values : Land: 21700 Buildings : 56500 Extra Features :
Road System: 157 Index: 1015 (MELBOURNE ROAD ) Frntg: 62
Index: ( ) Frntg:
Control Info: Last Auto Upd: 050695 Status : C Last TACS Update : 052986
Land Reviewed By: Date : 0000 Bldgs Reviewed By: ML Date : 0991
Tax Title : Account : Taken: Account Status : Hold Status :
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