HomeMy WebLinkAbout0369 MITCHELL'S WAY - Health 369 MITCHELLS WAY, HYANNIS
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Town of Barnstable Hcalth Inspector
i Office Hours
�"�"0' . Regulatory Services 8:30—9:30
Thomas F.Geiler,Director 1:00—2:00
BAMUMar e, = i
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Public Health Division , ,
a Thomas McKean,Director
200 Main Street,Hyannis,MA 02601 a
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Office: 508-862-4644 F2 508 90-6304
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AMMSTY PROGRAM APPLICANT—SEPTIC UESTIO AI
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1. General Information: Size of Prope 7
Address: F Map Cg�l Parcel
Name: Phone#: -V
2a. How many bedrooms exist at your property now?
2b. Are you planning to add any bedrooms? If yes, how many? f
2c. How many bedrooms total are proposed at this property(including the amnesty unit)?
2d.Please include a copy of the floor plans for the entire property -,Showing the existing
rooms in the home plus the proposed amnesty apartment and/or addition. Please label
each room clearly on the plans.
3. Is the dwelling connected to public sewer? YES or NO
It-the dwelling is connected to;public sewer,skip.,questions#4 through.09.below.
4. Location of dwelling is INSIDE or OUTSIDE a Zone of Cyn�i i ublic supply wells? W p
5. Is the dwelling connected to an ONSITE WELL or to PUBLIC WATER?
6. Is a disposal works construction permit on file? YES or NO
6a. If yes,how many bedrooms were approved according to this permit? Bedrooms.
7. Were any building permits obtained for construction of additional bedrooms? YES or NO
8. Is there an engineered septic system plan on file at the Health Division? YES or NO
9. Has the septic system been inspected by a DEP certified inspector within the last two years? YES or NO.
FOR OFFICE USE ONLY
-414
The Public Health Division has no objection tovalk&&L bedrooms at this property.
Special Conditions: b 0 Pf4DO1-71j)iV1Jz— 't-�-ctigo
Signed: Date:
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The Town of Barnstable
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+ BARNST"M +
9� 1 ,m� Office of Community and Economic Development
230 South Street
Hyannis, MA 02601
Kevin Shea Office: 508-8624678
Director Fax: 508-8624782
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March 3,2005
Mr.John C.Klimm,Town Manager
Gary K Brown,Town Council President
Barnstable Town Hall
367 Main Street
Hyannis,MA 02601
Re:
Jim Albrecht- 369 Mitchell's Way,Hyannis- a single-family accessory unit
Christina Kelley- 31 Keela Road, Cotuit- a single-family accessory unit
Gentlemen:
This letter is to inform you that the Accessory Affordable Housing (Amnest� Program has received
requests for project eligibility letters under the Community Development Block Grant(CDBG)
Fund and under.the General Ordinances of the Town of Barnstable,Article LXV- Pre-existing&
Unpermitted Dwellings and the Criteria for the Local Chapter 40B Program.
The Program Coordinator is reviewing the requests.If the Town has any comments on the projects,
please forward them to me so that they can be addressed in the site approval letter. This letter gives
you official notice of our receipt of the above application(s). We will issue a decision as to the
acceptability of the sites and the consistency of this development within the guidelines of CDBG.
Sinc rely
Kevin Shea,Director
Community&Economic Development
cc: Town Attorney's Office
Building Department
Public Health Department
L
McKean, Thomas
From: McKean, Thomas
Sent: Friday, April 01, 2005 9:24 AM
To: Dillen, Elizabeth; Shea, Kevin
Cc: Witter, Denise; Agostinelli, Joan; Daley, Jim; Desmarais, Donald; Kelleher, Maureen; McKean,
Thomas; Miorandi, Donna; Saad, Dale; Stanton, David; Wallace, Amy
Subject: 369 Mitchell's Way/Jim Abrecht
F.Y.I. I received a septic system questionnaire/amnesty application from Jim Abrecht regarding 369 Mitchell's Way,
Hyannis. The property is located within a nitrogen sensitive area (within a zone of contribution to public water supply
wells). The parcel size is 0.34 acre. He proposed to add one bedroom to his two bedroom home. This application fails to
meet 310 CMR 15.214, State Environmental Code, Title 5. Therefore, this application is denied.
I FAXED the disapproved application form to your office yesterday. The applicant simply does not possess enough land
area on his parcel.
TO: Kevin and Beth: FOR FUTURE REFERENCE
The formula is: one bedroom per every 10,000 square feet of land for parcels
located within zone of contributions and in areas where there are private water
supply wells .
EXAMPLE 1 : If a parcel of land is 30,000 square feet located within a ZOC (or within
an area where there are.private wells), the applicant could build a three bedroom
home on that lot. He/she could not construct a fourth bedroom.
EXAMPLE 2. If a parcel of land is 20,000 square feet located within a ZOC (or within
an area where there are private wells), the applicant could construct a two bedroom
dwelling on that parcel. That applicant couldn't construct a third bedroom on that
parcel of land.
EXAMPLE 3. If a parcel of land is 10,000 square feet within a ZOC (or within an area
where there are private wells), 'the applicant could only construct one bedroom
dwelling on that parcel. The applicant couldn't construct a second bedroom on that lot.
EXAMPLE 4. If a parcel of land is 15,000 square feet within a ZOC (or within an area
where there are private wells), the applicant could only construct one bedroom
dwelling on that parcel. The applicant couldn't construct a second bedroom on that lot.
EXAMPLE 5. If a parcel of land is 25,000 square feet located within a ZOC (or within
an area where there are private wells), the applicant could construct a two bedroom
dwelling on that parcel. That applicant couldn't construct a third bedroom on that
parcel of land.
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EXAMPLE 6: If a parcel of land is 35,000 square feet located within a ZOC (or within
an area where there are private wells), the applicant could build a three bedroom
home on that lot. He/she couldn't construct a fourth bedroom.
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Crocker, Sharon
To: McKean, Thomas
Subject: Phone call Amnesty Application
Jim Albrecht called to follow up on his Amnesty application. He said he faxed it a month ago. I had him refax it to
make sure we had it.
He would like to know status. 508-778-1782 x23
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COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFIAIRS
r d DEPARTMENT OF-ENVIRONMENTAL PROTECTION.
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TITLE 5
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 34,9 m i'tr-h e 11s "Ic<.�
Owner's Name: hCt Q�►t�
Owner's Address:�W m;fi�1P JS i,,;T
Ryuai-rn ,MC4 RECEIVED
Date of Inspection: j 1.t l_,xioij
Name of Inspector: (please print) �,t;r4n.� y rgQ ic� NOV 2 4 2004
Company Name: ��ln iJ ��Cnt�(`p����5 LLC-
Mailing Address:_PO, I�c;j )G�:3 TOWN OF BARNSTABLE
HEALTH DEPT.
Telephone Number; h cr, - -NGJ�K_
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the ini'ortnation 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
Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signature: ,f-� -- Date:
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or
DEP)within 30 days of completing this inspection.If the system is,a shared system or has a design flow of 10,000
gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP:The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving
authority.
Notes and Comments
****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 1
Page 2 of I 1
OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSN.1t.- T8
(� SUBSURFACE SEWAGE RISPOSAL'SYSTEM INSPECTION FORM
PART A '
CERTIFICATION(continued)
Property Address:
106
Owner: i:.hrjCxj Rrr��,z.ynSK i"
Date of Inspection: i i ]47r,7 )a
Inspection Summarys 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
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 orTepair,as approved by the Board of Health,will jpass.
Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not,determined"please
explain.
_DR 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 aiapproved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
n(Q Observation of sewage backup or break orator 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)anexaplaced.
obstruction is removed.',
distribution box is leveled or replaced.
ND explain:
-a& The system required pumping more than 4 times'a year due to broken or obstructed pipe(s).The system.will
pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
Page 3 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
�( SUBSURFACE SEWAGE DISPOSAL:SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 3&q m,'t,�li�ii5
Owner: -
Date of Inspection: 111 0 jc)�4
C. Further Evaluation is Required by the Board of Health:
A Conditions exist which require further evaluation by the Board of Health in order to determine if the system
is failing to protect public health, safety or the environment.
1: System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the
system is not functioning in a manner which will protect public health,safety and the environment:
nQ Cesspool or privy is within 50 feet of a surface water ,
aft Cesspool or privy is within 50-feet of a bordering vegetated wetland or a salt marsh
1. 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:
4A 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.
n The system has a,septic tank and SAS and the SAS is within a Zone I of a public water supply.
1t. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply well".Method used to determine distance
"This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other
failure criteria are triggered,A copy of the analysis must be attached to this form.
3. Other:
i 1
Page 4 of 11
OFFICIAL INSPECTION FORM—NOT-FOR VOLUNTARY`ASSESSMENTS
SUBSURFACE SEWAGE D. OOSAU-SYSTEM-INSPECTION FORM .
PART.A .
CERTIFICATION{continued)
Property Address: fn j tchell� L%c v
14 y--,n n i5
Owner:_f7 liaf)nr•c i
Date of Inspection: 1 j1 j, iC7 y
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections:
Yes No
)L_ 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
7� Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
Liquid depth in cesspool is less than 6"below invert or available volume is less than''/z day flow
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 i5 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 analy4s.•IThis system passes if the well water.analysis,
performed at a DEP certified laboratory;for cxflitnui bacteria and volatile organic.compoands
indicates that the well is free from-pollution from that facility.and the presence of ammonia
nitrogen and nitrate nitrogen is.equsi to or less than S ppm,provided that no other.f"ure criteria
are triggered.A copy of the.analysis must-be Vtached to this form.]
Ian(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'.
R Large Systems:
To be considered a large system the system must serve.a facility with A design flow of 10,000 gpd to 15000
gpd. - _"
You must indicate either"yes"or"no"to each'of the following:
(The following criteria apply to large systems-in.addition to the criteria above)
. yes no
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped
Zone H 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.
. i
' Page 5 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: :36cj m,tci,d 1 i 5 u3cGy ,
Owner: at`, y
Date of Inspection: 1!111,In jj
Check if the following have been done.You must indicate"yes"or"no"as to each of the following:
r
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 Sol]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 approximationof distance
is unacceptable)[310 CNa 15.302(3)(b)]
Page 6 of 1 l
OFFICIAL.INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS v
( SUBSURFACE SEWAGE;DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: I&;,tL
Owner: fi,��k�� J ► � �°
Date of Inspection:_i j 1 o C;0
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): Number of bedrooms(actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 30
Number of current.residents:
Does residence have a garbage grinder(yes or no),
Is laundry on a separate sewage system(yes or no):j10 [if yes separate inspection required]
Laundry system inspected(yes or no):l
Seasonal use:(yes or no):11.E
Water meter readings,if available last 2 years usage d - ; ` 41►1
( Y g (gpd)):ra 3.�. a��oyo 5
Sump pump(yes or no):jQ0 .
Last date of occupancy:
COMMERCL,L/INDUSTRUL
Type of establishment: .
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sgft,etc.):
Grease trap present(yes or no):_
Industrial waste holding tank present(yes or no):_ C
Non-sanitary waste discharged to the Title 5 system(yes or no):
Water meter readings,if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information:
Was system pumped as part of the inspection(yes or no):�C3
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 maintena
obtainednce contract(to be
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:
.SvST�m 3'nS�IIa�J I1] l�1' ,'��
Were sewage odors detected when arriving at the site(yes or no):&2
Page 7 of'11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
(� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: _ o m
14
Owner: o 'K
.Date of Inspection: I I "f a 10
BUILDING SEWER(locate on site plan)
Depth below grade: 1q;"N
Materials of construction: cast iron K_40 PVC_other(explain):
Distance from private 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:
Material of construction: concrete_metal_fiberglass_polyethylene
other(explain) -
If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):—(attach a copy of
certificate)
Dimensions: G,
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle: �,6''
Scum thickness: _
Distance from top of scum to top of outlet tee or baffle: till
Distance from.bottom of scum to bottom of outlet tee or baffle: '� _
How were dimensions determined: ^ '
rgapjr-
Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.):
Q_y-n p ec/ d e-r y ii P nc
GREASE TRAP:_(locate on site plan)
Depth below grade:_
Material of construction:_concrete_metal fiberglass. polyethylene_other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels
as related to outlet invert, evidence of leakage,etc.):
Page 8 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE-VISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 3(,G .iYLt�kil5
Owner' ..
Date of Inspection:
TIGHT or HOLDING TANK: n 4 (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade
Material of construction: concrete metal fiberglass_polyethylene other
(explain):
Dimensions: -
Capacity: gallons
Design Flow: gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping: '
Comments(condition of alarm and float switches,etc.):
i 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.):
PUMP CHAMBER: (locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no):
Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.):.
' Page 9 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
/ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
�l PART C
SYSTEM INFORMATION(continued)
Property Addresv.1&q jM,'iGn,_j 15 c;3cay
-
Owner: , I�ea� P��xzTNt
Date of Inspection: )) J h
SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required)
If SAS not located explain why:
Type
leaching pits,number:_
)6p— 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.):
e,I,a m b e ion R bQQj only o� �,Jc,+eC` r+�-�'mC32 �nS o��fi�c�fla
141,e r `
CESSPOOLS:AJ&(cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration:
Depth—top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction.
Indication of groundwater inflow(yes or no):
Comments(note condition of soil, signs of hydraulic failure,level.of ponding, condition of vegetation, etc.):
PRIVY: (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
0
Page l0.of l l
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: toc( Q rfi�Ci�eCS 3c1
Owner: Ir-b nS� .
Date of Inspection: 'A 1 l i,aIn Q,
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks.Lo cate all wells within 100 feet.Locate where public water supply enters the build' g.
cu r le-
3 i
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Page 11 of 11
OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SENVAGE DISPOSAL SYSTEM INSPECTION FORM
C PART C
SYSTEM INFORMATION(continued)
Property Address: _%q 11c. i:._�ay
llygnrl�� t11cd .
Owner: P I-a c w9 P Cg�Zl t15x j
Date of Inspection:
ME EXAM
Slope .
Surface water
Check cellar
Shallow wells
Estimated depth to ground water yI feet
Please indicate(check)all methods used to determine the high ground water elevation:
Obtained from system design plans on record-If checked,date of design plan reviewed:
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)
-2�—Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
BLS Maps a C AQfts
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DATE: -8/1 /00----- �. .
PROPERTY ADDRESS;._;.__----------------
369 Mitchells Wad______-
Hyannis, Ma
on the above date, I Inspected the septic system at the above address,
This system consists of the following:
1 . 2-cesspools 1 -6X4 1 -6X8
r
Based on my Inspection, I certify the following conditions;
2. This is not a title five septic system.
3. This is a sewage system.
4:-The- sewage system is in- hydrau-lic`falure.- -
5� A new Title Five Septic_System._should_be_installed.n
6.Pumped aewage system at time of inspection waste
& waste water was above the invert pipes of
both cesspools. SIG NATURE:
N a m e:_,L a,-A�s.4 mkv-r- )J-j------ 7
Company: Joai_vh_P __HacomDer_b Son , Inc .
Address;_ Box_66_
Centerville !- Nar-02632-006.6
Phonec___508_775_3398_____--
THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY
JOSEPH P, MACOMBER & SON, INC.
Tsnks•C�sspools•L4ichflI'ds
Pumped r. Instilled
Town sswsr Connsotlons
P.O. Box 6�75.3J38e�77, MA 02692-0066
RECEIVED
A I.J 0 2000
TOWN OF BARNS-FABLE
HEALTH DEPT.
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE WINTER STREET, BOSTON MA 02108 (617) 292.6600
TRUDY COKE
Secr+tary
ARGEO PAUL CELLUCCI DAVM B. STRUHS
Governor SUBSURFACE
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION Estate of Gladstone C611:,y ore
Property Addr,,,: 369 Mitchells Way NameofQkr[?er Arlene Woodruff
Hyannis, Ma Address of Owr►.r• n Apt 4A
Date of hspec"m: New York, N.Y 10025
�
Name of p.ctor: ( Joseph P. Macomber Jr..
I am a DEP approved system 414pec10r pursuant to Section 16.340 of Thie 5(310 CMR 15.000)
Company Nana: Jose h P. Macomber & Son Inc.
re4akrVAddress: Ox bb , Centeryille—, Ma, •2632-0066
T.aapfiw>.Ntrnber — —
CERTIFICATION STATEM
I certity 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 Lispectlon. The Inspection was performed based on my training and experience In the proper function and
maintenance of on-site sewage disposal systems. The system:
_ Passes
_ Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
r"" Feils �.� �
Inspector's Siflnsture: '' Dom: _
The System Inspector s II submit a copy of this Inspection report to the Approving Authority(Board of Health or DEP)whNn thirty (30) days of
completing this Inspection. It the system Is a shared system or has a design flow of 10,000 gpd or greater,the Inspector and the system owner
shell submit the report to the appropriate reglonal office of the Department oMYtvironmemil Protection. The original should'be sent toV*
system owner and copies sent to the buyer, If,applicabie, and the approving authority.
NOTES AND COMMENTS
revised 9/2/98 Page iorii
Printed on R"Ied paper
SUBSURFACZ SEWAGE DISPOSAL SYSTE 64 WSP£CTION FOFUA
PART A •
CERTlFtCAMN (00ertin4040
r�roo«tY AdCreaa: 369 Mitchells Way, Hyannis
OwTMr Estate of Gladstone Collymore
D u of t-pects0n: 8/1 /0 0
lk3r*CTtON SUs.t!•IANY: Ch r-k A. B, C, or P,
A. SYSTDA PASSES:
I}haw not pound any Information which Indlwt##that any of the 1aUure oontiJdona described In 310 CMR 16.303 exist. Any faeces
criuris not ovsJuoted sit Ind)catkd below.
CO4lMOM:
B. SYSTDA CONDfTMOKXUY PASSES: .. `
—AIL One a more system compononu a.#described In the 'Cortdltiortal Pea#'sootlon Mod to be replaced or rspaLed. Tha system, upc
cornoodon of the replacement w ropalr,u approved by the Board of Health, wW pus,
IndJcote.yes,no, or not determined(Y. N, or NO). Describe baaJs of doterni4wdon In all Instance#. If 'not doterminod', explain why rwt.
1LjWk_ The sepdc tank Is metal, urJess the owner or oparaw haws provided the system inspector whh a copy of a C-Of"cete of
CompUance (anached)IndJcedng that the tank wawa Uutaod wlthln twenty(20) years prior to the data of the Inspecowt:
the sepdc tank, whether or not metal, Is crooked, svuawraily unsound, shows subotandaJ InNuadon or exNvodon, w u
(allure is Imminent. The #ystom wW pass Irupeodon It the oxlsdng espdo tank Is replaced whh a comOytng peptic tans a
approved by the Board of Health.
41e&i Sewage backup or breakout or Ngh stado water level observed In the dJ#Vibutlon box Is duo to broken w obatrucud h+pa
of due to a broken, settled or uneven cUsVlbu0on box. The system will pass InapootJon If(with approval of the Board of
Ha alth).
broken pips(s) are replaced
obwvcdon la removed
disvibudon box is levelled or replaced
• The system requked pun%*girme than-four'drnea v"ardus to broYenw Ott; clod pipe(•). The vymm WW-Pcst-•
Inspecdon If(with approval of the Board c4 Health):
broken plpo(s) are roplecid
ob#trucdon Is removed
revised 9/2/98 PsgeIof11
SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECTION FORM �>'
PART A
CERTIFICATION (oor*wod)
Property Addroat: 369 Mitchells Way, Hyannis
OW7NW: Estate of Gladstone Collymore
Dove of`"'°"ts«': 8/1 /0 0
C, FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH'
Conditioner exist which require further evaluation by the Board of Health In order to determine If the system Is fading to protect ttw
public health, safety and the environment,
1) SYSTEM YAU PASS UNLESS BOARD OF HEALTH DETVtMINES W ACCORDANCE WITH 310 CWt 16.303(1)(b)THAT THE SYSTEM
IS NOT FUNCTIONUV0 IN A MANNER WHJCH yAU.PRa ECT THE PUBUC bEALTKAND SAFETY♦ALD THE BCOSOf MEWL
Cesspool or privy Is within 60 lest of surface water
Cesspool or privy Is within 60 last of a bordering vegetated wetland or a sell marsh,
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DET><RJAD ES THAT THE SYSTEM IS
FUNCTIONING W A A4ANNER THAT PROTECTS THE PUBUC HEALTH AND SAFETY AND THE ENViRONMSiT:
The system has a septic tank and loll absorption system (SAS) and the SAS le within 100 hat of a surface water wpply or
tributary to a surface water supply.
t& The system has a *optic tank and soil absorption system and the SAS Is within a Zone I of a pubUc water supply wail.
Ag The system has a septic tank and aoll absorption system and the SAS Is within 60 feet of a private water supplY woU.
The system has a septic tank and soll absorption system and the SAS Is less than 100 feet but 60 feet or mwe hom a
private water supply wall, unless a well water analysis for coliform bacteria and volatile organic compounds Indicates u+at u+e
wall Is free hom pollution from that facility and the presence of•mmonle nitrogen and nitrate nitrogen Is •dual to Or lost
than 5 ppm. Method used to determine distance _-4/,# (approximation not valid).'
3) OTHER
This is a
one cess o0 Oi I.
pi packed � n cf nna� �e�,�} ar'e R11 LL1 G.
revised 9/2/98 Page 3of11
SUBSURFACE SEWAGE DISPOSAL A SYSTEM INSPECTION FORM
PART
CERTIFICATION (cortHnuad)
r
propoMAddrs,": 369 Mitchells Way, Hyannis
Owner: Estate of Gladstone Collymore
Dote 014►spac16—: 8/1 /0 0
D. SYSTSA FAILS:
you must Indlcato either 'Yes' or 'No' to each o}the following:
Ing I have data►milneds dthat odab r morw. of he Board Health fail�houldure nbadcontact d to d�t�ons exist as �ntin•IwhatOwillibe n•cossary to corn the failu
determinatio
Yes No oornpononrdoo�to wn ovodoodod or•vWggod SAS-or•eaesrod. .y.-•- - -
Backup of oowage Into faculty-or•+Tat+++t .
Discharge or ponding of effluent to the surface of the ground or surface water,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 eesapool.
Liquid depth In cesspool is less then 6' below Invert or available volume is less than 1/2 day flow.
Required pumping more the 4 times In the last year o due to clogged or obstructed pipets).
Number of times pumped Z.
Any portion of the Soil Absorption System, cesspool or privy Is below the high groundwater elevation.
Any portion of a cesspool or privy Is within 100 feet of a surface water supply or tributary to a surface water supply.
Any portion of a cesspool of,privy Ii-within a Zone I of a public well
Any portion of a cesspool ortprivy is within 60 test of a private water supply wall.
Any portion o1 a cesspool or privy Is less then 100 feet but greater then 6o foot hom a private water wpply wets w"M ^
ty analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis to
acceptable water quell
-coliform bacteria, volatile orgenlo•compounds, ammonia n)trogon•and nitrate nitrogen.
E. LARGE SYSTEM FAILS:
You must Indicate either 'Yes' or 'No' to each of the following:
The following criteria apply to large systems In addition to the criteria above:
The system serves a facility with a design flow of 10,000 gpd or greater(Largo System) and the system Is a significant threat to
e one or more of the following conditions exist:
health and safety and the environment becaus
Yes No � .. _.._— ..
o/ the system Is within 400 fast of a surface drinking water supply
ar is eurlao+-0s +4 �r�►flY
the eyetem lrwitki� 200 feet of•aMl�ut y
sitive ore (Interim Wellhead Protection Area-IWPA)or a mapped Zone It of a p
the system Is located In a nitrogen son
water supply'well)
ot
The owner or operator of any such system shell upgrade the system In accordance with 310 CMR 16.304(2). Please consult the local r
office of the Department for further Inforpstlon.
. Psee 1 of 11
revised 9/2/98
SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECTION FORM
PART i
CHECKLIST
PropeoTY Address: 369 Mitehells Way, Hyannis
own«: Estate of Gladstone Collymore
oeu of Ln4pocti'on: 8/1 /0 0
Check if the following have been done: You must Indicate either 'Yes' or 'No' as to each of the following:
Yes No
Pumping Information was provided by the owner, occupant, or Board of Health.
None of the systemconya+artts ha*J;- a puss%pad►(+oanacJo" ttwo-Wo"4&A4.4 airystam hasba Wgec*I>assgesooi 1
rates during that period. Large volumes of water have not been Introduced Into the system recently or as part of vus
Inspection.
_ As built plans have been obtained and exemined. Note If they are not available with N/A.
_ The facility or dwelling was Inspected for signs of*swags back-up.
The system does not receive non-sanitary or Industrial waste flow.
_ The she was Inspected for signs of breakout.
_ All system components, i4�/
rfcluding the Soil Absorption SysIsm, havi been located on the site.
_V 4,e_ The septic tank manholes were uncovered, opened, and the Interior of the septic tank was Inspected for condition of be
or tees, material of construction, dimensions,depth of liquid, depth of sludge, depth of scum.
The sits and location of the Soil Absorption System onthe site has been determined based on:
Existing Information. For example, Plan st B.O.H.
_ Determined In the field (if any of the failure criteria related to Pan C Is at Issue, approximation of distance is unacceptac
115.302(3)(b)i
The faclAty owttu tend.—ewp=^+■,Jf dldarsat froauawmar).wau?iauldad.with Warm+tiomon sipta;_
SubSurfacs Disposal Systems.
revised 9/2/98 Nile 5of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM I•�
PART C
SYSTEM INFORMATION
PropwtyAd&*": 369 Mitchells Way, Hyannis
OWTW: Estate of Gladstone Collymore
Date of kwpocdon: 8/1 /0 0
FLOW CONDITIONS
RESIDENTIAL:
Design flow:aig.p.d./bedroom.
Number of bedrooms ( •sign): Number of bedrooms(actual):
Total DESIGN Aow /?il
Number of current residence:a
Garbage grinder(yes or no):
Laundry(separate system) (yes or®:_; If yes,sop"au Ins pactlon•require d / RID
Laundry system Inspected t�i or no) 19�� �tty�bb� (�1I Q (T
Seasonal use (yes or no): �[
Water meter readings,If available ((lost two year's usage(gpd): a /
Sump Pump (yes or no): .
Last date of occupancy:
C,OMMERCtAUINDUSTIPILAL:
Type of establishment: AM
Design flow: rl/A ood ( Based on 16.203)
Bells of design flow
Grease trap present: (yes or no)
industrial Waste Molding Tank present: (yes or no)-i9
Non•saMary waste discharged to the Title 6 system: (yes or no)AV
Water motor readings,if available: .GS
Last date of occupancy:
OTHER: (Describe)
Last dote of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and so rce of Informed n:
na u
System pumped as piA�
: (yes or no)
If yes, volume pumpsga o c
Reason for pumping: %L.(� /� eI�/QCGNT
TYP-. YE,[OF SYSTEM
� Septic tank/dlstribution box/soil absorption system
Single cesspool t
Overflow cesspool
Privy
Shared system(yes or no) (if yes, attach previous Inspection records,If any)
I/A Technology tc. Attach copy of up to date operation and maintenance contract
Tight Ta-n9k Copy of DEP Approval
Other
APPROXIJAATE AGE of all components, date Inotallediff known)-and sours ofJwfor"adon: -•-�ltfJf'�it�c S7t�I�i�•/� 7
Sewage odors detected when-arriving at the site: (yes or no) 10
revised 9/2/98 Pegg 6of11
SUBSURFACE:SEWAGE DISPOSAL'SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(contlrwed)
PropwtyAddreas: 369 Mitchells Way, Hyannis
ownw: Estate of Gladstone Collymore
Dieu of 4►apection: 8/1 /0 0
BUILDING SEWER:
(locate on site plan)
Depth below grade:
Material of construct) n: cas Von�40 PVC�th•r (explain)
Distant• fro .'?rivst• water supply well or suction line
Di motor
Comments: (condition of)oints, venting, evidence of feak"c-eitc.) .
Joints appear tight Nn Atr; ainne`o of 11 Q'a
S TAN K: g
tiocate on she plan)
Depth below grade. /L'R
Material of constructlon;AconcreteAm•tolAAFlberglsss VAPolythyl•n•{Aother(explain)
if tank Is metal, list age is.age.conArmed by Certificate of Compliance_ (Yes/No)
Dimensions: AM
Sludge depth: AM _
Distance hom top of sludge to bottom of outlet tee orbsffle-,
Scum thickness: AN _
Distance hom top of scum to top of outlet tee or baffle: Al* ��
Distance hom bottom of scum to bottom of outlet tee or baffle:
Mow dimensions were determined: AIA
Comments:
(recommandation for pumping condition of Inlet and outlet tees or-baffles, depth of liquid lovol in relation to-outlet invert, structuroHntegmy,
v'd• c• of leak, e, etc.) Once _new system is installed • The
�tan`�c should be pumps every 2-3 years-
GREASE TRAP:
notate on ilia plan)
Depth below grad•:
Material of constructlonAAconcretw✓Am•talkAFloerglass4APolyethyl•naAActher(explain)
AjA
Dimensions: AIA
Scum thickness:
Distance from top of scum to top of outlet tee or bafffe:_A&
Distance hom bottom of.AA
�
cum to bottom of outlet tee or.batle:,
K!/
Date of last pumping:
Comments:
(recommendation for pumping, condition of-inlet and outlet tees or baffles, depth of Qquid level In relation to outlet Invert, atrvcturai Integrity.
evidence of leakage, etc.)
Grease -trap is not present
revised 9/2/98 Page 7of11
SU93UFLFAC-9 SEWAGE DISPOSAL SYSTE)A kNSPECTVON FOPJA
PART C
SYSTEM IN1=0RbtAT10N(toad—ed)
369 Mitchells Way, Hyannis
Owrw; Estate of Gladstone Collymore
°"' of lr,apectsont 8/1 /0 0
n0KT OR MOLDING TANK-A&A(Tank nwet be pumped prior to, or at time of. Inspection)
locals on site plan)
Depth below grids:4
Metsrial of consuuction:,Jn concrete matalltAFlbsiplaaV Polysthylansa/Rother(expl►ln)
AN—
AIA
pimen►lour.
CIpICItY: gallons
Design Row: g►Ilona/day
Alarm present }�
Alarm level: Alarm lit�working order:Yes�� Nod(/Q
Dote of previous pumping: A
Commanw
Icondloon of Inlst tee, condltlon of alarm and float switches, etc.)
—or riolcling ranlc i c nn+- nrizsont.
WTR18UT10N 1110X:42"
Itocets on site plan)
Depth of liquld level above outlet Inven: AM
Comments: —
(nose if level and distrlbutlon Is equal, o Adenoe of solids carrvover, rAdence of leakage Into or out of box, etc.)
Distribution hnx i c n^ - p—oseRtz
PUMP CM M5ER:A' �
(IOCI4e on site Fran)
Pumps In working o(der.(Yes or No)
Alarms In wofking order IYeI or Nc):
ff
Comments:
Incts condition of pump chamber. condition of pumps and appurtenances, etc.)
r is no tares
Pe fe l of l l i
revised 9/2/98
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C '
SYSTEM INFORMATION (condnued)
PropwtyAd& s: 369 Mitchells Way, Hyannis
own«: Estate of Gladstone Collymore
Dot,of Muapectlon: 8/1 /0 0
SOIL ABSORPTION SYSTEM(SAS):,
(locate on site plan, If possible: excavation not required, location may be approximated by nomintruslve methods)
1f not located, explain:
Type:
leaching pits, number:—L
lesching chambers, number:-
leaching gallerles, number:
leaching trenches, number, length:
leaching flelds, number, dimensions:
overflow cesspool, number:
Alternative system:
Name of Technology:
Comments:
ilote condition of oil, signs of hydraulic failure, level o}po n , dam il, con tlo of veastation, etc.)
o�my Inc t g bone fine e�spooa� an� feacninq pit are in
ptrraa -r�'f_�3ULZ 5 e & waste water
o tne cess o0
: -
d be installed
cEssPOO
(locate on site plan)
Number and configuration: 1 ��
Depth top of liquid to Inlat In M: Q'ITr 1W,edr7
Depth of solids layer.
Depth of scum layer.
Dimensions of cesspool:
Materials of construction: , .
Indication of groundwater: Aoo
inflow (cesspool must be pumped as part of Inspection)
Inflow & overflow 1 earhi ng }zit wQrG ,,e be#1=pumped
Wafer i ntrttci ran was net pE'esen .
Commenu:
(note condition of soil, signs of hydraulic failure, level of ponding,condition of.vegetatlon, etc.)
Same as ahn,TQ
PRM'r�t:
(locate on site plan)
Materials of constructon: /VfIQ Dimenalons: N4
Depth of sollds:,_4ZA
Commenu:
(note condition o1 soil, signs of hydraulic }allure, level of ponding, condition of vegetation;etc.)
rivy is not QrPsent- _
revised 9/2/98 Ps lit 9orIi
3V93VF%FACE iEWAGE OLSW�CSYiTVA V4*PCCTON FOP-U
F,
ea,..►: h lls • Wa A 369 Mitc e Y, Hyannis
oq•Rr
0~: Estate of Gladstone Collymore
8/1./0 0
SKPTCH OF SEWAGE DLSPOSAL SYSTEM:
Include dea to ►t legal two pormanont referent•I&ndmuks or bonchmuks
locate Nl walls wlthln 100 (Locate whore public wstsr supply comes Into house)
�ovsc �3
rl/
r
r
P1�1 It1 Or II
revised 9/2/98
SUBSURFACE SEWAGE D13PQ3AL SYSTEM WSPECTION FORM
PART C
SYSTDd WFORMAT10N (con*wwoed)
Progarty Addra+a: 369 Mitchells Way, Hyannis
Owns(: Estate of Gladstone Collymore
Dau of InapectSon: 8/1 /0 0
MRCS Report name
SoU Type_
Typical depth to groundwatsr
USOS Date webslts visited
Observedon WeUs checked
Oroundwster depth: Shallow Moderate Deep
SITE EXAM Slops
Surface water
Check caller
Shallow wells
Estimated Depth to Oroundwate(,r��Feet
Plesse Indicate all the methods used to decermJne High Groundwater Elevation:
_ Owalned hom Design Plans on record
50.,'.,r
beved Site (Abutdng property, baervetlon hole, basement ►ump ate.)
mine0 from local conditions
Chocked with local Board of health
Checked FEMA Maps
Chocked pumping records
hocked local excavators, Installers
Used USOS Data
Describe how You established the High Groundwater Elevedon. (byCEJ be completed)
Used water contours Map
Gahret & Miller Model
12/16/94
z •
revised 9/2/98
refit llofll
I'OWN OF BARNSTABLE BOARD OF HEALTH
SUI)SURFACR SEWAOF 1)13r'OSAL .SYSTEM INS['BCTION FORM - PART D •- CERTIFICATION
-•�.��..,.....-�.n �.�rnwn��w•��r�ww►.w'R���o�+.� -TYw�w�,•+�•�w'� AIMLY-
PROPERTY INSPECTED
STREET ADDRESS 369 Mitchells Way, Hyannis
ASSESSORS HAP , BLOCK AND PARCEL I
OWNER' s NAME Estate bf Gladstone Collymore
PART D - CV?r1FICATI0N
NAME OF INSPECTOR —Joseph P. Macomber Jr,
COHPANY NAME Joseph P. Macomber S""Son Inc.
COMPANY ADDRESS Box �6 nterville MA. 02632-0066
itrqqt Tovn or C ty itat• t P
COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX ( )
CmrI FICATION STATEMENT
I certify that I have personally inspected the sewage disposal system nt
this nddress and that the Information reported is true , accurate , and
me of -inspection , The inspection was performed and any
ompleCe as of the ti
upgrade , maintenance , and repair are consistent
regarding il) u g �
recommendations g 8 N
with my training and experience in the proper function and maintenance of on-
site sewage disposal systems
Check one :
System PASSED
The inspection which I have conducted has not found any information
which indicates that the system fails to adequately protect public
IjeA1Lll or, the environment as defined in 310 CMR 16 . 303 , Any failure
criteria not evaluated are as stated in the FAILURE CRITERIA section of
this form ,
�Sys_t_em FAILED*
The inspection which I have con tTcted has found that the system fails to
protecce with
5 , 110tCHRe a
16 , 303 , ndl s a specifically and the rnotedtonnPARToCd-n Title
FAILURE
CRITERIA of this inspection form .
i
or Signature Date �l
Inspector S
P
no copy of this ce tirication must be provided to the OHNER, the BUYER
( where apDlloable ) and the pOARD OY HEALTH. '
• If the inspection FAILED , We owner or"`operator shall upgrade the system
within one year of the date of the inspection , unless allowed or required
otherwise as provided in 3.10 chIR 16 . 306 . partd , doe
' p '
TOWN OF BARNSTABLE ,
LOCATION 34? M`Z'C/�,e LL S u1A Y SEWAGE #A0®D-- F�
VILLAGE 1VA AAl—1 S y- ASSESSOR'S MAP & LOT I C? 013
INSTALLER'S NAME& <.PHONE NO. �J. /[✓L A C 0 M d�eX t- S®�
SEPTIC TANK CAPACITY SbB0
LEACHING FACILITY: (size) �-O0 �'G R4
NOs.OF BEDROOMS 3
BUILDER O)ECO—WgR (i uu(I VV44
PERMIT DATE: 1 I3y '� COMPLIANCE DATE: 41 I 0
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Welland 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 3001cet of leaching facility) Feet
Furnished by
s �
e - �
O
- �
.fir � ���
� �
� i^�
i
. �� � �_ ..
i
� / ���
/ � .
f
f = _ a _� �
� �
�ry
� � .
,.
. ,
r '.
TOWN OF BARNSTABLE
,�-•Tt 369 Mitchells Way W
`LC..�•.GN v SEWAGE #
VILLAGE Hyannis ASSESSOR'S MAP &LOT
_SNSPECTED BY: &PHONENOJ-P.Ma�comber & Son, Inc 775-3338
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) 2-cesspools (size)
NO.OF BEDROOMS
OWNEREstate of Gladstone Collymore
PERMIT DATE: COMPLIANCE DATE:
Separation Distance Between the:
cilit
Feet
Maximum Adjusted Groundwater Table to the Bottom of Leaching Fay
Private Water Supply Well and Leaching Facility (If any wells ezist�
on site or within 200 feet of leaching facility) 10 Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
,7
f �
1 /
4�
t
Fee $ 5 0.0 0
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE., MASSACHUSETTS
01ppYication for Mtgooar bpotem Construction Permit
Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) XX Complete System ❑Individual Components
Location Address or Lot No. 369 M i t c h e l l s Way Owner's Name,Address and Tel.No.
McAR94144APS• Arlene Woodruff
369 Mitchells Way Hyannis,Mass.026 1
Installer's Name,Address,and Tel.No. 5 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.No. 5 0 8—7 7 5—3 3 3 8
J.P.Macomber & Son Inc. J.P.Macomber & Son Inc.
Box 66 Centerville,Mass.02632 Box 66 Centerville,Mass.02632.
Type of Building:
DwellingXXXNo.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 3 X 1 1 0=3 3 0 gallons per day. Calculated daily flow 355 gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank 1 500 + Box Type of S.A.S. 2-500 chambers
Description of Soil Loamy sand to medium sand to. coarse sand.
Nature of Repairs or Alterations(Answer when applicable), Omitting cesspools. Installing
1 -1500 gallon tank, 1 —Distribution box and two 500 gallon leaching
chambers packed in 4 ' of 1 '—z" stone with a pea stone cap.
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 be*e,,I,,yis B ar f Health.
Signe ` Date 1 0/3 0/0 0
Application Approved by Date
Application Disapprove g reasons
Permit No. Date IssuedUlu
TOWN OF BARNSTABLE
LOCATION U? %7C c'LG S �� SEWAGE # x40tJ— 9
VILLAGE f-V Nei/!S ASSESSOR'S MAP & LOT Z
INSTALLER'S.NAME&PHONE NO -120 M C Q_M d CCt S 4,Al
SEPTIC TANK CAPACITY �B�Q
I LEACHING FACILITY: (type).��/e1GSLrl CE/ �l��:4� (size) .S 4d G.44
NO.OF BEDROOMS 3
BUILDER OF\��� ���.� ;�v'V ,
PERMITDATE: COMPLIANCE DATE: I Z 0 Z-Z�"
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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�`_•i Fee $� 5rJ.00
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: .
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
ZIpplication for �Diopoml *potem Construction Permit
Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) X®Complete System ❑Individual Components
Location Address or Lot No. 369 M i t eh e l l s Way Owner's Name,Address and Tel.No.
Arlene Woodruff
as'eao n pNocliss.� 9/ 0/3 369 Mitchells Way Hyannis,Mass.026 1
Installer's Name,Address,and Tel.No. 5 0 8-7 7 5—3 3 3 8 Designer's Name,Address and Tel.No. 5 0 8—7 7 5—3 3 3 8
J.P.Macomber & Son Inc. J.P.Macomber & Son Inc.
Box 66 Centerville,Mass.02632 Box 66 Centerville,Mass.02632
Type of Building:
DwellingXXXNo.of Bedrooms S Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 3`X 1 10=3 3 0 gallons per day. Calculated daily flow 355 gallons.
Plan Date, ` Number of sheets Revision Date
Title
Size of Septic Tank 1 500 + Box Type of S.A.S. 2-500 ehanbers
Description of Soil Loamy sand to medium sand t§Ocparse sand.
Nature of Repairs or Alterations(Answer when applicable) Omitting cesspools. Installing
1+=1500 gallon tank, l -Distribution box and two 500 gallon leaching
chambers packed in 4 ' of 11" stone with a pea stone cap.
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*issed, his B ardr f Health.
Sig lv n Date10/30/00
Application Approved b ?/t t Date
�, Applicattop� isapproveng reasons y
.
Permit No. Date Issued U
fi
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
s THIS I3 :' CERTIFY,that the On-site Sewage Disposal System Constructed'( )Repaired(! )Upgraded(XX)
J.P.Macomber & Son Inc
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Abandoned O b off .
369 M 1 iAlls Way Hyannis,Mass.' as n constructed in accordance
with the provisions o41 t1 5 and the for Disposal System Construction Permit No dated /O-3 0— L*
;) Installer J, Manber & Son Inc. Designer .J.P.NTaeom J& Son Inc.
'' The issuantoftithis pe' shall not be construed as a guarantee that the sys"teiri=wi11 function s desrg ed.
&' Date Inspector
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Fee$ 50.00
t THE COMMONWEALTH OF MASSACHUS ,r+. S
�y st
PUBLICtHEALTH DIVISION- BARNSTABLE s MASSACHUSETTS"
¢. ' ,65ar*p.5tern �on5tructton erutit
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t " ` Permission is, reby granted to Co tritct'(' ;)R'epair( �)�,Upgradel(X Abandon
System 6cat d t} .`, Mit!tballs Way. Hyanni _f.i+lass.
y�rF$ ��7�� A�`"
a
1' 3aniis des�rlbed in the above A��ltcaton for Disposal System Construction Permit.The;appltc�antxrecognizes his/her duty to
comply w th T tle S nd the followtng;lo�cal'provtstons or special conditions. , �.x _
W +r �,
1 &ideWConstructton must;be completed within three,years of the date of thi permit. '
4��+• ...zw ..• i '`jai .
10 z w Approved by
' .: Fir r'�`" ;� '...+� a + �� A e •. 'r`e�'r"ems,, ,a o ,lA V 'bk
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NOTICE: This Form Is To Be Used For the Repair Of Failed
Septic Systems Only.
CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL
WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS)
Joseph P.Macomber Jr., hereby certify that the application for disposal works
construction permit signed by me dated 10130100 concerning the
property located at 369 Mitchells Way Hyannis,Mass. meets all of the
following criteria:
• The failed system is connected to a residential dwelling only. There are no commercial or business
uses associated with the dwelling.
• The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch.
• There are no wetlands within 100 feet of the proposed septic system
• There are no private wells within 150 feet of the proposed sepdc system
• There is no increase in flow and/or change in use proposed
• There are no variances requested or needed.
• The bottom of the proposed leaching facility will not located less than five feet above the
maximum adjusted groundwater table elevation. (Adjust the groundwater table using the Frimptor
method when applicable)
• if the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed
leaching facility will m be located less than fourteen(14) feet above the maximum adjusted
groundwater table elevation,
Please complete the following:
A) Top of.Ground Surface Elevadon(cuing GIS information)
B) G.W. Elevadon 0 +the MAX. High G.W. Adjustment.7, _ 1
DIFFERENCE BETWEEN A and B '
SIGNED : DATE: 1 0/30/00
(Sketch posed plan of system on back).
Q:health folder.cm
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TOWN OF BARNSTABLE
L(k'All ON Alec( �1�G�ie11_�- t�ea U SEWAGE # y�
?f,1.AGf. LtYLt17.`iQ ASSESSOR'S MAP & LOT�-9 I V 1
hrdFTALLER-S NAME&PHONE NO. x�,�9� in I—_)
-:SEPTIC TANK CAPACITY I a�®C� (�i�D
I EACHING FACILITY: (type) 9,— 0,Inc,1M b.0 J:s (size) Gtq 1.
NO. OF BEDROOMS
BUILDER OR OWNER [ki'Q-na cd
PERMTTDATE: _COMPLIANCE DATE:
Separation Distance Between the:
Maximum adjusted Groundwater Table to the Bottom ofLeaching 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
withir. 300 feet of leaching facility) Feet
Furnished by
p
CP
1