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HomeMy WebLinkAbout0438 OLD TOWN ROAD - Health ..� �tr♦ d" ,DA x. � �i °I I u o n Ik u II� o No. /60 � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01ppItration for 33tgoAY �§p5tem Con.5truction Permit ,Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) l_1 Complete System ❑Individual Components Location Address or Lot No ®e����� 0 _ Owner's of S/ Na Address,an Tel.No. Assessor's Map/Parcel e —�" --4 � Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. o Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building loG"le&_Ir6 No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) ® gpd Design flow provided gpd Plan Date �'� ` O Number of sheets J Revision Date Title _ Size of Septic Tank o0 Type of S.A.S. Description of Soil 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 Certificate of Compliance has been issued by this Boa H lth. � o Sig d !� Date / Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. r Date Issued 1'',p' ':' No.. C�' CQ '— 40 .F 1 Fee �©O THE COMMONWEALTH OF MASSl,HUSETTS Entered in computer: PUBLIC HEALTH DI, I.�SIOON - TOWN OF BARNSTABLE, MASSACHUSETTS Yes y Zipplication for TkOpozal �&pgtem Construction Permit Application for a Permit to Construct O Repair O Upgrade O Abandon rCoplete System ❑Individual Components Location Address or Lot NoZ%r� 6" 4 � N OP'O• fJ� Owner's Name,Address,and Tel.No. Wye a Assessor's Map/Parcel T OFlp Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �J � o7v .7 Type of Building: ��. Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( ) h Other Type of Building !mil"�f' No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) -1 gpd Design flow provided gpd Plan Date 9 Number of sheets Revision Date _ Title k- Size of Septic Tank �'S"G►�J Type of S.A.S. �' � 5 ��X J Description of Soil _ /r 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 Certificate of Compliance has been issued by this Boa &alth, t. Sig ed Date o Application Approved by Date 7 t Application Disapproved by: Date for the following reasons - Permit No. � " G Date Issued o'er- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance •d THIS IS TO CERTIFY,that the On; ite Sewage Disp s 1-System Constructed ( � Repaired ( � ) Upgraded ( ) Abandoned( )by � 'V7 at 5::e 3 4> c!.-:, C'd la of, ,o✓ 400r'd has been constructed n accordance 6�/ with the provisions of Title 5 and the for Disposal System Construction Permit No. oD"��y`��� — dated b Installer �d;_4!0P1d_1 Designer #bedrooms :3 Approved design flow .3 =�Q gpd The issuance of this permit shall no be construed as a guarantee that the system - Date �d/,- !/ Inspector . r - —---- No. c-ao CO _ cl O 9 Fee l d V THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Oigogar �tent Construction Permit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) System located at y a ZP o C G Wp'o . -0y 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: Construct on mustpe completed within three years of the date(by,� his p f Date ��a 1 ( Approved _ i Town, of Barnstable Reguintory Services Thomas F.6eiler,Director { } Public Health Division Thomas McKean,Director .200 Math 8b'eet.Hymnh+MA 02601 Fax: 508-790-6304 pee:-9ds.$f�2�t644 . f~ Dater& Foxm Date: Dyer: l Address: . Address: �/ •�c'�3� 6�" " on ad-'�d � L� U was ismod a permit to install a kdate) Ins or �� O O �•w-,/?6 '�`� based an a design drawn by septic systant - 8� /'14,erfify septic systeM refEMced above was kw lied substwi Tally accordwg to to dear vv ieh may include minor appro Pled uhaagcs such f1atual relocation of the diatribo��box and/or septic tank. I y OW the septic hued above was installed with major dhan es (i.e. greater&M 10, lateral r nation of the SAS yr any v�l ielncation of any compWMt of gm septic eyMM)but in with Su tc&Local Regulat►oos. Plan foridon or Culaed as-buM by"per to fallow. a"Q � MABoN M 8 f� 9 No.1Q68 o g� T TOO jNiWerps S�gnsture) Da *mes Stamp Here ABLE C TS DIYjSION. CATS OF NCVj pj B gy C TH DIVISION. Q.HeaIVd3eOdI)edper CeaMcadun Foam T'd tb0€90GLeosT:01 :WMJd dZT:bO LO02-22-83d i. ,_-..:Town of Barnstable P# lima Depart of Regulatory services s Public Health Division Date a� 200 Main Street,Hyannis MA 02601 D M►�A Date Scheduled Time Fee Pd. `7 Soil Suitability AW4LQss 'ssment for Sewage Disposal Performed By: Witnessed By r LOCATION& GENERAL INFORMATION Location Address L/ 'z¢ /N��� � /� Owner's Namee� ]+�/ D LJ i�Q' Address Assessor's Map/Parcel: s;;I, /�� Y Engineer's Name y` NEW CONSTRUCTION REPAIR Telephone# i t } Land Use ��ac'Jr'�'�l�'\ � Slopes(36) � Surface Stones Distances from: Open Water Body ft Possible Wet Area—ft Drinking Water Well ft 1 P Drainage Way ft 'Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands�n proximity to holes) a • Parent material(geologic)�v"� "� Depth to Bedrock "`� Depth to Groundwater. Standing Water in Hole: W . . Weeping from Pit PpCe Estimated Seasonal High Groundwater Q►4 � r l r DE NATION FOR SEASONAL HIGH-WATER TABLE- Method Used: Depth Observed standing in obs.hole: _ __�in, Depth to soil mottles: v Depth to weeping from,side of obs.hole: in. Groundwater Adjustment " — ft. Index Well# Reading Date: Index Well level Adi.faetor Adj.Oqoandwater level .PERCOLATION TESL' tiet� e Observation I -� Hole# i I 'time at 4" -- ! . Depth of Perc Time at 6"Start Pre-soak Time @ 'Time(V-61 End Pre-soak Rate MinJlnch Site Suitability Assessment., Site Passed Site Failed: Additional Testing Needed(Y/N) . Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100',of wetland,you must first notify the. Barnstable Conservation'Division at least one(1)week prior to beginning. Q:\.SEPTICVERCFORM.DOC ` 1 • ` DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Qther. Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency, Gravel) 71 0 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,% -7% 6. DEEP OBSERVATION HOLE LOG Hole# o Depth from Soil Horizon Soil Texture Soil Color Soil Other h• Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Grave t,. s . y . DEEP OBSERVATION HOLE LOG Hole* Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency. Flood Insurance Rate Man: • ': ,Above 500 year flood boundary No_ es Within 500 year boundary Ni Yes Within 100 year flood boundary No,�Yes ' Depth of Naturally Occurrina Pervious Material Does at least four feet of naturally occurring perviou ma nal exist in all areas'observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally'occurring pervi us material? q� Certification I certify that on �D (date)I have passed the soil evaluator examination approved by the Departmt nvironnIntal Protection and that the above analysis was performed by me consistent with . the required training,exp se and xp rience described in 310 CMR 15.01 . Signature Date 2-- Q:\SEPTI0PERC12ORM.130C Ln m Il4[�+1Ls�i1 ,a � I D' Postage $ y 0 CertMed Fee &al C3 Return Receipt Fee POSM O (Endorsement Required) ere O Restricted Delivery,Fee � (Endorsement Required) O 'q Total Postage&Fees $ •G �` t11 p Sent To O [` SYieet,Apt. o. o.; 4- - T ....... .. . .. .........•---- or PO Box N------Y-D�-- +.c�1�7? . t ---------- City State.Z/P+4 J `_ ......... -- -- - Certified Mail Provides: (e—ey)Zooz eunr'008E WJoj sd n A mailing receipt e A unique identifier for your mailpiece a A record of delivery kept by the Postal Service for two years Important Reminders: o Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®. o Certified Mail is not available for any class of international mail. o NO INSURANCE,COVERAGE IS PROVIDED with Certified Mail. For valuables;please consider,lnsured or Registered Mail. e Fora additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return'Receipt seance,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.'Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,+a USPSe postmark on your Certified Mail receipt is required. 4- a For an'additlofial fee, delivery may be restricted to the addressee or addressee's authorized aggent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". o If a postmark on the Certified'Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. Internet access to delivery information is not available an mail addressed to APOs and FPOs. COMPLETE THIS SECTION ON rZOVERY ■ Complete items 1,2,and 3.Also complete A. Si a e t✓ item 4 if Restricted Delivery is desired. X ` 0 Agent ■ Print your name and address on the reverse ❑ dressee II so that we can return the card to.you.p t- B. Received by(Printed Name I JC.,�,�el.very■ Attach this card to.the'back of the mailpiece, Py ) I or on the front if space permits. i D. Is delivery address different from item 1? ❑Yes' f 1. Article Addres sed to:1 h fY If YES,enter delivery address belo Uj% olcrn ICY 3. Service Type � �/J "77 ❑Certified Mail ❑Express Mail� ///tq 0,21 l�U� ❑ Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number (Trdnsfer from service label) p p 5 1160 0000 0191 11851. S Form 3811,February 2004 Domestic Return Receipt 10 ss-o2-M-1sao UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid LISPS Permit No.G-10 Sender. Please print your name, address, and ZIP+4 In this box � d } I � PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE I 200 MAIN STREET HYANNIS, MASSACHUSETTS 02601 i uu fill t Town of Barnstable F tME Tp� do Regulatory Services Thomas F. Geiler,Director MANS9� 0BM MASS. •�� Public Health Division ATEO MA'S A Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 May 16, 2006 Mr. Peter Sheehy 438 Old Town Road Hyannis, MA 02601 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, Title 5 The septic system owned by you located 438 Old Town Road,Hyannis,MA,was last inspected on May 5th, 2006 by, Sean Jones, a certified septic inspector for the State of Massachusetts. The inspection of your septic system showed that your system has "Failed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: Leach pit was full with solids to cover. You have 2 years from the date of the system failure to bring the system into compliance. If there are any questions about this reminder,please feel free to contact the Barnstable Health Department. BARNSTABLE HE TH DEPARTMENT o as A. McKean, R.S., C.H.O. Agent of the Board of Health COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 - -- OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A - CERTIFICATION Property Address: 438 Old Town Road Hyannis r Owner's Name: peter Sheehy (Byers) -+ Af _ Owners Address: 03J3 of Z 'rower, 2Q. 71 . Date of Inspection: 5�s f®, T'I Name of Inspector:(please print)_Sea,, Company Name: William E. Robinson Septic Service Mailing Address: P O Box 1089 _ > Centerville, MA - r� Telephone Number: (5081 775-8776 CERTIFICATION STATEMENT 1 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 15340 of Title S(310 CMR 15.000). The system: Passes Soliditionally Passes eeds Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: 5 doc56 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 seat to the system owner and copies sent to the buyer,if applicable,and the approYing authority. ' sySfc� Ter1t /r1 sPeclv.+ bCrarX PrLcas* lfkC� Q/* overFla,. Notes and Comments .,1 _ ""This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection dots not address how the system will perform in the future under'the same or different conditions of use. i „ Title 5 Inspection Form 6/15I2000 page `% I 4�"4'.•�i.,. .. .. - .. - / .. .. - �- ,.... ___.. ._.`T,....... .rat,.. _�.`tC _ ....... ���_., ..., ..,_-....._ . Page 2 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 438 Old Town Road Hvanni_ Owner: Peter Sbee ` Dale of lnspectlons Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: A/�A 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: N /A One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain. The septic tank is metal and over 20 years old•or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exftltration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. •A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 tires a year due to broken or obsat-eted pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is rt:movcd ND explain: •Page 3.of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Prop"Address: 438 Old Town Road Hyannis Owner: Peter _S .ee Hy Date of Inspection: S C. Further Evaluation is Required by the Board of Health: IV IA 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. I. 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(hat 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 front 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 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) FropertyAddress: 438 Old Town Road Hyannis Owner: Peter Sheehy Dale of Inspection: S o6 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yell/ 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 feet front a private Kato 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(lie presence of ammonia nitrogen and nitrate nitrogen.is equal to or less than S ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this forma Yes/No The system fails. I have determined that one or more o the above( ) ) f ho a faihue 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: ,Nl iN To be considered a large system the system must serve a facility with a design (lost•of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of lice following: (lie 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—I WPA)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 crmsidered a significant threat,or answered "yes'in Section D above the large system has failed.The awry or operator of arty large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CIv1R 15.304.The system owner should contact the appropriate regional office of the Department. 4 Page 5 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 438 Old Town Road , _Hyannis Owner: Peter Sheehy Date of Inspection: Ub Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes ✓ .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: 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 CUR 15.302(3)(b)J 5 R Page 6 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 438 Old Town Road Hyannis Owner: Peter Sheeh _ Date of Inspection: 0 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):. 3 Number of bedrooms(actual): -3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x N of bedrooms): 330 bP►D Number of current residents: 3 Does residence have a garbage grinder(yes or no): A!o Is laundry on a separate sewage system(yes or no):,,V� [if yes separate inspection required] Laundry system inspected(yes or no): � Seasonal use:(yes or no): IVO Water meter readings,if available(last 2 years usage(gpd)): 2005 — 52,000 Sump pump(yes or no):_lVo 2004 — 44,000 Last date of occupancy: CurrtAf- COMMERCIAIANDUSTRIAL /v /R . 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):_ 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):n/o If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM Septic tank,distribution box,soil absorption system _7 mgle cesspool ✓Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Altemative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank Attach a copy of the DEP approval —Other(describe): Approximate age of all components,date installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no):/v' 6 4. TOWN OF BARNSTABLE LOCATION :5�-J eR o�'a T�k'"���' SEWAGE# -VILLAGE ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY ./d`oo &'Ae. LEACHING FACILITY:(type) (size)��x3 s—X� NO. OF BEDROOMS 3 OWNER PERMIT DATE: 9' 6 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 ���`► L��oE'!i�" A o • �� drie"Ole 4ers . - Odd�wr 1TJ- }ya nr% S } 02601 ?eQ rig-3S3 Diced : &-11-79 CarnPIet d: e 9 •a Page 7 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SE\VAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 438 Old Town' Road Hyannis Owner: Peter Sheehy Date of Inspection: S,SfT ro BUILDING SEWEII(locate on site plan) Dcp111 below grade: a Materials of construction:_cast iron _40 I'VC vllo"dicr(explaut): or'a".1-Joy-, Distance front private water supply well or suction lute: Comments(on condition ufjuutts,venting,cvidcncc of leakage,etc.): SEPTIC TANK:Y1A`(locate on site plan) Depth below grade: Material of construction:_cuncrctc_metal—fiberglass pol)-catylene _othcr(cxplain) If tank is metal list age:_ Is age conftrnted•by a Certificate of Compliance (yes or nu):—(attach a copy of certificate) Dimensions: Sludge depth: Distance Gom top of sludge to buitom of outlet Ice or bafllc: Scun1 thickness: Distance from top of scum to top of outlet Ice or baflle: Distance from bottom of scum to bottom of outlet Ice or battle: lo%v were dimensions determined: Comments(on pumping recommendations,inlet and outlet tee or ba file.eonditicn,st-clwal integrit),,liquid levels as related to outlet invert,evidence of leakage,ctc.): GIIEASE TRA1':_(locate on site Man) Dcpth below grade:— Material of eonstructiun:—cuncrctc m —etal fibetglass polyelh)•Iene _other (explain): -. _ Dimensions: Scum 1110ulcss: Distance Gom lop of stunt to top of outicl(cc or baffle:_ Distance from bottom of scum to bottom of outlet ice or baMc: Date of last pumping: Conunents(on pumping recommendations, inlet and outlet ice ur bank conditio:t, structural integrity,liquid Ic\cls as related to outlet invert,ct•idcucc of leakage,ctc.): 7 Page 8 of OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSNIE'N'I'S SUBSUIVACE SE\VAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 438 Old Town Road H�annjs Owner Date of Inspcctloo: S— TIGIIT or I[OLD ING TANK:LN^(tank must be pumped at tune of inspection)(locate on site plan) Depth below grade; Material of construction:—concrete_ntelal_fiberglass_pulyellrylene olber(explau)): Dimensions: Capacity; Calluns Design Flow; gallonstday Alarm present(yes or no): Alarm level: Alarm in working order(ycs or no): Date of last pumping: Comments(condition of alarm and float switches,ctc.): DISTIUUUTION BOX:���if present must be opcncd)(locatc on site plan) Depth of liquid level above outlet invert: Conunents(note if box is level and distribution to outlets equal,an)-evidence of solids carr)•over, any evidence of leakage into or out of box,ctc.): ) f PUAIP CIIAMBLH _(locate on site plan) f I Pumps in working order(yes or no):_ ! Alarms in working order(yes or no): _ l t Comments(note condition of litany chamber,cunditivn of pumps and appurtenances, cic.): t t F t i ` Page 9 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFOR MATION(continued) . Property Address: 438 Old Town Road Hyannis Owner h Date of Inspection: 5 6 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type J leaching pits,number: 1 leaching chambers,number. leaching galleries,number:. leaching trenches,number, length: leaching Gelds,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.): rns Pee h Q. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration:.. - .-� Depth—top of liquid to inlet invert: 3" Depth of solids layer: Depth of scum layer: — Dimensions of cesspool: — Materials of construction: f3/; Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): 5"4( Lni4s �. �. I.•-a�.r 1<vcl IN�.3 t,& of+4 4- PPc t�Jrlll— p,0* r®„mil l o 1cGc1. ,oi¢. PRIVY:AA(loca(c 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.): 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: 438 Old Town Road Hyannis Owner: Peter Sheehy Date of Inspection: 7o SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchrharks.Locate all wells within 100 feet.Locate where public water supply enters the building. i3ACk� of Hoose Q a CQSSPov! Pr- L.eu�� Pik 10 Page 11 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 438 Old Town Road Hyannis Owner. Peter Sheeh Dale of Inspection: p SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet _L 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) Accessed USGS database-explain: You must describe how you established the high ground water elevation: 5N 6� nc l we w4j A,n� c� Jr.'M M c/ I1 a*� F1cs5.�.00_......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....... ...............Town...OF......Barns.t.able.....----------------........................------ Apptiration for Eliipos al Works Tontrnrtion umit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: 4.3.a...old-..Tnwn....$d_•-t...Hyannis.......................... ...........•--•---.......---------••---•--•------------. Location.Address o Lot No. __Byr ..-- •---.--.---•-•-------------•--------- .... .....Old...Town Re a.�...H-�ann i s._............-•-- .. Owner Address a A...° .. _._C SS�?oo-7--- ery ee....------•--------------•--•---•-- -128 _Bishops Terrace: H rannis.-••-------•-. Installer Address Type of Building Size Lot............................Sq. feet a Dwelling—No. of Bedrooms----------------3....._...._.._.._.......Expansion Attic ( ) Garbage Grinder ( ) p., Other—Type of Building ............................ No, of persons........3------.._.-_....._ Showers ( ) — Cafeteria ( ) aOther fixtures ------------------------------------•--•-- ............................................................................................................ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. G4 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth----------- W Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area_.......--..........sq. ft. x Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area.................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) �_q Percolation Test Results Performed by.......................................................................... Date........................................ Test-Pit No. l................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch' Depth of Test Pit..................... Depth to ground water........................ a ------------------- ---------•-------••-..... ......... ----------------•-•--------------- .................-----...--•---...__....-- D .Description of Soil-•-•----••--..Zaild---•---------------------•----•---_...-------•----•--•-------------------------------=--------------•- x _ _ w -------------------•---•..... ----- --- --------------------------...------------------------------------------.......---------- .................................. N ature of Repairs r Alterations—Answer when a llcable..... .....................TnSt3113t1-o, i---of___a...�,_¢eQ_QQ__ v galion pre-Cast, sone packed leach pit (overfiow •-----------=--------------- - ............................................................. Agreement: ` The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITiZ 5 of the State Sanitary Code—The undersigned fur her agrees not to place the system in operation until a Certificate of Compliance has been issued b t boar I th. 6/11/79 _ Sign° _� V...9__._ ` .... ..................•--•----•--------•---•- •- - - ._.. . . .._ i Date Application Approved By......-- . . . - - Date - ----•-------•- ---------64-1-/-fig----------- f /_ Application Disapproved for the following reasons: -------------------------------------------•-------------...----•-•. ---------•----••--. ..........................--•--.....-------•------------------•-•-------...------...........--------------•-----------------------------•------------------------------------------------------------- Date PermitNo....... 9.------------------------------------------- Issued......... /.1)-l7_q.__...--------•-------•---- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ✓ � Town................oF..............Barnstable ....................................... (frrtifirate of TompliFanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( X) by-,&...K... ... ema.p0o1--.5s_xYi. .....12 ...Hi.5-hQPs---1erraae., Hyannia......Maa- Q.2 Q:1..._.__..... Installer . at.....4 8 1d Torn Ra* ann s_,_..02601 '" Addr ean-Bye.r.a-------------•-------------------------------- has been installed in accordance with the provisions of TITLE 5 of_The State Sanitary Co e as described in the ` application for Disposal Works Construction Permit No._79'...-��.,?............ dated.....6�_...-�79....................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................. Inspector.................................................................................... r { K y;.� THE COMMONWEALTH OF MASSACHUSETTS BOARD. . �-1*E°ACTH. �s --TQ ...OF......Baxx�a-ftble-.. ... .......... 1traafiun for Dispuuaal 19orks Tomitrnrtion rum...,_ Application is hereby made for a Permit to Construct ( ) or Repair ,( ) an Individual Sewage Disposal System AMC T y Location Address o �{ po3 Lot No �/ 3�.bSSPI+r. 'z,yRe ° � .............................................. Q _ Town .RFC�_L..fixa>�> .. .....__..._. �w W �. pbol 1i7exvioe................... Address 1 Installer w Address 1' UType o£IBtlilding s Size Lot____ ,....Sq. feet DvuelI ` No of 'Bedrooms.................. ............ � � _______...__Expansion-Attic ( ) Garbage Grinder ( ) aOder TType of;.B'u lding ____________________________ No. of persons__,_.__...t_.____.__.___.___ Showers (: ) yCafeteria ( ) a , f; Other fixtures ...............................------------------------ ------------ .................. ............. W Design,-Flow ......................................______ gallons per person per day. Total daily flow............................ ......gallons. GG SepticTank } Liquid capacity .gallons Length________________ Width.__.._.____._.__ Diameter__-___ Depth ............. DisposaTrench h :Vo-.................... Width.................... Total Length.................... Total leaching area Y_--._._..sq. ft. u :f 3 Seepage �i. No ....... Diameter.................. ... Depth below inlet.................... Total leaching area _ ` .......so. ft. Other ?istribtition box ( ') .Dosing tank,.(. ) ��" PercolQn Test Results . Performed .by. ........ ........................................................ Date--- M4-:-----.....:_----- s. { ,`�l TePitY io 1 minutes per inch Depth of Test Pit____________________ Depth to ground water ------------- GL, Te t Pit �,',0 2 :______minutes per inch Depth of Test Pit____________________ Depth to ground water.� ............_... � .................................... ....................•---........... ........ ............................ Descript ons o£'Soil . na........................................................... -_.... ` ------------ ............................... 1 ' 1 _ .__. .................................................. ......................... . *t. k. U �1ature of Repairs`a I'Al ations—Answer when applicable.___ __ n$ & �t ri O 8 Opp. gallan{ ' re-cas , sine parked leach pit �©verflow) . Agre4nent { "' The,undersigned agrees to install the aforedescribed Individual Sewage.Disposal System in accordance with the pqQYJsiop .ot Tip' 5 of the State Sanitary Code'=The undersigned fur,ier agrees not to place,.the system in operation until a;Certificate of Compliance has been issued b boar i th. " f , Signe _.... t *Date ._ Application-Approved By......... .................... :. ...-6,ef1-.174•----•---- x:. Date Appheaf on isapproved for the following reasons-.......... ._......._........... - .-__- _: _ ..- F # -N ,.Date ..............-:----------------- - - Issued. . � _l� __. t Date r `=x THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH is Town Barnstable .......................O F.................: .:..>..... ......... ......... ............................ .. (9rdifiraa#r of Toutplia ttrr THIS IS TO CERTIFY, That the Individual Sewage Dis opal System . . M ` Raired� 1a �by *� ejais 0.1.._ 99e.9... � A....... _._ ........__ n t ller at �a rt? ,1 o�un..... •�.._Hya; n s_:__.02��� .Ac.€ rYean xere, _.... F.•-•---- -•--- -- has �een,irik lied in accordance with the provisions of T :1 F 5 of The State Sanitary C gibed in the �t application for Disposal Works Construction Permit �o.--_r--l=...3 '„*..._....... dated.. -______- ,__,_ . T t. .t. THE U ANCE OF,THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE,THAT THE SYSTEM! �1AlILL FlJP1CTION SATISFACTORY. IVI f D "........................................ Inspector{ ........ ---------------•--... -•-- •----- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH a $ ab -...............Town.....O F............B•_-r.]Mt-_ ............................. NOg { a FEE Q�. aal Works Tonutrudion �eruti# x, Perriatssion,-is hereby gran ted:_,:�-..A..a__C---AAA _00 .• `V C@� 28 B��hOj�S der. , Hyannis to Construct,( ) or Repair ( an Individu 1 Sevtr i osal Sys at No a $ Old 'Town R1. H annTs �0 xde 'r ears a rs ,a. Street ? _ ' 6/l2/? as,'shown on.the application for Disposal Works Construction Per o.._.. .. ated_..__ { Board of Health ' s :7 r a{ FORM +Z551P.H0eBSr&".WARREN, INC., PUBLISHERS �d�ienne ,Q�ers Old Two, j. �a nr►i S � YY1�4 �2doo! 79-5-0 � died : �•��-?9 _- Cornpl eft d:1,-Z9-79 V e e- o i e t E , S j a �►sTi G. �#'a wS-� t C Lbmt°rudiow C e PO Bar m _ H .MA 0W01 CIVti ,FC'e fl F0 �1 V " � � SCALE: � �. / APPROVED BY: DRAWN BY DATE: $�a0 REVISED DRAWING NUMBER '�/�Q tj tuC e � i i � ) i f i4+ � 71 0 t _.._._........,,....- a -,. .^,....._._,._.._,..... ; PI 2 QI Z � . C A (� I s � y t _ ktIlk M I J- T7� : 3 i s y d� 3 f 9 p z ma A A Q C n �5 ti . to E IA n1l ( E.1 m m i r t y 1 P] m - v m f a - Z � A s • LN JE a. A 2 ' W G 4 �e 4 n x n tA x � k G C� 0 A 0 n �� �n 2 C � � 0 m A II a ,.• �. ;.. ' --�.sa - -".__ _ ..r.-_.- - -.._.._._- ,. _._,.. ,.,=r�„ ......_ .:.uu+o- ....M-as.�-tfr�c:Lw , ,»uwu�%s.-aw�ac:r�.�u..rw-., .-.us:r__'- � u.c4r .:s:.:x..0•nc.n: u...�c_._ _ .... ati310 I r , °rt 1N1UIN:+ WA t LV. r �y31�x� �3r is GMC Co woudim Ca PO Box 6.% Hr vli4 MA&MI _I S� �^ t APPROVED BY: L SCALE: DRAWN BY DATE: REVISED DRAWING NUMBER W ASSESSORS MAP: 4 Z'0 _-- TEST HOLE LOGS NOTES: PARCEL: 23 G FLOOD ZONE O/ 9;_ SOIL EVALUATOR: Gam. W 1 TNESS. I 1) The installation shall comply with Title V and Town of Barnstable Board of REFERENCE: cS/TZ: r^'L/f ���f1>>92a a � DATE: IZ Health Regulations. �twaErQ�Q bG KLrC.L L� EiJ!{IW S e PERCOLATION RATE: - 2 1 b4 2) The installer shall verify the location of utilities, sewer inverts and septic r_ ��- components prior to installation and setting base elevations. c�NTZ.vi�.c.� �,r✓ 6 ib - - -- -- —--- -�-- - 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8" per foot. The first TH T -2 two feet out of the dbox to the leaching shall be level. LOA 4) This plan is not to be utilized for property line determination not any other, .' fl purpose other than the proposed system installation. 5) All septic components must meet Title V specifications. 6 Parking over icomponents.) arks g shall not be constructed septic LOCATION MAP (WT' "5) 7) The property is bounded by property corners and property lines. 1'��7� 8) The property owner shall review design considerations to approve of total 5�W design flow and number of bedrooms to be considered for design. Receipt of Lpayment for the plan and installation based on the plan shall be deemed approval of the design flow by the owner. 9) The existing leaching or cesspools shall be pumped and filled with material per Title V abandonment procedures. Those within the proposed SAS shall be removed along with contaminated soil and replaced with clean washed sand 0 (�ptJD LvfY.f� per Title V specs. 10)System components to be 10 feet from water line. Sewer lines crossing the water line shall be sleeved with 4 inch SCH 40 PVC with ends grouted if -- SEPT I C SYSTEM DES I GN applicable. >' 11) If a garbage grinder exists it is to be removed and is the responsibility of the FLOW ESTIMATE owner to ensure such. 12)The installer is to take caution in excavation around the gas line if applicable. i Q 1- 1V BEDROOMS AT 110 GAL/DAY/BEDROOM -330 GAL/DAY. SEPTIC TANK l �L GAL✓DAY x 2 DAYS - �U GAL / USE GALLON SEPTIC TANK C Ew -MW�C. l 5 . -- 1 SOIL ABSORPTION SYSTEM G.of r. -iN OF t \ t 1 ? DAM / 6MASON S I"E AREA: Z-�C ti3 -�-Z,�1 Z.�C a �? 9 No.toga �� GJO I \ 7►b i BOTOi AREA: X " O ST 1 ID� ' 1 b 'v ,3L SEPTIC SYSTEM SECTION t ,4 of: FbU t , v° VA-XI.Am Mry(. IZ f , 1 �r°ii U b w4c 0-1 n/ ,:, } • � GAL . SEPTIC TANK f It, 10000, l �,yN_ �;� were STD.. of -rr'5T" 1001/ SITE AND SEWAGE PLAN LOCATION : 438 OW i OWN 1?o9 �o PREPARED FOR : k4�w� ��.. - / o \ SCALE: = DAV I D B . MASON V DATE: DBC ENVIRONMENVL DESIGNS g DATE HEALTH AGENT EAST SANDWICH . MA a ( 508) 833- 2I77