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HomeMy WebLinkAbout0106 SEVENTH AVENUE (HYANNIS) - Health 106 Seventh Ave. Hyannis . o e o o No. —� �' Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Zipplitation for Disposal 6pstem ConstCurtion Permit Application for a Permit to Construct( ) Repair()j Upgrade( ) Abandon( ) ❑Complete System [Individual Components Location Address or Lot No. d©/, -744 RPM Owner's Name Address and Tel.No. 13 Tea Sz CH Q�Igc� Assessor's Map/Parcel Installer's Name,Address,and Tel.No. 5;:1`% i°���3 "i? Designer's Name,Address,and Tel.No. 0" " WLCA "s�l4P&, Type of Building: J Dwelling No.of Bedrooms l4 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd x� Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) REF L4#jg Eft L4o a ig TZ C��C C, Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Heal Si d II�� n' Date— Application Approved by Vl/v Date—k — Application Disapproved by Date , l for the following reasons r/ � Permit No. �d C� _ �d Date Issued r y No. Fee / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION- TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for MIsposal 6pstem Cott8tructlon Permit Application for a Permit to Construct( ) Repair()o Upgrade( ) Abandon( ) [:]Complete System [Individual Components Location Address or Lot No. l o(p "?#fit Av5 YA09)(5 Owner's Name Address and Tel.No. C3��.rA Assessor's-Map/Parcel pZ q,5 Q 71ZOI WIPTERBETUE4 VL 6ETWeSbAs MD Installer's Name,Address,and Tel.No. -�`I`T�g�S�1? Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria Other Fixtures A ' Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: i The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Heal Sid Date T Application Approved by vl v Date --Application Disapproved by Date v for the following reasons ,. Permit No. 0 O�- t,d Date Issued � P -------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS �' �''` Certificate of Compliance THIS IS TO CCERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(X) Upgraded( ) Abandoned( )by QAP&J%X-bE ELMEReA156< LLC at 11)(n '7"h AuE has been constructed in aJ&c dance with the provisions of Title 5 and the for Disposal System Construction Permit No. ��t T- dated / Installer <,,A?6(_9)1 Z)& >✓[�/l����Sf l Designer LV #bedrooms &Mf_ Approved design—flow /V gpd The issuance of this permit shall not be construed as a guarantee that the system will ncti has design Q Date I I I \ Inspector t/ I --------------------------------------------------------------------------------------------------------------------------------------- No. ( ) {, Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal &pstem Construction Permit Permission is hereby granted to Construct/( ) Repair( Upgrade( ) Abandon( ) System located at����'t AV C— H YAk)MIS and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. i Provided:Construction must a completed within three years of the date of this permit. Date r Approved by l Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 106 Seventh Ave Property Address Deborah Rodrigues Owner Owner's Name information is West Hyannisport MA 02672 03/07/13 required for every page. CRy/Town State Zip Code Date of Inspection Inspection results must be submitted on this form.Inspection forms may not be altered in any way.Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, use only the tab 1. Inspector: j key to move your cursor-do not Michael Kellett use the return Name of Inspector key. Aardvark Environmental Inspections Company Name PO Box 896 Company Address East Dennis MA 02641 City/Town State Zip Code 508-385-7608 S13742 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑' Fails d Q ❑ Needs Further Evaluation by the Local Approving Authority 03/08/13 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approvin 3 AuthoriW'(Boaf�kl of Health or DEP)within 30 days of completing this inspection. If the system is a 4hared syi fi§m o"9 has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•11/10 Title 5 Offeial I ctlon Form:Subsurface Sewage Dis Deal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage.Disposal System Form-Not for Voluntary Assessments 106 Seventh Ave Property Address Deborah Rodrigues Owner Owner's Name information is p required for every y West H annis ort MA 02672 03/07/13 page. City[Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary:Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Check the box for"yes","no"or"not determined"(Y,N, ND)for the following statements. If"not determined,"please explain. The septic tank is metal and over20 years old*orthe septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins•11/10 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 't 106 Seventh Ave Property Address Deborah Rodrigues Owner Owner's Name information is required for every West Hyannisport MA 02672 03/07/13 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑' N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR" 15.303(1)(b)that the system is not functioning in a mannerwhich will protect public health, safety and the environment: Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11i10 Title 6 official lnspec ion Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 106 Seventh Ave Property Address Deborah Rodrigues Owner Owner's Name information is required for every West Hy p annis ort MA 02672 03/07/13 page. Cityrrown state Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier,if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well"*. Method used to determine distance: *"This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6"below invert or available volume is less than Y2 day flow t5lns.11/1p Title 5Official inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 t Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 106 Seventh Ave Property Address Deborah Rodrigues Owner Owner's Name information is required for every West Hyannisport MA 02672 03/07/13 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ 0 Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped: ❑ ® Any portion of the SAS,cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliforrn bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.) ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails.I have determined that one or more of the above failure criteria e)dst as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems,you must indicate either"yes"or"no"to each of the following,in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered`yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. t5lns•11/10 Title 5Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 106 Seventh Ave Property Address Deborah Rodrigues Owner Owner's Name information is West H annis ort MA 02672 03/07/13 required for every y p page. Cityfrown State Zip Code Date of Inspection C. Checklist Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner,occupant,or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components,excluding the SAS,located on site? ® ❑ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction, dimensions,depth of liquid,depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example,a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)1310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 t5ins•11110 Title 5'Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 106 Seventh Ave Property Address Deborah Rodrigues Owner Owner's Name information is required for every West Hy p annis ort MA 02672 03/07/13 page. Citylrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings,if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 110/e 1 DatCommercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft.,etc.): r Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings,if available: t5ins•11/10 Me 5 Official inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 106 Seventh Ave Property Address Deborah Rodrigues Owner Owner's Name information is required for every West Hyannisport MA 02672 03/07/13 page. City/town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ❑ Septic tank,distribution box,soil absorption system ❑ Single cesspool ® Overflow cesspool 13 Privy ❑ Shared system (yes or no)(if yes,attach previous inspection records,if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the VA system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): bins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System form-Not for Voluntary Assessments w 106 Seventh Ave Property Address Deborah Rodrigues Owner Owner's Name information is required for every West Hyannisport MA 02672 03/07/13 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components,date installed(if known)and source of information: 06/22/82 per BOH Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.5 feet Material of construction: ❑ cast iron ®40 PVC ❑'other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints,venting,evidence of leakage,etc.): Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ® concrete Q metal F1 fiberglass El polyethylene ❑ other,(explain) h. ,I If tank is metal,list age: years Is age confirmed by Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No 'Dimensions: Sludge depth: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 106 Seventh Ave Property Address Deborah Rodrigues Owner Owner's Name information is required for every West Hy p annis ort MA 02672 03/07/13 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑metal ❑'fiberglass ❑'polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•11/10 Title 5 Official Inspection Form:Subsurtace Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Fora "s Subsurface Sewage Disposal System form-Not for Voluntary Assessments 106 Seventh Ave Property Address Deborah Rodrigues Owner Owner's Name information is required for every West Hy p annis ort MA 02672 03/07/13 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete ❑metal ❑fiberglass ❑polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches,etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '< 106 Seventh Ave Property Address Deborah Rodrigues Owner Owner's Name information is required for every West Hyannisport MA 02672 03/07/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 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 ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): Soil Absorption System(SAS)pocate on site plan,excavation not required): If SAS not located,explain why: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 106 Seventh Ave Property Address Deborah Rodrigues Owner Owner's Name information is required for every West Hyannisport MA 02672 03/07/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number,length: ❑ leaching fields number,dimensions: ® overflow cesspool number: 1 ❑ 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.): This system has a 6'x6'precast pit surrounded by a foot of stone.The pit was dry with a stainline 36" below the inlet invert. Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration 2 inline Depth—top of liquid to inlet invert 47" Depth of solids layer 2" Depth of scum layer' na Dimensions of cesspool 4'x5' Materials of construction drywell block Indication of groundwater inflow ❑ Yes ® No t5ins-11/10 Trtte 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 106 Seventh Ave Property Address Deborah Rodrigues Owner Owner's Name information is West Hyannisport MA 02672 03/07/13 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.): The cesspool was dry with a stainline at the outlet invert.The pit was sound with no sign of ponding or failure. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 106 Seventh Ave Property Address Deborah Rodrigues Owner Owner's Name information is required for every West Hy p annis ort MA 02672 03/07/13 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system,including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building.Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately rear 34 19 30 50 t5lns•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 106 Seventh Ave Property Address Deborah Rodrigues Owner Owner's Name information is required for every West Hyannisport MA 02672 03/07/13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ® Check cellar El Shallow wells Estimated depth to high ground water: 9.5 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked,date of design plan reviewed: Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators,installers-(attach documentation) El Accessed USGS database-explain: You must describe how you established the high ground water elevation: I augered to 12.0 feet andfound no water. I adjusted to 9.5 feet. Bottom of leaching is at 9.1 feet. Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 106 Seventh Ave Property Address Deborah Rodrigues Owner Owner's Name information is required for every West Hyannisport MA 02672 03/07/13 page. Cityfrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A,B,C,D,or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•11/10 Tft 5Officia1 Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Date: ------ Cotnpleted by HIGH GROUND-WAMR LEVEL COMPUTATION Lot No. Loratum: Address: ner: Mraetor: Address: tes: P 1ea�rre dep h to water table 01�0 ..._ _.............. Date to nearest 1110 ft. -------------------------------------------- mom�.la�ayl EP 2 Using Water-Level Range Zone and Index Well Map locate Q/ site and det mirke: O Appropriate index well.._............ _..... - ------- __._ star-level range zone.-.--_--_-----_-------------------------------- - rep 3 Using rrranthly report"Current Mates Resmma Canditione• dtermine c t,rren't d to € tl.3, l 8.'a v++at°f for index we" TEP 4 Using T of Watervei-Ie Adpstments for index well(STEP 2A},current depth to water revel for index wvll(ASP 3?. and water-Iere1 zone(STEP 28) _. _...._......_......._..........__...._........__.......... determine wtsr-"eves ad :TEP 5 Estimate depth to water by subtraMbIg the WSW level of jusunent(STEP 4) 9 �J from eawred dePth 10**ter ................ ................_....._....._._......_..---.......__--•-- (STEP UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No. G-10 III • Sender: Please print your name, address, and ZIP+4 in this box • s �( Loam or HeL...i �j Town of Bamstabie ?.O. Box 534 --`- Massachusetts 02601 I IF. 3 COMPLETESENDER: COMPLETE THIS SECTION SECTION. DELIVERY ■ Complete items 1,2,and 3.Also complete A. Received by(Please Print Clearly) B. Date of Delivery item 4 if Restricted Delivery is desired. ■ Print your name and address on the reverse C. Sig t 01) so that we can return the card to you. ■ Attach this card to the back of the mailpiece, gent or on the front if space permits. ❑Addressee D. Is delivery address different from' 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑ No 01 J �r^7 3. Service Type %% Wess* a T [ ertified MRegistered Merchandise ❑ Insured Ma . esrxl ted Delivery?(Extra Fee) ❑Yes . 'U 4e "2."Xtfcle-Number(Copy 1forri service label) w d S Form 11,July 1999y Domestic eoAa 102595-00-M-0952 Town of Barnstable �pTME r Regulatory Services Thomas F.Geiler,Director � Public Health Division Thomas McKean,Director 367 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Mr. William Crowell 106 7TH Av. Hyannis Port, MA. 02647 Tenants: Charles Marino, Eric Gerson, Geoffrey Anderson 11 Oakridge Rd. Osterville, MA. 02655 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY CODE II,MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE,ARTICLE 51 The property owned by you located at 11 Oakridge Rd. Osterville,MA was inspected on Oct. 12, 2001 by Edward Barry,Health Inspector for the Town of Barnstable, because of a complaint. The following violations of 105 CAM 410.00,State Sanitary Code H,Minimum Standards of Fitness for Human Habitation were observed: 410:351 Water on floor around furnace in the basement. Main water line into the house appears to be leaking. 410:201 Furnace inoperative therefore there is no heat or hot water. 410:253 Rear door exterior light inoperative, a number of face plates missing from electrical outlets, two ceiling lights in the kitchen are inoperative. 410:256 Using power strips for appliances. 410:480B No keys are supplied to tenants. 410:500 Kitchen windowsill retains water. 410:481 Building does not have 20 sq. inch sign bearing name, address,and telephone number of owner. 410:602 Debris in the rear yard. You are directed to correct the violations of within TWO WEEKS of receipt of this notice. You may request a hearing if written petition requesting the Board of Health receives it within seven (7)days after the date order is received. However,these violations must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than $500. Each separate day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean Director of Public Health 10 CATION SEWAGE PERMIT I�0 0(o I L L A G E �I INSTA LLER'S NA_BE & ADDRESS SUILDER OR OWNER DATE P- EItNIT ISSUED agL - DATE C6MPLIANCE ISS-UED � - - —� e p_r,eQ+ / ;o� � � t �. � � � � n � � � � "a �s � rp � � �, c,-�- �' �( � � � � �_ - . �� � - �!. -. � � � . .. }, �� a r; �; �; �.� D THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ........................T.own--......OF......Baxnstaue..........................--•-•---........................ , ppfira#ion for Dtipa,ial orkii Tnn�trarttun Prrutit Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal System at: , 79_-Seventh.Ave ,West•- Iyannisz).a ,•-MA-....02672 Location-Address or Lot No. Henry.Schre;bner 2 Walnut St:, Newport, -R;I: _•._.._.._.__ Owner Address a A & BCesspool-Service 128 Bishpps Terrace, Hyannis.,_ M..._ 026ol Installer Address Type of Building Size Lot.... ......... .._..Sq. feet Dwelling—No. of Bedrooms.......... ...............................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons.........?................ Showers ( ) — Cafeteria ( ) a' Other fixtures -------------------------------- - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No:.................... Diameter.................... Depth below inlet_................. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ••••••--•-----••--------•------•--•-•-•...............••-----------.........................._•-•---......................................................... O Description of Soil....-------•----.Sa>nd..--•---•.............•----- ",� W U Nature of Repairs or Alterations—Answer when applicable insta flat i-on._of_a_1,000•._gall on•,--_p;p -oast, stone__packed. leach.pit..(oYerflow� --------------. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of THL'xTIZ 5 of the State Sanitary Code— The undersigned further agrees not to place the system in . operation until a Certificate of Compliance has'ken issued by the b ar f health. Signedd � .. 6-15-82 ;.... --- ------------------- .........--••- Application Approved By.....%�� 6-15-g�e Date Application Disapproved for the following reasons:................................................................................................................ ..........................................-•---•---•-••.......--••-•-----------••--••-•---------.......... ------------------------------- Date Permit N5.2- Issued-.6-15-82.................................... Date No.R2-..° 12.... Fzc ,p0............... THE COMMONWEALTH OF MASSACHUSETTS� BOARD OF HEALTH .........................T own.......OF......Barn-stabWs......--------.............--------.--------------------- Appliratiun for Ei5pusal lgorko Tunitrurtiun umit Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal System at: • 7�•• iuent �r�e,s • e$t 3 nr*tet© *j.. .....02672-----------------------------------or-Lot-No---..-...-•------••------------------------ Location-Address or Lot No. •die -,S�hlr................................•-•------------•----. ... 2 r�Tvl2lii .i..FFetrFp4 i R.1................................_ Owner Address oa1,•-S�acvl............................................. 12R.-piss '1"s�acs./r...ld ar��is, �tp.....02601----- InstallerF s Addre Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms...........3................... .....Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons----------Z............... Showers ( ) — Cafeteria ( ) 04 Other fixtures ---------------------------••••. ---------•---.•---•---•--•---••-•--•-•...••-----••-•••---...-•--......--•.......................--•-•-•• r d W Design Flow ........................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid'capacity....._......gallons Length............... Width................ Diameter................ Depth................ x Disposal Trench—No.-------------------- Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter..................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '-, Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water....................,.-. fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P ---•-------------------------------•-------------------•-------•---..................--•-------.................._...........-•-••..........--•-•--••--.--•-- ® Description of Soil---------------•---SaM---•......_........_..............-----••--•-•.....••••••------•------•-•-••----•----•-•-•----•---•-•--•-••--•-------•...............-----• W -•••-----------------------------•••••....... --••••......-----------------------------•----------------------------------------------------•----- ..................................................... U Nature of Repairs or Alterations—Answer when applicable..lns+,-illati to--of••a---I.,-000•-g-al.lon,•••pZe-cast, -stogie.Packed-•1e.ach--pit..4var#1.ow).-------------•----•---••--•------------------------------------------------•-------------------------------••----•---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITTLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has een issued by the b and of health. f Signe t,. �.6.12-1 L I.._. 6--15._.£�2............... .. ..... � Date j Application Approved By.....- ! /L - 6 15nSZ--------------- Date Application Disapproved for the following reasons:................................................................................................................ ....................•---•-••_.......-•-••---••-•----••••-•-•-•------•---•----....._...-----••••-----....---•--••.....---•---•••-•-•-•-------•--•--•-•------------------•••-----••••-----•-------••-•---- t Date PermitN692:................................................... Issued..6 15 8-2--------•-------.-..--------•------- Date 1\ THE COMMONWEALTH OF MASS;ACHUSETTS BOARD OF HEALTH � .....................T awn..........OF............Barnstable............................................... 1 ,` Clurdifiratr of Toutpliattrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( X) by.............A..&..B Cesspool_Service.. 128 Bishops_Ter ce.,_..I?y nnis� MA....02601..... .... '\ - Installer at.._...-579._Seventh Ave., West ?dyannisport1 tA_...02672 Hen?"x.Schreibner has been installed in accordance with the provisions of TITLE C o The State Sanitary Code as described in the application for Disposal Works Construction Permit No.-82_.-._�e?................ dated.......6-1-5 82.._...-_...._............ THE ISSU IN F THIS CERTIFICATE SHALL NOT B O STRU AS A GUARANTEE THAT THE SYSTEM 1Al/IL FION SATISFACTORY.DATE.......t? .. v .... Inspec - ,.-----_---------- j, THE COMMONWEALTH F M SSACHUSETTS BOARD OF HEALTH 2 ...................�'.Q. .............O F.............. m bI ............................................Nb�.----••----•............. FEEA...5..-..-..00 ........ Disposal Workii Taunutr ion rrnti# Permission is hereby granted.............. ----------------------------•-------..........•-••........_........._. to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at No..-5.74.Seventh._Ave._,--- est._H-yannispo ................................. Street •-• - as shown on the application for Disposal Works Construction Permit N�O2 6 Dated.... -15- 2 ------------------------•------------•-- Oarof Health DATE................................................................................ t FORM 1255 HOBBS & WARREN..INC.. PUBLISHERS