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Home My WebLink About0039 WEST HYANNISPORT CIRCLE - Health 39�W HI'AN�IISPO:RTCIR, H_YAIVN'IS ,F .- Y , I I� o I' i P 1� THE Tp� Town of Barnstable MRN9TABLE, Regulatory Services MARI 1639. Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Certified# 7015-1730-0001-4990-2304 May 10, 2017 Mindie Lawrence 39 West Hyannisport Circle Hyannis, MA 02601 NOTICE TO ABATE VIOLATIONS OF TOWN OF BARNSTABLE BOARD OF HEALTH REGULATIONS,NUISANCE CONTROL REGULATION NO. 1 The property owned by you located at 39 West Hyannisport Circle, Hyannis, MA was visited on May 5, 2017 by Marybeth McKenzie, R.S., Health Inspector for the Town of Barnstable. This inspection was conducted in response to a complaint filed with the Public Health Division. The following violations of the Town of Barnstable Board of Health Regulations, Chapter 54 Building and Premises Maintenance were observed: �54-3 (A) Outdoor Storage Large amounts of items observed which were not screened from public view in accordance with Chapter 54, Town of Barnstable Ordinance. The items included, but were not limited to old pieces of wood, lawnmowers, and other assorted debris. You are directed to correct the violations within sixty (60) days of receipt of this order letter by disposing said items or storing all mentioned items from public view or in an enclosed structure. i You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served Non-compliance will result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the.inspection. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S. Director of Public Health Town of Barnstable QAOrder letters\Refuse\Marybeth's Order letters\39 West Hyannisport, HY refuse complaint letter.docx IC3 m Orlin nLl C3 v ws`. Q" Certified Mail Fee Ir y_r Extra Services&Fees(check box,add fee as appropriate),( �`OZ rq 211fetum Receipt(hardcopy) $ 3 ❑Re rn Receipt(electronic) $ '�N POStfllar�lx erred Mail Restricted Delivery $ C Her r 0 ❑Adult Signature Required ❑Adult Signature Restricted Delivery$ t� M Postage m $ Total Postage and Fees $ Sent To / p T _ F�CL([ .................................... Street and Apt. o. or PO o No9� --------� =----`��---) Ciq;State,ZIP A. . •� /,_ r. r r r rrr•r, �� Certified Mail service provides the following benefits: ■A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail a A unique identifier for your mailpiece. associate for assistance.To receive a duplicate ■Electronic verification of delivery or attempted return receipt for no additional fee,present this delivery. USPS®-postmarked Certified Mail receipt tothe_i ■A record of delivery(including the recipient's retail associate. ., signature)that is retained by the Postal Service- Restricted delivery service,which provides t+ for a specified period. delivery to the addressee specified by name,or to the addressee's authorized agent Important Reminders: Adult signature service,which requires the ■You may purchase Certified Mail service with signee to be at least 21 years of age(not First-Class Mail®,First-Class Package Service®, available at retail). or Priority Mail®service: Adult signature restricted delivery service,which ■Certified Mail service is notavailable for requires the signee to be at least 21 years of age. international mail. and provides delivery to the addressee specified�. ■Insurance coverage is notavailable for purchase by name,or to the addressee's authorized agent: with Certified Mail service.However,the purchase (not available at retail). ` of Certified Mail service does not change the g ■To ensure that your Certified Mail receipt Is insurance coverage automatically included with accepted as legal proof of mailing,it should bear a_-, -'certain Priority Mail items. USPS postmark.It you would like a postmark on f tin ■For an additional fee,and with a proper this Certified Mail receipt,please present your _4 endorsement on the mailpiece,you may request Certified Mail item at a Post Office'for the following services: postmarking.If you don't need a postmark on this -Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply F_ You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece. electronic version.For a hardcopy return receipt, complete PS Form 3811,Domestic Retum r Receipt•,attach PS Form 3811 to your mailpiece; IMP0ffrAffP Save this receipt for your records. PS Form 3800,April 2o15(Reverse)PSN 7=-m-0008047 .__.- Citizen Web Request Page 1 of 1 TME ; �4 . [ z " a. ( Juc O A VSTASL e ' 4� `- 6r� Citizen Request Management ` Request ID: 58756 Created: 5/2/2017 10:50:59 AM Status: Assigned To Staff Assigned To: McKenzie, Marybeth Health Office y Chapter 54-5 Anonymous: Yes Category: : Rubbish and QeGarbage E.C. Date: 5/16/2017 Created By: Sousa,Vanessa Citations: Health Office arP Time Worked: 0 Response Time: 0 Request Location: 39 WEST HYANNISPORT CIRCLE Hyannis, Ma 02601 Parcel Number: Map: 267 Block: 126 Lot: 000 Request: A lot of trash on driveway, open bags, and 2 junk cars. Request Work History: i http://issgl2/IntemalWRS/WRequestPrintPub.aspx?ID=58756 5/5/2017 r . Town of Barnstable U.S.POSTAGE>>PITNEY80WES Public Health Division BARN ABLE.Sf MASS. 200 Main Street cs� 6 0 h -O 59• pTED inn+"� Hyannis,MA 02601 k ZIP 02 4VV601 006.56 7015 1730 0001 4990 2304 j 0000336455MAY. 11. 201.7. TD aPo i VA, LGt,�✓ l� Y l ♦ n ...-. - 1 , I, ■ Complete items 1,2,and 3. 7Re.ceived 6 Print your name and address on the reverse ❑Agentso that we can return the card to you. O Addresseet Attach this card to the back of the mailp ei e, dhtetl Name) C. Date of Delivery I or-on the front if space permits, I 1. Article A dressed to, D.,Is delivery address different from item 17 ❑Yes m�%I _ �wVe4A_�, If YES,enter delivery address below: ❑ No I �✓��S i ✓��fio 0� � I � I I j II 3:Service Type' 0 Priority Mail Express® ❑I IIIIII IIII III I III I II I II I III) I III I I I III II III E Adult Signature Registered MaiITM Ad I ❑ ult Signature Restricted Delivery 0 Registered Mail Restricted Certified Mail® Delivery I 9590 9402 2480 6306 7524 18 Certified Mail Restricted Delivery ❑Return Receipt for O Collect on Delivery, Merchandise I \ ❑Collect on Delivery`Restricted Delivery ❑Signature Confirmation M \ irla Nri nhec 1Transferfmm_sarvice_lahell ❑Signature Confirmation, r .asured Mail g ivered Mail Restricted Delivery Restricted Delivery f 15 17 3 0 0 0 01 4990 .2 3 0 4 Aver$cool ry Delivery PS Form 3811,July;2015 PSN7530-02-000-9053 L_ �___,_�_Domestic Return Receipt. ;. .T__,_ ,.. _ �t"F Town of Barnstable } B^^ KASS. Regulatory Services 9� f6gy. Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Certified # 7015-1730-0001-4990-2304 May 10, 2017 Mindie Lawrence 39 West Hyannisport Circle Hyannis, MA 02601 NOTICE TO ABATE VIOLATIONS OF TOWN OF BARNSTABLE BOARD OF HEALTH REGULATIONS,NUISANCE CONTROL REGULATION NO. 1 The property owned by you located at 39 West Hyannisport Circle, Hyannis, MA was visited on May 5, 2017 by Marybeth McKenzie, R.S., Health Inspector for the Town of Barnstable. This inspection was conducted in response to a complaint filed with the Public Health Division. The following violations of the Town of Barnstable Board of Health Regulations, Chapter 54 Building and Premises Maintenance were observed: 04-3 (A) Outdoor Storalle Large amounts of items observed which were not screened from public view in accordance with Chapter 54, Town of Barnstable Ordinance. The items included, but were not limited to old pieces of wood, lawnmowers, and other assorted debris. You are directed to correct the violations within sixty (60) days of receipt of this order letter by disposing said items or storing all mentioned items from public view or in an enclosed structure. You may request a hearing before the Board of Health if written petition requesting same is - received within ten (1.0) days after the date the order is served Non-compliance will result in a' fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. PER ORDER OF THE BOARD OF HEALTH McKean, Director of Public Health Town of Barnstable Q:\Order letters\Refuse\Marybeth's Order letters\39 West Hyannisport, HY refuse complaint letter.docx ✓ f �l vl COMMONWEALTH OF MASSACHUSETTS �z Z a O EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS + d DEPARTMENT OF ENVIRONMENTAL PROTECTION M F K o� vow �'1M Sae 7 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTXRY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 39 West Hvannisport Circle RECEIVED Hvannisport,MA Owner's Name: Ernest Wood FEB 0 5 Owner's Address: 39 West Hvannisport Circle 2001 Hvannisport,MA TOWN OF ARNSTABLE Date of Inspection: 1/24/01 HEALTH DEPT. Name of Inspector: (please print) Mr.Carmen E.Shay Company Name: Shay Environmental Services,Inc. Mailing Address: 34 Thatchers Lane East Falmouth,MA 02536 Telephone Number: (508)-548-0796 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DE approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Vk OF XX Passes R Conditionally Passes � Needs Further Evaluation by the Local Approving Author - 0 y Fails Inspector's Signature: Date: 1/24/01 s 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 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 39 West Hvannisport Circle Hvannisport,MA Owner: Ernest Wood Date of Inspection: 1/24/01 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: XX 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. 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 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. 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 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: 39 West Hvannisport Circle Hvannisport,MA Owner: Ernest Wood Date of Inspection: 1/24/01 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone i of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more 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: Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 39 West Hvannisport Circle Hvannisport,MA Owner: Ernest Wood Date of Inspection: 1/24/01 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6"below invert or available volume is less than day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped Any portion of the SAS,cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 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 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. Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 39 West Hyannisport Circle Hyannisport,MA Owner: Ernest Wood Date of Inspection: 1/24/01 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No XX Pumping information was provided by the owner,occupant,or Board of Health XX Were any of the system components pumped out in the previous two weeks? XX _ Has the system received normal flows in the previous two week period? XX Have large volumes of water been introduced to the system recently or as part of this inspection? XX _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) XX _ Was the facility or dwelling inspected for signs of sewage back up? XX _ Was the site inspected for signs of break out? XX _ Were all system components,excluding the SAS,located on site? XX _ 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? XX _ 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 XX _ Existing information.For example,a plan at the Board of Health. XX _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 39 West Hyannisport Circle Hyannisport,MA Owner: Ernest Wood Date of Inspection: 1/24/01 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 0 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use: (yes or no): No Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no): No Last date of occupancy: Currently Unoccupied-Unknown COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sqft,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: Not Pumped Since at least five years ago Was system pumped as part of the inspection(yes or no):_ If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM XX Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: 1995-per BOH Records Were sewage odors detected when arriving at the site(yes or no): No Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 39 West Hvannisport Circle Hyannisport,MA Owner: Ernest Wood Date of Inspection: 1/24/01 BUILDING SEWER(locate on site plan) Depth below grade: 18" Materials of construction: cast iron __40 PVC XX other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: XX (locate on site plan) Depth below grade: 12" Material of construction: XX 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: 5' deep x 51wide by 10' long (1,500 gallons Sludge depth: 4.5' Distance from top of sludge to bottom of outlet tee or baffle: 2.5' Scum thickness: '14 inch scum laver noted Distance from top of scum to top of outlet tee or baffle: 9" Distance from bottom of scum to bottom of outlet tee or baffle: 18" How were dimensions determined: Measured Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Structural integrity of tank was ok.No evidence of cracks,leaks,or water infiltration/exfiltration. 4"PVC Tees present at inlet end and Outlet and in good condition. Liquid level equal with outlet invert. 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.): i Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 39 West Hvannisport Circle Hvannisport,MA Owner: Ernest Wood Date of Inspection: 1/24/01 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/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.): DISTRIBUTION BOX: Present (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.): 3 Hole D-Box with one outlet to recent leaching trench. No evidence of back-up into system or of any deterioration. D-Box is located 2.5below grade. 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.): 1 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 39 West Hvannisport Circle Hvannisport,MA Owner: Ernest Wood Date of Inspection: 1/24/01 SOIL ABSORPTION SYSTEM(SAS): XX (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number:_ leaching chambers,number: leaching galleries,number: XX leaching trenches,number, length: 1 trench(12'wide x 30' long x 2' deep) 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.): No evidence of hydraulic failure, ponding damp soil or stressed vegetation. Probed stone around SAS with a 6' probe with no evidence of hydraulic failure noted. Excavated & inspected cover — no liquid in trench CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes 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.): Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 39 West Hvannisport Circle Hvannisport,MA Owner: Ernest Wood Date of Inspection: 1/24/01 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. Swingy Ties• A- Tank In—14' B- Tank In—33' A-Tank Out—22' B- Tank Out—37' A- -D-Box-25' B—D-Box—33' A—Trench Cover-32' B—Trench Cover—27' Exist House A B Leach Trench D-Box O Q 101 Septic Tank i (1500 Gal.) West Hyannisport Circle Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 39 West Hvannisport Circle Hvannisport,MA Owner: Ernest Wood Date of Inspection: 1/24/01 SITE EXAM Slope Surface water -'/2 mile+/- Check cellar -Yes Shallow wells—None Estimated depth to ground water Over 20' 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) XX Accessed USGS database-explain: You must describe how you established the high ground water elevation: Checked with Quadrangle of USGS Map. TOWN OF BARNSTABLE r� LOCATIONS Gtl�sr ��•.+ el�!/s�oxr C, j,' SEWAGE # 40 VILLAGE ASSESSOR'S MAP & LOTI?k-71 INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY X ftt�0 LEACHING FACILITY:(type) 6A L1, e r> ,S (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER VA?,j1>�z � DATE PERMIT ISSUED: ' DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No _. _ \ - '7 •i � �..1, �� `�'� � �3 ��` �, � ��` �� _ ,,_ `�` No.. ... ...^....... Fic$$.....3.ft e.11.0...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Allpliration for Diipoottl Workii Ton.strnrtion rnmit Application is hereby made for a Permit to Construct ( ) or Repair �X) an Individual Sewage Disposal System at: ....39...�e,%t...ayanRj.5_pgr ._Circle West H.yannisport ..... ...................... ............................................................. Location-Address or Lot No. Daniel Burns ......................_.......................................................................... -••--------•-------•----........•--•.......-•----------....-•--•---------•-•-----......----------- Owner Address J I41_ "_ -- r. GO ...................----.............................. •--••-••--•-•---••-••--------••••......••.....-----•----•---•------•-•......--.....--------------- PQ Installer Address UType of Building Size Lot............................Sq. feet DwellingX--No. of Bedrooms-------------4-----------------------.-----Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) 04 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........................ a •---••-•-••-------------------•-------•-----•----•------•----•---••-----------------..........------......................................................... 0 Description of Soil.................................................................... --------------------------- -----------------------------------------------------------------.--•-- W v --••---------Sand.... ...Cr-auel...................................................................................................................................................... W UNature of Repairs or Alterations—Answer when applicable------Omi_t... gallon...: --- 4--4.°.x4......g3Lli-es---Aac hed...in...s.tnaa....................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compli ce has e issued by the ol of health. Signed ..... - /............................. /9.5............. Dare ApplicationApproved By . .... . .... .. ........._- . .. .........................' --.............. - ——--- ..---- - - Dace Application Disapproved for the following re t ns: ---*...................... ----- ................................................-- .............. r / PermitNo. - - ------------------------ Issued ........f ........... ........ .... -------------- Dare No.... Fmc.$... .�?.n.�? ..... THE COMMONWEALTH OF MASSACHUSETTS a BOARD OF HEALTH X TOWN OF BARNSTABLE j Appliratiou for Divj-.Voott1 Works Towitrurtion Vamit Application is hereby made for a Permit to Construct ( ) or Repair ZKX) an Individual Sewage Disposal System at: �9 r�a��t H��nnz•snort__Circle t3est...Hyannisport........................................................................ - ...................... ------ Location-Address or Lot No. Daniel _Burns -•---------------------•---•---------.-------•-••-••----•-•-----•---•-- ---------------------------....-----••---...-•--------•---•-•-•----.........._•--------...._...._. Owner Address a .....?-4 P.,Macomber Jr.................................................. •-•••---•-------------•----•-•-•---------•---••----•--••••••-••-••------••-•......--••--.._....... Installer Address d Type of Building Size Lot............................Sq. feet Dwelling a No. of Bedrooms............. _--------------------__---Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building -------_-------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q' 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........................................ a Test Pit No. 1----------------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........................ ----------------------------------------------------------------------------------------------•••---...................................... .-•---------------- 0 Description of Soil........................................................................................................................................................................ U 19and--- G have...--•-------------------------------- W -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•----_---•-- U Nature of Repairs or Alterations—Answer when applicable.....OM t---cessD.o_ols.___.Install._-1= 50.0.---. gallon tank 1 -`ii-str _b t on box 4-4'x4�- gal-lies._.packed -in_-stone Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complia ce has een issued by the -oard of health. Signed ... l✓G1!1.....,1 ... ..�.-....... 1 /?0/95 y Date ApplicationApproved By .......................... -- -//l��--- -------- y.... - ... 1,it...V_ .........:................. ................ e.................. Application Disapproved for the following ye�on nr: .......................................................... --- --------------------------------------------------------- --------------------- -- --- ------- --- ---------------------------------------- .- Permit No. .......J...� .-----------�---V---------------------- Issued ........ /....,. 1...� Date ... l Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Cer#ifirate of C araylinure THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (XXXX by .. J_.P M_a_rombor----"-7r--•--------------------------------------------------------. ....-----------------..._------------.....----------.._----- Installer at ...........39 West Hysnnisport C rcle....West_..tiyann.is.nor-t--------------------------------------------------------------------- ------ has been installed in accordance with the provisions of TITI.E 5 f T e State Environmental Code as described in the application for Disposal Works Construction Permit No. ..... -: --. .._ dated _..---- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE, AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE. ... f Vi ,- -- - - THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH ILI � TOWN OF BARNSTABLE No... .. �q FEE--$--.30.Oa.. s �i n tt1 nrkii Tomitrurtion Wrnti# Permission is hereby granted..! .P..-Maeamber 3r. to Construct ( ) or Repair (KX)a an Individual Sewage Disposal System � 33 tiaeat Ii nnisz�ort Circl - r ation�PerStreet .`.'t.._ J�rr - - mit as shown on the a h tton for Dts osal Works Const act. vann-�sr-t--- � Dat� !? ... ..................... ... PP P [4, �j ,. �. ' —B��rd�Heal�h .,DATE -d--f.---... . •----•••-----•••••-• V FORM 38D08 HOBBS R WARREN.INC..PUBLISHERS