Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0304 HIGH STREET - Health
304 High St . , WEST BARNSTABLE, A = 111 -027 to 4 TOWN OF BARNSTABLE LOCATI SEWAGE# i�� VILLAGE &J, ASSESSOR'S MAP&PARCEL �•�� �� INSTALLER'S NAME&PHONE NOrqq-4-)%X SEPTIC TANK CAPACITY LEACHING FACILITY:(qT0 (Size), -A "NO.OF BEDROOMS OWNER PERMIT DATE: @ to l 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 leachin facili ) Feet FURNISHED BY 61 t E 't•Th'- �� 5 COMPLETE •N COMPLETE.THIS SECTIONON • ■ Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. X ( _ (�� ❑Agent ■ Print your name and address on the reverse 01,Addressee so that we can return the card to you. B. Received by(Printed Name) C. Date Delivery Attach this card to the back of the mailpiece, Er 1,C Spa S 3 or on the front if space permits. D. Is delivery address different from item 1? ,,, yes 1. Article Addressed to: If YES,enter delivery address below: Ll�No Mr. Eric Strauss 304 High Street r West Barnstable, MA 02668 3. rviceType Certified Mail ❑Express Mail ❑ Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number '�4`7 0, 0 0 01, 4 5 2 51115 4 8 8 (Transfer from service/abed PS F -m 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 I i .,..Y�,.w •aatt�:A.. UNITED STATES VIA(%12 t* ostage&' es Paid USPS V. �k Permit No.G-10 ` s. I • Sender: Please print your name, address, and ZIP+4 in this box • I I I I I a Town of Barnstable I Public Health Division _ 200 Main Street j Hyannis, MA 02601 I co co �. . .; . Ln ru .¢ n Ln Postage $ -- Certified Fee o t IN 66"OR0 0 Return Receipt Fee r O (Endorsement Required) Here T Restrict�f Delivery Fee � (Endorsement Required) 171- :11' O Total Postage&Fees $ r-3 C Mr,Efic Barr 304 H*h Bared Wei Bwnstable,MA 026" i Certified Mail Provides: ■ A mailing receipt ® A unique identifier for your mailpiece a A record of deliveryrkept by the Postal Service for two years Important Reminders: ® Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®. ® Certified Mail is notavailable for any class of international mail. a NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. 11 ® For an additional fee;a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,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 USPS®postmark on your Certified Mail receipt is required. a For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement TestrictedDelivery". ® 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. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 r w+ Town of Barnstable Barnstable °F try T eti Regulatory Services Department et"aM j > IARN'C;T , • m 639.�r Public Health Division �63q. �m 4'Affa r�tt'" 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL # 7011 0470 0001 4525 5488 December 20, 2011 Mr. Eric Strauss 304 High Street West Barnstable, MA 02668 ORDER TO COMPLY WITH'STATE ENVIRONMENTAL CODE, TITLE 5` The septic system located at 304 High Street,West Barnstable, MA, was last inspected on 12/2/2011, by Mark L. Wright, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under.the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • Hydraulic failure. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system with the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S. CHO Agent of the Board of Health Docum ent2 ,�y/����i 0`�i � �urP �v � c� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 304 HIGH ST Property Address ERIC STRAUSS Owner Owner's Name information is required for every WEST BARNSTABLE MA 02668 DECEMBER 2, 2011 page. Citylrown 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: key to move your cursor-do not MARK L WHITE use the return Name of Inspector key. A.B. CANCO Ivl Company Name 350 RT 28 Company Address rem WEST YARMOUTH MA 02673 City/Town State Zip Code 508-775-2820 S-13381 Telephone Number License Number E3.M Lr) BJ 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 + wasF performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title'5(310 CMR 15.000).The system: El Passes Conditionally Passes ® Fails Needs Further Evaluation by the Local Approving Authority `\``\\��u u u u t r rrU�ii OF o?' MARK yN DECEMBER 2, 2011 `o' WHITE Inspector's Signature Date : *: No.S13381 The system inspector shall submit a copy of this inspection report to the App%v �Adfli&41 b rd of Health or DEP)within 30 days of completing this inspection. If the system is1k ' 'Od1t� J.0m or has a design flow of 10,000 gpd or greater, the inspector and the system owner shamit 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 futu a under the same or different conditions of use. J G t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage s I System-Page of 9 7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 304 HIGH ST Property Address ERIC STRAUSS Owner Owner's Name information is required for every WEST BARNSTABLE MA 02668 DECEMBER 2,2011 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 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. ❑ Y ❑ N ❑ ND(Explain belowj: t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 19 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 304 HIGH ST Property Address ERIC STRAUSS Owner Owner's Name information is required for every WEST BARNSTABLE MA 02668 DECEMBER 2, 2011 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cunt.): ❑ 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): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 19 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments wM ,. 304 HIGH ST Property Address ERIC STRAUSS Owner owner's Name information is required for every WEST BARNSTABLE MA 02668 DECEMBER 2, 2011 page. City/Town State Zip Code Date of Inspection C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is 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 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. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 19 Commonwealth of Massachusetts f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 304 HIGH ST Property Address ERIC STRAUSS Owner Owner's Name information is required for every WEST BARNSTABLE MA 02668 DECEMBER 2, 2011 page. City/Town State Zip Code Date of Inspection 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 ❑ 0 Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ 0 Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ N Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool 0 ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow 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. ❑ 0 Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ 0 Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ 0 Any portion of a cesspool or privy is within 50 feet of a private water supply well. t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 19 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 4M >'' 304 HIGH ST Property Address ERIC STRAUSS _ Owner Owner's Name information is required for every WEST BARNSTABLE MA 02668 DECEMBER 2, 2011 page. Cityrrown State Zip Code Date of Inspection ❑ I-XI 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 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 and chain of custody must be attached to this form. Y Y ] i ❑ © 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 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. 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 ❑ p the system is within 200 feet of a tributary to a surface drinking water supply n Protection ❑ � the system is located in a nitrogen sensitive area Wel lhead s 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. C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ❑x ❑ Pumping information was provided by the owner, occupant, or Board of Health, ❑ ❑x Were any of the system components pumped out in the previous two weeks? O ❑ Has the system received normal flows in the previous two week period? ❑ Z Have large volumes of water been introduced to the system recently or as part of this inspection? t5ins-11/10 Trle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 19 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 304 HIGH ST Property Address ERIC STRAUSS Owner Owner's Name information is required for every WEST BARNSTABLE MA 02668 DECEMBER 2, 2011 page. City/Town State Zip Code Date of Inspection n ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A)N/A © ❑ Was the facility or dwelling inspected for signs of sewage back up? x❑ ❑ Was the site inspected for signs of break out? ❑x ❑ 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? 0 ❑ 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: ❑x ❑ Existing information. For example, a plan at the Board of Health. Determined in the field (if any of the failure criteria related to Part C is at issue ❑ approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): LINK Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): UNK D. System Information Description: SYSTEM HAS 2 LEACHING PITS AND THEY BOTH ARE HOLDING LIQUID LESS THAN 6 INCHES FROM THE TOP OF THE PIT. THE INVERTS TO BOTH PITS ARE IN THE RISERS. Number of current residents: 2 t5ins•11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 7 of 19 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 304 HIGH ST Property Address ERIC STRAUSS Owner Owner's Name information is required for every WEST BARNSTABLE MA 02668 DECEMBER 2, 2011 page. Cityrrown State Zip Code Date of Inspection 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)): WELL Sump pump? ® Yes ❑ No Last date of occupancy: CURRENT Date Commercial/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.): Grease trap present? ❑ Yes El No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 19 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage'Disposal System Form-Not for Voluntary Assessments 304 HIGH ST Property Address ERIC STRAUSS Owner Owner's Name information is required for every WEST BARNSTABLE MA 02668 DECEMBER 2, 2011 page. Cityfrown State Zip Code Date of Inspection General Information Pumping Records: Source of information: TOWN &OWNER, 2/07, 1/09, 5/10 Was system pumped as part of the inspection? ❑ Yes 0 No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ❑x 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/Altemative 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 I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 12/96, TOWN t5ins•11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 9 of 19 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments s•''r 304 HIGH ST Property Address ERIC STRAUSS Owner Owner's Name information is required for every WEST BARNSTABLE MA 02668 DECEMBER 2, 2011 page. City/Town State Zip Code Date of Inspection Were sewage odors detected when arriving at the site? ❑ Yes No Building Sewer(locate on site plan): Depth below grade: 2 FEET 9 INCHES feet Material of construction: ❑cast iron 0 40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): INSPECTED LINE WITH CAMERA AND IT 1S IN GOOD SHAPE Septic Tank(locate on site plan): Depth below grade: 26 INCHES feet Material of construction: Z concrete ❑ metal ❑fiberglass ❑polyethylene ❑other(explain) 1000 GALLON TANK, TEES ARE PRESENT AND IN GOOD SHAPE If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: 4 INCHES D. System Information (cont.) t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 19 f Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 304 HIGH ST Property Address ERIC STRAUSS Owner Owner's Name information is required for every WEST BARNSTABLE MA 02668 DECEMBER 2, 2011 page. Cityrrown State Zip Code Date of Inspection Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 4 INCHES 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? SLUDGE JUDGE, TAPE MEASURE 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: O 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 t5ins•1111.0 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Pago 11 of 19 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 304 HIGH ST Property Address ERIC STRAUSS Owner Owner's Name information is required for every WEST BARNSTABLE MA 02668 DECEMBER 2, 2011 page. Cityfrown State Zip Code Date of Inspection Date of last pumping: Date 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.): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 19 r Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 304 HIGH ST Property Address ERIC STRAUSS Owner Owner's Name information is required for every WEST BARNSTABLE MA 02668 DECEMBER 2, 2011 page. City/Town State Zip Code Date of Inspection "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert AT 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.): D BOX IS MODERATELY DETERIORATED. NO SIGNS OF SOLIDS CARRYOVER OR LEAKAGE. 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) (locate on site plan, excavation not required): -P e13Of19 t5ins 11/10 Title5 Official Inspection Farm:Subsurface Sewage Disposal System as Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 304 HIGH ST Property Address ERIC STRAUSS Owner Owner's Name information is required for every WEST BARNSTABLE MA 02668 DECEMBER 2, 2011 page. Cityrrown State Zip Code Date of Inspection If SAS not located, explain why: D. System Information (cont.) Type: leaching pits number:2 2/1000 GALLON LEACH PITS ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number. ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): EACH PIT HAD LESS THAN 6 INCHES OF ROOM TO THE TOP OF THE PIT. THE LINES ENTERING EACH PIT WERE IN THE RISERS Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): t5ins•11/10 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 19 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments •'� 304 HIGH ST Property Address ERIC STRAUSS Owner Owner's Name information is required for every WEST BARNSTABLE MA 02668 DECEMBER 2, 2011 page. Cityfrown State Zip Code Date of Inspection 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 ❑ No D. System Information (cont.) 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.): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 19 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M . ' 304 HIGH ST Property Address 'ERIC STRAUSS Owner Owner's Name information is required for every WEST BARNSTABLE MA 02668 DECEMBER 2, 2011 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 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 19 r • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y 304 HIGH ST Property Address ERIC STRAUSS Owner Owner's Name information is required for every WEST BARNSTABLE MA 02668 DECEMBER 2, 2011 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: Check Slope 0 Surface water t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 19 • Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �< 304 HIGH ST Property Address ERIC STRAUSS Owner Owner's Name information is required for every WEST BARNSTABLE MA 02668 DECEMBER 2, 2011 page. City/rown State Zip Code Date of Inspection © Check cellar 0 Shallow wells Estimated depth to high ground water: 14+ 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) p Checked with local Board of Health-explain: PRIOR T5 INSPECTION ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: 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 18 of 19 • Commonwealth of Massachusetts W Title 5 Official Inspection Fora a� Subsurface Sewage Disposal System Form-.Not for Voluntary Assessments 304 HIGH ST Property Address ERIC STRAUSS _ Owner Owner's Name information is required for every WEST BARNSTABLE MA 02668 DECEMBER 2, 2011 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Fx_1 Inspection Summary:A, B, C, D, or E checked N Inspection Summary D(System Failure Criteria Applicable to All Systems)completed N 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 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 19 of 19 �oWgrM1- W ' Iz (40 • � d �-}=3q �� http://town.bamstable.ma.us/Assessing/HMdisplay.asp?mappar=111027&seq=1 11/29/201". No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 21ppliLation for Vspo�al *pBtrm Construction Permit Application I for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components n Location Address or Lot No Owner1 s Name,Address,and Tel.No.�gl C, fg,4 j Assessor's Map/Parcel `l-a fj '� go-/ 14 f* v Installer's Name,Address,and Tel.Noeq �,N� ,r f Designer's Name,Address,and Tel.No. k Type of Building: Dwelling No.of Bedrooms 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 Plan Date L�Z `) Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. r Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the const ction and m ' tenance of the afore described on-site sewage disposal system in m accordance with the provisions of Title 5 of the Envi onental od and not to place the system in operation until a Certificate of Compliance has been issued b s Board eal a ign %, Date ? ! Z Application Approved byMM, Date Application Disapproved Date for the following reasons Permit No. Date Issued No. / Fee ' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS a application for D18�1o�41��BJEYCY: Construction Permit Application fora Permit to Construct( ) Repair( ) Upgrade( ) Abandon(') ❑Complete System ❑Individual Components Location Address or Lot No.-W 0 Owners Name .,Address,and Tel.No. 7 Assessor's NlapRarcel Z ,30 / /4f1l ry Installer's Name,Address,and Tel.N0610 —05,,10 L&Mr f Designer's Name,Address,and Tel.No. e/Z . o- /2��'S' i �r•� A �� Type of Building: Dwelling No.of Bedrooms J Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required)�j�O gpd Design flow provided Z gpd Plan Date 2�2 '7 Number of sheets Revision Date Title Size of Septic Tank Type of S.A`.S. Descripti.an of Soil i Nature of Repairs or Alterations(Answer when applicable) R Date last inspected: Agreement: The undersigned agrees to ensure the cons, ction and m" tenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Envi onmental od and not to place the system in operation until a Certificate of Compliance has been issued b lids Board eal igne Date Z. Application Approved by �., / H / Date Q Application Disapproved . Nt �__ Date for the following reasons A on Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposals stem Constructed( ) Repaired( Upgraded Abandoned 21 by`&,,L/VB & � IIC� ag � at� �Ql� (f has been const cted i accor a with the pro 'sions of Title 5 he for Disposal System Construction Permit No Installer t i4R9i�fii� ( '�s7",c�C�iGN Designer 1 4v; ,) #bedrooms Approved design flow gpd The issuance of this permli shall t b c nstrued as a guarantee that the system will fu cti sig ed. Date 5pqII{{ Inspectort\ ----------�9/_ - ------------ --------- ---------------------------------------------------------------------�1- No. 1`� Fee �/ V\ THE COMMONWEALTH MM WEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction permit Permission is hereby granted to C nstruct( ) Repair(V Upgrade(V Abandon( ) System located ats o Ll 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. s Provided:Cons do must b/completed within three years of the date of this permit. lJ Date Approved by + Town Of Barnstable o Regulatory Services } t Thomas F.Ceiler,Director BARNSTtYBLEI . a Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,AIA 02601 Office:.508-862-4644, -Fax: 508-790-6304 Installer &Designer Certification Form Dat6 i 1 9012 Designer:—"D401 C) �. ]IIAM;a� Installer: eftw1wt, Address: . Address: 4f�rL>I I On f O -L7— �DI �J�!"�,J! was issued a permit to install a ( te) (installer) septic system at tased on a design drawn by � l✓ /�• �y�l � � dated / a7 02_0 (designer) ..certify that the.septic system referenced above was installed substantiah�according'to ?he design,_which may include min approved changes such as lateral : ocatian of the trrbution box and/or septic tank, 17�pV r I cerWNthat the septic system:referenced above was ins+all d wit$'rriafor.changes (,;e greater IfiapI0' lateral relocatibn-of the SAS or-any verticat relocrafien of a cy compon I of the.sep6 , tem)but in �kc&dance with State &Local,Regulations. Plan revis oh.of certified as- 4 by designer>to'follow. 0F,Mqs� DI�VIDB. �y w Nsee s Signature) : SON NIT-A (D =er-s Signature) (Affix] .e. lgner's Stamp Here) PLEASE RE'�URN TO gA STABLE I'IJBLIC.HEALTH DIMION. CIERTIfFICAT Off-. COMPLIANCE WILL;NO'F. E-: SSUEWTNTIU—IOTff-T ES.'FORM AN WA - BUILT-CARD ARE RECE D B'YTTBYBAI S`I=ABLE PUBLIC RAM DIVISI0N TYOU, . , • 4 1 3 .. IHealtiy/Se tic/DesiperCe. cationForrn x; Q: P. r.: Health Department Drop-Off Hours: 8:00 AM — 4:30 P.M Town of Barnstable Received by Health �.IHE T � Regulatory Services Department on Richard V.Scali,Director (: BAPHAS& E,A Public Health Division - o; �'00 Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 ACCESSORY AFFORDABLE APARTMENT SEPTIC QUESTIONNAIRE Property Address: Si j-irns'rc�- I e Assessor's Map/Parcel Number: Applicant(s) Name: Iris Phone: 71 H 19LI - 1 a y E-Mail: STcgg 0- C0:,-,cyst-, net Size of Lot: I - C)S--acnv_"�o 2a. How many bedrooms exist at your property now? 2b. How many bedroom are you planning to add as part of the Accessory Affordable Apartment Program application? _ 2c. How many bedrooms total are proposed at this property (including the Accessory unit)? 3 2e. Is the proposed Accessory Apartment contained within: ✓ the main house; OR a detached structure 2f. Submit floor plans for all buildings on the entire property. Show all existing rooms in the dwelling and the proposed accessory apartment. Label each room clearly. Label measured width of all open doorways. Use straight edge for hand drawn plans.and be sure all labeling is legible. p , Signed: Date: �-_:F- 4� 1 r ACCESSORY AFFORDABLE APARTMENT SEPTIC QUESTIONNAIRE FOR STAFF USE ONLY 1. Is the dwelling connected to Town sewer? ❑ Yes L 40 2. Dwelling located ❑ INSIDE L3 OUTSIDE the Saltwater Estuary Protection Zone 3. Dwelling located ElINSIDE TSIDE public supply well Zone of Contribution 4. Dwelling is connected to ON-SITE WELL ❑ PUBLIC WATER 5. Disposal works construction permit on file? es ❑ No �l � ©� P 6. If yes, how many bedrooms were allowed by this permit: bedrooms 7. Were building permits obtained for additional bedrooms? ❑ Yes ❑ No 8. Engineered septic system plan: a. On file at the Health Division? Yes ❑ No b. If proposed accessory unit is detached from principal dwelling, is that plan on file? ❑Yes ❑ No 9., Existing septic system capacity is :3 bedrooms For the accessory unit to receive approval from the Health Department the following action must occur: ❑ Existing system accommodates proposed additional bedroom(s) ❑ Upgrade existing system to accommodate additional bedroom(s) ❑ Must remove a bedroom from the main house ❑ Must connect detached structure to the existing septic system ❑ Must install septic system for the detached structure Beer (Z4*mA1'tX 3 Signed Date ` CP 2 Town of Barnstable P# � Department of Regulatory Services J f Public Health Division Date 200 Main Street,Hyannis MA 02601 Date Scheduled ` � Time / Fee Pd. (� Soil Suitability Assessment for Sewa4e Disposal (j Performed By: Witnessed By: L Cl Y TIc QN& GENERAL INFORMATION L Location Address fj t{ Ct' Owner's Name -ck;G ST9AG s S W J —6 l Address3O V /`f;911 15- Assessor's Map/Parcel: Engineer's Namejpy;o NEW CONSTRUCTION REPAIR L/ Telephone#S-6r 3-3 --0R J 7- Land Use Slopes(96) Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Lino ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) l Parent material(geologic) Depth to Bedrock Depth to Groundwater. Standing Water in Hole: Weeping from Pit FAce Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: In, Depth to soil mottles: !n, Depth to weeping from side of obs.hole: In, Groundwater Adjustment ti. Index Well# Reading Date: Index Well level Adj,iketor—Adj,Groundwater Level,, PER ATION TEST bate Thne,� Observation Hole# Time at 4" Depth of Perc Time at G' Start'Pre-soak Time @ rv,1� 'lime(9"-6") End Pre-soak Rate Min./lac h .00 (� 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:\SEPTIC\PERCFORM.DOC ' I DEEP.OBSERVATION HOLE LOG Hole# _ Depth from Soil Horizon Soil Texture Soil Color Soil• Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. onsistency.%'Gravel) 40 2 G LS � ✓L6 . DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Grave DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, O DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones',Boulders. Consistency. e _Flood Insurance Rate Map_ / Above 500 year flood boundary No— es Within 500 year boundary No'! Yes Within 100 year flood boundary No. Yes _ Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring perviouss mattenal exist in all areas observed throughout the area proposed for the soil absorption system? ��,� If not,what is the depth of naturally occurring per sous material? Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Enviro ental Protection and that the above analysis was performed by me consistent with . the required training,exp rtise a d experience described in 10 CMR 15.017. r Si n g Datb Z-7 ��1 Q:\.S.EP11CIPERCPORM.DOC down cape engineering, Inc. SIEVE SOILS ANALYSIS 304 HIGH ST W. BARNSTABLE, MA DATE OF REPORT:IV20/11 JOB : GRAIN SIZE ANALYSIS-sIEYE TEST SITE: 304 HIGH STREET W. BARSTABLE, MA LOCATION: CARDINAL CONSRTUCTION TESTHOLE SIEVE ANALYSIS Weight Sample(Grams): 239.7 SIZE ;WEIGHT RETAINED %RETAINED %PASSED sum —_ _ 141 .. .................... 3/4" OA: _0.0%: 100.0% . 1/2" 0.0. 0.0%: 100.0% 3%8-- ----.:�... ............... .O0.0%%-----100.0% ----- ------------------------- 0.0: ------------0.0°/ rW_. 100.0% j0 -------------------------•--16.8;� ��_ ---6.8"%..'- --Y 93.4%° 0 89.8 29.0%: 71.0% 0 .�E.................. .�81.8u r 67.5// ......... .32.5%0 .............�................._... _..-Y�-_---_--�_��.............. ... - ------- -------------------226.3: �' 94.4%;.....-------5.8% --------------.- ---------------- - -----�---------------- -- - - • --- ---- #100 : 233.. 2.7% 00 237.4: 99.0%: 1.0°!o -------------t---------------------- •-c--------------------,�---------- PAN' 238.7; 100.0% 0.0% -------r----------------------�T. NOTETEST 239T. NOTE:TEST ON PASSING#4 ONLY,8.2%RETAINED ON#4<45%O.K. RESULTS: SOIL CLASSIFIED AS AASHTO A-3(GRANULAR,COARSE SAND)(UNCOMPACTED) PERCENTAGE OF MATERIAL PASSING#4 SIEVE: 04 1000% (TEST ONLY MATERIAL PASSING#4) OK #6010°/e-100% OK #100 0%-200/a OK #200 0%-5% OK SAMPLE MEETS TITLE 5 FILL SPECIFICATION >98%SAND RESULTS:PERMEABLE MATERIAL-CLASS 1<2 MINJIN.MATERIAL NONCOMPACTED SOIL DESCRIPTION: COARSE SAND °_�DANIELA.� OJALA CIVIL N No.r465 ? AL tid WdPT:ZZ 110z 9Z '3au 80TT6ZS 'ON Xdd -l7138dWUD 110=DS W0d9 L . 9-j— I� fivfp 2000 �. �N HE91IN0�ABIF � ra COMMONWEALTH OF MASACHUSETTS ; EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS £ DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET BOSTON MA 02108(617)292-3500 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION /'a r Property Address: 304 HIGH ST. ,ARNSTABLE, MA MAP I I I PAR 27 02630 Name of Owner RICHARD SHECHTMAN Address of Owner: BOX 4 BARNSTABLE 02630 Date of Inspection: 2/9/00 Name of Inspector: JOHN GRACI 1 am a DEP approved system inspector pursuant to Secdon 15.340 of Tide 5(310 CMR 15.000) Company Name: JOHN GRACI SEPTIC INSPECTIONS Mailing Address: P.O.BOX 2119 Telephone Number: 608-564-6813 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 inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.The system: X Passes _ Conditionally Passes _ Needs Further Evaluation the Local Approving Authority Fails Inspector's Signature: �Y Date: The System Inspector shall su mit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(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 Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS "The inspection is based on criteria defined In Title V code 310 CMR 15.303.My findings are of how the system is performing at the time of inspection.My inspection does not imply any warranty or guarantee of the longevity of the septic system and any of its component's useful life." THE SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING THE SYSTEM EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. revised 9/2/98 Page 1 of 11 l F C SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 304 HIGH ST. BARNSTABLE, MA MAP I I I PAR 27 02630 Name of Owner RICHARD SHECHTMAN Date of Inspection: 2/9/00 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: X I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. 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. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances.If"not determined",explain why not. n/a The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank, whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection If the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. n& Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health). _broken pipe(s)are replaced _obstruction is removed _distribution box is levelled or replaced n& The system required pumping more than four 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 revised 9/2/98 Page 2 of 11 t _ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 304 HIGH ST. BARNSTABLE, MA MAP I I I PAR 27 02630 Name of Owner RICHARD SHECHTMAN Date of Inspection: 2/9/00 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 the public health,safety and 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 ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of 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 AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well, _ The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis 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,Method used to determine distance n(a(approximation not valid). 3) OTHER n/a revised 9/2/98 Page 3 of 11 .., _ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 304 HIGH ST. BARNSTABLE, MA MAP I I I PAR 27 02630 Name of Owner RICHARD SHECHTMAN Date of Inspection: 2/9/00 D. SYSTEM FAILS: You,must indicate either"Yes"or"No"to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No - X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. - X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. - X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. - X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow, - X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped Q. - X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. - X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. - X Any portion of a cesspool or privy is within a Zone I of a public well. - X Any portion of a cesspool or privy is within 50 feet of a private water supply well, - X 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.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No - X the system is within 400 feet of a surface drinking water supply - X the system is within 200 feet of a tributary to a surface drinking water supply - X 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) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 304 HIGH ST. BARNSTABLE, MA MAP I I I PAR 27 02630 Name of Owner: RICHARD SHECHTMAN Date of Inspection: 2/9100 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No X _ Pumping Information was provided by the owner,occupant,or Board of Health. X - None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period. i_arge volumes of water have not been introduced into the system recently or as part of this inspection. X - As built plans have been obtained and examined.Note if they are not available with N/A. I X - The facility or dwelling was inspected for signs of sewage back-up. X - The system does not receive non-sanitary or industrial waste flow. X - The site was Inspected for signs of breakout. X - All system components,excluding the Soil Absorption System,have been located on the site. X - The septic tank manholes were uncovered,opened,and the interior of the septic tank was Inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been determined based on: X - Existing Information,For example,Plan at B4O,H, X - Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)1 5.302(3)(b)) X - The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Subsurface Disposal Systems. revised 9/2198 Page 5 of 11 L' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 304 HIGH ST. BARNSTABLE, MA MAP 111 PAR 27 02630 Name of Owner RICHARD SHECHTMAN Date of Inspection: 2/9100 FLOW CONDITIONS RESIDENTIAL: Design flow: 110 g.p.d./bedroom Number of bedrooms(design): 3 Number of bedrooms(actual): Total DESIGN flow: 330 gpd Number of current residents:2 Garbage grinder(yes or no):NO Laundry(separate system)(yes or no): NO If yes,separate inspection required Laundry system inspected(yes or no): NO Seasonal use(yes or no): NO Water meter readings,if available(last two year's usage): n/a gpd Sump Pump(yes or no): NO Last date of occupancy: n/a COMMERCIAL/INDUSTRIAL Type of establishment: n/a Design flow: n/a gpd(Based on 15.203) Basis of design flow:n/a Grease trap present:(yes or no): NO Industrial Waste Holding Tank present:(yes or no): NO Non-sanitary waste discharged to the Title 5 system:(yes or no):NO Water meter readings.if available: n/a Last date of occupancy:n/a OTHER: (Describe) n/a GENERAL INFORMATION PUMPING RECORDS and source of information: 1998 BY BORTOLOTTI System pumped as part of inspection:(yes or no):NO If yes,volume pumped n/a gallons Reason for pumping:n/a TYPE OF SYSTEM X 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) I/A Technology etc.Attach copy of up to date operation and maintenance contract _ Tight Tank Copy of DEP Approval Other:n/a APPROXIMATE AGE of all components,date installed(if known)and source of information: ORIGINAL INSTALLED IN 1988 WITH A REPAIR IN'96 Sewage odors detected when arriving at the site:(yes or no): NO revised 9/2/98 Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 304 HIGH ST. BARNSTABLE, MA MAP I I I PAR 27 02630 Name of Owner RICHARD SHECHTMAN Date of Inspection: 2/9100 BUILDING SEWER:X (Locate on site plan) Depth below grade: 30" Material of construction: _ cast iron X 40 Pvc _ other(explain) Distance from private water supply well or suction line: n/a Diameter: 4" Comments: (condition of joints,venting,evidence of leakage,etc.) THERE IS TOWN WATER SEPTIC TANK: X (locate on site plan) Depth below grade: 24" Material of construction: X concrete_ metal_ Fiberglass_ Polyethylene_ other explain: n/a If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): NO Age: n/a Dimensions: L 10'6"H 6'7"W 5'8"" Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 32" Scum thickness: 3" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 15" How dimensions were determined: MEASURED Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING EVERY TWO YEARS. GREASE TRAP: _ (locate on site plan) Depth below grade: n1a Material of construction: _concrete_ metal_ Fiberglass _ Polyethylene_other Explain: n/a Dimensions:n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle n/a Date of last pumping: n/a Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) n/a revised 9098 Page 7 of 11 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 304 HIGH ST. BARNSTABLE, MA MAP 111 PAR 27 02630 Name of Owner RICHARD SHECHTMAN Date of Inspection: 2/9/00 TIGHT OR HOLDING TANK: _ (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: n/a Material of construction: _concrete_ metal_Fiberglass _Polyethylene _other Explain: n1a Dimensions: ;n/a Capacity: n/a gallons Design flow: n/a gallons/day Alarm present: NO Alarm level:n/a Alarm In working order:NO Date of previous pumping: n/a Comments: (condition of inlet tee,condition of alarm and float switches,etc.) n/a DISTRIBUTION BOX:X (locate on site plan) Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage Into or out of box,etc.) DISTRIBUTION BOX IS STRUCTURALLY SOUND. PUMP CHAMBER: _ (locate on site plan) Pumps in working order:(Yes or No): NO Alarms in working order(Yes or No): NO Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) n/a revised 9/2/98 Page 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 304 HIGH ST. BARNSTABLE, MA MAP I I I PAR 27 02630 Name of Owner RICHARD SHECHTMAN Date of Inspection: 219/00 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: n/a Type: leaching pits,number:(2)1000G H 6'XD 6' leaching chambers,number: (n/a)n/a leaching galleries,number: (n/a)n/a leaching trenches,number,length: (n/a)n/a leaching fields,number,dimensions: (n/a)n/a overflow cesspool,number: (n/a)n/a Alternative system: n/a Name of Technology: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE LEACH PITS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.ONE PIT WAS 1/2 FULL;DID NOT EXPOSE OTHER PIT CESSPOOLS: _ (locate on site plan) Number and configuration: n/a Depth-top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer. n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater: n/a inflow(cesspool must be pumped as part of inspection)NO Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a revised 9/21'98 Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 304 HIGH ST. BARNSTABLE, MA MAP 111 PAR 27 02630 Name of Owner RICHARD SHECHTMAN Date of Inspection: 2/9100 SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) G R k y C 6e o a � V L� ID Ac .51 �A 31 a revised 9/2/98 Page 10 of 11 M SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 304 HIGH ST. BARNSTABLE, MA MAP I I I PAR 27 02630 Name of Owner RICHARD SHECHTMAN Date of Inspection: 2/9100 NRCS Report name: n/a Soil Type: n/a Typical depth to groundwater: n/a USGS Date website visited: nla Observation Wells checked: NO Groundwater depth: Shallow_ Moderate_ Deep_ SITE EXAM _ Slope _ Surface water _ Check Cellar Shallow wells Estimated Depth to Groundwater 12 Feet+ Please Indicate all the methods used to determine High Groundwater Elevation: �Q Obtained from Design Plans on record �LQ Observed Site(Abutting property,observation hole,basement sump etc.) �LQ Determined from local conditions NQ Checked with local Board of health NQ Checked FEMA Maps NQ Checked pumping records Na Checked local excavators,installers X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS.12+FEET revised 9/2198 Page 11 of 11 CERTIFICATE OF ANALYSIS o ., Page: 1 � M Barnstable County Health Laboratory \sb� HtySt�t Report Prepared For: Report Dated: 5/2/2008 Eric Strauss Order No.: G0846022 304 High Street West Barnstable, MA 02668 Laboratory iD#: 0846022-01 Description: Water-Drinking Water Sample#: Sampling Location 304 High Street West_Barnstable,MA r Collected: 5/1/2008 Collected by: Eric Strauss Received: 5/1/2008 Routine ITEM RESULT UNITS RL MCL Method# Tested Nitrate as Nitrogen 2.7 mg/L 0.10 10 EPA 300.0 5/l/2008 Copper 0.27 mg/L 0.10 1.3 SM 3111B 5/2/2008 Iron ND mg/L 0.10 0.3 SM 311113 5/2/2008 Sodium 33 mg/L 1.0 20 SM 311113 5/2/2008 Total Coliform Absent P/A 0 0 SM9223 5/1/2008 Conductance 250 umohs/cm 2.0 EPA 120.1 5/1/2008 pH 6.5 pH-units 0 SM 4500 H-B 5/l/2008 [`Sodium level is dbove the maximum cantaminant level=Those on a low sodiuin_diet.may wish to consult-a phy_sic'ia t. Approved By: (La it ctor) VD=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 JUL-28-1999 01:54 .KINLIN GROUER NORTON 509 362 9001 P.02 1z, 7. : . `�ST:8 ,TABLE FIRE DEI'ARTMEliTT 2160 MEET NGHOUSE WAY i .ter! P.O. BOX 456 WEST BARNSTABLE, MA 02668 • JOHN P. JENKIN'S Chief of Department EMERGENCY: 362-3131 BUSINESS: 362.3241 F M 362-3241 December 16, 1996 Thomas A. McKean, Director Health Department .Town of Bar. nstable ;N 367 Main Street Hyannis, MA 02601 Dear Mr. McKean, RE: Underground Tank Abandonment Notification This is to notify you of the abandonment of an underground storage tank. The following in�ormation is provided for your convenience. WBFD Reference: 96-100 Date of Abandonment: November 1996 Street Location: 304 High Street �av-�� Property Owner: Doak Martin Type of Tank: Steel, round, 500 gallon Product: #2 Home Heating Fuel Tank Reg. Tag#: 1303 As the underground tank was below a poured concrete patio, the property owner was permitted to open and clean the tank and fill same with concrete. Chief Jenkins from this Department observed the abandonment of this tank. The tank was solid and there was no indication of any leakage from the tank. To the Department's knowledge, there are no other underground tanks on this property. No application has been made for the installation of any new underground tank on this premises. Sincerel bh Jenkins, Chief of Department JPJr TOTAL P.02 Citizen Web Request Page 1 of 3 Ott 14 �" 1�.+•C.+° r,: �a R�1N5'Y'1C11 r- dd A s� Logged In Citizen Request Management Wednesday,January 112012 TOWN\desmamarad Route to Users Search Requests Create Requests Request Information Request ID: 36416 Created: 1/10/2012 4:17:21 PM Status: Assigned To Staff Assigned To: Desmarais, Donald Health Office Anonymous: Yes Request Category: Title 5 : Section 353-7 Sewage edit Routine work: No Estimate: No edit Date scheduled: edit Estimated 1/25/2012 Change Estimated Dec January 2012 Feb Completion Completion Date: Date: Sun Mon Tue Wed Thu Fri Sat 25 26 27 28 29 130 31 1 2 3 4 5 16 7 8 9 10 11 12 13 14 15 16 17 18 19 2#72:8 22 23 24 25 26 229 30 31 1 2 Created By: Parvin, Lindsay Priority: Medium edit Health Office Citation Numbers: edit Requestor Information Requestor Request DETAILS: LOCATION: 304 HIGH STREET West Barnstable, Ma 02668 Request Parcel Number Ma 1 `Block: 027 Lot: 000 I Requestor reports that a septic p' 11 m "" system in being installed at 304 High Street.There is a concern that the Parcel Lookup septic is being installed too close to an adjacent well. Email: Edit Requestor Information = 1/11/2012 htt ://iss 12/InternalWRS/WRe uest.as x.ID 36416 P q q P Citizen Web Request Page 2 of 3 Track Request Progress Request Work History: Internal Note History: Entered'on 1/10/2012 4:17:21 PM by Parvin, Lindsay Don, I don't see that a permit has been pulled for this address. It failed a title 5 inspection in December. System entry on 1/10/2012 4:17:22 PM: Assigned to Desmarais, Donald .Enter work progress: Enter internal note: (Viewed by everybody) (Viewed internally only) x� tlE __ ° -: _.j Spell Check ,. SpeIl:Check Add document or image link: Browse *You can also type in a folder name to see everything in the folder Current Links: Time worked on request: Response time: *Time entries are in hours. Examples of time entries: 1.25, 0.5, 0.75, 1, 3.5, 0.25, 0.10 * Response time: Measured from the creation date to your first actions on the request. * Do not include nights, weekends, and holidays in response time for most departments. F;Save changes r Check to notify town employee below to review this request. 0 Save changes and notify Health office citizen* Q rrra�_ � .._ ..� Crocker, Sharon 0 Close request Brief message to reviewer: r Close request and notify citizen* r- *notify works if email address was given E SpelhCheck i http://issgl2/InternalWRS/WRequest.aspx?ID=36416 1/11/2012 TOWN OF BARNSTABLE Al LOCAT10N ��C (�`` SEWAGE # 6031 VILLAGE" \� `� ASSESSOR'S MAP & LOT / INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 't (size) /000,� NO.OF BEDROOMS BUELDER OR OWNE PERMTTDATE: 1 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (1f 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 le hin facility) Feet Furnished by '" ® � P m 051 VVv Fee THE COMMONWEALTH OF MASSA HUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 0[ppitcatton for Miquar *pgtem Congtructton Vermtt Application for a Permit to Construct( )Repair( /upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Z��0 �clvi , Owner's Name,Address and Tel.No., Assessor's Map/Parcel �9y�� A Inst et:sN ara —,,� o. 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 Design Flow gallons per day. Calculated daily flow gallons. Plan Da`�e Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterati (Answer when Ipplicable) JA5�'z� �1�kQy—, _� Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore de9cribed 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 7fi- cate of Compliance has been is ued b hi oard ealth.Signed Date I/ � 76, Application Approved by 11,4 Date Application Disapproved for the following reasons Permit No. 42 Date Issued Gam` is Fee , THE COMMONWEALTH OF MASSA HUSETTS Entered in computer: r ' Yes _ 1 PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Zlpprication for Migaar *pgtem Congtruction Permit Application for a Permit to Construct( )Repair(/upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Z O q Owner's Name,Address and Tel.No. Assessor's Nlap/Pazcel �w1 1 InstalleCs Natne, i s,and Tel. o. 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 Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when pplicable) :7\�� 1If`f\ L u ( �S 1.1 ` - `��- Date last inspected;' Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been is a hi oard Signed Date Application Approved by Date Application Disapproved for the ollow ng reasons Permit No. Date Issued i THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( )Repaired ((Upgraded( ) Abandoned( )b at % as been constructed in accordance with the provisions of Title 5 d the for Disposal System Construction Permit No. — dated4..^• ,., Installer T� � ►y �� Designer The issuance of this rmit shall not be construed as a guarantee that the syste 1 function as design Date P _,�~ Inspector No.--�-----------------------------Fee 6&f2_9 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migwar *pgtem Con!6truction Permit Ill Permission is hereby granted to Construct( Repair( -lupgrade( )Abandon( ) System located at �gNk jC:j}J, 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:Constru ion st be completed within three years of the date of thi e it. Date: Approved by t f, CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) ereby certify that the application for disposal works PP P construction permit signed by me dated' ( Q ca concerning the property located at �)CQL\ �� d �`�5 meets all of the following criteria: �• There are no wetlands within 300 feet of the proposed septic system There are no private wells within 150 feet of the proposed septic system ,%�The observed groundwater table is 14 feet or greater below the bottom of the leaching facility ,o/There is no increase in flow and/or change in use proposed ,w ,here are no variances requested or needed. SIGNED DATE: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. E � r' - -ti ._ �. t .. ;. ' t �_ � � � � � � • 4 ,` � ,. JUL-28-1999 01.54 KINLIN GROUER NORTON 508 362 9001 P.02 TMSTP o, o� ARNSTABLE FIRE DEPAR V y TMENT 2160 MEEMGHOUSE WAy l� r! P.O. BOX 456 WEST BARNSI'ABU, MA 02668 a • JOHN P. JENKINS Chief of Department EMERGENCY: 362-3131 BUSMSs; 362.3241 F.AX 362-3241 December 16, 1996 Thomas A. McKean, Director Health Department OWn of,8a�rista le - 367 Main Street r. . Hyannis, MA 02601 Dear Mr. McKean, RE: Underground Tank Abandonment Notification This is to notify you of the abandonment ent of an underground information 9 d storage tank. T Lion i g he foil s owin Provided for your convenienc g e. WBFb Reference: 96-1 00 Date of Abandonment: November 1996 Ol. Street Location: 304 High Street Property Owner: Doak Martin Type of Tank; Steel round, \ Product: 500 gallon #2 Home Heating Fuel Tank Reg. Tag#: 1303 As the underground tank was below a poured concrete patio, the property owner was Permitted to open.and clean the tank and fill same with concrete. Chief Jerikinsfrom this Department observed the abandonment of this tank. The tank was soli was no indication of any leakage from the tank. so d and there f To the Department's knowledge, there are no other underground tanks on this Property. No application has been made for the installation of any new underground tank on this premises. Sincerel `�vh Jenkins, Chief of Department JPJf TOTAL P.02 �� ,� i i t - � • t ` * . • L u - _.�7���ti."4:,�✓"`'riq a.y��"G2"'n,.�,�rry;�('Mro".tt rT.r"'r:,..-'k8r+a�++r..m^r*: r-.�r°�^i'�rn.:A„.n,�,a"r-'T�jy;y......a-.,y,;.w.=..-.;."fib'9...rf��'''�*,;,'�+ .-..-..�•`-`..,, { =r+•..,,rr •• :,. TOWN OF BARNSTABLE — UNDERGRUUND FUEL AND CHEMICAL STORAGE REGISTRATI N MAP N0. � ` j PARCEL N0. =� 2 � TAG N0. y� ADDRESS OF TANK: J (4 `== �V^ VILLAGE • T fvum bar Ytr��.t MAILING ADDRESS ( IF DIFFERENT FROM ABOVE ) : `� L� 'W 11, C,Ct i (c O L.('r-V OWNER NAME: a ` rY` wtµ .� - " - '� PHONE INSTALLATION DATE: (` r 1, BY,': , INSTALLER ADDRESS: ' ! (% V r=- -CERT .NO. *TANK LOCATION: '•Avft—' BELOW ' r'� C� V �V � I G(j )t t �^tJVL+•'4 './1ffCrt�J (DCa0/V I aC r^NK LOCATION W i TH RQOPmCT TO au I LD I NO) CAPACITY' 0 6, 6A TYPE OF TANK %T L AGE l0 -YRS. FUEL-#CHffM---CAL TESTING CERTIFICATION [ 1] PASS [ ] FAIL DATE ` LEAK DETECTION [ ] ,CHECK IF WA TYPE/BRAND ly...- 1 ~ ZONE OF CONTRIBUTIO.N7 [ ] YES [ NO ;. DATE TO BE REMOVED FIRE DEPT. PERMIT ISSUED [ ] YES [INO DATE CONSERVATION [ ] CHECK IF N/A DATE BOARD OF HEALTH TAG NO. [ '- ] DATE PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD WO, �oOQ {— cr) 1 � 111 _ w7 a� i= o a 01 t �t� Q rA a .3 L - - - 17 Pre se,) boo 30 �r r � ' f ! l Fit 00 r O � o i 1 ben n _ !i { s s • • j i� f? r { El F w o $boo ki 4 ' ` rA *L�x 17 is Den t E; Propose� .- .Sfe V e i reg :' 0 o erg^e--lk e l k E � i `k. t F f ' t i _ L 0f4 a of en J I s f t pr�dPds�d� 4 k Y 1 - e iS Af I1 GI a Q Ij � ' h3 frr QO !q y f 00 ,g 1 i 6 o : i FI 17 Den - Pro foSe� -S love react' 30 f, y it op p r j q R00rn i F . EC] Fool 576 z: k!7'• t 410 Ga Pr'ese ram, 304 1Op Y F c i ' i I r ( E Lof4 R 5 F(2)4 I. i ,a: i A ASSESSORS MAP : /I/ --_ _ _._ _... . _ TEST HOLE LOGS NOTES: PARCEL: J�v FLOOD ZONE: /�/oT �I PPL"C'�SC-� SOIL EVALUATOR: DJVXZ> .3. �-i')' 1) The installation shall comply with Title V and Town of;j1�y�AP�I,& Board of n _----------_._--_.__ WITNESS : DCI,,;� ��'1 � '�� Health Regulations. — REFERENCE: G p/�' ,L n/!� $� qZ-L CIS DATE: -� 'Zc�/ / 2) The installer shall verify the location of utilities, sewer inverts and septic PERCOLAT ON RATE• .G Z AVAI 1 • components prior to installation and setting base elevations. 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8"per foot. The first two feet out of the d-box to the leaching shall be level. TH- 1 TH-2 4) This plan is not to be utilized for property line determination nor any other 0A yr9w//G ,, purpose other than the'proposed system installation. 5 L 5) All septic components must meet Title V specifications. 6) Parking shall not be constructed over H10 septic components. 7) The property is bounded by property corners and property lines. li �$ �� G 8) The property owner shall.review design considerations to approve of total L O CA T I ON MA P( ► T,::5) `� �i' design flow and number of bedrooms to be considered for design. Receipt of payment for the plan and installation based on the plan shall be deemed \ Crrr �` approval of the design flow by the owner. _ 9) The existing leaching or cesspools shall be pumped and filled with material 112'� per Title V abandonment procedures. Those within the proposed SAS shall be removed along with contaminated soil and replaced with clean sand per / AA _ d�,� Title V specs. _ ND g4tq_D. 7 /L� wp1`! ^cw 4 10)System components to be 10 feet from water line. Sewer lines crossing the 1 water line shall be sleeved with 4 inch SCH 40 PVC with ends grouted if -------- ---- . - -- -- ------ L c5✓EY lL . �y/ ir/ ,Srj applicable. The proposed SAS is being installed below the water service SEPTIC SYSTEM DESIGN line. The line is to be sleeved as aforementioned and maintained in place. 11) If a garbage grinder exists it is to be removed and is the responsibility of the owner to ensure such. NJ I FLOW ESTIMATE MATE ! 12)The installer is to take caution in excavation around the gas line if such exists. r BEDROOMS AT GAL/DAY/BEDROOM -3AL/DAY 13)The installer shall verify the location,quantity and elevation of the sewer lines exiting the dwelling prior to the installation. SEPTIC I C TANK 14)This plan is representative only that a system can fit on a property meeting- - Title V requirements. CAL/DAY x 2 DAYS N USE/ GALLON SEPTIC TANK{EXI��WCr> `� l►.lt��2.►2 �t,/vT � — — — soil ABSORPTION -SYSTEM` �. OF A44,\ ft : 1. DAVID MASON m� No.tOfiP01 � F. 5Co e-f o�sT\ �,105, c� M _ D DAVID B. ON Co" S C T I O N N0. G SEPT I SYSTEM E 1 )7---q1111 ecno t w/JW u e ' o 0 o o o a o GAL I I 1�0 4l.'11Fljl_ ��� �� , o u v o D 0 /O So 7_ �_ SEPT I C TANK ��k '��l ,bX3/,I z ���aCGp"y�4 ,/� >� eop �- __ �vx, SITE AND SEWAGE PLAN L) Awp , PZG LOCATION : �.3 f-�� �7PZ PREPARED FOR : C'*?b/A/jt, CyW�7�2V I cc�rvi� SCALE: ZO DAVID B . MASONJR$ DATE: o DBC ENVIRONMENTAL DESIGNS s EAST SANDWICH . MA DATE HEALTH AGENT ( 508 ) 833- 2177 Z --------------T-- ---- -- --— -