HomeMy WebLinkAbout2495 MAIN ST./RTE 6A(BARN.) - Health 2495 Main Strde Ste 64 (B;Efrn) �
Barnstab,e
A = 257 t016 `
a
o
P
C o
'� i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M
^M 2495 Route 6A
Property Address
Nancy Lewis ,
Owner Owner's Name
information is
required for every 1A�est Barnstable ✓ Ma 02668 4-5-17
page. City/Town State Zip Code Date of Inspection "
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When filling out forms A. General Information..
on the computer,
use only the tab 1. Inspector:
key to move your
cursor-do not Matthew Gilfoy
use the return Name of Inspector
key.
B&B Excavation
r� Company Name
374 Route 130
Alf Company Address
Sandwich Ma 02563
City/Town State Zip Code
(508)477-0653 S113640
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5(310 CMR 15.000). The system:
® Passes- ❑ Conditionally Passes ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
4-5-17
Inspector's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****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.
l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17
�o vS
Commonwealth of Massachusetts
w Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
„M
2495 Route 6A
Property Address
Nancy Lewis
Owner Owner's Name
information is required for every West Barnstable- Ma 02668 4-5-17
page. Cityfrown 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:
System was in working order at time of inspection.
B) System Conditionally Passes:
Y
❑ 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 below):
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�M 2495 Route 6A
Property Address
Nancy Lewis
Owner Owner's Name
information is required for every West Barnstable Ma 02668 4-5-17
page. City/Town State` Zip Code Date of Inspection
B. Certification (cont.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired. -
B) System Conditionally Passes (cont.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s) or due to a broken, settle_ d 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 0 ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
y
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
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
H
2495 Route 6A
Property Address
Nancy Lewis
Owner Owner's Name
information is required for every West Barnstable Ma 02668 4-5-17
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well".
Method used to determine distance:
**This system passes if the well water analysis,,performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
3. Other:
i I.II.
1
Y
D) System Failure Criteria"Applicable to All Systems:
You must indicate "Yes" or"No"to each of the following for all inspections:
Yes No
❑ ® 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 '/z day flow
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
2495 Route 6A
Property Address
i
Nancy Lewis
Owner Owner's Name
information is required for every West Barnstable Ma 02668 4-5-17
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® 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.
❑ Z Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑, ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
'laboratory,for fecal 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.]
❑ ® 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
❑ ❑ 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.
i
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
t -
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
;M 2495 Route 6A
Property Address
Nancy Lewis
Owner Owner's Name
information is required for every West Barnstable Ma 02668 4-5-17
page. Citylrown State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes" or"no" as to each of the following:
Yes No
❑ ® Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
❑ ® Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
❑ ® Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS)on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): 3 Number of bedrooms (Actual) _3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 336.1 gpd
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
,M 2495 Route 6A
Property Address
Nancy Lewis
Owner Owner's Name
information is required for every West Barnstable Ma 02668 4-5-17
page. City/Town State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents: 3
i
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No
information in this report.).
Laundry system inspected?' ❑ Yes ® No
Seasonal use? ❑ Yes ® No
Water meter readings, if available last 2 years usage p d See below
Detail:
2015- 17,000gallons 2016- 18,000gallons
Sump pump? ❑. Yes ® No
Last date of occupancy: Current
Date
Commercial/Industrial flow Conditions:
Type of Establishment: NA
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,-❑f No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
,M 2495 Route 6A
Property Address
Nancy Lewis
Owner Owner's Name `
information is required for every West Barnstable Ma 02668 4-5-17
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
General Information
Pumping Records:
Source of information: Owner- Date of last pump unknown
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:.
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval!
❑ Other(describe):
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
2495 Route 6A
Property Address
p Y
Nancy Lewis
Owner Owner's Name
information is required for every West Barnstable Ma 02668 4-5-17
page. City/Town State Zip Code `" Date of Inspection
D. System Information (cone.)
Approximate age of all,components, date installed (if known) and source of information:
2004
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 26�
feet
Material of construction:
® cast iron ®40 PVC ❑ other(explain):
Distance from private water supply well or suction line: Town
feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
Septic Tank (locate on site plan):
Depth below grade: 14t
• feet
Material of construction:
® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age:
years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 1500gallons
3"
Sludge depth: -
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
ssachusetts Commonwealth of Ma
w Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
°M 2495 Route 6A
Property Address
Nancy Lewis
Owner Owner's Name
information is required for every West Barnstable Ma 02668 4-5-17
page. City/Town State Zip Code Date of Inspection
D. System Information (cont)
Septic Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle. 33"
Scum thickness 1
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 16"
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.):
Tank was in working order at time of inspection with liquid level equal to outlet invert. Tank is not in
need of pumping at this time but should be pumped every two years for maintenance.
Grease Trap (locate on site plan):
Depth below grade: NA
feet
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions: f
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle '
Date of last pumping:
-Date
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection i n Form
0
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
- 9 p Y Y
�nM 2495 Route 6A
Property Address
Nancy Lewis
Owner Owner's Name
information is required for every West Barnstable Ma 02668 4-5-17
page. CityFrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade: NA
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain).-
Dimensions:
Capacity: gallons
Design Flow:
gallons per day
Alarm present: El Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: ? . Date
Comments (condition of alarm and float switches, etc.):
*Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 11 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�M 2495 Route 6A
Property Address
Nancy Lewis
Owner Owner's Name
information is required for every West Barnstable Ma 02668 4-5-17
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box (if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert 0
11
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 was in working order at time of inspection. No sign of past back up or carry over were present.
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.):
NA
* If pumps or alarms are not in working order, system is a conditional pass.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
•
Commonwealth of Massachusetts
W Title 5 Official. Inspectiono Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 2495 Route 6A
Property Address
Nancy Lewis
Owner Owner's Name
information is west Barnstable Ma 02668 4-5-17
required for every
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont)
Type:
. _ m
❑ leaching pits number:'
® leaching chambers number: (3) 500 gallon
❑ 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.):
Leaching was in working order at time of inspection. Chambers were dry with a stain line 6" up from
bottom.
Cesspools (cesspool must be pumped as-part of inspection) (locate on site plan):
Number and configuration - NA
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
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 2495 Route 6A
Property Address
Nancy Lewis
Owner Owner's Name
information is required for every West Barnstable Ma 02668 4-5-17
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privylocate on site plan):
T
( p )
Materials of construction: NA
Dimensions
Depth of solids
Comments (note condition of soil, signs ofhydraulic failure, level of ponding, condition of vegetation,
etc.):
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
,M 2495 Route 6A
Property Address
Nancy Lewis
Owner Owner's Name
information is required for every West Barnstable Ma 02668 4-5-17
page. CitylTown 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
`,
B FRONT
. A2. 33'6 62-29'6"
ROP T 6k,
t5ins-3/13 " Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
,M 2495 Route 6A
Property Address
Nancy Lewis
Owner Owner's Name
information is required for every West Barnstable Ma 02668 4-5-17
page. City/Town State Zip Code -Date of Inspection
D. System Information (cont.)
Site Exam:
® Check Slope
® Surface water
® Check cellar
® Shallow wells
Estimated depth to high ground water: No GW @ 180"
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: 2-28-03
Date
❑ Observed site (abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health -explain: .
❑ Checked with'local excavators, installers-(attach documentation)
❑ Accessed USGS database=explain:
You must describe how you established the high ground water elevation:
Plan on file with BOH.
I
Before filing this Inspection.Report, please see Report Completeness Checklist on next page.
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
° 2495 Route 6A
M
Property Address
Nancy Lewis
Owner Owner's Name
information is required for every West Barnstable ' Ma 02668 4-5-17
page. City/Town State . a Zip Code Date of Inspection
E. Report Completeness, Checklist
p
® Inspection Summary: A, B, C, D, or E checked
® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed
® System Information—Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
1
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 17 of 17
tel..(508)362-4541
939 main street rt 6a. fax(508)362-9880
yarmouth port
mass 02675 - t
down cape._en . e fg�
civil engineers&eland Ley�rs
structural design
i23;. Arne H.Ojala RE.,P.L.S.
Daniel A.Ojala,P.L.S.
'rBp �S�� L '+� Timothy H.Covell,P.L.S.
land court ; TH'DEPT�:
surveys
April 23, 2003
site planning
Sam White L
sewage system Barnstable Health Department
designs 200 Main Street
Hyannis, MA 02601 03,
inspections
Re: 2495 Rte 6A, Barnstable
permits
Dear Mr. White:
At your request, Down Cape Engineering, Inc. performed a
sieve analysis of a representative sample of the soil from
the excavation of the septic system at the
above-referenced site. We have classified the soil as
having a textural -classification of loamy sand. The
textures are as follows:
gravel : 8.3%
coarse sand: 42 .8%
fine sand: 40.7%
silt/clay: 8.2%
If you have any questions, please do not hesitate to call
me.
Yours truly,
Arne H. Ojala, PE, PLS
Down Cape Engineering, Inc.
cc: Tim Baker
Po�T�ETo,� The Town of Barnstable
Health Department
367 Main Street, Hyannis, MA 02601
MYl
tap i639
.
�0 VAR M.
Office 508-790-6265 Thomas A. McKean
FAX 508-775-3344 Director of Public Health
TO: Warren Rutherford, Town Manger
FROM: Thomas McKean Director of Public Health , ,ft&a-,--
DATE: November 3, 1992
SUBJECT: Response To Complaint From Brian Boots/ 2495 Main
Street, West Barnstable/Trailer Occupied By
Cornelius Trowbridge
We are planning to hold a joint inspection with the Building
Department and the Police Department tomorrow. To date, the
Health Department has been unable to determine whether the
trailer is occupied. Also, the Health Inspector has been
unable to obtain permission to inspect the trailer for
health code violations.
Health Inspector Jerome Dunning was assigned to investigate
the complaint on July 23, 1992. Due to the fact that Mr.
Boots described Mr. Trowbridge as a Vietnam veteran who shot
flares at his house, possibly tapped into his telephone,
connected wiring to a utility pole to receive electricity,
and punctured his neighbor's tires, and due to the fact that
there are several no trespassing signs posted in the area,
Inspector Dunning has been very careful not to trespass on
this property. On July 24, 1992, Inspector Dunning went to
the complainants property and observed the dwelling
described as a "shack" and the subject trailer. He stated
that he was unable to observe any health violations.
On November 3, 1992, Health Inspector Jerome Dunning went to
the property again. He again stated he was unable to obtain
permission to enter the property and was unable to observe
any health violations.
Police Department Officer Greenwood investigated the site on
September 28, 1992 and cited Mr. Trowbridge for unregistered
motor vehicles. According to Jenny Robbins of the Building
Department, Mr. Trowbridge later complained that the Police
Officer drove his cruiser onto his lawn and caused damage.
Therefore, it is recommended there should always be a
witness present when an investigation is conducted at this
property.
i
At this time, we can only assume that there may be no legal
onsite sewage disposal systems provided at the dwellings.
However, an onsite inspection should be conducted before we
make that determination.
Although the occupancy of trailers is illegal in the Town of
Barnstable and enforcement of this Zoning Ordinance is
usually accomplished by the Building Department, the Health
Department is compliant by continuing to attempt to
determine occupancy and to inspect for health code
violations in order to provide support to the Building
Department in their enforcement of this Zoning Ordinance.
You will receive a report of our findings as soon after
tomorrows inspection as possible.
-w
•
CORPA —.QA SUMMONS VV47H Oft ICI PS Rf_l UPN 0-4066S a WARREt4. INC PUbLISHCR-S
Ducts lEcum REVISCO Otc 1971 BOSTON, MASS.
4r (9BmtonwraI14 of Natifiar4usrmi
Barnstable
........................................................ss-
.................................................................................
..........JqrjQ.Mp p3jnainq, Health Inspector for the Town of
..............................................—*-------------111111111-1-1------ ----------
Barnstable, 367 Main Street, Hyannis MA
...........I..................................................... .............................................................................................
....................................................................................................................................................greeting.
tau are 4crebg ramtuanbeb. in the name of The Commonwealth of Massachusetts, to appear
before MY.............F.ir.st...Di strict
...................................Court (Civil Jury Session)
...................................................................
&ldenat Barnstable within and for the county of. Barnstable
.................................... ...............................................................
on the.........1.0.th..................................................day of
.. . .... .............j!�,�-!4ary...........
..... ...........................at
9 : 0 0
....................................o'clock in I&.....fore..1100", and from day to day thereafter, .until the action
hereinafter nained is heard by said Court, to give evidence of what you know relating to an action
of....Contract _._...._.then and there to be beard and tried between
. .... .... . .... .. ..........................................
Timothy Kelley
......................................................................................................................................plaintiff and
Barbara. Oube.r........ j
..............I......................................................................... and
you arc further required to bring with.you............................................................................................
...............................................................................................................................................................
................................................................................................................................................................
.................................1---...-...............................................................--.............................................
...............................................................................................................................................................
......................................-..—..................................................................................................................
...............................................................................................................................................................
...............................................................................................................................................................
14trrat fatt not,. as you will dusuArr your default xxder.the Pains and penalties in the law
in that behalf "sade and provided.
jktrb at ..........Oster
....O.s.terv.i.l 1:e............................the........ .3 rd.................... .Jan.ua.r.y....
.. . .... .. ....diy of... ...... .... . ..
A. D. 1992
................... ............. . ..... ....... . ........
Albert J. Sch 2 wary pubfic---xx xkxox
Barnstable, ss. Jan. 7, 1992
I this day summoned the within named Jerome Dunning to appear and give evidence as
within directed by delivering to him in hand an attested copy hereof, in the Hyannis
.district of said Barnstable, together with $8.00 fees for .attendance and travel.
Svc. & Trvl. $20.00
Pd. witness 8.00 C� v
Cop. 3.00
M.V. 5.00 William G. Litchfield
$36.00 Dep. Sheriff
POFTHE To;+ TOWN OF BARNSTABLE
OFFICE OF
DARISTAMN r BOARD OF HEALTH
00 2639• 367 MAIN STREET
o pAY HYANNIS. MASS. 02601
I e�
October 26, 1989
Barbara Ouber �. 1
9 Beth Lane
Hyannis MA 02601 TYz!r+�•
NOTICE TO ABATE VIOLATIONS OF 105 CMR 410. 000 SANITARY CODE
II MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION
The property owned by you located at the apartment at 9 Beth
Health
Lane, Hyannis, MA was inspected by Jerome Dunning,
Inspector for the Town of Barnstable, on October 25, 1989 because
of a complaint. The following
Standards f violations f 105 F tnessMforl0.000
Human
State Sanitary Code II, Mini
Habitation were observed:
Regulation 105 CMR 410.190: Insufficient hot water provided,
temperature of water only 57 degrees farenheit
Regulation 105 CMR 410.200: Insufficient heat provided,
temperature of habitable room only 58 degrees farenheit.
Regulation 105 CMR 410.482: Smoke detector inoperative at time
of inspection (10:00 A.M. )
Regulation 105 CMR 410.450: No second means of egress observed. •
The above listed violations are also listed as violations of
105 CMR 410.750 as conditions deemed to endanger or impair health
or safety of the occupants and must be corrected within
twenty-four (24) of receipt of this notice.
You may request a hearing if written petition requesting is
received by the Board of Health within seven (7) days after
the date order is received. However, these violations must
be corrected regardless of any request. for a hearing.
Non-compliance may result in a fine of up .to $500.00.. Each day s
failure to comply with an order shall constitute a separate
violation.
• P.ER :ORDER OF TH BOARD OF.'.HEALTH
Thomas A. McKean
Director of Public Health cc: Hyannis Fire Department
Building Department
':TM a cs t
TOWN OF BARNSTABLE
LOCATION o���'qS &A SEWAGE # aY:i— (5-7
VILLAGE A('Y1S-64b'f— ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. ShOc-2 5, e CfnS� ' -M`C-u 1 19&4tf-
SEPTIC TANK CAPACITY 1500 qa{
LEACHING FACILITY: (type) 50o� e br•(size) a0 X I D
NO.OF BEDROOMS-3
BUILDER OR OWNER —T I VY1t�2r
PERMITDATE: 'i 1S 0 COMPLIANCE DATE: Y,/I�lW03
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by -
d �
\no
M
*o
s -
`V
No.
j S / - Fee Z)
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE,, MASSACHUSETTS
01pplication for Ditpaar *p$tem Construction 3permit
Application for a Permit to Construct( )Repair( )Upgrade(k )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address and T 1.No.
7%;►'I �jA c2
Assessor's Map/Parcel ` S 9/h C
`o
Installer's Name,Address and Tel No. Designer's Name,Address and Tel.No. $_
t32ucC a�l;s%cam y38 5`sa4 Dba,,1 CA r;,s„4Cc0 ;s 3�2 ysyi
cis—e�„,71� A. (j36s�s y�a�n-to�r�i hip c��7:6°?S
Type of Building:
Dwelling No.of Bedrooms Lot Size 46Xj ,1/t sq.ft. Garbage Grinder(.io)
Other Type of Building No. of Persons G GN°9l\1GSrtaURM7MR)keffe-tCn1a`(7—
Other Fixtures
Design Flow 3345 C3346,/) gallons per day. Calculated daily flow gallons.
Plan Date I'M2C H c,Z 6,,200 3 Number of sheets Revision Date
Title
Size of Septic Tank /5-00 6g . Type of S.A.S. .So 0 Gl 1. C AAMX 25 L/
Description of Soil
Nature of Repairs or Alter tions(Answer when applicable) �UMD PX/s Cesl19oo1j
/Soo 6% 5cdT,c 7-4 — 'b 3"X e 3—SaO•SH I ry,,)` je�j eviT�j o7„�`v STv.�e S�irov1a ivt r C.r�Irtt��J
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 issued by this Board oNZ
.
Sig Date - -0 2D0
Application Approved by Date��) 15)&!3
Application Disapproved for the following reasons
Permit No. o_Q1z1:5 --I S -1 Date Issued 14 15 1 cr 3
w. .{.r�.s...•t--. 5....:..�_, .. R..f t✓.w.'..ice ... ,, _ _ _
r- •'Y.w.'.'c%. .,Yi' r .z"h-..✓N1,.,{:�:... (s•,i:-.: �.t•. r:.'- '..r.{i:......h,'tit..,<-„ny.+...b.r.*+ Y''
Fee _
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: V'
' Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
Application for Migogal bpgtem CCongtruction Per M' it
Application for a Permit to Construct( )Repair( )Upgrade(lf)Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No:
Assessor's Map/Parcel
Installer's Name,Address and Tel.No. _'" -rod— Designer's Name,Address and Tel.No.
U-
,1�'2^uC2 /LlCCi1/i 5!r y,,2b'-5�'.7t 9 �J(n.• l Cti�c �"iC;,1rCc'..� /
051er'L ,I/r
Type of Building:
Dwelling No.of Bedrooms 13 Lot Size ;Ib,' ', = sq.ft. Garbage Grinder(-Gu) ,
� gs
t Type of Building No. of Persons Showers( ) Cafeteria( )
ttie i t
Design Flower r;36, jafn per day. Calculated daily flow gallons.
Plan Date �`irlt �� ,�' ,. QiQ Nu' b.�r ttof' 5�eets / Revision Date
Title f �,
Size of Septic Tank fJrUb 6AI, Type of S.A.S. 3" Sep 0 Cara/, C1/09,)►Al-es
Description of Soil .)S .-So. Z 71)!o�
Nature of Repairs or Alterations(Answer when applicable) ?1,91D I lPr z)m c c rr s f7uu/J
a0o 6-1/.
! 1 G S/G•IC _R,/YUv 'i�t t[ (' 7 1,l t rZJ'
-J
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 issued by this Board of Health.
Sign /��- C.. Date ." l
Application Approved by Date C) 1 SJ o-3
Application Disapproved for the following reasons
Permit No. c9_Cc:,:5 ^1 S "1 � �� Date Issued
----- - -- TA - - -
T46COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded(s
Abandoned( )by S F-i v
at I ct 5 ?�__—C < has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. 'ZOOS-157 dated ' 15'03
Installer `�' c< `(CL C C_t l , s i �- Designer
The issuance o t this pprrmt shall not be construed as a guarantee that the syste wA' €u n J signed.
Date t 2 t 3 Inspector-- ,
No. 2C90 3 — 1- Fee �o -
' THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
Migpogar *pgtem Congtruction Permit
Permission is hereby granted to Construct( )Repair( )Upgrade(yf Abandon( )
System located at �.� 5 2U %t c 61 ,.�
t
1
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: Construction must be completed within three years of the date of this perm'
Date: 4'115/0 3 Approved by
j TOWN OF BARNSTABLE -
i
LOCATION o�gg5 �� ��rns ably SEWAGE # olar3—' 1:5
VILLAGE �QC'n5 ��- ASSESSOR'S MAP & LOT't g "I
INSTALLER'S NAME&PHONE NO. �hOr���1e CeM-�t
SEPTIC TANK CAPACITY 1500 qal -
LEACHING FACILITY: (type)& 54 t each CMb'r•(size) a0 x I D
NO.OF BEDROOMS _3
BUILDER OR OWNER -1 VY1 ttkt V, C
PERMITDATE: �$ 03 OMPLIANCE DATE: Y�l 3403
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
i
O
i
I
i
FIRST FLOOR_= 50.00' SYSTEM PROFILE _ TEST HOLE LOGS
ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE)
� ACCESS COVER (WATERTIGHT) To ENGINEER: ARNE H. OJALA, PE
/49..
WITHIN 6" OF FIN. GRADE ,0 MINIMUM .75' OF COVER OVER PRECAST /� 2% SLOPE REQUIRED OVER SYSTEM 45.0 WITNESS: CAM WHITE�BOH)
2 DOUBLE WASHED PEASTONE DATE: 3/25/03
"
RUN PnPE LEVEL
; '* FOR FIRST 2' � r - ASSUMED < 5 MINIINCH IN C3
46.0 3' MAX. PERC. RATE -
7, 7IPROPOSED 1500 e
GALLON SEPTIC 45.0' Y3.83' CLASS ► SOILS P# 10437 � -
45.25 TANK (H- 10 )
,� : - ws aA c7000 43.83' `� Focus
44.0 Cl000D 0 CDE7L� M
MIN o 4 .0' C3G7L C7G7C7C7 D
ELEV. BARNELEM,
( 2 SLOPE) �6" CRUSHED STONE OR MECHANICAL I� C7 O C� Cl C7 C� Q CJ 0 45.0
COMPACTION. (15.221 [2]) z5o�3$ 2' [] [� 0 0 p 41 .0'
DEPTH OF FLOW 4 ( 4 �; SLOPE) A �
TEE H OF 3/4" TO 1 1/2" DOUBLE WASHED ST�,)NE r
SL z
,. 12" 10YR 3/2
INLET DEPTH 1 0
OUTLET DEPTH 14" g LOCATION MAP NO SCALE '
SL
LEACFOUNDATION 33' SEPTIC TANK 23' D' BOX 12' FACILITY( 36" 2.5Y 5/6 42 0,
ASSESSORS MAP 257 PARCEL 16
PROVIDE 46' OF 40 MIL LINER AT 5' DRAIN C1
OFF LEACHING FACILITY AS SHOWN. TOP SWALE 5 FINE SILTY SOME GLEY
*PLUMBING PROPOSED TO RE-ROUTED AS AT ELEV, 44.0, BOTTOM AT EL. 40.0' \_" �41•27 2.5Y 5/1
REQUIRED WITH INVERT ELEV. AT MIN. 46.0' ,zF'�1�36 SAND
� �•+40.68 84" 7.5YR 5/6 38.0'
**SIEVE ANALYSIS
GAS zs REQUIRED OF C3 LAYER
MAIN C2 PRIOR TO INSTALLATION;
I 36
� �2 PERCHED/WATER SEEP AT SL ' SCHEDULE WITH
REQUIRED AAROUND PER L OF UNSUITABLE METER OF � eOLE
EL. 36.0' 1 .0 WAT R E SEEP ENGINEER
LEACHING FACILITY, DOWN TO i 1N"
SUITABLE SOIL LAYER (TO C3, 1 „ IOYR 5/6 ,
LOAMY SAND LAYER). REPLACE 94 132 34.0
11!i TH CLEAN MED. SAND. ENGINEER UY C3
TO INSPECT AND CERTIFY G
4211 i
REMOVAL. i *' / LS
Ov 2.9 194 �`� �}-46a1 180" 10YR 5/6 30.0'
b
BENCHMARK: USE FIRST FLOOD - /
ELEVATION HERE AT 50.0' �' z N /
•4 ` ASSUMED � �•
,,4'3,43 / ��/ / / �� S ''TIC DES(^vial: (GARBAGE DISPOSER IS NOT ALLOWED )
1 DATUM IS
/ 2. MUNICIPAL WATER IS EXISTING
OFF- P r UTILITY p('SIGN FLOW: 3_ BEDROOMS ( 110 GPD) _ 30 GPD
101 /:// T . .. `�.. .i3� GPD DESIGN FLOW ivliivPiVI�M PIF'r= PITCH i O dr '8 r�Er FOOT.
' 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO 1 - 10
.92 SE PTIC TANK: 0 GPD (-2 -) = 660 GALLONS
�4a.a g5 �.. 5 = 33 5. PIPE JOINTS TO BE MADE WATERTIGHT.
,� / U`�E A 1500- GALLON SEPTIC TANK 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS.
\ (+44,�i1� 'k 4
I 5� LEACHING: ENVIRONMENTAL CODE TITLE V.
r_-+45.24, 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO PE
_L
a gPL �Nr% SIDES: 2(30 t .83� 2 �.74) = 117.9
Y\` 1 24 + A0 - USED FOR LOT LINE STAKING.
7 � / QOTTOM: 30 x 9.83 (.74) 218.2 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4 PVC.
44. 9 W 20,074f SF / TCTAL: 454--- S F 336.1 GPD 9. COMPONENTS NOT TO BE BACKFILLED OR .CONCEALFO WI i HOUT
�. - INSPECTION BY BOARD OF HEALTH AND PERMISSION 001 -,INED
o 61 a g/ / 7. 6� U F (3) 500 GAL LEACHING CHAMBERS (ACME OR FROM BOARD OF HEALTH.
\ 4 �` / 47 1 E,.)UAL WITH 2.25' STONE AT ENDS AND 2.5' AT
�� ►�, _ �� j / ) 10. CESSPOOLS TO BE PUMPED AND FILLED WITH CLEAN SAND OR
IRT�\ Ap 5.83 SIDES REMOVED AS NECESSARY. NOTE: UNKNOWN LOCATION(S)
4 ,2 .79 2 �i LEGEND
\� 6.92 �, 5 4 .27 EXISTING �+
\ 46,07 + •13 ��4 , DWELLING PROPOSED SPOT ELEVATION
'OoFF=50.0 +4 .22 TITLE 5 SITE PLAN
100x0 EXISTING SPOT ELEVATION '
9.70 4679 .E 3� 49'15 10o OF 2495 ROUTE 6 A
-A� 4a + C-' PROPOSED CONTOUR
43 T' IN THE TOWN OF:
Et, 100 EXISTING CONTOUR
l EXISTING '� BARNSTABLE
2 / O
5 53 l S BARN - - ----- 06 + 55 �Qi PREPARED FOR: TI M BAKER
BLDG
s \ T �`r'�--F "-- BOARD OF HEALTH
5� -\\� / __ y 6 0.1 20 0 20 40 60 Feet
FiPPROVED DATE MA
6.8��(� �/ 05 CAS A �'
` SCALE: 1" = 20' DATE: MARCH 28, 2003
i
/ �'� r ��
7.27 5�//'''' �G`� off 508-362-4541
�
�g9 ���� Fax soe 362-e8e0 .
�6h1 ° �' ' � 00wn cape engineering, Inc,
li OF
"/ !�
OF
CIVIL ENGINEERS 1ARNE
H. ARNE H
LAND SURVEYORS ALq (VILLA ,
p N 2634
939 main st. yarmouth, ma 02675 2 /c��
0
I k P.L.S. ATE
03--054