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HomeMy WebLinkAbout3604 MAIN ST./RTE 6A(BARN.) - Health 3604 Main St. (Rt. 6A) A = 318-053 Barnstable I j) Town of Barnstable. Barnstable Regulatory Services Department A'MW=1 I `AR; r Public Health Division 2007 200 Main Street, Hyannis MA 02601 r Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7015 1520 0000 1968 9682 June 22, 2016 Thomas Connors 320 Tappan Street . Brookline, MA 02146 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 3604 Main Street, Barnstable, MA was last inspected on 06/16/2016, by Michael DiBuono, a certified septic 'inspector for the state of Massachusetts. .The inspection of the septic system showed that the system"Conditionally Passes under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • H-10 distribution box is under driveway; need H-20 under driveway. You are ordered to repair or replace the septic system within two (2) years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BO OF HEALTH . r e , R.S. CHO Agent of the Board of Health QASEPTICU.etters Septic Inspection Failures or Future Ev1\3604 Main Street Bamstable.doc l ` Town of Barnstable � s + BARNS!"LF, .- Regulatory Services Department -Public Health Division 200 Main Street, Hyannis MA*02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev..5/11/16 DEADLINES TO REPAIR FAILED SYSTEMS. (Town Code §360-44 and Title V: 310 CMR 15.000) An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1)YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation t _ ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2)YEAR DEADLINE CRITERIA ❑ Single Cesspool L "conditionally passed systems" (broken cover,relocation of a pipe, relocation driveway due to H-10 components, etc) ching pit or cesspool with high liquid level, <12"below inlet(per Town Code 0-9.1)ching facility with standing liquid level at or above the invert pipe (per Town e §360-20 h)ER II ^� f" i1 �0 V '"/� V ndR r y r ue WGA Y\J U Tl o Un e� r,u-0VA ' 7 Repair deadline: - Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc SECTIONSENDER: C0110PLETE THIS SECTION OMPLETE THIS ON DELIVERY ■ Complete itenis' and 3.Also complete A. Signature item 4 if Restrictef Delivery is desired. X ❑Agent ■ Print your nar'rie Ad address on the reverse e ❑Addressee so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from Item 1? ❑Yes' L 1. Article Addressed to: If YES,enter delivery address below: ❑No 3070 ��ppa� str 3. Service Type �iC�D/ oK��rlba/ l l_ ,K Certified Mail® ❑ s'"Priority Mail Expres❑Registered XReturn Receipt for Merchandise ❑Insured Mail ❑Collect on Delivery _ 4. Restricted Delivery?(Extra Fee) p Yes 2. Artick .� . :; : i; : "[ j I t I. 1 ° 7015 1;520 00'001,t1968?19662 s :BSI (Trans- PS Form 3811,July 2013 Domestic Return Receipt UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4®in this box• Town of Barnstable Health Division 200 Main Street Hyannis, MA 02601 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments C 3604 Main st Property Address Thomas and Feiga Conners ~ Owner Owner's Name information is required for every Barnstable Ma 02630 6/16/16 page. City/Town State Zip Code Date of Inspection C71 . 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 S/# IW b on the computer, use only the tab 1. Inspector: key to move your cursor-do not Michael DiBuono use the return Name of Inspector key. DiBuono Sewer and Drain Company Name 8 Johns path Company Address S Yarmouth Ma 02664 City/Town State Zip Code 508-364-9587 S103522 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 roving Authority 6/21/16 I pector'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. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 3604 Main st Property Address + Thomas and Feiga Conners 'Owner Owners Name +information is required for every Barnstable Ma 02630 6/16/16 w page. City/Town State Zip Code Date of Inspection .s Wit: 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 contains a 1,500 GI septic tank as well as a Dbox and two 1,000 GI leach pits. Distribution box is rotted and needs to be upgraded to an H2O distribution box as it is underr the driveway. Home is seasonal. 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 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 a 3604 Main st Property Address Thomas and Feiga Conners Owner Owner's Name information is required for every Barnstable Ma 02630 6/16/16 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 obstructedpipe(s) or due to a broken settled or uneven distribution box. System will Y 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): Needs new H2O Distribution box under driveway. ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a 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 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 3604 Main st Property Address Thomas and Feiga Conners Owner Owner's Name equired foatifo is every r Barnstable Ma 02630 6/16/16 requir page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 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 ^M 3604 Main st Property Address Thomas and Feiga Conners Owner Owner's Name information is required for every Barnstable Ma 02630 6/16/16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No El ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal 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. l 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. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 3604 Main st Property Address Thomas and Feiga Conners Owner Owner's Name information is required for every Barnstable Ma 02630 6/16/16 page. City/Town 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? ❑ Z 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): 5 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 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 3604 Main st 'M Property Address Thomas and Feiga Conners Owner Owner's Name information is required for every Barnstable Ma 02630 6/16/16 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: System contains a 1,500 GI septic tank as well as a Dbox and two 1,000 GI leach pits. Distribution box is rotted and needs to be upgraded to an H2O distribution box as it is underr the driveway. Home is seasonal. Number of current residents: 2 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 (gpd)): Well Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Occupied 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 ❑ 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 3604 Main st Property Address Thomas and Feiga Conners Owner Owner's Name information is required for every Barnstable Ma 02630 6/16/16 page. Cityrrown 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: None provided. Pumping is recommended 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): t.iins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 3604 Main st Property Address Thomas and Feiga Conners Owner Owner's Name information is required for every Barnstable Ma 02630 6/16/16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 36 Years Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan). Depth below grade: 4 feet Material of construction: , ® cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): System is vented at roof line Septic Tank(locate on site plan): Depth below grade: 3.5 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1500 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: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 l Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 3604 Main st Property Address Thomas and Feiga Conners Owner Owner's Name information is required for every Barnstable Ma 02630 6/16/16 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 24" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 42" Distance from bottom of scum to bottom of outlet tee or baffle 1" Sludge stick How were dimensions determined? 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.): No evidence of Ieaking,Tees and or baffles in place at time of inspection. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 3604 Main st Property Address Thomas and Feiga Conners Owner Owner's Name information is required for every Barnstable Ma 02630 6/16/16 page. City/Town 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.): Tees are in place and levels are normal. Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 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 3604 Main st M - ' Property Address Thomas and Feiga Conners Owner Owner's Name information is required for every Barnstable Ma 02630 6/16/16 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 H10 And needs to be replaced with H2O Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * 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: tins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 3604 Main st Property Address Thomas and Feiga Conners Owner Owner's Name information is required for every Barnstable Ma 02630 6/16/16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 2 1,00 gl ❑ 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.): Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3113 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 3604 Main st Property Address Thomas and Feiga Conners Owner Owner's Name regjir atifo is Barnstable Ma 02630 6/16/16 required for every pace. 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.): No ponding no break out 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.): t`.ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3604 Main st Property Address Thomas and Feiga Conners Owner Owner's Name information is required for every Barnstable Ma 02630 6/16/16 page. City/Town 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 Frn� fi 21 b r 3�j D S 1 l \ 1 J 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 3604 Main st M Property Address Thomas and Feiga Conners Owner Owner's Name information is rec wired for every Barnstable Ma 02630 6/16/16 page. Cityrrown 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: feeetet ft Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date May 23 1977 of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers -(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Test hole data on plan shows water at 30' z 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 r s Commonwealth of MaissacNusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 3604 Main st M Property Address Thomas and Fei9 a Conners Owner Owner's Name information is required for every Barnstable Ma 02630 6/16/16 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ❑ Inspection Summary: A, B, C, D, or-E checked ❑ Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ❑ System Information- Estimated depth to high groundwater ❑ Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 CERTIFICATE OF ANALYSIS Page: 1 of 1 u., Barnstable County'Health Laboratory (M-MA009) Report Prepared For: Report Dated: 6/17/2016 C Vicky Whittier Order No.: G169388 N 1045 Old Post Rd. v Cotuit, MA 02635 Laboratory ID#: 1693889-01 Description: Water-Drinking Water 'ca Sample#: Sample Location: 3604 Main St. Barnstable CollefWd: 06/16/2016 Collected by: VW Received: 06/16/2016 Routine ITEM RESULT UNITS RL MCL METHOD# ANALYST TESTED NOTE Nitrate as Nitrogen 0.56 mg/L 0.10 10 EPA 300.0 LAP 6/17/2016 Copper ND mg/L 0.10 1.3 SM 3111 B LAP 6/17/2016 Iron 2.1 mg/L. 0.10 0.3. SM 3111E LAP 6/17/2016 pH 6.6 PH AT 25C NA 6.5-8.5 SM 4500-H-B DCB 6/16/2016 Sodium 14 mg/L 2.5 20 SM,3111B LAP 6/17/2016 Total Coliform Absent P/A 0 0 .1 SM 9223 RG 6/16/2016 Conductance 170 umohs/cm 2.0 EPA 120.1 DCB 6/16/2016 Based on the results of the parameters tested, the water is suitable for drinking,but may present aesthetic problems (taste, odor, staining)due to Iron. Attached please find the laboratory certified parameter list. Approved By: "7 (Lab Manager). - r ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level 3195 Main Street, PO..Box 427, Barnstable, MA 02630 Ph: 508-375-6605 ,o 9 CERTIFICATE OF ANALYSIS w Barnstable County Health Laboratory (M-MA009) Recipient: Matrix: Water- Drinking Water Vicky Whittier Sampled: 06/16/2016 15:20 1045 Old Post Rd. Received: 06/16/2016 15:37 Cotuit, MA 02635 Collection Address: 3604 Main St. Barnstable Order#: G1693889 Sample Location: Description: 3 DAY RUSH RE KIT-3604 Main St. Lab ID: 1693889 01 Date Analyzed: 6/17/2016 @ 13:19 Sample#: Analyst: ym Method: EPA 524.2 Dilution Factor: 1 Comment: Based on the results of the parameters.tested,the water is suitable for drinking, but may present aesthetic problems(taste, odor,staining)due to Iron. EPA 524.2 - Volatile Organics by GC/MS Result MCL MDL Result MCL MDL Parameter ug/L ug/L ug/L Parameter ug/L - uq/L ug/L Dichlorodifluoromethane ND 0.50 IChloroform ND 80 0.50 Chloromethane ND a 0.50- cis-1,2-Dichloroethene ND 70 0.50 Vinyl chloride NO 2.0 0.50 cis-1,3-Dichloropropene ND 0.50 Bromomethane ND 0.50 Dibromochloromethane ND 0.50 1,1,1,2-Tetrachloroethane. ND 0.50 Dibromomethane ND _ 0.50 1,1,1-Trichloroethane ND 200 I 0.50 Ethlbenzene ND 700 0.50 1,1,2,2-Tetrachloroethane ND I 0.50 Hexachlorobutadiene ND I 0.50 1,1,2-Trichloroethane ND 5.0 0.50 Isopropylbenzene I ND I 0.50 1,1-Dichloroethane ND 0.50 Methylene chloride ND 5.0 0.50 1,1-Dichloroethene ND 7.0 0.50 Methyl-tert-butyl ether ND 0.50 1,1-Dichloropropene ND 0.50 Naphthalene ND 0.50 1,2,3-Trichlorobenzene ND 0.50 �n-Butylbenzene ND 0.50 1,2,3-Trichloropropane ND 0.50 I n-Propylbenzene ND 0.50 1,2,4-Trichlorobenzene ND 70 0.50 I p-Isopropyltoluene ND I I 0.50 1,2,4-Trimethylbenzene ND I 0.50 1Isec-Butyl benzene ND ( 0.50 1,2-Dibromo-3-chloropropane ND I 0.50 Styrene ND I 100 I 0.50 1,2-Dibromoethane(EDB) ND 0.50 tert-Butylbenzene ND 0.50 1,2-Dichlorobenzene ND 600 0.50 Tetrachloroethene ND. • 5.0 0.50 1,2-Dichloroethane ND 5.0 , 0.50 Toluene ND 1000 0.50 1,2-Dichloropropane ND 0.50 Total xylenes ND 10000 0.50 1,3,5-Trimethylbenzene ND 0.50 trans-1,2-Dichloroethene NO 100 0.50 1,3-Dichlorobenzene ND 0.50 trans-1,3-Dichloropropene ND I 0.50 1,3-Dichloropropane ND 1 0.50 I Trichloroethene ND I 5.0 0.50 1,4-Dichlorobenzene ND 5.0 0.50 ITrichlorofluoromethane ND I 0.50 2,2-Dichloropropane ND 0.50 0 0 Surrogates /o Recovered QC Limits 2-Chlorotoluene ND 0.50 p-Bromofluorobenzene 82% 70 130 4-Chlorotoluene ND. o.so 1,2=Dichlorobenzene-d4 85% 70 130 Benzene ND 5.0 0.50 Bromobenzene ND 0.50 Bromochloromethane ND 0.50' Bromodichloromethane _ ND 0.50 Bromoform ND 0.50 Carbon tetrachloride ND 5.0 0.50 . Chlorobenzene ND 100 0.50 Chloroethane ND 0.50 Attached please find the laboratory certified parameter list. Approved . (Lab Director) ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level 3195 Main Street, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 Page 1 of 1 No. / C!� P-c L \� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftplitatlon for ]Disposal *pstem ConstrUttlon permit Application for a Permit to Construct( ) Repair <grade( ) Abandon( ) ❑Complete System ❑Individual Components Loca inAddr Owner's Name,Address,and Tel.No. � y �r-S.4 �/ /0��D 15; Assessor's Map/Parcel / 5, IAAstaller's Name,Address,and Tel.No. ? Designer's Name,Address,and Tel.No. TI pe 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 Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: ?t—16 Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. _ao/b — Date Issued 0 _ No. /6C7` I }' Fee � � n THE COMMONWEALTH OF MASSACHUSETTS Entered in compute%,- Yes ' PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE, MASSACHUSETTS IpYItatlOn for bisposal 6pstPlu`'Construction Vermit Application for a Permit to Construct( ) Repair( grade( ) Abandon( ) ❑Complete System ❑Individual Components. Location Address or Lot No.qj; Qar ��� 1 f' ' Owner's Name,Address and Tel.No.%o Al e-,,, -Fle Assessor's Map/Parcel 1 7r 3 ' I(nsstalller's Name,Address,and Tel No. S� �G jr s�f Designer's Name,Address,and Tel.No. ; �nj �✓'h 1 v� may, i Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures tc !�. Design Flow(min.required) _ gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title -- Size of Septic Tank Type of S.A.S... -' Description of Soil g t Nature of Repairs or Alterations(Answer when applicable) eF'/!,�Ct �f4 --- 7a �3 Date last inspected: 7 16 Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this 1 6ard of Health. Signed Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. r / Gp — ' Date Issued -- -------.------------------------------------ ------------------------ ---------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compfiante THIS IS TO CERTI'FFY,that the On-site Sewage Disposal system Co tructed( ) Repaired( � Upgraded( .l Z7 ) Abandoned( )by i /,plc it o ,j ey✓--c �al4c at �j G % /'y�ja �' has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.,,/V/j, -2 )dated Installer Designer #bedrooms N Ir Approved design flow/, N l A gpd The issuance of this permit shall'of be construed as a guarantee that the system will fQ tion as designed. Date ,r/ ��L Inspector 0� e� - - -------- ------------ ------------------------------------------------ -------- No. 'Da I - - - -FeeTHE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal *pstrm Construction permit Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( ) System located at ��D -/ /?7.4 . .c 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. --^-. Provided:Construction must be omelet d '.thin three years of the date of this permit Date / Approved by 4: No........... Fxv... ! THE COMMONWiIE LTH OF MASSACHUSETTS 3. OAR® OF HEALTH fl� .......... .................OF........�-O_Ly - �y V Appliration for Disposal Works Tonstrurtion Vrrmit � Application is hereby made for a Permit to Construct 1�4 or Repair ( ) an Individual Sewage Disposal System at: .................................... .................................................................................................. on-Address or Lot No. •�.-�•r� �Jcj ars ------------------------------•--------------- -----...............•...................... ..-•---------••----------------............... Owner --------------------------------Address Installer Address U Type of Building Size Lot_\KAC_.rS..._S et 0-4 Dwelling—No. of Bedrooms.............. �S .Expansio Attic ( ) Garbage Grinder aOther—Type of BuildinglQ #L&�.._} No. of persons.....:. ................... Showers (Z) — Cafeteria ( ) Other fixtures\.- ,.S!�.�t '�----W�R� �t --------------------------------------------- ��� ..... W Design Flow..... _. . _.......-•-_.gallons per person per day` Total daily flow--I ............gallons. WSeptic Tank—Liquid capacitylS gallons Length...............:•Width................ Diameter................ Depth................ x Disposal Trench—No................. ... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-------4......... Diameter......(0__--..... Depth below inlet......6........... Total leaching area ------- ft. Z Other Distribution box (Y) Dosin tank ( ) aPercolation Test Result Performed by_ ... 6-11•�•.14-------- T est . Test Pit No. 1_.3.1 'e' ..... ---- to 1'`'' .___minutes per inch Depth of Test Pit.__._-_,�_...._. Depth to ground water..&O..... •-..__- G4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.....__._............... --------------------------------------------------------------------------------------•••••..-•-•-•......................................................... O Description of Soil.... .`•- --------------------------------------------------------------------------------------------------------•---------------------------------------------......--------------------------- ------------- U Nature of Repairs or Alterations—Answer when applicable.............................................................................................. ...............................Y........................................................................................................................................:..._........................._. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of MTU 5 of the State Sanitary C e— The undersigne further agrees not to place the system in operation until a Certificate of Compliance has ee sued by the board f iealt . Signed- -- - .. - •-'---•-------- ------- ...:�-f� .... Date Application Approved By..... J-� •-- . •••-- •--•••••.. .................................... Date ,Application Disapproved for the following reasons:------= ••-•••--••••••-••••--•••---------•-••----••------•-•••--••-•--••----••••--•••--•-••-•---•--••••-..... ••-•-••.........•-- •••••-•••-•-•---•--•••••••••-••----••-•••---•--•••••••••---•••.......•••-•-•--•••••---•••--••-•••••••-•----•---------•-----•••-----------•-----•---•--------------------•-•••••.... te Permit No.•••••••-•••••-•••---•••-...-----•-•---•-----••-••••••... Issued-'7..1� 7 ` 3d 77, —a �'���y Date a s THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) m A- No............ ......... : FEs..... _.... ....._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................OF................................................................ Appliration for Uiopootal Works Tonitrurtion Vprrmit Application is hereby made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal System at: _ Location-Address or Lot No. q�O a Owner Address=-----------•-•-•----•--------•-•-•----•------- -•------------.---.----•---•.--.••-•-•---•• Installer Address _ Q Type of Building Size Lot-�`.�'!..-<:c rf_s__-__meet V Dwelling—No. of Bedrooms____..____`=_______.._ •Expansion ttic ( ) Garbage Grinder ( ) + .5----- Other—Type of Building XQ .... No. of persons......._�------------- Showers ( ?J — Cafeteria ( ) Other fixtures-_--- --� we------------------------------------------ JJ---•--------...........---•-- W DesignFlow....: _ .__ - _ _. allons per person per day. Total daily flow__--._ ^` -- - - ---- g P P P Y. y --------------dons. WSeptic Tank—Liquid ca.pacityl Ogallons Length................ Width................ Diameter---__-__--_._ - Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No------- ......... Diameter--------- ... Depth below inlet........6.1f-..... Total leaching area... •----sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '-' Percolation Test Results Performed by.--J ........................ Date...f5-=_a7--')_? ------ Test Pit No. 1.41-------minutes per inch Depth of Test Pit.. !._ "._.__.. .Depth to ground water_�O_~........... (� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Q+' --••--•---------------•-------• ...._._....--•-....-----•-•-•-••----•---•---•-•--•--•-•--•••--•---........---------------••----...-------------•-••-......-- O Description of Soil �'�A� &2.S,�a!�!•. ' :- /16 C� �L' V .....------.F-I �.a..40,w � •.._..tj�,-t •y-••--•------------------------------ ..� W -------------------------------------------------•----•-----------------------------•-----------•------•--•---•-----•------------•-•---------------•-----------•----------------•--------•----••--•---. UNature of Repairs or Alterations—Answer when applicable----------------------------------------------------------------------------------------------- ---------------------------------------------------------•---------------------------•------•----•-----•--------------------------------------•--------------------------------------------......••---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI!.1.,. 5 of the State Sanitary C de—The undersigned urtl:er agree not to place the system in operation until a Certificate of Compliance has a sued by th and oAhlth,.,Signe --•--- .... � ... -.... Application Approved B -:! _______________ � Date � PP PP By------ '--lti----- Date Application Disapproved for the following reasons______________________________ •--•-------•--•----•........................................ -----.....--•• -------------------------------•-•--•.._............•----•---------•-----•-------•--------....---•---•--•---...----------------------•----•--------------------....--------...--•----•--------------•--- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS ; f'"7 BOARD OF HEALTH �i•� ...............� % C ............OF........ li�s�..f.%.:�°?�.�.�....:........... ...... Cprrtifiratr of Toutpliatta THIS 0 CERTIFY, h��att the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by............. .._.... �......% 'v.....-------------•--------------Installer-----------------.----------•-----------• -••----------------------------------- has been installed in accordance with theGprovisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated------------------------........................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.....-•---•--•-------------------------------------•----••-------...........•--• Inspector.................................................................................... ! it t /r {� JL i irf r/° _ f��f:-./ ('•c�-�/>/!fit (.i �i,%i �`f i� i• TL � / ,"G � /!> r �f THE COMMONWEALTH OF MASSACHUSETTS ? BOARD �OF HEALTH �% / i/t...........OF.........L% t, cT f/s....................................... /r- .� No.......•=•- /.•..... FEE.c...................... �io�oottl rko �onotrnrtion rrntit Permission is hereby granted------.1/" �� .............................................................................. to Construct or Repair ( ) an Individual Sewage Disposal System r , r r.................................... ......................------ --------•---------------------------....------------................__........ Street as shown on the application for Disposal Works Construction Per tt No.................... Dated.....................__._..._..._._._._. / / . .............. .... --- G��.y..._.... : - . Board of Health DATE /l --------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS /� CRAIG R. SNORT. 'P. E.` MEMBER OF: PRn109NT AMERICAN SOCIETY Ce. WA04 cAr. OF CIVIL ENGINEERS CIVIL ENGINEERING - BUILDING P. O. BOX 769 - 14 TORY LANE DENNIS, MASSACHUSETTS 02638 TEL. (617) 388-2831` May '27 1977 Barns,�able Conservation Commission Barnstable.Town Hall " Main Street ` Hyannis, Massachusetts 02601 To Members: As requested, we have conducted a percolation test on Lot 2 Route 6A, Cummaquid, Mass. owned by Chris Hosford. the test » was conducted on May 27, 1977 in virgin ground next to test boring #3 at elevation 31 in fine-Yellow sand. As a result of this test the percolation rate.was determined to be 1 inch in 3 minutes. This rate shows that the designed leaching area will be sufficient as shown. Sincerely, "jkW11 - �- Crag R. Short, PE President cc Enc Paul T. Anderson, Regional Environmental Engineer Mass. Dept. of Env. Quality Eng. Waterways Division Town of Barnstable Health Dept. Chris Hosford A23 52, - - - - - — -- -- - - - - - - - - - - - -- - - - - - - - - - - - - -- - - - - - - - - - - - —— — —— — —— — —Sol a� _ o0 00 M v to 'C inn _-- D C O V Pro osed FirstiFloor SCOPE OF WORK: _ �Nd�ati 1. Replace All Windows&Doors[Including Interior] 2. Clean&Repoint Fireplace as Necessary at Waterstained Areas. Provide New Flashing eon' �o 3:Mold Remididation As Required 4. Roof Scupppers to be Cleaned and Redirected Away From Exterior Walls or Abandoned and New Drainage to be Channeled through Downspouts into In-Ground Drywells. sa, o` Existing First Floor Al 1, () /G E / 1 , , , P/2 o PC)5;c.r7 Z 7;:"E" 7�T'.ti �./ /i) J�A Z I S Furo4F_ Iwie VJA 0 PO ED (61 r \ , r4.4 + j . 1 i o ) _ L�. 'l�- /f C` r � 11 b� T(J� �Ga GJi'✓L�' Q '�•• r ��p M Flo n rk �•h11,J ` �.I�,'Iry� � � � -_--- � .�J" C� ��/k•� �/ l�;.fL� L:, i' Tf ^ r ..- + 4 G 7 '� '� Ao ,= .._ i :•� 2 to Mr to' AA � ... �� raA/ ,e�.�v r•-� av cox - Era) A O ACAVIAlt5 AD/r- `3 `✓ j. .`= . �o ,e>E v� aeEc.A/Fo c c,�rvC.itEr ��'' s r- �y-,,) COA/C��T4 EsT,T�'�,c✓677.1 .3OG7O 1WiTO p M f \ ELL ` `' !`' - ►�'1 alert 4�1 } F� C7 t� /!( #-' ,, _ c STEEL Z400 '0 7C— 5, .? 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