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HomeMy WebLinkAbout0251 GREEN DUNES DRIVE - Health 251 Green Dunes Drive Centerville A= 245-033 SMEAD No.2-153LOR UPC 12534 smead.com • Made in USA 14Ogq� mZ FO RUMINIMPRMMUNE SFI ��SOUmm '� fFRTIFlED SDURC4JGWWWWROGRAMARS j No. Fee /HIE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Apptiration for Misposal *pstrm Construction Permit Application for a Permit to Construct( ) Repair(x) Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. 1S l (o2G6r,v.Awv r:s DR, Owner's Name,Address,and Tel.No. 'P4}Jl. v- JrVVILA (M-MbAAJ� 0 jAS Assessor's Map/Parcel ?I1/S/033 'F o. L-S x 41 A W. OAA• 02(e-1 z Installer's Name,Address,and Tel.No.50?5 ei77-vs 77 Designer's Name,Iddress,and Tel.No. CAA?eisou$ cwriam 45ts (-LC /S3 sr. ,/W 4SHPet !M+• Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date 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) C N.4-rg a C <<w E From l s c a G*L coAA S;E k. 'IoNrAV To b— b9x Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. 9gn d Date r} �L)r 3 Application Approved by Date 10 Application Disapproved by 'a IT wDate for the following reasons Permit No. Date Issued No., r.. \. `` Fee HE COMMONWEALTH,OF MASSACHUSETTS Entered in computer: .. PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ' Yes �pYitation for Disp al Y�pstem Construction Vernut Application for a Permit to Construct( ) Repair(x) Upgrade( ) Abandon( ) ❑Complete System [Individual Components .s. Location Address or Lot No. .251 (92E1;:w DWv e 5.DR, Owner's Name,Address,and Tel.No. Tlsi-,jk- " 50e LA (ohr bitty 0 ,A-5 Assessor's Map/Parcel yV 63-3 F.o. Sox ct%-t`t +� nmsi itr, +�1�• 0Zb'1 Z Installer's Name,Address,and Tel.No.SO 6-c/I 7-88_�7 Designer's Name, ddress,and Tel.No. )�3 114i4s11r'-pt, vtA* 02t-g7 IV /T Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other , Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date ' Title Size of Septic Tank Type of S.A.S. x Description of Soil !� Nature of Repairs or Alterations(Answer when applicable) C i-J 4 N(-tr l f-I w E- %ih "s e° 6 4"c"i S,�p 4 c IAmV Tc b- 11?3'D)( , Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date p�oZ ,a o�L (3 Application Approved by i / Date t v Application Disapproved by Date t, for the following reasons se Permit No. Date Issued I / TH FJ COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(X) Upgraded( ) Abandoned( )by CA PIE:-GJ I D S C-',v?E i g s L L C at a S I (p e e,� A.�,e D�wc I� I R��r�t S has been constructed in accord ce with the provisions of Title 5 and the for Disposal System Construction Permit No �1 Installer Designer Q #bedrooms Approved design flow ! gpd)), The issuance of this permit sliall noibe construed as a guarantee that the system willl ffu�\tio n as designed. Date �., Inspector ! /��! `�/ I,�-� '� Z �d NG�%. ✓.1.• - 1 ------------------------------------------------ NO. +y' Fee y /// HE COMMONWEALTH OF MASSACHUSETTS �+ PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6petem Construction Permit ,Permission is hereby granted to Construct( ) Repair(X ) Upgrade( ) Abandon( ) System located at d S/ G2i�_t;N bun+t s PR%J eT 14ya ncl,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:Constructio must a completed within three years of the date of this permit. Date Approved by I x Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 251 Green Dunes Dr. Main House (Report 1 Of 2) Property Address Paul - Sheila Gar ano Trust Owner Owner's Name information is rt 6 0 K ` f MA 02672 11-16-13 required for every West-Hyannispo page. Cityrrown 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. lm out tames filling forms A. General Information ,++++unlnr►,►► on e computer, \`\���(N Of MgSS9c use only the tat 1. Inspector: ;o=: •y G key to move your U � (� cam; JAMES cursor-do not James D. Sears ke the return Name of Inspector =�' S€/!RS �U� y Capewide Enterprises,LLC R�••.cFR T I F��•'��� IC I Company Name I N SP0�A 153 Commercial St. �''�►nnnnunu++``O Company Address Mashpee MA 02649 City/Town State Zip Code 508-477-8877 S1623 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 11-16-13 spector'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. IZ5/I t5ins•3113 Title 5 Olndel In ' farm:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 'f 251 Green Dunes Dr. Main House (Report 1 Of 2) Property Address Paul - Sheila Gargano Trust Owner Owner's Name information is required for every West HY P annis ort MA 02672 11-16-13 page. cityrrown 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: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair; as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins-3113 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Pape 2 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 251 Green Dunes Dr. Main House (Report 1 Of 2) Property Address Paul - Sheila Gargano Trust Owner Owners Name information is West Hyannisport MA 02672 11-16-13 required for every � page. City/Town State Zip Code Date of Inspecdon B. Certification (cont.) ❑ Pump Chamber pumpstalarms 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, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND-(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Pepe 3 of 17 Commonwealth of Massachusetts Title 5 Official 'inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 251 Green Dunes Dr. Main House (Report 1 Of 2) Property Address Paul - Sheila Gargano Trust Owner Owner's Name information is West H annis ort MA 02672 11-16-13 required for every Y P 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 aseptic 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 cesspiml is less than 6"below invert or available volume is less than %day flow t5ins-3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts VIM Title 5 Official Inspection Form Subsurface Sewage-Disposal System Form-Not for Voluntary Assessments 251 Green Dunes Dr. Main House (Report 1 Of 2) Property Address Paul - Sheila Gargano Trust Owner owners Name Information is required for every West Hyannisport MA 02672 11-16-13 City/Town page. State Zip Code Date of Inspection B. Certification (cunt.) 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. ❑ 0 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 N 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 tri99ered.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 f,ft.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. t5ins-3/13 Title 5 official Inspection Form:Subswface Sewage Disposal System•Page 5 or 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments q 251 Green Dunes Dr. Main House (Report 1 Of 2) Property Address Paul - Sheila Gargano Trust Owner Owner's Name information is West H annis ort MA 02672 11-16-13 required for every -� p 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? ® ❑ 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): 5 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 yr 251 Green Dunes Dr. Main House (Report 1 Of 2) Property Address Paul - Sheila Gargano Trust Owner Owner's Name information is required for every West Hyannisport MA 02672 11-16-13 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: The system is a 1500 Gal.tank D. Box and 18"chambers. 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 to No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage 2011-117,000Gal g ( y g (gPd))` 2012-225,000Gal's Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Present Date CommerclaUlndustrial 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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 N Commonwealth of Massachusetts upreenunesTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 251 G D Dr. Main House (Report 1 Of 2) Property Address Paul - Sheila Gargano Trust Owner owner's Name information is required for every West Hyannisport MA 02672 11-16-13 page. City/'Town State Zip Code Date of Inspection D. System Information (cunt.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: 2010 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 1/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Mots!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 '< 251 Green Dunes Dr. Main House (Report 1 Of 2) Property Address Paul - Sheila Gargano Trust Owner Owner's Name information is required for every West Hyannisport MA 02672 11-16-13 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1995-Permit#95-602. Were sewage odors detected when arriving at the site? ❑ Yes Z No Building Sewer(locate on site plan): Depth below grade: 3'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.): Pipeing is 4" PVC SCH 40. Septic Tank(locate on site plan): Depth below grade: 26"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: 1500 Gal.Precast Sludge depth: 2" t5ins-3113 We 5 Offidal Inspection Form:Subsurface Sewage DIsposat System-Page 9 of 17 Commonwealth of Massachusetts IBM Title 5 official Inspection Form MAW a= Subsurface Sewage Disposal System Form Not for Voluntary Assessments 251 Green Dunes Dr. Main House (Report 1 Of 2) Property Address Paul - Sheila Gargano Trust Owner Owner's Name inrmation required for erY every West Hyannisport MA 02672 11-16-13 -- page. Citylrown State Zip Code Date of Inspection D. System Information (cunt.) Septic Tank(cont.) Distance from top.of sludge to bottom of outlet tee or baffle 28" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 17" How were dimensions determined? Asbuilt-TapeSludge Judge 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 at working level. Tank at 26'below grade w/covers at 1'. In and outlet tee's. No sign of leakage or over loading. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete El 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 251 Green Dunes Dr. Main House (Report 1 Of 2) Property Address Paul - Sheila Gargano Trust Owner Owners Name information is required for every West H annis ort MA 02672 11-16-13 Y p page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order. ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 Title 5 Oflkial Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 251 Green Dunes Dr. Main House (Report 1 Of 2) Property Address Paul - Sheila Gargano Trust Owner Owner's Name information is required for every West Hyannisport MA 02672 11-16-13 page. Cityrrown State Zip Code Date of Inspector D. System Information (cunt.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 16"x21"-32"below grade. Box is clean and solid w/two lines out. No sign of over loading or solid carry over.. 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: t5ins-3113 Title 5 Met Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ` 251 Green Dunes Dr. Main House (Report 1 Of 2) Property Address Paul - Sheila Gargano Trust Owner owners Name information is required for every West Hyannisport MA 02672 11-16-13 page. City/town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 18 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is two rows-total 18 infiltrators 12x58. Chambers are clean. No sign of holding water. Chambers are 42"below grade. 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 Fond:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 251 Green Dunes Dr. Main House (Report 1 Of 2) Property Address Paul - Sheila Gargano Trust Owner Owner's Name information is required for every West Hyannisport MA 02672 11-16-13 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.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-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 251 Green Dunes Dr. Main House (Report 1 Of 2 ( P ) Property Address Paul - Sheila Gargano Trust Owner owner's Name information is required for every West HY P annis ort MA 02672 11-16-13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) 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 41 -3 Vol O 3 a'- ? 3 0 2 t5ins-$113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 -� Commonwealth of Massachusetts lugTitle 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 251 Green Dunes Dr. Main House (Report 1 Of 2) Property Address Paul - Sheila Gargano Trust Owner owner's Name required fn is West H annis ort MA 02672 11-16-13 required for every - ---y p page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ElCheck cellar r ❑ Shallow wells N 11 Estimated depth torigh ground water: 12 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: 11-3-92 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: T.H.on Design Plan 11-3-92 no G.W.at 12'. Bottom of chambers at 4'below grade. Bottom of chambers at V above T.H.Depth. Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °< 251 Green Dunes Dr. Main House (Report 1 Of 2) Property Address Paul - Sheila Gargano Trust Owner owner's Name information is West Hyannis port MA 02672 11-16-13 required for every p 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 Oftidal Inspection Forth:Subsurface Sewage Disposal System-Page 17 of 17 c.�✓ld��hv✓a Iwo s� bV) . J Commonwealth of Massachusetts Title 5 OfficialIns-pection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 251 Green Dunes Dr.Cottage(Report 2 Of 2) Property Address Paul-Sheila Gargano Trust Owner Owners Name information is rt-0yftrV1 � MA 02672 11-16-13 required for every �fa#lnisp0 page. Cityrrown 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. Importaft When A. General Information % filling the computer, o r, \`\�p�`�"OF lMgss use only the tab key to move your 1. Ins tor: `��� .• • �' �% cursor-do not JamesD.Sears U �: JAMES �u'= me use the return —o key. Name of Inspector 10 CapewideEnterprises,LLC * Company Name 153 Commercial St. °'''� �, utp `y``�`` Company Address Mashpee MA 02649 Cityfrown State Zip Code 508-477-8877 S1623 Telephone Number License Number B. Certification I.certify that 1 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 W "2 11-18-13 \_ spectors 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 Mahe future under the same or different conditions of use. I ItSIIS l5ins•3113 115116 Inspe ,T. : ubsurface Sewage Disposal System-Page 1 of 17 44 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 251 Green Dunes Dr.Cottage(Report 2 Of 2) Property Address Paul-Sheila Gargano Trust Owner Owner's Name information is West Hyannisport MA 02672 11-16-13 required for every page. Cityrrown 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 3101 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: Line Change Need to replace line tank to D Box,Tank is leaking. Need to reseal tank. 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-3113 Title 5 Olfldal Inspection Farm:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 251 Green Dunes Dr.Cottage(Report 2 Of 2) Property Address Paul-Sheila Gargano Trust Owner Owner's Flame information is required for every West Hy annisport MA 02672 11-16-13 page. Cityrrown 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(cunt.): ® Observation of sewage backup or break out or high static water level in the distribution box.due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ NO(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): Line tank to D Box. Need to replace line. Tank is leaking. Need to reseal tank. ❑ 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 publicc 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•3113 Title 5 Official Inspection Forth:Subsurraoa Swage Oisposel System•Page 3 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 251 Green Dunes Dr.Cottage(Report 2 Of 2) Property Address Paul-Sheila Gargano Trust Owner Owner's Name information is required for every West Hyannisport MA 02672 11-16-13 page. Cityfrown State Zip Code Date of Inspection B. Certification (cunt.) 2. System will fall 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 is less than 6" below invert or available volume.is less than%day flow 4E,4 G t5ins•3/13 Title 5 Official Inspection Forth: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 251 Green Dunes Dr.Cottage(Report 2 Of 2) Property Address Paul-Sheila Gargano Trust Owner Owner's Name information is required for every West Hy annisport MA 02672 11-16-13 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. ❑ ® 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 N 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 abovefailure 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r 251 Green Dunes Dr.Cottage(Report 2 Of 2) Property Address Paul-Sheila Gargano Trust Owner Owner's Name information is required for every West Hy annisport MA 02672 11-16-13 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? ® ❑ 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 Meld(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): NA Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 t5ins-3/13 Title 5 Official Inspection Form:Subswface Sewage Disposal System-Page 6 of 17 I Commonwealth of Massachusetts o Title 5 Official Inspection Form )WSubsurface Sewage Disposal System Form-Not for Voluntary Assessments 1 251 Green Dunes Dr.Cottage(Report 2 Of 2) Property Address Paul-Sheila Gargano Trust Owner Owner's Name information is required for every West Hyannisport MA 02672 11-16-13 City/Town page. State Zip Code Date of Inspection D. System Information Description: The system is a 1500 Gal. tank D.Box and ten infiltrators. Number of current residents: NA Does residence have a garbage grinder? El Yes ® No Is laundry on a separate sewage system?(Include laundrysystem inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available last 2 ears usage NA 9 ( Y 9 (gPd))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: NADate 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-W1 3 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Pepe 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments "< 251 Green Dunes Dr.Cottage(Report 2 Of 2) Property Address Paul-Sheila Gargano Trust Owner Owner's Name information is West Hyannisport MA 02672 11-16-13 required for every -- page. Cityfrown 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: 7-10 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/Altemative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 or 17 4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °( 251 Green Dunes Dr.Cottage(Report 2 Of 2) Property Address Paul-Sheila Gargano Trust Owner Owner's Name information is required for every West Hyannisport MA 02672 11-16-13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Approximate age of all components,date installed(if known)and source of information: 1995 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2'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.): Pipeing is 4" PVC SCH 40. Line from tank to D Box-need to replace line. Septic Tank(locate on site plan): 1' Depth below grade: 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: 1500 Gal.Precast Sludge depth: 0" t5ins•3113 Title 5 Official Inspection Form:Subsurfeae Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments rt 251 Green Dunes Dr.Cottage(Report 2 Of 2) Property Address Paul-Sheila Gargano Trust Owner Owner's Name information required for eve West Hyannisport MA 02672 11-16-13 page. every Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Septic Tank(cont.) Distance from top of sludge to bottom-of outlet tee or baffle 30" Scum thickness 1" 8" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 17" How were dimensions determined? Asbuilt Jape Sludge Judge 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 level low.Tank leaking,need to reseal tank.Tank at 1'below grade w/covers at 1'.In and out let tee's. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑metal ❑fiberglass El 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•3113 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form t Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 251 Green Dunes Dr_Cottage(Report 2 Of 2) Property Address Paul-Sheila Gargano Trust Owner Owner's Name information is required for every West Hyannisport MA 02672 11-16-13 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3H3 Title 5 official Inspedion Form:Subsurface,Sewage Disposal System-Page 11 or 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 251 Green Dunes Dr.Cottage(Report 2 Of 2) Property Address Paul-Sheila Gargano Trust Owner Owners Flame information required for every West Hyannisport MA 02672 11-16-13 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid.level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover,any evidence of leakage into or out of box, etc.): D Box is 16"x21"-28" below grade. Box is clean and solid w/two lines out. No sign of over loading or solid carry over. 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: t5ins-3113 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y 251 Green Dunes Dr.Cottage(Report 2 Of 2) Property Address Paul-Sheila Gargano Trust Owner owners Name information is required for every West Hyannisport MA 02672 11-16-13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 10 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is ten infiltrators. Chambers are clean and dry. No sign of over loading or solid carry over. Chambers at 32'below grade. 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 t51ns-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 251 Green Dunes Dr.Cottage(Report 2 Of 2) Property Address Paul-Sheila Gargano Trust Owner Owners Name information requ'ired for eve West Hyannisport MA 02672 11-16-13 page. every City/Town State Zip Code Date of Inspection D. System Information (cunt.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.): t5ins-3113 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 251 Green Dunes Dr.Cottage(Report 2 Of 2) Property Address Paul-Sheila Gargano Trust Owner Owner's Name information is p required for every west Hyannis port MA 02672 11-16-13 page. Citylrown 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 P-i=35�Gy G�'oo L Rs _ -s �-a =33'-V" A �ye�ss t5ins-3113 Title 5 OrBaal Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 251 Green Dunes Dr.Cottage(Report 2 Of 2) Property Address Paul-Sheila Gargano Trust Owner Owner's Name information is required for every West Hyannisport MA 02672 11-16-13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells N� Estimated depth t�hi9 ground water: 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: 11-3-92 Date ❑ Observed site(abutting property/observation hole within 150 fleet of SAS) ❑ Checked with local Board of Health-explain: El Checked with local excavators,installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: T.H:on Design Plan 11-3-92, No G.W.at 12'. Bottom of chambers at 40"below grade. Bottom of chambers at 8'+above T.H.Depth. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3M3 Title 6 Official Inspection Form:Subudece Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Forth-Not for Voluntary Assessments "~ 251 Green Dunes Dr.Cottage(Report 2 Of 2) Property Address Paul-Sheila Gargano Trust Owner Owner's Name information is required for every West Hyannisport MA 02672 11-16-13 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-W13 Title 5 ottldal Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 %M ec 05 13 09:03a p.1 ■ '■ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary_Assessments 251 Green Dunes Dr Cottage(Report 2 Of 2) Property Address Paul-Sheila Gargano Trust Owner Owner's Name information is West Hyannisport MA 02672 12-4-13 required for every page. Cityrrown State Zip Code Date or 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. rmprtat t When fbffm filling u A. General Information , On the corrt computer, ```\ NOFAdgS4,����i use only the tab 1. Ins pector0 -�� key to move your , J A M E 9 tiN ' cursor;do not James D Sears use the return Name of Inspector v�^%XJ ti key. CapewideEnterp rises,LLC �1 Company Name 'N 153 Commercial St: ����4gi1nwwt10��\ Company Address Mashpee MA 02649 Cityrrown State Zip Code 508-477-8877 .31623 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 0 Conditionally Passes 0 Fails 7 Needs Further Evaluation.by the Local Approving Authority 12-4-13 js-pectorsSignature 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. t5+ns•3113 Tr%5 Offioial MspeWm Fow Subsurface Sewage Disposal System Page 1 of 17 I Dec 05 13 09:03a p.2 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments - 251 Green Dunes Dr.Cottage(Report 2 Of 2) Property Address Paul-Sheila Gargano Trust _ Owner Owner's Name info`nnabon is West Hyannis ort MA 02672 12-4-13 required for every p page. Cily/rown State Zip Code Date of Inspection B. Certification (cunt.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not determined," please explain_ The septic tank is metal and over 20 years old`or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. A metal septic tank will pass inspection if it'is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins-3113 Title 5 oRic!W Inspection Form:SubsuAeoa Sewage Dispasei System-Pape 2 of 17 Dec 05 13 09:04a ' p.3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 251 Green Dunes Dr-Cottage(Report 2 Of 2) Property Address Paul-Sheila Gargano Trust Owner Owner's Name hbrmrequired is West Hyannisport MA 02672 12-4-13 required for every page. CityrTown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumpslalarms not operational. System will pass with Board of Health approval if pumps/alarms;are repaired. B) System Conditionally Passes(cunt): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 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 t51ro-•3/13 . Tae 5 ORdal trnpedion Fonre Subxalaae Sewage D'gposal System•Pegs 3 d 17 Dec 0513 09:04a p.4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 251 Green'Dunes Dr Cottage(Report 2 Of 2) Property Address Paul-Sheila Gargano Trust Owner Owner's Name information is West Hyannisport MA 02672 12-4-13 , required for every Ci /Town ' page. tY State Zip Code Date of Inspection B. Certification (cunt.) 2. System will fall 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 El ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in savqW is less than 6" below invert or available volume is less than '/Z day flow 4 e44flliti J-�' t5ins•3113 Tide 5 Official Inspection Form_Subsurface 9ar<aga Disposal System•Page 4 of 17 ,Dec 05 13 09:04a p.5 Commonwealth of Massachusetts Title 5 Official Inspection, Form Subsurface Sewage.Disposal System Form-Not for Voluntary Assessments 251 Green Dunes Dr Cottage(Report 2 Of 2) Property Address Paul-Sheila Gargano Trust Owner Owner's Name information ie West Hyannisport MA 02672 12-4-13 required for every page. citylrown state Zip Code Date of Inspection B. Certification (cunt.) 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. ❑ 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 colfform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or leas than 3 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 ❑ 0 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-3113 Title 5 Official ktspectm Farm:Subacfew Swrage piVM19)oarn•Page 5 0117 Dec 05 13 09:05a p.6 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary.Assessments 251 Green Dunes Dr Cottage(Report 2 Of 2) Property Address Paul- Sheila Gargano Trust Owner Owner's dame infbrmation requiredforeve West Hyannisport MA 02672 124-13 Page. ry 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 backup? ® ❑ 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 ff 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. Y ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)1310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): NA Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 15im•3n3 Title 5 Officiai hvpacbm Forth:Subsurface Sexap Disposal System-Page 6 aft7 Dec 05 13 09:05a p.7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Fort-Not for Voluntary Assessments _251 Green Dunes Dr Cottage(Report 2 Of 2) Property Address Paul-Sheila Gargano Trust Owner Owner's Name inf TmaWn is West Hyannisport MA 02672 12-4-13 required for every page. City/Town State Zip Code Date of Inspection . D. System Information Description: The system is a 1500 Gal tank D.Box and ten infiltrators. NA Number of current residents: 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 ears usage NA 9 ( Y 9 49pd))� Detail: Sump pump? ❑ Yes ® No NA. Last date of occupancy: Date CommerciaYindustrial Flow Conditions: Type of Establishment: Design flow(based an 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seaWpersonslsq.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: t5;ns•3113 Trde 5 OfWel hupec5on fomr.Suhswface Sewage Disposal System-Pap 7 of 17 Dec 05 13 09:05a p.8 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 251 Green Dunes Dr Cottage(Report 2 Of 2) Property Address Paul -Sheila Gargano Trust Owner owner's Name information is West Hyannisport MA 02672 12-4-13 required for every 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: 7-1 0 - Was system pumped as part of the inspection? ❑ Yes M 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): 15ns-,S13 - Title 5 Official lnspedion Form:subsiaraoe sewage Disposal SySem•Page 8 of 17 Dec 05 13 09:06a p.9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 251 Green Dunes Dr Cottage(Report 2 Of 2) Property Address Paul-Sheila Gargano Trust Owner Owners Name information is West Hyannisport MA 02672 12-4-13 required for every - page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Approximate age of all components,date installed (if known)and source of information: 1995 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 2' Depth below grade: feet Material of construction: ❑cast iron. 0 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Peeing is N' PVC SCH 40. Septic Tank(locate on site plan): Depth below grade: 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: 1500 Gal.Precast o„ Sludge depth: t5ins-3113 Title 6 O,final Inspection Fomc Subsurface Sewage Ou"sal System•Pape 9 of 17 Dec 0513 09:06a p.10 Commonwealth of Massachusetts lam Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary.Assessments 251 Green Dunes Dr.Cottage(Report 2 Of 2) Property Address Paul-Sheila Gargano Trust Owner Owners Name requiredifo is West Hyannisport MA 02672 12-4-13 required for every page. City[Town State Zip Code Date of Inspection D. System Information (cunt.) Septic Tank(cunt.) Distance from top of sludge to bottom of outlet tee or baffle W �R Scum thickness Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 1T, How were dimensions determined? Asbuilt-Tape Sludge Judge 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 at working level. Tank and cover's at Tbelow grade. In and outlet tees. No sign of leakage or over loading. 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 t5lns-3n3 - - Title 5 Official In spection Form Subsurboe Sewage Disposal System Page 10 0,'17 i Dec 0513 09:06a p.11 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 251 Green Dunes Dr Cottage(Report 2 Of 2) Property Address Paul-Sheila Gargano Trust Owner Owner's Name information is required for every West Hyannisport MA 02672 12-4-13 page. Citylrown state Zip Code Date of Inspection D. System information (corn.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present ❑ Yes ❑ No Alarm level: Alarm In working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 151t15'3/73 Tltle 5 C nldsl Rtsomdon Fo ..Subaurfe Sewage Dlepoml System-Page t I of 17 Dec 05 13 09:07a p.12 Commonwealth of Massachusetts RON Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 251 Green Dunes Dr Cottage(Report 2 Of 2) Property Address Paul-Sheila Gargano Trust Owner Owner's Name information is West Hyannisport MA 02672 12- -13 required for every page. Cityrrown - State Zip Code Date of Inspection D. System Information (cunt.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert O Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box,etc_): D Box is 15"x21"-28"below grade. Box is clean and solid wltwo lines out. No sign of over loading or solid carry over. 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.appurtienances, 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: . t5bns•3113 .. Title 5 DfRckal Inspection Form:Subsurteoe Sewage Disposal Syslan-Page 12 of 17 Dec 0513 09:07a p.13 x Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 251 Green Dunes Dr Cottage(Report 2 Of 2) Property Address Paul-Sheila Gargano Trust Owner Owner's Name information is West Hyannisport MA 02672 12-4-13 required for every page. City/rowrii State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number. ® leaching chambers number. 10 ❑ leaching galleries number. ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number. ❑ innovative/altemative system Typetname of technology: Comments(note condition.of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.): Leaching is ten infiltrators. Chambers are clean and dry. No sign of over loading or solid carry over_ Chambers at 32'below grade. 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 Offidd Inspection Form;Subsurface Sewage Disposal System-Page 13 of 17 Dec 05 13 09:07a p.14 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 251 Green Dunes Dr.Cottage(Report 2 Of 2) Property Address Paul-Sheila Gargano Trust Owner Owner's Name informatrequired for `� West Hyannisport MA 02672 12-4-13 required for every page. cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note_condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): • Materials of construction: Dimensions Depth of solids Comments(note-condition of soil, signs of hydraulic failure; level of ponding, condition of vegetation, etc.): t5ins•3113 TWO 5 Offidel Inspection Forth:S b suface Sewage Disposal System•Page 14 of 17 'Dec 05 13 09:08a p.15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 251 Green Dunes Dr.Cottage(Report 2 Of 2) Property Address Paul -Sheila Gargano Trust Owner Owne1's Name i on reequiredd for e required is West Hyannisport MA 02672 12-4-13 very page. Cityrrown state Zip Code Date of Inspection D. System Information (corn.) 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 /3 ,2A� 5 ,��► ,4- 3V�� lT7.3 - 3 3 - /=S'=_7 � '2A� y t6Yu 3113 Title 5 Oftig Inspection Farm:Suba-d ce Sewage Disposal System-Page 15 or 17 Dec 05 13 09:08a p.16 Commonwealth of Massachusetts Title 5 Officiai inspection Form Subsurface Sewage Disposal System Foam-Not for Voluntary Assessments 261 Green Dunes Dr.Cottage(Report 2 Of 2) Property Address Paul-Sheila Gargano Trust Owner Ownel's Name infbrrnationrequired `� West Hyannisport MA 02672 12-4-13 required for every page. Cityrrown Stab 210 Code Date of Inspection D. System Information (cost.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells AI C 12' Estimated depth to nigh ground water. 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: 11 Dattee ❑ Observed site(abutting propertylobsefvation 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: T.H.on Design Plan 11-3-92, too G.W.at 12'. Bottom of chambers at 40"below grade. Bottom of chambers at 8'+above T.H. Depth. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3M3. Tdie 6 Ofridet Inspection Form:$ubnuAaoe Sewage Disposal'System-Page 16 of 17 Dec 05 13 09:08a p•17 CommonweaM of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 251 Green Dunes Dr.Cottage(Report 2 Of 2) Property Address Paul-Sheila Gargano Trust Owner Owner's Name requiretifo is West Hyannisport MA 02672 12-4-13 required for every pa.qe. 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 3r13 7nHe 5 QfflrM hipeetion Form:Subsmfam Sevxge Dispose!System•Page 17 of 17 TOWN OF BARNSTABLE LOCATION, J S- 1 DJL t C)2 SEWAGE# VILLAGE- tv--- ASSESSOR'S MAP&LOTS INSTALLER'S NAME&PHONE NO. a V,4- SEPTIC TANK CAPACITY I SO o � �z LE.=),CHING FACILITY: (typt :—h (size) NO.OF BEDROOMS BUILDER OR OWNER S w i g of G 5 S Q C.. PERMITDATE: 9--10' g� COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 v4r--c- -7 IS if TOWN OF BARNSTABLE LOCATION . `S Gl ecn D J n-C -P2 SEWAGE# 10r: "' VILLAGE W if7�'�� S P° ASSESSOR'S MAP& INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type��`1 v�C �T f " (size) NO.OF BEDROOMS BOLDER OR OWNER Jc��ti S Wi e2 4s5 ot� PERMITDATE: l 'n'/ e '�COMPLIANCE DATE: 2''� Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 I� .,Furnished by i .L A•`F ' S-� �"F ' yy'3 J3,S„ y3, / V r SAS Fzcs.....t..Q.2........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Ow.4................OF..-" SAP.��-4 .\. 1 .L ........................ Appliration for Uiipoiial Warko Tun,3trurtion rantit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at .�!�:!r_ �.....���1,.ta.L� .. '� ..............•--- ..... Location-Address or Lot No. Owner Address a ----------..... v ..................................... - i...... Installer Address Q Type of Building Size Lot.. �_17�._--Sq. feet UU Dwelling—No. of Bedroo sd _ Expansion Attic ( � Garbage Grinder ( 1�\�)b ---•-- Other—Type T e of Building 1 a yp g . ... .................... No. of persons_________.______.....__.__.. Showers ( ) — Cafeteria ( ) Pa Other fixtures -------------------------------- - - -- W Design Flow.............55..........--.......•__gallons per person per � y. Total daily flow......- - -. !J-__ �' .._._gallons.�r WSeptic Tank—Liquid capacity... gallons Length .._. Width9`.-j... Diameters-� Depth...5.4.�. x Disposal Trench—No- -------------------- Width.._.�.Z.......... Total Length......��__........ Total leaching area._`__ ........sq. ft. Seepage Pit No.............. ...... Diameter.................... Depy-i below inlet.................... Total leaching area..................sq. ft. Other Distribution box ( Dosin nk aPercolation Test Results� Performed by.-- . •..l"` -__-!- - ---------.-•• Date_.��°_ �_� ............... Test Pit No. L...............minutes per inch Depth of Test Pit------l_............ Depth to ground water. Mar-62%itco UT ;3, Test Pit No. 2..L:Z____minutes per inch Depth of Test Pit-----AZ-------- Depth to ground water........................ ------------ CEO-To Description of So ------- S -------- .................................... .....7.... ( fl.._�.-_t.2�!«?_ '_.. (�d C).. x ----••-------------------------•----•------•-•----•-----•---------------•---•.....•-•------•-----••------•----•-------._....----•-••-------•-----------------------------•••... ........................ U Nature 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 TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b e issued by the board of health. Signed --_--------------- --..........:.. . --....------- .------.....--------------...---..... 13[ qq Application Approved By ....... � ..... � "'---------- ------------------------------------------------ ------1"'..D. ,7_1 ;z Application Disapproved for the following reasons: "_""""____""""""""""__....__"""_"""------------------------------- ._..."""."__""..".._..." ..... . ......................"._..._....................---------......------------------------------------------------------.."..-- g l Date PermitNo. --------,/ems— 6-e-1------------------------ Issued -------............................................................. Date No................- .. Fes$..: ....................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OE HEALTH ............................................................... ApplirFatiun for Dispati al Works Tonutrurttun pamit Application is hereby made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal System at•/ -�-- G 7 l •C �' - 1 I i7°mil - �fdi'`�t� t\► t-1 l�_ ...........__ • .........Location-•--•-ress............................� ----....••••.-_.... f. 1. Location-Address _ or Lot No. -• •••- ! �)!_: l [�Y_(-Y f\141 �1 ..........iF_ C7ti�a�\.(J f 1-` �A P1 C-�'+i�' -- ... - ......................... ......... ........... ............... �---...............-.-.--........_... .... W Owner Address a ---.....-- Installer Address d Type of Building Size Sq. feet U Dwelling—No. of Bedrooms......_.._Z;�__........•.................Expansion Attic ( ��)! Garbage Grinder (N � Other—T e of Building No. of persons............................ Showers — Cafeteria G.1 Other fixtures ----------------------------•-•. • . W Design Flow..............5.`—.......................gallons per person per day. Total daily flow------- ........................gallons. f?� Septic Tank—Liquid capacity__! allons Length S.`�.... Width��_.'1n.._ Diameter----- ._�_. Depth_. .-_ . W x Disposal Trench—No. .................... Width-..A.%........... Total Length.....]�'........ Total leaching area.`{!�' ........sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box (�� }� Dosingrtank (�i)) ,`,y1" 1 r . W Percolation Test Results Performed bY...................-..................................................... Date........ _ .............................. Test Pit No. 1-_:4i.--___minutes per inch Depth of Test Pit______ ........... Depth to ground water_ _= .... u _ t Test Pit No. 2...e.....-....minutes per inch Depth of Test Pit.....AZ.......... Depth to ground water........................ ----•---•- ........._..........................................................................--•----.................-- --- --------- O Description of Soil_..0...�...�5..... C... G tyl: � � C tt�t;>'� �rl1L= � L'-� i �ti1�:l�`._4 rfT 5f�oi x U-2- J,�U.� -� �..._4� tr, / t c• 1...._..,:/-\;y 1)._�..- t.4-.0;(EO'�`:(.�_ �._.+��.._.. ---••..•... W -----------------------------------------------------------------------------------------------•------------•----------•-----------••-•---••--•---------•-••-•-•-•-------•--•---•-•----•---•----------- U Nature 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 TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed ---------------------------------------------------------------------------------- ................ — —----- ---'-- -- Date Application Approved By ---------------a---------- �: -- --- ............:.:..:..:....... . .. .......................................................... ... ... > (_� v X Date Application Disapproved for the following reasons- ------------------------------------------------- ------------------------------------------------------------------------------ ----...........................................----------------.............--.. ......................--.........---...............................--------'----------------'------- -......---------Date------------------ Permit No. ----------�f f-''' Issued -------------------------------.................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ------------ C .�./ 1•�----------- OF `,tis,w t•1S•�3 } .( .(-` Gertifirate of Cfoutplia re THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by ......................................................... . .. .. . . ...................................... ...... ---- ..................------....................... ----- _ / _ Ins alter at ......_L- .i.....��.� !=-t~t �-�"'``���''.... t=' �. `�1` I+.l p....ISS f has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. .......... ij/.....----- dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE ....... ..`........2.-9" �----- -------------------- lnspecto ;.... .........----- THE COMMONWEALTH OF MASSACHUSETTS —�-�~ BOARD OF HEALTH 5 _ O........;........:...... FEE............. ....----.. Y - - Dispnoal Works Tionotrnrtiun Vprrmit Permission is hereby granted.........-----------------------•--•--........---•-•---...............-•-----•--••--........................................................ to Construct( k-or Repair () an Individual) Sewage Disposal System ..at No.. _. ........................................................................................................................................................................... .....-•----------•----.....•------•-......._..•-•-•••-•---•.................--•-••••----------•-----•---•••-••--....---•••-•-•-----••-•--•---•-----••••---•...._......••--- Street t-+ as shown on the application for Disposal Works Construct' it No.___.;_-:..-_ irw Q zr ........................... Board of Health DATE-•---- -. 1 ` FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS BAXTER & NYE, INC. Professional Land Surveyors and Civil Engineers 812 Main Street .Osterville, Massachusetts 02655 Tel. (508) 428-9131 FAX(508) 428-3750 WILLIAM C.NYE,P.L.S.-President PETER SULLIVAN, P.E.-Vice President-Engineering RICHARD A. BAXTER, P.L.S.-Vice President / December 4 , 1992 Board of Health Town of Barnstable P.O. Box 367-Town Hall Hyannis , Ma 02601 Re: Paul Gargano 251 Green Dune Drive w. Hyannis Port , Ma 02672 Dear Board Please find attached copies of a site plan which details the septic system design for Mr . Gargario 's property . The systems for the main house and the garage have both been. designed in accordance. with your latest regulations . The Gargano property is fronted by a coastal bank as defined by . DEP's Wetlands Protection Program Policy 92-1 . The toe of this. bank is not subject to tidal action therefore I have used the upward edge of the marsh .as our closest resource area . There is a. vertical separation distance of 154 feet and a horizontal separation distance of approximately 16 feet . I believe that this design meets or exceeds .all your regulations . If you have any questions please feel free to call . Ytt aj Cf . PETS Very truly yours , fro.2:733 A). Peter Sullivan , P. E. :Baxter & Nye,. I:nc Attachment PS:s l g MEMBERS OF CAPE COD SOCIETY OF PROFESSIONAL ENGINEERS AND LAND SURVEYORS I AMERICAN CONGRESS ON SURVEYING AND MAPPING MASSACHUSETTS ASSOCIATION OF LAND SURVEYORS AND CIVIL ENGINEERS -- ------------- ........... ------- —------ • NROA 03 s mmm" #1 SYSTEM, #2 CONSTRUC" N BE) AIMMATE DW,MW DATA DEMN DVIA Symm NOTE: NO WATER OR GAS LINE EVIDENT. z V; C: 0 USE 14- (4'X*') FLOW DIFFUSORS bi Li C.B. VIA. DELL SINGLE FAMILY— 5 BEDROOMS SINGLE FAMILY- 3 BEDROOMS W1 TH 2' OF CRUSHED STONE ON ALL. SIDES. Cy A V, Lj ? Cn FND. S jOHN A N P\N NO GARBAGE GRINDER NO GARBAGE GRINDER ELEC ;10 sysm"a #2 4. -1 DAILY FLOW =- 110 X 5 = 550 G.P.D. DAILY FLOW =- 110 X 3 =- 3,30 G.P.D. B.M. 26.49' BOX USE 8, (4'X 8') FLOE DIFFUSORS HYDRANT" 0) SEPTIC T-ANK = 550 X 150% = 825 G.P.D. SEPTIC TANK = 330 X 150% = 4-95 G.P.D. Io ,tea­3 i r uj 7 USE 1500 GAL. USE 1500 GAL. WITH 2' OF CRUSHED STONE ON ALL SIDES. #420 Z_ SPINDLE )"\N 0.0, G. LOCUS kn s - --) - x MMMATOR — USE WGH CAPACrty NMTRATO,R — USE MGH CAPAWY MARSH WATER METER I N PIT O USE 18 (XX 6') CHAMBERS USE 10 (3'X 6') CHAMBERS _j < BUFFER Z 0 N E.-_ USE, A 12 X 58 WASHED STOI�E FIELD USE -A I 2'X 34' WASHED STONE. FIELD AS SHOWN AS SHOWN ID LOCUS MAP SYSTEM IS WITHIN 250' OF A RES;OURCE AREA SYSTEM IS WITHIN 250' OF A RESOURCE AREA L0 XX systm #1 S YSTEM THEREFORE THE APPLICATION RATE EQUALS THEREFORE THE APPLICATION RATE EQUALS \ ----� \ \ "' SCALE 1 P-5,000 550 G.P.DJ.75 = 734 S.F. OF BOTTOM AREA IS R'_QUIRED 330 G.P.Q. = 440 S.F. OF BOTTOM AREA REQUIRED L, A14i ASSESSORS USE 12'X58 - (12+1)X(58+1) = 767 S.F. AREA PROVIDED USE 12X34' (1241')X(,34'+1') = 455 S.F. AREA PROVIDED c' • MAP 245 PARCEL, 33 PERCOLATION RATE: PERCOLATION RATE: ( I \ 50.0' 1 INCH IN 2 MINUTES OR LESS. 1 IN CH IN 2 MINUTES OR LESS. C ZONE AP #2 Q 7p .7 iNf tx 0/1 U U 34' _j Rno f\M 5 4- 5 WAI .00' C) 0.00' AL "CD 4qq a. 0,, '_v FND 50.00' BUF V, LairZONE PA r10 X INFILTRATOR LA '�� "�� "I -\_-- 0 0 12 12' 2' 4' 4' 2' -------------- FIINISHED GRADE M \< x X/ X/ /x X/ 12" 12" 3/4" TO 1 44 '4 18,1 4 4 .4 o. ""- '4 4 4 1 4 4 4 '44.'4' 4 4 /2 4 4 A, 4,6�4 V�ASHED $TONE., ,, L4 4 14. % PEASTONE .' Alk. it FLOW DIEFUSORS ALIEERNATE I N F1 Ll R.ATORa / R 2 A,) TYPIC C� 1 Ali ,9T Holps COVERS LOCATED TO WITHIN NOVEMDt'__R 3,1992 12 OF F.G. F.F ELEV. 25.8' P. SULLIVAN EAXTER & NYE 1NC #P-/960 ..0i, 2 4' REV,= 24.8 20.4 TOP OF PIT #2 INV. FQkJNDAI'ION PIT #1 ELEV. 24 0' 23,± (20.2') LOAM SUB SOIL 4 DIAMETER 71 LOAM & SUD SOIL. R INV. 21 .8 SYSTEM #1 - 2 - 2 NV. 20.0 \j.C. DIST. 20 5 LO (21 .0') SYSTEM #2 1500 GAL. INV. (19 5) BOX TOP ELEV. SEPTIC TANK PERK TL.Si _C1 INV. 20.6' 0.8� 2 1 .0' ti (20.0) �sIN V. 20�6') (20.8') 6" STONE BASE (2&4 INFILTR 0 V v MEDIUM MEDIUM ATORS R� v v v v v 2" PEASTONE —S ..L = 19.0' TO COURSE FD 4 X & GSM TO COURSE ':� SAND T 3/4" TO 11/2 18 ) MIN. AND 5 - WASHED STONE 0 -7 2" PE/,.STONE PLAN OF LAND 1.N CD Ln MEDIUM WHITE I MEDIUM WHITE (HYANNISPORT) 1 SAND SAND NO WATER OBSERVED BARNSTABLE MASS . EL. 1 FOR L- 11 NO WATER (1,_').5) u-, . 0 uj E L. 1 .5 1 2 NO WA-TER R PROFIM (3 . 1L PAU L GARGAN 0 EL. 12.0 NO SCALE SCALE: AS NOTED DATE: NOV. 24 ,1992 ALL COMPONENTS LOCATED IN POTENTIAL PLAN VEHICLE TRAFFIC AREAS OR BURIED 4 FEET 4A BAXTER & NYE INC, OR GREATER SHALL BF_' H-20 LOAD CAPACITY. GRAPF[IC SCALE REGISTERED LAND SURVEYORS 0 40 80 CIVIL ENGINEERS V k I-ME z: OSTERVILLE, MASS, CERTIFY THAT THE PROPOSED FOUNDATION SHOWN HEREON 1 inch = 40 ft. p ':R X'w \,I!_, h ! H[ SIDELINE AND SETBACK REQUIREMENTS OF t UYAR ELEVATIONS ARE BASED ON N-C.V-D. 7 3 3 100 YEAR FLOOD ELEVATION 12 0' THE 1D\,,/N OF AND IS NOT LOCATED WITHIN THE L F L 0 LIT LAIN DAT R S. #92013A . 4. a qq NI P 24S ?A-cc:S L 3'131 No....J. - FF$ ............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH © 5, c)53 I )J3 7 .Q................OF....T k Sys Lev AVVIkatiou fur UiipniFal Workg Tnntrnrtinn Famit Application is hereby made for a Permit to Construct (K) or 4epair ( ) an Individual Sewage Disposal System at: (Z4. p✓U d I t L ation-Address or Lot N. . Owner Address ............... ...... Installer Address i3 12-� QType of Building �,,(( Size Lot___________________________Sq.#et aDwelling—No. of ....._______________________________Expansion Attic l � Garbage Grinder (K6 p, Other—Type of Building ............................ No. of persons.________-__-____-----_____- Showers ( ) — Cafeteria ( ) a' Other fixtures __________________________---------------------------- W Design Flow................? ...................gallons per person per day. Total daily flow-------------- ....................gallons. WSeptic Tank—Liquid capacity l gallons Length__!®q'* Width---5.9e-"'Diameter...-'--__.._. Depth_.. x Disposal Trench—No..................... Width_M............ Total Length.....�15...... Total leaching area.C9l0......sq. ft. Seepage Pit No--------------------- Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( Dosin tank A _ 1 Percolation Test Results Performed by---- 15 £'_ ��`Ev__` C-r____________________ _ Date �� ._.-____--•--.--__-. 1 Z Test Pit No. 1...._-----------minutes per inch Depth of Test Pit----- `__-__-_____- Depth to ground water_. (T4 Test Pit No. 2....4......minutes per inch Depth of Test pit----i2r.---------- Depth to ground water........................ .............................-- ................................ =----------------- -•--••..... O Description of Soil------- '2 LRAM --c���?t- -�=- i� Ccx�Qs . 1-- --• _ U -•--• ?•` ...... 5'� � 2=�7 � �SG..�a!an_�-.12---�-� .Wl�_f .. W -•-•••------------------------------------------•--...••••-•--------------•-•--•--•-•-•-•--------••-------•--•••--------.....---...---•-••••--•••--•-•---••••-•---•----••------•---••-•••......-•.--•-•- VNature 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 TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bern issued by the board of health. iSigned ------------- -- �.— -------------------------------------------------------------- -e.� Dare Application Approved By ....... V � --------------------------------------------------------------- ---- -----/ ..�.7:- Date Application Disapproved for the following reasons: ...................................... --. -------.......................... . .. ...---.........------.-- -- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ........................................ Dace PermitNo. .... ----- —---_------------------- Issued ------------------------------------------------------------------ Dace No........................ FEE.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH t�./ -4�...__._ Appliration for Disposal Works Toustrnrtinn lirrutit Application is hereby made for a Permit to Construct (K) or Repair ( ) an Individual Sewage Disposal ' System at: __ _,yj_/� ` r ...... -• �k I �, �/LI P l —•.•••,` .............. \�,�. ��yi_ti I`A tea,L;�—�=4S —' ���=cs�:.. I`If- —`�_ .. f Location Address or Lot No._ ,JC._ l 1 -E r+ .......t�� ...................... ! tt1 3a.............................................................. =Owner Xz-•----------------------------------------- ress W Installer Address Type of Building Size Lot...____a.::..............Sq. feet F..I Dwelling—No. of Bedrooms..........2...............................Expansion Attic (�L) Garbage Grinder Ac) `4 Other—T e of Building No. of persons............................ Showers — Cafeteria Other fixtures ____________________________ IS W Design Flow................ ....................gallons per person per day. Total daily flow............. V_-'-...................__gallons.., WSeptic Tank—Liquid capacity.:'��=.gallons� Length__Ir_ ..- Width.. .._�.. Diameter_-"":__--•- Depth....`?.:.r�. x Disposal Trench—No..................... Width_. ....._....._ Total Length.._.r�'_ _._... Total leaching area a 42---.--sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box (4 )., Dosing tank Percolation Test Results Performed by__ t2Jl Y i�"---:.-"'..`.' __..'�:--....................... Date--- __ �_.................. G', Test Pit No. 1________________minutes per inch Depth of Test Pit..___�_�_____..._.._ Depth to ground water._?�i.;,- _=.__..-_. fs, Test Pit No. 2.... ------minutes per inch Depth of Test Pit..._E.:~ .......... Depth to ground water....................... a --•-----•------•--------•----------------•-•----•----•----•----...•-•-••••---•.._..._...--••--•••••......................................................O Description of Soil......t�' �. Lt""&% A ::�. -'-. .. `.-L- W � ✓ iG Q`. )[.:' � -t1I'j U (_,- I ( P1[-�l\J{1 x J c. �vt -"T�tii � ila : c �c- ]rte.��� ?' � c 1+It✓� \cl .ii 5�-11 ti7 v •-----. --------------•-•-• --------------•-•--------------------------------------- ------......----------•--•-•-••.........- W ---------------------------------------------------------------------------------------------••------------------.....------------••-------•------------•-••-------••-•-------•----•-•--•....--•.....-- U Nature 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 TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed ...................................................................................................... ........................................ Date ApplicationApproved By ....... � .. u_. 1..:'... e~ r------------------------------------------------------------------------------------------------ J Application Disapproved for the following reasons- .......................................--- - ------------ ----- - ------------------------ -------------------------- -------------------- ----------------- ------- ---- - - - - -- ----------------------------- - --------- ------------------------------------------------------------------------ ---------------------------------------- �. Permit No. _ � ''` Dale ----.. Issued ------------------------------------------------------------------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH G�R�L.r`-� of .. /ZKJ � ' 1c5U=� ............................................ . . (9ertifirate of 0-I'Ll�xrcce THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by.................................... ... --- -- --------..............------------ --. -------- .------.............----------------. ---. ------- ------. . --..........------- --------------- Installer �� at L i 121...E ,J DZ\U(� � ..................................................................---.......-- - ..............------ - . . ----- ........................................................................... has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ....!7 )_-...-4-. "..,;1-.-------- dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. �� s DATE-.....-. `. ©. ..-.... 5 Inspecto . 7 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....................................... oF.................!.--p''- .................... No.....:..:..:...:........ FEE.---................... Disposal Works T.1ntr inn rrmit Permissionis hereby granted.............................................................................................................................................. to Construct_(, ) or Repair ( ) ,an Individual_Sewage Disposal System at No.. `= ' i�.0 C .1:� 1. U L I V— , `; �-�y f l a................ ,s t ---• ---- •---•-•••._....-..--•----••.......-- ......S Street as shown on the application for Disposal Works Construction" �o.%`----------------_.D eg ----- v/�� f Board of Health DATE.----•-•------- G' FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS BAXTER & NYE, INC. Professional Land Surveyors and Civil Engineers 812 Main Street •Osterville, Massachusetts 02655 Tel. (508) 428-9131 FAX (508) 428-3750 WILLIAM C:NYE, P.L.S.-President PETER SULLIVAN, P.E.-Vice President-Engineering = RICHARD A.BAXTER, P.L.S.-Vice President i December 4 , 1992 Board of Health Town of Barnstable P.O. Box 367-Town Hall Hyannis , Ma 02601 Re: Paul Gargano 251 Green Dune Drive :W. H.yannis Port , Ma 02672 ,Dear Board : Please find attached copies of a site plan which details the septic system design for Mr . Gargano' s property . The systems for the main house and the garage have both been ,designed in accordance with your latest regulations . The !Gargano property is fronted by a coastal bank as defined by FDEP 's Wetlands Protection Program Policy 92-1 . The toe of this bank is not subject to tidal action therefore 1 have used the `upward edge of the marsh as our closest resource area . There is a vertical separation distance of 154 feet and a horizontal ;separation distance of approximately 16 feet . I believe that this design meets or exceeds all your regulations . If you have any questions please feel free to call . PFTFR Very truly yours , f 1 SULL17i AN Jul Q S ti No. 1J; In Iv .. =sr� Peter Sullivan , P. E. Baxter & Nye, Inc . Attachment P S:s l g MEMBERS OF CAPE COD SOCIETY OF PROFESSIONAL ENGINEERS AND LAND SURVEYORS I AMERICAN CONGRESS ON SURVEYING AND MAPPING MASSACHUSETTS ASSOCIATION OF LAND SURVEYORS AND CIVIL ENGINEERS ---------- --------- ----------- N gEACN ROAD SYSTEM #1 SYSTEM #2 CONSTRUCTION 01 BED ALTERNATE SYS= #1 7 NOTE- NO WATER OR GAS LINE EVIDENT. C) 0 DZ=lq DATA DIMIC DATA 6-TA C: 0 -Z USE 14 (4'X*') FLOW DIFFUSORS C.B. DELL W L.Li -;0 �; ��i SINGLE FAMILY- 5 BEDROOMS SINGLE FAMILY- 3 BEDROOMS Li Z U) --a WITH 2' OF CRUSHED STONE ON ALL SIDES. FN D. 0'- rn 0 NO GARBAGE GRINDER NO GARBAGE GRINDER S JOHN A. NANCY ELEC SYS= 02 4 B.M. 26,4-9' BOX DAILY FLOW = 110 X 5= 550 G.P.D. DAILY FLOW = 110 X 3 = 3,30 G.P.D. USE 8 (4'X 8') FLOE DIFFUSORS I SEPTIC TANK = 550 X 150% 825 G.P.D. SEPTIC TANK = 330 X 150% 4-95 G.P.D. HYDRANT WITH 2' OF CRUSHED STONE ON ALL SIDES. #420 co 7 2 USE 1500 CAL. USE 1500 CAL. z- SPINDLE S8,2-0210"\N 0-0, Lil- LOCUS tl- ro MMTUTOR — USE MrsH CAPACM? UVM7RA670H — USE WGH CAPACrrY uj MARSH Soy USE 18 (3'X 6') CHAMBERS USE 10 (3'X 6') CHAMBERS WATER METER IN PIT BUFFER O USE A 12' X 58' WASHED STONE FIELD USE A 12'X 34 WASHED STONE FIELD D ZONE " K AS SHOWN AS SHOWN co LOCUS MAP (7) SYSTEM IS WITHIN 250' OF A RESOURCE AREA SYSTEM IS WITHIN 250' OF A RESOURCE AREA SYS= #1 ,uf'- THEREFORE THE APPLICATION RATE EQUALS THEREFORE THE APPLICATION RATE EQUALS SCALE I ; 25,000 550 C.P.D./,75 =. 734 S.F. OF BOTTOM AREA IS REQUIRED 330 C.P.D./.75 = 440 S.F. OF BOTTOM AREA REQUIRED i " ASSESSORS USE 12'X58' (12+1)X(58+1) = 767 S.F. AREA PROVIDED USE 12'X.34' (12'+l')X(,34'+l') = 455 S.F. AREA PROVIDED / �, \ MAP 245 PARCEL 33 PERCOLATION RATE: PERCOLATION RATE: 50.0' 1 INCH IN 2 MINUTES OR LESS. I INCH IN 2 MINUTES OR LESS. .7 ZONE AP CD TP , CD 2 z 4 1 I Q, tx. Ln ;9l ill 1500 Gf\L- 0/1 1�1 r 0 TA,NK, K u 6 58' 34' 71 1500 -,PROP su 50.0 WAI f "4- 9 . ------ -po 0 -y. -vo am - F�Opos . V, C.B 01, I`NI) 50.00' BU ZONE PA rjO INFILTRATOR LAYOUT C CD C�- 12 & 09 TO 0/� N 611 1L X 12' 12' 3' 3' 2' 2' FINISHED GRADE M44 aa 4�4—4 4 4 4 4 4 4 4 4 4 4 4 a 4 4 4 44'444 ..................... 4 44 4 d4 4 4 4 ., -, 4-, -4 44 444 4 d'. - 4 4 4 d, 4 444 4- 44 e' '444,14 1444 44 4 4 4 4 ASTO - 12" 12" P I- NE 3/4 TO 1 1/2 " 4 41 4 4 18 WASHED STONE 4& 4 6 4, 4 n, 44 44 1 4� FLOW DIF-fUSORS ALTERNA INFILTRATOR 2 b R TYPICAL S=-,,10 I jk 2 TEST MIX COVERS LOCATED 1-0 WITHIN AiL NOVEMBER 3,1992 12" OF F.G. m F.F. ELEV. 25.8' P. SULLIVAN . BAXTER & NYE INC. #P7960 ELEV.= 24.8 ( r /�� F.C,.= 24'± 20.4' TOP OF PIT #2 INV. FOUNDATION PIT #1 ELEV. = 24.0' 23'± (20.2') ELEV. 225 LOAM & SUB SOIL. F. (22,±) INV. 21.8 SYSTEM #1 T X -2 7 --2 LOAM & SUD SOIL. �"7D I M E-17t� 4 NV, DIST. = 20.0 1,1� 3;/ (21.0') SYSTEM #2 40 1500 GAL. INV Box TOP ELEV. sc, ��DUL� SEPTIC TANK 1(19 5) 21 0' (20.0) INV. 20.6p INV. PERK TEST 6" STONE BASE (20.4') (20.6') (2.0.8') MEDIUM MEDIUM v INFILTRATORS V v v v v v v 2" PEASTONE v V V V 7 V R V V TO COURSE TO COURSE FD 4 X v,vvy , EL = 19.0' MIN. SAND SAND 3/4" TO 1 1/2' (18.5') 0 WASHED STONE -7 2" PEAMNE PLAN OF LAND Lu o IN L6 MEDIUM WHITE MEDIUM WHITE (HYANNISPORT� SAND SAND NO WATER OBSERVED o Q-f 6ARNTABLES q MASS . EL. l4dq - 11 NO WATER (13�5) C) FOR EL. 11.5 —1 12 NO WATER PROFILE carEL. QD 12.0 PAU L GARGAN O NO SCALE SCALE AS NOTED j DATE: NOV. 24 ,1992 ALL. COMPONENTS LOCATED IN POTENTIAL A N VEHICLE TRAFFIC AREAS OR BURIED 4 FEET BAXTER & NYE INC, OR GREATER SHALL BE H-20 LOAD CAPACITY. GRAPHIC SCALE REGISTERED LAND SURVEYORS II 0 40 80 CIVIL ENGINEERS OSTERVILLE, MASS, cw, 1 CERTIFY THAT THE PROPOSED FOUNDATION SHOWN HEREON 1 inch 40 ft.. A ✓ PErzR COMPL\i/S WITH THE SIDELINE AND SETBACK REQUIREMENTS OF SIRLIVAR ELEVATIONS ARE BASED ON N.G.V.D. 2 29733 100 YEAR FLOOD ELEVATION 12 0' No THE TO\,�/N OF BARNSTABLE, AND IS NOT LOCATED WITHIN THE AR FLOODPLAIN, DATE. R.L.S. #92013A