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HomeMy WebLinkAbout0005 ALICIA ROAD - Health !;pia Road Hyannis P r _ _ _ - .. A 292 229 �I 8 in 'y9 A A 1� F i i u i f < ^ TOWN OF BARRNSTABLE G / lz SEWAGE # 1 b� VIL-L;Al-z �1�5 ASSESSOR'S MAP & LOT�'c7eZ oZo�� INSTALLER'S NAME& PHONE NO. SEPTIC TANK CAPACITY �017 nT LEACHING FACU-=: (type ��) d� S� 5A� �rize) /r I ` NO. OF BEDROOMS -'qBUILDER OR OWNER A A G PERMITDATE:, COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leachit facility) Feet Furnished by tv; ` 13��ky A (� a a cl(o as 30 y TOWYOF BARNSTABLE ,e� ..►_�f3CA'I'ION � SEWAGE # VILLAGE y ASSESSOR'S MAP & LOT !� INS ER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PST DATE: v2�- o S COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by of s � 0 ti TOWN OF BARNSTABLE WCA`1ON t7r R 1) C 1 A P SEWAGE # VIL-LAvE 1k ASSESSOR'S MAP & LOT ' INSTALLER'S NAME&PHONE NO. M riCOMIL9-- 115— S!i346 SEPTIC TANK CAPACITY 000 CA LEACHING FACILITY: (type) �217 607 (size) NO.OF BEDROOMS _l BUILDER OR OWNER IL PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by ',�. . .S _ �` � � � <. / � r Q ✓ k �� � e i e�' / e £ � �� � �� �i � � �i �,9� � ��� TOWN OF BARNSTABLE q, p Al—AZIA 7� SEWAGE#Ays V'5LOCATION �' VILLAGE 5!!��s �ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type), �O(� 6' ,(,�', (size) �al� NO.OF BEDROOMS OWNER PERMIT DA : ' COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility feet Private Water Supply Well and Leaching Facility(if any wells exist on site or within 200 feet of leaching facility) feet. Edge of Wetland and Leaching Facility(if any wetlands exist within 300 feet of leaching facility). feet .,FURNISHED BY . ® ' �� . . ��� r .fir 4 �lam.(1• _ No. �--;; H ' Fee "'THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes .UBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS appricPtton for �Btoogal �braem Conotructton Permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑.Complete System ❑Individual Components Location or Lot No. S- ALIC I AO R(CD Owner's Name,Address,and Tel.No. �/ff Assess_is Map/Parcel! 7_ Installer's N e,Address,and Tel.No.W I LI-1 t„I V I 6 Designer's Name,Address and Tel.N0ZW�"c�/v"" y, �/.gG sJ- _y,�. 6 !2- Type of Building: Dwelling No.of Bedrooms Lot Size sq:ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures P p� Design Flow(min.required) m 3� gpd Design flow provided , oC 15— gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank ,,&�5757 /0099 Type of S.A.S. `2 'SQ0 45;0�e_ Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 issue�by this Board f th. Sign v Date Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. Date Issued i ".r'Y�.�l�Y.-...'4'1...+`/�''� ""�+ti.:+'f�w�:..�....�17,...r�N/�+ w/`l •.,�:,.,, ...,t,��y.....+.., ..a. .i-`.-�...�"."..�+C' ^i/..-.wt'..,`�,., ``. de No. ^- .,�"�f Fee THE C05WONWEALTH OF MASSACHUSETTS Entered in computer: UBLIC HEALTH DIVISION - TOWN-9F BARNSTABLE, MASSACHUSETTS Yes 12(`placation for i ogaf 6pgtem Cow6truction Permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon stem( ) Complete Sy stem y ❑Individual Components Location Address or Lot No. ALIC R014 D Owners Name,Address,and Tel.No. Assess is Map/Parcel _ Installer's N e,Address,and Tel.No.w �'�'r"r 6� �Designer's Name,Address and Tel.No "C x/�r V, - .��"i•9G L�t. .. Type of Building: . f Dwelling No.of Bedrooms Lot Size s . ft. Garbage Grinder . g 1 9 g ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) � gpd Design flow provided gpd d - Plan Date Number of sheets Revision Date Title Size of Septic Tank 2E5i 000 Type of S.A.S. Description of Soil' ' r Nature of Repairs or Alterations(Answer when applicable) I 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 jCode and not to place the system in operation until a Certificate of Compliance has been issued by this Board of ealth. SignQ 1997 Date Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. ..� Date Issued _THE COMMONWEALTH OF MASSACHUSETTS gip,a BARNSTABLE, MASSACHUSETTS Certificate of Compliance , THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (!/) Upgraded ( ) 4+ Abandoned( )by U Z!2 Z /&�%iC� at Z—JL Cc/ ()A I) has ben constructed in cco dance, with the provisions of Title 5 and the for Disposal System lEonstruction Permit No. dated. Installer �� / Designer E ] w -r v r + -#bedrooms Approved design flow a gpd The issuance of this permit sh 11 not be construed as a guarantee that the system will' ction as dde/signed. D Date ,1 a I�75 Inspector �,�/ff p -------------�r----------------- ---�— `I No. Fee. �— �. THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH.DIVISION-BARNSTABLE, MASSACHUSETTS 1i.5po9;al 6potem Conotruction Permit Permission is hereby granted to Construct,( ) Repair ( (�� Upgrade ( ) Abandon ( ) System located at '� /� ,C� u� iC 1 t/�/l./!//� /,Jtia/ and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Const ctio must be omn 1 eted within three years of the date of th�69i ­64 Date Approved by _ Town of Barnstable �111E, � Regulatory Services Thomas F. Geiler, Director I IInRNsrnat.L MAS& Public Health Division Thom•as McKean, Director 200 Main Street, Hyannis, CIA 02601 Office: 503-36'-464 f Fax: 503-790-6304 Installer & Designer Certification Form Date: 10 -ot -oz Sewage Permit# 208-3q5 Assessor's Map\Parcel Designer: I �� " ' ' Installer: V ) 61 tu✓V) )PJ6,ey Address: PO 66)e q b 1 Address: 26 n V S-f, SA'tlAw� MA 02—b01 On -10- 01 W 1 <<IQ,►M hW6M' was issued a permit to install a (date) (Installer) septic system at S based on a design drawn by (address) e44 PC dated (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved charges such as Ir:teral relocation o �the distribution box an&'or septic tank. 1 certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or ariv vertical relocation of any component of the septic system) but in accordance with State 8c Local Regulations. Plan revision or certified as-built by designer to follow. - r� N' OF MAss9 r a DAR E• —a (Installer's Signature) No. 1140 ISiE SANITAR�P� ��• 0� , c (Designer's SignaruT, ABLE (Affix Designer's Stamp Here) PLEASE RETURN TOPUBLIC HEALTH DIVISION. CERTIFICATE OF CONIPL1ANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q: Heal th/SepticlDesigner Certification Fomi 3-26-4doc 'town of JBaimstable. P# of Department of Regulatory Services • Public Health Division 1 Hate— ' erseth � •� .;; WA.va e$ 200 Main Street,Hyannis MA 02601 A/ �ffD fAA'tAIM 'Wl Date Scheduled ® Time Fee Pd. c Assess $ ,5r�atabilaty me nt for�Sew oak txge Dis osar µ 1/ per, o w��. �r',d�b i • Performed By. DA-r,- ' ` " - l/�� Witnessed By: i LOCATION & GENERAL INFORMATIONBMJ Owner's Name QS � Location Address'S . A 1.t tJ A 'Po" Address Sq 'l D l C-O CA 4 L 127 ' Q Engindees Name JGt.Crlo-L t� Assessor's Map/Parcel: NEW CONSIRU('PON REPAIR X . , Telephone# S0� 3 6Z- Z9 27i C ,1 w'' // Land Use Slopes(go) ' Surface Stones y LIL Distances from: Open Water Body ZOO ft .Possible Wec'Area>Zod ft Drinking Water Well ��ft Drainage Way 7 O ft. Property Line �!a ft Other ft SIOTCH:($treet name,dimensions%f lot,exact locations of tqt holes&perc tests,locate wetlands in proximity to holes) SEE P2OPC6" o CID -0 4, co ca � Ln r s o rn i 1 A114- Parent material(gcdlogic) kel'i't u vlw4o I Depth to Bedrock i . I Weeping from Pit Face /" Depth to Gm!tndwar. Standing Water in Hole:' A/ Estimated Seasonal Sigh Groundwater DtTERMINATION FOR SEASONAL ffi(�IEI yVATR TABLE Method Used: I' I iu. Depth to soil mottles: In. Depth db,served standing in obs.hole: i in. proundwnter AdJuatment Depth[olweeping from side of obs.hole , _ A� {actor-�.._.v- Ad).Groundwater Lavel.,.,e Index Well# � Reading Date Index Well level i- PERCOLATWN TEST . Data� Tltue•�._... Observation I Time at 9" -------- Hole# Depth of Perc �8 r' Time at 6" l cS Time(9"-6'7 Start Pre-soak Time.@ ' ' t7 End Pre-soak _l__-_— Rate MinJlnch ; Site Failed.. Additional Testing Needed(YM) — Site Suitability Asse¢sment: Site Passed _ ; Observation Hole Data To Be Completed on Back Origm2l:.Public Halth Division -- ***If ercola•ion test is to be conducted within 100' of wetland,.-You m must first notify the P � Barnstable C44servation Division at least one(1)weik prior to beginning. DEEP OBSERVATION HOLE LOG Hole# a Depth from Soil Horizon Soil Texture Soil Color Soil ' Other .Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. Gravel) L-0±!44 5"o t 0 -"/1 3g 6c ` G DEEP OBSERVATION HOLE LOG Hole#9 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) " ` ' 4' ` (USDA) (Munsell) Mottling• (Structure,Stones,Boulders. Consistency: Gravel) &4)0 10 V 2 IT) rJ ;� f r .nJ 4r o p- s/B DEEP OBSERVATION HOLE LOG Hole# N Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. o 0 vel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onit Flood Insurance Rate Man: Above 500 year flood boundary No_ Yesx— Within 500 year boundary No x Yes,.. Within 100 year flood boundary No k Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist.in all areas observed throughout the area proposed for the soil absorption system? �� If not,what is the depth of naturally occurring pervious material? Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the requiredjraining,expertise and experience described in 3.10 CMR 15.017, Signature Date° 21 Q.%EPTIC\PERCFORM.DOC Fi"�'r3'.'. tri_ w r* .•�-r^.'..--'. •r•e�C+—'�r..++«...aY' _.,,,,'- t --"'� ri-� : '`3^'f" .. l •{ ri � 1;? ` RiY. � .` •. �'. r-•'t rt"M1,' .� '• } ,.. j . ✓ -.tea. TOWN OF BMMSTABLE " BAR-W A 346$ Ordinance or Regulation WARNING jN�OTICE Name of Offender/Manager /c.i.Hp� tJr r7t(,`r Address of Offender A/,'�„ i2� MV/MB Reg.# Village/State/Zip A^ , ✓jn A od 1 G Business Name �.'Ld r am/�,- on t'a / h"120U( Business Address (Signature of Enforcing Officer Village/State/Zip Location of Offense ' Enforcing /Dept/Dfivision Offense 1 ,1,dw ef : ,�r..e �r. (✓t/(? 3 � �—/ Y �t'/fJ/!/'J_/Y. �i1' 'r+� ,�7 flt.t/I�fQM�s' 11 � Facts ;{ 1 !?�f! r�i'trfe�'+rw I�Yr 'i..,I�.MI�7I'/`P f foI� 04V'/'"M I t`P/ti+ ✓(' Y, /�i,. s�+ �a�:r /?�X G. Ur r or P ; �do'`.n/c/u 44"<4G ' /h,�.•� f` �s c✓ " This will serve only as'�a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary ,.compliance. Subsequent violations will result in appropriate legal action by =the Town. WHITE-OFFENDER CANARY ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. TOWN OF BSTABLE BAR-WJ Ordinance or Regulation WARNING NOTICE Name of Offender/Manager ' J Address of Offender MV/MB Reg.# Village/State/Zip '; - '' s Business Name am/pm.; on -� 20_ Business Address Signature of Enforcing Officer Village/State/Zip Location of Offense " . Enforcing Dept/Division Offense Facts I This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. . t i �. COMMONWEALTH OF MASSACI3USETTS Z EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS d DEPARTMENT OF ENVIRONMENTAL PROTECTION e� ,�,M cVey 350 MAIN STR'r-,ET WEST� Y0 H,MA ,y�� 508-775-2802800 j TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM ' PART A ry CERTIFICATION C? MAP 292-PARC 229 L Property Address: 5 ALICIA ROAD HYANNIS,MA 02601 < _ "'n Owner's Name: ASSIS,VAGNER v3 C) Uj r- Owner's Address: 5 ALICIA ROAD C) HYANNIS,MA 02601 Date of Inspection MAY 23,2005 co Name of Inspector:(please print) t- .C- m Company Name: A&B Canco Mailing Address: 350 Main Street Wesr.Yarmouth,MA 02673 Telephone Number: 508-775-2800 CERTIFICATION STA CEMENT I certify that I have personally i,is,)ected 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 Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: - Date: The system inspector shall submit a co— 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 ystem.owner shall submit the report to the approh-fate regional office of the DEP. The original should be sent to ths system owner and copies sent tot he buyer,if appl-cable,and the approving authority. Notes and Conunents ****This report only describe.;conditions at the time of inspection and under(;he conditions of use at that time. This inspection does not addri.s;how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Fornh 6/15/2000 1 I Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 5 ALICIA ROAD HYA.NNIS,MA 02601 _ Owner: ASSIS, VAGNER Date of Inspection: MAY 23,2005 , Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Panes: N/A 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. s Answer yes, no or not determined(Y,N,ND)in the for the following statements. If"not determined" please explain. _ The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfrltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: _ Observation of sewage back-up or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health)" broken pipe(s)are replaced obstruction is removed I ND explain: Title 5 Inspection Form 6/15/2000 2 Page 3 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 5 ALICIA ROAD HYANNIS,MA 02601 Owner: ASSIS, VAGNER Date of Inspection: MAY 23,2005 C. Further Evaluation is Required by the Board of Health:N/A 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(i)(b)that the system is not functioning in a manner which will protect public health safety and the environment: Cesspool or pnvy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone I of 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 R h This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of arnmonia 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: 4 r Title 5 Inspection Form 6/15/2000 3 Page 4 of l 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 5 ALICIA ROAD HYANNIS,MA 02601 Owner: ASSIS, VAGNER Date of Inspection: MAY 23,2005 D. System Failure Criteria applicable to all systems: N/A 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 leaching is less than 6"below invert or available volume is less than%day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation N/A Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply N/A Any portion of a cesspool or privy is within a Zone 1 of a public well N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well N/A Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. (This system passes if the well water analysis performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm, provided that no other failure criteria are trigg.red. A copy of the analysis must be attached to this form.) NO (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CUR 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: N/A To be considered a large system the system must service a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes' or"no to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No ' the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well. If,you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system is 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 CUR 15.304. The system owner should contact the appropriate regional office of the Department. Title 5 Inspection Form 6/15/2000 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 5 ALICIA ROAD HYANNIS,MA 02601 Owner: ASSIS, VAGNER Date of Inspection: MAY 23. 2005 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,including 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 scunn ✓ Was the facility owner(and occupants if different from oxvner)provided with infonnation on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)has been determined based on: Yes No ✓ Existing infonnation. 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(3Xb)] �r Tide 5 Inspection Form 6/15/2000 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 5 ALICIA ROAD HYANNIS,MA 02601 Owner: ASSIS, VAGNER Date of Inspection: MAY 23,2005 FLOW CONDITIONS RESIDENTIAL✓ I Number of Bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms: 330 Number of current residents: 4 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): YES Seasonal use(yes or no): NO Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no) NO Last date of occupancy: PRESENT COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: N/A Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: gallons—How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM i ✓ 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) i ' Tight tank Attach copy of the DEP approval Other(describe): ' Approximate age of all components,date installed(if known)and source of intormation: 1999—PERAUT#99-684. Were sewage odors detected when arriving at the site(yes or no): NO :. Title 5 Inspection Form 6/15/2000 6 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 5 ALICIA ROAD HYANNIS,MA 02601 Owner: ASSIS, VAGNER Date of Inspection: MAY 23,2005 BUILDING SEWER(locate on site plan): ✓ Depth below grade: 4" Materials of construction: Cast iron ✓ 40 PVC _ other(explain) Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK(locate onsite plan): ✓ Depth below grade: 10" Material of construction: , concrete metal fiberglass polyethylene _ other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1000-GALLON PRE CAST Sludge depth: 4" Distance from top of sludge to the bottom of outlet tee or baffle: 26" _ Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle: 12" Distance from bottom of scum to bottom of outlet tee or baffle: 16" How were dimensions determined: ASBUILT&TAPE. 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,INLET BAFFLE—OUTLET BAFFLE. NO SIGN OF OVER LOADING OR LEAKAGE. GREASE TRAP(located on site plan) N/A Depth below grade: Material of construction: concrete metal fiberglass _ polyethylene other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Title 5 Inspection Form 6/15/2000 7 r Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 5 ALICIA ROAD HYANNIS,MA 02601 Owner: ASSIS, VAGNER Date of Inspection: MAY 23,2005 TIGHT or HOLDING TANK: N/A (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass polyethylene other(explain) Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no) Alarm level: Alarm in working order(yes or no): Date of last pumping Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: (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"X 16"—10'-BELOW GRADE,ONE LINE IN—TWO LINES OUT.BOX IS CLEAN AND SOLID. NO SIGN OF OVER LOADING OR SOLID CARRY OVER. PUMP CHAMBER: N/A (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or.no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Title 5 Inspection Form 6/15i2000 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 5 ALICIA ROAD HYANNIS,MA 02601 Owner: ASSIS, VAGNER Date of Inspection: MAY 23,2005 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: T leaching chambers,number: 2 leaching galleries,number leaching trenches,number,length leaching fields,number;dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) LEACHING IS TWO 500-GALLON DRY WELLS AND ONE 1000-GALLON PRE CAST PIT,PIT HAS 2'WATER. CHAMBERS HAVE 2"WATER. NO SIGN OF OVER LOADING OR SOLID CARRY OVER. CESSPOOLS: N/A (cesspool must be pumped as part of inspectionXlocate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: _ Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation etc.): PRIVY: N/A (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.) 4 Title 5 Inspection Form 6/15/2000 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 5 ALICIA ROAD HYANNIS,MA 02601 Owner: ASSIS, VAGNER Date of Inspection: MAY 23,2005 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet Locate where public water supply enters the building. ° ° >l� 3 V' c � Title 5 Inspection Form 6/15/2000 10 r ..>....=='.-��:.�:..._........<t.�..:::....a.=.._ _ ...p. '�? -�.: ..,�t�_�.. G*�`.s�:\<f'. ;#_. e.x -S•` -.=Y'Yi:J)�� 1_ ,i t, �: .3�'�, C..� � �%:.w i. 1 f I Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 5 ALICIA ROAD HYANNIS,MA 02601 Owner: ASSIS, VAGNER Date of Inspection: MAY 23,2005 SITE EXAM Slope Surface water Check cellar , Shallow wells Estimated depth to no groundwater 10 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-if checked,date of design plan reviewed: �— Observation site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers{attach documentation Accessed USGS database-explain: You must describe how you established the high ground water elevation: TEST HOLE 10' NO WATER. TEST HOLE Y BELOW BOTTOM OF PIT. BOTTOM OF PIT 7'BELOW GRADE. _7y • y Q O7oM 9/7— Title 5 Inspection Form 6/15/2000 11 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTALRROTEG 11-ON a nr.T 2 4 ZOOZ O'04, O LTH NSTABLE TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 5 Alicia Road Hyannis, MA 02601 Owner's Name: Anna Nt; Owner's Address: Date of Inspection: October 2, 2002 Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford Mailing Address: P.O. Box 49 Map:292 Osterville,MA 02655-0049 Parcel.229 Telephone Number: (508) 862-9400 _ CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ Passes Conditionally Passes Need&further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: October 5, 2002 The system inspector shall sub ' a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: S Alicia Road Hyannis, AM Owner: Anna NQ Date of Inspection: October 2. 2002 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 CM , 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: I B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please explain. I The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: S Alicia Road Hyannis, MA Owner: Anna Ne Date of Inspection: October 2. 2002 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 5 Alicia Road Hyannis, MA Owner: Anna NA Date of Inspection: October 2. 2002 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than '/z day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either`yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well If you have answered`yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: S Alicia Road Hyannis, MA Owner: Anna NA Date of Inspection: October 2, 2002 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: Yes No ✓ _ 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(3)(b)J. I 5 Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 5 Alicia Road Hyannis, MA Owner: Anna Nz Date of Inspection: October 2. 2002 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 2 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220. Number of current residents: 0 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): No (if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings,if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: . Unknown COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sqft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: New system never pumped Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: _gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM a ✓ Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)`(if yes,attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: 10119199 Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: S Alicia Road Hyannis, MA Owner: Anna Ne Date of Inspection: October 2, 2002 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: To grade Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1000 gal. Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle: 28" Scum thickness: 12" Distance from top of scum to top of outlet tee or baffle: 9" Distance from bottom of scum to bottom of outlet tee or baffle: 3" How were dimensions determined: Measuring stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tees were present. The liquid level was even with the outlet invert. There were no signs of leakage. Recommend pumping GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete —metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 i Page 8 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: S Alicia Road Hyannis, MA Owner: Anna Nz Date of Inspection: October 2. 2002 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even 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.): The D-box was level. Clean no solids present. No sign of backup or failure from leach field. PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: S Alicia Road Hyannis, kM Owner: Anna Ng Date of Inspection: October 2. 2002 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 1 ✓ leaching chambers,number: 2-500 gal. chambers per as-built leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: Innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.): The chambers were dry. Scum line was app. 6"up from the bottom..No sign offailure. Bottom to grade was approximately S'. The old pit was located but not dug up. CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: None (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.): 9 Page 10 of 11 o , OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM-INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: S Alicia Road Hyannis, MA Owner: Anna NQ Date of Inspection: October 2, 2002 Map: Parcel: SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Q � � a3 as 3 O 30 y 10 a Page 11 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: S Alicia Road Hyannis, MA Owner: Anna Ng Date of Inspection: October 2. 2002 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked, date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: The bottom of the leach pit to grade was approximately 7. Using Barnstable Topographic Map and water contours map. Maps are showing app. 20'+1-to groundwater. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report. 11 MRVP # l � Assessor's office (1st Floor) Assessor's Map and Parcel # " Building Department (4th Floor) Zoning INSPECTION FEE RE-INSPECTION FEES_%;*e Request For A Housing Inspection For Certification Under the MA Rental Voucher Program Your Name �, e} �' �z Affiliation (Circle One) Owner Real Estate Agent Tenan Your Address � ,, �� ��$, Telephone Number (Day) (Night) Address of Property Where Inspectiop is Requested Unit/Apt.# f ' � Name of Owner ,fJ��'/Pd � 0� � NIN aZ: Add ress.7AVA(gk..ellA/z _,4Ai 3f�._ Ae Mailing Address (if different) 26 Telephone Number (Day) !i$ 419K Night) Will there be any children under the' age of six (6) who will be occupying the rental unit? (circle one) Yes No Was the dwelling 'constructed prior to 1979? Yes No ------------------------------------------------------------ FOR OFFICE USE ONLY: Certification The dwelling, dwelling unit, or rooming unit located at was inspected on Health Inspector for the Town of Barnstable and was found to be in compliance with the provisions contained within 105 CMR . 410.00, State Sanitary Code II: Minimum Standards of Fitness for Human Habitation. However, this certification does not include a determination as to whether this unit contains any lead paint because under 760 CMR 49.02 Massachusetts Rental Voucher Program, a separate lead paint inspection must be conducted. Inspector's Signature Date �1r ♦ 4 • MRV C # '4 Assessor's office (1st Floor) Q �i . Assessor's Map and Parcel # f " •G Building Department (4th Floor) Zoning INSPECTION,%%FEE` 4AM=ft'\ 1�` ti.'�► � ~ �` }' �` �`��' RE!'3NSPECTION FEE &0 Request For A"$ sng Inspection F'or•' eert"i►fication Underth MA Rental Voucher Program Your amel_ iw -� Affiliation Cir, le One Ow a eat .E t T t Your Address - Telephone Number (Day) ,>(�N'ght) f; � �'f� ..�'a'✓tom"' , ' Address of Property Where inspection is Requested Unit/Apt. # ��' .4/, xv .� Name of Owner Al h Address PAK&�`,����� Il Mailing Address (if different) Telephone Number (Day).,*$,..,r,$$.2. Night) • Will there be any children under the age of six (6) who will be occupying the rental unite circle one Yes No ' PY 9 ( ) t Was the dwelling constructed prior to 1979? Yes No r ------------------------------------------------------------ FOR OFFICE USE ONLY: Certification The dwelling, dwelling unit, or rooming unit located at x. was inspected on b - Health Inspector for the Town of Barnsta le and was found to be in compliance with the provisions contained within 105 CMR 410.00, State Sanitary Code II: Minimum Standards of Fitness for Human Habitation. However, this certification does not include a determination as to whether this unit contains any lead paint because under 760 CMR 49.02 Massachusetts Rental Voucher ro ram, a separate lead paint inspection must be conduct .� ,\\< f1 Inspector's Signature Date- .--�,�� f !ham/ ri• ` 7i Y ` �� �� TOWN O N OF BARNSTABLE F BOARD OF HEALTH ARTICLE 11:MINIMUM STANDARDS FOR HUMAN HABITATION Date " Owner jy"!4 o" I Tenant oeV-A;t: ,� � IZ46�V'T— Address � zz, Address �� 4 Compl!once _ Remarks or Regulation# Yes No Recommendations 2. Kitchen Facilities 3. Bathroom Facilities A. Water Supply 5. Hot Water Facilities 6. Heating Facilities 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities 1441 10. Curtailment of Service 11. Space and Usei°���' 4-oza vie, 12. Exits VOY,4 13. Installation and Maintenance of Structural UW f- Lyiez Elements V014 IA. Insects and Rodents �2 15. Garbage and Rubbish Storage and Disposal f� 16. Sewage Disposal 17. Temporary Housing r PART II 37. Plocarding of Condemned Dwelling; Removal of Occupants; Demolition `����� Person(s) Interviewed 5 iA ���' Inspect 1 -7 If Public Building such as Store or Hotel/Motel specify Here HOBBS$WARREN.INC. TOWN OF BARNSTABLE I� LOCATION t7 R I ' C A 1 SEWAGE # ��C1 VILLAGE ASSESSOR'S MAP & LOT P ^ r INSTALLER'S NAME&PHONE NO. M[)CO M 4tR- SEPTIC TANK CAPACITY 000 LEACHING FACILITY: (type) L 5C Cl¢G �P�(s,IIe) NO. OF BEDROOMS `l BUILDER OR OWNEI PERMITDATE: COMPLIANCE DATE: �) Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by � X7( X i Fee$ 5 0. 0 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0(ppricatton for Mtgaal *pgtem Construction 3permit Application for a Permit to Construct( )Repairi(X X Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 5 Alicia Road Owner's Name,Address and Tel.No. 1—5 0 8—5 2 8—2 5 3 6 Hyannis ,Mass. 02601 Anna Ng 3 Annabell Lane Assessor's Map/Parcel .11 2 A I Frank t i n ,Mass. 0 2 0 3 8 Installer's Name,Address,and Tel.No.5 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.No.5 0 8—7 7 5—3 3 3 8 J.P.Macomber & Son Inc . J. P.Macomber & Son Inc . Box 66 Centerville ,Mass. 02632 Box 66 Centerville ,Mass . 02632 Type of Building: Dwelling XX No.of Bedrooms 2 Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No.of Persons 1 Showers( ) Cafeteria( ) Other Fixtures Design Flow 355 gallons per day. Calculated daily flow 2 x 110=2 2 0 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of soil Loamy sand to medium fine sand . Nature of Repairs or Alterations(Answer when applicable) Adding two 500 gallon leaching chambers to the existing tank & pit .Packed in 4 ' of lz" stone. Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue by thi o d of ealth. Signed Date 10/14/9 9 Application Approved b Date Application Disapproved for the following reasons Permit No. Date Issued Fee$ 50.OO THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 0[ppYtcation for 33t5pogal 6-pgtem Congtructton pedir4t� Application for a Permit to Construct( )Repaia X)§Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 5 Alicia Road Owner's Name,Address and Tel.No. 1—5 0 8—5 2 8—2 5 3 6 Hyannis;Mass. 02601 Anna Ng 3 Annabell Lane Assessor's Map7rdrea �7, 9-7 A Franklln,Mass. 02038 ' Installer's Name,Address,and Tel.No.5 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.No-5 0 8—7 7 5—3 3 3 8 J.P.Macomber & Son Inc . J.P.Macomber & Son Inc . Box 66 Centerville ,Mass. 02632 Box 66 Centerville ,Mass. 02632 Type of Building: Dwelling XX No.of Bedrooms 2 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building = No.of Persons 1 Showers( ) Cafeteria( ) Other Fixtures +. ' Design Flow{ 355 gallons per day. Calculated daily flow 2 x 1 10=2 2 0 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank ° Type of S.A.S. Description of Soil Loam' sand to medium fine sand. 4J - Nature of Repairs or Alterations(Answer when applicable) Adding two 500 g a kl o n leaching chambers to the existing tank & pit.Packed in 4 ' of 1"-j"" stone. Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issu9d by thi Bo d of Health. , Signed Date 10/14/99 Application Approved b Date Ie.,- Application Disapproved for the following reasons r r ` _ r _' "Pemut No. `.—..,.'Date Issued r ---Y- -- :. .n T- . :., .—.,dam..--_ ------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS _,ertiftcate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed(e )Re-pa�iredX )Upgraded( ) Abandoned( )by J.P.Macomber & Son Inc . at 5 Alicia Road Hyannis,Mass. has been constructed in acc�oorrda ce with the provisions of Title 5 and the for Disposal System Construction Permit No dated ` Installer J.P.Macomber & Son Inc . Designer J.P.Macomber & So Inc. n The issuance of this a.. sal• of-be-construed as a guarantee that the s ste ill-functiona esigp �� /a Date ,� � T� Inspector I�1 � _____ No. --(�,—L�--------------------------Fee $ 50.00 .. ._THE COMMONWEALTH-OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Mtf ppgol Wpgtem Congtruction Permit 44" Permission is hereby granted to Construct( )Repair(XX)Upgrade( )Abandon Systemlocatedat 5 Alicia Road Hyannis,Mass. and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction' must be completedwithin three years of the date of t ermit. Date: / / / Approve bd y-�/ , r, \� 1/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) L Joseph P.Macomber Jr . hereby certify that the application for disposal works construction permit signed by me dated 10/14/9 9 concerning the property located at 5 Alicia Road Hyannis ,Mass , meets all of the following criteria: • ,—The failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. •L,The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. ✓There are no wetlands within 100 feet of the proposed septic system There are no private wells within 150 feet of the proposed septic system There is no increase in flow and/or change in use proposed /There are no variances requested or needed. Y The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. (Adjust the groundwater table using the Frimptor method when applicable] If the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed leaching facility will Lol be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) B) G.W. Elevation _+the MAX. High G.W. Adjustment. 17 / DIFFERENCE BETWEEN A and B �. SIGNED : DATE: 10/14/9 9 V. (Sketch pr sed plan of system onZckl. q:health folds.cen 1 r Y all C) O' i J I � I . I I I I r' 9 , tC No......................... Fimim..o2..................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.............................. ...........I....... Apphratiou for 15hipofial Works Tonstrurtion Vautit Application is hereby,made for a- Permit to Com"ct or LRepair an ndividual Sewage Disposal System at: .. ............. .... --- ............ ....... 0C on.A re No. ner .... .... ........................... Ac Address ................ .... .................. ...... ........................................................................................ Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms..............................Expansion...................Expansion Attic Garbage Grinder ( ) Other—Type of Building .................... ... No. of persons............................ Showers Cafeteria ( ) P4 Other fixtures......................../ <� 0..................................................................................................... .*----------------------- Design Flow.................... 9-idons per person per day. Total daily flow........... ..__. ._..__.._.__._.gallons. P4 Septic Tank—Liquid capacity.YHjallons Length................ Width.._.........._.. Diameter................ Depth.........._.._.. Disposal Trench—No....................:'Wid h.......... ../ Total Length........ ........... Total leaching area....................sq. f t. S -D, am ]Depth below inlet..Seepage Pit.No....... ........... I D i "e 201 - ............ Total leaching area D.4.._-'—�. ft. Z 'Other Distribution box ( ) - Dosing tank ( ) Percolation Test Results Per-formed by................................................................ ........ Date........................................ Test Pit No. 1....... ________minutes per inch Depth of Test Pit_................... Depth to ground water------_..._____________. LL, Test Pit No. 2................minutes per inch Depth of Test Pit...___._...._____... Depth to ground water_______________-___-___. . ..... ..... . ................ ....................................................................... 0 Description of Soil:: .4 -------------­*--------------------------------------------- U .................................................................................................................................................................................................... ....................................................................................................................................................................................................... U Nature ofApairs or Alterations Answer when applicable._.____......................................................................................... .....................................................................................;................................................................................................................... Agreement: .1 -T,he undersigned agrees to install the afore d&..;jribed Individual Sewage Disposal System in accordance with Z the provisions of Article XI of the State Sanitary Co dl�—The undersigned further agrees not to place the system in I b 1. operation until a Certificate of Compliance 1-a een i sued Yt e. th. S . .. .(rd 7 Signed__. ...... .. ... ...... ... ... ............ ................. ............................. Dat' ................ Application Approved tate p Application Disapproved for the following reasons:-----_-------_------------ ............................................................................... ............................................................................................................................................. .................................................... Date PermitNo......................................................... Issued.... .....Date ----------------------- ----------------- No......................... ................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF......................................................................................... Appli.ra#iott fur 15itivatia1 Warkii (ion.0#rur#ilatt Permit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an jndividual Sewage Disposal S stegi at: oc on-Adres� .... r yfo A o/ /J f weer Address W 'V. ......................................................... V. Installer Address UU Type of Building,- Size Size Lot...........:................Sq. feet Dwelling d—�'No. of Bedrooms.................. °":' .............Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of,Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures .................................. W Design Flow..................... ..;a --------------- gallons per person per day. Total daily flow__......._.: :_.( .....gallons. g g P P P Y Y g WSeptic Tank—Liquid capacity/ gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width............. Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.......I__---_.._._ Diameter..:a.�.�...:'_..epih below inlet.._�b............ Total leaching area.--Cx. . ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ - Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water---.-----_-_------_----. rX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ---------- t -- ... ..../.' -- - ODescription of Soil-------------- ,r,�-�/- -V..... . .---•----...-----------......------------------------------------------- x V W -••-•••-------------•-----------•---------•••--•-••••••-•-----------•--•-•-••••••-••••-•••--•--••-----.....---••--------••------•••--••••••••-••-••-•-•---•---•---------•-----•-•--•-••••-••---•--••---- UNature of Repairs or Alterations—Answer when applicable......................................__....._._.__...__.........................._._........... -------------------------------------------••--•-•-••-•-••--••-•-••••-•---_....•••••--•---..._•--•--•-•----••-•...............:•----••------•--•-••------••---••--•••••........--------••--......_-••••• Agreement: The undersigned agrees to install the aforede jibbed. Individual.Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary od The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is . ed by the boa d 0 i lth. �' f /f / j rI Signed..: ..<°rr� ,y................. ............. Date Application Approved BY � �s 1 �:'.�'.� :_�.s�f``---------------- .� 9 ....................•---•....._...............--•-•-....bate-----...... . Application Disapproved for the following ren.sons:.......::........:.......... ... .. -------------------------------------------------------------------------•------•-----•-•----------------••--------------------------------------------•-••-••-•••......--:----------------------------- + � � y Date ._. Permit No......................................................... Issued ...� "� "". Dati. ............................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH.;..:,;,.,._ 19 Terfifiratr of f 4.11mpliattre - T � IS TOICERTIF , That the ividual Sewage Disposal System constructed ) or Repaired ( ) by � r' ...•✓..... 'I �-o:z"".�..... -••----- --.._.. --------------------•---.............----........ �'. s e f ast'}h at 7/ f 5+.��C R��'�"- -.(r' _�.'' ~ a� ' /fi r° �`._... ---------------------------------•. has been installed in accordance with the provisio�is of Article XI of. 'lie State Sanitary Code as des flied in the application.for Disposal Works Construction Permit No------------------------ _i"" ' :.. �-_ ____...dated_- - "'}-- ...... THE IS 4JANCE,OF THIS CERTIFICATE SHALL NOT BE CONSTRUED A A t3ll�!#RANTEE THAT THE SYSTd►�:llilL; U. �- FQN SATISFACTORY. .. ?'' + �f -^.w ;},,,,-,.fir r.� ! •ate�r.s0 ��'n��F t � q.!r�� DATE................................................................................ Inspecto ............................................L F ......... k THE COMMONWEALTH OF MASSACHUSETTS •---� BOARD OF HEALTH XV ^. y .etF �''a"r �N _ .......... No.-- .�_............ . FEE-2 ..... 'or Permission is hereby granted. 1,/�!' �--2.•... ell, e J ` to Constru0�(,r�or Repair�i an .individual Sewage Dispopl-•Sy&t r51 at No.. �:,7` C�.f.... . > '„d'. �... �%-:.._ ...... '#.. .��1 f, .L.r ........... ; ..!, .... ...... Stre,a" as shown on the application for 'Disposal Works Construction , mit No .. __...�,ra.... D L' L'uar of Health (� " DATE.........................................:....................................... (v/ h FORM 1255 HOBSS & WARREN,,j.!NC;. PUSUSHERS . _� \ Ito-, �-. SURVEY REFERENCE: LEGEND .=` \ 1 If �C Ifi' C PLAN OF LAND BY BARNS. COUNTY CONSULTANTS INC. DATED: JULY 1972 /� L ' t - _ vvV••// PROPOSED CONTOUR Ra mr' E(pGE" O 99 PROPOSED SPOT GRADE \ OF pA`/EMEr AD —— —— EXISTING CONTOUR _ - _� /$\. JT 98 OUR _ �zS �_ �� 5/7 ;b rs`' '_'; , t + 96.52 EXISTING SPOT GRADE lam' ` Ir ,,,�"{" 1 I' r � j f' %/`/ d.Q`8 51 �� W— EXISTING WATER SERVICE -- 1 a = 48.03 \\ TEST PIT ;! fb,' ! T�r'v ° (1� ,lw, fe 1 r _ay'-- , � "' 'r `•��3-i(:� `t\ _— l 1 7 '..Cinders_ L O 1 0 1 �M t \ � \� / �. 3 "Al !' aryalrce�� ; 'o', �rQ3~se�.10C ,\ �S Gnestnurl / I AREA = 2643 sf 2 / \ LOCUS MAP N.T.S. �. \o 1ti �..� \� GENERAL NOTES: 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL BOARD OF HEALTH AND THE DESIGN ENGINEER. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS OF THE STATE ENVIRONMENTAL CODE,, TITLE V. AND ANY APPLICABLE LOCAL RULES AND REGULATIONS. I /S 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR ��� j TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE h 45.22 ��' / I T j DESIGN ENGINEER. OA j 4 ANY FROM CONDITIONS SHOWN 0 HEREONDS DURING BE CONSTRUCTION DIFFERING TO E DESIGN ENGINEER BEFORE CONSTRUCTION CONTINUES. 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. �J (0 / I 9`��/� / \ j ' 1 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF O¢ U / I // �F� `51 HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 50 % j �\ // ���F. j 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. lD j 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR To VERIFY THE THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. Zz\ _- �� \\ ��� �t 10. EXISTING LEACHING. TO BE PUMPED, CRUSHED AND REMOVED. SOIL ABSORPTION SYSTEM (SECTION) ! I -- ;I .P 111 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION / O 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY O AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY O <� NC 1 13. NO PRIVATE WELLS WITHIN 150' OF PROPOSED LEACHING. I / �e O 1 14. NO WETLANDS WITHIN 150' OF PROPOSED LEACHING. 15. ALL PIPING TO BE 4" SCH 40 ® 1/8-/FT (UNLESS SPECIFIED) 16. IF EXISTING 50OG PRECAST CHAMBERS ARE NOT SUITABLE FOR RE-USE OF ,I/ % -- ' THEN USE 3-INFILTRATOR 3050 UNITS W/ 4' STONE ON SIDES AND gSs9�y % �` TH_2 /__ _ - _ -133 O9 ft - 1.3 ' STONE ON ENDS (25'L X 12.16'W X 2'D). ALL PROPOSED ELEVATIONS o D REN o � / _ - - - � 1 SHOWN REMAIN THE SAME. THIS SYSTEM PROVIDES 334.95 GPD. 1140 50 PROPOSED SEPTIC SYSTEM UPGRADE PLAN �Er>rs1E BENCH MARK PAINT ,SPOT ON 5 ALICIA ROAD, HYANNIS, MA ft: NI1AR�pa `Q� 1 6� a sy BULKHEAD CORNIER r � Prepared for: Pinheiro F� ELEVATION = 5 2. 0 7 f MAP.• 292 Engineering by: Surveying by: SCALE DRAWN JOB. NO. BAP,IVSTP.BLE GIS DATUM LOT.229 DARRENM.MEYER,R.S. Bea-Tech Bnvimamenlel 1"=20' DMM PO BOX t DEED BOOK. 19978 EA ASTSANO��WlCH, (508) 364-0894 • MA02537 DATE CHECKED SHEET N0. - I DEED PAGE.•227 508,W2M ' 09/27/08 DMM 1 of '2 ELEV. TOP FOUNDATION NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS (Existing) 52.93 �F.G.EL: 51.5 FINISH GRADE=50.0 •� F.G.EL: 51.25 F.G. EL: 50.5 • MAINTAIN 2% MIN SLOPE OVER LEACHING AREA i s ' :i 2" OF 3/8" DOUBLE WASHED 3/4" - 1-1/2" DOUBLE :p 6" . . STONE OR FILTER FABRIC WASHED STONE 3. 4" SCH 40 PVC 10"I moue.e®®®®®® ' 14 a IINV.48.05 19; MIN.) ®®a 3 3 10 a 3 TEE'S ARE TO BE INV.48.25 4" SCH ao PVC 2 EFF. DEPTH a®a®a®®®®®® INV.49.25 4' 2 X 8.5' 4' GAS PROPOSED DB-3 EFFECTIVE LENGTH = 25' AlmExlsnNc ouTLET BAFFLE H-10 DISTRIBUTION BOX . INV. ELEV.= 46.80 INV. 49.50 EXISTING 1000 GALLON SEPTIC TANK OF GAS BAFFLE TO BE INSTALLED ON BREAKOUT OUTLET TEE AS MANUFACTURED BY AR ♦~IM• s ELEV.= 47.30 TUF-TITE, ZABEL, OR EQUAL M , R �' TOP CONC. ELEV.= 47.30 o. 1140 " INV. ELEV.= 46.80 �®®� O ®e NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING �NITAR�p� BOTTOM EL.= 44,80 , ®®®®®®e q5' PIPE INVERTS PRIOR TO CONSTRUCTION 3.75 5 FT. 3 2) D-BOX SHALL BE. SET LEVEL AND TRUE TO �L'�••ai7 `v GRADE ON A MECHANICALL COMPACTED SIX EFFECTIVE WIDTH = 12.5' INCH CRUSHED STONE BASE, AS SPECIFIED IN SEPTIC SYSTEM PROFILE SEPARATION 6.8 FT. 310 CMR 15.TING 1 SOIL ABSORPTION SYSTEM SECTION) 3) REPLACE EXISTING 1,000 GALLON SEPTIC BOTTOM OF TESTHOLE EL: 38.0 = � TANK WITH 1500 GALLON SEPTIC TANK (500 GALLON LEACH CHAMBER (H-10) LOADING) IF FAILED, DAMAGED, OR UNDERSIZED. 4) INSTALL INLET & OUTLET TEES AS REQUIRED DESIGN CRITERIA SOIL LOGS P#: 12366 NUMBER OF BEDROOMS: 3 BEDROOOM DATE: SEPTEMBER 26, 2008 SOIL TEXTURAL CLASS: CLASS 1 (0.74 GPD/SF) SOIL EVALUATOR: DARREN MEYER, R.S., CSE DESIGN PERCOLATION RATE: <2 MIN/IN WITNESS: DONNA MIORANDI, BARNSTABLE B.O.H. DAILY FLOW: 110 G.P.D. X 3 BR = DESIGN FLOW: 330 G.P.D. GARBAGE GRINDER: NO (not designed for garbage grinder) SEPTIC TANK: 330 gpd x 4.5 = 1485 gpd USE EXIST. 1,000 GALLON SEPTIC TANK Elev. TH- 1 Depth Elev. TH-2 Depth 50.0 •A LOAMY SAND 0 50.24 A LOAMY SAND 0. LEACHING AREA REQUIRED: (330) = 445.94 S.F. / 10YR 4 1 .74 kit both bed 49.17 B 1oYR 4/1 10" as.49 B 9" USE TWO (2) 500 GALLON PRECAST LEACH CHAMBERS W/ 4' STONE room LOAMY SAND LOAMY SAND ON SIDES & 3.75' STONE ON SIDES: 25' L x 12.5' W x 2'D lOYR 5/8 10YR 5/8 BOTTOM AREA: 25 x 12.5= 312.5 SF 46.84 38" ,l 47.16 37" SIDE AREA: (25 + 12.5) X 2 X 2 = 150 SF /iV. bed bed C1 C1 TOTAL SQUARE FEET PROVIDED = 462 vs. 445.94 REQ'D 1 rm room room MEDIUM DESIGN FLOW PROVIDED: 0.74(462 S.F.) = 342.25 G.P.D. vs. 330 G.P.D. req'd MEDIUM SAND PERC ®45.17 SAND 2.SY 7/4 2.5Y 7/4 PROPOSED SEPTIC SYSTEM UPGRADE PLAN • +} 5 ALICIA ROAD, HYANNIS, MA 1ST FLOOR Prepared for: Pinheiro Engineering by: Surveying by: SCALE DRAWN 38.0 144" 38.24 144" DARRENM.MEYER,R.S. Bea-Tech Boviromneola/ N.T.S. DMM POBOX 81 EASTS (D PERC RATE <2 MIN/IN. ("C" HORIZON) PERC RATE <2 MIN/IN. ("C" HORIZON) w/CH,M•ao2s37 (506) 364-0894 DATE CHECKED SHEET NO.09�27�08 DMM 2 Of 2 NO GROUNDWATER OBSERVED NO GROUNDWATER OBSERVED 508-362.2922 ! f ` } _ .._. -T 14 P-00 { c { I i INN q' lo ROOM __ 20©M _ y � A ' �3 Z i ROOM LA RGE R CvO" / R®®N�'# 7.� — !F- Fly/ ice+ / \ , <IT�N�td pA'T�ROOM FZoc> xx ' I , r+. r 1 9 9.. .» :.// r f \ , Y+_ —Y •_-._.__..,ram '.,/ ', , � � ��. ar , r I r w _ h i 1 t F , 1 tt r,p .r r f 1 L A PG E ;. oa�._,_�- =.._ � ;. � Rom� � � Roo" _ A rTE R k