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HomeMy WebLinkAbout0098 BACON ROAD - Health 98 BACONROAD, HYANNIS z` - A=309-041 1 a TOWN OF BARNSTABLE LOCATION !z trap/i'�t.! SEWAGE# 9_0AQ-> ()[_, VILLAGE ASSESSOR'S MAP&PARCEL M'-O'I INSTALLER'S NAME&PHONE NO.,D" _A �� (Ckzt'\� 1/�,r c SEPTIC TANK CAPACITY ��f-/�/` %"WO LEACHING FACILITY:(type)[ ( ,,size) NO.OF BEDROOMS OWNER CaVJf�:� PERMIT DATE: COMPLIANCE DATE: 10 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 ge of Wetland and Leaching Facility(If any wetlands exist within 300,feet of leaching facili ) Feet R FtRNISHED BY �: !y ' f G 3 + =27 e s-X7 No / ` - Fee l/ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ye PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 9pplitation for disposal *pstrm Construction Vermit Application for a Permit to Construct( ) Repair(4pgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. �j�j Ce, � #P V4/S Owner's Name,Address,and Tel.No. Assessor's Map/Parcel - Wa i e-, .-Ci� Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms j Lot Size /V V sq.ft. Garbage Grinder( ) Other Type of Building /�5/�c'•�/�7G f No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 �jC/ gpd Design flow provided 3 gpd Plan Date /Z -/2- Number of sheets % Revision Date Title f Size of Septic Tank ike, .1j,6*,--4 Type of S.A.S. .1-?o Description of Soil Nature of Repairs or Alterations(Answer when applicable) &6 // _ 4-,ew e►O /t -j/Sc' Lecc4 c4ic J,i ce✓C1 age Ci§ 5�ot✓ v a�/ dJlc•�✓ 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 issueEi d of Health. Date Application Approved by Date ph 0 Application Disapproved by Date for the following reasons Permit N . l Date Issued --------------------------------------------—.._�___a�_- 77 k • No. ,;i_.� .. - Fee THE CO4WONWEALTH OF MASSACHUSETTS Entered in computer: Y ds PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Rpplicatiou for -MigW!W%pstem Construction Vermit ;. Application for a Permit to Construct( ) Repair( Upgrade_( ') Abandon( ) ❑Complete System Individual Components s. Location Address or Lot No. R )f/16iVfj;s Owner's Name,Address and Tel.No. �8 r cOn! Assessor's MapTarcel 42 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 13/ou-)ro 1 t x c -41a � Type of Building: i' Dwelling No.of Bedrooms 12, Lot Size 6,,.,,., sq.ft. Garbage Grinder( ) Other Type of Building ���/�,�1, No.of Pers ns Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �•2r) gpd Design flow provided gpd Plan Date '/ _ 7P 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) Xi 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 oard of Health. r` Sign Date _ Application Approved by t-Date Application Disapproved by Date for the following reasons Permit N v_)1d _2_/(7 Date Issued --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS r certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( 41T Upgraded( ) Abandoned( )by at rd has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No: !, _ f t dated / �' Installer i� � �Nr Designer — t,4- � #bedrooms 117 Approved design flow gpd O The issuance of is permit shall not,be construed as a guarantee that the system.will`fxncf o ass esigned. Date / `T lrsr /an Inspector __ ________ _______ __ ! -__ ____ l -_--__-___ No. . —!t 1- 1 L/©. _ _ _ . . Fee / 1 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction Vermlt Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( ) System located at7� and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this pe it./ --- Date / N Approved by � _owd Bq_ In H. zoom Vat fix Orr-M MI kdaft All - _ I 11 JJ_ a 5 hogo _ _ - ��� ;� . T�? ' �-��' � �ic:� r�.:���rr�rE�ls: ear�� 4:�^ iaa�.�lil'�+• s '"�, ��� `' �� wo .� b _ I - Me ow_ ,tp; i c_lt���' ter" I � 'q Oct PI is _OW WOW macy war k 4jnAjliK + x PAT 0 • .f t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments. 98 Bacon Rd. Property Address Mark Cabral Owner Owner's Name information is required for Hyannis Ma. 02601 1/29/2009 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key _J to move your Robert Paolini cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC. Company Name r� P.O.Box 763 Company Address Centerville Ma. 02632 rerun City/Town State Zip Code (508)428-4028 S 14454 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 ❑ N eds Further Evaluation by the Local Approving Authority 1/29/2009 Inspector's Signatu 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. Lo 2461 t5ins•09/08 Title 5 Official Inspection Form:Subsurface aewage Disposal System•Page 1 of 2 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 98 Bacon Rd. Property Address Mark Cabral .Owner Owner's Name information is required for Hyannis Ma. 02601 1/29/2009 every page. CitylTown 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: The septic system is in proper working order at the present time. 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 2 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 98 Bacon Rd. Property Address Mark Cabral Owner Owner's Name information is required for Hyannis Ma. 02601 1/29/2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 3 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 98 Bacon Rd. Property Address Mark Cabral Owner Owner's Name information is required for Hyannis Ma. 02601 1/29/2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) � t 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 indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or Tess 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 El ® 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 '/2 day flow t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 4 Commonwealth of Massachusetts W Title 5 Official . Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments LAM 98 Bacon Rd: f Property Address Mark Cabral Owner Owner's Name information is required for H annis Ma. 02601 1/29/2009 y every page. City/Town 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: El ® Any portion of the SAS, cesspool or privy is below high ground water elevation. El ® 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. ElAny portion of a cesspool or privy is withirr50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis . and chain of custody must be attached to this form.] ❑ The system is a cesspool serving a facility with a design flow of 2000gpd- 10,0006pd. ❑ ❑ The system fails. I have determined that one or more of the'above failure criteria exist as described in 310 CMR 15.303, therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) .Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes".or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well 1f 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 5 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 98 Bacon Rd. Property Address Mark Cabral Owner Owner's Name information is required for Hyannis Ma. 02601 1/29/2009 every 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? M ❑ 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? ® 'El . Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® Determined in the field (if any of the failure.criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 6 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 98 Bacon Rd. Property Address Mark Cabral Owner Owner's Name information is required for H annis Ma. 02601 1/29/2009 y every page. City/Town State Zip Code Date of Inspection D. System Information Description: The septic system consists of a 1500 gallon septic tank,distribution box and two 500 gallon leaching chambers. Number of current residents: unknown Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2007:106,000 g ( y g (gpd)): 2008:233,000 Detail: 2007:290 gpd 2008:638 gpd NOTE:House has a sprinkler system Sump pump? ❑ Yes ® No Last date of occupancy: 1/29/2009 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow.(seats/persons/sq.ft., etc.): Grease,trap.present? ❑ 'Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 7 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 98 Bacon Rd. Property Address Mark Cabral Owner Owner's Name information is required for Hyannis Ma. 02601 1/29/2009 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: Capewide Enterprises,LLC. Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? Measured Reason for pumping: Maintenance Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system(yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 8 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °wM 98 Bacon Rd. Property Address Mark Cabral Owner Owner's Name information is required for Hyannis Ma. 02601 1/29/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 2003 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 18"feet Material of construction: v ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented through the house vents. Septic Tank(locate on site plan): 2' 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 gallon Sludge depth: NA t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 9 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 98 Bacon Rd. Property Address Mark Cabral Owner Owner's Name information is required for H annis Ma. 02601 1/29/2009 y every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle NA Scum thickness NA Distance from top of scum to top of outlet tee or baffle NA Distance from bottom of scum to bottom of outlet tee or baffle NA How were dimensions determined? Tank pumped at inspection Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump aeptic tank every 2 years.inlet and outlet tees are in place.No evidence of Ieakage.Tank appears to be structurally sound. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness _ Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 10 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 98 Bacon Rd. Property Address Mark Cabral Owner Owner's Name information is required for y H annis Ma. 02601 1/29/2009 ' every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 11 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 98 Bacon Rd. Property Address Mark Cabral Owner Owner's Name information is required for Hyannis Ma. 02601 1/29/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution.Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert No 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.): Box is Ievel.Box has one outlet Iateral.No evidence of solids carryover.No evidence of leakage into or out of box. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 12 Commonwealth of Massachusetts ti Title 5 .Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 98 Bacon Rd. Property Address Mark Cabral Owner Owner's Name information is required for Hyannis Ma. 02601 1/29/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type. ® leaching.pits number: 2-500gl LC ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Sandy dry soil.No signs of hydraulic failure.Water level was 13"' below invert at time of inspection with no stain line above this point. 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 13 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M .' 98 Bacon Rd. Property Address Mark Cabral Owner Owner's Name information is Hyannis Ma. 02601 1/29/2009 required for y every 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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 14 Map Page 1 of 2 Town of Barnstable Geographic Information System Parcel Viewer Custom Map, Abutters Map Size IM Zoom Out'il In 'Nile It"X vy ,X? jj V. a� @,i+ av \ a3 1 5 l�Y Y` K s 5 > f .� � e �• �� ,r 1. I � I I §'* e y \ r t a r/ 2 s` v > Set Scale ill — 20 I Aerial Photos I MAP DISCLAIMER .......................................... Cnrntrinhf 9f1l1F_9MA Troun of Rornefohle KAA All rinhfe recent. http://www.town.bamstable.ma.us/arcims/appgeoapp/map.aspx?propertyID=309041&mapp... 2/3/2009 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 98 Bacon Rd. Property Address Mark Cabral Owner Owner's Name information is required for Hyannis Ma. 02601 1/29/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope. ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water. Bottom of LC 40' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: As-Built Card ❑ Checked with local excavators,installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: USED:USGS Observation Well Data. USED:Technical Bulletin 92-000-01 plate#2 annual ranges of groundwater elevations. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 16 Commonwealth of.Massachusetts W Title 5 Official Inspection Form , Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 98 Bacon Rd. Property Address Mark Cabral Owner Owner's Name information is required for Hyannis Ma. 02601 1/29/2009 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist E Inspection Summary: A, B, C, D, or E checked E Inspection Summary D (System Failure Criteria Applicable to All Systems)completed E System Information—Estimated depth to high groundwater E Sketch of Sewage Disposal System either drawn on page 15 or attached'in separate file y t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 t. I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 98 Bacon Rd. Property Address Ricardo Varella Owner Owner's Name information is required for Hyannis Ma. 02601 1/15/07 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important:When filling out A. General Information - forms on the computer,use 1. Inspector: only the tab key to move your Robert Paolini cursor-do not Name of Inspector use the return key. Capewide Enterprises Company Name P.O.Box 763 Company Address Centerville Ma. 02632 �70A City/Town State Zip Code (508)428-4028 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 1;5.340=0f Title 5(310 CMR 15.000). The system: =` •�) r,,� WTI ® Passes ❑ Conditionally Passes ❑ Fails ' ❑ Nee�Fer Evaluatio y the Local Approving Authority CU '� 1/15/07 Inspector's Signature Date The-system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. t ****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. 98 bacon rd.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page t of 2 t i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4M 98 Bacon Rd. Property Address Ricardo Varella Owner Owner's Name information is required for Hyannis Ma. 02601 1/15/07 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: . ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Septic system was in proper working order at time of inspection. 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. ❑ 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 98 bacon rd.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 2 . r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 98 Bacon Rd. Property Address Ricardo Varella Owner Owner's Name information is required for H annis Ma. 02601 1/15/07 y every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 Mimes 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: 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. 98 bacon rd.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 3 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 98 Bacon Rd. Property Address Ricardo Varella Owner Owner's Name information is required for Hyannis Ma. 02601 1/15/07 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The-system has a septic tank and SAS and the SAS is less than 100 feet Ibut 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 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 cesspool is less than 6" below invert or available volume is less than '/2 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. 98 bacon rd.-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 4 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 98 Bacon Rd. Property Address Ricardo Varella Owner Owner's Name information is required for Hyannis Ma. 02601 1/15/07 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. 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. 98 bacon rd.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 5 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 98 Bacon Rd. Property Address Ricardo Varella Owner Owner's Name information is required for Hyannis Ma. 02601 1/15/07 every 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? ® El available 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? r ® 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)] 98 bacon rd.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 6 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 98'Bacon Rd. Property Address Ricardo Varella Owner Owner's Name information is required for H annis Ma. 02601 1/15/07 y every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system Inspected? ® Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2005:54,000 g ( y g (gpd)): 2006:62,000 Sump pump? ❑ Yes ® No Last date of occupancy: 1/15/07 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ® No Industrial waste holding tank present? ❑ Yes ® No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ® No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): 98 bacon rd.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 7 Commonwealth of Massachusetts Title 5. Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments GSM 98 Bacon Rd. Property Address Ricardo Varella Owner Owner's Name information is Hyannis Ma. 02601 1/15/07 required for y every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 2003 Were sewage odors detected when arriving at the site? ❑ Yes ® No 98 bacon rd.-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 8 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 98 Bacon Rd. Property Address Ricardo Varella Owner Owner's Name information is required for Hyannis Ma. 02601 1/15/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 18"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.): Joints appear tight.No evidence of Ieakage.System vented through house vents. Septic Tank (locate on site plan): 2' 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: 10'6"long/5'10"wide/5'7"high 2" Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 42" 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 14" How were dimensions determined? Measured 98 bacon rd.-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 9 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 98 Bacon Rd. Property Address Ricardo Varella Owner Owner's Name information is required for Hyannis Ma. 02601 1/15/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump septic tank every 2-3 years.lnlet and outlet tees in place.Tank appears structurally sound. 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: bate 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): 98 bacon rd.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 10 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 98 Bacon Rd. Property Address Ricardo Varella Owner Owner's Name information is required for H annis Ma. 02601 1/15/07 y every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) 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.): i *Attach copy of current pumping contract(required). Is copy attached? El Yes El No r Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert No 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.): Distribution box is Ievel.No evidence of solids carryover.No evidence of leakage into or out of box. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 98 bacon rd.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 11 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 98 Bacon Rd. Property Address Ricardo Varella Owner Owner's Name information is required for Hyannis Ma. 02601 1/15/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type. ❑ leaching pits number: ® 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.): Medium fine to medium sand.No signs of hydraulic failure.Vegetation appears normal 98 bacon rd.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 12 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 98 Bacon Rd. Property Address Ricardo Varella Owner Owner's Name information is required for Hyannis Ma. 02601 1/15/07 every page. City/Town State Zip Code Date of Inspection D. System Information cont. Y (cont.) 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 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.): 98 bacon rd.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 13 commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments G M 98 Bacon Rd. Property Address Ricardo Varella Owner Owner's Name information is Hyannis Ma. 02601 1/15/07 required for City/Town State Zip Code Date of Inspection every page. D. System Information (cont.) 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. -`f q7. 8- Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 14 98 bacon rd.•08/06 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments M 98 Bacon Rd. Property Address Ricardo Varella Owner Owner's Name information is required for Hyannis Ma. 02601 1/15/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to ground water: 40' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: As-Built Card ® J Checked with local excavators, installers- (attach documentation) ® Accessed USGS database-explain: http:Town.Barnstable.Ma.US You must describe how you established the high ground water elevation: used:gahrety&miller model 12/16/94 ground water elevations above sea Ievel.Used:USGS observation well data june 1992.Used:Technical bulletin 92-000-1 pplate#2 annual ranges of ground water elevations January 1992 98 bacon rd.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 15 TOWN OF BARNSTABLE l 9/9 (',D D SEWAGE LOCATION VILLAGE / ASSESSOR'S MAP & LOT ` INSTALLER'S AME&PHONE NO. /ter IQ-144" Pik 221 2 SVI 6 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 1 4 C'1`61'c2c�9 (size) A2 J NO. OF BEDROOMS BUILDER OR OWNER .Z/CAL00 /776/2 A V-&,44 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 Date: - 10`6 ,l$ttO0 3 TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: \j R?_CLk^ ?r",-j,'"j 6- BUSINESSLOCATION: Q18 6Pvcroj A-D MAILINGADDRESS: Mail To: TELEPHONE NUMBER: SOB, ebZ-- -0k51 Board of Health Town of Barnstable CONTACT PERSON: V9-k giLeuvV P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: Hyannis, MA 02601 TYPEOFBUSINESS: T)A-tNT114 G. Does your firm store any of the toxic or hazardous materials listed below, either for sale or for you own use? YES NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site otherthan your mailing address: ADDRESS: 1�(�6 b Arm -i'O TELEPHONE: LlI-ILi LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Quantity Antifreeze(for gasoline or coolant systems) Drain cleaners NEW USED — Cesspool cleaners Automatic transmission fluid Disinfectants -- Engine and radiator flushes — Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) Diesel fuel, kerosene, #2 heating oil NEW USED Other petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages — Wood preservatives (creosote) Battery acid (electrolyte) — Swimming pool chlorine Rustproofers -- Lye or caustic soda Car wash detergents " Jewelry cleaners Car waxes and polishes Leather dyes Asphalt & roofing tar Fertilizers 6,S Paints, varnishes, stains, dyes PCB's Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint & varnish removers, deglossers Any other products with "poison" labels Paint brush cleaners (including chloroform, formaldehyde, Floor& furniture strippers hydrochloric acid, other acids) -- Metal polishes Laundry soil & stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): Spot removers & cleaning fluids 2,0 GArL .ol-j_5 (dry cleaners) raw 6 4 '1 of 6 H Other cleaning solvents (A-��X Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS TOWN OF BARNSTABLE L 0<0 ATION 's A C OAJ AP D SEWAGE VILLAGE / 1 ASSESSOR'S MAP & LOT fj. INSTALLER'S AME&PHONE NO.1/L//LL/41" )q/ya ' 27y- />�I SEPTIC TANK CAPACITY / G LEACHING FACILITY: (type) 4 C% (size) 1.2 X 4 NO. OF BEDROOMS BUILDER OR OWNER � y.. /t2.4- 7 L,, r,� 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 I. . G�i '�iG� 1Q' I "<`� � ���- - �$ � ,�2- �� _ �-3 � � � �`( -aq .. � . � t � ,f J No.�� _i. o. I / FEE COMMONWEALTH OF MASSACHUSETTS Board of Health, I-BAgmen-ROLE MA. APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( .) - ❑Complete System, Individual Components Location 4 'S Owner's Name I tZk=dn Map/Parcel# MAP - 201 Address 913 Lot# Q 68 Telephone# _ a Installer's Name t)eAtacE Designer's Name t Address t� Address my F, I A Telephone# O _ Telephone# - �oZSo Type of Building s i A@ Lot Size Cod sq.ft. Dwelling-No.of Bedrooms Garbage grinder W� Other-Type of Building on-e No.of persons Showers ( 4<tafeteria (e Other Fixtures A tU ` . LpAir-Apt, Design Flow (min.required) 2C %3b gpd Calculated design flow 3 n Design flow provided�]-so gpd b Plan: Date `�'� 0 Number of sheets I Revision Date Title W N Description of Soil(s) G//'�� Soil Evaluator Form No. �� o�. Name of Soil Evaluator CAQ,,14TyS &aPate of Evaluation 1 G 0 3 DESCRIPTION OF REPAIRS OR ALTERATIONSG' QO The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed 13 &j4 Date -Age, �'- No./Jy �" t/1 i ? i' " ��, �f FEE Board of Health, 1 P 1,a<7r R3LE MA. ` APPLICATION FOP DISPOSAL SYSTEM CONSTRUCTION PERMIT a ,� Application for a Permit to Construct( k4`pairX Upgrade( Abandon( ❑Complete System �(Indikid ual Components n il \ I Location t� G n n\S Owner's Name q�1 C C.t_•, c 1 G V G�'e>�`17, Ma /Parcel# Address P MAP ' �jD�j �CC'C•2\ I I`8 (� �ccx� �c�• . � c,.nr,•c. MR �. . Lot# -}} CJ8 Telephone# Installer's Name Designer°s Name (F\� l UAT 10tJ Address Address A ( r 1 3ox p ' C�rty)6A Ali) Telephone# �G _ r}. _ Telephone# S Llt �_ -}gb• ;; tJS3C t 4 _ • Type of Building � Lot Size CO sq.ft. Dwelling-No.of Bedrooms Garbage grinder (/�A Other-Type of Building p `r` ( �/ '� (►�nn'p No.of ersons Showers Cafeteria f, l Other Fixtures =1 u a-rb9_ `-1 ki C by t. ,C c,�, � v .f�� 1 T Design Flow,(min.required) -� (D gpd Calculated design flow 3-�C) Design flow provided SU gpd Plan: Date \ C\ b�"ID Number of sheets I r Revision Date Title 4&C S ' v c�Q AP Description of Soil(s) � C C. C�C \Dc\ Soil Evaluator Form No. Name of Soil Evaluator CAA 2Zj j) SN ra;Date of Evaluation i - (S '(0 3 DESCRIPTION OF REPAIRS OR ALTERATIONS icy Gib C C HQc� �� � C The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed 1T;-A,&a Date + � J • FEE�- --- Board of Health, &1711- MA. r CERTIFICATE OF COMPLIANCE Description of Work: X4ndividual Component(s) ❑Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ),Repaired ( ,Upgraded ( ),Abandoned ( ) by: t~�5 U r-Q n c at rN 5 has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the a proved design plans/as-built plans relating to application No. 2A)S 107 dated Approved Design Flow 3 (gpd) Installer Designer: Inspec£orL A Date: The issuance of this permit shall not'be construed as a guarantee that the system will function as designed. No. FEE COMMONWEALTH Of MASSACHUSETTS Board of Health, MA. . DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair( ) Upgrade( ) Abandon( ) an individual sewage disposal system at -1 Sr,e Otn 9u.,o �P��1�1 as described in the application for Disposal System Construction Permit No.a elo�-�d �, dated y/a r Provided: Construction shall be completed within three years of the date of this permit. All local conditions must be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date Board of Health FORM 11 - SOIL EVALUATOR FORN Page 1 of No.: Date: 1/06/03 COMMONWEALTH OF MASSACHUSETTS Barnstable , Massachusetts Performed By: Carmen E. Shay Date: 1106/03 Witnessed By: Waiver Location Address or#98 Bacon Road Owners Name: Ricardo Varella Hyannis,MA Address and #98 Bacon Road,Hyannis,MA Lot# (Map—309,Parcel 041). Telephone Number: New Construction : X Repair : OFFICE REVIEW: Published Soil Survey Available: No ❑ Yes ❑ Year Published: Publication Scale: Soil Map Unit: Drainage Class: Soil Limitations: Surficial Geologic Report Available: No❑ Yes❑ Year Published: Publication Scale: Geologic Material: (Map Unit): Landform: Glacial Outwash Flood Insurance Rate Map: Above 500 Year Flood Boundary: No ❑ Yes a Within 500 Year Flood Boundary: No F-xl Yes ❑ Within 100 Year Flood Boundary: No F7x Yes ❑ Wetland Area: INone National Wetland Inventory Map (map Unit): Wetlands Conservancy Program Map (map unit): Current Water Resource Conditions (USGS): Month Range: Above Normal ❑ Normal 5_1 Below Normal ❑ Other References Reviewed: USGS Topouraphic Map DEP APPROVED FORM 12/7/95 FORM 11 --SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No.: #98 Bacon Road, Hyannis, MA On -Site Review Deep Hole Number: #1 Date: 1/06/03 Time: 1:00 AM Weather: Sunny. Cool Location (identify on site plan): Refer to Sketch Landform: Outwash Plane Position on Landscape (sketch on back): Refer to Sketch Distances From: Open Water Body NIA feet Drainage Way N/A feet Possible Wet Area N/A feet Property Line 26' feet Drinking Water Well N/A feet Other DEEP OBSERVATION HOLE LOG Depth From Soil Soil Soil Soil Other Surface Horizon Texture Color Mottling Structure, Stones, (inches) (USDA) (Munsel) Boulders, Consistency, % Gravel 0" - 6" AP Sandy 10 YR 3/2 None <5% Gravel, Friable Loam Friable 6" -48" Bw Sandy 10 YR 5/6 None <5% Gravel, Friable Loam Friable 48" - 144" C' Medium 2.5 Y V4 None Medium Sand, <5% Sand gravel, Loose Parent Material (Geologic): Glacial Outwash Depth to Bedrock:None encountered Depth to Groundwater: Standing Water in the Hole: None Weeping From Face: None Estimated Seasonal High Water Table 144" Assumed— No groundwater Observed DEP APPROVED FORM 12/7/95 FORM 11 - SOIL EVALUATOR FORM Page 3 of 3 Location Address or Lot No.: #98 Bacon Road, Hyannis, MA Determination of Seasonal High Water Table Method Used: ❑ Depth observed standing in Observation Hole: NIA inches ❑ Depth weeping from side of Observation Hole: 144 inches (assumed) ❑ Depth to Soil Mottles: None inches ❑ Groundwater Adjustment: None feet Index Well Number: Reading Date: Index Well Level: Adjustment Factor: Adjusted Groundwater Level: NIA DEPTH OF NATURALLY OCCURING 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: Yes CERTIFICATION: I Certify That on September 17, 2000, (date), I have passed the soil evaluators examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature: Date: 4 6 3 FORM 12 - PERCOLATION TEST Location Address or Lot No.: #98 Bacon Road COMMONWEALTH OF MASSACHUSETTS Hyannis , Massachusetts Percolation Test Date: 1/6/03 Time: 2:30 PM Observation Hole #: #1 Depth of Perc 48" — 66" Start Pre-soak 1 :30 PM End Pre-soak 1 :45 PM Time at 12" 1 :59 PM Time at 9 2:13 PM Time at 6" Time (9-6") Rate Min./inch 2MP1 * Minimum of 1 percolation test must be performed in both the primary area AND reserve area. Performed By: Carmen E. Shay Witnessed By: Waiver Comments: Would Not Hold 24 Gallon Presoak - 2 MPI Site Passed X Site Failed DEP APPROVED FORM 12/7/95 Sep- 20-01 13 : 52 BARNSTABLE HEALTH DEPT 5087906304 S17S�O1 .NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. PERCOLATION TEST AND SOIL EVALUATION EXEMPTION ' FORM hereby certify that the engineered plan signed by me de;eC I concerning the property located at meets all of the l;:l'ow;ng cr,tena • This failed system is connected to a residential dwelling only. There are no ommer,:ial or business uses associated with the dwelling, • The soil is ciass:;:ed as CLASS l and the percolation rase is less than or equal to 5 -rLnutes per inch. The applicant may use historical data to conclude this fsc: or may -onduct are!tm,::ar% tests at the site without a health agent present. • There 's no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed.leachin.; facility will not be located less than Fourteen l L,,; lee; aonve the maximum adjusted goundwater table elevation. (Adjust 'he ;r.)undwater table using the Fnmptor method when applicable) Please complete the following! 'a. I -fop of Ground+ Surface Elevation (using GIS informa'ion) _43 Ob_ S; G.Vy' E;evat:or, C90 _ ad;usi:ment for 'nigh G.w.., 4 = _ � y-O FT FRENc.F EETWEE' and B S:(J.VED ,-- DATE: 119 105 NOTICE 3asec j-On t^,e abo,e information, a repair permit wil! be issued for bedrooms T.�xir.0 n `;r ;td.ti,-Mal bedrooms are authorized to the future without en,tneerec plans. — --- — Pcicc.tm9 Permit Number: Date: Completed by: HIGH GROUND-WATER LEVEL COMPUTATION Q i Site Location: —L c� ♦S Lot No. ±S� E Owner Address: p n 'S Contractor: tS�VI �0ti�b(1h�Q �Address:�$ (� _t". Notes: STEP 1 Measure depth to water table to nearest 1/10 ft. .............................................................................. Date b A month/ ay/year STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: OAppropriate index well.................................................... O © Water-level range zone..................................................... STEP 3 Using monthly report"Current Water Resources Conditions" determine current depth to �Lk� water level for index well ........................... mon" tb/ STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A),current depth to water level for index well (STEP 3), and water-level zone(STEP 2B) determine water level adjustment .......................................................................................... STEP 5 Estimate depth to high water by subtracting the water• level adjustment (STEP 4) ,from measured depth to water levelat site (STEP 1) ............................................................................................................. 'T Cape Cod Commission: USES Well Data - December 2002 .Pagel of? United States Geological Survey Observation Wells As a service to Cape officials, engineers and other interested parties,the Cape Cod Commission publishes monthly groundwater data gathered by its Water Resources Office. The water level measurements shown below are taken monthly from United States Geological Survey (USGS) observation wells and compiled during the last week of each month. They are published as soon as possible thereafter. Listed below are nine out of the 61 wells measured across Cape Cod by the Commission's Water Resources Office. These nine are employed as index wells to be used with Technical Bulletin 92-001 to predict high groundwater levels. For your convenience, we've also provided links to USGS national and state data. See the last column in the table and the footnotes below. For further information, please contact Hydrologist Gabrielle_Belft at the Commission offices (508-362- 3828). December 2002 [:SGS Site Water Record Record Departure from Number, Location Well No. Level* High* Low* Average** (links to I. SG:S Monthly Overall national water-level database) Barnstable 230 24.9 20.5 26.6 -0.7 -1.2 413956070164301 Barnstable 24W 26.9 20.5 28.6 -1.8 -2.4 4141540701 55001 Brewster BMW 21 13.2*** 6.9 13.6 -2.6 -3.0 414518070020301 Chatham CGW 138 24.7 20.9 26.6 -0.3 -0.8 414100070011101 Mashpee MIW 29 8.2 5.6 10.0 0.7 0.3 1413525070291904 Sandwich SDZ 47.6 45.9 48.2 -0.1 -0.3 414 418 070241601 Sandwich D3 54.2 45.8 55.1 -3.6 -4.0 41412407026590I EEL] TSW 89 11.9 10.2 13.0 0.2 0.2 4202060 10045901 W�W 11.7 7.3 12.8 -0.7 -1.3 415353069585401 http://www.capecodcommission.org/wells.htm 1/13/2003 COMMONWEALTH OF MASSACHUSETTS � . EP EXECfUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION - Y r I+ii t TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION t y, Property Address: 98 BACON RD HYANNIS,MA 02601 M309 P041 "- ;'" Owner's Name: PATRICIA WASILEWSKI Owner's Address: 42 POINT LANE HYANNIS MA.02601 Date of Inspection: 12/27/00 . Name of Inspector: (please print) JOHN GRACI It-•„ Company Name: t SEPTIC INSPECTIONS WOOF gApEPT s ,a Mailing Address: I-sf4 P.O.BOX 2119 TEATICKET,MA.02536 , >;. ,7 Telephone Number: 508-564-6813.FAX 508-564-7270 .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,o.f Title 5(310 CMR 15.000). The system: X Passes _ Conditionally Passes Needs Furt r Evaluation by the Local Approving Authority j,'''''1 _ Fails Inspector's Signature: '' Date: 12/27/00 The system inspector shall submit la copy of this inspection report to the Approving Authority(Board of Health or DEP)within ,i6.,1f;� 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 L� f THE SYSTEM PASSES TITLE V INPECTION.RECOMMEND PUMPING NOW AND EVERY ONE TO TWO YEARS TO PROLONG THE SYSTEM'S'USEFULL LIFE. 4 . i ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This ; rM1a inspection does not address how the system will perform in the future under the same or different conditions of use. T;fl,• f Incnnrtion Form (,/I5!')000 I r i. 34 Page 2 of 11 5`s 4 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 98 BACON RD HYANNIS,MA 02601 M309 P041 Owner: PATRICIA WASILEWSKI'y'r`:. :. Date of Inspection: 12/27/00 . Inspection Summary: Check A,B,C,D or /ALWAYS complete all of Section D A. System Passes: y J X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 xz ti . CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: THE SYSTEM PASSES TITLE V INPECTION.RECOMMEND PUMPING NOW AND EVERY ONE TO TWO as YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. 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. t, ti y. Answer yes,no or not determined(Y,N ND)in the for the following statements. If"not determined"please explain. s t i >,31 n/a The septic tank is metal and over 20�ears old*or the septic tank(whether metal or not)is structurally unsound,exhibits nisi: substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replacedi� t. with a complying septic tank as approved by the Board of Health. q ' *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating 34 A1:'' that the tank is less than 20 years old is available. 4ek i9y E ND explain: n/a }! � k k n/a Observation of sewage backbp or'break out or high static water level in the distribution box due to broken or obstructed fs} or due to a broken settled or uneven distribution box. System will ass inspection if with approval of Board of pipe(s) y P P ( PP 1.31k:.1 Health): broken pipe(s)are replaced _ obstruction is removed s _ distribution box is leveled or replaced : ' •R'F ND explain: n/a 4 n/a 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 s { _obstruction is removedV. e . . fii q*u • .• 1 it ta7��7?Y€, ND explain: n/a �4 x$ i 1 {.' i{. 7 .41 q .t • Pagp 3 of 11 i ` 1 Jvjr�� Y OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A ' CERTIFICATION(continued) Property Address: 98 BACON RD HYANNIS,MA 02601 M309 P041 Owner: PATRICIA WASILEWSKI Date of Inspection: 12/27/00 C. Further Evaluation is Required by the Board of Health: _ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect 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 Oo J, n- Y4 _ 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 .; a 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 septcltank and SAS and the SAS is within 50 feet of a private water supply well. r . _ 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 n/a "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indi'6s 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 ,.*, 11 of the analysis must be attached to this form. T{;ys' 3. Other: n/a rt`i3r: . :4 t Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS ,fy SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 98 BACON RD HYANNIS,MA 02601 M309 P041 Owner: PATRICIA WASILEWSKI Date of Inspection: 12/27/00 , D. System Failure Criteria applicable.,to all systems: You must indicate"yes"or"no'to each of the following for all-inspections: x Yes No ` - X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool - X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged r • . SAS or cesspool a - X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ;.,. - X Liquid depth in cesspool is less than 6"below invert or available volume is less than '/Z day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed i e s .Number of times - q p p g Y gg p�P ( ) pumped nLa. - X Any portion of the SAS,cesspool or privy is below high ground water elevation. , - X Any portion of cesspool oriprivy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or:privy is within a Zone 1 of a public well. 's - X Any portion of a cesspool or privy is within 50 feet of a private water supply well. - X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with y no acceptable water quality4nalysis. [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.] ' 5+ (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 1 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 failures �� 15 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. You must indicate either"yes"or;"no,to each of the following: J, (The following criteria apply to large systems in addition to the criteria above) yes no - X the system is within 400 feet of a surface drinking water supply Q'S - X the system is within 200 feet of a tributary to a surface drinking water supply - X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped - Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered E "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 icy should contact the appropriate regional office of the Department. i 4 A Pago 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM s5_. PART B CHECKLISTf� " Property Address: 98 BACON•,RD HYANNIS,MA 02601 M309 P041 Owner: PATRICIA WASILEWSKI ' Date of Inspection: 12/27/00 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: ''{. Yes No X _ Pumping information,was provided by the owner,occupant,or Board of Health T X Were any of the system components pumped out in the previous two weeks? §n` X _ Has the system received normal flows in the previous two week period? Y P P X Have large volumes of water been introduced to the system recently or as part of this inspection ? f ,'r, ; X _ Were as built plans of the system'obtained and examined?(If they were not available note as N/A) r X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of breakout? ? F P g X _ Were all system components,excluding the SAS,located on site? j f s X _ 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? X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal system's? . t 4 t The size and location of the Soil Absorption System(SAS)on the site has been determined based on: f Yes no X _ Existing information. For example,a plan at the Board of Health. rv't •_ X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is r >E unacceptable) 310 CMR 15.302 3 b sy �, ! k ,I i��• > as t S r Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE'SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 98 BACON RD HYANNIS,MA 02601 M309 P041 Owner: PATRICIA WASILEWSKI Date of Inspection: 12/27/00 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):3 Nurrib`erof bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(f&example: 110 gpd x#of bedrooms):330 s ' Number of current residents: 5 Does residence have a garbage grinder(yes.or no): NO A ; 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 n . .;5 Water meter readings,if available(last 2 years usage(gpd)): n/a Sump pump(yes or no): NO Last date of occupancy: n/a is 4 COMMERCIALANDUSTRIAL°5 ` {•' Type of establishment: n/a t Design flow(based on 310 CMR 15,203): n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no):NO Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings, if available: n/a { Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION k - Pumping Records ;;`y. Source of information: n/a Was system pumped as part of the inspection,(yes or no): NO , If yes,volume pumped: n/agallons--How was quantity pumped determined?n/a Reason for pumping: n/a TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from 1 system owner) { Tight tank Attach a copy`of the'DEP approval Other(describe): n/a `b Approximate age of all components,date installed(if known)and source of information: 1998 NEW SYSTEM INSTALLED Were sewage odors detected when arriving at the site(yes or no): NO i 1i 9, Y - S q:r, •!1 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM :ts; PART C SYSTEM INFORMATION(continued) t`"= Property Address: 98 BACON RD HYANNIS MA 02601 M309 P041 ' '° P Y X r Owner: PATRICIA WASILEWSKI Date of Inspection: 12/27/00 i)Xl, -f v BUILDING SEWER(locate on site.plan) Depth below grade:30" Materials of construction:_cast iron,;X40 PVC_other(explain): n/a Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): THERE ARE TWO INLETS SEPTIC TANK: X(locate on site plan) k Depth below grade:24" Material of construction: Xconcrete_metal fiberglass_polyethylene other(explain)n/a s If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: 150OG L 10' 6" H 5' 6" W'S';811" Sludge depth:4" Distance from top of sludge to bottom of outlet tee or baffle:30" Scum thickness:3" {tt' Distance from top of scum to top of outlet tee or baffle:6" Rom,ifl,'f Distance from bottom of scum.to bottom of outlet tee or baffle: n/a How were dimensions determined: MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related ' s to outlet invert,evidence of leakage,etc.): THE SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING NOW AND EVERY ONE TO TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. GREASE TRAP:_(locate on site'plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related f: to outlet invert evidence of leakag a etc n/a t , EL f `fit tr +�ti 4r 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM kil PART C SYSTEM INFORMATION(continued) Property Address: 98 BACON RD HYANNIS,MA 02601 M309 P041 Owner: PATRICIA WASILEWSKI Date of Inspection: 12/27/00 „ 1 TIGHT or HOLDING TANK: (tank"must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass polyethylene_other(explain): n/a7 k. Dimensions: n/a > t Capacity: n/a gallons Design Flow: n/a gallons/day i � t r: Alarm present(yes or no): N/A "':;i;? : Alarm level: N/A Alarm in working order(yes or no):NO ti Date of last pumping: n/a !>'. Comments(condition of alarm and float switches,etc.): '° n/a DISTRIBUTION BOX: X(if preseent must be opened)(locate on site plan) Depth of liquid level above outlet invert: n/a Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into 1 or out of box,etc.): APPEARS TO BE FUNCTIONING;PROPERLY.SYSTEM SHOWS NO SIGNS OF FAILURE.D-BOX WAS NOT UNCOVERED DUE TO FROZEN GROUND. PUMP CHAMBER:_(locate on site plan) ' • R � Pumps in working order(yes or no): NO 41 1 Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): tl; a. ( 14:{ I PageL 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 98 BACON RD HYANNIS,MA 02601 M309 P041 ,•.`� ; Owner: PATRICIA WASILEWSKI Date of Inspection: 12/27/00 =r SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) {J I:Irv' If SAS not located explain why: * n/a Type ; .. .. n/a leaching pits, number: 0 MAXIMIZERS ', leaching chambers, number: 3 n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a ;innovative/alternative system ;•I gig:; Type/name of technology: n/a i, y Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.): y � R�1 di THE LEACH FIELD APPEARS TO BE FUNCTIONING PROPERLY,THE SYSTEM SHOWS NO SIGNS OF FAILURE.SOIL PROBED DRY CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a t. . Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a y; Depth of scum layer: n/a Dimensions of cesspool: n/a ` t Materials of construction: n/a Indication of groundwater inflow(yes or no):NO ,t Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) Materials of construction: n/a ' Dimensions: n/a { Depth of solids: n/a r ' Comments(note condition of soil,signs mf hydraulic failure, level of ponding,condition of vegetation,etc.): n/a E `t tr+1 .t t Q 3'. Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 3 Property Address: 98 BACON,RD.HYANNIS,MA 02601 M309 P041 Owner: PATRICIA WASILEWSKI Date of Inspection: 12/27/00 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. Al AA Iq FA s�-f `• t4� pt i " o � d,, s a s ..k a� *} `y f t .•3 •� � tl rt in Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 98 BACON RD HYANNIS,MA 02601 M309 P041 Owner: PATRICIA WASILEWSKI Date of Inspection: 12/27/00 = "' SITE EXAM k _Slope t .s Surface water - r _Check cellar Shallow wells Estimated depth to ground water 12+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a NO Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) YES Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: USGS MAPS AND CHARTS- 12+FEET ,a Aq. 4 fe L n ikt it • i i tat •t1 - a zl' 203 499 087 US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail See re ers Se St t Number i Po ,State,&ZIP Code, Postag $ Certified Fee Special Delivery Fee Restricted Delivery Fee Retum Receipt Showing to Whom&Date Delivered a Return Receipt Showing to Whom, Q Date,&Addressee's Address COP TOTAL Postage&Fees $ c") Postmark or Date U- rn a i Stick postage stamps to article to cover First-Class postage,certified mall fee,and charges for any selected optional services(See front). !!! 1. If you want this receipt postmarked,stick the gummed stub to the right of the return jaddress leaving the receipt attached, and present the article at a post office service i window or hand it to your rural carrier(no extra charge). i` 2. If you do not want this receipt pcstmarked,stick the gummed stub to the right of the Q) iP return address of the article,date,detach,and retain the receipt,and mail the article. cc N 3. If you want a return receipt,write the certified mail number and your name and address on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article a RETURN RECEIPT REQUESTED adjacent to the number. Q 4. If you want delivery restricted to the addressee or to an authorized agent of the O i Y ry 9 O i r EUVERY addressee,endorse RESTRICTED D on the front of the article. Go 1 i 5. Enter fees for the services requested in the appropriate spaces on the front of this c receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. u`o I 6. Save this receipt and present it if you make an inquiry. 102595-97-8-0145 a 1 SINE , Town of Barnstable ST" Department of Health, Safety, and Environmental Services MUMM NAS&16 . Public Health Division p'E0N'°�A P.O. Box 534,Hyannis MA 02601 Office: 508-862-4644 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health June 25 1998 Patricia Wasilewski Megan Holway 42 point Lane Hyannis,MA 02601 NOTICE TO ABATE VIOLATIONS OF 310 CMR: 15.00 THE STATE ENVERONMENTAL CODE TITLE V: MINIMUM REQUIREMENTS FOR THE SUBSURFACE _DISPOSAL OF SANITARY SEWAGE, AND 105 CMR 410.00 STATE SANITARY CODE H - MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION. The property owned by you located at 98 Bacon Road, Hyannis, listed as Parcel 309 on Assessor's Map 041 was inspected on June 18, 1998 by Jerry Dunning, Health Inspector for the Town of Barnstable, because of a complaint. The following violation of 310 CMR 15.00, the State Environmental Code, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage and 105 CMR 410.00 State Sanitary Code H - Minimum Standards of Fitness for Human Habitation was observed: REGULATION 310 CMR 15.02 (207)AND 105 CMR 410.300: Overflowing sewage onto the ground. This violation is a serious public health hazard. 1) You are directed to hire a licensed septage hauler to pump the overflowing cesspool within twenty-four(24) hours of receipt of this letter. 2) You are also directed to keep the on-site sewage disposal system pumped as many times as necessary to keep from overflowing onto the ground. 3) You are further directed to contact and hire a licensed Disposal Works Installer within seven (7)days of receipt of this letter in order to repair this system or connect to town sewer. You may request a hearing before the Board of Health if written petition requesting same is received within seven (7) days after the date the order is served. Non-compliance could result in a fine of up to $500.00. Each day's failure to comply with an order shall constitute a separate violation. PER WMcKean BOARD OF HEALTH Director of Public Health NOTICE TO ABATE VIOLATIONS OF 310 CMR: 15.00 THE STATE ENVIRONMENTAL CODE TITLE V• MINIMUM REQUIREMENTS FOR THE SUBSURFACE DISPOSAL OF SANITARY SEWAGE AND 105 CMR 410.00 STATE SANITARY CODE II - MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION. The property owned by you located at listed as Parcel-3o9 on Assessor's Map ®yl , was inspected on 199 , byke D , Health Inspector for the Town of Barnsta -becaus� a complaint. The following violations of 310 CMR 15.00, the State Environmental Code, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage and 105 CMR 410.00 State Sanitary Code II - Minimum Standards of Fitness for Human Habitation were observed: REGULATION 310 CMR 15.02 (207) AND 105 CMR 410.300: Overflowing sewage onto the ground. This violation is a serious public health hazard. 1) You are directed to hire a licensed septage hauler to pump the overflowing cesspool within twenty-four (24) hours of receipt of this letter. 2) You . are also directed to keep the on-site sewage disposal system pumped as many times as necessary to keep from overflowing onto the ground. 3) You are further directed to contact and hire a licensed Disposal Works Installer within seven (7) days of receipt of this letter in order to repair the system. You may request a hearing before the Board of Health if written petition requesting same is received within seven (7) days after the date the order is served. Non-compliance could result in a fine of up to $500.00. Each day's failure to comply with an order shall constitute a separate violation. pan ORDER OF THB BOARD OF HEALTH Thomas A. McKean Director of Public Health m SENDER: I also wish to receive the 'o ■Complete items_=and/or 2 for additional services. m ■Complete items 3,4a,and 4b. following services(for an U0 ■Print your name and address on the reverse of this form so that we can return this extra fee): card to you. ai ■Attach this forth to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address m permit. dr ■Write'Retum Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery N t ■The Return Receipt will show to whom the article was delivered.and the date ., delivered. Consult postmaster for fee. °L o 3.A ' le A ressed to: 4a.Article Number d d Gva7 2 4b.Service Type 0 V ❑ Registered d Certified ¢ a) _; Im o � n�� Express Mail ❑ Insured ❑ Return Receipt for MercPandise P COD 0 7..Date of Delivery til— z C/ X,� 61/51 M 5.Received By:(Ptint Name) 8.Addressee's Address(Only if requested c u~t j and fee is paid) t 6.SIYC ': PS Fir, receipt II UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid LISPS Permit No.G-10 I • Print your name, address, and ZIP Code in this box• I Public Health Division--'�" Town of Barnstable P.O.Box 534 Hyannis;Massachusetts 0-"DI I f P LC p - 'TOWN OF BARNSTABLE LOCATION /3 4 coti J SEWAGE # EV V[LLAGE, N ASSESSOR'S MAP& LOT 6 INSTALLER'S NAME&PHONE NO. /gaeG14 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 3 i ZC2-" (size) NO.OF BEDROOMS 3 BUILDER OR OWNERS PERMITDATE: 7 a I q-9T COMPLIANCE DATE: Z p^2-0 9fe 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 �c�vSF Q � . Q t � � � z No. Fee J THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSA HUSETTS 01ppfication for Di!5po.5ar *p5tem Construction Permit Application is hereby made for a Permit to Construct( )or Repair( an On-site Sewage Disposal System at: Location Address or Lot No. 9 ecf/ Owner's Name,Address and Tel.No. ;F 1�/¢L�s�/ �2®l9Gl' f�0��!/�►y LIlA-$/ <!=LC�Sr; Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �GL�H Cows i T pe of Building: Dwelling No.of Bedrooms Garbage Grinder( ) Other Type of Building No.*of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Description of Soil Nature of Repairs or Alterations(Answer when applicable) 1'5-04 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 Cod nd pWo place the system in operation until a Certifi- cate of Compliance has been iss this Board of Sign Date O Application Approve 00!210 C Application Disapproved for the following reasons Permit No. r- Date Issued ——————————————————————————————————————— -"No. ✓ i.1 i .w"» { Fee THE COMMONWEALTH OF MASSACHUSETTS 3 PUBLIC HEALTH DIVISION.=TOWN OF BARNSTABLE,MASSA HUSETTS 01ppricatiou for Migogal *p!9tPm Cougtructiou.Permit Application is hereby made for a Permit to Construct( )or Repair( an On-site Sewage Disposal System at: Location Address or Lot No. / Owner's,Name,Address and Tel.No. Installer's Name,Address,and Tel.No. . Designer's Name,Address and Tel.No. '09R9 Cowl i Type of Building: Dwelling No.of Bedrooms 3 Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) 3 Other Fixtures Design.Flow r gallons per day. Calculated daily flow gallons. Plan Date k; ' 4� Number of sheets Revision Date • Title Description of Soil J: Natuie'of Repairs or Alterations(Answer when applicable), T le' r/ V%6:_!1!a + / SG4 ST 1�/3gx 3 ^,.14 X.,I it2J 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 nuotlo place the system in'operation until a.Certifi _ cate of Compliance has been issu this Board of Signed�r Date Application ApprovedEb� Application Disapproved for the following reasons Permit No. f Q t Date Issued _ . THE COMMONWEALTH'OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Certificate of Compliance - THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( )or repaired/replaced( )on T by /U�t�h' mew?% for a �/ Aeon/ i2oe ��'A�✓y' j ee constructed in a co nce�,.. .. ,h ► with the provisions of Title 5 and the for Disposal System Construction Permit No. dated �� Use of this system is conditioned on compliance with the provisions set forth below: i No. Fee S THE COMMONWEALTH OF MASSACHUSETTS i PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS I=i,5pogal *pgtem Cou.5tructiou Permit Permission.is hereby granted to Ave—e m rq, to construct( )repair(--)an On-site'Sewage System located at f .3Ac�'w oA An.�i� F i 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. All construction must be completew• • two years of the date below. Date: Approved by---- / � � 10/9/97 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 ENGINEERED PLANS) hereby certify that the application for disposal works construction permit signed by me dated ! S F , concerning the property located at 4J0 #y4,v 4/Ir J meets all of the following criteria: There are no wetlands located within 100 feet of the proposed leaching facility •��lieie a no private wells within 150 feet of the proposed septic system • There is no increase in flow and/or change in use proposed "ere,are no variances requested or needed. •Zlfe proposed leaching facility will be located within 250 feet of any wetlands,the bottom of the proposed leaching facility will Mt be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation. Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.I.S.map) 302 B)Observed Groundwater Table Elevation(according to Health Division well map) LZ C7 SIGNED DATE: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. q:health folder:cent l 1 q .� 6---- --- ---------- ---.--- Health Complaints 15-Jul-98 Time: 8:00:00 AM Date: 7/15/98 Complaint Number: 1437 Referred To: GLEN HARRINGTON Taken By: EDWARD BARRY Complaint Type: TITLE V SEWAGE Article X Detail: UNSANITARY CONDITIONS Business Name: PAUL WASILEWSKI. Number: 98 Street: BACON RD ._.. Village: HYANNIS Assessors Map_Parcel: 309-035 " , Complaint Description: OVERFLOWING SEPTIC , HEALTH AGENT HAS BEEN OUT THERE TWICE BEFORE.UNIT IS RENTAL. OWNER LIVES OFF POINT LANE WHICH IS OFF' GREENWOOD AVE HYANNIS . SAID ,.,,,,.,,, OWNER IS AWARE OF PROBLEM AND IS CONTRACTING WITH AN INSTALLER TO LOCATE SEPTI IN FRONT OF HOUSE ? Actions Taken/Results: Investigation Date: Investigation Time: J� j y A Glad J7 �ly�eo�L( dV ," �!l�Q�f� (� G�f. �.✓4`yv..e TfJ ° p k9- .� ry(n � /2C' Gv-vv� �,S-Q �dzi �n.ti(x t h �'c�.v�, � .SGc.,r/ P,44, a,� d ,'-1 �� 4a s .. L �, Health Complaints 14-Jul-98 Time: 11:58:36 AM Date: 6/11/98 Complaint Number: 1381 Referred To: JEROME DUNNING Taken By: LS Complaint Type: TITLE V SEWAGE Article X Detail: Business Name: Number: 98 Street: BACON ROAD Village: HYANNIS Assessors Map_Parcel: Complaint Description: SEPTIC HAS A BAD ODOR. COMPLAINANT SAID YOU CAN SEE AND SMELL IT FROM HIS PROPERTY AND HE DOESN'T MIND IF YOU GO IN HIS BACKYARD IF HEISN'T THERE, JUST OPEN THE GATE AND WALK IN. HE SAID BRAZILIANS LIVE THERE. HE CALLED AGAIN ON 7/14/98. HE SAID SEWAGE IS GOING INTO HIS BUSHES ON HIS YARD AND HE WANTS SOMETHING DONE SOON. HE SAID JERRY WENT OUT AND DIDN'T SMELL ANYTHING. Actions Taken/Results: Investigation Date: Investigation Time: YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you Z' must do by M..G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office,. Fl. 367 Main P a n St. Hyannis, s MA 02601 Town Hall n h i and et the Business Certificate h i Y ( ) that required b law: g q Y DATE:v3 i l.3 TE. Fill in lease: �@ P aI: APPLICANT'S YOUR NAME/S: �L/4 l (CC-) i t A c � _ BUSINESS YOUR HOME ADDRESS: -T19 (Z�r.�L.e^��n �U /if�/L/yV l TELEPHONE # Home Telephone_Number O g l NAME F.CORPORATION �. NAME OF NEW BUSINESS ".TYPE OF BUSINESS I$THIS A HOME OCCUPATION YES NO ` ADDRESS OF BUSINESS ' MAP PARCEL NUMBER Off+ l/ (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtainingthe information you may need. You MUST GO TO 200 Main St. - corner of Yarmouth Y Y Rd. &Mai n m Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 2. BOARD OF HEALTH This individual has peen gf,r,0 of the permit requirements that pertain to this type.of business. MUST�:OMPLY WITH ALL � V VIVA Authorized Signature* COMMENTS: 3. CONSUMER AFFAIRS(LIC NSI A THORITY) This individual has binfo f he licensing requirements that pertain to this type of,business. Authorized Signature* COMMENTS: V f BARN STABLE TOWN F TABLE Dater / I3 / i3 O S TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: BUSINESS LOCATION: (UQ INVENTORY MAILING ADDRESS: TOTAL AMOUNT- TELEPHONE NUMBER: 14 CONTACT PERSON: TtA [ --c EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: L Iljw p S c_ I & INFORMATION / RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals(Fixers) Diesel Fuel, kerosene,#2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals(Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives(creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous(please list): Metal polishes S 74;�yNj Laundry soil &stain removers (including bleach) Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash J)6A WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Si4nat re cI Staff's Initials .. aM.Plf,'�L�.�,,:SaTP02Y5FAl�f�? .. ACtR.:... . .i1MK'A'GWNM1'7u'-•. - . a Mat '- '.' • •�"' 5} The in "l ti n +;a _�/With th ` {. ,. a c- -� Town f `` sty= a o , shall chi .pr, th f e 5t2te Eritiironrn�ntal fed 1�1 V?ln 7 n O U`� - Board of Health Regtitat?otns. G _ p �._ e .,� 7.f i i,1 septic system as pr opoi th,.,plan shale not be installed until a licensed town lns'ta.l_r put- receives iroiS and i;nstallil ioi er it fr to li ahl tiauatn, -approval p m � o the asap � ,�. 3 l riot to installation,the rinaialler shah verify o of ti!ities sewer inverts sewer fines atto , F �the tor_ati n t� , r�✓,• Z_ E wind existing septic c�r�pent'nts Prior to installation, lAl �� ��7iZk3 �' g p �:. ti. • , , a , �r �, fil r�,vity sewer i ir�6 Ps to be rriclZ schect ira�t3PVCat 18 er f;ot. 7 he First 2 feet out of iL g p p u r # - the distribution box shalt be lever. All piping connections to be glued. i > l 5; This sp ticdesign tan is n�tt.o be utflizt rd for property fine doter�ii.atr;�n or for an other f 10 ri p a la p y y purpose other thr n the proposed s�, system installatiotn; i t r t r At!Tgle V corn €;•rents are t meet I,zre v saaeclfic�tldns, 16 W b r Parking shaft iz rf #i;Eaiwed over Title t components unless c^°i onents�1re l iZt7 loaded. ;z1 US The existing leaching co cesspools shall fae pumped and fillEA with material per Title V -ION i f abandonment procedures. Leaching and cesspool(s)and con ar'nirnated soils within the i be rernoved C nd replaced h clean sand e,Title V s ecifications- i t� � proposed SAS..haf, p cod with ea s ri � p 1 C> r� 1 l r) Septic components are to l?e 10 from a water service line. .Sewer lines Grassing a water line shy i be sleeved with an appropri;tel sized schedule 40 PVC with ends grouted ThP water servic"i SE t #' £� i? sleeve,, v,,iil a �' dis ynii f 10'"on bo i,shies of �i the septic tic lir_c2 so h the sleeve b ing a<. to c t <; �✓ � t crossing the litre: w= OZ .i.., if a garbage grinder eirrsl::s in tbe'sti`f.d.l'tare, 11 rs to be remover! 1, rile seftrc system is not t F designed to accc,rnrnsr,,',.,tcg�a garbage grinder, to kii ��---- -.h , .. c TS=� tnstalic�r is PesS,er+,st l�ro Cara of exicavation around`all Iit}l$.i€, os,tl,e property and w f � protecting the structural iptegrit , or all Structuresurin the. instal!a i.rr; rides o the septic F � r � ct g p l 1 .a ,.=stem. F 12 T is i � � that f 4 lt� . r, ,rt meeting Title V ? l� plan only repres i�,s t11�a a seer i� system can tx rristal .rl a.f�l e larc,l y g recivirements. he property'owner sh.-;!review design criteria to apprtarre ilrah total i�i,m or of bedrooms and cl� c', =lesion flow.installation of the ser�tic.system as proposed osed and receipt of;payment for the design �. � ` p p p � r e, shall be deemed approval of tine"d:si_n criteria`by the ' roper-tt w owner or agent gent of, Ala � � Y g } oS t ,. •.°.��=! T=ne iralrrlit of this' fan sl-��i; expire with the expiration of the ti.��vr: installation permit issued. 1•c;f t�rs planCr the validii�xof tt,rS plans.all exvlre on t#ie.expir7tlr:~<n.dl'tfine Col tiricate of Carnplitincr; 1 d r I l . � 7 ^ `ti of the i 4 1- r issued for the iris_iI1�i.,.n of the .7rw, cfsed system en Pints .�P. J '"'� - ... ,.,., r. /A���_. ;::s >. ?... , .. ,Pict - .- .5x + ,.,,• 4 ,..-.:... - , ._..... :,. .. ... .:.:,..., •ems 1. r» a n Ct , k�rq k u r------------- �' DAVsD w ; Cz- r f NMASON c v p 2 i to f Cr to t? 1 s 9r f + Go � s I `r Muni ip,-t-Wa _ f ism f - r y 10 w L O } � � r f^r. Q Ulf � •�'^_,�r�•�.i f }�'� lr��i ` l l_� t l U7 �, E►, o i _ t '`r t+°v'l lLJty 1 :� M1 CJ _ IV b ZZ )Orr E• r f i i i i ..--�, � ;i �O 7 o fa o i w, rf4 2'r of 3 fi } ` r dr q �J'7 +� t i�i ./ Yd Fes*' '" ""._• �. ` 95Pn l ____ r .00'00 l i rr �� �, is� W. Z5` Z�� .-.--- � w os �t 1, pop s 3 ; � � l Cb ei i l , ' � - r/ "�:`l •YU9Fv3P'kf�+5�S7CAnR'-S'YklfflRlrJYNSP�.'MR1+•'J .'�5711�` 1:�.l:�E4a^`�i'�47K`ld.yl,�p7P�aapy'•S= '. �ill ,/ � , • + 4 '' =moo 0-f;t-in N t - _ V_ 1 4drk - i. ( i M _ - ( ' v < `P ,.el , , 9 T ,: s - - + - vEN? PIPE a least 24 inches tali)--�---: SECTION A A I ;?000 / _. ,. I F- AL OUTLET PIPE 10 min. from * Schedule 4t�,PVC w/Charcoal Odor Her L TL S FROM ME DISNOTE. ALL PIPES ARE TO BE 4 SCHEDULE 40 P.V.C. house to septic tank PROFILE VIEW OF LEACHING SET LEVEL F R A LEAS BE > Existing Foundation P SYSTEM SET LEVEL FOR AT LEAST 2 FT. t2 CONCRETE COVER' a Septic lank covers must be vnihm 6 in. of finished grade 3 (_ ' Grade over Septic Tank - 99-00 Grade over D-Sox - 99.00 L SAS - 99.00 3 of 1/8 1/2 Washed Peostone 3- 5 OUTLET 2 N 3/4' to 1 1/2 washed Crushed Stone KNOCKOUTS ~ .. tCh ROAD r. r 75.5- OUTLET , \ 12 MLET Q s 0.02 s Hoce r 20 -. L iSITE TOP OF SAS - 95.50 DIST. BOX 3' Wa imam Cover :r , t Ott Z. � _ EXIS7. SeiO.ot or Greater . '• t REXIST PIPE `no 1,500 GAL. ,"_-"-.--- s4 0.01" foot x O 4n 40 4 - SCH. 40 Te 1.75- FRON EXIST. FOUNDATION W Lo SEPTIC TANK f -Y ineKw nyorn H-10 a> r 20' � C3 / PLAN SECTION CROSS-SECTION//1 rn � � n o 0 0 0_op n Ea o CONCRETE FULL FOUNDAT70N-�. . to t` rJAnIl 1 0>> 4 �'v3 Units @ 8.5' 25.5' SYSTEM PROFILE 6 m.af 3/+-t t/2 y. 3 HOLE H-20 DISTRIBUTION BOX BF' compacted stone > > f3' � . dNot to Scale c m Effective vkltn NOT TO SCALE - > c c 33.5' wqr� LDCU-S MAC' c c _ a Effective Length 6 in.of 3/4--1 1/2' GENERAL NOTES compacted stone rg SOIL ABSORPTION SYSTEM (SAS) 1. Contractor is responsible for Digsofe`notification f Bottom of Test Hole ITElev=87.00_ 500 - C (H-20) LEACHING UNITS / WIGGINS PRECAST and protection of all underground utilities and pipes. -------- - - Elevations Aparoximote Based on i_xstina Information and Field Conditions 2. The septic'tank and distribution box shall be set NEW Trench to be Constructed at Some Elevotion as Existing Trench. Not to Scale level on 6" of 3/4"-1 1/2 stone. - 3. Bockfill should be clean sand or gravel with no stones over 3" in size. 4. This system is subject to inspection during installation by or E. Shay Environmental Services, Inc. 5. The contractor shall install this system in accordance PERCOLATION TEST with Title V of the Massachusetts state code, the approved pion and Local Regulations. Date of Percolation Test: JANUARY 6, 2002 6. If, during installation the contractor encounters any Test Performed By CARMEN E. SHAY, R.S., C.S.E. soil conditions or site conditions that are different Results Witnessed By. WAIVER ( per Barnstable B.O.H.) from those shown on the soil log or in our design Excavator. Shay Environmental Services LOT #51 LOT #52 installation must halt & immediate notification be Percolation Rote: Less Than 2 MPI made to Cormen E. Shay Environmental Services, Inc. 7. No vehicle or heavy machinery shall drive over the septic system unless noted as H-20 septic components. Test Hole 8. Install Tuf-Tite gas baffles or equals on all outlet tee ends. No. 1 S 29ot 45' 10" E 9. All Distribution Lines shall be 4 diameter Schedule 40 NSF PVC: pipes. 10. All solid piping, tees & fittings shall` be 4" diameter DEPTH SOILS ELEV. f OO.00' _-_-99 P P 9. 9 0 99.00 LOT # 57 & #58 - Schedule 40 NSF PVC pipes with water tight joints. Looms f0,00D Square Feet+/ 11._Municipal Water is Connected to The Residence and Abutting Sond --`-""'-`------ Properties Within 150 Feet. 10 YR 3/2 -f UnST ICieanout EXIST. Cieanout 0'-6" A, 98,50 99---- O THE PROPERTY LINES ARE APPROXIMATE AND Loamy 4 COMPILED FROM THE SURVEY PLAN GENERATED BY Sand YANKEE SURVEY CONSULTANTS OF MARSTON MILLS, MA 10 YR 5/6 O "" LOT #55 ENTITLED PLAN OF LAND OF LOT #57 & #58 BACON ROAD, IN 6"- 48" B„ 95 DO! HYANNIS, MA", DATED January 24. 2001. AN Sad EXISTING GARAGE TNDHOU IS NDTBE USED DFOR TO NO PURPOSE OTHA SURVEY OER7 THAN 2.5 Y 7/4 I 3 BEDROOM THE ,SEPTIC SYSTEM INSTALLATION. 48"- 144 C 7.00I _ xausE EXISTING LEACH TRENCH TO BE PUMPED REMOVED. LOT #59 #93 1,41 I I TO FACILITATE INSTALLATION OF NEW LEACH TRENCH I I t , I I NOTE: Y P AN STRIPPED OUT.SOIL CONTAINING ACHAT ---PROJECT- I ILE E ` F3EN H MARK _ -- - _ , H r_ T FROM T,,E-E�iST�N�-LEACH-ARE �0 BE DISPOSED TOP OF FOUNDATION I I F A PER AR F HEALTH t ASPHALT I _-_'_99 0 S BOARD 0 E LTH SPECIFICATIONS. ELEV. - 100.00 (Assumed) Perc #1 O 22'l DRIVEWAY - Depth to Perc: 48" to 66" lc� r--___ i J�'� W Perc Rote= Less Tha 2 MPI - __ 1 -__ II ------' I .- 98 LEGEND D --------- ---- - r �I VENT PIPE. Groundwater Not Observed ^ 20 I t 25, O No Observed ESHWT 99 -` C I rl-- .- ko . - ,�I �' 104X 1 ADJUSTED H2O Elev. = None 23 eAc�N .,: .� LOT #56 SPOT GRADEES O _ �_ ___ _ � - I t•, .' 4-10,- ti x 104.46 DENOTES EXISTING 0 I cc'o SPOT GRADE !`EXIST. 1500 qo u ----JID-BOX Septic Tank f _- �_ PL PROPERTY LINE 97- ----- - ------14a.9ft'-_-- -- -- - I - 996P PROPOSED CONTOUR N 29c1 45' if 0" W : . i I JL,r --------------------EDGE OF _PAVEMENT SIDEWALK --- . �I EDGE OF PAVEMENT SIDEWALK - - - - - -97 EXISTING CONTOUR _-_-------- ---- -� ---- -14 --_-_-------- -------- -- ----------------- EXIST. LEACH TRENCH 3-24' DiAM..ACCESS MANHOLES DEEP TEST HOLE & PERCOLATION TEST LOCATION ,o -s 1'A C" OAT C7A D ,� ,, -• 6 FOOT STOCKADE FENCE �.' (40 FOOT RIGHT OF WAY) INLET \ 11 REV.: 2/1/03 - Showed Existing Cleanouts from House to Tank _----�� INLET t L t :• OU ET P LOT P THE ACCESS COVERS FOR THE SEPTIC TANK. LAN DISTRIBUTION BOX AND LEACHING COMPONENT :.� ��'^ -+•r -.r,t` ,^ .-�, FINISHED RAISED TO WITHIN 6" OF O 20 40 50 ,. OFF PROPOSED SEPTIC SYSTEM UPGF?A[)E STEEL REINFORCED PRECAST CONCRETE INSTALL TUF-TITE GAS BAFFLES OR EQUALS' PLAN VIEW ON ALL OUTLET TEE ENDS 3 24"REMOVABLE COVERS PREPARED FOR f SCALE: 1 „=20 MR . RICARDO MANTA VARELLA _3" min. cieom"te ;` '04LET 8' men�_�2'-min. inlet to outlet 6 mh t3' m�ET'T' INLE L quid kvd OUTLET #98 BACON ROAD ' i0`min. u• ': .ti HYAN N IS , MA E� y g r 4'-0' min. o b ,aee Borne !• Liquid deplh _Design Calculations \ Or n ,g Number of Bedrooms: 2 Equivalent to 220 GaL/Day (330 Gal./Doy Min. per Title V) u - PREPARED BY: Garbage ,Grinder: No -8 Leachin Capacity Proposed- 330 Goi. Da Minimum Min. Per Title V 9 P Y P X Y ) F. S l.C-1 l CROSS SECTION END-SECTION Septic Tank : - 2 x 330 Gol./Doy 660 USE 1,500 GAL: Septic Tank: SOIL ABSORPTION AREA: Using percolation rote of <2 min./inch `k n' ENVIRONMENTAL SERVICES, INC. Bottom Area: 0.74 gol/sq ft. x 300sq. ft. = 222.00 gallons Io G ' TYPICAL 1500 GALLON H- 10 SEPTIC TANK Sidewoli Area: 0.74 �� P.O. BOX 627 gal./sq. ft. x 148 sq. ft. - 109.50 gallons ^r , g: g f -F EAST FALMOUTH, MA 02536 Providing: 331 50 gallons NOT TO SCALE d e 0 ¢ Use: (2) PRECAST 500-C UNITS, HAVING A 2' EFFECTIVE DEPTH, ' - w TEL/FAX : 508-548-0796 TO BE USED WITH 3.5' OF WASHED STONE ON THE_SIDES AND SCALE: 1 "=2Q' DRAWN BY: CES DATE: JAN. 9, 2Q03 3' OF WASHED STONE ON THE ENDS AND 2 FEET IN BETWEEN 2 UNITS. PROJECT#SD385 FILENAME: SD385PP.DWG SHEET 1 0 1