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HomeMy WebLinkAbout0191 BISHOPS TERRACE - Health 191 Bishops Terrace A = 251 — 197 Hyannis 1 1• Commonwealth of Massachusetts a��"'� ip Title 5 Official Inspection Form }; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments fee 191 Bishops Terrace - �tr Property Address Amilton & Leonor Guedes Owner Owner's Name/ information is required for every Hy annis V MA 02601 06/30/2020 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information 6Jqw r q(piiq on the computer, use only the tab Michael T Bisienere key to move your Name of Inspector cursor-do not Cape Septic Inspections use the return Company Name key. 52 Rivers End Road Company Address Teaticket Ma. 02536 City/Town State Zip Code ran 508-280-3356 S13938 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails -06/30/2020 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 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts �v ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ...........e, 191 Bishops Terrace V Property Address Amilton & Leonor Guedes Owner Owner's Name information is requirE`d for every Hyannis MA 02601 06/30/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) 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: This 3 bedroom home has an H-10 1000 gallon septic tank with a D-Box feeding 2 leaching chambers with stone. At the time of inspection no visible failure criteria was found. 2) 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): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts �v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 191 Bishops Terrace V Property Address Amilton & Leonor Guedes Owner Owner's Name information is required for every Hyannis MA 02601 06/30/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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): 3) 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. a. 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: l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �1� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 191 Bishops Terrace Property Address Amilton & Leonor Guedes Owner Owner's Name information is required for every Hyannis MA 02601 06/30/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts �v ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments . 191 Bishops Terrace Property Address Amilton & Leonor Guedes Owner Owner's Name information is required for every Hyannis MA 02601 06/30/2020 page' CityTrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply 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 2000 gpd- 10,000 gpd. ❑ ® 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. 5) 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 CA. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 191 Bishops Terrace Property Address Amilton & Leonor Guedes Owner Owner's Name information is required for every Hyannis MA 02601 06/30/2020 page. ' Citylrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health Were an of the system components❑ ® y y pumped out in the previous two weeks. ® ❑ Has the system received normal flows in the previous two week period? El ® Have large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans f® ❑ p a s o the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form 11 11 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 191 Bishops Terrace Property Address Amilton & Leonor Guedes Owner Owner's Name information is required for every Hyannis MA 02601 06/30/2020 page. City/Town State Zip Code Date of Inspection D. System Information 1. 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 plus GPD Description: did a walk through of the home and found 3 bedrooms Number of current residents: 4 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) P ) Laundry system inspected? El 0 No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d Town water 9 ( Y 9 (gP ))� Detail: In 2019-6100 cubic feet were used and in 2018-they ussed 4600 cubic feet. Sump pump? ❑ Yes ® No Last date of occupancy: occupiedDate t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form lip Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u, 191 Bishops Terrace Property Address Amilton & Leonor Guedes Owner Owner's Name information is required for every Hyannis MA 02601 06/30/2020 page'. CityTrown State Zip Code Date of Inspection D. System Information (cont.) 2. 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 Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: 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 below): 3. 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form lip Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 191 Bishops Terrace Property Address Amilton & Leonor Guedes Owner Owner's Name information is required for every Hyannis MA 02601 06/30/2020 - page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. 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): Approximate age of all components, date installed (if known) and source of information: New leaching installed 2015 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 15"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: town water feet Comments (on condition of joints, venting, evidence of leakage, etc.): Water was flushed and it came freely. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts �v Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 191 Bishops Terrace Property Address Amilton & Leonor Guedes Owner Owner's Name information is required for every Hyannis MA 02601 06/30/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 6"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: H-10 1000 gallon Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle 33" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? sludge judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): I recommend the new owner put the septic tank on a maint. plan with a local septic pumping co. based on the future use of the home. At the time of inspection the liquid level was at working level and the tee's were in place. t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form lip Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 191 Bishops Terrace Property Address Amilton & Leonor Guedes Owner Owner's Name information is required for every Hyannis MA 02601 06/30/2020 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 7. 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 p of scum to to of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts �v Title 5 Official Inspection Form lip Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ............ !% 191 Bishops Terrace Property Address Amilton & Leonor Guedes Owner Owner's Name information is required for every Hyannis MA 02601 06/30/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cont.) 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 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): At the time of the inspection the liquid level was at working level and there were no visible signs of leakage or solids carryover. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts -. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 191 Bishops Terrace Property Address Amilton & Leonor Guedes Owner Owner's Name information is required for every Hyannis MA 02601 06/30/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. 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: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts �v p Title 5 Official Inspection Form lip Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 191 Bishops Terrace Property Address Amilton & Leonor Guedes Owner Owner's Name information is required for every Hyannis MA 02601 06/30/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At the time of the inspection no visible failure criteria was found. 12. 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments V 191 Bishops Terrace Property Address Amilton & Leonor Guedes Owner. Owner's Name information is Hyannis MA 02601 06/30/2020 required for every y page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 191 Bishops Terrace Property Address Amilton & Leonor Guedes Owner Owner's Name information is required for every Hyannis MA 02601 06/30/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately ** As-Built from the BOH attached on next page** t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 TOWN OF BARNSTABLE LOCATION (q 1 Q i${gip 6 -tegbkE' SEWAGE# D( 0 0, VILLAGE ASSESSOR'S MAP&PARCEL r�1 INSTALLER'S NAME&PHONE NO.;., 1._ SEPTIC TANK CAPACITY 106 6A.LLOL) LEACHING FACILITY: (type) 508 Gib c` (size) NO.OF BEDROOMS OWNER Pa PERMIT DATE:_3'all-alb 15 COMPLIANCE DATE: `� -;I-A 015 Separation Distance Between the: No Cam';Q0LArQ'� Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Z40) Feet Private Water Supply Well and Leaching Facility Of any wells exist on . site or within 200 feet of leaching facility) N LA Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) _- N A Feet u e V u 7 a 3 A'1 30' ° A-2, 34•0' A•4 =33,i' r$-S 31' P B B.( Z31 p.t.Zero' 4-S' 1b•o+ 3 ® o Commonwealth of Massachusetts �v Title 5 Official Inspection Form Igo Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �V 191 Bishops Terrace Property Address Amilton & Leonor Guedes Owner Owner's Name information is required for every Hyannis MA 02601 06/30/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 12 plus feet 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: ❑ Checked with local excavators installers- attach documentation ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: I augered a hole at a lower elevation to show 4 plus feet of seperation. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 cam, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 191 Bishops Terrace Property Address Amilton & Leonor Guedes Owner Owner's Name information is required for every Hyannis MA 02601 06/30/2020 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist)completed ® D. System Information: For 8: Tight/Holding Tank— Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 Commonwealth of Massachu I setts Tine 5 Official Inspection Form r7 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Olt M 191 Bishops Terrace, Hyannis 00 PropertylAddress JeffreylCutter Trustee ; Owner Owner'sIName information isX. required for every 33 Prince Road,W. Yarmouth MA 02673 12/19/17 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. I I Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your cursor-do not Charlotte Phillips keY y the return Name of Inspector Speakman Excavating LLC r� Company Name 15 Speak Way Company Address Harwich MA 02645 city",own State Zip Code 508-432-5565 S114065 Telephone Number License Number i I B. Certification f I certify1that 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: ® I Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 21 Inspycto Signature Date Th 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 I thelsame or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 V# "-S i Commonwealth of Massachusetts = Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 191 Bishops Terrace, Hyannis Property Address Jeffrey Cutter Trustee Owner information is Owner's Name required for every 33 Prince Road, W. Yarmouth MA 02673 12/19/17 page. Citylrown State Zip Code Date of Inspections B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D i 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 f indicated below. Comments: I I i B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. Thei 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. f *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): I I ( t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 I Commonwealth of Massachusetts : Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,c M 191 Bi i hops Terrace, H annis Property I Address JeffreyJJlCutter Trustee Owner Owner's Name information is required for every 33 Prince Road W. Yarmouth MA 02673 12/19/17 page. City/Tow, State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) I 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(t) 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): I ❑ 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): 0 broken pipes) are replaced ❑ Y ❑ N ❑ ND(Explain below): i 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. I. 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, lafety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form.Subsurface Sewage Disposal system•Page 3 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection p coon Fora Subsuirface Sewage Disposal System Form - Not for Voluntary Assessments 191 Bishops Terrace, Hyannis Propertyl,Address JeffreyjCutter Trustee Owner Owner'same info ;N rmation is I required for every 33 Prin'ce Road, W. Yarmouth MA 02673 12/19/17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, i safety and environment: ❑ .The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: i { I i D) System Failure Criteria Applicable to All Systems: I Youjmust indicate "Yes" or"No"to each of the following for all inspections: it Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/day flow t5ins•3/13 I Title.5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 I i com onwealth of Massachusetts a Title 5 Official Inspection Form SubsuIrface Sewage Disposal System Form -Not for Voluntary Assessments SVBy'�e 191 Bishops Terrace H annis Property Address JeffreylCufter Trustee Owner Owner's,Name information is I required for every 33 Prince Road, W. Yarmouth MA 02673 12/19/17 page. CitylTown State Zip Code Date of Inspections B. Certification (cont.) iYes No Required pumping more than 4 times in the last year NOT due to clogged or El ® 99 obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ( E] ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. i ❑ ® 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. I ❑ 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.] El ® The system is a cesspool serving a facility with a design flow of 2000gpd- I 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. Forilarge systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No 0 ❑ 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 i If yIu have answered "yes"to any question in Section E the system is considered a significant or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 1 Commonwealth of Massachusetts I Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 191 Bishops Terrace, Hyannis Property)Address Jeffre Iiy Cuttl er Trustee Owner Owner'slName information is required for every 33 Prince Road, W. Yarmouth MA 02673 12/19/17 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 I El ® Pumping information was provided by the owner, occupant, or Board of Health 0 ® Were any of the system components pumped out in the previous two weeks? 0 ® 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?. N ❑ Was the site iinspected for signs of break out? ❑ Were all System components, excluding the SAS, located on site? i ❑ Were the septic tank manholes uncovered,.opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ Existing information. For example, a plan at the Board of Health. ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information I Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DES 1 IGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 I t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Tit !e 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 191 Bishops Terrace, Hyannis Propertlli Address JeffreY1Cutter Trustee Owner Owner's!Name information is required for every 33 Prince Road, W. Yarmouth MA 02673 12/19/17 page. Clty/TomI State Tip Code Date of Inspection, D. System Information Description: i i i I Number of current residents: 0 Do I s residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection =ry ation in this report.) ❑ Yes ® No l system inspected? El Yes ❑ No I Se4sonaluse? Ell Yes ® No 9 Water meter readings, if available (last 2 years usage (gpd)): Detail: 2015: 7,900 C.F 2016: 1,400 C.F Sump pump? ❑ Yes ® No Last date of occupancy: April 2017 +/- 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form SubsuI face Sewage Disposal System Form - Not for Voluntary Assessments M 191 Bishops Terrace, Hyannis Property Address Jeffrey ICutter Trustee Owner Owner's Name information is required for every 33 Prince Road, W. Yarmouth MA 02673 12/19/17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: April 2017 Date Other(describe below): I i i i General Information i Pumping Records: Sou Irce of information: Was system pumped as part of the inspection? El 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 0 Single cesspool I 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 0 Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•page 8 of 17 I Commonwealth of Massachusetts m Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments I 191 Bishops Terrace, Hyannis Property Address Jeffrey Cutter Trustee Owner information is Owner's iName required for every 33 Prin1ce Road W. Yarmouth MA 02673 12/19/17 page. Cit- own State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed known if ( ) and source of information: Per C.O.0 4/2/15 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 45" feet Material of construction: ® cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: 101+ II feet Comments (on condition of joints, venting, evidence of leakage, etc.): BuiIdin g sewer in good condition, no signs of leakage or failure Septic Tank (locate on site plan): Depth below grade: 6" feet Mat rial of construction: ® concrete El metal ❑fiberglass ❑ polyethylene ❑other(explain) If tan is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No [Dimensions: 1000 Sludge depth: 3" t5ins•3/13 Title 5 Official Inspection Form:Subsurface sewage Disposal System•Page 9 of 17 I I I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 191 Bishops Terrace, Hyannis Property,,Address Jeffrey!Cutter Trustee Owner Owner'siName information is required for every 33 Prince Road, W. Yarmouth MA 02673 12/19/17 page. City/Tow'n State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) If " Dlstance from top of sludge.to bottom of outlet tee or baffle 31 i oilScum thickness I Distance from top of scum to top of outlet tee or baffle 6 I: Distance from bottom of scum to bottom of outlet tee or baffle 31" How were dimensions determined? Measured Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): I Tank in good condition, PVC tee in place I 1 ! i I Gre�se Trap (locate on site plan): Depth below grade: feet Material of construction: i ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): 1 F 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 i i Date,of last pumping: Date t5ins•3/13 ( Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 i ! I Commonwealth of Massachusetts y c Title 5 Official Inspection Form SubsuIrface Sewage Disposal System Form -Not for Voluntary Assessments 191 Bishops Terrace, Hyannis Propertyl Address Jeffre Cutter Trustee Owner owner's lName information is required for every 33 Prin'ce Road, W. Yarmouth MA 02673 12/19/17 page. Cltyfrowp 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.): I t Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: l I material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene Y ❑other(explain): Dimensions: I Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alar' Alarm in working level: A I 9 order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): I `I I I i *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No l5ins-3113 I Title 5 Official Inspection Form:Subsurface Sewage.Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 191 Bishops Terrace, Hyannis Property Address Jeffrey Cutter Trustee Owner Owners Name information is required for every 33 Prince Road W.Yarmouth MA 02673 12/19/17 page. CitylTowI State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): I Del th of liquid level above outlet invert 0" Co ments (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.): I D- i Box in good condition two outlets with speed levelers in place Cover 14"b I I Pump chamber(locate on site plan): Puml ps in working order: ❑ Yes ElNo* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): I * If pumps or alarms are not in wo rking order,.system is a conditional pass. Soil I bsorption System (SAS) (locate on site plan, excavation not re quired): If SAP not located, explain why: I } t t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 191 Bishops Terrace, Hyannis PropertylAddress JeffreyiCutter Trustee Owner Owners Name information is required for every 33 Prince Road, W. Yarmouth MA 02673 12/19/17 page. CltylTowI State Zip Code Date of Inspections D. System Information (cont.) Type: leaching pits number: leaching chambers number: (2) leaching galleries number: i ❑II leaching trenches number, length: Llj leaching fields number, dimensions: ❑ overflow cesspool number: 0 innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegl tation, etc.): . Leaching chamber is dry, faint stain line 3" +/_from bottom of chamber I Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration I Depth—top of liquid to inlet invert Depth of solids layer _ Depth of scum layer Dimensions of cesspool Matirials of construction Indication of groundwater inflow El ❑ No I t5ins-3113 Title.5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 comG T onwealth of Massachusetts N - a Title 5 official Inspection, Form Subsuirface Sewage Disposal System Form -Not for Voluntary Assessments 191 Bishops Terrace, Hyannis y PropertyjAddress JeffreylCutter Trustee Owner Owner's!Name information is i required for every 33 Prince Road;W. Yarmouth MA 02673 12/19/17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etch): {{I 1 Privy(locate on site plan): Materials of construction: i Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.!): 1 i I t 1 I I i t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 i i I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsu ace Sewage Disposal System Form-Not for Voluntary Assessments 191 Bishops Terrace, Hyannis Property Address Jeffrey Cutter Trustee Owner Owners Name information is required for every 33 Prince Road, W. Yarmouth MA 02673 12/19/17 page. cltyrrowo State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, i ncludinties at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet Locate where public water supply enters the building. Check one of the boxes below: ❑ Ihand-sketch in the area below ❑ drawing attached separately i I . A-A I . A z 3+ 0` I A•� =33,i ` t�•S � 31 ` .��0 A a i 15ins•3/13 ! Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Comr onwealth of Massachusetts Title 5 Official Inspection Form T Subsurface Sewage.Disposal System Form- Not for Voluntary Assessments i i wM 191 Bishops Terrace, Hyannis Property Address Jeffrey;Cutter Trustee Owner Owner's Name information is 33 Princ required for every e Road, W. Yarmouth MA 02673 12/19/17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) i Site Exam: ®� Check Slope ®C Surface water I ® Check cellar i z I Shallow wells 4- Estimated depth to high ground water: 5 Lot�rraFA' ® ��sF.toi feet Pleb se indicate all methods.used to determine the high ground water elevation: ®I 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) i i Lji Checked with local Board of Health -explain: 1 I ❑i Checked.with-local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: j You, must describe how you established the high ground water elevation: Engineers letter on file dated 4/3/15 i I I I i i Bef lore filing this Inspection Report, please see Report Completeness Checklist on next page. I t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 16 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsulrface Sewage Disposal System Form - Not for Voluntary Assessments M 191 Bishops Terrace, Hyannis Property'Address Jeffreyl,Cutter Trustee Owner Owner's Name information is i required for every 33 Prince Road,W. Yarmouth MA 02673 12/19/17 page. City/TowI State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, Ci D, or E checked ® �Inspection Summary D (System Failure Criteria Applicable to All Systems)completed i ® System Information —Estimated depth to high groundwater ® Sketch.of Sewage Disposal System either drawn on page 15 or attached in separate file I I it i t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 TOWN OF BARNSTABLE LOCATION (Q ( BI5i4e>P& i SEWAGE# ;t®1'1 y 06�t, VILLAGE ASSESSOR'S MAP&PARCEL vt57 INSTALLER'S NAME&PHONE NO.dAP6W1D6 L*JT6RP({(:5a5 U-c- eI77�; SEPTIC TANK CAPACITY 100(D (Syi�-L c)j) LAaov a i LEACHING FACILITY.(type)(A) Soo&,41— CLAA (size) 101 )E ;t S NO.OF BEDROOMS OWNER PATP-LO LA—I)AP4Y PERMIT DATE: ;' ,-o 7 COMPLIANCE DATE: '4 -A-A to I S Separation Distance Between the: 0jo G&00r16ta)ArQ 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) 0 LA Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) NIA Feet FURNISHED BY CAP e E*)T8TJ,is0; LLC_ (A G� t Cif cp o e o N I • Ee O No. ` Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Applitation for Misposal Opstem Construction Permit Application for a Permit to Construct( ) Repair(M) Upgrade( ) Abandon( ) Complete System ❑Individual Components Location Address or Lot No. q k 13PS4to IDS T Owner's Name,Address,and Tel.No. Assessor'sMap/Parcel t��1 19"7 tJ�.�ts y-`1-Rla cHDP t4y Yjxlf Installer's Name,Address,and Tel.No.501'-t{ZZ-2P2'7 7 Designer's Name,Address,and Tel.No.5®g--X7 3 -d 311 Type of Building: Dwelling No.of Bedrooms Lot Size $f0435�( sq.ft. Garbage Grinder( ) Other Type of Building 9E6(DE?01-44-- No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 30 gpd Design flow provided 3-3 f;5 gpd Plan Date 3-d( -- �5 Number of sheets I Revision Date Title 19 1 ' i4 C>P< rL YAN(i!I S Size of Septic Tank Type of S.A.S. Description of Soil �=i t � ]'� f�Q l M -C @sue 5&4� i� P Nature of Repairs or Alterations(Answer when applicable) tJ S E rG Srf&.& J a(In 60f2L l,) 5 r�Tf L Tip N 3..5 t big .CmLA9" n,Q &P cS A-d.,OD �f ` ®ju eulcC Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board ealth. igned Date "1 1 Application Approved by Date Application Disapproved by Date for the following reasons Permit No. /f2- �� Date Issued No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Rpplication for SIB !o8 BtPIYC;�OYC 'tCUttloYY Permit Application for a Permit to Construct( ) Repair(M Upgrade( ) ~Abandon`( ) [�Complete System ❑Individual Components i Location Address or Lot No. i ci I t31S OpS�"L1t � Owner's Name,Address,and Tel.No. Assessor's Map/Parcel .9.:51 197 t4`1�4 tS IPATVt lC p+ bA c3191 't- Installer's Name,Address,and Tel.No.Spg-4(77-8'%-7 7 Designer's Name,Address,and Tel.No.SD g -a 13 _4 3 71 I6�c ut1�lv� C_ Type of Building: Dwelling No.of Bedrooms Lot Size s`®(p$± sq.ft. Garbage Grinder( ) Other Type.'of Building gEjS!NgUrtA4— No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided 3I, gpd Plan ' Date 3 -Zls- a w S Number of sheets 1 Revision Date Title 1 91 1_1 61;? r]MUZ,d`�e-1 Size of Septic Tank 1, � Type W C-- /', T T e of S.A.S.�� SOp c�.C.. L�4E�-/j� c['tl�-�{�*4.5 •� Description of Soil �1s)r. S4w? k (9 01 lqi COAASIG 54045 - i tt Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of g Compliance has been issued by this Board o • ealth. igned Date - Application Approved by Date Application Disapproved by Date V for the following reasons j Permit No: �j d 4 Date Issued 1 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(X ) Upgraded( ) 1 Abandoned( )by CA P ec c cE &—uDD 2PdLc s E-S 44—r at 7,(� � '7'Z= N�/ has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit N-. /1 —G L l � J (dated Installer 4?,A067Wfn& LLC Designer ZC- ��1TOdXJ� G" 2NG. #bedrooms 3 Approved design flow / gpdr The issuance of this permit shall not be co�istru d as a guarantee that the system w• n do �i designe /© f1 r Date Inspector ,y/ ( j /m��i Al .? v J , -V- No Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS i Zisposal 6pBtem Construction 3permit Permission is hereby granted to Construct( ) Repair.(x) Upgrade( ) Abandon( ) System located at 1 9 ! j3/S!4 y-P5 /S' 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 mus��257 pleted in three years of the date of this ermit. Date Approved by 4/02/2015 19:30 5082730367 #3827 P. 001/001 Town of Barnstable Regulatory Services 4 Thomas F.Geller,Director eeae, t Public Health Division '6 • Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 ; tj-cam Date: Sewage Permit# _ Assessor's Map/Parcel 2,51 1 17 Installer& Des aner Certification Form Designer: Sc Erl�cneeci;nr� , T�nL. Installer: GaQewick t J erns" Address: Zb54 Ccar,4oerr% 4-4nr ey Address: 153 Comme.rc,'a( Sfrbei t1A 07,53t5 O:z(c y 5c6 273­0377 On 3 r�Z �.�t S CQpew�dr~ C-�fz��ise-s was issued a permit to install a (date) (installer) septic system at l9 I df zmae% Terrac e- based on a design drawn by (address) -S C E r,5tr�ee c c.n5 , T;nc_ dated N VAI 26, A 15, (designer) ✓ I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component Qf the septic system) but in accordance with State&Local Regulations. Plan revision or certified as-built by designer to follow. Stripout(if required) Wed and the soils were found satisfactory. HOF JOHNML. CHURCHILL ns er's Signa e) IV{L 4160 esigner s Signature (Affix De I Here) P ASE RETURN TO ARNSTABLE PUBLIC HEAL DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD RECEIVED BY ME BARNS'I'ABLE PUBLIC REAI.,TH DIVISION. THANK YOU. - gAoffice furmAdesignereertification form.doc � � y �VIE Town of Barnstable P# Department of Regulatory Services - ELAMSTAMA r Public Health Division Date / MAB& . � e6 200 Main Street,Hyannis MA 0260 j0jf A ell— 4,ti'I Date Scheduled_ _ r Tune € Fee Pd. Slo l Suitability Assessmentfor S age JJz ® al �j �j �C � Performed By:Vre dle-1 Of do If=w GS e Witnessed By: LOCATION& GENE][tAI,E�'OIIM[A�'IOIV Location Address Owner's Name -•ili DAB\j l� ! L3 i�N-c�`PS 1 Address l`'1 t F�1S�ri��S T~e �wJCc �F Assessor's Map/Parcel: - OL 5 1/{c1 I Engineer's Name C-AP&QA DE: uc_ NEW CONSTRUCTION RREPAIR _ Telephone# di��—(41-1 —��''i 7 Land Use Red IeCG ((,Q.) Slopes(%) �' Surface Stones_ NQti E Distances from: Open Water Body 7 1,0 O ft Possible Wet-Area , 0 0 ft Drinking Water Well ? f e_) ft Drainage Way I oo ft Property Line , d ft Other ft SIC C' TCII:(Street name,dimensions of lot,exact locations of test holes&Pere tests,locate wetlands in proximity to holes) I lav) //'�� � Parent material(geologic)_V� 0.S 1/t Depth to Bedrock Depth to Groundwater. Standing Water in Hole:. 0 M t Weeping tl'oin Pit Pace /lo o le Estimated Seasonal High Groundwater DETERMINAUON FOR SEASONAL HIGH WATER TABLE Method Used: _ Depth Observed standing in obs.hole: ia. Depth to soil Inottles: ht. Depth to weeping from side of obs.hole: In. Groundwater Adjustment Index Well# Reading Date: Index Well levol _ •�- Adj,factor � � Adj.Groundwater Level _ PERCOLATION TEST Date i ' l Y 'times ►_1,_!_ew.R"1 Observation Hole# I Time at 9" fa'U Depth of Pere Time at 6" �02 'l o Start Pre-soak Time C& Time(9"-6") End Pre-soak IQ'V Rate Min./loch t111 v1 l h Site Suitability Assessment: Site Passed- X Site Failed:. Additional Testing Needed(Y/N). 'Y Original: Public Health Division Observation Hole Data To Be.Completed on Back----------- ***1f percolation test is to be conducted witbin,100' of wetland,you Must first notify the. Barnstable Conservation Division at least one (1) week prior to beginning. Q:\S EPTICVERCFO RM.DOC 1 DEEP.OPSERVATION HOLE LOG Hole# �_ Depth from Soil Horizon Soil Texture .Sdil Color Soil Other Stface(in.) (USDA) (Munsell) Mottling (Stnucture,Stones,,Boulders. onsistency,%Gravel) 0-1a s �0123 e o-k,4 y'i a 6 Ca M-C Su ) . -' -v 3 Am-e %S° ro e DEEEP OBSERVATION HOLE LOG Hole#� Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. o sisten % ra -I a LS Id,- y O 13 -, y-r 6 ca H- sa, a, y66 `d "tV DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in_) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%O e DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones',Boulders. Consistency, y Flood insurance Rate Man: Above 500 year flood boundary No— Yes .X____ Within 500 year boundary No Yes Within t00 year flood boundary No,_X_ Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? �2 S If not,what is the depth of naturally occurring pervious material? Certification I certify that on a (date)I:have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required tra ing,expertise and experience described in 10 CNM 15.017. Signature � �� Date g , Q:\S.EFTIC\PERCPORM.DOC ................ THE COMMONWEALTH OF MASSACHUSETTS 9F HEA T e_tjj!0ARD . OF.... .. . ....... . .............Appliratiou for Bigposal Mnarks Tonstrurtion Prrmit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: ................................................................................. ..... ocat 'Add ... .. r Lot No. .................. ...... . ......0 .........Addr Own ................................................................................................ j .......................y Installer Address _I Type of Building Size LotJri_.0. -----Sq. feet U 3 Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder 04 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria 04 Other fixtures ...................................................................................................................................................... Design Flow............. ........................gallons per person per day. Total daily flow._...............7-o...o............gallons. 04 Septic, Tank—Liquid capacitylDW--gallons Length................ Width.............___ Diameter......_......... Depth.............__. Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....1(2:9.......sq. ft. Seepage Pit NoJ------------------ Diameter..........._._._.._. Depth below inlet.................._ Total leaching area.14.(/O.......sq. ft. Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.........._.___..... Depth to ground water-.._------------__-_-. f�, Test Pit No. 2................minutes per inch Depth of Test Pit.._.._........._.... Depth to ground water........................ -I----------------------------------*-------- ----------------------------*...........*............................. -------*...... 0 Description of Soil----I'flia-la. .....a_AA-ac-- ----------------------------------------........................................ ............................. x U ........................................................................................................................................................................................................ W Z .................. ......................................................................................................................................... ........................................... U Nature of Repairs or Alterations—Answer when applicable........ --------------------------------------------------------------------------------- ..............................................................................I---------------------------------------------------------------- ------------------------------------------------------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b issued by the—botard of h Ith. )6) 71,961-/2 Signed 4A41. M..i./. --- =---------_--------_------ -------------------------------- D Application Approved By.... C ................................. ....... ....................................... ..77/ M---Z... Date Application Disapproved for the following reasons:.................... ........................................................................................... ........................................................................................................................................................................................................ Date Permit No........21.3.................................... Issued..... ................... Date ter, No.. „�_. _ ._.... F$$...................._......_ THE COMMONWEALTH OF MASSACHUSETTS BOAR® F HE�THt� .. i ,mom t G �iirf+d :` '. �¢:. �:..............OF.. ..��. ::�..r .. ... - _ ..-----..........--_... Appliration for Bi-spooal Works Tonstrurtton rumit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at } �-- p) Location-:Address ,. ... �� rl a!..j..................... ' or Lot No. e.e..t �° •! .'.'y""�. _. ...TrY 1 .. s-: .................. ..........�' :.K.YY'............................,.................,................,......_ • Owner j Address installer Address Q Type of Building Size Lot_. , . r .....Sq. feet aDwelling—No. of Bedrooms.........::.................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures .-----•--------------------------------------------•-----------------------._..----------------------•-•-----------------------------...--••-••-•---. Design Flow____.__...{ gallons per person per day. Total daily flow................,._' t._.; .............gallons. W .y,......_...__�.........._ WSeptic Tank—Liquid capacity;%i:,_gallons Length................ Width................ Diameter................ Depth............... x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area-----;_ .D_.......sq. ft. Seepage Pit No.i__________________ Diameter__...._.._._..__.:.. Depth below inlet._..._.______....._. Total leaching area.gajfl_.._....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by__________________________________________________________________________ Date................._...................... Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_-.-__-___________-._._- W Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ O Description of Soil.....- _,...._,_ `-_..--� Y-. - - - -- -- t c.> .•••--•••••••••-•-•-•-----••---••••••••••••••••................•-•••-......•••-•••••-••••••--•••..._.....•••••••••••••._...•-••••••-••••-•----•••••••••••••••------••••••••......••••....._........--,--- W ----------------------- --------•-------------------------------------------------------------•-......._....------•------•-....----------------------------------•-------------......••••.._.......•••- U Nature of Repairs or Alterations—Answer when applicable................................................................................................ ----- ----------•----------------------------------.._.........••-•••............-• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article NI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has issued by the board of h lth. � Signed. i=,�,� •----•--... Date Application Approved B . •-•••••-------•--•-••-••.............•...__...-•--•- ...........7, t Date Application Disapproved for the following reasons:................................................._................................................_............. .....--•.................................•---....------•----•----------...-----------........--------•---•--•.._._..••-••-•••••••••••••••••--••-•-••-•--•--••••-•---•••-••.........I..------•-•••-••_... Date PermitNo.......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF•..,HEALTH---,- f Tutiftrate of C�ootplia ce !/ TICS IS TQJ�ERT I', Tha the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by. r• u F{ .......ram. . ............ ...---._ _..-----.............. � �` n Ater ��.� t .. has been installed in accordance with the provisions of Article YI of T(K State Sanitary Co as desVi} din the application for Disposal Works Construction Permit No.........�t..33................ dated_--41'.................................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED -GUA ANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector... . ..................................................... ......... THE COMMONWEALTH OF MASSACHUSETTS BOARD QQF HEALTH E.:. OF..:............. . ,.._._.. t..l.,.f ............................... J No.....� .��.... FEE........................ �io�o,��l fk� rixr�i�o mots# 7 r.. � Permission >< 'hereby granted -` 'u.....-- •••••-•••••-•......••••-•••.................•-•••••..........__..._..................-••--- to Co Z ).�j Repe ) a *j it 1n ual Sewage Disposal System atNo.P �,Y ....[ .............. - " ..._..._._.............._....._. stree as shown on the application for Disposal Works Constiuctigriern� o.,: ... llated f 1 C� ..................................... . . 5....�. 4. . ..•.4 ..... Board of xycalth DATE................................................................................ s/ FORA 1255 HOBBS & WARREN, INC.. PUBLISHERS _ I _ GENERAL NOTES FINISH GRADE OVER D-BOX= 63.9'± FINISH GRADE OVER CHAMBERS= 63.6' - 63.9' T.O.F. EL.= ± PROVIDE EXTENSION RISER REMOVABLE WATER-TIGHT COVER OVER SLOPE p0 2% MIN. OVER SYSTEM 3/4"TO NE T DOUBLE WASHED STONE TO CROWN OF PIPE 1. UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION WITH COVER OVER INLET& RISER TO WITHIN 6"OF FINISHED GRADE 4"SCHEDULE 40 PVC INSPECTION PORT WITH ACCESS FINISH GRADE OUTLET TO WITHIN 6"OF F.G. 0 2"OF 1/8"TO 1/2" DOUBLE WASHED METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL @ FND. EL.= 65.5'± F.G. OVER TANK EL. = 6.5 9 ± 5"DIA. OUTLET(S) MIN SLOPE 1 /o BOX TO F.G. (SEE NOTE 21) CODE AND ANY APPLICABLE LOCAL RULES. STONE OR GEOTEXTILE FILTER FABRIC --- _-- - ____-_ ________ __. -.___ 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED _. -- ---- ------- ___ G S S US O ED BY THE BOARD OF HEALTH AND THE PLACE RISERS ON ALL DESIGN ENGINEER. PROPOSED 4" 9"MIN. TOP OF SAS - 60MI 93 CHAMBERS WITH " 9 MIN. 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL EXISTING 4'" SCH.40 PVC 36 MAX. 60.1 O� 36'MAX. � INLET PIPES TO 6"OF SEWER PIPE SEWER PIPE I BREAKOUT EL= 60.6FINISHED GRADE SYSTEM UNLESS OTHERWISE NOTED. 6N 3" 3" DROP MAX _ '+ L 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN 2" DROP MIN 3 9 MIN.SLOPE @t% L 42 _ PROVIDE WATERTIGHT o ELEVATION =60.60' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A 13" 4" PVC IN FROM JOINTS(TYP.) o �w� 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF " * ' SEPTIC TANK 4"PVC OUT TO 0 0 O 0 0 0 0 00D O THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. CONTRACTOR TO PROVIDE 14 �63.04 ± LEACHING FACILITY 000 o 05. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. SPECIFIED DROP BETWEEN o0 0 00 INLET AND OUTLET CONTRACTOR " CONTRACTOR SHALL OUTLET TEE 60.47' MIN. 6 60.30' 2� o 00 000 oc�o 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. SHALL VERIFY SIZE 48 VERIFY CONDITION OF 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK AND CONDITION OF EXISTING TEES GAS BAFFLE 6"CRUSHED STONE 000oo FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS EXISTING SEPTIC AND REPLACE AS OVER MECHANICALLY o00 0 o NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH TANK NECESSARY COMPACTED BASE AND DESIGN ENGINEER. 5 4.0 8.5'(TYP) - 4.0' 3.6' 4.83' 3.6' OUTLET DISTRIBUTION BOX 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM. BENCHMARK ELEVATION OF 66.00' TO BE INSTALLED ON A LEVEL STABLE 25.0' (Np') ESTABLISHED ON TOP OF CORNER BULK HEAD AS SHOWN ON PLAN. BASE. FIRST TWO FEET OF OUTLET = < 53.10' PIPES TO BE LAID LEVEL. Ir8.10� GROUND WATER ELEV.- 12 p3' 9• CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION EXISTING 1,000 GALLON CONCRETE SEPTIC TANK 2 - 500 GALLON CHAMBERS 5'MIN. CHAMBER END VIEW THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT �f CROSS SECTION VIEW 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES *CONTRACTOR TO VERIFY EXISTING SEPTIC TANK PROFILEDISTRIBUTION �+ pp (''� p('� �q TYPICAL CHAMBER PROFILE p � TO THE DESIGN ENGINEER. ELEVATION PRIOR TO ANY WORK& D I ST I B U T I°�'N B`.�' D 1``'�I� I` C I�AM L7�R D ETA I 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT. NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE NOT TO SCALE NOT TO SCALE NO DETERMINATION HAS BEEN MADE A TO COMPLIANCE WITH DEEDED OR ZONING ,. TEST PIT DATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM PERC NO. 14634 APPROPRIATE AUTHORITY. / INSPECTOR: Donna Z. Miorandi, RS 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS EVALUATOR: Bradley Bertolo EIT, CSE LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE 'C.S.E.APPROVAL DATE: July 2003 THEY SHALL WITHSTAND H-20 LOADING. ( ` a MAP 251 ,' DATE: March 18, 2015 / 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES.\ --- PARCEL 198 • +� TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE N7g° ,+ * MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. ST 34'14"VV • ELEV TOP= 63.60' REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, \ ' OCKADE I-ENC 115.0p,� * . • ELEV WATER- <53.10' FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). / -65- - • i 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN ' o Kry ` : s PERC RATE _ <2 min./inch SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. N _ F ••• I DEPTH OF PERC= 44"-62" 16. PROPOSED PROJECT IS LOCATED WITHIN: + < CO " • ASSESSOR'S MAP 251 LOT 197 �Q \ J w • '• LOCUS : TEXTURAL CLASS: 1 = " „ OWNER OF RECORD: PATRICIA DABY f I J 0. ADDRESS: 191 BISHOPS TERRACE 01� A Loamy Sand HYANNIS, MA 02601 \ I + ' • u * s 10Yr 3/2 ZONE 2 12" 62.60' FEMA FLOOD ZONE X 24" PINE / 07 OiHiw OiHiw O/H w X + , COMMUNITY PANEL# 25001C0562J O/H/w EXISTING 1000 GALLON SEPTIC ' + 66' ' • • i' Loamy Sand 17. DEED REFERENCE: L.C.C. 167541 / TANK TO BE UTILIZED AS PART OF ,� x ` B 10Yr 5/6 THIS DESIGN • 18. PLAN REFERENCE: L.C. 25306-B SHEET 3 � 64x5' /- a • • • • 40" 60.2T ( ) �- "� *! • . r : 44" 59.93' ' / * ' : • ` PercI 28 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. • • DECK w 62" Fine Sand 58.43' 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY a`� / / \ X # • • * • C-1 2.5Y 7/'2 FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY �' +��� FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. rj% #191 20"OAK / APPROXIMATE LOCATION OF EXISTING k • ' ' " 56.60' 21. A 4"PERFORATED SCH.40 PVC PIPE SHALL BE PLACED IN A VERTICAL POSITION TO A EXISTING DEPTH OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3"OF FINISH GRADE. A LLJ' LEACHING PIT TO BE PUMPED, FILLED Medium Coarse ' � ! 3-BEDROOM I ,.e k WITH CLEAN SAND AND ABANDONED. C-2 Sand REMOVABLE THREADED CAP SHALL BE PLACED ON THE TOP TO ALLOW FOR INSPECTIONS. �r LING \ LOCUS PLAN 15%Gravel TOE= SCALE: 1"= 1000' 2.5Y 6/3 T / O X MAP 251 126" 53.10, Z / O LP r No Mottling, Standing or Weeping Observed I / x PARCEL 206 -- - ---- -------- --------- DESIGN DATA TEST PIT DATA LEGEND ..`�„ GAS- PERC NO. 14634 64x3' INSPECTOR: Donna Z. Miorandi, IRS 50x0' EXISTING SPOT GRADE W GAS HREE 8" OAKS Benchmark NUMBER OF BEDROOMS (DESIGN) 3 �;��--_-.._. _-_ GAS- . _ v', -- ---- -__ _-_ __- _ EXISTING CONTOUR / - W/ x Comer Bulk Head EVALUATOR: Bradley Bertolo, EIT, CSE 50 / g Elev. =66.00' DESIGN FLOW 110 GAUDAY/BEDROOM CH/11�1. H � r. � Approx. M.S.L. C.S.E.APPROVAL DATE: July 2003 r� PROPOSED CONTOUR 1 GAS` � ' TOTAL DESIGN FLOW 330 GAUDAY DATE: March 18, 2015 J Ek aR/VEw�Y GAS o DESIGN FLOW x 200 % = 660 GAUDAY TEST PIT#: 2 50 PROPOSED SPOT GRADE N USE EXISTING 1,000 GALLON SEPTIC TANK ELEV TOP= 63.20' GAS ------- EXISTING GAS LINE \ ` --- CONC. PAD c' 10" CHERRY X ELEV WATER= < 53.70' - ❑/H/W EXISTING OVERHEAD UTILITIES / � ' \ HCA J_ X PERC RATE _ <2 min./inch -65-- �' i 1 W W EXISTING WATER LINE \ ea INSTALL 2 - 500 GAL. CHAMBERS W/ AGGREGATE DEPTH OF PERC = TEXTURAL CLASS: 1 TEST PIT LOCATION \ 64x6 2) X SIDEWALL CAPACITY c0a 12,0, (LENGTH + WIDTH) (2 SIDES) (2' HIGH) (0.74 GPD/S.F.) = GAUDAY O O O EXISTING 1,000 GALLON SEPTIC TANK Tp 1 (25.0'+ 12.0')(2 ) (2') (0.74 GPD/S.F.) = 109.5 GAUDAY MAP 251 / 63x6' X 0" 63.70' PROPOSED 4 SOLID SCHEDULE 40 PVC PIPE \ LOT 197 "� O X BOTTOM CAPACITY A Loamy Sand 10Yr 3/2 ❑ PROPOSED DISTRIBUTION BOX r \ 15,065t S.F. 64x1' TP Z PROPOSED 2-500 GALLON LEACHING (LENGTH x WIDTH) (0.74 GPD/S.F.) = GAUDAY 12" 62.70' 63x7' X CHAMBERS w/AGGREGATE (25.0'x 12.0') (0.74 GPD/S.F.) = 222.0 GAUDAY �O PROPOSED 500 GALLON LEACHING CHAMBER I \ PROPOSED - Loamy Sand t \ DISTRIBUTION BOX _ PROPOSED INSPECTIGN PORT TOTALS: B 10Yr 5/6 \ TWIN 8 CH RIES . \ x 2 40" 60.37' REV. DATE BY APP'D. DESCRIPTION \ TOTAL NUMBER OF CHAMBERS - -- -� TOTAL LEACHING AREA 448.0 SQ.FT. PROPOSED SEPTIC SYSTEM UPGRADE \ TR E (TYP) • . TOTAL LEACHING CAPACITY 331.5 GAL./DAY \ \ (4) C-1 Fine Sand PREPARED FOR: r^ ' 12" OAK 12, J 3) 2.5Y 7/2 CAPEWIDE ENTERPRISES t POST _ z3 0" OAK k 2 bMl� FENCE 12"OAK Co SC-2 I 84" 56.70' LOCATED AT Medium Coarse 191 BISHOPS TERRACE SWING-TIES C-2 Sand NOTES: 115.00' SHED 15 Gravel HYANNIS, MA 02601 /o DESCRIPTION HCA SC-2 2.5Y 6/3 - SCALE: 1 INCH = 10 FT. DATE: MARCH 26 2015 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF MAP 251 " '- �' I CORNER OF STONE (1) 24.1' 35.9' 126 53.2' o s 10 20 ao FEET EACH SEPTIC SYSTEM COMPONENT. No Mottling, Standing or Weeping Observed I� PARCEL 196 X I CORNER OF STONE (2) 36.1' 32.9' P��N�F r�ASS 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF -- -- ------ - _ - _ _ -------- �aa q�yv PREPARED BY THE PROPOSED LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST _ CORNER OF STONE (3) 45.3' 8.2' RESERVED FOR BOARD OF HEALTH USE o JOHN L. �� JC ENGINEERING, INC. CHURCHI JR. PIT DATA SHOWN ON THIS PLAN. REPORT TO ENGINEER AND LOCAL CIV 2854 CRANBERRY HIGHWAY BOARD OF HEALTH IF SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. CORNER OF STONE(4) 36.5' 16.6' N0. 807 EAST WAREHAM, MA 02538 3.) ENTIRE PROPERTY IS LOCATED WITHIN A DEP APPROVED ZONE 2, BUT F RF SST NOT WITHIN THE ESTUARINE WATERSHEDS. SITE PLAN 'h;s 508.273.0377 _ _ SCALE: 1"= 10' Drawn By: JC Designed By:BMB Checked By:JLC JOB No.3006