Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0166 BRISTOL AVENUE - Health
f -: 66 Bristol Ave -.- - Hyannis A= 291 - 096 �. c o i A ` Town of Barnstable Barnstable " . Regulatory Services Department 'e`�C� �SMB� 1 I I `� ,.� Public Health Division 200 Main Street, Hyannis MA 02601 2007 I Office: 508-862-4644 - Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7014 1200 0001 0358 3858 April 22, 2015 David Holt Today Real Estate 1533 Falmouth Road/Rte 28 Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 • The septic system located at 166 Bristol Avenue,Hyannis,MA was inspected on 4/04/2015, by Sean Mcelroy, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: 0 Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within One (1) year from the date of this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. ! PER ORDER OF HE BOARD OF HEALTH I 1 T omas McKean, R.S., CHO • Agent of the Board of Health I� I Q:\SEPTIC\L.etters Septic Inspection Failures or Future Evl\166 Bristol Ave Hy Apr 22,2015.doc ' • V in .. ImFor delivery information visit our website at%vww.usps.conn9 cc OFFICIAL E..D__S [� H QPostage $ r �S Certified Fee ri / k d Return Receipt > Receipt Fee rB M (Endorsement Required) NHere C3 O Restricted Delivery Fee ,IU 0 (Endorsement Required) r� ru Total Postage&Fees L� r-9 i� David Holt Today Real Estate 1533 Falmouth Road/Rte 28 Certified Mail Provides: ■ A mailing receipt ■ A unique identifier for your mailpiece ■ A record of delivery kept by the Postal Service for two years n Important Rem/nders: ■ Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®. ■ Certified Mail is not available for any class of international mail. r*, ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. ■ For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the j fee.Endorse mailpiece'Return Receipt Requested".To receive a fee waiver for a duplicatq return receipt,a USPS®postmark on your Certified Mail receipt is required. ■ For an additional fee, delivery may be restricted to the addressee`or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement'RestrictedDalivery°. - ■ If a postmark on the Certified Mail receipt Is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail -•receipt is not needed,detac h and affix label with postage and mail. IMPORTANT.Save this receipt and present It when making an inquiry!" PS Forth 3800,August 2006(Reverse)PSN 7530-02-000-9047 i UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid Permit No.G-10 I • Sender: Please print your name,address, and ZIP+4®in this box• E I -dwn of Barnstable. Public Health Division j 200 Main Street Hyannis, MA 02601 I li 1 it ull 11 111 ii.11il 1 it I I ,II it I SENDER: COMPLETE THIS SECtiON COi4PLETE THIS SECTION ON.DELIVERY ■ Complete items 1;2,and 3.Also complete A. lature item 4 if Restricted Delivery is desired. ❑Agent X 10 Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. Fe by(Printed Name) Date of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is deliv address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No David Holt Today Real Estate 1533 Falmouth Road/Rte 28 3. Service Type ❑Certified Mail® ❑Priority Mail Express'" Centeniille, MA 02632 ❑Registered ' in Retum Receipt for Merchandise; ❑insured Mail ❑Collect on Delivery 4. Restricted Delivery?(Extra Fee) ❑Yes, e' 2;Article Number — `(Transfer from service tabeq 701.4 1200 , 0001 0358 3 8 5 8 PS Form$811,JUIy 2013 Domestic Return Receipt f - Town of Barnstable L& ' Regulatory Services Department i63q. �0 Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 4/7/15 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000). An "x" marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1) YEAR DEADLINE CRITERIA - Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any "conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑ Leaching pit with high liquid level, <12" below pit (per Town Code §360-9.1) OTHER rl Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc W Commonwealth of Massachusetts Title 5 Official Inspection Form ` Subsurface Sewage Disposal System Form -Not for Voluntary Assessmerifs M 166 Bristol Ave ; 5 Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name "- information is Hyannis MA 02601 4-4-15 required for every H y 1` page. City/Town State Zip Code Date of Inspection Q1 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. A. General Information 1. Inspector: Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluate he Local Approving Authority 4-4-15 pector's Signature Date. The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , 166 Bristol Ave Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Hyannis MA 02601 4-4-15 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check. A,B,C,D or E/always complete all of Section D A) System Passes: 7 ❑ 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: 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. 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): i t5ins-3/13 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 L Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 166 Bristol Ave Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Hyannis MA 02601 4-4-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) ordue to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts A . Title 5 Official Inspection Form " Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 166 Bristol Ave Property Address j Bank Owned (Contact David Halt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Hyannis MA 02601 4-4-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: j 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 or 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 day flow than 'n t5ins•3/13 Title 5 Official In Form:Subsurface Sewage Disposal System•Page 4 of 17 j 1 I d6o, ° .T Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 166 Bristol Ave Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Hyannis MA 02601 4-4-15 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: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet:of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] El ® The system is a cesspool serving a facility with a design flow of 2000gpd- 1 0,000g pd. ® ❑ 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 j questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspectlon Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 166 Bristol Ave Property Address Bank Owned (Contact David Holt @ Today Real'Estate 1-800-966-2448) Owner Owner's Name information is required for every Hyannis MA 02601 4-4-15 page. Cityfrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 166 Bristol Ave Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Hyannis MA 02601 4-4-15 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® Ng information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 3-2015Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official 'Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 166 Bristol Ave Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Hyannis MA 02601 4-4-15 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: N/A Was system pumped as par 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) ❑ InnovativelAlternative 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts v: Title 5 Official Inspection Form f° o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 166 Bristol Ave Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Hyannis MA 02601 4-4-15 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1996 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 36"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.): Good condition. Septic Tank(locate on site plan): Depth below grade: 30"feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ® polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gal Sludge depth: 10" t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 - 1 u Commonwealth of Massachusetts t Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 166 Bristol Ave Property Address j Bank Owned (Contact David Hold @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Hyannis MA 02601 4-4-15 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 201, Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 166 Bristol Ave Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Hyannis MA 02601 4-4-15 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-3/13 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 I M 166 Bristol Ave Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Hyannis MA 02601 4-4-15 page. Cityrrown 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 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box had water at working level with stain lines above inlet invert. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M s. 166 Bristol Ave Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Hyannis MA 02601 4-4-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: Infiltrators ❑ 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.): Infiltrator leach field had clear evidence of back-up into d-box and surrounding stone as observed from inspection port. 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 166 Bristol Ave Property Address Bank Owned (Contact David Holt .Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Hyannis MA 02601 4-4-15 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.): i 1 . Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts , Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 166 Bristol Ave Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Hyannis MA 02601 4-4-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately { 8� 'G 3 3 . - -- t5ins-3113 TiUe 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 A Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 166 Bristol Ave Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448). Owner Owner's Name information is required for every Hyannis MA 02601 4-4-15 page. City/Town State Zip Code Date of Inspec-ion D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 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: Original design plans show no groundwater at 12'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts , W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 166 Bristol Ave Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is H required for every y annis MA 02601 4-4-15 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 166 Bristol Ave ? �� Property Address e ('1 Segundo Calle Owner Owner's Name information is required for Hyannis Ma. 02601 6/25/2008 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. ImpoWhen filling A. General Information When filling out 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,LLC. Company Name P.O.Box 763 Company Address Centerville Ma. 02632 City/Town State Zip Code (508)428-4028 S14454 Telephone Number License Number B. Certification certify that I have personally inspected the sewage disposal system at this address and that the C= 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 (1� sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: Ec ' ® Passes El Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority p 6/25/2008 In ector's Sig ure Date Zn IW o The system inspector shall submit a copy of this inspection report to the Appr ing Au�rity8oard of Health or DEP)within 30 days of completing this inspection. If the system is a shareT.)system or has a design flow of 10,000 gpd or greater, the inspector and the system own r shall swbmit jRe report to the appropriate regional office of the DEP. The original should be sen to the gy�;terrf dwner 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. 166 Bristol Ave.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 166 Bristol Ave Property Address Segundo Calle Owner Owner's Name information is required for H annis Ma. 02601 6/25/2008 y 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: / ® 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: 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. 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 166 Bristol Ave.-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 2 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage.Disposal System Form -Not for Voluntary Assessments wM 166 Bristol Ave Property Address Segundo Calle Owner Owner's Name information is required for Hyannis Ma. 02601 6/25/2008 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 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed ND Explain: 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. 166 Bristol Ave.•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 166 Bristol Ave Property Address Segundo Calle ' Owner Owner's Name information is required for Hyannis Ma. 02601 6/25/2008 every page. Cityrrown 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 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 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 El 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 1h day flow El ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times.pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. El ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 166 Bristol Ave.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 166 Bristol Ave Property Address Segundo Calle Owner Owner's Name information is required for Hyannis Ma. 02601 6/25/2008 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. El ® 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 IT ❑ the system is within 200 feet of a tributary to a surface drinking water supply El 0 the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 166 Bristol Ave.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System+Page 5 of 5 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 166 Bristol Ave Property Address Segundo Calle Owner Owner's Name information is required for Hyannis Ma. 02601 6/25/2008 every page. Cityrrown 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? El ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] 166 Bristol Ave.-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 6 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w� 166 Bristol Ave Property Address Segundo Calle Owner Owner's Name information is required for Hyannis Ma. 02601 6/25/2008 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 5 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 5,000 :8 Water meter readings, if available (last 2 years usage (gpd)): 2002006: 5,000 Sump pump? ❑ Yes ❑ No Last date of occupancy: 6/25/2008 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): 166 Bristol Ave.•03/08 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 166 Bristol Ave Property Address Segundo Calle Owner Owner's Name information is required for Hyannis Ma. 02601 6/25/2008 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)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: System installed in 2005 Were sewage odors detected when arriving at the site? ❑ Yes ® No 166 Bristol Ave.•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 8 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 166 Bristol Ave Property Address Segundo Calle Owner Owner's Name information is required for Hyannis Ma. 02601 6/25/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): _ Depth below grade: 28"feet Material of construction: ❑ 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 leakage.System vented through the house vents. Septic Tank (locate on site plan): Depth below grade: 2.5 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: 6" Distance from top of sludge to bottom of outlet tee or baffle 26" Scum thickness 3 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 91. How were dimensions determined? measured 166 Bristol Ave.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 166 Bristol Ave Property Address Segundo Calle Owner Owner's Name ' information is Hyannis Ma. 02601 6/25/2008 required for y 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 years.lnlet 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 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): 166 Bristol Ave.-03/08 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 10 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 166 Bristol Ave Property Address Segundo Calle Owner Owner's Name information is required for Hyannis Ma. 02601 6/25/2008 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.): 4 *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert No r 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 level.Box has 1 outlet Iateral.No evidence of solids carryover.No evidence of leakage into or out of box. Pump Chamber(locate on site plan): Pumps iri working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 166 Bristol Ave.-03/08 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 166 Bristol Ave Property Address Segundo Calle Owner Owner's Name information is required for Hyannis Ma. 02601 6/25/2008 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: i Type: ❑ leaching pits number: ® leaching chambers number: 7-HC Infiltrators 50 x10'x10" ❑ 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 soil.No signs of hydraulic failure.No ponding or damp soil. 166 Bristol Ave.-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 12 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 166 Bristol Ave Property Address Segundo Calle Owner Owner's Name information is required for Hyannis Ma. 02601 6/25/2008 every page. City/Town State Zip Code Date of Inspection D. System Information. (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.): 1166 Bristol Ave.-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 13 Map Page 1 of 2 Town of Barnstable Geographic Information System Parcel Viewer Custom Map Abutters Map Size ® Zoom Out , a Nl r { � f In ® JJJJJJ� WAC PCA '�„ry + 'D rR. hex 0 Ilk r �f s` 't I- 1 � 't I 0 20 ee t ��+� � Set Scale 1" = 20 I I Aerial Photos I MAP DISCLAIMER !`nnvrinhf 9nnFAMR Tnum of Rornefohln UA All inhte rcecn. httD://www.town.bamstable.ma.us/arcims/appgeoapp/map.aspx?propertyID=291096&map... 6/25/2008 Commonwealth of Massachusetts. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 166 Bristol Ave Property Address Segundo Calle Owner Owner's Name information is required for Hyannis Ma. 02601 6/25/2008 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 leaching 30' 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. 166 Bristol Ave.•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 15 "yo Regulatory Services BARNSTABLE, : Thomas F. Geiler, Director y 6� `fig` �prFo��a Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-M-4644 Fax: 508-790-6304 REGARDING-SEPTIC INSPECTIONS BY PRIVATE CONTRACTORS DISCLAIMER This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original or copy of the report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observations and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would be listed on the "Disposal Works Construction Permit".. If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection.. QASEPTf Disclaimer Private Septic[nspections.DOC YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates cost $30.00 for 4 years. A Business Certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L. - it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1 FL., 367.Main Street, Hyannis, MA 02601 (Town Hall) and 200 Main Street Offices at the Licensing counter. DATE: r`? tag Fill in please: APPLICANT'S YOUR NAME: _BUSINESS YOUR HOME ADDRESS: TELEPHONE # Home Telephone Number: NAME OF NEW BUSINESS % ZF-,� ` � t7 S t rat, TYPE OF BUSINESS - IS THIS A HOME OCCUPATION? —� YES NO_ _ rCUC,{,,1 gtGQi�l�� l'rtfi�rl Have you been given approval from the building division? YES NO _ V ADDRESS OF BUSINESS I -"� Ccm v1 5 . MAP/PARCEL NUMBER P 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 obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in'this town. 1. BUILDING CO TONER'S OFFICE This individ al 4hoAurize een m any permit requirements that pertain to this type of business. MUST COMPLY WITH HOME OCCUPATION ture** RULES AND REGULATIONS. FAILURE TO' OMMENT COMPLY MAY RESULT IN FINES. JAA U ' m 2. BOARD OF HEALTH This individual has b n informed of th erm�re �eme�nts that pertain to this type of business. m MUST COMPLY WITH ALL Authorized Signature* HAZARDOUS MATERIALS REGULATIONS COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual h een in d f the o n r quirements that pertain to this type of business. MA J,�Q L44LX, Authorized Signature** COMMENTS: r Haza ous Materials Inventory Sheet Chec ist �� Date /d v ~ Physical Street Address-Check databa a to ensure't-exit s Working Phone Number Actual Amounts—(i.e.gas being used to fuel machines,thinner to clean brushes all count as hazardous materials) Storage Information—location of storage,how long is storage for? If none,note that. Disposal Information—where and who? If none,note that. Applicant Signature—understand what is listed and noted. Staff Initial—any questions,know who to ask. Vehicle Washing/Rinsing?—provide a vehicle washing policy and explain it—note that it was given. Attach the Business Certificate with your sign-off and comments. "The Inventory form should explain what the business consists of and the procedures they are doing. Notes need to be left to explain what You discussed with them Date:� /2"Z / o? TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE' INVENTORY._ NAME OF BUSINESS: ffi±5 :%o GC— © W C�,Cko_ BUSINESS LOCATION: INVENTPPYY MAILING ADDRESS: TOTA VA,MiG TELEPHONE NUMBER: CONTACT PERSON:--- -Sv P }� Z� - r _ EMERGENCY CONTACT TELEPHONE NUMBER: Soul — y MSDS O SITE? T`►YPEOFBUSINESS:rerlern ��t1SZ�rc�rG:�.CI 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 materials 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) Misc. 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 Misc. 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 Misc. Combustible i Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt & roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) NEW USED Any other products with "poison" labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor &furniture strippers Other products not listed which you feel Metal polishes be toxic or hazardous (please list): Laundry soil & stain removers (including bleach) — Spot removers &cleaning fluids moo` ,S Noy�P_ (dry cleaners) y Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS TOWN OF BARNSTABLE `1 LOC 4TION f y,Y� T1�� SEWAGE # ? � y VILLAGE ASSESSOR'S MAP & LOT �"U INSTALLER'S N &PHONE NO SEPTIC TANK CAPACITY LEACHING FACILITY: (type) �,� (size) ���1GIQlG� NO.OF BEDROOMS BUILDER OR OWNER PERMUDATE: 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 L.; F7hsyd by J 1 A IL I 1^�A6 V „KI V / + 'TOIMd OF Br iSTA�BLE / OcAl10 Sirt S Y n v e SEWAGE;'#•gam' LAG ASSESSOR'S MAP St L( 7,2Z/-� STA],J�- R'S NAME&PHONE NO. SEP1'lC TANK .CAPACITY LEACI ING•PA,CILITX: (type) ._ — --------- No.opB5DR00MS_ 1�ujL1'ASR OIL OVINUR »—�...--'�..— F1�}Z1i1d�Tl�Amk::,.....•.,.,...—•_.,..,......�..,...�..._..y.C(�Mt'1..XAdvCir DA►�'�.,_.,......_._..._.�....___._.___......... Sep*0adon Tyistunce Between Vbe: E'C4 1 Maximum M}ustO Groundwater Table to the Bottom of Leaching 1?ncility ...- -- --- 1M1vaQe''JV•at&supply VIC91"131d Leaching X acility'(If any dells exist koo on,site or w1wn 200 feet of lencliitlg facility) �--�---- pcip(g..'Weiland alld Leacltiag Fsoility(if any wetlands exist tvllhill 900 feet of jenaling.racllrry�� �� �s r, � � t 00 06 � M cl I t I V t\ •No.T Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pplication for Df�pogal �bpotem Con!5truction Permit �9l Application for a Permit to Construct( , )Repair;(Upgrade( )Abandon( )Xcomplete System ❑Individual Componen s Q Qr j(J Location Address or Lot No. (�(; 3�-�e p #O E Owner's Name,Address and Tel.No. Assessor's Map/Parcel CPA 1 ts-M re Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. '?N01b2X_k-> SvCS, bwr %e ENO. S\l C S 4-3 - 5 3\O 5 2s-'+q(oL Type of Building: Dwelling No.of Bedrooms '� Lot Size 13 l9 +0 sq.ft. Garbage Grinder(0 Other Type of Building h�0 tJ Q No. of Persons S Showers( &)Cafeteria( ✓) Other Fixtures *Ci%e^ Design Flow 1440 gallons per day. Calculated daily flow ;___Hn gallons. Plan Date o Number of she is I Revision Date Title rUt?0&OA e J e,{a e Size of Septic Tank N eto ►SOO G�, :Xpgt k Type of S.A.S. ' 1 N L'f-R4'� T'CZ��1G� Description of Soil= �Q�c.t— Aim YLY_,]�!4 Nature of Repairs or Alterations(Answer when applicable) �-h0 Ste- An C�Q.q- Date last inspected: Agreement: The undersigned agrees tp ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with,the provisio s of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issil.d y this PZ d of th Signed Date hq In Application Approved by Date Application Disapproved for the following rea o Permit No. Date Issued —�j A. w�aa= Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLEs MASSACHUSETTS Application fori4ogaY OpMem Cott.5tructfoit Permit a�� Application for a Permit to Construct( . )Repair,O Upgrade( )Abandon( ) Complete System ❑Individual Component O p/ Location Address or Lot No. I u la '�a` �1)E Owner's Name,Address and Tel.No. ` I J(� N Y A N..►�s ya cz Y L N4 Assessor's Map/Parcel ^� C7C u �ME Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 3 'vY � ob2C1CS }:C �j�C�. 5�1�Y ErvU. SvCS 4--8 - 5 3\d 5 2;-+9(9L Type of.Building: Dwelling No.of Bedrooms A Lot Size 131q sq.ft. Garbage Grinder(►uh�1 / s� Other Type of Building N°m Q No.of Persons S Showers Cafeteria( ✓) Other Fixtures rV Q f;. ! /G Design Flow gallons per day. Calculated daily flow 4A -+0 gallons. Plan Date '�Jj o s Number of sheets Revision Date Title J 0 etc a de Size of Septic Tank_ NeLg I.SDn GlC\ 'WANK Type of S.A.S. �' IIvF�I..TRA-tUR. T'(ZC►.1GN, Description of SoilQ _ Nature of Repairs or Alterations(Answer when applicable) 2Q C- ' s ` i �a Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with.the provisions of Title 5 of the Environmental Code.and not to place the'system in operation until a Certifi- cate of Compliance has been issued/by this- bard of a It - Signed Date _ Application Approved by V v Date Application Disapproved for the following re o y Permit No. r-- Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERM,that.the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded (W) Abandoned( )by r([C 1 4,-) tq,�I/ A at v ( 1e,in I P J0Jjjhas bee constructed in a cordance with the p visio s of Title 5 and the for Disposal System Construction Permit No. — dated ' IJ Installer__ Q! Designer The issuance of this permAt shall n t be construed as a guarantee that th(ystem I c pion as designed. Date l/ Inspector No.v— Fee fW THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS )3i5po$a1 bp5tem Coif.5truction Permit Permission is hereby granted to Construct( )Repair( )Upgrade�X)Abandon( ) System located at pin d i -7) I �lw n i a a�` n!► / C and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Cons ucti 'n must be completed within three years of the date of tmrmit. © C Date:� _ Approved by 9/16/03 Notice: 'This Form Is To Be Used For the Repair Of Failed Septic Systems. Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM C, hereby certify that the engineered plan signed by me dated G J�165 ,concerning the property located at meets all of the following criteria: • This failed system is connected to'a residential dwelling only. There.are.no.commercial or business uses associated with the.dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or may conduct deep test holes and percolation tests at-the site without a health agent present. • There is no.increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will-be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the. Frimptor method when applicable] Please complete the following: A) Top of Ground Surface Elevation(using GIS information) 48 .m B) G.W. Elevation +-adjustment for high G.W. V : = a(." DIFFERENCE'BETWEEN A and B 0 SIGNED : DATE: NOTICE Based upon the above information; a repair permit will be issued for bedrooms maximum.. No additional bedrooms are authorized in the future without engineered septic system plans. q ASeptic\p--xemp.doe Iti Permit Number: Date: Completed by: HIGH GROUNDWATER LEVEL COMPUTATION Site Location: -NL,3 Vk" r+"r 11,� Lot No, 4�41 Owner: 1 f 'Ti 6. Address: fit"t 6 Contractor: C,�,Jcc, Address:_ Notes: STEP 1 Measure depth to water table tonearest 1/10 ft. .............................................................................. .Date 51 OS o2 mont /day/year STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: w`1 t OA Appropriate index well.................................................... OBWater-level range zone ........................................... STEP 3 Using monthly report "Current Water Resources Conditions" determine current depth to water level for index well as- r�►. mon h/year 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 213) determine water-level adjustment ..............................................:........................................... STEP 5 Estimate depth to high water by subtracting the water• level adjustment (STEP 4) from measured depth to water level at site (STEP 1) .......I......................... fr i Figure 13.—Reproduclble computation form, 15 e Regulatory Services Thom •�wcn.v; • as F.Geiler,Director ULM Public Health Division Thomas McKean,Director " 200 Main Street,Hyannis.,MA 0260, Dffice: 508-862-4W i Fax: 308-790-6304 Installer& Desi nor Certfficsaion Form esigner: Service e. lnstaAer: Robert Septic Se rvicec ddress: 27 East Falm uth Address: 5 Trenton Street , (I mouth MA e was issued a (��) (installer) permit to install a tic system at 1 Av—en UXAAnitdv_IAbased on a design drawn by (address) ervi(desi Inc. dated MAX 29.2005 I 1 certify � that ptic system referenced above was installed substantially according to the desILF4 w may include minor approved changes such as lateral relocation of the distribution d/or septic tank. I I I $' that eptic system referenced above was installed with major changes (i.e. greater than 1 al relocation of the SAS or any vertical relocation of any component of the septic s ) but in accordance with State & Local Regulations. Plan revision or certified as-b designer to follow. �cT� OF R4 ler s 1gn� CARMENs E. SHAY up No. 1181 ,p o igner's Si ) -rf. (A p Here PL STABLV PITUT ird- Up A Ell' L ARD ARE NO B L DIVI IFICATE BARNST HEAL + ,�' rQ tWScptiC/Dpi�er C pn Form IAY-�9 , 12:33PM ID: PRGE:1 I *NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. OTtAND Mc*ALtY 0 10' min. from -- VENT PIPE ( Least 24 inches toll)--"-- Et,n TION A -f � AL. OUTLET PIPES FROM THE Existing Foundation house to septic tank Schedule 40 PVC w/Charcoal Odor Filter r I DfsTRreurfoN Box SHALL eE -tY D-Aox Dover must be PROFILE i IEW OF ADDITION TO LEACIIING SYSTEM SET LEVEL FOR AT EAST z FT. coNCRET COVER TOP OF FOUNDATION = ELEV. 100.00 (Assumed) septic tank covers must be _ within 6 in, of finished grade wthin 6 in, of finished grade °� _ ;�-< ,_ ,•' ;a o xi a at Grade over S tic Tonk - 98.00 Grade over D-Box - 98.50 ode over SAS - 9&50 3 - 5' OUTLET t V '� /- 3" of t/8' 1/2"Washed Peastone ;�� ��' KNOCKOUTS �._. 3/4" to , t/2 " Washed Crushed Stone / • �. .-' � � �, -" � + ---- S 15.5 ....- '� O.D2 _ 3 HOLE H-10 4- P (CAPPED) INSTECTION PORT TO BE _ -- pU11_ET 6" (�) 1 72" INLET �'^- `'+4 t �,"t , 'ts:•a --- Le DIST. BOX 3' Maztmum Cover INSTkLED AND TO BE '"THIN 6" OF GRADE T OF System- Elev. s95.75 NEW S=o.Df or Greater °p r' "� 2' X 166 Bristol Ave EXIST PIPE N 1,500 GAL, O 3o' S: 0.01- py toot --,0" Effective Depth --75.5'- 4" - SCH. 40 Te - ``7.75- FROM EXIST: FOUNDATION a> SEPTIC TANK - O II �' �, ,,,, N a s• - PLAN SECTION CROSS-SECTION CONCRETE FULL FOUNDATIO n, Ih H-10 _ II rn 7 Units E 6.25' = 43.75' , a v 0.83' (10 Inches) _ a > rn S' SYSTEM PROFILE 6 In.of 3/4--1 ,/2 t yi 3.75' -I - 3 HOLE H-10 DISTRIBUTION BOX E n.n1-Ila compacted stone > rn `r ...... Not to Scale c v u N rn 5,75' NOT TO SCALE 00h 5tlm i f 11 N.M Rand A"'8 , S c,.....• > 2.5'-- 1� ...-2.5' � Effective Length � n /.., ox�'pNY©:1Nld t'iAVTC"]i 3'-1 S❑IL ABS❑RPTI❑N SYSTEM (SAS) 6 in.of 3/4"-l1/2' o $' GENERAL NOTES compacted stone a Effective vfach INFILTATROR HIGH CAPACITY (H-20 L❑ADING)/ GE❑RGE ❑'BRIEN - NOTE ALL COMPONENTS MUST HAVE RISERS To WITHIN 6" BELOW GRADE m - 1. Contractor is responsible for Digsafe notification, Verification of Utilities - o (OR EQUIVALENT) Not to Scale and protection of all underground utilities and pipes. Z eotundw terreCibse.vedt-aNON OBBSERVED YERALL HEIGHT OF INFILTRATOR IS 18" /EFFECTIVE HEIGHT IS 10" 2. The septic tank and distribution box shall be set w NOTE: O level on 6 of 3/4"-1 112" stone. 3. Backfill should be clean sand or gravel with no stones over 3" in size. 4. This system is subject to inspection during installation P E R C O 1T I O N TEST by Carmen E. Shay - Environmental Services, Inca 5. The contractor shall install this system in accordance with Title V of the Massachusetts state code, the approved plan Date of 'Percolation Test: MAY 25, 2005 and Local Regulations. Test Performed By. CARMEN E. SHAY, R.S„ C.S.E. 6. If, during installation the contractor encounters any Results Witnessed By. Waiver (per Barnstable DOH) soil conditions or site conditions that are different EXCAVATOR: Shay Environmental Services, Inc. from those shown on the soil log or in our design Percolation Rate: Less Than 2 MPI 042 installation must halt & immediate notification be made to Carmen E. Shay - Environmental Services, Inc. Test Hole 7. No vehicle or heavy machinery shall drive over the No. ,1 septic system unless noted as H--20 septic components. 8. Install Tuf-Tite gas baffles or equals on all outlet tee ends. DEPTH SOILS ELEV.' 9. All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipes. _. 0 98.50 - --- --- 10. All solid piping, tees & fittings shall be 4" diameter Sand �"---_� Schedule 40 NSF PVC pipes with water tight joints. 10 YR 3/2 _ 11. Municipal Water is Connected to ALL OF The Residence and Abutting 0"-9" A 97.75, �P� --��_ _,98 Properties Within 150 Feet. Loamy , _ Sand to YR s/6 TEST HOLE #1 THE PROPERTY LINES ARE APPROXIMATE AND I 9"-42" Be 95.00 _ ELEV.= 98.50 11.5 COMPILED FROM THE SURVEY PLAN GENERATED BY Medium ELDRIDGE ENGINEERING CO, BARNSTABLE, MA ENTITLED Sand "CERTIFIED PLOT PLAN OF LOT #4 BRISTOL AVENUE, HYANNIS, MA" 2.5 Y 8/6 + DATED MAY 11, 1981. IT SHOULD BE USED FOR NO PURPOSE 42"-132" C, 87.50 • r • • • 1 OTHER THAN THE SEPTIC SYSTEM INSTALLATION: 4" PVC p Vent EXISTING CESSPOOLS TO BE PUMPED OUT AND FILLED IN PLACE PROJECT BENCH MARK O NOTE ANY STRIPPED OUT SOIL CONTAINING LEACHATE v TOP OF FOUNDATION Fa'le 20 FROM THE EXISTING CESSPOOLS TO BE DISPOSED I ELEV. = 100.00 (Assumed) O c CES OOL OF AS PER BOARD OF HEALTH SPECIFICATIONS, THERE ARE NO WETLANDS, ARE PRESENT WITHIN 200 OF THE PROPERTY Perc #1 1 Depth to Perc: 42" to 60" LOT #5 Si�KEENED EXIST. ASSESSORS MAP 291 LOT 096 Perc Rate= 2 MPI (�" Groundwater Not Observed j PORCH GARAGE LEGEND No Observed ESHWT ADJUSTED H2O Elev. = None , •: 3-24' aAM. AccEss MANHOLES EXISTING l I 1�4X 1 DENOTES PROPOSED ,0 -6 4 BEDROOM I LOT #3 SPOT GRADE I::. .,_ ,r. . •: . : _. :._ .. ��// HOUSEDENOTES EXISTING #1ss SPOT GRADE Failed INLET _ -�.1 i._�'1 �. CESSPOOL , Pt PROPERTY LINE INLET ` / ` / OUT11T i ASPHALT I � THE ACCESS COVERS FOR THE SEPTIC TANK, / DRIVEWAY i ov1_ PROPOSED CONTOUR DISTRIBUTION BOX AND LEACHING COMPONENT �( SHALL BE RAISED TO WITHIN 6' Of I -97 EXISTING CONTOUR , _�• .• "-_.. +'� n .. - FINISHED GRADE. , l - - - STEEL REINFORCED PRECAST CONCRETE INSTALL TUF-TITE GAS BAFFLES OR EQUALS ON ALL OUTLET TEE ENDS PLAN VIEW / i i DEEP TEST HOLE & 3-24" REMOVABLE COVERS / LOT #4 } ; i PERCOLATION TEST LOCATION 1 6 FOOT STOCKADE FENCE � F I > 3,970 Square'Feet + - l - I « --. 3' min. clearance INLET B��In.�-12' min. inlet to outlet 6'q WTLETtlrLELiquid level ,I I _-�_- =y ez.oo' L = ze.0o'` LOT 4'-0" min. ( ZaI PLAN Llquld depth -- -- l 1s 98 I R = 2075.82' a OF PROPOSED SEPTIC SYSTEM UPGRADE �- -------------------------�_______-- PREPARED FOR j ,CROSS SECTION END-SECTION I D:ARYL MATHER - PIKE TYPICAL (H- 10 LOADINGS 1500 GALLON SEPTIC TANK BRI.S' T OL VFN UE' AT NOT TO SCALE (40 FOOT RIGHT OF WAY) 16 6 B I \ I STO L AV E N U E May Substitute with 1500 gallon H-10 Polyethylene Tank-George O'Brien Co. HYAN N I S MA , Design Calculations H qss Number of Bedrooms: 4 Equivalent to 440 Gal./Day C EN yG REPAIRED BY: Garbage Grinder: No /� Leaching Capacity Proposed: 440 Gal./Day Minimum (Mina Per Title V) H _4 CAA EN E. Sff Y f Septic Tank - 2 x 440 Gal./Day = 880 USE NEW 1500 GAL. Septic Tank. j SO4L ABSORPTION AREA: Using percolation rate of <2 min./inch N ENVIRONMENTAL SERVICES, INC. Bottom Area: 0.74 al s ft. x 500 s ft. = 370 gallons g / q. q' g � oIsTE� ° P.O. BOX 627 I Sidewoll Area: 0.74 gal./sq. ft, x 99.6.sq, ft. = 73.7 gallons 0 20 40 50 Providing: 443.70 gallons SANITARNP� EAST PALMOUTH; MA 02536 _ TEL/FAX 508-539-7966 Use: (7) INFILTRATOR HIGH CAPACITY H-20 UNITS, HAVING A 0.83' (10 INCHES) EFFECTIVE DEPTH, , TO BE USED WITH 4.0' OF WASHED STONE ON THE SIDES, AND 3' OF WASHED STONE SCALE: 1 =2O DRAWN BY: CES DATE: MAY 31 , 2005 ' ON THE ENDS. No STONE UNDER: SCALE: 1'>=20' PROJECT#SD752 FILENAME:-SD752PP.DWG SHEET 1 OF 1 I