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HomeMy WebLinkAbout0174 BRISTOL AVENUE - Health ,174 Bristol Avenue Hyannis P f A = 291 095 I I a i h o ° 1 U o u o 0 v o ° 0 op G A n � I TOWN OF BARNSTABLE LOCATION 1:7 13'/c I S /G L SEWAGI AN Z VILLAGE ✓� ASSESSOR'S MAP&PARCEL.1 q I INSTALLER'S NAM &PHONE NO. /TG`j :N SEPTIC TANK CAPACITY 16-0 41 LEACHING FACILITY:(type) G (size) /3— 9t-- NO.OF BEDROOMS OWNER Zi PERMIT DATE: —/ ? 6 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility_ feet Private Water Supply Well Leaching Facility(if any wells exist 'on site or within 200 feet of leaching facility) feet. Edge of Wetland and Leaching Facility(if any wetlands exist within 300 feet of leaching facility). feet FURNISHED BY r- 1 ci • / 1 a B A T� �t No. .G OO�� S �.� � Fee ace THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTAB.LE, MASSACHUSETTS ppli.ratton for �Bie;po!gal i§pgtem Con0truaton Vermtt Application for a Permit to Construct( ) Repair t<) Upgrade( ) Abandon( ) ❑.Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address Tel.No. 1-7-4 `36Qs of U2, C�,In.'l1S GJPr1 GL. 1 'VIA. Assessor's Map/Parcel Installer's r\ CNarr Address,�S d \N' 'S �� Designer's N ame,A dress and Tel.No.5ov,-SUA-ovi'l Type of Building: 2 Dwelling No.of Bedrooms J Lot Size sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3 D gpd Design flow provided 3 3 O .0 94 gpd Plan Date 2 I(v LO G$ Number of sheets Z. Revision Date Title Size of Septic Tank Type of S.A.S. 2 - L5Zf0 44(, e FGe ►-1 h��-1 k•i7N Description of Soil s'7o.v 2 Nature of Repairs or Alterations((A,nnsswer when applicable) f�5 �Q �� e 5 V&-^ Date last inspected: Agreement: A The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date ��' "t Application Approved by Date 12" 1'1 — ZOO Application Disapproved by: Date for the following reasons Permit No. Z O Of3- S /S- Date Issued I Z 1 -7 Z O O No. 0 o Fee QQvye THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: r,r PUBLIC HEALTH DIVISION --TOWN OF BARNSTABLE, MASSACHUSETTS ZppYicatton for �Dio_ogal 6potem Con truction Permit I Application for a Permit to Construct( ) Repair(A Upgrade( ) Abandon( ) ❑.Complete System ❑Individual Components Location Address or Lot lJo. Owner's Name,Address;and Tel.No. 1-74 13f-lg4d Ue, t cunt�il5 J"�e1c s,I, ► VCR. Assessor's Map/Parcel o �� {�irQ�c�►(�P Q-n n-i5 Installer's Nam ddress,and Tel.No. �o De si ner's Name,Address and Tel.No. 5DSr`'54oq.0T9 I 7 q, C&i4e r 1 le- 43 'Triav\61C� rt . �w►�-'�- Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures /f Design Flow(min.required) ?>O gpd Design flow provided 3 3 6 .o y gpd Plan Date `Z j I(v ' Z O O s Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. O (TAM rt E'f-S 1-�-19t t Description of Soil STUB, y h Nature of Re airs or Alterations(Answer�when applicable) nS-�$p Q [; (n(�c) `(�`�k e- 5 j5 40 e1Gos At- c--tE--3o-)a Date last inspected: x Agreement: !I The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this.Board of Pealth. Signed Date Application Approved by Date 12- 1-1 - Z-o 08 { Application Disapproved by: Date for the following reasons I, ———— Permit No. 2 O 0,6-S / ——————— Date Issued 1 Z 1 Z d 0 ———————————————————-- THE COMMONWEALTH OF MASSACHUSETTS 1 Jc� BARNSTABLE, MASSACHUSETTS j (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Dis osal System Constructed ( ) Repaired ( Upgraded ( ) Abandoned( )by I \ F� lnwNol AStA-% 7L at 0 _6r'v5�p1 Alf a� o 15 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 2-6 , -s/.S dated 12 O Installer G N So i A Designer 1= C 0 - T E C I l #bedrooms 3 Approved design flow OJ gpd The issuance of this permit shall t e onstru das a guarantee that the system wipuncon as designed.Date (/ Inspector 1 `i/ ——————————-- ----------------- No. 2 006 " 51S Fee 100, THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS 1=i!9po5a1 6p5tem Congtruction Permit Permission is hereby granted to Construct (++ ) Repair ( ) 1 'Upgrade ( ) Abandon ( ) System located at 7�-1 �1 S I O t �tJC r t�� V�b\\5. and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of thi7et. . Date Z 17 �� G,D Approved by v , Town of Barnstable Regulatory Services Thomas F. Geiler, Director • BARNSfASM ,►ss. Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,NIA 02601 Utlice: 508-862-4644 Fax: 508-790-6304 1 r Installer & Designer Certification Form Date: I�-y�/-o- Sewage Permit# d� 1 Assessor's Map�Parcel'1 S Designer: CD , I Installer: L e�� i�n S+Z C �C Address: 73 �i 0-n 4-p-- O'LA L(c. Address: '?C) C)C)--7� l O gr-1 On was issued a permit to install a (date) (installer}j(I-� septic system at i;-f(S 1b� XN.()Oe, k�JCUNO' based on a design drawn by (address) E cc) dated (designer) -11/1 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. 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 of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. T _f t -Signature) Ins alley s - (Designer's Signature) (A. i `Vfe i, . tam` I'erej` PLEASE RETURN TO BAT NSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q: Heafdt/Septic/Designer Certification Fomi 3-26-04.doc � I� � town of B i>rnstable. P# . Department of Regulatory Services C (, �D�( S ersstl4 Public Health Division Date D ' v �f6J¢ 200 Main Street,Hyannis MA 02601 • !11 '�ffD At►. � � ul ® ' d. Date Sched ed Time Fee P ► oat-' Suitability Assessment fop Sewage i posal c� L ii 4l •Witnessed 0 Performed By:�a�t� � � it�"' � t � Wetness / i • LOCATION & GENERAL'INFORMATION f Location Address T Owner's Name Ar K& q � L Ok BhS�I 11'� Address Assessor's Map/P4rcel. 7ia `� I Engineer's Name NEW CONSpIRU�'i70N REPAIR Telephone# �7 o e9f It A FC'eict4elll_"C4 Slopes(36) 0 Surface Stones �D� Land Use � Distances from: Open Water Body too ft Possible Wee b Area OD+—fr Drinking Water Well ft I ft Drainage Way �0 } F ft. Property Line �Q ft Other SKETCH:(Street name,dimensioos%f lot,exact locations of 14t holes&pert tests,locate wetlands in proximity to holes) 00, GROUNDWATER ADJUSTMENT EXISTING 'GROUNDWATER LEVEL 0_2 BASED ON TOWN OF BARNSTABLE GIS DEPARTMENT RECORDS. INDICATED GW 23.00 INDEX WELL AIW-230 ZONE D ' READING DATE NOV. 2008 READING 24.6 i ADJUSTMENT 5.5 �lST j ADJUSTED GW 28.5 1 I Parent material(geologic) d u` 001vrq; / I Depth to Bedrock ' YNO N� I from Pit Pace h D Depth to Groundwatdr. Standing Water in Hole: Weeping I p g Estimated Seasonal high Groundwater See DYNE 4 TION FOR SEASONAL BaGH wAJ A R& 3LE Method Used C7 � ! ^ in. Depth to Sall mottles: ln. Depth dbperved standing in obs.hole: I in, Groundwater Adjuatment fr Depth tolweeping from side of obs.hole: q factor,,,._..a. Adj.Groundwater Level,,,,e. index Well# Reading Date index Well►evdl - dj PERCOLATION TEST Date t2115 �t9uir.�. . Observation ( I Time at 9" �.. Hole# t Time at 6" Depth of Perc .-.------- . Z.. Start Pre-soak Time.@ to�a Time(9"-6") End Pre-soak Rate MinJlnch 2 rv+ I Site Suitability Assessment Site Passed Site Failed: Additional Testing Needed.(YIN)' Originak.Public Halth Division Observation Hole Data To Be Completed on Back-- ***If percola ipn test is to be conducted within 100' of wetland,.-You must first notify the Barnstable Cooservation Division at least one(1) wedk prior to beginning. zoos- ' S-1j^ SOIL TEST LOG DATE OF TEST: DECEMBER 15, 2008 APPROVED SOIL EVALUATOR: DAVID D. COUGHANOWR. #461 WITNESSED BY: DONNA MIORANDI. HEALTH DEPT. PERC NUMBER: 12437 I ` NO NCOUNTEE TEST PIT I PAARENOTUMAATERIA EPROGLACIRALD OUTWASH PERC AT 56 in — 2 MIN/INCH IN C SOILS ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING 41.05 0-6 Ap SANDY LOAM 10 YR 2/2 NONE FRIABLE 36.55 6-30 B LOAMY SAND 10 YR 4/6 NONE LOOSE 29.55 30-138 1 C MEDIUM SAND 10 YR 5/4 NONE LOOSE NO TEST_ PIT 2 GROUNDWATER PAARENTUMAATER AL ENCOUNTERED PROGLAC AL OUTWASH 2 MIN/INCH IN C SOILS ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER 41.00 (INCHES) HORIZON TEXTURE (MUNSELLI MOTTLING 0-8 Ap SANDY LOAM 10 YR 2/1 NONE FRIABLE 38.33 8-32 B LOAMY SAND 10 YR 4/6 NONE LOOSE 30.00 32-132 1 C MEDIUM SAND 10 YR 6/4 NONE LOOSE DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent o Gravel DEEP OBSERVATION HOLE LOG `` Hole# Depth from Soil Horizon SeiI Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Cginisaiigency. Gravel) Flood Insurance Rate May: Above 500 year flood boundary No_ Yes 1*1 Within 500 year boundary No✓ Yes Within 100 year floodl boundary No 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? 5 If not,what is the depth of naturally occurring pervious material? Certification lR� I certify that on NpV (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 wit the required training,expertise and experience described in 3.10 CMR 15.017. SN OF,ygs c �. G� R� «� . peC t 5 �,ji N �° DAVID y� Signature Date U D. COUGHANOWR y s0 CENSEO 0 Q:ISEPTIC\PERCFORM.DOC /� E VA L U N I i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 174 Bristol Avenue Property Address Angela Silva Owner Owner's Name information is required for Hyannis MA 02601 10/16/2008 every page. Citylrown 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. lmpoWhen filling A. General Inform tion When filling out / forms on the `--✓� computer,use 1. Inspector: only the tab key to move your David D. Coughanowr, IRS cursor-do not Name of Inspector use the return key. Eco-Tech Environmental Company Name 43 Triangle Circle Company Address Sandwich MA 02563 �101 City/Town State Zip Code 508 364 0894 1328 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority i bkJ 5 10/16/2008 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****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. Ib I31 ! t5ins•09/08 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 cwM 174 Bristol Avenue Property Address Angela Silva Owner Owner's Name information is required for Hyannis MA 02601 10/16/2008 every page. Citylrown 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 in-ormation which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, wim 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): l5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form i a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 174 Bristol Avenue Property Address Angela Silva Owner Owner's Name information is required for Hyannis MA 02601 10/16/2008 every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): [j 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 FIND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): I 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 ,Sins•09/01, Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 174 Bristol Avenue Property Address Angela Silva Owner Owner's Name information is Hyannis MA 02601 10/16/2008 required for H y . every 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 coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than :z day flow t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 174 Bristol Avenue Property Address Angela Silva Owner Owner's Name information is required for Hyannis MA 02601 10/16/2008 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 174 Bristol Avenue Property Address Angela Silva Owner Owner's Name information is required for Hyannis MA 02601 10/16/2008 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ❑ ® Were all system components, excluding the SAS, located on site? 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 Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins-09/08 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 174 Bristol Avenue Property Address Angela Silva Owner Owner's Name information is required for Hyannis MA 02601 10/16/2008 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 4 Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): 206 gpd Detail: 2006-2007 Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 174 Bristol Avenue Property Address Angela Silva Owner Owner's Name information is required for Hyannis MA 02601 10/16/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: 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): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 174 Bristol Avenue Property Address Angela Silva Owner Owner's Name information is required for Hyannis MA 02601 10/16/2008 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Age: 9+ years. Certificate of Compliance for new leaching gallery issued 1/25/99 (Board of Health permit#99-32) Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: ® cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Sewer appears structurally sound with no evidence of backup or leakage into dwelling, Septic Tank(locate on site plan): Depth below grade: 2 feet i 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: 8.5 ft x 6 ft x 5 ft(1000 gallon) Sludge depth: n.d. l5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 174 Bristol Avenue Property Address Angela Silva Owner Owner's Name information is required for Hyannis MA 02601 10/16/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle n.d. Scum thickness n.d. Distance from top of scum to top of outlet tee or baffle n.d. Distance from bottom of scum to bottom of outlet tee or baffle n.d. How were dimensions determined? permit applicatin form Comments (on pumping recommendations, inlet and outlet tee or baffle condition, rStructural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Liquid level in tank was halfway up inlet pipe. A thick scum layer was observed on all interior surfaces of inlet riser and cover. Tank should be pumped dry at time of system repair and checked for structural integrity. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ':❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 174 Bristol Avenue Property Address Angela Silva Owner Owner's Name information is required for Hyannis MA 02601 10/16/2008 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No l5ins•09/08 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 174 Bristol Avenue Property Address Angela Silva Owner Owner's Name information is required for Hyannis MA 02601 10/16/2008 every 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 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 was not uncovered as conclusive evidence of hydraulic overload was observed at the septic tank and in the soil absorption system. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 I N, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 174 Bristol Avenue Property Address Angela Silva Owner Owner's Name information is required for Hyannis MA 02601 10/16/2008 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ® leaching galleries number: 1 ❑ 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.): An observation hole was dug into leaching gallery. Effluent contact staining of soils was observed approximately 1 foot below surface. At approximately 1.5 feet below surface and 1 ft above peastone effleuent was observed welling up into hole. 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 l5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 174 Bristol Avenue Property Address Angela Silva Owner Owner's Name information is required for Hyannis MA 02601 10/16/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): i I I t5ins•09/08 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 174 Bristol Avenue Property Address Angela Silva Owner Owner's Name information is required for Hyannis MA 02601 10/16/2008 every 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 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 174 Bristol Avenue Property Address Angela Silva Owner Owner's Name information is required for Hyannis MA 02601 10/16/2008 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: 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: Barnstable GIS Department records ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation. Town of Barnstable GIS Department records indicate that the property is 12 feet above groundwater table. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 N, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 174 Bristol Avenue Property Address Angela Silva Owner Owner's Name information is required for Hyannis MA 02601 10/16/2008 every 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Page 10 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 174 Bristol Avenue Hyannis)AM Owner: Joan Harrington Date of Inspection: June 22, 2001 Map: 291 Parcel: 095 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. A � � 5 a l 33 � a qa- 3a .J 10 � v COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 174 Bristol Avenue Hyannis, MA Owner's Name: Joan Harrington Owner's Address: 105 Captain Carleton's Road Cotuit, MA 02635 Map: 291 Date of Inspection: June 20, 2001 Parcel. 095 Name of Inspector:(Please Print) James M. Ford Company Name: James M. Ford Mailing Address:' P.O. Box 49 Zerfo Osterville,MA 02655-0049 Telephone Number: (508) 862-940020010ERTIFICATION STATEMENT NSTABBEI certify that I have personally inspected the sewage disposal system at this address andg$Ti o below is true,accurate and complete as of the time of the inspection. The inspection w 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 N rther Evaluation by the Local Approving Authority Fail Inspector's Signature: Date: June 26, 2001 The system inspector shall subm copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. . Notes and Comments ****This reporfonly describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 174 Bristol Avenue Hyannis, MA Owner: Joan Harrington Date of Inspection: June 22, 2001 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally 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 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 _ ass inspection.if with approval of the Board of Health .P p. (_� PP . .. broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 174 Bristol Avenue Hyannis, MA Owner: Joan Harrington Date of Inspection: June 22, 2001 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a.surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) i Property Address: 174 Bristol Avenue Hyannis, MA Owner: Joan Harrington Date of Inspection: June 22, 2001 D. System Failure Criteria applicable to all systems: You must indicate either`yes"or"no"to each of the following for all inspections: Yes No _ ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than'/Z day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped— _ ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within-a Zone 11 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 watei'analysis, performed at a DEP certified laboratory,for coliform bacteria.and,volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The.system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well If you have answered`yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 174 Bristol Avenue - - -. Hyannis, AM Owner: Joan Harrington Date of Inspection: June 22, 2001 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? i ✓ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ Was the site inspected for signs of break out? ✓ Were all system components,excluding the SAS, located on site? ✓ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? ✓ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No ✓ Existing information. For example,a plan at the Board of Health. ✓ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)]. 5 Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 174 Bristol Avenue Hyannis, MA Owner: Joan Harrington Date of Inspection: June 22, 2001 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 Number of current residents: 0 Does residence have a garbage grinder(yes or no): Yes Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings,if available(last 2 years usage(gpd)): 2000-60,000 gals.; 1999-84,750 gals. Sump Pump(yes or no): No Last date of occupancy: Unknown COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information:Pumped in 2000-per owner Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes, attach previous inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other-(describe): Approximate age of all components,date installed(if known)and source of information: January 25 1999-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 174 Bristol Avenue - - - Hyannis. MA Owner: Joan Harrington Date of Inspection: June 22, 2001 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron 40 PVC _other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 16" Material of construction: ✓ concrete metal _fiberglass _polyethylene.. _other(explain) - If tank is metal list age: Is.age confirmed by-a Certificate of Compliance(yes or no):' (attach a copy'of certificate) Dimensions: 1000 gal. Sludge depth: 1„ _ Distance from top of sludge to bottom of outlet tee or baffle: 30 Scum thickness: I" Distance from top of scum to top of outlet tee or baffle: 10" Distance from bottom of scum to bottom of outlet tee or baffle: 13" How were dimensions determined: Measuring stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): The tees were present The liquid level was even with the outlet invert. There were no signs of leakage. GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass polyethylene _other (explain): Dimensions: Scum thickness: Distance from top ofscum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: a Comments(on pumping recommendations,inlet and-outlet tee or baffle condition,structural,integrity,.liquid levels as related to outlet invert,evidence of leakage,etc.): 7 r i Page 8 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 174 Bristol Avenue Hyannis, MA Owner: Joan Harrington Date of Inspection: June 22, 2001 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: Rallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: j Comments(condition of alarm and float switches,etc.): i IS.TRIBUTION BOX:. ✓, (if present must be opened)(locate.on site plan) ' Depth of liquid level above outlet invert: Even Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): The D-box was level and there were no signs of leakage or solids Speed levelers were present. There were no signs of back-up or failure from the leach field PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 174 Bristol Avenue Hyannis, MA Owner: Joan Harrington Date of Inspection: June 22, 2001 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: ✓ leaching chambers,number: 6-infiltrators(16'x 28'x 19-per design plans leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: Innovative/alternative system .Type/name.oftechnology:.... Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): The infiltrators were located but not dug up -There were no signs of failure'in the D-box. 'The bottom to grade was approximately 4' CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): 9 1• , Page 10 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 174 Bristol Avenue Hyannis, MA - Owner: Joan Harrington Date of Inspection: June 22, 2001 Map: 291 Parcel. 095 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. aA�k A � i 3, .3.3. 3 q3- 3-7 133� y I 10 Page 11 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORIVIATIO'N (continued) Property Address: 174 Bristol Avenue - Hyannis, MA Owner: Joan Harrington Date of Inspection: June 22, 2001 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth'to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked, date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours maps I Checked with local excavators,installers-(attach documentation) - Accessed USGS database-explain: You,must describe how you established the high ground water elevation: The bottom ofthe leach field to grade was approximately 4'. Using the Barnstable topographic map and the water contours map, the maps were showing approximately 20'+/-to groundwater at this site. I . This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report. 11 TOWN OF BARNSTABLE ('• 6 U �APOt: B IJ����ll'l� SEWAGE # -�v 2 VILLAGE /f Ze_,Vd`5 ASSESSOR'S MAP & LOT Z9/`D�✓`� INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACII.ITY: (type) d �� '/fg���s (size) NO.OF BEDROOMS c3 BUILDER OR6� 70alY PERMITDATE: �" 2�—�I COMPLIANCE DATE:4S,/_ff_ Separation Distance Between the: i Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet I Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by ;�v ,�, N � � � i ` 1 ` m N � �' t �1 � . �C © O S t �. ,� �4 -.-- - -� � � t I _ � J � _ No. — "' Fee THE-COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ye PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE. MASSACHUSETTS Zipplication for �iqu al 6potem COtt�trurtton Permit Application for a Permit to Construct( )Repair(t')Upgrade( )Abandon( ) Complete System El/individual Components Location Address or Lot No. J 7 L f ��f���/�� Owner's Name,Address and Tel.No. Assessor's Map/Parcel ` ` ( / ��Q� r� �4� Installer's Name,Add ss,and Tel.No. Designer's Name,Address and Tel.No. Add Go1 Go�r�s/7 Type of Building: 7 Dwelling No.of Bedrooms cJ Lot Size sq. ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow /l,�2 gallons per day. Calculated daily flow gallons. `S Plan Date Number of sheets Revision Date \ Title Size of Septic Tank ��® �X�57`�Q Type of S.A.S. Description of Soil �t Z$�� Z �Ows O 3 Nature of Repairs or Alterations(Answer when applicable) I—/e �1� 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 bMSO- HealtSignedDate // Application Approved by Date 2 Application Disapproved for the following reasons Permit No. Date Issued —--------- --- sv. No. lt?�-ZRVCOMMONWEALTH OF MASSACHUSETTS Entered in computer: ye PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zlpplication for )Di!5po9;al 6potem Cong4rurtton Permit Application for a Permit to Construct( )Repair( /)Upgrade( )Abandon( ) D Complete System t /Individual Components Loc�tion Address or Lot No. Owner's Name,Address and Tel.No. 17 y Al',,5;X1 lel-e Assessor's Map/Parcel Joaly ell Installer's Name,Add ss,and Tel.No. Designer's Name,Address and Tel.No. �/: 6,40Ks/7' 77/-i�Y Type of Building: Dwelling No.of Bedrooms ✓ Lot Size sq. ft. Garbage Grinder Other Type of Building. No. of Persons Showers(_ Cafeteria( Other Fixtures Design,Flow gallons per day. Calculated daily flow el gallo ns. Plan pate Number of sheets 'Revision Date Title Size of Septic Tank 1Ov -Type of S.A.S. Description of Sod 7- Natuire of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: "Thd dnaersigned 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 b( is o Nl- 7�1,M,t�� 2f Signed Date Application Approved by Date Application Disapproved for the following reasons .-Permit No. Date Issued ---————— - ————————————————————————-------- - THE COMMONWEALTH OF MASSACHUSETTS 2(7/49 BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY that th On-sJte Sew Disposal System Constructed Repaired ( Upgraded _Age Abandoned by ce,45,>t at 1,5 le/ 9 4-r jS has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer The issuance of this peT/s 1 h 11 nolA, e 4 nstrued as a guarantee that the sy2!jtemtwiI1 function aslys gn-e Date A Inspector r I No. ' - ————————————————————---— Z?/ �3 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Miqozal 6pelem Conttruction Permit Z Permission is hereby granted to Construct Repair a )Upgrade( )Abandon System located at 17.q and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of th&t.- it. Date: Approved by - ell- .ter. NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) / �0� 107hereby certify that the application for disposal works construction permit signed by me dated /�Z�/�� , concerning the property located at 0 4/ fd Z Q'Ue /�j�Qi�Gl%S meets all of the following criteria: l/ a soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. There are no wetlands within 100 feet of the proposed septic system There are no private wells within 150 feet of the proposed septic system There is no increase in flow and/or change in use proposed ,�,o/There are no variances requested or needed. The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor rgethod when applicable] l•/ If the S.A.S.will be located with 250 feet of any vegetated wetlands,the bottom of the proposed , leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) <a B)'Groundwater Table Elevation Z 0 max,adjusted g.w. Z l = Z Z. DIFFERENCE g SIGNED : DATE: [Sketch proposed plan of system on back]. , F ,'t •w�_r 'n4 r Q:buM folds:oat 44, 2,6 IX Z- TOWN OF BARNSTABLE � Isr�'��' SEWAGE # 9Y- Z LOCATION I7y VILLAGE 1�7�Q��/5 ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. Bdl tB / 4"dr. 2r' SEPTIC TANK CAPACITY LEACHING FACILITY: (type) d j -5 (size) NO.OF BEDROOMS 3 BUILDER OR6" PERMTTD �9 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 Feet within 300 feet of leaching facility) Furnished by i 2 0 zF T— t. I �93 ) COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION r MAP ' PARCEL, Q � LOT TITLE 5 OFFICIAL INSPECTION.FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address:. Owner's Name: ry Owner's Address: `�" h��y Date of Inspection: NOV 13 2003 Name of Inspector• please pr'nt) �4) ,, T(" r r 7n.���o1 F Company Name. ' ..., Mailing Address: a2n Telephone Number: 6 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the:inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: V Passes Conditionally Passes Needs.Further Evaluation by the Local Approving Authority a'Is Inspector's Signature: Date: / O_? 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 ofthe DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approvi.ng authority. Notes and Comments ��`-ZL4`b ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will.perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page I Page 2 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: /Ov 'Owner: Date of Inspection: �3 Inspection.Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A:lystem Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally 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 Conpliance indicating that the tank is less than 20 years old is available. ND explain: Observation of-sewage backup or breakout or high static water level in the'distribution box due to broken or obstructed pipes)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken�)ipe(s)are replaced obstruction is,removed distribution box is leveled or replaced ND explain: The system required pumping more than'4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health):. broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 1*1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: f 9 Q Owner: Date of Inspection y 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,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any)determines that the system is functioning in a.manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100.feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates.:that the well.is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A•copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 11 OFFICIAL,INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: / / Owner: Ali f Date of*spectlion �) D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to'each of the following for all inspections: Yes N/� 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 �J 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 Required pumping more than c times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped _ V 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. V Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is within 50.feet of a private water supply well. Any.portion of a cesspool or privy is less than 100 feet but.greater than 50 feet from a private water supply well-with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from.pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen.is equal to or less than 5 ppm,provided that no other failure criteria rg� are triggered. A copy of the analysis must be attached to this form.] �v U (Yes/No)The system fails. I have cetermined 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• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large.systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply — the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered yes in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 1.1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION"FORM . . PART CHECKLIST Property Address: S 1 Owner• Date of nspection: Check if the following have been done. You must indicate`Yes"or"no"as to each of the following: Yes o 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? v _ Were the septic tank manholes uncovered,opened;and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of.liquid,depth.of sludge and depth of scum? Was.the facility owner(and occupants if different from owner provided with information on the proper . maintenance of subsurface sewage disposal systems ? The size and location of the Soil-Absorption System-(SAS)on the site has been determined based on: Yes ino Existing information.For example, a plan.at the Board of Health. Determined in the field(if any of the failure criteria relat4to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] 5 Page 6 of 11 OFFICIAL INSPECTION-FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGEDISPOSAL SYSTEM INSPECTION FORM PART C . SYSTEM'INFORMATION w Property Address: Owner: Date of Inspection: �j FLOW C NDITIONS RESIDENTIAL✓ Number of bedrooms(design):-- Number of bedrooms(actual): 3 DESIGN-flow based•on 310 CMR 15.203 (for xample: 11:0 gpd x#of bedrooms): .-Number of current residents: Does residence'have.a garbage grinder(yes or no s-eeot.-2e, Is laundry on a separate sewage system (yes--or-no P separate inspection required) Laundry system inspected(yes or no): Seasonal use: (yes or no) Water meter readings, if available(last 2 years usage(gpd)):© 1 Z?M0 Sump pump(yes or no): Last date of occupancy: COMMERCIAL/INDUSTRIAWtti- Type of establishment: Design flow.(based on 3.10 CMR.15.203): gpd Basis of design.flow(seats%persons/sgft,etc.): . .. Grease trap present(yes or no): Industrial waste holding•tank present(yes or no): Non-sanitary waste discharged to the Title 5 system'(yes or no):-_ Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source•of information:Y�/ f�xlvqe, 't6,1 /I At Was system.pumped as part ofth inspec ' n(yes.orno)° If yes, volume pumped: gallons-`'How was quantity pumped determined? Reason'for.pumping! TYP7iOF SYSTEM Septic tank, distribution box,soil absorption system _Single cesspool _Overflow cesspool _:Privy ' _Shared system.(yes or no)(if yes,attach previous inspection records,if any) Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy'of the DEP.approval Other(describe): roxi ate age afall c m one ts, ate ins ]led °f kn f fmtio ' n:pd Weresewage odors-detected when arriving.at the site(yes'or • �no -- 6 Page 7 of l 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C (/ SYSTEM INFORMATION(continued) Property Address: Owner: Date of nspection: a BUILDING SEWER(locate on site plan)' Depth below grade: Materials of construction:_cast iron 40 PVC—other(explain):. Distance from private water supply well or suction liner Comments(on condition of joints, venting,evidence of leakage, etc.): SEPTIC TANK: V Nate on„site an Depth below grade, ' Material of construction: ✓oncrete_metal_fiberglass polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a.copy of certificate) Dimensions: �� SC b` x Sludge depth: �rr `► Distance from top of sludge to bottom of outlet tee or baffle: 8 Scum thickness:/ o �r Distance from top of scum to top of outlet tee or baffle: Z ,r Distance from bottom of scum to bPdatiod, of outlet tee orb ffle' How were dimensions determined Comments(on pumping recomme inlet and outlet tee or baffle condition,structural integrity, liquid levels ,s related to outlet invert, evidence of leakage,etc.)`. rr it GREASE TRA�ocate on.site plan) L ' Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels 'as related to outlet invert,evidence of leakage, etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY,ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 9V Owner: A4 Al Date of Inspection: ?J TIGHT or HOLDING TANK:/ (tank mist be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete m--tal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments (condition of alarm and float switches, etc.): DISTRIBUTION BOX:.—Z(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of lakage into r out of box, et .): i � 1 PUMP CHAMBER,:���'(locate onsite plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber;condition of pumps and appurtenances,etc.): 8 Page 9 of H OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: A Owner: Date of nspection: SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type leaching.pits,number:_ 1 aching chambers,.number: leaching galleries,number: leaching trenches, number, length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil;condition of vegetation, ALL CESSPOOLS-,anr-(cesspool must be pumped as part of inspect ion)(]ocate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.): PRIyyi t,1_"(locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): 9 Page 10 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: {,�Q a Owner: Date of spection: 3 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. I i 1 3 tiq L01 10 Pace 11 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C . SYSTEM INFORMATION(continued) - Property Address: Owner Date of nspection:Z&Ea3 SITE EXAM Slope Surface water Check cellar Shallow wells / Estimated depth to ground water ` Z feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked, date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators, installers-(attach documentation) Accessed USGS database=explain: You must describe how you established the high ground water elevation: 11 i � • Permit Number: .__/Date Completed by: (yw` HIGH GROUND-'WATER LEVEL COMPUTATION Site Location: /. rS l (/� Lot No. Owner: /�' j��j/J�/` b fO ,ddr'ess: � ��s Contractor: / Address: Notes.: STEP 1 Measure depth to water table to nearest 1/10 L. .......................... ... _ . ..................:..............:...... .�...; .Date month/day/year i STEP 2 Using Water-Level Range Zone _ and_1ndex WTI•Map locate ,. site and determine: A Appro.priate index well...................:..... . 1..'!'�-• l�vi/ L-- OWater-level range zone .....................................................................................:...... S I EP 3 Using monthly report "Current Water Resources Conditions" determine current depth to I • � wa.tar level for index well .......:•:..... /Q 032 L1,15- month/year STEP 4 Using Table of 1Nater-level Adjustments for index well (STEP 2A), current depth to Water level for index.well ('STEP 3), 'and water-level zone (STEP 2B) determine water-level adjustment•................ .:................................... . 'STE P 5 • Estimate depth to high'water by subtracting the water- .'level adjustment (STEP 4) rom me•asured'de'pth to water level at site (S•T EP 1)'.:....__... ............................. ................. 6, 7 Figure 13,Reprcducible computatio�i fern. . , ------_ . :� .�,4 -> • .�•. ��--�� �; .�O �----- 1 i ( � ' . � �. - �. . � a . � ----. � . � i . .' 1 � � � . • ! t � i ( � � i ��� ; � 3 �`' E]] 6� i 1� �. 1 . . �l� .. � .:--;� ��;}i 3j � � i • � � e � � . !.: �, ":h ----�•-t �.-� � � � ; �� i \` � �r i � � } �� i � �. � � � �� �l � � ;�� TOWN OF'BARNSTABLE S7c'j1;��,9,,0-aia�o SEWAGE # 9/0<' VILLAG,- ASSESSOR'S MAP & LOTr191-O9S" INSTALLER'S NAME PHONE NO. (?OnSP SEPTIC TANK CAPACITY /DCo 00 LEACHING FACILITY:(type)// 7:' NO. OF BEDROOMS -- -P-RIVATE WELLI�;PUBLIC WA R BUILDER O WNER 1 DATE PERMIT ISSUED: OLS DATE COMPLIANCE ISSUED: "' ^- ' VARIANCE GRANTED: Yes No .i Y .a 1 T No.. � `_ ...�0.�....... F$s. APPROVEDNCO,gM,O.NWEALTH OF MASSACHUSETTS Barnstable Conservation Department BOARD OF HEALTH S�=S OWN OF BARNSTABLE Bea .�1��ltPttfiJt�li �Ur �i�i�Ili�i��'��11xIt5 �d1flt��rlgrftitti �Prl2ttt Application is hereby made for a Permit to C•OIISt,aCt,( ) or Repair Y an Individual Sewage Disposal System at: 7 ...........................------•---------------...----•-- �VnJ�.s .,r._ '4.. ......!�Ikj 1.------........----- � Address/ j /�� � �+ �/e- or Lot_Ng. �1t./ is --------------_...................------... .................................. ----------------------------------- ....... �JJ/VJ ............................. - Address a (.sue GOn► �i 7�r.1 `7 "� W y � 174 M/u.S M04- -------------------•-------•----------..._....-•------------•------------------------------------- --------------------------•---•---............/ ,t............. Installer Address go Type of Building Size Lot............................Sq. feet ,. Dwelling—No. of Bedrooms.......................1:3 ..................... Attic ( ) Garbage Grinder ( ) aOther Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 04 Other fixtures ............................... . .. . W Design Flow.................� .................gallons per person per day. Total daily flow........� �_......................gallons. a Septic Tank—Liquid capacity/. ...gallons Length................ Width---------------- Diameter................ Depth................ W p g -�.... Total leaching area....................sq. ft. x Disposal Trench—No. ................... Width.._....�_____.. 1 otal Length Seepage Pit No..................... Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 0* Percolation Test Results Performed by.........................•-------•--------------------------------------_. Date........................................ ,.� Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ tX4 Test Pit No: 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 •----------------------------------•---------------•....------------------------•----....-••-•-...........--•---••----...................------••-•---••----- ODescription of Soil........................................................................................................................................................................ ••- --------------------------------------------------------------------•--------------•----------•----------------------------...------------------------------------------------------------.......-- U Nature of Re airs or Alterations—Answ r when applicable...L..._..�� A .....e*a41M! t_.......__. .�� ..... G ..,......... ......� --.__r. , ;L ,�- --•- "�/��" ' ...................... .... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code —The undersigned further agrees not to place the system in operation until a Certificate of Complian ha bee i ued the board of health. Signed ..... .......................... :...... .. ..................................................... ......... .. ... Application Approved `.. �y�J� c fir"'r—. , ........................................... ................Dare................. r the following seasons:Application Disapproved fo h fo g ....................................................................................................................................... ................................................................................................................................................................................................................ ........................................ Permit No. .... .....'.' .�?............................. Issued ......... ►. . .. Dare 1 _ i I ' Fa ......................... THE COMMONWEALTH OF MASSACHUSETTS /J BOARD OF HEALTH 1) ->S -SYTOWN OF BARNSTABLE Appliratinn for Di►ipwial Worli5 Tomitrnr#inn 1prmit Application is hereby made for a Permit to Construct ( ) or Repair O an Individual Sewage Disposal System at: ..../7 y ----------------_..__....._...._ ,�� i7an....I.s.................... ddr -- -•-• ......................................... Location-:\ddress .............. l--r�lZ/LI r�J !ZJN �� ;G 'tr.3:ZiC. �r % r►,dlS ..............._....-•-•---- ---•--....-•----••------•- •-----------... ................................................ .. .... ------.........�.........----- // �..t�� .. .........1.....,..... W fly f[/�.I I I / Otcncr 7 ✓V/��7 I�.i! [� r I/ �� , /Y i'T (�/�,n,r U C 7i r 6>� /�� Address a -•----•----•----••-------•--•--•--•-.....---••-------••-----------••----•--•------••-•--•--•-•---- -•-•--•------------•---...-•-------••----------------• ---------•------••-------- Installer T. .... Address UType of Building Size Lot............................Sq. feet a Dwelling—No. of Bedrooms............... •--•---_--_--__-.--Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) QOther fixtures --------------------------------------------------------------------------------------- -----•---•-•--•--•------------......•--•-••-•••-------...---- W Design Flow........................�......:__..___..-.gallons per person per day. Total daily flow.._.........................................gallons. x Septic Tank—Liquid capacitvZtkk�__-gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No. ......../...___.. Width....... L-ength...� _1.... Total leaching area....................sq. ft. 3 Seepage Pit No..................... Diameter.................... Depth below inlet........:........... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank (L ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fT. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0 9 ---••--••--•-•--•...............••---••--•--•--•.......•---•-•-••---••-••••-•-•-•--•....------........_............•---.....---.........................----- Description of Soil........................................................................................................................................................................ W V ......................................................... ••----...-----••------•-•--•---------•-••---••-•-•...............•-•••...---••-------•-•--.....-•-•----.............----........-------------- W x ••-•--••-•••...-•--•--------••-----•-•••------••••-•-•.......................•••-••----•-•--•---•----•••-••••---•-••._.......--•...•----•-•----••••••-•••-••-•--••----••---....-----•---................ U Nature of Repairs or Alterations—Answer when applicable...l_ ti-..._ .._...!U ................./= �....._..._.. !f �- (: ..:........G- 7......... .......'�c.'�......�/!Ur_/....zz Cs....._�''���%�.-.-- -�tD?�Z •...............••.............._.......... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee is uedd by,the board of health. (-:± Signed .....1...:..`............`...� ....... T. ............................................... �_ .... Application Approved B�y�........... !- - .. ...... ��4 ...................... .................. .! .... -.DaeApplication Disapproved for the following searonr: ........ ............................ V......................................................................I...................... ................................................................................................................................................................................................................ ........................................ PermitNo. ............ ......... ... .............................. Issued ...........a................ Date --------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (WITL>ertifirate of C�omplianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by ................................................-.......................................................... ........ .. ....................................................................................------............................ " ..h,tau�a / .y.............-%.�CIS.G L .. .V .............. :y �J1V!5...1../L1�4:...: .............. a[ ...................:.......................................... y. has been installed in accordance with the provisions of TITLE of The State Environmental Code as described in the application for Disposal Works Construction Permit No. 4f . ..e,I........ dated ,�.-'..�" .. �........ I�� THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. r DATE........ ............ .. ... .. ......... `> ....................... Inspector . .:.....> ...............5% %' ............................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE _.:'.. FEE........................ �in�rnnttl nrl;n �nn�tr�trtiun �rrntit Permission is hereby granted.............. .l-..:�:_..1��:�.�..........�.� ^i to Construct ( ) or Repair ( \41 an Individual.Sewage Disposal System at No................................................... `� l t ..f.. �:...''f!.V w_;.-------- //60ADAJ)4S.,). Street {// _ , as shown on the application for Disposal Works Construction Permi�N�,__%....__...�__ Dated....:^__...... r1 f -o j y Board of Health DATE -------------- .. ......................... j FORM 36508 HOBBS&WARREN.INC.,PUBLISHERS I SOIL TEST LOG DESIGN CALCULATIONS DATE OF TEST: DECEMBER 15. 2006 DESIGN FLOW: 3 BEDROOMS X 110 GPD = 330 GPO APPROVED SOIL EVALUATOR: DAVID D. COUGHANOWR. #461 SEPTIC TANK: 330 GPD X 2 DAYS = 660 GALLONS WITNESSED BY: DONNA MIORANDI. HEALTH DEPT. USE EXISTING 1000 GALLON SEPTIC TANK IF IN SOUND STRUCTURAL PERC NUMBER: 12437 CONDITION. IF NOT. INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED) TEST PIT I NO GROUNDWATER ENCOUNTERED DISTRIBUTION BOX: USE 3 OUTLET D-BOX. PARENT MATERIAL: PROGLACIAL OUTWASH SOIL ABSORBTION SYSTEM: A 24 Ft. x 12.5 Ft x 2 Ft LEACHING GALLERY CAN LEACH PERC AT 56 in - 2 MIN/INCH IN C SOILS Abot = ( 24 x 12.5 ) = 300 sf Asdw = ( 24 + 24 + 12.5 + 12.5 ) x 2 = 146 sf ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER Atot = 446 sf 41.05 (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING Vt 0.74 x 446 = 330.04 GPD 0-6 Ap SANDY LOAM 10 YR 2/2 NONE FRIABLE USE A 24 ft x 12.5 Ft. x 2 ft GALLERY. Vt = 330.04 GPD > 330 GPD REQUIRED 36.55 6-30 B LOAMY SAND 10 YR 4/6 NONE LOOSE 29.55 30-138 1 C MEDIUM SAND 10 YR 5/4 1 NONE ILOOSE L EA CHING GA L L ER Y 1000 GALLON SEPTIC TAW NO GROUNDWATER ENCOUNTERED OUTWASH USE SHOREY PRECAST 500 GALLON NOT TO DIMENSIONS AND DETAIL NOT TO TEST PIT 2 MIN/INCH IN C SOILS LEACHING DRYWELL lH-10 LOADING) SCALE L1SE EXISTING H-10 LNVIT SCALE ELEVATION CONSTRUCTION DETAIL DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER SEPTIC TANK IS TO BE PUMPED DRY (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING DRYWELL UNIT AT TIME OF INSTALLATION AND IS TO 41.00 S T O N BE EXAMINED FOR STRUCTURAL 0-8 Ap SANDY LOAM 10 YR 2/1 NONE FRIABLE 24.0 ft INTEGRITY. INSTALL NEW PVC OUTLET TEE EQUIPPED WITH A GAS BAFFLE. 38.33 8-32 B LOAMY SAND 10 YR 4/6 NONE LOOSE Q7c' 1 in 32-132 C MEDIUM SAND 10 YR 6/4 NONE LOOSE 0 `T' 4 TAPER 30.00 � W t!l N v�` N C �4 C p GROUNDWATER ADJUSTMENT o � EXISTING GROUNDWATER LEVEL 3.5 t 8.5 ft 8.5 ft 5 t (' lf) BASED ON TOWN OF BARNSTABLE 2 4.0 f t J,.. GIS DEPARTMENT RECORDS. m vo INDICATED GW 23.00 �, INDEX WELL A1W-230 500 GALLON DRYWELL 6 r£�J" Q ZONE D DIMENSIONS AND DETAIL READING DATE NOV. 2008 INLET OUTLET READING 24.6 1 H-10 LMT COVER COVER ADJUSTMENT 5.5 INSTALL ONE INSPECTION ADJUSTED GW 26.5 RISER TO WITHIN THREE sz+z .zz+ +„azG"2 x a'zz zzz.,:xa7 nzs•z f_ INCHES OF FINAL GRADE _ 3 IN � DROP AND INDICATE LOCATION Il FLOW LINE ON AS-BUILT PLAN FROM l0 to - 14 TO BUILDING D BOX • in 48 to J 33 NOTES LIQUID GAS 0O LEVEL BAFFLE moz Op 00 11 INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE STARTING WORK. 0000000p00o 40pp� In a00000000000 2) SEPTIC TANK TO BE PUMPED DRY AT TIME OF SYSTEM REPAIR AND CHECKED �0000 p vo CROSS SECTION VIEW FOR STRUCTURAL INTEGRITY. INSTALL PVC OUTLET TEE FITTED WITH GAS BAFFLE. I �0 3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REOUIREMENTS 1021n OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15). 4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES BEFORE EXCAVATING FOR SYSTEM. CROSS SECTION VIEW SEWAGE DISPOSAL SYSTEM PLAN 5) EXISTING LEACHING GALLERY TO BE ABANDONED IN PLACE. 2 in PEASTONE 2 In PEASTONE 6) ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON. FINES AND DUST IN PLACE. -TO SERVE EXISTING DWELLING o a 7) ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION OF LOW FLOW FIXTURES 28 �a,n ro EFFECTIVE TO 26 ANGELA SILV/� AND APPLIANCES. AND BIANNUAL PUMPING OF THE SEPTIC TANK. ln -�/z�oRA�L oEarH ���- � in 6) SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. DO NOT 174 BRISTDL AVENUE HYANNIS, MA PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM. 461n 581n 461n ECO-TECH ENVIRONMENTAL 9) SEPTIC TANKS SHALL BE INSTALLED LEVEL AND TRUE TO GRADE ON A LEVEL 150 In STABLE BASE THAT HAS BEEN MECHANICALLY COMPACTED AND ON TO WHICH INSTALLER MAY SUBSTITUTE AN APPROVED GEOTEXTILE 43 TRIANGLE CIRCLE SANDWICH MA 02563 SIX INCHES OF CRUSHED STONE HAS BEEN PLACED TO MINIMIZE UNEVEN SETTLING. FABRIC IN PLACE OF THE 2 In. PEASTONE LAYER SPECIFIED. ETE-3072 DECEMBER 16. 200E31 12121 HYANNIS. MA ' NOTES CONTOURS 1 EXISTING LEACHING GALLERY IS TO BE ABANDONED IN PLACE. EXISTING - - - - - - - 50 MINIMAL GRADING PROPOSED SNi E m r ' c R � EXISTING SEPTIC TANK IS TO BE PUMPED m�\ NPMP N\1E DRY AND INSPECTED FOR STRUCTURAL w INTEGRITY. REPLACE WITH 1500 GALLON \�F LOCUS UE 0o SEPTIC TANK IF EXISTING TANK IS FOUND , �. BEN F?� TO BE CRACKED OR STRUCTURALLY UNSOUND. oovw SYSTEM IS NOT DESIGNED TO WITHSTAND �<J m VEHICULAR LOADING. DD NOT PARK OR / i m N m�; m N DRIVE VEHICLES OVER SEPTIC SYSTEM. GARBAGE GRINDER NOT ALLOWED WITH THIS DESIGN. ALL EXISTING GRINDERS ARE TO BE u DISABLED AND/OR REMOVED. �P/ LOT \�e9� LOCUS M A P wa< J � NOT TO SCALE BENCH MARK Ln ui W 0� PAINT SPOT ON / ` 24 ft x 12.5 f L x 2 ft W d �r't ;} m (A w 3 p6• o 9;0-, Ir oo CONCRETE SUPPORT /0 LEACHING GALLERY �� awo c �J z -, w o0 ELEVATION = 41.66 �� \ / o J u z (A J r-i 3 rr �m BARNSTABLE GIS DATUM �� LEGEND LLJw} UJ -) Z �� �� ❑ JN o<= �� ��� �� EXISTIG o <z N < Or p z !v � 1000 GALLON m< W LU w / �� \ SEPTIC TANK w i o zQ :.,,•.,, _j CD v / �� UTILITY POLE $ �::::::• / TEST PIT ® D-BOX ❑ i- m c� ❑ :::::•: W DECIDUOUS CONIFEROUS Ww o_j X umi %�� I / TREE o-0o TREE lL WO W Z O (m0 [r_ m ti / d�b 12-M 12-P m Ln . ZIf n f1L I rr _ _ / , m4 -NUMBER REFERS TO DIAMETER IN w (n W m al / I ti INCHES. LETTER DENOTES TYPE. LL Z Z Q �..}-� / / 41 O-OAK M-MAPLE P-PINE C-CEDAR ui Lf x ow Czw cn Ila Z F Z W Z co(n(n ���0 O U z w m /� 0 j �� / o`' DAVID yGs o`' DAVID yes jWO 3 Z Z 9c. ,c�� �^ / m 4w o� D. o� D. w.Z o = �,� �6 04,V A�. COUGHANOWR " OUGHANOWRWO Z� m ti � No. 1093 �� cn O3 z m \ \ -9` Q� / �FG TE��o `�0����ENS���W Ld X O W N \ \"�'y O A R\P� Ali �vf � ��ewtbPr LG, Zg°� w f w W z z TE SEWAGE DISPOSAL SYSTEM PLAN ? -TO SERVE EXISTING DWELLING J o LL z -i LL o o �m F < ~ O/ F�c� SfZ) WA TER MF_TER ' EST. ANGELA SILVA O f J (n Ur U ` Q\w �` OWNER OF RECORD (� LL ° 11' m W Ay � � i �° 14 BRISTOL AVENUE LL O + W ���/�cni �\ �� q / ��i 1995 ��� PROPERTY ADDRESSIS. MA m vs, !� / GARBAGE GRINDER (�j FL N `�`\ \ �� IS NOT ALLOWED 43 TRIANGLE CIRCLE ASSESSORS MAP 291 PARCEL 95 v <\ 0i I SCALE: 1 In = 20 f't \ \ WITH THIS DESIGN. SANDWICH MA 02563 LAND COURT PLANS 14034 E & I Z \ 506 364-0694 rx � DATE DECEMBER 16. 2006 Ln w w Z0 0 Z0 I JOB #E T E-3 0 7 2 PAGE 1 OF 2 VERSION: 0 l0 20 THIS PLAN IS BASED ON AN INSTRUMENT SURVEY AND IS INTENDED SOLELY FOR INSTALLATION OF THE PROPOSED SEPTIC SYSTEM DEPICTED HEREON. FOR ANY OTHER CHANGES TO PROPERTY INCLUDING PLACEMENT OF ADDITIONS. SHEDS. FENCES OR SWIMMING POOLS. OWNER SHOULD CONSULT WITH A MASSACHUSETTS REGISTERED LAND SURVEYOR.