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0007 CARLA ROAD - Health
Lot 47 C:ARLA RD., HYANNIS A=248 - 209 I i Commonwealth of Massachusetts °?�� a05 :. Title 5 Official Inspection Form lI Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 Carla Road Property Address Beaulah Perry t Owner Owner's Name/ information is required for every Hyannis V MA 02601 09/30/2020, page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist.at the end of the form. Important:When filling out forms A. Inspector Information hit H 9 t 9 on the computer, use only the tab Michael T Bisienere key to move your Name of Inspector cursor-do not Cape Septic Inspections use the return Company Name key. 52 Rivers End Road Co Company Address Teaticket Ma. 02536 Alf City/Town State Zip Code r�on 508-280-3356 S13938 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 10/01/2020 In pector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts �v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7 Carla Road Property Address Beaulah Perry Owner Owner's Name information is required for every Hyannis MA 02601 09/30/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: This 2 bedroom home has an H-10 1500 gallon septic tank with a D-Box feeding 2 leaching chambers with stone. At the time of the inspection no visible failure criteria was found. 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts �v Title 5 Official Inspection Form r �I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ............. 7 Carla Road u— Property Address Beaulah Perry Owner Owner's Name information is required for every Hyannis MA 02601 09/30/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 c , Commonwealth of Massachusetts -. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 Carla Road V Property Address Beaulah Perry Owner Owner's Name information is required for every Hyannis MA 02601 09/30/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and.soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due town overloaded or clogged SAS or cesspool t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form pig Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 Carla Road u— Property Address Beaulah Perry Owner Owner's Name information is required for every Hyannis MA 02601 09/30/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. El Z Any portion of a cesspool or privy is within a Zone 1 of a public water supply well ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CM 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a' design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts �v itifp Title 5 Official Inspection Form 11 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �.� 7 Carla Road Property Address Beaulah Perry Owner Owner's Name information is required for every Hyannis MA 02601 09/30/2020 - page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no" for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts �v Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c � 7 Carla Road Property Address Beaulah Perry Owner Owner's Name information is required for every Hyannis MA 02601 09/30/2020 page. Cityfrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 2 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 plus GPD Description: Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage town water 9 ( Y 9 (gpd))� Detail 2019 to current the home has used 101 units of water. Sump pump? ❑ Yes ® No Last date of occupancy: occupiedDate t5insp.doc•rev.7/26/20181 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts w ,p Title 5 Official Inspection Form yI Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ............. 7 Carla Road Property Address Beaulah Perry Owner Owner's Name information is required for every Hyannis MA 02601 09/30/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per d P Y(gP ) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 c Commonwealth of Massachusetts e Title 5 Official Inspection Form �1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7 Carla Road Property Address Beaulah Perry Owner Owner's Name information is required for every Hyannis MA 02601 09/30/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 2000 per site and septic plan obtained from health department. Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): 21 Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: town water feet Comments (on condition of joints, venting, evidence of leakage, etc.): Water was flushed and came freely. l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts �� ,tip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 Carla Road u Property Address Beaulah Perry Owner Owner's Name information is required for every �H annis MA 02601 09/30/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 12"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: H-10 1500 gallon 2" Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 34" 1 Scum thickness Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? sludge judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): I recommend the new owner put the septic tank on a maint. plan with a local septic pumping co. based on the future use of the home. At the time of inspection the liquid level was at working level and the tee's were in place. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 f Commonwealth of Massachusetts p Title 5 Official Inspection Form �i; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 Carla Road Property Address Beaulah Perry Owner Owner's Name information is required for every Hyannis MA 02601 09/30/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 -7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 Carla Road Property Address Beaulah Perry Owner Owner's Name information is required for every Hyannis MA 02601 09/30/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: AI rm i aa n working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): ' Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site.plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): At the time of the inspection the liquid level was at working level and there were no visible signs of leakage or solids carryover. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 r- Commonwealth of Massachusetts �v a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u— 7 Carla Road Property Address Beaulah Perry Owner Owner's Name information is required for every Hyannis MA 02601 09/30/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: Two ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments h 7 Carla Road Property Address Beaulah Perry Owner Owner's Name information is required for every Hyannis MA 02601 09/30/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): :) At the time of the inspection no visible failure criteria was found. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No i Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form + iie Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 Carla Road Property Address Beaulah Perry Owner Owner's Name information is required for every Hyannis MA 02601 09/30/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev:7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 < Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7 Carla Road Property Address Beaulah Perry Owner Owners Name information is Hyannis MA 02601 09/30/2020 required for every Y page. Cityrrown State Zip Code Date of Inspection D. System Information (cons.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below E] drawing attached separately A B - o A B Oz Oi 1 48' 13' 2 39' 18' 3 48'8" 27' 3 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 r Commonwealth of Massachusetts �v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7 Carla Road Property Address Beaulah Perry Owner Owner's Name information is required for every Hyannis MA 02601 09/30/2020 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 10 plus feet feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: I augered a hole at a lower elevation and shot it with a transit. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 Carla Road Property Address Beaulah Perry Owner Owner's Name information is required for every Hyannis MA 02601 09/30/2020 page. CitylTown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included l5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7 Carla Road Property Address Kenneth and Rosemary Curry Owner Owner's Name information is required for every Hyannis MA 02601 October 29, 2012 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information _ on the computer, '^ use only the tab 1. Inspector: J key to move your cursor-do not David D. Coughanowr, R.S. use the return Name of Inspector key. Eco-Tech Environmental Company Name 43 Triangle Circle Company Address >;. � Sandwich MA 02563 V' City/Town State t Zip Code'''' 508 364-0894 1328 � Telephone Number License Number F E--J 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 Z�• �/ October 29, 2012 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. V t5ins-11/10 Title 5 Official I act roForm:Subsurface Sewage Disposal System•Page 1 of 17 .. _.. ._.. . . ... . Commonwealth of Massachusetts W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 7 Carla Road Property Address Kenneth and Rosemary Curry Owner Owner's Name information is required for every Hyannis MA 02601 October 29, 2012 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Inspector's Note==> The septic system described herein is deemed to pass this Real Estate Transfer Inspection if it does not meet any of the failure criteria enumerated in Section D on pages 4-5. The scope of this inspection is limited to health and environmental compliance and the septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. B) System Conditionally Passes: ❑ One or more system componerts as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank:is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 7 Carla Road Property Address Kenneth and Rosemary Curry Owner Owner's Name information is required for every Hyannis annis MA 02601 October 29, 2012 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts f W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7 Carla Road Property Address Kenneth and Rosemary Curry Owner Owner's Name information is required for every Hyannis MA 02601 October 29, 2012 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 7 Carla Road Property Address Kenneth and Rosemary Curry Owner Owner's Name information is required for every Hyannis MA 02601 October 29, 2012 page. Citylrown 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ° 7 Carla Road M Property Address Kenneth and Rosemary Curry Owner Owner's Name information is required for every Hyannis . MA 02601 October 29, 2012 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? ® ❑ 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): 2 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 gpd t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7 Carla Road M Property Address Kenneth and Rosemary Curry Owner Owner's Name information is required for every Hyannis MA 02601 October 29, 2012 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ® Yes ❑ No Water meter readings, if available last 2 ears usage d n/a 9 ( Y 9 (gP ))� Detail: Water Department records have been unavailable for the past two days due to technical problems. Sump pump? ❑ Yes ® No Last date of occupancy: 1 month agoDate 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 7 Carla Road Property Address Kenneth and Rosemary Curry Owner Owner's Name information is Hyannis MA 02601 October 29, 2012 required for every page. Cityrrown 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: owner's agent Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was Y uantit pumped determined? q 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 7 Carla Road Property Address Kenneth and Rosemary Curry Owner Owner's Name information is required for every Hyannis MA 02601 October 29, 2012 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: 11+ years. Certificate of compliance for new system was issued 11/13/2000.(Permit#2000-583 at Health Dept). Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 3 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 line appears structurally sound with no evidence of leakage or backup into dwelling. Septic Tank(locate on site plan): Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No ' Dimensions: 10.5 x 5 x 6- 1500 gallontank Sludge depth: 2 in t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 7 Carla Road Property Address Kenneth and Rosemary Curry Owner Owner's Name information is required for every Hyannis MA 02601 October 29, 2012 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 32 in Scum thickness 0 in Distance from top of scum to top of outlet tee or baffle 10 in Distance from bottom of scum to bo_tom of outlet tee or baffle 14 in How were dimensions determined? Design plan Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping is not required at this time. Maintenance pumping is recommended every 2-4 years. Tank and tees appear structurally sound and functioning as intended. 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 7 Carla Road Property Address Kenneth and Rosemary Curry Owner Owner's Name information is required for every Hyannis MA 02601 October 29, 2012 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 t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 Carla Road Property Address Kenneth_and Rosemary Curry Owner Owner's Name information is required for every Hyannis MA 02601 October 29, 2012 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet iivert at 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 appears structurally sound with no evidence of leakage in or out. Few solids in sump. 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•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 7 Carla Road Property Address Kenneth and Rosemary Curry Owner Owner's Name information is required for every Hyannis MA 02601 October 29 2012 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.): Soils above leaching gallery appear unsaturated. No evidence of surface ponding, breakout, lush vegetation, or other evidence of hydraulic failure was observed. An observation hole was dug into leaching gallery stone and no effluent contact staining was observed in the stone or overlying soils. No standing effluent was observed to a depth of 1 feet below the top of the peastone layer. 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 7 Carla Road Property Address Kenneth and Rosemary Curry Owner Owner's Name information is required for every Hyannis MA 02601 October 29, 2012 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.): l5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal Sys.em-Page 14 of 17 Commonwealth.-of Massachusetts r Title 5 "official l s_"p a�r� 'F®rim Subsurface Sewage Disposal.System Form Not,for Voluntary Assessments 7 Carla Road Propeay.Address' _ Kenneth and Rosemary Curry Owner me Own Na -- information'is requimcilorevery, Hyannis MA 02601 October,2% 2012 page: GitylTown. ;State *Zip;code Date of=Inspection' D "System Information {,coat.} Sketch Of Sewage'Disposaf;System. Provide a�view,.of thesewage disposal system, including ties'to at least`two permanentreference landmarks or benchrnarks Locate all wells within 100 feet., Locate: where,public wat&" "'ppI- Onters"#he building:Check one of the boxes'below hand-sketch in:the area,below [) .drawing attached separately f 4;6 27 PTa e �7 151ns v 11J1D Ti11e 5 Official,Inspection Form:,Sub Oka Sotvago Disposal System?Page'15 or17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 7 Carla Road Property Address Kenneth and Rosemary Curry Owner Owner's Name information is required for every Hyannis MA 02601 October 29, 2012 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: 10/5/2000 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you estab ished the high ground water elevation: Approved design plan on file with tie Board of Health shows bottom of system to be 8.25 feet above the bottom of a witnessed test pit in which no water or groundwater mottling was encountered. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M017 Carla Road Property Address Kenneth and Rosemary Curry Owner Owner's Name information is required for every Hyannis MA 02601 October 29, 2012 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 I (Sins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 FEE Board of Health, �XAC14USETTS -_. , MA. APPLICATION FOR DISPO SAL SYSTEM CONSTRUCTION PERMIT V Application for a Permit to Construct(- Repair( ) Upgrade( ) Abandon( ) lsl-Complete System ❑Individual Components Location Lot C oc ktA (zd W� _ Owner's Name Map/Parcel# Ao Address Lot# Telephone# Installer's Name G tfj Designer's Name A PL-ee So.,Ve ( Uc ,,W 4"VS Address Address es *" LJ� VZW M f Le, Telephone# Telephone# OO Type of Building Lot Size /0/�® sq.ft. Dwelling-No.of Bedrooms to A-v 1 u m Garbage grinA/0 Other-Type of Building No.of persons Showers ( ),Cafeteria( ) Other Fixtures Design Flow (min.required) as 0 gpd Calculated design flow a® Design flow provided gpd Plan: Date A- 1 7-430 Number of sheets Revision Date Title 5 !J-e- $ S`e,7f,L ✓J L A N ' Description of Soil(s) 5r'Y � t�4,V Soil Evaluator Form No. l✓7 /ate ! Name of Soil Evaluator Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrge o not place_the syste ,in o ra'on un ' a Certificate of Comp' cce has b en issued by the Board of Health. Signed s/'%; Date f �� Inspectio ,��1 ..a •tY!' _ -..::.Y {-'ti_++a-�-." s. .....'y.!'^y s. ♦ r• ' FEE l COMMONWEALTH OF M SAC14USETTS -� Board of Health, a.r k, MA, APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application'for a Permit to Construct('Repair( ) Upgrade( Abandon( - MI omplete System ❑Individual Components l s Location Lot 6A /Zc1 v lb ' 0 Owner's Name Map/Parcel# Address �'^^t 1� a'ie /rK Lot# ,^ Telephone# Installer's Name Re/0 (p ,o/S % Designer's Name S i`lq PI,�i/kPP u/VP_ C�C/1n SuC �- Address Address 1(o/8 A, C� 9p, / 1Pw S twN M I te- Telephone# Telephone# 00 $" Type of Building Lot Size /0J 00® sq.ft. Dwelling-No.of Bedrooms m 6l V'M ' Garbage grin /0 y Other-Type of Building No.of persons Showers ( ),Cafeteria( ) i Other Fixtures t Design low(min.required) vZo1 d gpd Calculated^design flow a0 Design flow provided `/ gpd Plan: Date o,` 1 —00 Number of sheets a Revision Date Title 5 t t o A A N ' "\Description of Soil(s) St-t t�6Qq►h-t""^ •- - Soil Evaluator Form No. �Vay ! Name of Soil Evaluator Date of Evaluation S DESCRIPTION OF REPAIRS OR ALTERATIONS i The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further afire Ito not to place the system m oger 'on until a Certificate of Compliance has-bWn issued by the Board of Health. Signed %1' Date i Z Z/vl Inspectio�4' b No." FEE C-OM ONWLALT14 OF MASSACHUS ETTS Board'of Health,), J WCOC--�IV' MA. CERTIFICATE OF COMPLIANCE Description of Work: ❑Individual Component(s) :complete System The undersigned hereby certify that the Sewage Dispo 1 System; Constructed ( ),Repaired ( ),Up graded ( ),Abandoned ( ) by. (�tlGt l(vt@ c�+Gt•wrw� l/ "/ d fi v vdr�-i--, _ at L°T- 1.7/7CAK(-4 X O!q ( NyC.r?h i has been installed in ac/cordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. dated �°° /dA� oved Design Flo 3 (gpd) a Cf Installer c �1 7�- Designer: )LAwk--e, J�✓Ue lwtS j(-TGQ�J7nspector: yr � f✓ te: The issuance of this permit shall not be construed as a,guarantee that the sy tie �i will function as designed. No. FEE . I . COMMONWEALTH OF MASSAC14USETIS Board of Health, MA. �. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted b; Construct(L< Repair( ) Upgrade( ) Abandon( ) an individual sewage disposal system at LOB �-7 ! d IA LA R6'4 as described in the application for r / Disposal System Consw4ction Permit No. 3 ,dated 7 ZrkJJ Provided: Construction shall be completed within three years of the date of th!'§permit. All local conditions conditions must be met. Form 1255 Rev.5/96 A.M.Sulkln Co.Boston,MA Date/D� oard of HealthL. Sent By: Yankee Survey; 1 508 420 5553.; May-11 -01 10:30AM; Page 1/1 IfIFTIC SYSTFAf INSTI-ILLLD BY AR( ) v A 0 Zj T, J 4' 0 `3 0 HISPRS ON DISYRIEUTION ROX t1 cam_ AND Ll4,AC7/fAr(,-' UNITC), 14 7 'A jZ1 2 RFDROOM-Sy UN LOT 7 CA HIA HOA D LOT 47 HYANN7.5 ARX57TABLE), MA. 5:62TIC TIES Al 1,Y. 5 Hl 46.1 A2 18. C5 3R2 D2 2 R3 48. 8 A4 "29. 3 R4 56, 3 A5 37 2 H5 = 571 noon -Ioxe .57-117-l110" CERTIFICA '170AT HAS ZoArF: 0" PT REF-165141 .4ogF-FV- IV I ClRFIFY TUAT ME ABOVE YANKEF SU Y CR VT .70A7,50LYANYS SEPTIC 5Y57Y2,M P-5 LO CA TEE P. O. BOX 265 ON THE GPO IND AS SWOWIV UNIT 1, 40 WDITS'TRY' ROAL) AND IS lNS7A1,1,A'V /,V VA f 6TONS AM. 0,?648 SUB.57AN7111L COMPLIANCE 7LL- 4Z-'8 0055 WITH DRSIC, '1AV hsl `0 5C 52rF1 Y,- Iv . . . 0A /00 NUMBER— SE,P I , Jane Kosciuczyk of 3 Beach Plum Circle, Sandwich, MA 02537 , for coir-ideration paid in the amount of Sixty Five Thousand Dollars.($65,000,00), grant to Kenneth M. Curry and Rosemary A. Curry, husband and wife as tenants by the entirety of 350 Lincoln4koad, Worcester, MA. 01605, STReer with quitclaim Covenants, the land in Barnsiable (West Hyannis) Barnstable County, Massachusetts and being Lot 47 and-.' Parcel.B combined with said Lot 47, as shown on the "Plan of Land West Hyannis, Mass." by Paul R. Johnson, Surveyor, dated December 9, 1977, recorded with the Barnstable County Registry of Deeds as Plan 319-73, and bounded and described as follows; NORTHERLY by the southerly boundary of Carla Road, so called, there measuring 90.54 O feet; r IQe EASTERLY by Lot 48 shown on said plan, measuring 73.52 feet; SOUTHEASTERLY by Lot 46 shown on said plan, 106.65 feet; SOUTHWESTERLY by the easterly boundary of Carlota Avenue measuring on an arc 99.37 feet; and NORTEASTERLY on an arc at the intersection of said Carla Road and Carlota Avenue measuring 34.01 feet; Containing 10698 square feet, more or less. Said premises are conveyed subject to easements and restrictions of record, if any there be, and subject to the provisions of a document heretofore recorded and entitled "Restrictive Provisions" dated November 16, 1970, to which the grantee, by there acceptance hereof, covenant and agree for themselves, their heirs, executors, administrators and assigns to conform. This conveyance is also subject to the taking by the Town of Barnstable for the widening of said Carla Road and Carlotta Avenue, or for building sidewalks by said road and avenue, or both. This conveyance is further subject to a restriction imposed upon the lot by the Town of Barnstable Board of Health, as to the number of bedrooms which can be included on any home built on said lot as a pre-condition to obtain a variance from 310 CMR 15.214. State Environmental Code, Title V. Whereas , the Town of Barnstable, Board of Health herein requires the following restriction shall run with the land and be binding upon all successors in title: Said restriction shall run with this and all succeeding transfers of title- See letter of February 9, 2000 from the Town of Barnstable Board of Health attached hereto. For my title see deed dated November 1, 1980, recorded with Barnstable County Registry of Deeds in Book 3200 Page 203. Executed as a sealed instrument this o? 7 day of September, 2000 J e Kosciuc COMMONWEALTH OF MASSACHUSETTS Barnstable ,ss Septembero?� , 2000 Then personally appeared the above named Jane Kosciuczyk and acknowledged the foregoing instrument to be her free act and deed, before me Notary Public My commission expires 11/23/0.3 NOW— TOWN OF BARNSTABLE OF THEtO OFFICE OF i ZABXSTABLIy a BOARD OF WEALTH y Wang aj ' �o i639• `0m 367 MAIN STREET HYANNIS,MASS.02601 2 /zo 49' February 9, 2000 Jane Kosciuczyk 3 Beach Plum Circle Sandwich, MA 02537 RE: Lot #47, Carla Road, Hyannis Dear Mrs. Kosciuczyk: You are granted a variance from 310 CMR 15.214, restricting sewage flows to one bedroom for every 10,000 square feet of land within Zone II districts. You are granted permission to construct an onsite sewage disposal system at Lot 47 Carla Road, Hyannis, with the following conditions: (1) If two (2) bedrooms are proposed, an engineered septic system plan and house plans shall be submitted to the Board of Health each designed for two (2) bedrooms maximum. Dens, study rooms, finished attics, sleeping lofts and similar-type rooms are considered "bedrooms" according to the Massachusetts Department of Environmental Protection. (2) If three (3) bedrooms are proposed, the septic system and FAST system shall be installed in strict accordance with the revised plans dated on 2/2/2000. (3) If three (3) bedrooms are proposed, the applicant shall submit a monitoring plan for the FAST system. (Note: The submitted sample monitoring plan contained several blanks and was not signed.) This was not acceptable to the Board. (4) The applicant shall record a properly-worded deed restriction at the Barnstable County Registry of Deeds limiting the dwelling the number of bedrooms authorized. The deed restriction shall be signed by the property owner. A copy of the recorded deed restriction shall be submitted to the Board of Health prior to obtaining a disposal works construction permit. jane r (3) bedrooms nitrogen reducing if alternative-type systems are proposed on lots of less than 18,000 square feet in size. Sincerely yours, Susan G. Rask, .S. Chairperson Board of Health Town of Barnstable SGR/bcs I jane Sent By: Yankee Survey; 1 508 420 5553; Nov-30-99 2:20PM; Page 2/2 a�woarw�s i�i►� TownRSC C. BY nof Barnstable 8tB8D- Board of Health 367 Main street,Hyannis MA 02601 Office- 508.790.6265 Susan G.Raak,R.S. FAX. 508-790-6304 Sumner Kaufman,M.S.P.H. Ralph A.Murphy,MD. VARIANCE REQUEST FORM LOCATION Property Address: CL h k Assessor's Map and Parcel Number. � l�U t G Size of Lot: Wetlands Within 300 Ft. Yes Subdivision Name: No Business Name: Name: Ma 4�aW i yc , V k Name: Address: A i�.PC P�l?:IY) l't rC ��. Address: > S1C a)(Q_� �' w-,0-1 Phone. Phone: .5 FAX: FAX. VARIANCE FROM REGLILAITON(Liu Aev.) REASON EQ A (May Utuh if more space needed) Check&t(to be completed by ofce staff person receiving variance request application) Four(4)copies of plan submitted(including septic system plans and/or restaurant floor plans) Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense(for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variances only) Vwiniace request application ree collected ole fa for Iihoswd modirmasim raa wo.ym o irvp.wia maaaau{same os.nerrkasee uosyL o 4s Buie®varhnm meewtla(name oa+sndlesem only{.aw nrfaoear o repair failed aeaa�6isgmai aynems{aMy iP m b eM OtrilQwq V^�b Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Susan G:Rask,R.S.,Chairman NOT APPROVED Sumner Kaufman, M.S.P.H. REASON FOR DISAPPROVAL Ralph A.Murphy, M.D. Q:/WP/VARSRSQ r - i FEB-05-00 SAT 12 :28 AM P. O2 r{ i Bedroom ( 1 Ol E� L, Kitchen Pantry I Patio DinUP ing Woodstove �fX• V V�7 , Living Entry f � Porch r. Study Open to living room Dn Bedroom i. No. FEE c a COMMONWEALTH EALTH OF MASSZ7CCHUSETTS Board of Health, 9 A 9 P ST 6 fS)—E:' , MA. Al APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT Appli\forait to Construct(1, epair( ) Upgrade( ) Abandon( ) - O-C�omplete System ❑Individual/ponents Location 6MLIq R0jJV Owner's Name Map/Parcel# v` Address Lot# '7' 7 Telephone# Installer's Name t Designer's Name Y Aoikee S ve CaAS00wAit Address Address 410 & 1ti-baS MS I Telephone# Telephone# L/,A 00 Type of Building Lot Size /09 0 00 sq.ft. Dwelling-No.of Bedrooms Y Garbage grin Other-Type of Building No.of ersons Showers ( ).,Cafeteria( ) Other Fixtures �+� Design Flow (min.required) :� g d Calculated design flow 330 Design flow provided 3 j '7 gpd Plan: Date r"`�' `� Number f sheets Revision Date Title S i`le-t- S I c_ i( Lf}X/ Description of Soils) Scc /1✓ / h� n nn 3--&S Soil Evaluator Form No. ! '�' �:��q Name of it Evaluator�", ILLS Date of Evaluation a DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual ew\oCompliance osal System in accordance with the provisions of TITLE 5 and further agrees to not to place the system in operation until a C� tific has been issued by the Board of Health. Signed Date Inspections 1 No. oard of Health,CO ®N V'�YiF. LTA OF MASSA'� SETT �" S FEE ° �RR iu s�+�QL� CERTIFICATE OF COMPLIANCE Description of Work: ❑Individu Components) ®-Complete System \ The undersigned hereby certify t at the Sewage Disposal System; Constructed �Repaired (\), U raded ( ),Abandoned ( ) by: i at C lot P L IT 0,6 AD has been installed in accord - ce with the provisions of 310 CMR 15.00 (Title 5) and the Approved d\esig plans/as-built plans relating to application No. dated . Approved Design Flow 3'Y / (gpd) Installer Designer: it%kf'� tl�e C�1S�11�4� spector: Date: The issuan7her�eby t shall not be construed as a guarantee that the system will function as designed. _ No. FEE Board of Health, AMA)Tr)i I3 L� MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permissi. nted to Construct Re air U rade Abandon an individual sewa a dis al stem (L.Y P ( ) Pg ( ) ( ) g P sYat ,LA &0 I �� L��' 7 as described in the applic tion for Dispq�`al System Construction Permit No. dated Provided: Construction shall be completed within three years of the date of this permit. All local conditions must be t. Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date Board of Health No.' # %EE .4 COMMONWEALTH OF MASSACHUSETTS Board of Health, { P ST 1 ! I d,L i:�: , MA, 1 /mponents Application for rmi\C nstruct(l;}Y epa rt(;:)=,Upgrade(,) Abandon( - �mplete System ❑Individ Location R014V Owner's Name k0 SA yVC Z Y K Map/Parcel# Address v Lot# Telephone# Installer's Name 3 Designer's Name �4Nkt� S Q CcM SUC 77 4-N73 Address Address 4yo 6 �� Y ; Telephone# , Telephone# m g /O 000 . Type of Building Lot Size � sq.ft. Dwelling-No.of Bedrooms t z Garbage grin4 . � R Other-Type of Building Ii No.o ersons Showers ( ),Cafeteria ( ) Other Fixtures 7 Design Flow (min.required) J 3 Q` g\d Calculated design flow 3 3 0 Design flow provided 3 7 gpd ~ Plan: Dace �!_ a"- Cr u ber bf sheets Revision Date Title S! 't S,FPP G- PL-11 ``Description of Soil(s) $re //¢A/ r Soil Evaluator Form No. =q yaZ5 g Nam of ,oil Evaluator R ILLS Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATION x The undersigned agrees to install the above described dividu wage ,isposal System in accordance with the provisions of TITLE 5 and further agrees to not to place the system in operation until a rtifi ate of�Compliance has been issued by the Board of Health. 1 Signed. t Date : Inspections No. CO B ONWEALTH OF MASSA SETTS. r; FEE j ., oar of Health, AR N S`TA BLS f E CERTIFICATE Of C®�' PLIAN ' Description of Work: ❑Individu Component(s) ` &06mplete System The undersigned hereby certify t at the Sewage Disposal System; Constructed(-'j,Repaired ( U raded ( ),Abandoned ( ) by: at Cti P,e-1 K0Iq has been installed in accor�ce with the provisions of 310 CMR 15.00 (Title 5) and the approve esig plans/as-built plans relating to application No. dated Approved Design Flow y� (gpd) Installer �' ,�r�k," �� rw►�V/NN Designer: spector: ate: The issuance of this p ymit shall not be construed as a guarantee that the system will function as design d. i.. No. FEE COMMONWEALTH Of MASSAC14USETTS Board of Health, 1J/Q �' L-LG MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permissi is hereby granted to; Construct(t,)"Repair( ) Upgrade( ) Abandon( ) an individual se ge dis, ,sal system at A 'F L/'-}. �U��' M v}- gL zlJ q �uTly7 as described in th applic�tion for 4fa i 1 i • Disposal System Construction Permit No. dated i rovided: Construction shall be completed within three years of the date of this permit. All local conditions must be met. Form 1255 Rev.5/96 A.M.Sulkin Co.,Boston,MA ';, . Date Board of Health •e I - 3`- APPLICATION FUR PERCOLATION '1'I,S'1' A14D 013SERVATION PITS LOCATION L o ��l 7 Ca�e� e _ NU I'- 5 VILLAGE ti. a An AA IS. N��. _ DATE— APPLICAN'T yr ( C141 _ 1'LL_ ADDRESS �X 9� Ce-"'4.„•,�„1,1 � M4- TELEPHONE NO. 77L_ ogys!(NOr►-refur►dable) ENGINEER f_Id�►p �, . 1,7� _TELEPHONE NO.17.S- DATE SCHEDULED (Applicant' s signature ) . . . . . . .. o . .. . .. ., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,. . . . . . . SOIL LUG SUB-DIVISION NArt[: DATE— A0V ,?3 TIM 9. .go .9� EXPANSION AREA : YES) ✓rJo _ �? m1 7fj_L-2ED6E ENGINEER R)WN WATER ✓PRIVATE WELI., -Jhmf5 BOARD OF HEALTH EXCAVATOR SKETCH: ( Stre(,t: n�une , et.c. ,cl.i.mr.nsi.c�r►s of lot- , exact location of test- holes Z►nd r4 perco.lat-ion tests , locate .wp[Jands in proximity to test holes ) p NOTES : A L vq s'! Sc s h i • Q O PhRCOLATION RATi.'. : TFST HOLE NO: /_ l ELEVATION: TEST HOLE NO: ELEVATION: 2 2 `1 _. ._. . 4 6 2 /Z � S,4rJ;-%4 6 7 •1 9 9 10 �-- 10 11 11 12 12 13 12 �.0r+a''1 No v.AJV1 , 13 -... - 14 14 15 15 16 - _ 16 SUITABLE FOR SUB-SURFACE SEWAGE : LEACHING FIELD_✓LEACHING PITS LEIACHING TRENCHES A UN.SUITABLE FOR SUB-SURFACE SEWAGE . REASONS : NME: ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION ORIGINAL: COMPLETED IN ENTIRETY 13Y P . E ._ AND _RETURNED TO BOARD OF_HEALTH /may . • r, , t ` ' . l a DESIGNING ENGINEER MUST SUl�NBIT NG A INSTAUATIONW O NSTAL IIN11� ST�IGT _ THE SYSTEM e• J? �' oAD Ef�_ V 98 PINE SMEr ET yv L EMS. _ z - EI V .�� � OA X/LL CA — — P ALBERr MAY BENCHMARK r- � -OF ELEV4 100' (ASSUMED) �,� UNDA LANE, EL. = 99 _ — — — \ TOP OF CB a CARa EDGE Rra , _ — GE _ o - 8\ 54 i 10. 0' (fnd) AN� ¢° / o � \ N79`42 30 vo PARCEL B tip ' 698f sq/ft RyE soNA RESE 1 TUBES~ LOCUS MAP LOT 48 1 0 1 _ — � Apo � - �•- - -� , 11,E 10 O , p��=_ __ � %'` �,, PLAN REF 165/41 & 319/73 I �p 4 _______________ AS MAP & PAR„ 2481209 ~ \\ o 1 �- , -===--_-_-_-__---. N. RES ZONE RB .. FLOOD ZONE C cl ip.� o o- -_=-_ _ --HOUSE__-o= sow - ��- _========= ==6 -=- - l0000 sQ,ft � ' (f d) SITE & S�'P TIC PLA N \ ---------- - -- - -SUN _. � .. ROOM- ---__-__--_- - _ _ y ��e PRO✓EC T L OCA TION 0 9 �f �. LOT f47 CARLA ROAD \ �� ____- , �� 5 s HYANNIS(BARNSTABLE), MA. N \\ p r APPL/CANT. X:, \ C> - \ JANE KOSCI VCZYK YANKEE SUR I/EY CONSUL TAN TS �• 1`� P. O. BOX 265 LOT 46 UNIT 5, 40B INDUSTRY ROAD \ -. MARSTONS MILLS, MA. 02648 NOTE, e 2 BEDR09M DEED RESTRICTION PH.(508)428-0055 - FA X(508)420-5553 REQUIRED \ WELLHEAL: PROTECTION t � r, SCALE. 1 -20 FDA TE. 11112/99 \\ O VERLA Y`DISTRICT. CIOi I1',U P \ = No.749 � REV. 2117100 REV. 9/21/00 2 JOB NO. 52161D` CB SHEET 1 OF EL. = 101' TOP OF FOUNDATION � 20' MIN. i j 10' MIN. CONCRETE COVERS l' 4" SCHEDULE 40 P. VC � EL=100' MIN. PITCH 1/8 PER FT. 2 LAYER OF 1/8"-1/2" CONCRETE COVER WASHED STONE6' MAX 4" CAST IRON PIPE (OR EQUAL MINIMUM 6" MAX CLEAN SAND 12"MAX Pl7CH 1/4 PER FT. FLOW LINE EL = 97.50' I INVERT 1 10" MIN. 14" _ _ _ = O = = _ = EL.= 98.50 �Zp'� = = o = = = = = _ _ = og000 ---- CAS INVERT LEVEL ° 0. o = = oo = o = = = = = o ° INVERT EL._��0' 6 SUM IN °°o 00 = _ = _ _ _ _ = _ _ BAFFLE INVERT ° _ _ _ _ _ _ _ _ _ _ _ °°oo°° EL.=95.25 EL. =98.25 EL.=�2ZZ5__ EL.=97 50 4' 4 (719 BE PLACED ON FIRM BASE) DISTRIBUTION (2) 500 CAL LEACHING CHAMBERS MECHANICALLY COMPACTED OR 6" OF STONE BOX EL.=97.25' GALLONS TO BE WATER TESTED SEPTIC TANK IF MORE THAN ONE OUTLET Iz 6' X 25' TRENCH FORMATION PLACE ON 6" STONE SOIL ABSORPTION F 3/4" TO 1-1/2" DOUBLE WASHED STONE SYSTEM (SAS) PROFILE OF SEWAGE DISPOSAL SYSTEM NO GROUND WATER-- BOTTOM OF TEST HOLE ELEV. =__ 87' NOT TO SCALE OBSERVATION HOLE 1 ELEV.= 99' PERCOLATION RATE �2 _ MINI INCH DEPTH TEXTURE O"-24" LOAM & SUBSOIL GENERAL NO TES 24"-144" SAND 1) ALL WORKMANSHIP AND MA TERIALS SHALL CONFORM TO D.E.P. TITLE 5 AND THE TOWN OF _HARNSL4RLE__-- RULES AND NO WATER ENCOUNTERED REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. 2) ONE COVER ON SEPTIC TANK SHALL BE BROUGHT TO SOIL TEST WITHIN 6" OF FINISHED GRADE, OTHERS WITHIN 12" DATE OF SOIL` TEST 5123185 SOIL TEST DONE BY P. MILLS-ELDREDGE ENGG, CO. INC. 3) ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF WITNESSED BY: JAMES CONLON WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE Pf.•4259 DESIGN CAL CULA TIONS.' USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. I2 �4) ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL INSTALL~- NUMBER OF BEDROOMS . . . . . . . BE MORTERED IN PLACE. (2) 500 GAL LEACHING CHAMBERS GARBAGE DISPOSAL . . . . . . . . . NO 5) NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH WITH 4' DOUBLE WASHED STONE TOTAL ESTIMATED FLOW DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO ALL AROUND ( R!2--GAL/BR.IDAY x 2___ BR.) 220 GAL/DAY OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. 12.8' X 25' REQUIRED SEPTIC TANK CAPACITY - . 1500 GAL 6) UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCA VA TION CONTRACTOR SOIL CLASSIFICATION . 1 IS TO CALL "DIG- SAFE" AT 1-800-322-4844 AT LEAST 72 HO URS DESIGN PERCOLATION RATE < 5 MIN./IN. PRIOR TO COMMENCING WORK ON SITE. EFFLUENT LOADING RATE . . 74 GAL/DA Y/S.F. 7) CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS . . SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. LEACHING CAPACITY (AREA X RATE) 347 GAL/DA Y 8) PARCEL IS IN FLOOD ZONE___"C" RESERVE LEACHING CAPACITY . . . 347 GAL/DA Y 9) LOT IS SHOWN ON ASSESSORS MAP __248 AS PARCEL (25XL2.8X. 74)+(25+25+12.8+12.8)X2X. 74) r JOB NUMBER-52161 _ µ11 . .. . 4.. ,.,» , -I�.,,,;.I�II7.:-,-.,i",.-:,�"I-i�--IlI..�,%".e.I,'-,s-�,�,�,,,I,l"...I�-.�1--1.,i�,-,.!1,.;,,.I,1-,I"-,L,-"�."�-..eI:�.�...�:-,,I�-.I..�-..".-"�,i:,',1'i���k..�..-i 4�..�,.��,-,I..�;�k,I-,4*�i--..��,1��,�I-I�;.,-:I,,V:.,,i-'f.�i,-.,.,".,,:!---�.11i.1.',"�7.%.�i,,-,X�.,�.,1,,.�I�--.;..1.-'"I,-.,-..V-.I.,.;..�!.,:,',",.:-�.�-.."1.�,�.-�.',�'I',I,.,,,....1.,.,.,�-.1I."'-,E,!..�.:1 ,,,.'"I,.-.��,.",,,.'�;4Ar�I�...�-..--.:..�,L.",4"-i..,,.i,,.,.��I�,�,�41,,Ili"."�!-.--,�,,.�'�,..--,1..,-�..-��.N�i--i,i.l,�.-"1.._iI�1 41-�:�rI.''.�-.l"�,�-:i.,.�1';.I��1�I�I"'.,,-�.-v,O-1�,-.�!+�t.I,'�,;?�I..,1"�.".�.,1;+�-"..,-,��-,.,-��-,,,-,-,,:,�.�.-l�1.%',,;,I 11,,,,�'.i,--.,,.i_",�-'.,"I-" ,-"-'.l;�I.1,-,,;...--.".--.....I,""P4-.,,v:,,1�i7,,,.,-�....�.-,.""1i.+1�I.,,V..,-�:-�I.,-..,--.1--,.'���- :i:.-,.I.�,.'",...*,,.,,-.:�,,.-!l'�;I'��,.I-I;.��,�.,.-,;�Ij,,��..,���:,"--"_ - .:w . - .. ,"�,,.-'!',,,��:,,,-'�.,.`'..I,44,1.,,i�';..,l�.A��-.,,, . - x:, _ - . • 4. 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