Loading...
HomeMy WebLinkAbout0020 COUNTY SEAT STREET - Health 71Y a ,_ y 20 County Seat Road e Hyannis --�— — — — —- — — — - A A=291 — 160 i o . • Y P c Commonwealth of Massachusetts r29/.- 1400 Title 5 Official Inspection Form Subsurface Sewage,Disposal System Form -Not for Voluntary Assessments 20 County Seat Street Property Address F-! Shanna Clough r? Owner Owner's Name ,. information is required for every Hy annis Ma 02601 7/8/2020 page. City/Town State Zip Code Date of Inspection i; 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 fitting out forms A. Inspector Information on the computer, use only the tab Sean M. Jones key to move your Name of Inspector cursor-do not " S.M.Jones Title V Septic Inspection use the return Company Name key. 74 Lane. � Companypany Address Centerville Ma 02632 City/Town State Zip Code 774-248-4850 smjonestitle5@gmail.com, S14522 sean@smjonestitle5.com 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 ;i 7/8/2020 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments j� 20 County Seat Street Property Address Shanna Clough Owner Owner's Name i information is required for every Hyannis Ma 02601 7/8/2020 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: The property located at 20 County Seat St Hyannis is served by a Title V septic system consisting of a 1000 gallon septic tank, distribution box and 2 leach trenches Although the system was found to be in proper working condition at the time of inspection this report does not guarantee future performance under similar or increased usage. 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. r *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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 20 County Seat Street Property Address Shanna Clough Owner Owner's Name information is required for every Hyannis Ma 02601 7/8/2020 page. Cityrrown 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 i Q Commonwealth of Massachusetts Title 5 Official Inspection Form w� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 20 County Seat Street Property Address Shanna Clough Owner Owner's Name information is required for every Hyannis Ma 02601 7/8/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and.nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: I 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 20 County Seat Street Property Address Shanna Clough Owner Owner's Name information is required for every Hyannis Ma 02601 7/8/2020 page. Cityrrown 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. ❑ ® 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. El ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 16,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection ❑ ❑ Area—IWPA) or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments j� 20 County Seat Street Property Address Shanna Clough Owner Owner's Name information is required for every Hyannis Ma 02601 7/8/2020 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? ® E Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 i� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments k� j✓ 20 County Seat Street Property Address Shanna Clough Owner Owner's Name information is required for every Hyannis Ma 02601 7/8/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gpd Description: i Number of current residents: 2 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 Seasonal use? ❑ Yes 0 No Water meter readings, if available (last 2 years usage (gpd)): j Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current Date t5insp.doc•rev.7/26/2018 w Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form `le Subsurface Sewage Disposal System Form - Not for Voluntary Assessments F v 20 County Seat Street Property Address Shanna Clough Owner Owner's Name information is required for every Hyannis Ma 02601 7/8/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. .Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: l5insp.doc-rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments -� 20 County Seat Street Property Address Shanna Clough Owner Owner's Name information is required for every Hyannis Ma 02601 7/8/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: system repaired 12/18/2013 , tank 1977 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5.- Building Sewer(locate on site plan): Depth below grade: 1 I feet Material of construction: ❑cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet i Comments(on condition of joints, venting, evidence of leakage, etc.): Joints in good condition, no leakage, vented through roof. L,5,n.p.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts :. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,.� 20 County Seat Street Property Address I Shanna Clough Owner Owner's Name information is required for every Hyannis Ma 02601 7/8/2020 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: .5 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallons Sludge depth: 5„ Distance from top of sludge to bottom of outlet tee or baffle 3' Scum thickness 2" 7" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? Opened covers and took measurements Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank does not need to be cleaned now but should be done soon and again every 2 years for proper maintenance. water level was even with outlet, tank was not leaking and was structurally sound. 1 t5inspI doc-rev`7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 20 County Seat Street .�r Property Address Shanna Clough Owner Owner's Name information is required for every Hyannis Ma 02601 7/8/2020 page. Cityrrown 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 Y- Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments .'' 20 County Seat Street Property Address Shanna Clough Owner Owner's Name information is required for every Hyannis Ma 02601 7/8/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0,t Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Distribution box was level and in good condition with no rot. Water level was even with outlet invert with no signs of past backup. i . f t5insp.doc-rev.7/2 612 01 8 f Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 20 County Seat Street Property Address Shanna Clough Owner Owner's Name information is required for every Hyannis Ma 02601 7/8/2020 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: ❑ leaching galleries number: ® leaching trenches number, length: 2 32'x3'x2' ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: l5insp.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 20 County Seat Street Property Address , Shanna Clough Owner Owner's Name information is required for every Hyannis Ma 02601 7/8/2020 page. Citylrown 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.): s.a.s. consists of 2 leaching trenches 32'x3'x2'. Trenches were video inspected from vent and was found dry with no signs of past hydraulic overloading. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018' Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 14 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 20 County Seat Street Property Address Shanna Clough Owner Owner's Name information is required for every Hyannis Ma 02601 7/8/2020 . 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.): l t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 20 County Seat Street Property Address Shanna Clough Owner Owner's Name information is required for every Hyannis Ma 02601 7/8/2020 page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately I i �1 A3' • 8 3 S3•5( 6 .4) Ay 6 i REAR t5insp.doc•rev.7/26W18. Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form LL Subsurface Sewage Disposal System Form.- Not for Voluntary Assessments F 20 County Seat Street Property Address Shanna Clough Owner Owner's Name information is required for every Hyannis Ma 02601 7/8/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12'+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: r ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Groundwater was established by accessing town of Barnstable groundwater contour maps. t - • _t {""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 20 County Seat Street Property Address Shanna Clough Owner Owner's Name information is required for every Hyannis Ma 02601 7/8/2020 page. City/Town 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 ~ t5irisp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 r WE Town of Barnstable P# y' Department of Regulatory.Services umwa, r public Health Division Date 200 Main Street,Hyannis 1V1A 02601 Date Scheduled . � Time Fee Pd. Soil Suitability ,Assessment for Se Dis Z s Performed-By: �h � . (.c/=11� S?/✓� f^••v ?'' / Witnessed By: / M• • Y LOCATION& GENERAL INFORMATIO Location Address d Co �� p�"t /—. Owner's Name � a. vt�t� Address Assessor's Map/Parcel: ! /6 V Engineer's Name (�0 1A/� e NEW CONSTRUCTION REPAIR Telleeppphone0 Lso� �4a_ �. Land Use: T<sw i 4$ 4T t4Ll Slopes 96 —� / O � //..'' P ( ) Surface Stones Distance9 from: Open Water Bodyy�/K'ti� R possible Wet Area ft Drinking Water Well ft Drainage Way_J ��r"'C� ft Property Una G ft Other ft SI TCIEI:(Street name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands•In proximity to holes) p ' -0 S 1 Parent material(geologic) Depth to Bedrock 7 Depth to Groundwater. Standing Water in Hole: N4 N C-' Weeping from Pit Face Estimated Seasonal High Groundwater _ - -DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: In. Depth to soil mottles: Itt. Depth to weeping from side of obs.hole: In, Groundwater Adjustment ft. Index Well# Rcading Date: ]ndox Well levol Adj.factor �. __ Add.Groundwater Leval s PERCOLATION TEST Observation Hole# Thno at 9" Depth of Perc Time at 6" Start Pre-soak Tima® Timo(9"G") End Prc-soak Rate Min./Iuch .77-1ql nJ v Sits Suitability AssessmcnC Sits Dassct- 5itp Failed_ __ Addldonal Testing Ncedcd_(Y/N)_._ Original: Public Health Dlvlsion Observtition Hole Data To Be Completed on Back------- ***If percolation test is to be conducted witbfn 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(I) week prior to beginning. Q:\SEPTIC\PERCFORM.DOC r :y DEEP.OBSERVATYON HOLE LOG Hole#- / Depth from Soil Hor.'zo-i Soil Texture .Sdil Color Soil• Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders, I]EiatrTipy.%'Q vel)__ Joy2s6 PEEP OBSERVATION DOLE LOG. Hole# Depth from Soil Horizon Soil Texture Soil Color Sail Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. . up �-ej /�'� • �l/ is yre-Z/ 71/6 7, /t; DEEP OBSERVATION HOLE LOG Hole#. Depth from Soil Horizon Sall Texture Soil Color Soil Other. Surface(In.) (USDA) (Munsell) Mottlln g (Structure,Stones,Boulders. Co i to c Q e --------------------------------- DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Solt Color Soil Other r.. Surface(in.) (USDA) (Munsell) Mottling (Structure,StIottes'.Boulders. Consistency y I ' Flood Insurance Rate Malr. Above 500 year flood boundary No_ Yes Within 500 year boundaryy No Yes ' Within 100 year flood boundary No.�` Yds Depth of Naturally Occurr=ng Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed thrpughout the area proposed for the soil absorption sys tem? If not, what is the depth of naturally occurring pervious material? Certification . I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise and experience described In�10 CMR 15.017. Signature Alp. Q:15,1?PTIC)P)?RCPORM.nOC ' • I TOWN OF BARNSTABLE LOCATION C2O 0nun4 W Tc 1::J S-1 SEWAGE# 20 i 3 - Sr98 "VILLAGE ggcLAn;S ASSESSOR'S MAP.&PARCEL 29f - ILo INSTALLER'S NAME&PHONE NO. Q Excaya-lid,� qTn- OG53 SEPTIC TANK CAPACITY 1000 4al I LEACHING FACILITY: (type) Trcnc kc (size) 2 x 3 3 Z NO.OF BEDROOMS 3 OWNER S k<%jjrno0. Clove k PERMIT DATE: /Z -14 • f 3 COMPLIANCE DATE:,/Z -)$ • I3 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Welland 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 Z A'_ a2, r A3•,��'$.. 3 .83 Ay -62 B`�-W6'y REAR r -'1- � . .... .... .-. V.s - . . . r _.. ♦ : 1-. ..-.1.. �{'"N- � ,r 1 .r.+r-...✓.y W-•-�. __ . . - ..Y-.- ....w.{- ...'`. .� .. -..�r"h+3 No. Dlc Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in com ter: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 1 V1 ftpliratlon for Misposal 6pstem Construction permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. DOUNY S7- er''slNaame,Address,and Tel.No. Assessor's Map/Parcel C/-'f �Q f`l I�Q(Ce� I staller's Name,Address,and Tel.No. a igner's Nam Address, d el.No. �xc-avejo 509 477-D&5 wn Caper. .soy 3�Z- ifs �t Type of Building: Dwelling No.of Bedrooms J. Lot Size sq.ft. Garbage Grinder( ) Other Type of Building r No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �33 (� gpd Design flow provided gpd Plan Date 12a I Q 3 Number of sheets ' Revision Date Title Size of Septic Tank 106 o QQ J eX 16 f'1 C7r�e of S.A.S. Description of Soil TT Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal-system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Bo o Health. Date ZI 1 Application Approved by Date Application Disapproved by Date for the following reasons Permit No. llrlKDate Issued pe - ' ,a,4' z No. 0 . _ i oe i" /0') Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in comp ter: PUBLIC HEALTH DIVISION -'TOWN OF BARNSTABLE, MASSACHUSETTS Yes ; "l ftpliLatlon for Mlsposal ,pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade(' ) ,Abandon( ) ❑Complete System ❑Individual Components Location.Address or Lot No. p,�Q�U��/ f ST- , er's N/a�mLe Address,and Tel.No. Assessor's Map/Parcel t—44 z� !pQ(ee(��9 U�`7 ,J .,' Installer's Name,Address,and Tel.No. Designer's Nam ,Address, d el.No. _818 �xL0vaf( 50g-477 0l05 burn 6Qp ," .50k 362_45 y( Type of Building: Dwelling No.of Bedrooms J Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures y` Design Flow(min.required) �� U gpd Design flow provided gpd Plan Date / I;?_j l � Number of sheets � Revision Date Title Size of Septic Tank 106 Q Q j P.X j �Je of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: r 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 Bo o Health. w S'gn d Datel2 11 j Application Approved by Date Application Disapproved b Date for the following reasons Permit No. .� 4ryK Date Issued -_ __rr------ w=-...,:: -..c.- _r.r e..-,:�-..---a-r= --:-.-._._ - --.--: .- .--"- - -•--- - -------,-------------------------------- ------ - -THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that t e On-site Sewage Disposal system Constructed( ) Repaired( ) . Upgraded( ) Abandoned( )by �'I _x�� �'() n at 2- - has been constructed in accordance h with the provisions of Title 5_ d the for Disposal System Construction Permit No:� 91. Odated G Installer-Rt S E)(ccl yafi 0 n Designer 1 C #bedrooms— Approved design flow gpd The issuance of this permit hall not be construed as a guarantee that the system wil function d sig ed. Date ,� /� Inspector -- ------- - -- _ -- - -- _ -- - -_ ---- ------ --- -- - . - No. - - - Fee JQ L/ %ao- I L��-�%% THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) System located at 20 4(e e-+ 1 and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Cons cti n must "e com leted within three years of the date of this permit. / Date . Approved by FROM :down cape engineering inc FAX NO. :15083629880 Dec. 19 2013 02:32PM P1 C�.111 1.Fw gula J'+. !(s�nlea, .i�nn•�e't�z' MAMassna l 'Wflife Blea itlln DllVll:�ll�DI7t ,�`"�=••e� '1'�t�zaaas 1'�Ic)l,�e�w,:II'ta'�ettaa� no mtin street,111=Bdr Fax: 50 8-')40-63 04 C)ffice,,: ,S08-Sr,2-4644 LM!',ll Clr c 1Ne~ V2`K ]LDaite: �� 1 ' Se;•, age Perwl►t'`� gDedgniff: daln°esn: Chu _ — Qt�. ��(Ca�ya� 8'�'• •was i;.3u.ed dpenni'L'to in;�EE+11�. (dati:) (n st�lli:X) septic syste"M at 2 0 2 .bw cd. on,a d.esi.p drawn by a (• css) I certify that the septic system.ref--cared above w�� ia�iallc:rl ubstat�tiall'y according to tJie dr5it;rz which may include:: minor app.mve,L1. cJi rages �u�:h ,.j liltePal..relucatiou Uf'lllc� OL-tjIbution box.andla septic:tank. _ I rerti.:l'y that the s(,ptic. system. ri,fi'(,-eRcecl. allow W&,; iustalleei. wirh innjor c huges (i.�'• greater than IQ` lata,:cF`,redocatiou of th.e SAS or any'vertirsl•relocaticu of zny COIJIPo:o.eut ui'tbe scpti.c system) but iu ac.ccrdanre�n.th 5t-ate : L.ociti Regtalatton;:;. Plfln rcivitiietr�or rertiiied as•=b4ill'by desiewer to fbllaw. J DANI5LA. OJALA 1 ell No.46502 (jlesi;��tir'8 ;iincsi ►qr.'s Stamp HC,r,e) T.a:4 Zdfd�''�j�6o,lF� •2"•ti.T;Sd..��:'. R�lk_ .!��'q'�: .lA.IN.I,aIlQDJ`?_ �.Lkk:'h�71F'i;C;�7`Tti .'�>k' CGT�'A,JANj!k F WFLL NPA III j'Is.0-U')D 'Tlgz:1_� -P! TTcIlE.9 UTc�I (•,�!)),A°�-Y«�J..E-L t�'1_�dtJID AA�t A16��1 U•'18"f I%G ID?ABt1V A'.AIFy'1<,k;R'�'JID:JC.REAI s>c[3�� �C1I'I. i`1gt '�Aal l.•.. f CF ZHE T Town of Barnstable Barnstable �. � Regulatory Services Department &k"STABLE, I MASS. 1639. Public Health Division m `0m '�rEDNS°�Q 200 Main Street, Hyannis MA 02601 2007 Office: 508-8624644 Richard Scali,Interim Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7012 1010 0000 2851 1135 November 25, 2013 Shanna Clough 20 County Seat Street Hyannis, MA 02601 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 . The septic system located at 20 County Seat Street, Hyannis, MA was last inspected on 10/30/2013 by Matthew Gilfoy, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Distribution box is deteriorated; must be replaced. 0 Leaching pit is in poor condition. Water level 5" below invert and must be replaced. You are ordered to repair or replace the septic system within Sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future.Eval\20 County Seat St HY Nov 2013.doc ` Parcel Detail http://issgl2/intranet/propdata/ParceiDetaii.aspx?ID=22713 ��Y�r'.�"�'"""""�'� .r 't,�"''Te` .�. •n 11IIff.. r ll\\ .El 5 Dix MASS Logged In As: Parcel Detail Tuesday, November 19 2013 Parcel Lookup Parcel Info Parcel 291-160 i Developer ILOT 21 ID Lot Location 120 COUNTY SEAT STREET I Pn 116 Frontage Sec� — I Sec Road Frontage Village JHYANNIS f Fire HYANNIS District Town sewer exists at this RoadO I address No Index 3364 Asbuilt Septic Scan: Interactive 291160_1 Map Owner Info Owner CLOUGH, SHANNA L I Co- I Owner Streetl 120 COUNTY SEAT STREET Street2 City JHYANNIS State[MA I Zip 02601 Country Land Info Acres 10.30 J Use ISingle Fam MDL 01 Zoning I RB Nghbd 10104 Topography Level Road Paved Utilities i Septic,Gas,Public Water Location Construction Info Building 1 of 1 Year 1977 Roof Gable/Hip I Ext Vinyl Siding Built Struct f Wall LArea 1104 I Cover RoofI~sph/F GIs/Cmp l Type AC None woK.. Style Ranch Int Drywall I.- Bed 3 Bedrooms 6 , Wall Rooms ,2 — ' [ Model lResidential FloorA Carpet �.Rooms 1 Full 11A I Heat Total a ` Grade jverage Minus Type Hot Water Rooms 5 Rooms I ., ,-' aBMT s ' ` �e-Stories 1 Story Heat Oil Found- Poured Conc. .f � Fuel ation -Gross -. http://issgl2/intranet/propdata/ParcelDetaii.aspx?ID=22713 11/19/2013 I � r _ ., , �� � K r� `� '� •. ; - r� � ' S Commonwealth of Massachusetts Title 5 Official Inspection Form — o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 20 County Seat Street Property Address Shanna Clough Owner Owner's Name information is required for every Hyannis MA 02601 10/30/13 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. Important:When filling out forms A. General Information on the computer, r use only the tab 1. Inspector: key to move your cursor-do not Matthew Gilfo U I use the return key. Name of Inspector B&B Excavation, Inc. Company Name 14 Teaberry Lane Company Address Forestdale MA 02644 Cityrrown State Zip Code (508)477-0653 S113640 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 urther Evaluation by the Local Approving-Authority 10/31/13 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. 0f.1,L It5ins•3/13 /✓Title 5 Offcial Inspection form:Subs Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts _ W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 20 County Seat Street Property Address Shanna Clough Owner Owner's Name information is required for every Hyannis MA 02601 10/30/13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,Q,D or E/always complete all of Section D I A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: i i B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts ' _ u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 20 County Seat Street Property Address Shanna Clough Owner Owner's Name information is required for every Hyannis MA 02601 10/30/13 - page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑.Y ❑ N ❑ ND (Explain below): I ` ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): t C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool,or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 20 County Seat Street Property Address Shanna Clough Owner Owner's Name information is required for every �H annis MA 02601 10/30/13 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: .t y You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ® El clogged of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t51ns•3/13 . Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 i= Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 20 County Seat Street Property Address Shanna Clough Owner Owner's Name information is required for every Hyannis MA 02601 10/30/13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® 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 11 of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 20 County Seat Street Property Address Shanna Clough Owner Owner's Name information is required for every Hyannis MA 02601 10/30/13 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® 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 in for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? Z ❑ 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 3/13 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 °M 20 County Seat Street Property Address Shanna Clough Owner Owner's Name information is required for every �H annis MA 02601 10/30/13 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection El Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No i Seasonal use? ❑ Yes ® No I Water meter readings, if available (last 2 years usage (gpd)): Detail: 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? El Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 1x Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 20 County Seat Street Property Address Shanna Clough Owner Owner's Name information is required for every Hyannis MA 02601 10/30/13 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: 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 I ❑ Overflow'cesspooI n • ❑ 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. El Other(describe): t5ins:3113 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 , �t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage.Disposal System Form -Not for Voluntary Assessments 20 County Seat Street Property Address Shanna Clough Owner Owner's Name information is required for every Hyannis MA 02601 10/30/13 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: 1977 \ Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1,6„feet Material of construction: ® cast iron ❑ 40 PVC ❑ other(explain): Distance from private water supply well or suction line: > 10'feet Comments (on condition of joints, venting, evidence of leakage, etc.): At time of inspection building sewer appears to be in working condition. No sign of leakage \ Septic Tank(locate on site plan): Depth below grade: 6 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) Y ( P ) If tank is metal, list age: \ years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ® No Dimensions: 1000 T' Sludge depth: t5ins•3/13 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 20 County Seat Street Property Address Shanna Clough Owner Owner's Name information is required for every Hyannis MA 02601 10/30/13 page. Cityrrown State Zip Code Date of Inspection D. System Information (coat.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 31" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 6 Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? scour 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.): At time of inspection septic tank appears to be structurally sound. No sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene El other(explain): Dimensions: Scum thickness - Distance from top of scum to top of outlet tee or baffle Distance,from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments I -- 20 County Seat Street Property Address Shanna Clough Owner Owner's Name information is required for every Hyannis MA 02601 10/30/13 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 um In ` p p g• Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 L Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 20 County Seat Street Property Address Shanna Clough Owner Owner's Name information is required for every Hyannis MA 02601 10/30/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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 time of inspection d-box is deteriorated and in poor condition and must be replaced 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.): I II * If pumps or alarms are not in working order, system is a conditional pass. ` Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: .j t5ins•3/1 V Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17„ -h � .R ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 20 County Seat Street Property Address Shanna Clough Owner Owner's Name information is required for every Hyannis MA 02601 10/30/13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At time of inspection leaching is ir`poor condition. Water level 5" below invert and must be replaced per Barnstable BOH requirements. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer ` Dimensions of cesspool Materials of construction . Indication of groundwater inflow . ❑ Yes ❑ No ' t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 F.' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 20 County Seat Street Property Address Shanna Clough Owner Owner's Name information is required for every Hyannis MA 02601 10/30/13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 NX Commonwealth of Massachusetts Title. 5 Official Inspection Form :Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 20,.C6unty 8eat,Street Rroperty:Address Shan na:Clough Owner Owner's.Name information is required for every Fiy annis MA 02601 10/30/13 page. Citylrown State Zip Code Date of Inspection .20 -System Information (cont.) Sketch Of.Sewage Disposal System: Provide a view of the sewage disposal system,.includingties.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: 0' hand=sketch:in the area below E1..drawing attached separately lJ Al- 36 A2 �31= 2z.r t5ins-3/13 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 M 20 County Seat Street Property Address Shanna Clough Owner Owner's Name information is required for every Hyannis MA 02601 10/30/13 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: > 144"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: 8/18/77 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: Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 t , Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 20 County Seat Street Property Address Shanna Clough Owner Owner's Name information is Hyannis MA 02601 10/30/13 required for every y ' 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 4 t i t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 —roo" cer/ Commonwealth of Massachusetts tm� Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 20 County Seat Road Property Address Bill Fratus Owner Owner's Name information is required for Hyannis MA 02601 08/15/07 every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important:When filling out A. General Information forms on the O_ )` computer,use 1. Inspector: only the tab key to move your Adam R.Riker cursor-do not use the return Name of Inspector key. Riker Landscape Construction ' Company Name P.O. Box 726 Company Address South Yarmouth MA 02664 'eQa" Cityrrown State Zip Code 5087766460 Telephone Number License,Number ' B. Certification I certify that I have personally inspected the sewage disposal system at this address and thattheS= information reported below is true, accurate and complete as of the time of the inspection. The:f►spection 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 oEi, Title 5(310 CMR 15.000).The system:• 1i zn u ® Passes ❑ Conditionally Passes ❑ Fails N ❑ Needs Further Evaluation by the Local Approving Authority Inspectors 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. title five inspection report•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 15 .! Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 20 County Seat Road Property Address Bill Fratus Owner Owner's Name information is required for Hyannis MA 02601 08/15/07 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 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 title five inspection report-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 'r 20 County Seat Road Property Address Bill Fratus Owner Owner's Name information is required for Hyannis MA 02601 08/15/07 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. title five inspection report•08/06 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 20 County Seat Road Property Address Bill Fratus Owner Owner's Name information is required for Hyannis MA 02601 08/15/07 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet 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 '/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. title five inspection report•68/o8 Title 5 Official Inspection Fonn:Subsurface Sewage Disposal System-Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form A a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 20 County Seat Road Property Address Bill Fratus Owner Owner's Name information is required for Hyannis MA 02601 08/15/07 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems.(cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a'significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. title five inspection report•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 20 County Seat Road Property Address Bill Fratus Owner Owner's Name information is required for Hyannis MA 02601 08/15/07 every page. Cityrrown. State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: i 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? i ❑ ® 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)] i L C R r Ode five inspection report•08f06 Title 5 Official Inspection Form:Subsurface Sewage Dis posal sposal System•Page 6 of 15 AL Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments I 20 County Seat Road Property Address Bill Fratus Owner Owners Name information is required for Hyannis MA 02601 08/15/07 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual). 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330gpd 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 0 9 ( Y 9 (gpd)) Sump pump? ❑ Yes ® No Last date of occupancy: 2006Date Commercial/industrial Flow Conditions: Type of Establishment: . Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): title five inspection report-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments < 20 County Seat Road Property Address Bill Fratus Owner Owner's Name information is required for Hyannis MA 02661 08/15/07 _ every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Home Owner 7)Aev2 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 20 years Were sewage odors detected when arriving at the site? ❑ Yes ® No title five inspection report-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 20 County Seat Road Property Address Bill Fratus Owner Owner's Name information is reqquireduired for y H annis MA 02601 08/15/07 o every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 1.5 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.): Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No --------------------------------------=----------------------------------------------------------------------------------- Dimensions: 5x8x6 Sludge depth: 6" Distance from top of sludge to bottom of outlet tee or baffle S Scum thickness 611 Distance from top of scum to top of outlet tee or baffle _Distance from bottom of scum to bottom of outlet tee or baffle 18" How were dimensions determined? sludge judge title five inspection report•08/06 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 20 County Seat Road Property Address Bill Fratus Owner Owner's Name information is required for Hyannis MA 02601 08/15/07 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.): Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): tide five inspection report•08/06 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 20 County Seat Road Property Address Bill Fratus Owner Owners Name information is required for Hyannis MA 02601 08/15/07 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level.' Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 1 title five inspection report•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 I - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments N 20 County Seat Road Property Address Bill Fratus Owner Owner's Name information is required for Hyannis MA 02601 08/15/07 _ every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: � ® leaching pits number: 1 x1000gal. ❑ leaching chambers number: ❑ leaching galleries number: ❑ Teaching 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.): title five inspection report-Oa/06 Tille 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 20 County Seat Road Property Address Bill Fratus Owner Owners Name information is required for Hyannis MA 02601 08/15/07 _ every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): title five inspection report•08M Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 20 County Seat Road Property Address Bill Fratus Owner Owner's Name information is required for Hyannis MA 02601 08/15/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells.within 100 feet. Locate where public water supply enters the building. s z i id.. title five inspection report•08J06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 20 County Seat Road Property Address Bill Fratus Owner Owners Name information is required for Hyannis MA 02601 08/15/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar . ® Shallow wells Estimated depth to ground water: feeetet 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: located well data from gis map You must describe how you established the high ground water elevation: 3"augured observation hole to depth of 15'with no signs of ground water at max. depth of 15'. A h title five inspection report-08/06 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 15 of 15 HIGH GROUND-WATER LEVEL COMPUTATION Date: Site Location: ((jun T y SX n cc) . Permit: Owner: Phone: Contractor: /��,�, �,'1�c�- Phone: ,soi5 774 GYcU Notes: STEP 1 Measure depth to water table to pearest 1/10 ft.( � (depth is in feet below land surface Date: ® 0 m /dd/yy feet below Is STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: i A) Appropriate index well B) Water-level range zone STEP 3 Using monthly "Current Water Resources Conditions" determine current depth to water 1 level for index well. lo Pe/� mm/yy STEP 4 Using Table of Potential Water Level Rise 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. 61o7 0 STEP 5 Estimate depth to high water by subtracting the ` water-level adjustment (STEP 4) from 0 measured depth to water level at site (STEP 1). NOTE* Tables 1-9 "Potential Water-Level Rise" are attached as worksheets to this file. monthly index well data: www.c6pecodcommission.org/wells.htmi LOCATION SEWAGE PERMIT NO. VILLAGE 1KSTA LLER'S NAME & ADDRESS lifr'S1 " Y�I��yu�-� �i�4 y2�73 B U I-L D E R OR OWNER DATE PERMIT ISSUED �- 7-3 -�� DAT E C.OMPL. IANCE ISSUED / 000 �,-9Afil %vvi PI l 13o t ^� ��y ` f`_V �� �` � C� i1 �� �3 � �, j No........... ZI... ., Fizs...... . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...............OF...... ` Appliration for Dispoii al Marks Tnnitranrtinn rrrantit Application is hereby made for a Permit to Construct (V�or Repair ( ) an Individual Sewage Disposal System at: A.7.......... EFT,........ ' ....... oT.2Z.......... oc, '.... Lorat'In-,,Add ress or Lot No �e .R-- ...... ....... A. . ...._ �,. � 1�. .G:__........._ Owner Address W .......... .:............. - .............940� _!rC Installer Address Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms___..._,...............................Expansion Attic ( ) Garbage Grinder ( ) a .Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures --------------------------------- . Design Flow...........�2....................gallons per person per day. Total daily flow............................................gallons. Septic Tank—Liquid'capacity/M gallons Length .lP.._-. Width.Y.`/0.... Diameter................ Depth..,5.0. W Disposal Trench—No. ....................x Width............. Total Length..................... Total leaching area...._..............sq. ft. Seepage Pit No......,1........... Diameter....//....... Depth below inlet....16........... Total leaching area...;W.V._sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed ............ Date....8��8��_rI.............. Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ - 44 Test Pit No. 2...... ......minutes per inch Depth of Test Pit...../Z_........ Depth to ground water........................ .. ------••----------------•----------•-----------....---....•`----------._...........••••--•----•-----......................----------.._.._..-•••-•----- O Description of W VNature of Repairs or Alterations—Answer when applicable............................................................................................... -----------------------------------•------------------------------------------------....--••--------------------------------------------------------------------------------------------............---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the b d f health. a Signed------.... • •... � '1 a Date Application Approved By.......... ---_--.~- Date Application Disapproved for the following reasons:.............................................................................. --•-•------------------------------•-••--•---------------••-•---•-------....--•-••---------•--................-•--••---••-----------------------•-------------------................................... Date Permit No...... Issued....................................................... sF,'' Date Nd.::.......... FimB............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................OF........e .44..&......................... Appliration for Disposal Works Tonstrurtion Permit tv, Application.is hereby made for a Permit to Construct �or Repair an Individual Sewage Disposal System at: C6 41AI 7-/ 7- �57;e-r-74'r ....................... .......................................................................... ............................................... Location-Address or Lot No. ..................................... ------------------------------------:7 ....... ­ ­ �Oer � ------------- --------- -""----------........................................ r t .. Address Installer Address Type of Building d Size Lot............................Sq. feet Dwelling—No. of Bedrooms.......3.................---------.....Ex ansion Attic Garbage Grinder Other—Type of Building ............................. No. of persons........_.__................ Showers Cafeteria aOther fixtures ....................................................................................... .............................................................. Design Flow......... ....................gallons per person per day. Total daily flow............................................ga 4 _]Ions. 9 Septic Tank—Liquid'capacityA?q�?gallons , Length.S.'"**....... Width..Y.�9­. Diameter................ De'pth._-5­;�.,. Dispo4 Trencli":t�,-,,No......:,�.............. Width.................... Total Length............;....... Total leaching area....................Sq ft. S epag'-F&7%....... iameter...Za, Depth below inlet__...?__._....... Total leaching area__..;�.V!..sq. ft. e e ....... D ....... Z Other Distribution box ( Dosing tank Percolation Test Results Performed by..,)e0A1W1_10 ell S17 7 .................. ............ Date.......I.............................. Test Pit No. I................minutes per inch Depth of jest Pit._____._............ Depth to ground water____.................... 44 Test Pit No. 2.....�......minutes per inch Depth of Test Pit...._ ........ Depth to ground water........................ ----------------------------------------------------------------------------------------------------------- ------ ------ �4 0 Description of Soil...4240E/­!f.­------ . .... ... . ."zc Z--------- ... ...... . ... ............................. .................... 64JI r1A1 4 - /V........................................ .................... ............................................ I ........................................................................................................................................................................................................ U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ....................................................................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT!L- 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed............ -------- *-----------Date,*------------- Application Approved By............ ... ......... . ---------------- ---------- - ------------------ ........................................ Date Application Disapproved for the following reasons:.......................................................... ............ ........................................ ......................................................................................................................................................................................................... Date Permit No........ Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...... .........;jtjW,-A...........OF. . ......................................... . THIS IS - - , �Fy, That the Individual Sewage Disposal System constructed or Repaired by---------------- - _14.12..... gis.............................................................................................................................. Installer at.. - h r........ T, •­------- --- ........L------- ----------0 ---------------- ----------------- I er ----------- -V----------- as bee Aft e in accord�nce with the prAWs of TITLE. 5 of The State Sanitary Code as 'described in the application for Disposal Works ,Construction Permit-IN.O.....,j- dated__... -7. ---------------------- ------------------- U UA.?�, THE ISSUANCE OF TWt' CERTIFICATE SHAIL"KOT BE CONSTRUED AS A XNTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector..................................................................................... lTA V THE COMMONWEALTH OF MASSACHUSETTS BOARD'._QF, .`'AEALTH • ............ X//.............0 F........ . .......................................... No..nl............. . FFE........iw........ 11isposal Works T10notrurtion Permit /Y' Permissionis hereby granted.......... ------- .................................................................................... to Constructs or Repair ( ', Yrliv�id;utawl S e w a g e isposal System at No ..........;. . ---------5-pw;o- t r----------0--;t-------------/ -g--------------------------------- Stree as shown on the application fortDisposal 'V� ulin Permit No.................... Dated..... ........... .............................................................................. Board of Health DATE................................................................................ , FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS- V'41 t, AsBuilt Page 1 of 1 LOCATION SEWAGE PERMIT NO. VILLAGE j?o <=ouu7y r � T G3C) YAYif 'A14 y-L60/ INSTA LLER'S NAME a ADDRESS f�i T /-lo Cry+ e S g'&- ��/ c olP.2 S LAyam' . B U I'L D E R OR OWNER d�JQ/h R A/Q 3 o l L r DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED i3/lc,r 3 ti� i http://.issgl2/Intranet/propdata/prebtiilt.aspx?mappar=291160&seq=1 10/30/2013 } J ''t1 } i • N� 71 PV TES 7- H OL E ,QES U L. TS T -r oi14^,/ reECO,QDS k D Mi^/�Mv/� Eau /LD/NG SETB �9CK CEOu/ ,2EM,E- AYT_S � E g4eo ,1�- D�oo .�15 ti SEf'T/C SySTE/vI CO/VSTRUCT/ O/V 5r/f3LL �� �� i'�;,•'� __ % _ 4' CpNFoR 7 To /"IASS. ENV/� ONMEn/ T,9L zz T'/TLZ",S/ L L... F- 1/ TO 7" YP / Cf9L PamAE -roo of FD UNDRT/ON'= %D 70 AJ O //MPE RV/oU5 ccv��2 /41-jAJHOLE� COVER- TO EXTEND TO To P2EVENT FINES W/TH/A! I' OF �r','�//SHED GRf3DE - FROM iNF/LT�2AT/nl� `�''�\ STO^/E 2 2Y"coVE,es -- D/ST /�� ' _�/'��f Co✓ER ✓�i9.5 --.� S TJ�c Box j Q CRST/SON 4' M97ri -.� 2'Nrn. — /6 _� O,. q /�'1/N/MUM -x--FLOW L NE I M/,v P/TGN ' '+ Y�� FOOT IO''M/til. /4.. ! ;i ' \ a - Ji �r� "/Fool ! ,y ,c; n {� wAS,HE:D ' Lill et /-• I LEACH e A I t ,LAVER-7— N E L, � ( P -/-- t j Cc cR-r L L 1 /NVE27 i CA P/9 C /TY $, J • 5 E P7-/ C Tfi N K �WHTERT/GHT} y j ; /N✓ERT /NVER7" r t /n/VERT 21 P.L Or P1.�9A/ O C � T I O/�/ `lei, ' 3'®' D f1 T"E• LOT C S S H Q%�//�' ' % c.'` 6�E�.r r 17, D N H P L f� /./ E C O.e O E D //V THE B�reti`- �4N1c ' :x` .:>-4 r �.✓ r i> v= /J COUNT r2 E G / S Trey O/ D E E D5 �`.�: •�'}�; S E 7-/ 7"_A N k 7 D B E- 'q 'A41/V-- FR `L') UND.9 N D L E N /C, 17-s . �/ e �� /�° Gam✓ `/ ��U I� L E A H / N G P / T-5 7.O B E :�.'i I�.'-- L)/`I C� F i O FROM P,e u7 f�E R7�' a L / /V E S A N D S E. PT SNo P,/n/ oAJ 7- l / S STF-�K D - I" on/ TN E G k O [JN S S ,HF:./2 FC7,'`+` �� GEORGf �+ 1.9 /�1 D TH T / T �?<�c� C O ,� ' .�o.2N� pow, ��: 7-0 THE B U / L D /LAG SFT B/9cK RECJ �. C/sT�� /"/E A/TS O F Tf-,' E T 6.//�/ Of= Bel O� - -- -- ALL SYSTE SHALL SYSTEM PROFILE MARKED WITHCMAGNETICTTAPE OR BE PROVIDE MIN. 20" DIAM WATERTIGHT (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. NOTES Route 28 ACCESS COVERS TO WITHIN 6" OF FIN. GRADE 1. DATUM IS APPROX. NGVID 0 TOP FOUND. EL. 47.6' 2. MUNICIPAL WATER IS EXISTING c o \_77 MINIMUM .75 OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 41 .0' - 42.0' 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. PRECAST H-10 PROP. TEE PROVIDE INSPECTION PORT TO WITHIN 3" OF FINAL G DE RISERS (TYP.) 4. DESIGN LOADING FOR ALL PROPOSED PRECAST a . .• 2 42.3' 4"�SCH40 PVC 2" PEASTONE OR GEOTEXTILE UNITS TO BE AASHO H-10 us PIPES LEVEL 1ST 2' FILTER FABRIC OVER STONE ° 5. PIPE JOINTS TO BE MADE WATERTIGHT. Hya. Ed et 38.0' Elem. Sch. 10" EXISTING 14" TEE SEPTIC TANK** TEE '.\40.9±*� 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE r{evens Not h 70--0000.0 ° ° ° o ° ° ° ° ° ° ° ° o ° ° ° °°°°°°°° °°°°°°°°°°°°° WITH 310 CMR 15.000 (TITLE 5.) °°°000°000°° 6,. MIN. SUMP 37.4 0° O0°O°O0°O0°OQ°OUo°°°°°o°°o°°o°°°°g°OQ°Ogo2Oog°°go°Ogo°O�°O O�°O0°O0°°0°O0°O0O0GAS BAFFLE::: ,°°°°°°°°°°? 12" MIN INT. DIM. °°°°°°°°°°°°O°O°°°°°°°°°°°°°°°° °°°°°°°° °°°°°°°°°°°°°° Mitchell ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND Io°°°°°°°°°o°°°o°o°°°°°°°°°°°°°°° °°°°°°° °°°°°°°°°°°°°o° 35.3 NOT TO BE USED FOR LOT LINE STAKING OR ANY \ 38.17' 38.0' 4" PVC SET AT .005'/' SLOPE-' OTHER PURPOSE. n w n ON 6" DOUBLE WASHED 3/4" - 1 1/2" STONELid ` �{ 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. m "LL.V// Main West Main 6" CRUSHED STONE OR MECHANICAL 13.0't 9. COMPONENTS NOT TO BE BACKFILLED OR 4.0 CONCEALED WITHOUT INSPECTION BY BOARD OF dde COMPACTION. (15.221 [2]) HEALTH AND PERMISSION OBTAINED FROM BOARD So ve. ( 30% SLOPE) ( 1 % SLOPE) OF HEALTH. _ MIN 10. CONTRACTOR SHALL BE RESPONSIBLE FOR FOUNDATION- EXIST. SEPTIC TANK 9' D' BOX 1�' LEACHING BorroM TH 1 EL. 31.3' CALLING DIGSAFE (1-888-344-7233) AND FACILITY (G-W EXPECTED AT EL. 22.0't) VERIFYING THE LOCATION OF ALL UNDERGROUND & LOCUS MAP OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL **INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS WORK. NOT TO SCALE PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM 1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE WITH 1500 GALLON H-10 SEPTIC TANK IF NOT SUITABLE. r 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE REMOVED 5' BENEATH AND AROUND THE ASSESSORS MAP 291 PARCEL 160 PROPOSED LEACHING FACILITY. 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. VARIANCES FOR SEPTIC SYSTEM REPAIRS WHICH MAY BE IMMEDIATELY GRANTED BY THE BOARD OF HEALTH AGENT OR PROP. VENT WITH CHARCOAL FILTER BY HEALTH INSPECTOR AND BUGSCREEN (FINAL PLACEMENT BY CONTRACTOR WITH HOMEOWNER 35.76 PAPERWORK AND HEARING REDUCTION PROPOSALS APPROVED CONSULTATION) FENCE BY THE BOARD OF HEALTH REVISED DURING A PUBLIC HEARING HELD ON AUG. 4, 2009 g3 55 7 SYSTEM DESIGN. GARDEN AND COMPOST AREA 39.93 3) FAILED SYSTEMS ONLY SOIL AfSUKPTION SYSTEM FENCE INSTALLATIONS PROPOSED PROPOSED MORE THAN THREE FEET BELOW 1 Q �9 40 39.98 GARBAGE DISPOSER IS NOT ALLOWED GRADE WITH PROPER VENTING (PIPED TO THE ATMOSPHERE) N ❑ AND WITH H-20 LOADING, BUT IN NO CASE SHALL THE SAS DESIGN FLOW: 3 BEDROOMS © 110 GPD = 330 GPD BE LOCATED MORE THAN SIX FEET BELOW GRADE. 40.49 4/ 1 t.o1 USE A 330 GPD DESIGN FLOW 32 TH 1 8" OAK - SEPTIC TANK: 330 GPD (2) = 660 ��f9 .84 41.10 ■ 2 RE-USE EXISTING 1000 GAL. SEPTIC TANK ** 45.1 TEST . HOLE LOGS 2 ■ �+ LEACHING: 35, X 42. SIDES: 2[2 (32 + 3) 2 (.74)] = 207 GPD ARNE H. OJALA, PE, SE BOTTOM 2[32 x 3 (.74)] = 142 GPD ENGINEER: I / O 16" OAK WITNESS: DONNA MIORANDI, IRSEXIST�LP X 42.49 42 TOTAL: 472 S.F. 349 GPD DECEMBER 9, 2013 X 43.1 �, '� .62 X 42.17 USE (2) 32' LONG x 3' WIDE x 2' DEEP DATE: N X 42 85 N �, 42,21, BENCH MARK - TOP OF SONO PERC. RATE _ < 2 MIN/INCH N 44,62 1 TUBE AT DECK COR. EL. = 43.2 LEACH TRENCHES OF PERF. SCH. 40 PVC PIPE AND STONE o m 44 DECK 42.97 CLASS I SOILS P# 14220 z n m 47.65 � ELEV. ELEV. 1 4 I ❑ p-- 43.92 0" 41 .3 0" 41.8 ❑ EXISTING DWELLING t I TOP FNDN. EL. 47.6' 0_ -1 44.90 FILL FILL ❑ MA 44 50 'DIRT 1 APPROVED DATE BOARD OF HEALTH 14„ 16„ �p p PARKING A/B A/B LOT 21 �Rvp oy �Fs I TITLE 5 SITE PLAN SL SL 13,219 Sq. Ft. OF 18" 10YR 2/1 20" 10YR 2/1 ix 44.93 20 COUNTY SEAT STREET R=482•7 45.87 CO) ' X E�5199 14 4512 eW eW56.4�' HYANNIS 63 LS LS �� PREPARED FOR _ 4� 1 OYR 5/6 1 OYR 5/6 X 4 .6�- EpT' STYE B&B EXCAVATION/CLOUGH 46„ 37.46 46 37.96 COUNTY S DECEMBER 10, 2013 C C PERC ' �� c /�s OF 4 off 508-362-4541 MCS MCS � agssa� tips I fax 508-362-9880 ° LAAIIELA. 5� ,. , �° DRNIEL �N1w downcape.com 0JA!_A A. CIVIL !� OJi'Lq 8OW8 cope ellg�neeridg, Inc. 7.5YR 5 6 7.5YR 5 6 1 .4Fi502 � + `��No.40280 120 / 31.3 120 / 31.8 �� ��� \oF civil engineers Scale: 1"= 20' 'L �� os' c�c�r � OF land surve.}/Ors NO GROUNDWATER ENCOUNTERED 1 D PJAL 939 Main Street ( R to 6A) 0 10 20 30 40 5o FEET DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 3-2'76