The URL can be used to link to this page

Home My WebLink About0035 COUNTY SEAT STREET - Health '35 County Seat,Street Hyannis o � i I'' f: jaA Commonwealth of Massachusetts V9/ Title 5 Official Inspection Form Subsurface Sewage Disposal SycAem i'r„,�.in_ f r OrVoluntary Assessments �v R'operly Address — ✓1 �. ._.._. s� Owner Owners—er s�Narr>7/ �— / _ _._.�_-- V/ Gt/G information is requQedforevery ,4 4 I•S f /Y� �+ page- CdylTown �Vecin Zlp Code tote of �+ 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. `M P°o ""1e" A. General Information f��ng out fours on the computer, use only the tab 1. Inspector. key to move your cursor-do not , use the return G r p /S //� key. Name of Inspector CorMa"r M11,11,1111i • CD"Wy Address &S�ti1, V 7 Qly/Town St at Zip Code s�� a90-��9c _ �to� Telepho �moer License Number 13. 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 C 16.000). The system: Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority ktspUSignature `� 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,Go0 god or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DER 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. l9es•T13 riide5Official Inspection F crrrt Subs rfacesewageoisposal System*Pagel 0117 o ,� VS Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Dis"l System Form -Not for Voluntary Assessments 315 COu Roperty Address - Ow ner A WArz� — mformatbn is ON ner's Name // requ'vedfor every `-f�G✓t✓lif / 4 page. Glty/Town State Zip Code Date of s n B. Certificalion (cunt.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) Syste sses: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: i B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yres "no"or"not determined"(Y,.N, ND) for the following statements. If"not determined,"please ex0ain. I 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 toat the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): k a tsm-3M3 Title 5 Official InspectionFormSuburfaosSe eDi orals �q SP ystem-Page 2oft7 , F Commonwealth of Massachusetts Tide 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3 kn Se� 7� S� Property Address Owner s("� �► Z information is Owner's Name / required for every 14 (j page- CityRown State Zip Code Date 6f ftifection B. Certification (corn.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if Pumps/al arms 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):. ❑ 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 ❑ Nb(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. ' 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ns•3h3 TFti850fficial Inspection Form SubsLeacesevgeDisposal Symm-Page 3of17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r Property Address COW Owner Ow ner's Name information is / j required for every a;y n 4 l I A4 Od 6 p l A J / page. WITown State Zip Code We of Ins n i B. Certification (cont.) 2 System will fail unless the Board of Health (and Public Water Supplier,if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen Is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other. D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded or El 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 Eltic liquid level in the distribution box above outlet invert due to an overloaded 7Uquid logged SAS or cesspool ❑ M/:� depth in cesspool is less than 6°below invert or available volume is less t than Y day flow r. tsns 3M3 Title 6 official Inspection F arm SubsWace Savage Disposal Systam Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3s �- i Property Address � i,✓R r� ON ner ON nePs Name / information is required for every ✓41 .Qa 60/ /r /L page. CStyRown -St—ate-1— Zip Code Da of I pection B. Certification (cunt.) Yes No Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ L'1 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. ❑ l.� 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.] ❑ 21-� 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 - I, criteria exist as described in 310 CM 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 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. W T f5ns•3M 3 TiUe 50ffidal Ins peoficn F omt Submdace Sevgge Disposal Sim•Page 5 of 17 Z Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address —"— Ow ner ��•✓�✓ �Z information is Owner's Name _ ,,(( required for every �i✓iv1( 11V, o-) G o, page. cityrrm"n State Zip Code Date inspedtion C. Checklist Check if the following have been done. You must indicate"yes"or'no"as to each of the following: Yes ❑ umping information was provided by the owner, occupant, or Board of Health ❑ Were any of the system components pumped out in the previous two weeks? ❑ as 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 WA) 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 (f 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): Number of bedrooms (actual): 330 t. DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): t5irs-3M 3 Me 50f idol Inspection Form Subsurface Sewage Disposal System•Page 60f 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 35 Cp c1 n � `r J - Property Address D� Ouv ner �(1r 4z- information is ON ner's Name required for every / GI H Vol 15 �j9 �� C? page- City/Town State Zip Code Gate f Ins tan D. System Information Description: � SPl o4i C 1--- 1 J(/ /S0O 67,11a,4 -.2I,, T7l U 6 Number of current residents: Does residence have a garbage grinder? ❑ Yes No Is laundry on a separate sewage system?(Include laundry system inspection information in this report.) ❑ Yes Cl--"No Laundry system inspected? ❑ Yes M-17o Seasonal use? ❑ Yes VY No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑/'Yes No Last date of occupancy: v t4✓��'^ Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CM R 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: 15irs•3%3 Titlesoffidai inspecEm 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 Property Address ON rter Qnr ner's Name information is required for every /Y61c-,0d11 page. ClyyNown State Zip Code Datb Of 61sp ction D. System Information (cunt.) Last date of occupancy/use: Date Other(describe below): it General Information Pumping Records: ' (7) / Source of information: Was system pumped as part the inspection? Yes ��N�o If yes, volume pumped: gallons How was quantity pumped determined? ReXofstem: ing: Ty 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 VA system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(descri be): Mrs.313 1'iUe S Offidal Inspecfian form Subsuface Savage Disposal System•Page Sot 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address �•�Owv ner Ow Nam alener's e S �j uma on isreired for every ✓N 1 � 0 I°N'n State Zip Code Date of Ins Lion D. System Information (corn.) Approximate age of all components, date installed(if known)and source of information: Were sewage odors detected when arriving at the site? ❑ Yes No Building Sewer(locate on site plan): Depth below grade: 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, eHdence of leakage, etc.): Septic Tank pocate on site plan): Depth below grade: feet Maten f 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 t l� � Dimensions: Sludge depth: C;L// 19re•3H 3 Tide S Official lnspeclion F orm SubsWace Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts IVTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments sew ��- Property Address Ow ner V!Wa✓7 Z Owner's Name information isl / required for every G✓f t f �7 ems`'6 a I page. C1ityfrown State Zip Code Date 01 Ins ction D. System Information (coat.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness .q Distance from top of scum to top of outlet tee or baffle o�� Distance from bottom of scum to bottom of outlet tee or baffle 0 // How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): P(A � t�� C , �a N 1✓ GH.d 7 S /✓I f f ooc Cpn C'I�0✓! - 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 S5ns•W13 Tiae 50ftidal Irspecticn Form Subsulace SevMe Disposal System•fte 10 of 17 C Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments O t,t h 4 RopertyAddre ss I_ 5 C>� Owner iA �aK47— infomration its Ow ner's Name required for every ell '�L/TIS11j,' Page. CdylTown State Zip Code Date Ins lion D. System nformabon (corn.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, e%idence 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: galons 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 Oro-3M3 r Title 5Qffid21lr5peetimForm Subsurface SevrdgeDisposal Sysoem•Page 11 c(17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments -7s Coin Property Address57 I � i.✓�✓ Z Ovv ner Ow ner's Name information is /�� Od required for every G✓! t f G 6 page. City/Town State Zip Code Date of Insp6etion De System nformation (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): b p� eVz, //0 Se/ s �a �ec,�f Pump Chamber(locate on site plan): Pumps in working order. ❑ Yes ❑ No' Alarms in working order. ❑ Yes ❑ No' Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) pocate on site plan, excavation not required): If SAS not located, explain why: t9re•W13 Title 5Official IrrpeCtlon Far[Subsurface SSW Disposal System Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3S COu H S� Property Address Ow ner s7; mac,/ information's Owner's Name / /Yf requ'vedforevery Gtity/Town G✓l✓/!J Q_(0� Page. State Zip Code Date Inspection D. System Information (corn.) Type' -LL ./ (/)-9 -LH T��l T�? 7 J H`e ❑ leaching pits number. ❑ leaching chambers number. ❑ leaching galleries number. ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number. ❑ innovativelaltemative system Typetname of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): o i c4a., A10- S, dt J o /a L./r c % 4 r Al re 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 dns-M Tive5of5dal lmpecdon Fort SubsWaee Sewage Disposd System-Page 13 d 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments o J.� Property Address �e QNRer information is Owner's Name requiredforevery / a r 4 11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): � y73 Tiae50tfiaal IrspecfionFam[Subsuface Sewage0ispcsai System,Page 14 or 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -blot for Voluntary Assessments Property Address S 157"- bfornuU n is ouv ner's Name required for every 0 h I S &0 .0 page. CkyfTown State Zip Code 5 of Inspection De System Information (cons) 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 l.• Ors•3'13 TIU50f ial Irspectm Form Subsuiacesexmeuspmal System,Page 15of 17 . r { 4 Commonwealth of Massachusetts J ' Title 5 Official Inspection Form r Subsurface Sewage Disposal System Form -Not for Voluntary Assessments o-perty Address ou I Ow ner Ow ner's Name hformation is 6 0 requ'vedforevery G✓1 N/ page. Cdy/rown State Zip Code W of h ection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Id Estimated depth to high ground water. 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 ❑ bserved site(abutting property/observation hole within 150 feet of SAS) Checked with local oard of Health-explain: �� S ❑ Checked with local excavators, installers-(attach documentation) t ❑ Accessed U GS database-explain: You must desc how you esXablishgd the high ground water ele i ion: �D (f v) S a A t1 ,¢,� O C�. V`q k1 s 4 & �� I' � S'. / - -5 � s o �L= le; Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5M-3M 3 Title 6016cial Inspection Form SuDsufaee Sevage Disponl SyMm-Pdge 16 of 17 i Commonweafth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage D°sposal System Forth-Not for Voluntary Assessments prWerty address ON nor � (.✓G�T� hfornatim is QN flPJ'S l�latilB req�edforevery / ✓�v1 i 1 ev ' Q-2 6 0� L� /��page. Cdy/TownSubst Zap Code D9d of E. Report Completeness Checklist 0 inspection Summary:A, B, C, D, or E checked Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ud sy em I tomration—Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file i Sr:6.3113 TMeSOfftW iMpeCdMFmi[SubWMO-%YMO0ispasA Sysmm•Page 17 d 17 Assessing As-Built Cards Page 1 of 2 TOWN OF BARNSTABLE LOCATION $ Ctwnli Sca.4 S44 SEWAGE#_DD/,1•1y3 VILLAGE Ji ann.S ASSESSOR'S MAP&PARCEL 291.167 INSTALLER'S NAME&'PHONE NO. R (3 EXOayoAi on N77-OLS3 i SEPTIC TANK CAPACITY Mo9%n,J LEACHING FACILITY:(type) Cit) (size) 9X33 NO.OF BEDROOMS 3 OWNER S�nne �cl.eco PERMIT DATE: 5-11-I Z COMPLIANCE DATE: T-M-12 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility Of 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 i i Al a2-a9�o" Qp A3'IS ry~ 3 34- C4 Zo A �� REAR I i http://www.town.barhstable.ma.us/assessing/HMdisplay.asp?mappar=291167&seq=2 4/13/2016 Town of Barnstable P# /3 fo J Departinent of Regulatory Services s J &MMOU Date y S j Public Health Division Z- � D Md A � 200 Main Street,Hyannis MA 02601 Date Scheduled Ttme / Pd 1 U_7c Fee "U _ . Soil Suitability Assessment for S age Disposal Performed By: 4-e-- /11 C 61 I-ee Witnessed By: LOCATION&GENERAL INFORMATION Location Address 31 s Cv v_ Owner's Name Hy(4 h h P S Address O�c 19 u.Y9hdl ,'s A14 6 Z601 Assessor's Map/Parcel: Z�' f —1 Engineer's Name NEW CONSTRUCTION REPAIR .X Telephone# $JO�f-�737—�.-7 6 Land Use- Slopes('Yo) Z'I "Surface Stones tN/A Distances from: Open Water Body? I arofft Possible Wet Area 7 ZC-2D ft Drinking Water Weller LsZft Drainage Way 7 3 w ft .Property Line��ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands fn proximity to holes) ' Z 3 ' P Y T. SGGT Parent material(geologic) Depth to Bedrock Depth to Groundwater. Standing Water in Hole: /VMA Weeping from Pit Face Estimated Seasonal High Groundwater t DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole:. in: Depth to soil mottle: Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level fir- Adj.factor,,,,,, Adj.Groundwater level PERCOLATION TEST bate . Thita Observation Hole# 1 , Time at 911 An-� Depth of Perc 6 4 Time at 6" Start Pre-soak Time @ ^ f AMo( Time(9"-611) End Pre-soak Rate Min✓Inch 2 Site Suitability Assessment: Site Passed Site'Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back-=--------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1) week prior to beginning. Q:XSEPTICIPERCFORM.DOC I DEEP•OBSERVATION HOLE LOG Hole# 1 Depth from Soil Horizon Soil Texture .Soil Color Soil• Other Surface(in.) (USDA) (Mansell) Mottling '(Structure,Stones;Boulders. Consistency, Gravel) —3v 4 5 lo'Yel 5/s, -12o C #A-c 50\" . 7.57 6/ DEEP OBSERVATION HOLE LOG Hole# Z Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistencv.%Gravel) A . ac 10 lie 4/-L S0,� DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. O e DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) ;USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency, } i Flood Insurance Rate Mau: Above 500 year flood boundary No_ Yes JK Within 500 year boundary No Yes Within 100 year flood boundary No Yes Death of Naturally Occurring Pervious Material:) Does at least four feet of naturally occurring pervious material exist in all,areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? . Certification I certify that on t�� 4>� (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 310 CMR 15.017. �p �� d 2i Z Signature � Date , Q;\S,gpmCVERCFORM.DOC t- TOWN OF BARNSTABLE LOCATION 35 eovMLi Sead 54 SEWAGE# aol2 -1N3 VILLAGE ASSESSOR'S MAP&PARCEL 19/ •167 INSTALLER'S NAME&PHONE NO. fl EX0a►Va4 i on 1417• OGS3 SEPTIC TANK CAPACITY /Soo qa,I LEACHING FACILITY:(type) C18) (size) 9X33 NO.OF BEDROOMS !j OWNER ShQnc.. Pack.ceo PERMIT DATE: S'-1-1.12 COMPLIANCE DATE: S•f G •1�. Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY Al - a1'4" A2- g2 ,ag,G „ A3. YS'q y 13 - 0'2' Cy - Zo ' q �� Ll il RCA R No. FeeU v THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN;OF BARNSTABLE, MASSACHUSETTS Yes Rppfication for ]Disposal *pstem Construction 3permit Application for a Permit to Construct( ) Repair(4 Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No 0 u N ry 5-'-Slu O er's Nam ddress,and Tel.No. 5o%d 3 6 4_ 2 45 A 99 -7011N ec Assessor's Map/Parcel I I 3 tape 's e,Address,and Tel.No. :Sog`!� Q�IJ� D igner's Name,Address,and Tel.No. �cau ' n l 6�60 7 - 63 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 D gpd Design flow provided gpd Plan Date 'q I3o 12 Number of sheets L Revision Date Title tr0 +lC -+ Size of Septic Tank Ty e A.A.S. Description of Soil t Nature of Repairs or Alteratior(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 b this Board o ealth. Signed Date Application Approved by Date Application Disapproved by Date 'for the following reasons 7 Permit No. 1 - Date Issued _..,,,.,.�.,.:...:. :�� yy""'"'"`.`^..•'^•�-v.:.+yv..::,:+i..:..aide,,.'t,�n:�}i_a'X,,...,-...-+»,�f....is,,,r..,�+�.,.i...�v�..a-tia�iic+:+.'v�,..ra.r.--•-sSf�w/'^"""�=N'�'.-w,�s:++4�:f-w..vi%...,r..r.;'•M� No. O O , ,t:_ ^. �\ Fee / Qvye ;- Location yr• THE COMMONWEALTH OF F MASSACHUSETTS Entered in computer: v,t�yRr-Q3�'.+PUBLIC HEALTH DIVISION - TOWN�AF4RNSTABLE MASS�ACHUSETTS ftprication for Misposaf 6pstem Construction hermit. Application for a Permit to Construct( ) Repair(✓S Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Address or Lot No.35 CO UNT Y ST . 1XMT Owner's Name Address,and Tel.No. Jog- 3 6 y - 2464 Assessor's Map/Parcel !o Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. �-+ 3 �xcn 508•ti 17-0b63 , rye l d S o i Type of Building: / ' 2 + Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other ( Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �1�n gpd Design flow provided gpd Plan Date 2 Number of sheets 7 Revision Date. Title { I Size of Septic Tank Ty e o A.S. Description of Soil 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 Board of Health. Signed Date Application Approved by Date Application Disapproved by Date for the following reasons F s Permit No. Date Issued + THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(� Upgraded( ) Abandoned( )by at 3- (/)I I l I SOD A ��i9x'I- has been constructed in accordance with th-pra 'sions of Title 5 and the for Disposal System Construction Permit No. )��13 dated Installer rzyDesigner ( n ®)) #bedrooms 3 Approved desigrillow gpd The issuance of this permit shall no be cons ued as a guarantee that the system will f e9i Date v no be Inspector No. 3. .. - Fee _ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH IDIVISION -BARNSTABLE,MASSACHUSETTS Misposal &pste Construction 3permit Permission is'hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) System located at 3 S_ 6 a()nrts f'(-'d A f eeT A \i o n n i C, I and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be c mple d within three years of the date of this pe it. Date �� O1 Approved by 1 � 05/16/2012 07:57 5084775313 ENGINEERING WORKS PAGE 01 Town of Barnstable Regulatory Services Thomas-F. Geller,Director Public health Division Thomas McKtan,Director 200 Main Street, Hyannis,MA 02601 Office: 508462-4644 Fax: 508-790-6304 Date: 16 1 Z Sewage Permit# Assessor's Map/Parcel 201 J 1 1r Installer&Desiancr Ce tion.F-QM Designer: fFny:n�,.r.'��_ w�, the . Installer: f & c,e.Vc��- M•-. Address: 12 W. 2, . ,Address: 1 y 7 ca>.e+ni k rA �� j-dt,4 MA, ozo ��h{c k MiA, oZ64N On l EK cc.sa�cn.. was issued a permit to irmta11 a (date) kimsuUIC11 � septic system at s based on a design drawn by (address) of-e�J� &4-0- eE _ dated 3 Z� (designer) _�C I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State& Local Regulations. Plan revision or certified as-built by designer to follow. Stripout(if required)w ed and the soils were found satisfactory. of c PETER T. McENTEE y• Installer's Signature CIVIL 9 No,36109 TE (Designer's Signature) (Affix Design ) PLEASE TURN T BARNS LE PUB C HE TH D I N. RTIFI QF CoMPL CE WILL NOT BE ISSUED TH S- BUILT CARD ARE RECEI D BY BARN TABLE PUBLIC HE�LTH DMSI N. TEANKYQU. gAofice formw siSw=mt ft=cn form.doo 0 Town of Barnstable Barnstable °� Regulatory Services Department �' i 9IIA MASS. � public. Health Division ASS. t6gq. �0 AlfD+AAA p 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL #7011 0470 0001 4525 5645 March 1, 2012 ReMax Classic c/o Lisa Burgess ReMax RE 681 Falmouth Road/RT/28 Mashpee, MA 02649 RE: 35 County Seat Road ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,Title 5. The septic system located at 35 County Seat Road, Hyannis, MA, was last inspected on 1/11/2012 by Brian Reyener, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Fails" under the guidelines of the 1995 TITLE 5 Q 10 CMR 15.00) due to the following: • System is in Hydraulic Failure. • Septic Tank is leaking. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. P ORDER OF THE BOARD OF HEALTH mas cKean, R.S. CHO Agent of the Board of Health QASEPTIC\Letters Septic Inspection Failures or Future Evall35 County Seat Rd Hy.doc i • r Commonwealth of Massachusetts Title 5 Official Inspectior �Norm Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 35 County Seat Rd. Property Address Bank Owned -c/o Lisa Burgess ReMax RE Mashpee MA Owner Owner's Name information is required for every Hyannis MA 02601 01/11/12 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your vv/ cursor-do not Brian Reyener use the return key. Name of Inspector Ranger Construction de Company Name 46 Crowell Rd. Company Address East Falmouth MA 02536 Citylrown State Zip Code 508-274-9753 SI 13242 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 01/11/12 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, ystem is a sharedd 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. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 35 County Seat Rd. Property Address Bank Owned-c/o Lisa Burgess ReMax RE Mashpee MA Owner Owner's Name information is Hyannis MA 02601 01/11/12 required for every Y _ 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: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes:. ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. 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): u ` 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 35 County Seat Rd. Property Address Bank Owned -c/o Lisa Burgess ReMax RE Mashpee MA Owner Owner's Name information is required for every Hyannis MA 02601 01/11/12 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh Commonwealth of Massachusetts u159 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 35 County Seat Rd. ,p - Property Address Bank Owned -c/o Lisa Burgess ReMax RE Mashpee MA Owner Owner's Name information is required for every Hyannis MA 02601 01/11/12 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well*". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is.equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ❑ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6" below invert or available volume is less I ® than Yz day flow Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 35 County Seat Rd. Property Address Bank Owned -c/o Lisa Burgess ReMax RE Mashpee MA Owner Owner's Name information is required for every Hyannis MA 02601 01/11/12 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ❑ Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ❑ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ❑ Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ❑ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ❑ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet. from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ❑ The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system Is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 35 County Seat Rd. Property Address Bank Owned -c/o Lisa Burgess ReMax RE Mashpee MA Owner Owner's Name information is required for every Hyannis MA 02601 01/11/12 j page. Cityrfown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance-of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 3 DESIGN flow based on.310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Commonwealth of Massachusetts Title 5 Official Inspection Form, Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 35 County Seat Rd. Property Address Bank Owned -c/o Lisa Burgess ReMax RE Mashpee MA Owner Owner's Name information is required for every Hyannis MA 02601 01/11/12 page. Citylrown State Zip Code Date of Inspection D. System Information Description: Existing 1000 gallon Septic Tank with a 6'x6' pit 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 years usage(g•pd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: NA Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No l Water meter readings, if available: .'" r - 4. ,� �. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 35 County Seat Rd. IF — Property Address Bank Owned-c/o Lisa Burgess ReMax RE Mashpee MA Owner Owner's Name information is required for every Hyannis MA 02601 01/11/12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: NA Date Other(describe below): ' General Information Pumping Records: Source of information: -NA Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ` ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): -t Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 35 County Seat Rd. Property Address Bank Owned -c/o Lisa Burgess ReMax RE Mashpee MA Owner Owner's Name information is requireequired for every Hyannis MA 02601 01/11/12 - page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Septic Tank and Leaching installed in mid 1970's Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2.0 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: NA feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good Condition Septic Tank(locate on site plan): Depth below grade: 1.5 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: 4„ Sludge depth: Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 35 County Seat Rd. UV - Property Address Bank Owned-c/o Lisa Burgess ReMax RE Mashpee MA Owner Owner's Name information is required for every Hyannis MA 02601 01/11/12 page. Cityrrown State Zip Code Date of Inspection D. System Information (coot.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle NA Scum thickness 10" Distance from top of scum to top of outlet tee or baffle NA Distance from bottom of scum to bottom of outlet tee or baffle NA How were dimensions determined? measured Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): System is in Failure . Septic Tank is leaking 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 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 35 County Seat Rd. Property Address Bank Owned -c/o Lisa Burgess ReMax RE Mashpee MA Owner Owner's Name information is required for every Hyannis MA 02601 01/11/12 page. City/Town State. Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No. Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 35 County Seat Rd. Property Address Bank Owned-c/o Lisa Burgess ReMax RE Mashpee MA Owner Owner's Name information is required for every Hyannis MA 02601 01/11/12 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert NA 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.): NA Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: SAS in Hydraulic Failure Commonwealth of Massachusetts Title 5 Official. Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 35 County Seat Rd. Property Address Bank Owned -c/o Lisa Burgess ReMax RE Mashpee MA Owner Owner's Name information is required for every Hyannis MA 02601 01/11/12 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1- 6'x6' ❑ 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.): SAS in Hydraulic Failure 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 35 County Seat Rd. Property Address Bank Owned -c/o Lisa Burgess ReMax RE Mashpee MA Owner Owner's Name information is required for every Hyannis MA 02601 01/11/12 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.): SAS in Hydraulic Failure 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.): Commonwealth of Massachusetts Title -5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 35 County Seat Rd. Property Address Bank Owned-c/o Lisa Burgess ReMax RE Mashpee MA Groner Owner's Name information is required for every Hyannis MA 02601 01/11/12 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately A 23 (D - 23 2 s = 2-1 3-7 3 = Z 3 O � 2 0 Commonwealth of Massachusetts Title 5 Official Inspection Form . Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 35 County Seat Rd. Property Address Owner Bank Owned-Go Lisa Burgess ReMax RE Mashpee MA information is Owner's Name required for every Hyannis MA 02601 page. CitylTown 01/11/12 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: 10'+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design_plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Local Perc Test results showing no ground water 10+ below grade Before filing this Inspection Report, please see Report Completeness Checklist on next page. Y i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 35 County Seat Rd. Property Address Bank Owned-c/o Lisa Burgess ReMax RE Mashpee MA Owner Owner's Name information is required for every Hyannis MA 02601 01/11/12 page. Cityrrown 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 1 Flynn, Judith From: Crocker, Sharon Sent: Friday, March 02, 2012 1:17 PM To: Flynn, Judith Subject: Failed Septic-35 County Seat, Hy For Your Information: I received a call from the inspector, Brian Reyander, who failed the system. Apparently, the woman managing the property for the bank, Federal Nat'l Mtg Co., called him concerned with the 60 Day repair notice they received. No one is living in the house. I explained that the woman can request an extension from the BOH by writing a letter to them to be placed on the next meeting and explain the situation. Brian will call her back and relay this information and have her contact us directly with any further questions. (I put a note in the database regarding this.) Thanks Sharon I 1 j '^ TOWN OF BARNSTABLE LOCATION �-� C o uXTY S'E.9r AOP SEWAGE# q VILLAGE � ASSESSOR'S MAP&LOT :NSTAEtER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO.OF BEDROOMS BUILDER OR OWNER . U 2) PERfvf T DATE: / - t"19.5— COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by i o w_ P O� 0 OQ i J ` . r M �4 P ,/ COMMONWEALTH OF MASSACHUSETTS Z EXECUTIVE OFFICE OF ENVIR(.)NMENTAL AFFAIRS a DEPARTMENT OF ENVIRONMENTAL PROTECTION �qM Jee 350 MAIN STREET WEST YARMOUTH,MA 508-775-2800 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Map 291—PARC 167 cT Jf4 y7 Property Address: 35 COUNTY SEAT STREET V,f— / HYA,NNIS,MA 02601 Owner's Name: BROOKS,JUDY Owner's Address: 35 COUNTY SEAT STREET HYAN'P1IS,MA 02601 Date of Inspection SEPTEMBER 7,2005 Name of Inspector:(please print) JAMES D. SEARS Company Name: A&B Canco Mailing Address: 350 Main Street West Yannouth,MA 02673 Telephone Number: 508-775-2800 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this addre ss 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 Needs Further Evaluation by the Local ;approving Authority Fails Inspector's Signature: Date: 09-8-05 The system inspector shall submit a copy of this inspection report to the Approving;Authority(Board of Health or DEP)within 30 days of completi:ig 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 approp-siate regional office of the DEP. The original should be sent to tiie s;vsteni owner and copies sent tot he buyer,if applicable,and the approving authority. Notes and Continents ****This report only describe.,conditions at the time of inspection and under the conditions of use at tha(time. This inspection does not address how the system will perform in the future under the same or differerR conditions of use. Title 5 Inspection Form 6/15.%2000 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 35 COUNTY SEAT STREET HYANNIS,MA 02601 Owner: BROOKS,JUDY Date of Inspection: AUGUST 31,2005 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes:./ I have not found any information which indicates that any of the failure criteria described in 310 CUR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: N/A 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 eafiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health)" broken pipe(s)are replaced obstruction is removed ND explain: Title 5 Inspection Form 6/15/2000 2 Page 3 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 35 COUNTY SEAT STREET HYANNIS,MA 02601 Owner: BROOKS, JUDY Date of Inspection: AUGUST 31,2005 C. Further Evaluation is Required by the Board of Health:N/A _ 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 W 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 salt marsh 2. System will fail unles's 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 public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance ** This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile'organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: L Title 5 Inspection Form 6/15/2000 3 Page 4 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION"FORM PART A CERTIFICATION(CONTINUED) Property Address: 35 COUNTY SEAT STREET HYANNIS,MA 02601 Owner: BROOKS, JUDY Date of Inspection: AUGUST 31, 2005 D. System Failure Criteria applicable to all systems: N/A 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 orponding 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 pit is less than 6"below invert or available volume is less than%z day flow Required pwnping 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 N/A Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply N/A Any portion of a cesspool or privy is within a Zone 1 of a public well N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well N/A Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. (This system passes if the well water analysis performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.) NO (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 311 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to detennine what will be necessary to correct the failure. E. Large Systems: N/A To be considered a large system the system must service a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply I 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.lI 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 is failed. The owner or operator of any large system considered a significant threat under Section E or failed tinder 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. Tide 5,Inspection Form 6/15/2000 4 L i Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 35 COUNTY SEAT STREET HYANNIS, MA 02601 Owner: BROOKS,JUDY Date of Inspection: AUGUST 31, 2005 Check if the following have been done. You must indicate`yes"or"no"as to each of the following Yes No ✓ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ Has the system,received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection? ✓ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ Was the site inspected for signs of break out? ✓ Were all system components,including 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)has been determined based on: Yes No ✓ Existing information. For example,a plan at the Board of HealtL ✓ Detennined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is tmacceptable)[310 CUR 15.302(3)(b)] Title 5 Inspection Form 6/15/2000 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 35 COUNTY SEAT STREET HYANNIS,MA 02601 Owner: BROOKS,JUDY Date of Inspection: AUGUST 31, 2005 FLOW CONDITIONS RESIDENTIAL,/ Number of Bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms: 330 Number of current residents: 2 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO (if yes separate inspection required] Laundry system inspected(yes or no): YES Seasonal use(yes or no): NO Water meter readings,if available(last 2 years usage(gpd)): 2003—40,400 GAL/2004—49,500 GAL. Sump pump(yes or no) NO Last date of occupancy: PRESENT COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: N/A—NOTE:MAINTENANCE PUMP AFTER INSPECTION. NO If yes,volume pumped: gallons—How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM Septic tank,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 copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: 1976—PERMIT#76-323. Were sewage odors detected when arriving at the site(yes or no): NO ,Title 5 inspection Form"6/15/1000 . 6 F� .i OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 35 COUNTY SEAT STREET HYANNIS,MA 02601 Owner: BROOKS,JUDY Date of Inspection: AUGUST 31, 2005 BUILDING SEWER(locate on site plan): ✓ . Depth below grade: 6" Materials of construction: Cast iron ✓ 40 PVC _ other(explain) Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK(locate onsite plan): ✓ Depth below grade: i 0" Material of construction: concrete metal fiberglass polyethylene _ other(explain) If tank is metal list age: Is age confined by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1000-GALLON PRECAST .Sludge depth: 101, Distance from top of sludge to the bottom of outlet tee or baffle: 20" Scum thickness: 2" Distance from top of scum to top-of outlet tee or baffle: 12" Distance from bottom of scum to bottom of outlet tee or baffle: 16" How were dimensions determined: TAPE&ASBUILT. Comments(on pumping reconunendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): TANK AT WORKING LEVEL,TANK&COVERS AT 10",INLET BAFFLE—OUTLET BAFFLE. NO SIGN OF OVER LOADING OR LEAKAGE. GREASE TRAP(located on site plan) N/A Depth below grade` Material of construction: concrete metal fiberglass polyethylene other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Title 5 Inspection Form 6/152000 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 35 COUNTY SEAT STREET I-IYANNIS,MA 02601 Owner: BROOKS,JUDY Date of Inspection: AUGUST 31, 2005 TIGHT or HOLDING TANK: N/A (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/day Alarm present(yes or no) Alarm level: Alarm in working order(yes or no): Date of last pumping Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: N/A (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: N/A (locate on site plan) Rumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Title 5 Inspection Fonn 6/1512000 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 35 COUNTY SEAT STREET HYANNIS,MA 02601 Owner: BROOKS,JUDY Date of Inspection: AUGUST 31, 2005 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: 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.) LEACHING IS ONE 1000-GALLON PRE CAST PIT,PIT AND COVERS AT 30". 30"WATER,STAIN LINE AT 3'. NO SIGN OF OVER LOADING OR SOLID CARRY OVER. CESSPOOLS: N/A (cesspool must be pumped as part of inspectionXIocate on site plan) Number and configuration: _ Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: _ Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation etc.): PRIVY: N/A (locate on site plan) Materials of Construction: _ Dimensions: Depth of solids: Conunents(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) Title 5 Inspection Form 6/192000 9 6 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART.0 SYSTEM INFORMATION(continued) Property Address: 35 COUNTY SEAT STREET HYANNIS,MA 02601 Owner: BROOKS,JUDY Date of Inspection: AUGUST 31,2005 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide,a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. . i . r �' Title Inspection Form 6/15/2000 10 r Page I 1 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 35 COUNTY SEAT STREET HYANNIS,MA 02601 Owner: BROOKS,JUDY Date of Inspection: AUGUST 31. 2005 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to no groundwater 12 feet Please indicate(check)all methods used to detennine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: �— Observation 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: TEST HOLE AT 12'NO WATER. TEST HOLE 3'—6"BELOW BOTTOM OF PIT. BOTTOM OF PIT AT 8'—6"BELOW GRADE. �. CRAZE 0 o Tic ?- 6 p/ Title 5 Inspection Form 6/15/2000 1 1 LOCL.TION : . S o,GE PERMIT 1 O. lI�IST�►LLER•5 1:l�tJlE � ADDRESS � BUILDER 5 Q & E. �- ADDRESS DATE PER"IT ISSUED . D ATE COMPLI &KICE ISSUED : \ L� a � w �p p' r�1 , M CI �� + ..ri;—•cam. THE COMMONWEALTH OF MASSACHUSETTS .-BOARD HEA .........r ..................OF....... ....G:1("001✓/!V off':../..................... ............. Appliration -for Bhiposttl Workii Tonuitrurtion Perotit Application is hereby made for a Permit to Construct ( `<Or Repair ( ) an Individual Sewage Disposal System at ocaf dd es or t No r W OwWr i ddress •.......... - Ins Address ------------- Q Type of Building Size Lot.. / "'P......Sq. feet V Dwelling—No. of Bedroo Expansio Attic ( ) Garbage Grinder ( ) n a Other—Type of Buildin IK-. No. of Pei-soiis �-c_.... Showers (/ ) — Cafeteria ( ) QOther fixtures ......................................................------••••••-•--•••------------------------••--•--••••••.....••----------------............•--- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic T:ttik—Ligtiid capacity:-----------gallons Length-------------_- Width................ Diameter................ Depth.....------..... xDisposal Trench—No. .................... Width----..--.----------- Total Length:............._-.-.. Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter..--.---............ Depth below inlet....�.. ._^-..-..... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank �C''�( . Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1----------------minutes per inch Depth of "Pest Pit..............----.. Depth to ground water...........--.---....... f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.-.- -.-..--..---- LY, ---------------- ------ _ x Description of Soil----.......0-- ....6..-....•-��1/� P�r�� ..�. -.•�-u/- ..:s� V -----------to------ l 2 `.---...... x --• .................................................................................................................................................................................................... U Nature of Repairs or Alterations—Answer when applicable...............:................................................................................ ......-•---•---•----•.................................................................•----------------------........ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article YI of the State Sanitary Code— The undersigned further agrees not to 1 ce the system in operation until a Certificate of Compliance has been iss-up y the rd o health. a _ Signed. ..... ---------- Date Application Approved By----ii ---- G�11�1 .. ...7.,rn,2_2,74 _ 11 Date Application Disapproved for the following'reasons:.........................................................----••---••-------........--------- •.._--_--..-_. ------------------------------•--------------------------------------------•--... ----------------------------- Date PermitNo..................... .................................. Issued........................................................ Date J� No. •• Z '1D.............. • ti THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................... ......................OF...........................-...--............-.....-.-...--..-.-...---.-.-............... Application •fur Tiopuuttl Works Totuitrurtion Prrntit Application is hereby made for a Permit to Construct ( ✓�or Repair ( ) an Individual Sewage Disposal System at _dam '....c ocati - ddr ss or I.ot Ivo. Owner •••••-••-•-•••-•--••-••- ----•-------- � f +�"� -----••-- Instal Address Type of Ifuilding Size Lot--,llJ_ -----L------Sq. feet Dwelling—No. of Bedroo s._._._ ________________________Expansio Attic ( ) Garbage Grinder ( ) Other—Type-of Building�.�.44. Ak No. of pet sons- tom-!ram-�.,, Showers ( /) — Cafeteria ( ) PaOther fixtures ......................................................-------.._._._..-------------------- d W Design Flow............................................gallons per pet-son per day. Total daily. flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length________________ Width................ Diameter................ Depth................ x Disposal Trench—No.___________________• Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No--------------------- Diameter.................... Depth below inlet_______ __.__.._.__ Total leaching area------------------sq. fI. Z Other Distribution box ( ) Dosing tank ( ) e)6 /�C 4L(-•. I/ /S-- Ili -- W Percolation Test Results Performed by...................................................................... -•-- Date-------------------------------•-----... Test Pit No. 1................minutes per inch Depth of "Pest Pit.................... Depth to ground water........................ r3:4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water...................... 0 ------x r - ( :.__ ------ - --------------- - Ow _. .. _.. .......l: - - _ ----•y-•--•--1 __-G,•-•••• 'escrpton•ool 4, .............. . C_ _12-- ---- J ,. ; .�..cj: ram_ U Nature of Repairs or Alterations—Answer when applicable................................................................................................ ------------------------••-•....••--_.....----------•------•------•-••...------••••-••-••-•---•--•--•-•--•-••-------•--•----...•----•-------•-••----•-•.._...._...............•••-••-•-•--••.........-_. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issue y the rd of healthg��et,Q ,�` �Signed _-- •-- - —- ... _.._--•a._........--••• �i��-/f � Date Application Approved B ///>G�i�.. �Il/6`j4 2 PP PP Y �� — IA-Date Application Disapproved for the following reasons:..........................................•____........__...____________•____-_--_._.._.........____.________-__ ._...._...--•--------•.................•--_._._.._...._...--•--••---._...--••-•--•--••--------••-•--•----.._.__.__...------------•-•-•--------------•-----------•---..._.___...._•-----•-•---._...-•-•••- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS •� BOARD HEALTH .......... . OF........ ../.... ..CQ C. .. .............. �lr.rttfirate of fITum iiattr.e THIS I TO C RrIF at t e dividual Sewage Disposal S stem constructed or Repaired ( ) Z' Zt � inst aller alter a at {� lRA, � r_••' r� - ,...�'�/fir a�a�it} has been installed in accordance with the provisions '- Ar c e XI of The 5t�t Sanitary Code as described in the application for Disposal Works Construction Permit No._-l�J-♦ __ ________________ dated....7��2. .-_7�__...._...___.___. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUN N TISFACTORY. DATE------- ••-••---•-••••-•-•-••---•-••----- Inspector----------------- - ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH �Z�l .....OF-........ ... ... . .............. No....- 2� ----- FEE . %spagal It 'kq tru at Vrrmit Permission s reby granted..-- . _J(./t 1�-----u to Construe or Repair--(} ) an Ividual Sew e D' po. I ystem °Street as shown on the application for Disposal orks Construction Per o...........:........ Da ed .... :. ______ -----. Ii --- � ! oard oi�FIe� � DATE......�T___`d.4 76---------------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS -f , i • I 1 _ - pq } ' FU U►,J�` 5 Ij OF L 07T' YVi4i.lA1}A yGN� . U � , t ,� ,-iSTCR49 4, ruG> 5 VrlGy ( j. • EXISTING LEACH PIT LEGEND •-N - veer°rd TO BE PUMPED, FILLED WITH -- 18 -- EXISTING CONTOUR SAND AND ABANDONED x 16.82 EXISTING SPOT GRADE Ma � Ave � PROPOSED SEPTIC TANK -W EXISTING WATER SERVICE S HOm gh1re 0.41 EXISTING SEPTIC TANK -O.-H.VIA-OVERHEAD WIRES coo o s a t TO BE PUMPED, RUPUTURED & Ave TEST PIT N m set g FILLED WITH SAND. lane t $ BENCHMARK I B�yetot Ave t9 BENCHMARK SET {en�e I y ) TOP CONCRETE/BULKHEAD COR. / I a��t seat St M EL.=39.70 Assumed Datum) 5 39.02 t c LOCUS d V \A Q� I skating a 1� 39 '`� TPT2 t _ + �� I LOCUS MAP �\TP-1 `�-0� \` I I NOT TO SCALE 36.75 �t39.46\ ��`;' t N f � r �N` N � °: GENERAL NOTES: � 0 44ilt W 1, ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE �F�� \ O �' LOCAL BOARD OF HEALTH AND THE DESIGN ENGINEER. 38.01�� 8 53x O, holly trees 31,1q ��\� 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS \ BM r `� ` 10 m OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE 9.70 39.07 1' 1 LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: 5xt MANIFOLD 3 ROWS AND -310 CMR 15.405(1)(b): �0 8• 139.61I INSTALL INSPECTION PORT 1) A 1' variance to the 3' maximum cover requirement, for 4' 37.67 x DECK SE�E26 i AND VENT of max. cover. S.A.S. shall be H-20 and vented. ENV'3/ )39.61 1 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR x 4 8 TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE �i � i DESIGN ENGINEER. /EXISTING f/ 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING 37 92 HOUSE(#35) DECK t FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN x 39.44 ENGINEER BEFORE CONSTRUCTION CONTINUES. x �� T.O.F.=39.70E Cb 5. ALL ELEVATIONS BASED ON AN ASSUMED DATUM (APPROX. MASHPEE GIS). �� \v 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 37.79 x 38.64 (�� m t THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF c HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. Z �\ 3839 �\`J x 90 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. t x 40.42 x 4 rn \1 37.62 `r' x \ 8. THERE ARE NO POTABLE WELLS WITHIN 150' OF THE PROPOSED S.A.S. 37•63 t 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS 3 07 AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE O I / t \ DIRECTED BY THE APPROVING AUTHORITIES. 0 1 -o.. t LOT 6 0 ` _ t 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY APN 1 291-1 67 00 \1 UP THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING I 101602 S.F.t t'�i j 0.51 10 CONSTRUCTION. x j 40.44 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS /�7.8S IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND 40,00 REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). �_-_ ____•� �., rL2. 12.ent AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE o Jett g �� 01 Mgss INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. -c:• 38,27 P Q� 9� 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND 38.04 39.59 _�` �G IS NOT CONSIDERED TO BE A PROPERTY LINE SURVEY. PETER T. 14. THE CONTRACTOR SHALL BE RESPONSIBLE FOR OBTAINING A TRENCH of M CIVIL PERMIT FROM THE LOCAL MUNICIPALITY IN WHICH THE WORK IS BEING 38,63 ( PERFORMED. 39.22 S No. 35109 15. ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED SEPTIC \,- 52 edge F �'EGI$TE� tt`c``� SYSTEM COMPONENTS NOT SHOWN ON THE PLAN. 38.33 X 1 �1-54- 38.81 P 1, FFSS N�� PROPOSED SEPTIC SYSTEM UPGRADE PLAN 38.68 S ( )-z. 35 COUNTY SEAT STREET HYANNIS MA OWNER OF RECORD Prepared for: Shane Pacheco, 4 Deep Hole Road, Sandwich, MA 02563 1 ,N t Engineering by: SCALE DRAWN JOB. NO. V 1 FEDERAL NAT'L MTG ASSOC C 0F.O. Box 174 Engineering Works, Inc. 1"=20' P.T.M. 152-12 a HYANNIS, MA 02601 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. & PACHECO, WAYNE (508) 477-5313 4/30/12 P.T.M. 1 of,2 t i . NOTE: TO PREVENT BREAKOUT, THE PROPOSED " FINISH GRADE SHALL NOT BE < EL.36.33 FOR A DISTANCE OF 15' AROUND THE " PERIMETER OF THE S.A.S. SEPTIC TANK PROPOSED D-BOX a PROPOSED S.A.S. 1 INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & WATERTIGHT INSTALL 1 INSPECTION PORT AT CHARCOAL VENT OUTLET AND SET TO 6" OF FINISH GRADE COVER SET TO 6" OF GRADE EACH END OF S.A.SI. (CONNECT ALL LINES) T.O.F.--39.7t I F.G. EL.=39.1 f F.G. EL: 40.3(MAX.) F.G. EL.=38.6t � F.G. EL: 39.0t � � . MAINTAIN 2% GRADE (MIN.) OVER S.A.S. '. INSPECTION PORT L = 18' L 24' L — 6'(MAX) (1, MINIMUM) ® S=1% (MIN.) S=1% (MIN.) ® S=1% (MIN.) 4"SCH4 PVC 4"SCH40 PVC 4"SCH40 PVC 17.46" 6" 10" " g^ —�{INSTA10 14" 10.75" TO I LENGTH INV.=36.75 48" LIQUID INVERT I I 9.45" LEVEL GAS BAFFLE f INV.=36.17 PROPOSED INV.=36.00 (3 ROWS OF 6 UNITS AT 5.0'/UNIT) + 2.4' (2 COUPLERS) = 32.4' 16" 12 37„ J INV.=36.50 � SOIL ABSORPTION SYSTEM (PROFILE) Aft Am Am am& INV.=35.90 10.38" PROPOSED SEPTIC TANK INVERT DOME END ESTABLISH VEGETATIVE COVER HEIGHT BACKFILL WITH CLEAN NATIVE OR POST END CONNECT TO EXISTING 4" SCH 40 PERC SAND TO TOP OF CHAMBERS SEWER AT HOUSE, INV.=37.28 J[33.75" BREAKOUT=TOP TOP ELEV.=36.33 INV. ELEV.=35.90 NOTES: BOTTOM ELEV.=35.00 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE 2,83' NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT INVERTS, PRIOR TO INSTALLATION. 4' OF NATURALLY OCCURRING TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY 2) SEPTIC TANK & D—BOX SHALL BE SET LEVEL AND 5' MIN. SEPARATION TO G.W.PERVIOUS MATERIAL EFFECTIVE WIDTH=8.5 DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. TRUE TO GRADE ON A MECHANICALLY COMPACTED EXISTING SUITABLE 4640 TRUEMAN BLVD SIX INCH CRUSHED STONE BASE, AS SPECIFIED NO GROUNDWATER, EL.=29.2 — ` MATERIAL ImS. HILLIARD, OHIO 43026 Are 36HC SIDE PORT COUPLER IN 310 CMR 15.221(2). Q L ADVANCED DaaNACE srsTEMs,INC. UNITS MUST BE STAMPED H-20 3) INSTALL INLET & OUTLET TEES AS REQUIRED. 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE USE 3 ROWS OF 6—ADS Arc36HC UNITS + 2 COUPLERS PER 63.25" AS MANUFACTURED BY TUF—TITE, ZABEL OR EQUAL. ROW WITH NO SEPARATION BETWEEN EACH ROW & NO STONE SEPTIC SYSTEM PROFILE TYPICAL SECTION N.T.S. 34.5" DESIGN CRITERIA SOIL LOG Wr NUMBER OF BEDROOMS: 3 BEDROOMS DATE: APRIL 25, 2012 (REF#13,617) TOP VIEW SOIL EVALUATOR: PETER McENTEE (SE#1542) 60" SOIL TEXTURAL CLASS: CLASS I WITNESS: DONALD DESMARAIS R.S.-HEALTH AGENT END CAP END CAP DESIGN PERCOLATION RATE: <2MIN/IN Elev. TP- 1 Depth Elegy. TP-2 Depth FRONT VIEW SIDE VIEW DAILY FLOW: 330 GPD 39.2 q 0" 39.9 q 0" END CAP REAR/TOP VIEW DESIGN FLOW: 330 GPD SANDY LOAM I SANDY LOAM 1OYR 4/2 10YR 4/2 DI WITHOUT UNIT CONFIGURATION AND AVAILABILITY SUBJECT SIDE VIEW GARBAGE GRINDER: NO 38.7 6" 39.4 6" CHANGE NOTICE. PRODUCT DETAIL MAY B , B DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. LEACHING AREA REQUIRED: (330) = 445.9 SF SANDY LOAM SANDY LOAM 4640 TRUEMAN BLVD .74 10YR 5/8 10YR 5/8 9mcm.HILLIARD, OHIO 43026 Arc 36HC DETAIL PROPOSED SEPTIC TANK: 1500 GALLON CAPACITY 36.7 C 30" 36,9 C 36" ADVANCED DPANAGE SYSTEMS.INC. UNITS MUST BE STAMPED H-20 (TO REPLACE EXISTING GALLON TANK) PERC ► PROPOSED SEPTIC SYSTEM UPGRADE PLAN PROPOSED D-BOX: 1 INLET, 3 OUTLETT (MINIMUM), H-10 RATED 36"/48" USE 3 ROWS OF 6—ADS Arc36HC UNITS + 2 COUPLERS PER M—C SAND I, M—C SAND 35 COUNTY SEAT STREET, HYANNIS, MA ROW WITH NO SEPARATION BETWEEN EACH ROW & NO STONE 2.5Y 6/4 2.5Y 6/4 BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.80 SF/LF OF UNIT) , 1 Prepared for: Shane Pacheco, 4 Deep Hole Road, Sandwich, MA 02563 (Arc36HC Units) 18 UNITS x 5.0 LF x 4.80 SF/LF = 432.0 SF Engineering by: SCALE DRAWN JOB. NO. (COUPLERS) 6 COUPLERS x 1.2' x 4.80 SF LF = 34.6 SF 29.2 120" 29.9 120" 1"=20' P.T.M. 152-12 / Engineering Works, Inc. TOTAL AREA = 466.6 SF PERC RATE: <2 MIN/IN ("C" HORIZON) 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. DESIGN FLOW PROVIDED: 0.74(466.6 S.F.) = 345.3 G.P.D. NO GROUNDWATER OBSERVED (508) 477-5313 4/30/12 P.T.M. 2 Of 2 11