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0044 COUNTY SEAT STREET - Health
44 COUNTY SEAT RD. HYANNIS A = 291 158 i ii i a 1 TOWN OF BARNSTABLE LOCATION - SEWAGE#,::�9Tl VILLAGE ASSESSOR'S MAP&PARCEL. 2 a INSTALLER'S NAME&PHONO. �/SEPTIC TANK CAPACITYLEACHING FACILITY:(typ i (size)AaZ V-c V -0 NO.OF BEDROOMS OWNER PERMIT DATE QGJ COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) _ Feet FURNISHED BY:` / .' W II } r) 13� No. 'i Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYication for ai,5pozar *pgtcm Cowaruction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No.y,�I cool /y :529;r 51-7— Owner's Name,Address,and Tel.Noo Assessor's Map/Parcel c'�2 / IJ—F Installer's Name,Address,and Tel.No.t-� 6��n �� Designer's Name,Address and Tel.N � Type of Building: Dwelling No.of Bedrooms Lot Size -7, sq.ft. Garbage Grinder ( ) Other Type of Building �� No.of Persons Showers f ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3� gpd Design flow provided ,> s�� ° gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank / — 00 Type of S.A.S. p� ' 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 H alth. 17?2 Signed Date Application Approved by Date " Application Disapproved by: Date for the following reasons aotPermit No. 0 C Date Issued rr •! No. 0 Fee THE COMMONWEALTH OF MASSACyHUSETTS Entered in corriputer PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIppYication for Dioogal *p.5tem Cow5truction Permit Application for a Permit to Construct( ) -Re-p-air( ) Upgrade( ) Abandon( ) El Complete System ❑Individual Components Location Address or Lot No.�y COU`7!y 5€mot r 5 Owner's Name,Address,and Tel.NO. e./ Assessor's Map/Parcel 1;29/ / C Installer's Name,Address,and Tel.No.��</��� Designer's Name,Address and Tel.No�/7 0 5 6 6% Type of Building: Dwelling No.of Bedrooms Jtrt _ '); Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building /�/ 'S No.of Persons _ i Showers( ) Cafeteria( ) J Other Fixtures Design Flow(min.required)(/ gpd, Design flow provided J . gpd Plan Date Number of sheefs �d �jr Revision Date Title 3. /.•f,�'� %' '-i.J C. � Size of Septic Tank ;yY7 40�00 XType of S.A.S. Description of Soil' Nature of Repairs or Alterations(Answer when applicable) C) -7 00 5'A-=5 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 g. / Date , Application Approved,by j Date X5—� Application Disapproved by: ,! Date for the following reasons ,r �Per .. it No. �C` Date Issued THE COMMONWEALTH OF MASSACHUSETTSt, BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (!-) Upgraded ( ) d,. Abandoned( )by attas been constructed in accordance Q with,the provisions of Tit�thefo ispos�Construe ton Permit No. a0t 1" a10 dated Installer ,✓ ,. yam / G �: Designer ' . #bedrooms ,3 r Approved de ign flo 33� gpd The issuance of hi permit shall not be construed as a guarantee that the system wt I fu\nct o(gas design d. Date Inspector ,W — No...- 2,011 a�i'1S ----_----__ __.__—_--- _--,-- Fee --�"`-" ----_. THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS wizpogal *p!5tem Construction Permit Permission is hereby granted to Construct ( ) Repair ( `)Upgrade ( ) Abandon ( ) System located at �� S and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit,^ , Date Approved by ;i r Darren Meyer, R. S. 178,15850293 P. 1 Town of Barnstable Regulatory Services Thomas F.Geiler,Director � S& Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,ivLa 02601 Ofce: 503-8624644 , Fax: 503-790-6304 Installer&Designer Certification Form Q f � Date: `1 t I 1 'Sewage Permitar�Il" 0 Assessor's Map\Parcel Designer: Installer: Address: !94 Address: 0n 0 '� Gt�vas issued a permit to install a (date) (installer) septic system at '"l`� 1� � Cora-j- �� based on a design drawn by (address) dated (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocatiun of the distribution box andlor septic tank. I cernfv 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 systern) but in accordance with State& Local Regulations. Plan revision or certified as-built by designer to follow. OFDAR . +G ^ (Installer's Sisnature) ` 1i 1 (A /V4 M1df I A% � (Designer's SignatuT* TABLE (Aft:,Designer's Stamp Here) PLEASE RETURN TO PUBLIC HEALTH DIVISION. CERTIFICATE OF COiNIPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORiVI AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Heaith,Septic�Designer Certification Form 3r26-lkf:'doc f Town of Barnstable Barnstable OfVE h� o� Regulatory Services Department !edcaC 1 + BAftNSTABLE, MASS : Public Health Division . 0Q m �ArfD 39. b. 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 7567 August 08, 2011 David Holt C/o Today Real Estate 1533 Falmouth Road (RT. 28) Centerville, MA 02632 . ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic System located at,44 County Seat , Hyannis, MA. was last inspected on 7/26/2011 by Shawn Mcelroy, a certified septic inspector for the State of Massachusetts. According to the private septic system inspector, the system "Fails" due to the following: • Static Liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS. You are ordered to repair or replace the septic system within One (1)Year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period may result in future enforcement action PER ORDER OF THE BOARD OF HEALTH i omas McKean, R.S., CIO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures\l-I SAMPLE 60 Day Deadline.doc o J�f l� � i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments i 44 County Seat St Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) . Owner Owner's Name information is required for every Hyannis MA 02601 7-26-11 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. A. General Information I A 1. Inspector: Shawn Mcelroy Name of Inspector ° Upper Cape Septic Service Company Name 29 Atwater Dr Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. Th-e-inspection was performed based on my training and experience in the proper function and maintenance of ori4te sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.3401-1 Title 5(310 CM 15.000).The system: , —n ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority ry r-- rn 7-26-11 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to.the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•11/10 Title 5 Official Inspection Form:Subsurface S age Disposal jim, •Page 1 of 17 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 44 County Seat St Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Hyannis MA 02601 7-26-11 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: 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): t t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form " Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �Y 44 County Seat St 4 M Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information Hyannis MA 02601 7-26-11 required for every y page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 44 County Seat St Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Hyannis MA 02601 7-26-11 page. Cityrrown State Zip Code. Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: "* This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes No ® , ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/day flow t5ins-11/10 . Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form " Subsurface Sewage Disposal System Form -Not for Voluntary Assessments I 4M 44 County Seat St Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Hyannis MA 02601 7-26-11 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis _ and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area-IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 44 County Seat St Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Hyannis MA 02601 7-26-11 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? El Have large volumes of water been introduced to the system recently or as part of ® this inspection? ❑ ® Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (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): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x #of bedrooms): 330 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 44 County Seat St Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Hyannis MA 02601 7-26-11 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail Sump pump? ❑ Yes ® No Last date of occupancy: 5-2011 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �^M 44 County Seat St Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Hyannis MA 02601 7-26-11 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): # General Information Pumping Records: Source of information: N/A Was system pumped as 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) (f 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. i ❑ Other(describe): t5ins•11/10. Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 44 County Seat St Property Address, Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is Hyannis MA 02601 7-26-11 required for every y page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (f known) and source of information: 1983 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 16 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints,venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): Depth below grade: 8 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gal Sludge depth: 12" t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form " Subsurface Sewage Disposal System Form -Not for Voluntary Assessments uM 44 County Seat St Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Hyannis MA 02601 7-26-11 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 20" Scum thickness 0 Distance from top of scum to top of outlet tee.or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments M 44 County Seat St Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Hyannis MA 02601 7-26-11 page. City(Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 44 County Seat St Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Hyannis MA 02601 7-26-11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box had clear signs of failure with stain lines above inlet invert. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11/10 - - Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 44 County Seat St Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Hyannis MA 02601 7-26-11 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1-1000 gal ❑ 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.): Leach pit had clear signs of failure with stain lines above inlet invert and into riser. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•11/10 Title 6 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 44 County Seat St Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Hyannis ! MA 02601 7-26-11 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.): i t5ins•11/10 4 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 44 County Seat St Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Hyannis MA 02601 7-26-11 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 . . OG Vr _ t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth m ealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 44 County Seat St Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Hyannis MA 02601 7-26-11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 20 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: USGS and town maps show groundwater at greater than 20'. i i Before filing this Inspection Report, please see Report Completeness Checklist on next page. ' e t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 I � Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 44 County Seat St Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Hyannis MA 02601 7-26-11 page. City(rown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-11/10 Titfe 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 TOWN OF BARNSTABLE LOCH T ION �d li�fy sect -5 r SEWAGE# vlz.z4ArE /+�T�.'� ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. 1 SEPTIC TANK-CAPACITY LEAcFuNG FAa .1TY: (type) NO.OFBEDROOMS `3 BUILDER OR OWNER PERMITDATE: COMYL IANCE�DKM Separation Distance.Between the: Maximum Adjusted.Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and L.eaciting 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 of2:'r, h ing facility) Feet Furnished by J �► l i aJ � , � � n ts Nl CFI f r r J L t ° N -r-71,� °C k�7 .............. CZ, qzz- ��9 � �, g. p. O � � � _ _-------- � � O o /(I� ` r i � i n -- _ „� I �� � {� ��� � � � � �� �� � w o � � �n � 0 � � � � � � _ � �� T � � � � � � � � �� �, III_51 1 . Town of B ~nstable. - P# -� Department of Regulatory.Services • Public jIealth Division Date_ e1sr� ' Frew. ses9 tee$ .200 Main Street,Hyannis MA 02601 / . Time _ Fee Pd. Date Scheduled i i Soil Suitability Assess rr e&t for S wage Disposal . B : P"S Performed By: .,1,• !\ LL /k itnessed�, �/!G W Y f LOCATION &;GENERAL INFORMATION . : g Location Address . � //�� �/ -�� S�f' IJ Owner's Name �PCS�t_�!A lJ �S l �PI l AddressrM Assessor's Map/P�rcel: Z I Engineer's Name t'- a�/rs� x D NEW CONSIRUI'�'MON REPAIR ` Telephone# S0 (0 2n/- Z 22 Land Use t-�,� � Slopes(To) S o o Surface Stones t" 0-0 Distances from: Open Water Body ft Possible Wee Area �f)t" ft Drinking Water Well? f[ ft Drainage Way '' i-'� ft. .Property Line, '� 'd Ot her ft S110ETCH:(street name,dimenstod5'4104 exact locations of test holes&perc tests,locate wetlands in proximity to holes) N77'10'45"E 127.02' 08lbh FEN _ P - - ARCfL 10. PANT 1 G ��� TwOMf 8 �'AREAe9 ii5t S.F. 0. O TOM. T e.0 m DECK m '^ JB. �/44 ..,., o... 30.14' � E'(OEYOF FlJO 2.28• of FENCE FENI CD 273 . � W / 'DRIVEWAY --___—• t,J••d' L 135,W- /P to a � A. Parent material(geglOgic) �G�.LI. CV1 �L'f. /lc. Depth to Bedrock k I in from PI Face.., + Depth to Groundwatdr: Standing Water in Hole:' , Weeping g Estimated Seasonal I-hgh Groundwater DtTERMINATION FOR SE"ONAL HIGH WATER T"LE' Method Used: ln. Depth C1bperved standing in obs.hole: in. Depth t0 sgll tttottles: y . Depth toiweeping from side of obs:hole: in,' OroundwnterAdjustment f Index Well# Reading Date: Index Well leve] Adj.f tetar..._ Ad1,droundwaterLev�el.,,,,Q, n$tp PERCOLATION TEST f---= �c Observation Ttme at 9"- �'-.-------- Hole# e! .. _ 4� Time at G'. ,,._..�...._. . Depth of Pere' l l D 7 i Time(9".6'i) f Start Pre-soak Time.@ gg Z End Pre-soak Rate inJInch Additional Testing Needed(YIN)' Site Suitability AsseasmenC Site Passed i Site Failed; — Original:-.Public Filth Division Observadon Hole Data To Be ComQleted on Back ***If percolafii6n test is to be conducted within 100' of wetland,.-You must first notify the Barnstable C44servation Division at least one (1)wedk prior to beginning. DEEPibBSERVATIOly I3[OLE`LOG Hole# Depth from • Soil Horizon Soil7exture Soil Color,. Soil Other. Surface(in.) (USDA) (Munsell) Mottling (Structure.Stones,Boulders. Consistency,%Gravel b u I. A ` 13 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. A Consistent %Gravel) 1 A Asti✓l J(�� t • 0.11 DEEP OBSERVATION HOLE LOG Hole# Depth from' Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel DEEP OBSERVATION HOLE LOG Hole# F Depth from Soil orizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones.Boulders. Consisten ra I Flood Insurance Rate Map: Above'500yearflood'boundary No_ Yes Within 500 year boundary No Yes Within 100 year flood.boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring per i us aterial exist.in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring per ious material? Certification I.certify that on 0 41 (date)I have passed the soil evaluator examination approved by the Department of-Environmental Protecfion and that the .above analysis was performed by me consistent with the required tr ' ing,,e ertise,and perience described in 30 CMR 15.017. J Signature / 1 Date C Q:ISEPTIGIPERCFORM.DOC ` Town of Barnstable Barnstable THE pp Tp� " Regulatory Services Department 11111.1 � IIARIMASS. E, Public Health Division 9 MASS. � 039. > 200 Main Street Hyannis MA 02601 2007 Ea MA't Y Office: 508-862-4644 Thomas F.Geiler,Director . FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7011 0470 0001 4525 7567 August 08, 2011 David Holt C/o Today Real Estate 1533 Falmouth Road (RT. 28) Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic System located at, 44 County Seat , Hyannis, MA. was last inspected on 7/26/2011 by Shawn Mcelroy, a certified septic inspector for the State of Massachusetts. According to the private septic system inspector, the system "Fails" due to the following:' • Static Liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS. You are ordered to repair or replace the septic system within One (1) Year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period may result in future enforcement action PER ORDER OF THE BOARD OF HEALTH 1W)omas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures\1-1 SAMPLE 60 Day Deadline.doc COMMONWEALTH OF`MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS V DEPARTMENT OF ENVIRONMENTAL PROTECTION t bV� �y 350 MAIN STREET WEST YARMOUTH,MA Cc� 508-775-28001C0 RECEIVED TITLE 5 A�UG o 3 2001 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMEN S SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM TOWN OF BARNSTABLE PART A HEALTH DEPT. CERTIFICATION Property Address: 44 COUNTY SEAT ROAD HYANNIS,MA 02601 Owner's Name: PAUL FREDERICKSON Owner's Address: 44 COUNTY SEAT ROAD HYANNIS,MA 02601 Date of Inspection JULY 18,2001 Name of Inspector:(please print) JAMES D.SEARS Company Name: A&B Canco Mailing Address: 350 Main Street West Yarmouth,MA 02673 Telephone Number: 508-775-2800 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: �" Date: The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent tot he buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 1 f Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 44 COUNTY SEAT ROAD HYANNIS,MA 02601 Owner: FREDERICKSON,PAUL Date of Inspection: JnY 18,2001 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X I have not found any information which indicates that any of the failure criteria described in 310 CMR. i 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 exfiltration 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 Healthy' 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: 44 COUNTY SEAT ROAD HYANNIS,MA 02601 Owner: FREDERICKSON,PAUL Date of Inspection: DULY 18 2001 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 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 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 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: I Title 5 Inspection Form 6/15/2000 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 44 COUNTY SEAT ROAD HYANNIS,MA 02601 Owner: FREDERICKSON,PAUL Date of Inspection: JULY 18,2001 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 X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in pit is less than 6"below invert or available volume is less than''/,day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped X 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 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: 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 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 is failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Title 5 Inspection Form 6/15/2000 4 L Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 44 COUNTY SEAT ROAD HYANNIS,MA 02601 Owner: FREDERICKSON,PAUL Date of Inspection: JULY 18,2001 Check if the following have been done. You must indicate"yes"or"no"as to each of the following Yes No X Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks? X Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection? X Were as built plans of the system obtained and examined?(If they were not available note as NfA) X Was the facility or dwelling inspected for signs of sewage back up? X Was the site inspected for signs of break out? X Were all system components,excluding the SAS,located on site? X 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 X 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 X Existing information. For example,a plan at the Board of Health. X 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(3Xb)] 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: 44 COUNTY SEAT ROAD HYANNIS,MA 02601 Owner: FREDERICKSON,PAUL Date of Inspection: JULY 18,2001 FLOW CONDITIONS RESIDENTIAL Number of Bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms: 330 Number of current residents: 3 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)): 1999 27,000 CU.FT./2000 38,500 CU.FT. 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: MARCH 2O01 Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: gallons—How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) - Tight tank Attach copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: UNKNOWN Were sewage odors detected when arriving at the site(yes or no): NO Title 5 Inspection Form 6/15/2000 6 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 44 COUNTY SEAT ROAD HYANNIS,MA 02601 Owner: FREDERICKSON,PAUL Date of Inspection: DULY 18,2001 BUILDING SEWER(locate on site plan): N/A Depth below grade: Materials of construction: Cast iron _ 40 PVC _ other(explain) Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK(locate onsite plan): X Depth below grade: 8" Material of construction: X concrete metal fiberglass polyethylene _ other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1,000 GALLON PRE CAST Sludge depth: 2" Distance from top of sludge to the bottom of outlet tee or baffle: 28" Scum thickness: F, 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: 17" How were dimensions detetnuned: TAPE Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): TANK AT WORKING LEVEL,TANK AND COVERS 8"BELOW GRADE.OUTLET BAFFLE,NO SIGN OF OVERLOADING SEEN IN TANK. 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 6/15/2000 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: 44 COUNTY SEAT ROAD HYANNIS,MA 02601 Owner: FREDERICKSON,PAUL Date of Inspection: JULY 18,2001 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 0 Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: X (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 0 Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.,): DISTRIBUTION BOX IS 9"X15",15"BELOW GRADE,BOX IS NEW JULY 24,2001. ONE LINE IN, ONE LINE OUT. PUMP CHAMBER: N/A (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Title 5 Inspection Form 6/15/2000 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: 44 COUNTY SEAT ROAD HYANNIS,MA 02601 Owner: FREDERICKSON,PAUL Date of Inspection: DULY 18,2001 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: Type X 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.) ONE(1)1,000 GALLON PRE CAST PIT.PIT AND COVER T BELOW GRADE. 3'WATER IN PIT.NO HIGH STAIN LINE,NO SIGN OF OVERLOADING. CESSPOOLS: N/A (cesspool must be pumped as part of inspectionXlocate 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: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) Title 5 Inspection Form 6/15/2000 9 e S Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 44 COUNTY SEAT ROAD HYANNIS,MA 02601 Owner: FREDERICKSON,PAUL Date of Inspection: JULY 18,2001 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 obi �? �4t a ,.G o S � Title 5 Inspection Form 6/15/2000 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 44 COUNTY SEAT ROAD HYANNIS,MA 02601 Owner: FREDERICKSON,PAUL Date of Inspection: DULY 18,2001 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to no groundwater 20 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observation site(abutting property/observation hole within 150 feet of SAS) X 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: G.I.S. BARNSTABLE HEALTH DEPARTMENT. Title 5 Inspection Form 6/15/2000 11 3' TOWN OF BARNSTABLE LOCATION C���"�r�£�T �'� SEWAGE # VILLAGE �1�Y�1'U1U�.5 ASSESSOR'S MAP & LOT jNs�£c7ae t IT 'S NAME 6z PHONE NO. A & B CANCO 775-6264 -SEPTIC TANK CAPACITY £c o LEACHING FACILITY:(type) (size) NO.OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE P-ER'Aff-ISSU-B-D: 7- DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No c� 9� J t) 0 p 0 No. ae o I—S3 97 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 3pprication for Migotaf 6potem Construction Perron Application for a Permit to Construct( )Repair(k)Upgrade( )Abandon( ) El Complete System ,Individual Components Location Address or Lot No. 7 o I,iv T k' S Z's$"t—�e'9 Owner's Name,Address and Tel.No. File.EZ Z:,f/C&-.Y& v Assessor's Map/Parcel / �. 4/Y C G u ov7y/ S 14 r�D / nS Instal er's Name,Address,and Tel.No. S6d - 7 9 f'-A frc Designer's Name,Address and Tel.No. 146 to,4AIC-0 3s-1; ,191' 4/A15r- Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) e ��� t £ l' Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been is d by this Board of Healtill Signed s� Date Application Approved by Date 7 7z y G Application Disapproved for the following reasons Permit No. Date Issued G No. 2 — .��O Feet a. Y r_. THE COMMONWEALTH Entered in computer: ,OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Yes pprication for �Diopozar *pgtem Construction Permit Applioa/fion for a Permit to Construct( )Repair(k)Upgrade( )Abandon( ) ❑Complete System FfIndividual Components Location Address or Lot No. L/y �►p L/N'�Y r- �° Owner's Name,Address and Tel.No. )=Rex j 4le C Irl.9 Assessor's Map/Parcel u A.,-r S£4- mo o rl fi i r Installer's Name,Address,and Tel.No. S- a'• r Designer's Name,Address and Tel.No. gr- 4,v- ff Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures 'k Design Flow gallons per day,�Calculated daily flow gallons. Ian Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) �Zd c r 4- Date last inspected: Agreement: The undersigned agiees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a-Certifi- cate of Compliance has been iss d by this Board of Health. Signed Date Application Approved by Date 7 7-4 G A lication Disapproved for pp pp roved o the following reasons 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 />?x-1e,6 S'G ody A, 5:r- at j. A7- e j /1 Y has been constructed in accordance with the prov sions of Title 5 and the for Disposal System Construction Permit No.!2 mg dated 7- 7 _0 Installer Designer The issu a of this permit shall t be construed as a guarantee that the syste wi nction es' d. Date Inspector ---- -No.y 2en)/— - - -- ��'��� Fee S� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS X11j11i0poga1 *p! tem Construction Permit Permission is hereby granted to Construct( )Repair(44 Upgrade( )Abandon( ) System located at ! e'01�iv'� �g 17- y and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction ust be completed within three years of the date of this 20, Date: Z Approved by L O.0 A`T-10N SEWA C�E�PERMIT NO. VIkLACE 11IST LIER'S NAME i ADDRESS oberT Our 0o C.3iC 3 U I L D E R OR OWNER DA T E PERMIT ISSUED.:'. - 1 DATE COMPLIANCE ISSUED i�I-Ael �,�.-� �� � .. �� i• � - ._ �! THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH . . :".....................OF...-............... :2 - ..AP .... ApplirFation for Uispuaaal Workii Tnnitrurtion Prrutit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: L• ion Afldress q / r t ko. - T caner Address w � ' C, i�--------------------------------------- - 1 1.1 �f..------- l..A.................................. Installer Addres Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms..................�....................Expansion Attic (r/a) Garbage Grinder (a) a'4 Other—Type of Building p ( ) ( ) g �,J_�a�____�(1/s�?ENo. of ersons_________________ _______ Showers — Cafeteria dOther fixtures ------------------------------------------------------•-•--••-••-•-•-----------------•----•------•••--•-••-••••••••-•-••-•--•-_... W Design Flow__________________'.0_____..__-:__.____gallons per person per day. Total daily flow............... - ...............gallons. WSeptic Tank—Liquid Li uid ca ac' f p ' q p y.,10.60._gallons Length___ �.___:Width__._ ./.v___ Diameter..__..:-______ Depth_._-f�___9__- Disposal Trench x No. ._____tf________. Width.........-_........ Total Length......._".......... Total leaching area-------=.......sq. ft.�Seepage Pit No.............../_.... Diameter........C__4...... Depth below inlet........6-r_•-•-_•_ Total leaching area_. ft. Z Other Distribution box ( ) Dosing W� ,tl ik Percolation � )� � �.�� D � i s sTest pi �oQ Performed mch Depth of T t Pit_. _.___ . Depth to.ground Water_._____.!��N�� --------------- Gi, Test Pit No. 2..ht!�_._minutes per inch/Depth of Test Pit.................... Depth to ground water________________________ 0 v O j f .................................................... Descnption of Soil----------------0. - I•••• ••• 7V . � � - 01 .......---•------•---•••••••-•-•-•--•••.._..._�• ----- -1z------------------ ---- 6�-b---•---•----------•----------••-•----••----------- W 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 MI TIi; 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has byT issued by the board of heajth. Signed �leSdt`._ `G- ••- .. .... 4 Date Application Approved BY = � ••-••- --• , .%f,!'+ ............. Date Application Disapproved for the following reasons:-----•--•---•---...••••-•-••-••--••-•••-----•--•---••-•••-•-•••----•••-•••-•••-•----••-----••--••-•-••••......_ ..---•---....-•.............•-----•-•----....___...----------.._..------------------=---...._..-----------•----••••-•-•-••-••---------------•--•-••••---------------------------•----•--•••-•--•-•--•--- Date PermitNo......................................................._ Issued....................................................... Date No. � �/ / 6 $ �- � Fzcs....� D THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................O F..........................................------------------.............._..._----------- ApplirFa#ion for Bispwi al Works Tonilruriion JIrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: •..............._..-----._..................................----.................._......_---... ...........---•----...-•-•--------••----------•..._:..•--•---•--•----------------.----------•---- Location-Address or Lot No. ......................-----...................................................................... ..........--...................................................................................... Owner Address W Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) ax Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ------------------------•------•-------•----•-•-----...-----._.......---------•--------................--------...---•--------•........--•------------ W Design Flow............................................gallons per person 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. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit-------__..__....... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit-----............... Depth to ground water........................ ---------------------------•--•--••----•---------••----..........-•----............---------....--•.......................................................... ODescription of Soil........................................................................................................................................................................ W ------------------------------- •----------------•------------------------------------------------------------•-•---------------------•-------------•------•-----------------=......•---•...----------- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ..-------•----------••-----------•-•--------------------------------------•---------._...----•-••--•----...•------------------------------•--••-------------•----------------------........._.....---.. Agreement: The undersigned agrees to install the. afor.edescribed Individual Sewage Disposal System in accordance with the provisions of i.l..,,, 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed...................................................................................... Date Application Approved BY = t° ......................................................... ..-! ,,��`2t5l.a'`-....----------- Date Application Disapproved for the following reasons:-------••-----------------•--------------------------------•--•--•-----------•----•-....._...------------..._... ............................•------------------------------:..........._.....--------------•--•--•-•--•---•-------------------------•---------------------------•--••-----------------------••---------- - - Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH � r............OF.......... ....... Trrtifirtttr of Toutph aurr T THIS IS TA2 CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) by............. .. -°''" --•----•..............•--------. ...-------••-...•••---------------.......................--------........._......--••--••-_..._ / — Installer at.............. .......4 cn . ...... t '---------•......-•-•---••------- has been installed in accordance with tl e provisions of T �5 of The.State Sanitary Code as described in the application for Disposal Works Construction Permit Nck., ............. dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACT 1Y,.. DATE................................................... C�L --..\-..---- Inspector.................... r COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH +Y c "�- O F N � ' --"�. ".`.^ .:... ................ FEE._......__.. ... 3 d = " Mipooa l Nab Tonu#rudion Vamit Permission is hereby granted--------- 62.t.,.........ir .!!.............................................................................-.... to Construe r Repair ( ) an Individual Sew isposal System ry atNo.------- '..... ?*�s.x ----- r,........ �----------- -----------•-•------- -77---------- as Street as shown on the application for Disposal Works Construction Permit No. No. Dated.......................................... -=---------------------------- ------------- yar'�d of Health DATE................................................................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS r . �,/ -�;, . 'r ,h t..'`S I ,c=t 1 :f;':�'... �x�'._' i , �L. 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GATE =ka Y :AGENT . .„; a SCALE' / '''• -* �-p ' -DATES "l , t . f. .. 4, , a 1� A is '' /�/ 1 .7*} -.., ,•_ � R> -' �.DRED.GE ENGINEERING CQ< CLIENT , 4 A , �> il ,:, -1 A , , p , L r: l CERTIFY F,THA. , T, E PRQPt�1�E0� ` 1 ', J©B NO,.r8'1/� �` BUi.ILOINB : 8H01�N ON;' TN $ a P .:AN c $t 4 e _- EGI3TEAE 4 REt314T@RED h °` �5�, 5 CIVf l k Y ` LAND . ' L C:Ot F0:RM8 Y0 THE 'Z014INo t,�► � C r R 31. P ,, r r Mk tir! ' � E QINE R VE >tv=. .DR.$Y�{ 1. - O;F k BA�tPIS?'A ;E, ASN �l ' i4'$` , I :. .i L F r p 4 , , y aY P 'Kip 3 712 MAI ST r Y� QY R� *. U��4t h& ; .11 , 4 YZl _sue may, ,1 -g �y ' "1 •: d• J 't t' C1J�;e;f��'; % s r.°r' t .r ( x }, v �'HYANNIS, MASS'' Sbi"EET.L,,aF z .:QATE: ` ` D., L; ►ND 'SUA'V€Vh - t k �, .ram .� " rI r NOTE. = /F E/TNER,Ta/ SEPT/G TAN�C OR: 20 FT. M/N.<. LEAGf//iYG P/T ARE 'MORE TNA IV lV'AFLOW /O /7.M/�/ GRAOF, 2Q'O/AMETEK CONC'e— AS COVER SNAL L 49PE ®Rd 414AI7- TQ 4,TA P W.�AN EXTRA E CON E .P ' Pt Q VC O �yEgyy C/lST. /RON GoVE=R $/L/AL,L. Q USE.D Ir1 s OFRTFT covE_ . /F/N OR/VEyVA Y CCO VER E G�Oc` CZ ACXF/LNO B L t/pc//o LEveL Z'LAYER d CAST •�.o OF J/9 -JIB, //IPON .._ l o o GAL. _ ° • . . . •1 1 , •,� WJN P/TGI✓- D/ST, o 1 • •>. . 0 1 1 • q • WASHED 57i�NE "PtJt J�7: SEPT/C. TAAYX . . �. i •b . � • •EFFECT�t' ; : • •• 34 � VZ ' • D1=PTN / ® e AS/JED STONE p #'• • • • ••• 1 p o e .• s � 1 • • • .• � •� 1 �o P PREG45T SEE.oAGE - 4`344'1( UPfl . v. . '• P/T OR EQL//V. ']g.'3 x 1,0 - 1RGPD a •: • r • • • • • 1 / e� o _ T AT OU/LO/Nts ��•S J=T Pcrc.4orr+' O/I4!►'f. C�SEETABUL4TJON> ., SEPT/c Ti4NX 9 6.2 F7.' OUTLET SEPT/G TANK 9 6." FT.. f /4/B1/T/ON BO,Y -7 A SECT/ON OF GROUND.T ITER TA1fLE ^ d "'D/STR/BlJ7/ON BOX g �T SPyVAGE 0/SPO�SA L SY.STE/�9 / LEr.cgACJ/JnrG /�i7- S•.3 FT. , TABIJL..4Tl�N LEACH/NG P/T oJMEiv510N_-q Z S ,cT DES/GN CRITER/A 9CAGE ..I4" p/Mt°CNS/ON MIA )' NUA98ER OF B�'ORaO/NS Z .. . G.aR�tG.E 0/SPOSAC UN/T SOJ'G. LOG SD/L. TE.5T TOTAL EST!/�►IA'TEQ FLON/ Z�G.4L.�Q.4'y SOIL TEST. ,#/ SO/L TLCST 2 7 N&J&18zR OF LEACNlNG P/TS I f`L-LAW 1-7 j"ELIrl PATE OF SO/J- NEST S/OEL.--ACN/NG PER P/T _L4�.SIa PT. L9 RESI/LTS It/fTNESSED BYE T '7� FT z PERCOLATION RATE / LS Ml/V�I/NCH BaTTOM LEa'IC'NJNG PER P/ $Q , ;` LDS y'� � TOTitL LCACN%NG �4REA Z-�' E' Soo.",fr. PERCOLA770IV RATE 2 Ts/ rd MJN.�/NCN RESERVE LEAC//!N6 ARE/U s; 6 SQ. FT.. S /3 .�_ Z of At. T j ELUSr CA T 1 q,i ��. i�a 29874 a LrA RE ;,";A ;T57*" /STEO � 3 Z. "1ASugv N TEEO NJJ, NO Gmo[/ p` ; 4.r EN GRO tJNC LV<1 TE.Q AT Js�L Ei/. HYANNIS - PARCEL ID: . 291/106 ROUTE 28 �F s EXISTING LEACH PIT CB/DH N PARCEL ID: (NOTE 10) 291/107 M A,2 2 - =- "-- J t LOCUS: PARCEL ID: ��\ 44 COUNTY 45"E __- - x 291/158 \t�\ SEAT STREET N�� �O ---�-' AREA=13,115t S.F. _ - ��- S v - NCE �� 8„OAK ,t � FE TW OAK � P� 10"P� ®TH-2� ; WEST MAIN STREET IN Lr EXISTING 1,000G I 8'OAK LOCUS MAP SEPTIC TANK �= PARCEL ID: LOCUS INFORMATION t = O 291/11 O PLAN REF: LCP TITLE REF: CTF#1 162980 (SH.2) 1 N TBM: $ PARCEL ID: MAP 291 PAR. 158 COR OF BLHD O ; `� , PROPERTY NOT IN ZONE II OR NITROGEN SENSITIVE AREA v1 -=39 00 30.14 FLOOD ZONE: "C" tQ ,� `I GISt � f' COMMUNITY PANEL: 250001-0005—C DATED:08/19/85 SEPTIC SYSTEM #44 0-0__ ,"-- ` REPAIR PLAN t t I`� /% TOP OF FND LOCATED AT: ELEV.=40.04 PARCEL ID: " " 44 COUNTY SEAT STREET '"f_ � � ` ` HYANNIS 291/159 �... ---/, t , t , MA. 11 GENERAL NOTES: PREPARED FOR --` FEN E 1 W _--_, ti 1• ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL -�'"---" --'-"'"'" T I P L E A N D R 0 R. D A S I L V A & BOARD OF HEALTH AND THE DESIGN ENGINEER. OJ t\\ - \\ t ' t ��' ORt�fEwP� �,' �t t� 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS p \ - \� �� 1 -- \ VI i t VI VI A N E C. P 0 S S A. OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE N_ W /S _-�� AUGUST 15, 2011 LOCAL RULES AND REGULATIONS. 't \ �� \ --- t t 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR \ '\ �' y \\ t 1(j /� _____------ TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE t \ � _ _ y \ to ���jrJ,- i - DESIGN ENGINEER. t \ �.A ` ` `-4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING t \ '� \\ 1� �-5� FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN -1---- jR� E�N s ENGINEER BEFORE CONSTRUCTION CONTINUES. `, \�, `\ 1 YL . 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. ; \, \ �'l _ - ` _ 1 N o. 1140 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF � \ ice' , � �r THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF \� C� - CATCH "-- L HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. \ ti--BASIN _ iQ�r�� EEO 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. �� \' -`r ELEV.=36.89 P� 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED \; S SANI TAR�A� TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. -1, 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY HYDRANT THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING 1G0 CONSTRUCTION. I 10. EXISTING LEACHING PIT TO BE PUMPED, CRUSHED AND FILLED PER TITLE 5. 11. 48 HOUR NOTICE FOR. ENGINEER CERTIFICATION I � CATCH MEYER & SONS, INC. 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY P.O. BOX 981 13. NO PRIVATE WELLS WITHIN 100 FT. OF PROPOSED LEACHING UPOLE e 14. ALL PIPING TO BE 4" SCH 40 0 1/8"/FT (UNLESS SPEC. OTHERWISE) EAST SANDWICH, M A. 02537 15. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A GARBAGE GRINDER 16. NO WETLANDS WITHIN 100 FT. OF PROPOSED LEACHING (5 0 8)3 6 2—2 9 2 2 17. PROPERTY IS NOT IN ZONE II OR NITROGEN SENSITIVE AREA. SHEET 1 OF 2 J#1357 NOTE: TO PREVENT BREAKOUT, THE PROPOSED NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS FINISH GRADE SHALL NOT BE < EL:35.39 FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. SEPTIC TANK PROPOSED D—BOX PROPOSED S.A.S. T.O.F. EL.=40.04 INSTALL OUTLET ANDERS SET8 COVERS TO 6" OF OVER INLET GRADE SET TO 6"ISOF GRADE ONE INSTONEgLL A 4" DIAMETERCHAMBER (MIN.) ANDINSPE SETCTION TO 3" OFTF.G R OF MAs�9� 1//--F.G. EL.=38.50f F.G. EL.=38.50f F.G. EL: 38.0t F.G. EL: 38.0(MAX.) i Dl l • ✓' �, f Uvl YE`f� _ No. 1140 L = 11't ' 9" MIN COVER/ L =40' �/$TE ® S=1% (MIN.) 36" MAX COVER TEE L = I0'(MAX) INSTALL TWO INSPECTION PORTS (MIN.) O 4"SCH40 PVC 0S=1% (MIN.) 0S=1% (MIN.) NITAR 4"SCH40 PVC 4"SCH40 PVC \a� ,o" 6. T') INV.=37.05 14" 11.2" TO 48"LIQUID INV.=36.80 INVERT LEVEL INV.=35.80 GAS BAFFLE PROPOSED 4 ROWS OF 4 UNITS AT 6.25'/UNIT = 25'/ROW • INV.=36.0 D-BOX INV.=35.0 SOIL ABSORPTION SYSTEM (PROFILE EXISTING 1.000 GALLON SEPTIC TANK EXISTING SEWER OUTLET RESTORE VEGETATIVE COVER BACKFILL WITH CLEAN PERC SAND 75" TO TOP OF CHAMBERS NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE INVERTS PRIOR TO CONSTRUCTION 2) TANK AND D—BOX SHALL BE SET LEVEL AND BREAKOUT=TOP ELEV.--35.39 INV. ELEV.= 35.0 TRUE TO GRADE ON A MECHANICALLY COMPACTED SIX INCH CRUSHED STONE BASE, AS SPECIFIED IN BOTTOM ELEV.= 34.06 EXISTING SUITABLE 310 CMR 15.221(2) 2.83' MATERIAL 5' MIN. ABOVE BOTTOM OF 76" _ 3) PLACE SANITARY TEE IN D—BOX AS SHOWN. T.P. EXCAVATION OR G.W. EFFECTIVE WIDTH = 4 x 2.83' = 11.32 4) INSTALL INLET & OUTLET TEES AS REQUIRED (7.16' PROVIDED) USE 4 ROWS OF 4-16" HIGH CAPACITY (H20) PROFILE BOTTOM OF TESTHOLE EL.=26.90 _ ADS 16008D BIODIFFUSER UNITS—NO STONE SEPTIC SYSTEM PROFILE TYPICAL SECTION 16" N.T.S. N.T.S. 11� DESIGN CRITERIA SOIL' LOG P#: 13379 NUMBER OF BEDROOMS: 2 BR EXISTING/3 BEDROOM DESIGN DATE: AUGUST 15, 2011 I�34" ►I SOIL TEXTURAL CLASS: CLASS I SOIL EVALUATOR: DARREN M. MEYER, R.S., CSE. SECTION END CAP DESIGN PERCOLATION RATE: <2 MIN/IN WITNESS: DONALD DESMARAIS, BARNSTABLE BOH r • 1 16"" HIGH CAPACITY (H-20) BIODIFFUSER UNIT DAILY FLOW: 330 G.P.D. Elev. TP—1 Depth Elev. --2 Depth DESIGN FLOW: 330 G.P.D. 38.10 LOAMY SAND 0" ' 37.90 0" A q MODEL 16" HICAP GARBAGE GRINDER: NO NOT DESIGNED FOR GARBAGE GRINDER LOAMY SAND ( ) 37.60 10YR 4/3 6" I 37.40 10YR 4/3 6" LENGTH 76" NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT PROPOSED SEPTIC TANK: 330 X 200% = 660 GPD, USE EXIST. 1,000 GALLON CAPACITY B B _ EFFECTIVE LENGTH 75" TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY LEACHING AREA REQUIRED: (330) = 445.94 S.F. LOAMY �D ! LOAMY 6 8 SIDE WALL HEIGHT 7 " DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. .74 35.43 C1 32" r 35.40 C1 30" OVERALL HEIGHT 16" DISTRIBUTION BOX: 5 OUTLETS (MINIMUM) OVERALL WIDTH 34" 4640 TRUEMAN BLVD MEDIUM SAND MEDIUM SAND HlLLIARD, OHIO 43026 PRIMARY S.A.S. 2.5Y 6/4 2.5Y 6/4 13.6 CF M&WO USE 4 ROWS OF 4 — 16" 160OBD ADS BIODIFFUSER (H20) UNITS—NO STONE ; CAPACITY PERC m EL 35.43 (101.7 GAL) ADVANCED DRAINAGE SYSTEMS, INC. BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.73 SF/LF OF BIODIFFUSER) PROPOSED SEPTIC SYSTEM/SITE PLAN (BIODIFFUSERS) 16 UNITS x 6.25 LF x 4.73 SF/LF = 473 SF DESIGN FLOW PROVIDED: 0.74(470 GPD/SF) = 350.02 GPD > 330 GPD req'd 27.10 132" 26.90 132 44 COUNTY SEAT STREET HYANNIS MA PERC RATE <2 MIN/IN. ("C" HORIZON) Prepared for: Mike Dedecko NO GROUNDWATER OBSERVED Engineering by: Surveying by: SCALE DRAWN JOB. NO. R' MEYER&SONS,INC. MacDougall Survey NTS D.M.M. • 1, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 pO BOX 981 to conduct soil evaluations and that the above analysis has been:,performed by me consistent with the EASTSANDWICH,MA02537 (508) 419-1086 DATE CHECKED SHEET NO. requirements of 310 CMR 15.017. 1 further certify that I have passed the Soil Eval. Exam in October, 1999. 08/15/11 508-362-2922 D.M.M. 2 of 2 r