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0103 COUNTY SEAT STREET - Health
103 .County Seat Street Hyannis"' � ' A = 291 116 , l.. i e :j TOWN OF BARNSTABLE LOCATION 103 (g;;4— SEWAGE# VILLAGE 'A'!7t,i M 1J ASSESSOR'S MAP&PARCEL_ P_ 1/=, INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 6EX-1 FTi&W l c06 4 kf— h1-/d LEACHING FACILITY:(type) 'IQa,-),[Gj 4— (size). i� �4- ;.4- NO.OF BEDROOMS OWNER !� E`IZO- PERMIT DATE: / �-e s� COMPLIANCE DATE: 2,311y Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 4-S� Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) X A Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY A �c� O N-1 n c r - � ` No. Fee u THE COMMONWEALTH OF MASSACHUSETTS Entered in comp ter: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS es 01pplitation for Vsposal 6pstpm ConstrULtion pprmit Application for a Permit to Construct( ) Repair JV Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No.1�� Owner's Name,Address,and Tel.No.V�$'7�10..D 9O mcLm &A SO A6Z 198 Assessor's Map/Parcel Q9 " OPG96 Installerr's Name Address,an Tel.No. ,�lj."7ij/- 9, , Designer's Name,Address,and Tel.No. jl'tY�l `OM4YwcWCr1,M+C Q.G> '�yplC On L�r i» i �3»G 999, /°!! $� 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) gpd Design flow provided 390, gpd Plan Date ,IV, y, a161n Number of sheets 7 Revision Date Title i i��S i i-eJ" [ - /b 3 Ltd n4, �2e T i /1 i Y , MA , e Size of Septic Tank ' I Type of S.A.S. ' fU as X /uZ. iel Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and mainten f of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental C e a not to place the system in operation until a Certificate of Compliance has been issued by this Board of Healt . Signed Date A Application Approved by Date Application Disapproved by Date for the following reasons Permit No. �_ — �� Date Issued Z C i d a ` ' No. Fee A)U'_ , y THE COMMONWEALTH OF MASSACHUSETTS Enteredmcomputer: , Z yyes�� PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pplication for Disposal 6pstem Construction permit Application for a Permit to Construct( ) Repair W Upgrade( ) Abandon( ) ❑Complete System A/IIndividual Components Location Address or Lot No. /0-3 n 1{•- Owner's Name,Address,and Tel.No..So s-77G—a,-/9& i 'thakdan cmcL," A-A Po P3ac 198 Assessor's Map/Parcel a9 j biGP f v r ilzrt _ L4� 0 6 Installer's Name,Address,and Tel.No. jv8 '77/.J93 Designer' Name,Address,and Tel.No. ��' 114 a &CW- -tbL C'l "64'r c�+ar►,Sr,c -P v• (ox 1 �/� e. ��xj i ,7»c 93'r �irz Sf- it ds . A owy8 o t-ns, 2 aces' Type of Building: ,. Dwelling No.of Bedrooms Lot Size 11 S 3`/ sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided 39 C/ gpd Plan Date ybv, ay oars Number of sheets t � Revision Date Title Ti p S ���Pei" a-p �tU3 +��)n o�e� �S��o_f , l�v�n/ItS , 1�14 , t Size of Septic Tank ey i5�ir,� /a alp Type of S.A.S.,2 to Svcs.d Q6, _ ,a, p�S X /o1.83�ie[Ct't Description of Soil ,Cor ce_ r EI �cc' 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 Coded not to place the system in operation until a Certificate of Compliance has been issued by this Board of Healt Signed 1 Date Application Approved by Date / A/ Application Disapproved by Date for the following reasons Permit No. O / ) — �� 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, � It /03 4Iun ,,1W �IaAnn1 S has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. a O'yid r dated r Installer(fir ho c LG„��Ic,r t`trn ,�nc . Designer C&4 e ms,i f1e�Y v r,t #bedrooms Approved design flown gpd The issuance of this permit shall not be construed as a guarantee that the system wil functi n`as designed. \ �( Date t'l-��-31 , 1) Inspector � 11./ ---------------------------------------------=----------------------------------------------------------------------------------------- No.�a_ d ( '% � Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Disposal 6pstem Construction Vermit Permission is hereby granted to Construct( ) Repair LV Upgrade( ) Abandon( ) System located at 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 ust be completed within three years of the date of this permit. jj Date / �� T Approved by I', DEC-30-2015 00:32 From: To:15087906304 Pase:1/1 FROM FAX NO. Apr. 30 2010 12=08PM P1 'To�rjui fl�f Barnstable Aegwatoky Sakes Th....3r. Cle&x,:Director hu mm McKaa)A,Duector MOO' 508-86),4644 �'ax 548�79Q-S3Q4 . 1f9site: 1fD®ear; �Vd�,Jr�: �q�� .... ,�tlttj�1 �&g��ee�: Uer"1v d!� Ir�tLI��^'•�• 07a i,L liS G� .,. _�. yva:3 ia5aed a Pc'unit•Cii iastaJY a saptic system at 14.3 Cep� � J%-U L based on deai�di-awn.by Alf xc�s) I ursb_Cy-that the sraptb 931Sie icd(,TuwRd abuve was ius Q d subsrta tially acaaxdig-to the design.,vMch may.inr.lu e-mI'mor ap�oved gh�mgea swi;as lataxe.I mlocafirp-t of tbUa distribidium box=dia s,,�.Ptir tong I certify tat the septic, sy-A ,trtL�xamned Rbovr wag b.sta.l:i with olg ay, nhiaWa Cie, • gzeatex th=,ip' latnzez rcdor tion of tU SM or avy vertical.relcep'fton d,any cpMpOIO+ t of the squo systems)brit is a.,surdmur:with. two 4.Local Regulations. flea revi4un.or certified w-i' ' We to folly , ya 1"OF A(A�$4 OJALA I15 a 's 5i itu�9) No,448502 �sSrONAL�Nb {I7� A='s Sign-ature) (Affix tlasi ?�'s S�k�7?7�p�Ile e) t7prr 't lsAaS Yes kt !, , aa.�vu �ar1.- a rah • �:QJI a�� .,�����'�_'_Y.,f�� �.�a..�_U: 1��.��U� 'i'�Q.F�.�..,�r� Ar:r�C'J��l;-. 7� A.'�.'��,', �1+'�NEID�T�k�A1aN?I'A`;9�i7L'1h, 4�Tli�,:5Y,71"S l'DF�i'��$i�� ii Std�U - 9 - 1 1/ 0 LIP c � c � J Town.of 0arnatsta ble # "W, De a�rtinent oie' P Regulatory.St:z'vlit:es A'lPublic Health DITIsiou gate /XAM ; r� h� 290 Main Street,Hyannis MA 02601 Date Scheduled < < It S Tiime k{ec Pd. Soil Suitability Assessment fol Sig Performed-13y; Witnessed By: Loea[lon Address /Q 3 l_.tl ` /)Q_ - Owner's Name �f ram/ Address Ascssor's Map/Parcel: OZ�//�I F� Engineer's Nam. e �1I QV✓� ���i'� NEW CONSTRUCTIONREPAIR. T-ellephone# gyp/ Land Use: 2 �d �r I Slopes(96) �7�� Surface Stones 'V Distances from: Open Water Body I�J/JC�/ ft Possible Wet Arenh prinking Water Well / ft Dralbage Way ?- �b ft Property Line ft Other, ft SICCI TCH.(Street name,dimensions of lot,exact locations of test holes&.pore tests,locate wetlands 1`n pxoxin-dty to holes) IN' Parent material(geologic) "��f i1�ICs+ �U Vt�'t Depth tq�eGlrgclt Depth'toGroundwaker. 5tandingWakerinHole: Al(Yk)• Waepingl'7'otzlPiti�get.• /JV��v Estimated Seasonal High Groundwater /V /A- o DET RHWA 'ION FOR SEAS ONAL ffiGII WATER T Method vsea: t j r Depth Observed standing in obs.hole: lu, ,Depth to s.411.tx=1961 Depth to weeping from side of obs.hole: in, ©rountlwaterAdjudtmant f. Index Well Rcad}ng Date; Index Well 19VoI -:,..,.,_.._.,, A4 tatitdr..AdJ.,GivuiidwaterLevol,.,,,,• EER.COLA.TION TEST Dide _ , Time Observation �] Hole# Tim.-at 9" I/ Depth ofPera- �[� ` Tlment6" Start Pre-soak Time @ �i � Time(9"-6") End Pro-soak Rate Min./Inch C�y it,. Sltc Sultaballty Assessment; Slte Passed V Sitp Failed: Additional Testing Needed tYM) Orlginal: Public health Dlvlslon Observation Hole Data To Be Completed on Back----- **411f percolation test is to be conducted witbin.100' of wetlaluud,you must first notify that Barnstable Conservation Division at least one(1) week prior to beginning. Q:ISEPTIC F-RCFORM.DOC l/S DEED OBSB� V2 k,T][O'14 TEOLE LOG Nola# Depth from Sall Horizon Soil.Texture Shcl Color Soil.. Ot"hor Surface(in.) (U§bA) (Murrell) Mottling (Struoturc, Stones;Boulders, I- ' Nnsis'ten a 1'Cravell ►�4 �. wy Depth from Sell Horizon Soil'Texture Soil Color Sail Other Surt'acc(in.) (USDA) (Munsell) Mottling (Structure,stones,Boulders. Consistency,90 Greve DEEP OBSERVATION ROTE EOG Role#._ Depth-from SoilHorizon Sall Texture Soil Color Soil Other Surface(ill.) (USDA) (Munsell) Mottling (Structure,Stones,)3oulders. Co i tc c G e DEEP OPSERV'.A.TI0N110 LlG+ E0G 110184 Depth from Soil Horizon Soil Texture Soil Color Soil Lather Surface(in.) (USDA) (Munsell) Mottling (Structure,Stories,Boulders, Co s' ten b • y �i y+'lood Insuranc���ate'1V1�p: Above 500 year;flood boundary No— Yes Within 500 yearboundary No �K Yes ' Within 100 year flood boundary No. Depth.ofl' turaii�occurring=PerviousMater%aY Does at least four feet of naf orally occurring pervious ntiterial exist in all areas observed thrpughout tho area proposed for the soil absorption system? If not,what is the depth of Naturally occurring pervlous material) Cyr I certify that th on ' at on V5 A57(data)Y havepassed 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,exportian and experience described in�10 CUR 15.017. signature Datb oa +f 6 Q:�s.>?t�rlc�r�lzcnortM.�oc . i °ter` `"' �j� Town of Barnstable .�.. .. Barnstable .� Regulatory Services Department A&Ameftj NAM � Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7015 1520 0000 1971 7095 November 30, 2015 Bernice G. Segerman Tr Mark R. Segerman Payback Trust 103 County Seat Street Hyannis, MA 02601 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 103 County Seat Street,Hyannis, MA was last inspected on 8/18/2015,by Chad Hathaway, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Fails" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Septic tank in back yard has heavy concrete decay. • Leaching pit or cesspool with high liquid level,<12" below inlet(per Town Code 360-9.1). a You failed to respond to the first order letter dated August 26, 2015. You are ordered to replace the above listed system problems within one (one) year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH ean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\103 County Seat Rd Hy Nov 2015.doc Map Page 1 of 2 Town of Barnstable Geographic Information System New Search I Home I Help Parcel Custom Ma Abutters Map size ® [ zoom out ��I I IIn viewer _ 10 ar •• gym, 2911 D2 291115 p 127�p q8 309008 291114 %105 N 102 291113 R 92 ��� 291151 Att NO 291115 N 0 103 E Map: 291 Parcel: 116 Full Property 211152 .. 291152 Location: 103 COUNTY SEAT STREET Info .0 p 16 Owner: SEGERMAN,BERNICE G TR 291153 _ Location Information #70 Map&Parcel 291116 291121 Location 103 COUNTY SEAT STREET q 17 291153 •201120 q28. Acreage 0.39 acres. q 20 291119 lae - current Owner y Mailing Address SEGERCRR SEGERMAN PAYBACK TRUST 103 COUNTY SEAT STREET Set Scale 1" 171 Aeri I Photos v I MAP DISCLAIMER HYANNIS,MA 02601 ApOpsr�amiisse55d Value(FY 2015) Copyright 2005-2010 Town of Barnstable,MA All rights reserved.Send q Xtn Featu es r6GIS$55,800 BaI"nstableMA v1.2.9494[Production] Out Buildings $0 1 . Land $69,300 Buildings $93,600 Total Appraised $218,700 Assessed Vaiue(FY 20153 Extra Features $55,800 Out Buildings $0 Land $69,300 Buildings $93,600 Total Assessed $218,700 construction Detail Style Ranch Model Residential Grade Average Minus Stories 1 Story Exterior Wall Wood Shingle Roof Structure Gable/Hip Roof Cover Asph/F GIs/Cmp Interior Wall Drywall Interior Floor Carpet Heat Fuel Electric _ Heat Type Elec Baseboard AC Type None Number of 2 Bedrooms . Bedrooms Number of 1 Full Bathrooms Total Rooms 5 Rooms Living Area - 1360 Replacement Cost $111,487 Year Built 1967 Depreciation 16 Building Sketches r r , http://66.203.95.236/arcims/appgeoapp/map.aspx?propertyID=291116 11/25/2015 �f Barnstable Town of Barnstable Regulatory Services Department Q p 1639- Division �1 m. 200 Main Street,Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7014 1200 0001 0358 7566 August 26, 2015 Bernice Segerman 103 County Seat 1 Sze r P 41 Hyannis,MA 02601 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 • The septic system located at 103 County Seat Road, Hyannis, MA was last inspected on 8/18/2015,by Chad Hathaway, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Septic tank in back yard has heavy concrete decay. You are ordered to replace the above listed septic system components within sixty (60) Q days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH omas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\103 County Seat Rd Hy Augu 2015.doc THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR i QUALITY ORIGINAL (S) Im ^C&' � i DATA Postal • , RECEIPT C� ...� (Domestic Ci LO ' Town of Barns., A M Postage $ r,` Regulatory Services D C3 + Certified Fee Postm 0ark Division Return Receipt Fee • 1p,4+ Here!, b +�1 C3 (Endorsement Required) ,t 200 Main Street Hyannis M;o Restricted Delivery Fee (Endorsement Required) O a~p`a , r r ti Total Postage&Fees Office: 508-862-4644 �( FAX: 508-790-6304 ; o Bernice Segerman 103 County Seat CERTIFIED MAIL#7014 1200 0001 0358 7566 Hyannis, MA 02601 a a m Z a August 26,2015 o m w m a s < iD Bernice Segerman ❑❑❑ a i 103 County Seat Road C3 o 9-6 N w ; v 3 H a Hyannis,MA 02601 m 3 m 3 � w 3 ORDER TO COMPLY WITH STATE EN"ROND 9 a o D • N M CL CD 3 . The septic system located at 103 County Seat Road,I o m C ID on 8/18/2015,by Chad Hathaway, a certified septic inspector for the Mate of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Septic tank in back yard has heavy concrete decay. You are ordered to replace the above listed septic system components within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. . PER ORDER OF THE BOARD OF HEALTH 0. omas McKean,R.S., CHO Agent of the Board of Health �° J o ,7�7 G r �, b� Q:\SEPTIC\Letters Septic Inspection Failures or Future Ev1\103 County Seat Rd Hy Augu 2015.doc � � ve Town of Barnstable Barnstable Regulatory Services Department p M p 91639. Division m 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7014 1200 0001 0358 7566 August 26, 2015 Bernice Segerman 103 County Seat Road Hyannis, MA 02601 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 103 County Seat Road,Hyannis,MA was last inspected on.8/18/2015,by Chad Hathaway, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Septic tank in back yard has heavy concrete decay. You are ordered to replace the above listed septic system components within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH S -� -fir 67�p 0-,7 -h-r 01--ez z� Z. jo qt omas McKean, R.S., CHO Agent of the Board of Health �' ��G� J 4 — I 7 G — �^ b� If Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\103 County Seat Rd Hy Augu 2015.doc � &25/2015 Parcel Detail 40 GARNsTABLr— :MASS, {� �x r f/, ). _ �. �.� p'.•' {'; Logged In As: Parcel Detail Tuesday, August 25 2015 Parcel Lookup J ' Parcel Info Parcel ID 291-116 I Developer Lot LOT 1 _ Location 003 COUNTY SEAT STR j Pri Frontage i128 Sec Road CROOKED POND ROAD sec Frontage ,126� A village HYANNIS y I Fire District HYANNIS� — Town sewer exists at this address No f I Road Index 0364 .. Asbuilt Septic Scan: Interactive Map I t, 2911161 - r -, - Owner Info_ Owner SEGERMAN, BERNICE C00 wnerMARC R SEGERMAN Pd Streeti ,103 COUNTY SEAT STR Street2 `„ J City HYANNIS - I state MA _ -- I zip ,02601 ` I Country' Land Info Acres V39 I use Single Fam MDL-01 I zoning 'RB I Nghbd r0104 Topography Level -- Road 'Paved Utilities `Septic,Gas,Public Water I Location Construction Info Building 1 of 1 Year 1967 Roo ,Gable/Hip t wall ,Wood Shingle jJ Built �1 Struct= Living 1360 RO°rjAsph/F GIs/Cmp A rea Cover T AC 'None Type style Ranch walI!Drywall Roome '2 Bedrooms Bath Model Residential Floor Ior{Carpet Roams f1 Full-0 Half J' Grade Average Minus "eat E c Baseboard Total 5 Rooms Type Rooms Stories t1 Story Heat Electric_9 Found Poured Cone. J Fuel ation Gros Are as{3781 L� Permit History Issue Date Purpose Permit# Amount D e Comments 6/30/2016 11/18/2014 Insulation 201408002 $5,000 12:00:00 WEATHERIZATION/INSULATION AM http:/Iissq l2rintranet/prooata/Parce[Detail.asp)PID=22670 1/3 r Town of Barnstable p 9 ,m Regulatory Services Department lED MA't� Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 7/6/15 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1)YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation o Any portion of the cesspool within a Zone 1 to a public well ❑ Any.portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA Single Cesspool o Any"conditionally passed systems" (broken cover,relocation of a pipe, relocation of a driveway due to H-10 components, etc) Leaching pit or cesspool with high liquid level, <12"below inlet(per Town Code §360-9.1) OTHER Repair deadline:°10 D,,�f r Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc I Commonwealth of Massachusetts -?q/ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form•Not for Voluntary Assessments 103 County Seat.Rd Property Address Fri Segerman " Owner Owner's Name/ r' information is H annnis / Ma 8/18/15 required for every y .l. 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: 1v key to move your f cursor-do not Chad Hathaway use the return key. Name of Inspector H.P.S. � Company Name P.O.Box 151 Company Address Forestdale Ma 02644 City/Town State Zip Code 774-274-2581 12866 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 8/8/15 Inspector's Signa4 Date The system inspector shall submieeatyer, is inspection report to the Approving Authority(Board of Health or DEP)within 30 daysg this inspection. If the system is a shared system or has a design flow of 10,000 gpd oe 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. �—o V s t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a 103 County Seat Rd Property Address Segerman Owner Owner's Name information is H annnis Ma 8/18/15 required for every y page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any 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): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 103 County Seat Rd Property Address Segerman Owner Owner's Name information is annnis Ma 8/18/15 H required for every y page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 103 County Seat Rd Property Address Segerman Owner Owners Name information is annnis Ma 8/18/15 H required for every y page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ` ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ® ❑ Liquid depth in cesspool is less than 6° below invert or available volume is less than '/2 day flow t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 103 County Seat Rd Property Address Segerman Owner Owner's Name information is required for every Hyannnis Ma 8/18/15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ❑ The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinkirig 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form 150 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1W103 County Seat Rd Property Address Segerman Owner Owner's Name information is annnis Ma 8/18/15 H required for every y page. Citylrown 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 l5ins•3113 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M y� 103 County Seat Rd Property Address Segerman Owner Owner's Name information is required for every Hyannnis Ma 8/18/15 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 5 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 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 G M , 103 County Seat Rd Property Address Segerman Owner Owner's Name information is annnis Ma 8/18/15 H required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: unknown Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 103 County Seat Rd Property Address Segerman Owner Owner's Name information is annnis Ma 8/18/15 H required for every y 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: back septic 1960s front 1970s neweer pit 1988 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: back 1' front 18" feet Material of construction: cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: back tank 8"front tank 16" 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: both tanks 1000 gal Sludge depth: back 9" front tank 6" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 103 County Seat Rd Property Address Segerman Owner Owner's Name information is annnis Ma 8/18/15 H required for every y 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 25" back-front tank 29" Scum thickness 12" back tank front 7" Distance from top of scum to top of outlet tee or baffle 1" back tank front tank over tee Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? tape and sludge judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): tank in backyard has heavy concrete decay. signs of dirt flowing into tank around inlet pipe. tank in front yard has no visable cracks or leaks but is a h10 load rated tank and is partially located under driveway. tank in front yard is overfull. liquid level is over inlet and outlet pipe 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 l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 103 County Seat Rd Property Address Segerman Owner Owners Name information is annnis Ma 8/18/15 H required for every y 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 103 County Seat Rd Property Address Segerman Owner Owner's Name information is annnis Ma 8/18/15 H required for every y 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 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.): 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) (locate on site plan, excavation not required): If SAS not located, explain why: block cesspool pit in back yard is full and has havy staining on bottom side of cover to indicate septic has reached cover level. pit in front yard was not located do to heavy brush and overgrowth. tank in front yard was overfull water level is over pipe t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 L Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 103 County Seat Rd Property Address Segerman Owner Owner's Name information is annnis Ma 8/18/15 H required for every y page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 2 ❑ 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.): 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments < 103 County Seat Rd Property Address Segerman Owner Owner's Name information is annnis Ma 8/18/15 H required for every Y page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): h t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 14 of 17 i Commonwealth of Massachusetts pal 9� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 103 County Seat Rd Property Address Segerman Owner Owner's Name information is annnis Ma 8/18/15 H required for every y 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 33 � t� cd t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 • 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M y 103 County Seat Rd Property Address Segerman Owner Owner's Name information is annnis Ma 8/18/15 H required for every y page. Cityrrown 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: 13' 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: usgs topo maps You must describe how you established the high ground water elevation: Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 103 County Seat Rd Property Address Segerman Owner Owner's Name information is annnis Ma 8/18/15 H required for every y 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 t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 f fffjjj��� A. wJ A TOWN OF BARNSTBLE \F, LOCATION + Gt l��l ISCWAGE # ^6 U VILLAGE_14 "h ,�_ ASSESSOR'S MAP & LO'T INSTALLER'S NAME & PHONE NO._j� � SEPTIC TANK CAPACITY _ LEACHING FACILITY:(type) � NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER--- BUILDER OR OWNERf)_("e � ¢-�� — DATE PERMIT ISSUED: DATE CCIMPLIANCE ISSUED: —��--- VARIANCE GRANTED: Yes No ,� i � , �� � l_ � 1 � �1 h � � ti� �� 6- � `� ` � ' � � \ � -z � � � ��� �, ,. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TownOF............Rar.Ins.t.a.lal-e---------------------------------------------- .. .. Applira#iou for UiupuuFal arks Tonstrurtion rrutif Application is hereby made for a Permit to Construct ( ) or Repair { ) an Individual Sewage Disposal System at: .......1.4.3._.CQ1UL y;aP.at....H-Y lllli-s............................. .................................................................................................. Location-Address or Lot No. B.G. Sec�erman Owner Address W J.P.Macomber Installer Address dType of Building Size Lot............................Sq. feet U�+ Dwelling—No. of Bedrooms..................3 .Expansion Attic Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons.........................--. Showers ( ) — Cafeteria ( ) aOther fixtures -------------------------............................................................... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter..-----......... Depth................ Disposal Trench—.\'o. .................... 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. 1----------------minutes per inch Depth of Test Pit.------.-.---.-----. Depth to ground water-..--..----------_---. fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_..................... (� ...-•-------------------------------•--••--••---•-•---•----------•---..............................•............................................I------------ 0 Description of Soil........................................................................................................................................................................ - ---------------------------•--------------•----•---------------•----•---......--•-•----•------- V ------•--------------•-------------•--•--•-------- ----------------------------------------------------------------------------------------------------------------------------------------------------•-------•------------------•------------•----------- V Nature of Repairs or Alterations—Answer when applicable ..............................:e. ............................................................. --------•---------------------------------------------------------------------------------------------------1_-1-0-0.0---gal-1-on...1.e-a-ching Pl tr-----------•---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of 1 i'TT LE 5 of the State Sanitary Code—The ndersigned further agrees- not to place the system in operation until a Certificate of Compliance has begn issue by e o rd of hea . Signe 9/j.�.8 8....... Date ApplicationApproved By.............................. ---•--•---•-•--•--•••-•----•--•-•---------•--•--•--•--•-•-_...-- •••--•------•-----•------•-------------- Date Application Disapproved for the following reasons-----------------------••-----------------------------.......................................................... --------------•-----•---••---------•-----••-•----------------...-•--•-----...---..............-------------------------.....----------------•---•---------------------------------------------.......... Date PermitNo._.(' I---••.! 6.......................... Issued...---....------------. ....... ---- FRs.... ....�Q._nn THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH - ------. TQ17.3]- ------------------OF. ApplirFatton for Btopooaf Works Tome rnrtion runat Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: v ........................... ----.....-------•----------------.....----.. .....--------------------•----•---------•. Location-Address or Lot No. B.G. SeaerMlfl----•-----••........................................•--- ..........------------....--•--.......-------•._.....__.........-----•-•---.....---------------•-- Owner Address W J.P.Maco�►rer Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.................. -__--Expansion Attic ( ) Garbage Grinder aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) P4Other fixtures .....................................................:................................................................................................ 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. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_.__--_-_---_-_-_______. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------_--------------- Ix •--••-•--•--------•-••-•--•-------•-----•----------•---•••-------•--•--------------------------------------•---•-•-----------•-•....... -------------------- 0 Description of Soil......................................................................................................................................................-.......... --------- , W Z -------------------------- --------------------- ------------------------------------•------------------•--•--------•-------•--....••------••-••----•--•••-•-•--•--•--•-•--••-------•------•-•----....•- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement: J The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of f:'ITnI-�'y t:E 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,th-board of heif{�1th. A '= --------------------- ----------------- •----- . a --... - ---. te Application Approved By............................ `. f. Date Application Disapproved for the following reasons:..........................................-------------•------------------------------•-••--•--•------........-- --------------•••------•---•-----•-•---------•-._...--------•-__......------------.......------••--------I......._....................................................................................... Date Permit No.---•--•--..f-,.5------!-�..................... Issued....................................................... D— THE COMMONWEALTH OF MASSACHUSETTS Town BOARD OF HEALTH Barnstable OF..................................................................................... err if irtt a of Toutplittnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaire(k-(ty ) Macomber ---------------------------------------•---......---•-•------------.....---------.......----------••••-- at 103 Count peat. H annis Installer ••-••• --•• •.-•.... ..... ... --------•-----------••---------------•••--•---•--•-------•-••----•--••--••---•--•-•--------••-----------•-•-- has been installed in accordance with the provisions of TITLE of The State Sanitary Code as described in the c5 .SoC' • application for Disposal Works Construction Permit No------------- ______________________ dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DDATE............................ ........................... Inspector------.....- ...................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH To.wn........................OF............_.Barnstable ........... ................................................... $ 20 00 No...........�.1�._..._2 0 LJ FEE....................... DWpooat Vork,5 Tronotr ion rrtnit Permission is hereby granted.............!T.P.Macomber to Construc� or Repair�X ) an Individual Sewage Disposal System i ountyseat Hyannis at No........ a....----•------------•--•----------------------•--••----•-----------•----------•. Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... ...................................................................................................... Board of Health DATE.................... .... �.---•--•-----.......-----------..... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS ALL STE SHALL SYSTEM PROFILE MAR ED WITHCMAGNETICTTAPE OR BE NOTES PROVIDE MIN. 20" DIAM. WATERTIGHT (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. 1. DATUM IS ASSUMED 28 Route ACCESS COVERS TO WITHIN 6" OF FIN. GRADE CONCRETE COVERS TO WITHIN 3" GRADE 2" PEASTONE OR GEOTEXTILE 2. MUNICIPAL WATER IS EXISTING \ TOP FOUND. EL. 100.7' FILTER FABRIC OVER STONE s � 99.0' MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 98.5 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. Cb oc o NOTE: 2" MIN. WALL 4. DESIGN LOADING FOR ALL PROPOSED PRECAST PRECAST H-10 THICKNESS REQUIRED BLOCKS OR UNITS TO BE AASHO H-10 RISERS (7YP.) PRECAST RISERS 2 f 99 0' 4"0SCH40 PVC MORTAR ALL a ;:... PIPES LEVEL 1ST 2' 4' COMPONENTS H-10 4, 5. PIPE JOINTS TO BE MADE WATERTIGHT. o Locus (�) �. :• ENDS SIDES E IN ACCORDANCE 10" EXISTING 14 o°o°o° WITH 310 CMR 15 000 (TITLE ) Clem. Sch. tr et St EE 6 CONSTRUCTION DETAILS TO BE ` TEE SEPTIC TANK** TEE o o o o 0 0 0 0 ° ° ° ° s ° ° ° ° ®��� ®®I� ®��O ��0� °o°o°o° TI 5. n or h St. :: °°°°°°°° o p�Jp� o 0 0 � o '°°°°°°°° N in \97.6 * ° O O•O O O �O°O°O°O° ®®I�®®®®®®®IJ ®®®®®I�®O�I�I� ,°°°°°°°° t O ° ° ° ° ° ° 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND o ° ° ° ° ° ° ° ° ° ®®®®®®®®®®® ° ° ° GAS BAFFLE., ° ° ° ° ° ° ° Mitchells 00�0���®�®® ®®�®OO®OO��� ,°°°°°°°° NOT TO BE USED FOR LOT LINE STAKING OR ANY • f f )°O°O°O°O °O°O°°°° "`. ` 4' LIQ. LEVEL (ACME OR EQUAL) 94.97 94.80 °°°°°°°° °°°°°°°° OTHER PURPOSE. :,. •: oth St• o 5� J°°•° °•OO`°•O"G'° °•C•O O-O-°••C'O•'O C•C o<< EL. 92.7 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. OOOOOOOOO ° ° ° ° ° ° ° ° ° ° ° ° ° H-105000AL. LEACHINGCHAMBERBYACMEPRECASTOREQUAL m ° O O ° O ° ° ° O O ° O O O O ° O ° ° O ° ° O °�0^0�" '�°�'°'°°°°°°°°°°�"�"�"�'�'�°°° 3/4"-1-1/2" DOUBLE WASHED STONE 4' MIN. a Main �a 2) UNITS REQUIRED 9. COMPONENTS NOT TO BE BACKFILLED OR West Main St. t ALL AROUND PRECAST STRUCTURES S • 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 25.00' X 12.83, CONCEALED WITHOUT INSPECTION BY BOARD OF a COMPACTION. (15.221 [2]) w HEALTH AND PERMISSION OBTAINED FROM BOARD ee vo OF HEALTH. Pie a 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING DIGSAFE (1-888-344-7233) AND LOCUS ,�� 22 NO BOTTOM TH-1 VERIFYING THE OVERHEAD UTILITIESTION OF ALL UNDERGROUND &PRIOR TO COMMENCEMENT OF M ( % SLOPE) ( 1 % SLOPE) NO GROUNDWATER FOUND WORK. NOT TO SCALE FOUNDATION- EXIST. SEPTIC TANK 12' D' BOX 12' LEACHING 11. ANY UNSUITABLE MATERIAL ENCOUNTERED FACILITY SHALL BE REMOVED 5' BENEATH AND AROUND THE ASSESSORS MAP 291 PARCEL 116 *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL **INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT PROPOSED LEACHING FACILITY. UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS 1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE 12. EXISTING LEACHING FACILITY SHALL BE PUMPED PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM WITH 1500 GALLON SEPTIC TANK APPROPRIATE TO SITE AND REMOVED OR PUMPED AND FILLED WITH CLEAN LEGEND CONDITIONS IF NOT SUITABLE SAND. 99- EXISTING CONTOUR X 99.1 EXIST. SPOT ELEV. 99 PROPOSED CONTOUR w Y 198.41 PROPOSED SPOT EL. TH 1 ?,g TEST HOLE \ R 21 6�' � �� \ �o SYSTEM DESIGN: 2% SLOPE OF GROUND 0' \2 UTILITY POLE L�101 . 62 W \ GARBAGE DISPOSER IS NOT ALLOWED R,2 I \ FIRE HYDRANT DESIGN FLOW: 3 BEDROOMS @ 110 GPD = 330 GPD NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING ter, ✓\\ / W O USE A 330 GPD DESIGN FLOW _. r' r� APPROX. C) / 01 ; `�______---��,,,-�� \\ o O SEPTIC TANK: 330 GPD (2) = 660 'NOTE. ABANDON TEST HOLE LOGS \�12 1` \ **RE-USE EXISTING 1000 GAL. SEPTIC TANK L\R • \ EXISTIl3G-SYSfEM, �� \ � Z � LEACHING: CRAIG J. FERRARI, SE #13871 RE-ROUTE PLUMBING - ENGINEER: TO REAR, MATCH SIDES: 2 (25 + 12.83) 2 (.74) = 112 GPD DAVID W. STANTON RS EXISTING _ N_ BOTTOM 25 x 12.83 (.74) = 237 GPD WITNESS: DATE: 1 1/13/2015 EXISTING --em Q TOTAL: 472 S.F. 349 GPD PERC. RATE _ < 2 MIN/INCH DWELLING 'oo X TOF = 100.7 , USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) CLASS I SOILS P# 14889 / / WITH 4' STONE ALL AROUND ELEV. ELEV. / o» 98.5' o,, 98.5' PORCH O O/A O/A \ \ 99 � � APPROVED DATE BOARD OF HEALTH, MA SL SL 10YR 3/2 10YR 3/2 ' X 99 J ,� J TITLE 5 SITE PLAN 10" 12„ N w � � \ �,�JJ ��`✓� J OF B B p rn� SL SL - TH, y J , ,, v� J J #103 COUNTY SEAT STREET 27" 38» 95.3 10YR 5/6 96.2' 10YR 5/6 TH2� � �� 97-___.� HYANNIS MA PREPARED FOR C C32 32 BORTOLOTTI CONSTRUCTION / PERC SEGERMAN 8 BENCHMARK: 9 � � E M/CS M/CS CONC. BOUND 6•�3'20 ELEV. = 96.3 06 64' DATE: NOV. 24, 2015 2.5Y 7/4 2.5Y 7/4 / � N Mgssq ���H°F MgsS� off 508-362-4541 fax 508-362-9880 DANIEL DANIE A. am, downcape.com �� �� JA " OCIVIL O ALA down ca a en inee�in inc. 132 87.5 132 87.5 � � 502 Q �No.4o0so � � �i NO GROUNDWATER ENCOUNTERED Scale: 1"= 20' \-1.�1-\� �G/STE N �� ` ' osu � -� civil engineers o ( land surve ors sL a 939 Main Street ( R to 6A) BI CE # > 5-30 > 0 10 20 30 40 50 FEET DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 15-301