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HomeMy WebLinkAbout0064 CROOKED POND ROAD - Health 64 Crooked Pond Rd. Hyannis 'J A=291-320 .00 INI 6 a a e o o , �a e o n m F TOWN OF BARNSTABLE LOCATION Gy Orock<cL PoiNJ QL SEWAGE# ZQj9=3�L VILLAGE ASSESSOR'S MAP&PARCEL Z91 - 3 ZO INSTALLER'S NAME&PHONE NO. B 4,g ZXCauJo-J;O,/\ 1127-OGS3 SEPTIC TANK CAPACITY /O'O'O LEACHING FACILITY.(type) TOO qn-1 !4c. (;A) (size) 13 x 25 A 2 NO.OF BEDROOMS�3 OWNER o5c-i PERMIT DATE: -9. J/- COMPLIANCE DATE: q•/ - j$ 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 to N dg Qq Q Q n �j No. 4� d � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes RpliCAtlon for loisposAY 6pBtrin Construction 3pPrmit Application for a Permit to Construct( ) Repair Zupgrade( ) Abandon( ) ❑Complete System gindiidual Components Location Address or Lot No. H CrOo alp Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Q q J -3 TOBA I k rl4If TOIL 6 b 8 '737- 85 Sq Ins ller's ame,Address,and Tel. o. yc�nntt Designer's Name,Address,and Tel.No. l E v -9914-1/bL 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) h gpd Design flow provided Y gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank z0 7�-`/ Type of S.A.S. c ur Description of Soil Nature of Repairs or Alterations(Answer when applicable) Zo ox b Qr, S 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 Boar p Signed S�t4Date —` —1(2-19 Approved by Date Application Disapproved by Date for the following reasons Permit No. L. Date Issued !� / ,- 5.1 _{ No. i 1 p " ✓ l� Fee 'VV THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes y PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftPhration for Misposal *pstem Construction Permit Application for a Permit to Construct( ) Repair Xupgrade( ) Abandon( ) ❑Complete System UZdiidual Components Location Address or Lot No. Owner'sn� ,and Tel.No. -Name,Address �� Groo��o1 puQ� ABAk C 1 to r� 5 a9 �737- y Assessor's Map/Parcel t ! 6 V 5 Installer's Name,Address,and Tel.1,4o. �}t�o,nn;S Designer's Name,Address,and Tel.No. n,. tQ xGuVal ivo _�bR- �-177-0_653 Type of Building: Dwelling No.of Bedrooms S 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 gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank ' �( Type of S.A.S. 2 a Description of Soil Nature of Repairs or Alterations(Answer when applicable) !`F d h/ ' ti ►t�('3 r v^,r r, 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/o'He., . Signed 94 Date Application Approved by Date Application Disapproved by Date for the following reasons r 1 Permit No. — "1 Date Issued --------------------------------------------------------------------------------------------------------------------------------------- ,y THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS ` (Certificate of Compliance., THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by at 40 H 1',r! has been constructed in accordance ..�Y 's i.le 5 and1 v f ry -with the provisions of Title 5 and thefor Disposal System Construction Permit No. �(Cdated Installer r x�j jmyT Designer #bedrooms +✓ Approved design flow 1 gpd The issuance of this p rmit hall not be construed as a guarantee that the system wil fim�co as desi d. Date "� / Inspector r ------------------------------------�----------------------------------------------------- - -----------------------------,-�--}--------- No. of / J`�-C1 r' Fee �V THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposar *pstem Construction Permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) System located at (,,,4 nr,(/n 9:R) 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. 5FTA Provided:Construction must bee completed ithin three years of the date of this permit.Date "/ �— � ( "" t Approved by I V 1 Town of Barnstable �oFTHt ram, Regulatory Services Thomas F. Geiler, Director BA MASS.BLE. » ]Public Health Division.y MASS' � s639.1639. N Thomas McKean, Director 200 Main Street, Hyannis, MA. 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: 9 Sewage Permit# Z014 -346 Assessor's Map/Parcel 291 -3Zo Installer & Designer Certification Form Designer: Fj"CX4U Env)'no mffNa, Installer: _g ( xerayo��1 or Address: P0. Box 331 Address: iy -Teo�.Sert^d N ar w�cl� �orc s-4da.lL On 9- 11- IQ $ EX.00.1j�a1;0,n was issued a permit to install a (date) (installer) septic system at 1,L4 (2rC)nKQ0(_ Pt)no4 Pd. based on a design drawn by (address) JD9XQC- V3"e rA u dated 9-`)- 19 (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 relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State &.Local Re ulations. Plan revision or certified as-built by designer to follow. Stripout (if required9- ected and the soils were found satisfactory. sy ( taller's Sig i ) No. 1211 7 '4NITAM (Designers Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gaoffice formsWesi;nercertification form.doc Town of Barnstable PT# Department of Inspectional Services Y . f Public Health Division fp�yCl a 200 Main Street,Hyannis MA 02601 Office: 508-862-4644 Date Scheduled toG Time Soil Suitability Assessment for Sewage Disposal Performed By: Witnessed By: LOCAT,ON& GENERAL INFORMATION Location Address: fJwner's Name: ke�l Owner's Address: S" Assessor's Map/Parcel: 2-9 V Certified Soil Evaluators Name: r0 Certified Soil Evaluators Email:: - � New Construction or Repair: Certified Soil Evaluators Telephone# Land Use / Slopes(%) � '� Surface Stones (/V Distances from: Open Water Body ( ft Possible Wet Area ft Drinking Water Well ft Drainage Wayft Property Line ft Other It Parent material(geologic Depth to Bedrock Depth to Groundwater. Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL"HIGH WATER TABLE Method Used: _ -. -. . ...�. Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level _ PERCOLATION TEST vat Z Time Observation t Hole# —1/— Time at 9" Depth of Perc Time at 6" Start Pre-soak Time @ Time(9"-6") End Pre-soak Rate Min./Inch =— Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/1) Deep Observation Hole:Log Hole Depth from Surface Soil Horizon Soil Texture Soil Color Soil Mottling Other (in) (USDA) (Munsell) (Structure,Stones,Boulders, Consistent %Gravel LS l- 2 N LS . //I- dall- S Z4 T E -Deep'Observation Hole Log . Hole#• Depth from Surface Soil Horizon Soil Texture Soil Color Soil Mottling Other (in) (USDA) (Munsell) (Structure,Stones,Boulders, Consistency,%Gravel LS104r %-W. Y V/0/4( Deep Obselrvation�Hole Log' Hole# :, Depth from Surface Soil Horizon Soil Texture Soil Color Soil Mottling Other (in) (USDA) (Munsell) (Structure,Stones,Boulders, Consistent %Gravel Deep OWeryation'Hole Log Hole#: Depth from Surface Soil Horizon Soil Texture Soil Color Soil Mottling Other (in) (USDA) (Munsell) (Structure,Stones,Boulders, Consistent %Gravel I � I Flood Insurance Rate May: Above 500 year flood boundary No k 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�na 1 ccurting pervious material exist in all areas observed throughout the area proposed for the Does at least four feet ofsoil absorption system? If not,what is the depth of n ally occurring pervious material? Certification I certify that onWc�Zo. (date)1 have passed the soil evaluator examination approved by the Department of Environmental d that the above analysis was performed by me consistent with the required training,expertise and experience describe in 310 CMR 15.017. Signature Date SKETCH: (Or you can attach a separate sheet) (Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) t'1 ` 1 Town of Barnstable MAM Regulatory Services Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 April 19, 2018 Certified Mail#7015 1730 0001 4990 3257 Tobai Leighton 64 Crooked Pond Road Hyannis, MA 02601 NOTICE TO ABATE VIOLATIONS OF TOWN OF BARNSTABLE CODE The property owned by you, located 64 Crooked Pond Road, Hyannis was inspected on April 18, 2018 by.Town of Barnstable Health Inspector Timothy B. O'Connell, R.S., because of a complaint. The following violations of the Town of Barnstable Board of Health Regulations, Chapter 54 Building and Premises Maintenance were observed: 04-3 (A) Outdoor Storage Observed trash bags, furniture, a sink, wood, plastic containers, tires, tools and other debris strewn about property. You are directed to correct the violations within fourteen (14) days of receipt of this order letter by disposing of said items or screening them from public view by placing them in an enclosed structure. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served Non-compliance will result in a fine of$100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. PER ORDER OF THE.BOARD OF HEALTH _ a Thomas A. McKean, R.S. Director of Public Health Town of Barnstable Town of Barnstable �ops�ray Regulatory Services BARNSfABL, Richard Scali,Director MASS.9: A � Public Health Division rED MA'S Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 September 8, 2015 Tobai Leighton 64 Crooked Pond Road Hyannis, MA 02601 NOTICE TO ABATE VIOLATIONS OF TOWN OF BARNSTABLE CODE The property owned by you, located 64 Crooked Pond Road, Hyannis was inspected on September 8, 2015 by Town of Barnstable Health Inspector Timothy B. O'Connell, R.S., because of a complaint. The following violation of the Town of Barnstable Board Code was observed: 353-1 Responsibilities of Owners: Items observed during inspection are an old duck cage made of wood which is no longer operable; old windows that are rotten; broken flower pots and other strewn trash and garbage items. You are directed to remove the garbage and rubbish from your property and dispose of it properly within 7 days of your receipt of this notice. You may request a hearing before the Board of Health if written petition requesting same. is received within ten (10) days after the date the order is served. Failure to comply with an order will result in a fine of$100.00. Each day's failure to comply with an order shall constitute a separate violation. PER ORDER OF T E BOARD OF HEALTH _Thomas A.McKean, R.S., CHO Director of Public Health Town of Barnstable QAOrder letters\Refuse\64 crooked pond,Hyannis 4.doc Town of Barnstable Barnstable_ IKgE ty Regulatory Services Department 1 M"a� li+ BARMUABLE, • - MASS. r Public Health Division A 1639 2007 200 Main Street, Hyannis MA 02601 r Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO r CERTIFIED MAIL #7011 0470 0001 4525 5600 March 1, 2012%~ ReMax Classic' 1 c/o Lisa Burgess ReMax RE 681 Falmouth Road/RT/28 Mashpee, MA 02649 RE: 64 Crooked Pond Road ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, Title 5. The septic system located at,64 Crooked Pond Road, Hyannis, MA, was last inspected on 1/11/2012 by Brian Reyener, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system`.`Fails"under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • System is in Hydraulic Failure You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification: PER ORDER OF E BOARD OF HEALTH Thomas McKean, R.S. CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\64 Crooked Pond Rd,Hy.doc J -xUSPS.comO-Track&Confirm https://tools.usps.com/go/TrackConfinnAction.action 1 English Customer Service USPS Mobile Register I Sign In usps,k- ►0 Search USPS com or Track Packages Quick Tools Ship a Package Send Mail Manage Your Mail Shop Business Solutions Track & Confirm You entered:70110470000145255600 Status:Delivered Your item was delivered at 11:19 am on March 02,2012 in MASHPEE,MA 02649. Additional information for this item is stored in files offline. 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Town of Barnstable Barnstable SHE Regulatory Services Department er"a�1 �BARN SfABLE.� Public Health Division . MIASS. �A 039. 2007 rf°"M A 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL #7011 0470 0001 4525 5600 /March 1, 2012, ReMax Classic c/o Lisa Burgess ReMax RE 681 Falmouth_Road/RT/28 Mashpee, MA 02649 RE: 64 Crooked Pond Road ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, Title 5. The septic'system located at 64 Crooked Pond Road, Hyannis, MA, was last inspected on 1/11/2012 by Brian Reyeher, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Fails"under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • System is in Hydraulic Failure I You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. PER ORDER OF E BOARD OF HEALTH Thomas McKean,;R.S. CHO .Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\64 Crooked Pond Rd,Hy.doc Commonwealth of Massachusetts Title 5 Official Inspection Form M Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 64 Crooked Pond Rd. Property Address Bank Owned -c/o Lisa Burgess ReMax RE Mashpee MA Owner information is Owner's Name required for every Hyannis MA 02601 01/11/12 page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms q� on the computer, use only the tab 1. Inspector: key to move your cursor-do not Brian Reyener use the return Name of Inspector Pector Ranger Construction Company Name 46 Crowell Rd. Company Address East Falmouth MA 02536 Cdylrown State Zip Code 508-274-9753 S1 13242 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that,the C 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 maintenanc6bf 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: i 1 ElPasses ElConditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 4 1 ' `J 01/11/12 Inspectors Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board r 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. f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M . ' 64 Crooked Pond Rd. Property Address Bank Owned -c/o Lisa Burgess ReMax RE Mashpee MA Owner Owner's Name information is required for every Hyannis MA 02601 01/11/12 page. Cityrrown State Zip Code Date of inspection B. Certification (cont.) 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: r 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 a Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 64 Crooked Pond Rd. Property Address Bank Owned-c/o Lisa Burgess ReMax RE Mashpee MA Owner Owner's Name information is required for every Hyannis MA 02601 01/11/12 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): s ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The c 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: • S ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 64 Crooked Pond Rd. Property Address Bank Owned-c/o Lisa Burgess ReMax RE Mashpee MA Owner Owner's Name information is required for every Hyannis MA 02601 01/11/12 page. CitylTown 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 I ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded 1 or clogged SAS or cesspool ® ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less' than %day flow _ _ 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 64 Crooked Pond Rd. Property Address Bank Owned -c/o Lisa Burgess ReMax RE Mashpee MA Owner information is Owner's Name required for every Hyannis MA 02601 01/11/12 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. (Phis system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence j 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. i i i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments '< 64 Crooked Pond Rd. Property Address Bank Owned-c/o Lisa Burgess ReMax RE Mashpee MA Owner Owner's Name information is required for every Hyannis - MA 02601 01/11/12 page. Cityrrown State Zip Code Date of Inspection 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? f ® ❑ 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 N � i r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 64 Crooked Pond Rd. Property Address Bank Owned-c/o Lisa Burgess ReMax RE Mashpee MA Owner information is Owner's Name required for every Hyannis MA 02601 01/11/12 page. Cityfrown State Zip Code Date of Inspection D. System Information Description: Existing 1000 gallon Septic Tank with 2-6'x6' pits 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? r ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: NA Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No 1 Water meter readings, if available: 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 64 Crooked Pond Rd. ,p - Property Address Bank Owned-c/o Lisa Burgess ReMax RE Mashpee MA Owner Owner's Name information is required for every Hyannis MA 02601 01/11/12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: NA Date Other(describe below): General Information Pumping Records: Source of information: NA r 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. I ❑ Other(describe): is Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 64 Crooked Pond Rd. Property Address Bank Owned-c/o Lisa Burgess ReMax RE Mashpee MA Owner Owner's Name information is required for every Hyannis MA 02601 01/11/12 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Septic Tank and Leaching installed in early 1980's Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2.0 feet Material of construction: ❑cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: NA feet Comments(on condition of joints, venting, evidence of leakage, etc.): Good Condition Septic Tank(locate on site plan): Depth below grade: 1.5 feet Material of construction: ®concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 6„ Sludge depth: Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y< 64 Crooked Pond Rd. Property Address Bank Owned-c/o Lisa Burgess ReMax RE Mashpee MA Owner Owner's Name information is required for every Hyannis MA 02601 01/11/12 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 36" Scum thickness 8" Distance from top of scum to top of outlet tee or baffle 3" Distance from bottom of scum to bottom of outlet tee or baffle 4" How were dimensions determined? measured Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank T's are intact. Needs Pumpin Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene El other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 64 Crooked Pond Rd. ,p - Property Address Bank Owned-c/o Lisa Burgess ReMax RE Mashpee MA Owner Owner's Name information is required for every Hyannis MA 02601 01/11/12 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene El other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 64 Crooked Pond Rd. Property Address Bank Owned-c/o Lisa Burgess ReMax RE Mashpee MA Owner Owner's Name information is required for every Hyannis MA 02601 01/11/12 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert NA Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): NA Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No .Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: SAS in Hydraulic Failure Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 64 Crooked Pond Rd. Property Address Bank Owned-c/o Lisa Burgess ReMax RE Mashpee MA Owner Owner's Name information is required for every Hyannis MA 02601 01/11/12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 2- 6'x6' ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): SAS in Hydraulic Failure Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 64 Crooked Pond Rd. Property Address Bank Owned -c/o Lisa Burgess ReMax RE Mashpee MA Owner Owner's Name information is required for every Hyannis MA 02601 01/11/12 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): SAS in Hydraulic Failure Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): I Commonwealth of Massachusetts upTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 64 Crooked Pond Rd. Property Address Bank Owned-c/o Lisa Burgess ReMax RE Mashpee MA Owner Owner's Name information is required for every Hyannis MA 02601 01/11/12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately A �3 O = 23.s 0= s 3 37 3 zl � 23 = 32 FTI A G4 C26C)Y-0 ?ONb • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 64 Crooked Pond Rd. Property Address Bank Owned-c/o Lisa Burgess ReMax RE Mashpee MA Owner Owner's Name information is required for every Hyannis MA 02601 01/11/12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 10'+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Local Perc Test results showing no ground water @ 10+ below grade Before filing this Inspection Report, please see Report Completeness Checklist on next page. Commonwealth of Massachusetts ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 64 Crooked Pond Rd. Property Address Bank Owned -c/o Lisa Burgess ReMax RE Mashpee MA Owner Owner's Name information is required for every Hyannis MA 02601 01/11/12 page. Citylrown State Zip Code Date of Inspection 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 y • i • s - COMMONWEALTH OF MAS'SACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL;AFFAIRS' DEPARTMENT`rOF ENVIRONMENTAL PROTECTION ,e TITLE 5 OFFICIAL INSPECTION:FORM=NOT FO'R;VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE'DIsSPOSAL SYSTEM;FORM, PART A CERTIFICATION Property Address: 64,Cr-ooked Pond Road lyahnis MA 0260'1 Owner's Name: Denise`-Mitchell Owner's Address: Same Date of Inspection: March 27 2007), Job#07 63 Name of Inspector: PATRICK M.O'CONNELL Company Name., SEPTIC INSPECTION SERVICES'CO o� Mailing Address: 1S9 CAMMETT ROAD, .:..1 MARSTONS'MILI S MA 02648 j Telephone Number: 508-4284779 CERTIFICATION STATEMENT a� '�'' I certify that I have personally inspected the sewage:disposal system;at this address and thatahe informat on reported below is true,accurate and complete as.of th.e time o'f the mspect�on:The.inspection was,Performed base: 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 GMR 15000).,The system: . X_ Passes Conditionally Passes Needs Further Evaluation by the Local,Ap;proving:Authority Fails - t Inspector's Signature: P(—�.OADate:3/27/07 The system inspector shal .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 ts?a shared;system or has a design;,flow of I Q,000 gpd or greater,the'inspector:and the system owner shall submit the report to.the appropnate regional office of the DEP.The original should be sent to the system owner and copes sent to.the'buyer;'ifappl :able,and:the approving authority. Notes and Comments: Overflow pit empty at time of ins'pechon'Tank'is not in need of pumping atthis time. i ****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 pe"r--form fn.the future under tiie same or different conditions of use. r--- ' Page 2 of 11 OFFICIAL INSPECTION FORM--NOT FOR VOLU,NTA'RY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL'S YSTEM<-INSPECTION FORM PART.A CERTIFICATION (continued) Y Property Address: 64 Crooked Pond Road,Hyannis Owner: Denise Mitchell Date of Inspection: March 27,2001 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _XX_ 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. 1 Answer yes,no or not determined(Y,N,ND) in the for the following statements. If"not determined"please explain. a The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 64 Crooked Pond Road,Hyannis Owner: Denise Mitchell Date of Inspection: March 27,2007 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 • i 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. jy _ 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 i failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: . 1 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 64 Crooked Pond Road,Hyannis Owner: Denise Mitchell Date of Inspection: March 27,2007 D. System Failure Criteria applicable to all systems: 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 cesspool 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. _X_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _X_ Any portion of a cesspool or privy is within a Zone 1 of a public well. 1 X Any portion of a cesspool or privy is within 50 feet of a private water supply well. —X_ 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 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.[ _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: To be considered a large system the system must serve 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) f yes no + _ the system is within 400 feet of a surface drinking water supply 3 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 It 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. Page 5 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 64 Crooked Pond Road,Hyannis Owner: Denise Mitchell Date of Inspection: March 27,2007 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? j _X_ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) _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)on the site 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(3)(b)] I i fj S 4 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 64 Crooked Pond Road,Hyannis Owner: Denise Mitchell Date of Inspection: March 27,2007 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):330 Number of current residents: 2 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected (yes or no): Seasonal use: (yes or no): Yes Water meter readings, if available(last 2 years usage(gpd)): Two years total: 45,750 gal.=62 gpd. Sump pump(yes or no): No Last date of occupancy: Currently Occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd + Basis of design flow(seats/persons/sqft,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: r OTHER(describe):_ ' GENERAL INFORMATION Pumping Records: Tank pumped 9/9/03 Source of information: Owner 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) t Tighttank, Attach a copy of the DEP approval —Other(describe): Approximate age of all components,date installed(if known)and source of information: Original system installed in 1977,overflow pit installed in 1987 Were sewage odors detected when arriving at the site(yes or no): No Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 64 Crooked Pond Road,Hyannis Owner: Denise Mitchell Date of Inspection: March 27,2007 BUILDING SEWER: XX (locate on site plan) Depth below grade: 1' Materials of construction:_cast iron _X_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: XX (locate on site plan) fr Depth below grade: 1' 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:8.5' long x 5.2'wide—1000 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle:28" j Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle:6" { Distance from bottom of scum to bottom of outlet tee or baffle: 12" How were dimensions determined: STICK WITH HINGE FLAP. Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tees intact and clear,liquid level at bottom of outlet invert.Tank is not in need of pumping at this time. t GREASE TRAP: No (locate on site plan) 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.): ' Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 64 Crooked Pond Road,Hyannis Owner: Denise Mitchell Date of Inspection: March 27,2007 TIGHT or HOLDING TANK: No (tank must be pumped at time of inspection) (locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: No (if present must be opened) (locate on site plan) i t Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): ( r` r PUMP CHAMBER: No (locate on site plan) r i 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.): 4 f1 V �l } ' Page 9 of I l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 64 Crooked Pond Road,Hyannis Owner: Denise Mitchell Date of Inspection: March 27,2007 SOIL ABSORPTION SYSTEM(SAS): XX (locate on site plan,excavation not required) If SAS not located explain why: Type _X_leaching pits,number: Two 6x6 pits in series. 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.): Original pit had previously failed,overflow pit was emote at time of inspection with a stain line 6" from bottom of structure leaving 5.5' of effective leaching. i CESSPOOLS: No (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 or no): Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: No (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.): s 3 1 a 5 Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 64 Crooked Pond Road,Hyannis Owner: Denise Mitchell Date of Inspection: March 27,2007 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. Crooked Pond Road f Water Service ... ..... ...... ............ ............. . . ................... .... ................... . .. ................. ......................:::.:. ............ .......... . ................................ ................... ............................ ............... .............................. 24 5 23 i 32 20 37 ' r ' Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 64 Crooked Pond Road,Hyannis Owner: Denise Mitchell Date of Inspection: March 27,2007 SITE EXAM Slope None Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water: More than 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: _X_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: Pond adjacent to property is considerably lower than bottom of SAS. 1 °PYRE r Town of Barnstable Barnstable ti Board of Health , Ammica My * BARNSTABLE, y nrnss. 200 Main Street,Hyannis.MA 02601 i639. �0 ATEO��A 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi Luis R. Montero October 30, 2007 156 Sunnywood Dr. Centerville, MA. 02632 NOTICE TO ABATE VIOLATION OF THE TOWN OF BARNSTABLE CODE, &360-20 (1) The property owned by you located at 64 Crooked Pond Road, Hyannis, MA. was inspected on October 27, 2007. by Donald Desmarais RS, Health Inspector for the Town of Barnstable because of a complaint regarding overcrowding. The following violation of the Town of Barnstable On-Site Sewage Disposal Systems Ordinance, §360, was observed: §360-20 (I): Criteria for Determining System Repair or Replacement There were a total of five bedrooms observed in the dwelling (four bedrooms upstairs and one bedroom downstairs). However, the existing septic system was designed for three (3) bedrooms total only. You are ordered to remove two (2) bedrooms from dwelling by removing entrance doors, by removing the beds, and by opening all door-way entrances (by partially . removing walls) to each room to a minimum of five foot wide openings within fifteen days of your receipt of this letter. Your second option is to upgrade your septic system to handle more than three bedrooms. Any structural changes must be done with a building permit. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in the issuance of non-criminal ticket citations of$100.00 each. PER ORDER OF HE BOARD OF HEALTH mas A.PER Director of Public Health r l i - f r ,,t`r TROY WILLIAMS k SEPTIC INSPECTIONS Certified by MA Department of Environmental Protection (508) 585-1500 19 Hummel Drive South Dennis,A4A 02660 �-� COMMONWEALTH OF MASSACHUSETI'S EXECUTIVE OFFICE OF ENVIRONMENTAL,AFFAIRS F DEPARTMENT OF ENVIRONMENTAL. PROTECTION TFFLF 5 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION ProperiN Address: 64 Crooked Pond Road Hyannis,MA Owners Name: John Cosmo RECEIVED Owners Addres,: 64 Crooked Pond Road Hyannis,MA 02601 O\VVVI Date of Inspection: September 25,2001 OCT 0 1UU i Name of Inspector: Troy M. Williams TOWN OF E<Hr;NS tAgLE t Company Name: Troy Williams Septic Inspections HEALTH H Dkp?. Mailing Address: 19 Hummel Drive I South Dennis,MA 02660 Telephone Number: (508)385-1300 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 appro%cd system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The s\' tcm /^ _1._ Passes Conditionall\- f'asws Needs Further Evaluation by the Local Approving Authont) Fails Inspector's Signature: �/ Date: � 1.2s'/o I The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of I lealth 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. Notes and Comments i Although system meets the minimum requirements set forth by the Massachusetts Department of Environmental Protection,certification is not to be construed as a guarantee of future working condition , of system,piping or components. This inspection represents the conditions of the system on the Date of Inspection noted above. •""This report only describes conditions at the time of inspection and under the conditions of use at that time. phis inspection does not address how the system will perform in the future under the sane or different conditions of use. are I Title 5 Inspection Form 6/15/2000 H i Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 64 Crooked Pond Road Owner: Hyannis, MA Date of Inspection: John Cosmo September 25,2001 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need be replaced or repaired. The system, upon completion of the replacement or repair,as approved by the B and of Health,will pass. Answer yes. no or not determined(Y,N,ND)in the for the following state nts. If"not determined"please explain. f 4 The septic tank is metal and over 20 years old* or the septic to - whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failur s imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approve y the Board of Health. *A metal septic tank will pass inspection if it is structurally so d,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. 1 ND explain: Observation of sewage backup or break t or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settle r uneven distribution box. System will pass inspection if(with approval of Board of Health)': b en pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system quired pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection ' with approval of the Board of Health): ' broken pipe(s)are replaced obstruction is removed , ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 64 Crooked Pond Road Owner: Hyannis,MA Date of Inspection: John Cosmo September 25,2001 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to detennine if the system is failing to protect public health, safety or the environment. 1. S}stem Hill pass unless Board of Health determines in accordance with 310 CMR 15.303 (b)that the System is not functioning in a manner which will protect public health,safety and the vironment: 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 sal arsh 2. System will fail unless the Board of Health (and Public W er Supplier,if any)determines that the system is functioning in a manner that protects the public alth,safety and environment: ' _ The system has a septic tank and soil absorpti system(SAS)and the SAS is within 100 feet of a surface %+ater supply or tributary to a surface w, r supply. _ The system has a septic tank and S and the SAS is within a Zone I of a public water supply. The system has a septic tank d SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septi ank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply we *. Method used to determine distance **This system p es if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and atile organic compounds indicates that the well is free from pollution from that facility and the prese a of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failur riteria are triggered.A copy of the analysis must be attached to this form. 3. Other: 4 3 f t �� Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 64 Crooked Pond Road Hyannis, MA Owner: John Cosmo Date of Inspection: September 25,2001 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 L.4 Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6"below invert or available volume is less than ''/2 day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped Any portion of the SAS,cesspool or privy is below high ground water elevation. ,vlq Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. A/q/A Any portion of a cesspool or privy is within a Zone 1 of a public well. /v/, Any portion of a cesspool or privy is within 50 feet of a private water supply well. w/., 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 eater 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 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.1 No (Yes/No)The system fails. 1 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 desig ow 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 a ve) yes no the system is within 400 feet of a surface drinking wa supply the system is within 200 feet of a tributary to a face drinking water supply the system is located in a nitrogen sensiti area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well If you have answered"yes"to any questi in Section E the system is considered a significant threat,or answered "yes"in Section D above the large sys m has failed.The owner or operator of any large system considered a significant threat under Section E o ailed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner shou contact the appropriate regional office of the Department. 4 Page 5 of I l OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 64 Crooked Pond Road Owner: Hyannis, MA Date of Inspection: John Cosmo September 25,2001 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No I'::;r,ping information was provided by the owner. occupant. or Board of I Lald, Were any of the system components pumped out in the previous two .%-eeks? _ 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 backup? _ 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: Yes no 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(3)(b)] 5 Page 6 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 64 Crooked Pond Road Owner: Hyannis, MA Date of inspection: John Cosmo September 25,1W CONDITIONS RESIDENTIAL Number of bedrooms(design):.) Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): . 30 Number of current residents: I Does residence have a garbage grinder(yes or no): No Is laundry on a separate seNvage system (yes or n,)1:wu_ [if yes separate inspection required] Laundry system inspected(yes or no): N/q Seasonal use: (yes or no): AID Water meter readings,if available(last 2 yearslrsage(gpd)): oo - /3 Sump pump(yes or no): ivo Last date of occupancy: 6 r.-,-.)- . COMM ERCIA WINDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd 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 syste yes or no):_ Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Alo Was system pumped as part of the inspection(yes or no): .4j If yes, volume pumped: gallons-- How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM v/Septic tank,distribuiien fie ,soil absorption system. _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained.from system owner) _Tight tank _Attach a copy of the DEP approval Other(describe):. Approx1-imate age of all components. date installed(if known) land source ofinformation: tGrk ". ,( OV: al .�ul �il O.va �-IL .. .�yt /n Ync LGca- G•k n'j 7/t3 / 07 Were sewage odors detected when arriving at the site(yes or no): /moo 6 Page 7 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 64 Crooked Pond Road Owner: Hyannis, MA Date of Inspection: John Cosmo September 25,2001 BUILDING SEWER(locate on site plan) Depth belo�% grade: 18 " f Materials of construction: _cast iron _/40 PVC mother(explain): Dktanc•r fron-, private water supply well or suction line: Comments(on condition of joints, venting, evidence of leakage,etc.): I Usk-_e% ��(ntS Fr.1 A'J'J ea, cw � L_-�.n� - C7/C' raf.2 SEPTIC TANK: (locate on site plan) Depth below grade: I ' Material of construction: ✓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: $ /)r5 i}cC /uyu yaft. Sludge depth: y� ' Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: t , rem. Distance from top of scum to top of outlet tee or baffle: (, " Distance from bottom of scum to bottom of outlet tee or baffle: i y How were dimensions determined: Pk.f,R Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): L c_ ✓ -_ � -A ..- �-� �L� �� - ` `.isvim_f'a-,.i �, i-/o✓/c.&'f O✓ ✓. NJ t.,r lJe e [ J Z CA. IG e Lt Ji 4_... ¢_ .t/. 4-4 t 7 Ca. ✓ -1 - --T LIV—} 1,107' �� Htt � d��JN �• N� 47 (N'J �wfL . / Teti GREASE TRAP:_(locate on site plan) Depth below grade:._ Material of construction:_concrete_metal_fiberglass_p yethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outl/etc.): Distance from bottom of scum to bottomfle: Date of last pumping: Comments(on pumping recommendatiotee or baffle condition, structural integrity,liquid levels as related to outlet invert,evidence of le 7 Page 8 of I 1 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 64 Crooked Pond Road Owner: Hyannis, MA Date of Inspection: John Cosmo September 25,2001 TIGHT or HOLDING TANK: (tank must be pumped at time of inspe on)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass olyethylene other(explain): Dimensions: Capacity: gallons Design Floe. _gallons/day Alarm present(yes or no): Alarm level: Alarm in working order s or no): Date of last pumping: Comments(condition of alarm and float s tches, etc.): DISTRIBUTION BOX: (if present must be opened)(I ate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to lets equal,any evidence of solids carrygver, any evidence of leakage into or out of box,etc.): PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,c dition of pumps and appurtenances,etc.): t 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: 64 Crooked Pond Road Owner: Hyannis, MA Date of Inspection: John Cosmo September 25,2001 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required) If SAS not located explain why Tye u. . y.w� t C '?< ' ft, -2, leaching pits. number: 2 leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: innovative/altemative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): J /+ V V Lr T�u w j-.-. u,�- {'1 N.t u.lam r.J`pc-cam�i J.� /' .L V, r.<<»c.s o 7� In ..�✓ J I• c. Y " ,/✓.; CESSPOOLS: (cesspool must be pumped as part of inspectio (locate on site plan) ' Number and configuration: Depth—top of liquid to inlet invert: _ Depth of solids layer: Depth of scum la*er. Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes o/no): Comments(note condition of soil,signsulic failure, level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan) i Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraul/f—* ure, vel of ponding,condition of vegetation,etc.): Y 1 9 Page 10 of 1 I OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 64 Crooked Pond Road Hyannis,MA Owner: John Cosmo Date of Inspection: September 25,2001 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. r �000 y4,w, 5 I z' - - - - 37 23 ' 3 n/c W c 5 Cx w.fl� '>Yans t{ 10 Page I 1 of I 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 64 Crooked Pond Road Owner: Hyannis, MA Date of Inspection: John Cosmo September 25,2001 SITE EXAM Slope ✓ Surface water ✓ Check cellar V Shallow wells t Estimated depth to ground water feet Adjusted high ground water elevation feet Please indicate(check)all methods used to determine the high ground %cater elevation: Obtained from system design plans on record- If checked,date of design plan reviewed: 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:A iw z 7 u z `/. You must describe how you established the high ground water elevation: / c G h h ( ' W c. a u r /�._. cQ T6 ✓v/ .A I CA✓t 4 !t1 '� 1 h j �++ Yti t 4` /h .C-_Se—f tJ"] W Ci S y f` /� <cX .'� .� G l�ta✓n .:� (.�w �"�,V .0 e,t/o-7� a� 060 i - p 15.00 �.Ia �) > 11 TOWN OF BARNSTABLE .I rf L/{)CATION CQL{ CQ-QC�--(U E02L)Q V-0 SEWAGE # VILLAGE ��rA 5 ASSESSOR'S MAP & LOT 2O INSTALLER'S NAME & PHONE NO. 5 SEPTIC TANK CAPACITY c�a�vs� �,CT'731� gf-e``C- LEACHING FACILITY:(type) 'F4(e c or eV�T- (size) NO. OF BEDROOMS_3_PRIVATE WELL O UBLIC WAT BUILDER OR OWNER 1 `C' c��?JC� DATE PERMIT ISSUED: 7 C7"' DATE .COLIPLIANCE ISSUED: '7 -C3 - `g 7 VARIANCE GRANTED: Yes No f/ I_ U � J N v 3� q14 THE COMMONWEALTH OF MASSACHUSETTS BOARD,�OF HEALTH .......... Appl ration for-Disposal Works Tonstrur#ion f rrutft Application is.hereby made for a Permit to Construct ( ) or Repair ( L-)— In ividual Sewage Disposal System it: Location.Address or Lot No. ............... x�:..---!�i AYL.. :..:.--=...... ............ ....................?mil Y!.................................................. ..._. Owner. Address a ............ .....:............... = ....... ................ !ti K ...................................................... Installer Address q� Type of Building Size Lot...........................Sq. feet ,-, Dwelling—No. of Bedrooms..:-------------- ------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of,.Building ............................ No. of persons..................... Showers ( ) — Cafeteria ( ) dOther_fixtures ..---•---------------------------•-•------------------.----.-------:-...---.........-•------------•--...............................--•---•--•••••.... WW Design Flow....... . ....................gallons per person per day. Total daily flow........ ....................gallons. WSeptic Tank . Liquid cap acity.............gallons Length................ Width................ Diameter--:-............ Depth................ x Disposal Trench—No. .......... Width.................... Total Length.................. Total leaching area...................sq. ft. 3 Seepage Pit No-----I............. Diameter....l `...... Depth below inlet.'../v............. Total leaching area.................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by...............................:.....•-•------._..........----••--...:....... Date........................................ ,.a 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........................ x --------------------• ......••••. ---.............................--- -•--••-••............--•••..........----•-......-•----•-- Descriptionof Soil.............................................----------•----•--.. .................................................................................................... W ..................................................-------------•----------. -----.....•-•••-.........••.......... ----•••-----............----................ ......._. -- •••......... U Nature of Repairs or Alterations—Answer when applicable.......AV.*..............0w�......6W.C....... ............. ..............e.-J.a...... .. ................................................................................................................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of,iITLL 1 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation•until a Certificate of Complianc been issued by the bo o i -- .... ....__ �o:�� '"7 Application Approved By--------------•--..........L-............-- --..... _ ---------•------------- Date Application Disapproved for the following reasons:.......................:..............................................•........:........._................___ ...............................................................•--•-------------•---------........:---._...........-•--•-------....------..................---.....-------------•-•----•--...---------- r Date PermitNo...................................:.........Z_ Issued............................................_.......... Date -7 q I/ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF... HEALTH ...........................................OF........- `d1...- ....t........................................................-F' { Appliration for Disposal Works Tono#rurtion jrruttt Application is hereby made for a Permit to Construct ( ) or Repair ( "--an,:1-dividual Sewage Disposal System at: �' . ....................._..........__._.. Location-Address - -or Lot No. _......_..... �C__..._. �2�':n......... . ........................... ••---•---•-------- t vu ... •............................ Owner Address ................................ - - a ............ = - Installer Address q� Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms......_ ?..............................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ------------------------•--------............------•--.---•-....•----••----••--•---•---•--•-............._............_....----•-••._.........--••---- WW Design Flow....... ...... ...............:......gallons per person per day: Total daily flow........ 3. ....................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter----- ------ Depth................ x Disposal Trench—No..................... Width....................Total Length.................... Total leaching area...................sq. ft. 3 Seepage Pit No...... ............. Diameter....1.lJ`......... Depth below inlet__._/D__ ........ Total leaching area..................sq. ft. V. Z Other Distribution box ( ) Dosing tank ( ) 1 ~' Percolation Test Results Performed by.......................................................................... Date....................................... Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 1 fs. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R'+ •--••----•-•-------------••-............................................................. .-...... ---------------------------- •----------------- -----•----- D Description of Soil......................... W UNature of Repairs or Alterations-Answer when applicable.......A19Y:?..............n !� ...... lr_ ...... .?.-1--.............. a-—I---- ..!....S 4!1-kwnc..................................................................................... l Agreement: ` —`­_11),The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with C the provisions of TITIS 1 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance as been issued by the bb000 d of"l 1th:— ____Signed ;......_ //Dee � Application Approved By.................. ...............�:�..�� '.`�----''.. .............................. ..._-•---- Date Application Disapproved for the following reasons:---•----•--•-----------•--•...........................................•---......------.__................-_--_ t ------•-•---••-•--•••---••----•---•---•------•-------------------------------••-•--••-•••---•--.._...•---I---..:---------•----•--••--•-------......---•----•---••---......._--••-•-•-..........-----•.. Date PermitNo................................................... •-- Issued....................................................... Date ----------------- ----__e—=_------------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........K� . . a!`-.......OF.......���►'N.S��:�� `�....................................... (Irr#ifiratr 'of Tout;,pliane THIS IS TO CERTIFY_ That the Individual Sewage Disposal System constructed ( ) or Repaired by............................ ----- -------------- -••------------•-----•-------------.----•---.-- ----------.--.-.-..--------.-.-_-_----_-_ Installer at_......................... ►7.....•1..4i..........---K)..................... r--•-----•----------------•-•-----------------•-------•---------- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......._..._......~.....4Z dated----.�/z -/ 7.......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE ... t .>.....---... ��......................................................... Inspector....... '_" - . :.... -........... ---------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . ^76-' ,t)- V................OF... :r.N-S. x:. `t'.......................................... Disposal Works Tonotrurtion Errant Permission is hereby granted------. - ---------•-•--------------------------•- to Construct ( ) or Repair ( 6 an Individual Sewage Disposal System at No.-•-•------------•--./mot... !..•-•--e: tk rk, .:. ��'`�� Qom: ✓., Strcet as shown on the application for Disposal Works Construction Permit No.� _//w Dated........... .......... Q..7. ,r - "'7 1 �7 Board of Health l DATE...................... ._..... �"'s�.__.......----•--------------- TO BA NSTA LE ---�� LOCATION �ra®� ®n0 " ?J SEWAGE#--' 15P VILLAGE_ o-\y_G^r1M% ASSESSOR'S MAP&PARCEL 1*9TXrL-t*S NAME&PHONE NO r1io-k (3(1. lrtQ;� � e66- I-no? SEPTIC TANK CAPACITY f OOCS LEACHING FACILITY:(type) (size) I OW AJ NO.OF BEDROOMS OWNER PERMIT DATE: COhIRMtReE DATE: (p�7 f G� 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 I _ Crooked Pond Road Water 1 Service F t 2 5 , 23 32 a 5 / 1 20 37 I � 1 0771 � [ ao e No..---------- FR$......lS................ THE COMMONWEALTH OF MASSACHUSETTS t Q BOARD OF HEALTH ,;r-�--- .----OF....... ..li/...... ..r .J.... V' Appliration -for Eli,ipoott1 Warkii Tontrnrtion PrrnZDisposal Application is hereby made for a Permit to Construct ( ) or Repair ( ) an .Individual System at• - - , ---------•--••-- Locatio Address Lot o. Owner A dres� r Installer r*. Address / UType of Building Size Lot..._-- -- d-'/•_:��_..Sq. feet 1-� Dwelling—No. of Bedrooms--------- ----------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fi_ tres . Design --- --------------------gallons per person per day. Total daily flow............. . ......... ---W n Flow_______________ _ WSeptic Tank—Liquid capacity-/ gallons Length................ Width................ Diameter_----. -..----_ Depth.--.-_-----.-..- x Disposal Trench—No. .................... Width.................... To 1 Length-.-______-_-____---- Total leaching area---------------------sq. ft. � Seepage Pit No...... -••----_---__ Diameter__. --- Dept --•-• -- ... hiug area------------------sq. ft. z Other Distribution box ( ) Dosing tan 7 7 '-' Percolation Test Results Performed b 6.3r_ ..................... Date............................____-_--.... 1 Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water......_-_--_-------_w f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ ODescription of Soil----=------------------------- --------------------------------•------••----------------------------------- U ----•-----••----•-•-------•------------••----------------------- W VNature of Repairs or Alterations—Answer when applicable..--------------------------------------------------------------------------------------------- ---------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------- --------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been ' ued by the board of_ ealth. { ` Sign --- --- �------- •- - -�� - •----•- ----------------------•--------- Date E :------_-_- --- S_-/?7----------- Application Approved BY C�C� Date .Application Disapproved for the following reasons:-------•-------------•--••------•--------------•--------------•---------•-----•--------------------------------- --•-•--••------------------------•-......_ Date PermitNo......................................................... Issued........................................................ Date �7// No............Z `' Fizic ..6...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 9.�-:• -.7700 ---�OF..�---ja 4.8... Appliration -for Dtgpoiial Workii Tonitrnrtion Prrntit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System.a 0 if .. Loeatio Address Lot No. • Owner N. dress } w -- ----------- # ,�" --- ------------------------- Installer Address Q Type of Building Size Lot----� f_ � __Sq. feet U Dwelling—No. of Bedrooms________ __ ------------------------------Expansion Attic ( ) Ga age rinder ( ) aOther—Type of Building ____________________________ No. of persons_..._-___-__________-____-__ Showers ( ) — Cafeteria ( ) a' Other fixtures ------------------------------------------------------- w W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity-JAW-gallons Length---------------- Width................ Diameter---------------- Depth.__.___.------ x Disposal Trench—No_ ____________________ Width-------------------- Toj#ij Length------------_------ Total leaching area_._..__.____..._____sq. ft. Seepage Pit No------ ------------- Diameter_ De * — liin area------------------sc ft. z Other Distribution box ( ) Dosing tank ( ) j ' �- /— 7 7 Percolation Test Results Performed b . _ .�.y o r --Wiz______________________ Dale-_______-.-__.-___-_______--.._-_._-__-- Test Pit No. 1................minutes per inch Depth of "Pest Pit-------------------- Depth to ground water...--.-____.--.._-____. (1 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-....................... a --•------•••----- -- ---- ........... ------ t O Description of Soil------------------------------ . � -='- U •••--•-•------------------•---------. -------------------------------------------------------- ••••-•-••--------------------------•-----•------•----------••-----•--•--•-•-------•-----•-------- W UNature of Repairs or Alterations—Answer when applicable------------------_----------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------- ---------- --------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee t sued by the board of ealth. , Signed-- ---- d....... . — -------------------------------- Date ✓. � r J e Application Approved By... Date /� ��`mot .� !J1 GL ! l / l ---••--•- Application Disapproved for the following reasons_________________________________________ -----•----------------------------- ----•-------- --------------------------------------------•---------------.._._..----------------------_--••----------- Date PermitNo........................................................ Issued..........=............................................. Date ^* THE commONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........r'.:...�'�C_�Y� .......OF......., ` 4 tZ.. ...........;....................................-- ........ Trrtifirnte of (�ontpliaurr THIS IS 0 . ERTI/FY, That thy- Individual Sewage Disposal System constructed or Repaired ( ) by...-, ' . / Installer has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No -____���1._v_________________ dated_...7.'_i '__.____ ._7.._.___..___. THE- ISSUANCE OF THIS CERTIRCATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FU14CTION SATISFACTORY. DATE.................................................................-------------• Inspector------------------------------------------------------------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF......... ............ ... i),,Iv . __ FEE----, P "'.'.._.. Di-sVoiittl Nork �tr rtio$t rrntit Permission is hereby granted---------'�J15' --...'.r----- =-----•-•--------------------------•-••--•---•---•------------- to Construct or Re r ( } an Ili ; 'dua Se e is System z at No----_____ Street as shown on the application for Disposal Works Construction Perm' No _'____ •_.._ Dated-__-�t-�k _.�P_�-------- - ' e. DATE....... ----------------------------------- s. FORM 1255 Hoses .WARREN. INC.. PUBLISHERS - - - -• I' •r , TOP OF FOUNDATION COVERS TO BE WATERTIGHT AND SEPTIC SYSTEM PROFILE BROUGHT TO WITHIN 6"OF FINAL GRADE Flaherty Environmental Services EL. 58.0' EL. 56.0' (not to,scale) COVER TO BE W/I 3" OF GRADE CLEAN SAND P.O. Box 331 2"of 8" to I" DOUBLE WASHED EL. 56.0' Harwich, M.4 02645 4"CAST IRON or EQUIVALENT PEAS�'ON�OR GEOTEXTILE 774.9-04.1166 MIN. PITCH 1/4" PER FOOT FILTER FABRIC ! 4" SCHEDULE 40 PVC PIPE 4^SCHEDULE 40 PVC PIPE COVER TO BE W 13" O GRADE FLOW LINE VENT REQUIRED 1% E .5 .3 •'O'' L.EXIST. p • 'p p:p p 0°00o°o°c 0 '— o 0 0 0 0 0 0 �� o 0 0 0 EL.EXIST EL.53.6' '� o°o°o°o°o° o o .'®®Fcm���� p o00°o°ooc 0 0 0 0 0 0 0 0 0 o c EL.53.2' EL.53.03' °o 0000 0°0°0°0°0°0° o°o°o°o°c 2.0' GAS BAFFLE EL.53.0' o°o°o°o°o°o°o°o° �' �'0 o°o°o°o°c— (H-20O-BOX) 0 0 020000 000000 , e ��'•M. oo0 0000C •;'a. o 0 0 0 0 0 o a °o°o°o EL.51.0' STALL INLET r7r °i 6"CRUSHED STONE OR 1"ABOVE OUTLET INVERT SOIL ABSORPTION SYSTEM 1000 GALLON SEPTIC TANK MECHANICALLY COMPACTED (2) 500 GALLON H-20 CHAMBERS (DATUM: ASSUMED) (EXISTING) 3i WITH 4'STONE AROUND IN A 5.5' 4 to 1 DOUBLE WASHED STONE 12.83'X 25'X 2' CONFIGURATION BOTTOM OF TEST HOLE EL. 45.5' EL. 45.5' USGS ADJUSTMENT: N/A LOCATIONMAP GROUNDWATER ELEV: N/A N TH LOT 61 0.26 ACRES± �L�� Bristo►Ave. MAP 291 LOT 320 1O LP �j9 Coun Seat St. .qy 56 LOCUS O`+ O® EXIST, S.T. LP -a o 12.0 54 6 ® \ EXISTING NTS 3 BR ® \ DWELLING PORC2 7 y �Z14 OF •P DECK ":'.'•"' pp •�j \ / GARAGE -ITH-2 ~ a �® Osy�l�+ DRIVEWAY ( 54 ��ilgdp� 26.5' Ar ) 56 elY 117.32 DATE:91712019 REVISED: BENCHMARK: LEGEND ` EL. 8 0' ` SITE AND SEWAGE PLAN FOR B & B EXCAVATION, INC. W / - W 6-- GAS LINE t TOBAI A. LEIGHTON -�_—. W—1,F• WATER LINE E E rm r=6 EXIST. ELECTRIC 64 CROOKED-POND ROAD 99 EXIST. CONTOURS ; (HYANNIS) BARNSTABLE, MA ————— 99 PROP. CONTOURS SCALE : - WAE jig web UNDERGROUND UTIL 1 3 0 REF:LCP 14034-M SH2 PAGE 1 OF2 ..... ........ .................................................................................. .............. ... ................. ......................................................................................................................... ........................................ ....................................................... .. . ...... ........ ... ... . ...... . ............................................................................................................................................................................................................................................................................................ GENERAL NOTES DESIGN CAL CULA TIONS S YS TEM DETAIL Flaherty Environmental Services P. 0. Box 331 1. ALL PRECAST COMPONENTS TO BE H-1 0 Harwich, MA 02645 RATED UNLESS OTHERWISE SPECIFIED, NUMBER OFACTUAL BEDROOMS 3 774.994. 1166 DISTRIBUTION BOX AND ANY COMPONENTS WITH ANY ANTICIPATED GARBAGE DISPOSAL UNIT NO VEHICULAR TRAFFIC TO BE H-20 RATED. 2. THE DESIGN OF THIS SYSTEM DOES NOT TOTAL ESTIMATED FLOW ALLOW FOR THE USE OF A GARBAGE (I 10 GA UBRJDA Y X 3 BR) 330 GAL./DAY GRINDER. REQUIRED SEPTIC TANK CAPACITY 660 GAL. 3. MUNICIPAL WATER IS AVAILABLE, — 25' 4. ALL CONSTRUCTION TO CONFORM WITH SIZE OF SEPTIC TANK 1000 GAL. (EXISTING) 310 CMR 15.000 AND ALL OTHER APPLICABLE LOCAL, STATE AND FEDERAL SOIL CLASSIFICATION CODES AND REGULATIONS, 5. INSTALLER/CONTRACTOR TO REVIEW& DESIGN PERCOLATION RATE <2 MINAINCH. VERIFY ALL ELEVATIONS AND DETAILS EFFLUENT LOADING RATE 0.74 GAL.IDA YIF T-' AND REPORT ANY DISCREPANCIES TO 12,83' DESIGNER PRIOR TO CONSTRUCTION OR LEACHINGARE4 ASSUME ALL RESPONSIBILITY. (2)x(25.0'+ 12.83)(2) = 151SF 6. INSTALLER/CONTRACTOR IS 25.O'x 12.83' =320 SF RESPONSIBLE FOR MAINTAINING SAFE 471 SFx 0.74 =348 GPD WORK AREA, VERIFYING ALL UTILITIES AND NOTIFYING "DIG SAFE" USE(2)500 GALLON H-20 CHAMBERS WITH 4'STONE (1-888-344-7233) 72 HOURS PRIOR TO INA 12.83'X25'CONFIGURATION AS DIAGRAMMED CONSTRUCTION. Z ANY CHANGES TO OR DEVIATIONS FROM RESERVE LEACHING CAPACITY NIA THIS PLAN MUST BE APPROVED IN WRITING BY FLAHERTY ENVIRONMENTAL SERVICES AND LOCAL BOARD OF HEALTH. 8. FINISH COVER OVER COMPONENTS IS NOT TO EXCEED 3'PER 310 CMR 15.000 (NTS) UNLESS SHOWN PER PLAN 9. ALL ABANDONED SEPTIC SYSTEM COMPONENTS TO BE PUMPED DRY AND SOIL EVAL UA TION , FILLED WITH CLEAN SAND OR REMOVED TESTHOLE#1 TPT#19-119 TESTHOLE#2 TPT#19-119 AND REPLACED WITH CLEAN SAND. Evaluator., David D.Flaheffy Jr.,RS,REHS Evaluator., David D.Flaherty Jr.,RS,REHS 10.ALL COMPONENTS TO BE PROVIDED SE#2755 SE#2755 BOHwitness. David Stanton,RS BOH Witness: David Stanton,RS WITH WATERTIGHT ACCESS PORTS Date.- August22,2019 Date: August 1,2019 WITHIN 6"OF FINISH GRADE. 1 1.ALL SEPTIC TANKS, DISTRIBUTION TH-I ELEV.56.0' TH-2 ELEV 56.0' BOXES AND PIPING TO BE INSTALLED WATERTIGHT. 0.-8. A LS IOYR312 0.-8. A LS 10YR 312 12.NO KNOWN WETLANDS OR WELLS WITHIN 150 FEET OF PROPOSED 8--25- B LS IOYR514 6'-25- B LS IOYR514 LEACHING. 13.THIS IS NOT A CERTIFIED PLOT PLAN AND UNDER NO CIRCUMSTANCES IS THIS PLAN TO BE USED FOR ZONING OR Pero7 certify that on November 12,2002, have passed _�F/ 47 the examination approved by the Department of BUILDING PURPOSES, Environmental Protection and that the above analysis SITE AND SEWAGE PLAN FOR has been Performed by me consistant with the 14.LOT IS SHOWN AS ASSESSOR'S MAP 291 8 & B EXCA VA TZON, INC./ 25"-126" C MS 2.5Y614 25"-120" C MS 2.5Y614 required training expertise and experience described LOT 320. In 310 CMR 15.018(2). TOBAZ A. LEZGHTON 15.LOCUS PROPERTY IS NOT LOCATED 64 CROOKED POND ROAD WITHIN AN AQUIFER PROTECTION (HYANNZS) BARN TABLE, MA IS DISTRICT(ZONE II). G.W.ELEV.NIA G.W.ELEV.NIA BOTTOM TH-I ELEV. 45.5' BOTTOM TH-2 ELEV. 46.0'1 PAGE 20F2 D�IE� ...................................................................................... .................................... ............................................................................................................................................................................................................................................................................................. ............................ ............................................................................................................................................................................................................................ .............................. ............ ................... t tips c�,L'�-r: 8y; •t �.�✓�-aas=��r_,�+_c-�_ ..-� - 4 .. / • �Z. UQV!D LEVEL TYP�GAL SEPrI C TI► r>\1f;L TyPi CA'L— I(ST-0-11%QT I OKJ max ►.�Or To x s�E NOT T'o x�L.E �w+s�a �a1C�a • 2'DC! Fi►,su 6�tAoL FINISH Gttso•E Tqv oc �ru..�o r -._ .• �•,r 1 t.1. . C IC LawE �N�I ,7i i ( i-ZXf�. �r� j j, f,' 1 uV ' .k',? � rL az Gf. .QQ Fti- I icx)0 yA-` .. _ . __ - ! a� • I • `% , µ�`L>2 3 t D 15 T BOX. v o m d t+E Rrewproccoo C_'d cop I A • 0 4 • I o n ry t, TZD, SK LEVEL.- 1 1 � a � A ` g O'Trl C T-A.". 4 ti � [ '_'TpI�►_ E • r- AX, C sv�-r-E M P�pF«...� T''• uoT To xjL.L.c 3<� .S 'iw A Ilk NV �r •-f . , t �Z I JX� �xtsf OF ' �'��,�,��'._.; '�:,~*'.'_ �` �'_ (,,._ t °t 7/L-'44`a`-..► '� ; '; `� ;��� 1gRW1M ,-�'�.,'`�••';©•..'':��:, `✓ ,��"'!✓'`�:"�.�_,. +,.s�0.'�'��i �' ��'` »s. •CALft QATft: SHUT `\C7_ + --?' f 3�•+' , �IrK.. i .,�,. �?'_+,.1'� .f`,. r'".+ut c...l+' '^'.'^'•.TV (—...^"'q h' Y 60AW; w CMKQ ow AMMO f v fR.EN N& < t «- r� }• ��„/�}~ * ��+4 ��� :-.,.a °t�. .. 4 4 ,,- '��• •. - 3'i+�. a'+ ,, ��ti - R;�„ �""y�. ���� '�n`�'-Mfg .,. Y` SF7 r 7G,