Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0085 DUNN'S POND ROAD - Health
"85 Dunn's Pond Road Hyannis P µ A 249 099001 vp ` v S P 1 o k 9 o e C i -�t.. Town of Barnstable Barnstable .� 'Regulatory Services Department A54W=Waj MAM 1ARNSTABLE ; � Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scalie,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7014 1200 0001 0358 7559 9/01/2015 David P. O'Conner 85 Dunn's Pond Road Hyannis, MA 02601 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 85 Dunn's Pond Road, Hyannis, MA was last inspected on 8/12/2015,by Shawn Mcelroy, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Leaching pit or cesspool with high liquid level,<12" below inlet(per Town Code 360-9.1 You are ordered to repair or replace the septic system within two (2)years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF TINE BOARD OF HEALTH o s McKean, R.S., Agent of the Board of Health - Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\85 Dunn's Pond Rd Hy Sept 2015.doc 9/1/2015 Parcel Detail 4 6 THE 4 11AFtl�STABLt, # s [I _ hiS55, ,rJll + "' Lagged In As: Parcel Detail Tuesday, September 1 2015 Parcel Lookup Parcel Info Parcel ID 249-099-001 _ I Developer Lot LOT122 4 Location 85 DUNN'S POND ROAD Pri Frontage 72 Sec Road Sec Frontage village HYANNIS I Fire District HYANNIS z_ Town sewer exists at this address,No I Road Index 0459- A Asbuilt Septic Scan: - Interactive Map „ 249099001_1 � Owner Info Owner OCONNOR, DAVID P-A CO- Owner. streets `85 DUNNS POND RD r I Streetz City HYANNIS I State MA I zip'02601 _ I Country I Land Info Acres '0.27 (use Single Fam MDL-01 I Zoning ,RB I Nghbd 0104 Topography ;Level I Road :Paved. utilities Public Water,Gas,Septic I Location Construction Info Building 1 of 1 Year I1942 Struct- �� Root Ext Built Gable/Hip Wall Wood Wood Shingle J Living 7204 - Roof Asph/F GIs/Cmp AC None _ Area Cover Type style Ranch J I"t Bed Wall -Drywall Rooms 2 Bedrooms th Model,Residential Carpet RoBoa„s Full-0 Half Floor Heat ___. _. Total Grade Af Zage Minus Type 'Hot Air Rooms 4 Rooms Heat Found- 'w.- - . . Stories 1 Story I Fuel',Gas ation COnC. BIOCk Gross - --- Area` 912 Permit History — - Issue Date Purpose Permit# Amount Insp Date Comments 5/1/2003 Addition 68480 $13,500 6/19/2003 12:00:00 AM 2/28/2003 Wood Deck 67247 $1,000 6/19/2003 12.00.00 AM http:/Iissq t2fi ntranet/propdata/Parcel Detai l.aspx?[D=18079 1/3 Town of Barnstable + lARNSUBM �9 ,.� Regulatory Services Department jDtfD N4A�� Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 7/6/15 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1)YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any "conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) j Leaching pit or cesspool with high liquid level, <12"below inlet(per Town Code yyyyyy"``��§360 9.1) r, OTHER . ❑ Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc - Commonwealth of Massachusetts I"/ L 4 _ title 5 Official Inspection Form Subsurface Sewage Disposal System Form.=Not-for Voluntary Assessments 85 Dunns Pond Rd , Property Address Susan Lavallee Owner Owner's Nam , information is required for every NYE MA 02601 8-12-15 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. General Information 1. Inspector: _ �j 8 0 Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905. S13971 Telephone Number License Number B. Certification ; I certify that I have personally inspected the sewage disposal system at this address and that the -information reported below is true, accurate and complete'as of the time of the inspection. The inspection was performed based on my training and experience in the proper function.and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 16.000).The system: ❑ Passes ❑ Conditionally Passes, ® Fails - ❑ Needs Further Evaluatio y the Local Approving Authority J 8-12-15 spector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board w 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 't 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. 0 vs t5ins•3/13 TRIe 5 Official Inspection Form:Subsurface Sewage DisFro�Page 1 of 17 Commonwealth of Massachusetts Title 5 Official In-spection. Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments - 85 Dunns Pond Rd Property Address Susan Lavallee Owner Owner's Name information is required for every Hyannis MA 02601 8-12-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system; upon completion of the replacement or repair, as approved by the Board of Health, will pass. { Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent.,System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑,Y ❑ N ❑ ND (Explain below): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 85 Dunns Pond Rd •# Property Address Susan Lavallee Owner Owner's Name information is required for every Hyannis MA. 02601 8-12-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage,backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a-broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ' ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y '❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ', ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 'g t5ins-3113 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 85 Dunns Pond Rd Property Address Susan Lavallee Owner Owner's Name information is required for every y H annis MA 02601 8-12-15 page. City/Town , State Zip Code Date of Inspection B. Certification (cont.) ` 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within ' 100 feet of a surface water supply or tributary to'a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes No M ® ❑ - 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 El ® due to an overloaded or clogged SAS or cesspool ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y day flow t5ins-3/13 Title 5 Official Inspectlon Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts _ Title 5 Official Inspection Form ; Subsurface Sewage Disposal System,Form -Not for Voluntary Assessments M 85 Dunns Pond Rd r Property Address Susan Lavallee Owner Owner's Name ' information is required for every Hyannis MA 02601 8-12-15 , page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis a and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 101000gpd. ❑ ® ' The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. 'For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone 11 of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 �. Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage.Disposal System Form -'Not for Voluntary Assessments M 85 Dunns Pond Rd Property Address Susan Lavallee Owner Owner's Name information is required for every Hyannis MA 02601 8-12-15 i page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No A ® ElPumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? f ® ❑ 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? t ® ❑ 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? ® 0 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 P been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. c r 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 n. Residential Flow Conditions: Number of bedrooms (design): 2 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 r ' t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 r Commonwealth of Massachusetts _ J Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 85 Dunns Pond Rd Property Address Susan Lavallee Owner Owner's Name information is required for every Hyannis MA 02601 8-12-15 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 5 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? _ ❑ Yes ® No Last date of occupancy: 8-2015 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) \_ Basis of design flow(seats/persons/sq.ft., etc.)-. Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official, Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 85 Dunns Pond Rd Property Address Susan Lavallee Owner Owner's Name information is required for every Hyannis MA 02601 8-12-15 page. City[Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: t Source of information: Owner--pumped 7-2015 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: . gallons How was quantity pumped determined? Reason for pumping: Maintenance 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/Altemative technology.Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins a 3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -.Not for Voluntary Assessments 85 Dunns Pond Rd Property Address Susan Lavallee Owner Owner's Name information is required for every Hyannis MA 02601 8-12-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1986 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 12"feet Material of construction: i ® cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): Err Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No d Dimensions: 1000 gal Sludge depth: Err t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts - a v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for.Voluntary Assessments M 85 Dunns Pond Rd Property Address Susan Lavallee Owner Owner's Name information is required for every Hyannis MA 02601 8-12-15 page. City/Town 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 26" Scum thickness 1" 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 15" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 85 Dunns Pond Rd Property Address Susan Lavallee Owner Owner's Name information is required for every Hyannis MA 02601 8-12-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):. Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection -Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ti 85 Dunns Pond Rd Property Address Susan Lavallee Owner Owner's Name information is required for every Hyannis MA 02601 8-12-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) .. r Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Good condition with water at working level and stain lines above inlet invert. i Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No" Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working orders stem is a conditional ass. P P 9 � Y P Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 I Commonwealth of Massachusetts _ Title 5 Official Inspection form a Subsurface Sewage Disposal System'Form -Not for Voluntary Assessments. ' 85 Dunns Pond Rd Property Address Susan Lavallee Owner Owner's Name information is Hyannis MA 02601 8-12-15 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) s Type: ® leaching pits number: 1-1000 gal ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system - Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level.of,ponding, damp soil, condition of vegetation, etc.): Leach pit was holding water at 6"below inlet invert with stain lines above inlet invert. Cesspools (cesspool must be pumped as part of inspection) (locate on-site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts • ' Title 5 Official. Inspection Fo'rm' Subsurface Sewage Disposal System Form -Not for.Voluntary Assessments 85 Dunns Pond Rd Property Address Susan Lavallee Owner Owner's Name information is required for every Hyannis MA 02601 8-12-15 page. Citylrown` State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins 3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments_r 85 Dunns Pond Rd Property Address Susan Lavallee Owner Owner's Name information is required for every Hyannis MA 02601 8-12-15 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 �-, .,� �iistl�IM�lf■1111 Ili X t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments b 85 Dunns Pond Rd Property Address Susan Lavallee Owner Owner's Name information is required for every Hyannis '. MA 02601 8-12-15 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: 12+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: ® Checked with local excavators, installers- (attach documentation) ® Accessed USGS,database-explain: You must describe how you established the high ground water elevation: USGS and town maps show groundwater at greater than 12'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-W 3 f Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 85 Dunns Pond Rd Property Address Susan Lavallee Owner Owner's Name information is y required for every Hyannis MA 02601 8-12-15 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file I � t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 TOWN OF BARNSTABLE -1 OCATION A{P 12 SEWAGE# �-1�"-. �1 'VILLAGE ASSESSOR'S MAP&PARCEL —/ INSTALLERS NAME&PHONE NO. Z C-t 5,-057-"77(-q 39!j e SEPTIC TANK CAPACITY is '�a.",(n, ,c—oo g — 1i1-"'o or LEACHING FACILITY:(h'Perl-�-l�f Gib (size � 1CiA NO.OF BEDROOMS OWNER t� PERMIT DATE: COMPLIANCE DATE: ` Separation Distance Between the: II 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 -o cr- 0 CKN s s --v 7lb IQN , -SEWAGE PERMIT NO. VIIIAGE Icy. INSTA LLER'S NAME & ADDRESS OR OWNER DATE PERMIT ISSUED 7k - DATE COMPLIANCE ISSUED p�.� f a^ j 'l No. I Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:__Lz� Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pplitation for Disposal *pstem Construction Permit Application for a Permit to Construct( ) Repair(k Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ur% ✓�� Owner's Name,Addres ,and Tel.No. SOV- 94.2 d 0, YW 1-�ycu,r�i ,ZA.-Ae La 11aj1ee S<i-ounns l% ram/ Assessor's Map/Parcel a �9/99�/ 5 a-a4 Installer's Name,Address,and Tel.No. �54_ 7'j/- 9.5 jg Designer's Name,Address,and Tel.No. �_09-3(,,.a -1`JY/ ,i/CvinSfrvt -ien,Zvu. P.v• fix���/ �ac�nG�e. i r�o i n5 /MM- 431,^flair,� WS 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) oC , gpd Design flow provided 3Y2 gpd Plan Date Oc�. -M 5 Number of sheets 4 Revision Date Title `7� 0 .�'�St Own $S�[4,mm9 �"1U htV/ q/1�`5 � ` i \ Size of Septic Tank &_%.4i►'� m4.ZQ Type of S.A.S.Ja. )(,as .2- Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental e and to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed - ' Date 111,311 s Application Approved by r / _ Date Application Disapproved by. Date for the following reasons Permit No. Date Issued 111310015 No Fee m THE COMMONWEALTH OF MASSACHUSETTS Entered in co4F mputer: `_ Yes PUBLIC HEALTH'DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01politation for Misposat*vstem Construction Permit Application for a Permit to Construct( ) Repair"V Upgrade( ) Abandon( ) ❑Complete System ❑Individual. Components Q� i Location Address or Lot No. G) urin5 �-�o� �*-� Owner's Name,Address,and Tel.No. _5 D6-34a -USVO "Aa(Nn i t, ._Vz�nne La r1a-/ke & _.Uut►ns/�brld 411 Assessor's Map/Parcel 07q?`q9�-/ r �v Installer's Name,Address,and Tel.No. 7S9 Designer's lame,Address,and Tel.No. J-08-3',a -'/5-1 �rTU+vC '�v��S+f'vG�-io►��Tv��. RO. (fixr)6q ,DoA �e ineerinS :sm. 93Smo_iv,S-�• AIIA M6,r.-, 61s 11 !L1 Hato rti UaG S TI pe of Building: 1 Dwelling No.of Bedrooms Lot Size -a7 A! sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided 3Y gpd Plan Date Od. ASS aUl`i Number of sheets / Revision Date Title `7774L, p1jr," 64 5 < ,,,ti,J.,Q pnrv� al {4 kjA Size of Septic Tank eX,4 r ,ey)C_6 r Type of S.A.S.1,2. / \ Description of Soil��� ¢ „G,� J,� 15, Z Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: �• " rr The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposallsys'temin----. accordance with the provisions of Title 5 of the Environmental Cod -a-nd-Zo�to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. / Signed s Date Application Approved by Date r_ r Application Disapproved by o Date` for the following reasons j Permit No. 7,2 F °J I Date Issued Imo'7�0/S --------------------------------------------------------------------------------------------------------------------------------------- t� THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS QCertificate of Compliance THIS IS TO CERTIFY, 1 1TIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(� Upgraded( ) Abandoned J� d( )by r-N1 - 1 ,�; -4 ie ti nrn I r,t at `n _Jt na, P/,n-ti f2-A. 1, has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.701 S-311 dated 111 31A>5- Installer 1 �v fa e IJ�M��ft l . I r-m_• Designer � Pam, A n,,�,,n r n,o ._i O C C #bedrooms Approved design flo 'X , gpd The issuance of thisipehnit shall not be construed as a guarantee that the system wil func i as desk'ned. �f Date 11_(�1 I� Inspector W_S ----------------I---------------------------------------------------------------------------------------------------------/---------------- No. ,Vl f I Fee P0a THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS MispoBal 6pstem Construction Permit Permission is hereby grantedto Construct( Repair Upgrade( ) Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date 11( Approved by v DEC-10-2015 00:30 From: To:15097906304 Page:1,11 FROM :down cape engineering inc FAX NO. :15083629BBO Dec. 09 2015 10:27AM P1 /s~ a?�. lawn of Barnstable e Ptegulgtt®a"y'gra-VICes. ' 'Dao�as .�e'o� rt,1]ir¢a�arr oftb: .501-462.464 $tix: saii,79a 63oa Y�,ta]➢�it > ufi�iaa. CC��rl6iDa_�a��Form }ate- De6 iev&A� 2 rLP,[✓y fmBtaJlea': 4 r Address; 3 �`��►� <�`�" �dalx et4e� �' (J �� ()n �I .e .. r 5 , . ,was ae ued a Ares to install it 0 J u.A w.Q mod' based an a de dl drEmm by septic system Ott --- �.ri►�f d did-. (dam Y certify t1'ih� se�rlic; systezarerewed ahcr�c;w��irl:led sab9tanfiir+]Jy acoordTn� &e. dr. 6,n,,-4,ich Jaky i=IVAr-. >a irPT LLPInwed,changes N(WIL W IiMZal.TMWC-cb,17n Of'Fht: q[rib�atinn box=&a sep f c iwuli:. 1 oerti y tut the SaVar sp,q:��jt;fi 1.c'ed abdirm%MR ixiM11Bd W10.T2*1 c31allges (i.0. " g�sea[ rt n 1,0' laterr�i,1rlc�c�atinn ufth�'�A`4 car t'vsrCiael xelta��sian o�i�sly com v-lie►t of t}Le , xt in�v tdAnee*,Mitts Stste&Lac'41. tr gt�l iaus. k'Ieu rc vi. oiL Ox cexlirrl ►�3P goer touIlu�r. dfINIELA , d QJALA t �(lnstt► er'�5-itllfP)T CIVIL �No.486024 w4 o �r (Desir's 3in �) / Oe�'s 5'�aru�Fletr') WN u]yiAa u� 7e:• t+�}'C_7 �1g, .�1 pox crta ,a ,2 7J. 'own.of'04 rusia ble ' ]Departiaeut of Regulatory.Services �c Public Realth.Divdszon Date ran 200 Mahn Street,Hyannis MA 02601 Fti� a boaDate Scheduled `�'® ( Time l Fee)? G O Soil Suitability Assessmentfor Sepe disposal perfornned By: Witnessed By: n Location Address �p0 n Owner's Name M-41 Address Assessor's Map/Parcel: �f 7 f/ Engineer's Name NEW CONSTRUCTION REPAIR Telephone# cS 0 6 01 Land Use: � a Of ( Slopes(96) m Surface stones Dlstanccs from: Open Water Body y'' `4 ''6 tt Possible Wet-Area P Drinking Water Well 622t Drainaga Way 100 ft Property Line _ ft Other ft si.m a y iao(Street name,dimensions of lot,exact locations of test hales&pero tests,locate wetlands-In proxhnity to holes) v� A 01 ! r Parent material(geologic) 9 I V1�1itvF t �Depth tq 8adrgclt . Depth'toGroundwater: S Landing Water inHole: IVA. weeping from Pit Fficz—. Estimated Seasonal High Groundwater`' DE OF �+OR SEASONAL HIM WATER TOLE, Method Used: ,J Depth Observed standing in obs.hole: _ ___lu. :Doptla;to,SQll llnotila8: in. Depth to weeping from side of obs.hole: In, ©roundwatorA,djusttnvnt fl. Index Well# Rcading Date: Index Well IPYel _ Adj.factor-At�.,Gi)oundwatar Levol , PERCOLATION TEST Data ;Z Time ►GSM Observation Hole# Tlma at 9" f/ Depth of Ferc. Time At G" _ f V Time(9"-G") Start Pro-soak Time @ Bud Frc-soak '10 i Rate Min./Inch 1'2 Sitq SultabiIity Assessment: Site Fassed _ Sitp Failed: Additional Testing Needcd CM) original: public Health Division Observation Hole Data To Be Completed on Back---------- ***1f percolation test its to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1)Week prior to beginning. Q-MEPTICIPI;RCFORM.D O C Lo DEEP.msFRV TI0X Tiftrn 0G Vole it Depth from Sol Horizon Soil Texture Shcl Color Soil., Ofhcr Surface(in.) (tftbA) (Munsell) Mottling; (Structurc,Stones;Boulders, o i`ten'V.9�'Cravell ' Z - 17(�> 10 Y F) ' DMPU3 ETt A 7Z01'�T fJ]GlE O. ®7e Depth from Soil Horizon Soil Texture Soil Color' Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistmov.Ae �o.Grave DEEP OBSERVATION ITOEE LOG Hole g. Depth from Soil Horizon Soil Texture Soil Color Soil Other' Surface(in.) (USDA) (Munsell) Mottling (Structure,Stoncs,Boulders. a i to c G e DEEP OBSERVATION ION]SOLE V)G Depth from Soil Horizon Soil Texture Soil Color Sall Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones:Boulders. Consistency.q& 9 Flood Ynsutrance Rate_Mam. Above 500 year flood boundary No— Yes _ . "Within 500 y=boundary No X Yes ' Within 100 year flood boundary NoX -Yes — Depth.of Ngtitrally Occurring]Pervious Matorial Does at least four feet of naf urally occurring pervious materlxl exist in all areas observed thrpughout th6 area proposed for the soil absorption systeml yS If not,what is the depth of naturally occurring pervious matorlall- Certi�catiog � . Z certify that on (date)Y have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise and experience described in�10 CMR 15.017. Signature Datb Q:1S,Li'T1C11'BItCF0R.M.DOC , -\ COMMONWEALTH OF KASSACHUSETTS E��ECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PR0TE.CTIC� RECCI ��� ` .. EB242004 TOWN OF BARNSTABLE HEALTH DEPT. TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION p �,5-t,/ r�� �1 eet� MAP �nZ4�_ Property Address: r4� O Coo/ PARCEL ,_ l 001 _I Owner's Name: - LOX , Owner's Address: ILIA / Date of Inspection: oo V Name of Inspectftaaset) 1-toml Company Name: Mailing Address )620 n QULM ��Q Y TelephoneNumber: `7`7 CERTIFICATION STATEMENT I c'ertify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as.of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: /Passes Conditionally Passes ,Needs Further Evaluation by the Local Approving Authority / ails V / c Gila Inspector's Signature: ; Date: The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10.000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. "Notes and Comments , ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of I 1 OFFICIAL.INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A., ., CERTIFICATION.(continued) Property Address: Q Owner: / Date of Inspection: Z Inspection.Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A.`/System Passes: IY 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 indicatedpbelow. 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. tit .a. .3. ;tt,. `Y['.. .e • 1:., .. .. .. Answer yes,no or not determined(Y,N,ND) in the for the following statements. If•"not determined"please explain. c; 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 back-up 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: 2 . t Page 3 of l'l OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION'(continued) Property Address: &�— �t a)-ea Owner, Date of Inspection: C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. ''System will fail unless the Board of Health (and Public Water Supplier, if any)determines that the system is functioning in.a manner that protects the public health,safety and environment: The system has a septic tank and'soil absorption system (SAS)and'the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone l 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A-copy of the analysis must be attached to this form. 3. Other: 3 Pace 4 of 1 l OFFICIAL.INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE-DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION-(continued) Property Address: Owner: ` Date of Inspection: >4O�000 V D. System Failure Criteria applicable to all systems: You must indicate "yes"or"no"to each of the following for all inspections: Yes Nq 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 1/ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or J cesspool Liquid depth in cesspool is less than 6"below invert or available volume is less than %day flow . Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number / of times.pumped Any portion of the SAS, cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface Water supply or tributary to a surface water supply. _ 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. Any portion of a cesspool or privy is less than 160 feet but'greater`tl an 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.] (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)` 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. t ,4 ` i Page 5 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECI{LIST ' Property Address: Owner / /! Date of Inspection: " 1 Check if the following have been done.You must indicate"yes" or"no"as to each of the following: Yes Pumping.information was provided by the owner, occupant,or Board of I-Iealth, Were.any of the system components pumped out in-the previous two weeks? �Ias the system received normal flows in the previous two week period? r/ Have large.volumes of water been in to the system recently or as part of this inspection? L/-"-_ 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?4 / 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? _V 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 Lz�— _ 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 I 1 OFFICIAL-INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE,SEWAGE DISPOSAL SYSTEM INSPECTIONTORM PART C SYSTEM!INFORI<'IATION` Property Address: Owner: Date of Ins'pectiow. 4 ZZW V / FLOW CONDITIONS RESIDENTIAL ✓ Number of bedrooms(design): Number of bedrooms(actual): 02 DESIGN flow based on 310 CMR 15.203 (f9r example: 11:0 gpd x#of bedrooms): Number of current residents: Does residence.have.a garbage grinder(yes or no): Is laundry on a separate sewage system (yes or n f yes separate inspection required)' Laundry system inspected(yes or no): Seasonal use: (yes or not,/l�-•.. Water meter readings, if available(last 2 years usage(gpd)): 02" 331a&P U'3-2 Sump Pump(yes P r n Y !I�e �Cit Last date of occu anc�� i . �S� R��G'P.�/yJz.�Pic� . • COMMERCIAL/INDUSTRIAL (,� 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 system (yes or no): - - Water meter readings, if available: j Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION / Pumping Records Source of information: �/ Was system pumped as part of the inspection(yes or no): If yes, volume pumped: &allons--How was quantity pumped determined'?., ,... _ � : Reason-for pumping: TYPE F SYSTEM _Vbep tank, distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy —Shared system.(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology.Attach a copy of the current.operation and maintenance contract(to be obtained from system owner) Tight tank Attach a copy'of the DEP.approval s_ �.. .. �,. a. Other(describe): _ 0, pomate a e of al omponents,dat inst ]led( kno n)and source of information: Were sewage odors detected when arriving at the site.(yes or no) 6 i Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS .,SUBSURFACE SEWAGE DISPOSAL SYSTEM:INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: PC,aL91� )Poxei/�aa'/ Owner: Date of Inspection: CT BUILDING SEWER(locate on site plan)"A61` Depth below grade: Materials of construction: cast iron _40 PVC_other(explain):_L Distance from private water supply well or suction line: " Comments(on condition of joints, venting, evidence of leakage, etc.): SEPTIC TANK: (locate on site plan) Depth below grade: 6P i Material of construct-Jon n: ✓onCrete_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: s=k CO lC Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle: _ Distance from bottom of scum to bottom of outlet tee Qr baffle: How were dimensions determined: n ,'—A Q 'Ap vhA- Comments(on pumping recommendations; let and outlet tee or baffle,condition, structural integrity, liquid levels related to outlet invert,evide ce of leakage, etc : C + GREASE TRAP (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.): 7 Page 8 of 11 OFFICIAL:INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM PART C SYSTEM _(continued) Property Address: �X } Owner:. Date of Inspection: 7 TIGHT or HOLDING TANK:,j 84, (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): v Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments (condition of alarm and float switches, etc.): DISTRIBUTION BOX L! (tf,present must.be opened)(locate,on.site plan) ":'Depth of liquid level'above outlet-invert -adfs Comments(note if bok is level and distribution-to outlets qual;.any evidence'of solids carryover, any evidence of age into or out of box, 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,condition of pumps and appurtenances, etc.) A S . Page 9 of 11 OFFICIAL INSPECTION')F'ORM—NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE-SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C '-SYSTEM INFORMATION (continued) Property Address: ( C Owner: Date of Inspections SOIL AIBSORPTION SYSTEM (SAS): L,,�Oocate on site plan, excavation not required) If SAS not located explain why: Type ]eaching pits;number: leaching chambers, number: leaching galleries, number: leachine 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; CESSPOOLS: (cesspool must be pumped as part of inspect ion)(]ocate on site plan) Number and confizuration: Depth—top of liquid to inlet invert: Depth of solids laver: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soih`signs of hydraulic failure, levJof ponding; condition of vegetation;etc.):` PRIVY locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation,etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS 'SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM �'. TART'C. , y SYSTEM INFORMATION(continued) Property Address: Owner: Date of Inspection• I�P� 000 V 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. yo ca l 000 . i-1-ao 1006) 10 Page 1 1 of I I OFFICIAL INSPECTION.FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C , SYSTEM INFORMATION(continued). Property Address: Q goolo� Owner: r/ Date of Ins ection: 1&,�'j07 .SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 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: 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:*/ 1 � i 11 Permit Number: Date: Completed by: � HIGH GROUND-WATER LEVEL COMPUTATION Site Location: S` �Et�C15 ��1�/J� r ��` 1�60{�/S_Lot No. Owner: e�j^�� �gtloll' es Address: Contractor: ©�7 � � ���c� _Address: �✓c / _ Notes: STEP 1 Measure depth to water table to nearest 1/10 ft. ............................................................................... .Date month/day/year STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: y� OA Appropriate index well........................................../.......... ff OWater-level.range zone .....................................................I� STEP 3 Using monthly report "Current Water ReSOLIrceS Conditions" determine current depth to water level for index well ........................... ! `� month/year STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A), current depth to water level for index well (STEP 3), and water-level zone (STEP 2B) determine water-level adjustment ................:......................................................................... STEP 5 Estimate depth to high water. by subtracting the water- level adjustment (STEP 4) from measured depth to water I z levelat site (STEP 1) .............................................................................................................. > Figure 13.--Reproducible computation form. 15 �- � ` �` ` � � �� .� \ h � ��� _ �., ��� �� e �.�_� � � i t =; 4F �,� • � � � - e .. � � .� � ff �, �. I � y i lq .. {� r s.�_ �, �,� .! . i i !. . _ 1 '� k .� 4, � �� 4 � ' ti%�� I �_ �a � � F � ` F � 1 f .. y i �; Ir �'. T �, t j ��� �A— � ' �. � z.._.,i V COMMONWEALTH OF MASACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAI AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET BOSTON MA 02108(617)292-3500 TRUDY COXE Secretary ARGEO PAULCELLUCCI DAVID B.STRUHS Govemor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 86 DUNNS POND RD. HYANNIS, MA 02601`M240 P099-001 L122 Name of Owner SANDY VALLADARES Address of Owner: 85 DUNNS POND RD.HYANNIS,MA 02601 Date of Inspection: 3131/00 c� Name of Inspector: JOHN GRACI 1 am a DEP approved system inspector pursuant to Section 15.340 of Tide 5(310 CMR 15.000) c Company Name: SEPTIC INSPECTIONS _ • .� Mailing Address: P.O.BOX 2119 TEATICKET,MA.02536 APR Telephone Number: 608-564-6813 FAX 608-664-7270 S 2000 CERTIFICATION STATEMENTrr 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 Inspection.The inspection was performed based on my training and experience in the,proper function and maintenance of on-site sewage disposal systems.The system: yea X Passes _ Conditionally Passes _ Needs Further Evalqfti By the Local Approving Authority Fails Inspector's Signature: Date:4/1/00 The System Inspector shall s mit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(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 Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS "The inspection Is based on criteria defined in Title V code 310 CMR 15.303.My findings are of how the system is performing at the time of inspection.My inspection does not imply any warranty or guarantee of the longevity of the septic system and any of its component's useful life" THE SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING THE SYSTEM EVERY TWO YEARS FOR PROPER MAINTENANCE. revised 9/2198 Page 1 of 11 } SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 85 DUNNS POND RD. HYANNIS, MA 02601 M240 P099-001 L122 Name of Owner SANDY VALLADARES Date of Inspection: 3/31/00 INSPECTION SUMMARY: Check A, 8, C, Of D: A. SYSTEM PASSES: X I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. 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. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances.If"not determined",explain why not. nta The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Wa Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health). _broken pipe(s)are replaced _obstruction is removed _distribution box is levelled or replaced 1>1a. The system required pumping more than four 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 revised 9/2/98 Page 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 85 DUNNS POND RD. HYANNIS, MA 02601 M240 P099-001 L122 Name of Owner SANDY VALLADARES Date of Inspection: 3/31/00 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 the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 16.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER.IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well, _ The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis 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,Method used to determine distance n/A (approximation not valid). 3) OTHER n/a revised 9/2/98 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 85 DUNNS POND RD. HYANNIS, MA 02601 M240 P099-001 L122 Name of Owner SANDY VALLADARES Date of Inspection: 3/31/00 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No - X Backup of sewage into facility or system component due to an 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 1/2 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 0. X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. - X Any portion of a 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 I of a public well. - 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.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: 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: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No X the system is within 400 feet of a surface drinking water supply - X the system is within 200 feet of a tributary to a surface drinking water supply - X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IW PA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 85 DUNNS POND RD. HYANNIS, MA 02601 M240 P099-001 L122 Name of Owner: SANDY VALLADARES Date of Inspection: 3/31/00 Check if the following have been done:You must indicate either"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 _ None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. X As built plans have been obtained and examined.Note if they are not available with N/A. X - The facility or dwelling was inspected for signs of sewage back-up. X - The system does not receive non-sanitary or industrial waste flow. X - The site was inspected for signs of breakout. X _ All system components,excluding the Soil Absorption System,have been located on the site. X - The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been determined based on: X _ Existing information,For example,Plan at B4O,H, X _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)1 5.302(3)(b)] X _ The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Subsurface Disposal Systems. revised 9/2/98 Page 5 of 11 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ' SYSTEM INFORMATION Property Address: 85 DUNNS POND RD. HYANNIS, MA 02601 M240 P099-001 L122 Name of Owner SANDY VALLADARES Date of Inspection: 3/31/00 FLOW CONDITIONS RESIDENTIAL: Design flow: 110 g.p.d./bedroom Number of bedrooms(design): 2 Number of bedrooms(actual): Total DESIGN flow: 220 gpd Number of current residents:1 Garbage grinder(yes or no):NO Laundry(separate system)(yes or no): NO If yes,separate inspection required Laundry system inspected(yes or no): NO Seasonal use(yes or no): NO Water meter readings,if available(last two year's usage): n/a gpd Sump Pump(yes or no): NO Last date of occupancy: n/a COMMERCIALIINDUSTRIAL Type of establishment: n/a Design flow: n/a gpd(Based on 15.203) Basis of design flow:n/a Grease trap present:(yes or no): NO Industrial Waste Holding Tank present:(yes or no): NO Non-sanitary waste discharged to the Title 5 system:(yes or no):NO Water meter readings.if available: n/a Last date of occupancy:n/a OTHER: (Describe) n/a GENERAL INFORMATION PUMPING RECORDS and source of information: SYSTEM WAS LAST PUMPED TWO YEARS AGO. System pumped as part of inspection:(yes or no):NO If yes,volume pumped n/a gallons Reason for pumping:n/a 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) _ I/A Technology etc.Attach copy of up to date operation and maintenance contract _ Tight Tank Copy of DEP Approval Other:n/a APPROXIMATE AGE of all components,date installed(if known)and source of information: 1993 Sewage odors detected when arrlving at the site:(yes or no): NO revised 9/2/98- Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 85 DUNNS POND RD. HYANNIS, MA 02601 M240 P099-001 L122 Name of Owner SANDY VALLADARES Date of Inspection: 3/31/00 BUILDING SEWER:X (Locate on site plan) Depth below grade: 12" Material of construction: _ cast iron X 40 Pvc _ other(explain) Distance from private water supply well or suction line: n/a Diameter: 4" Comments: (condition of joints,venting,evidence of leakage,etc.) THE SYSTEM HAS TOWN WATER. SEPTIC TANK: X (locate on site plan) Depth below grade: 4" Material of construction: X concrete_ metal_ Fiberglass_ Polyethylene_ other explain: n/a If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): NO Age: n/a Dimensions: 1000G L 8'6"H 6'7"W 4'10"" Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle: 33" Scum thickness: 1" 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: n/a How dimensions were determined: MEASURED Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. GREASE TRAP: _ (locate on site plan) Depth below grade: n/a Material of construction: _concrete_ metal_ Fiberglass _ Polyethylene_other Explain: n/a Dimensions:.n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle n/a Date of last pumping: n/a Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) n/a revised 9/2/98 Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 85 DUNNS POND RD. HYANNIS, MA 02601 M240 P099-001 L122 Name of Owner SANDY VALLADARES Date of Inspection: 3/31/00 TIGHT OR HOLDING TANK: _ (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: n/a Material of construction: _concrete_ metal_Fiberglass _Polyethylene _other Explain: n/a Dimensions: n/a Capacity: n/a gallons Design flow: n/a gallons/day Alarm present: NO Alarm level:N/A Alarm in working order:NO Date of previous pumping: n/a Comments: (condition of inlet tee,condition of alarm and float switches,etc.) n/a DISTRIBUTION BOX:X (locate on site plan) Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) THE DISTRIBUTION BOX IS STRUCTURALLY SOUND. PUMP CHAMBER: _ (locate on site plan) Pumps in working order:(Yes or No): NO Alarms in working order(Yes or No): NO Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) n/a revised 9/2/98 Page 8 of 11 J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 85 DUNNS POND RD. HYANNIS, MA 02601 M240 P099-001 L122 Name of Owner SANDY VALLADARES Date of Inspection: 3/31/00 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: n/a Type: leaching pits,number:(1)1000 GAL 6'X 6'H2O leaching chambers,number: (n/a)n/a leaching galleries,number: (n/a)n/a leaching trenches,number,length: (n/a)n/a leaching fields,number,dimensions: (n/a)n/a overflow cesspool,number: (n/a)n/a Alternative system: n/a Name of Technology: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE LEACH PIT IS STRUCTURALLY SOUND AND APPEARS TO BE FUNCTIONING PROPERLY.THE PIT HAD 6"OF WATER IN IT AT THE TIME OF THE INSPECTION.THE PIT HAS NOT HAD MORE THAN 6"OF WATER IN IT. CESSPOOLS: _ (locate on site plan) Number and configuration: n/a Depth-top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer. n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater: n/a inflow(cesspool must be pumped as part of inspection)NO Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a revised 9/2/98 Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 85 DUNNS POND RD. HYANNIS, MA 02601 M240 P099-001 L122 Name of Owner SANDY VALLADARES Date of Inspection: 3/31/00 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) bhc l� A C g A AA Ae, L q0 37 PSI `� 309 revised 9/2/98 Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 85 DUNNS POND RD. HYANNIS, MA 02601 M240 P099-001 L122 Name of Owner SANDY VALLADARES Date of Inspection: 3/31/00 NRCS Report name: n/a Soil Type: n/a Typical depth to groundwater: n/a USGS Date website visited: n/a Observation Wells checked: NO Groundwater depth: Shallow_ Moderate_ Deep_ SITE EXAM _ Slope _ Surface water _ Check Cellar _ Shallow wells Estimated Depth to Groundwater 10 Feet+ Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record _ Observed Site(Abutting property,observation hole,basements ump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping.records Checked local excavators,installers X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) UGSS MAPS AND CHARTS-10+FEET revised 9/2/98 Page 11 of 11 A Q IL 3 - O UI \ W L7 p Z F 4S. < j. 9 CL 3 m d 0 0 Q o .. m DauphincLis 85 Dunns Pond Rd, Bruin Corp, H annis Ma, 02601 479 Mt, Hope St, N, Attleboro Ha, 02760 Uiveea construction Super license AND Home Improvement License Owner cannot pull own permit ,. PkOPo�E'J Su►JQooM oN ;i cam- A rovEO Dr C 1107, x '` ass I 12 LO 7-1 y 1 22 L i LOT 14 4y 0 ZONE.- "Rg This MORTGAGE, INSPECTION Plan is For FLOOD ZONE "C" Bank Use Only 'N: _ 1,S--- -------- -- REGISTRY OWNER: JOEPh'tIV_E pQRA1V __ _ _ _ __ _ _ _ _ ;D REF: _fy--6695Z� _- - - ---BUYER: -,S�JLVDSAALLAD REDS'- - - - - -- -- - - - - - - - - �E: _3f_24/93 - PLA.N RE1 : _10614 S - - - - - - - - SCALE: I"= 30 ___FT ;R E B Y CERTIFY TO fL-YMQL1YL 90RIfA_�: _'Q. ------------------------THAT THE BUILDING `�n Of k� YANKEE SURVEY i NN ON THIS PLAN IS LOCATED ON THE GROUND AS o�s� Xfl CONSULTANTS WN AND THAT ITS POSITION DOES _ __ CONFORM PAUL fHE ZONING LAW SETBACK REQUIREMENT'S OF THE Z A. = 40B (SUITE 5) I, c� MERITHE'N ' V OF dg8LVSL4—&Z: ------------AND THAT INDUSTRY ROAN OES_ NOT _ LIE WITHIN THE SPECIAL FLOOD Iln7nRU No. 32Cfd8 �: �, ��� MARSTONS MILLS, MA. 026 I%1 k AS SHOWN ON THE H.U.D. MAP D ATE D-0.J��'8 ...... Qy �,`iSil �%��a TrL: 428-0055 unit f�ar�el e50001 0005 C FAX: 120-5553 TIIIS PLAN NOT MAIL; VROM 1P UMEN'I' jU8i0 DEG UL A M Rl1'1'li .W S SURVEY, NOT TO HE' USED FOR FENCES, ETC. �construction Super license AND Home Im r Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION.FORM PART C SYSTEM INFOIWATION(continued) Property Address: L(� C Owner: Date of Inspection l�P� adQ 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. 2(0 ia-ao /caw 10 No... .:. Fxs....3�-�o��......... 7 THE COMMONWEALTH OF MASSACHUSETTS '/� BOARD OF HEALTH r TOWN OF BARNSTABLE 4amnivi tM Application is hereby made for a Permit to Construct ( ) or Repair 4X) Sewage tsp g. System at: S`�Dunns Pond Road Hyannis ----------------------------•------•-•------•••--------- -•-••••--•--------------•-.._......•-------•-•--•--------•----•-----------•-------..._•••••----•-- Location-Address or Lot No. Doiron W J.P.Ma e o mb e r O .Pr Address Installer Address Type of Building Size Lot............................Sq. feet U Dwelling-X No. of Bedrooms.................2__-.....................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures� ------------------------------------------------•------------------------•-----------------------------......._............_.__....---...........__... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. W Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water-----------------_...... ` rXq Test Pit No. 2................minutes per inch Depth of.Test Pit...:................ Depth to ground water........................ a -•-----•--••----------•-•-•-----•-----------------------•-----------.......-----------••••---•-••-•.......................................................... 0 Description of Soil..... ind...&_._Gr 37.el.......................... U --------------------------------•---••-•----------------------•-----•--•---•---------•--••--••--•••-•-----------------------•-•---•---•-------•--••--------------------------------.......•------------- W ------------•------------------------------------------------------------------------------------------------•---_._......-----•----••------•---------•---•--------------------------•----•••-••....... V Nature of Repairs or Alterations—Answer when applicable______1-1000 gallon tank 1 distributui on box ---1000 gallon leach pit packed in stone. Omitting existing cesspool. Agreement: P The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b n issued by th boar f health. Signed . 2/26/93 ..-- rL{,P�- ------------- - ---------------------- ----------------------------------------- Date q Application Approved By ............. .... ) C'�. Dtte Application Disapproved for the following reasons- -------------------------- -- ------ --------- --- ------------------------------------------------------------- ............................................. --...----------------- -- . 77 PermitNo. ---------- ...J......- --................... Issued --- -- ---- ---- --- ----........----...--- --Date------ Date No._ � �0.00 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Applutttiun for Disposal Works Clunstrnrtr a rrmit - _2 - Application is hereby made for a Permit to Construct ( ) or Repair �X) an Individual Sewage Disposal System at: P,57'Dunns Pond Road Hyannis ....._..._..______---.........._... ............. - -------- - --------------------------------------------------...._ --- Location-Address or Lot No. Doiron W J.P.Maeomber °i"r. Address ,a ---------- - -- ----------- - - ----------- Installer Address 4 Type of Building Size Lot--------------------------Sq. feet Dwelling X No. of Bedrooms-----------------P-------------------------Expansion Attic ( ) Garbage Grinder ( ) `4 Other—T e of Building No. of persons____________________________ Showers — Cafeteria P- Other fixtures -------------------------------------------------- w Design Flow-------------------------------------------- per person per day. Total daily flow-------------------------------------------_gallons. WSeptic Tank—Liquid capacity............gallons Length---------------- Width---------------- Diameter---------------- Depth---------------- x Disposal Trench—No--------------------- Width--------------------Total Length-------------------- Total leaching area------------------sq. ft. Seepage Pit No--------------------- Diameter__-_-_____-_________ Depth below inlet-------------------- Total leaching area------------------sq. ft. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by......................................................------------------- Date------------------------------------- - Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water------------------------ rxq Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water------------------------ P4 -•-•----•--•--------------•••-•--•-•---•-•------•-••----------------------------------------------------------------------------------------- - O Description of Soil-----Salld---.&---Gra:Le- .....................................--------------------------------------------------------------------------------------- x c., w UNature of Repairs or Alterations—Answer when applicable_---__---1�_�J_J___�.allon__-tank_--1-_-distributui -on_box__1-10J�J_.--fa11on--_1each__Dit--Dacked_-in___s_tor)e.___0mittin� existing - ---------------------------------------------------------- Agreement: cesspool. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board f health. Signed - ---- /�C - -- -- ------ 2/26/93 --------------------------------------- Date ApplicationApproved BY .............. J.--------...... ---------------------------------------------------------------------------- -----'�.-- - z- t Date Application Disapproved for the following reasons- --------------------------------------------------------------------------------------------------------------------------------------- ------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------- PermNo. it > --- *�) Issue ------------------------------------------------------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Olertifir xk of Tomplia ><ce• rr THIS IS TO CERTIF_ That the Individual Sewage Disposal System constructed ( ) or Repaired(CXX ) J p vlacomber �. Installer ------------------------------------------------------------------------------------------------------------------------ at ��---Dunns----Pond ----Road -- Hyannis - has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ____ --------- dated __-_--__-___-___--__--_---_----_-----_---- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. - DATE--------------- - f " > .. --------------------------------------- Inspector - I ------------------------------------------------------------------- "Z- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No.._t/..��.-7 ._ TOWN OF BARNSTABLE Fim_�._.30.00 - Diupuuttl Works Tunutrnatiun ilermit Permission is hereby granted -' J P'Macomber Jr. _____________________--__ -----------•-------------------- to Constru ) or Repair 4X ) an Individual Sewage Disposal System atNo-------- Po rl d-_-Road_,Hvan n s--------------------------------------------------------------------------------------------- - Street CX as shown on the application for Disposal Works Construction Permit No. _.__-:: __ Dated.......................................... Board of Health DATE _..�•-- 7�---------------------------------- FORM 36508 HOODS Q WARREN,INC-.PUBLISHERS TOWN OF BARNSTABLE I.O^ATIiIN RS SEWAGE # .73• Z 3 VILLAGE ` 4 ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. C, SEPTIC TANK CAPACITY //,��o , c/ LEACHING FACILITY:(type) (size) /,(J��Q GeA I NO. OF BEDROOMS PRIVATE,WELL OR PUBLIC WATER BUILDER OR OWNER M r .DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: - L � VARIANCE GRANTED: Yes No �/ r /' \\� � ��' .a y ?/ �� I v� i i, �� � �/ i \� � p . ~ l� �: .;`, ` . _ �i �. 'A� ; ..w. �. %7 TT OF B STABLE ✓� . LOCA'I1G' :;S _ �'(nI CC) SEWAGE # VILLAGE—, 'ntS ASSESSOR'S MAP & LO INSTALLER'S NAME&PHOta NO. SEPTIC TANK CAPACITY 00 I LEACHING FACILITY: (type) (size) T�f NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site.or within 200 feet of leaching facility) Feet Edge of or and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 120 0 C .. � �� �� o � ���� o��� �, a ,, -,,. ,. ` � `, TOWN OF S I TABLE' SEWAGE� LpC Vii;I:AGE /t_T�► s ASSESSOR'S:NhQ k Lt)T IhhrS'T1�..LER'S 1dAt�E�P€�t)NNE�G SB�T'EC TANK CAI'AC£FY ���77 LEAUUNGTAClit TY' ( } �, vL is�e} / Al. lr� NO.` l~�abAllQO B UUM SW QR nurpm.R PE MATE ti�MP1GfANC1r DA"I£ Sdpamon I?stance Betvree tic Ivlaxuneun Adjnstecl Groundwater Table to the Bottocn'of leacheng Facility Eeet Pnva a Water Supply=Well an, I,ead4ung Facaiity ug or.:w�tetun feet of leaclfing facility} t Edge';of Wetland and'Leadluatg l"�aality(If any wetlands exist withla 300 feec�f lead hi €acilitj�} Eeec �uasushed b (�c . , �� � � Jc o o \ � � M � � � � i � �� �. � _� ,�, c�• s O � o `� �. 1 ! b a 37No 1 q• FEE THE COMMONWEALTH OF MASSACHUSETTS 00 BOAR® OF HEALTH O-Wn.......OF.... -1 :..... Appliration for Mipasal Nuitkii Tnntrnrtinn ramit Application is hereby made for a Permit to Construct ( ) or Repair (V� an Individual Sewage Disposal System at: L ........................... ...................N ow' Address or Lot No. - . ...• ,/��r . aL - .�_5.................................................... W ress W ail Installer .. ?11?.�C--•- ------..._.C: � �1 •1-���--•-------------•------•-•---•--.......... a ¢ Address Type of Buildings Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ). aOther—Type of Building ............................ No. of persons_-----_--___---_____.__-__-_ Showers ( ) — Cafeteria ( ) IL Other fixtures -------------- --------------- W Design Flow...........................................gallons per person per day. Total daily flow-___------_--_-------_------_-_---•---------gallons. WSeptic Tank—Liquid'capacity............gallons Length---------------- Width................ Diameter................ Depth................ x Disposal Trench—No.--__----_-----_- Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed bY-----------------------------------------------.......................... Date---------------------------------------- 4 • Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0 Description of Soil........ L .......... U -------------------------------------- ------------------------------------------------------------------------- ------------------------------------------ •--------------- -------------- ------------------- W -----------------------------------•------------•-------------------------------------•-------------- UNature of Repairs or Alterations—Answer when applicable____._.,�_0-0 -.- -� ......0-Ue- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TL I Ti iE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been ss d by the boar of 1� h. Sig ..••---...................CC1�0�--••---- ... /� 1 =" Date -_L•!/1- -- - -------------------- Y` .c :. Date Application Approved BY Application Disapproved for the following reasons----------------------------------------------------------------------------------------------------------------- ------•.....-------•-------------------------•••-----------------•••----------••.._....------------------'------•------•--••---•-•-•••-----------•-•--••-•••----•=••-••--•-----••-••-•• •--••----......-- Date PermitNo------------------------------------------------=........ Issued_.-=.................................................... Date No. .. ......... Fms:...� i. .. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH R• i Own......-.OF.,.... ::.. al��� E� :.............. ApplirFatiuta for Bigpu,i al Mods Cnomtrurtiurt Virmit � F o' ;a, Application is hereby made for a Permit to Construct" ( ) or Repair, an.,Individual Sewage Disposal System`` at: ........................... ......... ......... ................. ....... ................................ Lo Address or Lot-No. Owner ress % Installer Address" Lot...........................5 feet -f -Type Attic ( ) Garbage Grinder( ) '4 Other—T e of Building No. of erson`s............::.___..._..... Showers Cafeteria W . g h Other fixtures •-- ..g--•ti.---- ---- -••••---•• •---•-•y ;-------•----..--------------••----•----••......•---•-=-•-••......�....... Design Flow...._ gallons per person per.-da . ,,xTotal dail flow .......................................... Ions. WSeptic Tank—Liquid 'capacity............gallons Length---------------- Width________________ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No----------_---------- Diameter.................... Depth below fii7let ..... . Total leaching area..................sq. ft. ., Z Other Distribution box ( ) Dosing tank. ( '-' Percolation Test Results Performed by.........:..............:_ ' -------•---......---•---------------•---•---•--- Date........................................ � aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water___-___._______________. GL, Test Pit No. 2....,.............minutes per inch .Depth of Test Pit.................... Depth to ground water........................ C.... -••••••-••••-•••••••...........-••-•-••••••---••-••-•.................................................................. O Description of Soil....... '�� ................................................ '.................... x � .- x ----- • ------------••. --------- U Nature of Repairs or Alterations—Answer when applicable_.... _ L ___ L ��_ ly)....._.O.V.6��..�(.�- ........ ----------------------------------------•---------------------------••---•----------•--....-----:---------•-----------------------.._._.....---------------------•-...._..---- Agreement: The undersigned agrees. to install"the"aforedescribed Individual Sewage Disposal System in accordance with the provisions of. lT�.;;,. 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Sig . •- ----•-- Application Approved By....... •• • .-••--•-- `L /.=-- Date Application Disapproved for the following reasons:... ---------•• .............. .......................................... -•--•-•-----------......................-----•......•....•--- Date a PermitNo............................--•--•----------------------- i Issued_....................................................... Date , THE COMMONWEALTH OF MASSACHUSETTS ,BOARD OF HEALTH SIT) .. O (Irdifiratr of f ompliattri TSS IS TO CERT That the Individua Sewage Dis osal System constructed ( ) or Repaired 9` �y. Installer .......... g . � f' 15 --------------------- -- ��'Ca�-.l`at....?? _-• -•-- • .h_n: .._ has been installed in accordance with the prdvisions4f Ti TL r of The State Sanitary Code as described in the application for Disposal Works Construction Permit No. �1 ?`............... dated_-.n_ ....................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST4ZUED AS A GUARANTEE THAT THE SYSTE14."dell kL,ONCTION SATISFACTORY. w DATE ..,. . ?9 ......................... THE COMMONWEALTH OF MASSACHUSETTS fi? BOARD OF HEALTH t ri ] $ M No�7� 6.0 ...OF...•...� .. ns_t _ _ ........... .... FEES.,.:.>. 'Z:..... �� . • -�liu��au�l ur� +�utauirtuan rrutii "` `� • Permission is hereby granted." ` e� >h-----�:_'._ C� _ ' _._` 1.1. _i `t �k to Construct ( or Repair e: - n Individual SeVVage Dispo System at No:__ _._.." .. .Y)1[2.. YQ-�•.... •-•........ - - ,z.Street 7G as shown on the application for Disposal Works Construction Permit r,o�__ }------- Dated.._ ..................................Board"of Hth R DATE.___._ / (f FORM 1255 HOBBS & WARREN. INC., PUBLISHERS ..ri SYSTEM PROFILE ALL SYSTEM COMPONENTS SHALL BE NOTES MARKED WITH MAGNETIC TAPE OR 1. DATUM IS ASSUMED PROVIDE MIN. 20" DIAM. WATERTIGHT (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. � ACCESS COVERS TO WITHIN 6" OF FIN. GRADE CONCRETE COVERS TO WITHIN 3" GRADE 2. MUNICIPAL WATER IS EXISTING \ TOP FOUND. EL. 49.5' 2" PEASTONE OR GELTEXTILE FILTER FABRIC OVER STONE 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. Q° MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 49.0 4. DESIGN LOADING FOR ALL PROPOSED PRECAST Roy{e 28 i PRECAST H-10 BLOCKS OR UNITS TO BE AASHO H- RISERS (TYP.) PRECAST RISERS S�� Locus a _.; 2° 48.1' 4"0SCH40 PVC MORTAR ALL 'INVERT IN 45.5 5. PIPE JOINTS TO BE MADE WATERTIGHT. PIPES LEVEL 1ST 2' �4' COMPONENTS 4, f a ENDS ) SIDES 46.33' s�9h �a 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE ®®®® mmmrmm m_ mmm o°g°o°o WITH 310 CMR 15.000 (TITLE 5.) ° 10" EXISTING 14" TEE SEPTIC TANK** TEE * ;0000g000 ®®®®®®®®®m ®®®®m®®® 46.7f 6" MIN. SUMP o °°°°°a°° 00000000 °o°o°o°o°o°o t2` MIN. INT. DIM. N ®®®®®®®®®m ®®®®®®®® 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND O° 0 0 0 0 0 0 ®®®®m®®®®L ®®GAS BAFFLE::' __Oo_?°0°09 ;°o°°°°°° °°°°°°°° NOT TO BE USED FOR LOT LINE STAKING OR ANY °°°°°°°° 43.5 OTHER PURPOSE. In o 45.78 45.61 J\e� H-10 500 GAL. LEACHING CHAMBERS BY ACME PRECAST OR EQUAL 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. �o 3/4"-1-1/2' DOUBLE WASHED STONE 4' MIN. (2) UNITS REQUIRED = aGtO 9. COMPONENTS NOT TO BE BACKFILLED OR �\ ALL AROUND PRECAST STRUCTURES _ � OVERALL DIMENSIONS TO OUTSIDE OF STONE: 25.00'.-X 12.83' CONCEALED WITHOUT INSPECTION BY BOARD OF a 6" CRUSHED STONE OR MECHANICAL HEALTH AND PERMISSION OBTAINED FROM BOARD COMPACTION. (15.221 [2]) OF HEALTH. ( 6.1 % SLOPE) ( 1 % SLOPE) 10. CONTRACTOR SHALL BE RESPONSIBLE FOR 38.5' BOTTOM TH-t CALLING DIGSAFE (1-888-344-7233) AND LOCUS MAP LEACHING NO GROUNDWATER FOUND VERIFYING THE LOCATION OF ALL UNDERGROUND & FOUNDATION- EXIST. SEPTIC TANK 15' D' BOX 13' FACILITY OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF WORK. NOT TO SCALE *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL **INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT 11. ANY UNSUITABLE MATERIAL ENCOUNTERED UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS 1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE SHALL BE REMOVED 5' BENEATH AND AROUND THE ASSESSORS MAP 249 PARCEL 99-1 PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM WITH 1500 GALLON SEPTIC TANK APPROPRIATE TO SITE PROPOSED LEACHING FACILITY. CONDITIONS IF NOT SUITABLE SITE IS LOCATED WITHIN A ZONE II 12. EXISTING LEACHING FACILITY SHALL BE PUMPED 2 BEDROOM DEED RESTRICTION REQUIRED AND REMOVED OR PUMPED AND FILLED WITH CLEAN LEGEND SAND. 99 - EXISTING CONTOUR \' X 99/ EXIST. SPOT ELEV. (•'jgnC ►7ar'K1 99 ray, gg.PROPOSED CONTOUR CaA , ' 67 198.4] PROPOSED SPOT EL. SYSTEM DESIGN: TH1 TEST HOLE / - MAP 249 YYY GARBAGE DISPOSER IS NOT ALLOWED 2% SLOPE OF GROUND Sl° PARCEL 9 00 DESIGN FLOW: 2 BEDROOMS @ 110 GPD = 220 GPD �Qo UTILITY POLE USE A 220 GPD DESIGN FLOW s ti4y FIRE HYDRANT NOTE- NOT ALL SYMBOLS:,MAY APPEAR IN DRAWING, 18" P/ E \ ss' _._._SEPTIC TANK: 220 GPD (2) = 440 **RE-USE EXISTING 1000 GAL. SEPTIC TANK O TEST1 L MCP 249 LEACHING: - S HOLE LOGS PARCEL 99-2 / \ \ O SIDES: 2 (25 + 12.83) 2 (.74) - 112 GPD `7� c? `� � `• BOTTOM 25 x 12.83 (.74) = 237 GPD CRAIG J. FERRARI, SE #13871 i \ Q ENGINEER: o o WITNESS: DAVID W. STANTON IRSk i \ Fr�sr c�q�F\ / TOTAL: 472 S.F. 349 GPD DATE: 10/20/15 O ���� o� \ eoa USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) WITH 4' STONE ALL AROUND PERC. RATE _ < 2 MIN/INCH E E E L J�\\ ��oo \ 14860 CLASS SOILS P# E E ELEV. ELEV. x \ TH 1 TH2 C' p„ 4 48.5' p» � 48.5' R_10.00' •� k •� - - MAP 249 00 A A L- 15.71' k PARCEL 99- 1 ^ry SL SL \ SrOc F 0.27 AC. a� APPROVED DATE BOARD OF HEALTH , MA 10YR 3/3 10YR 3/3 12" lots �M \ TITLE 5 SITE PLAN B g 6S, \ QW OF SL SL � M #85 DUNNS POND ROAD � 24" 18"1OYR 5/6 46.5' 1OYR 5/6 47.0' ; HYANNIS, MA ' PREPARED FOR R=10.00' PERC o o PARCEL MAP 4 8 L=15.71 ' o BORTOLOTTI CONSTRUCTION/ cs cs � � �, LAVALLEE DATE: OCT. 28, 2015 10YR 6/4 10YR 6/4 _ ptiz OF�igss �H of A sq off 508-362-4541 NE QANIEL fax 508-362-9880 ALA. o G o OJALA GN A �� downcope.com CIVIL OJALA a j down cope engiaeefing, 417C. 120" 38.5' 120" 38.5' 46502 No.40980 > , ®-Z� �' F�� T��e @asss� �af t < landSuy0 scivil urveyors ineers NO GROUNDWATER ENCOUNTERED Scale: 1 = 20 �ss"ONAL ��'G`� tAti SURv -� D 939 Main Street ( Rto 6A) DCE # 15-273 0 10 20 30 40 , 50 FEET DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 15-273 BORT-LAVALLEE.DWG