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0121 DUNN'S POND ROAD - Health
121 Dunn's'Pond Road Hyannis A = 270 - 001 it f ASSESSOR'S MAP NO. PARCEL L �--CATION S E W A E PERMIT NO. VILLAGE 11 NST'"A 1. ER'S N"AM[ A DRESS i WU 1 LD E R OR OW ER G d-, DATE PERMIT _ISSUED IDAT E COMPLIANCE ISSUED - r !�� No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in com Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 9ppYitation for Misposal 6pstrm Construction Permit Application for a Permit to Construct( ) Repair ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 121 j'>,*jn is Phu(Rd Owner's Name,Address,and Tel.No. Assessor's Map/Parcel a 7 O O(3 t/'� /i/v -Dvy\ Woo Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. N 1, "J"oe Mavfi cs dbA *k pal SA000jjj 02 " Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. XA t Description of Soil Nature of Repairs or Alterations(Answer when applicable) _ S 44 1777n!� �e Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued b this Board of Healt ign d A o Date G Application Approved by d Date Application Disapproved y _ Date for the following reasons Permit No. i Date Issue .•: n Fee THE COMMONWEALTH;OF MASSACHUSETTS Entered in corn u er: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE,. MASSACHUSETTS 0(pplitation for Mis' pDs_al *pst m Construction Permit Application for a Permit to Construct( ) Repair ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components a Location Address or Lot No. 12 DL.�,i1 S P �( ady�/�/ Owner's Name,Address,and Tel.No. ' Assessor'sMap/Parcel a 7O / OG T// l►r►� ��'� �00D d Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. N 6; Type of Building: Sa t 30r Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) s Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title r Size of Septic Tank a J( i Type of S.A.S. ft T _ Description of Soil. i Nature of Repairs or Alterations(Answer when applic ble) _ 6Lf.� � Date last inspected: Agreement: ' The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has,been issued b this Board of Health ig d ,, 0 Date /O ' Application-A-pproved'by ., _ .Date, Application Disapproved y Date for the following reasons Permit No. Date Issued _ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS 1 l Certificate of Compliance :� THIS IS TO CERTIFY,that the On n-srte Sewage.Disposal system Constructed( ) Repaired) Upgraded( ) Y Abandon�le( b at �l( ! �'/ f �' , { !,l�1, 1 � l t`C�rhas-been const ted i acc r5at with the provisions of Title 5 afid the for Disposal System Construction Permit No. r Installer Designer J /, #bedrooms Approved design flow V A/�, gpd 3 The issuance o this'permit shall not be construed as a guarantee that the system Will function as designed. Date Inspector / � f ri �, 1''zl Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Y MIStJDBaY �pstem CDUBtrUttlOU Permit Permission is hereby granted to Con ct( ) Repa' ( ) ZU de( ) bando System located at I and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction st co pleted within three years of the date of this permit. j Date Approved by / Town of Barnstable Barnstable Regulatory Services Department P ST"M p "'" 039. Public Health Division on m 200 Main Street, Hyannis MA 02601 tD 2007 i A Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7012 1010 0000 2851 3573 May 12, 2014 Louis P. Wood, Don and Jill Wood 121 Dunn's Pond Road Hyannis, MA 02601 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 121 Dunn's Pond Road, Hyannis MA was last inspected . on 4/25/2014, by Joe Martins, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Conditionally Passes" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Distribution-box needs to be replaced. • Sanitary tee needs to be replaced. • Recommend septic tank be pumped You are ordered to replace the above listed septic system components within sixty (60) days) from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Ltr not sent repairs done 5/17/2014 Thomas McKean, R.S., CHO • Agent of the Board of Health Q:\SEPTIC\Sample Conditionally Passes\121 Dunn's Pond Hy May2014.doc rl �°F SHe r°ham Town of Barnstable Barnstable Regulatory Services Department edcaCj } BARNSTABLE, • D im" a63q.9. Public Health Division Q° ,0 ATfD MA1 A' 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7012 1010 0000 2851 3573 May 12, 2014 Louis P. Wood, Don and Jill Wood 121 Dunn's Pond Road Hyannis, MA 02601 ORDER TO COMPLY W H STATE ENVIRONMENTAL CODE, TITLE 5 The septic system locate at 121 Dunn's Pond Road, Hyannis MA was last inspected on 4/25/2014,/es rtins, a certified septic inspector for the State of Massachusetts. The inspectiotic system showed that the system"Conditionally Passes" under the gui995 TITLE 5 (310 CMR 15.00) due to the following: • Distri needs to be replaced. • Sanitary tee needs to be replaced. • //Recommend septic tank be pumped You re ordered to replace the above listed septic system components within sixty (60) days)'from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean,R.S., CHO Agent of the Board of Health Q:\SEPTIC\Sample Conditionally Passes\121 Dunn's Pond Hy May2014.doc Parcel Detail http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=19972 AM � % 6 , -..R�'^+..L �.T .. _ .+n+nrR...eese�'%x..�"'�� �����t�V,��NG�4 V•��CJ'4� � 4� TM ��/��w �. Logged In As: May 7 Parcel D2ta I I Wednesday, 2014 Parcel Lookup Parcel Info Parcel 270-001 _MI DeveloperLOTS 9&10 �� ID Lot Location 1121 DUNN'S POND ROAD I Pri 200 Frontage Sec I Sec ' Road' Frontage Village 1HYANNIS _ I re District l HYANNIS Town sewer exists at this _ Road addresslNo Index 0459 Asbuilt Septic Scan: Interactive ` 270001 1 Map T1 Owner Info Owner IWOOD, LOUIS P ! Co- Owner Streetl 1121 DUNN'S POND ROAD Street2 F — City[_HYANNIS __�� ��__._�.�_-_.__.____.____..__ State MA] zip,02601 Country Land Info Acres[1.27 Use Sin le Fam MDL-01 Zoning FRB Nghbd F0104 — .�__ Topography Level I Road Paved Utilities'IPublic Water,Gas,Septic ( Location I Construction Info ......... Building 1 of 1 Year j- 9 — ___ __.) Roof Gable/Hip I Ext Wood Shingle Built Struct Wall Living 2022 �- Roof Asph/F Gls/Cmp AC jNone Area Cover Type4` t._ � , r_,_...__-___ ! Int� - Bed _ Style ICape Cod ! Wall IDrywall ! Rooms 13 Bedrooms t r GAR-M Int Bath` t Model;Residential ICarpet � 1 Full Floor Rooms .; , Pfi0> Heat L....�.__._-_-_� Total iN m ,eta Grade'Average Minus Hot Water 6 Rooms Type Rooms Heat Found- Stories 11.2 roll lConc. Block Fuel^ ation � Gross http://issgl2/intranet propdata/ParcelDetail.aspx?ID=19972 5/7/2014 Commonwealth of Massachusetts Title 5 Official Inspection Form _Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 121 Dunn's Pond Road Hyannis MA Property Address Don and Jill Wood 121 Dunn's Pond Road Cw ner Cw ner's Name information is required for every H anniS MA 02601 4/25/2014 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 checidist at the end of the form. Important:When filling out fours A. General Information on the computer, use only the tab 1. Inspector. key move your cursor-do not use the return Name of Inspector _131% Martina key. Accu Sepcheck Company Name S. Dennis, MA 02660 Company Address . Warn Cdylrown y 3 97 6"' State �� � � Zip Code Telephone Number t1 (•) License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.00O). The system: LJ Passes Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority "? C) alVIA5' G how his toes Signature Date The system inspector shall submit a copy of this inspection report to the Approvinq Authority(Boardo of Health or DEP)within 30 days of completing this inspection. If the system is a flared system or,. has a design flow of 10,000 gpd or greater,the inspector and the system owners II submkJt e report to the appropriate regional office of the DEP. The original should be sent to the systertf owne'r� 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. t5irs•3113 Title 5offidall U FormSub surfaceSew�eDisposalSys�em•Page Iof17. Commonwealth of Massachusetts WPM Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for.Voluntary Assessments 121 Dunn's Pond Road Hyannis NIA Ftoperty Address Don and Jill Wood 121 Dunn's Pond Road Owner Owner's Name requirefo� Hyannis MA 02601 4/25/2014 required for every y - page. Cdy/rown State Zip Code Date of kupection 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 Orin 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: 00/one or more system components as described in the"Conditional Pass'section need to be replaced or repaired. The system, upon completion ofthe 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 orexfiltration ortank failure is imminent. Systemwill 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): S'��t iT y e �1 PeG�s Ze— r4 -Ce6 k1j, Se G T c L iA f.5ins•3113 Title5 Official InspectionFonrc Subsurface Savage Disposal System-Page 2of17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 121 Dunn's Pond Road Hyannis MA Roperty Address Don and Jill Wood 121 Dunn's Pond Road Car ner Cw nees Name inf°""ation is requaed for every for Hvannis MA 02601 4/25/2014 page. City/rown State Zip Code Date of Mpection B. Certification (cons.) ❑ 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 wat evel in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled 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 replaced [IY El El ND(Explain below): ❑ The system req red pumping more than 4 times a year due to broken or obstructed pipe(s). The- system will pa inspection if(with approval of the Board of Health): ❑ bro n pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ o struction is removed ❑ Y El ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines In accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-3/13 Title 5 official Inspectim Form Subsurface Sevege Olsposal SVOM-Page 3of 17 Commonweaith'd Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form.-Not for Voluntary Assessments 121 Dune's Pond Road Hyannis MA FYoperly Address. Don and Jill Wood 121 Dune's Pond Road O,vne; OronWs Name r0 'is Hvannic MA 4/25/2014 required for every —11G.s1St-L— page. Cilylrown State Zip Code Date of Inspection B. Certification (coat.) 2. System will fail unlessthe Board of Health(and Public Water Suppl' determines that the system is functioning in a manner that prote a public health, safety and environment: ❑ The system has a septic tank and soil absorption syst (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a su water supply. } ❑ The system has a septic tank and SAS and the AS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS d the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and S and the SAS is less than 100 feet but 50 feet or more from a private water supply P`*. Method used to determine dist ce: This system passes if well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicat absent and.the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, rovided that no other failure criteria are triggered. A copy of the analysis must be attached to this 3. Other. D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each ofthe following for all inspections: Yes No ❑ R Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ d Discharge or ponding of effluent to the surface ofthe.ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ Static liquid level in the distribution box above outlet invert due to an overloaded / or clogged SAS or cesspool ❑ I�PI[ Vquid depth in cesspool is less than 6"below invert or available volume is less than%day flow t5m-W3 rd1e50fG W 1mpectimF"m Suwdace Sewage Disposal Syftm•Page 40f 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 121 Dunn's Pond Road Hyannis MA Property Address Don and Jill Wood 121 Dunn's Pond Road Cw ner Cw nees Name information is required for every Hyannis MA 02601 4/25/2014 page. Cilyfrown State Zip Code We of hspmbon B. Certification (coat.) Yes No ❑ �/ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number oftimes pumped: ❑ Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ Ego,^ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ L�! Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ GY' 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 ofthe analysis and chain of custody must be attached to this form.] ❑ ER The system is a cesspool serving a facility with.a design flow of2000gpd- s g ❑ The The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CM R 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 ofthe following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of urface drinking water supply ❑ ❑ the system is withi 0 feet of a tributary to a surface drinking water supply ❑ ❑ the syste ' located in a nitrogen sensitive area(Interim Wellhead Protection Are PA)or a mapped Zone II ofa public water supply well If you have answe "yes°to any question in Section E the system is considered a significant threat, or answered " s" in Section D above the large system has failed. The owner or operator of any large system sidered a significant threat under Section E or failed under Section D shall upgrade the s in accordance with 310 CMR 15.304. The system owner should contact the appropriate egional office ofthe Department. t5irs•3M3 TMa 5 Crfidal lnspecfim From Sul swface Savage Disposal Sptem•Page W 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface �-Pwage Disposal System:Form-Not for Voluntary Assessments 121 Dunn's Pond Road Hyannis MA ftperty Address Don and Jill Wood 121 Dunn's Pond Road Ow ner Owner's Name information is Hyannis MA 02601 4/25/2014 required for every page Cityfrown State Zip Cade Date of inspection C. Checklist Check if the following have been done. You must indicate'yes"or'no'as to each of the following: Yes No . ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ - Were any of the system components pumped out in the previous two weeks? ❑ Has the system received normal flows in the previous two week period? ❑ Have large volumes of water been introduced to the system recently or as part of this inspection? pa Were as built plans of the system obtained and examined?(If they were not available note as N/A) / 5T1 N c f 49 :❑ Was the facility or dwelling inspected for signs of sewage back up? ❑ Was the site inspected for signs of break out? ❑ Were all system components ng the SAS, located on site? [� ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: r ❑ Existing information. For example, a plan at the Board of Health. ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: 3 Number of bedrooms(design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): One•3/13 TM950ffiaal lnspactlonFomt Subswface Semu Disposal System-Page 6of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments s ' 121 Dunn's Pond Road Hyannis MA Property Address: Don and Jill Wood 121 Dunn's Pond Road Owner Owner's tame information is Ham MA 02601 4/25/2014 required for every page Qty/Town State Zip code Date of Inspection D. System Information Description: 26%04�,-y6 Z�N sme S�e4-v,�5- !cik 4gV-0 &, Number of current residents: 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 system inspected? Yes ❑ No Seasonal use? ❑ Yes ( No 'Z Water meter readings, if available(last 2 years usage(gpd)): Z Detail. 0/ 3 r 4O 7SO 20/ Z - Sump pump? ❑ Yes ❑ No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): gallons per day(g� Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank prese ❑ Yes ❑ No Non-sanitary waste disc ged to the Title 5 system? ❑ Yes ❑ No Water meter dings, if available: Me Title50MUMbispezUMFom[Subsurface SeaageDisposalSVMM•Page7of17 Commonwealth of Massachusetts Title 5` Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 121 Dunn's Pond Road Hyannis MA Property Address. Don and Jill Wood 121 Dunn's Pond Road Om ner QN ner's Name requiredfo is H�all11tS MA 02601 4/25/2014 required for every page. Cilylfow n State Zip Code Date of Inspection D. System Information (corn.) Last date of occupancy/use: Date Other(describe below): General I nibrr�mation�j Pumping Records: '"o Source of information: —r1 4C-e 1?q Was system pumped as part of the inspection? ❑ Yes No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: Septic tank, distribution box, soil absorption system ❑ Single cesspool Overflow cesspool ❑ Privy ❑ Shared system(yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/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 VA system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval ❑ Other(describe): fir.W3 T050fflelal IrspecflonForm Subsurface Savage Disposal System-Page 8of 17 t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 121 Dunn's Pond Road Hyannis MA Property Address Don and Jill Wood 121 Dunn's Pond Road Owner owner's Name infortrequiredtion Hyannic MA 02601 4/25/2014 required for every .� - page. M rown State Zip Code Date of inspection D. System Information (corn.) Approximate age of all components, date installed(if known)and source of information: 2 Cass f Z�r i Were sewage odors detected when arriving at the site? ❑ Yes No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: XCast iron ❑ 40 PVC ❑ other(explainy Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): / Depth below grade: feet Material of construction: concrete ❑ metal ❑ fiberglass .❑ polyethylene ❑ other(explain) If tank is metal, list age: yearn Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: /a0&4c ������!r d7 7 Sludge depth: t5ins-3M3 Title501fichd Inspection Form Subsurface Sewage Disposal System-Page got17 Commonwealth of Massachusetts Title $ Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 121 Dunn.'s Pond Road Hyannis MA Property Address Don and Jill Wood 121 Dunn's Pond Road Cw rw Cw na's Name inforrratirequired Hvannis NI 260 4/25/2014 requ�ed for every , 2�_ page. atylrown Slate Zip Code Date of Inspection D. System Information (cola.) Septic Tank(cont.) 2-2" Distance from top of sludge to bottom of outlet tee or baffle Scum thickness ©— �d it Distance from top of scum to top of outlet tee or baffle —� Distance from bottom of scum to bottom of outlet tee or baffle 1 y<, How were dimensions determined? Caere Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): h� o92 a C Ie Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene e r(explain): Dimensions: Scum thickness Distance from top of scum t p of outlet tee or baffle Distance from bottoZfscum to bottom of outlet tee or baffle Date of last pumping: Date Me•3R3 Title 50ffiotet Inspec§mFamc Subsurface Savage Disposal system-Page 10 of 17 Commonwealth of Massachusetts Title $ Officisl Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 121 Dunn's Pond Road Hyannis MA FYoperty Address Don and Jill Wood 121 Dunn's Pond Road Ovr ner ON ner's tame information is Hvannis MA 02601 4/25/2014 required for every page. Uy/Town state Zip Code We of hspeetion D. System Information (corn.) 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 tim f inspection)(locate on site plan): Depth below grade: Material of construction: concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gins Design Flow. gallons per day Alarm pres t: ❑ Yes ❑ No Alarm 1 e1: Alarm in worldng order. ❑ Yes ❑ No Da of last pumping: Date omments (condition of alarm and float switches, etc.): •Attach copy of current pumping contract(required Is copy attached? ❑ Yes ❑ No 15rs•Y13 rM50ffidWImpectimForm Subadwe Sevege0 System•Page 11 of 17 Commonwealth of Massachusetts Title 5' Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments.: 121 Dunn's Pond Road Hyannis MA Property Address Don and Jill Wood 121 Dunn's Pond Road Ow ner Owner's tame requiretia is Hyannis MA 02601 4/25/2014 required for every � page. Cityfrown State Zip Code Date of 6ispection D. System Information (cunt) Distribution Box (if present must be opened)(locate on site 7plan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): CO S_ie.,4PS AlPfol s r7,r he r4PP 1QC 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 appurt es, etc.): *N pumps or alar/not ' ing order, system is a conditional pass. Soil Absorption cate on site plan, excavation not required): If SAS not locate 15rs•3M3 Tide 50fftWIrrspectonForm SutsufaeeSeaageOisposal System•Page 12d V Commonwealth of Massachusetts Title $ Official Inspection 'Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 121 Dunn. s Pond Road Hyannis MA Property Address Don and Jill Wood 121 Dunn's Pond Road Cw ner Ow nees tame m required for is Hvanni c MA 02601 4/25/2014 requ'Ired for every _ page, Cityfrown State Zip Code Date of Inspection D. System Information (cons) Type: i � w 3 leaching pits number. jV S� ❑ leaching chambers number. ❑ leaching galleries number. ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: / Q/ overflow cesspool number. ❑ innovative/altemative system Typetname of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 4�Gt -rxWe 9W j"rAU 111-ev4V 6MP ->2 3LOCk iAd-e- 7-JI Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration / Depth—top of liquid to inlet invert JW Depth of solids layer Depth of scum layer AP Dimensions of cesspool 'p Materials of construction Indication of groundwater inflow ❑ Yes (0 No 15hs-313 TdIeSaficial InepectionFomc Subsurface Savage Disposal System-Page 13 d 17 Commonwealth of Matsachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System F,!-%►m-Not for Voluntary Assessments 121 Dunn's Pond Road Hyannis MA Property Address Don and Jill Wood 121 Dunn's Pond Road Cw ner Cw nees Name inforrmWn is required for every Hyannis MA 02601 4/25/2014 page. Cityfrown State Zip Code Date of Irspection D. System InWmation (conL) Comments (note condition of soil, signs of hydraulic failure, level of pon , condition of vegetation, etc.): Privy(locate on site plan): Materials ofconstruction: Dimensions Depth of solids Comments (note co dition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 15ins•3M3 TM50ffidalinspectanForm 8UWWf=Sav"eDiSp0sal System-Page 14of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 121 Dunn's Pond Road Hyannis MA Property Address Don and Jill Wood 121 Dunn's Pond Road Ow ner CW nees Name information is requaed for every Hvannis MA 02601 4/25/2014 page Cityfrown State Zip Code Date of Irspmfon D. System Information (coat) 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: [9 hand-sketch in the area below ❑ drawing attached separately t0 or Al A3=31; 63=Yl Heil .- rP-� Uns•3M3 Tvw5omciallnspecoonForm subsumaw samweaeDisposal SyMm•Page 15of 17 Commonwealth dM ass achusetts Title $ Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 121 Dunn's Pond Road Hyannis MA Property Address Don and Jill Wood 121 Dunn's Pond Road Oro ner Car ner's Name Inforffrequired ion is Hyannis MA 601 4125/2014 required for every Hyannis Ciityfrown State Zip Code Date of Inspection D. System Informatoon (corn.) Site Exam: ❑ Check Slope ❑ Surface water Ind Check cellar ❑ Shallowwells / Estimated depth to high ground water. feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: pate 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: t. �d �t sue ��efs oa l 2�D. aa�t vs r.+ " �f zoi V 01 Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ts•3113 Tide 50Hicial fro pectiatForm Subsuc'ace SewageDispaeal System-Page 16at 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 121 Dunn's Pond Road Hyannis MA Property Address Don and Jill Wood 121 Dunn's Pond Road owner ow nets tame rmu dforeis very Hyannis MA 02601 - 4/25/2014 page, Cty/Taan State Zip Code Date of krpmWn E. R_,/eport Completeness Checklist LEI Inspection Summary: A, B, C, D, or checked t.lt Inspection Summary D(System Failure Criteria Applicable to All Systems)completed System Information—Estimated depth to high groundwater $ketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5i s•W13 Title 50Mdal i spedon Fart[SuCstirrace Sewage Disposal Syem•Page 17 o117 ASSESSORS MAP NO: aZ 70 7 ,7 PARCEL NO.: OdZ�� No. --......... Fss............... .e....... THE COMMONWEALTH OF MASSACHUSETTS BOARD �-1 E/ 227°/0(3l ,C,1 .........O F. ....... -- ---- ------ ------------------------------- Appliratinn for Uiipuga1 Worko Cfunuitrur#inn ramit Application is h by made for a Permit to Construct ( ) or Repair (�an Individual Sewage Disposal System at: `S • • ation ss ............. Lot No. ---.. .----•------------•-•-- J ---------- ------- ! - - .............................. ---........-•----------------------------•-•----...-•--•- ....... - •-- ---- -- JAL - Owner Address Installer Address d Type of Buildings� Size Lot............................Sq. feet U Dwelling XNo. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures .................................. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid'capacity....___..._.gallons Length................ Width................ Diameter................ Depth___-___.__--___- Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area--------------------sq. ft. 3 Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ a1 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-___--_-----____--_____. Gi, Test Pit No. 2________________minutes per inc Depth.of Test Pit.................... Depth to ground water........................ ---- ------------------- -------•--•-------------------...........----------------------•---......................................................... ODescription of Soil--------------- - - - - --------------------••-•--------------------•---------------------------------------------•-•-----------------------.......----.----- W U •-------------------------------------------------------------------•------------------..........------•-----------------------------------------------•---........................................... UW ---------------------------------------------------------------------------------------•------------------------ ._....... Nature of Repairs or Alterations—Answer when applicable_-__ ----------------------------------------------- --------------------------------------------------------•------�-40V� - Y-'## .................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'T'i i.E ;of the State Sanitary Code— he undersigned further agrees not to place the system in operation until a Certificate of Compliance has been 'ssu by �h oard of he h. Signed .. . e---------- : ---- --� ... to p Application Approved BY ----------- Application Disapproved for the following ons: Dat --------------------------------------••----••------••-•--------...........--------._....--------.........-•-----•-------------•-----•-•-----..............................---------- ......-------- Date PermitNo......................................................... Issued_....................................................... Date 7 .......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HE< rid ........................................ .........OF......./... Appliration for Elh4paoul Works Tonstrurtion ramit Application is hereby made for a Permit to Construct or Repair (Z-,)•'an Individual Sewage Disposal System.at: i ............. ------------ Lcation;Address or Lot No.......................�,....................... ------ ....................... .......... ------------*---------- --------------------------- 0 W,ner 7 Address ...................o..... .................................................................................................. Installer Address Type of Building _?, Size Lot............................Sq. feet U Dwelling 4e,"No. of Bedrooms............................................Expansion Attic Garbage Grinder ( ) P�4 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria ( ) Otherfixtures ----------------------------------------------....................................................................................................... Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid capacity............gallons Length................ Width........_._...._ Diameter................ Depth................ Disposal Trench—No. .................... Width..............:..... Total Length.................... Total leaching area....................sq. f t. 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----------------minutesperinch Depth of Test Pit....._............__ Depth to ground water.._._....__._........_... Gil Test Pit.No. 2................minutes per inch Depth of Test Pit................._.. Depth to ground water_.._._.............__... ----- --------------- C............................................................................................................................. 0 Description of Soil..........._ .. ..... ...................0..................................................................................................................... .0 ...................................................................................................................................................-- ..................................................... ---------------------------------------------------------......................................... ...............................Y.tl__. ....... ------------------------------------------------ Nature of Repairs or Alterations—Answer when applicable....-e'�`-Z,-- ........11�.................................. -, Z Z. - - _'. -,I!? * ...........................................0.................................................................. ........ ................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of 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. W .......................Signed.... ... ............... Application Approved By.............I ------- ........................ ............ Dat 11"_,"Zons:..............................................................................................................Application Disapproved for the following ..................................................................................................................................................................................................... Date PermitNo.....................................................o--- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .." .............................................. .....OF....... Trrfifiratr of Toutpliatta 1 e, TH1Sf,1S-,,T%%CE,RT1FY, That the Individual Sewage Disposal System constructed or Repaired .... ......... . Xby......... . ............................................................................. jnsta6r 7 at.................... ........ ............ ........... -------------------------------------------------------- has been installed in accordance with the provisions of TITIE 5 of The State'�Sanitary Ce/s qescribed in the ------- application for Disposal Works Construction Permit No................ .....tz",_ ........ dated.........../.. la--------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT !HE SYSTEM WILL FUNCTION 4ATISFACTORY. DATE__... . Inspector.............................4 ...................... -------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD- OF HEALTH ...........................................OF.......................... .. FEE........................ Disposal Workii Tonstration "pauttit Permissionis hereby granted_______________.!n............................................................................................................................ to Construct or Repair an Individual Sewage Disposal System atNo...................1..............._1............I..........0......................................................0......................................................0................... SET' et .I as shown on the application for Disposal Works Construction Per,11 No.............. D ted.......................................... .......... .. Board of Health DATE.................. ----_/_y ...................................... FORM 1255 HOBE3/& WARREN. 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Ist,and 2qo flpq tT)gqttTer,=riaM D?- � the e�eTsting sTl plates the are 8"14"'CCX'ply�aad,;glued to"Joi8t .. belted to�"nk fomOAOa i i .i ill uvirid®w end- door hTa ; rear to 1 � kl ,9 3Aerungs He�dsr in,lbaal 4 f ;21a:'Jaisi -:#o eiSttn�,- 16"C _C'W Bearing V;:_, s: per w ndow.° +• sable sus. A `' `R��,�tt:insuhtion at:erTd af.�o�sM_to . . 9 f �''piorao subflo�r` `' . r 12iaZt TiTi Jftla(r:` . ExstTng 8"foundafion C•R SEC°fl( 1 : 121.DUNN'S POND ROAD"V,. IHY- NMS ' f