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Home My WebLink About0007 ERIN LANE - Health 7 ERIN LANE, HYANNIS A="291017 1 - - --- 3 I i -7- —3 ►a C�JiL�.S pd► fi S /y'Z� � �� -� ��'1.11:� LoW►�' 2 17 J` CnA 0 ✓"" /Y►1 N►�� " Si d� t�., 09 'milt .�r Poof car,ivy Qx 9 H-4 Via. C�� 36 11 ©205 OL ra oF��e .+- CA Sc=�� h;�Z��d��.►fps. go AN I 4 i i _ s, TOWN OF BARNSTABLE " ' 0- t7ON SEWAGE # VILLAGE ' 'y9t -N.1S ASSESSOR'S MAP& L r- T INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACII.ITY: (type) k k (size) NO. OF BEDROOMS BUILDER OR OWNER �)C t DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Welland Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) N(^A Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) : Feet _ . Furnished by - —— -. . TOWN OF BARNSTABLE LOCATION 7 SEWAGE# ?_QZI- y ZJ . VILLAGE H V A V,,„�,i ASSESSOR'S MAP&PARCEL 2Q) a/7— Q f 1 INSTALLER'S NAME&PHONE NO. (_121 C STQ.i!�nb<2 510A 12L" 7(3,51 SEPTIC TANK CAPACITY bb0 LEACHING FACILITY:(type) �{� ( �<p6 cal (size) .Y X/3 NO.OF BEDROOMS I U1A' OWNER 11.41 rEr lcov'i d y, PERMIT DATE: �1� J COMPLIANCE DATE: a ® C;A.� J Separation Distance Between►the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY V\l V�\ s cr3 N 7h- -0 i Y CA I � � e c S. \ P � l N No. , � Fee THE COMM .1EALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01ppYitation for Misposal 6pstem Construrtion Vermit NQkNr` 50 V's Application for a Permit to Construct( ) Repair( ) Upgrade( )'Abandon( ) ❑Complete System ❑Indivi al Components Location Address or Lot No. 32044 1 EV,A LP4A_ Owner's Name,Address,and Tel.No. A n CL Z-Z,a A rck-u 0 Z.q\ r)1'f- a ik Assessor's Map/Parcel *RX tky OWS, A 0 260\ 1 Eir i tt LaiLe-, AY colrLi s, MA o 2.b u I Installer's Name,Address,and Tel.No. E r%c SxevtM Designer's Name,Address,and Tel.No.-Zl� O'•I>p` • ��i?\1CV\5. 5 k 3 0( �+ IL T( 11l MtLiA . Mofs-�s N�-61.,SMA �Zll%vm^ C r*elriA ) 5AC-VYI Ike, 02-6 J Type of Building: ) j a�, 42 8 -3 i 4.4 Dwelling No.of Bedrooms U (`LOt'Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 44 0 gpd Design flow provided 4-54 gpd Plan Date Number of sheets Revision Date Z!�; Za 2- Title--I Ev t y\ LaA'y , _i ox to 5tc4A e. (!yJa '\IS) MA Size of Septic Tank 0-\ Type of S.A.S. Description of Soil U f1y Nature of Repairs orAlteratio (Answer when applicable) - cAA t i:(A ^c tom, a-acAi' `g a- 1 i Zvr-p o E JA sus - 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 provi§ions of Title 5 of the Environmental Code and not to place the system in operation.until a Certificate of Compliance has been issued by this Board o ealth. Signed Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. _�to v Date Issued L( (. ----------------------------------------------------------------------------- � a` No: '��`�� . Fee / !. ' THE C01VIMNWEALTH OF MASSACHUSETTS Entered in computer:;�k.,, ti Yes r*k PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS application for Mispo'k. ?' �trm Construction Permit Awl .:4 V SON— Application ;. �• for a Permit to Construct( ) Repair( ) Upgrade( `)'Abandon( ) ❑Complete System ❑Indiv d al Components,: Location j Address or Lot No. "3 Ev'n Lmks- Ownerrs Name;Address,and Tel.No. `}A n CLA Z2 a A I a�tJ E O Assessor's Map/Parcel �O�AA+.5,.tA A a 2tZ\ 1 e n 1A X cth►,1 t s; Installer's Name,Address,and Tel.No. Et 9 t SkeoVtt Designer's Name,Address,and Tef'No. W�, 5Ye' ns 30 lak -it -�u bhoN 'St. Qrn$truu�ck 1Aats 9 M�4 .�5MA .-Sul;eva,� t�tr�ptr�n (9s�cvvill pr ta26 Type of Building: 1 ��,�' ��P Dwelling No.of Bedrooms 1 �`-V_U Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 440 Q gpd Design flow provided �5�{- gpd _ Plan Date Number of sheets Revision Date i -2 S 2.0 2.1 •Title "7 S t i^ �-.Ot Aj..,. , _b ok ir►Sto-�)X Q, ( am t3) MA Size of Septic Tank �.. �'� r��•q Type of S.A.S. Description of Soil �t1 Ufa l; Nature of Repairs orAlteratiio/ ,(Answer when applicable) : D A l e(d �� :"" Gl` le U 1� tl 'kO Z .� ,fps ' :!,� bate last inspected: Agreement: -----� --- ��-- •- ; The undersigned agrees to ensure the construction and maint ena ee 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 ti Compliance has been issued by this`Board o •ealth. // Signed Q� .�C Date 1 1 1-71 7 i Application Approved by A w) Date V V' r a Application Disapproved by Date for the following reasons ' Permit No. tom) �" aL1 Date Issued i �.� /),k 1 THE COMMONWEALTH OF MASSACHUSETTS M BARNSTABLE,MASSACHUSETTS' Certificate of Compliance THIS IS.TO CERTIFY,that the On-site Sewage Disposal system Constructed 00 Repaired( ) Upgraded(4) Abandoned( )by ►- at Ei✓tA j ```7 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer #bedrooms Approved design flow gpd The issuance of this permit shall not b_ej construed as a guarantee that the system Will�func� t�ion as designed..,.----- Date �� r7 Inspector - - - - ---------------- -- --•--- -- ----- -- = = = No '� '" �) Fee r `"°".... THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS a ';D1sposal *pstrm Construction Permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) System located at tlu 1.Gnu.. tA,h vtt5 ' 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 i Approved by VVN,sit..t,AA�o}� / 1 ��. A. KleanTu® LLC John R.Smith KleanTu Wastewater P.O.Box 1154 Treatment fdgartown,MA 02539 Technologies 4127719-5976-Mooile ® 508-627-3072-Office November 16,2021 To: Andrezza N.Araujo 7 Erin Lane Hyannis,MA 02601 John O'Dea,P.E. - Sullivan Engineering&Consulting,Inc. . _ P.O. Box 659 ..... .... 711 Main Street Osterville,MA 02655 RE: Installer Certification for New NitROE®2KS WWTS Enhanced Title 5 Septic System Installation for 7 Erin Lane,Hyannis,MA 02601;KleanTu®Project No.80024-2111. - To: Andrezza Araujo and John O'Dea: To comply with Item IV-#5 cited in Mass DEP Provisional Permit issued to KleanTu®LLC(DEP Transmit.al No.:X285590; Issued May 12,2020),this letter certifies that the New NitROOD 2KS W WTS Enhanced Title 5 Septic System design for 7 Erin Lane,Hyannis will be installed with supervision and direction provided by KleanTu®personnel will be onsite to ensure that the NitROE®Enhanced Title 5 Septic System is installed in a manner that conforms with KleanTue's design and operating requirements. This also acknowledges that the site owner will be contracting with a Licensed Installer. Please contact me with any questions or comments regarding this certification. My cell#is 412-491-0122. Regards, 7aW e Tit Jaw K Fu(Nov 16,202116:31 EST) ... .. - Jaw K. Fu Vice President Engineering&Operations t - 1- ii KleanTu® LLC John R.Smith KleanTu Wastewater P.O. Box 1154 Treatment Technologies Edg412artown,MA 02539 Mobile 508-627-3072-Office To: Town of Barnstable Board of Health November 16,2021 200 Main Street Hyannis,MA 02601 RE: Designer Certification for New NitROE®2KS WWTS Enhanced Title 5 Septic System Installation for 7 Erin Lane,Hyannis,MA 02601;KleanTu®Project No. 80024-2111 To Whom It May Concern: To comply with Item IV-#2 cited in Mass DEP Provisional Permit issued to KleanTu®LLC(DEP Transmittal No.:X285590; Issued May 12,2020),this letter certifies that the New NitROE®2KS WWTS Enhanced Title 5 Septic System design for 7 Erin Lane,Hyannis conforms with the Provisional Approval and that the system is consistent with the NitROE®2KS WWTS capabilities. Furthermore,the system was designed by John O'Dea, P:E.,of Sullivan Engineering&Consulting,Inc.who is a Massachusetts Registered Professional Engineer, License#48168. Please contact me with any questions or comments regarding this certification. My cell#is 412-491-0.122. Thank you, (Za LL Jaw K.Fu(Nov 16,202116:30 EST) Jaw K.Fu Vice President Engineering&Operations - 1- KleanTu® LLC John R.Smith KleanTu Wastewater P.O:Box 1154 Treatment Technologies Edgartown,MA 02539 412-719-5976-Mobile ® 508-627-3012-Office November 16,202.1 To: Town of Barnstable Board of Health 200 Main Street Hyannis,MA 02601 RE: Homeowner Certification for New NitROE®2KS WWTS Enhanced Title 5.Septic System Installation for 7 Erin Lane,Hyannis,MA 02601;KleanTu®Project No. 80024-2111 To Whom It May Concern: To comply with Item IV-#1 cited in Mass DEP Provisional Permit issued to KleanTu®LLC(DEP Transmittal No.: X285590; Issued May 12,2020),this letter certifies that the Site Owner for 7 Erin Lane,Hyannis,Andrezza N. Araujo,has been made aware and agrees(per the signature below)with the following: 1. Has been provided a copy of the Provisional Use Approval and agrees to comply with all terms and conditions cited herein: - -- 2. Has been informed of all homeowner's costs associated with operation&maintenance(O&M)activities and associated costs with the operation of the New NitROE®2KS WWTS Enhanced Title 5 Septic System to be installed,including power consumption,maintenance,sampling,recordkeeping,reporting,and equipment replacement. 3. Understands the requirements for a O&M contract to be in place with KleanTu®,or with their desigr_ated and trained entity,and that the NitROE®2KS WWTS operator must be licensed by the Mass DEP as stipulated in KleanTuo's Provisional Permit. 4. To fulfill his responsibilities to provide a Deed Notice as required by310 CMR 15.287(10)and the Approval by the Town of Barnstable BoH. 5. To fulfill his responsibilities to provide written notification of the Approval conditions to any new owner, as required by 310 CMR 15.287(5). Please contact me with any questions or comments regarding this certification. My cell#is 412-491-0122. Thank you, . c7awk Tie - Jaw K Fu(Nw 16,202116:33 EST) Jaw K.Fu Vice President Engineering&Operations i SYSTEM OWNER SIGNATURE ame: Andrezza N.Arauio Affiliation/Title: Site Owner .4�r�rr�N,4.Nauid- Signature: Mdreua N Araujo(Nov 16,20212:42 EST) -- - -- --- -- - - 1- . S KleanTu'9 LLC KleanTu Wastewater . _John R.Smith Treatment P.O.Box IIS4 Technologies Edgartown,MA 02S39 412-719-5976-Mobile 508-627-3072-Office CONTRACT No.80024-2111 for 7 Erin Lane Hyannis November 16,2021 To: Andrezza N. Araujo(Site Owner) 7 Erin Lane Hyannis,MA 02601 atidrezzausa@lzmail.com Henrique Sousa AMG Builders.&Services, Inca amabuildersusa@grnaii.com RE: NitROE®2KM WWTS Installation for 7 Erin Lane, Hyannis,MA;KleanTu®Job No.: 80024-2111 Dear Andrezza: KleanTu®LLC is pleased to provide this contract document for a NitROE®2KS Waste-Water.Treatment System (WWTS)to be installed at 7 Erin Lane:residence. The main purpose of the NitROE®2KS WWTS is to serve as a supplemental upgrade to a new Title 5 Septic System. A new NitROE®2KS WWTS consisting of an H-10, 2,000-gallon NitROE®2KS Tank will be inserted in the gravity flow path of the existing septic tank and a new leach field. The purpose of the NitROE®2KS WWTS tank is to significantly reduce total nitrogen(TN)from the sanitary wastewater flow prior to permitted discharge to the new Title 5 leach field. In addition to significantly reducing TN,the NitROE®WWTS enhancement will produce a highly treated.wastewater effluent with significantly reduced levels of organics and suspended solids as well. NitROE®ENHANCED TITLE 5 SEPTIC SYSTEM OVERVIEW The NitROE®2KS WWTS to be installed is specified in the Site Drawing Project No.: 1998138,prepared by Sullivan Engineering&Consulting,Inc.,dated and stamped by John O'Dea,P.E.,on October 25,2021. With reference to this site drawing,wastewater will be collected into the existing.1,000-gallon septic tank. After solids separation in the septic tank,wastewater will then gravity flow into the 2,000-gallon.H-10 NitROE®WWTS Tank for enhanced total nitrogen reduction. From there the significantly treated wastewater will gravity flow into a distribution box where wastewater will be disbursed to a new leach field. REGULATORY REQUIREMENTS The NitROE®2KS WWTS will be installed and operated under a Mass DEP Provisional Permit granted to KleanTu®LLC(DEP Transmittal No.:X285590;issued May 12,2020). Specific.regulatory items that need to be addressed are summarized below. It is to be noted that various actions among the site owner,the site design engineer,the installer,and KleanTu®:LLC must'be followed and respectively documented. The majority of the documentation required will be provided by.KleanTu®. Furthermore,these Mass DEP regulatory requirements pertain to respective actions from project initiation through to NitROE®2KS WWTS start-up and yearly operation. 1 KleanTu®LLC John R.Smith KleanTu P.O.Box 1154 Edgartown,MA 02539 . 412-719-5976-Mobile 508-627-3072-Of=ice . CONTRACT No.80024-2111 for 7 Erin Lane Hyannis A. Obtaining a Disposal System Construction Permit(DSCP). This is.issued by the local Board of Health (BoH)after.completion of the following: I. Submittal of the site engineering design and DSCP application to the local BoH. Normally this is done by the Design Engineer. 2. Along with the DSCP application,to comply with Section IVA of the Provisional Permit,the Design Engineer,with input from KleanTu®LLC,will provide to the local BoH,a certification letter that the site owner: a. Has been provided a copy of the Provisional Use Approval and agrees.to comply.with all terms and conditions cited herein. b. Has been informed of all owner's costs associated with operation&maintenance(O&M) activities with the operation of the New NitROE®2KS WWTS Enhanced Title 5 Septic System to be installed includingPower consumption,maintenance sampling,recordkee in g, reporting,and equipment replacement: c. Understands the requirements for a O&M contract to be in place with KleanTu®LLC,or with their designated and trained entity, and that the NitROE®2KS WWTS operator must be licensed by the Mass DEP as stipulated in KleanTu®'s Provisional Permit. d. Agrees to fulfill their responsibilities to provide a Deed Notice,and file with the local Registry of Deeds,as required by 310 CMR.15.287(:10)and with the Approval by the local BoH. e. Agrees to fulfill their responsibilities to provide written notification.of the Approval conditions to any new owner,as required by 310 CMR 15.287(5). 3. Along with the DSCP application,to comply with Section IV-2 of the Provisional Permit, KleanTu®LLC will provide to the local BoH,with a copy to the Designer and the Site Owner,that the site-specific design conforms to Provisional Permit requirements and that the proposed use of the NitROE®2KS WWTS is consistent with the unit's capabilities and all KleanTu®LLC requirements. B. Executed Operation& Maintenance Contract In-Place. To comply with Section IV-4 of the Provisional Permit,thirty(30)days prior to installation of the NitROE®WWTS,the Design Engineer,with input from KleanTu®LLC,will provide to the local.BoH,a copy of a signed O&M contract fora minimum period of one.year,between the site owner and KleanTu®LLC,or their designated approved operator,who has been properly trained and certified by KleanTu®. In this regard,in addition to signatory execution of this Contract document,the site owner will also be required to sign and thus execute an O&M contract for start-up and the first 12-months of operation and monitoring. -2 KleanTu LLC eCCRR John R.Smith P.O.Box 1154 Edgartown,MA 02539 412-719-5976-Mobile 508-627-3072-Office CONTRACT No.80024-2111 for 7 Erin Lane Hyannis C. Obtaining a Certificate of Compliance(COC). This is issued by the local Board of Health(BoH)after installation,local BoH inspection and sign-off, p and completion of the following to comply with Sections IV-5 and.IV-6 of the Provisional Permit citing the following: 1. A local BoH inspector,the installer and the designer all need to sign the COC.and thus certify,in writing,that the NitROE®2KS WWTS was constructed in compliance with both the Provisional Permit and Mass DEP 310 CMR 15.000 requirements,and that any changes to the design plans are reflected in as-built drawing and/or notes. The completed COC then needs to be filed with the local BoH. 2. The Design Engineer,with KleanTu®LLC input,will submit a written certification letter to the local BoH,and copy the site owner,that the: a. NitROE®WWTS has been constructed and installed in compliance with approved site design plans,the Provisional Permit requirements,Mass DEP 310 CMR 15.000 and local BoH requirements. b. NitROE®WWTS was constructed and installed under direct supervision and oversight by KleanTu®personnel,and that KleanTu®also did the installation of the aeration system, bacterial seeding of the tanks,and installation of other pertinent items such as risers and access ports. D. NitROE®WWTS Site Inspections and Monitoring. To comply with Section III B,items 13-36 of the Provisional Permit related to Operation and Maintenance(O&M),KleanTu®, or a designated entity trained by KleanTu®,will be responsible for doing the appropriate number of site inspections,along with sampling and analyses for specific wastewater treatment parameters,and for reporting respective results to the Site Owner,the local BoH and the Mass DER Initially the required number of site visits and monitoring will be done on a quarterly basis,per the Provisional Permit requirements. Once a General Permit is issued,then the site inspections and monitoring will be reduced to a semi-annual or annual basis. In any event,the site owner will be required to have contracts in place with KleanTu®,or their designated representative,for O&M,including the monitoring and reporting required. 3 KleanTu LLC Cea John R.Smith P.O.Box 1154 Edgartown;MA 02539 412-719-5976-Mobile 508-627-3072-Office CONTRACT No.80024-2111 for 7 Erin Lane Hyannis INSTALLATION ACTIVITIES AND PRICE For installation of the enhanced NitROE®2KS WWTS,the task activities to be carried out,along with their respective,prices,are provided in the table below. An electronic copy of the NitROE®WWTS Installation Manual is provided along with this Contract proposal. This document serves to identify the various activity respons_bilities among the site owner,the installer and KleanTu®LLC. Of particular note,it is the responsibility of the site owner to identify and make the installer aware of any buried utility lines such as gas,electrical and cable;here Dig Safe can be contacted to provide this service at no cost(http://www.digsafe.com),but they only identify public utility lines and not any private lines. As cited in the Table 1 below,the contract.price for KleanTu®to.provide the task activities cited is $12,500: KleanTu®LLC understands that the Barnstable Clean Water Coalition(BCWC)will provide funding for the NitROE®2KS WWTS. Additionally,it is to be noted that the BCWC/site owner must arrange for,and pay for,additional site-speciEc activities related to: 1. Providing a dedicated electrical service and a two-receptacle GFI outlet box:in a location near the NitROE® 2KS tank locations. 2. Filing a notarized deed restriction with Barnstable County and paying the filing fee as well as obtaining a copy of the deed restriction document for the local BoH. A deed restriction to be executed is provided with this contract proposal. a 4 : KleanTu LLC CKIeaffu John R.Smith P.O.Box 1154 Edgartown,MA 02539 412-719-5976-Mobile ' 508-627-3072-Office CONTRACT No.80024-2111 for 7 Erin Lane Hyannis Table 1. KleanTu Price of Title 5 Enhancement via NitROE®2KS WWTS Enhancement for 7 Erin Lane,Hyannis,MA ONE 2,000 GALLON NitROE TANK: T-AS2000-H10 (KleanTu®Project No.80024) Task Categories and Description KleanTu® Price Task 010-Project Management,Engineering and Permitting Includes overall project management coordination including review and input to the site engineering design, local BoH and MassDEP permitting interactions,and ensuring that all work is done in a manner protective of workers and the environment. Note:BCWC/Site Owner is responsible for site design engineering and local $500 BoH interactions including obtaining all permits and final certification. The Site Owner is also responsible for filing"Notice of Alternative Sewage Disposal System"with Registry of Deeds and paying$105 fee,with. KleanTu®providing review and coordination. Task 020-Procurement and Fabrication Includes providing one 2,000-gallon NitROE®2KS H-10 Tank at a price of$10,500. This price includes all media, access riser ports and covers near or to surface,aeration assembly w/air pump and installed air tubing,and $10,500 faux rock for air pump enclosure. Task 030-Tank Delivery and Installation Oversight Installation oversight and air-line hook-up of delivered NitROE®Tank,including remote sensing unit connection to homeowner Wi-Fi network. Note:Installer is responsible for procurement and sewer piping connections of $1,500 septic and NitROE®Tank,procurement and installation of leach chambers and all piping.connections,providing electrical service(120V;20 amp)and outlet boxes to.location selected by site owner for.running air pump. ..- TASKS 010-020 TOTAL THRU INSTALLATION $12,500 Task 040-Start-Up Monitoring,Operation&Maintenance(MOM)Per:MassDEP Provisional Permit and Barnstable BoH Requirements Includes NitROE®WWTS bacterial seeding;system start-up,bi-monthly visits,quarterly sampling and analyses- by MA certified lab, record keeping,and reporting required by MassDEP,and operational oversight for 1st year $1,300 to address issues that may arise. MOM for subsequent years will be$500-$1,300 depending on MassDEP and Barnstable BoH requirements. Note: Separate 0&M contract to be executed for 1st year of operation. Note: Final Grading and Some Landscaping to be Provided by Installer and/or Site Owner 5 KleanTu LLC KleanTu John R.Smith P.O.Box 1154 Edgartown,MA 02539 412-719-5976-Mobile 508-627-3072-Ofice CONTRACT No.80024-2111 for 7 Erin Lane Hyannis SCHEDULE Barring unforeseen circumstances,KleanTu®will have the NitROE®WWTS tanks ready for installation the week of November 29, 2021,with the actual date to be finalized with the site owner and their installer: PAYMENT SCHEDULE • With signature of this"Contract"below by the site owner,the following payment.terms apply: o 75%.($9,375)immediately upon signatory execution of this Contract. o 25%($3,125)to be invoiced and paid within 30 days after installation and startup. • Payment Issuance. Respective checks should be made out to KleanTu®LLC and sent to the Edgartown, MA P.O.address cited in the top right corner of each page of this"Contract". WARRANTY KleanTu®guarantees equipment and materials to properly operate for a period of one year. This is contingent that the NitROE®2KS WWTS is installed per the engineering design and that the NitROE®2KS WWTS receives typical sanitary wastewater(as defined.per Title 5)and is within the design flow and does not exceed 440 gallons per day(gpd). SITE ACCESS By signing this contract,homeowner agrees that KleanTu®designated personnel will be allowed access to the site for the purpose of performing routine MOM activities associated with the NitROE®2KS WWTS.. 6 KleanTu LLC John R.Smith KleanTu P.O:Box 1154 Edgartown,MA 02539 412-719-5976-Mobile QD 508-627-3072-Office CONTRACT No.80024-2111 for 7 Erin Lane Hyannis CONTRACT ACCEPTANCE KleanTu®looks forward to working in partnership with the Site Owner and to providing direction and overs_ght for installing and operating a NitROE®2KS WWTS to enhance your upgraded Title 5 septic system. By accepting this contract,you also agree to comply with the regulatory requirements cited on pages 2 and 3 of this contract document. Specifically,that you agree to yearly MOM contracts with KleanTu®,or their designated representative. To accept this contract so that work may continue as planned,please sign below and send the down payment check as per the PAYMENT SCHEDULE above. Also, please contact me with any questions or comments. My cell #is 412-491-0122. Sincerely, 7GIEe Tg Jaw K.Fu(Nov 16,2021 16:31 EST) - Jaw K. Fu Vice President Engineering&Operations Signature: Andrezza N Araujo(Nov 16,2021 2(51 EST) Andrezza N. Araujo .�9 Signature: Hen i ue S usa(Nov 16,202121:16EST) Henrique Sousa 7 I KleanTu® LLC KL@dt1TU Wastewater John R.Smith Treatment P.O;Box 1154 Technologies Edgartown,MA 02539 412-719-5976-Mobile 508-627-3072-Office. CONTRACT No.80024-2111-040 for 7 Erin Lane,Hyannis November 16,2321 To:. Andrezza N.Araujo 7 Erin Lane Hyannis,MA 02601 RE: NitROE®2KS WWTS_Start-Up and Monitoring;Operation,and Maintenance(MOM)for 7 Erin Lane, Hyannis;KleanTu Job No.: 80024-2111-040 Dear Andrezza: KleanTu®LLC is pleased to submit this"Contract"to provide Start-Up and Monitoring,.Operation,and Maintenance(MOM)oversight services for one year from the NitROE®2KS Waste-Water Treatment System (WWTS)installation date at 7 Erin Lane,Hyannis. The main purpose of the NitROE®2KS WWTS is to enhance your Title 5 Septic System for the purpose of significantly reducing total nitrogen(TN)from the sanitary wastewater flow. In addition to significant TN reduction, the NitROE®enhanced Title 5 septic system will also produce a highlytreated effluent low in organic carbon constituents(measured as BOD5)and low in total suspended solids(TSS)levels. Please note that entering into a yearly MOM contract is a requirement of KleanTu®'s Massachusetts Department of Environmental Protection(DEP)Provisional Permit(DEP Transmittal No.:X285590;issued May 12,2020). As this is the first year of:operation, start-up services are also provided. As cited in Section IV-4 of the Provisional Permit,yearly MOM contracts must be in place to ensure proper operation and consistent treatment performance. In this regard,this contract also provides budgetary price estimates for subsequent years of MOM. CONTRACT DETAILS AND PRICE PROJECTIONS Regarding start-up and MOM services,Table 1 provides a yearly breakdown of scheduled deliverables and associated prices. The contract price for 12 months in the 2021/2022-time frame.is fixed and reflects requirements cited in the Mass DEP Provisional Permit. All MOM activities, including monitoring and sample collection,will be performed,or directly supervised by a System Operator that has been certified at a minimum Grade Level IV by the Board of operators_of Wastewater Treatment Facilities,in accordance with Massachusetts regulations 257 CMR 2.00. Specific to any.KleanTu® Contract,the System Operator will be John R. Smith,Certificate No.: 1914. Electronic copies of the Provisional Permit and the NitROE®2KS WWTS MOM Manual are provided along with this contract proposal. -1- KleanTu® LLC _ John R.Smith KleanTu P.O.Box 1154 Edgartown,MA C2539 412-719-5976-Mobile o - 508-627-3072-Office .CONTRACT No.80024-2111-040 for 7 Erin Lane,Hyannis The prices for subsequent years 2022 and beyond are estimates in 2021 dollars;with the higher amounts reflecting continuation of quarterly inspections and sampling,or being allowed to do less frequent inspections and sampling by the Mass DEP and the Barnstable Board of Health(BoH). Being in 202.1 dollars,these future estimates could vary for a number of reasons,including the effect of inflation on costs of personnel materials and energy. Table 1. Scheduled(Routine)Yearly MOM Deliverables and Pricing for New NitROE®.2KS WWTS for 7 Erin Lane,Hyannis(provided in 2021 dollars) Time Price per Period Period Deliverables November 2021 . Start-Up including bacterial seeding and monitoring at least once $1,300 thru every.2 weeks during the 1"8-weeks of operation to ensure that ($600 for site October 2022 NitROE02KS WWTS is properly functioning. inspectio i!sampling (12 months) • Provide and Review MOM Manual to homeowner and address any and visits and$700 for all related questions. Mass DEP certified • Quarterly Sample Collection and Analyses per Mass DEP Provisional lab analyses) Permit. • . Respond to Homeowner issues,concerns and questions. • Quarterly Inspection and Monitoring Updates to Homeowner. (NOTE:All NitROE®WWTS Components Covered Under Warranty) November 2022 . Quarterly Inspection and Sample Collection.per Mass DEP Provisional $600- $1,250 thru Permit Issued or Yearly Inspection per General Permit,once issued. (Projected Range October 2023 e Covers Maximum of 4 site calls per year. with New Contract (12 months) . Yearly Update to Homeowners.. to be Executed) (NOTE: O&M Calls(>4)and Issues Addressed per Table 2 Items) ... November 2023 . Quarterly Inspection and Sample Collection per Mass DEP Provisional $600-$1,250 thru Permit Issued or Yearly Inspection per General Permit to be issued. (Projected Range October 2024 . Covers Maximum of 4 site calls per year. with New Contract • Yearly Update to Homeowners. to be Executed) (NOTE: O&M Calls(>4)and Issues Addressed per Table 2 Items) November 2024 • Yearly Inspection and Sample Collection per Mass DEP General $450.- $650 And beyond Permit. - (Extended Yearly • Covers Maximum of 3 site calls per year. Contract to be • Yearly Update to Homeowners. Executed) (NOTE: O&M Calls(>4).and Issues Addressed per Table 2 Items) -2- KleanTu® LLC John R.Smith KLeanTU P.O.Box 1154 Edgartown,MA C-2539 412-719-5976-Mobile 508-627-3072-Office CONTRACT No.80024-2111-040 for 7 Erin Lane Hyannis I As the NitROE®.2KS WWTS moves through the Mass DEP permitting process from Provisional Permit Use to General Permit Use,Tabled reflects that the associated price for yearly MOM significantly decreases. This MOM price reduction is primarily due to the fact that the Mass DEP requirements for inspections and sampling and analyses move from quarterly(under the Provisional Permit)to yearly under a General Use Permit. At this time, it is not known if a General Use Permit will be issued in year 2022 or 2023 as that decision rests with the Mass DEP. It is also cited in Table 1 that this 1st year contract once executed runs fro m November 2021 through Octooer of 2022 during the Provisional Permit phase. As the NitROE®2KS WWTS operation then moves into November 2022,a new contract will need to be executed with each renewal for a minimum 1-year period. In addition to the pricing of scheduled MOM activities cited in Table 1,Table 2 provides non-scheduled and non-routine MOM activities and estimated prices in 2021 dollars,with anticipated timeframes as to when such MOM activity may be needed and thus the cost incurred. While KleanTue has designed and utilized equipment to provide low maintenance operation and treatment,Table 2 is provided so the system owner has some idea what costs may be incurred in future years associated with non-routine MOM activities in terms of 2021 dollars. The only cost estimate in Table 2 that will be incurred each year is the electrical cost associated with the continuous operation of one(1) 120-watt air pump required to enhance and maintain the appropriate level of biological processes required. This yearly cost will be borne by the homeowner,along with periodic pumping of their septic tank as required. -3.- i KleanTu® LLC John R.Smith KleanTU P.O.Box 1154 Edgartown,MA C2539 412-719-5976-Mobile 508-627-3072-Office CONTRACT No.80024-2111-040 for 7 Erin Lane Hyannis Table 2. Non-Routine MOM Items and Estimated Prices for New NitROV 21(S WWTS Replacement Items for 7 Erin Lane,Hyannis(provided in 2021 dollars) Item Description Price Estimate Air Pump . One(1) 120 W air pump. $210 Electrical Usage . Total daily electrical usage measured at-2.9 kWhr/day/pump. per Year Cost/day at$0.20/kWhr x 2.9 kWhr/day=$0.58/day. Non-routine . After 12-month warranty period,troubleshooting site calls(more than $120 Troubleshooting 4/year)will be charged at$120/hr with 1 hour minimum. per Hour Visits Septic Tank . KleanTu will determine when this is needed based on scheduled site $600 (EST)Pump visits. (for EST Septic Out . Pump out to be done by non-KleanTu contractor with estimated price= Tank Pumped $600/EST tank. Out Every • Exact time period is site-specific with estimate of every 3-5 years. 3-5 Years) (NOTE: This pump out cost would need to be done even if this was a conventional Title 5 septic system) Replace Remote e Replacing remote sensing unit and probes=$360. $360 Sensing Probes . Exact time period is variable with estimate of every 8-10 years. (Every and Unit (NOTE: For remote sensing operation,Wi-Fi connection from homeowner 8-10 Years) is needed) Replace Air • Air pump repair and/or replacement. $500 Pump . Exact time period range is variable with estimate.of.every7-8 years. (Every 7-8 Years) Replace • Replace all air tubing=$800: $800 Aeration . Exact time period is variable with estimate of every 10-20 years. (Every Tubing 10-20 Years) Replace Wood . Replace all wood chips=$1,000. $1 000 Chips • Exact time period is variable with estimate of every 20-30 years. (Every . 20-30 Years) Replace . Limestone Addition=$1,600. $1,600 Limestone . Exact time period is variable.with estimate of every 20-30 years. (Every 20-30 Years) Being in 2021 dollars,these future estimates could vary for a number of reasons,including the effect of inflation on costs of personnel,materials and energy. 4 I KleanTu® LLC John R.Smith Mean TU P.O.Box 1154 Edgartown,MA 02539 412-719-5976-Mobile' ` o - 508-627-3072-Office I CONTRACT No.80024-2111-040 for 7 Erin Lane' Hyannis PAYMENT TERMS _.. For the 2021-2022 period price of$1,300,$650(50%)'needs to be paid upon signature execution of this contract. The remaining amount of$650 will be invoiced in May 2022. Contracts executed for subsequent yearly time.periods will need to be.signed by October 31"of the respective contract time period and will have similar payment terms as cited above. CONTRACT ACCEPTANCE To execute this contract,and comply with Mass DEP Provisional Permit Requirements,please sign below to acknowledge acceptance of this proposal and mail original with your signature,or e-mail pdf copy of this page with your signature,back to.me. Please contact Jaw Fu,412-491-0122,of KleanTu®LLC with any questions or comments. Thank you, �7gWe Jaw.K.Fu(Nov 16,202116:32 EST) - Jaw K.Fu Vice President Engineering&Operations SYSTEM OWNER SIGNATURE Name: Andrezza N.Araujo Af Signature: Andrezza N Araujo(Nov 16,20212 :49:EST) -5- t Town of Barnstable NAM aesr►sr,�eis, 6 Board of Health 200 Main Street,'Hyannis MA 02601 Office: 508-962.4644 Donn T.Norman FAX: 509-790-6304 Donald A.Gi ffD.M.D.li,M.D. Paul J.:Canniff,D: .D Mr.Henrique Sousa January 27, 2020 7 Erin Lane Hyannis, MA 02602 RE7 Erin LraneH anrnsMassachusettsTl �� _ � � A,291017 Dear Mr. Sousa, You are granted permission to design and install an onsite sewage disposal system which incorporates a secondary treatment unit with enhanced nitrogen removal technology in order to accommodate a four(4) bedroom single family dwelling at 7 Erin Lane, Hyannis., Massachusetts. This permission is granted with the following L conditions: 1. You must hire a professional engineer(or registered sanitarian)to design an onsite sewage disposal system with a secondary treatment unit with nitrogen reduction technology(e.g. NITROE system). 2. No more than four(4) bedrooms are authorized. Dens, study rooms, finished attics,sleeping lofts, and similar type rooms are considered "bedrooms." 3. The owner shall record a properly worded deed restriction, signed by the owner of the property, at the Barnstable County Registry of Deeds restricting the property to four(4) bedrooms maximum. A copy of the recorded deed restriction shay be submitted to the Health Agent prior to obtaining a disposal works construction permit., 4. A monitoring plan shall be submitted for the use of the.secondary treatment unit. The nitrogen concentration shall not exceed 10 milligrams perliter at the downgradient property line. Q:\WPFILES\Sousa 7Erinlane 2020.docx a 5: The designing engineer shall supervise the construction,of the onsite sewage disposal system and shall certify in writing to.the Board that the system.was installed in substantial,compliance with the:submitted plans. This property consists of 11,412 square feet and is located within a well protection district and a State designated Zone II. A two bedroom septic system was.approved by the Health Department when the home was constructed in 1983. However,four bedrooms currently exist within this two level dwelling; The applicant recently purchased the home which was advertised as a three to four bedroom home by a realtor. This permission is granted because an. innovative/altemative nitrogen removal system will be provided.onsite. Sincerely, n-T.' orMan Chairman Board of Health q:\WPF1LESISousa Hridane 2WOA6d b�N a e b100N . 1 i �fIWN f � i 2,077 dam ab FIR5T FLOOR.: IW.Sd FT n � P SEGOA1 D r-LOOR Ito 5Q Fr ' 3 4,31 27 P_,i 3 2 14 8 ^ � B-ol_13_2022 a 02 9 49P ' | DEED RESTRICTION /�4. ` �^U�� U� ' ^^ � ~ . -- � Andez�A�u�� n�pf7EMn �n�Barns�� (Hyannis), Page 42W � Lot 11,Plan Book 373 Page 1O,dated�KAarh16' '1983)recondedattbeBarnotab|eRe�mtryof � � Deeds as required by 310 CMR 15.287(10)hereby provide notice that the existing dwelling is to be served by a NitROE alternative on-site septic system,.and is subject to the conditions contained Within the Certification for Provisional Use issued by the Department of Environmental Protection toK|eanTuLLC.dated May 12-2Q2CL and approval hv the Town of Barnstable Board of Health dated January 27, 202O and further agree that until such time as � technology changes and/or the Barnstable Board of Health changes its regulations or otherwise grants permission,structures built on the premises mf7 Erin Lbne, Hyannis,shall have npmore A s. � AndrezzaAraujo ' � � COMMONWEALTH OFK8AS8ACHUSETTS � ' Barnstable County On this 22th day of December,2021,before me,the undersigned notary public, personally appeared oppearedAndrezzaAraujo proved ton\o through satisfactory ev| ncapfide- 0cation,vvhioh | was:Tobe the person whose name is signed on this document and acknowledged tonnathat he signed itvo|untari/yfor its stated purpose, 'Notary Public K8y Commission Expires Town of Barnstable KAM s,�sner�st.t� : A Board of Health 200 Main Street,Hyannis MA 02601 Office: 508.8624644 John T.Norman Donald A.Guadagnoil,M.D, FAX: 508-790-6304 Paul I Canniff,D.M.D. Mr. Henrique Sousa January 27, 2020 7 Erin Lane Hyannis, MA 02602 RE" 7 Edr La6W4H ahnis4 Massachusetts }^ y X;��?? " ; <' �_�(( 2g�x 1 $ 0'T "C.::,� ��s�£ �✓t''� K'4 t'i5` �r "y'3 yf Ns.3 ski 'w4�ifitt�s.,4..`:S`. 5`�c�e7 �hS%.:S-,e ,ku.n u�.. Dear Mr. Sousa, You are granted permission to design and install an onsite sewage disposal system which incorporates a secondary treatment unit with enhanced nitrogen removal technology in order to accommodate a four(4) bedroom single family dwelling at 7 Erin Lane, Hyannis, Massachusetts. This permission is granted with the following conditions: 1. You must hire a professional engineer(or registered sanitarian)to design an onsite sewage disposal system with a secondary treatment unit with nitrogen reduction technology(e.g. NITROE system). 2. No more than four(4) bedrooms are authorized, Dens, study rooms, finished attics,sleeping lofts, and similar type rooms are considered"bedrooms," 3, The owner shall record a properly worded deed restriction, signed by the owner of the property, at the Barnstable County Registry of Deeds restricting the property to four(4) bedrooms maximum. A copy of the recorded deed restriction shall be submitted to the Health Agent prior to obtaining a disposal works construction permit. 4• A monitoring plan shall be submitted for the use of the secondary treatment unit. The nitrogen concentration shall not exceed 10 milligrams per liter at the downgradient property line. q:\wPFIEES\Sousa 7E&Lane 2020.docx I lr 1 5. The designing engineer shall supervise the construction of the onsite sewage disposal system and shall certify in writing to the Board that the system was installed in substantial compliance with the submitted plans. This property consists of 11,412.square feet and is located within a well protection district and'a State designated Zone II, A two bedroom septic system was approved by the Health Department when the home was constructed in 1983. However,four bedrooms currently,exist Within this:wro level dwelling. The applicant recently purchased the home which was:advertised as a three to four bedroom home by a reaitor. This permission is granted because an innovativelalternative nitrogen removal system will be provided onsite. Sincerely, 41) n T. �rmaii Dhairrnan Board of I-ealth R:\WPFIP.ES\SQus�7Erintane 2020.docx C Bk 34781 P9319 083611 Notice of Alternative Sewage Disposal System M.G.L. c.21A, § 13 and 310 CMR 15.0287(10) [This NotW to be recorded nd/or filed for registration In the chain of title of the Property served by an Alternative Sewage Dis- posal System("Alternative System").] N 0 T 12 N`APT 2021 .& 03 -40P NAMES)OF OWNER OF PRQPFpR'PY§E�RV1EIXBX ALTERN,6TJVFFS)[SVErJ1: tn&ezza N.Argj4 o ADDRESS OF PROPERTY SERVEUPB'9 A11RNATIVE SYSTEM:f EN fang.Hyanni§MA.02601 TITLE REFERENCE FOR PROPERTIY Q&,gED BY ALTERNATIVE§YaTfM[check and complete each that applies]: A N A N X Deed recorded with the Barn Lgellstff of DkcdAln Book 3446TV 22-1 C I A L _Certificate of Title No.�issu� l tip Iynd Registration Office of Seen P V Registry District ,Source of title other than by deed [if Alternative System Owner(s)is other than Property Owner(s),complete the following:] Alternative System Owner Name: AU Alternative System Owner Address: ':4 F12 i Al Lfl NE , H VAAJAI e-, MA WHEREAS, Section 15.280 of Title 5 of the State Environmental Code("Approval of Alternative Sys- tems"),provides for the Massachusetts Department of Environmental Protection(the"Department")to approve or certify,as appropriate,all proposals to construct,upgrade or replace on-site sewage disposal systems using alterna- tive systems; WHEREAS, owners and/or operators of approved or certified alternative systems are subject to general con- ditions,as specified in Section 15.287 of Title 5 of the State Environmental Code,310 CMR 15.287,and may be subject to special conditions,as specified in the Department's approvals or certifications; such general and special conditions potentially including,without limitation,requirements relating to the use of trained operators,periodic inspections,maintenance,sampling,reporting and/or recordkeeping; WHEREAS,Section 15.287(10)of Title 5 of the State Environmental Code,310 CMR 15.287(10),re- quires that"prior to obtaining a Certificate of Compliance for installation of a new or upgraded system,the sys- tem owner shall record in the chain of title for the property served by the alternative system in the Registry of Deeds and/or Land Registration Office,as applicable,a Notice disclosing both the existence of the alternative on-site system and the Department's approval of the system.The system owner shall also provide evidence of such recording to the local Approving Authority[;J"and WHEREAS, the Property is served by an alternative sewage disposal system. . NOW,THEREFORE,Notice of an alternative sewage disposal system is hereby given for the above- referenced Property,as follows: 1.Existence.An alternative system has,been installed as a new or upgraded alternative sewagedisposal system,on or adjacent to the Property,and serves the Property.The trade name and model number(s)of the alternative system are as follows: . Trade name of Technology:NitROF1 Waste-Water Treatment System Manufacturer Name: KleanTuO LLC Model number(s): NitROE®2KS WWTS Page l of 2 .S 1' Bk 34781 Pg320 #83611 2.Approval/Certification. On May 12, 2020 [date],the Department,pursuant to its authority under the sec- tion of Title 5 as specified below,.approved or certified the technology used in the above-referenced alternative system,,under MassDEP Transmittal.Number:X285590(Transmittal Number of approval or certification(. [Check one of the following,as applicable 0 T N 0 T _Approved for remedial use under AftMR 15,284 A N _Approved for piloting unflerl91�dMPL A.A5L O F F I C I A L X Provisionally approved under 3(P0 tN?RX 5.286 C 0 P Y Certified for general use under 310 CMR 15.288 A copy of the Department's Approval/ke�tfication is available from th%DApartment in person or on-line at the Department's website: htt :// w�.►�asT ..•L OFF I C I A L WTI'NESS the execution heoPull'de$scal this day ofC'PffiS�:.T2-2021,made by the above- named Alternative System Owner(s). . Signature- 0L /9('t Print Name: 0 M 0QC zZ9 N A,RA V J O Signature: Print Name: A t rna rve SyW&h caner s Print Name(s): 14/ 1 PzA U a COMMONWEALTH OF MASSACHHUSETTS Bamstable ,ss On this�day of tJ ' ,2021,before me,the undersigned notary public,personally appeared 1&,,> (name of document signer),proved to me through satisfactory evidence of identification,which were -Qp j'y cglS ,cn5trto be the person whose name is signed on . the preceding or attached document,and acknowledged to meth he)signed it voluntarily for its stated purpose. (official signature and seal of notary) (Complete the following Property Owner(s)Consent if Alternative System Owner(s)Is other than the Property Owner(s):l CONSENTED TO: , (Property CK er(s)1. 1 Print Name(s): A0002 A RAU JQ Date: �3/ :PCo,,v.J COMMONWEALTH OF MASSACHUSETTS y Barnstable ,ss 1. On this L day of, ,2021,before me,the undersigned notary public,personally appeared ARA U- O (nametof document signer),proved to me through satisfactory evidence of identification, which were J�F� 54 393-�Ql VET S L i C�1u`'�F .to be the person whose name is signed on the precedingor attached document,and acknowledged to me that(he) s igned it voluntarily for its.stated p��urpose. o icia signature and seal of notary Upon recording,rehun to: NIVIA M FAGUNDES Andrezza N.Araujo,7 Erin Lane,Hyannis,MA 02601 a Notary Publio VD1 COMMONWEALTH OF MASSACHUSETTS ®A Page My Commission Expires 'BARNSTABLE REGISTRY OF DEEDS Sept. 12, zo2s co.. o Cy�X,,; Jahn F. Meade, Register Town of Barnstable .°�" .� Inspectional Services • r EARN rae[.s, Public Health Division 039. �� Thomas McKean,Director off° 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: 11^7,2 ZPL\ Sewage Permit# Assessor's Map\Parcel ZA\-o1-7"a! Designer: w w. + Installer: E-I►-ry w Address: ��G�"Fxr� (oS�{ Address: Pb, � -1 1 Yh1R,�sTorJS W�t(�,,5 05Wk, py1l�r bZ6 tM►�SS. 626�P�_ On 2. Z1 2 1 C STe_TC4VS was issued a permit to install a (date) (installer) septic system at 72 1✓nn 1-c/,c, h7gwlt based on a design drawn by (addre s) dated -SA-T G,1010 (Ilesig*e It,;, 11 o(ulto'-l I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out (if required) was inspected and the soils were found satisfactory. .,-' certify that the system referenced above was constructed in co a with the to rms of the RA approval letters (if applicable) tN OF a14S.Y c gJOHN C J> GDEA r ; CIVIL vs i n s Signature) " No.48ts8 L 9FGIST FSS/OVAL LNG ( esigner's Signature) (Affix Designer p Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. WoAdeptAHEALTMSEWER connecASEPTICOesigner Certification Form Rev&I4-I3.DOC Town of Barnstable IM"STABLL MAS& Board of Health 200 Main Street,Hyannis MA 02601 Office: 508-862-4644 John T.Norman FAX: 508-790-6304 Donald A.Guadagnoli,M.D. Paul J.Canniff,D.M.D. Mr. Henrique Sousa January 27, 2020 7 Erin Lane c Hyannis, MA 02602 RE-'.7 Erin Lane; Hyarnis, Massachusetts: Dear Mr. Sousa, You are granted permission to design and install an onsite sewage disposal system which incorporates a secondary treatment,unit with enhanced nitrogen removal technology in order to accommodate a four (4) bedroom single family dwelling at 7 Erin Lane, Hyannis, Massachusetts. This permission is granted with the following conditions: 1. You must hire a professional engineer (or registered sanitarian) to design an onsite sewage disposal system with a secondary treatment unit with nitrogen reduction technology (e.g. NITROE system). 2. No more than four (4) bedrooms are authorized. Dens, study rooms, finished attics, sleeping lofts, and similar type rooms are considered "bedrooms." 3. The owner shall record a properly worded deed restriction, signed by the owner of the property, at the Barnstable County Registry of Deeds restricting the property to four (4) bedrooms maximum. A copy of the recorded deed restriction shall be submitted to the Health Agent prior to obtaining a disposal works construction_permit. 4. A monitoring plan shall be submitted for the use of the secondary treatment unit. The nitrogen concentration shall not exceed 10 milligrams per liter at the downgradient property line. Q:\WPFILES\Sousa 7ErinLane 2020.docx r, 5. The designing engineer shall supervise the construction of the onsite sewage disposal system and shall certify in writing to the Board that the system was installed in substantial compliance with the submitted plans. This property consists of 11,412 square feet and is located within a well protection district and a State designated Zone II. A two bedroom septic system was approved by the Health Department when the home was constructed in 1983. However, four bedrooms currently exist within this two level dwelling. The applicant recently purchased the home which was advertised as a three to four bedroom home by a realtor. This permission is granted because an innovative/alternative nitrogen removal system will be provided onsite. Sincerely, ,46nn T. orman Chairman Board of Health Q:\WPEILES\Sousa HrinLane 2020.docx t E McKean, Thomas _ From: McKean, Thomas Sent: Wednesday, October 23, 2019 12:26 PM To: 'Patrick Foran' Cc: 'Thiago Monteiro' Subject: RE: 7 Erin Lane ®�vnP,lL' Good Afternoon, ----�, Thank you for your e-mail. The issue is: This site is located within a State designated Zone II (nitrogen sensitive area) and the parcel is only 11,412 square feet in size. Based upon today's regulation(s), only a one-bedroom home could be constructed there. However there is an existing home there. The number of bedrooms is not based upon an inspection report nor on outdated calculations of the capacity of what the existing septic system could handle. According to MA Department of Environmental Protection ( DEP) , the only document that is used to determine the maximum number of bedrooms which may be allowed at a particular piece of property is the disposal works construction permit. On that document, there is a line entitled "no. of bedrooms_" The existing disposal works construction permit for this property is for only two (2) bedrooms (permit number 83-484), not three nor four. If you should have any additional questions, please call me at 508 862-4640. Sincerely, Thomas McKean From: Patrick Foran [mailto:pforanCabforanrealty.com] Sent: Wednesday, October 23, 2019 12:10 PM To: McKean, Thomas Cc: Thiago Monteiro Subject: 7 Erin Lane Importance: High Dear Mr. McKean, One of my agents,Thiago Monteiro, represented the buyer on the above referenced property. I am trying to figure out what the issue is that the BOH is concerned with so we can have the appropriate parties at the upcoming hearing. I am hopeful you can shed some light on it for me. Attached is a copy of the failed inspection report completed by Sean Jones of SM Jones Title V Septic Inspection dated 7/8/19. According to this report the current(failed) septic is a 4 bedroom system (see section D 1. Page 7). 1 also have attached a copy of the plans for the new 4 bedroom system as prepared by EcoTech dated September 18, 2019. This plan appears to call for the replacement of the current 4 bedroom system with a new 4 bedroom system. In looking at the field card the assessor's office has the property listed as a 4 bedroom. (see attached). I understand errors can be made on field cards and have had them come up in the past(outside of Barnstable) where they had a property listed as a 3 bedroom but the septic was only for a 2 so we marketed the property as a 2 bedroom in one case and in another we had the system upgraded to a 3 bedroom. I • 4 I noticed that on the BOH agenda the issue appears to be a bedroom discrepancy, which I would understand if the existing system was smaller than 4 bedrooms but from everything we see it is not. If you could please explain to me what the issue is I would greatly appreciate it. Thank you, I look forward to hearing from you and working with you to resolve the concerns of the BOH. Patrick Oh, by the way... Please remember, we can help your friends and family move anywhere, across town or across the country. We are never too busy for any of your referrals. Patrick J Foran, a-Pro, SFR President(MA Brokers License #9089920) Foran Realty, Inc. (MA License#7149) Office: 543 Route 6A Dennis, MA 02638 Mail To: PO Box 839 East Dennis, MA 02641 Telephone 508-385-1355 Ext. 211 Toll Free 888-385-9114 Cell Phone 774-836-0182 Fax 508-385-7308 Residential and Commercial dales Vacation Rentals Property Management WWW.Ca peCod Properties.com E-mails sent or received shall neither constitute acceptance of conducting transactions via electronic means nor create a binding contract until and unless a written contract is signed by the parties. WIRE FRAUD ALERT: If you receive an e-mail from this office requesting that you wire or otherwise transfer funds:you must confirm the request and any corresponding instructions by telephone with this office before you initiate any transfer. It is the practice of this firm not to accept wire transfers. E- mail accounts of Real Estate office are being targeted by hackers in an attempt to initiate fraudulent wire requests. The information contained in this email,including any attachments,is confidential information intended only for the individual named above. If you are not intended recipient,you are hereby notified that photocopying or disclosure of the information contained herein is prohibited. If you received this email in error please contact this office immediately at 508-385-1355. Thank you. CAUTION:This email originated from outside of the Town of Barnstable! Do not click links, open attachments or reply, unless you recognize the sender's email address and know the content is safe! 2 i Crocker, Sharon 0 From: Crocker, Sharon Sent: Tuesday, November 26, 2019 11:00 AM To: 'thiago@foranrealty.com'; davidcou@hotmail.com; 'henriqueaosouse@hotmail.com'; 'ddc@ddc.is' Subject: FW: Board of Health Agenda - Tue Nov 26 TO: Henrique,Thiago, and David Coughanowr Yes,that would be fine. The next Board of Health meeting is Tuesday, December 17, 2019 and I will put 7 Erin Lane, Hyannis onto Dec 17, 2019 agenda. Thank you. Sharon Crocker Administrative Assistant From: Thiago Monteiro [mailto:thiago@foranrealty.com] Sent: Tuesday, November 26, 2019 9:42 AM To: Crocker, Sharon Cc: Henrique Sousa Subject: Re: Board of Health Agenda -Tue Nov 26 Hi Sharon, I just heard from the engineer and unfortunately he will not be able to attend today's hearing on behalf of Mr. Sousa for 7 Erin Ln. He was flying from Iceland this morning but had some issues and will not be able to make it. When is the next hearing and could we be on it's agenda? Regards, Thiago L. Monteiro • Realtor(MA License#009529804) Foran Realty, Inc. (MA License#7149) Office: 543 Route 6A Dennis, MA 02638 Mail To: PO Box 839 East Dennis, MA 02641 Telephone 508-385-1355 Ext. 217 Toll Free 888-385-9114 Cell Phone 508-360-0205 Fax 508-385-7308 e 1 Excerpt from the Board of Health Meeting Minutes on January 21, 2020 I. Bedroom Discrepancy (Cont.): Henrique Sousa, new owner, and Maureen Shea - 7 Erin Lane, Hyannis, Map/Parcel 291- 017, 2 versus 4 Bedrooms, continued from.December 17, 2019 meeting. GRANTED CLASSIFICATION AS A FOUR BEDROOM WITH CONDITIONS. The Board discussed their concerns. The program which Zenas Crocker is currently accepting applicants for was brought up. The pilot program is for-the Nitro system and he would be willing to see if they could get into the pilot program and Mr. Crocker's program would help bridge the gap of cost between what is held in escrow and the cost of this I/A system. Mr. Crocker believes the ongoing maintenance would be very minimal as it is a standard septic system with an additional tank and with the use of wood chips. The Board voted to approve the four bedroom classification pending the submission and permitting of the Nitro I/A system (pilot program) which reduces nitrogen flow to less than 10 mg/liter at the downgradient property line and would be maintained in perpetuity with the property through a deed restriction; otherwise, must be reduced to a three bedroom. • I7 • . KleanTu MEW t v mWN�y Muml _ flip m Converts Converts "Ammonia-N toa Nitrate-N to a - Air?urn ,', Nitrate-N Nitrogen Gas ,.-- Mach Pit,dr;r a h Field .Septic Tank �Aerataion Wood Chi g ` P P Effluent Absbrptican r v m Chamber Chamber w... 100,percent gravity flowOwl . h... a . . :1 Nil ft-- * F KLeanTu Conventional Title 5 Septic System w 13�' m. lid � . Ieach Pit air Ledch, Frei�f Septic Tank ¢ . �� ifitueir4t AbsorptiQn .. :< ' ' ,+ .x4t . . x -. r... .., r,i. t - m z�a07H m a-„ ,k u MR ...... .. ......_. _ ........ �. y . .......... �o .... t� zl; �l 1 4J i ) f rt- All. -..r .'.. ._.._._.. ..... ._ _ _. ........ 1� ti ran .a _ __ .. .. ........ 3 rya' i i . y .... _ ..... _ . ; 1 ,P e / ...o.. i,�.... ,....... ............ ... ... .... ...... ... ..:.......... .. ..:.. .......... :.. .....\ ` ............_ e....... T'i . ..i... ....... ..... .. ....... ... �J i y 3. _ ...i... . . ........ . 1 r .......... ,....... 3 _. Mimi -- .. .. .. ......... ..._... ...... ...._...c _ : .._.... .... ...:___. _..._._. _.. .. .. ibAOPT _. .._. ......�..... UP I ... .. ... SM V I e... ..._..._ .._......._ __......_ .....__..... _4. _._.. .. ..._............ .......... j_. .. ..........__.. ... c 1 . v a "........ .......... ..... ........... .. ...s. .... .......... ......... : P ........__ _ _. ..__ �. .__.._..._ . . . �v R 3= G 1 . ....... � _ .....-. _.. ...... ill ..,.. . . . �. ,. ... . . .. .. .. ... .. .. .. i ... .. d.. ._.__..... _..__._._ .__..._.... ..._.... ........... ............ .......... . IbO 60 F7 i BOH JAN 21, 2020 I. Bedroom Discrepancy (Cont.): Henrique Sousa, new owner - 7 Erin Lane, Hyannis, Map/Parcel 291-017, 2 versus 4 Bedrooms (Continued from the December 17, 2019 meeting. CONTINUED TO THE JANUARY 21, 2020 MEET ING. Henrique Sousa was present. The Board voted to continue to the January 21, 2020 meeting and will research building files and assessing. i F- 0( Crocker, Sharon W4 From: McKean, Thomas Sent: Wednesday, December 18, 2019 3:07 PM To: Donald Guadagnoli, M.D.;fplee@horsleywitten.com;johnnormanl2@comcast.net; Paul Canniff(canniff.paul@gmail.com) Cc: Crocker, Sharon Subject: Documents/ Records for 7 Erin Lane, Hyannis This site is located within a ZONE II, a nitrogen sensitive area, and the parcel size is only 11,412 square feet. The number of bedrooms is restricted to one bedroom per 10,000 square feet. Hypothetically if this parcel was vacant, only a one bedroom home could be constructed there. As requested at yesterday's Board meeting,the following documents were retrieved from the Building Department, Assessor's records and real estate listing: - Building Department records-Only document found there is building permit application to construct a dwelling; Number of Rooms"4." [The number of"rooms" are noted, not bedrooms; the Building Department did not ask for the number of bedrooms on their application forms in 1983. Also, there are no floor plans on file at the Building Department]. - This building permit application document is dated June 28, 1983 and references the sewage permit number 83- 484, which was issued by the Health Department for two(2) bedrooms. - Assessor's Record - Indicates 4 Bedrooms currently. - Real Estate listing—Indicates 3 Bedrooms in the main heading of the real estate listing; then the listing describes "three to four bedrooms" in the description,then it specifically lists it as a 3 bedroom in the "Property Summary." As discussed during the meeting,the Health Department issued Disposal Works Construction Permit number 83- 484 for two(2) Bedrooms,which is the only recognized official document for use when determining a maximum bedrooms count,according to MA DEP . NOTE: Erroneously within the file folder for 7 Erin Lane,there was a disposal works construction permit#77-102 for Lot 11A Pitchers Way which noted thee (3) bedrooms. This record was erroneously marked in red as "#7 Erin Lane "by someone and does not belong within this street file. - 1 o. Fee /o d THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for �Digpogal 6pgtem Construction Permit Application for a Pe`Irmit to Construct O Repair D< Upgrade O Abandon O ❑Complete System 4individual Components Location Address or Lot No. ��J �,��i� Owner's Name,Address,and Tel.No. r,-c>!& � 1 (a l,Ma�`Ct Assessor's Map/Parcel rG l -7 C�.S,J l�l Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. tUS (k l��C. N'fANMS Type of Building: v Dwelling No.of Bedrooms X 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. Description of Soil Nature of Repairs or Alterations(Answer when applicable) QL'nxje lmMISUTlcla 6-0j- 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 o the Environmen de and not to place the system in operation until a Certificate of Compliance has been issued by this B rd f H al Signed Date Application Approved by Date b l 7d 7 Application Disapproved by: Date for the following reasons Permit No. 2,0t)'j Date Issued a 1 d o. �_ ` i, �J - Fee /uJ ` Entered in cbm uteri THE COMMONWEALTH OF-MASSACHUSETTS p PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE, MASSACHUSETTS Yes ` A _ - ZIpprication for Mi5pogal 6pgtem Construction Permit _ pplication for a Permit to Construct O Repair;(K) Upgrade O Abandon O ❑ Complete System Individual Components iN Location Address or Lot No. "' L !� �� Owner's Name,Address,and Tel.No. { ) Owrc a, Assessor's Map/Parcel G ) — o I r G 11 —7 kEYZ0 J LIJ Installer's Name,Address,and Tel.No. a Designer's Name;Address and Tel.No. w of&Qtotq (0-,WGL4j -k"M 50�-11-5 1'itot, Type of Building: (n 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 spa +. Plan Date Number of sheets Revision Date 4 Title s Size of Septic Tank Type of S.A.S. Description of Soil 1 Nature of Repairs or Alterations(Answer when applicable) QEP LX.0 N`�;l fb gU l&3 e,w 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 Titlo"01 the Environme ode and not to place the system in operation until a Certificate of Compliance has been issued by this ar of ea h. Signed 4 Date` �d>' Application Approved by f, Date b I o -7 i Application Disapproved,by: Date i' for the following reasons Permit No. 7Qd3 Date Issued G v ----------------------- ------ --- -- -- THE COMMONWEALTH OF MASSACHUSETTS 04 V/4x ull BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the /On-site /Seewage Disposal System Constructed ( ) Repaired (�� Upgraded ( ) Abandoned( )by b! L11j-_-Z 11I,l.cLe / V lwil 4 at `� n rJ r,� has.been Constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. a1T&_-7 dated 19 Id 7 /a � 4 Installer ",-.u-� -cw{. 6,�til i 2 Designer r #bedrooms AI Ifi, Approved design flow AJ A gp The issuance of this permit shall dot be co 'trued s a guarantee that the systewill unction`as designed Date Inspector N r----1—/------- ——————————— L/ ——————— •� y—�-- -- No. 0 7 cf b Fee 00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS : .: . &-gpo!gal �6p!gtem Construction Vermit Permission is hereby granted to Construct ( ) Repair Upgrade ( ) Abandon ( ) System located at '� Cori;V _ram-►.� and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must�0-7 e completed within three years of the date of this pe m-Date �{ Approved by rA r Town of Barnstable Baenstable THE Inspectional Services Department A&ft 'ccrty • BARNR ABLE; MASS. 1639. �� Public Health Division a �ArE° 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL47015 1730 0001 4987 9071 August 12, 2019 ALMONTE, REBECCA & MICHAEL 7 ERIN LANE HYANNIS, MA 02601 ' ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 7 Erin Lane, Hyannis, MA was inspected on 07/08/2019 by Sean M. Jones, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within one (1) year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. f } PER ORDER OF THE OARD OF HEALTH e n, S., Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mading\Failed or Needs Further Evaluation Letters\7 Erin Lane Hyannis.doc r 1NE ram, Town of Barnstable i • BARNFrAHLE, 6 9 1. Inspectional Services Department rfD MA'S - Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 4/26/19 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 ❑ Structurally unsound septic tank or SAS ME 1 YEAR DEADLINE CRITERIA tatic 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) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc O!/ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal,System Form-Not for Voluntary Assessments 7 Erin Lane Property Address r:+ Michael& Rebbeca Almonte s Owner Owner's Name/ information is . required for every Hyannis Ma 02601 7/8/2019 page. Cityrrown State Zip Code Date of Inspection - is 3 Inspection results must be submitted on this form. Inspection forms may not be altered in any way.Please see completeness checklist at the end of the form. Important:When A. Inspector Information �� 89 9 fillip out forms Z' on the computer, use only the tab Sean M. Jones key to move your Name of Inspector cursor-do not S.M.Jones Title V Septic Inspection use the return Company Name key. 74 Beldan Lane "Ir=51 Company Address Centerville Ma 02632 Cityrrown State Zip Code ICI 774-248-4850 smjonestitle5@gmail.com, SI4522 sean@smjonestitle5.com License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 16.340 of Title 5 (310 CMR 16.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ❑ Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ® Fails 7/8/2019 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 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note;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. 15insp.doc•rev.MUM 8 Me 5 Official Inspection Form:Subsurface Sewage Disposal System•Page t.of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 7 Erin Lane Property Address Michael &:Rebbeca Almonte Owner Owner's Name information is required for every Hyannis Ma 02601 7/8/2019 ' page cityrTown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1,2, 3, or and all of 4 and 6. , } r 1) 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: 2) System Conditionally Passes: El 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): t5insp.doc-rev.7262018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Pepe 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 7 Erin Lane Property Address Michael& Rebbeca Almonte Owner Owner's Name information is Hyannis Ma 02601 7/8/2019 required for every H Y = page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes(cunt.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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): 3) 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. a. 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: 15insp.doc•rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 7 Erin Lane Property Address Michael & Rebbeca Almonte Owner Owner's Name Information is required for every Hyannis Ma 02601 7/8/2019 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ . Cesspool or privy is within 50 feet of a surface water El Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. '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: El 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. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: . .Yes No El Backup of sewage into facility or system component due to overloaded or ® clogged SAS or cesspool Discharge orponding of effluent to the surface of the ground or surface waters ❑ ® due to an overloaded or clogged SAS or cesspool t5lnsp.doa c rev,7/28018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 I Commonwealth of Massachusetts - — Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 7 Erin Lane Property Address Michael & Rebbeca Almonte Owner Owner's Name information is required for every Hyannis Ma 02601 7/8/2019 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ® ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipes) 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 water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes If the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen Is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ® ❑ 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. 5) 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 C.4. 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 15insp doc rev.726/2018 Title 5 Official Inspetlion Form,Subsurface Sev a Disposal system•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 7 Erin Lane Property Address Michael& Rebbeca Almonte Owner Owners Name information is required for every Hyannis Ma 02601 7/8/2019 page. Cityrown State Zip Code Date of Inspection C. Inspection Summary (cont ) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The. owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 31.0 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for all inspections: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? El ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on; ® ❑ Existing information. For example, a plan at the Board of Health. IR El 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)] t5insp.doc•rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 c� Commonwealth of Massachusetts -- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 7 Erin Lane Property Address Michael& Rebbeca Almonte Owner Owner's Name information is required for every Hyannis Ma 02601 7/8/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 gpd Description: Number of current residents: 0 Does residence have a garbage grinder? El Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: 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: unknown Date 15insp.doc•rev.71262018 Tlge 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7 Erin Lane Property Address Michael &Rebbeca Almonte Owner Owner's Name information is required for every Hyannis Ma 02601 7/8/2019 page. CitylTown State Zip Code Date of Inspection D. System Information (cont) 2. Commerciallindustrial 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 Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system?. ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping:' 15insp.doc•rev.7 IW118 Title 5 Of ciRl Inspection Form:Subsurface Sewage Disposal System page 8 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 7 Erin Lane Property Address Michael &Rebbeca Almonte Owner Owner's Name information is Hyannis Ma 02601 7/8/2019 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components,date installed (if known)and source of information: original system 1984 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑cast iron ❑40 PVC unknown ❑other(explain): i Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Inlet cover of tank is under deck, sewer line was not inspected. i5insp.doc-rev 7282018 Title 5 official Inspection Forth:Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 7 Erin Lane Property Address Michael& Rebbeca Almonte Owner Owner's Name information is H annis Ma 02601 7/8/2019 required for every y page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 6. 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: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallons Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle Scum thickness w Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How,were dimensions determined? measurements not taken. Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Inlet cover is under deck and not easily accessable. Inlet cover was not opened. Tank is overdue for cleaning.Water level was at outlet invert. t5insp.doc-rev.72612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 7 Erin Lane Property Address Michael& Rebbeca Almonte Owner Owner's Name information is required for every Hyannis Ma 02601 7/8/2019 page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) 7. 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 Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): - 8. 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 [Sinsp.dod;rev.7/28f2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 1 a Commonwealth of Massachusetts Title 5 Official Inspection Form ^ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 7 Erin Lane Property Address Michael& Rebbeca Almonte Owner Owner's Name information is Hyannis Ma 02601 7/8/2019 required for every y page, Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 8, Tight or Holding Tank(cont.) 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 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Stain lines 2'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.): Distribution box was video inspected and found full of solids carryover. High stain lines indicate box has been overloaded in past. t5insp,doo-rev..7/26/2018 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts I uv� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 7 Erin Lane Property Address Michael&Rebbeca Almonte Owner Owner's Name information is required for every Hyannis Ma 02601 7I8/2019 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ' ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain,why: Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: El leaching fields number, dimensions: overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.72812018 Title 5 official Inspection Form!Subsurface Se."go Disposal System Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for VoluntaryAssessment s 7 Erin Lane Property Address Michael & Rebbeca Almonte Owner Owners Name information is required for every Hyannis Ma 02601 7/8/2019 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS)(coot.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach pit was found with standing water 10"below inlet. stain lines indicate that the pit has been overloaded when house was last occupied. 12. 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 Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp,doc-rev_7f2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 7 Erin Lane Property Address Michael& Rebbeca Almonte Owner Owner's Name information is required for every Hyannis Ma 02601 7/8/2019 page. City/Town State Zip Code Date of Inspection D. System Information (coot.) 13. 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.): 15insp.doc•rev.7260018 Tide 5 Official Inspection Form;Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 7 Erin Lane Property Address Michael&Rebbeca Almonte Owner Owner's Name inftirmation Is Hyannis page, gY p Ma 02601 7/8/2019 required for every frown State. Zip Code Date of Inspection D. System Information (cont.) 14. 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 O O ' b I ; �l i3 Llz Z He A3 3 Uilnsp.doc•rev.7/wml a Tide 6 Official Ytspedlon Forth:Subsurface Sewage Disposal System•Page 16 0116 Commonwealth of Massachusetts -W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments ' 7 Erin Lane Property Address Michael& Rebbeca Almonte Owner Owner's Name information is y required for every Hyannis Ma 02601 7/8/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells 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: 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: Groundwater was not established. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc rev.7r2812018 Title 5 ORaal Inspection Form,Subsurface Sewage Disposal System!Page 17 or 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 7 Erin Lane Property Address Michael & Rebbeca Almonte Owner Owner's Name information is Hyannis Ma 02601 7/8/2019 required for every y page. cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete ail fields in this section. ® B. Certification: Signed&Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4(Failure Criteria)and 6(Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 TdW 5 Official Inspection Form;Subsurface Sewage Disposal System•Page 18 of 18 I BOUCHARD BAKERPC 120 North Main Street,Suite A1 ( Attleboro,R,�4 42703 Phone:509-222.0409 1 Fwc 401-427-2311 ww"rBouchardBaker.com July 16, 2019 Barnstable Town Hall Health Division Attn: Vanessa 200 Main Street Hyannis, MA 02601 RE: Sousa, Henrique 7 Erin Lane, Hyannis, MA 02601 Septic Inspection Dear Sir/Madam, Enclosed, please find check no., 1885, in the amount of$25.00 (Twenty-five and 00/100 USD), representing payment for the Septic Inspection for the above-referenced property. If you have any questions regarding this matter,please do not hesitate to contact us. Sincerely; Rebecca Godbout, Legal Assistant rebecca@bouchardbaker.com Town of Barnstable Regulatory Services Thomas F. Geiler, Director Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 July 16, 2007 Ms Rebecca Almonte 7 Erin Lane Hyannis, MA 02601 i ORDER TO COMPLY WITH STATE ENVIROMENTAL CODE, TITLE 5 The septic system located at 7 Erin lane, Hyannis, MA was last inspected on June 8th, 2007, by Jason Burnie, a certified inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Conditionally Passed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: The D-box is rotted and needs to be replaced. You have 2 years from the date of the system failure to bring the system into compliance. If there are any questions about this reminder, please feel free to contact the Barnstable Health Department. BARNSTABLE HEALTH DEPARTMENT Thomas A. McKean,R.S., C.H.O. Agent of the Board of Health 1 ! . 'G,' ._ '�i ....'t'.• .: I 1 � .. • ,, a r r-t ui �. • Im rq • I - ,. Postage $ o p Certified Fee pReturn Receipt Fee =a JUL i y ` (Endorsement Required) �S O Restricted nt RQ'Fee ` � (Endorsement Required) rq Total Postage&Fees p2/ USPS t3 Sent To O � (� �h ------------- tlrMt�No.: or PO Box No. City State.Z%P+4---- ------- 0a 6-0/ Certified Mail Provides:e A mailing receipt (asianad)ZOOZ eunf'008E wood Sd o A unique identifier for your mailpiece n A record of delivery kept by the Postal Service for two years Important Reminders: n Certified Mail may ONLY be combined with First-Class Mail®or Priority Maile. e Certified Mail is not available for any class of international mail. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPSS postmark on your Certified Mail receipt is required. n For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". n If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. Internet access to delivery information is not available on mail addressed to APOs and FPOs. f Town of Barnstable Regulatory Services Thomas F. Geiler, Director Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 July 16, 2007 . Ms Rebecca Almonte 7 Erin Lane Hyannis, MA 02601 ORDER TO COMPLY WITH STATE ENVIROMENTAL CODE, TITLE 5 The septic system located at 7 Erin lane, Hyannis, MA was last inspected on June 8th, 2007, by Jason Burnie, a certified inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Passed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: The D-box is rotted and needs to be replaced. You have 2 years from the date of the system failure to bring the system into compliance. If there are any questions about this reminder, please feel free to contact the Barnstable Health Department. BARNSTABLE HEALTH DEPARTMENT C Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health -Ilaq Q� Town of Barnstable Regulatory Services Thomas F. Geiler, Director Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 July 16, 2007 Ms Rebecca Almonte 7 Erin Lane Hyannis, MA 02601 ORDER TO COMPLY WITH STATE ENVIROMENTAL CODE, TITLE 5 ( The septic system located at 7 Erin lane, Hyannis, MA was last inspected on June 8`h, 2007, by Jason Burnie, a certified inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Conditionally Passed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: The D-box is rotted and needs to be replaced. You have 2 years from the date of the system failure to bring the system into compliance. If there are any questions about this reminder, please feel free to contact the Barnstable Health Department. BARNSTABLE HEALTH DEPARTMENT Thomas A. McKean, R.S:, C.H.O. Agent of the Board of Health l �? r Commonwealth of Massachusetts y� VgeimTitle 5 Official Inspection Fo rm orm Not for Voluntary Assessments Subsurface Sewa Dsposal System Form i Inspection results must tie submitted on this form. Inspection forms may not be altered in any way. A. General Information Important: When filling out 1. Property Information: forms on the I / • �� computer,use 7 ERIN LN HYANNIS,MA 02601 y'1/ ' only the tab key Property Address to move your REBECCA ALMONTE r r cursor-do notes use the return Owner s Name i r10 key. 7 ERIN LN cr Owner's Address HYANNIS j MA 02} 1 f„ unylrown i State Zip C eco Date of Inspection:. I: 6-8-07 Date 2. Inspector: JASON BURNIE Name of Inspector D.J BURNIE&SONS Company Name 105 FERNDOC ST UNIT A Company Address HYANNIS _ MA _ _ 02601 Cityrrown State Zip Code 508-775-0139 Telephone 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. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ❑ Passes ® Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority I —�` 6-8-07 Inspector's Sig2We Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 130 days of completing this inspection. If the system is a shared system or has a design flow of 10,600 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 b l yer, 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. back up 1.doc.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System- Page 1 of 16 I Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments s Subsurface Sewage Disposal System Form B. Certification (coat.) 7 ERIN LN HYANNIS,MA 02601 Property Address HYANNIS MA 02601 Cdyrrown State Zip Code REBECCA ALMONTE 6-8-07 Owner's Name Date of Inspection Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.3031 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: I i i I 13) 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. i Answer yes, no or not determined (Y, N, ND) in the ❑for the following statements. If"not determined,"please explain. ❑ The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with 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: back up 1.doc.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 2 of 16 Commonwealth of Massachusetts Title 5 Official Ins ection Form p Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Certification (cont.) 7 ERIN LN HYANNIS,MA 02601 Property Address HYANNIS MA 02601 Cityfrown State Zip Code REBECCA ALMONTE 1 6-8-07 Owner's Name l Date of Inspection 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(WithI approval of Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed ® distribution box is leveled or replaced ND Explain: ------�f THE DISTRIBUTION BOX IS ROTTED AND THE SIDEWALLS ARE CRUMBLING I i ❑ 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 pip i(s)are replaced ❑ obstruction l is removed ND Explain: i I I C) Further Evaluatio i 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. I. System will pass unless Board of Health determines in accordance with 310'CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh �I back up.i.doc.doc•0312006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 3 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for VoluntaryAssessor ents y Subsurface Sewage D I isposal System Form M B. Certification (colnt.) 7 ERIN LN ; HYANNIS,MA 02601 Property Address HYANNIS MA 02601 City/Town State zip Code REBECCA ALMONTE 6_8_07 Owner's Name Date of Inspection C) Further Evaluation is Required by the Board of Health(cont.): I 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and enviro ment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surfa Ice water supply or tributary to a surface water supply. I ❑ 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 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: i I — I back up 1.doc.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4 of 16 i i Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments J. Subsurface Sewage iisposal System Form B. Certification (cunt.) 7 ERIN LN HYANNIS,MA 02601 Property Address HYANNIS MA 02601 Cityrrown State ZipCode REBECCA ALMONTE 6-8-07 Owner's Name II Date of inspection f D)System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No El ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded oi'clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or structed pipe(s). Number of times pumped: i ❑ ® 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. ❑ ® A y portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [Phis system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence 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 of chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. 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. I back up 1.doc.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 5 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments y Subsurface Sewage Iisposal System Form B. Certification (cunt) 7 ERIN LN HYANNIS,MA 02601 Property Address HYANNIS ; MA 02601 City/Town State Zip Code REBECCA ALMONTE 6-8-07 Owner's Name Date of Inspection E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 Igpd 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 A�ea—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. i back up 1.doc.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 6 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary As$ pessments ,r Subsurface Sewage Disposal System Form r C. Checklist i 7 ERIN LN j HYANNIS,MA 02601 Property Address HYANNIS MA 02601 . City/Town State Zip Code REBECCA ALMONTE 6-8-07 Owner's Name Date of Inspection 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? I ❑ ® Has the system received normal flows in the previous two week period? El ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Wire all system components, 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: ® ❑ Ez S ting 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 aproximation of distance is unacceptable)[310 CMR 15.302(5)] I bade up 1.doc.doc•03/2006 I Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 7 of 16 i i Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments ,y Subsurface Sewage Disposal System Form i D. System Information 7 ERIN LN HYANNIS,MA 02601 Property Address HYANNIS MA 02601 City/Town j State Zip Code REBECCA ALMONTE I 6-8-07 Owner's Name Date of Inspection Residential Flow Conditions: Number of bedrooms(design): r epoper prior Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 per prior report Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonaluse? ® Yes ❑ No PD Water meter readings, rf available(last 2 years 1 06=usage(gpd)): 07= 0 G GPD Sump pump? ❑ Yes ® No Last date of occupancy: UNKNOWN Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) 9 Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No I Industrial waste holding ltank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): i back up 1.doc.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System- Page 8 of 16 i � i Commonwealth of Massachusetts Title 5 Offi'cial Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cunt.) 7 ERIN LN I I HYANNIS,MA 02601 Property Address HYANNIS i MA 02601 cdylrown State Zip Code REBECCA ALMONTE 6_8_07 Owner's Name I Date of Inspection jGeneral Information Pumping Records: Source of information: ' OWNER, PUMPED WITHIN 5 YEARS Was system pumped as part of the inspection? ❑ Yes ® No i If yes,volume pumped:, gallons How was quantity pumped determined? I Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single I cesspool El Overflow cesspool ❑ Privy i ❑ Shared,system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all Components, date installed(if known)and source of information: 1984 PER PRIOR REPORT ON FILE AT BARNSTABLE BOH h Were sewage odors detected when arriving at the site? ❑ Yes ® No i back up 1.doc.doc•0312006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 9 of 16 r Commonwealth of Massachusetts Title 5 Official Inspection Fora Not for Voluntary Assessments ,o y` Subsurface Sewage Disposal System Form D. System Information (cont.) 7 ERIN LN j HYANNIS,MA 02601 Property Address J' HYANNIS MA 02601 Cityrrown ! State Zip Code REBECCA ALMONTE 6-8-07 Owners Name Date of Inspection Building Sewer(locate on site plan): I „ Depth below grade: 21 feet Material of construction: R ❑ cast iron N 40 PVC ❑other(explain): I Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): I Septic Tank(locate on site plan): Depth below grade: 13"feet Material of construction': I ® 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 ❑ Yes ❑ No certificate)--------------I---------------------------- -------------------------------------------------=----------- Dimensions: 1000GAL Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 2" Distan r k ce f om top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? SLUDGE JUDGE back up 1.doc.doc•03/2006 I Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 10 of 16 - i Commonwealth of Massachusetts . Title 5 ®fficial Inspection Form Not for Voluntary Assessments Subsurface Sewage iisposal System Form D. System Information (cont.) 7 ERIN LN j HYANNIS,MA 02601 Property Address HYANNIS MA 02601 City/Town State Zip Code REBECCA ALMONTE 6-8-07 Owners Name Date of Inspection Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease Trap (locate on site plan): Depth below grade: feet Material of constructioni: ❑ concrete d 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 Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): i Tight or Holding Tanki(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: 1 Material of construction: ❑ concrete ❑�metal ❑fiberglass ❑ polyethylene ❑other(explain): back up 1.doc.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal system f Page 11 of 16 i i Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 7 ERIN LN HYANNIS,MA 02601 Property Address HYANNIS MA 02601 Citylrown ` State Zip Code REBECCA ALMONTE 1 6-8-07 Owners Name Date of Inspection Tight or Holding Tank(cont.) i 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.): 1 f r i ' Attach copy of current!pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level ab ve 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.): THE BOX IS ROTTED AND NEEDS TO BE REPLACED. I Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No I i I back up 1.doc.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal system Page 12 of 16 i Commonwealth of MIassachusetts Title 5 Offi Inspection Form lug � p Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cons.) 7 ERIN LN HYANNIS,MA 02601 Property Address HYANNIS MA 02601 Cityrrown F State Zip Code REBECCA ALMONTE 6-8-07 Owner's Name Date of Inspection Comments(note condition of pump chamber, condition of pumps and appurtenances,etc.): Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: Type: ` ® leaching pits number: 1- 6 X 6 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching�trenches number, length: ❑ leaching,fields number, dimensions: i ❑ overflow cesspool number: i ❑ innovative/alternative system Type/na a of technology: — • I Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of Al vegetation, etc.): THE SAS WAS FOUND TO BE DRY UPON THE DAY OF INSPECTION I - back up 1.doc.doc•0312006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 13 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 7 ERIN LN HYANNIS,MA 02601 Property Address HYANNIS I MA 02601 City/Town I State Zip Code REBECCA ALMONTE 6-8-07 Owner's Name Date of Inspection 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 I Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): I I i i Privy(locate on site plan): I Materials of construction: Dimensions I Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): i back up 1.doc.doc•03/2006 I Title 5 Official Inspection Form:Subsurface Sewage Disposal System- Page 14 of 16 f . i Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M e D. System Information (cont.) 7 ERIN LN j HYANNIS,MA 02601 Property Address I HYANNIS j MA 02601 CityrTown State Zip Code REBECCA ALMON I Ef 6-8-07 Owners Name ; Date of Inspection Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. i C _ /3 IE t 41326 , l 30 I I I puny 1 i j bads up 1.doc.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 15 of 16 i I Commonwealth of Massachusetts Title 5 Offi Inspection� Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cunt.) 7 ERIN LN I HYANNIS,MA 02601 Property Address HYANNIS MA 02601 Cityfrown State Zip Code REBECCA ALMONTE 6-8-07 Owners Name Date of Inspection Site Exam: Slope / Surface water Check cellar '�5 Shallow wells �o Estimated depth to ground water: �,C`4 �� i��°zi+i !fie �•�� 0,,v Die T�:D Please indicate all methods used to determine the high ground water elevation: i ❑ 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: i ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: AIW-230 ZONE D 4-5 WATER LEVEL 21.7 1.6 X 12= 19"ADJUSTMENT You must describe how you established the high ground water elevation: FROM GRADE TO BOTTOM OF SAS IT IS 84". IF YOU ADD THE 8'4"+A 4'SEPERATION+THE ADJUSTMENT OF 171 YOU HAVE A TOTAL OF 13' 11". A PREVIOUS REPORT DONE ON THE PROPERTY DATED 1998 AND ON FILE AT THE BOH AND WATER WAS SHOWN TO BE 20'+. YOU ARE OUT OF GROUNDWATER BY AT LEAST 6'. i back up 1.doc.doc•0312006 I Title 5 official Inspection Form:Subsurface Sewage Disposal System Page 16 of 16 r i c i e -ZC)o CA- zz co I j i I _ p I f d COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS " 4 DEPARTMENT OF ENVIRONMENTAL PROTECTION w j k y k f F F TITLE 5 , OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS �Y SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A 1 CERTIFICATION Property Address: 7 ERIN LN.HYANNIS,MA 02601 �� — o k Owner's Name: MEDEIROS ' Owner's Address: 7 ERIN LN.HYANNIS,MA 02601 C 1 Date of Inspection: 11/14/01 Name of Inspector: (please print) JOHN GRACI NOv s �r8 k, Company Name: SEPTIC INSPECTIONS �F gPRNgTpe�E4 � T�wH Mailing Address: _ t P'Q.BOX 2119 TEATICKET,MA.02536 EA�1H pEP 5 ` Telephone Number: 508-564-6813 FAX 508-564-7270 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below.i.s 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 psi T inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: , X Passes _ Conditional sses Needs F e valuation by the Local Approving Authority Fails Inspector's Signature: Date: 11/14/01 The system inspector shall submi a copy of this inspection report to the Approving Authority" (Board of Health or DEP)withjn%', 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 y k , inspector and the system owner shall submit the report to the appropriate re ional office of the DEP.The original should be inspe y Pg � sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. r�� •A y1. Notes and Comments SYSTEM PASSES TITLE V RECOMMEND PUMPING EVERY YEAR TO MAINTAIN SYSTEM. Sr{ i ****This report only describes conditions at the time of inspection and under the conditions of use at that time This inspection does not address ho"w4fe.system will perform in the future under the same or different conditions of use: d , Page 2 of 11 $ t a .t a._ OFFICIAL INSPECTION FORM—NOT FORS VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM �t PART A � ;. CERTIFICATION(continued)Property Address: 7 ERIN LN.HYANNIS,,MA 02601 Owner: MEDEIROS �` P'.��' Date of Inspection: 11/14/01 � ;. Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D �� . A. System Passes: i 1 X 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: ` SYSTEM PASSES TITLE V RECOMMEND PUMPING EVERY YEAR TO MAINTAIN SYSTEM. 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. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explains�f , i n/a The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits ; substantial infiltration or exfiltration or tank failure is imminent. System.will pass inspection if the existing tank is replaced' with a complyingse tic tank as approved b the Board of Health. , P PP Y *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. k ,tom ND explain: n/a n/a 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 sir Health): t _ broken pipe(s)are replaced ��3 _ obstruction is removed _ distribution box is leveled or replaced '4 r M }� t, 'j ND explain: n/a . z } it � n/a The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass �r inspection if(with approval of the Board_ of Health): ° _broken pipe(s)are replaced _obstruction is removed v �e � r , ND explain: n/a 1 t , r; Page 3 of 11 , .- i i OFFICIAL INSPECTION FORM-NOT FORYOLUNTARY ASSESSMENTS , g SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) f' ) hR p ttt Property Address: 7 ERIN LN.HYANNIS,MA 02601 ' Owner: MEDEIROS ?f� Date of Inspection: 11/14/01 . C. Further Evaluation is Required by the Board of Health: irt� Conditions exist which require further evaluation b the Board of Health in order to determine if the system is failing to q Y Y g K it protect public health,safety or the environment. K� S 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 r' _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 4z 111 y 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 ��rm 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 aYw: supply well".Method used to determine distance n/a Y "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 ammotuak Fes" nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy a; of the analysis must be attached to this form. �{�3�• 3. Other: , n/a � . ,- Y 7 rYtw� l. h1 )k'KF-L�l v TV Page 4 of 11 r �'q OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS . ; . SUBSURFACE`SEWAGE DISPOSAL SYSTEM INSPECTION FORM ` PART A tr; CERTIFICATION(continued) ' Property Address: 7 ERIN LN.HYANNIS,MA 02601 � � Owner: MEDEIROSl � Date of Inspection: 11/14/01 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all-inspections- Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _ X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool , X Liquid depth in cesspool is less than 6"below invert or available volume is less than dayflow °( q p p 4 times in the last year N Mdue to clogged or obstructed i e s .Number of times ------ pumpedr } _ X Required pumping more than t s y gg p p O n1a. ' �^ X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply, h -01 X Any portion of a cesspool b:r,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. � $4. 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, r , no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP ' of�` certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free ,x ' 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 criteriatare triggered.A copy of the analysis must be � :. attached to this form.] X _ 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. " kN E. Large Systems: a, ,t 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) fi 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- wi X 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 �y 4 ri� i �T If you have answered"yes"to an;y question in Section E the system is considered a significant threat,or answered ' 5 � "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 ownerqo E should contact the appropriate regional office of the Department. YEA; f Page 5 of 11 11V : OFFICIAL INSPECTION FORM—NOT FOR-VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ., PART Bi CHECKLIST K Property Address: 7 ERIN LN.HYANNIS�MA 02601 P Y Owner: MEDEIROS Date of Inspection: 11/14/01 t 3 ` Check if the following have been done4You must indicate"yes"or"no"as to each of the following: Yes No t X _ Pumping information was providedby the owner,occupant,or Board of Health u+ . X Were any of the system components pumped out in the previous two weeks? X _ Has the system received normal flows in the previous two week period? V X Have large volumes of water been introduced to the system recently or as part of this inspection? , X _ Were as built plans of the system obtained and examined? If the were not available note as N/A i P Y ( Y ) x1i X _ Was the facility or dwelling inspected for signs of sewage back up? €t4 X Was the site inspected for signs of break out? " X _ Were all system components,excluding the SAS,located on site? L X _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the 3 baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? ;' X _ Was the facility owner(and'occupants if different from owner)provided with information on the proper maintenance 5 of subsurface sewage disposal systems? �� i .S .. � The size and location of the Soil.Absorption System(SAS)on the site has been determined based on: t. Yes no X _ Existing information. For example,a plan at the Board of Health. X _ Determined in the field(if any ,of the failure criteria related to Part C is at issue approximation of distance is > unacceptable)[310 CMR 15.302(3)(b)] '' � M Y �XaN-fir'" Page 6 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ° PART C51 SYSTEM INFORMATION Property Address: 7 ERIN LN.HYANNIS,MA 02601 Owner: MEDEIROSk Date of Inspection: 11/14/01 i FLOW CONDITIONS RESIDENTIAL c * f Number of bedrooms(design):3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.20 (for example: 110 gPd x#of bedrooms):330 = Number of current residents: 4 Does residence have a garbage grinder(yes or no):NO � Is laundry on a separate sewage system(yes or no):NO [if yes separate inspection required] . Laundry system inspected(yes or no): NOS®* � n } _. Seasonal use:(yes or no): NO , Water meter readings, if available(last 2 years usage(gpd)): n/a Sump pump(yes or no): NO rMM' x � � ay. . Last date of occupancy: n/a COMMERCIAL/INDUSTRIAL Type of establishment: n/a a I' Design flow(based on 310 CMR{15.203): n/agpd Basis of design flow(seats/persons/sqft,etc.): n/a Grease trap present(yes or no):NO t 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/use: n/a OTHER(describe): n/a ,. GENERAL INFORMATION Pumping Records ,: Source of information: n/a Wass stem pumped as art of the inspection es or no : NO l ` Y P P P P (Y ) ,�: �W: If yes,volume pumped: n/agallons--How was quantity pumped determined?n/a 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) . 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 � 4. Other(describe): n/a r , Approximate age of all components,date'installed(if known)and source of information: ; f 1984 ! Were sewage odors detected when arriving at the site(yes or no):NO �� Page 7 of I 1 T All OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C . SYSTEM INFORMATION(continued) _ Property Address: 7 ERIN LN.HYANNIS,MA 02601 tz Owner: MEDEIROS Date of Inspection: 11/14/01 Vi, x. BUILDING SEWER(locate on site plan) w ". ,M^MN4�x�, . Depth below grade: 18" Pk �3 Materials of construction:_cast iron X40 PVC_other(explain): n/a r a Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): V' : TOWN WATER j SEPTIC TANK: X(locate on site plan) ka Depth below grade: 12" � Material of construction:Xconcrete_metal fiberglass_polyethylene Ether ex lain n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) a; � . Dimensions: 1000G L 8' 6" H 5' 7"W 4%10"1 Sludge depth:2" ,M, , k. Distance from top of sludge to bottom of outlet tee or baffle: n/a z xM , Scum thickness: n/a Distance from top of scum to top of outlet tee or battle:61' Distance from bottom of scum to bottom of outlet tee or battle: n/a s, How were dimensions determined: MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related ' to outlet invert,evidence of leakage,etc.): SEPTIC TANK APPEARS TO BE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.RECOMMEND 14, PUMPING EVERY YEAR. GREASE TRAP:_(locate on site plan) Depth below grade: n/aJMN Material of construction: concrete' metal fiberglass_polyethylene other(explain): n/a ' ; Dimensions: n/a � . Scum thickness: n/a s3 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 & 44 Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related t to outlet invert,evidence of leakage,etc.): n/a ,. . s sr Page 8 of I 1 uX OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS y-b ` SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ,h PART C SYSTEM INFORMATION(continued) Property Address: 7 ERIN LN.HYANNIS,MA 02601 k Owner: MEDEIROS Date of Inspection: 11/14/01 TIGHT or HOLDING TANK: (tank must be pumped 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 .Trra g Design Flow: n/a gallons/day 4y Alarm present(yes or no): N/A 4<. Alarm level: N/A Alarm in working order(yes or no):NO *� Date of last pumping: n/aY=,: ; Comments(condition of alarm and float switches,etc.): n/a ' DISTRIBUTION BOX:X(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE , Comments note if box is level and distribution to outlets equal,an evidence of solids carryover,an evidence of leakage into " ( q Y m' Y g or out of box,etc.): �33�ay tb°c7'' D-BOX IS STRUCTURALLY SOUND. PUMP CHAMBER:_(locate on site plan) N I' 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 � *. 1 r,�i1y! S f 4 .+ 4}'1Y977rr Y' i a{s7: ? u . r ' Q Page 9 of 11 " Jc 1. OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORMT �"` r k � { PART C SYSTEM INFORMATION(continued) , ) Property Address: 7 ERIN LN.HYANNIS,MA 02601 a rd Owner: MEDEIROS �` Date of Inspection: 11/14/01 f,. SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) ' If SAS not located explain why: 5 n/a Type 1000 GAL 6' X 6' leaching pits, number: 1 n/a leaching chambers, number: n/a �,, . n/a leaching galleries, number: n/a n/a leaching trenches, number,length: n/a ^f� , n/a leaching fields, number: n/a � n/a overflow cesspool, number: n/a ° n/a ,innovative/alternative system Type/name of technology: n/a r ; s3r Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): , ' LEACH PIT IS STRUCTURALLY SOUND AND FUNCTIONING`PROPERLY.BOTTOM IS AT WAND HAS 6" fi` OF LEACHING LEFT.ESTIMATED 2' OF STONE. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) L "* Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a F • Depth of scum layer: n/a Dimensions of cesspool: n/a .;r � Materials of construction: n/a Indication of groundwater inflow(yes or no): 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 s x r 5 d•f'��u x�...' f n _ Page 10 of 11 , gf OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORMx n. PART C SYSTEM INFORMATION(continued) L ' Property Address: 7 ERIN LN.HYANNIS,MA 02601 Owner: MEDEIROS ' Date of Inspection: 11/14/01 k ' 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 buildings :: J. y_tif' 6�f . ptcl� L `gin f_ T�tva AAaO �x ,wart A C L1 . ` y i-16 741 P. � y nn� i t n .Page 11 of 11 c =xi k r OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS } SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM t: PART C SYSTEM INFORMATION(continued) A '. Property Address: 7 ERIN LN.HYANNIS,MA 02601 Owner: MEDEIROS � Date of Inspection: 11/14/01 SITE EXAM 43 _Slope _Surface water Check cellar _Shallow wells Estimated depth to ground water 12+feet x - Please indicate(check)all methods used.to determine the high ground water elevation: 1" NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a ly Y m NO Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a � NO Checked with local excavators'installers-(attach documentation) N{YN''T� ir_. YES Accessed USGS database-ex lain: n/a QT9k You must describe how you established the high ground water elevation: ' '' USGS MAPS AND CHARTS- 12+FT. ° is r 64 3 11�,, -� , ; y"gT s n r r 1 COMMONWEALTH OF MASSSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617) 292-5500 A. ` ITRUDY OXE VVULIAM F. WELD SFA Secret' l Governor -sY ARGEO PAUL CELLUCCI V �q<,. DAVID.B. STRUHS I Lt. Governor //,0 Co+*** ��iotier SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 'U 1�99� PART A s f 4 0 not , CERTIFICATION }� Property Address: ` (( �� i I��v N,S Address of Owner: Date of Inspection: � �°� (If different) Name of Inspector: rA tr�r�� I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CN R 15.000) Company Name: r � L Mailing Address: Telephone Number: ;= �11 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true. accurate and complete as of the time of 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: Passes Conhionally Passes Needs Further Evaluation the Local Approving Authority _ Fails 1 y ' L Date: \S t Inspector's Srgnatu The System Inspector shall submit a copy of this inspection report to the Approving Authority 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 thr buyer, if applicable, and the approving authority. INSPECTION SUN 1ARY: Check A, B, C, or D: A] �SYSTEM PASSES: v\ I have not found anv information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Anv —� 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. Indicate yes, no, or not determined (Y. N, or ND). Describe basis of determination in all instances. If'not determined", explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (a(tached) 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 exftltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04/25/97) Page 1 of 10 M SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: B) SYSTEM CONDITIONALLY PASSES (continued) _ Sewage backup or breakout or high static water level observed in the d/ri�bution box is due to broken or obstructed pipe(s) or due to a broken. settled or uneven distribution box. The system will p ss inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced _ The system required pumping more than four times a year due o 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 C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Boa d 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 HEAL DETER.MLN'ES THAT THE SYSTEM IS NOT FL'NCTIOhZtiG IN A • MA.NN•ER W117-CH WILL PROTECT THE PUBLI HEALTH AIND SAFETY A.ND THE ENNIRON`IENT: _ Cesspool or privy is within 50 feet of a s face water Cesspool or privy is within 50 feet of a ordering vegetated wetland or a salt marsh. 2) SYSTEM NVILL-FAIL UNLESS THE BO OF HEALTH (AIND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETEILNIIrES THAT THE SYSTEM IS CTION•LNG IN A MANNER THAT PROTECTS THE PUBLIC HEALTH A.N'D SAFETY AIND THE ENVIRONMENT: The system has a septic tank an soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water sup ly. _ The system has a septic tank d soil absorption system and the SAS is within a Zone I of a public water supply well. _ The system has a septic tank nd soil absorption system and the SAS is within.50 feet of a private water supply well. _ The system has a septic tan and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from at facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determi distance (approximation not valid). 3) OTHER (revised 04/25/97) P2ge 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: DJ SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: I have determined that the system violates one or more of the following failure criteria as define in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine hat will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an overloaded or cl gged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an ov�er�oaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. / / Required pumping more than 4 times in the last year NOT due to c ogged or obstructed pipe(s). Number of times pumped _. _ Any portion of the Soil Absorption System. cesspool or privyis/below the high groundwater elevation. Any portion of a cesspool or privy is within 1.00 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a..iublic well. Any portion of a cesspool or privy is within 50 feet of 4rivate water supply well. Any portion of a cesspool or privy is less than 100 f�t but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has b n analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds. amnia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: The following criteria apply to large systems in additigti 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 r more of the following conditions exist: Yes No the system is within 400 feet of a su face drinking water supply the system is within 200 feet of a ributary to a surface drinking water supply the system is located in a nitrog n sensitive area (Interim Wellhead Protection Area -IWPA) or a mapped Zone II of a public water supply well) The owner or operator of any such system/shallng the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. onsult the local regional office of the Department for further information. (revised 44/25/9'n Page 3 of to SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address ^� Owner- Date of Inspection: Q 5 K Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No Pumping information was provided by the owner, occupant, or Board of Health. _ 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 pan of this inspection. _ As built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. Q( _ All system components. excluding the Soil Absorption System, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or *� tees, naterial 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: The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub- Surface Disposal System. _ Existing information. Ex. Plan at B.O.H. _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) [15.302(3)(b)] . (revised 04125/9T) Page 4 of 10 r, SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: `I tL i ry Owner: Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow: ." 1 p.d./bedroom for S.A.S. Number of bedrooms: 3�, Number of current residents: o� Garbage grinder (yes or no): IL: Laundry connected to system (yes or no): Seasonal use (yes or no): 1�- Water meter readings, if available (last two (2) year usage (gpd): i'*-J Sump Pump (yes or no): fU Last date of occupancy: 71L> N COMD1[ERCIAL/INDUSTRIAL: Type of establishment: Design flow: eallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GEC-ERAL INTOWNLATION PUN PL\G RECORDS and source of information: ty� A- System pumped as part of inspection: (yes or no)_ � If yes, volume pumped: gallons 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) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: Sewage odors detected when arriving at the site: (yes or no) % i (revved 04125/97) p2re 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Addr��9z, Owner: V-44 Date of Inspection: BUILDING SEWER: (Locate on site plan) Depth below grade: Material of construction: _cast iron _40 PVC _other (explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints. venting, evidence of leakage, etc.) SEPTIC TANK:*b (locate on site plan) �Y1 Depth below grader _Polyethylene other(explain) Material of construction: concrete _metal _Fiberglass _other If tank.is metal. list ace _i Is age confirmed by Certificate of Compliance _(Yes/No) Dimensions: Sludge depth:at` I -" -6z Distanct from top of sludi:e to bottom of outlet tee or baffle: Scum thickness: Ot` ct Distance from top of scum to top of outlet tee or baffler Distance from bottom of scum to bottom of outlet tee or baffle:_ O How dimensions were determined: U1AWJI_, ZCa Comments: (recommendation for pumping. condition inlet and outlet tees or baffles. depth of liquid level in relation to outlet invert. structural integrity. evidct nce of leakage. etc.) I 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: (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.) (revised 04125/97) Page 6 of 10 1 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: i Date of Inspection: 2s I S c C` TIGHT OR HOLDING TANK: (Tank must be pumped prior to, or 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 level: Alarm in working order _ Yes: _ No Date of previous pumping: Comments: (condition of inlet tee. condition of alarm and float switches. etc.) )ISTRIBUTION BOX: s (locate on site plan) // �7 Depth of liquid level above outlet invert: 11 Comments: (note if level and distrib ion is ual. evide ce of solids carryover, ev' ence of leakage into or out of box, etc.) c�« I'sCk i i 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.) (revised 04/25/97) P2ge 7 of 10 u_ r 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: I Owner: ��ti Date of Inspection: SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible: excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number:.pX(0 leaching chambers, number:_ leaching galleries, number: leaching trenches. number.length: leaching fields. number, dimensions: overflow cesspool. number: Alternative system: Name of Technology: Comments: (note condition ofsoil. signs Iof hydraulic failure, level of ponding, cond' ion of v etati etc.)Q I CESSPOOLS: (locate on site plan) Number and configuration: 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 (cesspool must be pumped as part of inspection) 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.) (rcyised 04125197) P2ge 8 of 10 II , f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOPUNI PART C SYSTEM INFORMATION (continued) Property Address:—7 gy-► Owner: j Date of Inspection:9�5� SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) Z- Tk ( 37 , (revised 03/2S/97) P2ce 9 of 10 Rw SUBSURFACE SEWXGE DISPOSAL SYSTEM INSPECTION FORM r PART C SYSTEM INFORMATION (continued) Property Address: Owner: 1 Date of Inspection: Depth to Groundwater Z�Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of Site (Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators. installers i Use USGS Data -Drescribeinin2your own words ho%w you established the Hugh Groundwater Elevation. -Must be completed) / V i S: 0 — .L G S t c--�vo � V�t �,C-e.. 1 �^ �►v\.k-Zs�t_'�r��r`hi J� l'�d �- I C � it (revised 04125/97) Page 10 of 10 LOCATION SEWAGE PERMIT NO. VILLAGE aq/- a "7- 0/ 1 INS A LLER'S NAME & ADDRESS 8 U I L 0 E R OR OWNER DATE PERMIT ISSUED c93 DATE COMPLIANCE ISSUED �� s `' °�� : r � �� . . �� No.: ..: � Fxs... ............ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .......................OF.7t* ��--..........._.............-_..._................... ,� r�rlirtt#iaan for Disposal Works (fonstrnrtiun rnmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: e. Into •- c1 cL1 es ��a I.o t f/ ..... ... �...............Lol _-..-..__--...---- --.....----.... ... ......._......._... .....----- .- _.....--------- ---. ...-.......-- ,;; Location Address or Lot No. L CCc�� H?i1If ..5..:.....-'--•------•------------------•-----•....----•--•-----• --•----•--......_.....- _..-----------•----......-......... I /� Owner f , 1 A dress a ��CKend. __ _( -Gl S` .IAJf.'. �:. `�4 1��. H,4p)L_'1_�1_f_- ....... ................................................... -•--•- ............. Installer Address Type of Building Size Lot../-0 0� Sq. feet ._......... v ........Dwelling—No. of Bedrooms.__...._.�.......... Expansion Attic ( ) Garbage Grinder ( ) -•------ Other—Type T e of Building DWs&� _c ------ No. of persons.......... ............. Showers — Cafeteria Aa YP g ---•-•-•- - P ( ) ( ) Otherfixtures -----------•-----------i-------------•---•----•-•----------------------------------------------•---------•--------•••-•••----•--------------------- Design Flow............!a.G�.......................•_..gallons per person per day. Total daily flow......._. �.........................gallons. WSeptic Tank—Liquid capacity.c r�u.gallons Length._SS_-.6...... WidthA._1-O---.. Diameter---------------- Depth.`..-___- x Disposal Trench—No. .................... Width....... ...._._._.. Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.................................. Diameter.4na :-'.�_#. Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ ,.a Test Pit No. 1...._��._-.......minutesperinch Depth of Test Pit-----fA.Y...._. Depth to ground water...... fs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ p.' ....-•----•=----------------••-•-•........----•---•------...........------------••-•-••-•-••------••......................................................... O Description of Soil--- S 6_Se /-------?,a-...--- .....-•--------------•---....-•----------------7 -• W •••-----------------------............................................................................................................................................................................. U Nature of Repairs or Alterations—Answer when applicable______•______________________•-_-__-•-•....................................................... -------------------------------------------------------------------•--------------•----...........••--••--••••••••••••---••-••-•-•---••-•-•-----------•------......................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TTTLv 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b sued by the board Qtf heal h. gne ............ J .......`'...-------------- ....... -----------=- _..._ Application Approved B _.._ G�. _-.__ ate ------------- Application Disapprove or a following reasons----------------•------••--=---------•--------------•----------•-------------•---------------------........_...._ Date PermitNo......................................................... Issued........................................................ Date %...................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _...................OF. �YG- 0& .e..,..................................................... Appliration for Disposal Works Tnnitrurtinn rrntit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: tr— l�SS P t't.r 1 /1 �t$S �•-- Ta"'f_t_.�n___t�____S_____C_�____ ....r.......... ..._.........l:{..:- .............................................•------------;-----------------•---•---------------- Ldcation--Address or Lot No. .._....1 . ._. .Gw .. ..............•--.....-•-•-•----......._..._......._.... .3.L..k.�......_0t:Vra.v?. ��`......4l�a- v-%5---•---___---------__-____--______- Owner ! Installer Address d Type of Building Size Lot.A j o0o.." ......Sq. feet Dwelling—No. of Bedrooms.______. -______________________________Expansion Attic ( ) Garbage Grinder ( ) per-, Other—Type of Building wits c......... No. of persons......... .-............... Showers ( ) — Cafeteria ( ) Q' Other fixtures ----------------------------------- W Design Flow...........1.1.0__________________________gallons per person per day. Total daily flow..____.�aP.__...._....____.._._____gallons. WSeptic Tank—Liquid'capacitylt7�__gallons Length�5. (a`° Width`i_!O__-_.. Diameter---------------- Depths:_19__...-- x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No....... Diameter�..V!'X. Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ~' Percolation Test Results Performed by....................................................__...._._..._......_.. Date........................................ 1_4 Test Pit No. 1.... _._.._-minutes per inch Depth of Test Pit.....0___....... Depth to ground water------""_-_--_-._.--. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a -------------------------------------------- ----..._........................ ----- ----- - ------------------------------------------------ O Description of Soil...1_'��..... �?!2 ___Su ?: /7c �u ' _. ........ x W ---------------------------•----------------------------------.-.----------------------------------------------------------------------------------------------------------------------._....-----= VNature of Repairs or Alterations—Answer when applicable. -------------------------------------------•-------------------------------------------•--•-------------------------------------••-==-••--•••...--•--•--•-•--•••••••••••••••--•••••••---•--......•-•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of ILTY 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b ssued by the board ,, health. � ign - � Date Application Approved B f 'e::..:..........:.......................•----------._.............._----•• -• -f-------- (Date Application Disapprov f o he following reasons-----------------------------•--------------------...---..-._._.-------------•-------------------••••-••--------- ..--•---------•--•-•--•-••--------------------••-----••--•-•----------•--•----••-----.........--••-••-•---••------••-•-----••----•-•-•-•-•-•---•--••-•••-••-•--••--••--•••-•--••••--•••-•-•-•••---•----- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Trr#if irzttr of Toutpliattrr TW4T I t `CE IFY, That the Individual Sewage Disposal System constructed (� der Repaired ( ) at....�a�_ -- i�---- �1.._ �?` -7mw S.,t...... - ==_ - ----------------•------------------------------------- d -_ /�i ____________has been installed in accordance with the provisions of T 5 of T State Sanitary o a dd in the application for Disposal Works Construction Permit No. ..7"'_��!� __-_-____ dated-A.. -•----•------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................•------...._.....------..__..._•---•------..._.. Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............................OF..................................................................................... N ......................... FEE........1............. �inF�nrrnruan rrntit Permission is her y granted--- -•-• •--• -•-............'. ;-__"A/e---- --•----------------•-----_-------------------------------_-__-_______-_-__-____ • gam,•��• -- at to Construct Re air ari Individual Sewa e o sty ./Street 1 as shown on the ap licat n for Disposal Works Construction Permit No.............. e Date�"I _ _?.-_. ............ --------------•-------------- ----- ............................................................ O /T V _____________________•--_--_•--•_--------______. Board of Health DATE---------- ------••------------- FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS s. S � C e II No............... ... �� W Fu�...0 ................... ' THE COMMONWEALTH OF MASSACHUSETTS A BOARD 9F HEA T ..... . ..d`�tw -..:..oF... .... . .. .... . Appliration -fur Disposal Works T Mtrurtinn Vauut Application is hereby'made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal Syst Lo tion Addres or Lot No, ... ...... . ................... ......... ._ ....... ...................... ..............r------------r--- '•--/✓v✓vZ! _.-•------ . o- w er. Address Installer / Address / Type of Building Size-Lot... /s_...7_ - .....Sq. feet U Dwelling—No. of Bedrooms---------- .............................Expansion Attic ( ) Garbage Grinder ( ) aOther-Type of Building ..:......................:.. No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures _ _-.. W Design Flow-- ------------1`s:>..__-_-__-...-___.gallons per person per day. Total daily flow...................79.q........... 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 areaV..�_-.sq. ft. Z Other Distribution box ( ) Dosing tank ( ) �,�- �C h 2 --2-` T '-� Percolation Test Results Performed by...........................................................................Date---------------------------------------- Test Pit No. 1.................minutes per inch Depth of Test Pit-------------------- Depth to ground water...._..- --.----.----- Gr., Test Pit No. 2..................minutes per inch Depth of Test Pit.................... Depth to ground water.___-.-.-_-.--_-__-_-. p ao - x Descriptio�$oil -�� = i .x �t "Ia - U ---------------- .. -----s� ------- - --•-.-----•- -� :��a . � �e ----------------- w ' ----------------------------------------------- ------ --------------------..................... V Nature of Repairs or Alterations—Answer when applicable------------------- -------------------- -------------------- ------ ------ ---------- ---------------------------•------------------------------------------------------------------•------------------------------------------------------------------------------------ .................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of.the State Sanitary Code—The undersigned further agrees not to place the system in. operation until a Certificate of Compliance has been issued by thee�boardXf health.�� Lgnej ----- Date APPlication Approved BY E L ------ -- �......--�...••. Date Application Disapproved for the following reasons---------------------------------------------------------------------------------------------------------- Date Permit No......................................................... Issued.---- f � ---- --- Date - --- ------------- ----- -- . -- ` --- - - - - FALMOuvl HD RtE Z8 s z9 �5 P ��(� �� / • o o [DRAIN R LINE J§ES mIVA U ;; LINE NOT ERIN LANE ELEVATION EAD WIA SCALE m LOCUS 45. 8 Ta Op OF FOUND F WEST MAIN STREET -- HYANNIS, MA IN 42 Qti 44 `F FM�cN 99 ft Q / I � l # PROP SED SOIL a� /T, FqS M ABS RPT ON W T WHERE SEWER �Z� , �,'r SY TEM Q LINE CROSSES ;tea ►� WATER LINE w. Y T - EE D TAIL �n -USE DEP 1, ON �ACK g APPROVED x SLEEVING E FOG " TECHNIQUE C N TO SHIELD �F4 0 lS ft WATER. LINE : 41 - 21 ft t NO GAS LO Ib OAK ON \� i _ % 0 I,gINI,vtAL Z +/�� \N)IV GRADING Q �_.O. .� O FO PROPOSED �� (0f 9� • �041 �.o °� / LOOT U O c �iti• �� AREA = 11412 sf+- 41 ♦ �tij PLAN BOOK 373 PAGE 10 ASSR MAP 291 PCL 17-11 42 . J ♦♦ \ < �L4 4 111.00 ft > - 16 in OAK 16 in 43 ♦♦ OAK THIS IS A LEGEND COLOR OR SEPTIC COMPONENTS PLAN USE COLOR PLAN ONLY PLAN EXISTING FOR INSTALLATION 1 GAL SEPTICTIC TANK � FULL DETAIL IS BEST SCALE: 1 in = 20 f t VIEWED IN EXISTING FULL COLOR 0 20 40 G OT OLEACH PIT/ iA OWED CESSPOOL 0 10 20 PRINT ON 11 x 17 in DISTRIBUTION BOX oO ii PAPER FOR PROPER SCALE TEST PIT - EXISTING LEACH PIT TO BE .PUMPED AND FILLED OR REMOVED ��SH Ul'44 J-- �P 0f'�ss9 o DAVID yes o DAVID rya D. D. COUGHANOWR N COUGHANOWR N SEWAGE DISPOSAL No. 1093 No. 461 c T �F �o SYSTEM PLAN d°cF`o°o�dd'o GISTE� s gPPRO�� -TO SERVE EXISTING DWELLING O REBECCA & MICHAEL ALMONTE OWNER(S) OF RECORD 7 ERIN LANE THIS PLAN IS INTENDED SOLELY FOR INSTALLATION OF THE SEPTIC SYSTEM 155 Geo R der Rd S HYANNIS, MA DEPICTED ON IT. FOR ANY OTHER CHANGES TO THE PROPERTY INCLUDING PROPERTY ADDRESS ChOthom, MA 02633 PLACEMENT OF ADDITIONS. SHEDS. FENCES OR SWIMMING POOLS. OWNER SHOULD CONSULT WITH A MASSACHUSETTS REGISTERED LAND SURVEYOR. DOVidcouOHotm011.Com DATE. SEPTEMBER 18., 2019 508 364-0894 PG.1i2 Joa& ETE-44-- nec'oe Oo IL TE T LOO G . . •' DEGIG I CaALC UULATI0W SOIL EVALUATOR: DAVID D. COUGHANOWR• ASE #461 DESIGN FLOW: 4 BEDROOMS X 110 GPD = 440 GPD WITNESSED BY: DONALD DESMARAIS. HEALTH DEPT. NO GROUNDWATER ENCOUNTERED SEPTIC TANK: 440 GPD X 2 DAYS = 880 GALLONS TEST PIT 1 PERC AT 50 in - 2 MIN/INCH IN C SOILS USE EXISTING 1000 GALLON SEPTIC TANK IF IN ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER SOUND STRUCTURAL CONDITION. IF NOT, INSTALL 44.00 INCHES HORIZON TEXTURE (MUNSELL) MOTTLES NEW 1500 GALLON SEPTIC TANK. 0-8 A SANDY LOAM 10 YR 3/2 NONE FRIABLE • INSTALL UNIT DEPICTED BELOW. P 41.50 8-30 Bw LOAMY SAND 10 YR 5/6 ,NONE FRIABLE SOIL ABSORBTION SYSTEM: 30-132 C MEDIUM SAND 10 YR 5/4 NONE LOOSE 33.00 THE LONG TERM ACCEPTANCE RATE FOR A CLASS ONE SOIL WITH A PERCOLATION RATE BELOW 5 MINUTES TEST PIT 2 NO GROUNDWATER ENCOUNTERED PER INCH = 0.74 GALLONS PER DAY PER SQUARE FOOT. 2 MIN/INCH IN C SOILS THE 33.5 ft x 12.83 ft x 2 ft LEACHING GALLERY ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER WITH CUT CORNERS DEPICTED BELOW CAN LEACH: 44.10 INCHES HORIZON TEXTURE (MUNSELL) MOTTLES 0-10 Ap SANDY LOAM 10 YR 3/2 NONE. FRIABLE BOTTOM AREA= (33.5x12.83)-(3.33)-2 = 418.7 sq. ft. 41.43 10-32 Bw LOAMY SAND 10 YR 5/6 NONE FRIABLE SIDEWALL AREA= 2x(33.5+9.5+4.71+ 32-132 C MEDIUM SAND 10 YR 5/4 NONE LOOSE 26.83+4.71+9.5) = 177.5 sq. ft. 33.10 TOTAL AREA = 596.2 sq. ft. FLOW CAPACITY = 0.74 x 596.2 = 441.1 gal/day INSTALL LEACHING GALLERY GALLERY AS CONFIGURED �p BELOW. FLOW CAPACITY = 441.1 gal/day WHICH EXCEEDS �000 OQL�L�ONI SEPT§C� .,,.T-QN� THE 440 galldoy REQUIRED FOR A FOUR BEDROOM DESIGN. EXISTING UNIT = DIMENSIONS & 1 DETAIL TANK TO BE PUMPED DRY AT TIME OF INSTALLATION AND EXAMINED FOR STRUCTURAL INTEGRITY. INSTALL S O§L' Q .o S_O R F1•T§O N' NEW PVC OUTLET TEE EQUIPPED WITH A GAS BAFFLE. REPLACE., WITH A NEW S YS T( EMI' CONSTRUCTION DETAIL 1 in 1500 GALLON TANK USE SHOREY PRECAST 500 GALLON LEACHING DRYWELL TAPER °.r IF CRACKED. ROTTED OR OTHERWISE 26.83 ft STONE y COMPROMISED. a� A& w „�d Q 4- T' co Awl p= Og. SL � u� co NOT u) i� r!. o, TO� SCALE DLINWELL •�0 4 ft 8.5 ft 8.5 ft 8.5 ft 4 ft / IT \0 33.5 ft 8 ft-6 in k 500 GALLON DRYWELL INLET OUTLET DIMENSIONS & DETAIL INSTALL ONE INSPECTION COVER COVER RISER TO WITHIN THREE USE INCHES OF FINAL GRADE 3 IN DROP H-10 & INDICATE LOCATION -► 1 FLOW LINE UNIT ON AS-BUILT FROM _ 14 D-BOX �- w 33 BUILDING 10 in - 14 TO in 48 in ok$a LIQUID GAS 3 ` LEVEL#' BAFFLEw 5a .. b !n STONE BASE /F NEW CROSS SECTION VIEW INSTALL AN APPROVED GEOTEXTILE-\ SEPARATION BETWEEN INLET. & OUTLET FABRIC OVER STONE TEES NO LESS THAN LIQUID DEPTH CROSS SECTION VIEW roil 3%4 In TO E 24 in ey 314 In 28 2 1-112 in GRAVEL o EFFEC IVEM-I-112 In ll� PT GRAVEL � �u/ � §o U T§On " O//� USE SHO20Y 3 DIMENSIONS PIPES EXITING D-BOX TO RUN LEVEL 58 in 46 46 in in AND DETAIL. FOR 2 FEET BEFORE PITCHING'DOWN' 150 in ALL STONE TO BE DOUBLE WASHED AND a FREE OF IRONS, DUST AND FINES IN PLACE 12 in 1 MIN L(] S e -� -INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE FROM � N STARTING WORK. TANK 1 b TO 111J 0 ; 1 p; ^ F SAS O -ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REQUIREMENTS OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15). � INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND ,t \� b in STONE BASE l9 UTILITIES BEFORE EXCAVATING FOR SYSTEM. 21 jn 2\ CROSS SECTION VIEW ECO-TECH RAPID RESPONSE RECOMMENDS THE INSTALLATION OF LOW FLOW FIXTURES & APPLIANCES. AND PERIODIC PUMPING OF THE SEPTIC TANK. S -SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. DO NOT PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM. Ej TOP OF FOUNDATION RAISE COVERS TO WITHIN ALL PIPE TO BE 4 in SCH. 40/fPVC EL = 45.84 +- 6 in OF FINAL GRADE AND TO PITCH AT 1/8 inI MIN I 44.00 D-B 0 { ... 3. MAX EXISTNIG USE H-20 41.75 EXISTING 1000 CC��L�LQO�I o00 ° o PRECAST o °oo��oo 'o 0° oo°o o�opO o°000°a oo°o° SEPTIC TAN V 42.75 41.13 0000�0000aa DRYWELL o°oo°o°0000 °oo0_o, °6 in °°0000 ao° EXISTING REFER QBSORpT�ON TO DETAIL BOX 41:30 STONE, �� BASE 41.00 SYSTEM -REFER TO EXISTING b !n STONE BASE IF NEW DETAIL BOX 60 ft 5-12 ft Lri NO GROUNDWATER BELOW 39.00 MOTTLING OBSERVED TV'-3 3.00 SEWAGE DISPOSAL SYSTEM 'PLAN JF7 ERIN LANE HYANNIS. MA ISEPTEMBER 18. 2019 ETE-440 PG 2/2 w � F � Fr e a d1, N iS A S:s ✓+,; xL y.x..;x a 'i'. ,k °'A' �RFr '�, r' �� F ts�v�-'�'� °3i r+'",a-�4,'a 's"�xe �,, •s{ ,g,. ,,,,z, x � .t � r �#� s - . €:: •` �✓°a'v„ ?�..� `� .:c �, :' '��`aye,._��aa,� .��,�. x'�.� ,r, a' e�* s m k S�'* �. :_.� i�.�,�"[,�� ""✓ 4�., � � �: 441, 4f 4M .�rbf �''65,� `� a e e '�` ,.�t'. .�' '�. o v `x $ ' "� � ;ram� Y-.::r n-�raj o- ,"��?� �� m,:.; �'[� � � '•i t" � ;. a'`4 �-� = e� {;�` ,�-v,L ,� w"',..i s • a a,,.rt� ''{"' ,�:e:x'€ -. v�;:r ``�' Z y <�. iy .^fi -a°`t g 16 FIRM- 4-*' �..''`•.�s§r�'tN£'3 $e'��, z.Ea""��r ,�,,,tb.,�a��' R,�.�y; ,�. ��'„e z. K.a:�ac t j4 .;, r = zip a= sy{� a: F, ;.`�� ,�✓a:��cs`x"'',�,�r � ��-�x�fr��3� �� a � r v ARN�'4<C +!a'''£ .� 3{� •'fib s¢.�, /6. �K NZ Ai " T cw'+t " 1 ryy, I.'w6€ k�„QiF 1 �zN. N"MWI . g9y.. y • N '�f°'` ise e�{vf A� :43� boil Ma .q�5� '*2�k .T� ::5.� { .` : NO sNZI, c � g Yg�X 4 a�s"r � yew. �a•: M.IN, `•�i�• a ZONE: , RB ► , � � «? ?` Area (min.) 43,560 SF E ;` Frontage (min) 20 Width (min) 100' Setbacks: Fron t 20' Side 10' Rear 10' N� OVERLAY DISTRICT: WP - Wellhead Protection District FLOOD ZONE: Zone X (Min Flood Hazard) t Y ; Community Panel No, »• . ;.., #250001 c0568J July 16, 2014 LOCATION MAP: 1"=2,000f' - ASSESSORS REF.: DISTANCE VARIES 154" TOTAL TANK LENGTH Map 291 Parcel 017-011 OUTSIDE WALL TO OUTSIDE WALL ' TANK WALL REFERENCES: S8 0' 247E THICKNESS Q a _?3.33, R=280 9 _ AT TOP a " LL Deed Bk: 32249 Pg 316 63.49 \ (3 TYP) -*- -'� j06 Plan Bk: 373 Pg 10 wo Edge of Pavement \ O w r' u o Fn INFLUENT D ENITRIFlCA ER o So 3 �. INFLUENT -I- A ON � DC) 1 l \ �.> / (SEE NOTE 1) Y=O EFFLUENT Erin Lane poi INFLUENT PERC TEST: 19-136 SAMPLING PIPE 1 / (2"DIA PVC PIPE) �-3 \ i3 TO TITLE 5 PERFORMED BY:DAVID CAUGHANOWR ® Edge of Pavement SEE NOTE 6 o -y- SOIL SOIL EVALUATOR N0.461 .- -'" ---- ------- u� �- ABSORPTION WITNESSED BY.DONNALD DESMARAIS,R.S.-TOWN OF BARNSTABLE o TITLE 5 SEPTIC ~ TANK WALL -._ SEPTERMBER 16,2019 SYSTEM TANK THICKNESS (SAS) SITE PASSED C �fl �--�- s8 • o' 24" )rf� t aa R= 4 _ / NOT TO SCALE AT BorroM ; 10'\ 6 l (41/2-TYP) i I MlN• 1 'IU it Easement TEST HOLE- I EL.40.7 TEST HOLE-2 EL.40.5 AP LAYER 10YR3/2 AP LAYER IOYR3/2 AN, t�\C �/ SEE NOTES 2,3 AND 4 VERYDARK GRAYISHBROWN VERYDARK GRAYISHBROWN I SANDY LOAM SANDY LOAM TBM To of CB 0 p`' r s- i/ 8 40.0 ]0 39.7 p Bw LAYER 10YR 5/6 Bw LAYER 1OYR 5/6 EL.=38.6' Assumed ` h � r Grovel � ` Datum from Town GIS Drive -42-._ ' ' � ' •� �'"` YELLOWISH BROWN YELLOWISH BROWN /� I \ _ 30 38.2 32 37.8 6 ) LOAMY SAND LOAMY SAND D-BOX I& PIT J ' 1 C TO BE L G RGRAY.4 C LIG LAYER /4 GRAY ` SL EVE o M/N. ABANDONED M SAND M ,AIVD rn " S O c i OR REMOVED GROUND SURFAC�P) - - n CDH Fndr QUIRED - -_ -- o � - - - - - SO" P TEST 36.5 �= m 1 m o ,r �'� ROPOSED TO TITLE 5 SOIL PERC RATE<2 MIIV/1N 1 4 - 0 3 cv N/TROE 132' (L TAR=0.74) 29.7 132 29.5 J '� 51/2"TANK ABSORPTION SYSTEM o � rt � o �O-, ro. /� � TOP(TYP) (SAS) NO GROUNDWATER ENCOUNTERED NO GROUNDWATER ENCOUNTERED < i N Deck cp INFLUENT 3 BR Fndl a _ N (SEE NOTE 1) % '.' .� .• ry ,. .. •" •t •••• �,• .•, •• ' ' EXISTING 48"STATIC EFFLUENT o EPTIC WATER DEPTH ` -- TANK #7 Z o _ 9- - - - - o� 1 3/4 Sty �_ ° W z n 1 QO + w/f c r a SUBMERGED DENITRIACAMN CHAMBER o w Q�OOr�� J I TITLE 5 SEPTIC o a f-IL a. Finish Grade Dwelling TANK �o CHAMBER z AERAION (DC) �� ,a- NOT TO SCALE o ° -�' f z W"'W 3' Max. - -" I= I Lot 19 ( ) z "' (SAC) D 3 5 9" Min - co � LL Compacted Fill Filter 1;`430f SF -i• a. z Fabric E �W ► ► And -0r / _ b 1 i 2 • 2 f / � . � Pea Stone ELEV.-0 3 " LEACHING 3/4" - 1 1/2" --- 111.00' TANK BOTTOM Double Washed N88' 43' 15" THICKNESS 4" CRUSHED AGGREGATE OR APPROVED I CHAMBER Stone _ TANK WALL THICKNESS MATERIAL(DEPTH TBD-6"MIN);ON LEVEL. , u�p AT BOTTOM(41/T) COMPACTED AND STABLE BASE �` 0----_ TANK WALL THICKNESS KleanTu LLC 4' - 10' -- _ AT TOP(3') PLAN AND PROFILE VIEW r- 12' - 10" NITROE WASTE-WATER TREATMENT SYSTEM (WWTS) 1 � CROSS SECTION OF CHAMBER . T-as2000-1110 PLAN VIEW NOT TO SCALE SCALE: 1"=20' DESIGN DATA SEPTIC NOTE NITROE NOTES 1.Location of Utilities Shown on This Plan Are Approx.At Least 72 Hours 1. PROVIDE MINIMUM 2"DROP WHILE MEETING REGULATORY SLOPE Single Family / Prior to Any Excavation For This Project the Contractor Shall Make REQUIREMENT FROM THEW SEPHC TANK OUTLET PIPE INVERT TO -4 Bedroom Q I10 GPD ✓ t) the Required Notification to Dig Safe(1-888-344-7233)and contact THE INVERT OF THE IIFLUENT PI!'E IIVTO THE NTlROE TANK No Garbage Grindet / r r I / �t_c� ' Sullivan Engineering�&ConsW' IncSOS-428-3344. Total-Daily FCow 4 OGPD 1/ �i/ U 1 �g ( ) 2. NITROE TANK TOP TO HAVE TWO-24;THREE-12"HOLES AND - --_ t w ? 2.The Contractor is Required to Secure Appropriate Permits From Town sea 1500 Gal Septic Tank 1 U'J S F F. I. 43.73 eq PProP MULTIPLE 4"DIAMETER ACCESS HOLES WITH RISERS AND COVERS Agencies For Construction Defined by This Plan. FOR MAINTENANCE AND SAMPLING. i 3.Wherever Sewer Lines Must Gross Water Supply Lines Both Lines Shall 3. FOR THE 24"HOLES;PROVIDE 24"DIA.ADS PIPE WITH COVER TO 12" LEACHIlVG AREA F.G. EL. 41.00* - *Final Foundation Grading To Be F.G. EL 40.5 Be Constructed of Class 150 Pressure Pipe and Shall be Water Tested to BELOW GROUND SURFACE', BOLTED TO TANK TOP. 440 GPD/0.74(LTAR)=446 SF Required ` oor m a e i an See Note 6 (typ.) F.G. EL. 4 1.0 Assure Watertigh mess. In General,Water Lines Shall be Constructed in 4. FOR THE 12 HOLES;PROVIDE THREE-12 " "HOLES WITH ADAPTER Sidewall=2(12.83'+33.5W'=185 SF I Coordination With COMM Water,and Shall be in Accordance RINGS,RISERS AND COVERS TO 12"BELOW GROUND SURFACE. Bottom Area=(12.83'x 33.59=429 SF Existing With 248 CAM 1.0 0-7.00&310 CAM 15.00. INSTALL 4"DIA.MONITORING PIPE "BELOW GROUND SURFACE) Total Provided=614 SF(454 GPD) EL. 39.95 l 4.A Minimum of9"of Cover is Required forAllComponents. WITH 6"PLASTIC ROUND BOX AND COVER TO BE FLUSH WITH `� Installer To "`" y Flow Equalizers 3 S.All Struchrres Buried Three Feet or More orSubject ` GRDUNDSURFACE. ! LEACIMV'GCHA MERDES'IGN �� Confirm Prior EL J Existing � As.Required n AND COVERS To An Work 1000 Gallo EL. to Vehicular Traffic to be H-20 Loading.It is the Engineers 5. PROVIDE FOUR-6 DIAMETER PLASTIC ROUND BOXES All Pipes to be Schedule 40. Use y t , ep tie~ an k EL. 38.50 EL. 38.00 Recommendation that H-20 Always be Used. (AMOE AND SEPTIC TANKS)TO BE INSTALLED AT GROUND LEVEL. PROPOSED 3-500 Gal.Leaching Chambers in a wy (See Note 5) NI TROE 37.42 R0` Top EL. 38.00 6.Install Watertight Risers and Covers to Within 6"ofFinished Grade 6. PROVIDE INFLUENT SAMPLING PIPE(2"DIA)6"FROM EDGE OF 12.83'x 33.5'Double Washed --°" H-20 Over Septic Tank Inlet and Outlet,D-Box,and One Leaching Chamber. SEPTIC TANK WALL WITH 6"PLASTIC ROUND BOX AND COVER AT -. EL. 37.25 P Stone Field as Shown. ......_..�.�.�� D-Bohr All covers are to be maximum 18"for concrete or 24"Cast Iron. GROUND SURFACE. M- ° 37.00 PROPOSED 7.Septic System to be Installed in Accordance With 310 CAM 15.00& ° � Leaching 248 CMR 1.00-7.00 Latest Revision and the Town ofBarnstable To Be Installed On Chamber ' Board ofHealth Regulations. Viable Compact aB se Bo'. .00 8.All Piping to be Sch.40 PVC. Bedding,»T„s, 9.D Box Shall Have a Minimum Inside Dimension of 12,and a Minimum Inspection Port, If Encountered Remove & Replace Sump of6 & Baffels All Unsuitable Soils Within 5' of Ln 10.The Separation Distance Between the Septic Tank Inlets and as Per Title 5 The Outer Perimeter of The System Ld Outlets Shall be No Less than the Liquid Depth.Inlet Tees Shall Extend P�SN Of IfggsS� a Minimum of 10"Below the Flow Line.Outlet Tees Shall Extend 14" EL. Below the Flow Line,and Shall be Egwpped With a Gas Battle. No Ground for JGD d C, No Groundwater ®SEA `-4 IVIL DEVELOPED PROFILE OF SYSTEM Per Test Hale 48168 G/S WN�° NOT TO SCALE QNA� LEGEND: - g 1 Remove Garage & Adjust S.A.S. 10 25 2021 REV.: 2 Adjust S.A.S. to meet setback to street drain & Add Reserve 10 16 020 CDT Cedar Tree I l � � � HT Holly Tree NOTES: PREPARED FOR: PREPARED BY. Tl TLE: • Site Plan DT Deciduous Tree Barnstable Clean Water Coalition Engineering & Proposed CT Coniferous Tree 1.) The structures shown were located on the ground P/ ��0�7e� Improvements Vftft by conventional survey methods in June 2020. Q • Unlit Pole 864 Main St. A y Consulting, Inc. t 2.) The property line information shown hereon was -E Electric - compiled from available record information. -G- Gas p OS t erVlll e, MA �26 Jc J� (508)428-3344•P.O. Box 659 .711 Main Street, Osterville, MA 02655 7 Erin Lane Wetland Flag 3.) The datum is assumed and obtained from Town seci@sullivanengin.Com•www.suilivanongin.com >� Light Post of Barnstable GIS. ~ j 9 Barnstable (Hyannis) Mass. Draft Field: W � CB/DH 20 0 10 20 40 80 ASL WHK/CTR OHW- Overhead Wires Review: CTR Comp.: ASL DATE; SCALE: �� I V=) Elevation Contour July 6, 2020 1 =20 25 Project: BCWC Project#• 1998138 J i Am"I FIT, j low -Vwxvx MK fly zn.4 TITS IK,wq,N vxw,�,'J714 ANT 1;0 0-snow - 0 0", T-now) W007 41 0 6 2: J 0 IV nil NuMi A MAN Wo"t VOLVO, SOW N TWO g "TWIT M TACO" Yoe "j in A 1, AMIN Th %-Y Z van: 3 m A:," V ? : : ",- A, Alt! "W ,�n7 ;,-q 11 4� : '::,�� 11 ., -1 . AJ 000k -0� o A T I z MOO, owl:rA, �-T q -00& MIT A 3^: USA A IVA!, P44 �K 4"- A,- WON Y` nil-I . Wo "an, IWO 1 -n own :'TO P 11 INDAT 10 N 11� 0 TAM%, �4 001910, vo'� 84 n 7 A WTI 7-!,1`-,-, 7."- A K t 00 &x 7 L"& W-WO-1 ... 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